42 PRIMITIVE TREPHINING IN PERU [ETH. ANN. 16 
such as to prove conclusively that the fracture preceded the incision. 
In this case, too, there are irregular scratches about the extremity of 
the incision, showing slipping of the tool. The terminus of a fourth 
incision or series of incisions appears near the anterior extremity of 
the wound, approaching the central part of the second incision. These 
deep scratches were apparently made on a hinged fragment of the bone 
connecting this part of the skull with the principal depressed tongue; 
and it is evident, first, that they were not made until after the fracture, 
and, second, that a fragment of bone has disappeared since they were 
made. In addition to these definite incisions, there is a shallow cut or 
scratch 15 mm. long, nearly parallel with the second incision, extend- 
ing from the anterior extremity of the wound toward the median line; 
it is indistinctly shown in plate XXrx, 
It is noteworthy that the bone was stained and the periosteum modi- 
fied over a tract considerably larger than that of the fracture (though 
this is not clearly indicated in the reproduction). On the lower side of 
the wound this tract is not clearly defined, though its margin seems to 
be close to that of the fracture; but on the upper and posterior sides 
it forms a zone 10 to 15mm. wide, semicircumscribing the wound. This 
feature is especially significant in connection with the local discolora- 
tion and modification of several other crania, notably 1, 2, and 5. It 
would appear to represent extension of the injury to the soft tissue, 
perhaps resulting in periostosteitis, or death and exceptionally rapid 
post-mortem decomposition in advance of mummification. 
The sequence of events and movements in the history of the case is 
indicated by this specimen with considerable clearness and certainty. 
It is evident that the first event was the production of the wound by 
impact of a hard object (perhaps a sling stone or club spike). It seems 
probable that several hours then passed without treatment, during 
which local inflammation developed and extended to the periosteum. 
Then the operation was commenced, apparently by opening the scalp 
and laying bare the bone (since otherwise the subsequent removal of 
bony splinters could hardly have taken place). Then it would appear 
that a short incision (the fourth of the foregoing description) was made, 
whereby one or two fragments of bone were liberated and removed 
from the anterior and lower margins of the wound. Then the principal 
incision skirting the upper side of the wound was made, and another 
splinter partly liberated; and, to dissever this splinter, the short inci- 
sion aboye the depressed tongue was then produced, when the frag- 
ment was broken out by means of an elevator, leaving a small irregular 
projection of the inner table just beneath the intersection of the two 
incisions. It would appear that the anterior incision was then started 
for the purpose of removing the rough edges of the bone and giving 
access to the conspicuous sliver of the inner table at the lower side 
of the fragment. This incision was soon abandoned, and the opera- 
tion discontinued, There is nothing to indicate whether the scalp was 
