PATIENT 39

 

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THE TREATMENT OF BRAIN INJURY IN WORLD WAR TWO

By Patient 39, Apr 17 2014 06:59AM

At the outset of World War Two, St Hugh’s College Oxford was requisitioned as a 300 bedded military hospital specializing in head injuries. A number of brick buildings were hurriedly constructed on the lawns to house the wards and therapy services while the College’s female undergraduates were moved into alternative accommodation.


The specialist unit was led by Australian born neurosurgeon Hugh Cairns who pursued an aggressive policy of early intervention, often in the field hospital before transfer to Oxford. The arrival of penicillin also dramatically reduced the mortality of open head injury. It is likely that a soldier like Patient 39 would have ended up as one of the 13000 patients treated at the Oxford Military Hospital (Head Injuries), and that he would have been flown in from France via Brize Norton.


Although head injuries have always been and remain an unpopular subject with neurologists, there have been a number of notable exceptions. One of these was William Ritchie Russell (1903-1980), a Scot from a distinguished dynasty of Edinburgh doctors who in 1932 published an influential paper in the journal ‘Brain’ entitled Cerebral Involvement in Head Injury in which he emphasized how long the patient was completely unconscious after the trauma as an important prognostic factor. In his paper, he provides an account of how the unconscious patient recovers. On coming round, the first attempts to speak usually take the form of repeated groans or shouts followed by the utterance of a few words. There is still no level of understanding or reason and speech is often repetitive, restricted to pat phrases and nonsensical. There is often profound social disinhibition and delirium. Eventually orientation returns along with alertness and the patient then begins to think of events leading up to the injury.


After a period of training at the onset of war at my hospital, Queens Square in London, Ritchie Russell joined Cairns in Oxford. Had Dr. Moran in Patient 39 been a real character, it is Russell we should look to. By this time his earlier research had been enshrined as post-traumatic amnesia. Although he recognized the importance of very early childhood memories to the adult and had an interest in psychoanalytical theory, after the war at Oxford he devoted a considerable amount of time to collaborative neuropsychological studies. He is said to have bubbled with ideas and to have been painstaking in taking clinical histories from his patients. He gave the appearance of unhurried serious dedication in his work, lightened by the occasional humorous dedication but like many neurologists of his generation he could be brutally frank with patients and colleagues.


After the war the Oxford Military Hospital was closed and St Hugh’s returned to being a college, though the case notes of the patients and fascinating archival materials are still stored in the college library. Here is recorded that local children would bring cowslips for the injured men and that the female undergraduates would push the wounded soldiers into Oxford for a day out. Perhaps too hidden away amongst Ritchie Russell’s case notes can be found more insights into Patient 39’s beatific visions.

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