Friday, 11 March 2016

The Treatment of Head Injuries in Norman Dott Case Notes

     It has been one month and a half since I started cataloguing the Norman Dott case notes as a Project Cataloguing Archivist, and I am happy to say that I reached my 1000th case note last week. Cataloguing never gets tedious or repetitive, because every case note is different, and every life story is fascinating. However, some conditions are more recurrent than others, and today I would like to expand a bit more on the treatment and effects of head injuries.

     As a pioneer in neurosurgery, the treatment of head injuries was important for Norman Dott. For example, we know he assiduously attended meetings of the Brain Injuries Committee set up in 1940 by the Medical Research Council, and participated actively in the formulation of the committee’s recommendations for treatment and management of head injuries. During World War 2, he set up the Bangour Brain Injuries Unit, where service members and civilians were treated during the war. According to a paper produced by Norman Dott’s team in 1942[1], two third of the cases treated at the Brain Injuries Unit were mechanical injuries of the brain, and one third were injuries to the brain by disease. Not only would patients receive the highest standards of operative care of the acute head injury, but they would also receive extensive post-operative rehabilitation services, that is to say occupational therapy, speech therapy, physiotherapy, etc. Indeed, Norman Dott had always been close to his patients, connecting with them on a personal level and doing everything he could to help them to reintegrate into society. Bangour Hospital would be the site of operation, then patients would be transferred to the Royal Infirmary of Edinburgh for post-operative care and rehabilitation. After the war, roles were reversed: patients would undergo surgery at the Ward 20 of the Department of Surgical Neurology at RIE and convalesce at Bangour Hospital. Norman Dott himself admitted that he had learnt much from each case at Bangour Brain Injury Unit, which enabled him to cope with the increasing amount of road accident victims in the 50s. Ward 20 was in operation twenty-four hours a day, seven days a week, and although toward the end of his career Norman Dott didn’t personally perform the demanding operations on head injuries, he was always available for help and advice.

Photograph of a nurse preparing anaesthetic in the operating theatre in Ward 20 of the Royal Infirmary of Edinburgh, 1943. 

     The case notes I have been cataloguing date from the late 50s and reflect perfectly these facts. I have come across all kinds of head traumas, ranging from very mild to fatal. Work accidents – particularly in mine pits – and, indeed, car crashes seemed to be among the primary causes of serious head injuries, which could lead to intracranial haemorrhages and in particular subdural and extradural haematomas. These conditions often required surgery and very quick action: in one case note, Norman Dott regrets that the patient, a young man who did not survive a car crash, was not brought earlier to his unit because he could have been saved if the operation had been performed one or two hours earlier. Head injuries could also lead to brain oedemas and cerebral abscesses, which were often life-threatening.

     Naturally, many head injuries weren't as serious, although sometimes the effects could still be felt years later. These effects, grouped under the name of “post-concussional syndrome”, could include headaches, dizziness, nausea and vomiting, memory impairment, post-traumatic anxiety, vision disorders, and personality changes (irritability, euphoria, apathy…).  These disturbances could be chronic or permanent; they could be immediate or appear after a few hours, even after several years. It is particularly the case for post-traumatic epilepsy; in many a case, Norman Dott links the appearance of epileptic manifestations to a head injury that happened years earlier and that seemed to be completely innocuous at the time. This kind of case makes us understand why the past medical history of each patient is recorded in such great detail in most case notes. For some unfortunate patients effects would be incurable, however Norman Dott was very eager to alleviate these patients’ suffering and reduce their disabilities, which is why he always put such an emphasis on rehabilitation. He was also very keen on following up his patients, asking for news to their family doctors and conscientiously replying to every letter he received. In my opinion, this is why the Norman Dott case notes are such a fascinating collection: not only are all the technical summaries and charts they contain very useful for medical history and medical research, but the many letters, postcards and notes also give us a great insight into the patients’ relationships with Norman Dott, the man who changed their lives.


Rush, C., and Shaw, J. (1990) With Sharp Compassion, Aberdeen: Aberdeen University Press, p. 165-173.  

Ainsworth, C., and Brown, G. (2015) Head Trauma Treatment & Management [online]. Medscape. Available from: [Accessed 10/03/2016]

[1] ‘The Importance of Psychiatric and Psychologic Assessment in the Management and Disposal of Organic Brain Damage’, paper read by Norman Dott to the summer meeting of the Society of British Neurological Surgeons in London on 1 August 1942. 

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