480 ANNUAL REPORT SMITHSONIAN INSTITUTION, 195 7 



artificial openings had been made in the same rectangular fashion as 

 that in the original Squier specimen (fig. 1). Since there are indica- 

 tions of osteitis about one of these rectangular openings, probably the 

 individual briefly survived his operation. The third case probably 

 represents a healed decompressed fracture. It is noteworthy also that 

 all three Palestine cases were culled from a collection of several hun- 

 dred skulls, which suggests that skull surgery was not practiced very 

 often in this locality. 



MOTIVES FOR OPERATING 



A skull which has been operated upon seldom by itself tells why the 

 operation was undertaken. It is owing to this fact that most explana- 

 tions of primitive skull surgery include the word "thaumaturgy" — 

 magic, from the Greek word for wonderworking. Doubtless a large 

 element of mysticism became involved in such operations in the 

 course of time, but whether or not it led to, or grew out of, a therapeutic 

 measure, is debatable. For example, McGee (1897), evidently in- 

 fluenced by the discoveries in Europe and North America of amulets 

 and human skulls cut post mortem, maintained that "trephining 

 began . . . and was performed after death for the purpose of obtain- 

 ing amulets. It . . . was gradually extended to living captives for 

 the same vicarious purpose." (P. 72.) From this beginning McGee 

 saw the procedure tied in more and more with "incantations . . . ac- 

 companied by medication or manipulation." Then, according to this 

 reconstruction of events, whenever the procedure proved beneficial, 

 an otherwise aimless operation tended to grow into empiric surgery. 

 Other writers on this subject, who have not been impressed by the 

 role of amulet collecting, have felt that traumatic and/or pathological 

 indications requiring therapy first induced primitive man to cut into 

 the head. Tello (1913) listed four such indications, foremost of 

 which was fracture of the skull. On the other hand, Ford (1937), 

 speaking for Melanesia, where, as in Peru, warfare resulted in many 

 skull fractures, reconstructs events as follows : 



The operation was undertaken for the immediate treatment of traumatic 

 cranial injuries, and in certain areas its performance was extended to the treat- 

 ment of severe headache and other ailments, and as a prophylactic measure, in 

 children, against the occurrence of such affections in subsequent life. (P. 477.) 



Besides cutting through the skull, primitive surgeons in certain 

 areas, as we have seen, produced extensive scars on the skull vault, 

 some of them in the form of a cross (sincipital T) . So far as Europe 

 is concerned, the nature of this practice is clear from surviving 

 medieval medical records (MacCurdy, 1905) : chemical or thermal 

 cauterization was applied as a counterirritant in cases of dementia 

 and epilepsy. This does not mean that any large bone scar need be 



