70 PRIMITIVE TREPHINING IN PERU [ETH. ANN. 16 
culture advanced, the materialization or incarnation of the evil ‘“mys- 
tery” declined, yet the primitive theory of disease persisted long, and 
indeed crops out today in the lower strata of civilization in every 
country on the globe; and medicine-men and medicine-women, wearing 
the mantles of the shamans of old, treat disease by incantation and 
exorcism, perhaps accompanied by simple medication or manipulation, 
which not infrequently chances to be beneficial. Thus, although the 
records of: trephining among the South Sea islanders are in one respect 
incomplete, there can be little doubt as to the motive underlying the 
operation. Interpreted in the light of invariable ideation among primi- 
tive peoples, the motive must be considered thaumaturgic, and the 
actuating idea the design of liberating some ialeficent ‘‘mystery” by a 
ceremonial incantation grown into local treatment of unusual severity; 
and in view of the unanimity of motive among all primitive peoples, so 
far as known, it seems not only just and safe but necessary to ascribe 
to the ancient practitioners of Peru the motives of other American 
Indians as well as the methods of the South Sea islanders. Thus the 
16 apparently erratic and aimless operations displayed in these 11 
erania find a rational and adequate explanation; the treatment may 
have been for vertigo, headache, or other disease; for coma, produced 
by shocks or blows of such character as to leave no marks, or for tri- 
fling wounds; but it is safe to consider the trephining thaumaturgic 
and (albeit perchance beneficial) wholly independent of physiologic 
knowledge and eticlogic skill. 
On considering the relation of this group of operations to individual 
history, it appears that at least 6 out of 16 were so far successful that 
the subjects survived for years, as attested by growth of bone, and that 
at least 4 and perhaps 5 more survived for shorter periods, giving a 
ratio of success quite as high as that attending modern practice; so 
that, whatever the motive in detail, there was adequate prestige for the 
practitioners and adequate encouragement for continuing the practice. 
Recurring now to the 5 or 6 crania displaying antecedent lesions 
associated with the operations, and considering the cases in the light 
of the almost inevitable inferences concerning contemporary treatment 
in other cases, a suggestion arises as to the special motive in these 
individual cases. The suggestion is that the victims were treated not so 
much for the wounds, which the skilless practitioner was unable prop- 
erly to diagnose, as for the symptoms attending the lesions. Pursuing 
this suggestion, it appears that in every case the wounds were of such 
character as to produce coma, delirium, or other functional derangement 
so serious as completely to control the conduct of the individual—i. e., to 
produce in exaggerated degree such disorders as are habitually treated 
by the South Sea islanders. Assuming the treatment to have been 
actuated in this way, its localization, sometimes accurate but as often 
erratic, is easily understood; for no shaman is so completely dominated 
by his ideals as to neglect local indications. A parallel case in which 
