MUNIZ—MC GEE] THREE DISTINCT OPERATIONS NIL 
(more exactly) a horseshoe. In the earlier part of the cutting the knife 
apparently slipped occasionally, particularly toward the heel extrem- 
ities, though as the incision deepened care was taken to bring these 
extremities nearer together. Finally, it would appear that the points 
of the incision were connected by a transverse cut, slightly curved, 
made with the right hand, slightly oblique to the axis of the horseshoe, 
as determined by convenience of movement, whereby the aperture was 
defined. Throughout the instrument was held obliquely, the obliquity 
increasing with the depth in such manner that the aperture measures 
considerably larger on the exterior surface than on the interior, while 
the profile of the cut surface is slightly concave. The aperture averages 
about 33 mm, in diameter without, and a little over 20 within. It appears 
rather probable that an elevator was used before the inner table was 
penetrated, and that the outer table was removed separately, affording 
greater freedom in extending the incisions through the inner table. 
After the aperture was opened, the operation was completed by serap- 
ing or rasping down the ragged edges produced in making the inci- 
sions and smoothing the entire margin of the aperture, evidently with 
great care, in such manner as to leave a thin projecting edge of the 
inner table resting on the intracranial tissues. In this final operation 
the deep scratches due to the slipping of the instrument toward the 
point of the horseshoe-shape incision were filed out into broad grooves, 
but two or three exploratory scratches forward of the opening were 
allowed to remain. Thus the operation was completed, evidently to 
the satisfaction of the operator; yet it is doubtful whether the patient, 
already mature or perhaps somewhat advanced in age, survived. While 
there are no clear indications of reparative process on the surface of the 
bone, and no unmistakable growth spicules, the diploe seems to be par- 
tially obliterated, and there are a few salients along the thin projected 
margin of the inner table which suggest secondary growth. On the 
other hand, there is some discoloration of the skull about the aperture, 
such as might be produced by localized inflammation, perhaps develop- 
ing into periostosteitis, suggesting that while the patient survived the 
immediate operation the sequelie were fatal. It may be observed that 
this great aperture, opening almost directly over an important sinus, 
violates in its location the modern rules of trephining, and could 
hardly be expected to eventuate otherwise than in the death of the 
victim. 
Of the three operations, two were undoubtedly long ante-mortem, 
while it is practically certain the third was ante-mortem also. Although 
the instrumentation is indicated only by the last operation, the simi- 
larity in form in the three apertures suggests that all were performed 
in essentially the same way. 
Aside from the operations, there are several indications that the 
individual led an eventful life; there is a deep contusion near the center 
of the right parietal (shown in plate xxxvu1); there is one of the cus- 
tomary supraorbital grooves or scratches near the right side of the 
