PRE-FRONTAL LOBOTOMY : Fifteen Patients Before and After Operation

The 15 cases reported range in age from 16 to 62, and presented a wide variety of symptoms, from apparent psychotic deterioration to a chronic but non-psychotic tension state. These patients were all considered to have a hopeless prognosis and most of them had been in hospital for many years, one continuously for 18 years. All but 4 had received one or more forms of shock treatment.

The first lobotomy operation of the series was performed April 1, 1942, the last on January 28, 1944; hence the report cannot deal with end-results. However, the first patient is gainfully employed for the first time in his life, but has had a convulsive seizure; 5 of the others are with their families, comfortable and socially acceptable; one of them doing regular housework. One patient is attending a special school. The rest are still in hospital but one of them has freedom of the grounds, not possible before, and makes day-visits away from the hospital. None of the 15, so far, was made worse, and all showed some degree of improvement. Two aged patients, not included in this series, died of post-operative hypostatic pneumonia.

Each patient's history is presented as a graph representing onset of illness, the time of hospital residence, and the patient's status in the categories of mental comfort, social acceptability, and capacity for work, before and after lobotomy. (Only 5 representative graphs are reproduced here.)

The technique of the operation, its dangers, and the anatomical considerations involved are briefly discussed.

It is suggested that anxiety may be an important common factor in a wide variety of syndromes, allayed by lobotomy; and that the operation may intervene to modify the physical basis for a pathogenic degree of "cerebrotonia."

In some cases, edema and/or tenderness and blister formation appeared during the month following lobotomy, and is thought to be a trophic disturbance of central origin.

There has also been transient diuresis with low specific gravity, in connection with prolonged or periodic enuresis.