68 PRIMITIVE TREPHINING IN PERU [BTH. ANN. 16 
fall into three categories. In the first category, represented by crania 
6, 14, and 15, the operations were located by depressed fractures of con- 
siderable gravity, and the procedure, albeit clumsy, was of such char- 
acter as to tend to afford relief—i. e., the wounds were such as modern 
practitioners would treat by cranial cutting, including the removal of 
bony splinters, the excision of rough edges, and the elevation of the 
depressed bone, in a manner corresponding fairly with the primitive 
procedure, Accordingly, if these cases stood by themselves, they 
would appear to indicate rational therapeutic surgery; and the indica- 
tion of the operation coinciding with pathologic lesion (cranium 2) is 
similar. The second category is represented by cranium 19, in which 
the wound was apparently a depressed fracture, with extensive stellate 
fissuring—i. e., a wound in which trephining would be indicated to 
modern practitioners, unless the symptoms permitted diagnosis of the 
great extension of one of these fissures through the orbital and nasal 
bones. Accordingly, this example also suggests rational therapeutic 
motive, and the suggestion is greatly strengthened by the use of a 
plate. In the third category, represented by crania 16 and 17, on the 
other hand, the treatment was not only barbarous and clumsy, but ill 
directed. In the first example the wound was of such character as to 
contraindicate trephining, while in the second it was of such nature 
as to require a treatment quite different from that adopted. As 
already noted, this and several other cases demonstrate ignorance of 
physiology and etiology on the part of the operators. They might, per- 
haps, be regarded as representing the efforts of specially bungling 
practitioners, though there is nothing save the treatinent in the three 
or four foregoing cases to suggest greater skill on the part of any of 
the practitioners; and accordingly these exampies can hardly be con- 
sidered to represent a rational therapeutic surgery. On the whole, 
this group of crania, taken by themselves, appear at first sight, albeit 
somewhat doubtfully, to represent definite therapeutic treatment; yet 
it is to be observed that their testimony is indicative or merely sugges- 
tive rather than conclusive. 
On considering the outcome of the treatment exemplified in the six 
cases, a significant relation appears—three of the victims died under 
the knife early in the operation, two more died before the aimless 
hacking and scraping was completed, and the sixth died after the oper- 
ation was completed but before the beginning of reparative process in 
the bone. Thus none of the subjects of the suggested therapeutic 
treatment survived. It is true that in three of the cases the wounds 
were almost necessarily fatal, and that in the others they were so seri- 
ous as probably to result fatally without prompt and judicious treat- 
ment, yet the fact remains that the collection shows absolutely no basis 
for the encouragement of trephining as a therapeutic treatment for 
traumatic lesions. 
Accordingly, on full consideration of all of the facts and relations 
displayed by the group of crania in which the operations were located 
