History of the eye cataract surgery

Cataract surgery is one of the oldest surgical procedures known, first documented in the fifth century BC. The earliest method known was couching. This method involved applying pressure digitally or via a sharp needle to the cataract and dislocating it into the posterior part of the eye known as the vitreous. There was no replacement of the lens and patients were left with a large focussing error known as aphakia. There was little regard for the prevention of infection by sterilisation of instrumentation and no anaesthesia. Complications such as chronic inflammatory scarring were common and patients were often left blinded. Couching is still performed in some parts of rural Africa and Asia today.

Twelve of September

On 12 September 1897 Irene Joliot-Curie was born in Paris as the daughter of Pierre and Marie Curie, who went on to become Nobel Laureates in Physics and Chemistry. She worked together with her mother to provide mobile X-ray units during World War I, resumed her studies at the university in Paris after the war, and later worked at the institute that her parents had founded. Irene Joliot-Curie awarded the Nobel Prize for chemistry in 1935 for the discovery of artificial radioactivity. This made the Curies the family with most Nobel laurates to date. Both children of the Irene Joliot-Curie, Helene and Pierre, are also stemmed scientists.  

 

Walter Freeman: The Father of the Lobotomy

Walter Freeman is known in history as the father of the lobotomy, an infamous procedure that involved hammering an ice pick-like instrument into a patient’s brain through their eye sockets. The horrifying procedure often left patients in a vegetative state and is responsible for an estimated 490 deaths.

Freeman was born on Nov. 14, 1895 and after graduating from Yale University, he enrolled as a medical student at the University of Pennsylvania and earned a medical degree in 1920.  Freeman worked as a pathology intern at the Hospital of the University of Pennsylvania before traveling to Europe to study neurology in 1923. He returned to the United States a year later, taking a position as the director of laboratories at a leading psychiatric institution in Washington, D.C. -- Saint Elizabeth’s Hospital -- practicing as the first neurologist in the city. Over the next few years he earned his PhD in neuropathology and secured a position at George Washington University as head of the neurology department. 

Influenced by the devastating effects of mental illness, Freeman began using oxygen therapy and experimented with chemical treatments for patients. In 1935, Freeman learned of a frontal lobe ablation technique that had been used on chimpanzees with the effects of subduing their temperament. That same year, a new procedure intended to treat mental illness was performed in Portugal under the direction of neurologist and physician Egas Moniz called a “leucotomy,” which took small corings out of the frontal lobes.

Freeman modified the procedure, renaming it a “lobotomy” with the help of neurosurgeon James Watts. Freeman and Watts performed a number of lobotomies carried out at his private practice in Washington, D.C. The first lobectomies consisting on drilling into a person’s head. Such procedure was improved rendering a patient unconscious by electroshock before inserting a sharp ice-pick-like instrument above the patient’s eyeball. Four hours later, the patient awoke without any anxiety or apprehension.


Photo of Walter Freeman performing a lobectomy

In reality, the procedure resulted in leaving many patients in a vegetative state, or reduced them to child-like behavior. Despite its shortcomings, many hospitals adopted the procedure for no other apparent reason than the fact that lobotomized patients were easier to handle than emotionally charged ones.

Freeman began traveling across the county visiting mental institutions and spreading the use of the lobotomy by training staff to perform the operation. Despite much criticism toward the controversial procedure, it gained popularity through major publications across the country hailing the lobotomy as a “miracle” surgery.

By 1949, 5,000 lobotomies were being performed annually, up from just 150 in 1945 and a total of 490 individuals are estimated to have died as a result of a lobotomy. For the survivors, some were left with no noticeable differences, but others were crippled for life or lived in a persistent vegetative state.

One of Freeman’s most notable patients was Rosemary Kennedy, sister to the man who would later become President of the United States, who was born with mild learning difficulties. She was given a lobotomy in 1941 with the consent of her father, but it ended in failure. She was left incapacitated by the procedure and spent the rest of her life in and out of various institutions.

Freeman performed his last lobotomy in 1967. The lobotomy eventually came under attack from the medical community. By the 1970s, several countries had banned the procedure altogether. Freeman eventually retired the lobotomobile and opened a private practice in California. Contrary to popular belief, he never lost his license to practice medicine.

Today, surgical lobotomies are no longer performed.

 

Luis Mendoza, MD, PhD

8 September 2017