Walker and Erculei (1970) examined a cohort of head-injured Bavarian World War I veterans. The veterans were patients at a medical center established in Munich in 1916 for head injuries. Medical records, including field medical records and neurology reports on 5,500 men who had sustained head injuries, were reviewed in 1964–1966. The records also included information on the men for up to 50 years after injury. About 1,000 records were randomly selected from the 5,500, and death certificates were sought from social-welfare offices in Bavaria and West Germany. Vital statistics were obtained for about 600 of the 1,000 men; the remainder could not be located. Controls were about 600 uninjured Bavarian World War I veterans. Men who were born before 1880, who died before the age of 35 years, or whose dates of death were not known were excluded. Head injuries were diagnosed on the basis of demonstration of immediate posttraumatic neurologic disturbance or evidence of a contusion, laceration, or compound wound injury of the scalp. Posttraumatic epilepsy was diagnosed on the basis of absence of preinjury seizures and the occurrence of seizures at some time after injury. Seizures were verified by a physician, nurse, or family member; if no outside party could verify the seizure occurred, this was noted. The authors noted that most of the patients had their first seizure within a year after the injury and others many years after the injury (Walker et al., 1971).
Walker and colleagues (1971) compared life expectancy of those with injuries and unwounded Bavarian veterans of World War I who had been awarded service medals carrying small pensions. The injured group had 1.8% more deaths than expected in the general male population, and a 4-year shorter life expectancy than the control group. In 1965, 73% of men at least 65 years old with TBI and 80% of those at least 65 years old without TBI were alive. Weiss et al. (1982) used the same data and found that in 1972, 497 (76.8%) of 647 TBI veterans and 483 (78.4%) of 616 of the control group had died.
Walker and Ercluei (1969) also conducted a cohort study of 364 severely head-injured World War II veterans 15 years after injury. Of these, 241 were originally studied at the Army Posttraumatic Epilepsy Center at Cushing General Hospital in Framingham, Massachusetts, in 1945–1946; these patients experienced at least one posttraumatic seizure. A battery of medical, psychologic, and electroencephalographic (EEG) tests were administered 1–3 years after injury; a 10-year followup consisted of examination, phone interview, or questionnaire. The authors reported that annual contact was made with nearly all subjects. The other 123, unselected head-injured men were studied as part of a followup in Baltimore from 1950 to 1954 and identified through Army and Veterans’ Administration (VA) pension rosters; the population was comparable with the Cushing General Hospital group in severity of injury. Medical records were not as detailed and complete as those on the group described previously. Neurologic, social, psychometric, and EEG tests were administered 6–9 years after injury.
In general, the study participants had more severe brain wounds than would typically be seen in civilian or military hospitals. Dural penetrating frontal wounds tended to be included in the series although occipital and temporal injuries tended to be excluded (Walker and Erculei, 1969); dural penetration was found in 87% of the Cushing General Hospital group and in 71% of the Baltimore group (Walker and Erculei, 1970).