Mandatory Bicycle Helmet Laws in the United States: Origins, Context, and Controversies.

This article examines the origins and context of mandatory bicycle helmet laws in the United States. Localities began to enact such laws in the early 1990s, having experimented with helmet laws for motorcycles previously. As cycling became increasingly popular in the 1970s and 1980s because of a variety of historical trends, from improved cycle technology to growing environmental consciousness, cycling-related injuries also increased. Bicycle safety advocates and researchers alike were particularly troubled by head injuries. National injury surveillance systems and a growing body of medical literature on bicycle-related injuries motivated a number of physicians, cyclists, children, and other community members to advocate helmet laws, which they argued would save lives. Controversy over these laws, particularly over whether they should apply universally or only to children, raised public health ethics concerns that persist in contemporary debates over bicycle helmet policies. (Am J Public Health. 2020;110:1198-1204. doi: 10.2105/AJPH.2020.305718).

Primary blast wave protection in combat helmet design: A historical comparison between present day and World War I.

Since World War I, helmets have been used to protect the head in warfare, designed primarily for protection against artillery shrapnel. More recently, helmet requirements have included ballistic and blunt trauma protection, but neurotrauma from primary blast has never been a key concern in helmet design. Only in recent years has the threat of direct blast wave impingement on the head-separate from penetrating trauma-been appreciated. This study compares the blast protective effect of historical (World War I) and current combat helmets, against each other and 'no helmet' or bare head, for realistic shock wave impingement on the helmet crown. Helmets included World War I variants from the United Kingdom/United States (Brodie), France (Adrian), Germany (Stahlhelm), and a current United States combat variant (Advanced Combat Helmet). Helmets were mounted on a dummy head and neck and aligned along the crown of the head with a cylindrical shock tube to simulate an overhead blast. Primary blast waves of different magnitudes were generated based on estimated blast conditions from historical shells. Peak reflected overpressure at the open end of the blast tube was compared to peak overpressure measured at several head locations. All helmets provided significant pressure attenuation compared to the no helmet case. The modern variant did not provide more pressure attenuation than the historical helmets, and some historical helmets performed better at certain measurement locations. The study demonstrates that both historical and current helmets have some primary blast protective capabilities, and that simple design features may improve these capabilities for future helmet systems.

La "Donna di Ostuni", a case of eclampsia 28,000 years ago?

La "Donna di Ostuni", the Lady from Ostuni (fortified medieval city, on the southern Italian Adriatic coast) is the skeleton of "the human most ancient mother" ever found by paleoanthropologists, grave dated of 28,000 years BP. It concerns a 20-years-old woman buried with her baby in her womb estimated at 8 months gestation. To date, the cause of the maternal-fetal deaths is qualified of unknown origin. We propose that eclampsia may be a possible explanation for these deaths (mother and baby together). Eclampsia (convulsions), the curse of human births (non-existent in other mammals), has been described since writings has existed 5000 years ago in all civilisations. This plausible description dating from Palaeolithic times, 28,000 years BP, long before the emergence of agriculture (10,000 years BP) may be an interesting milestone. Further, she was buried with a shell-made headdress, as represented in several "Venus" figurines retrieved in all the Eurasiatic area (notably the "Willemdorf Venus"). The authors propose a new hypothesis that this headdress could be a protective device for pregnant women not only for birthing, but also against the terrorising convulsions (eclampsia) which could happen in all human pregnancy, especially in the first ones (primiparae).

Evolution of Sports-related Headgear.

The major focus of this review is to establish concussion in sport as a silent epidemic in our society that is not an accident. Brain injury has a definitive pattern and distinct nonrandom predictable characteristic. The development of successful head protection requires a scientific database approach to the mechanics of headgear. It is the responsibility of the health care clinician to help with the maintenance of protective standards for headgear and support rule changes to decrease the morbidity and mortality of athletes.

A Historical Perspective on Sports Concussion: Where We Have Been and Where We Are Going.

The approach to sports concussion diagnosis and management has been evolving at an unprecedented rate over the last several years. So much so, that committees at all level of sports have implemented concussion protocols and made adjustments to certain league rules in an effort to minimize the risk of head injury. With this newfound attention has come an even greater push by the scientific community to address the many questions that remain. The aim of this review article is to present the topic of sports concussion by means of discreet eras. It begins by introducing the very first mentions of concussion, dating back to ancient Greece, to present day, highlighting important periods along the way. It then goes on to review emerging scientific data, from biomarkers and serum studies, to imaging modalities, and brain networking. All of which will hopefully contribute to both the diagnostic and therapeutic approach to sports concussion.

Helmet Use and Head Injury in Homer's Iliad.

BACKGROUND: Homer's detailed descriptions of head injuries inflicted during the Trojan War are of particular interest to individuals in the medical community. Although studies have examined the prevalence of such injuries, none have examined the preventive measures taken to avoid them. An in-depth review of helmet use in Homer's Iliad was conducted to address this previously unexplored facet of the epic. METHODS: An English translation of Homer's text was reviewed for all references to helmet use. The number of helmet references in each book was recorded, along with other pertinent details for each reference. RESULTS: There were 87 references to helmets (40 combat, 47 noncombat). The helmet belonged to a Greek warrior in 41 cases (47.1%), a Trojan warrior in 38 cases (43.6%), a divinity in 5 cases (5.7%), and a general group of warriors in 3 cases (3.4%). Helmet use provided protective benefit to Greek warriors at a rate of 30.0% (3 of 10) and Trojan warriors at a rate of 11.1% (2 of 18). This difference was not statistically significant (P = 0.23). The overall combined protective benefit of helmet use in the text was 17.9% (5 of 28). Helmets belonging to 15 specific Greek warriors and 18 specific Trojan warriors were referenced in the text. Helmets belonging to Hector (n = 12) and Achilles (n = 8) were most frequently mentioned. CONCLUSIONS: Helmet use and head injury both play a prominent role in Homer's Iliad. Helmets are frequently used in combat settings but with relatively little success. Helmets are also used in various noncombat settings.

The neurosurgeon as baseball fan and inventor: Walter Dandy and the batter's helmet.

Baseball maintains one of the highest impact injury rates in all athletics. A principal causative factor is the "beanball," referring to a pitch thrown directly at a batter's head. Frequent morbidities elicited demand for the development of protective gear development in the 20th century. In this setting, Dr. Walter Dandy was commissioned to design a "protective cap" in 1941. His invention became widely adopted by professional baseball and inspired subsequent generations of batting helmets. As a baseball aficionado since his youth, Walter Dandy identified a natural partnership between baseball and medical practice for the reduction of beaning-related brain injuries. This history further supports the unique position of neurosurgeons to leverage clinical insights, inform innovation, and expand service to society.

The history of neurosurgical treatment of sports concussion.

Concussion has a long and interesting history spanning at least the 5 millennia of written medical record and closely mirrors the development of surgery and neurosurgery. Not surprisingly, much of the past and present experimental head injury and concussion work has been performed within neurosurgically driven laboratories or by several surgically oriented neurologists. This historical review chronicles the key aspects of neurosurgical involvement in sports concussion as related to the diagnosis, treatment, mitigation, and prevention of injury using the example of American football. In addition, we briefly trace the developments that led to our current understanding of the biomechanical and neurophysiological basis of concussion.

From Pergamon to Army Base Hospital No. 5: the history and significance of the galea aponeurotica in the evolution of neurosurgery.

The authors trace the etymology and historical significance of galea or epicranial aponeurosis. In ancient Greece, galea referred to a helmet worn by soldiers, typically made of animal hide or leather. Throughout antiquity, physicians referred to all soft tissue between the skin and the skull as panniculus, a standard established by Galen of Pergamon. A manual of surgery in the Middle Ages referred to the entire scalp as a "great panicle that is called pericranium." During the early Renaissance, Leonardo da Vinci famously and stylistically analogized the dissection of the cranium with the peeling of an onion. Not until 1724 would the tendinous sheath connecting the frontalis and occipitalis muscles be defined as "Galea tendinosa cranii." By 1741, the convention of referring to the galea as an aponeurosis was well established. Harvey Cushing's wartime experiences at Army Base Hospital No. 5 reinforced the surgical significance of the galea. Operative mortality was significantly diminished due to "closure of the wounds with buried sutures in the galea." This operative nuance was then passed from teacher to pupil and has now become one of the tenets of modern neurosurgical practice.

Twenty-five years of bicycle helmet promotion for children in Skaraborg District, Sweden.

The purpose of this study is to describe some of the results of a long-term bicycle helmet campaign for children in Skaraborg District, Sweden. The hospital discharge data for bicycle-related injuries occurring in children under the age of 15 were reviewed, to assess changes in patterns for head and other body injuries. The study shows that head injuries to children as a result of bicycle injuries were reduced between 94 and 99% in the study areas. The tremendous gains in safety for children who ride bicycles in Skaraborg District were the result of not only national policy changes that occurred in the latter half of this study period but also the result of local collaborations based on the Safe Communities model, which were organised during the first part of the study period.

Change in size and impact performance of football helmets from the 1970s to 2010.

Linear impactor tests were conducted on football helmets from the 1970s-1980s to complement recently reported tests on 1990 s and 2010 s helmets. Helmets were placed on the Hybrid III head with an array of accelerometers to determine translational and rotational acceleration. Impacts were at four sites on the helmet shell at 3.6-11.2 m/s. The four generations of helmets show a continuous improvement in response from bare head impacts in terms of Head Injury Criterion (HIC), peak head acceleration and peak rotational acceleration. Helmets of 2010 s weigh 1.95 ± 0.2 kg and are 2.7 times heavier than 1970s designs. They are also 4.3 cm longer, 7.6 cm higher, and 4.9 cm wider. The extra size and weight allow the use of energy absorbing padding that lowers forces in helmet impacts. For frontal impacts at 7.4 m/s, the four best performing 2010 s helmets have HIC of 148 ± 23 compared to 179 ± 42 for the 1990 s baseline, 231 ± 27 for the 1980s, 253 ± 22 for the 1970s helmets, and 354 ± 3 for the bare head. The additional size and padding of the best 2010 s helmets provide superior attenuation of impact forces in normal play and in conditions associated with concussion than helmets of the 1970s-1990 s.

Social factors in occupational health: a history of hard hats.

Personal protective equipment (PPE) is the least desirable way to ensure workplace safety, and it is difficult to use consistently. Hard hats are different; they have cachet and are often worn even when they are not required. We investigated the history of this personal protective equipment to see if there were any lessons that could be applied to other forms of PPE. We learned that what makes hard hats special are social factors that are specific to a certain time and place. The importance of social factors illuminates the requirement that cultural and social norms of workers be included in any kind of worker safety and health training.

Jean-Martin Charcot and his vibratory chair for Parkinson disease.

Vibration therapy is currently used in diverse medical specialties ranging from orthopedics to urology to sports medicine. The celebrated 19th-century neurologist, J.-M. Charcot, used vibratory therapy to treat Parkinson disease (PD). This study analyzed printed writings by Charcot and other writers on vibratory therapy and accessed unpublished notes from the Salpêtrière Hospital, Paris. Charcot lectured on several occasions on vibratory therapy and its neurologic applications. He developed a vibration chair for patients with PD after he observed that patients were more comfortable and slept better after a train or carriage ride. He replicated this experience by having patients undergo daily 30-minute sessions in the automated vibratory chair (fauteuil trépidant). His junior colleague, Gilles de la Tourette, extended these observations and developed a helmet that vibrated the head on the premise that the brain responded directly to the pulsations. Although after Charcot's death vibratory therapy was not widely pursued, vibratory appliances are reemerging in 21st century medicine and can be retested using adaptations of Charcot's neurologic protocols.

A Tribute to William B. Long, Jr., and William B. Long, III: A Celebration of Their Revolutionary Contributions to Trauma Care.

An emergency medical system for trauma care has been conceived in our nation in an effort to improve delivery of emergency care to the accidentally injured patient. There are an estimated 20 million disabling injuries in our nation that should be cared for in trauma centers each year. This report has been written to acknowledge Dr. William Long, Jr., as well as Dr. William B. Long, III, for their unique contributions in establishing the Maryland Statewide Trauma System. Dr. William Long, Jr., played an instrumental role in working with Dr. R Adams Cowley to verify the life-saving value of the Maryland State Police helicopter system. In addition, Dr. Long, Jr., crafted a plan with Dr. R Adams Cowley that allowed Dr. Cowley the autonomy from the University of Maryland Medical School to develop a separate and distinct trauma facility, which is recognized throughout the world. It is indeed fortuitous that Dr. William B Long, III, experienced these landmark changes in trauma care in Maryland, which provided a catalyst for his future career that included extensive training in general surgery in Edinburgh as well as training in trauma surgery with Dr R Adams Cowley. These unique experiences convinced him to expand his training into cardiothoracic surgery. During these academic adventures, he became an international authority on the mathematics of trauma scores, cardiothoracic trauma resuscitation, and the components of a Level I trauma center. These empowering experiences became a catalyst for Dr. William Long, III, to undertake the scientific and clinical studies that would allow him to develop the only American College of Surgeons Committee on Trauma (ACSCOT) Verified Level I Trauma Center in the Pacific Northwest. This report describes in considerable detail Dr. William B. Long, III,'s Trauma Center at Legacy Emanuel Trauma Center (Portland, Oregon) as well as to outline his plans to further improve trauma care in the state of Oregon so that it remains a legacy for his academic career. His dreams for having a comprehensive trauma system in the Pacific Northwest are described in detail so that it an be replicated in our nation and our world.Dr. Long became the Trauma Medical Director for Emanuel Hospital in the Fall of 1983. He began building Emanuel's trauma program by establishing an infrastructure that would support technically advanced ways of restoring life and function. His trauma center consisted of the following components: trauma registry, trauma resuscitation nurse program, direct to operating room policy with unstable trauma patients, anesthesia as part of the trauma resuscitation team, massive transfusion protocol, mobile surgical transport team, outreach to rural communities, recruitment of specialists with interest in trauma care, development of a new trauma physical facility, and the Physician Assistant educational program.

Birth and evolution of the football helmet.

OBJECTIVE: To review the advent and evolution of the football helmet through historical, physiological, and biomechanical analysis. METHODS: We obtained data from a thorough review of the literature. RESULTS: Significant correlation exists between head injuries and the advent of the football helmet in 1896, through its evolution in the early to mid-1900s, and regulatory standards for both helmet use and design and tackling rules and regulations. With the implementation of National Operating Committee on Standards for Athletic Equipment standards, fatalities decreased by 74% and serious head injuries decreased from 4.25 per 100,000 to 0.68 per 100,000. Not only is the material used important, but the protective design also proves essential in head injury prevention. Competition among leading helmet manufacturers has benefited the ultimate goal of injury prevention. However, just as significant in decreasing the incidence and severity of head injury is the implementation of newer rules and regulations in teaching, coaching, and governing tackling techniques. CONCLUSION: Helmet use in conjunction with more stringent head injury guidelines and rules has had a tremendous impact in decreasing head injury severity in football. Modifications of current testing models may further improve helmet design and hence further decrease the incidence and severity of head injury sustained while playing football.