Very late outcome after focal wartime brain wounds

This paper reviews outcome studies of wartime head-injury in Europe and North America. These include Goldstein's major but neglected contribution. intensive clinical and experimental studies of World War I veterans, in which he emphasizes the need for rehabilitation and community care. The present paper reports a follow-up, in Oxford U.K., of a cohort of World War II veterans drawn from over a thousand head-injured servicemen admitted to St Hugh's Military Hospital in Oxford, usually within one to two days of wounding. This cohort was initially examined in 1963 and thereafter until the present day. Behavioural outcome is remarkably good. Cognitive data show a striking preservation of ability in the group as a whole, despite previously reported selective impairments related to specific loci of lesion. Psychiatric illness is rare; and there is little difference in self-report on rating scales between the veterans and a carefully recruited, age-matched control panel. This positive outcome is attributed to a number of factors, including the psychosocial context of World War II for British servicemen, the expert and systematic medical care that commenced within hours of wounding, and the positive attitude of the civilian population. It reinforces the crucial importance of after-care.