During World War II, my father served in England as a medical officer with the rank of Commander with the Royal Canadian Air Force. His post graduate specialty was in Otolaryngology, involving all manner of perturbations to the Ear, Nose and Throat. He had a lot of patients with head trauma especially with concussions. What did these physicians observe both clinically and experimentally in 1943? You will be surprised to read what they observed, and especially what they thought about concussions sixty years ago. World War II was in full swing with the tempo of human cruelty not yet at its crescendo of unspeakable horror. On each Remembrance Day, we stand at attention for a brief hesitation, remembering sixty years later but still not learning yet how to stop the killing that still continues to this day.
Churchill and Roosevelt meet at the Casablanca Conference. In July Mussolini is deposed and placed under arrest. Cost of a first class stamp is three pennies.
The first bomb fell at 10:09 p.m. The attack lasted 24 minutes, leaving the inner city a raging sea of fire. “Precision saturation bombing” had created the desired firestorm. A firestorm is caused when hundreds of smaller fires join in one vast conflagration. Huge masses of air are sucked in to feed the inferno, causing an artificial tornado. Those persons unlucky enough to be caught in the rush of wind are hurled down entire streets into the flames. Those who seek refuge underground often suffocate as oxygen is pulled from the air to feed the blaze, or they perish in a blast of white heat, heat intense enough to melt human flesh.
CHANGES IN BRAIN VOLUME AND BLOOD CONTENT AFTER EXPERIMENTAL CONCUSSION by Comdr James C. White, USNR, John R. Brooks, A.B., Joel C Goldwait, S.B., and Raymond D Adams, MD from the surgical research laboratories of the Harvard medical School at the Massachusetts General Hospital, Boston; and the Neuropathology laboratory of the Harvard Medical School’s Department of Neurology at the Boston City Hospital. The report was read before the American Surgical Association, May 13-14, 1943, Cincinnati, Ohio published in the Annals of Surgery October, 1943, Volume 118, Number 4, p 619-633.
” In recent surveys of acute craniocerebral trauma McConnell and Gurdjian, Webster and Arnkoff have reviewed the conditions which cause the brain to swell. The two basic factors concerned are intra cerebral hemorrhage or congestion of the cerebral vascular tree and swelling of the cerebral tissue by extravasation of fluid into the cells or inter-cellular spaces. While there is common agreement that localized edema occurs in an area of cerebral contusion, there is wide divergence of opinion as to whether extravasation of fluid through the capillary walls occurs throughout the brain. Pelcher traumatized the brain of dogs by dropping a weight on the animal’s head which was rigidly fixed in a head holder. More recent work has shown these experiments to be open toward two serious criticisms. The investigations of Denny-Brown and Russel have proved conclusively that cerebral concussion does not occur when the head remains stationary. Its production requires sudden acceleration or deceleration, such as occurs when the moving head encounters an unyielding object, or the stationary head is struck by a moving one.”
” Accurate methods of determining changes in volume of the brain and the blood content of the cerebral vascular tree in cats have been reported in a previous article by White, Verlot, Selverstone and Beecher. The correlation of brain volume with the capacity of the cranial chamber, originally suggested by Reichardt, was found by Alexander and Looney to be the most accurate index of variation from the normal cerebral volume in postmortem subjects. White and his coworkers adapted the procedure to cats and found it to give extremely consistent results. After decapitation and exsanguination the brain of the normal cat is from 10 to 12 percent smaller than the surrounding cranial cavity. For convenience we shall hereafter refer to this ratio as the differential index of brain volume (DIBV). The space is occupied by the meninges and cerebrospinal fluid in the subarchnoid space, cisterns, and ventricles. ”
“When severe degrees of anoxia (arterial oxygen saturation reduced to 40 percent) were introduced, the rain volume increased as much as 5 percent. While anoxia caused no congestion of the cerebral vessels, a 10 percent rise in the carbon dioxide content of the inspired air doubled the amount of blood in the cerebral tree. It was, therefore, important to prevent anoxia or hypercapnia. This was done by inserting an intra-tracheal cannula. In order to avoid any error, the oxygen saturation of the arterial blood and its carbon dioxide content were determined before the animals were killed. ”
” As shown by Denny-Brown and Russell, a relatively constant degree of cerebral concussion can be produced by striking the animal a blow over the occiput with a swinging pendulum.”
In those long quiet nights of the summer when the star field swings over my head I gaze into the past. Awake during those long hours, I sometimes have some 1943 queries to my father in the dark of night. ” Dad- when you were in Europe during the war did it bother you to have to deal with all the wounds that your patients were presenting you with? I mean at one point it must have bugged you all this mayhem repairing ripped tissues from horrific explosions was such a never-ending series of pain stirred with chaos? You were a young doctor then, did it get you used to the constant destruction staring at the evil behind all this distraught, anguished agony ? Or did you just go numb ? to deal with it as best you could? I mean there was such horrific things going on. People were stacked like dead wood in the fire bombed streets. Wedding rings were hacked off corpses severed fingers thrown away like table scraps, there was no dignity. Life was lost sucked out like bad oxygen from the lungs of all the innocent victims. You studied anatomy and now everything was disturbed flung back as if in another barbaric era ? Were you worried about the future about what might happen next ? ”
Somehow the human mind can decide to kill then to listen to music or enjoy a sunset yet the mixed thoughts don’t seem to hold together. We target people, we eliminate we destroy lives cities countries yet we think we are so smart, so advanced. Smarter than the animals our heritage deserves so much better, why are we so weak ? Evolution has been such a saga of building toward elaboration of cells learning to cooperate. When does our species learn to cooperate for the common good? When do we seek love instead of hate ? When do we learn ? So many doctors on the Nazi side did all the wrong things, what happened to their morality? Why did they test to the death human subjects in the concentration camps ? How could doctors even conceive of that abomination, let alone repeatedly perform such experiments ?
“And in this whole time, during the desperate struggle for a bowl of watery turnip soup there is a continuous commotion in the crowd, a clamour and hubbub carried on in the narrow passages between the bedsteads. Chamber-pots are being carried from one end of the hut to the other, are being emptied or filled. And all this keeps going on like this, eternally, these eternal chamber-pots, if only because of the children, the sick. And in all this confusion and tumult, in which soup, smells and excrement are passing by, where brooms are raising dust, grown-ups are screaming and children are crying, “hawkers” walk around tirelessly, shamelessly, obtrusively, and just as miserable as their customers. They swap some rags for bread, bread for cigarettes and vice versa. This strange business is accompanied by long discussions and unending negotiations. Boundless misery, shamefully put on show, stinking and howling. That is exactly what the Nazis wanted. Exactly this. To humiliate us to this infamous, animal degree, to drive us insane, and to kill even our innermost memory that we were once human beings.” Hann Levy-Hass, Diary Note”
In 1943 the Harvard researchers had the backdrop of the Second World War constantly on their minds yet they still did their work. I think they did extraordinary work for they keenly observed, which is the foundation always for great science. Without the benefit of magnetic resonance scanners these researchers were giving their best to observe the concussion affects within the human brain. It takes great focus to pay attention to what happens step by step as a concussive deceleration progresses. They have left us a roadmap of beacons that somehow has faded in time. Their 1943 legacy shames the modern researcher into thinking they are perhaps better. We have lost their edge- their voices from 1943 can still teach us what to concentrate on. Their words have become a legacy to cherish. We can always stride back in time to learn to listen. Despite our modern gadgets it is with reason, precision and passion that we can watch in wonder at their 1943 skills. I am humbled by their explanations and thoughts.
“Dr. Abel J. Hertzberg, a distinguished lawyer from Amsterdam, was one of the Jews in the Star Camp who worked in the “shoe commando.” He had been arrested, along with his wife in 1943 and sent to Westerbork, a transit camp in the Netherlands.
He kept a diary which he published after the war under the title Tweestromenland, dagboek uit Bergen-Belsen (Between Two Streams, A Diary from Bergen-Belsen). The book was translated from the original Dutch into English by Jack Santcross, who survived Bergen-Belsen as a nine-year-old fellow inmate of Herzberg.”
The following excerpt from his diary, written on August 29, 1944, is from the special English edition of a book by Eberhard Kolb, entitled “Bergen-Belsen from 1943 – 1945,” which was translated from German into English by Gregory Claeys and Christine Lattek.
“What does our work consist of? Mainly in unstitching the seams of old shoes and in cutting out the leather pieces that can still be used. It is work for idiots and – obviously – terribly dirty work. If one asks the Lance Sergeant who acts as overseer what the use of all this is he says: “We German are have-nots, and you Jews shall help to make us rich by your work.” Naturally we take this lesson in German political economy very much to heart. We burn with zeal to “make Germany rich” by unstitching shoes. And now a permanent and stubborn dispute develops between us Jews and the Lance Sergeant about the degree of efficiency of our labour. One thing is certain: under no circumstances can we allow the suspicion to arise that we are committing sabotage, because sabotage means the concentration camp at the very least. Hence something absolutely needs to be done. The only question is: how much or how little. Some manage to do as good as nothing. Records are kept about the amount of old shoes that are collected. The bookkeepers are Jews but of course they can fiddle the figures only within certain limits. Therefore the most ingenious methods are invented to cheat the Lance Sergeant. For example, we fetch shoes from the huge pile, have a figure recorded which is greatly “rounded off” upwards, and return moreover the said shoes in total or in part to the large heap again. If then one of the Lance Sergeants simply fails to understand why productivity is so low and why the pile does not get any smaller, then for a moment at least the Jews, too, have their fun.”
“As shown by Denny-Brown and Russel, a relatively constant degree of cerebral concussion can be produced by striking the animal a blow over the occiput with a swinging pendulum. The apparatus which was used was designed by Professor Nathaniel H Frank of the Physics Department, Massachusetts Institute of Technology. The striking speed of the pendulum is accelerated by heavy metal disks which are mounted eccentrically on an axle suspended on ball bearings. To obtain a slightly greater speed at impact a spiral spring was attached to one of the disks. The striking speed of the pendulum, when released from various angles, was calculated by the number of vibrations of a tuning fork recorded on a 12-inch length of smoked paper. After the induction of pentobarbitol sodium anesthesia the animal was placed on its side in the impact position for the standard swinging blow onto the occiput. Pulse, respiration, size of pupil (in millimeters) light and corneal reflexes, and the knee jerk were recorded all the while the animal was observed until these observations remained constant. The pendulum was then released.
“Traveling at a speed up to 46.5 feet per second ( 31.7 miles per hour), it produces an intense blow which is sufficient to spin the animal around and be thrown across the table. After the trauma, the recordings of the heart and respiratory rates , size of pupils, and the reflexes at 15- to 30-second intervals until they returned to normal. In addition, rectal temperatures were taken and warmth applied as necessary, in order to prevent an excessive loss of body heat.”
” The severity of the concussion was graded 1, 2, 3+, depending on the physiologic disturbances after the blow. The characteristic response was a brief period of apnea and then a recovery of the normal rate and depth of respiration. The heart rate was at first usually reduced, up to a maximum of 72 percent, but occasionally there was a slight acceleration. Irregularities of the heart beat were frequent. The corneal reflex was consistently lost, but recovered in a period of a few seconds up to two minutes. Dilation of the pupil and disappearance of the light reflex roughly paralleled the loss of the corneal response. In no case were the knee jerks abolished. (Usually with one exception, where the respiration failed to return, the animals appeared to have fully recovered within a period varying between two to for minutes. Pendulum-striking speeds of less than 30 feet per second failed to produce consistent evidence of cerebral disturbances. on he other hand, speeds of 46.5 feet per second caused pronounced reflex changes, basilar hemorrhages or occipital fractures as seen in three animals. Out of nine cats submitted to a striking speed of 43 feet per second ( just under 30 miles per hour ), one animal showed a slight separation of the occipital sutures, and five showed hemorrhages around the brain stem and cerebellum. On the whole, striking speeds of from 43 to 45 feet per second seemed to be he most satisfactory and to give fairly consistent moderate degrees of concussion.”
So why am I writing all these parallel excursions involving horror from WW II ? I am comparing two groups about the context of loss of value for human life. German doctors who swore on the Hippocratic oath were suddenly capable of using human beings toward experimenting on them in 1943. Yet at the same time American researchers were trying to improve knowledge to the benefit of all people. One group studied on animals one group became the animal, one group lost their humanity. Is humanity that fragile a concept, is it so unworthy of defending at all cost ? Are we that vulnerable ?
But what is spectacular about this 1943 concussion study is the sequence that was observed. In 2012 we talk of axonal strain which is referred to as diffuse axonal injury. What is specific to understanding concussions is what these researchers have observed just close to sixty years ago. They are talking about vision changes which as I have been pressing in my essays is the most ancient sensing system in evolution. They are talking about light sensitivity without the advantages of the cat being able to tell them, by talking what they are experiencing after the striking blow. They did not measure their animals balance capacity after the experiments which is something they didn’t appreciate back then. Listen to their observations again: “There was only slight dilation of the pupils, and the corneal and light reflexes recovered in 60 seconds.” What did NHL hockey player Guillaume Latendresse talk about following his concussion ? He talked about avoiding bright lights, he couldn’t read or watch television, he wanted to stay in a quiet, dark room. Guillaume Latendresse was talking about his eyes sensing after his concussion. Maybe if one of those 1943 Harvard cats if the cat could talk would say similar light based complaints since that is exactly what the experimenters observed.
That is the choice we all have to act: to choose good or evil, it is a singular individual choice. It is not an imposed duty none of that falseness, we have the power of choice. That choice is the legacy of heritage, just like our genes we pass on the link- it’s not a necessary condition, it is a person’s pivoting point, some choose right others choose wrong. Our species will only survive if we choose right from wrong. We have to know the difference if we don’t we are doomed.