The Intertwined History of Malingering and Brain Injury: An Argument for Structural Competency in Traumatic Brain Injury.

Every year millions of people suffer minor brain injuries, many of which occur in collision sports. While there has been substantial commentary and debate about the nature of this public health crisis, it is clear that the scientific and clinical arguments reflect values preferences and judgments that are often invisible in documents which combine artful language with undue focus paid to sources of uncertainty at the cost of clarity and transparency. This essay gives a brief history of these patterns and proposes a remedy.

Toward Complete, Candid, and Unbiased International Consensus Statements on Concussion in Sport.

Five international consensus statements on concussion in sports have been published. This commentary argues that there is a strong need for a new approach to them that foregrounds public health expertise and patient-centered guidance. Doing so will help players, parents and practitioners keep perspective about these potentially life-altering injuries especially when they recur.

The punch-drunk boxer and the battered wife: Gender and brain injury research.

This essay uses gender as a category of historical and sociological analysis to situate two populations-boxers and victims of domestic violence-in context and explain the temporal and ontological discrepancies between them as potential brain injury patients. In boxing, the question of brain injury and its sequelae were analyzed from 1928 on, often on profoundly somatic grounds. With domestic violence, in contrast, the question of brain injury and its sequelae appear to have been first examined only after 1990. Symptoms prior to that period were often cast as functional in specific psychiatric and psychological nomenclatures. We examine this chronological and epistemological disconnection between forms of violence that appear otherwise highly similar even if existing in profoundly different spaces.

Concussion: A History of Science and Medicine, 1870-2005.

OBJECTIVE: To review the intellectual history of concussion from the mid-19th century to the opening decade of the 21st century. BACKGROUND: Head injuries (HI) and their acute and long-term effects have been investigated for centuries, with major reviews of the topic appearing by 1870. Thus, while it has long been acknowledged that chronic traumatic encephalopathy was first described by Harrison Martland in 1928, an examination of the history of concussion research up to Martland's seminal report places his studies in a deeper historical context. This history makes clear that Martland's findings were one among many such studies showcasing the lasting dangers of blows to the head. In the years after Martland published his study, his paper was frequently cited in other papers that made clear that blows to the head, of all ranges of severity, were dangerous injuries with potentially life-changing consequences. METHODS: The author has engaged in an historical analysis of the development and elaboration of concussion research in clinical medicine, neurology, neurosurgery, and those scientific disciplines related to clinical medicine. The author has found numerous primary sources from the history of medicine and science that describe the acute and chronic effects of single and repeated sub-concussive and concussive blows to the head. RESULTS: This study makes clear that evidence-based methodologies inevitably short-change the knowledge of past clinicians and scientists by holding these figures to normative standards of recent invention. What criticism of this kind fails to recognize is that past investigators, many of them pioneers in their fields, published their work in ways that matched the highest normative standards of their day for the presentation of evidence. CONCLUSIONS: It has been recognized for a long time that concussions are dangerous injuries with potentially life-changing consequences, ranging from permanent symptoms to degenerative neurological states. The intellectual history of medicine and science from 1870 to the recent past shows both a continuity of clinical observations about HI and a steady, incremental accumulation of knowledge refining our understanding of those observations from a remarkably wide sphere of scientific disciplines.

British Romantic Generalism in the Age of Specialism, 1870-1990.

This essay explores the impact of 'generalism' and 'general practice' on the specialisation of British medicine using the case of neurology in Britain to reveal characteristics of British 'generalist medical culture' from 1870 to 1990. It argues that 'generalism' represented a particular epistemological position in Victorian medicine, one that then created a natural bridge between science and medicine over which almost all physicians and scientists were comfortable walking. The legacies of that Victorian 'generalist preference' exerted an enduring impact on the specialisation process as physicians experienced it in the twentieth century and as this case of neurology reveals so clearly. Neurologists and general physicians would still be arguing about the relative merits of a general medical education into the 1980s. By then, however, the emergence of government bodies promoting specialist labour conditions would have rendered the process seemingly inexorable.

The Currency of Consciousness: Neurology, Specialization, and the Global Practices of Medicine.

This article explores the formation of a global community of neurologists between 1918 and 1970. Relying chiefly upon documents located in Anglo-American archives, its argument follows a narrative from money to memory, and posits that this global community of neurologists formed not out of a shared science and medicine of the nervous system, but out of shared dispositions in tastes, values, and culture. The localism and heterogeneity of the science and medicine of the nervous system was in fact so pronounced that neurologists - especially when they worked as "global citizens" - were forced to focus upon their superficial commonalities rather than examine local distinctions. This avoidance of a direct effort to define the content of neurology - or at least to confront their differences - exercised a peculiar influence on the specialty. Neurologists and their "official memory" became negotiated, and even imagined constructs. Consequently, these diverse cultures were ultimately subordinated to dominant economic interests.

Of psychometric means: Starke R. Hathaway and the popularization of the Minnesota Multiphasic Personality Inventory.

ARGUMENT: The Minnesota Multiphasic Personality Inventory (MMPI) was developed at the University of Minnesota, Minneapolis, in the 1930s and 1940s. It became a highly successful and highly controversial psychometric tool. In professional terms, psychometric tools such as the MMPI transformed psychology and psychiatry. Psychometric instruments thus readily fit into the developmental history of psychology, psychiatry, and neurology; they were a significant part of the narrative of those fields' advances in understanding, intervening, and treating people with mental illnesses. At the same time, the advent of such tools also fits into a history of those disciplines that records the rise of obsessional observational and evaluative techniques and technologies in order to facilitate patterns of social control that became typical during the Progressive Era in the United States and after. It was those patterns that also nurtured the resistance to psychometrics that emerged during the Vietnam War and after.

History and neuroscience: an integrative legacy.

The attitudes that characterize the contemporary "neuro-turn" were strikingly commonplace as part of the self-fashioning of social identity in the biographies and personal papers of past neurologists and neuroscientists. Indeed, one fundamental connection between nineteenth- and twentieth-century neurology and contemporary neuroscience appears to be the value that workers in both domains attach to the idea of integration, a vision of neural science and medicine that connected reductionist science to broader inquiries about the mind, brain, and human nature and in so doing supposedly resolved once and for all questions germane to the human sciences, humanities, and arts. How those attitudes were produced and reproduced first in neurology and then in neuroscience; in what way they were constructed and disciplined, thereby eventuating in the contested sciences and medicines of the mind, brain, and nervous system; and even how they garnered ever-wider contemporary purchase in cultures and societies are thus fascinating problems for historians of science and medicine. Such problems shed light on ethics, practices, controversies, and the uneasy social relations within those scientific and medical domains. But more to the point of this essay: they also account for the apparent epistemological weight now accorded "the neuro" in our contemporary moment. They thus illuminate in a rather different way why historians have suddenly discovered the value of "the neuro".

One hundred members of the Association of British Neurologists: a collective biography for 1933-1960.

This article draws a quantitative portrait of British neurology in the interwar and postwar periods through an analysis of the first 100 members of the Association of British Neurologists. Through its presentation of data, this article argues that the members of the Association of British Neurologists were extremely ambitious and as a whole had attained unusually high levels of social, professional, and civil distinction. It makes this argument through an examination of their social and educational backgrounds, the trajectory of their careers, and their achievements in the form of editorships of journals, professorships in medicine, positions in government, honorary degrees, and other indicators of merit. This collective study therefore offers an explanation for how the Association of British Neurologists transformed from an elite club in the 1930s into an organization that eventually came to represent clinical neurology across Britain.

Trust, protocol, gender, and power in interwar British biomedical research: Kathleen Chevassut and the "germ" of multiple sclerosis.

In March 1930, reports of the discovery of an organism causative of multiple sclerosis circulated in the British press. At the same time, news of a therapeutically efficacious vaccine also reached the ears of neurologists and patients afflicted with the debilitating degenerative disease. It was soon shown that no organism had been discovered. The events leading up to this ultimately painful episode reveal many of the central problems created when social conventions and a sense of decorum scripted received understanding of good scientific practice rather than actual regulatory frameworks. In the absence of such frameworks, few means were present to censor inappropriate scientific conduct. This story thus provides a window into an emergent world of state-sponsored biomedical research; a world where recrimination, gossip, misogyny, uncertainty, exaggeration, and dreams and delusions of scientific and therapeutic progress were collapsed together.

Atlantic conjunctures in Anglo-American neurology: Lewis H. Weed and Johns Hopkins neurology, 1917-1942.

The emergence of neurology at Johns Hopkins presents a case study for reconsidering the international and institutional contexts of neurology generally. Using a variety of sources, Hopkins's interwar plans for neurology are presented and contextualized in the international environment of neurology, medical research, and philanthropy. During this period, neurology across the world, especially in Britain, was undergoing vast institutional changes. In order for Hopkins to remain at the forefront of excellence in both medicine and medical education, a program in neurology was deemed essential, and this would seem now to have been an unproblematic advance. Spearheading the project for the establishment of neurology at Hopkins was the dean of the medical school, Lewis H. Weed. Weed attempted from 1919 until 1942 to establish a department of neurology but had only limited success. The fact that finding support proved challenging for Weed and Johns Hopkins casts a provocative light on the broader historiography of neurology and illustrates the important role of the international context in defining neurology professionally.