Patterns and prevalence of violence-related skull trauma in medieval London.

OBJECTIVES: This study aims to identify the patterns and prevalence of violence-related skull trauma (including the cranium and mandible) among a large sample of skeletons from medieval London (1050-1550 AD). MATERIALS AND METHODS: In total, data from 399 skulls, representing six different sites from across medieval London, were analyzed for evidence of trauma and assessed for the likelihood that it was caused by violence. The sites include the three parish cemeteries of St Nicholas Shambles (GPO75), St Lawrence Jewry (GYE92), and St Benet Sherehog (ONE94); the two monastic houses of London Blackfriars (PIC87) and St Mary Graces (MIN86); and the early inmate cemetery from the medieval hospital of St Mary Spital (NRT85). RESULTS: The overall findings suggest that violence affected all aspects of medieval London society, but how that violence was characterized largely depended on sex and burial location. Specifically, males from the lay cemeteries appear to have been the demographic most affected by violence-related skull injuries, particularly blunt force trauma to the cranial vault. DISCUSSION: Using both archaeological and historical evidence, the results suggest that violence in medieval London may have been more prevalent than in other parts of medieval England, particularly rural environments, but similar to other parts of medieval Europe. However, more studies focusing on medieval trauma, and violence specifically, need to be carried out to further strengthen these results. In particular, males from the lay cemeteries were disproportionately affected by violence-related trauma, especially blunt force trauma. It perhaps indicates a means of informal conflict resolution as those of lower status did not always have the newly established medieval legal system available to them.

The philosopher's swoon--the concussion of Michel de Montaigne: a historical vignette.

The French philosopher Michel Eyquem de Montaigne (1533-1592) sustained a transient loss of consciousness due to a head injury. Montaigne described his concussion as a "swoon," with astutely illustrative details of the symptoms he experienced, including brief loss of consciousness, with apparent (temporary) confusion, and post-traumatic amnesia. His vivid portrayal of the recovery period lends understanding of the process of conscious awakening after his near-death experience. Thanks to his power of introspection and literary talent we may gain insight into the feelings and perceptions of some patients during their recovery from concussion.

Possible relationship of cranial traumatic injuries with violence in the south-east Iberian Peninsula from the Neolithic to the Bronze Age.

The main aim of this study was to analyze the presence and distribution of cranial trauma, as possible evidence of violence, in remains from the Neolithic to Bronze Age from the SE Iberian Peninsula. The sample contains skulls, crania, and cranial vaults belonging to 410 prehistoric individuals. We also studied 267 crania from medieval and modern times for comparative purposes. All lesions in the prehistoric crania are healed and none of them can be attributed to a specific weapon. In all studied populations, injuries were more frequent in adults than in subadults and also in males than in females, denoting a sexual division in the risk of suffering accidents or intentional violence. According to the archeological record, the development of societies in the SE Iberian Peninsula during these periods must have entailed an increase in conflict. However, a high frequency of cranial traumatic injuries was observed in the Neolithic series, theoretically a less conflictive time, and the lowest frequency was in crania from the 3rd millennium B.C. (Copper Age), which is characterized by the archeologists as a period of increasing violence. The relatively large size and the high rate of injuries in Neolithic crania and the practice of cannibalism are strongly suggestive of episodes of interpersonal or intergroup conflict. The number and distribution of injuries in Bronze Age is consistent with the increase in violence at that time described by most archeologists.

Pediatric neurosurgical techniques in the 15th century.

The renowned Turkish surgeon Serefeddin Sabuncuoglu (1385--1468 AD), delineates management of various pediatric neurosurgical diseases such as head trauma, spinal trauma, and intrauterine and infantile hydrocephalus, as well as basic surgical principles in his textbook Cerrahiyyetü'l Haniyye, which consists of three chapters dealing with a variety of surgical specialities. The sections on neurosurgery are still relevant to modern medicine. The book combines previous knowledge of Greek, Roman, Arabic, and Turkish surgery. Today, Sabuncuoglu is recognized as a pioneer of pediatric neurosurgery.

Brief communication: neurotraumatological aspects of head injuries resulting from sharp and blunt force in the early medieval period of southwestern Germany.

Approximately 10% (33 of 304) of the predominantly male skulls from the 6th through 8th centuries in southwestern Germany exhibit cranial fractures derived from blunt or sharp force trauma. No evidence of fracture healing characterizes 24% (n = 8) of these individuals. All nonhealed fractures were caused by sharp force, and four of these wounds cross the sagittal sinus. The lengths of these straight-edged wounds, produced exclusively by sword blows, measure around 8.0 cm for fatal, and about 5.0 cm for nonfatal wounds. Seventy-six percent (n = 25) of these skulls exhibit some healing, which indicates that these injuries did not lead to immediate death. In this group are all depressed fractures resulting from blunt force blows. Two thirds of the 45 cranial injuries noted on these 33 skulls are located on the left side of these individuals, with a concentration in the frontoparietal region. Bony indications of wound infection occur in four cases (12%). Three crania exhibit circular trepanations in association with fractures. These phenomena are discussed in the context of modern neurotraumatological knowledge.

Commentary and perspectives on R.M. Allen's "The test performance of the brain injured".

Significant advances have occurred in the study of the neuropsychology of head injury since R.M. Allen's (1947) paper. These include better conceptualization of brain-behavior relationships, advances in neuropsychological instruments, normative data and assessment paradigms, structural and functional brain imaging techniques, greater understanding of the mechanisms of brain injury, and the classification and quantification of brain injury. However, because of conceptual and methodological problems there has been a relative lack of progress in understanding the etiology of symptoms in mild head injury. To date, studies of mild head injury have produced widely mixed findings. Further, orthopedic injury, chronic pain, litigation, and other conditions may also produce cognitive and behavioral changes similar to those seen in mild head injury. The authors outline a study design with two control groups (other injury and noninjury) contrasted with mild closed head injury to resolve the issue of whether functional changes following an injury are due to a specific head injury effect or to more general injury factor(s). Results of extant studies using this design are discussed, along with future directions for neuropsychological assessment.

Charles Bonnet's description of Cotard's delusion and reduplicative paramnesia in an elderly patient (1788)

An elderly woman developed the delusion that she was dead ('Cotard's delusion') and that she was in another place ('reduplicative paramnesia'). Charles Bonnet reported this unique combination of symptoms a century before Cotard's influential description of the nihilistic delusions and of Pick's description of 'reduplicative paramnesia'.