History of Psychosurgery in The United Kingdom - Pioneers of Psychosurgery in The UK

Pioneers of Psychosurgery in The UK

The first leucotomies in the UK were carried out at the Burden Neurological Institute in Bristol and were a collaboration between Frederick Golla, director of the Burden Neurological Institute, Effie Hutton, clinical director of the Burden Neurological Institute, surgeon F. Wilfred Willway, and the medical superintendents of Barnwood House in Gloucester and Brislington House in Bristol, who volunteered their patients as guinea pigs. Frederick Golla was persuaded to undertake the surgery by psychiatrist William Sargant who had seen three of Freeman’s patients in the USA and tried to introduce leucotomy at the Belmont Hospital in London, only to be refused permission by London County Council. The first operation was carried out in December 1940, a further eight over the next four months – all of them on detained patients. The operations were done with a paper knife, using the standard Freeman-Watts technique. Some were performed under local anaesthesia, some under general. After nine operations the psychiatrists presented the results of the first eight operations in an article in The Lancet in July 1941, omitting the ninth case where a blood vessel was cut and the patient, a 27 year old woman, died. Of the eight, one died of a heart attack two days after the operation, three were discharged (two of them still suffering from incontinence) and four remained in hospital. One of the discharged patients, a veteran of World War I who had broken down during the bombing raids on Bristol and had been diagnosed as neurotic, was operated on after just 4 days in hospital. These results were considered sufficiently encouraging for the leucotomy programme to continue at the Burden Neurological Institute, and for Sargant to gain permission to introduce leucotomy at the Belmont Hospital in London.

Warlingham Park Hospital, Croydon, Surrey, started to experiment with psychosurgery soon after the Burden Neurological Institute and published the results of their first four operations in the same issue of The Lancet. One patient died. Surgeon John Crumbie designed his own leucotome (instrument for cutting the white matter in the brain) which was constructed by Warlingham’s assistant clerk of works, and referred to by Wylie McKissock, who operated with a Cushing brain needle, as a "mechanical egg-whisk". If the patients resisted the surgery they were given electroconvulsive shocks before being anaesthetised.

After the results of at the Burden Neurological Institute and Warlingham Park were published, mental hospitals throughout Great Britain began to use psychosurgery. Pioneering hospitals included:

Crichton Royal Hospital, Dumfries, Scotland: 142 patients had undergone surgery by the end of 1945. Most of them were judged to be "hopeless, chronic invalids" and were selected for surgery on account of being prone to aggressive, destructive and impulsive behaviour.

Graylingwell Hospital, Sussex: 200 patients were operated on between 1943 and 1945.

Belmont Hospital, Sutton, Surrey: mainly neurotic patients who had never been in a mental hospital were treated under the direction of Sargant for disorders such as dermatitis, battle neurosis, anorexia and depression.

Runwell Hospital, Essex: psychiatrist Rolf Strom-Olsen and surgeon Geoffrey Knight formed a psychosurgery partnership that was to last for thirty years. 116 operations had been carried out by the end of 1945, with six deaths. The first few patients had been selected for what Knight called their "low potential", so that harmful effects could be studied before the operation was used in cases of "higher potentiality".

Bexley Hospital, Kent: 48 leucotomies, with 3 deaths, had been performed by McKissock by mid 1945. McKissock developed a peripatetic psychosurgery service, visiting hospitals all over the south of England (except for part of Kent, which was the territory of Knight) and Wales on Saturdays and performing thousands of leucotomies.

The North Wales Hospital, Denbigh: Leucotomy was introduced in 1942. The first series of 24 patients operated on 1942-1944 were selected for their failure to respond to other treatments (usually electroconvulsive therapy) and, in at least half the cases, the demands they made on nursing staff. Operations were done by a local GP/general surgeon. One patient died.

Netherne Hospital, Coulsdon, Surrey: in 1942 Eric Cunningham Dax, medical superintendent of Netherne Hospital, called in surgeon Eric Radley Smith to operate on patients. Before the year was out, fifty patients had undergone surgery, and in April 1943 the results were published in the Journal of Mental Science. Cunningham Dax described how he selected patients:

"The operation was carried out with the primary object of relieving the most disturbed patients in the hospital quite independently of their poor prognosis. They formed a large proportion of the most violent, hostile, noisy, excited, destructive or obscene cases in the hospital; the type who distress their relatives, upset the other patients and consume the time and energy which could be put to so much better purpose by the staff".

Two died of cerebral haemorrhage, two were discharged (of whom one relapsed); of those remaining in hospital two-thirds had shown at least some improvement, needing less staff time and supervision.

St Lawrence's Hospital, Caterham, Surrey: in March 1944 a programme of leucotomy was begun on "mental defectives". Crumbie operated on one patient, McKissock and his assistant, McCall, on a further 43 (nine of them under the age of 21). There were five deaths and the majority of patients showed little or no improvement, with twelve of them becoming worse. Doctors at St Lawrence’s Hospital decided to abandon the experiment. Rampton Hospital, another mental deficiency institution, began using psychosurgery in January 1947. Twenty patients including a fourteen-year-old underwent surgery in little over a year. One patient died. Superintendent George Mackay found the results sufficiently encouraging to extend the programme to include "a wider group of clinical types". One young woman who underwent a leucotomy turned out to have been detained illegally for eighteen years.

By the end of 1944 about 1,000 psychosurgical operations had been performed in Great Britain, and the Board of Control published the results of a survey in a 30-page booklet. They described the operation in the following terms:

Crudely described the purpose of the operation is to break the connection between the patient’s thoughts and his emotions. It is to relieve the connection between the patient’s thoughts and his emotions. It is to relieve mental tension, to take the sting out of experience and thus to favour improvement or to hasten recovery from mental disorder.

Risks were listed as death due to cerebral haemorrhage or infection; epilepsy; and personality changes. A text book of the day went into more detail about personality changes, suggesting that they always occurred to greater or lesser extent and left the patient with diminished judgement, childish behaviour, carelessness, loss of ambition, and generally living at a lower level than previously. There was also the possibility of intellectual deterioration. Overall in the Board of Control survey six per cent of patients had died (half of them directly as a result of the operation); 36 per cent had left hospital and 58 per cent remained in hospital (often described as quieter or easier to nurse). Patients who were depressed and had not been ill for long were much more likely to have left hospital than those who had a schizophrenic illness and had been in hospital longer.