2 PRIMITIVE TREPHINING IN PERU [ETH. ANN. 16 
while there is not the slightest indication that the operation was 
vicarious in any ease. Accordingly the motive must be subclassed as 
sortilegic. 
SIGNIFICANCE OF PERUVIAN TREPHINING 
As set forth on earlier pages, trephining began in early prehistoric 
times, and was performed after death for the purpose of obtaining 
amulets. It seems necessary to conclude that the operation was grad- 
ually extended to living captives for the same vicarious purpose, and it 
seems certain that the operation was extended in turn to others than 
captives for slightly modified yet still essentially vicarious purposes. 
On this part of the development of trephining the Peruvian specimens 
do not seem to bear directly. 
As noted above incidentally, there is an important stage in the devel- 
opment of medical and surgical practice in which the motive is wholly 
thaumaturgic, yet in which the incantation is accompanied by medi- 
cation or manipulation; and it may be added that there are numberless 
known instances in which the manipulation is of great severity, extend- 
ing to searification, penetration of the tissues, incision of the bone, and 
actual trephining. Sometimes the manipulation is beneficial, when the 
prestige of the shaman grows, and the aimless operation is thereby 
encouraged until, if frequently successful, it grows into empiricism, 
the forerunner of scientifie medicine. There is thus a gradual transi- 
tion from purely thaumaturgic manipulation into empiric surgery. 
Now, it would appear that the Peruvian trephining represents some 
stage in this transition; and nothing more than inspection of the ill- 
planned, clumsy, and extravagant cutting is required to show that the 
stage was early, and that the empiricism in which the pupil imitates 
the teacher and the son the sire could hardly have been reached. 
Accordingly, Peruvian trephining marks one of the stages in the 
development of this branch of medical treatment, and indeed of med- 
ical treatment in general; and it falls in place with the other known 
instances of primitive trephining, running from the vicarious operation 
of prehistoric times to the empiric operation of the present day, to 
illustrate and demonstrate the rise of the art of trephination. 
As already noted, trephining is perhaps the boldest feature of mod- 
ern surgery; and it may be characterized as the only feature of modern 
surgery which is known to be of great antiquity. Accordingly, tre- 
phining may be considered to represent the trunk of the genetic tree 
of surgery, and the history of trephining may fairly be considered to 
represent the history of surgery, at any rate until within recent 
decades; and this history demonstrates that at least the major opera- 
tions of surgery were in the beginning performed on the dead, later on 
those whose lives were deemed worthless, and only in relatively mod- 
ern periods for the alleviation of suffering and the prolongation of life. 
Thus the Peruvian collection is of special note as a record of an 
important period in the unwritten history of surgery. 
