Biology

How a 20th-Century Doctor Treated Patients By Sticking an Ice Pick Into Their Brains Through Their Eyes

“It isn’t brain surgery.” We use the phrase to describe simple tasks that anyone should be able to do. The unstated assumption behind this is that brain surgery is far from simple and can only be done by, well, brain surgeons.

For that reason, the prospect of someone casually sticking things into people’s heads, cutting out sections of brain matter, and running patients through the procedure like an assembly line is nothing short of horrifying. Surely, if that sort of thing happened, it must have been in the Middle Ages, right?

You may wonder if someone has been tampering with your grey matter when you hear about the Freeman lobotomy craze that occupied much of the 20th century.

Dr. Walter J. Freeman

Walter J. Freeman was born on November 14, 1895, and raised in Philadelphia, Pennsylvania. After graduating from Yale University in 1916, he was accepted at the University of Pennsylvania Medical School, where he specialized in neurology. He began his medical practice in Washington, D.C. in 1924. While working at St. Elizabeth’s Hospital, he continued his studies in neurology and earned a Ph.D. in the field. Within a few years, he relocated to George Washington University Hospital as head of the neurology department.

Freeman was intrigued by a procedure performed by Portuguese physician Egas Moniz in 1935. Called a “leucotomy,” it purported to treat the mentally ill through the removal of small corings from the frontal lobe of the patient’s brain. Freeman was so impressed by the concept that he became a mentee of Moniz and threw himself into refining this revolutionary medical technique.

Freeman renamed the procedure the “lobotomy.” He also revised it by proposing to sever the connection between the brain’s frontal lobes and the thalamus.

This would be a good time to mention that Freeman was a neurologist, not a neurosurgeon. This is an important point to keep in mind for the rest of this saga.

Less than a year after Moniz performed his first leucotomy, Freeman was ready to try his new-and-improved lobotomy. He enlisted the assistance of neurosurgeon James Watts to hold the scalpel while Freeman directed where to cut.

The first victim patient was Alice Hood Hammat, a housewife from Topeka, Kansas. Mrs. Hammat was experiencing depression and difficulty sleeping. Freeman was sure he could improve her condition by drilling six holes in her head, sticking a poky thing inside, and cutting away. On September 14, 1936, she received the first prefrontal lobotomy in the United States. The surgery was a success. How do we know this? Because Freeman said so. The evidence to back this up was that Mrs. Hammatt went to a play that evening and enjoyed it.

What more proof do you need? Clearly, this procedure has been sufficiently tested and could be used far and wide.

Less than two months after boring into Mrs. Hammat’s head, Freeman and Watts had 20 lobotomies under their belts. By 1942, this number had climbed to over 200. Now armed with something more than anecdotal evidence, Freeman published the results of his surgical procedures. He was happy to announce that 63% of all patients experienced some improvement, 23% were unchanged, and a mere 14% were worse off than before.

Freeman’s biggest problem with the procedure was all the hassle of having to employ a neurosurgeon, schedule an operating room, and worry about the complications of anesthesia. If only there were a way to take all of those complications out of the equation.

They say that the eyes are the windows to the soul. Freeman realized they also provided easy access to the brain. He developed a procedure called the “transorbital lobotomy.” It quickly became known as the “ice pick lobotomy” because of the resemblance of the surgical instrument to an ice pick.

An illustration of the transorbital “ice pick” lobotomy

Using his newfangled device, Freeman obtained access to the brain by shoving the ice pick through the patient’s eye socket, using a hammer to break through the thin layer of skull that separated the socket from the brain. Once inside the brain, Freeman could root around with the ice pick until he had sufficiently destroyed irreplaceable brain matter to use surgical precision to sever the connections to the prefrontal cortex in the frontal lobes. In less than ten minutes, the whole thing was over.

What possible appeal could this procedure have over the drill-and-poke method? From Freeman’s perspective, the ice pick method was infinitely preferable. For one thing, it did not require a neurosurgeon. Apparently, as long as you are only rooting around in the brain through a hole that you have hammered through the eye socket, that’s not nearly as big of a deal as when you bore holes through the skull. Another plus was that it could be done outside of an operating room. Finally — and trust us, we double-checked this before writing it — the procedure did not require anesthesia. The way he got around this trifling thing was by sending a mild electrical charge through the patient’s head, inducing a small seizure, thus causing them to forget the discomfort.

This first fuel for nightmares and foreshadowing of gory Halloween movies innovative step forward in neurosurgery was performed in Washington, D.C. on housewife Sallie Ellen Ionesco.

Freeman promoted the ice pick lobotomy as the perfect solution for the overpopulated psychiatric hospitals throughout the USA. Freeman bought a van created a mobile brain surgery clinic. Although he never referred to it as such, customers started to refer to it as the “lobotomobile.” He drove to psychiatric treatment facilities all over the country, offering his services to the patients. The demand was so great that Freeman would crisscross the United States eleven times in one year, performing the procedure thousands of times.

Freeman promoted the procedure by inviting the public and the press to witness it. As curious spectators looked on, Freeman dazzled them by showing he could do the procedure just as easily with his left hand as with his right. He encouraged members of the audience to time him to see if he could break his speed record. Occasionally, he would do two lobotomies at once. He wore neither gloves nor a mask as he performed the lobotomies.

The seduction of celebrity status pulled on Freeman. He started to be more interested in getting good publicity than in being a competent physician. One time, a patient died because Freeman stopped in the middle of a procedure to pose for a photograph.

There was no shortage of patients, eager to try Freeman’s procedure. At just $25 per lobotomy, it was affordable for everyone.

One of Freeman’s patients was Rosemary Kennedy, the sister of future President John F. Kennedy. She was prone to mood swings and seizures, prompting her father, Joseph Kennedy, to seek Dr. Freeman’s services. He performed a prefrontal lobotomy on her, and she was a changed woman. Unfortunately, not in the way everyone had hoped. She became permanently incapacitated and was no longer able to speak intelligently. She had the procedure done when she was 23 years old and spent the remaining 63 years of her life being cared for in an institution.

Kennedy was not the only patient who had less-than-ideal results from the procedure. Frequently, Freeman’s patients had to relearn simple things such as how to eat or use the bathroom.

Oh yeah…. About 15% of his patients died.

Despite this appalling statistic, Freeman was fully employed for about 40 years. Despite having no formal surgical training, he performed an estimated 4,000 lobotomy surgeries during his career. Included in this number were 19 minors, including one 4-year-old. Some of his patients even came back for more.

Such was the case of Freeman’s final patient. In February 1967, Helen Mortensen came to Freeman for her third lobotomy. The third time was the charm, as she died from a cerebral hemorrhage.

The Soviet Union banned lobotomies in 1950, concluding that they were “contrary to the principles of humanity” and “‘through lobotomy, an insane person is changed into an idiot.” It wasn’t until the late 1960s that several U.S. states got around to prohibiting the practice. Apparently the phrase, “it isn’t brain surgery” no longer applied to performing brain surgery.

In 1967, Freeman saw the writing was on the wall and retired from George Washington University and opened a practice in California. He died in 1972.


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