44. PRIMITIVE TREPHINING IN PERU [ETH ANW. 16 
and approximately parallel incision was outlined. In addition there 
are several shallow notches in the lower margin of the aperture near 
the anterior extremity, evidently made by striking the instrument 
against the outer table while sawing across the base of the depressed 
tongue, either in making the third incision or (more probably) in making 
a nearly parallel incision traversing the tongue in a somewhat more 
nearly horizontal direction. All of the incisions and scratches were 
apparently made by the same tool. 
The sequence represented by the operation is indicated with consid- 
erable clearness. Initially there was a large depressed fracture with 
some adjacent cracking of the bone, the principal depressed tract being 
in the form of a tongue hinged at the anterior and upper sides, but com- 
pletely severed more than halfway around. Three or more incisions 
were made in such manner as to divide the hinge, and in making a 
part of them the tool was reciprocated on the depressed bone in such 
manner as to leave its marks on the free margin. When the incisions 
were fairly advanced, an elevator was used and the depressed tongue 
was forced out, leaving projecting edges of the inner table on the upper 
margin, and this operation was performed with such vigor that the 
anterior portion of the hinge passed beyond the nearly vertical incision 
and invaded the uninjured bone, breaking through both tables and 
leaving the inner projecting beyond the outer. At this point the oper- 
ation was discontinued, presumptively by reason of the death of the 
vietim; the rough edges were not smoothed, and there is not the slight- 
est trace of subsequent growth—indeed, the invasion of the cerebral 
tissues by the tip of the clumsily applied instrument would have been 
almost necessarily fatal. In this specimen there is no indication of 
local inflammation. 
Taken together, crania 14 and 15 appear to represent somewhat dif- 
ferent stages in precisely parallel operations. In cranium 14 the treat- 
ment was abandoned after the removal of a few fragments and splinters 
of bone, but before the removal of the principal tongue, while in 
cranium 15 it was abandoned immediately after removing the tongue or 
button. 
Cranium 15 displays the vertical grooves over the temples, one on 
either side, with a few smaller marks. In addition there is a prominent 
scar of a practically healed wound a little to the left of the center of 
the upper margin of the frontal bone. The wound was evidently pro- 
duced by a blow from a rather blunt edge, transverse to the median 
line, directed downward and forward so as to glance forward; the bone 
is indented and bruised, forming a transverse trough (15 mm. below 
the coronal suture) 5 or 6 mm. broad and 17 mm. long; below, the bone 
bulges slightly, and the lower side of the ridge is partly defined by 
a curved fracture of the outer table 18 mm. long. The edges of the 
fracture are knit, and there are other indications that the wound 
was practically recovered before death. 
