At the 1949 Proceedings of the First Research Conference on Psychosurgery, Charles C. Limburg of the Human Resources Division, Department of the Air Force, presented his research findings, A Survey on the Use of Psychosurgery with Mental Patients in the United States. To begin, Limburg briefly examined a 1949 article written by Lawrence C. Kolb titled An Evaluation of Lobotomy and its Potentialities for Future Research in Psychiatry and Basic Sciences. Kolb stated that “there appears to be good evidence that numerous patients considered chronically and hopelessly ill have been restored to life in the community following operation.” And thus, Limburg realized that this sentiment would likely be shared by many others that were familiar with the practice of lobotomy. As such, Limburg decided to survey physicians, hospitals, and medical schools across the nation to look at the “extent to which lobotomy [had] been used with the largest accessible group of persons with serious mental illness, namely, those in mental hospitals.” Limburg and his associates would then go on to prepare a questionnaire on the use of psychosurgery. The questionnaire was sent out to 855 institutions across the nation, including all Federal, State, private, and other mental hospitals, general hospitals with psychiatric wards, and all medical schools in the United States. A preface to readers noted that psychosurgery was performed outside of these institutions however it was impossible to include every single neurosurgeon and general hospital in the survey.
According to Limburg, based on an analysis of survey data returns, a total of 9,991 psychosurgical operations were conducted for the period from 1935 to August 15, 1949. The following table breaks down the estimated and reported number of patients that underwent psychosurgical operations in all mental hospitals and hospitals associated with medical schools in the United States:
| Type of Hospital | Estimated Total | Total | On Time | Late | Estimated Under-Enumeration |
|---|---|---|---|---|---|
| Total | 10,706 | 9,991 | 9,208 | 783 | 715 |
| Veterans Hospitals | 1,125 | 1,125 | 1,125 | —— | ——————– |
| Other Federal | 93 | 93 | 93 | —— | ——————– |
| State Mental Hospitals | 5,483 | 5,279 | 5,116 | 163 | 204 |
| County and City | 55 | 40 | 40 | —— | 15 |
| Psychopathic | 740 | 680 | 625 | 55 | 60 |
| Private Mental Hospitals | 1,010 | 863 | 564 | 299 | 147 |
| Psychiatric Wards of General Hospitals | 308 | 235 | 156 | 79 | 73 |
| Medical Schools | 1,892 | 1,676 | 1,489 | 187 | 216 |
It is important to mention that some of the hospitals failed to return the surveys to Limburg and his associates. As such, Limburg personally contacted the non-reporting hospitals to inquire with someone in charge that could relay information of approximately how many patients had been operated on by means of psychosurgery. Limburg also used some cases presented in scientific literature as a source. Including Limburg’s method of under-enumeration, he posited that the statistical number of patients operated on by means of psychosurgery would equate to 10,706. Projected figures by Limburg would leave that number at approximately 12,000 or more by January 1, 1950.
The data from Limburg’s survey was largely centered around patients in mental hospitals and patients subjected to psychosurgery under the direct care of at least one member of the staff of the 70 medical schools in the United States at the time of publication. Limburg also noted that care was taken to make sure that patients reported through medical school auspices were not double-reported on schedules returned from mental hospitals. For mental hospitals, mailing lists at the National Institute of Mental Health were utilized. Schedules were mailed to medical schools based on a complete list of approved medical schools for the United States and Canada; however, data was only used for the United States.
Limburg and his associates asked hospitals to provide categories of patients for which psychosurgery had been used rather than enumerated accounting of patients operated on according to the nature of their illness. As such, the classification of patients was divided into the following diagnostic or pathological categories:
- Schizophrenia
- Manic-Depressive Psychoses
- Involutional Psychoses
- Psychoneuroses
- Obsessive-Compulsive States
- Paranoia
- Intractable Pain
- Psychoses with Mental Deficiency
- Psychoses with Convulsive Disorders
- Psychopathic Personality
- Psychoses with Epidemic Encephalitis
Limburg reported that in excess of 90% of the respondents listed schizophrenia among the types of patient for which psychosurgery had been used. Additionally, some hospitals reported to Limburg that “In general, patients have been selected because of their behavioral traits rather than by diagnosis. Lobotomy is done only in patients considered treatment failures after more conservative methods have been used. In any case, lobotomy is not done unless the patient has been mentally ill for 2 years or longer. Candidates for lobotomy usually have symptoms of severe depression with suicidal drives, severe paranoid elaborations with homicidal drives or severe persistent hypochondriasis or anxiety.”
Based on the final results, Limburg felt comfortable in saying that the proportionate distribution of the responses [was] representative of the total number of hospitals in which schedules were sent.
Highlights from the study include:
- Of the 558 hospitals that returned the Limburg schedules, 164 or 29.4% reported the use of psychosurgery.
- Of the preceding numbers, 160 or 28.6% reported that they were continuing to use psychosurgery.
- State mental hospitals and hospitals affiliated with medical schools reported the most widespread use of psychosurgery.
- Psychiatric wards of general hospitals along with private mental hospitals and county and city mental hospitals resorted to psychosurgery the least.
- 58% of the reporting hospitals expected the use of psychosurgery to increase while 28.6% expected its use to continue unchanged and the remaining 13.4% expected it to decrease or had no opinion regarding the question.
- Of the 9,208 patients operated on, 3,101 were male and 3,775 were female; gender was not reported for 2,332 patients.
- Psychosurgery was performed on females two-to-one compared to males in state mental hospitals.
Types of Operative Procedures
| Type of Procedure | Percentage Performed |
|---|---|
| Bilateral Lobotomy | 69.9% |
| Unilateral Lobotomy | 2.0% |
| Transorbital Lobotomy | 17.0% |
| Topectomies | 2.9% |
| Other or Unreported | 8.2% |
- Bilateral Lobotomy: Severs nerve fibers of the front part of the brain to keep certain nerve impulses from reaching the brain; this is done on both lobes.
- Unilateral Lobotomy: Severs nerve fibers of the front part of the brain to keep certain nerve impulses from reaching the brain; this is done on one lobe.
- Transorbital Lobotomy: Electroconvulsive therapy initiates unconsciousness in patient and an “ice pick” like device called a transorbitome is forced through the thin plate of bone above the eye into the brain and the lower fibers running from the frontal cortex to the thalamus are cut.
- Topectomy: Excision of part of the cerebral cortex for the relief of unmanageable pain or especially as a treatment for certain mental disorders.
Kentucky and Psychosurgery
Though Limburg’s study did not reveal the names of the hospitals that were surveyed, data showed that four Kentucky hospitals in total were surveyed. Of those four hospitals, all returned the schedules back to Limburg. Only one of the four hospitals surveyed were using psychosurgery and one hospital would be continuing psychosurgery at the time of publication of the study. More specifically, data showed that a single female patient had been the recipient of psychosurgery and she had a bilateral lobotomy. The operation took place in 1947 with no other reports between 1940-1946 and 1948-1949. Kentucky was listed in the East South Central region with Tennessee, Alabama, and Mississippi. Tennessee had three hospitals surveyed with no reports of psychosurgery. Alabama had two hospitals surveyed with a total of 17 patients receiving psychosurgery. Mississippi had two hospitals surveyed with a total of 7 patients receiving psychosurgery.
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⁘ Works Cited ⁘
- The Lexington Leader, 9 December 1949
- The Lexington Leader, 12 December 1952
- Alexander, Leo. 1953. Treatment of Mental Disorder. Philadelphia: Saunders.
- Public Health Service of the National Institutes of Health. Proceedings of the First Research Conference on Psychosurgery. Fred A. Mattler and Newton Bigelow. Public Health Service Publication No. 16. Washington: U.S. Government Printing Office, 1951.
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