Editing Lobotomy (section)

====First leucotomies====

{{quote box|salign=right|align=right|quote=The hypotheses underlying the procedure might be called into question; the surgical intervention might be considered very audacious; but such arguments occupy a secondary position because it can be affirmed now that these operations are not prejudicial to either physical or psychic life of the patient, and also that recovery or improvement may be obtained frequently in this way.|width=35em|source=—Egas Moniz (1937){{sfn|Moniz|1994|p=237}}}}

On 12 November 1935 at the [[Hospital de Santa Marta]] in [[Lisbon]], Moniz initiated the first of a series of operations on the brains of people with mental illnesses.<ref>{{harvnb|Kotowicz|2005|pp=80–81}}; {{harvnb|Feldman|Goodrich|2001|p=650}}</ref> The initial patients selected for the operation were provided by the medical director of Lisbon's Miguel Bombarda Mental Hospital, José de Matos Sobral Cid.<ref>{{harvnb|Gross|Schäfer|2011|p=2}}; {{harvnb|Kotowicz|2008|p=482}}</ref> As Moniz lacked training in neurosurgery and his hands were impaired by gout, the procedure was performed under general anaesthetic by Pedro Almeida Lima, who had previously assisted Moniz with his research on [[cerebral angiography]].{{refn|Lima described his role as that of an "instrument handled by the Master".{{sfn||Gross|Schäfer|2011|p=2|ps=}}|group=n}}<ref>{{harvnb|Tierney|2000|p=29}}; {{harvnb|Kotowicz|2005|pp=80–81}}; {{harvnb|Gross|Schäfer|2011|p=2}}</ref> The intention was to remove some of the long fibres that connected the frontal lobes to other major brain centres.{{sfn|Pressman|2002|p=54|ps=}} To this end, it was decided that Lima would [[trephine]] into the side of the skull and then inject [[ethanol]] into the "[[Cerebral cortex#Connections|subcortical]] [[white matter]] of the prefrontal area"{{sfn|Moniz|1994|p=237}} so as to destroy the connecting fibres, or [[association tract]]s,{{sfn|Finger|2001|p=292}} and create what Moniz termed a "frontal barrier".{{refn|group=n|Before operating on live subjects, they practised the procedure on a cadaver head.{{sfn|Feldman|Goodrich|2001|p=650|ps=}}}}{{sfn|Kotowicz|2005|p=81|ps=}} After the first operation was complete, Moniz considered it a success and, observing that the patient's depression had been relieved, he declared her "cured" although she was never, in fact, discharged from the mental hospital.{{sfn|Feldman|Goodrich|2001|p=651|ps=}} Moniz and Lima persisted with this method of injecting alcohol into the frontal lobes for the next seven patients but, after having to inject some patients on numerous occasions to elicit what they considered a favourable result, they modified the means by which they would section the frontal lobes.{{sfn|Feldman|Goodrich|2001|p=651|ps=}} For the ninth patient they introduced a surgical instrument called a [[leucotome]]; this was a [[cannula]] that was {{convert|11|cm|in}} in length and {{convert|2|cm|in}} in diameter. It had a retractable wire loop at one end that, when rotated, produced a {{convert|1|cm|in}} diameter circular lesion in the white matter of the frontal lobe.<ref>{{harvnb|Jansson|1998}}; {{harvnb|Gross|Schäfer|2011|p=2}}; {{harvnb|Feldman|Goodrich|2001|p=651}}. For Moniz's account of the procedure see, {{harvnb|Moniz|1994|pp=237–39}}</ref> Typically, six lesions were cut into each lobe, but, if they were dissatisfied by the results, Lima might perform several procedures, each producing multiple lesions in the left and right frontal lobes.{{sfn|Feldman|Goodrich|2001|p=651|ps=}}

By the conclusion of this first run of leucotomies in February 1936, Moniz and Lima had operated on twenty patients with an average period of one week between each procedure; Moniz published his findings with great haste in March of the same year.<ref>{{harvnb|Kotowicz|2005|p=81|ps=}}; {{harvnb|Feldman|Goodrich|2001|p=651}}; {{harvnb|Valenstein|1997|p=504}}</ref> The patients were aged between 27 and 62 years of age; twelve were female and eight were male. Nine of the patients were diagnosed with [[major depressive disorder|depression]], six with [[schizophrenia]], two with [[panic disorder]], and one each with [[mania]], [[catatonia]] and [[manic-depression]]. Their most prominent symptoms were anxiety and agitation. The duration of their illness before the procedure varied from as little as four weeks to as much as 22 years, although all but four had been ill for at least one year.{{sfn|Berrios|1997|p=75|ps=}} Patients were normally operated on the day they arrived at Moniz's clinic and returned within ten days to the Miguel Bombarda Mental Hospital.{{sfn|Kotowicz|2005|p=92|ps=}} A perfunctory post-operative follow-up assessment took place anywhere from one to ten weeks following surgery.<ref>{{harvnb|Berrios|1997|p=75}}; {{harvnb|Kotowicz|2005|p=92}}</ref> Complications were observed in each of the leucotomy patients and included: "increased temperature, vomiting, [[urinary incontinence|bladder]] and [[fecal incontinence|bowel incontinence]], diarrhea, and ocular affections such as [[ptosis (eyelid)|ptosis]] and [[nystagmus]], as well as psychological effects such as apathy, [[akinesia]], lethargy, timing, and local disorientation, [[kleptomania]], and abnormal sensations of hunger".{{sfn|Gross|Schäfer|2011|p=3|ps=}} Moniz asserted that these effects were transitory and,{{sfn|Gross|Schäfer|2011|p=3|ps=}} according to his published assessment, the outcome for these first twenty patients was that 35%, or seven cases, improved significantly, another 35% were somewhat improved and the remaining 30% (six cases) were unchanged. There were no deaths and he did not consider that any patients had deteriorated following leucotomy.<ref>{{harvnb|Berrios|1997|p=74}}; {{harvnb|Gross|Schäfer|2011|p=3}}</ref>