Cerebral involvement in head injury. A study based on the examination of two hundred cases. By W. Ritchie Russell, MD. Brain 1932; 55: 549-603

Abstract

Jan van GijnUtrechtHead injury has always been, and remains, an unpopular subject with British neurologists, presumably because they tend to see it as a surgical rather than a medical disorder. The subject is ignored in the textbooks of (Sir) William Gowers, (Samuel Alexander) Kinnier Wilson and Russell (Lord) Brain, save for a few oblique references in sections on headache or cerebral haemorrhage. It is therefore the more remarkable that, writing in 1932, 29-year-old William Ritchie Russell (1903–1980) has recently submitted an MD thesis on the topic to the University of Edinburgh, where his father was professor of medicine and his mother (née Ritchie) an early female graduate, also in medicine (see Jellinek EH, The Russells of Edinburgh: a medical dynasty. Proc R Coll Physicians Edinb 2001; 31: 342–51). The article is a condensed version of the thesis, which earned Russell the Gold Medal. Brain damage through head injuries would remain a life-long interest: he came back to it in 1941 in his joint study with Derek Denny-Brown on experimental head injury (see Brain 2007; 130: 2479–81), and again, after retirement, in a monograph on the ‘Traumatic amnesias’ (1971).The 1932 series describes 200 consecutive patients with any degree of initial cerebral damage from head trauma; the only patients he excludes are those who died within 24 h. A mere 39 of them are female—almost invariably knocked down by a motor vehicle in the street. Amongst the 161 men, the most common cause is a motor cycle accident.Russell starts out by classifying this cohort according to the duration of the loss of full consciousness. It is this very aspect that constitutes his lasting contribution to the management of head injuries. He perceptively points out that the victim of an accident may be able to move and even to talk and yet have …