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From the Los Angeles Times:
In the 1946 issue of the Annals of Surgery, U.S. Army Maj. Ralph A. Munslow chronicled in exquisite detail the emergency care of 140 soldiers and civilians who suffered grievous head wounds — mainly from shell fragments — during the 5th Army's 1944 operation to seize and hold a beachhead in Anzio, Italy.

While liberally sprinkling antibiotic sulfa powder, and later penicillin, directly into his patients' gaping head wounds, Munslow meticulously collected all traces of foreign bodies and skull fragments, he reported. Where it was not possible to coax out debris with a magnet, Munslow would poke his finger into the soft tissue in a thorough effort to clean the patient's brain.

It was an approach that prevailed — with refinements — through the Vietnam War and beyond, yielding only in recent years to new discoveries about the dynamics of the injured brain. Today, neurosurgeons are more likely to remove large chunks of intact skull than to vacuum up tiny shards of debris — to give an injured brain room to expand while also leaving it in peace to recover from a violent insult.

"A lot of what was done in the early treatment of Congresswoman [Gabrielle] Giffords are things that would not have been done 20 years ago — even 15 years ago," says Dr. Jam Ghajar, president of the Brain Trauma Foundation and a neurosurgeon at New York-Presbyterian Hospital/Weill Cornell Medical Center.

Military surgeons such as Munslow have long been the nation's principal repositories of wisdom on the emergency care of those with penetrating brain injuries. But as gun violence accelerated in the United States after the 1970s, civilian physicians like Ghajar developed expertise of their own. And both groups were influenced by what neuroscientists were learning about the brain's response to injury.

The result is the widespread adoption of guidelines drafted by the Brain Trauma Foundation in 1995 for the treatment of severe brain injury. As a result, survival has improved among patients who've suffered a blunt or penetrating brain injury severe enough to have induced coma. In 1980, the overall death rate for such patients was 55%, Ghajar says; by 2010, it was just 20%.
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