Adamo Mario (Amarro) Fiamberti[1] was the first to perform a transorbital lobotomy (by accessing the frontal lobe of the brain through the orbits) in 1937. Fiamberti was later named Director of the Psychiatric Hospital of Varese, when it was opened in 1964.
Amarro Fiamberti, (Stradella, 10 September 1894 – Feltre, 31 August 1970) was an Italian psychiatrist who was the first to perform a transorbital lobotomy operation in 1937, accessing the frontal lobes of the brain through the eye sockets. The technique was widely applied by Fiamberti in Italy and by Walter Freeman in the United States, with different tools. In 1914, he enrolled in the University of Turin's medical and surgical degree program. He enlisted at the start of the war and served almost continuously, also as an operative, until his discharge on May 24, 1920. In July 1918, he was awarded the Cross of Merit, and the following year, before being dismissed, he had the opportunity to attend the University of Turin, where he graduated on July 20, 1920. Following his natural inclination for the clinic, he was soon appointed effective assistant in the Turin university's human anatomy institute, headed by G. Levi, but he soon turned to the study of nervous and mental diseases and to a career as a doctor. In fact, he was admitted to E. Medea's neuropathology school at the clinical training institutes in Milan in 1921. At the beginning of his career Fiamberti took care both to acquire a good practical experience, and to complete his scientific training: in August 1921, in fact, he took service as an internal doctor in the provincial psychiatric hospital of Brescia and attended advanced courses, necessary, at that time, to allow a qualified access to medical activity in mental hospitals. Between 1921 and 1926, at the University of Turin, he obtained the diplomas of health officer and expert hygienist and attended the clinical and prophylactic course on tuberculosis directed by F. Micheli, followed in Milan the course of radiology in the school of F. Perussia and that of immunology and serodiagnostics at the Institute directed by S. Belfanti. Appointed, following a public competition, section doctor in the provincial psychiatric hospital of Brescia, he continued to serve in the following years, except for a short period between 1927 and 1928, when, after winning the competition, he held the position of head physician in the provincial psychiatric hospital of Verona.
In the meantime, he deepened the study of neuropsychiatric pathology: after having attended in Paris in 1926 the lessons of pathological anatomy of the nervous system held by I. Bertand at the clinic of Salpetrière and those of neuropsychiatry at the clinic of mental diseases and the encephalon directed by H. Claude, he studied the semeiotics of nervous diseases at the school of Medea and attended the clinics of nervous and mental diseases of Pavia and Milan directed respectively by O. Rossi and C. Besta. In addition, to enrich his experience in the field of neurology and neurosurgery, also attended the Civil Hospital of Brescia.[2]
As of 1932 Fiamberti was director of the Psychiatric Hospital of Sondrio; between 1935 and 1937, he moved to Vercelli and was appointed director of the new psychiatric hospital, which was still under construction at the time. He drew up the regulations for the structure's future operation, in addition to overseeing its final completion. He moved to Varese in 1937 to take over the management of the new Bizzozzero Provincial Psychiatric Hospital. He was the director of that hospital until 1964, when he retired. He was given the title of director emeritus in 1970. After leaving the hospital's medical directorship, he was elected to the position of provincial councilor on the Italian Liberal Party's list in 1964, continuing to deal with psychiatric matters in a political capacity.
Fiamberti's proposal for using acetylcholinic acid to treat schizophrenia was part of a larger framework of confident time adherence to shock therapies. Fiamberti had joined the debate after having had experiences with acetylcholine epileptic in nature, and had adhered to the recommendations of these biological therapy practices for psychosis.
Fiamberti considered the following facts:
1) The existence of objectively controlled vascular disturbances in patients with schizophrenia; the presence of vascular alterations observed histologically in necropsied early demented patients and in experimentally catatonized animals.
2) The common factor to all existing methods for the treatment of schizophrenia would be constituted by the violent and profound vascular modifications provoked by several means.
3) The parallelism observed by several authors between the vascular modifications and those of the psychic state.
Fiamberti assumes that the "vascular storm" is caused by an active and violent condition that occurs in vessels activated by choline derivatives, altering the vascular changes seen in precocious dementia, which can be influenced by toxin-infectious causes.
He also claims that the "vascular storm," is a general element in all convulsive processes that work by restoring natural vascular irrigation.
Fiamberti concludes that, while with other methods, the physical or chemical stimulus must achieve the provocation of convulsive phenomena in order to verify the vascular changes that follow, with acetylcholine, it will not be necessary to achieve the provocation of convulsions. In his studies on patients diagnosed with psychological disorders, he used intravenous acetylcholine produced by the pharmaceutical company Roche. Fiamberti's approach ultimately proved to be less aggressive than other forms of shock, both in terms of duration and intensity of the spasms caused, resulting in clear improvements and even recovery of the patients' clinical conditions in several cases, according to Fiamberti himself. The below are Fiamberti's statistical findings for 120 people with schizophrenia treated with acetylcholine: 18 of the 23 patients with schizophrenia, who had been in the hospital for less than a year, were able to leave cured; in three, the recovery was significant; in one, the improvement was only temporary; and one patient remained resistant to therapy. Fiamberti's approach faded rapidly due to the fragility of its theoretical foundations after a brief period of diffusion and application in the 1950s.
Transorbital lobotomy
A lobotomy, also known as a lobectomy or leucotomy, was a neurosurgery approach. It entailed severing the connections between the prefrontal cortex and the rest of the brain. It could be done in two ways: directly removing them or destroying them. The most common side effect was a drastic change in personality and it is permanent. In the past, lobotomy was used to treat a variety of psychiatric disorders, including schizophrenia, depression, manic-depressive psychosis, and anxiety-related disorders.
Fiamberti's suggestion of leucotomy with the method of the transorbital path yielded the best results and recognition in the international scene. In 1935, Antonio Egas Moniz, a Portuguese physician, performed the first surgery on the oval center of the prefrontal lobe. Starting with the hypothesis that the role of the bonds formed by the connecting fibers, defined as "established connections," in some psychic patients' symptomatology, Moniz proposed to induce limited destruction of those fibers, either with alcohol injections or a special leucotomy, accessing the brain through trepanation holes in the skull. The theoretical foundations of Moniz' operation were immediately debated in Italy, with a reasonable amount of skepticism.
Psychosurgery was the name given to the new discipline, which grew in popularity despite many debates throughout the 1940s and 1950s before being abandoned in the following decades. Fiamberti was in charge of the hospital in Sondrio at the time, which was a long way from the main centers and lacked any neurosurgical collaborations or adequate facilities.
In order to be able to apply the new leucotomy techniques on his hospital's patients, the psychiatrist explored a less invasive intervention than Moniz's trepanation. The idea was suggested to him by a technique that he had seen practiced, for some years, by Achille Mario Dogliotti for cerebral ventriculography, performed with a transorbital puncture. The needle was introduced into the frontal horn of the ventricle passing through the oval center of the prefrontal lobe and Fiamberti thought of using the same instruments for his operative purpose. He inserted a guide needle into the cranial theca, sliding into the space between the supraorbital arch and the eyeball with a strong upward and backward obliquity, perforating the orbital vault about one centimeter behind the superciliary margin. Once the bone's resistance was overcome, he removed the guide needle's stylet and replaced it with a long, thin needle from a blunt tip brain puncture. He treated about ten serious patients, all of whom tolerated the intervention well, and reported his findings in 1937, with a presentation to the scientific community in October 1938. Because the transorbital intervention method did not require a skull trepanation, it had the significant benefit of being able to be used in any psychiatric facility and mastered by all psychiatrists, not just surgeons. Fiamberti was aware of the intervention's theoretical flaws, but he valued the experience of positive outcomes above all else, especially given the paucity of the psychiatric therapeutic arsenal at the time. He stated that leucotomy could not be considered a true treatment for mental illnesses and that the indications had to be limited to chronic cases that were considered irreversible by other means, but he maintained the usefulness of the effects in several patients, in whom he believed he had achieved a positive modification of particularly troubling symptoms such as impulsivity and aggression.[3]
The leucotomy was also well received on the international stage. It was presented at the seventh Réunion des Oto-Neuro-Ophtalmologues et Neuro-Chirurgiens de la Suisse Romande, and Freeman recognised his own autonomous placement among the most recommendable mental illness treatment strategies. The American neurologist Walter Freeman, improved the surgical technique, initially by using ice picks (hence the name "ice pick lobotomy") and later by employing more refined equipment. Many people saw these methods as the triumphal path towards successful intervention in mental diseases during those years, to the point where the Italian Society of Psychiatry chose psychosurgery as the first theme of the national congress report in Taormina in 1951. It's also worth noting that Egas Moniz, the inventor of lobotomy, was awarded the Nobel Prize for Medicine in 1949. These methods, without a doubt, did not live up to the expectations they sparked, as they failed to produce practical results over time and had a finite lifespan. Lobotomy, already denounced by many doctors as a cruel practice at the height of its success, fell into disuse with the advent of Chlorpromazine, a neuroleptic drug. The first country to ban lobotomy was the Soviet Union in 1950 as it was considered a practice that violated all forms of human rights. By the 1970s most nations had banned the procedure. Lobotomy, or rather a "light" version of it, is still used today on patients with drug-resistant epilepsy, and is called an anterior temporal leucotomy.
Others
"Il preteso corpo" is a hospital documentary about the testing of the drug (acetylcholine) produced by a well-known pharmaceutical company (Roche) on people considered psychiatrically calibrated that caused a "vascular storm" with horrible seizures. Patients were discharged when they were able to make the fascist salute. Found at the Senigallia Fair market in Milan, signed by Alberto Grifi as a ready-made.
Psychosurgery, also called neurosurgery for mental disorder (NMD), is the neurosurgical treatment of mental disorder. Psychosurgery has always been a controversial medical field. The modern history of psychosurgery begins in the 1880s under the Swiss psychiatrist Gottlieb Burckhardt. The first significant foray into psychosurgery in the 20th century was conducted by the Portuguese neurologist Egas Moniz who during the mid-1930s developed the operation known as leucotomy. The practice was enthusiastically taken up in the United States by the neuropsychiatrist Walter Freeman and the neurosurgeon James W. Watts who devised what became the standard prefrontal procedure and named their operative technique lobotomy, although the operation was called leucotomy in the United Kingdom. In spite of the award of the Nobel prize to Moniz in 1949, the use of psychosurgery declined during the 1950s. By the 1970s the standard Freeman-Watts type of operation was very rare, but other forms of psychosurgery, although used on a much smaller scale, survived. Some countries have abandoned psychosurgery altogether; in others, for example the US and the UK, it is only used in a few centres on small numbers of people with depression or obsessive-compulsive disorder (OCD). In some countries it is also used in the treatment of schizophrenia and other disorders.
A lobotomy, or leucotomy, is a form of neurosurgical treatment for psychiatric disorder or neurological disorder that involves severing connections in the brain's prefrontal cortex. The surgery causes most of the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain, to be severed.
Trepanning, also known as trepanation, trephination, trephining or making a burr hole, is a surgical intervention in which a hole is drilled or scraped into the human skull. The intentional perforation of the cranium exposes the dura mater to treat health problems related to intracranial diseases or release pressured blood buildup from an injury. It may also refer to any "burr" hole created through other body surfaces, including nail beds. A trephine is an instrument used for cutting out a round piece of skull bone to relieve pressure beneath a surface.
The frontal lobe is the largest of the four major lobes of the brain in mammals, and is located at the front of each cerebral hemisphere. It is parted from the parietal lobe by a groove between tissues called the central sulcus and from the temporal lobe by a deeper groove called the lateral sulcus. The most anterior rounded part of the frontal lobe is known as the frontal pole, one of the three poles of the cerebrum.
António Caetano de Abreu Freire Egas Moniz, known as Egas Moniz, was a Portuguese neurologist and the developer of cerebral angiography. He is regarded as one of the founders of modern psychosurgery, having developed the surgical procedure leucotomy—better known today as lobotomy—for which he became the first Portuguese national to receive a Nobel Prize in 1949.
Walter Jackson Freeman II was an American physician who specialized in lobotomy.
The study of neurology and neurosurgery dates back to prehistoric times, but the academic disciplines did not begin until the 16th century. From an observational science they developed a systematic way of approaching the nervous system and possible interventions in neurological disease.
Barnwood House Hospital was a private mental hospital in Barnwood, Gloucester, England. It was founded by the Gloucester Asylum Trust in 1860 as Barnwood House Institution and later became known as Barnwood House Hospital. The hospital catered for well-to-do patients, with reduced terms for those in financial difficulties. It was popular with the military and clergy, and once counted an Archbishop amongst its patients. During the late nineteenth century Barnwood House flourished under superintendent Frederick Needham, making a healthy profit and receiving praise from the Commissioners in Lunacy. Even the sewerage system was held up as a model of good asylum practice. After the First World War service patients, including war poet and composer Ivor Gurney, were treated with a regime of psychotherapy and recreations such as cricket.
An orbitoclast was a surgical instrument used for performing transorbital lobotomies.
Eric Cunningham Dax, AO, FRACP, FRANZCP, HonFRCPsych was a British-born Australian psychiatrist.
James Winston Watts was an American neurosurgeon, born in Lynchburg, Virginia. He was a graduate of the Virginia Military Institute as well as the University of Virginia School of Medicine. Watts is noteworthy for his professional partnership with the neurologist and psychiatrist Walter Freeman. The two became advocates and prolific practitioners of psychosurgery, specifically the lobotomy. Watts and Freeman wrote two books on lobotomies: Psychosurgery, Intelligence, Emotion and Social Behavior Following Prefrontal Lobotomy for Medical Disorders in 1942, and Psychosurgery in the Treatment of Mental Disorders and Intractable Pain in 1950.
The following outline is provided as an overview of and topical guide to abnormal psychology:
Psychosurgery is a surgical operation that destroys brain tissue in order to alleviate the symptoms of mental disorder. The lesions are usually, but not always, made in the frontal lobes. Tissue may be destroyed by cutting, burning, freezing, electric current or radiation. The first systematic attempt at psychosurgery is commonly attributed to the Swiss psychiatrist Gottlieb Burckhardt who operated on six patients in 1888. In 1889 Thomas Claye Shaw reported mental improvement in a case of General Paralysis of the Insane after a neurosurgical intervention. This led to a lively debate in the British Medical Journal on the usefulness of neurosurgery for the treatment of insanity. In the 1930s the Portuguese neurologist Egas Moniz developed a surgical technique for the treatment of mental illness and called it "leucotomy" or "psychosurgery". Moniz' technique was adapted and promoted by American neurologist Walter Freeman and his neurosurgeon colleague James W. Watts. They called their operation, where burr holes are drilled in the side of the skull and the white matter is sliced through in order to sever the connections between the frontal lobes and deeper structures in the brain, lobotomy. In the United Kingdom it became known as the standard Freeman-Watts prefrontal leucotomy. British psychiatrist William Sargant met Freeman on a visit to the United States and on his return to England encouraged doctors at the Burden Neurological Institute in Bristol to instigate a programme of psychosurgery.
This is a timeline of the modern development of psychiatry. Related information can be found in the Timeline of psychology and Timeline of psychotherapy articles.
Johann Gottlieb Burckhardt was a Swiss psychiatrist and the medical director of a small mental hospital in the Swiss canton of Neuchâtel. He is commonly regarded as having performed the first modern psychosurgical operation. Born in Basel, Switzerland, he trained as doctor at the Universities of Basel, Göttingen and Berlin, receiving his medical doctorate in 1860. In the same year he took up a teaching post in the University of Basel and established a private practice in his hometown. He married in 1863 but the following year he was diagnosed with tuberculosis and gave up his practice and relocated to a region south of the Pyrenees in search of a cure. By 1866 he had made a full recovery and returned to Basel with the intention of devoting himself to the study of nervous diseases and their treatment. In 1875, he attained a post at the Waldau University Psychiatric Clinic in Bern, and from 1876 he lectured on mental diseases at the University of Bern. Beginning in this period, he published widely on his psychiatric and neurological research findings in the medical press, developing the thesis that mental illnesses had their origins in specific regions of the brain.
The lunatic asylum was an early precursor of the modern psychiatric hospital.
Tone Vale Hospital was a psychiatric hospital located approximately 3 kilometres (1.9 mi) to the north west of Norton Fitzwarren, near Taunton, Somerset, England, in what is now the village of Cotford St Luke. It covered a large catchment area, with patients originating from places as far apart as Porlock and Yeovil.
Sir Wylie McKissock, OBE was a British neurosurgeon. He set up the neurosurgical unit at the Atkinson Morley Hospital, was Britain's most prolific leucotomist (lobotomist), and president of the Society of British Neurological Surgeons.
Psychosurgery, also called neurosurgery for mental disorder or functional neurosurgery, is surgery in which brain tissue is destroyed with the aim of alleviating the symptoms of mental disorder. It was first used in modern times by Gottlieb Burckhardt in 1891, but only in a few isolated instances, not becoming more widely used until the 1930s following the work of Portuguese neurologist António Egas Moniz. The 1940s was the decade when psychosurgery was most popular, largely due to the efforts of American neurologist Walter Freeman; its use has been declining since then. Freeman's particular form of psychosurgery, the lobotomy, was last used in the 1970s, but other forms of psychosurgery, such as the cingulotomy and capsulotomy have survived.
Psychiatry is, and has historically been, viewed as controversial by those under its care, as well as some sociologists and psychiatrists themselves. There are a variety of reasons cited for this controversy, including the subjectivity of diagnosis, the use of diagnosis and treatment for social and political control including detaining citizens and treating them without consent, the side effects of treatments such as electroconvulsive therapy, antipsychotics and historical procedures like the lobotomy and other forms of psychosurgery or insulin shock therapy, and the history of racism within the profession in the United States.
↑ Demétrio, Farid (March 1945). "Convulsoterapia pela acetilcolina: Estudo clínico e experimental do choque vascular". Arquivos de Neuro-Psiquiatria. 3 (1): 34–40. doi:10.1590/S0004-282X1945000100003.
↑ Armocida, Giuseppe (2007). "LA PSICOCHIRURGIA DI A.M. FIAMBERTI NELLA STAMPA DI INFORMAZIONE DI METÀ NOVECENTO". Journal of History of Medicine. MEDICINA NEI SECOLI ARTE E SCIENZA: 467–474 – via Dipartimento di Medicina e Sanità Pubblica Università dell'Insubria Varese, I.
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