Issue 3 Article 7

Nobel Intentions: Surgery Gone Wrong

25/3/20

By:

Lee Zhe Yu, Nathan

Edited:

Crystal Tay Yuan Ying

Tag:

Psychology and Psychiatry

The Nobel Prize is often regarded to be one of the, if not the most, prestigious award a scientist could attain. More often than not, revolutionary technologies and groundbreaking developments are rightfully conferred this honour. The discovery of penicillin (Nobel Prize in Physiology or Medicine 1945), the elucidation of DNA’s structure (Nobel Prize in Physiology or Medicine 1962) and the development of the CRISPR-Cas9 genome editing system (Nobel Prize in Chemistry 2020) are amongst the contributions to science that have been recognised with a Nobel Prize, and they have made a sizeable positive impact on human society.

Alas, even the Nobel Committee responsible for selecting these prize winners make mistakes. In this article, we’ll be focusing on the Nobel Prize in Physiology or Medicine 1949, where Dr Egas Moniz was conferred the award "for his discovery of the therapeutic value of leucotomy in certain psychoses".

The Origin

Rather interestingly, this story begins neither with Egas Moniz nor in 1949, but much earlier in 1888. Then, a Swiss psychiatrist Dr Gottlieb Burckhardt decided to undertake the first attempt at psychosurgery in the world. This involved removing sections of the cerebral cortex from the brain.

Figure 1: Labelled diagram of the cerebral cortex

The idea behind doing so was to sever neural connections in the brain. With the brain receiving and processing less nerve signals, the patients would experience less nervous stimulation, causing his / her schizophrenic symptoms to reduce. Without any formal surgical training and with little experience doing surgery at all, Dr Burckhardt proceeded to carry out this groundbreaking operation on 6 schizophrenic patients. Of these 6 patients, 1 had died from complications from the procedure, while another committed suicide. Only 3 patients were deemed successful as they were seen to be “quieted” by the procedure. Needless to say, when he published his findings, Dr Burckhardt received much backlash from the scientific community and his findings were largely ignored.

Enter Egas Moniz

It was not until 1935 where interest in such a surgical procedure was revived. At the Second International Neurological Congress, London, Yale neuroscientists John Fulton and Carlyle Jacobsen presented two chimpanzees which quickly became “irritated” when carrying out tasks. After conducting an operation whereby the frontmost part of their frontal lobes were removed, these chimpanzees were observed to be “calmer”, with their initial frustrated behaviour being largely toned down. While it is unclear whether Dr Egas Moniz already had a similar idea, this demonstration inspired him to try a version of this procedure on human patients.

Leucotomy

Figure 2: Labelled diagram of the frontal lobe and thalamus

The frontal lobe and the thalamus are linked through many neural circuits, which control human movement and complex cognitive functionality. By disrupting these connections, the brain is less able to process and detect stimuli, resulting in reduced aggression and sensitivity. This would in turn reduce the severity of schizophrenic symptoms, amongst other mental illnesses.

Initial versions of Dr Moniz’s procedure involved drilling two holes into the skull and injecting ethanol into them. This resulted in the destruction of the connecting fibres between the thalamus and the frontal lobe, resulting in the formation of fibrous tissue around the irreversibly damaged sites. However, with the procedure suffering from many complications including damage to other parts of the brain, Dr Moniz pivoted to a surgical procedure involving a sharp object (a leucotome). After drilling the holes, he inserted the leucotome into them and repeatedly extended and retracted it. Consequently, the nerve fibres that connected the thalamus and the frontal lobe were removed.

The Next Big Thing…?

With promising results observed from Moniz’s initial trials, the procedure was regarded as a breakthrough in mental illness treatment. Doctors like Dr Walter Jackson Freeman II from America and Sir Wylie McKissock from the United Kingdom adopted the procedure, and it soon became widespread in countries including the United States, the United Kingdom and Norway.

Things Fall Apart

The lobotomy procedure maintained its popularity throughout the 1940s, long enough for Dr Moniz to receive his Nobel Prize. This was in spite of mounting evidence of its low effectiveness and lasting side effects. A prominent example of the latter was demonstrated in 1941, when 23 year old Rosemary Kennedy (sister of future president John F Kennedy) was lobotomised. While she outlived her brother, who was assassinated, the operation failed and she required constant care for the rest of her life. In 1942, when Dr Freeman reported the results from more than 200 lobotomy patients he had carried out the operation on, 14% of the patients’ condition worsened.

By 1949, lobotomy’s popularity had peaked. Around that time, the long term effects of the operation on patients came to light. Patients that initially reported a reduction in anxiety later became apathetic and passive. Many lost the ability to concentrate or express emotions. The development of the first wave of psychiatric drugs also provided a non-invasive treatment for mental conditions.

In February 1967, the last lobotomy to be performed was conducted by Dr Freeman on Helen Mortensen, the third time he was operating on her. It would end in tragedy, she would die from a brain haemorrhage following the procedure, and Dr Freeman would shortly be banned from operating. Across 3469 lobotomies, he ended up with a 14% mortality rate from the procedure.

Lessons to be Learnt

In hindsight, one may look at Dr Moniz’s award as a stain on the Nobel Prize’s history, and the lobotomy to be one of the greatest medical mistakes in modern history. However, it is important to note that the alternative of that time, institutionalisation in asylums, was often perceived to be worse as the institutions often deployed uncomfortable straitjackets and locked the patients up in padded cells. It was also alleged that they were subjected to physical torture. With these patients already suffering, lobotomy was viewed as a hope for them to escape their grisly predicament for a less painful life. Rather than it being a mistake made by a scientist, we should look at the rise and fall of lobotomy as part of the progression of science, the proliferation of seemingly good ideas, and the rejection of those that fail to live up to its lofty expectations. The wondrous medical inventions we hail today may be looked upon with horror and scorn by future generations.

References:

Issue 4 - Apr 2025

Nobel Intentions: Surgery Gone Wrong