Examples of cases and understanding of brain injury are scattered all over the archaeological and historical record. Despite the fact brain injury is recorded as far back as 1600 BC, treatment for the condition is still limited and underfunded in medical settings today. My mother suffered from an acquired brain injury (ABI- brain injury occurred after birth) after brain surgeries for brain tumour debulking, and I became aware of the underfunding in rehabilitation and recovery. Brain injury can cause major behavioural, emotional, and cognitive changes that is traumatic for sufferers and their families. Although there are numerous types of brain injury that can be caused by an array of different conditions, I use the term ‘brain injury’ as an umbrella term in this post for the sake of simplicity.
I wrote this blog post as I have a background in archaeology and have recently been fundraising for the brain injury charity SameYou in my mother’s memory (you can donate or read our story here https://www.justgiving.com/fundraising/aoife-sutton). As I have intense personal experience with the condition, as my mother suffered from ABI for five years before she died, it makes sense I would want to delve into the archaeological record to examine cases. I will not be discussing treatment and tools used in brain surgery in this post as the subject is too large- I do however hope to do a separate post on the matter i.e. trepanation and craniotomy. The following cases are examples of individuals with brain injury or suspected injury and professional records – to highlight individual cases and general understanding of the condition in different eras.
Edwin Smith Papyrus, Ancient Egypt: c.1600 BC
The Edwin Smith Papyrus (names after the 19th century dealer who purchased it) is thought to be the oldest surgical treatise in existence. It allows remarkable insight into the treatment and understanding of brain injury in the ancient world. 27 cases of head injury are reported on by the surgeons of the time, with cases even discussing the brain, spinal cord, and cerebrospinal fluid. A sophisticated knowledge of the brain’s anatomy is presented, with surgeons recognising symptoms despite the limitations in diagnosis at the time. One particularly interesting case is thought to be the first mention and diagnosis of aphasia from a temporal bone fracture. Aphasia is the impairment of language, more specifically in speech and reading/ writing ability. This documentation predated the work of the 19th century French physician on the subject by thousands of years.

Greek works from Hippocrates and Galen, Ancient Greece: c.400BC to 200AD
Emerging intellectual insight into neurosurgery is perhaps most accredited to the ancient Greeks. Head injuries were plentiful, with War being an everyday part of Greek life. Hippocrates mentions brain injuries from battlefield interactions and understood the location of the injury was important, with certain areas posing larger threats than others. Galen seemed to be more optimistic when suggesting treatment and recovery for brain injury sufferers and commented on seeing a severely wounded brain heal. This could be a remarkable early reference to neuroplasticity, the brains ability to reorganise itself and compensate for injury or disease.

3 adult Males, Denmark: 12th-17th century
A study done on three male skeletal samples from the medieval to early modern period examined the mortality rates of individuals effected by cranial vault injury. Many of the examples of cranial vault fractures of the time were due to interpersonal violence, and the study was a simulation to observe risk of dying with conditions associated to brain injury/ trauma. Healed cranial fractures in the samples were three times the rate found in modern Danish population, with the rate in males being four times higher than that of females (Suggesting interpersonal violence as a cause according to researchers). The healed fractures were associated with an increased risk of death, suggesting that many men suffered the effects of brain jury in past populations. It was the long-term health consequences of the injuries that caused them to die, not from the immediate blow itself- although there are still many examples of larger blows consistent with peri-mortem contact. Men with brain jury or healed head fractures were 6% more likely to die than men without- this may have been due to changed behaviour, decreased mobility etc. The study of these brain injuries and fractures was part of an epidemiological study on mortality rates, helping understand care and death in the past.

Phineas Gage, Vermont: 1848
Phineas Gage survived a horrific accident in Vermont in 1848. A 43-inch-long iron rod penetrated his left check, went straight through the brain, and exited his skull. The rod had been used to pack explosives before the powder detonated, sending the rod straight through Gage’s skull before landing 80 feet away. Miraculously, Gage walked to a cart to be brought to a doctor and was able to speak. Dr John Martyn Harlow took over the case before Gage developed an infection, from which he recovered. It was noted that Gage knew how long had passed since the accident but had difficulty counting money and estimating sizes. One year after the accident, Harlow saw Gage again. His vision was lost in one eye and he was scarred but otherwise seemed in good health. It was the changes in his behaviour and personality that Harlow noted, with friend of the patient referring to him as ‘no longer Gage’. His case was one of the first sources of evidence that suggested that the frontal lobe was associated with personality. Gage influenced theories suggesting certain areas of the brain had different functions. He died 12 years after the accident after suffering from a series of epileptic seizures.

The above examples are a snapshot into the development of understanding of brain injury from the ancient world to the 19th century. These are just a small few of the cases that have been studied and there are many more from many different time periods that are too great in number to mention. The remarkability of ancient understanding was a foundation for understanding this complex condition- studies are still ongoing and plentiful today in the medical research world.
Sources Consulted
https://www.verywellmind.com/phineas-gage-2795244
https://vermontjournal.com/history/cavendish-annual-phineas-gage-walk-and-talk/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4330746/
https://phys.org/news/2015-01-analysis-skull-fractures-medieval-denmark.html
https://www.ncbi.nlm.nih.gov/pubmed/22271381
Allen, James P. (2005). The Art of Medicine in Ancient Egypt. New York/New Haven: The Metropolitan Museum of Art/Yale University Press.
https://en.wikipedia.org/wiki/Edwin_Smith_Papyrus
https://www.researchgate.net/publication/314004316_Landmarks_in_the_History_of_Traumatic_Head_Injury
https://www.aphasia.org/aphasia-definitions/
https://www.headway.org.uk/about-brain-injury/individuals/types-of-brain-injury/
https://www.sameyou.org/
https://www.medicinenet.com/script/main/art.asp?articlekey=40362
https://onlinelibrary.wiley.com/doi/abs/10.1097/01.mlg.0000191461.08542.a3
https://www.researchgate.net/figure/Edwin-Smith-Papyrus-Recto-Columns-8-and-9-Picture-from-the-archives-of-US-National_fig1_335469605

























