The difficulties attendant on all attempts at following up hospital cases are considerable, and consequently we are greatly indebted to Crisp English[36] for his tabulation and discussion on the after-history of 300 cases treated at St. George’s Hospital--300 cases personally investigated at periods varying from one to twenty years subsequent to the time of the injury.
English’s conclusions have been compared with those derived from my own personal experience, with the result that they were found to coincide so closely that they may be accepted as affording an accurate guide into the remote results of head-injury in general.
English classified his cases into three series--each 100 in number--according to the severity of the lesion.
Series 2. Cases of concussion, contusion, and laceration.
The remote results as observed in the first and second series were as follows:--
Series 1. No effects 31 Slight effects 50 Marked effects 19
Series 2. No effects 48 Slight effects 42 Marked effects 10
In the 200 cases, therefore, that come under Series 1 and 2, 79 experienced no ill effects from the injury, 92 developed slight effects, and definite defects were present in 29 cases.
Before alluding further to the mental and bodily condition of the patients subsequent to the accident, including their wage-earning capacity, it is necessary to enlarge on the fact that the depreciation in mental and physical faculties depends, not only on the severity of the injury, but also on the age, disposition, and status of the patient.
_The effect of age._ All evidence tends to prove that head-injuries in the young and the old are more serious than when the accident occurs during middle life. In the old, the power of repair is impaired; in the young, the developing faculties are impeded in their progress.
_The effect of disposition._ The temperament of the patient must always be taken into consideration, the neurotic type seldom recovering so quickly or so completely as the more plethoric.
_The effect of status._ A complete recovery is far more likely to occur when the status of the patient allows of complete rest, bodily and mental, for some considerable time subsequent to the accident. A premature return to work, with possible added family troubles, invariably acts as a deterrent to complete recovery. In the milder cases a few weeks suffice to allow of restoration to health, in other cases an interval of at least one year should be allowed before the patient again takes up his duties. It is obvious, therefore, that family troubles and business emergencies influence to a marked degree the completeness of recovery. It might be anticipated that the financial necessities of the case would cause the various after-results of head-injuries to be more marked amongst the labouring classes. The personal equation, however, enters largely into the question, and due allowance must be made for the greater financial and social losses entailed when the injury involves one who occupies a high social sphere. It must also be borne in mind that those occupying such spheres may not benefit from the Workmen’s Compensation Act.