16 PRIMITIVE TREPHINING IN PERU [ETH. ANN. 16 
cases it is replaced by a plate of silver or other substance; sometimes 
the aperture is left and covered only by the scalp. 
The operation is employed in certain cases of depressed fracture or 
other traumatic lesions of the cranium, and in cases of intra-cranial 
tumors or suppuration; it is also employed for epilepsy, and more rarely 
as a prophylactic, or to gain access to the intra-cranial tissues for local 
treatment. 
By most practitioners trephining is regarded as a serious or even des- 
perate operation, and is resorted to only in grave cases. According to 
Bluhm’s statistics, covering nearly 1,000 cases, the mortality exceeds 
50 percent, most of the cases being of course complicated by the origi- 
nal lesion. The risk is better determined from the operations for epi- 
lepsy without antecedent traumatic conditions; of these cases 16 out 
of 72 collected by Billings and 28 out of 145 collected by Echeverria, 
or a mean of 20 percent, proved fatal, though some practitioners, using 
special precaution against sepsis and avoidable injury to bone and tis- 
sues, have obtained better results, one operator recording a mortality 
so low as 1 out of 30 cases. 
Trephining is occasionally employed in the treatment of disorders 
among domestic animals, though not so much by trained veterinarians 
as by rude herdsmen possessing little knowledge of anatomy and less 
of etiology, and imbued with fantastic notions concerning the effect of 
the operation; e. g., it is performed on sheep and swine with the notion 
of rupturing a supposed bubble or bladder beneath the skull, or 
extracting a grub or worm from the brain of the animal, and thus 
relieving a mysterious disorder. In such cases the operation is com- 
monly performed in rude fashion, perhaps with carpenter’s tools, a 
chisel and mallet, and even an auger being sometimes employed. Not 
infrequently the animal survives, and in some cases appears to be 
benefited. 
Among certain primitive peoples trephining is practiced, sometimes 
with astonishing frequency. The Kabyle, a nomadic and essentially 
autochthonous tribe of Algeria, resort to trephining not only in trau- 
matic lesions of the head, but for neuralgia, vertigo, and various other 
disorders. The operation is performed rudely, either with such tools 
or implements as may chance to be at hand, or with crude metallic 
saws, perforators, and elevators designed for the purpose.! Ordinarily 
the aperture, which is frequently large and usually irregular, is closed 
by a plate, though it is often left open and covered only by the sealp. 
The frequency of the operation indicates that the mortality can not be 
very high, and one observer saw men who had survived five or six 
operations at different periods and for different injuries. The operator 
is a hereditary shaman or priest, and the operation is, at least in part, 
thaumaturgic; the methods are clumsy, painful, and tedious, yet the 
victim glories in his undemonstrative endurance of the ordeal. 
North American Ethnology, vol. v, 1882, p. 25 et seq. 
