Results of Leucotomy
Review of Pre-frontal Leucotomy. A Survey of 300 Cases Personally Followed Over One and a Half to Three Years. By M. Partridge, M.A., D.M., D.P.M. (Pp. 496. £2 2s.) Oxford: Blackwell Scientific Publications. 1950.
British Medical Journal, 24 March 1951, p. 625
It is a little difficult to conceive what Dr. Partridge intended by this study. It is not a primarily statistical work, for the numerical data are not arranged in a convenient tabular form (so that it is difficult to find one's way about), and it is often unclear whether categories are inclusive or -exclusive. Despite the book's great length, only a selection of the patients are described in detail, and much of its value for reference purposes is lost thereby. Regarded as a clinical contribution, the presentation loses by its unwieldiness. The author should not have expected to carry the interest of his readers through such a sea of words, even by the tidal flow of his own good spirits.
The factual background is large and important. The later histories of 300 leucotomized patients, operated on by Mr. Wylie McKissock, were followed for one and a half to three years. Dr. Partridge is an accomplished clinician and has the gift of reporting his findings vividly. He probably missed little of what could be found by ordinary methods of psychiatric examination. It is therefore important that he finds some sign of impairment of personality in practically every case. The question arises whether the price that is paid is justified by the benefits Which result. In general the answer can only be affirmative. The patients were nearly all severely ill and had been totally incapacitated for a long time. The best results were obtained in the very mixed group of affective disorders, in which 54 out of a total of 85 recovered, and a further 15 improved. The schizophrenics did far less well, but in so far as the picture was coloured by affective or atypical features the results were more favourable. The obsessional neurotics are divided into those showing compulsive rumination (of whom all improved and three-quarters recovered), and those with ritualistic behaviour (of whom all but one improved, but only two-fifths recovered).
The author concludes that the operation has its greatest effect on the positive emotional symptoms of agitation and distress, and is much less effective in cases where there is apathy or emotional loss. After the operation emotions are less complex and less intense, and intellectual life too is simpler. The physical basis of the bleaching of affect is attributed to degeneration of the dorso-medial nucleus of the thalamus. Dr. Partridge favours the view that the prefrontal cortex, a main receptor area for hypothalamic stimuli, "may be concerned with enabling the agitating or enlivening effects of hypothalamic activity to find their fuller and richer expression in the emotional life." It follows that interruption above the level of the thalamus could be expected to result only in a reduction of the fullness of the emotional experience, and not, for instance, in eliminating the occurrence of delusional ideas.
Although the investigation tends to confirm current ideas, and does not suggest anything very strikingly new ("Parturiunt montes…" the author observes), it represents very thorough and careful work on a large number of cases and deserves close study.