Medicine: Looking Backward

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As the father of psychosurgery in the U.S., Washington Neurologist Walter Freeman bears a heavy burden of responsibility, both medical and moral. With Dr. James Watts, he introduced the drastic operation of lobotomy (cutting nerve connections in the forebrain) to relieve unbearable pain and the severest mental disorders. Now, in the A.M.A. Journal, 16 years and 2,000 lobotomies later, bearded Surgeon Freeman takes a long, hard look backward over the hazards, successes and failures of lobotomy, and notes a sharp distinction between old and new techniques.

In general, Dr. Freeman is as confident as ever that the hotly debated brain operations are right and proper, provided always that the patients are chosen with care. Of 1,019 cases which he has been able to follow for a year or more (up to 15 years), Dr. Freeman rates the result good in almost half.

Patients who have spent not more than six months in a mental hospital, he finds, have a two-to-one chance of getting a good result. By this he means that the patient "not only is out of the hospital but is actively engaged in some useful type of activity, earning a living, keeping house, or going to school." After more than six months in a hospital, the patient's chances of a good recovery drop swiftly, to only one in ten after seven years. So, Dr. Freeman, who once said of prospective patients: "I won't touch them unless they are faced with disability or suicide," believes now that the hazard of delay is greater than the hazard of performing the operation promptly.

But on hazards within the pattern of brain surgery, Dr. Freeman has undergone a great change of heart. He has fallen completely out of love with the prefrontal lobotomy. in which a knife is inserted through a hole drilled in the temple, though he performed 624 such operations, most of them with Watts. Now he is a devotee of the transorbital lobotomy. in which approach to the frontal lobe is made through the eye socket (TIME, Sept. 15).

In prefrontal lobotomies, Dr. Freeman reports, the operation itself proved fatal to 24 patients (3.6%), whereas among almost twice as many of the transorbital type there were only 20 deaths (1.7%). Undesirable physical results, such as partial paralysis, loss of bladder control and convulsions, affected 51.5% after prefrontal operations, only 5.2% after transorbital. Undesirable social complications, such as indolence, profanity and sexual irregularities, also appeared ten times as often among prefrontal cases.

As a result of these findings, Dr. Freeman has almost abandoned the prefrontal operation in the last three years. But transorbital lobotomy, he is convinced, is here to stay.