24 PRIMITIVE TREPHNING IN PERU [ETH. ANN. 16 
so it must have been that the well-known ante-mortem mutilation, 
which on the one hand grew into the scalping of wounded warriors and 
the appalling torture found among the American Indians as well as 
among other savages, must have grown on the other hand (when ante- 
cedent conditions were favorable) into ante-mortem trephining of 
wounded and later of woundless captives. When this stage was 
reached, experience—which taught primitive men as modern men are 
taught, though much more slowly—must have shown that sometimes 
the sufferers survived, and were perhaps even improved. Now, if the 
practice were continued among a given people into that part of the 
stage of physitheism in which the cult of kismet prevails (as among so 
many people in the upper strata of uncivilized culture, including the 
Kabyle, if not the South Sea islanders), the custom of trephining 
wounded captives would almost necessarily grow up, with the idea that 
a mystical significance attached to the operation as a sort of ordeal; the 
idea might be that, if fate so willed, the captive would thereby become 
the more perfectly affiliated with the captors, while if Allah decreed 
death under the knife—so mote it be. Thereis but one short step more 
to the solid ground of known fact, i. e., the gradual extension of the fatal- 
istic or sortilegic operation from captives to others; and this transition 
is in accord with known methods of thought among primitive folk 
belonging to that stage of physitheism or incipient psychotheism in 
which the ordeal was developed; for it was quickly perceived among 
many peoples that if the ordeal was beneficent to one class it could not 
be devoid of good when extended to other classes. Here again the 
structure of explanation rests on the firm ground of observation; for 
the typical trephining of the South Sea islanders, and in large measure 
the typical Kabyle operation, represent the general sortilegic stage in 
the development of trephining. 
The span of the explanation-structure extending from sortilege to 
empiricism is long but well supported; for while the transition from 
purely fatalistic treatment of the sick to empiric treatment of disease 
was slow among each people, its course has been well observed. Grad- 
ually the mysticism, the belief in occult power, waned; gradually the 
recognition that given treatment (howsoever random) was followed by 
fairly uniform results waxed. Thus the doctrine of signatures grew 
into simple therapeutics; thus the belief in blind fate grew into belief 
in the kingly touch; and thus dimly realized experience of the uniform- 
ity of cause and effect made medics out of hermits and beldams and 
chemists out of alchemists, and in time made nurses and neighborhood 
practitioners out of sedate and observant men and women. With the 
tedious revolution in medicine went a slow transformation in surgery, 
and the shamans and their descendant doctors gradually forgot the 
ordeal motive, and trephined men and animals in desperate cases because 
their teachers had done so—and were they not wise men? 
The span from empiric treatment of disease to scientific medicine 
aud surgery is not long, and is covered in the history of every civilized 
