TrepannedPeruvianskull。
　　AfewyearsagoasepulchrewasopenedatChaclacayo，atthefootofMountChosica，notfarfromLima。Inthistomblaythreemummies，ofaman，awoman，andachild。Nearthemlayahumanskull，havingaboutthemiddleoftheforeheadanopening，measuringsometwoandahalfbytwoinches。Itisofpolygonalform，andeightdifferentincisionscaneasilybemadeout，whichappeartohavebeenmadewithsomenotchedstoneimplement。Onraisingastripofskin，stilladheringtotheskull，therewasseenonthefrontpartofthesagittalsutureaverysmallperforation，theresulteitherofawoundorofanoperationwhichbadtakenplaceduringlife。Ithasbeensuggestedthatthepieceofbonetakenfromtheskullhadbeenusedtomakealanceorarrow-head，whichwassuperstitiouslysupposedbytheownertoensurehisvictory。Thisis，however，ameresuggestion，ofwhichnoproofcanbegiven。
　　InotherpartyofAmericadiscoverieshavebeenmadeoftrepannedskulls，supposedtodatefromevenmoreremotetimesthanthosewehavejustbeenconsidering。AfewyearsagoProfessorPutnamfound，intheStateofOhio，someoldwellsidledwithcindersandrubbishofallkinds。Fromoneofthem，whichwasdeeperthantheothers，hetookseveralcrania，someofwhichboreevidenttracesoftrepanation。FromamoundnearDallasIllinoisweretakenmorethanonehundredskeletons，allofadults，placedsidebysideinacrouchingattitude。Everyoneofthemhadaroundopeningonthelefttemple，andinsomeofthesewoundstheflintimplementwhichhadproducedthemwasstillimbedded。Itisveryevidentthatwehaveheretokensofsomefunerealrite，themeaningofwhichisuncertain，thoughitwasevidentlypractisedalsoindistrictsveryremotefromIllinois。Tomentionyetotherexamples，theexcavationofatumulusofirregularformnearDevil’sRiverMichiganhasbroughttolightfiveskeletonsburieduright，whilstasixthlayinthecentreofthetumulus，whichwasevidently，ifwemaysoexpressit，theplaceofhonor。Oneachofthesixcraniaaperforationhadbeenmadeafterdeath。
　　AnumberofcraniaandpartsofcraniaonwhichtrepanationhadbeenperformedhavealsobeentakenfromseveralmoundsonChamber’sIsland，frombeneaththemoundintheneighborhoodoftheSableRiver，nearLakeHuron，andneartheRedRiver[198]GillmanthinksthattheMichigantrepanations，whichbadbeenmadewithclumsytools，weresimplyholesforhangingupskullsastrophies，asisstillcustomaryamongsttheDyaksofBorneo；butthisseemsscarcelyatenablehypothesis，forasaruletheskeletonslyingintheirlasthomearecomplete。Quiterecentlywerediscovered，beneathatumulusnearRockRiver，eightskeletons，theskullofoneofwhichboreacircularperforationmadeduringlife，whichratherupsetsGillman’stheory。
　　Buttoresumeournarrative。ThetrepanationsreportedfromNorthAmericaaregenerallyposthumous，andwecanprovenothingastotheirorigin。Weretheymarksofhonormadeinsomereligiousrite？Weretheyopeningstoallowthespiritofthedepartedtorevisitthebodyithadabandoned？or，tosuggestafarmoreworldlyandrevoltingmotive，weretheymerelyholesthroughwhichtopickoutthebrainsofthedead。Amissionary，inaletterdatedfromFortPittCanada
　　in1880，describesthemodeofscalpingpractisedbytheRedskins，andsaysthattheyoftentakearoundpieceofskullaswellasthescalp。Maynotthisbeacaseofatavism，orthetransmissionofacustomfromonegenerationtoanother，fortheoriginofwhichwemustgobacktothemostremoteages？Inthepresentstateofourknowledge，insufficientasitis，thisexplanationisthemost。plausible。
　　ItisevenmoredifficulttocometoasatisfactoryconclusionwithregardtoEuropeanexamplesofthepracticewehavebeendescribing。Trepanationwascertainlypractisedinthetreatmentofcertaindiseasesofthebone，suchasosteitisorcaries。ProfessorParrotmentionsacaseworthquoting。[199]AfewyearsagoseveralskeletonswerefoundatBray-sur-SeineSeine-et-Marnewithnumerousobjects，suchaspolishedstonehatchets，bonestilettos，shellnecklacesandornaments，allundoubtedlyNeolithic。Oneofthecraniahadbeentrepanned，thepositionoftheoperationshowingthatitsobjecthadbeentotreatanosteitis。Theoperationhadsucceeded，andthecicatrizationofthebones，bothaboutthewoundandinthepartsoriginallyaffected，showsthatrecoverywascomplete。Thisistheonlyexamplewehaveofanoperationexecutedwithaviewtocuringadiseasethatcanactuallybeseen，anditenablesustoconcludethatthesemen，ofwhomweknowsolittle，hadsomenotionofsurgery。Weretrepanationsalsopractisedtocureepilepsyortohealmentalaffections？Fromtheearliesttimestheseatofthesetroubleswasalwayssupposedtobethebrain，andanancientbookofmedicinerecommendsasaremedythescrapingoftheoutsideoftheskull。[200]Inarecentbook“DelaTrepanationdansl’EpilepsieparleTraumatismeduCrane“，Echeverriamentionsseveralcasesofcurebytrepanationwhenepilepsyhadbeentheresultofaninjury。Observationmayhaveledourprehistoricancestorstodiscoverthis。Maywedatethiscustomthenfromprehistorictimes？Itisverydifficulttodecidewithcertaintyeitherfororagainstit。
　　Ofonething，however，wemaybequitecertain。Thecranialperforationssomuchlikeoneanotherreportedfromdistrictssoremoteanddifferentincharacter，cannotbeaccidental。Itisimpossibletoattributetochancetheoccurrenceofinjuriesofexactlythesamesizeincraniaoftotallydifferentorigins。SettingasidetheEntre-Rochesskull，theantiquityofwhichdoesnotseemtoussufficientlyestablished，wefindthiscustommaintainedthroughouttheperiodcharacterizedbytheuseofpolishedstoneweaponsandimplements，theerectionofmegalithicmonuments，andthedomesticationofanimals。ItwaspractisedbythemenofthecaveofL’HOMMEMORT
　　atthebeginningoftheNeolithicperiod，andwasstillinuseatMoretwhenmetalsbegantobeknown。ThediscoveriesofDr。Wankel，theexcavationsofthetumulusofGuisseny，provethattrepanationwascontinuedthroughouttheBronzeage，whilsttheJeuillyandLimettombsshowthatitwasnotdiscontinuedeveninMerovingiantimes。
　　Thelongcontinuanceofsuchapracticeisaveryinterestingfact，andwemaymentionayetmorecuriousone。Howarewetoexplaintrepanationsthathadnoapparentmotiveoncraniashowingnosymptomsofdisease？Howaccountfortherepetitionatdifferenttunesofthisoperation，firstonthelivingsubjectandthenonthecorpse，asatSt。Affrique，BougonFig。82，atFeigneuxOise，whereDr。TopinardhasrecentlymadeexcavationsinaNeolithiccaveandreportsthatadolichocephalicskullofthesametypeasthecraniaofthecaveofL’HOMMEMORT，belongingtoamanofaboutthirtyyearsofage，boretwoperforations，onemadeduringlife，theotherafterdeath？Thefirstmeasuredtwoandathirdbytwoandahalfinches，andwassurroundedbyscratches，showinghowclumsytheoperatorhadbeen。[201]
　　SkullfromtheBougondolmenDeux-Sevres，seeninprofile。
　　Innearlyeverycasethesubjectsoperatedonwereyoung，andlongsurvivedtheoperation。Theknowledgeofthisfactwasfromthefirstaveryusefulguideinthestudyofthesubjectoftrepanation，andeagerlypursuedresearchesconstantlyconfirmit。Oneskull，forinstance，fromthecaveofL’HOMMEMORTFig。83，hadalargeopeningproducedpartlybyanoldoperationandpartlybytwoposthumoustrepanations。Thesubjecthadbeentrepannedinchildhoodorearlyyouth。Therecouldbenodoubtonthatpoint；cicatrizationhadbeencomplete，thebonytissuehavingreturnedtoitsoriginalcondition。Thenafterdeath，atanadultage，therelationsorfriendsofthedeceasedhadcutoutfurtherroundportionsoftheskullasnearaspossibletotheoldwound，probablywithaviewtokeepingthesepiecesasamulets。
　　Trepannedprehistoricskull。
　　ThiswastoBrocaaflashofilluminatinglight，andaccordingtohimwasinsomecasesareligiousrite，aceremonyofinitiation，perhapsevenacustominculcatedbyanestablishedreligion。Thechildwhohadbeensubjectedtoitandhadsurvived——asprobablymostofthevictimsdidsurvive，——attainedtoacertainpositionandcelebrityinhislife，andafterhisdeaththefragmentsofhisskull，especiallythoseportionsneartheoldwound，becametreasuredrelics，andwereintheendburiedwiththeirfortunatepossessoronhisdeath。
　　Thissuperstitionappearstohavelongsurvivedeveninhistorictimes，andaGallicchainisquoted[202]onwhichhungaroundpieceofskullwiththreeholesinit。In。deed，theseornamentsweresomuchsoughtafterthatcounterfeitsofthemweremade；atleast，wecannotinanyotherwayaccountfortheoccurrenceofobjectsexactlyresemblingroundpiecesofhumancrania，butinrealitymadeoutofpiecesofastag’santlerfoundintheBaumes-ChaudesCave。
　　Yetanotherpointdeservesmention。Itwasevidentlyconsideredundesirablethatthecraniafromwhichpieceshadbeentakenshouldbeleftinamutilatedcondition，andthereforepiecesfrontothercraniaweretakentofillupthegap，sothat，saysBroca，[203]
　　anewlifewasevidentlysupposedtoawaitthedead，forotherwisewhatobjectcantherestitutionhaveserved？
　　Dr。Prunieresisalsoofopinion[204]thattheintroductionintothecraniaofcertaindeceasedpersonsofroundpiecesfromotherskullsimpliesthebeliefinanotherlife。Thisexplanation，hypotheticalasitis，isreallyveryplausible，anditisapleasantthoughtthatourremoteancestorshadfaithinafuturelife；whichfaithisalikethegreatesthonorandthegreatestcomfortofhumanity。Isnotyetanothermorestrikingproofofthebeliefinasecondexistencetobefoundinthenumberofobjectsplacedintombsatallperiodsoftimeandineverypartoftheworld？Itisthisbelief，raisingmanasitdoesabovethematerialneedsofhisdailylife，whichformsthetruegrandeurofthehumanrace，andifanationoncelosesititissuretorelapseintobarbarism。
　　Whentrepanningwasthefashionthereisnodoubtthattheoperationwasperformedinmanydifferentways。Posthumoustrepanationswereaccomplishedwiththeaidofaflintimplementusedasachiselorasaw。Therewasgreaterdifficultyaboutanoperationonalivingsubject。BrocaisofopinionthatitwasdonewithadrillturnedroundandroundintheskullinthewaytheFrenchshepherdsstilltreatdiseasesofthecraniaintheirsheep。Theellipticalformofthewoundseemedtohimtoprovethis，andhewasfurtherofopinionthatwhenanopeninghadbeendrilledintheskullatthepointchosen，thetrepanationwascompletedbyscrapingthebonewithasmallflintblade。[205]DiscoveriesmadesincethedeathofthegreatFrenchanthropologist，however，compelustomodifythisopinion。Theinflammationofthebonenoticedalongtheedgesofthetrepanationprovesthatanotchedimplementwasusedtosawoutthepieceofskull。[206]
　　Howevertheoperationmayhavebeenperformed，itisnotoneofgreatdangertothepatientorofgreatdifficultytotheoperator。ExperimentsonanimalswithQuaternaryflintimplementshavealwaysbeensuccessful，andhavehadnotragicresults，whichisthebestproofwecanpossiblygive。
　　Thesizeoftheperforationsmadevariesadinfinitum。One，thelargestknown，isdescribedwhichisnolessthansixteeninchesindiameter。[207]Examplesareknownofthetrepanationofeverypartoftheskull，evenoftheforehead，whichatonetimewassupposedtohaveescaped。Wehaveourselvesgiveninstancesoffrontaltrepanation，andDr。Prunieresmentionselevencasesinwhichtheforeheadhadbeenoperatedon。
　　Toconclude，wemustrepeatthattrepanationisnotreallyadangerousoperation，andthereasonitisnearlyalwaysfollowedbythedeathofthesubjectinourowntimeisbecauseitisneverattemptedexceptindesperatecases，andthefatalresultisreallycausedbythecerebraldisease，onaccountofwhichtheoperationwasperformed。Historytellsusofitspracticeinveryancienttimes；HippocratesspeaksofitasoftenresortedtobyGreekphysicians。ItisperformedinthepresentdaybytheNegritosofPapuaandthenativesofAustraliaandofsomeoftheSouthSeaIslands，whereitisconsideredefficaciousinmanymaladies。WealsofinditpractisedbytheroughminersofCornwallandthewildmountaineersofMontenegro。[208]AnarmydoctorwhotravelledinMontenegroafewyearsagosaidthatitwasnorarethingtomeetmenwhohadbeensubjectedtotrepanationseven，eight，orevenninetimes。Itisaninterestingquestion，thoughwemustnotenterintoithere，whethermanyracescouldstandsuchanumberofoperationsasthis。
　　Theonlyinstanceweknowinthepresentdayoftrepanationpractisedasareligiousrite，ismetwithamongtheKabyles，whoareestablishedatthefootofMountAuresonthesouthoftheAtlas。TheoperationisperformedamongthembytheTHEBIBE，oneoftheirpriests，bytheaidofasimplegimletwhichheturnsrapidlyroundbetweenhisfingers。AmongtheKabylesaremenwhohavesubmittedtoanoperationofthiskindseveraltimes。
　　Wehavenowpassedinreviewtheweaponsofprehistoricpeoples，thewoundstheycaused，andthemodesofhealingthemknowntoourancestors；wehavestilltostudythemodesofdefenceresortedtobytheminfaceofthemanydangersbywhichtheyweresurrounded；
　　buttheimportanceofthissubjectissuchastodeserveseparateconsideration。