Concussion: History and Discovery

The idea that a blow to the head could disturb the mind without breaking the skull is one of the oldest observations in medicine. The ancient term for it — commotio cerebri, a “shaking” or “commotion” of the brain — reaches back through medieval surgery to Greco-Roman physicians and the Hippocratic writers. Over two thousand years, the concept passed from the Persian physician Rhazes, who separated a transient functional disturbance from outright bruising of the brain tissue, through the surgeons of medieval and early-modern Europe, to the boxing rings of the twentieth century, where the lasting damage of repeated blows acquired the name “punch drunk.” Only in 2005 did the modern understanding of Chronic Traumatic Encephalopathy (CTE) in athletes take shape. This page traces that long history, and draws a careful line between a single concussion — usually a temporary, recoverable event — and the repetitive head impacts now linked to chronic brain disease.

Commotio Cerebri in Antiquity
Rhazes and the Concussion–Contusion Distinction
Medieval and Early-Modern Surgeons
The Enlightenment: Petit and the Lucid Interval
The Nineteenth Century and the Functional View
Martland and the “Punch Drunk” Fighter (1928)
Omalu, Mike Webster, and Modern CTE (2005)
One Concussion vs. Repetitive Impacts
From Ancient Concept to Modern Science
Research Papers and References
Connections

Commotio Cerebri in Antiquity

Head injury and its effect on the mind were described long before there was any anatomy to explain them. The Hippocratic Corpus — the body of Greek medical writing associated with Hippocrates of Cos (c. 460–370 BCE) and his successors — includes the treatise On Injuries of the Head, the first systematic Western text on traumatic brain injury. It classifies skull fractures, describes trepanation (drilling the skull), and records that a blow could cause loss of speech, hearing, or sight even where the bone was not obviously shattered. This recognition that mental function could be disrupted by a “commotion of the brain” is, in effect, the earliest account of what later writers would call concussion.

The Greek and Latin medical tradition carried these observations forward. Greco-Roman physicians and the encyclopedists who followed them grouped together the cluster of dazed, stunned, and stuporous states that followed a knock to the head. The word that crystallized this concept — commotio cerebri, literally a shaking or agitation of the brain — would dominate medical thinking about concussion well into the nineteenth century. It is worth emphasizing that this ancient “commotion” was a description of symptoms, not a theory of pathology; the writers had no way to look inside the living brain.

For accessibility, these ancient works (the Hippocratic On Injuries of the Head and the writings of the Greco-Roman physicians) are named here as historical primary sources rather than as modern citations. They establish the crucial point that the human experience of concussion — a temporary clouding of mind and senses after a blow — has been recognized and recorded for well over two millennia.

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Rhazes and the Concussion–Contusion Distinction

The single most important conceptual step in the early history of concussion is usually credited to the Persian physician Abu Bakr Muhammad ibn Zakariya al-Razi, known in the Latin West as Rhazes (c. 854–925 CE), one of the towering figures of the medieval Islamic medical golden age. Writing around the late ninth and early tenth century, Rhazes is widely cited as the first physician to distinguish concussion — an abnormal, transient disturbance of brain function with no visible structural damage — from contusion, a true bruising of the brain substance itself.

This distinction matters enormously. It reframed concussion as a temporary physiological state rather than a tearing or crushing of tissue, and it set the conceptual stage for centuries of medical understanding. The later Latin vocabulary preserved exactly this contrast: commotio cerebri (concussion) implied a transient loss of consciousness with no underlying injury to the brain parenchyma, whereas contusio cerebri (contusion) implied loss of consciousness accompanied by actual damage to the brain tissue. The pairing that students still learn today — concussion as functional and reversible, contusion as structural — descends directly from the medieval distinction attributed to Rhazes.

As with any “first” this old, attribution should be read with appropriate caution: the historical record is reconstructed from surviving manuscripts and later commentaries, and Rhazes built upon a Greek inheritance he knew well. What the secondary literature consistently agrees on is that the functional, non-structural conception of concussion is firmly associated with him, and that it represents a genuine advance over the undifferentiated “commotion” of antiquity.

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Medieval and Early-Modern Surgeons

In the European Middle Ages the study of head injury passed from physicians to surgeons, who dealt directly with battlefield and accident wounds. The Italian surgeon Lanfranc of Milan (Lanfrancus, c. 1250–1315), in his influential Chirurgia Magna (Great Surgery, completed around 1296), used the term commotio cerebri and explicitly recognized concussion as distinct from skull fracture and other traumatic brain injuries. He described the transience of post-injury symptoms as a temporary loss of function, and set out when a surgeon should — and should not — intervene. Lanfranc’s text helped fix “commotion of the brain” as the standard medical name for the condition in the Latin West.

Three centuries later the great French military surgeon Ambroise Paré (c. 1510–1590), a founder of modern surgery, wrote about head injuries using commotio cerebri alongside the plainer phrases “shaking of the brain,” “commotion,” and “concussion.” Paré’s emphasis on careful clinical observation, drawn from his vast experience treating wounded soldiers, exemplified the early-modern shift toward describing what was actually seen at the bedside rather than relying solely on ancient authority. He recognized that a man could be stunned, confused, or rendered briefly senseless by a blow and yet recover.

Across this long medieval and Renaissance span, the underlying model remained the one inherited from antiquity and sharpened by Rhazes: concussion was a shaking that disturbed the brain’s workings temporarily. The surgeons added practical management — when to trephine, how to watch a patient — but the idea of a transient functional upset, separate from a structural wound, persisted essentially unchanged.

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The Enlightenment: Petit and the Lucid Interval

The eighteenth century brought a more systematic clinical analysis of head trauma, above all through the French surgeon Jean-Louis Petit (1674–1750), a leading member of the Académie Royale de Chirurgie in Paris. Petit and the surgeons around him are credited with providing some of the first complete clinical descriptions of the extradural (epidural) hematoma, the contrecoup injury (damage on the side of the brain opposite the blow), and the lucid interval — the period of apparent recovery that can precede a sudden, dangerous decline.

Petit’s work is important to the history of concussion because it began to separate the different things that can happen inside the head after a blow. The immediate, transient loss of consciousness he attributed to concussion itself — the functional “commotion” — while a later deterioration after a lucid interval pointed instead to a compressing lesion such as an expanding hematoma. By classifying skull fractures and intracranial bleeds and tying them to distinct clinical courses, the eighteenth-century surgeons moved the field from a single catch-all “commotion” toward a recognition that head injury is a family of related but different problems.

This is also where the limits of the era’s knowledge become clear. Without microscopy, imaging, or any way to study the living brain, even the most careful surgeons could only infer the internal state from outward signs and from what they found at autopsy. Concussion in particular — precisely because it leaves no obvious mark — remained a clinical diagnosis defined by the patient’s temporary symptoms, a situation that would persist far longer than for the bleeds and fractures that could be seen.

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The Nineteenth Century and the Functional View

Through the nineteenth century the dominant understanding of concussion remained the ancient one, now stated in more physiological language: a blow caused a temporary disruption of brain function — a “shaking” — without necessarily producing any structural lesion that the pathology of the day could detect. The persistence of this view is striking. The idea that mental function was transiently scrambled by a commotion of the brain, first articulated in antiquity and refined by Rhazes, was still essentially the accepted account of concussion as the century closed.

At the same time, nineteenth-century clinicians sharpened the description of symptoms and recovery. They catalogued the characteristic features — brief loss or alteration of consciousness, confusion, amnesia surrounding the injury, headache, dizziness, and nausea — and debated whether the disturbance was purely functional (a temporary failure of nerve action) or reflected some subtle, invisible physical change. This tension between “functional” and “structural” explanations of concussion would not be resolved in their time; in important respects it animates concussion research to this day.

What the nineteenth century did not yet have was any concept of cumulative harm from many small blows over years. The framework was built around the single event — the fall, the kick, the collision — and its temporary aftermath. The recognition that repeated head impacts might leave a lasting, progressive mark on the brain was a twentieth-century discovery, and it arrived not from the clinic or the battlefield but from the boxing ring.

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Martland and the “Punch Drunk” Fighter (1928)

In 1928 the American forensic pathologist Harrison Stanford Martland, chief medical examiner of Essex County, New Jersey, published a short, landmark paper titled simply “Punch Drunk” in The Journal of the American Medical Association. Martland borrowed a phrase already used at ringside by fight crowds — calling a damaged old fighter “punch drunk” or “cuckoo” — and gave it a clinical face. He described boxers who, after years of taking blows to the head, developed a progressive medley of neurological symptoms: tremor, unsteady gait, slowed movement, slurred speech, and mental deterioration that in some cases ended in institutionalization.

Crucially, Martland argued that this was a distinct condition caused by the repeated head trauma of the sport, and he observed that the fighters most affected tended to be those who had spent the most years in the ring and absorbed the most punishment. In doing so he made the conceptual leap that the previous two millennia had not: from concussion as a single, recoverable event to the idea that many head impacts, accumulated over a career, could produce a chronic and worsening brain disorder.

It is a common simplification — and worth correcting carefully — that Martland coined the term “dementia pugilistica.” The phrase Martland actually introduced into the medical literature was “punch drunk.” The Latinized name dementia pugilistica (literally “dementia of the boxer”) was coined later, in 1937, by J. A. Millspaugh, who re-termed Martland’s punch-drunk syndrome. Both names describe what is today understood as a form of Chronic Traumatic Encephalopathy (CTE) — the same disease, recognized first in fighters, that would re-emerge decades later in other contact-sport athletes.

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Omalu, Mike Webster, and Modern CTE (2005)

The modern recognition of Chronic Traumatic Encephalopathy in American football is credited to the Nigerian-American forensic pathologist Bennet Omalu. In 2002 Omalu performed the autopsy of Mike Webster, a Hall-of-Fame center for the Pittsburgh Steelers who had endured a long and troubled decline after retirement. Examining Webster’s brain, Omalu found an abnormal accumulation of tau protein — the same kind of degenerative change long associated with the punch-drunk boxers — in a pattern he interpreted as the consequence of years of repetitive head impacts in football.

Omalu and colleagues published the case in 2005 in the journal Neurosurgery, under the title “Chronic Traumatic Encephalopathy in a National Football League Player.” The paper concluded that Webster’s brain showed neuropathological changes consistent with long-term, repetitive, concussive brain injury, and it explicitly applied the term chronic traumatic encephalopathy to a football player. Omalu went on to report similar findings in the brains of other former NFL players, and his work — initially met with fierce resistance from the football establishment — helped trigger a wholesale re-examination of head injury in contact sports.

It is important to frame this accurately. Omalu did not discover CTE as a disease — its features had been described in boxers since Martland — nor was he the only or first scientist to study brain trauma in athletes. What the 2005 report did was bring CTE forcefully into public and scientific view in the context of football, catalyzing the large brain-bank studies and clinical research that followed. The broader picture that has since emerged, from researchers at multiple institutions, links the disease to the cumulative burden of repetitive head impacts — including sub-concussive blows that never caused obvious symptoms — rather than to any single concussion.

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One Concussion vs. Repetitive Impacts

The history above makes sense only if one distinction is kept firmly in mind: a single concussion and repetitive head impacts are not the same thing, and they carry very different outlooks. A single concussion — the ancient commotio cerebri — is, for the great majority of people, a transient functional disturbance. Symptoms such as headache, fogginess, dizziness, and trouble concentrating typically resolve over days to a few weeks with appropriate rest and a graded return to activity. This recoverable, “no structural damage” character is exactly what Rhazes captured when he set concussion apart from contusion more than a thousand years ago.

Chronic Traumatic Encephalopathy, by contrast, is associated not with one event but with the accumulation of many head impacts over time — the career of a boxer, a footballer, or others exposed to repeated blows. The current scientific consensus, reflected in the work that followed Omalu’s report, ties CTE to this repetitive burden rather than to any isolated concussion. Importantly, the precise relationship is still an area of active research: exactly how many impacts, of what force, in whom, and through what biological mechanism the tau pathology develops are questions that remain incompletely answered. The link between repetitive head impacts and CTE is strong and widely accepted; the finer details are still being worked out, and any claim of a simple one-to-one cause should be treated as hypothesis under investigation, not settled fact.

For an ordinary reader the practical message is reassuring and honest at once. Most concussions get better. The serious, lasting concern highlighted by the modern science is repeated head trauma, which is why prevention, honest reporting of symptoms, adequate recovery before returning to play, and reducing unnecessary head impacts in sport all matter so much. None of this is medical advice for an individual injury — anyone who has hit their head and has worsening headache, repeated vomiting, confusion, drowsiness, weakness, or loss of consciousness should be evaluated by a clinician without delay.

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From Ancient Concept to Modern Science

Few medical ideas have a lineage as long and as continuous as concussion. The thread runs from the Hippocratic On Injuries of the Head, through the Greco-Roman “commotion of the brain,” to Rhazes’ decisive separation of functional concussion from structural contusion; onward through Lanfranc’s commotio cerebri and Paré’s “shaking of the brain,” to Petit’s eighteenth-century analysis of the lucid interval and the contrecoup; and finally into the twentieth century, where Martland’s “punch drunk” fighters and Omalu’s 2005 report on Mike Webster opened the modern era of CTE research.

What changed across these two thousand years is not the core human observation — that a blow to the head can cloud the mind — but the depth of understanding behind it. Antiquity described the symptom. Rhazes and the medieval surgeons distinguished its types. The Enlightenment surgeons separated concussion from the bleeds and fractures it could accompany. And only in the last century did medicine grasp that the danger is not just the single blow but the sum of many, accumulating silently over years into a degenerative disease.

That progression — from a poetic “commotion” to tau protein in a pathologist’s microscope — is also a caution. The science of repetitive head injury is young, still resolving how impacts translate into chronic disease, and it deserves to be reported honestly: with confidence where the evidence is strong, and with clearly labeled uncertainty where it is not. The history of concussion is, in the end, a history of learning to tell the temporary from the lasting — a distinction first drawn over a millennium ago and still being refined today.

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Research Papers and References

The list below combines peer-reviewed historical and clinical reviews of concussion and Chronic Traumatic Encephalopathy with curated PubMed topic-search links into the wider literature. Ancient and pre-modern primary texts (the Hippocratic On Injuries of the Head, the writings of Rhazes, Lanfranc’s Chirurgia Magna, and the works of Ambroise Paré and Jean-Louis Petit) are named in the article as historical sources rather than as modern citations. Each external link opens in a new tab.

Omalu BI, DeKosky ST, Minster RL, Kamboh MI, Hamilton RL, Wecht CH. Chronic traumatic encephalopathy in a National Football League player. Neurosurgery. 2005;57(1):128-134. — doi:10.1227/01.NEU.0000163407.92769.ED (PMID: 15987548)
Changa AR, Vietrogoski RA, Carmel PW. Dr Harrison Martland and the history of punch drunk syndrome. Brain. 2018;141(1):318-321. — doi:10.1093/brain/awx349
Martland HS. Punch drunk. Journal of the American Medical Association. 1928;91(15):1103-1107. (Historical primary source) — PubMed: Martland punch drunk
McCrory P, Berkovic SF. Concussion: the history of clinical and pathophysiological concepts and misconceptions. Neurology. 2001;57(12):2283-2289. — doi:10.1212/WNL.57.12.2283
History of biological, mechanistic, and clinical understanding of concussion. Neurosurgical Focus. 2024;57(1):E2. — doi:10.3171/2024.4.FOCUS24178
Concussion historical and clinical review (al-Razi/Rhazes; commotio cerebri). The American Journal of Medicine. — PubMed: history of concussion and commotio cerebri
Hippocrates and the management of head injuries in ancient Greece — PubMed: Hippocrates head injury neurotrauma
Jean-Louis Petit, the Académie Royale de Chirurgie, and 18th-century neurotrauma — PubMed: Jean-Louis Petit neurotrauma history
Dementia pugilistica and the boxing literature (Millspaugh, 1937 onward) — PubMed: dementia pugilistica boxing
Chronic traumatic encephalopathy: neuropathology and definition — PubMed: CTE neuropathology and tau
Repetitive head impacts, sub-concussive blows, and CTE risk — PubMed: repetitive head impacts and CTE
Natural history and recovery after a single concussion (mild traumatic brain injury) — PubMed: concussion recovery and natural history
Bennet Omalu, Mike Webster, and the recognition of CTE in football — PubMed: Omalu CTE in football players
Rhazes (al-Razi) and contributions to medieval neurology — PubMed: al-Razi (Rhazes) and medieval neurology

External Authoritative Resources

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Connections

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