The early history of the experimental approach to craniocerebral injuries
The numerous treaties of the eighteenth and nineteenth centuries on closed and penetrating head injuries are made of assembles of multiple case reports by acute, well versed and very experienced observers. The authors failed, however, to establish logical and practical classification and left the surgeon bewildered, devoid of practical real-time diagnostic abilities and clear decision making guidelines. For many centuries there was a feeling that no progress has been made, and the appalling mortality instigated a mood of helplessness, frustration and pessimistic attitudes whenever craniocerebral injury was encountered. At the same time, however, some far sighted inquisitive surgeons were pioneering an attempt to define the problems encountered and to plan elucidative experimental avenues to solve them.
It was the Académie Royale de Chirurgie that started to cultivate, in the mid-eighteenth century, the experimental approach to craniocerebral injuries. Its masters contributed not only to understand the effect of traumatic lesions but also to the organization of the motor system. More important, they identified most of the themes that the nineteenth century experimental investigators will be dealing with – the physics of skull fractures, the mechanisms of concussion, the dynamics of intracranial pressure and space-occupying lesions, the brain control on the heart and respiration, the cerebral circulation and the effect of gunshot injuries. The French surgeon-experimenters were followed soon by the German and rather late by the British and American colleagues. This study will follow the development of the experiments from uncontrolled crude forms to sophisticated, planned, multiparametric studies using new technologies, and the rise of the once demoted surgeon to an indispensable collaborating member, or even the leader, of neurophysiological teams. It will explain why all the knowledge gained was gradually implemented into clinical practice only after many decades while the questions posed by our predecessors continue to intrigue researchers even nowadays.
Session XII -- Brain Trauma and Death
Montreal, Quebec, Canada