Moniz, Freeman and the lobotomy

At the International Neurological Congress in London in 1935, John Fulton of Yale and his colleague Jacobsen described two chimpanzees that, after frontal lobe surgery, made mistakes in tests without becoming aggressive. Egas Moniz, professor of neurology in Lisbon, a former foreign minister and the inventor of cerebral angiography, was a delegate. He went home convinced that mental illness driven by emotional tension might be relieved by cutting the connections of the frontal lobes.

In November 1935 Moniz and the neurosurgeon Almeida Lima began operating. They first injected alcohol into the white matter of the frontal lobes; Moniz then designed the leucotome, an instrument with a retractable wire loop, to cut cores of that white matter. He reported that his first 20 patients all survived without serious complications. In a second series of 18 patients, all with schizophrenia, 3 were judged almost cured and 2 much better, and he called the operation simple and always safe.

Walter Freeman, a neurologist at George Washington University, and the neurosurgeon James Watts performed the first American operation in September 1936, on Alice Hood Hammatt, a woman with agitated depression who had tried to withdraw her consent the night before. By 1942 they had operated on more than 200 patients and reported 63 percent improved, 24 percent unchanged and 14 percent worse. Rosemary Kennedy, operated on in 1941 at 23, could no longer walk or talk afterward and needed care for the rest of her life.

In 1946 Freeman introduced transorbital lobotomy, driving a thin instrument with a hammer through the bone above the eye socket, and said it needed neither general anesthetic nor a surgeon. Watts objected and ended their partnership in 1947. Moniz received the 1949 Nobel Prize in Physiology or Medicine after Freeman nominated him, and that year more than 5,000 lobotomies were done in the United States. Norway carried out about 3,000 between 1940 and 1960. Freeman performed 3,439 himself, the last in 1967. Many patients became apathetic and passive, losing initiative and emotional response.

The Soviet Union banned lobotomy in 1950 as inhumane. After chlorpromazine arrived in 1952 the operation declined, and from about 1960 only much more limited cuts were used, for severe anxiety and compulsive disorders that resisted other treatment.