Sir Hugh Cairns and World War II British advances in head injury management, diffuse brain injury, and concussion: an Oxford tale

Restricted access

The authors trace the Oxford, England, roots of World War II (WWII)–related advances in head injury management, the biomechanics of concussion and brain injury, and postwar delineation of pathological findings in severe concussion and diffuse brain injury in man. The prominent figure in these developments was the charismatic and innovative Harvey Cushing–trained neurosurgeon Sir Hugh Cairns. Cairns, who was to closely emulate Cushing's surgical and scholarly approach, is credited with saving thousands of lives during WWII by introducing and implementing innovative programs such as helmets for motorcyclists, mobile neurosurgical units near battle zones, and the military usage of penicillin. In addition, he inspired and taught a generation of neurosurgeons, neurologists, and neurological nurses in the care of brain and spinal cord injuries at Oxford's Military Hospital for Head Injuries. During this time Cairns also trained the first full-time female neurosurgeon. Pivotal in supporting animal research demonstrating the critical role of acceleration in the causation of concussion, Cairns recruited the physicist Hylas Holbourn, whose research implicated rotary acceleration and shear strains as particularly damaging. Cairns' work in military medicine and head injury remain highly influential in efforts to mitigate and manage brain injury.

ABBREVIATIONSEMS = Emergency Medical Services; MNSU = Mobile Neurosurgical Unit; MRC = British Medical Research Council; RAMC = Royal Army Medical Corps; UK = United Kingdom; WWI = World War I; WWII = World War II.
Article Information

Contributor Notes

INCLUDE WHEN CITING Published online February 19, 2016; DOI: 10.3171/2015.8.JNS142613.Correspondence James L. Stone, Department of Neurosurgery, NorthShore Neurological Institute, NorthShore University HealthSystem, 2650 Ridge Ave., 3rd Fl., Kellogg Bldg., Evanston, IL 60201. email: jlstone4@gmail.com.

© Copyright 1944-2019 American Association of Neurological Surgeons

Headings
References
  • 1

    Aarabi BHistory of the management of craniocerebral wounds. Aarabi BKaufman HHDagi TF: Missile Wounds of the Head and Neck Park Ridge, ILAmerican Association of Neurological Surgeons1999. 316

    • Search Google Scholar
    • Export Citation
  • 2

    Abraham EPChain EFletcher CMFlorey HWGardner ADHeatley NG: Further observations on penicillin. Lancet 238:1771891941

  • 3

    Ascroft PB: Control of sepsis in a hospital in North Africa. Lancet 243:5945951944

  • 4

    Bailes JEPetraglia ALOmalu BINauman ETalavage T: Role of subconcussion in repetitive mild traumatic brain injury. J Neurosurg 119:123512452013

    • Search Google Scholar
    • Export Citation
  • 5

    Bailey OT: Dorothy S. Russell. Surg Neurol 5:2672681976

  • 6

    Bailey OT: In memoriam: Dorothy S. Russell, Sc.D, MA, MD, FRCP (1895–1983). J Neuropathol Exp Neurol 43:5465481984

  • 7

    Blackwood WDodds TCSommerville JC: Atlas of Neuropathology EdinburghE. & S. Livingston1949

  • 8

    Bliss M: Harvey Cushing: A Life in Surgery New YorkOxford University Press2005. 416

  • 9

    Blumbergs PCScott GManavis JWainwright HSimpson DAMcLean AJ: Staining of amyloid precursor protein to study axonal damage in mild head injury. Lancet 344:105510561994

    • Search Google Scholar
    • Export Citation
  • 10

    Botterell EHBrain-injuries and complications. Carling ERRoss JP: British Surgical Practice LondonButterworth1948. 349384

  • 11

    Bucy PC: George Riddoch. Surg Neurol 4:3511975

  • 12

    Cairns H: Crash helmets. BMJ 2:3223231946

  • 13

    Cairns H: Disturbances of consciousness with lesions of the brain-stem and diencephalon. Brain 75:1091461952

  • 14

    Cairns H: Head injuries in motor-cyclists. The importance of the crash helmet. BMJ 2:4654711941

  • 15

    Cairns H: Neurosurgery in the British Army, 1939–1945. Br J Surg 55:Suppl 19261947

  • 16

    Cairns H: The organization for treatment of head wounds in the British Army. Br Med Bull 3:9141945

  • 17

    Cairns H: Penicillin in head and spinal wounds. Br J Surg 32:1992071944

  • 18

    Cairns H: Penicillin in suppurative lesions of the brain and meninges. Brain 70:2512611947

  • 19

    Cairns H: Rehabilitation after injuries to the central nervous system. Proc R Soc Med 35:2953081942

  • 20

    Cairns HHolbourn H: Head injuries in motor-cyclists: with special reference to crash helmets. BMJ 1:5915981943

  • 21

    Cairns HOldfield RCPennybacker JB: Akinetic mutism with an epidermoid cyst of the 3rd ventricle. Brain 64:2732901941

  • 22

    Campbell M: Sir Henry Souttar. Br Heart J 27:4534541965

  • 23

    Carey ME: Cushing and the treatment of brain wounds during World War I. J Neurosurg 114:149515012011

  • 24

    Carey ME: Major Harvey Cushing's difficulties with the British and American armies during World War I. J Neurosurg 121:3193272014

  • 25

    Chain EFlorey HWGardner ADHeatley NGJennings MAOrr-Ewing J: Penicillin as chemotherapeutic agent. Lancet 236:2262281940

    • Search Google Scholar
    • Export Citation
  • 26

    Chalif JIGillies MJMagdum SAAziz TZPereira EA: Everything to gain: Sir Hugh Cairns' treatment of central nervous system infection at Oxford and abroad. Neurosurgery 72:1351422013

    • Search Google Scholar
    • Export Citation
  • 27

    Committee of Privy Council for Medical Research: Medical Research in War: Report of the Medical Research Council for the Years 1939–45 LondonH. M. Stationary Office1947

    • Search Google Scholar
    • Export Citation
  • 28

    Cooke AM: My First 75 Years of Medicine LondonRoyal College of Physicians of London1994

  • 29

    Curnow WJBicycle helmets: a scientific evaluation. de Smet A: Transportation Accident Analysis and Prevention Hauppauge, NYNova Science Publishers2008. 141177

    • Search Google Scholar
    • Export Citation
  • 30

    Cushing H: Concerning operations for the craniocerebral wound of modern warfare. Mil Surg 38:6016151916

  • 31

    Cushing H: A study of a series of wounds involving the brain and its enveloping structures. Br J Surg 5:5586841918

  • 32

    Cybulski GRStone JLPatel KJ: Sir Victor Horsley's contributions to the study and treatment of gunshot wounds of the head. Neurosurgery 63:8088122008

    • Search Google Scholar
    • Export Citation
  • 33

    Debus AG: World's Who's Who in Science: A Biographical Dictionary of Notable Scientists from Antiquity to the Present ChicagoMarquis-Who's Who1968

    • Search Google Scholar
    • Export Citation
  • 34

    Denny-Brown D: Brain trauma and concussion. Arch Neurol 5:13151961

  • 35

    Denny-Brown D: Cerebral concussion. Physiol Rev 25:2963251945

  • 36

    Denny-Brown DRussell WR: Experimental cerebral concussion. J Physiol 99:1531940

  • 37

    Denny-Brown DRussell WR: Experimental cerebral concussion. Brain 64:931641941

  • 38

    Ecker AD: A bacteriologic study of penetrating wounds of the brain, from the surgical point of view. J Neurosurg 3:161946

  • 39

    Finger SStone JL: Landmarks of surgical neurology and the interplay of disciplines. Handb Clin Neurol 95:1892022010

  • 40

    Fleming A: On the antibacterial action of cultures of a penicillium, with special reference to their use in the isolation of B. influenzæ. Br J Exp Pathol 10:2262361929

    • Search Google Scholar
    • Export Citation
  • 41

    Florey HWCairns H: A review of the Florey and Cairns report on the use of penicillin in war wounds. J Neurosurg 1:2012101944

  • 42

    Florey HWChain E: The development of penicillin in medicine. Hygeia 22:3003021944

  • 43

    Fraenkel GJ: Hugh Cairns: First Nuffield Professor of Surgery Oxford University OxfordOxford University Press1991

  • 44

    Fulton JF: Harvey Cushing: A Biography Springfield, ILCharles C. Thomas1946. 539540

  • 45

    Gennarelli TA: Future directions in brain injury research. Prog Neurol Surg 28:2432502014

  • 46

    Gilkes CE: An account of the life and achievements of Miss Diana Beck, neurosurgeon (1902–1956). Neurosurgery 62:7387422008

  • 47

    Gurdjian ES: Impact Head Injury: Mechanistic Clinical and Preventive Correlations SpringfieldCharles C. Thomas1975

  • 48

    Guttmann L: Rehabilitation after injuries to the central nervous system. Proc R Soc Med 35:2953081942

  • 49

    Guttmann L: Statistical survey on one thousand paraplegics. Proc R Soc Med 47:109911031954

  • 50

    Hare R: New light on the history of penicillin. Med Hist 26:1241982

  • 51

    Holbourn AHS: Mechanics of head injuries. Lancet 242:4384411943

  • 52

    Holbourn AHS: Mechanics of head injury. Lancet 243:4831944

  • 53

    Holbourn AHS: The mechanics of brain injuries. Br Med Bull 3:1471491945

  • 54

    Holbourn AHS: The mechanics of trauma with special reference to herniation of cerebral tissue. J Neurosurg 1:1902001944

  • 55

    Horrax G: The era of neurosurgery as a surgical specialty. Neurosurgery: An Historical Sketch Springfield, ILCharles C. Thomas1952

  • 56

    Horsley V: An address on gunshot wounds of the head. Lancet 185:3593621915

  • 57

    Horsley V: Discussion of gunshot wounds of the head. Trans Med Soc Lond 38:1121281915

  • 58

    Hughes JT: Lawrence of Arabia and Hugh Cairns: crash helmets for motorcyclists. J Med Biogr 9:2362402001

  • 59

    Jefferson G: Memories of Hugh Cairns. J Neurol Neurosurg Psychiatry 22:1551661959

  • 60

    Lax E: The Mold in Dr. Florey's Coat: The Story of the Penicillin Miracle New YorkHenry Holt and Company2004

  • 61

    LeCount ERApfelbach CW: Pathologic anatomy of traumatic fractures of cranial bones and concomitant brain injuries. JAMA 74:5015111920

    • Search Google Scholar
    • Export Citation
  • 62

    Liu BCIvers RNorton RBoufous SBlows SLo SK: Helmets for preventing injury in motorcycle riders. Cochrane Database Syst Rev 1CD0043332008

    • Search Google Scholar
    • Export Citation
  • 63

    Ludovici LJ: Fleming: Discover of Penicillin Bloomington, INIndiana University Press1952

  • 64

    Maartens NFWills ADAdams CB: Lawrence of Arabia, Sir Hugh Cairns, and the origin of motorcycle helmets. Neurosurgery 50:1761802002

    • Search Google Scholar
    • Export Citation
  • 65

    Macfarlane G: Howard Florey the Making of a Great Scientist OxfordOxford University Press1979

  • 66

    Margulies SSThibault LE: An analytical model of traumatic diffuse brain injury. J Biomech Eng 111:2412491989

  • 67

    Medical Research Council: A Glossary of Psychological Terms Commonly Used in Cases of Head Injury. MRC War Memorandum No. 4 LondonH.M. Stationery Office1941

    • Search Google Scholar
    • Export Citation
  • 68

    Northfield DWC: Head injury. The Surgery of the Central Nervous System: A Textbook for Postgraduate Students OxfordBlackwell Scientific1973. 753763839

    • Search Google Scholar
    • Export Citation
  • 69

    Nuffield Department of Surgical Sciences: Sir Hugh Cairns (http://www.nds.ox.ac.uk/about-us/our-history/sir-hugh-cairns)[Accessed November 17 2015]

    • Search Google Scholar
    • Export Citation
  • 70

    Obituary: Hugh, William Bell Cairns. Lancet 2:2022031952

  • 71

    Ommaya AK: Head injury mechanisms and the concept of preventive management: a review and critical synthesis. J Neurotrauma 12:5275461995

    • Search Google Scholar
    • Export Citation
  • 72

    Pennybacker J: Sir Hugh William Bell Cairns. 1896–1952. Surg Neurol 4:3473501975

  • 73

    Rowbotham GF: A historical survey of the treatment of injuries to the head. Neurol Neurocir Psiquiatr 11:19291970

  • 74

    Rowbotham GF: Mechanisms of injuries of the head. Acute Injuries of the Head: Their Diagnosis Treatment Complications and Sequels EdinburghE. & S. Livingstone1964. 5692

    • Search Google Scholar
    • Export Citation
  • 75

    Russell WR: Cerebral involvement in head injury. Brain 55:5496031932

  • 76

    Russell WR: Disability caused by brain wounds; a review of 1,166 cases. J Neurol Neurosurg Psychiatry 14:35391951

  • 77

    Russell WREspir MLE: Traumatic Aphasia: A Study of Aphasia in War Wounds of the Brain Oxford, UKOxford University Press1961

  • 78

    Russell WRSchiller F: Crushing injuries to the skull; clinical and experimental observations. J Neurol Neurosurg Psychiatry 12:52601949

    • Search Google Scholar
    • Export Citation
  • 79

    Schorstein J: An atlas of head wounds illustrating standard operative technique. Br J Surg 55:Suppl 127611947

  • 80

    Schurr PH: The Cairns memorial lecture: the Cairns tradition. J Neurol Neurosurg Psychiatry 53:1881931990

  • 81

    Schurr PH: The evolution of field neurosurgery in the British Army. J R Soc Med 98:4234272005

  • 82

    Schurr PH: So That Was Life: A Biography of Sir Geoffrey Jefferson: Master of the Neurosciences and Man of Letters LondonRoyal Society of Medicine Press1997

    • Search Google Scholar
    • Export Citation
  • 83

    Strich SJ: Diffuse degeneration of the cerebral white matter in severe dementia following head injury. J Neurol Neurosurg Psychiatry 19:1631851956

    • Search Google Scholar
    • Export Citation
  • 84

    Strich SJ: Shearing of nerve fibres as a cause of brain damage due to head injury: a pathological study of twenty cases. Lancet 278:4434481961

    • Search Google Scholar
    • Export Citation
  • 85

    Symonds CPRitchie Russell W: Accidental head injuries: Prognosis in service patients. Lancet 241:7101943

  • 86

    Teasdale GZitnay GHistory of acute care and rehabilitation of head injury. Zasler NDKatz DIZafonte RDZafonte RD: Brain Injury Medicine: Principles and Practice New YorkDemos Medical Publishing2012. 1325

    • Search Google Scholar
    • Export Citation
  • 87

    Vance BM: Fractures of the skull: Complications and causes of death: a review of 512 necropsies and of 61 cases studied clinically. Arch Surg 14:102310921927

    • Search Google Scholar
    • Export Citation
  • 88

    Walker NM: Hugh Cairns—neurosurgical innovator. J R Army Med Corps 154:1461482008

  • 89

    Williams ET: Cairns, Sir Hugh William Bell (1896–1952). Australian Dictionary of Biography (http://adb.anu.edu.au/biography/cairns-sir-hugh-william-bell-5464) [Accessed November 17 2015]

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 346 346 101
Full Text Views 629 473 4
PDF Downloads 352 230 2
EPUB Downloads 0 0 0
PubMed
Google Scholar