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 Front Cover
 List of Illustrations
 Main
 Index






Group Title: Contributions to North American ethnology. vol.v pt.2
Title: On prehistoric trephining and cranial amulets
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Full Citation
STANDARD VIEW MARC VIEW
Permanent Link: http://ufdc.ufl.edu/UF00081792/00001
 Material Information
Title: On prehistoric trephining and cranial amulets
Alternate Title: Contributions to North American ethnology ; vol.5, pt.2
Physical Description: 32 p. : illus., ix pl. ; 30 cm.
Language: English
Creator: Fletcher, Robert, 1823-1912
Publisher: Government Printing Office
Place of Publication: Washington, D. C.
Publication Date: 1882
Copyright Date: 1882
 Subjects
Subject: Trephining   ( lcsh )
Amulets   ( lcsh )
Indians of North America -- Medicine   ( lcsh )
Genre: non-fiction   ( marcgt )
Spatial Coverage: United States of America
France
 Notes
General Note: At head of title: Department of the Interior. U.S. Geographical and Geological Survey of the Rocky Mountain Region.
Statement of Responsibility: by Robert Fletcher.
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Bibliographic ID: UF00081792
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: oclc - 03370712
lccn - 02027778

Table of Contents
    Front Cover
        Page 1
        Page 2
    List of Illustrations
        Page 3
        Page 4
    Main
        Page 5
        Page 5a
        Page 6
        Page 6a
        Page 6b
        Page 7
        Page 8
        Page 8a
        Page 8b
        Page 9
        Page 10
        Page 10a
        Page 10b
        Page 11
        Page 12
        Page 12a
        Page 12b
        Page 13
        Page 14
        Page 15
        Page 16
        Page 17
        Page 18
        Page 19
        Page 20
        Page 21
        Page 22
        Page 23
        Page 24
        Page 24a
        Page 24b
        Page 25
        Page 26
        Page 26a
        Page 26b
        Page 27
        Page 28
        Page 28a
        Page 28b
        Page 29
        Page 30
    Index
        Page 31
        Page 32
Full Text








DEPARTMENT OF THE INTERIOR
U. S. GEOGRAPHICAL AND GEOLOGICAL SURVEY OF THE ROCKY MOUNTAIN REGION
J. W. POWELL IN CHARGE




ON




PREHISTORIC TREPHINING



AND


CRANIAL AMULETS


BY


ROBERT FLETCHER M. R. C. S. ENG.


ACT. ASST. SURGEON U. S. ARMY


WASHINGTON
GOVERNMENT PRINTING OFFICE
1882








































LIST OF ILLUSTRATIONS.



Page.
PLATE I.-Cranial amulets ............................... .................---........... 5
II.-Cranium exhibiting surgical trephining ...-...............-.......-........-...... 7
III.-Crania showing effect of fracture and disease ..................................... 8
IV.-Vertex of skull showing effect of saber-stroke ----..............--.........-- ..... 10
V.-Cranium exhibiting effect of early surgical trephining ............................ 11
VI.--Cranium exhibiting both surgical and post-mortem trephining ......--............- 13
VII.-The Inca skull from Peru ....................--------------...............-------------............. 24
VIII.-Instruments for trephining used by the Kaby]es ................ ................. 26
IX.-Cranium artificially trephined by M. Championnire ---....--....................... 29

FIGURE 1.-Perforated skull from Sable River, Michigan--.................................... 24
2.-Fragment from Kabyle skull -----...---------------------..................---.... 26

3


















PRERIISTORIC TREPIININ'NC. IV. 1.


FIc. 1.


FIi. 2.


"i -,'


'N



.1
ii


I~ '....,_ D
r) ; '^^


FIG. 3.


A



treplhiing ; A-C, B-D, post-mortem sections. FIG. 4. A-B, cicatrized edge. Fl. 5. Amulet with groove for sus-
pension. All natural size. (Broca.)


r ." (7. ..INA ;. SrRi'I .


r-























ON PREHISTORIC TREPHINING AND CRANIAL AMULETS.


BY ROBERT FLETCHER.


Since the publication of Professor Broca's interesting article on Cra-
nial Amulets and Prehistoric Trephining, in 1877,1 no connected account
has been attempted, so far as the writer knows, of the additional discov-
eries which have been reported. These are scattered through the journals
on anthropology, and it would seem that a review of the whole subject,
commencing with a summary of Broca's observations and arguments, and
bringing together subsequent discoveries, would not only be of interest in
itself, but might result in more careful observation, leading perhaps to dis-
coveries of a similar custom in America.
The first communication upon the subject of cranial amulets, and which
led to the discovery of evidence of prehistoric trephining, was made in
August, 1873, by M. PruniBres, at the meeting, at Lyons, of the French
Association for the Advancement of Science.2 M. PruniBres is well known
for his researches in connection with the dolmens of La Lozere. He
exhibited to the association a piece of bone of an ovoid shape, 50 milli-
meters by 38 in its two diameters. (See Plate I, figs. 1 and 2.) The two
faces were untouched, but the edges had been beveled and most carefully
polished. It was discovered in the interior of a skull the entire side of
which had been cut away, but it was not a part of this skull; the difference
SSur la trEpanation du crnuo, et cls amulettes cranienues a 1'6poque n6olithique, par Paul Broca.
Paris, 1877, 80. Also, Rev. d'anthrop., Paris, 1877, vi, 1-42; 193-225. Also, Congres d'anthrop. ct
d'archdol. pr6hist., Budapest, 1876, 101-192.
2 Assoc. frangaise pour l'avancement des sciences. Compete rendu deo la 2'1 sess., Lyon, 1873, Paris,
1874. 8, p. 703.













PREHISTORIC TREPHI1ING.


in color, thickness, and density of structure showing, beyond a doubt, that
it had formed part of another cranium.
At various times similar pieces of bone were discovered, in some of
which holes had been drilled or grooves cut, as if for the purpose of sus-
pending the fragments from the person. The name of "rondelles" has
generally been applied to these fragments, although some archaeologists,
accepting the theory of M. PruniBres, have termed them amulets. (Plate I,
figs. 3, 4, and 5.)
The use of amulets, as is well known, comes down from the very ear-
liest period, and M. Prunieres was of opinion that the extreme care bestowed
in polishing these fragments, together with the fact that no other purpose
could be divined for them, was sufficient evidence as to the use for which
they were intended. The latter reason, it must be admitted, is not strikingly
convincing.
As early as 1868, M. Prunieres discovered, in, a large dolmen near
Aiguieres, a skull of which a large part of the side had been removed.
Thllis operation had evidently been effected by a cutting or sawing process,
although one portion of the edge appeared smooth and polished. Many
"rondelles" were discovered in the same spot, and M. Prunicres formed the
theory that they were pieces removed in converting a skull into a drinking
cup. To drink from the skull of a dead enemy was a refined enjoyment
not exclusively practiced in the Walhalla of the Norsemen. Livy tells us
that the Gauls celebrated their victories in that manner,3 and M. Prunieres
supposed that the skull and fragments which he had unearthed were relics
of a similar custom. He made known his views to the Paris Society of
Anthropology in 1874,4 accompanying his communication with specimens
of perforated skulls and rondelles.
These pieces were examined by Professor Broca, who at once observed
that the smooth or polished condition of parts of the edges of the rondelles
:'A cup made from a human skull was exhumed by Mr. E. R. Quick, in 1880, from an aboriginal
cemetery near Brookvillc, Franklin County, Indiana. From its size, and from the distinctness of 1he
sutures, it was evidently the skull of a young person. The base had been removed, and both the inside
and outside had been scraped, as the scratches on 1he bone indicated. Two small holes had been drilled
at one spot near the edge, evidently for the insertion of tendons or strings to check an incipient crack,
just as the modern housewife saves a bowl or teacup. Journal Cincinunai Soc. Nat. Hist., 1880-'81, iii,
296. Plate of same in vol. iv, p. 257.
SBull. Soc. d'authrop. de Paris, 187.1, -e s6c., ix, 135-2105.
























PREHISTORIC TREPHILNING, Pl. II.


II~


FVt


r ''


Cranium from the cavern of L'Homme-Mort (La Lozsre). Surgical trephiining has been performed upon the sagit-
tal suture. Two-thirds natural size. (Prunidres.)


1'. S. (;. AND G. SUR'I 'EY.


P i'
i |' 'i'' I













BROUA'S CONCLUSIONS-ON WHAT BASED


and of the sections of the skull was due, not to artificial polishing, but to
a process of natural cicatrization, which must necessarily have taken place
during life, and, indeed, many years before death. (Plate II.)
After examination of a great many other specimens, Broca finally
announced two conclusions as the result of his investigations:
I. In the neolithic age, a surgical operation was sometimes performed
for the cure of certain internal maladies, which consisted in making an open-
ing in the skull. This was almost, if not quite, exclusively practiced on
young children, and is to be termed prehistoric surgical trephining.
II. The skulls of those who survived this operation were supposed to
possess some remarkable qualities, and when the owners died, amulets or
rondelles, consisting of portions of the skull, were carefully cut out. By
preference, the portion should contain a segment of the original aperture.
This was posthumous trephining.5
A concise account must be given of the evidence upon which these
conclusions were based.
To the practiced eye there is no difficulty whatever in distinguishing
between a section of bone which has not been followed by any reparative
process and one in which that process has gone on to completion. In
the first case, the edges are sharp, the cells of the diploi are open, and the
action of the cutting instrument is seen in the successive cuts by which the
operation has been performed. It is not uncommon to find scratches on the
surface of the bone, indicating where the tool had slipped away from the
intended incision. (Plate I, fig. 3.)
When cicatrization of a trephined or fractured skull has been perfected,
the edges present a rounded, ivory-like surface, due to the new osseous tissue
deposited in the cells of the diploe and upon the edges of the outer and
inner tables.
But while it is easy to discriminate between a post-mortem incision and
one long since healed, it would be very difficult to decide that the incision
might not have been made during life, but shortly before death. The pro-
cess of repair in bone is much slower than in softer tissues, and it has been
suggested that the cases of so-called posthumous trephining were really
'Sur l; trdpanation du cranc, etc., p. 9.


FI.T 'IIEl.I













PREHISTORIC TREPHINING.


cases in which the operation had resulted fatally in a very short time, and
before any process of repair had commenced. To this it may be replied
that no examples have hitherto been found of skulls or rondelles where the
section was in process of cicatrization; all are either entirely fresh, or long
since healed." It would be unreasonable to suppose that these operations
were entirely successful or else immediately fatal. The operation, in itself,
is not very dangerous to life, as has been shown by many experiments on
animals. Its mortality as a surgical measure, in cases of fracture of the
skull, is due to the serious injury to the brain for which it becomes neces-
sary to employ it.
A more convincing reply is that, in the greater number of the trephined
skulls in question, the two sections coexist; a portion exhibiting the rounded,
ivory surface of ancient cicatrization, the rest of the section being absolutely
fresh. (See Plates I, V, and VI.)
The suggestion that these apertures were the result of blows from
weapons must be at once dismissed. No weapon of that day, or this, could
produce such openings with their well-defined, beveled edges. The blows
of stone hammers or axes resulted generally in necrosis, or death of the
bone, and often in disruption or bulging of the inner table of the skull for
some distance fiom the seat of injury. Some excellent examples of the
consequences of such formidable injuries are to be seen in an article by Dr.
F. W. Langdon, describing the crania in a prehistoric cemetery at Madison-
ville, Ohio.' The accompanying plate (Plate III), copied by Dr. Langdon's
permission, well illustrates the striking difference between the results of
blows followed by necrosis of the bone, and the condition succeeding the
operation of trephining.
The apertures made by the so-called surgical trephining do not differ
greatly in size; they are nearly always elliptical, seldom round, and extend
from 35 to 50 millimeters in length, by 6 to 10 millimeters in breadth. The
edges are very oblique, at the expense of the outer table of the skull. The
operation appears to have been performed upon all parts of the head,
"Some more recent discoveries, however, which will be referred to later, show that this assertion
ef Broca's was rather too sweeping.
7TheMadisouville prehistoric cemetery; anthropological notes. By F. W. Langdon, M. D. Jour-
nal of the Cincinnati Soc. Nat. Hist., iv, Oct., 1881, 250-253.
























U, S. G. A ND G. SUY.'~ E'.


-VM



J










FJG. 1. H








































Flu. 2.


Fiu;. 1. Perforat iug fYiactiiii .f tile left, pariel al 3t at its3 post! 10 311)1 Jupll an1gle interna view1 3 11w 51ill'l fi l, do-
prCessi( fralgment of' tile jilti-lllnl tal w11.0hich has rellilil ed. Fl(,. 2. Rlesu~lt of' iii urf to rights, frontal and pariital
region, Causinig extensive3 Sinulses betweenI tile inner and outer table. Natural size. (Langdotw.)


PhV_,'/JLS YORIC TRA-1711XING, PI. 111.












ABNORMAL CRANIAL APERTURES.


excepting the forehead, but in the greater number of instances one of the
parietal.bones has been the chosen site. There is a very interesting skull
in the Musde Broca [crane de Vaureal (Oise)], which, in addition to a large
depression in the frontal bone, presents a remarkable instance of trephining
on the occipital, two-thirds of that bone having disappeared. Part of this
opening is due to the surgical operation, the elliptical edges, about half of
the original aperture, exhibiting the characteristic ivory-like surface of cica-
trization, while the remainder has been removed by post-mortem trephining.8
In no instance has an artificial opening been observed excepting where
the bone was covered by the hairy scalp, and that the purpose was to avoid
noticeable disfigurement seems a justifiable conclusion. It is also another
argument against possible origin from wounds in battle, as in such cases
the forehead was the part most liable to be injured.
Broca states that the operation must have been performed just as fre-
quently on the female as on the male.
It is necessary to inquire what other causes may account for abnormal
cranial apertures.
I. There are congenital deficiencies. These are generally found in
the parietal bones, and are nearly always symmetrical, being found in both
bones. A single congenital aperture has been sometimes observed through
which hernia of the brain and meninges has taken place. In such cases
the edges are everted and show a more or less diseased condition.
II. Disease of the bone may produce openings which may afterwards
become cicatrized, and thus resemble the apertures in question; but disease
of the bone always extends beyond the limits of the perforation produced,
and leaves indelible traces. A close examination of these trephined neolithic
skulls shows a perfectly sound condition of the bone in the vicinity of the
aperture in all cases.9
III. Traumatic sources have been already discussed and dismissed.
Even the cavalry saber of to-day could not produce such results. It does
8L6sions osseuses do I'hounmo pr6historique en France ct en Alg6rie, par Jules Le Baron. Paris,
1831, 40 (thbse), p. 47.
"In this Broca was mistaken. A very remarkable instance of trephining in connection with
disease of the bones of the cranium was communicated to the Soci6t6 d'authropologie by M. Parrot, in
1181. A description of the relic will be found farther on.


FLETCIIHER. I












PRE IlliSTORIU TREPHllINING.


occasionally cut off a slice of the cranium, but it certainly could not cut
out rondelles from the parietal bones. (See Plate IV.)
Contused wounds, such as would be produced by rude weapons, pro-
duce necrosis or death of the bone, and where healing takes place irregular
apertures remain, entirely unlike the result of a surgical operation.
The reparative process in wounds of the cranium in the adult is one
of extreme slowness. An osteitis, or inflammation of the bone, is set up,
which extends to some distance from the edges of the wound. The vascular
canaliculi of the two tables become dilated, and it is often years before
they recover their normal caliber. But in the skulls under discussion, in
all instances, the edges of the aperture made by surgical trephining exhibit
the most perfect readjustment of the parts. This is the -case in young as
well as in old crania; in one instance particularly, that of a woman of less
than twenty-five years of age, the wisdom teeth being still in process of
development, the traces of the traumatic inflammation have as completely
disappeared as in the skulls of very old persons. This led Broca to believe
that the operation must have been performed at a very early age, and other
observations tend to confirm that theory. Although the operation of tre-
phining, as before stated, is not a very dangerous one when uncomplicated
by injury to the brain, yet it would be unreasonable to suppose that it was
never fatal. If sometimes fatal, we should expect to find skulls exhibiting
the evidence of partial recuperative process. But, with one exception, no
such relies have been discovered; the edges of the openings are either
absolutely fresh, indicating post-mortem work, or absolutely cicatrized,
indicating that the operation had been performed many years before the
death of the subject. What then became of the failures?
If the operation was performed only on young children, then the rapid
decay of their tender bones would answer the question. In dolnens con-
taining a large number of adult crania, it is usual to find nothing but mere
ddbris of the bones of children, and in the case of trephined skulls, the thin
edges of the apertures would offer favorable points for the chemical and
physical agency of erosion.
It is unnecessary to relate all the observations and arguments which led
Broca to the conclusion that prehistoric trephining was performed mainly,




















U. ~ C. A!)C. SA'17 PREHISTORIC TWEI'IILVING, P1'. IV,


01 M1
k rl~l,,!'' I !:~e~ iii' I A


Losaq of mabst acUCe 1fiom the, vertex of a Akull pIoduced by the stioke of a TartrI saber. iiatimii ze1 (.Muls(e Bro(a.)


U. S. G. AIND G. SURVEJKY.




- a- --


U. S. (;. A. /) (;.. sY 'El I.


1REHISTORIC T'I'EPHIVING, I. v.


-1c


I__
'7S-





j1 _


,1 _l


iiJ


~~~/


Craninum from Ciliourni si. A-!t, median line; E, left external orbital apoplhysis; F, right external orbitalapophysis,
broken. a-b, tie cicatrized edge of surgical trephining; a-c, b-d, post-mortem sections. The sagittal suture, instead of
following the lino C-D, has been driven over to the left. Two-thirds natural size. (Broca.)


i'












I DIFFERENTT METHODS OF ThFPHLNINCG.


if not entirely, upon the young child, but one especially striking and
ingenious illustration which he founded upon a cranium discovered by
Prunieres in the dolmen of Cibournios must be related.
It is well known that the sutures of the skull tend to become firmly
united with the advance of years. In the young child the remains of the
sutural membrane still exist, and a separation is easy. In the accompany-
ing drawing it will be perceived that the left parietal bone has been operated
upon, and the resistance of the arch on that side being thereby diminished,
the right parietal has encroached considerably over the median line, in the
process of after growth, indicating the youth of the subject at the time of
the operation. (Plate V.)
As regards the general harmlessness of the operation, there is a view
which must be suggested, in passing, which has not been considered before
in this connection, and that is the relation of race to traumatism. In other
words, the capacity to bear wounds or surgical operations, or the contrary,
dependent not on individual but on race characteristics. Long ago, Velpeau
said that French flesh and English flesh were quite different, and opera-
tions that were generally successful in the one were frequently fatal in
the other. The subject is of immense extent, requiring copious observa-
tions, which should include toleration of child-bearing, before any conclu-
sions can be reached. It will be seen presently that the Arab tribes who
practice trephining regard it as almost without danger. It is possible that
race is to be regarded as a factor in the calculation of the results of tre-
phining.
Some account must now be given of the probable manner of proceed-
ing in prehistoric trephining.
There are three processes by which an opening in the cranium can be
methodically produced-by rotatory movement, by cutting, and by scraping.
The most perfect example of the first-named method is in the use of
the modern trephine, which consists of a steel cylinder with saw-teeth and
a central pin to guide its first motion; the whole being worked by a cross-
handle like that of a gimlet. This instrument cuts out a circular piece of
bone, leaving a corresponding aperture with perpendicular edges. The first
form of the trephine dates back to the early days of Greek surgery; cer-


FLF.R CIIEIZ.












PR'EHSTORIC TREPHINING.


tainly to more than 500 years before the Christian era. While, of course,
no instrument of this kind could have been known in the neolithic age, yet
an opening by terebration could have been obtained with any pointed tool.
M. Prunibres says that the shepherds of La LozBre practice it to this day, to
relieve sheep of the "staggers." The head of the animal is held between the
knees of the operator who fixes the point of his large sheath-knife in the
skull, and by rotation of the handle between his hands a hole is speedily pro-
duced. A similar practice prevails in Germany, according to Vecken-
stedt, the operation being performed by the shepherds in order to "burst
a bladder in the inside of the head of the sheep." But all such openings
are necessarily round, with nearly perpendicular edges, while the surgical
trephining of prehistoric times is characterized by elliptical openings and
by obliquely beveled edges.
As regards the second method, by cutting, no doubt flint saws might
have been employed for the purpose, but it would have been impossible to
produce the even ellipsis, with its broad bevel, in such a manner. A polyg-
onal-shaped aperture could only have resulted.
There remains the process by scraping. In some of the South Sea
Islands trephining is practiced in this manner, and, indeed, the exfoliative
trepan of modern surgery provides for a similar process. Broca presented
to the Society of Anthropology of Paris, in 1876, some skulls upon which
he had himself produced precise counterparts of neolithic trephining by
scraping with a piece of broken glass.'1 The apertures were elliptical, the
long axis being in the direction of the to-and-fro motion of the scraper, and
the edges were broadly beveled. It might seem, at first, that this must
have been a very slow and barbarous operation, but when it is remembered
that the evidence points strongly to the belief that trephining was practiced
upon the very young, the objection, to a great extent,- disappears. It took
Broca nearly an hour to produce the opening in a hard adult cranium, but
in a child's skull it required but four minutes to attain the same result.
Again, in July, 1877, Broca presented to the same society the skull of a
two months' old puppy, upon which he had performed the operation of tre-
phining with a piece of flint from Cro Magnon, and, although the flint was
l"Bull. Soc. d'authrop. de Paris, 1876, 2'" s6r., xi, 512.














































































































































































'3I























I'REIllS J

---. I -


Cranium from Cibournios. A-B. cicatrized edge from surgical trephining. B-C, A-D1), post-mortou sections.
Two-hlirds natural size. (Broca.)


v. .. G. A. \) .SU.'(R' A Y.


2;'
/ --
-=
,Lblg~t~e~ik~ i

::I
*


I




r.


I.'





/:













CRANIAL AMMULETS OR RONDELLES.


very blunt and the bone twice as thick as that of a child of six years of age,
the operation was completed in eight minutes; the dog recovered rapidly
without any symptom of fever."
It is a curious fact that the amulets or rondelles, in the great majority
of instances, have been cut from skulls which had undergone, and a long
time survived, surgical trephining. Many of these skulls exhibit immense
openings, unmistakably of post-mortem workmanship, but with a fragment
of the original cicatrized edge of the surgical operation remaining. (See
Plates V and VI.)
Many crania have been discovered with the characteristic opening indi-
cating surgical trephining long since cicatrized, but which had been sub-
jected to no post-mortem operation. Why these exceptions should occur it
is impossible to discover. Possibly they were due to the law of demand
and supply, and the amulets not being wanted at the time, the skulls were
left undefaced.
Quite a large number of these so-called amulets or rondelles have been
discovered, and are to be seen in the museums of Europe.12 Some of them
are very regular in outline, and very considerable labor has been bestowed
upon them to produce a polished surface and rounded edges. The rondelle
discovered by Professor PruniBres in the interior of a skull, and which first
drew attention to the subject, is highly polished and beveled at the expense
of the outer table. (Plate I, fig. 1.) These carefully prepared amulets have
a very different appearance from the fragments of cranial bone which are
found in ancient burial places. The latter are more or less discolored and
eroded by the moisture and mineral ingredients of the soil in which they
have rested. The rondelles, on the other hand, have a dry, hard surface,
and are almost of the color of old ivory. This is probably due to their
having been worn as ornaments or amulets for a very long time; perhaps
by many successive owners. Other amulets are of irregular shape, being
elliptical, trapezoid, or triangular. Some amulets have been found with a
Bull. Soc. d'anthrop. de Paris, 1877, 2me s6r., xii, 400; 477.
'NPrunieres. Sur les cranes performs et les rondelles craniennes de 1'6poque ndolithique. Assoc.
francaise pour l'avanceucnt des sciences. Compte rendu, 3me sess., Lille (1874), Paris, 1875, 597-637.
La cremation dans les dolmens de La Lozbre. Nouvelles rondelles craniennes. Dolmens de
la Marcouibre et tombelle de Boujoussac. Ibid., 6me sess., Le Havre (1877), Paris, 1878, 675.


FL.TCHER.]













PR ElI [STOR IC TxEPI-I INING-.


groove cut around them, apparently for the purpose of suspending them from
the neck. (Plate I, Fig. 5.)
It now remains to give some account of Broca's theory as to the pur-
pose of this surgical and post-mortem trephining. He rejected the theory
that the surgical operation in early life was performed on account of fracture
or disease of the bone, nothing whatever in the relics seeming to indicate
such conditions. He was, at one time, disposed to think that the operation
had a religious or superstitious motive, and that it indicated initiation into
some sacred order; but the extent of the discoveries of trephined skulls,
and the fact that women as well as men were subjected to the operation,
obliged him to give up that view. His conclusion was that, in all probability,
the operation was performed as a cure for convulsions, simple or epileptic.
Trephining as a curative treatment for epilepsy has been practiced some-
what extensively in our own day, but it is now entirely abandoned, except
in cases of traumatic epilepsy, when the manifestation of the disorder has
been coincident with an injury to the skull. In such cases, removal of de-
pressed fragments of bone is clearly indicated, and has, in many instances,
been followed by entire disappearance of the epileptic fits.
In the curious storehouse of absurdities which our ancient Materia
Medica exhibits, powdered bone from the human skull, as well as powdered
mummy, figure as unfailing remedies for epilepsy. Sometimes the bone
was to be calcined, and the supplementary ossicles of the skull, known as
ossa Wormiana, were in high repute for this purpose. In old works the
title of os antiepilecticum was an ordinary name for a Wormian bone.
For many ages epileptics were believed to be possessed of devils and
to be fit subjects for exorcism. When, in obedience to spell or potent com-
mand, the evil spirit left the sufferer, or, in other words, when the fit was
over, it was through the open mouth that the exit was made. There is a
cut in a curious old German block-book representing the well-known inci-
dent of the epileptic of the New Testament. The mouth of the man is
painfully distended, and the horned head of a small imp is visible emerging
from his throat. The herd of swine, unconscious of the impending catas-
trophe, are watching the proceeding. It is not difficult to imagine how
appropriate it would appear to make an opening in the skull for the escape














BELIEF IN FUTURE EXISTENCE INFERRED.


of an evil spirit which could not be dislodged by ordinary exorcism.'3 It is
for this purpose, among others, that trephining is practiced to this day among
the South Sea Islanders and by some of the Arab tribes of Algeria.
From these and similar considerations Broca was led to believe that
prehistoric trephining was practiced for the relief of convulsions in infancy
or childhood, and that a fragment of the skull of a person who had under-
gone this operation was worn as a preventive of the like common and
alarming disorder. Hence the care with which a portion, at least, of the
cicatrized border was preserved in the piece cut out to form the amulet.
It must be borne in mind that a primitive people would not be likely
to discern any difference, except of degree, between the ordinary convul-
sions of childhood and epileptic fits. The former, though alarming in
appearance, are by no means generally dangerous, and we can easily under-
stand that the surgical operation would, in such cases; be credited with the
cure. It is thought, even in our own enlightened day, that the post quod
is occasionally taken for the proper quod, in surgical as well as medical
therapeutics.
So far, it may be said that Broca made a fair case in favor of his theory,
but he carried his theorizing still further. He was of opinion that these tre -
phined skulls and corresponding amulets indicated that a belief in a future
existence obtained among these primitive races. His argument is based
upon the discovery of amulets in the interior of trephined crania. Why,"
he asks, "was this precious relic placed inside the skull at burial? Was it
not a talisman to preserve the defunct, in a future existence, against the
evil spirits that had afflicted him in early life? If so, does it not show that
a future existence was anticipated "
When it is remembered that only three cases have been observed in

13 A curious custom is related by Miss A. W. Bucklaud, which may possibly be due to some legend-
ary trace of the belief in the efficacy of trephining as a remedy for fits. She observed at Cannes, in
the south of France, a number of dogs with oblong patches of red leather stuck on their heads, and
upon inquiry was informed that these dogs were subject to fits, and that the red leather was worn as a
means of prevention. Jour. Anthrop. Inst. London, 1881, xi, 16.
This part of the subject must not be dismissed without an allusion to the story of the birth of
Athene, so inimitably told byLucian. It will be remembered that Zeus, sufferingfrom intolerable pain
in the head, called upon Hephtestus to split open his head with an axe. The latter unwillingly obeyed,
when from the fractured opening sprang out the Goddess of Wisdom, clad in bright armor and with
spear in hand. This is probably the first recorded instance of historic trephining.


FLETCHER. ]














PREHISTORIC TREPHINING.


which rondelles were discovered in the interior of skulls, it must be ad-
mitted that this amiable theory rests upon a very slender foundation. It
seems much more probable that their presence in the locality in which they
were found was due to accidental causes, such as the pressure of roots, or
the movements of worms. Mortillet and PruniBres both mention finding
small bones of the hand or foot inside of crania.
As regards the extent and range of the relics indicating this singular
custom, it may be said that, in France, the department of La Lozere has
produced the greatest number. This, however, is probably due to the vig-
orous researches of Prunieres and others in that region. Throughout the
south and southeast of France discoveries of trephined skulls continue to
be made. Broca states that the custom certainly prevailed throughout the
entire neolithic or polished stone period, as trephined skulls have been
found in the cavern of L'Homme-Mort, in La Lozcre, which belongs to the
earliest part of that age, and in the grottoes of Baye, belonging to its close.
While it is not surprising that no trace of the custom should have been
discovered in the relics of the pakeolithic or mesolithic ages, it is certainly
remarkable that it should have disappeared with the neolithic age so com-
pletely. It is perhaps not too much to say that no authentic instance of the
discovery of a trephined skull from the bronze period is on record. Doubt-
less the rapidly increasing custom of incineration of bodies must be regarded
as a principal cause. M. de Baye has found cranial amulets in tombs of a
later epoch, and infers that the custom of trephining still prevailed.14 This
does not, however, follow, as the amulets may have been preserved through
many generations.
At the meeting of the International Congress of Prehistoric Anthro-
pology held at Brussels, in 1872, Dr. G-. A. Lagneau read a paper entitled,
"Sur les cranes de Furfooz"; and in the discussion which followed the meas-
urements of some Esthonian crania were given by M. Quatrefages. In the
plates1 illustrating the latter, one skull has an aperture about the center
of the coronal suture which strikingly resembles the beveled edges pro-
4 Bull. Soc. d'anthrop. de Paris, 1876, 2me s6r., xi, 121.
1~ CongrBs international d'anthropologie et d'archgologie pr6historiques. Compte rendu, 6me ses-
sion, tenue a Bruxelles en 1872, Bruxelles, 1873, 558.














SPECIMENS DISCOVERED IN FRANCE.


duced by trephining. No allusion was made to it, the subject at that time
not having been brought to light.
As early as 1875 a trephined skull was found in a tumulus at Bougon,
near Niort, in the south of France, which was described by M. Babert de
Juilld. In his specimen, the openings had been made near the top of the
skull, and the edges were perfectly cicatrized.16
At the meeting of the Association for the Advancement of Science held
at Nantes, M. Chauvet presented a cranial amulet found in a tumulus in the
forest of Boixe."7
In the tertre Gudrin, on the right bank of the Seine, not far from Paris,
M. Chouquet found the skull of an old man, with a trephined aperture which
had been long completely cicatrized."18 Chouquet also discovered some
specimens of both surgical and posthumous trephining in a mound, near
Rcuelles, which contained incinerated bones. He was disposed to think
that these relics belonged to the bronze age.19
In 1877 M. Prunieres presented to the Paris society two admirable
specimens, in one of which the aperture, thoroughly cicatrized, was in the
occipital bone, a little to the right of the median line-an unusual position.20
M. Gassies discovered a trephined skull at Entre Roche, near Bordeaux,
in a burial place which he thought to be paleolithic. Further researches,
however, by M. Chauvet, assigned it to the neolithic period, a polished stone
axe and similar relies having been discovered there.21 Some other doubtful
cases of trephined skulls from the palteolithic period have been announced,
but no well-authenticated specimens have been discovered which are of
earlier date than the polished stone age.
An interesting specimen was presented to the Paris society, in 1878,
by M. Gudgan.22 It was found in a dolmen at Etang-la-Ville, and exhibited
'6Rapport do la commission des tumuli do Bougon, suivi d'unc 6tude snr la tr6panation prdhisto-
riquc, et en particulior sur le crano tr6pan6 quo possbdo la mus6e do Niort. Par Babert do Juill. Niort,
1875. 80..
17Assoc. franIaiso pour 1'avancement des sciences. Compto rendu de la 4me scss., Nantes, 1875,
Paris, 1876, 854.
I'Bull. Soc. d'anthrop. do Paris, 1877, 2mC s6r., xii, 13-16.
'"Ibid., 1876, 2m s6r., xi, 279.
o2 Ibid., 551.
21Ibid., 1877, 2me s6r., xii, 12.
221bid., 1878, 3n3m s6r., i, 198.
2PT


F.LETCHER.]




_____ 1--------


18 PREHISTORIC TREPHINING.

incomplete trephining by raclcage, or scraping. This modification of the
process of trephlining consisted in removing the outer table of the skull by
scraping, leaving the inner or vitreous table intact. Altogether some twenty
specimens of the kind have been collected. What the object was of this
incomplete operation it is difficult to divine. Possibly the malady was
relieved and the further process rendered unnecessary.
In 1603 there was published in Lyons a book which is now excessively
rare. Its title was: Traict de l'Ypilepsie, maladie vulgairement appelee an
pays de Provence, la goutette aux petits enfants. Par Jehan Taxil. 8.
The writer evidently confounded convulsions with epilepsy, the latter disease
not attacking little children, rarely, indeed, developing itself before the tenth
year. The remedy he prescribes is scraping away a portion of the outer
table of the skull. Sometimes the inner table, also, was removed by the
exfollative trepan. This reproduction of a prehistoric usage may perhaps
be cited as a curious instance of atavism in surgery.
In 1878 M( Prunieres made some extensive researches in the caverns
of Beaumes-Chaudes (La Lozere), and found more than sixty specimens of
trephined skulls and cranial amulets. In three of these there was evidence
of the operation having been twice performed on the same subject.'3
In 1880 M. Mauvoisin found in soine artificial grottoes near I]aye sev-
eral crania of the neolithic age, of which two exhibited cicatrized openings
Upon one of them post-mortem sections had been made in the usual manner.24
A recent and very interesting contribution to our knowledge of the
subject is to be found in a paper read before the Paris Society of Anthro-
pology by Mf. Parrot."' It describes a cranium found in a grotto of the neo-
lithic period at Bray-sur-Seine (Marne). The frontal and both parietal
bones exhibit the consequences of extensive disease. Depressions exist, su h
as would be produced, AI. Parrot says, by pressing the thumb into soft
putty. On the left parietal a small island of undiseased bone stands up in
the center of the depressed portion, forming a strong contrast. The bone
2"Bull. Soc. d'anthrop. de Paris, 1578, 3'" scr., i, 211.
2"-Ibid., 180, 3"'e s6r., iii, 10.
2 Crane trouv6 dans uno grotto deo 1'pcque de la pierre polio A Bray-sur-Sdine (Marne), avoc nno
ruarantaine de squnlettes, haches poles, poingons en os, colliers et orneimc nts nc coquiilles. lbid., 1881,
:;'" sdr., iv, 104-103.













TREPHINING FOR DISEASE OF BONE.


which has been subjected to disease is excessively thin, and was broken in
two or three places in the process of extraction No trace was left of the
coronal suture, the disease having entirely obliterated it. But the most
interesting feature was the evidence that surgical trephining had been per-
formed, apparently for the relief of the disease. The opening made involved
the frontal and left parietal bones; it was of the usual oval shape, but its
size could not be exactly ascertained, as the posterior portion of it was lost
in a large, irregular hole, produced, no doubt, when the skull was removed
from-the earth. The trephining was performed partly on sound and partly
on the diseased bone, and the edges of the aperture (what remains of them)
are perfectly cicatrized, so that it is evident that the patient long survived
the operation. It cannot be held that the disease was the result of the opera-
tion. In the large number of trephined skulls which have been examined
there is no instance of disease of the bone, and in this particular case, as
M. Parrot observes, if the disease had resulted from the operation it would
have spread all around the opening, which is not the case, as what remains
of the aperture is in sound bone.
The disease, which was probably an exfoliative osteitis or inflammation
of the bone, was, M. Parrot thinks, of traumatic origin. There is a depres-
sion on the frontal bone which may have been caused by a hatchet-stroke.
Whether the operation was performed to arrest the disease, or to remove
some of its symptoms, is, of course, a matter of conjecture; but as the dis-
eased bone and the edges of the aperture had all become firmly cicatrized,
it is certain that the patient lived for some years after.
M. Parrot dwells upon the importance of this discovery as proving that
trephining was employed as a therapeutic measure in disease, and not only
for the relief of imaginary causes of evil, as in convulsions or epilepsy.
It is possible, however, that the subjective symptoms attending such exten-
sive disease of the cranium may have required the usual remedy for eviction
of the supposed malignant spirit.
In Germany a few examples have been met with of prehistoric trephin-
ing. Prof. H. Wankel discovered in the grotto of Bytchiskala, in Bohemia,
the skeleton of a girl of about twelve years of age. The skull bore unnis-
takable evidence of surgical trephining having been performed during life.


FLI.TCEil.rl I














PIREHIISTORIC TREPHINING.


The aperture was on the right side of the frontal bone, was nearly circular
in shape, and about 3 centimeters in diameter. The inner table of the skull
exhibited no trace whatever of inflammatory process, such as would inevi-
tably have accompanied caries or exostosis of the bone. At great length
Professor Wankel examines every possible disease or injury of the bone
which might be supposed to account for the opening, and rejects them all.
Fromn this argument by exclusion lie arrives at a very firm belief that the
case was one of surgical trephining, precisely analogous to those observed
in the crania of La Lozcre.26
About the same time Dr. B. Dudik sent a communication to the Berlin
Ethnological Society, announcing his discovery of many trephined skulls
in the ossuarium, or Beinhaus, at Sedlec in Bohemia.27 In this famous bone-
heap there are pyramids of skulls and thousands of human.bones. Tradi-
tion states that they came from the old churchyard of Sedlec, the soil of
which, having been made sacred by admixture with earth brought from Geth-
semane, had the property of rapidly decaying the flesh and of preserving the
bones with a whiteness as of alabaster. The structure which now incloses
the relics was erected in 1709, but allusions to the Sedlec bones are to be
found in very early chronicles. A local legend relates that the perforated
skulls (of which there are a great many) once belonged to the Cistercian and
Carthusian monks who were killed when the Hussites, under Ziska, captured
the convent of Sedlec in 1421. Dr. Dudik thinks that the punctures are
too even and too free from fracture to have been made by the spiked clubs
with which Ziska's followers were armed. This objection is probably not
well-founded. The writer remembers examining a heap of skulls of horses
in a knacker's yard, the animals having been destroyed with a pole-axe, a
weapon very similar to a spiked club, and the punctures were, in almost all
instances, round with sharp edges and not accompanied by fracture. It
seems probable that these bones have accumulated through a very long
period of time, but that they date principally from the year 1318, when
a pestilence ravaged Bohemia and thirty thousand persons were buried in
Sedlec alone.
'"Wankel (HI.). Ein priiliistorischer Schiidcl mit einer halbgeheitei VWinde anf tder Stirne hi]iihst-
wahrscheinlieh dlurchl Trepanation entstandeui. Mit1h. d. antlrop. Gcsellsch. in Wien, 1878, vii, 86-!5.
Dnudik (B.). Ucber trepan irtc Craniei ni Beiinhause zn Sedlee. Ztsclir. f. Etin., Berl., 1878, x,
227-2.'1,5.














THIE~ SEI)LEC BEINHIAUS.


Dr. Dudik describes at some length the appearance of the openings in
the crania which lie examined, but it would seem from his description that,
in most instances, posthumous trephining alone had been practiced. This,
of course, proves nothing. In a few cases he describes what seems like
cicatrization of the edges
A more competent observer, however, followed in his footsteps. Pro-
fessor Wankel visited Sedlec in order to verify the observations of Dr. Dudik,
and examined the one hundred and twenty crania which had been submitted
to the latter.2 Wankel was of opinion that, in every instance, the perfora-
tions were the result of wounds not immediately fatal. In two instances lie
agreed with Dr. Dudik that there were unmistakable marks of posthumous
trephining. Professor Wankel finishes his article by a description of his visit
to Prague, in the museum of which city he found two skulls from B3ilin, in
Bohemia, exhibiting evidence of prehistoric trephining. One, a dolico-
cephalic skull, presented an orifice 60 millimeters by 40, of elliptic slapie,
and situated in the center of the right parietal bone. The edges were
perfectly cicatrized, and exhibited the ivory-like surface characteristic of
long-healed trephining. In the other, a mesocephalic skull, the aperture
was round and about 40 millimeters in diameter. Professor Wankel was
of opinion that these skulls exhibited perfect specimens of prehistoric sur-
gical trephining, and goes on to observe that, even to the eye of a layman,
the difference between the holes in these skulls and those in the crania of
the Sedlec ossuarium was most marked.
A notice of these two interesting specimens was sent to the Paris
society by MI. Ingoald Cludset two years before.2
Professor Virchow has contributed some observations illustrative of
the subject. At a meeting of the Berlin Anthropological Society, in 1879,
he described a skull from a neolithic burial mound, in which the char-
acteristic marks of cicatrization were observed in an opening in the right
parietal bone. At a later meeting lie also reported some discoveries made
by General, von Erckert in a Cujavianu grave near Ziemcin, in Poland.
Among them was a bone disk, or rondelle, bearing a great resemblance to
"Wankel (ll.). lCeber die angeblich Irelmnirtcen Cranicu des U3einhauscs zu Sedlee in Bilulnicn.
Mitth. an. throp. Gesellsch. in Wien, 1879, viii, 352-360.
'ItBull. Soc. d'anthrop. de Paris, 1877, 221" s6r., xii, 10.


1FI.'I.TCIIILt. ]















22 PIEUI STORIC THEPHIINING.

those described by Broca."3 Dr. L. Schneider presented to the same society
a similar example fi'om the skulls of Strupcic, Bohemia."3
In 1875 an article was published by Dr. R. Wiedersheim, entitled,
"Ueber den Midcelhofener Schildelfund in Unterfranken." This appeared
before attention had been drawn to the subject of prehistoric trephining,
but in one of the plates is a cranium with an opening in the left parietal
bone, presenting a remarkably strong resemblance to the accepted form of
surgical operation."
At a meeting of the Italian Society of Anthropology, held in 1878, Pro-
fessor Mantegazza exhibited a papier-mache model of a Russian skull taken
from a tumulus at Bogdanoff, which presented an example of surgical tre-
phining undoubtedly performed during life. Posteriorly was a second
aperture of post-mortem origin."3
M. Nicolucci discovered in a tumulus in Italy a rondelle from the
occipital bone, highly polished on both sides, but no trephined skulls have
as yet been discovered in that country.
In Denmark a trephined skull was found in a dolmen at Borreby, and
another was discovered by M. Engelhardt, in a dolmen of the stone age, at
Noes, in the island of Falster.34
Broca received from General Faidherbe some casts of skulls from
Roknia, Algeria, one of which proved to be an excellent example of surgi-
cal trephining. Since his death another specimen has been received from
Roknia, which is deposited in the Musie Broca. In this skull the opening-
of the usual beveled, elliptical shape, and 13 millimeters in diameter-is
above the left external orbital apophysis. There is no evidence of repair on
the edges, so that it would seem that the operation was fatal; but as the
entire inner table of the skull has disappeared, from erosion, M. Le Baron
suggests that the cicatrized edges may have met with a similar fate.3"
Sofar no discoveries of trephined crania have been made in Great Britain;
:"Ueber trepanirte Schiadl von Giebichenstein. Verhandl. dcr Berliner Gesellsch. fiir Antlhrop.,
Berlin, 1879, 64-67. -- Knochenscheibe aus cincm Schiidel, welcho an cin trepauirtcs Stiick crin-
nort. Ibid., 436.
: Uober die Hradiste von Stradouice und die Schiidel von Strupcic (BShmen). Ibid., 239.
2Archiv fiir Anthrop., Braunschweig, 1875-'76, viii, 225-236. (Plato XV, figs. 1 and 2.)
3'Archivio per 1' antropologia, etc., Milano. 1878, viii, 527.
a de Nadaillac. Les trdpanations prdhistori'qns. Paris, 1879. 8-, p. 7.
Ldsions osseuses, etc., 67.














CASE OF UNCOM PLETED TRE PHlNIMNG.


but it may be mentioned, as illustrating the growth of interest in the subject,
that in France counterfeit rondelles have recently been put upon the market.
In the splendid prehistoric gallery of the geological section of the
museum at Lisbon is a cranium quite unique of its kind." It presents evi-
dence of an uncompleted operation of trephining upon the left parietal bone.
The groove, made by some cutting or sawing instrument, has nearly reached
the internal table, very clearly defining the rondelle, which measures 6 cen-
timeters by 2, and from the numerous scratches on the surrounding bone it
is evident that the instrument frequently slipped from the groove in the pro-
cess. Why the piece was not entirely detached it is useless to surmise. M. de
Mortillet was of opinion that the discovery rather tended to disprove Broca's
theory that the operation was performed by scraping until a hole was pro-
duced. It must be observed, however, that there is no evidence to prove
that the operation was performed during life in the case in question. It is
more likely that it was an attempted post-mortem trephining; but even
if it were not, its occurrence would only strengthen the views expressed
elsewhere in this paper, that though prehistoric trephining was probably
performed by scraping in the young subject, and that examples of this
method form the great majority of specimens in our museums, yet that it is
probable, front analogy, that when performed on the adult it was by saw-
ing, cutting, or by a series of punctures.
The cranium in question was found in the grotto of Casa da Mouva at
Peniche, which contains the remains of one hundred and forty persons of
the neolithic period.
In America nothing has been discovered that can be said to belong to
prehistoric trephining, except the famous Inca skull brought by Mr. Squier
from Peru, and presented by him to the Paris Society of Anthropology.
This relic, which consists of the face and frontal bone, is stated by Mr.
Squier to have been taken from an Inca cemetery in the valley of Yucay,
within one mile of the "Baths of the Incas."37
"Notes sur 1'archdologio prdhistorique en Portugal, par ~Im. Cartailhac. Bull. Soc. d'anthrop.
de Paris, 1881, 3m" s6r., iv, 281-307.-Trepanation prdhistorique, par A. de Morlillet. Ibid., le2, 3'
-sr., v, 143-146.
"'Peru. Incidents of travel and exploration in theland of the lncasE.By George Squier. New
York, 177. 1 8, p1. 456; Appendix, p. 577. II is also described iln 1halt singnlarly unique publication, vol.
i, No. 1 (all ever published), of the Joarnal of the Anthropological Institute of New Yoik for 1871-'72.


FLI.TCHE.IL1














24 PIEIllSTORI( TREPIINING.

The drawing (Plate VII) shows how entirely the operation in this case
differs from the elliptic openings of the French crania. The round white
lpot indicates where the periosteum had been removed by the operator; and
this was done, Broca thought, about eight or ten days before death. The
tailmous surgeon, N'laton, who also examined the bone, suggested fifteen
days." As no evidence of fracture was visible, the French experts were of
opinion that 1he operation was performed to evacuate fluid in the cavity,
but Dr. J. P. Nott, of Mobile, offered the very plausible suggestion that a
punctured wound, such as the known weapons of the Peruvians might
inflict, might have necessitated the operation. The incisions appear to have
been performed with a cutting instrument, something like an engraver's
burijt, and not with a saw.
In 1875, Mr. Henry Gilman, then of Detroit, published a description
of ten to fifteen skulls obtained from mounds on Sable River, Lake Huron,
and two fragments from Great Mound, River Rouge,
S Michigan."3 All of these skulls presented a circu-
-!'LI, ,'\ lar perforation at the vertex, "evidently made,"
h lie says, "by boring with a rude, probably stone,
instrument, varying in size, in some instances hav-
ing a diameter of one-third of an inch; in others,
of one-half of an inch, and flaring at the surface"
(fig. I).
At the Detroit meeting of the American Associa-
Fro. .--Artificially perforated
skull front moundatSablc River tion for the Advancement of Science, Mr. Gilman
(Lake Juron), Michigan; one-
quarter size. read a more elaborate paper on the same subject,4"
and, at tlle twenty-sixth meeting of the society, this was followed by
another paper, entitled, "Additional facts concerning artificial perforation
of the cranium in ancient mounds in Michigan."41 Mr. Gilman was very
positive that the perforations were not analogous to the prehistoric trephining
observed in France. They were merely holes bored after death, and it was
suggested by Professor Mason that, like the Dyaks of Borneo, the natives
:"Bull. Soc. d'anthrop. de Paris, 1867, 2"1 s86r., ii, 403.
:'Amer. Naturalist, Salem, 1875, ix, 473.
-P"'roc. Am. Ass. Adv. Science, 24th meeting, at Detroit, 1875, Salem, 1876, 316-331.
'" Ibid., 26th meeting, at Nashville, 1877, Salem, 1878, 335-339.
























I'REHISTORIC TREPHINING, PI. 1if.


The Inca skull brought by Mr. Squier from Peru.

(Photographed at Army Mcd. Museum.)


Ii. S. G. ANVD G. SURVEY,


1

L!




__














FLETCHIIER. PERFORATED AMERICAN CRANIA. 25

might have made the punctures for the convenience cf stringing the skulls.
This would explain why the hole was invariably at a point opposite to the
foramen magnum. A discovery of Mr. Gilman's, however, seems to throw
some doubt upon this theory. He found, in a mound at Devil River, Mich-
igan, the remains of a person, evidently of rank, lying upon his back, but
with the characteristic perforation in his skull.
Mr. W. C. Holbrook, in an account of his examination of some Indian
mounds on Rock River, at Sterling, Ill., says:
Inside this dolmen I found the remains of eight human skeletons. . One of the skulls pre-
sented a circular opening about the size of a silver dime. This perforation had been made during lil'e,
for the edges had commenced to cicatrize.42
It is not stated in what part of the skull the opening was found, nor
whether any evidences of fracture or other injury existed, so that, as it
stands, the case cannot be thought to be one of trephining, but rather one
of a partly healed wound.
Before concluding this review of the evidence so far accumulated upon
the subject, some account must be given of the method of trephining prac-
ticed in our own day by some semi-barbarous tribes, with the purpose of
seeing whether it throws any light on the prehistoric operation.
In the djebel Aouras (Mont Aures), the southern termination of the
Atlas mountain range, in the province of Constantine, in Algeria, there
exists a race of Kabyles who are the descendants of the Berbers, the gen-
uine autochthones of Africa. The practice of trephining prevails exten-
sively among them, although it is by no means general among other tribes
of Kabyles. Two French army surgeons, MM. L.-T. Martin43 and Amddde
Paris," have given very full accounts of the method adopted.
It appears that the operation is performed for fracture of the- skull,
whether simple or compound, for disease of the bone, and for violent pains
in the head. It may be performed at any age, upon either sex, and upon
any part of the skull, though the parietal bones seem to be most frequently
4"Amer. Naturalist, Salem, 1877, xi, 688.
43La tr6panation du crane, tell qu'clle est pratiqude par les Kabylcs de l'AurEs. Par L.-T. Mar-
tin. Le Montpellier med., 1867, xviii, .25-535. Also, Reprint.
4 Do la trdpanation c6phalique pratiqu6e par les inmdecins indigenes do l'Aouress (province de
Constantine). Par M. le dr. Am6dde Paris. Gazette mod. doe 'Algdrie, Alger, 1808, xiii, 25-28. Also,
Reprint.














PREHISTORIC TREPIINING.


chosen. M. Paris did not meet with any instances in which the operation
had been performed upon subjects of less than ten or more than sixty years
of age.
The instruments are rude and simple enough, consisting of a razor, a
serp)tte, one or two saws, some straight and curved elevators, and the
britma, or perforator. This latter is a metal rod, as thick as a ramrod, with
a point an eighth of an inch long, but not over one-third of the diameter
of the rod, which thus forms a shoulder and prevents too deep a penetration
of the instrument. (See Plate VIII.) The point being fixed in the bone,
after removal of the scalp by a crucial incision, the rod is taken between
the hands of the operator, and by a rapid to-and-fro motion is made to
revolve so that a puncture is produced. This is followed by another and
another, until the fracture or the portion of bone intended to be removed is
surrounded with a row of these holes, very close together. The saw is used
to run them one into the other, and by means of the elevator the fragment
is removed. The dentated edges are smoothed, a shield is fastened over the
aperture, and appropriate dressings, with many ceremonies, applied. The
operation is perforined with great slowness, and is not generally completed
at one sitting. It must, one would think, be exquisitely painful, but it is
held to be a point of honor to exhibit no evidence of suffering, and if
the patient should be so weak as to utter cries, he is jeered at, and even
beaten.
The foregoing description of the method of operating is taken from the
article by M. Martin. There is a difference in the pro-
Scedure as related by M. Paris, who does not mention
-j--j the use of the brima or of any analogous instrument.
He says that the thebibe cuts out a square piece of
bone, inclusive of the injured portion, with a saw, lift-
F..;. 2-.--ranmet from XabySe ing the fragment with the elevator. Great violence is
skull, forcibly broken out in the
opl lraion. sometimes used in this part of the operation, and a
portion of the outer or inner table is occasionally forced off, as in the accom-
panying figure; the bone from which it was drawn was in the possession of
M. Paris.


___ _CF_~I





















NR I.iiS STO ORIC T"A'.PfINIA PT. 1711.


FlI. 1. ouss (razor).
FiG. 2. Boussadi (knife).
FIG. 3. El-Chretaf (hook).
FIG. 4. MAesella (elevator).


Half-size. (Martin.)


FIc. 5. Chefra (elevator).
FIG. 6. eriima perforatorr).
FIG. 7. MAenchar (saw).
FIG. 8. Biossadi converted into saw,


Ir .S. C. AND NG. STURVRY.













KABYLE TREPHINING.


The thebibe (operator) is a sort of semi-priest who has inherited the
right to.exercise his function; the operation, the instruments, the dressings,
are all sacred, and the patient is held in reverence after recovery. The
dressings consist mainly of woman's milk and of butter; the former obtained
from a woman who has duly performed her religious rites. Both these
ingredients figure in ceremonial observances in the Orient.
It is impossible to draw any conclusion as to the results of this process
of trephining. The thebibes insist that it is always successful, but Arab
mendacity is proverbial, and neither M. Paris nor M. Martin gives any
credence to their statements. When commencing the incisions, the thebibe's
formula is thus pronounced: Thou wilt recover if it please God. If the patient
succumb, his family are told: It was written.
The natives, however, certainly regard the operation as without danger
to life, and it is even resorted to as a means of extortion. M. Paris relates
that two men having quarreled, one struck the other a blow on the body
with a stick. Some days after the latter had his head trephined for a pre-
tended fracture and sued his enemy for damages. The deception was
exposed, and both patient and surgeon were punished. The dieh, or price
of blood, is rigorously exacted among them, every injury, even a fatal one,
having its established price. M. Martin mentions that he has seen men upon
whom trephining had been practiced five or six times, so that their heads
were monstrously disfigured. It is to be borne in mind that in these cases
the operation was performed at intervals of time for different injuries.
A remarkable case has been recently published in which the, patient
was trephined five times within five years.4" The disease of the bone for
which these successive operations were performed originated in blows
received in a brawl in 1875. The last trephining took place in 1880, and,
so far, appears to have been successful.
In Otaheite, the operator's armamentatium consists of pieces of broken
glass bottles for scraping, or, sometimes, of flints, shark's teeth for incisions,
and pieces of gourd with shark tendons for strings with which to cover the
opening produced. A missionary at Uvea, one of the South Sea Islands,
A case of repeated trephining. By P. B. McCutchon. New Orleans Mcd. & Surg. Journal, 1881,
ix, 259-261.


FLETCIIER.]















P'tEHIIISTOR1U TREPIIRINING.


gives a very clear and interesting account of the method of trephining prac-
ticed at that spot."4 He says:
A very surprising operation is performed en the island of Uvca, in the Loyally group. A notion
prevails that headaches, neuralgia, vertigo, and other cerebral affections proceed from a crack in the
head or pressure of the skull on th6 brain. The remedy is to lay open the scalp with a cross or T
incision, then scrape the cranium carefully and gently with a piece of glass until a hole is made into
the skull, down to the dura mater, about the size of a crown piece. Sometimes this scraping operation
will be even to the pia mater by au unskillful surgeon, or from the impatience of the friends, and death
is the consequence. nl the best of hands about half of those who undergo the operation io ie from it.
Yet this barbarous custom, from superstition and fashion, ha3 been so prevalent t ha very few of ihe
male adults are without this hole in the cranium, or "have a shingle loose," to use an Australian phrase.
I am informed that sometimes an attempt is made to cover the membranes of the cranium so exposed by
placing a piece of cocoanut shell under the scalp. For this purpose they select a very hard and durable
piece( of shell, from which they scrape the softer parts and grind quite smooth, and put this as a plato
between the scalp and skull. Formerly the trephine was simply a shark's tooth; now a piece of broken
glass is found more suitable or less objectionable (if we may even so qualify the act). The part of the
cranium generally selected is that where the coronal and sagittal sutures unite, or a little above it, upon
the supposition that there the fracture exists.

The semi-religious character of all and everything concerned in the
operation amongst the Kabylian tribes of Algeria is of special interest, as
it seems to strengthen, by analogy, the theory that the subjects of prehis-
toric trephining acquired thereby a sacred character which led to the wear-
ing of amulets from their skulls, as already described.
The curious suggestion has been made that the tonsure of priests is a
perpetuation of the ancient custom of trephining. The Abbd Martigny, in
his Dictionary of Christian Antiquities, says that the oldest Christian
mosaics and manuscripts represent St. Peter with the tonsure as a mark of
pre-eminence over the other apostles. It is probable that no weight should
be attached to this fact. The picture galleries of Europe abound in Holy
Families where tonsured monks of various orders are adoring the infant
Christ-anachronisms which did not trouble the old masters. We know,
too, that Brahmin priests, of a period long anterior to the Christian era,
are represented as tonsured. This does not, of course, affect the question
of the possible origin of the tonsure from the supposed sacred custom of
trephining, but the matter may be safely left as unsettled.
. The discoveries which have been made of late in mapping out the
convolutions of the brain, or, as it is termed, the localization of function,
have led to the reintroduction of trephining from a highly scientific stand-
"'Native medicine and surgery in theSouthl Sea Islands, by the Rev. Samuel Ella. Med. Times &
Gaz., Lond., 1874, i, 50.



















































































Cranium artificially trephined by M. ChampionniBre.


U. S. G. AND G. SURVEY.


PREHISTORIC TREPHlVIING, PI. IX.














CONCLUSIONS.


point. Given, in injury of the head or abscess of the brain, the failure of a
function, the locality 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 first to initiate this method of tre-
phining.47 This matter is referred to because a distinguished French surgeon,
M. Lucas-Championniure, published a work upon the subject about four
years ago, and in the introduction, speaking of prehistoric trephining, he
takes the ground that the operation 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.48 To prove this, lie 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 with a
piece of flint. The result could not be distinguished fiom 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 partially trephined, the outer table only
having been unmistakably scraped aivay, 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 by a
series of punctures. It is likely that the first was employed for children
and the latter for the harder skulls of adults.
47M. Legonest, the professor of military surgery at Val de Grace, formulates this remarkable
rule: "Singular as it may appear, I think the rule is that you should always trephine when you are
doubtful whether it ought to be done"!
4EItuo( historique et clinique sur la trdpanation dn crane; la tr6panation guide par les localisa-
tions cerdbrales. Par Just Lucas-Championniire. Paris, 1878. 8, p. 12.


FLETCIIHER.]













30 PREHISTORIC TREPHINING.

5. Posthumous trephining consisted in removing fragments of the skull
of a person who had undergone surgical trephining.
6. Each fragment was to exhibit a portion of the cicatrized edge of the
original operation; and the purpose was, probably, to form an amulet to
protect from the same disease or injury for relief of which the operation
had been performed.
7. The evidence so far confines the custom to neolithic man on the
continent of Europe.

ADDITIONAL NOTE.
Since the foregoing was printed a curious discovery has been made of
something like "post-mortem trephining" in a remote region. Dr. Dy-
bowski, who has been traveling in Yessel and the Aino lands, sent eight
Aino skulls to Mr. Kopernicki, who observed in five of them that a resection
of the foramen magnum had been performed in what he described as "a
systematic manner analogous to the trephined skulls of the French dolmens."
In one skull a portion only of the edge of the foramen magnum had been
cut out; in another the alveolar process had been sawn off. He supposed
that the purpose of the resection was not ceremonial, but medical, and that
the excised bone was to be used as a remedy. Nothing is known of trephin-
ing among the Ainos.
Mr. Kopernicki sent the description of these skulls to the Ethnological
Society of Berlin, and Professor Virchow remarked that there was no doubt
that an artificial removal of fragments of bone had taken place, generally
fiom the posterior and lateral sections of the border of the foramen mag-
num and the adjacent parts. In the three Aino skulls in his own collection
nothing of the kind was to be seen, but a Goldi skull and a New Branden-
burg skull presented similar lesions He had supposed them, in the latter
case, to be due to an attempt to make a drinking-cup of the skull, it having
been found in the earth without any other parts of a skeleton, and in the
frontal bone two small holes had been made as if for strings. The five Aino
skulls in question had been dug out of graves by Dr. Dybowski himself,
and he did not think the drinking-cup theory was applicable to them. He
was unable to give any opinion as to the object of these resections.4
Zceschlrift fiir Ethniiiologi, lirlin, 18 31, xiii, 191-192. SIee, also, foot-note 3, p. 6 antc.





























IN DEX.


Page.
Additional note ...................0................. 30
Aigmurcs, Dolmen near .............. ................ 6
Aino skulls ..-......-................................. 30
Algeria ............................................15, 22, 25
-- Prehistoric trephining in ...................... 22
America, Prehistoric trephining in.................... 23
American Assoc. Adv. Sci.........-................. 24
Amulets ..............................................5, 6, 13
Athene, Birth of ...................................... 15
Babert de Juill6 ................. .................... 17
Baye, Grottoes of...................................... 16,18
de Baye ............................................... 16
Beaumes-Chaudes, Caverns of ......................... 18
Beinhaus at Sedlec.................................... 20, 21
Belief in future existence indicated by prehistoric
trephining .......................................... 15
Berbers ................................ ........... ... 25
Bilin, Crania from .................................... A2
Bogdanoff, Tumulus at .........................-...... 22
Eoixe, Forest of, Tumulus in .......................... 17
Bones fourd inside of crania .......................... 16
Bougon, Tumnulus at..------........... ..-- .........--- 17
Boujoissae, Tomb at ...........................-..--. 13
Braii, Localization of function of, applied totrephining. 29
Bray-sur-Scine (Marne) ............................... 18
Drimna, instrument for perforating skull............... 26
Broca, Paul..... ........... 5, 6,7,8, 10,12,14, 15, 16,22,29
Br ookville, Ancient cemetery at................--..---- ... 6
Buckland, Miss A. --..--........-------------..----- 15
Bytehiskala, Grotto of-..........---.--..-- -------..--. 19
Cartailhac, ....-- ------.........- ......---......... -----
Casa da Mouva, Grotto of ..-..........-................ 3
Cavalry saber stroke on skull ....... ................. 9
Crvern of L'Ilomme-Moit ............................ 10
Chauvet ....---......-------------..--------..... .--. 17
Chouquet--..--....--------------------- ..-------... 17
Cibournios, Dolmen of- ..................-............. 11
Cicat: ization of bone, Indications of ................. 7
Cludsef, Ingoald .......--------------........------........ ---21
Devil Rliver, Mounds at .................. ....- ...... 25
Dich, or price of blood ................... ..... ...... 27
Djebel Aourhs ...........................-.........-- 25
Dogs, Charm for fits in ...............--------...... 15
Drinking-cups of skulls .............................. 6, 30
Dudik, B ............. .................... ... ...... 20,21
Dy:ks of Borneo ..........-......................-- ... 24
Dybowski, Dr ..---............-..--- ---------------- 30
Denmark, Prehistoric trephining in..----------------. 22
ecucelcs, Mound at ................................-.. 17
Ella, Rev. Samuel .........--....................... .8
E:ngelhardt ......-...........--................ .... 22
Entre Rocle, Skull from .................. ......... 17
Epilepsy, lRemeldies for ....................-........ 14
-, Trephining for --..............-----------..........----.. 14
Epileptic of hie New Testament...................... 14
von Erckert, General ................................. 21


Page.
Esthonian crania............................ ....... 16
ttang-la-Ville, Dolmen at ............................. 17
Faidherbe, General-................................... 22
Falster, Island of, Skull from .......................... 22
Foramen magnum, Resection of ....................... 0
Forehead never trephined ........... ...-......... 9
French Assoc. Adv. Sci ............................---------5,13, 17
Furfooz, Crania from.................--..............-------- 16
Gassies ......-......... .............- ...........-----. 17
Germany, Prehistoric trephining in ..............19, 20, 21, 22
Gilman, Henry............................-...-..... 24,25
.Goldi skull ..................... ... ......... .... .... 30
Great Britain, No prehistoric trephining in ........... 22
Gudgan ........................... ...............---.. 17
Hephlestus-.................... ... -...... .... 15
Holbrook, W. C ..---.......... ....................---- 25
Horses killed by pole-axe, Skulls of.................... 20
Hussites, Slaughter at Sedlec by ...................... 20
Inca skull from Peru .....................----.......---- 23
Internal. Cong. Prehist. Anthrop. .....-............... 16
Italian Society of An:lrop ..............-----.---.... 22
Italy, Prehistoric trephining in ................... ... 22
Ivory-like surface of cicatrized bone...............--- 7, 11
Kabyles of Constantine-.................... ....-----. 25
- Trephining practiced by ......-..........--. 25, 26, 27
Kopernicki ----....---...---........------------------...... 30
La LozBre, Dolmens of ..................... 5,12,13, 16, 18,20
Lagneau, G. A ............. ............ --........--. 16
Langdon, F. W. ...................................... 8
Le Baron, Jules .................... ..... ............ 9,22
Legoucst................................. ..-....... 29
Lisbon, Museum of.................................... 23
Livy .................. ....... ......... ..........-- -. 6
Lucas-Championni6re, J............................. 29
Lucian ...-.....-.....--- ------...------...--- ---. 15
McCutchou, P. B ....................----........... 27
Madisonville, Prehistoric cemetery at................. 8
Mantegazza.......--- ----------..----------------- 22
la Marconitre, Dolmen at ............... ............ 13
Martigny, Abb6................... .........------.. 28
M martin, L.-T ....................................... 25, 2 ,27
Mason, O.T .-.............---...-....--- ...-----------. 24
Mauvoisin .........-.....--..... .-..... ------.--. 18
de Mortillet, A..................-................. 16, 23
Music e Broca ..................--................... 9,22
Nl6aton....----........... .....-----........----.....-- 24
New Brandenburg skull ........--......-............. 30
SNicolucci ........--...-----......--- --..-...... 22
N iort ..- ..- ............ ...- ........................... 17
Noes, Dolmen at ...................................---- 22
Norsemen drinking fom skulls.. ......--............ 6
Nott,J. P ............................. .... --- ....--- ... 24
Occipital bone, Trephining on ............. ..... .... 9
Os antiepilepticum ..................... .......------- 14
Ossa \Vormiana ................ ........----------- 14
Otaheite, Trephininig in ............-----..--.------- 27
i3
























INDEX.


Page.
Parietal bones usual site for trephining .........--.... 9,25
laris, Amd6 ...........---------------------......... 25,26,27
Parrot .................. ---.......-..------------. 9,18,19
Prunitres .............................. 5,6,11,12,13,16,17,18
Quatrcfies ....................--.--.................. 16
Quick, E. ..... ......- .......-- ................ 6
Race in relation to traumatism..............----......... 11
Raclage or scraping................................... 18
liver Rouge, Mounds at .............................. 24
Rock River, Mounds at ............................... 25
Rolnia, Skulls from...........................------........ 22
Rondelles ........-................----.. ....... 5,6,13,16, 21
Counterfeit .................................. 23
Sable River, Mounds at ............................... 24
Schneider, L .......................................... 22
Sedlec Beinhaus ..................................... 20, 21
Skull, Congenital deficiencies of....................... 9
Injuries of, from blows....... ...............-. 8,10
Reparative process of wounds of............... 10
Trephining of, for disease of bone.............. 18
-- W ounds of..................................... 8,9
Society of Anthropology of Paris............ 6,9,12,17,18,23
- of Ethnology of Berlin......................... 20
South Sea Islands, Trephining in....................12,15,27
Squier, E. G........................................... 23
Staggers in sheep cured by trephining ................ 12
Strupcic, Skulls from.................................. 22


Page.
Taxil, Jchan .......................................... 18
Tertre GuLrin, Skulls from............................ 17
Thebibes.............................................. 26,27
Tonsure a symbol of trephining....................... 28
Trephining, Incomplete .............................. 18
-- Posthumous, on Aino skulls................... 30
Prehistoric, confined to neolithic age........... 16
performed on females .................. 9
young children................ 10
Methods of ...........................11,12,13
Purpose of ............................. 14
Posthumous............................ 7
Surgical................. .............. 7
-- not dangerous per se ............... .......... 8
-- performed as a means of extortion ............. 27
-- repeated on same person ....................... 18,27
Uvea, Trephining in ..........................----........ 27, 28
VaurBal (Oise), Cranium from......................... 9
Veckenstedt ......................................... 12
Velpeau .............................................. 11
Virchow, Rudolph .................................... 21,30
Wankel, H..........................................19, 20,21
Wiedersheim, R.............................---....... 22
Woman's milk as surgical dressing.................... 27
Zeus, Trephining performed on ....................... 15
Ziemcin, Rondelle from................................ 21
Ziska, John.......................................... 20


~ Y




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