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 
(menchar) 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 diplve; 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 véritable orgie de 
trépanation!” 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. 
Recovery 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 Robert 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 
