1. Humans have a long history of drilling holes in skulls.
Drilling refers to drilling or scraping holes in the skull. According to Charles G. Gross, the author of A Hole in the Head, thousands of trephine (or trephine) skulls have been found all over the world. From the late Paleolithic to this century, these specimens include men, women and children.
At present, it is not clear why the earliest nesting was carried out, but scientists have determined that hard stone knives, metal knives and drills made of obsidian or flint are nesting tools. We know that these holes don't kill people who enter immediately, because scars that may take years to form can often be observed along the edge of the opening.
One of the earliest texts of Hippocrates' anthology describes several types of head trauma, which shows that trephination is a recommended treatment even in the case of minor bruising. One possible reason, Gross wrote, was that Dr. Hippocrates thought stagnant water was as bad as stagnant water. Therefore, letting blood flow out can prevent deterioration. Drilling is also used to treat epilepsy and mental illness. /kloc-an article in the 0/3rd century suggested opening the skull of epileptic patients and letting "body fluids and air evaporate".
2. "American crowbar case" has attracted the attention of media and medical circles.
1848, an explosion pushed a 3.5-foot 13-pound rammer over the skull of Phineas Gage, the railway construction foreman. The object pierced Gage's head, pierced his left cheek, passed behind his left eye, tore his forehead, and then exploded over his head. His survival is a miracle.
However, in every respect, he is different. Although his intelligence is intact, his memory is firmly grasped. He changed from a friendly person to a grumpy, rude and unrestrained person. It is reported that his character returned to normal after several years. It is said that he carried an iron bar that pierced his head everywhere until he died of a seizure after 12.
"American crowbar case" has become one of several key points in the development timeline of lobotomy.
3./kloc-the understanding of the functions of various parts of the brain is still in its infancy in the mid-9th century.
At the time of Gage accident, the rough mapping between brain function and seemingly consistent internal position is still a new concept. Scientists in European and American laboratories have removed or intentionally damaged brain regions of dogs and apes to understand how these injuries affect them. The researchers studied the effects of brain lesions (such as cysts or tumors) on patients. They examined the brain after death and related diseases or injuries to the symptoms of the deceased.
Finally, a new but still rough picture of the mysterious organ was formed. The frontal lobe seems to contain all aspects of emotion, behavior and impulse control. Scientists believe that if removing these parts from chimpanzees can make them more calm and complacent, then it may have the same effect on people with serious mental illness (such as schizophrenia).
4. Gottlieb Burckhardt, a Swiss psychiatrist, performed the first brain surgery to treat mental disorders in the 880s.
William Ireland, a British psychiatrist, wrote that Burckhardt believed that the brain was made up of "small parts that occupy a place in different parts of the brain". "Where there is excess or irregularity, he tries to examine it by ablating a part of the affected center"-or in other words, removing the brain area where he thinks the disease is located. To test his theory, Burckhardt opened the skulls of six schizophrenics, all of whom lived in the institution he led. He used a sharp spoon to dig out a specific part of the cerebral cortex, a process called topectomy. Although he reported that three patients had improved, 1 patient died and the other two patients remained unchanged. Some people later developed aphasia (inability to understand or express words) or seizures. Critics accused Burckhardt of being unnecessarily reckless.
At the beginning of the 20th century, the research on effective treatment of mental illness began to rise.
Before the mid-1930s, schizophrenics had no choice but to be held in overcrowded and inhumane shelters. The development of surgical techniques to treat "mental illness" seems to be not lacking after the First World War and the Great Depression, and it seems to be worth exploring [PDF]. It was not until the mid-1950s that other therapies such as drugs appeared. But what happened next broke the boundaries of science and blatantly ignored medical ethics.
6. A Portuguese neurologist was praised as the founder of psychiatry and won the Nobel Prize for his research.
Psychosurgery sounds like an American horror story, but it does describe the brain changes caused by surgery, aiming at influencing behavior or treating mental health disorders. Portuguese neurologist Antonio Igas moniz is the creator of this term, and he is widely recognized for developing cerebral angiography (a method of visualizing cerebral vessels). 1935, he turned his attention to psychiatric surgery and severe mental patients.
Moniz believes that mental illness is a problem of persistent and repetitive thinking in the frontal lobe of the brain. When attending the 1935 international neurology conference in London, he heard about a study in which two chimpanzees, Becky and Lucy, had drastic behavior changes after frontal lobe resection.
After the meeting, moniz was refreshed and developed the white matter resection of prefrontal cortex (from Greek leukos, "white" and tomia, "cutting"), which is a kind of operation aimed at the white matter between prefrontal cortex-the area behind the eyes and forehead-and thalamus, and is considered as "emotional brain".
Moniz and his colleague Pedro Almeida Lima performed white matter resection on 20 psychotic patients with schizophrenia, emotional disorder or anxiety neurosis. They used a white matter slicer (a surgical rod with a retractable thread loop) to "core" 12 blocks with a diameter of 1 cm in the white matter connecting the two areas of the frontal lobe to cut off the connection between them. Moniz soon announced the success of his technology in June 1937. "It is said that [surgery] removed the pathological part of human personality and transformed wild animals into gentle creatures", reported by The New York Times [PDF], and pointed out that 15 20 patients,% had a great improvement and 50% had a moderate improvement. Critics later pointed out that moniz's publications lacked information, especially about methods and results. There has never been any evidence that the patient has improved.
Moniz will continue to win the 1949 Nobel Prize in Physiology or Medicine for his psychiatric surgery. Many people call for the award to be cancelled after death, but this is unlikely to happen. )
7. 1936, a 63-year-old woman from Topeka, Kansas, became the first patient with lobotomy in the United States.
Neurologist and psychiatrist Walter Freeman has no surgical training. He attended the same medical conference that attracted moniz in 1935. At that time, Freeman was implementing the new agreement at George Washington University Hospital. He experimented with "shock" therapy by using drugs (such as insulin or metazole) or electricity (inducing "therapeutic" seizures and coma). However, he was fascinated by chimpanzees whose brains had been cut off, and paid close attention to moniz's leucopenia in Europe.
Freeman collaborated with James Watts, a neurosurgeon at the same university, to practice moniz's technique on some brains in the hospital morgue. Just one year after the medical conference, the two believe that they are ready for living human patients.
They chose Mrs Alice Hood Hamat, a housewife from Topeka, Kansas, as their first patient. She was diagnosed with anxiety and depression. According to Jack El-Hai's description in his book The Lobotomy, the doctor told Hamat that if she didn't have surgery, she would be taken to the hospital. Freeman and Watts used instruments similar to moniz as joint surgeons. They made two holes in the side of her head and then took out the white matter nucleus. It took about an hour.
The operation was considered successful, and two months later, Freeman began to call it lobotomy. Mrs Hamat's husband told Freeman that she had changed. Freeman wrote: "As she said, she can go to the theater and really enjoy the play, regardless of what her hair looks like at the back or whether her shoes pinch her feet." .
8. Freeman sought the spotlight in a jaw-dropping way.
By 1942, that is, six years after Hamat's operation, Freeman and Watts had performed 200 lobotomies, and it was reported that 63% had improved after operation, 23% had no change, and 14% was seriously injured or died.
El-Hai wrote that Freeman advertised his service, which was considered immoral at that time. He appeared at the meeting to attract the attention of the media. "I found the technique of attracting attention in the newspaper," Freeman wrote. "[Yes] arrive a day or two before the opening, arrange the exhibition in the most vivid way, and then be wary of wandering journalists." He usually shows an animal whose brain has been cut off.
The Saturday Evening News introduced Freeman and Watts, claiming that "a world that once seemed to be full of pain, cruelty and hatred is now full of sunshine and kindness", which is due to lobotomy. Newspapers and magazines say lobotomy is a panacea, but more often, it will only make patients more docile-if it doesn't incapacitate them or kill them.
9. Freeman finally changed the procedure of white matter removal, so there was no need to drill holes.
Freeman and Watts continued to improve their technology (so to speak) while remaining faithful to moniz's original premise. In their 1942 surgical plan, Freeman wrote: "The depth of the incision must be judged by the surgeon, and any increase in resistance is a signal to withdraw the instrument to prevent tearing the artery. Once the main incision is formed, it can be safely deepened by the radial thrust of the knife. "
He had nearly 1000 lobotomies with Watts, but Freeman became restless. He patched the programs and tools. Time magazine reported in 1952 that "[Freeman] no longer likes forehead incision, that is, a knife passes through a hole drilled in the temple ... the frontal lobe is formed through the eye socket."
10. Freeman was really inspired by the ice cone.
Freeman was frustrated that every lobotomy required the presence of an expensive neurosurgeon. He wants to find a faster, easier and cheaper method; One is suitable for the public.
This time, he found inspiration from the work of Italian psychological surgeon Amaro Fiamberti. He developed a new way to enter the brain: insert a thin tube into the fragile bone at the back of the orbit. Then he will inject alcohol or formalin into the frontal lobe through the tube to complete the frontal lobectomy. Freeman prefers to cut off the prefrontal cortex rather than inject Fiamberti. He searched for the ideal surgical tool and chose an ice pick from the kitchen drawer. He will eventually change his surgical instruments to imitate it.
From 65438 to 0946, Allen Norskov, a 29-year-old housewife and suicide mother, became Freeman's first patient to undergo frontal lobectomy. Freeman will insert an ice cone tool into the lacrimal duct of a coma patient, break the orbital bone with a surgical hammer, and then rotate the tool around the frontal lobe. Then repeat the process on the other side. Some people compare the cleaning movement of tools to windshield wipers. Onisko and later patients took a taxi home in an hour. Younescu's daughter later said that her mother came back to her after the operation and was the person she remembered.
Presumably, the first nine of these programs were completed in Freeman's office without Watts' knowledge. On day 10, Watts was either invited in or accidentally walked into Freeman, who was having surgery in his completely unsterilized office. Anyway, he was found.
1 1. Freeman had a lobotomy on the way.
Watts cut off their partnership when Freeman announced that he planned to start training other non-surgical psychiatrists to perform lobotomy.
Now that he is not responsible to anyone, Freeman has expanded his business scope. He promoted ice cone lobectomy to patients with postpartum depression, headache, chronic pain, indigestion, insomnia or behavioral difficulties. He began to believe that the most serious patients facing the risk of disability or suicide had gone too far to get help.
Freeman started a cross-country trip in a camper, and used 10 minutes to promote that anterior orbital lobectomy was a miraculous operation. Obviously, he is very convincing: during his career, he performed lobotomies in 55 hospitals in 23 States, although not all of them were considered successful. Once, he stopped to take pictures in the middle of the operation, and as a result, his instrument slipped deep into the patient's brain, which led to the patient's death.
12. "Remove the lungs and let them go home" is Freeman's motto.
There were some successful lobectomy, and the patient returned to normal life. Freeman often takes photos of his subjects before and after to prove that lobotomy is effective. In one series, the patient 12 1 stared at the camera in her preoperative photos; 165438+ 0 days after leukonectomy, she was smiling. "She often giggles," read the headline.
Unfortunately, there may be more unsuccessful programs. One of Freeman's most famous patients is Rosemary Kennedy, who is the sister of future President John F. Kennedy. At the age of 23, she had a lobotomy and was seriously injured. She needs constant care for the rest of her life.
Freeman finally published a long-term follow-up report on schizophrenic patients after his lobotomy. He wrote that although most people have improved, there are still 73% people in the hospital or at home who are "idle and dependent".
13. Effective drugs finally ended the lobotomy.
From 65438 to 0955, chlorpromazine, an antipsychotic drug, was approved in the United States, which initiated a new era of treating severe mental illness with drugs instead of surgery.
At the same time, the descriptions of frontal lobectomy characters in literature, movies and dramas further clarify the ethical errors of mental health care system. In Tennessee Williams' 1958 drama "Suddenly" last summer (which was later made into a movie starring Elizabeth Taylor and katharine hepburn), when a rich aunt was worried that she would reveal family secrets, her brain was forcibly cut off. 1975, Jack Nicholson played a patient who fought for power and profit with a terrible nurse in Flying Over the Madhouse (adapted from 1962 novel of the same name), and his role underwent lobotomy.
1967, after the death of a patient named Helen mortensen, Freeman was finally banned from surgery. She died of a fatal cerebral hemorrhage caused by the third lobotomy (performed by him).