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ELLIOT S. VALENSTEIN 429 Convinced that he could train psychiatrists to perform transorbital lobotomies, Freeman began to travel around the country demonstrating the procedure in as many state hospitals as possible. These trips evolved into a crusade, some said an obsession. The trips were well planned in advance, enabling him to visit as many institutions as possible. On some trips he drove 15,000 miles before returning home. Typically, he would arrive mid-morning, review the cases, and by mid-afternoon he had completed 20-30 transorbital lobotomies with young psychiatrists, often residents, observing him. Patients were lined up in an assembly line, receiving several electroconvulsive shocks just before the operation. Afterwards, the psychiatrists would practice on several cadavers saved for the occasion and then, with Freeman standing by, they would perform three transorbital lobotomies on patients. Before two full days had elapsed, Freeman was driving to the next hospital, leaving behind several psychiatrists who were now ready to do the procedure on their own. The operation itself took only five minutes, and in one twelve-day period in 1952, Freeman performed 225 transorbital lobotomies on patients from the four West Virginia State Mental Hospitals. Freeman died in 1972, convinced to the end that transorbital lobotomy had helped an enormous number of people live better lives and that it had played a major role in reducing the number of mental patients in state hospitals. He believed that without his operation most of these patients would have deteriorated beyond help. Even after the introduction of new drugs for treating mental illness, Freeman thought that transorbital lobotomy still could make a contribution, although a more limited one, to patients who did not respond to drugs. Toward the latter part of his life he drove around the country in a van tracking down former patients everywhere - a North Dakota farm, a jail in Mobile, large cities, and remote areas in Appalachia - despite repeated bouts with rectal cancer. He kept track of all his former patients, through exchanges of letters and Christmas cards and by periodic visits. All of this was done at his own expense, for he never had a grant to support the follow-up studies. Freeman followed many patients for more than twenty-five years; his last manuscript, published posthumously, was on the results of lobotomy. In order to better appreciate this national phenomenon, it is necessary to consider the growth and locations of lobotomy operations.
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