Until a few years ago, the subject of cranial injuries resolved itself very largely into a discussion of fractures of the skull. At this time, fractures of the skull were thought to be an exceedingly grave condition. Many patients died, thereby supplying incontrovertible evidence in favor of this opinion. But, on the other hand, not a few recovered, and, be it known, at times these were apparently more seriously injured than some of those who died. The question naturally arises, "Why was this so?"
In the light of our present-day knowledge of this subject, the answer to our question is not difficult. We now know that a fracture of the skull per se is not particularly serious and that it becomes a thing of real moment only when complicated by injury to the intracranial structures. This being so, in discussing the subject of head injuries, we must place special emphasis
HOLBROOK FR. THE DIAGNOSIS AND MANAGEMENT OF HEAD INJURIES. JAMA. 1924;83(7):489–492. doi:10.1001/jama.1924.02660070005003