MUNIZ—MC GEE] OPERATION BY CURVILINEAR INCISION 3 
Of the two operations displayed, the clearer as regards moaus oper- 
andi is high in the frontal bone, invading the metopic suture, and 
centering 30 mm. below the coronal. The aperture is approximately 
circular, averaging some 27 mm. in diameter, measured on the outer 
surface, and rather less than 20 mm. measured on the inner surface. 
While the marks of the instrument are indistinct, the general character 
of the incisions is fairly indicated. The most clearly defined incision is 
an approximately rectilinear cut 25 mm. long, defining the left side of 
the aperture, curving anteriorly toward the metopic suture, which it 
just reaches some 20 inm. beyond the point of sharpest curvature. The 
other side of the aperture is defined chiefly by two fractures, one of 
which apparently was located by an incision some 20 mm. in length just 
on the right of and parallel to the metopic suture. So far as preserved, 
the principal incision is V-shape in section, attenuating toward one 
extremity but becoming indefinite toward the other; and it seems to 
have been carried through the outer table throughout most of its length 
and around the sharper part of the curye, and also nearly or quite 
through the inner table about the middle part of its length; then, as 
the walls of the aperture indicate, an elevator was inserted and the 
button was broken out entire or, more probably, in fragments by lever- 
age over the firm bone outside the region of cutting. Strive extending 
from the termini of the two horizontal incisions indicate slipping of the 
instrument, or preliminary exploratory cutting; and these, together 
with the features of the main incisions, bear the usual testimony as to 
the use of a single-point blunt instrument, apparently of stone. The 
extension and conformation of the cuts are best explained on the sup- 
position that the operator occupied a rather low seat and held the head 
of the patient (sitting or reclining on the ground or floor facing toward 
the operator’s right) between his knees, using his right hand for the 
cutting, and sometimes turning the head slightly as the work pro- 
gressed. The sharp edges of bone, particularly in the outer table, were 
finally smoothed off, though whether intentionally by the operator or 
subsequently by reparative process is somewhat questionable; yet the 
condition of both tables and diploe indicate with practical certainty that 
the sufferer survived the operation for months or years. No trace of 
lesion antecedent to the operation appears, and the bone is so thick 
and the aperture so small as almost to prove that there could have 
been no antecedent depressed fracture or related injury. 
The loeus of the other and earlier operation is the upper left portion 
of the occipital, just invading the lambdoid suture. The aperture is 
elliptical, measuring 18 by 23 mm. between the narrowest portions of 
the walls. At this point the skull is somewhat eroded by weathering, 
and the margins, especially toward the lambdoid, are slightly crumbled ; 
yet the state of preservation suffices to indicate long-continued repara- 
tive process whereby the bony margins were smoothed and rounded, 
the diploe completely obliterated, and all traces of instrumentation 
16 BETH 3 

