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vived were looked upon with peculiar veneration, and that after death their skulls were sawn away from the cicatrized hole in order to provide amulets of peculiar value for the living, a portion of the cicatrized hole being carefully left upon the mutilated skull, whilst an amulet, cut from another skull, was frequently placed within the cavity made after death-the question naturally arises as to the reason of these singular practices.

Dr. Broca believes that this dangerous and painful operation was performed for the cure of epilepsy and convulsions, and he argues justly from the superstitious practices found in connection with it, that at that period, as well as long subsequently, these diseases were regarded as peculiarly the work of spirits, and that consequently neolithic peoples had attained to some conception of religion and of a future state. He shows that even as late as the seventeenth century, all convulsive diseases were regarded as epilepsy, especially in infancy, although true epilepsy seldom shows itself before the age of ten, and he thinks that this explains why the operation was so constantly practised upon young children, since the apparent cures effected by the process would be more numerous at that age, experience having proved that sufferers at a later age, that is true epileptics, were not cured thereby; whilst those who in early infancy were submitted to the operation, might grow up as living witnesses of its efficacy.

Dr. Broca quotes from a treatise upon epilepsy by Jehan Taxil published in 1603, not only to prove that at that date infantine convulsions were confounded with true epilepsy, but also as showing that up to that time epilepsy and kindred diseases were looked upon as spiritual diseases, the work of gods or demons, whilst the remedies recommended in this treatise are highly suggestive, consisting sometimes of the ashes of a human skull applied as a plaster on the crown of the head, sometimes the same administered in potions or pilules, and sometimes as nodules to be worn round the neck, whilst sometimes also scraping the skull was

recommended. Dr. Broca goes on to show that all through the middle ages, and even after the Renaissance, the substance of the human skull was used in the treatment of epilepsy, the skulls of Egyptian mummies being regarded as the most efficacious; whilst in the last century all the pharmacies contained a bottle labelled "Ossa Wormiana," for the treatment of epilepsy, the peculiar efficacy of the triangular lambdoidian bone consisting in its form, which resembles that of the amulets cut from the human skull; thus showing the step between prophylactic and mystic medicine.

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Neither was the use of trephining as a remedy for convulsive disorders confined to neolithic times: it is still in favour with Oceanic races, with the Kabyles of Algeria, and also, it is said, with the mountaineers of Montenegro. Even in the last century a certain number of practitioners employed trephining as a cure for epilepsy, and Taxil, before quoted, writing in 1603, gives minute directions for the process, which in epileptic cases differed from that employed in cases of fracture of the skull, which is its sole use at the present day, especially when that fracture is likely to produce epileptic convulsions, all modern practitioners regarding it as useless in cases of spontaneous epilepsy. But, says Dr. Broca, "how came it to be introduced into the practice of medicine? No one knows. Hippocrates, Galen, and other ancient authors, the Arabs and the Arabists, had not spoken of it; it was doubtless one of those popular practices which low empirics transmitted from one to another, and which sometimes got introduced into therapeutics." M. Prunières supposed that this practice of trephining was extended to idiots and insane, as well as to convulsive patients, and this Dr. Broca considers possible, although he believes its chief use was for infants suffering from convulsions, who were on that account supposed to be possessed by spirits.

Among the skulls examined by Dr. Broca was one which he regarded as particularly noteworthy, because from its appearance it would seem to have been partially trephined; a large surface had been scraped away, but

the operation was not completed, or at least it was not continued so as to produce the usual hole.

Dr. Broca possessed three specimens of this incomplete trephining; one from Roknia, in Algeria, one from Portugal, and another. This incomplete operation he supposed to have been employed either for a minor malady, or more probably that it was adopted by some unbelieving or less credulous individuals, who attributed the cure rather to the scraping of the substance of the skull, than to the hole made to facilitate the escape of the evil spirit of disease; but at the same time he regarded this incomplete operation as a sign of the decay of an old superstition, pointing out that in the comparatively late treatise of Taxil upon epilepsy, he recommends a treatment which consists of scraping the whole external table of the bone, but which was sometimes to be continued so as to expose the dura mater. "Hence," says Broca, "the empiric operators of the middle ages, whose barbarous practices are reflected in Taxil's book, did precisely that which had been done by neolithic operators many centuries before, with this difference, that with the former incomplete trephining was the rule, and complete the exception; whilst with the latter it was just the reverse, the complete operation being the rule, and the incomplete the exception."

I have before mentioned the amulets cut from the trephined skulls, some of which were found inside the skulls thus treated, although these invariably belonged to other skulls, and not to that within which they were found. These amulets are of various forms and sizes. A glance at the mutilated skull figured in Dr. Broca's book will show how they have been cut away from the hole made in trephining, and how much they must have differed in shape. Some of those found are carefully rounded and polished, and have a hole bored in the centre for suspension; some are triangular, some oblong, and some quite unpolished, just in the state in which they were cut from the skull; but in almost all there is a portion to be detected of the original cicatrized hole, and it is probably to this that they owed their value.

Dr. Broca thinks they were probably worn as a charm against those convulsive disorders for which trephining was practised, and that so great was their reputation that they became articles of commerce, so that it was necessary to preserve some visible token of their origin, in order to prove that they were really taken from a trephined skull. This, however, will not explain their presence within the skull from which others had been cut. Dr. Broca supposes that having gone as far as possible in robbing the deceased of his cranial substance, fear of his anger in a future state induced them to make some sort of restitution, by placing within the despoiled skull a valued amulet cut from another sufferer. cannot say that this hypothesis is quite satisfactory, and I may perhaps be allowed to offer another, which has suggested itself to me as probable.


It would appear to me that the permanent hole in the skull, whether of child or adult, would necessitate some sort of shield for the exposed portion of the brain, the least injury to which would be fatal; and what more appropriate covering could be found than a portion of the skull of one who had suffered in like manner, and had lived and grown old notwithstanding, and to whose skull therefore a specially preservative power might be assigned by superstition? One might imagine a mother hastening to provide her suffering child with this preservative shield, either polished or unpolished according to her means, which worn by him in a fillet bound round the head during life, would, as well as other precious possessions, be buried with him. But when, perhaps, after a lapse of years the skull of the trephined was again mutilated to provide amulets or coverings for the living, this amulet would be displaced, and of course, being found too small for covering the enlarged cavity, it would naturally be placed inside, perhaps with the vague notion that the departed spirit finding the accustomed covering, would not miss the pieces taken from the skull, or would suppose the loss to be the result of accident or natural decay; for it is not without significance we read that the skulls wherein the amulets have

been found, and which are always posthumously mutilated, are filled up with earth so tightly packed into the cavity as to require some patience to remove it.

One point in favour of this hypothesis is, that two out of the three amulets hitherto found in the interior of the mutilated skulls, have been of the rare type styled rondelles by Dr. Broca; that is, they are nearly round, highly polished, and neatly fashioned at the edge; the third was also rounded and polished, although of a more irregular shape, had been broken; whilst the ordinary cranial amulets are irregular in form, and generally left in the state in which they were cut from the skull. We must also bear in mind that we are treating of a time when metal was unknown, so that if a shield was required for the exposed brain, some hard substance such as stone, shell, or bone must have been chosen, and this would add to the probability of cranial amulets having been so applied.1 This, however, would account for very few, three only having hitherto been found within the cavity of trephined skulls, so that by far the larger number were doubtless used and worn as charms, probably to ward off or cure convulsive disorders.

Those who have followed this singular account of pre-historic surgery thus far, will naturally inquire whether the custom can be traced to its origin, and whether it was peculiar to one tribe and to one period. To both these questions Dr. Broca has given an answer, although necessarily an incomplete answer. He says that these pre-historic trephinings were in use through the whole of the neolithic age, for they have been found in the cavern of the "Homme Mort" (Lozère), which dates from the commencement of the polished stone period; also in the sepulchral grottoes of Baye, which date probably from the latter part of that epoch, and again in certain dolmens of Lozère in which a few rare objects in bronze testify to the end of the neolithic age. Traces of the practice have also been

1 In Otaheite they use cocoa-nut shell for this purpose, as recorded later.

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