PLETCIIER.J CONCLUSIONS. 20 



point. Given, in injuiy of tlie head or abscess of the brain, the faiUn-e of a 

 function, the locahty of that function being known, there is the place to 

 trephine. Some very remarkable results have been attained, and the con- 

 sequence is that trephining has again become popular in France Broca 

 deserves the credit of being among the tirst to initiate this method of tre- 

 phining.^' This matter is referred to because a distinguished French surgeon, 

 M. Lucas-Championniere* published a work upon the subject about four 

 years ago, and in the introduction, speaking of prehistoric trephining, lie 

 takes the ground that the oj^eration was not performed by scraping, as Broca 

 supposed, but by a series of punctures such as have been described as pro- 

 duced by the Algerian operator.*^ To prove this, he took a flint weapon, and 

 drilling a series of holes in a skull, afterwards ran them one into the other 

 and removed the piece. The serrations were easily smoothed off Avith a 

 piece of flint. The result could not be distinguished from the opening pro- 

 duced by scraping, the beveled edges being alike. (See Plate IX.) 



This is ingenious and surprising; but while it must be admitted that 

 the perforations may have been made by puncture, yet the existence of a 

 considerable number of skulls imrtialJy trepliined, the outer table only 

 having been unmistakably scraped away, offers a strong presumption in 

 favor of the latter method. 



The following conclusions may be permitted: 



1. The large number of perforated neolithic crania exhibiting cicatrized 

 edges establishes the existence of a custom of trephining. 



2. The operation was performed on both sexes, and generally at an 

 early age. 



3. The purpose is doubtful, but from analogy it would seem to have 

 been for the relief of disease of brain, injury of skull, epilepsy or convul- 

 sions. 



4. The operation was probably performed by scraping; possibly b}^ n 

 series of punctures. It is likely that the first was employed for chiUlren 

 and the latter for the harder skulls of adults. 



■"M. Legouest, the professor of military surgery at Val ile Grace, formulates this remarkable 

 rule: "Singular as it may appear, I lliiuk the rule is that you should always trcphiue when you are 

 rtouhtful whether it ought to be done"! 



■"Etude historique et clinique sur la trepanation du crAue; la trgpanation gui(l(?e i).ar les localisa- 

 tions c6r(5brales. Par Just Lucas-Ghampiounifere. Paris, 1878. 8°, ji. 12. 



