STONE AGE SKULL SURGERY — STEWART 485 



to have been the most common site of operation. This may have been 

 associated with warfare and the delivery of blows to the head by 

 right-handed adversaries. In a series of 112 operations studied by 

 the writer in the Tello collection in the Peabody JVfuseum, 48.2 percent 

 are on, or largely on, the left side, as compared with 29.5 percent on, 

 or largely on, the right side, and 22.3 percent in the midline. The 

 further distribution of these operations is shown in table 2. Accord- 

 ing to these findings, the front of the skull received most attention. 

 Again, this would be an area vulnerable in warfare. 



Table 2. — Distribution of trephine openings in Peruvian skulls (Tello collection, 

 Peabody Museum, Harvard University) 



Location Number of cases Percentage 

 Frontal area: 



Frontal bone 26^ 



Crossing right coronal suture 9 



Region of bregma 12>60 68.6 



Crossing left coronal suture _ 12 



Extending from frontal to temporal 1/ 



Parietal area: 



Right parietal bone 3^ 



Crossing sagittal suture ^U? «« n 



Left parietal bone 18 [ 



Extending from parietal to temporal lj 



Occipital area: 



Occipital bone 4" 



Crossing right lambdoid suture 2 



Region of lambda... 7/15 18. 4 



Crossing left lambdoid suture 1 



Extending from occipital to temporal 1- 



Total... 112 



If the ancient surgeons knew of the danger of hemorrhage from 

 entering the sagittal and transverse venous sinuses, table 2 shows 

 that they were not deterred from cutting through the bone in these 

 areas (see also pi. 1). Neither were they deterred by the danger of 

 infection from operating on the frontal sinuses, although operations 

 at this point are not very common. Moodie (1929) illustrates some 

 cases and there is another in the United States National Museum 

 collection (No. 293795, Cinco Cerros). In the latter a fracture had 

 involved some of the facial bones and the frontal bone above the right 

 orbit. In making a trephine opening above the right orbit probably 

 the frontal sinus was encountered. Be this as it may, before healing 

 finally took place there was extensive scarring of the accessory nasal 

 sinuses from infection. 



A word should be said about the efforts of the Peruvian surgeons 

 in some cases to follow outlines of fracture. There is a remarkable 



