Dr. Walter Freeman's Frontal Lobotomies at Athens (Ohio) State
Hospital
Few chapters in the medical history of Athens County, Ohio, are
more notorious or fascinating than that concerning Walter
Freeman, M.D., and the more than 200 frontal lobotomies he
performed at the Athens State Hospital in seven visits between
1953 and 1957.
Until the middle of the twentieth century, treatment for most
inpatients in large state hospitals, like that in Athens, was
limited to providing a safe and humane environment. Effective
drugs for mental illnesses did not become available until the
late 1950s and early 1960s.
In 1936 Egas Moniz, M.D., a Portugese physician who eventually
won a Nobel Prize for his work, reported the results of his
earliest frontal lobotomies in a French medical journal. Dr.
Walter Freeman, a neurologist at George Washington University in
Washington, D.C., who had met Dr. Moniz a year earlier, was
impressed with the report. Within the same year Dr. Freeman
teamed with a neurosurgeon to perform the operation, and over
the next decade the partners operated on many more cases.
However, Freeman became frustrated with the operation's
limitations. In 1946 he developed an alternative procedure that
could be done more quickly, outside an operating room, and
without anesthetic drugs.
He used electroconvulsive therapy to produce drugless
anesthesia. After the patient's convulsive movements subsided,
Dr. Freeman operated.
Lifting an upper eyelid, he inserted a long, metal pick between
the eyeball and the eyelid until it reached the bony roof of the
eye-socket. He pounded the pick through the bone into the
braincase where it entered a frontal lobe of the brain. He
repeated the insertion procedure on the opposite side. Then,
using the outer ends of the picks as handles, he made sweeping
movements which severed and destroyed the frontal lobes. He
finished before the patient awoke from the after-effects of the
induced seizure.
Dr. Freeman performed this procedure in state hospitals
nationwide that were understaffed, overflowing with patients,
and very receptive to any new treatment that held promise. Every
state hospital of that era could give electroconvulsive
treatment, and the hospital did not have to provide an operating
room. A minor procedure room sufficed.
Freeman met with families of patients, explained the risks and
benefits of the procedure, and answered questions. Some families
consented and others didn't. Assisted by the local medical
staff, and with a succession of patients filing into and out of
the procedure room, Freeman typically operated on his entire
case-load in just one day. Charging $25 per patient for his
services, he departed within a few days for his next destination.
Freeman visited the Athens State Hospital more times than any of
the other state hospitals in Ohio. On his first visit in 1953 he
was treated as a minor celebrity. The Athens Messenger of
November 16 reported his arrival with the headline "Lobotomies
to be performed: surgery may relieve mental illness of many
patients at state hospital." A follow-up article on November
20--entitled "Dr. Freeman, pioneer in trans-orbital technique,
demonstrates method: lobotomies are performed on 31 Athens State
Hospital patients"--showed pictures of Freeman with the local
staff, including Superintendent Charles Creed, Assistant
Superintendent Hubert Fockler and Drs. Beatrice Postle Fockler,
Wayne Dutton and Genevieve Garrett Dutton.
The surgeries were performed in the Receiving Hospital, a
separate building constructed in 1950 which is now the
eastern-most portion of the main building.
Wolfhard Baumgaertel, M.D., longtime general practitioner in
Albany, Ohio, was present for Freeman's third visit to Athens in
October 1954. Dr. Baumgaertel watched the procedure on the day's
first patient, and then provided after-care for this patient and
all the others who followed.
Despite his familiarity with surgery, Dr. Baumgaertel recalled
being surprised by the procedure, saying, "I do not remember
which made me more aghast while watching this--the hammering of
the picks into the brain or the simultaneous movement of the
picks' handles in the doctor's hands."
Describing his after-care of Freeman's patients, Dr. Baumgaertel
said, "At regular intervals the patients arrived in the recovery
room, my domain during this, to me, unknown and incomprehensible
event. My main equipment consisted of several suction machines
and oxygen, the latter being somewhat unnecessary. Vital signs
were monitored until the patient woke up. We had no major
complications. Some nasal drainage of cerebral liquor was not
considered a problem.
"I do not remember any immediate or late post-operative deaths
in the patients I attended to. Most returned to their floors in
the asylum within one to two weeks. Of course, none of them were
able to recall the event, but there were also no questions. I
remember having been surprised to the point of being shaken when
I discovered a total absence of wonder on the part of the
patients as to what happened to them."
Geneva Riley, R.N., who was director of nursing at the Athens
State Hospital 1975-1993, witnessed the same procedure at
another facility. She likened the noise made by the picks to the
sound of cloth tearing.
In the mid-1990s the author encountered one of Dr. Freeman's
former patients at Doctors Hospital of Nelsonville in
Nelsonville, Ohio. His computed tomographic (CT) scan showed
large areas of damage to the frontal lobes. The radiologist,
unaware of the patient's prior history, interpreted the
abnormalities as due to strokes.
But the patient and his wife had a different story to tell.
Emotionally traumatized by combat in World War II, the man was
an inpatient at Athens State Hospital in the 1950s when Dr.
Freeman came to town. The patient was functioning at a low
level, dropping to the ground at any sudden noise and smoking
cigarettes beneath a blanket. His wife agreed to the procedure
which was complicated by hemorrhage. Even so, he improved and
was discharged from the hospital after three months. For many
years he operated heavy equipment without difficulty except for
an occasional seizure.
Asked if she had regrets, the patient's wife said, "No. I still
think I made the right decision."
To see pictures related to this article visit: http://www.cordingleyneurology.com/lobotomiespictures.html
(C) 2005 by Gary Cordingley