A surgical instrument resembling an ice pick, known as an orbitoclast, served as the primary tool for Walter Jackson Freeman II to facilitate a transorbital lobotomy. By driving this device through the thin bone of the eye socket into the frontal lobes, he sought to alter the neurological function of patients without requiring a traditional operating room.
Early Education and Career
Born in 1895 in Philadelphia, Freeman grew up in a family with a strong medical background, as his father was a doctor and his grandfather, William Williams Keen, was a well-known Civil War surgeon. Freeman began his studies at Yale University in 1912, graduating in 1916. He continued his education at the Perelman School of Medicine at the University of Pennsylvania. In 1924, he relocated to Washington, D.C., where he became the city's first neurologist and began directing laboratories at St. Elizabeths Hospital. He subsequently earned a PhD in neuropathology and led the neurology department at George Washington University.
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Influenced by the work of Egas Moniz, who had performed a leucotomy by coring frontal lobes, Freeman adapted the procedure to sever connections between the frontal lobes and the thalamus. He partnered with neurosurgeon James Watts, and on September 14, 1936, they performed the first prefrontal lobotomy in the United States on Alice Hood Hammatt. By 1942, they had completed over 200 operations. During this period, Freeman reported that 63 percent of patients experienced improvement, while 14 percent were left in worse condition.
The Transorbital Procedure
Drawing on techniques devised by Italian doctor Amarro Fiamberti, Freeman developed a transorbital approach to access the brain through the eye socket. This method avoided the need for drilling the skull or general anesthesia, instead using electroconvulsive therapy to induce unconsciousness. He first performed this on Sallie Ellen Ionesco. Because the procedure was simplified, Freeman increasingly bypassed the need for neurosurgeons or operating facilities. This evolution led to a professional split in 1947 when James W. Watts ended their partnership, citing disgust at the transformation of surgery into a simplified office procedure.
Later Practice and Legacy
Over a career spanning four decades, Freeman performed approximately 4,000 lobotomies across 23 states, including on patients as young as 12, such as Howard Dully. He often demonstrated the procedure for free at various mental institutions. Notable cases included Rosemary Kennedy, who was left permanently disabled following a surgery directed by Freeman and Watts. By 1967, Freeman was banned from performing surgery. He died in 1972 in San Francisco and is buried at Calvary Cemetery.
Fast facts
- Born: 1895, Philadelphia
- Died: 1972, San Francisco
- Education: Yale University and University of Pennsylvania
- Professional Titles: physician, psychiatrist, neurologist
- First US Prefrontal Lobotomy: September 14, 1936
- Estimated total surgeries: 4,000
- Burial site: Calvary Cemetery
Questions readers ask
Did Freeman have surgical training?
No, he lacked formal surgical training despite performing thousands of procedures.
Why did his partnership with James Watts end?
Watts ended the partnership in 1947 due to his opposition to the transorbital lobotomy and the transformation of the procedure into a simplified office practice.
