Lobotomy: the history of a questionable "cure"
A very contorversial topic, probably most famous for its appearance and subsequent demonisation in "one flew over the cuckoos nest", it was long believed to be an effective treatment for physcotic or mental illnesses. The procedure was conceived in 1935 by Antonio Egas Moniz who would later win the nobel prize for Physiology or Medicine in 1949 for his work related to his "leucotomy". This procedure was continued for the next two decades as a mainstream treatment for phsyciatric conditions until its large decline in the mid 1950`s as the introduction of antiphsycotic medications was far more popular. Intial research was done on primates by aggravating them (placing food out of reach and taunting them) and observing their tantrums. "Becky" one of the chimps was then operated on and Moniz remarked her behaviour was as if she had "joined a happiness cult" and became far more Passive. He suggested its use on humans to John Fulton (a Yale Neuroscientist) who was "startled".
The first 8 procedures were performed by injecting ethanol temporaly into the patient between the frontal lobe and the remaining body of the brain to attempt to destroy certain fibres connecting the two and establish a "barrier" from the rest of the brain. The ninth patient was operated on by the newly invented "leucotome"
This was driven into the cranium to a depth of 5cm along the plane of the bridge of the nose, a small wire would be extended when the tool was operated and then rotated to create cores into the brain forming lesions. these were often performed multiple times. Every patient observed complications post surgery such as
"increased temperature, vomiting, bladder and bowel incontinence, diarrhea, and ocular affections such as ptosis and nystagmus, as well as psychological effects such as apathy, akinesia, lethargy, timing and local disorientation, kleptomania, and abnormal sensations of hunger"
although he Moniz concluded 35% had an improved condition significantly; another 35% observed less significant improvement and the remaining 6 patients (30%) went through no change.
In 1937 Freeman and Watts adapted this technique creating the "Freeman-Watts standard prefrontal lobotomy":
This new "transorbital" lobotomy involved lifting the upper eyelid and placing the point of a thin surgical instrument (often called an orbitoclast or leucotome, although quite different from the wire loop leucotome described above) under the eyelid and against the top of the eyesocket. A mallet was used to drive the orbitoclast through the thin layer of bone and into the brain along the plane of the bridge of the nose, around fifteen degrees toward the interhemispherical fissure. The orbitoclast was malleted five centimeters into the frontal lobes, and then pivoted forty degrees at the orbit perforation so the tip cut toward the opposite side of the head (toward the nose). The instrument was returned to the neutral position and sent a further two centimeters into the brain, before being pivoted around twenty-eight degrees each side, to cut outwards and again inwards. (In a more radical variation at the end of the last cut described, the butt of the orbitoclast was forced upwards so the tool cut vertically down the side of the cortex of the interhemispherical fissure; the "Deep frontal cut".) All cuts were designed to transect the white fibrous matter connecting the cortical tissue of the prefrontal cortex to the thalamus. The leucotome was then withdrawn and the procedure repeated on the other side.
