Editing Lobotomy (section)

=== Italian leucotomy ===
{{quote box|salign=right|align=right|width=35em|quote=In the present state of affairs if some are critical about lack of caution in therapy, it is, on the other hand, deplorable and inexcusable to remain apathetic, with folded hands, content with learned lucubrations upon symptomatologic minutiae or upon psychopathic curiosities, or even worse, not even doing that.|source=—Amarro Fiamberti<ref>Quoted in {{harvnb|El-Hai|2005|p=182}}</ref>}}
Throughout the remainder of the 1930s, the number of leucotomies performed in most countries where the technique was adopted remained quite low. In Britain, which was later a major centre for leucotomy,{{refn|group=n|It was estimated by [[William Sargant]] and [[Eliot Slater]] that 15,000 leucotomies had been performed in the UK by 1962.<ref>{{harvnb|Kotowicz|2008|pp=486 n.1}}; {{harvnb|Sargant|Slater|1963|p=98}}</ref>}} only six operations had been undertaken before 1942.{{sfn|Kotowicz|2008|pp=476–77|ps=}} Generally, medical practitioners who attempted the procedure adopted a cautious approach and few patients were leucotomised before the 1940s. Italian neuropsychiatrists, who were typically early and enthusiastic adopters of leucotomy, were exceptional in eschewing such a gradualist course.{{sfn|Kotowicz|2008|p=477|ps=}}

Leucotomy was first reported in the Italian medical press in 1936 and Moniz published an article in Italian on the technique in the following year.{{sfn|Kotowicz|2008|p=477|ps=}} In 1937, he was invited to Italy to demonstrate the procedure and for two weeks in June of that year, he visited medical centres in [[Trieste]], [[Ferrara]], and one close to [[Turin]]{{snd}}the Racconigi Hospital{{snd}}where he instructed his Italian neuropsychiatric colleagues on leucotomy and also oversaw several operations.{{sfn|Kotowicz|2008|p=477|ps=}} Leucotomy was featured at two Italian psychiatric conferences in 1937 and over the next two years a score of medical articles on Moniz's psychosurgery was published by Italian clinicians based in medical institutions located in [[Racconigi]], [[Trieste]], [[Naples]], [[Genoa]], [[Milan]], [[Pisa]], [[Catania]] and [[Rovigo]].{{sfn|Kotowicz|2008|p=477|ps=}} The major centre for leucotomy in Italy was the Racconigi Hospital, where the experienced neurosurgeon [[Ludvig Puusepp]] provided a guiding hand.{{refn|group=n|The 14 leucotomies reported by Puusepp in his 1937 paper were performed at the Racconigi Hospital.<ref>{{harvnb|Puusepp|1937}}; {{harvnb|Kotowicz|2008|pp=477, 486}}</ref>}}{{sfn|Kotowicz|2008|p=477|ps=}} Under the medical directorship of Emilio Rizzatti, the medical personnel at this hospital had completed at least 200 leucotomies by 1939.{{sfn|Kotowicz|2008|pp=477, 487|ps=}} Reports from clinicians based at other Italian institutions detailed significantly fewer leucotomy operations.{{sfn|Kotowicz|2008|p=477|ps=}}

Experimental modifications of Moniz's operation were introduced with little delay by Italian medical practitioners.{{sfn|Kotowicz|2008|p=478|ps=}} Most notably, in 1937 [[Amarro Fiamberti]], the medical director of a psychiatric institution in [[Varese]],{{sfn|El-Hai|2005|p=182|ps=}} first devised the transorbital procedure whereby the frontal lobes were accessed through the eye sockets.{{sfn|Kotowicz|2008|p=478|ps=}} Fiamberti's method was to puncture the thin layer of [[orbit (anatomy)|orbital]] bone at the top of the socket and then inject alcohol or formalin into the white matter of the frontal lobes through this aperture.<ref name="ElHaiFingerWeiss">{{harvnb|El-Hai|2005|p=182}}; {{harvnb|Finger|2001|p=293}}; {{harvnb|Weiss|Rauch|Price|2007|p=506}}</ref> Using this method, while sometimes substituting a [[leucotome]] for a hypodermic needle, it is estimated that he leucotomised about 100 patients in the period up to the outbreak of World War II.{{sfn|El-Hai|2005|p=182|ps=}} Fiamberti's innovation of Moniz's method would later prove inspirational for [[Walter Freeman (surgeon)|Walter Freeman's]] development of transorbital lobotomy.<ref name="ElHaiFingerWeiss" />