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.