1897] NOTES AND COMMENTS 155 



name for success in this operation, which they conduct in a manner 

 which is characterised by great boldness, combined with decidedly 

 rough and ready methods. The surgical equipment is of the 

 simplest description, the principal instruments being a kind of auger 

 (brima), or centre-bit rather, and two kinds of very rude saws 

 (mcnchar) of peculiar hooked shape and very short cutting edges. 

 The text-book, there is but one, is a manuscript, a copy of which is 

 possessed by each qualified trepanner. The brima is used for ex- 

 ploring, and holes are drilled into the bone of the skull, at first 

 through the outer table only, for examination of the diploe ; but, if 

 necessary, the hole is extended through the inner table, exposing 

 the dura mater. Large portions of the skull are, if it is deemed 

 desirable, removed through the agency of the brima, several holes 

 being drilled with it very close together, and when, after some weeks, 

 necrosis has destroyed the narrow bridges of bone between the holes, 

 the whole piece of bone round which the holes were drilled is 

 detached with a lever and removed. The saw is used for grave 

 cases, and the sawed grooves are sunk to the inner table, the remain- 

 ing thickness of bone being scraped away with a hooked instrument. 

 In other cases the grooves are less deep, and necrosis does the rest 

 of the work, the final detachment of the bone being effected as before 

 with a lever. Prayers and incantations always accompany the 

 operation. They must be needed ! Some stubborn cases demand 

 the trial of every class of trepanning, and at successive sittings the 

 operator puts them all in practice ; ' ' C'est une veritable orgie de 

 trepanation ! " The most peculiar part of the whole thing is that 

 the patient as a rule recovers, this being due rather to the natural 

 physical qualities of the Berber race, than to the skill of the operator. 

 Eecovery may, in fact, be said to be in spite of the surgeon. Dr 

 Malbot was fortunate enough to obtain a skull showing all the 

 methods practised, a most striking specimen of which he gives a 

 figure. The skull is now preserved in the Museum of Natural 

 History at Paris. 



This paper should be read in connection with Dr Eobert Munro's 

 paper on " Prehistoric Trepanning and Cranial Amulets," which has 

 been lately republished in his book on " Prehistoric Problems." 

 This gives a good and well-illustrated general account of ancient 

 trepanning, a special reference being made to cases belonging to 

 Neolithic times. The use of fragments of skulls as amulets is also 

 gone into in detail, and the fact made clear that trepanning was in 

 some cases surgical, in others posthumous, following Broca's famous 

 memoir of- 1876. Dr Munro gives a sketch of the geographical 

 distribution of this operation, and discourses on the methods 

 employed in early times. It is a pity that so few details regarding 

 the practice of trepanning amongst modern primitive peoples are 



