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.
Sources
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: http://emedicine.medscape.com/article/433855-treatment#d9
[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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