A Weight Is Lifted

A hole in the head is one of the oldest operations in medical history. Some half a million years ago, Stone Age medicine men were treating their patients by trephining (cutting out a circular piece of the skull). Evidence of their flint-knife gouging can still be seen in prehistoric skulls. Witch doctors in Melanesia and northern Africa still perform similar operations to cure insanity (a hole in the head is a handy exit for demons).

Sixty-five years ago the superintendent of a Swiss insane asylum, Gottlieb Burckhardt, cured a patient of auditory hallucinations (hearing things) by removing part of his brain. Thirteen years ago Portuguese surgeons invented and other surgeons developed the now-popular operation called pre-frontal lobotomy to treat certain types of insanity.

Last week surgeons were busily discussing an improvement on lobotomy announced at a special meeting called by the New York Society of Neurosurgery. Some thought that the new operation, called topectomy,* was the best yet. Others were skeptical. Instead of short-circuiting the whole frontal lobe, the surgeons remove part of the brain tissue--sometimes tiny bits, sometimes pieces as big as a cookie. The size depends on the patient's symptoms ; so does the area in which the hole is made (it may be in the temple just above the eyebrow, higher on the forehead, or at the top of the skull, depending on what part of the brain is to be removed).

Thus far, only 24 topectomies have been done, as compared with more than 2,000 lobotomies. Results have been promising. Of the 24, 17 were schizophrenics, three involutionals (agitated depressives), two manic-depressives, two psychopaths (morally irresponsible). Eleven of the 24 patients are now at home, ten are working at their former jobs as clerical workers, machinists, other occupations; nine more are ready for discharge; the remaining four are no worse and no better. None died.

One advantage of the new operation: apparently it causes no change in personality. Tests have shown no loss in intellectual ability, and in some cases improvement. Said one of the patients: "The weight has been lifted from my shoulders."

The doctors who developed topectomy warn that not all insane patients can benefit from it. The delicate operation, which takes four to six hours, should not be tried until all other forms of treatment (shock, psychotherapy, etc.) have failed.

* From the Greek topos (place) and ektome (cutting out).

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