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January 20, 1940


JAMA. 1940;114(3):243-245. doi:10.1001/jama.1940.62810030003011

THE THERAPY OF HEAD INJURIES  In Collaboration with Dr. Adrian VerbrugghenThe gravity of head injuries (average mortality rate now about 15 per cent at ward 22, Cook County Hospital) makes careful, cautious and conservative treatment imperative. It was formerly 38 per cent.The difficulty of making a complete diagnosis promptly enough for these unconscious and critically injured patients necessitates a simple and rather obvious classification that at once suggests appropriate treatment. The following may serve the purpose: class A, "in extremis" cases; class B, grave cases; class C, mild cases; class D, cases in which new symptoms develop, and class E, cases in which sequelae develop.

CLASS A. "IN EXTREMIS" CASES  A patient in profound collapse (almost pulseless) and in deep coma (with no reaction to supra-orbital pressure), who may have multiple injuries, is not in a condition for drastic treatment. The best that can be done for him

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