Abstract
The increase in road traffic accidents in twentieth-century Britain brought with it a rise in the number of patients admitted to hospital with blunt, non-penetrating head injuries. Patients who had suffered mild to moderate trauma typically complained of a variety of problems, including headaches, dizziness and giddiness. For the neurologists tasked with diagnosing and treating these patients, such symptoms proved difficult to assess and liable to obscure the clinical picture. This article focuses on why neurologists turned to time as a diagnostic-tool in helping to resolve these issues, specifically the measurement of post-traumatic amnesia (PTA). This article argues that PTA became so central to neurological diagnosis owing to a set of epistemic, professional and material factors in the decades prior to the Second World War. It concludes with a call for deeper appreciation of the range of issues that contribute to the shaping of medical theories of head trauma.
Highlights
From the interwar period onwards, members of the British medical profession connected a gradual rise in road traffic accidents with an increase in the number of patients being admitted to hospital with blunt, non-penetrating injuries to the head
This article focuses on why neurologists turned to time as a diagnostic-tool in helping to resolve these issues, the measurement of post-traumatic amnesia (PTA)
The centrality of PTA to the assessment of blunt head trauma is explained with reference to the epistemic, professional and material factors influencing British neurology in the decades prior to the Second World War
Summary
From the interwar period onwards, members of the British medical profession connected a gradual rise in road traffic accidents with an increase in the number of patients being admitted to hospital with blunt, non-penetrating injuries to the head. Ritchie Russell, ‘Medical Aspects of Head Injury’, British Medical Journal, 2, 4269 (1942), 521; J.G. Danson, ‘On Injuries to the Brain and their Sequelæ’, Proceedings of the Royal Society of Medicine, 33, 2 (1939), 60; Charles Symonds, ‘The Assessment of Symptoms Following Head Injury’, Guy’s Hospital Gazette, 51 (1937), 461–8, reprinted in Charles Symonds, Studies in Neurology (London and New York: Oxford University Press, 1970), 122. Whilst conceding that much remained unknown about minor head injuries, intracranial pressure, he noted, if distributed inequitably, altered the tension between the dural septa, with headache the consequence.[27] he identified disturbance of brain-circulation as central to the development of cerebral symptoms, as had already been shown by notable physiologists and surgeons like Horsley, Hill, Kocher and Cushing.[28] Because of this, Trotter pointed to the brain’s location within the skull as a source of distress, for when an organ needs to release a buildup of blood, he observed, it swells in such a way as to carry away any excess and to restore circulation to normal functioning. This build-up of fluid, Trotter concluded, was reversible and would resolve itself naturally in most cases, but for this required the passage of time
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