to become converts to the doctrine of finality, and to consider it very probable a priori that whatever is new is, therefore, not true, and if by any chance it should happen true, it would certainly prove not to be new; but when this frame of mind grows upon us, it will be well to consider that our past was once a future, and had a more undeveloped past before it, and that the old ways have been led up to, by ways still older, and no doubt worse to travel upon. While it is much to be desired that in this, as in other cases where modern surgery seems likely to reverse the weighty opinion of those who have gone on before us, no change in practice shall be made hastily, it is impossible to write on this matter now-a-days without seeing that, owing to the introduction of antiseptics, and the lessening dread of operations on the skull and brain, the pendulum of opinion, which has for so many years swung in the direction of non-interference, is now coming back again towards the opposite view.

If these battles over the best method of treatment have often-times waged fiercely, and if not fought to a conclusion, they have certainly won glorious victories on behalf of humanity and the establishment of scientific truth.

When we consider the peculiar development of the bones forming the cranium, the special function assigned it, of protecting so important an organ as the brain, its peculiar adaptation during the various periods of life to that viscus, it is evident that in cases of injury, we are called upon to adopt a line of treatment for which there can be no precedent in surgical affections in other parts of the body.

Early History.-To the medical historian the antiquity of trephining has been a frequent topic for research. During recent years discoveries have been made in France and other countries, conclusively proving that trephining was practised by neolithic men, who inhabited Europe several thousand years ago. As these inhabitants were probably cannibals, and therefore we may conclude ignorant and superstitious, it is highly probable that it was their very superstition which led them to trephine the skull. Epilepsy and insanity were the diseases in which the operation was supposed to be done, and the operator had probably no better instruments than sharpened shells or flints.

At first, an incision was made down to bone, the flaps retracted, and an opening made sufficiently large to expose the membranes of the brain, as a short way out for the demon in possession," which was the supposed cause of the affliction. M. Broca holds that trephining dates from very early history; he says:

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"By the oldest Greek medical writers, mention is made of it as a usual operation. In the time of Hippocrates it was applied only to traumatic lesions of the head, and appears to have been done with a circular trephine; but it seems that the operation was far more ancient, and was applied to the treatment of other head affections. Until quite recently trephining of a primitive kind was in use amongst some of the South Sea Islanders, for the treatment of epilepsy, insanity, and even headache, and the operation was done by scraping with a piece of flint or broken glass, when the latter was to be had from Europeans. In much the same way, and with similar instruments, the operation was done in the 'neolithic' or polished stone period, the age following the so-called quaternary, and preceding the bronze epoch. This period corresponds with the burial in dolmens, the use of agriculture and the employment of domestic animals, the making of hatchets of polished flint, though rough chipped flint instruments were still in use."

In examining a number of skulls of this period, Dr. Prunières and M. Broca discovered that the operation of trephining had evidently been done in two different ways and for two different purposes, one being surgical and the other posthumous. The posthumous operation was performed only on those who, in infancy, had undergone the surgical operation. It was evident that in nearly all cases the surgical operation had been performed on infants; and that the patients had lived many years was evidenced by the growth and development of the bone. But in many of the skulls which bore such signs, it was found that a number of pieces of bone had been chipped away from the edges of the orifice, and some of these either perforated for the purpose of suspension or otherwise shaped as amulets, were found. In explanation of these facts, M. Broca refers to the early idea that epilepsy, insanity, and even headache and low spirits were due to demoniacal possession. He

believes that the orifice was made in order to give exit to the evil spirit, and ever after the individual would be regarded as an object of peculiar sanctity. Hence, the pieces of bone around were taken, after death, to form amulets and charms, to drive away evil spirits. But still more remarkable was the fact, that in all the cases of this posthumous operation, a part, usually about a quarter, of the margin of the original orifice was left intact, and that into the skull were inserted amulets made from similar pieces from another individual. This, he thinks, not only indicates the belief in an existence after death, but that the person maintained his individuality, and therefore they would not rob him "in the other life of the glorious evidence of the operation he had undergone in his youth." This, as M. Broca states, is probably the earliest record of a belief in a future existence, if we may accept it as such. As to the operation, there seems to be evidence that it was always performed on the young, never on the adult, the instruments employed being too imperfect to allow of penetration of the hard adult bone. M. Broca tried the operation on a young dog, scraping with a piece of glass, and found that it was easy and not followed by any serious symptoms. Considering the class of case, the desperate nature of the operation, and the barbarous method of performing it, to say nothing of the after consequences-e.g., hæmorrhage, blood-poisoning, erysipelas, the danger of injury to the brain, the want of proper nursing and bad hygienic surroundings it is wonderful that any patient should have recovered, and yet incredible as it may seem, Dr. Prunières states that out of twenty skulls in his possession, nineteen exhibit indubitable signs of having recovered from the operation.

This discovery throws a very remarkable light upon the history of the earliest ages of mankind. It is curious that it should have been made at a time when trephining has been proved that it can be used with advantage in some cases of brain disease, not obviously due to surgical injury. If it were successful before localization of the functions of the brain was thought of, perhaps it will also be now, that the refinements of localization are realised facts; the majority of the holes were situate in the parietal region and over Ferrier's motor area.

In 1868 M. Prunières discovered in a large dolmen near Aiquiens, a skull of which a large part of one side had been removed. Many have been found in the cavern of L'Homme Mort in La Lozier and several in the grottoes of Baye. In a tumulus at Bougon, near Niort in the south of France, a trephined skull was found in 1875, and in the cloister of Guérin, on the Seine, near Paris, the skull of an old man was found with a trephined aperture, which was completely cicatrized. M. Chouquet discovered in a mound near Ecuelles specimens of both surgical and post-mortem trephining. M. Gassie discovered a trephined skull in a mound at Entre Roche, and another was found by M. Guigan at Etang-la-Ville. In 1878, M. Prunières found in Beaumes-Chaudes (La Lozier) more than sixty specimens of trephined skulls. In 1880 were found in some artificial grottoes near Baye, several crania of the neolithic age, of which two presented cicatrized perforations. An extensively diseased skull showing evidence of surgical trephining was found in a grotto of the neolithic period at Bray-sur-Seine.

In Germany a few examples of pre-historic trephining have been found. The skeleton of a girl, twelve years, was found in the grotto Bytchiskala in Bohemia. The skull bore unmistakeable evidence of ante-mortem trephining. A great number of trephined skulls have been found in the ossarium of Beinhaus at Sedle in Bohemia. This heap contains thousands of human bones. Many of the skulls contain perforations. Some evidences of trephining have been discovered in a Criquoian cave near Ziemerin in Poland. A skull was taken from a tumulus at Bogdauoff, Russia, in which was a perforation made undoubtedly during life. In Italy has been found a rondelle or amulet from the occipital bone, both sides of which were highly polished, but no trephined skulls have yet been found in that country. In Denmark, two surgically trephined skulls have been found, one in a dolmen at Boneby, and another in a dolmen at Nois in the island of Falster. A number of excellent examples have been discovered at Rokina in Algeria. A very interesting cranium was found in the grotto of Casa da Mouva at Penicher, which contained the remains of 140 persons of the stone age.

Thus, in nearly every portion of Europe, do we find the traces of races whose only history is that which can be read, but hesitatingly, and with many missing sentences, from their bones, and carvings, their weapons and utensils. Time will undoubtedly, through further discoveries, fill the gaps now so prominent in their disconnected record. Let us next consider for a few moments the character of these perforations, and the instruments, so far as known or surmised, with which they were made. The apertures in the skull mentioned at the beginning of this paper are remarkable for the smoothness of their sides, and their almost perfect circular circumferences. They have the appearance of having been struck out with a die. It is evident that no stone or flint instrument could have produced them. If the skull belongs to the stone age, as is very probable, the material used was undoubtedly obsidian, the utility of which has been recognised for ages. It was first described by Pliny under its present name, which it took from its discoverer, Obsidius, by whom it was brought from Ethiopia. It is a species of lava, and is in reality a natural glass, very hard and brittle, opaque in masses, but translucent in flakes or sections, and is still used in manufacturing pins, ear-rings, and like trinkets.

A very favourite method of accomplishing the trephining seems to have been scraping with a piece of flint or shell. This is the theory of Broca, who, in substantiation of it, presented to the Paris Society of Anthropology some skulls on which he had produced the counterpart of the stone age apertures by scraping with a piece of glass. The incisions of the Inca skull from Peru appear to have been made with some cutting instrument, something like an engraver's burin, and not with a saw.

There still exist a race in Algeria, called Kabyles, among whom the practice of trephining is still extensively used. They perform this operation for cranial fracture. The instruments are of the most simple pattern, and yet are all useful and well designed for the purpose. They consist of a razor, a serpette, one or two saws, some straight and curved elevators, and the burin or perforator. The perforator is whirled between the hands until a perforation is made. This operation is repeated until the portion of bone

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