Changing attitudes to the management of severe head injuries.

Just 100 years ago this term young Victor Horsley entered University College, London, as a medical student.He was a founder of British neurosurgery.Some of his other interests have a contemporary ring.Thus he helped to provide the pathological proof of an outbreak of rabies among the deer in Richmond Park in 1888, while his friendship with Pasteur and his vigorous advocacy led to the muzzling of dogs and finally the quarantine restrictions which helped stamp out the disease from Britain at that time.We find him in 19121 reporting on the forcible feeding of suffrage prisoners and urging its reconsideration, echoed in October 1975 by the World Medical Association in the "Dec- laration of Tokyo," which set out the role of the doctor in relation to these and other practices in a manner which I believe Sir Victor would have approved.In his medicopolitical activities Sir Victor made strenuous efforts to change the constitution of the BMA with the establishment of the Representative Body proper, of which he was its first Chairman in 1903.All these contributions to medicine and society Horsley pursued with energy, concentration, and almost apostolic fervour.Horsley made little direct contribution to the subject of cerebral concussion or the management of head injury, though he did study the mechanics of cerebral compression.Together with Kramer he also showed that intracranial pressure rose immediately after head injury and that the primary cause of death was due not to heart failure but to arrest of respiratory *The 16th Victor Horsley memorial lecture delivered at the Royal College of Surgeons of England on 11 December 1975.centre function; thus death could frequently be prevented by artificial respiration.26