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The state of consciousness. immediately following injury to the head is the subject of this study.1 Although measurement of mental functioning in the early stages of injury would be an aid to correct diagnosis and prognosis, to our knowledge no similar investigation of the intellectual functions has been made until convalescence. This is true because surgical complications and damage to vital centers usually monopolize attention immediately after head trauma. It seemed of interest, therefore, to determine the degree of incapacity within the first twenty-four hours and to observe the subsequent course of the mental disability. The status of consciousness was measured by the ability of the subject to submit to psychologic testing, and the results of these examinations were compared with the type and severity of the injury. CASE MATERIALFor investigation of the psychometric performance in the first twenty-four hours after injury, patients were studied who had been brought to the Boston City Hospital within approximately two hours after the accident. All patients admitted on alternate days and nights were accepted in order that an unselected sample of persons with head injuries might be obtained. In this way a series of 190 patients was secured. Of these, 80 per cent were males and 20 per cent females. Their ages ranged from 2 to 84 years, with a mean of 39 years. Fifteen per cent of the subjects were children under the age of 13 years. Although all racial groups were represented, the majority were of Irish origin.For the study of improvement in the succeeding days, the selection of patients was neces¬ sarily confined to those with a minimal stay in the hospital of four days. Eighty-five such patients were repeatedly examined during hospitalization. Sixty-six per cent were males and 34 per cent females. The ages ranged from 11 to 67 years, with a mean age of 35 years. Out of both groups, 70 patients submitted to reexamination after discharge. The mean intelligence quotient was 94.5, with a standard deviation of ± 13.1, an indication that the sample of the population studied belonged to the group of low average intelligence. PROCEDUREThe tests were selected to meet conditions imposed by the hospital environment. Injured patients are usually kept flat in bed, and methods of examination must be independent of body position. It was desired to follow the patients over a period of years, so that their active cooperation had to be assured, although the attitude of general hospital patients toward psycho¬ logic testing is often reserved, or even unfriendly. Hence, the procedures which might imply suspicion of low intelligence or doubt of sanity were minimized, and, in order to win the person's confidence, each session was preceded by an explanation of the need to test "mental speed." Preoccupation with the accident, serious and painful injuries and fatigue are often factors limiting the time of examination, and methods had to be selected to cover the widest possible range of mental functions within an allotted period of fift...

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