Selective Cortical Undercutting As a Means of Modifying and Studying Frontal Lobe Function in Man

Volpini, Matthew; Giacobbe, Peter; Cosgrove, G. Rees; Levitt, Anthony J.; Lozano, Andrés M.; Lipsman, Nir

doi:10.3171/jns.1949.6.1.0065

Cited by 5,139 publications

(30 citation statements)

References 2 publications

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“…Anecdotal evidence shows sparing of portions of his remote memory, with continued interest in the I Love Lucy television show and the \western" television genre. Since the time of the 1997 magnetic resonance imaging (MRI) investigation, a variety of new facts have come to light about H.M.'s preserved and impaired memory capacities (summarized in Postle and Corkin, 1998;Hood et al, 1999;Kensinger et al, 2001;Xu and Corkin, 2001;Corkin, 2002;O'Kane et al, 2004;Skotko et al, 2004;Steinvorth et al, 2005 The supraorbital trephine holes made by Scoville to access the temporal lobes for H.M.'s resection [previously diagrammed by Scoville, (1949) and exhibited by MRI by Corkin et al (1997)]. Images are presented in the coronal (A), axial (B), and sagittal (C) planes.…”

Section: Introductionmentioning

confidence: 99%

Neuroimaging H.M.: A 10‐year follow‐up examination

et al. 2006

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In 1997, Corkin et al. described the anatomical boundaries of the amnesic patient H.M.'s surgical resection, based on a comprehensive analysis of magnetic resonance imaging (MRI) scans collected in 1992 and 1993 (Corkin et al. (1997) J Neurosci 17:3964-3979). We subsequently scanned H.M. on several occasions, employing more advanced data acquisition and analysis methods, and now describe additional details about his brain anatomy and pathology. This account combines results from high-resolution T1-weighted scans, which provide measures of cortical and subcortical morphometry, diffusion tensor images, which provide quantitative information about white matter microstructure and the anatomy of major fasciculi, and T2-weighted images, which highlight damage to deep white matter. We applied new MRI analysis techniques to these scans to assess the integrity of areas throughout H.M.'s brain. We documented a number of new changes, including cortical thinning, atrophy of deep gray matter structures, and a large volume of abnormal white matter and deep gray matter signal. Most of these alterations were not apparent in his prior scans, suggesting that they are of recent origin. Advanced age and hypertension likely contributed to these new findings.

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Section: Introductionmentioning

confidence: 99%

Neuroimaging H.M.: A 10‐year follow‐up examination

et al. 2006

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“…In 1949, William Beecher Scoville pioneered methods of orbital undercutting, which separated abnormal cortex from normal white matter tracts and facilitated targeted ablation of abnormal tissue. 38 The same year, Lars Leksell introduced a stereotactic system designed to treat psychiatric disorders, and Leksell and Jean Talairach, creator of the Talairach neurosurgery coordinate system, codeveloped the anterior capsulotomy. 23,35 Although current technical advances show great promise, rigorous analyses of ethical and sociological topics remain imperative, because studies of lobotomy practice in the US reveal a multitude of ethical quandaries.…”

Section: Ethical Considerations and The Future Of Psychosurgerymentioning

confidence: 99%

Psychosurgery, ethics, and media: a history of Walter Freeman and the lobotomy

Caruso¹,

Sheehan

2017

Neurosurgical Focus

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At the peak of his career, Walter J. Freeman II was a celebrated physician and scientist. He served as the first chairman of the Department of Neurology at George Washington University and was a tireless advocate of surgical treatment for mental illness. His eccentric appearance, engaging personality during interviews, and theatrical demonstrations of his surgical techniques gained him substantial popularity with local and national media, and he performed more than 3000 prefrontal and transorbital lobotomies between 1930 and 1960. However, poor patient outcomes, unfavorable portrayals of the lobotomy in literature and film, and increased regulatory scrutiny contributed to the lobotomy’s decline in popularity. The development of antipsychotic medications eventually relegated the lobotomy to rare circumstances, and Freeman’s reputation deteriorated. Today, despite significant advancements in technique, oversight, and ethical scrutiny, neurosurgical treatment of mental illness still carries a degree of social stigma.This review presents a historical account of Walter Freeman’s life and career, and the popularization of the lobotomy in the US. Additionally, the authors pay special attention to the influence of popular literature and film on the public’s perception of psychosurgery. Aided by an understanding of this pivotal period in medical history, neurosurgeons are poised to confront the ethical and sociological questions facing psychosurgery as it continues to evolve.

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“…21,22 Both William Scoville and José Delgado in Connecticut proposed "physical control of the mind," including psychosurgery, for the control of domestic and international violence in the political sphere. 4,19 Walter Freeman, championing psychosurgery, stated that lobotomy was "the ideal operation for use in crowded state mental hospitals with a shortage of everything except patients." 7,8 The procedure became the operation of choice for treatment of "intractable and uncontrollable aggression, independent of any brain disease."…”

Section: Dr James Poppen and Prefrontal Lobotomymentioning

confidence: 99%

Prefrontal lobotomy on Evita was done for behavior/personality modification, not just for pain control

Nijensohn¹

2015

FOC

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Eva Perón, best known as Evita, underwent a prefrontal lobotomy in 1952. Although the procedure was said to have been performed to relieve the pain of metastatic cancer, the author carried out a search for evidence that suggests that the procedure was prescribed to decrease violence and to modify Evita’s behavior and personality, and not just for pain control. To further elucidate the circumstances surrounding the treatment of this well-known historic figure, the author reviewed the development of the procedure known as prefrontal lobotomy and its three main indications: management of psychiatric illness, control of intractable pain from terminal cancer, and mind control and behavior/personality modification. The role of pioneering neurosurgeons in the development of prefrontal lobotomy, particularly in Connecticut and at Yale University, was also studied, and the political and historical conditions in Argentina in 1952 and to the present were analyzed. Evita was the wife of Juan Perón, who was the supreme leader of the Peronist party as well as president of Argentina. In 1952, however, the Peronist government in Argentina was bicephalic because Evita led the left wing of the party and ran the Female Peronist Party and the Eva Perón Foundation. She was followed by a group of hardcore loyalists interested in accelerating the revolution. Evita was also suffering from metastatic cervical cancer, and her illness increased her anxiety and moved her to purchase weapons to start training workers’ militias. Although the apparent purpose was to fight her husband’s enemies, this was done without his knowledge. She delivered fiery political speeches and wrote incendiary documents that would have led to a fierce clash in the country at that time. Notwithstanding the disreputable connotation of conspiracy theories, evidence was found of a potentially sinister political conspiracy, led by General Perón, to quiet down his wife Evita and modify her behavior/personality to decrease her belligerence, in addition to treating her cancer-related pain. Psychosurgery was purportedly intended to calm Evita and thus avoid a bloody civil war in Argentina. It was carried out in maximum secrecy and involved a distinguished American neurosurgeon, Dr. James L. Poppen, from the Lahey Clinic in Boston. A recorded and videotaped interview with a former scrub nurse and confidante of Dr. James L. Poppen revealed that prior to the lobotomy on Eva Perón, he performed lobotomies on a few prisoners in the prison system in Buenos Aires. Later, Dr. Poppen seems to have regretted his involvement and participation in this sad chapter in Argentine history. The treatment of Evita at the end of her life was influenced by extraordinary circumstances of time and place but also involved general issues of medical professionalism, the ethics of neuroscience, and the risks of being manipulated by labyrinthine byzantine politics. This story serves as a reminder that any physician, even one considered to be one of the best in the world, may act naively and become a pawn in a game he cannot begin to fathom.

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Selective Cortical Undercutting As a Means of Modifying and Studying Frontal Lobe Function in Man

Cited by 5,139 publications

References 2 publications

Neuroimaging H.M.: A 10‐year follow‐up examination

Neuroimaging H.M.: A 10‐year follow‐up examination

Psychosurgery, ethics, and media: a history of Walter Freeman and the lobotomy

Prefrontal lobotomy on Evita was done for behavior/personality modification, not just for pain control

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