484 ANNUAL REPORT SMITHSONIAN INSTITUTION, 1957 



Nothing is known about the postoperative care of the surgical area 

 in prehistoric times. It is sometimes stated that a shell or metal disk 

 was placed over the hole in the skull, but there is no good evidence of 

 this practice. Hrdlicka (1939) illustrated a partly mummified head 

 from the Nasca region of Peru with what he interpreted as a surgical 

 bandage still in place over the rear parts. However, X-rays now show 

 that this head had not been trephined and nothing else about the head 

 itself suggests that this so-called bandage was connected with a surgi- 

 cal procedure. On the other hand, the writer has presented arguments 

 (1956) supporting the possibility that the patterns of osteitis and 

 bone scarring to which he has called attention (see also pis. 9 and 10) 

 were due to chemical irritants used in postoperative treatments. In 

 spite of this, the writer is inclined to favor septic osteitis rather than 

 chemical osteitis as the explanation of these features. 



In contrast to the paucity of information on postoperative pro- 

 cedures in ancient times, numerous observations made directly on 

 patients have been reported from Melanesia. From the data which 

 Ford (1937) has assembled it seems that in the Gazelle Peninsula "the 

 hole formed at operation was plugged with a piece of native bark 

 cloth." Here also it is reported that "before the scalp flaps were re- 

 placed the opening in the skull was covered with a piece of the inner 

 bark or inside leaf of the banana palm, which had been held for a 

 short time over the coals of a fire." In the Loyalty Islands cocoanut 

 shell was used instead of bark. In these islands also "The scalp was 

 stitched with a needle made from the wingbone of a flying fox, and 

 some of their own twine, which is fine and strong." And finally, after 

 the scalp flaps were replaced, it was the custom in the Duke of York 

 Group (north of New Britain), to bind the head with sun-dried strips 

 from the banana stalk. Ford adds (p. 474) that "the water of the 

 unripe cocoanut was used to wash the wound, and, in some cases, the 

 hands of the operator. This, since sterilization by heat was not under- 

 stood, provided the only relatively bacteria-free fluid available." This 

 pieced-together picture of postoperative procedures may approximate 

 a custom that was common throughout Melanesia. 



Ford implies that when the fracture cases were operated on the 

 patients were unconscious. This may have been true of most cases 

 of this sort everywhere. Even in Peru, where the cocoa leaf was 

 chewed for its narcotic effect, it is not certain how far this principle 

 was applied as a part of the surgical procedure. 



SITES OF OPERATION 



No part of the skull vault was immune to surgery, although naturally 

 the primitive surgeons did not go very deep under the temporal and 

 occipital muscles. Almost everywhere the left side of the skull seems 



