18 PRIMITIVE TREPHINING IN PERU [ETH. ANN. 16 
those of the South Sea islanders, and (b) neoteric, or that performed 
moderuly, or by means of metal, including the skilless operations on 
domestic animals. Commonly, or always, neoteric trephining is aceul- 
tural, and represents the gngrafting of a higher technology on the 
stock of a lower sophiology. Specialized trephining may in like man- 
ner be subdivided into two classes—(a) rude, or that performed in a 
simple and barbarous manner by untrained or shamanistie operators 
without knowledge of physiology, as among the Kabyle; and (b) refined, 
or that performed skillfully and intelligently, as by civilized surgeons. 
Classed with respect to motive or purpose, trephining may be consid- 
ered as (1) thawmaturgic and (2) therapeutic. Thaumaturgic trephining 
is presumed to act in an occult or mystical way, either for the good of 
the sufferer or for the benefit of the operator or others; it may be styled 
(a) vicarious, when designed to benefit the operator or others, and ()) 
sortilegic, when practiced in the interest of the sufferer. Vicarious 
trephining as thus defined is commonly (so far as known through 
observation, always) post-mortem, while sortilegic trephining must be 
essentially ante-mortem. Under these definitions the prehistoric tre- 
phining recorded by Broeca, Fletcher, and others must have been 
vicarious, at least so far as post-mortem; while the operations exem- 
plified among the South Sea islanders, and perhaps also among the 
Kabyle, are sortilegic, and thus occupy a well-marked early stage in 
the development of medical practice. Therapeutic trephining may be 
defined as that employed intentionally and intelligently, and without 
regard to the supernatural, to relieve a disorder; and it may be either 
(a) empiric, when it is not, or (b) scientific, when it is, guided by 
knowledge of physiology or etiology, one or both. 
Trephining may be classed also by the culture-grade of the people 
practicing it, as (1) savage, (2) barbaric, and (3) civilized; or, more con- 
veniently,as (1) uncivilized and (2) civilized. This classification crosses, 
and in a measure corrects, the grouping by period, since it emphasizes 
the persistence in some countries of characteristics which in other 
countries existed only during the prehistoric past. 
These classes are defined from the standpoint of anthropology rather 
than from that of surgery or medicine in general; yet their recognition 
seems essential to comprehension of the origin and development of one 
of the most remarkable among the triumphs of modern surgery. Their 
significance is such as to warrant juxtaposition and careful comparison: 
Period Method Motive Culture-grade 
§ Refined § Scientific 
+ Rude ~~ ? Empirie 
§ Neoteric § Sortilegie 
? Archaic ( Vicarious 
Modern Specialized -. Therapeutic. Civilized 
Prehistoric Primitive - -- Thaumaturgic . Uneivilized 
On comparing the method classes with the periods and culture-grades, 
itis found that archaic trephining was chiefly prehistoric and exclu- 
sively eodemotic, but that neoterie trephining persists, at least ves 
tigially, among backward representatives of civilized peoples; yet that 
