Abstract
Background
It is widely believed that trepanation prior to modern surgical hygiene was dangerous because of surgical infection, especially in the hospital. There has been a wide variability in the success and risks of different historical studies
Purpose
To obtain a more accurate assessment of the risks of post-operative infection following 18th-century cranial trauma and to note what factors were of prognostic significance.
Material and methods
Seven 18th-century texts on head injury are reviewed and analyzed.
Results
Infection was the commonest cause of death (in over 60 % of patients) in five series but not in the other two. Hospital admission did not appear to be a major factor influencing mortality from infection. Delayed infection was the indication for patient referral and trepanation in more than two patients in two series. In one series, the patients were helped by the procedure, in the other they were not. The reasons for the difference are discussed. The most striking finding was that patients treated in rural areas had a much better prognosis.
Conclusions
The risks of suffering a surgical infection following head injury and trepanation are multifactorial. Admission to hospital seems to have been less risky than has been previously thought. It seems that the greatest risk factor for a lethal infection for these patients was living in an urban environment.
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References
(1759) A collection of the yearly bills of mortality from 1657–1758 inclusive. A Millar, London, p 144
(1759) A Collection of the yearly bills of mortality from 1657–1758 inclusive. A Millar, London, pp 131 – 135
Abernethy J (1811) Surgical observations on injuries of the head. Thomas Dobson, Philadelphia
Bell B (1785) A system of surgery. Charles Elliot, Edinburgh
Bell J (1826) On fractures of the skull with depression in the principles of surgery. Thomas Tegg, London, pp 268–328
Bichat X (1814) The surgical works or statement of the doctrine and practice of P.J. Desault — in two volumes (trans: Smith ED. Thomas Dobson). Philadelphia
Blake W (1972) London in William Blake complete writings. Oxford University Press, Oxford, p 216
Botero JSH, Pérez MCF. (2012) The history of sepsis from ancient Egypt to the XIX Century. doi:10.5772/51484 accessed 2nd April 2013
Bromfield B (1773) Sudorific opiates, recommended in concussions of the brain in chirurgical observations and cases Vol 1. T Cadell, London, pp 9–23
Burnside W (1799) Dumfries. In: Sinclair J (ed) Statistical accounts of Scotland of 1791–1799. William Creech, Edinburgh, p 131
Celsus C (1938) De Medicina (trans: Spencer WG) Books I-IV. Harvard University Press, Cambridge, p 273
Cockayne E (2007) Hubbub, Filth, Noise & Stench in England. Yale University Press, New Haven
Dagi TF (1997) The management of head trauma. In: Greenblatt SH (ed) A history of neurosurgery. American Association of Neurological Surgeons, Park Ridge Illinois, pp 301–302
Dease W (1776) Observations on wounds of the head. G Robinson, London
Emsley C, Hitchcock T, Shoemaker R (2013) London history — a population history of London, Old Bailey Proceedings Online. http://www.oldbaileyonline.org, version 7.0. Accessed 16th March 2013
Ganz JC (2013) The lucid interval associated with epidural bleeding: evolving understanding. J Neurosurg 118(4):739–845
Gross C (2009) A hole in the head: more tales in the history of neuroscience. The MIT Press, Cambridge Massachussetts, 23
Gross C (2003) Trepanation from the Paelaeolithic to the Internet. In: Arnott R, Finger S, Smith CUM (eds) Trepanation history, discovery, theory. Swets & Zeitlinger Lisse, Abingdon Exton, Tokyo, p 311
Hamdy MK, Barton ND (1965) Fate of staphylococcus aureus in bruised tissue. Appl Microbiol 1:15–21
Heister L (1750) A general system of surgery in three parts. W Innys, London
Hill J (1772) Cases in surgery. John Balfour, Edinburgh
Hippocrates (1928) In the surgery IV in Hippocrates Volume III, Loeb Classical Library, (trans: Withington ET). Harvard University Press, Cambridge, pp 63 – 65
Lamont D (1799) Kirkpatrick-Durham, County of Kirkcudbright. In: Sinclair J (ed) Statistical accounts of Scotland of 1791–1799. William Creech, Edinburgh, p 253
Latta J (1795) Of wounds and contusions of the head in a practical system of surgery. G Mudie and Son, Edinburgh, pp 111–180
Le Dran H-F (1740) Observations in surgery: containing one hundred and fifteen different cases with particular remarks on each for the improvement of young students (trans: by Surgeon JS). James Hodges at the Looking Glass, London Bridge
Lennon C (2008) Dublin part II 1610–1756. Royal Irish Academy, Dublin
Lovett P (1981) The Wellesley Bridge. The Old Limerick Journal; Winter (9), 28–31
Mapother ED (1864) The sanitary state of Dublin. J Stat Soc Inq Soc Ireland 4:62–76
Muirhead J (1799) Parish of Urr, county of Kirkcudbright — synod and presbytery of Dumfries. In: Sinclair (ed) Statistical accounts of Scotland of 1791–1799. William Creech, Edinburgh, p 76
O’Halloran (1793) A New treatise on the different disorders arising from external injuries of the head. Zachariah Jackson, Dublin
Pimentel L (2004) Scurvy: historical review and current diagnostic approach. Am J Emerg Med 21(4):328–332
Pott P (1768) Observations on the nature and consequences of those injuries to which the head is liable from external violence. Hawes L, Clarke W and Collins, London
Putnam C (2007) Semmelweis Ignác Fülöp [Ignaz Philipp]. In: Bynum WF, Bynum H (eds) Dictionary of medical biography Volume 5. Greenwood Press, London, pp 1133–1135
Quesnay F (1848) Summary of observations on the use of the trepan. In: Ottley D (ed) Observations on surgical diseases of the head and neck selected form the memoirs of the royal academy of surgery of France. The Sydenham Society, London, pp 1–80
Riley JC (2001) Rising life expectancy: a global history. Cambridge University Press, Cambridge, pp 32–34
Roche D (1987) The people of Paris: an essay in popular culture in the 18th century. University of California Press, Berkeley, p21
Sharp S (1740) A treatise on the operations of surgery with a description and representation of the instruments used in performing it. J Brotherton, W Innys and R Manby, London
Turner D (1736) The art of surgery. C Rivington, London
UK National Statistics, Publication Hub (2013) http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-276695, Accessed 15th March 2013
UK National Statistics, Publication Hub. (2013) http://www.statistics.gov.uk/hub/population/deaths/mortality-rates [Accessed 15th March 2013]
Wallace AR (1898) The wonderful century it’s successes and it’s failures. George N. Morang, Toronto, pp 318–319
Zimmerman LM, Veith I (1967) Great ideas in the history of surgery. Chapter 22: German Wound Surgeons, Dover Publications Inc., New York, pp 293–217
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Ganz, J.C. Trepanation and surgical infection in the 18th century. Acta Neurochir 156, 615–623 (2014). https://doi.org/10.1007/s00701-013-1900-0
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DOI: https://doi.org/10.1007/s00701-013-1900-0