Musket ball injuries to the head - Experimental CT-study.

A smoothbore musket firing a round ball was the primary weapon of the infantry from the 16th to mid 19th century. Musket ball injuries are thus relatively common when archaeological remains of battlefield victims from that period are studied. Several experimental studies have focused on terminal ballistics of a musket ball. In addition, there is a good supply of historical records directly from the battlefield and military hospitals. Studies and historical records have both concluded that head injuries are among the most lethal types of musket ball damage. In this study we utilized modern day research methods, including Synbone ballistic skull phantoms and computed tomography (CT) imaging, to examine more closely the head injuries and tissue damage caused by a musket ball. We were especially interested to observe how different musket ball velocities and shooting distances would influence bone and soft tissue defects. Our experiments clearly demonstrated that musket ball was a lethal projectile even from a longer distance. Already at low velocities, the musket ball perforated through the skull. Velocity also influenced the appearance of entrance and exit wounds. CT imaging provided us with a three-dimensional view of the wound channel, skull fragments and lead remnants inside the skull phantom. According to our findings, musket ball velocity influenced defect size and cavitation. In addition, velocity influenced the size and distribution of skull fragments and lead remnants in the wound channel. Combining all these aspects could aid us in studies of archaeological musket ball victims. In particular, they could help us to estimate the shooting distance and shed light on the potential course of events in the battlefield.

Impact of World War I on brain mapping.

Although much tragedy was experienced during World War I (WWI), the nature of the war and the advancements of weaponry led to a change in the quality and quantity of injuries which were conducive for study. This paper discusses how trauma during WWI led to advances in brain mapping from occipital injuries. Gordon Holmes was a British neurologist who was able to create a retinotopic map of the visual cortex from studying more than 400 cases of occipital injuries; his work has contributed immensely to our understanding of visual processing. There have been many extensions from Holmes' work in regard to how we analyze other sensory modalities and in researching how the brain processes complex stimuli such as faces. Aside from the scholastic benefit, brain mapping also has functional use and can be used for neurosurgical planning to preserve important structures. With the advent of more advanced modalities for analyzing the brain, there have been initiatives in total brain mapping which has added significantly to the body of work started by Holmes during WWI. This paper reviews the history during WWI that led to advances in brain mapping, the lasting scholastic and functional impact from these advancements, and future improvements.

"Los libros y la noche", perspectiva neurológica de la ceguera de Jorge Luis Borges.

The works of Argentinian scholar Jorge Luis Borges (1899-1986) have captivated physicians. An assiduous reader, he was given, with magnificent irony, "books and the night". Borges suffered from chronic and irreversible blindness, which influenced much of his work and has been the subject of different literary and diagnostic analyses from the ophthalmological point of view. However, the characteristics of his visual impairment have escaped the neurological approach, which is why we reviewed his work looking for data suggesting a concomitant brain injury. On his autobiography, he recounts how, during an episode of septicemia, he suffered hallucinations and loss of speech; in addition, in some poems and essays he describes data that suggest "phantom chromatopsia", a lesion of cortical origin. After that accident, Borges survived with a radical change in literary style. Although a precise diagnosis is impossible, his literary work allows recognizing some elements in favor of concomitant brain involvement.

La obra del erudito argentino Jorge Luis Borges (1899-1986) ha cautivado a los médicos. Asiduo lector con magnífica ironía, le fueron dados "los libros y la noche". Borges padeció una ceguera crónica e irreversible que impulsó gran parte de su obra y ha sido objeto de distintos análisis literarios y diagnósticos desde el punto de vista oftalmológico. Sin embargo, las características de su ceguera han escapado al abordaje neurológico, por lo cual revisamos su obra en busca de datos que sugieran una lesión cerebral concomitante. En su autobiografía relata cómo durante un episodio de septicemia padeció alucinaciones y pérdida del habla; además, en algunos poemas y ensayos describe datos que sugieren "cromatopsia fantasma", lesión de origen cortical. Tras dicho accidente, Borges sobrevivió con un cambio radical en su estilo literario. Aunque un diagnóstico preciso es imposible, su obra literaria nos permite reconocer algunos elementos que sugieren involucramiento cerebral concomitante.

A Political Case of Penetrating Cranial Trauma: The Injury of James Scott Brady.

James Brady, the White House press secretary during President Ronald Reagan's first term in office, was 1 of 4 people (including the President) wounded during an attempted assassination attempt on President Reagan's life on March 30, 1981. John Hinckley, Jr. was found not guilty of this attempt by reason of insanity. The assassination attempt was a ploy by Hinckley, Jr. to impress the actress Jodie Foster. Brady was the most seriously injured of the 4 who were wounded. He suffered a gunshot wound to the left forehead that traveled through the left frontal lobe, corpus callosum, and then into the right frontal and temporal lobes. He initially required a bifrontal craniotomy for evacuation of a right frontotemporal intraparenchymal hemorrhage and debridement of tract. His postoperative course was complicated by seizures, cerebrospinal fluid leakage (necessitating multiple reparative procedures), aspiration pneumonia, and pulmonary emboli. Despite the severity of his injury and perioperative morbidities, Mr. Brady made good recovery. Although permanently left with residual weakness on the left side of his body, making a wheelchair necessary, Brady maintained cognitive and personality traits that were very close to his preinjury baseline. As a result, James Brady and his wife, Sarah, led a call to create legislative reform subsequently known as the "Brady Bill." This bill controversially made mandatory background checks for the purchase of firearms from licensed dealers. Our work aims to describe the assassination attempt, the neurosurgical injury and management of Mr. Brady's case, and the brief historical sequel that followed.

A century of British military neurosurgery.

At the time of the Boer War in 1899 penetrating head injuries, which formed a large proportion of the battlefield casualties, resulted in almost 100% mortality. Since that time up to the present day, significant improvements in technique, equipment and organisation have reduced the mortality to about 10%.

Fatal cranial injury in an individual from Messina (Sicily) during the times of the Roman Empire.

Forensic and archaeological examinations of human skeletons can provide us with evidence of violence. In this paper, we present the patterns of two cranial lesions found on an adult male (T173) buried in a grave in the necropolis 'Isolato 96', Messina, Sicily, dating back to the Roman Empire (1st century BC - 1st century AD). The skull reveals two perimortem traumatic lesions, one produced by a sharp object on the right parietal bone and the other one on the left parietal bone, presumably the result of a fall. The interpretation of fracture patterns found in this cranium are an illustration of how forensic approaches can be applied with great benefit to archaeological specimens.

Evliya Celebi's description of the removal of a musket ball from the brain of a Habsburg Prince: an interesting excerpt from the "Seyahatname".

In the 17th century an Ottoman traveler, Evliya Celebi, was inspired by a dream to embark on a journey across the Ottoman Empire. He traveled far and wide across Europe and North Africa and wrote extensively about his adventures in the Seyahatname. The Seyahatname, or "Book of Travels," is the longest and most detailed travel account in Islamic (if not world) literature. It is a vast panorama of the Ottoman world in the mid-17th century. This article is concerned with Celebi's description of several surgeries that he claimed to have witnessed in Vienna during the year 1665. He describes several procedures, the first and most detailed of which is a fascinating brain operation that seems to be a highly unusual procedure for the time. His impressions of Central European medicine, as viewed by a Muslim from the East, offer an unexplored perspective. We examine what his description tells us about the perceptions and images of surgery and medicine.

[Phineas Gage and the enigma of the prefrontal cortex]. / Phineas Gage y el enigma del córtex prefrontal.

Perhaps the most famous brain injury in history was a penetrating wound suffered by a rail road worker named Phineas Gage on September 13, 1848. Twelve years after his injury, on the 21st of May, 1860 Phineas Gage died of an epileptic seizure. In 1868 Dr. Harlow gave an outline of Gage's case history and first disclosed his remarkable personality change. One might think this report would assure Gage a permanent place in the annals of neurology, but this was not the case. There was a good reason for this neglect: hardly anyone knew about Harlow's 1868 report. Dr. David Ferrier, an early proponent of the localisation of cerebral function, rescued Gage from obscurity and used the case as the highlight of his famous 1878 Goulstonian lectures. Gage had, through a tragic natural experiment, provided proof of what Ferrier's studies showed: the pre-frontal cortex was not a "non-functional" brain area. A rod going through the prefrontal cortex of Phineas Gage signalled the beginning of the quest to understand the enigmas of this fascinating region of the brain.

[A murder case from 900 years ago? Analysis of extensive cranial trauma observed in a historical skeleton recovered in central Poland]. / Morderstwo sprzed 900 lat? Analiza rozleglych urazów czaszki zaobserwowanych na szkielecie historycznym odkrytym w centralnej Polsce.

This work presents the results of study of a human skeleton from the early Middle Ages recovered in Peclawice (province of Lódz), presenting signs of extensive cranial trauma suffered perimortem. The skeleton belonged to a 20-30 year-old male of sturdy build, with prominent bone processes, marked right-side asymmetry of the bones and joints of the upper extremities, and tallness (stature well above average for early medieval times). Except for the skull, the skeleton lacks any pathologic or traumatic lesions. The right side of the skull bears signs of three extensive injuries involving the frontal and parietal bones and the temporomandibular joint. Two of them penetrated deeply into the cranial cavity. The nature and location of the lesions suggests that the axe was used and that the victim was not confronted face-to-face. None of the lesions show any signs of healing. Fragmentation of the facial bones, which were mostly incomplete except for the well-preserved mandible, suggests additional blows to the face. These massive injuries must have been fatal due to damage to the brain and main blood vessels of the neck and thus they were recognized as the cause of death of the individual.

President Kennedy's death: a poison arrow-assisted homicide.

"President John F. Kennedy's death was a neurotoxin-assisted homicide" is the hypothesis of this study. A review of medical evidence demonstrates evidence of a neurotoxin-assisted homicide. The convergence of three independent actions, or the signature traits of a neurotoxin-assisted homicide- the emergence of neurological signs consistent with a neurotoxin-induced paralysis, the induction of a small neck wound consistent with a flechette-transported neurotoxin entry wound, and the execution of a coverup to eliminate neurotoxin evidence, supports this hypothesis. This review suggests, JFK's death had all the signature traits of a neurotoxin-assisted homicide.

Weapon-related traumas of human skeletons from Yuigahama Chusei Shudan Bochi, Japan.

The Yuigahama Chusei Shudan Bochi site (AD: twelfth to thirteenth centuries), located along the seashore of the southern end of Kamakura City in Japan, and has yielded a mass grave containing hundreds of human crania. The purpose of this study is to document cut marks on crania made by an edged weapon, paying specific attention to individuals who may exhibit scratch marks, and to understand the variability of weapon-related traumas in the medieval period in Japan. The observation leads to tentative findings regarding the identification and interpretation of weapon-related traumas of human skeletal remains. From macroscopic observation, the marks display the sharpness of cut surfaces which are characteristic of unhealed cut marks. Scanning electron microscopic observation of the marks also shows that they are V-shaped in cross-section, a morphological feature that is characteristic of cut marks. This study first demonstrates that the scratches on the crania have morphological features consistent with human-induced cut marks, and that the macroscopic and microscopic approaches provide important information for identifying anthropogenic cut marks on the human skeletal remains from an archaeological site in Japan.