MUXIZ—MC GEE] ORIGIN OF TREPHINING 19 
in general primitive method coincides with uncivilized culture. In like 
manner it is found that rude trephining, as displayed typically among 
the Kabyle, is distinctively above that of the prehistoric period and 
demonstrates a differentiation of labor and a social organization tran- 
scending that of simple kinship, so that it falls logically into the civilized 
stage, while refined trephining belongs to advanced culture. 
When the motive classes are compared with the others, it is found 
that vicarious trephining is wholly prehistoric so far as present knowl- 
edge extends, and that both the vicarious and sortilegie operations are 
essentially uncivilized, though the sortilegic practice is found in modern 
times among peoples of the lower culture status. So, too, the vicarious 
operation was performed by the archaic method, while the sortilegic 
operation is essentially neoteric, though the thaumaturgic motive out- 
lived the primitive method so far as partially to control the rude opera- 
tions of the Kabyle class. Similarly the empiric operation is character- 
istically rude, and in general pertains to the modern period and marks 
the transition from uncivilized to higher culture, while scientific tre- 
phining is modern in period, refined in method, and civilized or enlight- 
ened in culture-grade. 
These coincidences are too many and too close to be fortuitous, and 
the classes can be regarded only as indices to the progressive develop- 
ment, if not to the origin, of trephining and of so much of surgery as is 
involved therewith. 
ORIGIN AND DEVELOPMENT 
Trephining is one of the boldest operations of modern surgery, rival- 
ing plastic surgery and cceliotomy as a revelation of the ambition and 
ability of the trained practitioner to explore, modify, re-create, and in 
every way shape to his liking even the most delicate parts of living 
organisms. Yet, remarkable as is the modern achievement of special- 
ized trephining, it pales before the marvel of primitive trephining, which 
is proved by indisputable, though all but incredible, evidence to have 
been performed habitually and successfully by barbaric and even savage 
peoples during remote ages. The archeologic and ethnologic records 
prove not merely the occurrence of the operations in prehistoric times 
and among various tribes, but indicate that among certain primitive 
peoples the operation was better known than in modern civilization, 
more common even than in modern hospitals. Among the Kabyle, stu- 
dents are impressed by the number of individuals who have undergone 
‘the operation; among the South Sea islanders, the observers report 
that nearly every male adult has been trephined once or oftener; and 
among the prehistoric ossuaries of southern Europe the proportion of 
trephined crania is strikingly large. Perhaps the best evidence as to 
the frequency of the operation among the primitive people of the world 
is that afforded by the Muniz collection, with its ratio of 2 percent 
of trephined individuals and 2.5 percent of operations to entire 
