TRAUMATIC BRAIN INJURY

History
The Edwin Smith Papyrus

Head injury is present in ancient myths that may date back before recorded history.[114] Skulls found in battleground graves with holes drilled over fracture lines suggest that trepanation may have been used to treat TBI in ancient times.[115] Ancient Mesopotamians knew of head injury and some of its effects, including seizures, paralysis, and loss of sight, hearing or speech.[116] The Edwin Smith Papyrus, written around 1650–1550 BC, describes various head injuries and symptoms and classifies them based on their presentation and tractability.[117] Ancient Greek physicians including Hippocrates understood the brain to be the center of thought, probably due to their experience with head trauma.[118]

Medieval and Renaissance surgeons continued the practice of trepanation for head injury.[118] In the Middle Ages, physicians further described head injury symptoms and the term concussion became more widespread.[119] Concussion symptoms were first described systematically in the 16th century by Berengario da Carpi.[118] It was first suggested in the 18th century that intracranial pressure rather than skull damage was the cause of pathology after TBI. This hypothesis was confirmed around the end of the 19th century, and opening the skull to relieve pressure was then proposed as a treatment.[115] In the 19th century it was noted that TBI is related to the development of psychosis.[120] At that time a debate arose around whether post-concussion syndrome was due to a disturbance of the brain tissue or psychological factors