Pre-frontal leucotomy in 1,000 cases.

Date:
1947
Catalogue details

Licence: Public Domain Mark

Credit: Pre-frontal leucotomy in 1,000 cases. Source: Wellcome Collection.

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    dominated by the emotion associated with his hallucinations and phantasies that he is held as it were entranced or perhaps stimulated by them. to sudden impulsive violence. If emotional tension is lessened by leucotomy the patient may retain his ideas of ill-health, his thoughts of dirt and infection, or his hallucinations and delusions, but he ceases to care about them and is thus freed from their over- whelming power and can take up some everyday activities. If all goes well he _ will then lose his remaining symptoms and go on to recovery. Freeman has stated recently that the operation can also be used to lessen the mental distress from intractable physical pain (Meeting of the Psychtatric Section of the Royal Society of Medicine, April 9th, 1946). Several points emerge from this conception of the desired result of leucotomy. Firstly, as to the lessening or dulling of emotion—we have no measure of | the extent to which it may be expected to occur, nor is there any agreement as to whether the dulling is temporary or permanent. Sometimes it does not seem to occur at all. Secondly, though the preoccupation with self may be lessened, we are as yet without certainty as to whether the zormal consciousness of self is interfered with by leucotomy, and, if interfered with, to what extent. This question is bound up with the whole problem of possible post-leucotomy changes of personality which are discussed later (page 19). The resumption of everyday activities is the third point to mention here— that in itself is beneficial and may contribute a great deal to the result. Thus, re-education or rehabilitation of the patient after operation is very important. One contributor to this series of cases discharges his patients as early as three weeks after operation so that they may be influenced by their normal home surroundings. Others stress the importance of post-operative psycho-therapy and re-education within the hospital. Origin and technique.—The originator of leucotomy was Egas Moniz who introduced it in Lisbon in 1935: reference must also be made to the work of | Freeman and Watts who operated on a long series of cases in America. Since then much work has been done and many papers on the subject have appeared in this country and elsewhere. The approach to the brain is through a trephine hole in the skull made under local or general anaesthesia. Through the opening an instrument is introduced and moved so that its free edge or loop cuts the white matter. There are various methods of operating. In analysing the present series of cases no distinction of method has been made owing to lack of information. The operation may be unilateral or bilateral—in the great majority of cases it was bilateral. Right and left sides of the brain can both be dealt with at one session or they may be treated on different occasions. Risks.—Under operative risks is included the possibility of death from hemorrhage immediately or later, or from a complication (page 24) ; there is also the possibility of the occurrence of epileptiform fits (page 19) and of other post-operative symptoms or changes of personality (page 19). For technical reasons which need not be discussed here, the surgeon cannot always be sure of cutting the fronto-thalamic fibres. A. Meyer quoted a remarkable case in a paper read before the Royal Medico-Psychological Association (Jl. Ment. Sc., 1945, xci, 411). It was that of a schizophrenic of five years’ standing whose operation was regarded as ‘“‘ a great success.” He became “ unworried and happy”’ so that it was a “pleasure to see him.” He died eighteen months later from carcinoma of the cesophagus and it was found post-mortem that the cut in the brain had not severed the fronto-thalamic connections and that degeneration of the nucleus medialis dorsalis had not é