Cerebral involvement in head injury. A study based on the examination of two hundred cases

It is difficult to summarise the points which have been discussed in this thesis. The study of the two hundred cases dealt with has provided a large mass of material for investigation, of which only certain aspects have been analysed. My plan has been to record the facts and to discuss them throughout the text. The frequency with which the common symptoms and signs of concussion occur has been analysed, and their significance discussed. Changes in the pressure, cytology,and chemistry of the cerebro-spinal fluid have been investigated in a series of severe cases, and this has thrown light on the significance of certain symptoms and signs of the acute stage. The mechanism by which the brain is damaged in head injury has been discussed, and conclusions have been arrived at with regard to the mechanism of loss of consciousness and contre -coup injury. The pathology of the condition called "cerebral irritation" has also been considered. The conclusions arrived at in this section of the thesis are quite contrary to most current teaching. The cases in GROUP C provided material for study of the stages by which consciousness returns. I have been unable to find any record in the literature of an analysis of the clinical features of the acute stage of head injury in any large series such as is here attempted. Further special importance attaches to this work from the fact that most of the cases have not only been examined in the acute stage, but have been re- examined at an interval after discharge. The fact that, in the series, compensation cases are few in number has greatly added to the value of this part of the work. The frequency with which post-concussional disturbances occur has been investigated. It has become quite apparent that physical examination is of little value in the attempt to estimate the degree of cerebral damage, and hence the detailed analysis of the features of genuine post-concussional disturbances of a subjective nature has been of great importance. From the study of the post- concussional symptoms in a series of cases, I claim to have shown that these have well defined features which must be regarded as having an organic basis. This conclusion has been based on the clinical study alone, but is found to correspond with the opinion of some recent workers who have been investigating the pathological changes which occur in these cases. The investigation of post-mortem material forms only a small section of this work, but I have succeeded in demonstrating changes in the neuroglia . which have previously only been described in experimental work. Finally, the practical application of certain aspects of this work has been discussed in relation to diagnosis, prognosis and treatment, and the methods of examination which I have found useful have been described. The subject of this thesis suggests many lines of investigation, and the work which is here recorded must be regarded merely as a preliminary report based on the first two hundred cases seen