The Napsbury lobotomies
Lobotomy came to Britain via the United States and in the early days most of the operations were of the Freeman-Watts standard type, where burr holes are made in the side of the temples, and an instrument inserted and pivoted up and down to slice through the white matter in the frontal lobes, thus severing the fronto-thalamic connections. British surgeons however didn't adopt Freeman's term "lobotomy", preferring to use Moniz' original term "leucotomy".
British surgeons soon began experimenting with modified procedures in an attempt to find an operation that would do less damage than the standard Freeman-Watts standard prefrontal operations. In the 1940s Hugh Cairns in Oxford, for example, experimented with cingulotomy (an operation that is still used in Scotland) while the peripatetic Wylie McKissock devised the rostral leucotomy. But Freeman's own particular modification, the transorbital lobotomy in which an instrument is inserted through the eye socket, never became popular in Britain perhaps because it dispensed with the need for a neurosurgeon and neurosurgeons in Britain had already gained control of psychosurgery. Wylie McKissock certainly wasn't going to relinquish his profitable week-end excursions into the English and Welsh countryside: "Freeman's latest development of transorbital leucotomy", McKissock wrote, "is mentioned only to be condemned: the whole technique offends established aseptic surgical principles". What is more, he questioned its effectiveness: "From the number of patients so leucotomised who have come to me for more extensive operations, the results do not appear very satisfactory." Wylie McKissock's own rostral leucotomy was designed to cut much the same area of white matter as the transorbital operation, but McKissock approached from above through burr holes in the top of the head, while Freeman approached from below via the eye socket, where the skull is thin enough for the instrument to be hammered through without the need for a drill or a neurosurgeon.
There were, however, a few psychiatrists in Britain who experimented with transorbital lobotomy. John Walsh at Tone Vale Hospital in Taunton, Somerset, operated on eight women in 1949, even on three occasions following Freeman's example and using electroconvulsive shock as anaesthetic. On one of these occasions the operation was given as a demonstration at a meeting of the south-western division of the Royal Medico-Psychological Association. Walsh was disappointed with the results, finding "no definite clinical improvements" in any of the patients.
Meanwhile, in Napsbury Hospital near St Albans, Hertfordshire, more extensive experiments with transorbital lobotomy were being carried out by psychiatrist Alan Edwards. Napsbury was one of the three "Middlesex in Hertfordshire" county asylums, opened in 1905 to house the pauper lunatics of Middlesex, where suitable sites with sufficient grounds to provide inmates with work, exercise, and recreation were in short supply due to the urban nature of the county (Middlesex now forms part of London). During the first World War, Napsbury became a war hospital; poet and musician Ivor Gurney stayed there briefly. During the 1930s cat artist Louis Wain spent the last years of his life in Napsbury. The hospital closed in 1999.
Alan Edwards operated on seventy-one patients between February 1949 and February 1950, following the Freeman's technique (although Edwards baulked at using electronvulsive shock as an anaesthetic, preferring intravenous pentothal). Edwards found that the operation was only one third as effective as a standard leucotomy, two-thirds when he adopted Freeman's "full frontal sweep".
British surgeons soon began experimenting with modified procedures in an attempt to find an operation that would do less damage than the standard Freeman-Watts standard prefrontal operations. In the 1940s Hugh Cairns in Oxford, for example, experimented with cingulotomy (an operation that is still used in Scotland) while the peripatetic Wylie McKissock devised the rostral leucotomy. But Freeman's own particular modification, the transorbital lobotomy in which an instrument is inserted through the eye socket, never became popular in Britain perhaps because it dispensed with the need for a neurosurgeon and neurosurgeons in Britain had already gained control of psychosurgery. Wylie McKissock certainly wasn't going to relinquish his profitable week-end excursions into the English and Welsh countryside: "Freeman's latest development of transorbital leucotomy", McKissock wrote, "is mentioned only to be condemned: the whole technique offends established aseptic surgical principles". What is more, he questioned its effectiveness: "From the number of patients so leucotomised who have come to me for more extensive operations, the results do not appear very satisfactory." Wylie McKissock's own rostral leucotomy was designed to cut much the same area of white matter as the transorbital operation, but McKissock approached from above through burr holes in the top of the head, while Freeman approached from below via the eye socket, where the skull is thin enough for the instrument to be hammered through without the need for a drill or a neurosurgeon.
There were, however, a few psychiatrists in Britain who experimented with transorbital lobotomy. John Walsh at Tone Vale Hospital in Taunton, Somerset, operated on eight women in 1949, even on three occasions following Freeman's example and using electroconvulsive shock as anaesthetic. On one of these occasions the operation was given as a demonstration at a meeting of the south-western division of the Royal Medico-Psychological Association. Walsh was disappointed with the results, finding "no definite clinical improvements" in any of the patients.
Meanwhile, in Napsbury Hospital near St Albans, Hertfordshire, more extensive experiments with transorbital lobotomy were being carried out by psychiatrist Alan Edwards. Napsbury was one of the three "Middlesex in Hertfordshire" county asylums, opened in 1905 to house the pauper lunatics of Middlesex, where suitable sites with sufficient grounds to provide inmates with work, exercise, and recreation were in short supply due to the urban nature of the county (Middlesex now forms part of London). During the first World War, Napsbury became a war hospital; poet and musician Ivor Gurney stayed there briefly. During the 1930s cat artist Louis Wain spent the last years of his life in Napsbury. The hospital closed in 1999.
Alan Edwards operated on seventy-one patients between February 1949 and February 1950, following the Freeman's technique (although Edwards baulked at using electronvulsive shock as an anaesthetic, preferring intravenous pentothal). Edwards found that the operation was only one third as effective as a standard leucotomy, two-thirds when he adopted Freeman's "full frontal sweep".
0 Comments:
Post a Comment
<< Home