Bombs and hospitals.
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Biomedical subjects
Publications and source records attributed to W H Rutherford.
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Of 131 patients with mild concussion, 19 (14.5%) still had symptoms after 1 year. Of these 19 patients, 10 had some symptoms of which they had not complained at 6 weeks. Symptoms at 1 year were more common among women and among patients who had had positive neurological findings at 24 h. Of the 19 patients who had symptoms at 1 year, 8 were involved in law suits and 6 had been suspected of malingering 6 weeks after their accident. Five of these patients were both involved in law suits and suspected of malingering.
Of 1532 explosion victims only 9 died in hospital. Injury to the chest or abdominal organs was rare (10 patients of whom 5 died). Primary blast lung was apparent in only 2 patients. Major limb amputations occured in 16 patients of whom 4 died. None of the 50 patients with burns required skin grafts. Injuries were predominantly to the head and neck and limbs, suggesting the protective effect of clothing. Half of the patients suffered from emotional shock, most with no physical injury and 82 per cent of whom were female. Eighty-three per cent of patients arrived at hospital between 10.00 a.m. and 7.00 p.m.
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42 per cent of a consecutive series of patients with mild head injuries with concussion were found to have positive blood-alcohol tests. There were errors in the clinical diagnosis of alcohol ingestion among patients with both positive and negative blood-alcohols. Medicolegal questions have so dominated the problems of diagnosing alcohol ingestion as to prevent doctors considering its clinical importance. The value of a laboratory test giving an immediate reading is emphasised.
Of 145 patients with concussion from minor head injuries admitted to the Royal Victoria Hospital, Belfast, over one year, 49.0 per cent had no symptoms, 38.9 per cent had between 1 and 6 symptoms, and 2.1 per cent had more than 6 symptoms about six weeks after the accident. There was significant correlation between a high symptom-rate at six weeks and positive neurological signs and symptoms at twenty-four hours. Post-concussion symptoms were more frequent in women, in those injured by falls, and in those who blamed their employers or large impersonal organisations for their accidents. The results suggest that both organic and neurotic factors are involved in the pathogenesis of symptoms at six weeks.
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The injuries in 90 patients caused by rubber bullets are described. There was 1 death and 17 people in the series had permanent disabilities or deformities. In 41 patients the injuries necessitated admission to hospital. One fatality outside this series is known. Injuries to the head and neck were frequent and severe.
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A comparison was made of the characteristics of patients referred to the Accident and Emergency Department of the Royal Victoria Hospital, Belfast outside normal working hours by their own general practitioners and those referred by the general practitioner deputizing service during the same period.
The difficulties of applying the rules of the International Classification of Diseases to trauma cases are discussed on the basis of coding the injuries of 1,797 injured patients from civil disorders in Northern Ireland, 1969-1971. Certain inadequacies of the code are indicated and suggestions made about ways to modify it and make its applications more informative.