Penetrating head injuries.

The story begins long before the dawn of recorded history, at the time when man learned to use sticks and stones as weapons. We shall trace the injuries caused by weapons, which became increasingly more deadly from the Stone Age, through the ancient civilisations of Egypt and Greece to modern times. What do we mean by a penetrating wound of the head? There are three kinds of head injury. First, the blunt injury, often caused by a fall on a flat surface, which produces generalised brain damage without an open brain lesion. Secondly, the comminuted depressed fracture of the skull caused by a falling object such as a brick: indriven bone fragments may damage the cerebral cortex but the patient seldom loses consciousness and usually recovers without serious handicap. Thirdly, the penetrating head injury, where a sharp object or missile fractures the skull and enters the brain, driving fragments of bone before it. The spears and arrows of earlier civilisations frequently penetrated the brain. Nowadays most penetrating injuries are sustained in road traffic accidents or in assaults with sharp weapons; but the most severe penetrating wounds are caused by bullets or bomb fragments. PREHISTORY Our knowledge of the earliest penetrating wounds is derived from archaeological sources. Little trace remains of most ancient operations, but preserved skulls from the Neolithic Age provide clear evidence of surgical treatment of skull frarctures Piece.s of cnmminiited hone were elevated-[ snmetimPe hv makinn a hole beside the fracture not unlike the modern surgeon's burr hole. Admittedly, we don't know the depth of these wounds or the extent of brain damage, but new growth of bone at the edge of the defect shows that some patients survived the operation. The head was bandaged and occasionally the defect was repaired with a piece of shell, or even a sheet of gold. A greater number of prehistoric skulls have defects from the operation known as trepanning or trephining.' The deliberate fashioning of a hole in the normal skull was carried out in many parts of the world. In Neolithic times a flint or obsidian knife was used; in the Bronze Age more sophisticated