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Feature Christmas 2021: What if . . . ?

We all fall down: head injuries in nursery rhyme characters

BMJ 2021; 375 doi: (Published 15 December 2021) Cite this as: BMJ 2021;375:e068256
  1. Declan A Patton, research scientist
  1. Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, PA 19146, USA
  1. pattonda{at}

Nursery rhymes might aim to teach children morals and good behaviour, but Declan Patton examines several that involve or are suspected of involving fall related head injuries and wonders if they convey the correct message

Nursery rhymes are traditional poems, lullabies, or songs, sometimes centuries old, that are usually read or sung to children with the intention of teaching them morals and good behaviour. The origins and meanings of some nursery rhymes might have been lost over time, but occasionally researchers will dust off book covers to look again at the content of those short tales or ditties. Some have been criticised for containing references to violence.1 For example, six studied nursery rhymes mentioned head injuries but medical opinion was seldom sought for the patients, and when it was the suggested remedy was wholly inappropriate2: could all the king’s horses and all the king’s men have provided the correct treatment after Humpty Dumpty’s fall from a wall?

Seven popular nursery rhymes involving or suspected of involving fall related head injuries deserve some scrutiny (table 1). The injured characters were humans of various ages, five little monkeys, and an anthropomorphic egg. The head injuries were commonly due to falls—one was even related to the seemingly innocuous everyday activity of going to bed. These nursery rhymes have the potential to offer invaluable insights into the biomechanics of head injuries—an egg, as you will see, can easily act as a model for the human skull. So, let’s crack on.

View this table:
Table 1

Causes and types of injuries sustained by nursery rhyme characters

Humpty Dumpty: Tests on eggs and human heads reveal the biomechanics

Humpty Dumpty is an anthropomorphic egg who famously had a great fall from a wall.3 For more than 100 years the aviation and motor industries have used anthropomorphic devices to test safety equipment.4 More recently, the chicken’s egg has …

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