62 PRIMITIVE TREPHINING IN PERU [ETH. ANN. 16 
indicate that the tool penetrated the intracranial tissues in such man- 
ner that the operation probably became the immediate cause of the 
death of the victim, as in crania 1, 4, 5, and 17, and perhaps 2, 3, 6, 12 
(the later operation), and 15; this highly indefensible procedure appar- 
ently growing out of ignorance concerning the delicacy of brain and 
meninges. Again, the apertures seem to be located altogether at ran- 
dom with respect to the structures affected; no fewer than nine of the 
twenty-four operations involve sutures, and at least two (crania 13 and 
18) were, apparently needlessly, so located as to traverse the sagittal 
suture about its union with the coronal, thereby endangering especially 
delicate and conspicuous structures. Several of the operatious were, 
indeed, evidently located by wounds, and these cases might be con- 
sidered so desperate as to override ordinary prudence; yet a sufficient 
number are so manifestly ill placed as to indicate that the operator 
knew not whereof he wrought. 
While the inference seems unavoidable that some of the operations 
were intentionally located by traumatic lesions—indeed, the evidence 
of cranium 14 alone would appear conclusive on this point, even if it 
were not corroborated by that of 15, 16,17, and 19—yet there are a 
number of examples of aberrant location and erratic exploration. In 
cranium 1 no trace of antecedent lesion can be found about the locus 
of operation, though there was an evidently fresh wound, of a severity 
indicated by fracturing of the outer table, in a remote part of the skull; 
yet there is no indication of treatment about the wound, while explora- 
tory marks are found 30, 40, and even 50 mm. away from the center 
of the operation in the four cardinal directions, and the great out- 
lying incision would seem to have been exploratory or experimental. 
So also the score of widely distributed incisions, with exploratory 
scratches extending 25 mm. farther, displayed by cranium 5, tell of 
thoughtless hacking, with no indication of diagnosis or intelligent 
adaptation of means to ends. The fact that curative treatment was 
essayed at all in connection with the fearful wound displayed by 
cranium 16 would appear to indicate utter incompetence in diagnosis; 
and the fact that the chief treatment was located far from the center 
of the lesion, and that some of the more ambitious slashes were 
entirely beyond the region affected by the extensive fracture, strongly 
indicates absence of diagnosis in the ordinary sense, and demonstrates 
that the treatment was altogether inapplicable. In cranium 17, too, 
the operator went far afield in his earlier efforts, and evidently com- 
pleted an operation that had very little to do with the essential features 
of a wound which must have displayed conspicuous symptoms, and it 
is evident that he only approached the real locus of the lesion subse- 
quently, and then in an indefinite and blundering fashion which appar- 
ently resulted in the death of the long-suttering subject. These cases 
of obvious blundering might be doubled or tripled in the collection; 
they are only typical. Thus there are several examples of glaringly 
