Neurosurgery & Long-term Medical Effects of WWI

The case files of neurosurgeon Geoffrey Jefferson survive for patients admitted between 1927 and 1940 and inevitably a number of his patients were soldiers during World War One, and in one case the Boer War. Despite dating from over a decade after Armistice Day the effects of the war tend to play a part in these individual’s medical histories, some much more than others. Very often reference to a patient’s military past is brief and simply part of a thorough medical history, however there are a handful of patients who were still suffering the direct after-effects of their injuries many years later.

Jefferson himself was a member of the RAMC during World War One and spent time working as chief surgeon to the Anglo-Russian Hospital in Petrograd before heading to the 14^th General Hospital of the British Expeditionary Force in Boulogne, France as surgical specialist. He published a number of articles relating to his time in the RAMC largely relating to gunshot wounds to the head.

Examples of war injuries from Jefferson’s patient files include:

Head Injuries

Both patients 1928/7 and 1935/168 had received direct injuries to the head during the war which were believed to be the cause of their subsequent attacks of epileptiform fits. The former had received a gunshot wound to the temple whilst the latter had been injured by a hand grenade, small fragments of which could still be identified in the patient’s head on x-ray examination in 1953. There a number of patients amongst Jefferson’s case files that developed seizure disorders as a result of traumatic head injuries and very often little could be done surgically to treat them.  Patient 1935/168 was one such case and was discharged home in status quo and treated medically and his seizures ceased naturally about three years later. Patient 1928/7, however, developed an abscess in the right temporal region and following surgical efforts to drain the abscess died in December 1928.

Gas Poisoning

In September 1933 patient 1933/115 came under the care of Jefferson owing to a metastatic cerebral abscess. Central to this man’s condition was the bronchiectasis (disease of the lungs) he had suffered from since being gassed in the army. His condition quickly deteriorated and a post mortem examination confirmed the diagnosis and also identified multiple abscesses in the right lung.

Strangely the medical effects of toxic gases, and particularly mustard gas, went full circle following World War Two. Manchester haematologist John Frederick Wilkinson worked closely with workers in the toxic gas factories during World War Two and his observations contributed to his work on the development of chemotherapy utilising nitrogen mustards to treat leukaemia. More information on his work can be found amongst his research papers also housed at the University of Manchester Library.

Shell Shock

Patient 1934/110 had been demobilised from the army in 1918 suffering from deafness and shell shock and was still receiving a pension as a result of this when he came to see Jefferson in 1934. A few months before his admission his condition deteriorated significantly with alteration in behaviour and severe lapses of memory. His wife reported that he would sit in a chair doing nothing and when asked what was wrong replied “my head is going wrong”. He only remained an inpatient under Jefferson for a couple of days and no treatment was recorded during this period and he was discharged as suffering from cerebral degeneration complicated by syphilitic periarteritis.

Phantom Limbs

Whilst with the British Expeditionary Force in France in 1916 patient 1937/151’s left leg was blown off during a battle on the Somme and was amputated shortly afterwards. The patient reported that he was still able to feel his left foot immediately after the operation but was not troubled by pain. By the time he saw Jefferson in 1937 he had been experiencing regular episodes of extreme pain in his phantom limb, which had led him to contemplate suicide. A surgical root section of nerves affecting the pain pathways to the limb, or cordotomy, was performed after which his pain subsided, although he was still aware of the presence of the limb. At first considered a success, a return of the patient’s pain was regrettably reported only a few months after his discharge.

See an earlier posting by Dr Rebecca Wynter for further information about Jefferson’s involvement with phantom limbs during WWI.

In conjunction with Jefferson’s personal papers relating to his work during WWI (including his time in Russia and research into amputations) and the works and publications of many of his contemporaries it is possible to gain an insight into the methods employed to treat war injuries, the medical research they informed, and how this influenced developments in the practice of medicine.