It is difficult to summarise the points
which have been discussed in this thesis. The
study of the two hundred cases dealt with has provided
a large mass of material for investigation,
of which only certain aspects have been analysed.
My plan has been to record the facts and to discuss
them throughout the text.
The frequency with which the common symptoms
and signs of concussion occur has been analysed,
and their significance discussed. Changes in
the pressure, cytology,and chemistry of the cerebro-spinal fluid have been investigated in a series
of severe cases, and this has thrown light on the
significance of certain symptoms and signs of the
The mechanism by which the brain is
damaged in head injury has been discussed, and conclusions
have been arrived at with regard to the
mechanism of loss of consciousness and contre -coup
injury. The pathology of the condition called
"cerebral irritation" has also been considered.
The conclusions arrived at in this section of the
thesis are quite contrary to most current teaching.
The cases in GROUP C provided material for study of
the stages by which consciousness returns.
I have been unable to find any record in
the literature of an analysis of the clinical features
of the acute stage of head injury in any large
series such as is here attempted. Further special
importance attaches to this work from the fact that
most of the cases have not only been examined in
the acute stage, but have been re- examined at an
interval after discharge. The fact that, in the
series, compensation cases are few in number has
greatly added to the value of this part of the work.
The frequency with which post-concussional disturbances occur has been investigated. It has become
quite apparent that physical examination is of
little value in the attempt to estimate the degree
of cerebral damage, and hence the detailed analysis
of the features of genuine post-concussional disturbances
of a subjective nature has been of great
importance. From the study of the post- concussional
symptoms in a series of cases, I claim to have
shown that these have well defined features which
must be regarded as having an organic basis. This
conclusion has been based on the clinical study
alone, but is found to correspond with the opinion
of some recent workers who have been investigating
the pathological changes which occur in these cases.
The investigation of post-mortem material
forms only a small section of this work, but I have
succeeded in demonstrating changes in the neuroglia .
which have previously only been described in experimental
Finally, the practical application of
certain aspects of this work has been discussed in
relation to diagnosis, prognosis and treatment,
and the methods of examination which I have found
useful have been described.
The subject of this thesis suggests many
lines of investigation, and the work which is here
recorded must be regarded merely as a preliminary
report based on the first two hundred cases seen.