Golden Age Helmet

Nicolaes Maes
The Lacemaker
ca. 1656
oil on canvas
45.1 x 52.7 cm
Metropolitan Museum of Art, 32.100.5
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In this painting by the great seventeenth-century Dutch artist Nicolaes Maes, we see a young woman sewing lace while her baby sits quietly in his highchair. An example of a genre painting, or scene of everyday life, the woman is the epitome of domestic virtue, as she works diligently on her task. We can also infer that she is a good mother, as she has dressed her baby in a “pudding cap,” a hat with an extra band of padded fabric to protect a baby’s head against falls. These types of hats are not so different from more modern protective head coverings, including helmets worn by athletes and those prone to seizures.

Teaching a Child to Walk by Pieter de Hooch, a piece in the Neurology, Illustrated gallery at Tufts Medical Center in Boston, MA.During the Golden Age of Dutch art, genre paintings—depictions of everyday life, often in domestic settings—became increasingly popular. Nicolaes Maes (1634-1693), hailing from Dordrecht, was one of the great genre painters of the day, having studied with Rembrandt before striking out on his own. Known for his small, intimate scenes, here we see a young mother making lace, with her baby boy sitting in a highchair nearby. Creating lace was viewed by the seventeenth-century Dutch as a worthy task, a sign of diligence and feminine virtue. Many artists of the time, including Vermeer, painted scenes of woman making lace, though the subject was most frequently depicted by Maes. The woman’s young son wears a “pudding cap,” a seventeenth-century invention that continued to be popular in colonial America. The Lacemaker by Johannes Vermeer, a piece in the Neurology, Illustrated gallery at Tufts Medical Center in Boston, MA.Called in Dutch a valhoed, or falling cap, the hat features a thick roll of fabric around the head, to cushion the baby if he were to fall. Worn especially when babies were first learning to walk, the hats protected the brain from trauma should the child fall over. A painting by Pieter de Hooch, a contemporary of Maes, depicts a similar scene of a child wearing a pudding cap while learning how to walk.

Traumatic brain injury (TBI) is a leading cause of death and disability globally. It is affecting more and more people over time due to increasing use of motor-vehicles and armed conflicts. TBI is more common in young adults, which makes the financial and other costs to society extremely high because of the many years that are lost due to death and disability. There are several different ways to categorize TBI—by the mechanism of injury (closed head injuries like concussions vs. penetrating brain injuries like bullets), by the severity of the injury (coma vs. no coma), and by the assessment of visible damage on brain imaging. TBI can be as inconsequential as bumping your head on a cabinet door after standing up too quickly and feeling momentarily dazed, or it can be catastrophically severe, such as when an object penetrates the skull.

The brain is the consistency of gelatin and is suspended in the skull by cerebrospinal fluid. This acts as a cushion that protects it from wobbling around too much and bumping into the skull from the inside. However, this cushioning effect can be overwhelmed if the brain and skull are moving at different speeds. If you slip and fall your head and brain move at the same speed as they approach the ground. When the head hits, the skull suddenly stops moving but the brain inside is still going. The brain only stops moving when it hits the skull—a bit like a passenger without a seatbelt being thrown forward into the windshield of a car. A concussion occurs when this kind of head injury is associated with loss of consciousness, memory gaps, and other neurological symptoms at the time of the impact like confusion, double vision, and nausea.

While TBI can be an isolated event, much attention has been focused more recently on people who have suffered repeated concussions. Those who are most vulnerable are athletes who take part in contact sports (like American football) and members of the military. Known as chronic traumatic encephalopathy (CTE), this condition was first described in 1928 amongst boxers and was called “dementia pugilistica.” The brains of individuals with CTE deteriorate and shrink over time. It has been shown that a protein called tau accumulates near the cerebral cortex. Interestingly, this is the same protein that has also been implicated in other neurodegenerative conditions like amyotrophic lateral sclerosis (ALS), Alzheimer disease, and Parkinson disease. There has been greater awareness of this condition since studies of the brains of football players after they died began to show a new pattern of tau deposition that seems to be unique to people with CTE. Much of the pioneering and influential research has been done in Boston. The public awareness of CTE and its consequences has led to calls for more research, especially on injury prevention. Inventors are attempting to re-engineer NFL helmets while the NFL is considering how to re-engineer the game. Protecting the head and brain from sudden deceleration has evolved from the valhoed (“falling cap”) into modern NFL helmets. Unfortunately, brains are still vulnerable whether they belong to a toppling Dutch baby or a 250-pound NFL tight end. 


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Ghajar, J. “Traumatic brain injury.” Lancet 365 (2000): 923-29.