It must have seemed like a good idea at the time....

When 25-year-old Charles Hinkley was picked up by Miami police in early 1947 for renting an automobile using a bad cheque, it was just the latest in a long line of similar infractions. Born into a well-off Eastern family, Hinkley had long been seen as the "black sheep" by his relatives and well-known to police for passing bad cheques for amounts as high as $1500. He had a long and colourful history despite his young age, including being discharged from the military after 18 months for being "emotionally unstable." What had basically happened was that he had gotten into repeated scrapes, including several court-martial offenses, before finally going to far by fighting with a medical officer.

Once out of the military, he then went on a cheque-writing binge across the country which ended when he chartered a boat to Bimini before finally being picked up by police. Given that he was already wanted for similar crimes in other states, not to mention the fact that his family wanted nothing more to do with him, Hinkley likely knew that he was facing a lengthy prison sentence when his case came to trial. And so, when he read an intriguing news story while he was sitting in county jail, he immediately contacted his lawyer.

The story related to a radical new brain operation that had been developed years before by eminent Portuguese neurosurgeon Antonio Egas Moniz. Based prior research with lab animals, he concluded that most forms of mental illness were due to abnormal neural pathways in the frontal lobe. To test this hypothesis, Moniz developed a surgical procedure for removing white matter fibres from the frontal lobe which, theoretically, would cure abnormal behaviour. Dubbing this new operation a prefrontal leucotomy, Moniz and his surgical team soon found it made mental patients more docile and easier to manage.

Though the first surgeries involved injecting alcohol into the brain to destroy the frontal lobe, Moniz and his colleague Almeida Lima developed a new technique involving the use of a surgical instrument with a wire loop. Carefully rotating the loop allowed the surgeons to sever key white matter fibers in the frontal lobe. Based on his observations of the first 40 patients to undergo the operation, Moniz was enthusiastic in proclaiming the new operation to be a successful treatment for a wide range of mental disorders. Though he noted some personality and cognitive deterioration, he considered this to be an acceptable risk given the improvement his patients showed as far as their original symptoms were concerned.

While the international medical community was hostile to the idea of psychosurgery at first, surgeons in the United States, Brazil, Italy, Cuba, and Romania began using Moniz' technique on their own patients. Though the complex nature of the operation meant that few surgeons were willing to risk it on their patients, newer procedures were soon developed which mostly focused on accessing the frontal lobes through the eye sockets. Though critics of the operation were already warning that leucotomy patients were much more impaired than Moniz and his supporters were claiming, the prospect of a "cure" for many different kinds of mental illness and violence was too intoxicating for these warnings to be heeded. This enthusiasm surrounding psychosurgery would win Moniz the Nobel Prize for medicine in 1949.

But it was neuropsychiatrist Walter Freeman who really popularized the procedure in the United States. c Having met Moniz personally, Freeman became enthusiastic about the possible benefits of the new surgery and carried out the first leucotomy in the United States in 1936. Recognizing the difficulty of carrying out Moniz' original procedure, Freeman, along with his colleague Jamie Watts, found a way to streamline the procedure by developing what would be termed the Freeman-Watts standard prefrontal lobotomy. Though initially requiring surgeons to drill holes into the scalp, Freeman soon learned to lobotomize patients by going through the optic tract instead.

According to Freeman himself, he apparently first experimented with this approach by using an icepick from his own kitchen (though at least he tried it out on cadavers before proceeding to actual humans). This new procedure involved lifting the upper eyelid and placing a long, thin surgical instrument just above the eyeball. Using a mallet, he could then drive the instrument straight into the skull where, with some careful maneuvering, could then sever the neural tracts connecting cortical tissue of the prefrontal cortex to the thalamus. The operation would be then repeated on the other side of the brain. Not only did this procedure avoid drilling holes in the brain, but it could be done with minimal risk of infection.

Given the advantages of this new operation, which was much simpler than any previous operations of this type, it hardly seemed surprising that lobotomies became a popular procedure. In an era before the rise of psychiatric medication, mental hospitals were often filled to capacity with patients deemed to be incurable. As well, Freeman and Moniz also boasted about the effectiveness of the surgery in eliminating criminal behaviour and making prison inmates less violent. As for newspaper stories about the radical new operation that would revolutionize care for mental patients and even long-term prisoners, they were nothing but positive. Not only did they feature interviews with the ever-enthusiastic Walter Freeman, but the prospect of emptying out mental hospitals (which represented a major financial drain for most states) seemed tantalizing. Even the illustrious Kennedy family was sufficiently impressed by the news stories to have their wayward daughter Rosemary lobotomized in 1941 (a mistake they would later regret).

Certainly, Charles Hinkley was enthused over the stories he read and the possibility that the surgery could help him a lengthy prison sentence. While his lawyers were initially skeptical, he persuaded them to consult several psychiatrists who all agreed that the operation would be worth trying. After that, it was simply a matter of making the necessary financial arrangements. In an interview with reporters, Hinkley was open about why the surgery was necessary. "I'm a cooked goose," he said. "I'm wanted in many states. I'm willing to be a guinea pig. It's better to be dead than to go on this way."

As for his attorneys, they justified the need for the operation by describing their client's chronic passing of bad cheques as a "compulsion" given his above-average intelligence. Though they acknowledged that the lobotomy would leave him without any "emotional initiative" for a time, their hope was that he could eventually be taught the "difference between right and wrong." Then, after a lengthy recovery period, he would be presented to the court where he would face sentencing for his charges.

In the final hearing on whether the surgery should be allowed, Criminal Court Judge Ben C. Willard verified that Hinkley was of sound mind and willing to undergo the procedure. Then, after wishing Hinkley good luck, the judge signed the authorization. After that, all that remained was the operation itself. Since Hinkley was still a prisoners, jail guards had to escort him to the Miami hospital where the surgery would take place. They also posted a 24-hour guard to wait at the hospital until he was well enough to be transferred to another facility.

On October 29, 1949, neurosurgeons Irwin Perlmutter and Richard Strain conducted the surgery on Hinkley. They drilled two holes into his skull (the optic tract method wasn't widely accepted at the time) and directly separated the neural tracts linking the prefrontal lobe to the rest of the brain. According to newspaper accounts, the operation only took two hours and went without a hitch with doctors later describing the patient as being in "satisfactory" condition afterward.

Newspapers across the country followed the story, including openly speculating on what a successful operation would mean for criminals everywhere. As for Hinkley himself, his lawyers made arrangements for him to go to a hospital for his recovery (the exact location wasn't revealed to ensure privacy). As it happened though, the location of the hospital became public knowledge soon enough when Hinkley escaped from the Veterans Administration hospital in Topeka, Kansas just a few months following his operation.

Though nobody seemed certain what the operation would do to Hinkley, what followed suggests that there was very little change. After leaving a trail of bad cheques from Kansas to Massachusetts, he was finally picked up after passing a bad cheque for $150 after buying a watch. All of which left his defenders scrambling to try to explain what went wrong with the lobotomy plan. While the lawyer who had first arranged for the operation insisted that his client had been genuinely hoping to reform, police insisted that the entire lobotomy ordeal had been meant as a scam to escape justice from the very beginning.

As for Hinkley himself, he acted as his own lawyer at his hearing, Despite his lobotomy, he seemed highly articulate when he insisted that he needed to go back to hospital to finish recuperating. "I'm not insane," he said. "but I can't be asked to be responsible for my actions when I haven't been sufficiently hospitalized." The judge seemed unswayed by this argument and instead sentenced him to one year in jail. And, that seems to be it for Charles Hinkley. I haven't been able to find any later news stories describing what happened to him. Suffice it to say, there were no glowing success stories about him later in life.

Though it was clear enough from cases like Charles Hinkley and Rosemary Kennedy that lobotomies were hardly the panacea that had been promised, patients continued to be operated on, often for spurious reasons. Walter Freeman continued to be a major supporter of lobotomies and traveled across the country conducting operations (often without anesthesia or proper sterilization) and even trained non-surgeons to conduct lobotomies as well. Not only did he operate on adult men and women, he also operated on young children as well. All told, an estimated 40,000 people would be lobotomized in the United States alone though it wasn't until the 1970s that the operation was finally phased out. But lobotomies were widely practiced in countries around the world and it would take decades until the procedure fell out of favour.

As for Walter Freeman, he conducted his last lobotomy in 1967 and lived long enough to see himself being reviled over the surgical procedure that made him famous (he died in 1972). Lobotomies have since been banned in most jurisdictions and calls to rescind Egan Moniz' Nobel Prize are still being made. Though only a few patients who underwent a lobotomy are still living, they continue to represent a sad legacy to a medical innovation many believed would change the world.