Sir Wylie McKissock
Part I: the surgeon
By the late 1950s an estimated 20,000 leucotomies had been carried out in Britain. A few were performed by general surgeons, a few by psychiatrists, but the vast majority were performed by neurosurgeons. And of these neurosurgeons Sir Wylie McKissock (1906-1994) was probably the most prolific, responsible for at least 3,000 leucotomies.
McKissock, who in spite of his Scottish name hailed from Staines in Surrey, is remembered for his achievements in neurosurgery including the treatment of head injuries (he received an OBE for his wartime work) and the treatment of subarachnoid haemorrhages and intracranial aneurysms; and for setting up the world-famous Atkinson Morley's neurological service. He became President of the Society of British Neurosurgeons and received a knighthood on his retirement in 1971. But his contributions to British psychosurgery seem to have been quietly forgotten.
When McKissock died in 1994, obituaries in the The Times and The Independent newspapers made no mention of psychosurgery. Other tributes were likewise reticent on the subject. For example, psychosurgery was entirely absent from an 800 word article in the Journal of Surgical Neurology in 1988 even though the author Alan Richardson was himself a practitioner of psychosurgery, and a ten page reminiscence in the British Journal of Neurosurgery two years after McKissock's death containes only the following brief reference to psychosurgery:
Why did McKissock travel round the country rather than having the patients brought to his neurosurgical unit? In the early days of psychosurgery he claimed it was "owing to the extremely unpleasant and dangerous habits of the unfortunates who have been submitted to me for operation, and to the lack of proper facilities for dealing with the habits of such patients in my own neurosurgical unit." By the 1950s he had become more circumspect, claiming instead it was out of consideration for patients who could be treated in familiar surroundings and receive visits from relatives.
McKissock doesn't seem to have troubled himself much over the ethics of psychosurgery, although his excursions sometimes resulted in death or disability (some patients were left in what McKissock himself described as a "harmless vegetable state"). What little he wrote on the subject of psychosurgery is largely confined to notes on technique. He admitted that the operation was "academically and scientifically unsound" but felt it was justified if the "experienced psychiatrists" who selected patients felt there was no chance of a cure with other methods of treatment or a spontaneous recovery.
In the early years of his career as a psychosurgeon McKissock used the standard Freeman-Watts technique of leucotomy, drilling two burr holes in the side of his patients' skulls and severing the connections to the frontal lobes. He was scornful of specially designed leucotomes, referring to John Crumbie's as a "mechanical egg-whisk" and preferring to operate with an ordinary brain needle. In the late 1940s, as psychosurgeons were experimenting with different techniques in an attempt to avoid some of the complications and devastating effects on personality associated with the standard leucotomy, McKissock devised the "rostral leucotomy" in which holes were drilled in the top of the skull and the cut made in a downwards direction, undercutting Brodmann's areas 9 and 10 of the frontal cortex. Neuropathologists commented that the resulting lesion was similar to that of Freeman's transorbital leucotomy although McKissock approached from the opposite direction to Freeman. McKissock had little time for Freeman's transorbital operation, considering it an offence against "established aseptic surgical principles". The rostral leucotomy did not however entirely replace the standard procedure; even at the end of the 1950s McKissock was still using the standard technique on a minority of patients.
The last sighting of McKissock in the literature is an appearance at the November 1958 meeting of the Neurological Section of the Royal Society of Medicine where he talked about having performed 125 rostral and 19 standard leucotomies the previous year.
By the late 1950s an estimated 20,000 leucotomies had been carried out in Britain. A few were performed by general surgeons, a few by psychiatrists, but the vast majority were performed by neurosurgeons. And of these neurosurgeons Sir Wylie McKissock (1906-1994) was probably the most prolific, responsible for at least 3,000 leucotomies.
McKissock, who in spite of his Scottish name hailed from Staines in Surrey, is remembered for his achievements in neurosurgery including the treatment of head injuries (he received an OBE for his wartime work) and the treatment of subarachnoid haemorrhages and intracranial aneurysms; and for setting up the world-famous Atkinson Morley's neurological service. He became President of the Society of British Neurosurgeons and received a knighthood on his retirement in 1971. But his contributions to British psychosurgery seem to have been quietly forgotten.
When McKissock died in 1994, obituaries in the The Times and The Independent newspapers made no mention of psychosurgery. Other tributes were likewise reticent on the subject. For example, psychosurgery was entirely absent from an 800 word article in the Journal of Surgical Neurology in 1988 even though the author Alan Richardson was himself a practitioner of psychosurgery, and a ten page reminiscence in the British Journal of Neurosurgery two years after McKissock's death containes only the following brief reference to psychosurgery:
"His links to psychiatry were related to his large practice in the 1940s and 1950s as a leucotomist of extraordinary surgical speed, associated with a peripatetic service visiting major institutions in the UK in his motor car with the instrument set in the boot".These expeditions in his motor car took McKissock all over the South of England and Wales; among his destinations were St Andrews in Northampton, Graylingwell in Chichester, St Lawrence's in Caterham, Pen-y-Val in Abergavenny. The institutions (many of them Victorian Asylums) were often situated in pleasant rural locations and in those days the roads were comparatively empty. A visit from a well-known neurosurgeon would have been quite an event and doubtless the red carpet was laid out for McKissock. The operations themselves were quickly done - 15 to 30 minutes each - and so all-in-all these excursions must have been a reasonably agreeable way for McKissock to supplement his income.
Why did McKissock travel round the country rather than having the patients brought to his neurosurgical unit? In the early days of psychosurgery he claimed it was "owing to the extremely unpleasant and dangerous habits of the unfortunates who have been submitted to me for operation, and to the lack of proper facilities for dealing with the habits of such patients in my own neurosurgical unit." By the 1950s he had become more circumspect, claiming instead it was out of consideration for patients who could be treated in familiar surroundings and receive visits from relatives.
McKissock doesn't seem to have troubled himself much over the ethics of psychosurgery, although his excursions sometimes resulted in death or disability (some patients were left in what McKissock himself described as a "harmless vegetable state"). What little he wrote on the subject of psychosurgery is largely confined to notes on technique. He admitted that the operation was "academically and scientifically unsound" but felt it was justified if the "experienced psychiatrists" who selected patients felt there was no chance of a cure with other methods of treatment or a spontaneous recovery.
In the early years of his career as a psychosurgeon McKissock used the standard Freeman-Watts technique of leucotomy, drilling two burr holes in the side of his patients' skulls and severing the connections to the frontal lobes. He was scornful of specially designed leucotomes, referring to John Crumbie's as a "mechanical egg-whisk" and preferring to operate with an ordinary brain needle. In the late 1940s, as psychosurgeons were experimenting with different techniques in an attempt to avoid some of the complications and devastating effects on personality associated with the standard leucotomy, McKissock devised the "rostral leucotomy" in which holes were drilled in the top of the skull and the cut made in a downwards direction, undercutting Brodmann's areas 9 and 10 of the frontal cortex. Neuropathologists commented that the resulting lesion was similar to that of Freeman's transorbital leucotomy although McKissock approached from the opposite direction to Freeman. McKissock had little time for Freeman's transorbital operation, considering it an offence against "established aseptic surgical principles". The rostral leucotomy did not however entirely replace the standard procedure; even at the end of the 1950s McKissock was still using the standard technique on a minority of patients.
The last sighting of McKissock in the literature is an appearance at the November 1958 meeting of the Neurological Section of the Royal Society of Medicine where he talked about having performed 125 rostral and 19 standard leucotomies the previous year.
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