Hello, Lovelies! To the left is an image of Dr. Freeman and Dr. Watts preparing for an operation. Below, you’ll find Rebecca’s notes with links to sources. Even though this week gets real real real fast, we hope you are still able to enjoy the story of Dr. Freeman. Ashley and Tiffany are sending out big virtual hugs if you want one, but if you need someone to talk to, below are links to a couple resources:
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Walter Jackson Freeman II
Born November 14, 1895 in Philadelphia, PA to his father, Walter Jackson Freeman, an otolaryngologist (ENT doctor) and his mother Corinne Keen
His maternal grandfather, William Williams Keen, was a prominent surgeon during the time of the civil war and went on to treat 6 presidents (including President Franklin Roosevelt)
He graduated from Yale in 1916 and then enrolled in the University of Pennsylvania, earning a degree in medicine in 1920
After working at the Hospital of the University of Pennsylvania as a pathology intern, Freeman went to Europe in 1923 to study neurology
After a year, he returned to the States to take up the position as laboratories director at Saint Elizabeth’s Hospital in Washington DC (he was the first practicing neurologist in the city), it was here that he first witnessed the conditions experienced by mentally ill patients:
- This was a time before the appearance of affective psychiatric drugs (which showed up around the 1950s)
- Additionally, mental hospitals were typically overcrowded (for example, the state hospital in Philadelphia was known to have 75% more patients than what it was approved for) and would hold patients for decades at a time
- In 1948 writer Albert Deutsch described a visit to this hospital as reminding him of images he had seen of Nazi concentration camps
- At the time treatments were creative and barbaric, ranging from injecting patients with insulin to send them into hypoglycemic comas and giving patients malaria to cure insanity (this was called Pyrotherapy, which involved raising the patient’s body temperature, either by inducing a fever or hot baths, which was used in psychiatry)
He eventually earned his PhD in Neuropathology and became the head of the neurology department at George Washington University
Freeman believed that mental disorders had a well defined physical cause and that the current psychoanalytic approach, a view that thought mental illnesses stemmed from the unconscious, wasn’t useful in clinical settings.
(it’s a bit unclear if his belief that mental disorders stemmed from a physical cause and should be handled in a physical manner, or if he believed that, in clinical settings, that physical methods of treatment would be more efficient)
This caused him to be attracted to the idea of psychosurgery, where surgery was performed on the brain with the belief that this would be a psychological treatment.
In 1935, Freeman learned of a frontal lobe ablation (removal) technique that had resulted in subdued temperament on chimpanzees who had this procedure performed.
Additionally, in the same year, a new procedure was performed under the direction of Antonio Ega Moniz, who was a neurologist and physician. This procedure was called a Leucotomy which was meant to treat mental illnesses by removing small cores of the frontal lobe, more specifically, the prefrontal cortex.
- The Prefrontal Cortex is the most anterior part of the frontal lobe
- So think of it as the part of your brain right behind your forehead
- A tool called a Leucotome, which was a rod with a loop at the end for cutting, was used for this procedure
Freeman adopted and modified the procedure, renaming it a Lobotomy. (stories vary on how exactly he modified the procedure) He believed that the excess emotions caused mental instability, so by severing the nerves in the brain you would be able to stabilize a person’s personality.
It was at this time that Freeman teamed up with James Watts, who was a neurosurgeon. Since Freeman was a neurologist and not a “traditionally trained” surgeon. It’s reported that Freeman teamed up with
Watts because Freeman lost his license to perform surgery after having a patient die on the table.
They performed their first lobotomy in the September of 1936 on Alice Hood Hammatt, who was a Kansas housewife.
- She had previously been diagnosed with “agitated expresion”
- Would have bouts of hysterical laughter or crying
- She woke up from the procedure with a “placid expression” on her face and could not remember what upset her before
- Later, her husband wrote to Freeman, and said that post-surgery his wife was “the happiest of her life”
By 1942, Freeman and Watts had performed over 200 lobotomies, 63% they reported showed improvement postoperatively (no idea what that means), and the practice was being taken up by other surgeons.
Reportedly, Freeman was noted to had said that a lobotomy was “only a little more dangerous than an operation to remove an infected tooth.”
Still, Freeman knew of the hundreds of people in mental institutions and aimed to make a procedure that was faster, more effective, required less tools, and thus was more readily available to those who needed it. (many mental institutions at the time did not have things like surgery suites or access to anesthesia)
In 1945, he took a grapefruit and an icepick from his kitchen and started testing his idea, eventually moving on to cadavers
He came up with the Transorbital Lobotomy
- Trans: across, over beyond
- Orbit: the bony cavity perforated for the passage of nerves and blood vessels that occupies the lateral front of the skull immediately beneath the frontal bone on each side and encloses and protects the eye and its appendages. — called also eye socket, orbital cavity.
How a Transorbital Lobotomy is performed:
- The patient was typically rendered unconscious by electroshock therapy
- The eyelid was lifted and the instrument (a.k.a. icepick) was placed under the eyelid against the top of the eyesocket
- Using a mallet, the instrument was driven into the thin bone of the eye socket into the brain, following the plane of the bridge of the nose
- The instrument driven 2 inches into the brain before being swept towards the nose (horizontal cut)
- Returning to the neutral position, the instrument was driven an additional ⅘ in, then swept horizontally again
- A more radical variation involves sweeping the instrument up/down vertically for a “deep frontal cut”
- The instrument was removed and the process was repeated on the opposite side
It’s reported that in the earlier surgeries the original icepick from Freeman’s kitchen was used, eventually he created a glorified ice pick and it was named a Orbitoclast
Traditional lobotomies could take over an hour, this new procedure had an “operating” time of 10 minutes. Additionally, the new procedure didn’t require dressing of the wounds post operatively and could be performed by clinicians untrained in surgery.
The first transorbital lobotomy was performed in 1946 on a housewife named Sallie Ellen Ionesco. Her daughter, Sally Forester, remembers her mother being “absolutely violently suicidal”. Afterwards, she said “It stopped immediately. It was just peace.”
In reality, this procedure would typically leave people in a vegetative state or reduce them to childlike behavior. This was desirable since it would make patients easier to handle.
Despite the criticism and the controversy, the Transorbital Lobotomy gained popularity and was thought of as a “miracle procedure”.
Freeman started touring the country, promoting his new procedure, using the slogan “Lobotomy gets them home”.
However, contrary to popular belief, i couldn’t find information confirming that the car he used to tour was named the “Lobotomobile”, some references say the term was coined a decade after his death
5,000 lobotomies were performed annually by 1949.
Freeman was reported to have performed the operation on more than 2,900 people (and one source stated 3500), 19 of which being younger than 18
In 1952, in West Virginia, he performed 228 lobotomies in a two week span at state hospitals. He charged $25 per operation, during which he didn’t wear a surgical mask or gloves
He was known for showboating, being reported to once insert to ice picks into a patient’s eyes at the same time
In one instance in Iowa, 1951, a patient died when the pick slipped too far into the brain when he stopped for a photo op mid operation
An estimated total of 490 patients were reported to have died as a result of this “operation”
For the survivors, some showed no noticeable difference, some lived in a vegetative state, and some were crippled for life
The most notorious of Freeman’s patients was Rosemary Kennedy, John F. Kennedy’s sister. Her father gave consent and she received a lobotomy in 1941 that incapacitated her. She spent the remaining of her life in and out of institutions.
More effective psychiatric medications started appearing in the 1950s, sidelining Freeman’s efforts while the stigma towards lobotomies increased.
After a patient succumbed to a cerebral hemorrhage in 1967, Freeman decided it was time to retire.
He bought a camper and went to visit former patients to further document his successful procedure.
Freeman died of cancer in 1972 at the age of 76
Today, this procedure being performed is unheard of, and could be argued technically illegal.
http://projects.wsj.com/lobotomyfiles/?ch=two
https://www.theguardian.com/science/2008/jan/13/neuroscience.medicalscience
http://mentalfloss.com/article/502035/retrobituaries-walter-jackson-freeman-father-lobotomy
http://www.wondersandmarvels.com/2016/03/fighting-the-legend-of-the-lobotomobile.html
