PATIENT 39

 

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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.

By Patient 39, Mar 15 2013 04:01PM

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.


(You may be interested in Andrew's new book The Hurricane Port: A Social History of Liverpool. Just out in Paperback


http://www.amazon.co.uk/Liverpool-Hurricane-Port-Andrew-Lees/dp/1780575483/ref=sr_1_2?s=books&ie=UTF8&qid=1363363095&sr=1-2 )


RITCHIE RUSSELL DURING THE WAR
RITCHIE RUSSELL DURING THE WAR

By Patient 39, Feb 12 2013 11:58AM

A patient’s medical history, like the plot of a film, has a beginning, a series of unfolding events and an anticipated ending. Neurologists hear new descriptions of disordered brain function every day of their working lives. It is the deconstruction of these, combined with an element of abductive reasoning, that results in accurate diagnosis.


There are certain stories that may be particularly instructive. Ray Kennedy, the former Arsenal and Liverpool football player who developed Parkinson’s disease towards the end of his career in his early thirties, taught me what it is like for an athlete to live with chronic motor handicap. He also reminded me of the importance of narrative and humility in the healing process.

Narrative-based medicine differs from a series of measurements such as blood pressure or blood sugar, and may also provide information that has no direct bearing on the unfolding events. The filmmaker instinctively knows its dramatic power and its capacity to invite interpretation. Doctors and film-makers are bound together by this dying art of story telling.


Currently there is an epidemic of neurobling in the arts with computer generated brain mapping and its pretty but indecipherable pictures at risk of providing a new generation of intellectual quackery. The story of Patient 39 is uncontaminated by modern medical technology and contains many truths that neuroscience is in no position to trump. It is often said that doctors need their patients more than patients need their doctors and the beauty that Dr Moran glimpses through his care of Patient 39 may be one reason why.


http://www.indiegogo.com/patient39


By Patient 39, Feb 7 2013 11:42AM

BY LIZZIE CROUCH, CO-PRODUCER


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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