Prefrontal Leucotomy in Schizophrenia with Report of 25 Cases

In view .of the rather discouraging results and relapses with shock therapy with insulin (Sakel, 1934), with cardiazol (Meduna, 1937), with electrical convulsions (Cerletti and Bini), in the treatment of schizophrenia and other allied mental disorders, and in view of the hopeless ultimate prognosis of such cases, more drastic methods seem justified, where other methods of treatment are either unsuitable or have failed. It is from this viewpoint that the operation of 'prefrontal leucotoniy first recommended and performed by Moniz in 1936 seems justified, and any improvement in the condition of the patient constitutes a progress in the treatment of mental diseases. The published results of U.S.A. and Great Britain, where the operation is rapidly gaining support, offer a hope of cure where the other accepted methods of treatment are unsuitable or have failed. This operation was first performed at the Government Mental Hospital, Bangalore City, Mysore State, S. India, on 21st September, 1942, and this paper deals with the technique, experience and results of 25 cases operated on by us till October 1943. A detailed psychiatric analysis of this series is under publication, and this paper deals mainly with the surgical aspects. Moniz's original technique has been modified by numerous workers, notably by Lyerley (1938), and by Freeman and Watts (1939) who use a lateral approach. The operation is based on the assumption that the frontal lobe is producing a disordered note in the smooth working of the ' intellectual' behaviour of the person, and that by isolating the frontal cortex from the rest of the brain, a ' release' of the other parts of the cerebral hemispheres occurs. This isolation is best attained by cutting the subcortical white matter as it lies in front of the anterior horn of the lateral ventricle. Moniz approached this