{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T20:55:56Z","timestamp":1694206556959},"reference-count":122,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2018,9,7]],"date-time":"2018-09-07T00:00:00Z","timestamp":1536278400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Med. Hist."],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1017\/mdh.2018.42","type":"journal-article","created":{"date-parts":[[2018,9,7]],"date-time":"2018-09-07T11:38:23Z","timestamp":1536320303000},"page":"449-467","update-policy":"http:\/\/dx.doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":2,"title":["The Place of Post-Traumatic Amnesia in the Assessment of Blunt Head Trauma: The Epistemic, Professional and Material Factors Shaping British Neurology, circa 1920\u201340"],"prefix":"10.1017","volume":"62","author":[{"given":"Ryan","family":"Ross","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2018,9,7]]},"reference":[{"key":"S002572731800042X_r37","unstructured":"For example, C.P. Symonds, op. cit. (note 6), 71; William A. Brend, \u2018Differential Diagnosis of Contusion of the Brain and Psychoneurosis\u2019, British Medical Journal, 1, 4197 (1941), 885. I take the phrase \u2018dumping ground\u2019 from Ian Skottowe, \u2018The Dumping Ground of Neurasthenia\u2019, The Lancet, 215, 5550 (1930), 106."},{"key":"S002572731800042X_r87","unstructured":"As medical officers compiling patient-records were warned: \u2018Subjective and objective data should not be mixed up either.\u2019 See the untitled, unauthored and undated document contained in TNA, WO 222\/845. The topicality of this document would suggest that it was written by Symonds."},{"key":"S002572731800042X_r102","doi-asserted-by":"crossref","unstructured":"For more general comments on how databases are founded, and what problems this can create when the object of study does not yield to the planned system of classification, see Christine Hine, \u2018Databases as Scientific Instruments and Their Role in the Ordering of Scientific Work\u2019, Social Studies of Science, 36, 2 (2006), 278 and passim.","DOI":"10.1177\/0306312706054047"},{"key":"S002572731800042X_r67","unstructured":"See G.F. Rowbotham, \u2018The Long-Term Results of Injuries of the Head (A Medical, Economical and Sociological Survey)\u2019, British Journal of Psychiatry, 95, 399 (1949), 339 and passim. Indeed, many neurologists expressed disappointment that no one objective method could diagnose concussive sequelae, eg. see the comments in Symonds, op. cit. (note 5), 326."},{"key":"S002572731800042X_r25","first-page":"955","article-title":"An Address on the Management of Head Injuries","volume":"2","author":"Trotter","year":"1925","journal-title":"The Lancet"},{"key":"S002572731800042X_r4","first-page":"668","article-title":"The Treatment of the Sequels of Head Injury","volume":"211","author":"Russell Brain","year":"1928","journal-title":"The Lancet"},{"key":"S002572731800042X_r20","unstructured":"See eg. Brain and Cairns, op. cit. (note 4), 668."},{"key":"S002572731800042X_r64","unstructured":"Cross-examination was the best way to determine the stage that the patient was at, according to Russell. See Russell, \u2018Cerebral Involvement in Head Injury\u2019, op. cit. (note 7), 553."},{"key":"#cr-split#-S002572731800042X_r101.1","unstructured":"7. This was Symonds and Russell, op. cit. (note 65). An earlier pair of papers, both written by Russell and with PTA at their centre, was circulated to the Brain Injuries Committee. I suspect that these were later rewritten with Symonds. For the papers, see TNA, FD 1\/5343, 'Report from Ritchie Russell, Military Hospital (Head Injuries)', St.Hugh's College, Oxford, 10 August 1942"},{"key":"#cr-split#-S002572731800042X_r101.2","unstructured":"8. TNA, FD 1\/5343, 'Analysis of First Thousand Cases of Head Injury Admitted to the Military Hospital for Head Injuries (Explanatory Text to Paper B.I.C. 61 by Dr W. Ritchie Russell)'. For the positive reception of these papers to the Brain Injuries Committee, see the brief comments in TNA, FD 1\/5269, 'Brain Injuries Committee', 12 March 1942, 2."},{"key":"S002572731800042X_r10","unstructured":"On the growing role of time in medical diagnosis throughout the twentieth century, and the connection of this to patient-records, see David Armstrong, A New History of Identity: A Sociology of Medical Knowledge (Basingstoke: Palgrave Macmillan, 2002), 140 and passim."},{"key":"#cr-split#-S002572731800042X_r23.1","unstructured":"10. Wilfred Trotter, 'The scalp, skull and brain', in C.C. Choyce (ed.), A System of Surgery, 2nd edn (London, New York, Toronto and Melbourne: Cassell and Co. Ltd, 1923), 436-565"},{"key":"#cr-split#-S002572731800042X_r23.2","unstructured":"11. Wilfred Trotter and Julian Taylor, 'The scalp, skull and brain', in C.C. Choyce (ed.), A System of Surgery, 3rd edn (London: Waverly Book Company, 1932), 332-476."},{"key":"S002572731800042X_r43","unstructured":"For an overview of debates, see Trimble, op. cit. (note 16)."},{"key":"S002572731800042X_r54","unstructured":"Jefferson, op. cit. (note 50), 78. Symonds further proposed that neurologists were best placed to acquire this information and add it to the patient\u2019s chart. See Symonds, op. cit. (note 5), 326."},{"key":"S002572731800042X_r96","unstructured":"See eg. Symonds\u2019s comments in no author, op. cit. (note 42), 605\u20136."},{"key":"S002572731800042X_r63","unstructured":"Russell, \u2018The After-Effects of Head Injury\u2019, op. cit. (note 7), 135."},{"key":"S002572731800042X_r56","unstructured":"On tensions between neurologists and neurosurgeons, see Casper, op. cit. (note 13), esp. chs 3 and 4."},{"key":"S002572731800042X_r76","unstructured":"TNA, FD 1\/5342, \u2018Memorandum on Plans for Research at the Oxford Military Hospital (Head Injuries) and Application for Grant by Group-Capt. Symonds\u2019, undated, 1. For insight into the specific areas that Committee members suggested, see TNA, FD 1\/5342, \u2018Suggested Problems for Discussion\u2019, undated."},{"key":"S002572731800042X_r71","unstructured":"Symonds, op. cit. (note 5), 321. The minutes for the Brain Injuries Committee would appear to support Symonds\u2019s claim. In May 1940, the Committee recommended that a set of \u201c\u2018psychological\u201d terms\u2019 be produced in order to \u2018define in a succinct manner certain states of functional disorder\u2019. See TNA, FD 1\/5342, \u2018Brain Injuries Committee\u2019, 2nd May 1940, 3. For the final list of terms, see Medical Research Council Brain Injuries Committee, A Glossary of Psychological Terms Commonly Used in Cases of Head Injury (London: HMSO, 1941)."},{"key":"S002572731800042X_r45","unstructured":"Symonds, op. cit. (note 6); no author, op. cit. (note 42), 601\u20137."},{"key":"S002572731800042X_r26","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.1.3306.816"},{"key":"S002572731800042X_r49","unstructured":"See his comments in no author, op. cit. (note 11), 299."},{"key":"S002572731800042X_r79","unstructured":"See St Hugh\u2019s College Archives, HHA\/4\/2\/2, \u2018Letter from Hugh Cairns to Geoffrey Jefferson\u2019, 17 July 1940."},{"key":"S002572731800042X_r22","unstructured":"See Wilfred Trotter, \u2018The scalp, skull and brain\u2019, in C.C. Choyce (ed.), A System of Surgery (London, New York, Toronto and Melbourne: Cassell and Co. Ltd, 1914), 305\u2013418."},{"key":"S002572731800042X_r5","first-page":"327","article-title":"Closed Head Injuries","volume":"76","author":"Symonds","year":"1941","journal-title":"Journal of the Royal Medical Corps"},{"key":"S002572731800042X_r80","unstructured":"The minutes for the Brain Injuries Committee in this period suggest that neurologists were concerned that military records would be reclaimed by the Army or pension authorities at a later date, hence why the patient-records at the Military Hospital were to be compiled and stored separately. See Symonds in TNA, FD 1\/6137, \u2018Letter from C.P. Symonds to F.J.C. Herald\u2019, 29 February 1944; and the comments of Geoffrey Jefferson in \u2018Brain Injuries Committee\u2019, op. cit. (note 75), 2."},{"key":"S002572731800042X_r42","doi-asserted-by":"crossref","unstructured":"See Danson, op. cit. (note 1), 60; the comments of Symonds in [no author], \u2018Discussion on Differential Diagnosis and Treatment of Post-Contusional States\u2019, Proceedings of the Royal Society of Medicine, 35, 9 (1942), 604 and 608.","DOI":"10.1177\/003591574203500905"},{"key":"S002572731800042X_r17","doi-asserted-by":"crossref","unstructured":"I call this support of the organic theory \u2018temporary\u2019 as an attempt was made to espouse the opposite, psychogenic theory of concussive sequelae a few decades later. See Ryan Ross, \u2018Between Shell Shock and PTSD? \u201cAccident Neurosis\u201d and Its Sequelae in Post-War Britain\u2019, Social History of Medicine (in press).","DOI":"10.1093\/shm\/hkx118"},{"key":"S002572731800042X_r98","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.1.4288.313"},{"key":"#cr-split#-S002572731800042X_r3.1","unstructured":"26. James K. Slater, 'Trauma and the Nervous System, With Particular Reference to Compensation and the Difficulties of Interpreting the Facts', Edinburgh Medical Journal, 53, 11 (1946), 641. On medical debates over malingering, see Roger Cooter, 'Malingering in modernity: psychological scripts and adversarial encounters during the First World War', in Roger Cooter, Mark Harrison and Steve Sturdy (eds), War, Medicine and Modernity (Sutton: Stroud, 1998), 125-48. On the difficulties faced by physicians in deducing malingering in the nineteenth and twentieth centuries, see Edward M. Brown, 'Between cowardice and insanity: shell shock and the legitimation of the neuroses in Great Britain', in Everett Mendelsohn, Berritt Roe Smith and Peter Weingart (eds), Science, Technology and the Military (Dordrecht and Boston: Kluwer Academic Publishers, 1988), 323-5."},{"key":"#cr-split#-S002572731800042X_r3.2","unstructured":"27. Karl Figlio, 'How does illness mediate social relations? Workmen's compensation and medico-legal practices, 1890-1940', in Peter Wright and Andrew Treacher (eds), The Problem of Medical Knowledge: Examining the Social Construction of Medicine (Edinburgh: Edinburgh University Press, 1982), 174-224."},{"key":"S002572731800042X_r41","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.4012.1055"},{"key":"S002572731800042X_r60","unstructured":"Although Russell was often identified as the first to use PTA to in the assessment of head trauma, it is clear that he was heavily influenced by Symonds. See his comments in Russell, \u2018Cerebral Involvement in Head Injury\u2019, op. cit. (note 7), 552."},{"key":"S002572731800042X_r52","unstructured":"Symonds, op. cit. (note 34), 15. While early psychometric tests were seen as useful to used later to compare a patient\u2019s progress, Russell observed that they were not always needed, that simple tests and talking with relatives was usually more insightful. See W. Ritchie Russell, \u2018Studies on Head Injury\u2019, British Medical Bulletin, 10, 1 (1954), 66. Symonds also found talking to relatives fruitful. See Symonds, Studies in Neurology, op. cit. (note 1), 124."},{"key":"S002572731800042X_r39","unstructured":"Russell was often heralded as the originator of this line of thinking, based on a set of follow-up studies he did at the Edinburgh Royal Infirmary in the early 1930s, a discussion of which was published as Russell, \u2018The After-Effects of Head Injury\u2019, op. cit. (note 7); Russell, op. cit. (note 1), esp. 585 and passim. It should be noted, however, that Russell did not demur from the view that the desire for compensation could cause traumatic neurosis, merely that he found some follow-up cases that had long-term concussive sequelae despite no claim pending. See ibid., 134 and 142. Russell cautioned against making direct comparisons with his study, however; advice often ignored by his contemporaries, eg. Symonds, op. cit. (note 6), 102."},{"key":"S002572731800042X_r93","doi-asserted-by":"crossref","unstructured":"Alternatively, a researcher may identify a patient by their military-number or by the \u2018MRC Number\u2019 that the Oxford researchers gave to the first 1000 patients involved in the MRC-funded project to better organise their records. The use of these numbers meant that the punch-cards could be reassembled or removed from storage for the purposes of identifying a patient-record, and then returned later and in the correct order. On the flexibility of index-cards as a research-technology, see Isabella Charmantier and Staffan M\u00fcller-Wille, \u2018Carl Linnaeus\u2019s Botanical Paper Slips (1767\u201373)\u2019, Intellectual History Review, 24, 2 (2014), 217.","DOI":"10.1080\/17496977.2014.914643"},{"key":"S002572731800042X_r104","unstructured":"On the postwar period, see Ross, op. cit. (note 25)."},{"key":"S002572731800042X_r92","unstructured":"The index-cards are contained in St Hugh\u2019s College Archives, University of Oxford, HHA\/2\/1, \u2018Military Hospital Punch Cards, c. 1940\u201348\u2019. I assume that the cards were stored in a drawer, filing-cabinet or box, but I have not encountered a specific description in the primary sources."},{"key":"S002572731800042X_r61","unstructured":"Russell, \u2018Cerebral Involvement in Head Injury\u2019, op. cit. (note 7), 533; Russell\u2019s comments in [no author], \u2018Discussion on the Diagnosis and Treatment of Acute Head Injuries\u2019, Proceedings of the Royal Society of Medicine, 25, 5 (1932), 751\u201352."},{"key":"S002572731800042X_r24","first-page":"328","article-title":"Wilfred Batten Lewis Trotter","volume":"3","author":"Elliott","year":"1941","journal-title":"Obituary Notices of the Fellows of the Royal Society"},{"key":"S002572731800042X_r57","unstructured":"On the dichotomy between <24 hours and >24 hours patients, and its impact on professional roles, see the distinction imposed in Symonds, op. cit. (note 33), 829\u201331. On concussion as a neurological (and not surgical) issue, see Jefferson, op. cit. (note 50), 77; Symonds, op. cit. (note 33), 829."},{"key":"S002572731800042X_r74","unstructured":"For instance, Cairns had a long-standing interest in the accumulation of neurological patient-records for research purposes, as is evident in his attempts to found and develop the medical school at Oxford in the 1930s. See Fraenkel, op. cit. (note 9), 125."},{"key":"S002572731800042X_r6","first-page":"101","volume-title":"Injuries of the Brain and Spinal Cord","author":"Symonds","year":"1940"},{"key":"S002572731800042X_r66","unstructured":"Cf. Casper on the neurological belief that, with recourse to physiological and anatomical tests, the neurological exam \u2018turned the patient\u2019s body into a machine of its own reading\u2019 in Casper, op. cit. (note 11)."},{"key":"S002572731800042X_r83","unstructured":"For the information that Symonds wanted physicians to record on patients, and the means of how they were to acquire it, see TNA, FD 1\/5342, \u2018Report from the Oxford Military Hospital (Head Injuries)\u2019 and \u2018Guide to Index\u2019, undated. This report was not authored, but I know that it was written by Symonds (as, in it, he refers to himself as the \u2018grant-holder\u2019 of the MRC funding). Symonds also regularly reviewed charts to ensure uniformity."},{"key":"S002572731800042X_r68","unstructured":"Symonds, op. cit. (note 6), 101."},{"key":"S002572731800042X_r30","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.1.4330.1"},{"key":"S002572731800042X_r89","unstructured":"See Russell, \u2018Analysis of First Thousand Cases of Head Injury Admitted to the Military Hospital for Head Injuries\u2019, op. cit. (note 85), 1. Note Russell\u2019s reference to \u2018uniform assessment[s]\u2019, and relate this back to my discussion of standardisation, above."},{"key":"S002572731800042X_r100","unstructured":"Russell, op. cit. (note 1), 521. This article was originally delivered as a lecture."},{"key":"S002572731800042X_r28","first-page":"170","article-title":"An Address on the Evolution of the Surgery of Head Injuries","volume":"1","author":"Trotter","year":"1930","journal-title":"The Lancet"},{"key":"S002572731800042X_r31","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)56670-7"},{"key":"S002572731800042X_r38","unstructured":"See eg. Danson, op. cit. (note 1), 60."},{"key":"S002572731800042X_r62","unstructured":"Symonds, op. cit. (note 6), 76. This marked a development from previous comments made by Russell, who merely stated that PTA was useful in that it could be used long after an accident if needed. See Russell, \u2018Cerebral Involvement in Head Injury\u2019, op. cit. (note 7), 554."},{"key":"S002572731800042X_r19","unstructured":"See Wilfred Trotter, Instincts of the Herd in Peace and War (London: T.F. Unwin Ltd, 1919). For context, see Gillian Swanson, \u2018Collectivity, Human Fulfilment and the \u201cForce of Life\u201d: Wilfred Trotter\u2019s Concept of the Herd Instinct in Early 20th-Century Britain\u2019, History of the Human Sciences, 27, 1 (2013), 21\u201350."},{"key":"#cr-split#-S002572731800042X_r1.1","doi-asserted-by":"crossref","unstructured":"45. W. Ritchie Russell, 'Medical Aspects of Head Injury', British Medical Journal, 2, 4269 (1942), 521","DOI":"10.1136\/bmj.2.4269.521"},{"key":"#cr-split#-S002572731800042X_r1.2","doi-asserted-by":"crossref","unstructured":"46. J.G. Danson, 'On Injuries to the Brain and their Sequel??', Proceedings of the Royal Society of Medicine, 33, 2 (1939), 60","DOI":"10.1177\/003591573903300105"},{"key":"#cr-split#-S002572731800042X_r1.3","unstructured":"47. 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. Note that the accident-sufferer was always identified as male within the medical literature."},{"key":"S002572731800042X_r21","unstructured":"Notwithstanding my reliance on his writings, Trotter\u2019s influence probably also extended to correspondence and meetings with Symonds and other neurologists at the Oxford Military Hospital, as implied in The National Archives (TNA), FD 1\/3243, \u2018Head Injuries: Research by Dr W.R. Russell, Edinburgh\u2019, Letter from Wilfred Trotter, 25 November 1931; TNA, FD 1\/3243, \u2018Head Injuries: Research by Dr W. R. Russell, Edinburgh\u2019, Letter from unknown, 20 November 1931; Symonds, Studies in Neurology, op. cit. (note 1), 12."},{"key":"S002572731800042X_r33","unstructured":"C.P. Symonds, \u2018Observations on the Differential Diagnosis and Treatment of Cerebral States Consequent Upon Head Injuries\u2019, British Medical Journal, 2, 3540 (1928), 829; no author, op. cit. (note 11), 295; Russell, \u2018Cerebral Involvement in Head Injury\u2019, op. cit. (note 7), 600."},{"key":"S002572731800042X_r8","unstructured":"See his comments in Russell, \u2018Cerebral Involvement in Head Injury\u2019, ibid., 602."},{"key":"S002572731800042X_r55","unstructured":"From the literature review offered by Russell, it would appear that neurologists had little interest in concussion prior to the 1930s, with the twentieth-century literature dominated by physiologists and general surgeons (eg. Trotter). See Russell, \u2018Cerebral Involvement in Head Injury\u2019, op. cit. (note 7), 550. A similar point is also made in Cairns, op. cit. (note 12), 869. Also note the comments of Jefferson as to the lack of regard in which neurosurgery was held prior to the War, as quoted in Tailor and Handa, op. cit. (note 9), 190."},{"key":"S002572731800042X_r103","unstructured":"See Trimble, op. cit. (note 5)."},{"key":"S002572731800042X_r12","unstructured":"Note my focus on the earlyresearch undertaken at the Oxford Military Hospital. Later research ranged over a variety of areas, including the treatment of gun-shot wounds to the head and the use of penicillin in neurosurgery. However, these remain outside the scope of this article, which is concerned with blunt head trauma only. For a broader overview of the hospital\u2019s activities during the War, see Hugh Cairns, \u2018Investigations on Head Injuries in Britain During the Second World War\u2019, Schweizerische Medizinische Wochenschrift, 76, 37\u20138 (1945), 865\u201370."},{"key":"S002572731800042X_r15","unstructured":"As argued in Ryan Ross, \u2018Accidents and Their Medico-Legal Sequelae in Twentieth-Century Britain: Time, Trauma and Writing History\u2019 (unpublished PhD thesis: University of London, 2017)."},{"key":"S002572731800042X_r44","unstructured":"See eg. Jefferson, op. cit. (note 3), 1 and passim."},{"key":"S002572731800042X_r14","doi-asserted-by":"crossref","unstructured":"No author, op. cit. (note 11), 299.","DOI":"10.33026\/peg.v11i2.1312"},{"key":"#cr-split#-S002572731800042X_r11.1","unstructured":"57. For an outline of it, see Cairns in [no author], 'Discussion on Rehabilitation After Injuries to the Central Nervous System', Proceedings of the Royal Society of Medicine, 34, 4 (1942), 299"},{"key":"#cr-split#-S002572731800042X_r11.2","unstructured":"58. Russell, 'Cerebral Involvement in Head Injury', op. cit. (note 7), 533. On the neurological belief that the patient's outward signs revealed internal processes, see Stephen T. Casper, 'The patient's pitch: the neurologist, the tuning fork, and textbook knowledge', in L. Stephen Jacyna and Stephen T. Casper (eds), The Neurological Patient in History (Rochester, New York: Rochester University Press, 2012), 21-43."},{"key":"S002572731800042X_r46","unstructured":"For example, suggestion or unconscious motivations, of the sort identified by medico-legal examiners. For context, see Rhodri Hayward, The Transformation of the Psyche in British Primary Care, 1880\u20131970 (London: Bloomsbury, 2014), ch. 2. On the growing role of neurologists in adjudicating on compensation claims post-1918, see Casper, op. cit. (note 13), 80\u20134."},{"key":"S002572731800042X_r70","unstructured":"On which, see Symonds, op. cit. (note 6), 76; Jefferson, op. cit. (note 3), 3; Mapother, op. cit. (note 41), 1060."},{"key":"S002572731800042X_r50","unstructured":"As Symonds wrote: \u2018Our problem begins with the reconstruction of the story of the injury, often with scant information apart from what the patient can tell us.\u2019 See his comments in no author, op. cit. (note 42), 601. For a similar argument, see Geoffrey Jefferson, \u2018The Acute Head Injury as a Neurological Problem\u2019, Glasgow Medical Journal, 20, 3 (1942), 78."},{"key":"S002572731800042X_r40","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)86026-2"},{"key":"S002572731800042X_r59","unstructured":"On the importance of documentation, see the comments on clinical records in TNA, FD 1\/5342, \u2018Memorandum on the Treatment of Head Injuries in War\u2019, 2. This memo was unauthored, but written by Cairns as the minutes for the Brain Injuries Committee record that he introduced the discussion of it (see TNA, FD 1\/5342. \u2018Brain Injuries Committee\u2019, 7 March 1940, 2)."},{"key":"#cr-split#-S002572731800042X_r13.1","doi-asserted-by":"crossref","unstructured":"63. For broader context on the place of neurologists in this period, see Stephen T. Casper, The Neurologists: A History of a Medical Speciality in Modern Britain, c. 1789-2000 (Manchester: Manchester University Press, 2014), esp. ch. 3. For neurosurgeons and their relationship with neurologists in Britain, see Delia Gavrus, 'Skill, Judgement and Conduct for the First Generation of Neurosurgeons, 1900-30', Medical History, 59, 3 (2015), 361-78","DOI":"10.1017\/mdh.2015.25"},{"key":"#cr-split#-S002572731800042X_r13.2","doi-asserted-by":"crossref","unstructured":"64. Anna Kathryn Schoefert, 'Neither Physicians Nor Surgeons: Whither Neuropathological Skill in Post-War England?', Medical History, 59, 3 (2015), 404-20.","DOI":"10.1017\/mdh.2015.27"},{"key":"S002572731800042X_r32","unstructured":"Russell, \u2018Cerebral Involvement in Head Injury\u2019, op. cit. (note 7), 578 and passim."},{"key":"#cr-split#-S002572731800042X_r18.1","unstructured":"66. For recent studies on the place of the material in the neurosciences, see the special issue of Medical History, 60, 3 (2016)"},{"key":"#cr-split#-S002572731800042X_r18.2","unstructured":"67. and the contributions to Science in Context, 28, 1 (2015). For broader histories on the role of the material in the formation of scientific knowledge, see Annemarie Mol, The Body Multiple: Ontology in Medical Practice (Durham and London: Duke University Press, 2002)"},{"key":"#cr-split#-S002572731800042X_r18.3","unstructured":"68. Hans-J??rg Rheinberger, Toward a History of Epistemic Things: Synthesising Proteins in the Test Tube (Stanford, CA: Stanford University Press, 1997)"},{"key":"#cr-split#-S002572731800042X_r18.4","doi-asserted-by":"crossref","unstructured":"69. Henning Schmidgen, The Helmholtz Curves: Tracing Lost Time, trans. by Nils F. Schott (New York: Fordham University Press, 2014).","DOI":"10.2307\/j.ctt13x07fp"},{"key":"S002572731800042X_r27","unstructured":"Ibid., 816."},{"key":"S002572731800042X_r2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.4012.1061"},{"key":"S002572731800042X_r95","unstructured":"I refer here of the work of Lishman and Newcombe. On the former\u2019s research on gun-shot wounds to the head, see his reminiscences in Michael Salzberg, \u2018A Pioneer of Neuropsychiatry: Professor Alwyn Lishman\u2019, Australian and New Zealand Journal of Psychiatry, 38, 1\u20132 (2004), 2\u20139. For Newcombe\u2019s work on neurolinguistics, see Freda Newcombe, \u2018The Psychological Consequences of Closed Head Injury: Assessment and Rehabilitation\u2019, Injury, 14, 2 (1982), 111\u201336."},{"key":"S002572731800042X_r35","doi-asserted-by":"publisher","DOI":"10.1002\/jhbs.21777"},{"key":"S002572731800042X_r36","first-page":"1285","article-title":"An Address on Traumatic Neurasthenia","volume":"2","author":"Farquhar Buzzard","year":"1923","journal-title":"The Lancet"},{"key":"S002572731800042X_r7","unstructured":"For examples of Russell\u2019s exclusion of compensation cases, see W. Ritchie Russell, \u2018Cerebral Involvement in Head Injury: A Study Based on The Examination of Two Hundred Cases\u2019, Brain, 55, 4 (1932), 584 and 592; W.\u00a0Ritchie Russell, \u2018The After-Effects of Head Injury\u2019, Transactions of the Medical-Chirgical Society of Edinburgh, 48 (1933\u201334), 134\u20135; Russell, op. cit. (note 1), 521."},{"key":"#cr-split#-S002572731800042X_r16.1","doi-asserted-by":"crossref","unstructured":"73. Historians have charted the tensions between organic vs psychological theories of trauma throughout the nineteenth and twentieth centuries, and in debates over disorders like railway spine, shell-shock and the post-concussional syndrome. See Edgar Jones, Nicola T. Fear and Simon Wessely, 'Shell Shock and Mild Traumatic Brain Injury: A Historical Review', The American Journal of Psychiatry, 164, 11 (2007), 1641-5","DOI":"10.1176\/appi.ajp.2007.07071180"},{"key":"#cr-split#-S002572731800042X_r16.2","doi-asserted-by":"crossref","unstructured":"74. Stephen T. Casper, 'Concussion: A History of Science and Medicine, 1870-2005', Headache, 58, 6 (2018), 795-810","DOI":"10.1111\/head.13288"},{"key":"#cr-split#-S002572731800042X_r16.3","unstructured":"75. Michael R. Trimble, Post-Traumatic Neurosis: From Railway Spine to the Whiplash (West Sussex: John Wiley & Sons, 1981), ch. 5"},{"key":"#cr-split#-S002572731800042X_r16.4","unstructured":"76. Tracey Loughran, Shell-Shock and Medical Culture in First World War Britain (Oxford: Oxford University Press, 2017). A similar focus has characterised histories of whiplash: eg. Robert Ferrari and Edward Shorter, 'From Railway Spine to Whiplash: The Recycling of Nervous Irritation', Medical Science Monitor, 9, 11 (2003), 27-37. On how the same set of issues have dogged the neurosciences more generally in the past century, see Michael Hagner and Cornelius Borck, 'Mindful Practices: On The Neurosciences in the Twentieth Century', Science in Context, 14, 4 (2001), 507-10."},{"key":"S002572731800042X_r29","unstructured":"Trotter, op. cit. (note 26), 817."},{"key":"S002572731800042X_r48","unstructured":"Symonds, op. cit. (note 6), 97."},{"key":"S002572731800042X_r97","unstructured":"The correspondence for which can be found in St Hugh\u2019s College Archives, HHA\/4\/2\/5."},{"key":"S002572731800042X_r51","unstructured":"See the comments of Symonds in no author, op. cit. (note 42), 601; the implied criticism of surgeons in Russell, \u2018Cerebral Involvement in Head Injury\u2019, op. cit. (note 7), 600; Symonds, op. cit. (note 5), 320\u20131. Russell further complained that sometimes, if the patient presented with multiple injuries, only the most severe was written on the patient-notes; often, in other words, neurologists had to infer whether a patient had suffered from concussion based on a reading of their neurological symptoms. See Russell, \u2018Cerebral Involvement in Head Injury\u2019, op. cit. (note 7), 555."},{"key":"#cr-split#-S002572731800042X_r73.1","unstructured":"81. The Military Hospital originally housed 100 beds, though this number rose to 300 after one year once additional buildings were erected on the college grounds. The growth of the number of beds in the hospital occurred around 1941. From August 1941 onwards, the process of indexing and cataloguing patient-records (discussed below) ceased as it was no longer 'practicable' to study every patient, only the interesting ones. See TNA, FD 1\/5342, 'Report from Oxford Military Hospital (Head Injuries)', undated, 2"},{"key":"#cr-split#-S002572731800042X_r73.2","unstructured":"82. TNA, WO 222\/845, Derek Denny-Brown, 'Special Report Submitted in Conformity with Southern Command Medical Routine Orders, o1\/1940', 22 October 1940, para 410."},{"key":"S002572731800042X_r65","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)70687-8"},{"key":"S002572731800042X_r78","unstructured":"Symonds\u2019s grant application was initially reviewed by the Brain Injuries Committee, who recommended its funding to the MRC as noted in \u2018Brain Injuries Committee\u2019, op. cit. (note 75), 4."},{"key":"#cr-split#-S002572731800042X_r77.1","unstructured":"84. 'Memorandum on Plans for Research at the Oxford Military Hospital (Head Injuries) and Application for Grant by Group-Capt. Symonds', op.??cit. (note 76), 1. Symonds began advocating for additional resources for administrative support at the Military Hospital from December 1939 onwards. However, his early overtures to the Army, who ran the Military Hospital, and to the MRC were rebuffed. The MRC would only entertain Symonds's request if it were part of a broader attempt to help coordinate neurological research. The Brain Injuries Committee of the MRC was thus born. On Symonds's early rejections, and for his initial work in identifying Committee members, see TNA, FD 1\/6138, 'Brain Injuries Committee: Constitution and Membership, 1939-1943'"},{"key":"#cr-split#-S002572731800042X_r77.2","unstructured":"85. and some of the correspondence contained in TNA, FD 1\/6136, 'Wounds and the Nervous System: Research at Oxford, 1939-41'."},{"key":"S002572731800042X_r85","unstructured":"One of the primary foci of Symonds\u2019s research in this period was the relationship between predisposition and the severity of neurotic sequelae. For his comments on the subject, see Symonds, op. cit. (note 5), 326; Symonds, op. cit. (note 6), 100; and Symonds and Russell, op. cit. (note 65), 9. On the influence of Symonds on the collection of patient-data at Oxford with a view to assessing predisposition, see the comments of Russell in TNA, FD 1\/5343, Dr W. Ritchie Russell, \u2018Analysis of the First Thousand Cases of Head Injury Admitted to the Military Hospital for Head Injuries\u2019, 2. Symonds had aspirations for the Oxford data-set, hoping that the patient-records, when studied, revealed a positive relationship between predisposition and prognosis. See \u2018Report from the Oxford Military Hospital (Head Injuries)\u2019, op. cit. (note 73), 1."},{"key":"S002572731800042X_r86","doi-asserted-by":"crossref","unstructured":"On the use of paper-technologies to standardise neurological research, and thereby obscure local idiosyncrasies and replace them with \u2018universal\u2019 standards, see Susan Leigh Star, \u2018Scientific Work and Uncertainty\u2019, Social Studies of Science, 15, 3 (1985), 399 and passim.","DOI":"10.1177\/030631285015003001"},{"key":"S002572731800042X_r72","unstructured":"Both Cairns and Symonds had petitioned for its creation as early as 1938. See the correspondence in TNA, AIR 2\/3948, \u2018Treatment of Head Injuries at Military Hospital, St Hugh\u2019s College, Oxford in Time of War, 1938\u201343\u2019. On Cairns\u2019s role in petitioning for the creation of a neurology department at Oxford, see Fraenkel, op. cit. (note 9), chs 8 and 9. Note that Russell had no hand in the planning of the hospital, but was recruited from the Edinburgh Royal Infirmary by the time of the former\u2019s opening in 1940."},{"key":"S002572731800042X_r94","unstructured":"\u2018Report from Oxford Military Hospital (Head Injuries)\u2019, op. cit. (note 73), 1."},{"key":"S002572731800042X_r69","unstructured":"For neurologists\u2019 frustrations with terminology, see no author, op. cit. (note 42), 601; Symonds, op. cit. (note\u00a05), 321; and Symonds\u2019s complaint regarding the lack of objective standards for measuring amnesia, and the effect of this on neurologists, in Symonds, op. cit. (note 1), 119. Or, as Russell wrote, the two features of concussion (a return to normalcy and no evidence of visible pathology) could rarely be both proven in the one case with ease. Russell, op. cit. (note 52), 65."},{"key":"S002572731800042X_r99","unstructured":"Symonds and Russell, op. cit. (note 65), 7."},{"key":"S002572731800042X_r90","unstructured":"Technically, it was the first 1103 patients admitted to the hospital. In their publications, however, neurologists simply referred to this group as the \u2018first 1000\u2019. They also indexed another 300 or so patients \u2018of interest\u2019 in the same way as the first 1000, but retained their records in a separate series. See TNA, FD 1\/6137, C.P. Symonds, \u2018Progress Report, 1941\u201342\u2019, 5 September 1942."},{"key":"S002572731800042X_r81","unstructured":"This list is not exhaustive."},{"key":"S002572731800042X_r75","unstructured":"The first meeting of the Committee included Norman Dott, J.G. Greenfield, Geoffrey Jefferson, Aubrey Lewis, George Riddoch and E.A Carmichael, in addition to Cairns and Symonds. The Committee was chaired by E.D. Adrian. See TNA, FD 1\/5342. \u2018Brain Injuries Committee\u2019, 7 March 1940."},{"key":"S002572731800042X_r91","unstructured":"This is not an exhaustive list."},{"key":"S002572731800042X_r84","unstructured":"For an exact breakdown of the patient-data that was indexed, see TNA, FD 1\/5342, \u2018Routine Scheme for Examination and Case Records\u2019, undated. As Symonds later explained: \u2018The object [of research at Oxford] is to accumulate a well-documented and systematically indexed collection of clinical data from the material afforded by this hospital with its hitherto unique opportunities.\u2019 TNA, FD 1\/6137, \u2018Letter from C.P. Symonds to the Secretary of the Medical Research Council\u2019, 15 October 1943."},{"key":"S002572731800042X_r34","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.bmb.a071858"},{"key":"S002572731800042X_r88","unstructured":"I should issue a note of caution when describing the organisation of patient-data at Oxford as a \u2018database\u2019: databases typically organise pre-existing data that is independent from the database. As the discussion below makes clear, the medics at Oxford sought to collect patient-data in expectation that it would eventually be turned into a database (ie. by being indexed onto punch-cards)."},{"key":"S002572731800042X_r82","unstructured":"The list of medical criteria for collection is contained in TNA, FD 1\/5341, \u2018Case-Taking Scheme in Use at the Oxford Military Hospital (Head Injuries)\u2019, undated. Further, more detailed particulars of what Symonds wanted medics to record can be found in an unnamed, undated and unauthored report in TNA, WO 222\/845. The topicality of this report would suggest that it is was written by Symonds and distributed to the medical officers at Oxford at some stage upon the hospital\u2019s opening."},{"key":"S002572731800042X_r53","unstructured":"Symonds, op. cit. (note 5), 321. In 1928, Symonds had also written of the need for proper documentation of predisposing issues with a patient, which, he claimed, surgeons and physicians never bothered to record. See Symonds, op. cit. (note 33), 831."},{"key":"S002572731800042X_r47","unstructured":"For positive references to Trotter\u2019s work on concussion, see Symonds, op. cit. (note 6), 71; Symonds, op. cit. (note 34), 14; the comments in no author, op. cit. (note 11), 295."},{"key":"#cr-split#-S002572731800042X_r9.1","unstructured":"101. This was based at a repurposed St Hugh's College. The historical literature on the hospital remains somewhat scanty, however, and usually only crops up in biographies of Cairns, eg. G.J. Fraenkel, Hugh Cairns: First Nuffield Professor of Surgery, University of Oxford (Oxford: Oxford University Press, 1991), esp. ch. 11"},{"key":"#cr-split#-S002572731800042X_r9.2","doi-asserted-by":"crossref","unstructured":"102. J.??Tailor and A. Handa, 'Hugh Cairns and the Origin of British Neurosurgery', British Journal of Neurosurgery, 2, 1 (2007), 190-6","DOI":"10.1080\/02688690701317193"},{"key":"#cr-split#-S002572731800042X_r9.3","doi-asserted-by":"crossref","unstructured":"103. Peter H. Schurr, 'The Evolution of Field Neurosurgery in the British Army', Journal of the Royal Society of Medicine, 98, 9 (2005), 423-7","DOI":"10.1177\/014107680509800913"},{"key":"#cr-split#-S002572731800042X_r9.4","doi-asserted-by":"crossref","unstructured":"104. J. van Gijn, 'Sir Charles Symonds (1890-1978)', Journal of Neurology, 260, 4 (2013), 1191-2.","DOI":"10.1007\/s00415-012-6676-2"},{"key":"S002572731800042X_r58","unstructured":"On the value of neurological observation of the concussed, see Symonds, op. cit. (note 5), 321."}],"container-title":["Medical History"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S002572731800042X","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,10,23]],"date-time":"2019-10-23T22:27:34Z","timestamp":1571869654000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S002572731800042X\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9,7]]},"references-count":122,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2018,10]]}},"alternative-id":["S002572731800042X"],"URL":"https:\/\/doi.org\/10.1017\/mdh.2018.42","relation":{},"ISSN":["0025-7273","2048-8343"],"issn-type":[{"value":"0025-7273","type":"print"},{"value":"2048-8343","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9,7]]},"assertion":[{"value":"\u00a9 The Author 2018. Published by Cambridge University Press.","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}