Some historical sporting head injuries
The second in a series of posts based on the displays from Doctors on the Ball: Sports and Medicine in Ireland, this post looks at the work of two leading late eighteenth century surgeons on head injuries caused by sports. Then, as now, head injuries are some of the most common, and most serious, injuries sustained during sport.
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| Percival Pott |
Percival Pott was born in 1714; he trained as an apprentice surgeon in London, before being admitted to the Barbers' Company and gaining his license to practice in 1736. He spent much of his career at St Bartholomew's Hospital in London, and had an extensive private practice. He became one of the leading surgeons of his age, and one of the first to write on orthopaedic surgery.
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| Trephines |
In 1768 Pott published Observations on the nature and consequences of those injuries to which the head is liable from external violence. Pott was one of the first to realise that symptoms arising from head injuries were due to injury of the brain, not a fractured skill. In an age when trephination (drilling a hole in the skull) was the treatment for nearly all head injuries, even simple concussions, Pott advocated only using trephination in the most serious cases. Pott's work on head injuries was supported by 43 cases which had come under his own management. The most common causes in these cases were falls, road accidents, and assaults, but four cases record sporting injuries. The sport involved were cudgels (a form of fencing with sticks), quoits and cricket.
Case XVII deals with an injury sustained playing cudgels. Although the blow drew blood, it was not considered serious until the patient fell ill 12 days later and presented himself at St. Bartholomew's Hospital. Pott found a fracture of the skull, cutting away the damaged bone revealed discolouration and matter on the surface of the brain. Having cleared the fracture the patient was treated with repeated blood-letting, which was supposed to remove any infected blood from the system.
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| Sylester O'Halloran |
Sylester O'Halloran was born in Caherdavin, County Limerick, in 1728 the son of a prosperous farmer. Because of the Penal Laws, which restricted Catholics access to higher education in Ireland, O'Halloran studied medicine in London, Leyden, and Paris, before returning to Limerick in 1749. O'Halloran set up in private practice in the town, and also helped found the County Limerick Infirmary, where he became surgeon. Influenced by the French Académie Royale de Chirurgie in Paris, O'Halloran was instrumental in the founding of the Royal College of Surgeons in Ireland in 1784.
In 1793 O'Halloran published A new treatise on the different disorders arising from external injuries to the head. As with Pott's work, O'Halloran draws on cases from his own experience, selecting eighty-five cases from above fifteen hundred. In the introduction he states that;
'without doubt, there is no part of the habitable globe, that for half a century past, has afforded such an ample field for observation on injuries of the head, as Ireland ...for our people, invincibly brave, notwithstanding the cruel oppressions they have suffered for a century past, and highly irritable, soon catch fire; a slight offence is frequently followed by serious consequences; and sticks, stones, and every species of offence next to hand, are dealt out with great liberality! To this add the frequent abuse of spirituous liquors, particularly whiskey, which has, unhappily for the morals and constitutions of the people, found its way to every part of the kingdom! From these hitherto unrestrained causes, it is, that many of our fairs, patrons, and hurling-matches, terminate in bloody conflicts; and that violent outrages are frequently felt and complained of, but seldom punished!'
Case X in O'Halloran's work concerns an injury sustained during a game of hurling. Initially 'exempt from fever, or any kind of alarming symptom' the patient was treated with frequent bleeding, but nine days after the injury the patient succumbed to sickness and fever and died shortly afterwards. O'Halloran performed a dissection which showed there was considerable internal damage to the brain which had not been indicated by the external injuries.