Even in the 21st century, we are still learning about how trauma to the brain can cause serious injury or death. In the 19th century, medical understanding of brain injuries was almost non-existent.
From the 1889 Pennsylvania Mine Inspector’s report comes this story of a fatal accident at the Bear Valley Shaft of the Williamstown Colliery in northern Dauphin County:

Francis Reilly, a laborer, aged 25 years, was injured at the Bear Valley shaft of the Williamstown colliery, January 11, 1889, and died January 16, 1889.
He was standing by the bucket with his hand resting on it, when a small piece of rock fell from shaft and struck him on the finger. In his effort to get away he stumbled and fell, striking his head against the side of the shaft, but at the time did not complain of any injury to his head.
He stopped work and went to see a doctor to have his injured finger attended to, and remained at home moving around until January 16. That morning he complained of a pain in his head which continued to grow worse and during that night he died from concussion of the brain.
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