Image of the profession
The leucotome
CMAJ 1999;160:871
© 1999 Canadian Medical Association
The instrument pictured here was designed by Dr. Kenneth G. McKenzie in the 1940s to bring precision to prefrontal leucotomy, or lobotomy. It is part of the exhibition Brainwork, now on view at the Canadian Museum of Health and Medicine in Toronto to mark the 75th anniversary of neurosurgery in this country. McKenzie received the first Canadian appointment in that specialty at the Toronto General Hospital and the University of Toronto in 1923. His contemporary in the field, Wilder Penfield, took up an appointment at the Royal Victoria Hospital and McGill University five years later.
The McKenzie leucotome, shown with the cutting loops exposed. Made by Down Bros., UK, circa 1945. The instrument was passed through the frontal lobes to the orbital plates via burr holes made through the top of the patient's skull. –Canadian Museum of Health and Medicine
The fact that Egas Moniz, the Portuguese neurosurgeon who introduced frontal leucotomy in 1935, was awarded the Nobel Prize in medicine in 1949 may be jarring to modern sensibilities. Felicity Pope, curator of the Canadian Museum of Health and Medicine, notes: "By today's standards, lobotomy is seen as a dark episode in neurosugery's past. In its heyday ... it met the needs of doctors, patients' families and asylum superintendents. From the patients' point of view it was less satisfactory."
In 1946 McKenzie reported in CMAJ improvement or recovery in 23 of 27 consecutive patients who had undergone bilateral frontal lobe leucotomy to treat apparently intractable psychiatric illness, ranging from manic depression to schizophrenia and marked by "pathological fear" manifested as "anxiety, agitation or impulsive behaviour."1 By his death in 1964, McKenzie's view had changed: "the availability of tranquillizing drugs [has] reduced the importance of this drastic, irreversible procedure."2 Reporting on a five-year study in which 183 patients who had undergone leucotomy were matched with controls, McKenzie disclosed the unexpected finding that there was no significant difference between the two groups in rates of hospital discharge and concluded that "prefrontal leukotomy [did] not produce any rate of remission beyond that to be expected without the operation."2
Brainwork is on display at the Toronto General Division of The Toronto Hospital, in the College Wing Lobby, 101 College St., Toronto. For information call 416 340-4800 x1899, or email fpope@torhosp.toronto.on.ca
Anne Marie Todkill
Editor, The Left Atrium
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References
- McKenzie KG, Proctor LD. Bilateral frontal lobe leucotomy in the treatment of mental disease. CMAJ 1946;55:433-9.
- McKenzie KG, Kaczanowski G. Prefrontal leukotomy: a five-year controlled study. CMAJ 1964;91:1193-6.
