Percivall Pott and the miners of Cornwall

Percivall Pott (1714-1788) was an astute and prolific mid-eighteenth century English surgeon with a strong interest in head injury. He was partial to the use of the trephine for all skull fractures and favoured early exploratory trephination when an intracranial collection could not be ruled out. If haemorrhage or abscess was beneath the dura, it was incised. Later in eighteenth century England and France, trephination fell out of favour. This was especially so in the crowded hospitals where putrid conditions were common. Surprisingly, on the remote southwestern English peninsula of Cornwall, where compound depressed skull fractures in miners were a frequent occurrence, Pott's principles prevailed unchanged. Generations of surgeons trephined early in suspected cranial fractures, without waiting for symptoms of compression or irritation. A large percentage of patients recovered. Those who died generally had diffuse injury, brain laceration, or a fractured base. The Atlantic breezes were believed beneficial to recovery. The operation of early 'preventive' trephination continued in the Cornish mining districts through the 1870s, when antiseptic methods were gradually adopted as elsewhere in England. Head injuries in miners became less common as mining reforms were introduced and head protection improved.