/ Michigan quarterly review: Vol. 27, No. 3
430 MICHIGAN QUARTERLY REVIEW The number of lobotomies did not increase radically in the U.S. during the first years after Freeman and Watts introduced the procedure in the fall of 1936. Neurosurgeons had to learn the procedure and it was several years before the demand began to build up. By that time the Second World War had diverted attention to other medical problems. Prior to the war, no more than two hundred lobotomies were performed in any single year, but immediately afterward a large increase occurred. There were approximately 500 lobotomies performed in 1946 and the number doubled each successive year, leveling off at about 5000 annually in 1949. This rate was maintained for about five years. After the introduction of transorbital lobotomies in 1946, onethird of all the lobotomies performed in the United States during the peak years and 56 percent of those done in state hospitals used this procedure. More important, however, was the economic and political pressure to find some quick solution for the many veterans suffering from mental problems. Over 55 percent of all the Veterans Hospital beds were occupied by neuropsychiatric patients. This was not only expensive, but the families and the public conscience were demanding that something be done for these veterans. In response to this pressure, the Veterans Administration started training psychiatrists and neurosurgeons in "modern psychiatric treatment methods," namely electric shock, insulin therapy, and lobotomy. About 12 percent of all lobotomies were performed in Veterans Hospitals, but of more significance, those trained to perform the operation with VA support used these skills in other hospitals as well. It is not true, as often charged, that lobotomies were performed only on indigent patients in state hospitals. Although 56 percent of all lobotomies were performed in the state hospitals, many advantaged patients - some from prominent American families, given the "best" medical advice at exclusive private sanitoriums - were also lobotomized. The medical staff affiliated with many of the most prestigious university hospitals played leading roles in the practice of lobotomy at private sanitoria and in state mental hospitals. The often cited Columbia-Greystone Lobotomy Project, for example, involved a large team of Columbia University staff - neurosurgeons, psychiatrists, neurologists, neuroanatomists, and psychologists - but the patients were inmates at the New Jersey State Hospital in Greystone Park. Neurosurgeons at other major universities and leading medical research centers-Yale, Duke, Pennsylvania, Minnesota,
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