Lobotomy

   (from 1935)

   Also called leukotomy. Although the Swiss psychiatrist and asylum-director Gottlieb Burckhardt (1836–1907) had earlier made some tentative and quite unsuccessful efforts at operating on the brain for psychiatric indications (see Psychosurgery), the modern history of psychosurgery begins in Portugal. Egas Moniz (pronounced [EE-gosh Mon-ISH]) (1874–1955), professor of neurology in Lisbon, had studied with the great French neurologists and in 1927 described cerebral angiography in the Revue neurologique. (See Neuroimaging.) In 1935, at an international congress of neurology in London, he heard a full-day symposium on the frontal lobes of the brain, where psychologist Carlyle Jacobsen (1902–1974) and physiologist John Fulton (1899–1960) at Yale University described the taming of a chimpanzee’s behavior after the ablation of much of its frontal lobes. Thus inspired, between November 1935 and February 1936, Moniz asked Lisbon neurosurgeon Almeida Lima to resect part of the prefrontal lobes of 20 asylum patients in Lisbon once they were transferred to Moniz’s neurology service. In a paper in March 1936 at the Society of Neurology in Paris, then in a book published in Paris later that year, Operative Procedures in the Surgical Treatment of Certain Psychoses (Tentatives operatoires dans le traitement chirurgical de certaines psychoses), he claimed that seven patients had been "cured," seven improved, no change in the others. This was the beginning of "frontal leukotomy," approaching the lobes of the brain through the top of the skull.

   Yet, as Europe became embroiled in war, the greatest advocates of lobotomy turned out to be Americans. Walter Freeman (1895–1972), a former neuropathologist at St. Elizabeths Hospital in Washington who then became professor of neuropathology, neurosurgery, and neurology at George Washington University, had also attended the London conference and became an uncritical admirer of the procedure. Together with neurosurgeon James Watts (1904–1994), in 1936 Freeman presided over the first "lobotomy"—as they called it—in the United States, at George Washington University Hospital. In 1946, they introduced the "transorbital" lobotomy, approaching the brain from the roof of the orbital cavity. Freeman first reported their results in the Medical Annals of the District of Columbia in 1939. By 1942, they were able to describe, in an article in Diseases of the Nervous System, the results of "prefrontal lobotomy" in 74 cases. Their book, Psychosurgery: Intelligence, Emotion and Social Behavior Following Prefrontal Lobotomy in Mental Disorders, appeared in that year. Later, Freeman went on proselytizing tours of asylums and Veterans Administration hospitals, demonstrating the procedure and seeking converts.

   By the late 1940s, lobotomy had come to be widely practiced in the United States. More than 9000 operations were performed in 1949 alone. According to psychiatry historian Jack Pressman, who has written a careful history of lobotomy, "A large number of psychiatrists had found in lobotomy a tool that altered human character to an extent unmatched by any other resource in their armamentarium" (Last Resort, p. 10). With the marketing of chlorpromazine in 1954, the number of lobotomies declined sharply and the procedure, to all intents and purposes, went out of use, yet not before Moniz received a Nobel Prize for it in 1949.