486 ANNUAL REPORT SMITHSONIAN INSTITUTION, 1957 



example of this in the Tello collection, Peabody Museum (identified 

 simply by the letter "A," but probably in the LI. series), consisting 

 of a mummified head which had received a large comminuted fracture 

 on the left side of the occiput. Apparently the surgeon had taken 

 out the loose pieces of bone, leaving an irregular hole 46 mm. long 

 and 31 mm. wide. Then he had followed one of the fracture lines 

 forward to the coronal suture, turning back the soft parts and clean- 

 ing the bone (as evidenced by the still displaced tissues and by 

 scratches on the bone). This was bold surgery. Had the patient 

 lived, his skull would have shown widespread scarring. 



Piggott (1940, p. 122) says that in Europe "there . . . appears 

 little evidence for any regional predilection." However, he notes 

 that "The commonest region trepanned seems the parietal, and there 

 is perhaps a tendency for the left side to be preferred" (p. 123) . He 

 adds that "there is a curiously high proportion of frontal operations 

 in the Czechoslovak group and it occurs again at Grydejoj in Den- 

 mark" (pp. 122-123). 



In Melanesia the frontal bone seems to have been the site of elec- 

 tion for the prophylactic operations made in infancy (Ford, 1937). 

 So far as adults are concerned, the distribution of sites may well 

 follow the Peruvian pattern, since in both places most of the skull 

 fractures were received in warfare. 



OUTCOME OF OPERATION 



It should be clear from what has been said, as well as from the 

 illustrations given, that trephining was practiced in ancient times, 

 and recently by peoples in a primitive stage of culture, with a con- 

 siderable degree of success. Fairly reliable data on this subject are 

 available for Peru, owing to the large number of specimens that have 

 been assembled from there. For example, by combining the 214 

 operations seen by the writer in the collections of the U. S. National 

 Museum, the American Museum of Natural History, and the Peabody 

 Museum, 55.6 percent show complete healing, 16.4 percent beginning 

 healing, and 28 percent no healing. Others have reported similar 

 figures (Stewart, 1950). 



For the Neolithic period of Europe Piggott (1940, p. 122) says 

 simply that — 



the proportion of survivals from this operation ... is extremely high, as is 

 evidenced by skulls showing the healthy growth of new bone around the edges 

 of the opening, nor is it unusual for one skull to exhibit evidence of two or 

 more operations all with healed edges. 



Cases of repeated successful operations on the same individual are 

 known also from Melanesia. For this area Ford appears to subscribe 

 to the high estimates of recoveries given by several authors. One 

 figure he mentions is "about 80 percent," and here emphasis is placed 



