The purpose of this paper is to present the results of treatment by prefrontal leucotomy in 30 cases of mental disorder. In view of the fact that this procedure is not only comparatively new, and uncertain in its ultimate effects, but is also after all a destructive operation, its trial was only felt to be justified, in the first instance at any rate, in a selected number of chronic patients with an apparently hopeless or very poor prognosis.

Since 1955 there has been a steady decline in the number of leucotomy operations, particularly of the open standard type introduced into this country in 1941. It has been considered by most authors that the undesirable side-effects caused this decline but no doubt the introduction of ataractic drugs also played its part (Pippard, 1962). Sykes and Tredgold (1964) discussed in detail the literature up to that time and it was felt unnecessary to repeat that survey here. Suffice it to say that from about 1949 various modifications of the standard operation were devised in the hope of diminishing or eliminating undesirable sequelae. Following the publication of a paper on the late social results of pre-frontal leucotomy by Ström-Olsen and Tow (1949) the late Alexander Kennedy (1949) wrote in the correspondence column of theLancet—‘The future of this kind of operation (i.e. standard leucotomy) lies in limited and accurately localized sections. The correlation of these with their clinical and neuropathological effects offers a field of study which will occupy us for many years to come’.

Psychotic patients with periodically changing symptoms offer particular opportunities for psychosomatic and metabolic studies. Following the classical work of Gjessing (1932, 1935, 1939, 1953) other authors (Ashby, 1952; Rowntree and Kay, 1952; Smith, 1954; Gunne and Gemzell, 1956; Crammer, 1957) have studied metabolic changes in periodic catatonia. Cycles of behaviour and metabolism in psychiatric patients and in patients with “periodic disease” have been reviewed by Richter (1957) who also reported on interesting experiments aimed at the induction of periodic cycles of behaviour in rats.

No abstract

No abstract