Management of brain abscesses. I: Drainage and antiseptics

Listerian antisepsis opened the way to surgical treatment of brain abscesses, at a time when advances in neurology made it possible to localize many of these lethal infections. William Macewen, a pupil of Joseph Lister, published in 1893 a remarkable monograph on pyogenic diseases of the brain and spinal cord. He recognized that these were caused by bacterial infection, and reported a series of 20 cerebral and cerebellar abscesses, treated by surgical drainage with antiseptic precautions. His mortality was amazingly low, but later surgeons were less successful. The causes of failure included inability to control microbial infection of the brain. Various chemical antiseptics and also serotherapy were tried, but mortality remained very high.