by Lydia Kang
These setbacks didn’t stop the optimistic duo. After only six operations, Freeman and Watts went on an aggressive publicity campaign to show what they’d done. Articles popped up in the Washington Post and Time magazine. “Doctors with pocketbooks filled and minds agog” were reported to have attended meetings in droves. No matter that they’d had a terrible setback with their fifth patient, who showed no improvement but gained epilepsy and incontinence.
They soon became celebrities, and Freeman even coined a new term for the surgery: lobotomy. By rebranding Moniz’s leucotomy, Freeman distanced himself from the Portuguese doctor, and in doing so, the term became closely associated with him. Well played, Dr. Freeman. He was a brilliant publicist and salesman as well, sending out thousands of letters and articles to psychiatric institutions across the United States and taking every opportunity to speak out about the procedure.
In 1938, Freeman and Watts decided to change the surgery. Instead of burr holes at the top of the skull, they began to operate at the temples. Moniz’s leucotome was not rigid enough for the procedure. Sometimes, it broke off in the brain. Instead, they used what looked like a narrow butter knife. This was the exact instrument used on Rosemary Kennedy. According to Kate Clifford Larsen’s biography of Rosemary, the “quarter-inch-wide flexible spatula” was inserted through the burr holes in her temples. “Watts turned and scraped as he moved deeper into her brain.” Rosemary was told to recite stories, verses, and even sing a song during the procedure. But after one slice too many, “she became incoherent. She slowly stopped talking.”
Rosemary, as they knew her, was gone.
She couldn’t walk or speak after the surgery and was institutionalized forever after. She disappeared from the Kennedy family’s letters, as if forcibly forgotten. But these “setbacks” didn’t stop Freeman. He was about to embark on some major updates to the procedure.
Phineas Gage, the Hot Dude with a Hole in His Head
On September 13, 1848, a handsome foreman named Phineas Gage was working for a railroad company in Vermont. He and his team would drill holes into bedrock, lower in explosives, fill the hole with sand, and tamp it all down with an iron rod.
That was how it was supposed to work. Gage was lightly tamping down the powder before adding the sand, and in a moment of distraction, he turned his head to check on his men, skull poised above the javelin-like iron rod. As the rod accidentally scraped the side of the hole, it sparked against the rock, and the ensuing explosion sent the rod blasting through his left cheek, behind his left eye, and through the top of his head.
Miraculously, he woke up moments later. After a few convulsions, he was able to speak. His left eyeball protruded out of the socket. Brain tissue was smeared along the rod, which had landed eighty feet away. The town doctor examined him soon after and noted that “Mr. G got up and vomited. The effort of vomiting pressed out about half a teacupful of the brain, which fell upon the floor.” Splat.
What was most interesting, aside from his survival, was the change in his personality. Before the accident, he possessed “a well-balanced mind … shrewd, smart … very energetic.” Afterward, he became “fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice… . A child in his intellectual capacity and manifestations, he has the animal passions of a strong man.”
Gage, as they said, “was no longer Gage.” He would become a fascinating case study in the understanding of brain physiology and set the stage for more scientific exploration of frontal lobe surgery.
The path of the tamping iron through Gage’s skull.
Freeman Goes Solo
One day Freeman was going through his kitchen drawer and found an ice pick. It was the perfect instrument, he thought. Sharp, but not too sharp; strong, with just the right girth. Moniz’s leucotome had a habit of breaking, and the butter knife method required the pesky addition of an actual neurosurgeon. Freeman decided he didn’t need those complications.
And thus began the “ice-pick lobotomy.”
After rendering his patients unconscious with electroshock therapy, Freeman would access the frontal lobes by lifting the eyelid, inserting the ice pick, tapping it gently with a hammer to poke through the thin orbital bone above the eyeball, and impaling the brain tissue (here, he usually paused to snap a photograph). He’d swish the ice pick left, right, up, down, and then repeat the procedure on the other side. The patient would leave with raccoon-bruised eyes and hopefully a calmer demeanor.
Walter Freeman performing a lobotomy. Inset: His trusty ice picks.
His former partner, Watts, was furious that this new approach didn’t require an operating room or him, but Freeman didn’t care. He was now free to do as many lobotomies as he could, while touting his miracle treatment around the country. He even had a car he called the “lobotomobile,” which he had outfitted with all of his equipment to use as he traveled. He referred to his lobotomized patients as “trophies.” Oh, the hubris!
Freeman wasn’t without opponents, though. Many thought that slicing and scrambling brain tissue could not, by definition, bring back normalcy. Doctors verbally attacked him at American Medical Association (AMA) meetings. One physician later lamented, “It does disturb me to see the number of zombies that these operations turn out. I would guess that lobotomies going on all over the world have caused more mental invalids than they’ve cured.”
Although his methods were callous, Freeman was no charlatan. He truly believed the lobotomy would solve psychiatry’s biggest impediment—the sheer number of sick patients burdening families and societies. But more than a few patients became completely incapacitated by the procedure or died from hemorrhage. An undue proportion of patients were female. Even children, whose brains were not completely developed, were lobotomized, the youngest a mere four years old. “Troublesome” relatives or children with low IQs or difficult temperaments were lobotomized, like poor Rosemary Kennedy. Howard Dully, who wrote an autobiography entitled My Lobotomy, was a mentally sound twelve-year-old whose stepmother despised him and his imperfect behavior. She wanted a lobotomy performed on him despite six psychiatrists stating that Howard had no mental illness. Four told her that she was the one needing treatment. She convinced Freeman to perform the lobotomy, anyway.
And you thought evil stepmothers were only in fairy tales.
Psychosurgery Today
Freeman continued to perform lobotomies until his last procedure killed a woman in 1967 from cerebral hemorrhage. But the use of the lobotomy procedure had already been dying a slow death. Why? Because of the birth of a little pill called chlorpromazine, trade name Thorazine (named after the Norse god of thunder, Thor). Thorazine was the first effective antipsychotic, and though it wasn’t perfect, it was far more humane than the lobotomy.
Neurosurgery today is a finely tuned, intimidating, and exacting science, far removed from the skull-scraping procedures of the past. As for psychosurgery? Today’s better understanding of the complexities of the brain, mental illness, and the arsenal of multidisciplinary therapists and medications have transformed psychiatry. Surgical procedures do exist, but their use is scant.
The ice picks, thankfully, are long gone.
14
Cautery & Blistering
Of Hot Heads, Boiling Oil, Rude Coma Awakenings,Spanish Fly, and Flossing Peas through Your Pus
Let’s say you have a nagging headache. Which would you prefer?
1. A glowing, red-hot iron applied to your temple until it chars your skin
2. Boiling oil dripped onto your forehead, making your epidermis die and peel off
3. Glittering green beetle paste gooped onto your scalp until it blisters and oozes
4. Some ibuprofen, a nap in a quiet room, and world peace
If you picked 4, then you clearly are missing out on some horrific remedies. The very idea of using these treatments is puzzling. When it comes to blistering,
most people want to keep their skin intact, preferably not bubbling full of pus or watery ooze. And cautery? Well, one of the main jobs of the human nervous system is to jerk your hand away from that burning hot pot handle you just touched. Aerobic exercise aside, no one truly wants to feel the burn. But these “cures” were commonly used to treat every human condition, from fatigue to lovesickness. Ready for some sizzling flesh and blister popping? Read on, friend.
Ye Olde Arte of Making Yew Screame
Using burning-hot metal or electrically induced cautery to stop bleeding, slice through flesh, char a tumor to death, or annihilate whatever is making a wound fester—these all make scientific sense. In fact, cautery is commonly and successfully used in surgery today for many of these reasons. For the last few millennia, however, it wasn’t so neat a procedure. Even when physicians’ intentions were good, their tools were just too crude to execute the task in a way that was anything other than nightmarish. How nightmarish? Let’s take a quick look at the history of burning humans.
When searing flesh physically with hot metal or electricity, the procedure is termed actual cautery. If you’re imagining your favorite cooking show where you’re told to “sear the meat to seal in the juices,” well, you’re not far off. Just replace “meat” with “human” and “seal in the juices” with “burn the hell out of whatever is bothering them.” Delicious!
How was it done? Let’s say you’re a scullery maid with a pounding headache and you chose option 1 earlier. The physician or apothecary would shove a long iron rod (or, less commonly, copper or platinum if he was feeling fancy) into the fireplace or a hot coal–filled brazier. When the instrument was heated to red-hot, he’d lay it on your temple until it sizzled and fried the skin. And if you had an open wound on your noggin? The doctor would burn the open ends of blood vessels to closure, vaporizing the wound to dryness, and if all went well, leaving a good smoky char behind. You’d be screaming bloody murder, but hey, at least you’re alive! (For now.) As for the headache, who the hell cares? You’re too busy dealing with that charred skin on your face.
Or perhaps you picked option 2? You’re the lucky winner of the potential cautery package! This technique involves burning flesh chemically with “gentler” methods such as acids and boiling oil. First, you would lie down while your physician heated the oil in a copper flask. Once it was boiling—think french fry–friendly temperatures—he’d pour a tiny amount into a smaller vessel and then drip-drip-drip it onto your forehead. And if the situation called for a caustic substance, he’d place a tiny nugget of a burning chemical beneath a bandaged plaster. Unlike actual cautery, this would be a far slower flavor of torture because it took time for the caustic to dissolve and burn the tissue.
Obviously, both types of cautery didn’t always go as planned. If the charred flesh stuck to the iron, the wound would be torn wide open when the iron was removed. Too bad nonstick cooking spray was unavailable then. You were left bleeding and with an even larger wound—not exactly the point of cauterizing to begin with. And if the iron wasn’t heated to the right temperature, the whole process “begets nothing but pain and anguish,” claimed seventeenth-century surgeon James Yonge. If that wasn’t enough, there could be fevers, terrible scars, and death after cautery was applied. It also didn’t always fix the problem. When using boiling oil, the oil might drip onto perfectly normal tissue, causing “pains, inflammations, and other horride symptomes,” according to famed French surgeon Ambroise Paré.
Did we mention that there was a lot of screaming involved?
Tenth-century depiction of cautery on a surfboard. JK.
Fire Cures and Other Painful Prescriptions
You might be wondering what kind of monster would subject his patients to such pain. The founding father of medicine, for one. In the fourth century bce, Hippocrates used red-hot irons to incinerate painful hemorrhoids (or piles, as hemorrhoids were once called). “When the cautery is applied,” he directed, “the patient’s head and hands should be held so that he … should cry out, for this will make the rectum project out more.” Thankfully, we have no illustration for this example. You’re welcome. Afterward, he recommended a poultice of lentils and vegetables applied to the anus. Oh well. Cross lentil soup off the list of things you’ll be eating this week.
We can also thank Hippocrates for inspiring generations of medical practitioners to reach for sizzling hot pokers. One of his famous aphorisms in the Corpus praises cautery as a panacea that doctors should try when other options didn’t work: “As many conditions as drugs do not cure, the knife cures; as many as a knife does not cure, fire cures; as many as fire does not cure, these have to be considered incurable.”
In the first century, Celsus really took this “fire cures everything curable” theory and ran with it. He noted, “All afflictions … when inveterate, scarce admit a cure without cauterization.” A cautery iron could be applied to the head for headaches until the skin ulcerated. Got a bad cough? Cautery should be used under the chin, on the neck, on the breasts, and below the shoulder blades. Epilepsy? Apoplexy? Cauterize the crap out of that poor patient.
With the invention of the gun, doctors were faced with a new and deadly problem that Hippocrates knew nothing about: bullet wounds. The ancient founding fathers of medicine didn’t have to deal with guns, so practitioners in the fifteenth and sixteenth centuries had to wing it. Indeed, desperate times called for guesswork and boiling oil—until Ambroise Paré came on the scene.
At the tender age of twenty-seven and not yet sworn in as a surgeon, Paré was deployed during the third war between France and the Holy Roman Emperor, Charles V, in 1537. He dealt with gunshot wounds according to the writings of famous surgeons Hieronymus Brunschwig and Giovanni da Vigo—by cauterizing the wounds because the gunpowder was believed to be poisonous.
But Paré had a little problem. He ran out of elderberry oil for cauterization. Instead, he used the post-cauterization recipe of egg yolk, rose oil, and turpentine on the wounds and went to bed, terrified that the wounded soldiers would all be dead in the morning. He awoke to a surprise—the cauterized patients had horrible, oozy, excruciating wounds, but the ones that weren’t cauterized were recovering painlessly. So much for the “poisoned gunshot wound” theory. Paré started to doubt the long-standing practice, noting cautery caused “horride symptomes … and oft times death it selfe.”
Paré’s discovery was a landmark, but practitioners weren’t throwing out their oil and irons just yet. Cautery was still used for gunshot wounds and amputations more than two hundred years later during the American Civil War. Despite the fact that Paré showed that ligating vessels (tying them closed) worked better in amputations, wartime dictated cheap, fast, and easy methods. Sadly, that list didn’t include painless ones.
Counterintuitively, it was the pain of cautery that made it so popular for some. Let us introduce you to the baffling concept of counterirritation.
A variety of cautery instruments (of torture).
Ambroise Paré, French surgeon, tackled the “horride symptomes” of cautery in the sixteenth century.
St. Hubert’s Key
Let’s say you get mauled by a rabid Chihuahua. We get it, you’re having a bad day. Rabies is practically incurable, after all. But before you start glamorously foaming at the mouth, and because you have nothing to lose, how about you shove a burning hot nail into your wound?
The idea harkens back to the first century ce, when Celsus prescribed actual cautery for curing mad dog bites. And if you were really serious about burning the rabies out, you’d reach for a replica of St. Hubert’s key.
The tool looked like a nail on steroids and was named after a first-century Belgian who was the patron saint of hunters, mathematicians, opticians, and metalworkers. (Random, but then again, David Lee Roth ended up as a paramedic, so …) Apparently, after St. Peter gave him the key, St. Hubert used it to cure a case of rabies, making him famous. For centuries afterward, people fashioned replicas of the tool, claiming that
a burning hot St. Hubert’s key could prevent rabies if it cauterized the wound of a dog bite. A good thought, except the rabies treatment also included cutting the bitten person’s perfectly unbitten forehead, putting in a thread from St. Hubert’s clothes, and covering the wound with a black cloth. The keys were even hung in houses for protection. Unfortunately, the superstition extended to the point where dogs and people were branded as a preventative measure, to stave off rabies.
The key to curing rabies?
Burn This, Not That: Counterirritation
In 1882, a troubled patient consulted Dr. A. R. Carman of New York. The young woman had been bedridden for weeks. She couldn’t gainfully work in her position as a teacher and was rendered useless by violent headaches, crippling insomnia, and that useful catchall term for when everything simply feels awful—malaise. Sure, pharmacies were full of treatments that might have helped—tonics to pep up the spirit and liven up the liver, sedative draughts to ease the sufferer into a nice drugged sleep or an afternoon stupor—but Dr. Carman had a better idea. Similar patients had a miraculous recovery after receiving a series of burns up and down the spine.
So how did she do? Well, she also experienced an astounding recovery after her cautery treatments and went right back to work. In hindsight, it’s clear that there may have been other factors at play. (If someone threatened to sear you with hot irons again if you stayed in bed for another day, wouldn’t you jump up and run back to work instead?) To doctors at the time, though, it was a classic case study in the wonder of counterirritation via cautery.
Counterirritation, sometimes called counterstimulation, is not when you slap someone for saying something rude and receive a nice smack right back (actually, that would be double counterirritation and an invitation for a lawsuit). The theory went that if you provide a source of irritation or stimulation apart from where the actual problem is, it draws the offending sickness elsewhere so the original area can heal. Books are full of anecdotes, like the fellow with the “frenzies” (thought to be brain irritation) cured “by casual application of fire to the lower parts.” Casual? How is that casual?
