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By Patient 39, Feb 7 2013 11:42AM


A 16-year-old boy falls head first from a 20-foot balcony. Having been rushed to the hospital, a team of neurologists and neurosurgeons assembles to assess his head wounds. Tests are called for, including a MRI scan that allows the doctors to rapidly localize and assess the severity of the injury. With this vital knowledge, treatment begins.

This case from a documentary highlights how head injuries are treated in emergency units today. In stark contrast, during the First World War not only was such advanced technology unavailable but there was a lack of specialist neurological treatment. Those with head injuries were simply treated along with everyone else.

In the wake of the war, it became obvious to Sir Hugh Cairns, an Australian born neurosurgeon working as a Professor of Surgery in Oxford, that changes were needed. With the outbreak of hostilities in 1940, he opened the first Combined Services Hospital for Head Injuries at St Hugh’s College, Oxford.

Cairns had been trained by the ‘father of neurology’, Harvey Cushing, in Boston. In this new hospital he now enforced a meticulous regime of patient care based on Cushing’s principles. His insistence on accurate examination, careful recording and attention to detail led to a high standard of treatment.

Oxford was close to several RAF bases, meaning the wounded could be flown back from the front and reach specialist treatment quickly. Cairns’ recognition that the quicker the patient received treatment, the better the prognosis, also led him to create Mobile Neurosurgical Units, which treated those with head injuries as close to the front as possible.

Over the course of the war the Hospital for Head Injuries at St Hugh’s treated around 13,000 Armed Services personnel. Cairns’ team trained neurologists, neurosurgeons, nurses and doctors in how to process and treat head wounds. The rapid access to specialist treatment combined with the use of penicillin (which had been developed less than a mile away in the Radcliffe Infirmary) contributed to a dramatic drop in the mortality rate for those with head injuries, from 50% in World War One to just 5% in World War Two.

Neurology and neurosurgery has now evolved dramatically, and Cairns would barely recognize it today. However, the vital work carried out at St Hugh’s laid the foundations for how head injuries are treated, so that today young people like Aaron, the 16 year old who fell from the balcony, could survive his fall with no major complications.

In 1945, St Hugh’s was returned to Oxford University. Today, there is no visible reminder of the hospital, and the vital role it played, apart from a simple blue plaque.

Sir Hugh Cairns:

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