Blood and Guts: A History of Surgery (2008) s01e01 Episode Script
Into the Brain
Surgery.
Chances are at some point in your life, you're gonna need it.
And when you do, thank your lucky stars you live now and not 150 years ago.
My name is Michael Mosley.
Ever since I was a young medical student attending my very first operation, I have loved surgery.
I am in awe of the skill and nerve required to operate on a living, breathing human being.
GROANS OF PAIN Surgery tests medical knowledge under the most extreme circumstances.
PAINED SHRIEKS But that knowledge has been paid for in human lives.
This series reveals surgery's evolution from butchery to brilliance.
It's a tale of courage and missed opportunity, pathos and bloodshed.
I want to start with the surgical assault on that most extraordinary of all our organs - the human brain.
Operating on the brain promised to cure not just the body, but the mind.
Good Lord! It created challenges which were taken up by some peculiarly obsessive, driven individuals.
The operation I witnessed was diabolical.
'I've had parts of my own brain interfered with.
'And uncovered something that has never been seen before.
' Inside my head I have a black hole.
And I've discovered how, after many false starts, the pioneers began a programme of research that is only now beginning to pay off in truly remarkable ways.
HIGH-PITCHED BUZZING Right, you're now removing the bone.
Yes.
And that's the covering of the brain.
How extraordinary.
How are you doing, Kathryn? I'm not too bad.
How are you? We're doing very well up here.
Good.
Hello!Hello! Is there a part of the brain you can remove that football bit from? Not in boys! Kathryn's sort of chatting away happily and yet he's just probing away at the brain.
It really is quite extraordinary.
They get paid far too much money to kick a ball about.
'Kathryn has to be awake so that her surgeon, Andrew McEvoy, 'can monitor her responses as he operates.
' I like watching horseracing.
Do you ever go to the ballet? 'This operation, at the National Hospital for Neurology 'and Neurosurgery in London, is at the forefront of what is technically possible.
' What exactly is her problem? She has two problems.
The first is that she has focal epilepsy.
The second is that she has a cavernoma that could bleed in the future and cause a brain haemorrhage.
We're just trying to stop the bleeding.
Thank you.
'28 year-old Kathryn Proctor, a florist, has been having epileptic fits 'because of a cavernoma - an abnormal cluster of blood vessels in her brain.
'Epilepsy has forced Kathryn to give up work.
'If Andrew McEvoy can remove the abnormal area, she should be cured.
' You'll see lots of little arteries that we have to take as we get.
You're now revealing what I actually recognize as a brain.
Exactly.
They've just gone through and revealed the brain.
It's really, really extraordinary to see it.
You're doing just fine! When you see the care and precision and knowledge and all the instruments around here, it makes you wonder about the sheer nerve that 19th century surgeons must have had to open up the black box and probe inside.
'The truth is that few did.
'120 years ago, the brain was considered by most 'to be too complex and risky to operate on.
'But an obsessive young American was about to change that.
' Take some big deep breaths in and out through your mouth.
In through your nose, out through your mouth 'I've come to Yale University in the United States to find out more about the man 'who almost single-handedly created what we now call neurosurgery.
'His name was Harvey Cushing and he was so focused on his work 'that he refused to cancel an operation even when told that his son had died in a car accident.
' Wow! Is this where Yale keeps its treasures then? Well, you know, this appeared to be the safest place.
'Professor Dennis Spencer is a leading neurosurgeon and guardian of Cushing's archive at Yale.
' It's a bit like coming down into Tutankhamen's grave - apart from all the pipes.
Oh, more special than that.
More special than that.
This is really the legacy of Cushing.
Right.
So, it's cardboard boxes largely, by the looks of things.
I don't No, not quite like that.
Good Lord! Wow.
How many?Must be 1,000 jars collected over 30 years of his career.
How extraordinary.
All his patients.
Patients who willed their brains to him when they died.
'Cushing preserved more than a thousand brains - 'all of them from his own patients.
' I've never ever seen anything like this before in my life.
It's an extraordinary collection - probably unduplicated anyplace.
'Cushing started his collection in 1902, shortly after he began to operate on brains.
' So, what was the state of neurosurgery at the time? Surgery on the brain was just completely in the Dark Ages.
There were general surgeons who sometimes had the audacity to try to open the head to relieve pressure or to take out an obvious mass.
And they generally failed.
Mortality was 60%, 70%.
Cushing saw this as his stake - his way to go forward.
He wasn't put off by the fact that everybody else had failed? He was not.
He loved it! This is what he wanted to do.
The head is where the revolution is going to happen, and that's what I wanna do Rightand I'm gonna do that.
'Harvey Cushing's desire to master brain surgery was all-consuming.
' What did he have to sacrifice to make him successful, if you like? He sacrificed his family.
He sacrificed the kind of intimacy that we think should be normal in a large family.
Five children.
He couldn't really return that kind of love.
He was quite cold, wasn't he? He just had to concentrate on his discipline.
He was much more devoted in fact to his patients than he was to his family.
Now this is presumably a negative.
It is.
What's wrong with this guy? This man has acromegaly, which is an overproduction of growth hormone from the pituitary, and one of the first kinds of tumours that Cushing was able to diagnose.
I gather that somebody said that the pituitary gland was the only thing that he ever loved.
It could have been! I've got more over here I can see.
Let's have a look at these.
This must be growth hormone again.
Yes.
This demonstrates the connection that Cushing spent so much of his time at the hospital with his patients and with his discipline to the detriment of his relationship with his family.
'One of the main obstacles confronting Cushing and his peers was the extraordinarily high risk 'that the patients would bleed to death on the operating table.
'The brain has over 600 kilometres of blood vessels 'and uses nearly a litre of blood every minute.
' The scalp and the brain and the bone are all extremely bloody.
So just getting in usually exsanguinated the patient - they would bleed to death opening the skin, opening the skull.
Where others looked for grand solutions or gave up, Cushing focused methodically, pedantically, patiently, on a series of minute adaptations.
He devised small clips made from household wire which he used to stem blood flow in tiny arteries and veins.
He adapted a pneumatic cuff, normally used to measure blood pressure to make a tourniquet that could reduce blood flow to the scalp.
Here he is using huge arrays of artery clamps to stop bleeding.
He was an absolute tyrant in the operating theatre, demanding from his staff the same high standards he expected from himself.
He was changing a field.
This is a big change moment because basically nobody knows what they are doing.
He was revolutionizing a field.
He was making brain surgery possible.
Wow! Thank you very much.
You've been absolutely fantastic.
I'm glad.
I've enjoyed showing you our collection.
It is an extraordinary one.
What a man.
What an extraordinary man.
Harvey Cushing's systematic approach cut operating deaths from 70% to 10%.
His work gave other surgeons the confidence to try and "open the box".
But though they could now open the skull and remove obvious tumours, much of the time they really didn't know what they were looking at, let alone what they were doing.
The precise workings of the brain were still a mystery.
This is some brain, some pig brain, fresh from the abattoir.
'It is surprisingly similar to human brain, 'and illustrates just what these early surgeons were up against.
' This is only a section of it, but it's very small.
It is incredibly gelatinous - it feels like, sort of, cold tapioca pudding.
It's very soft.
You feel like you could just crush it in your hand.
It's surprisingly tender.
Just looking at it, you'd never know which parts did what.
And that was a problem for surgeons.
When they were operating - trying to remove a tumour or perhaps a foreign body, they might inadvertently remove a vital part of the brain that left the patients incapacitated, paralysed and often dead.
Like any explorer, what surgeons really needed was a decent map.
Down the years, many people have contributed to the mapping of the brain.
For me, one man in particular stands out.
His story begins 160 years ago, on the East Coast of America, with what I think is one of the strangest and most curious incidents in the whole history of surgery.
It's 1848 and 25 year-old Phineas Gage is a foreman working on the construction of the railways.
He's described as smart, energetic and iron willed.
An unfortunate description in the light of what is about to happen to him.
Little does he know he is about to become medical history.
On September 13th, 1848, Phineas and his gang are preparing the way for some new tracks.
That day they are laying explosives.
So Phineas is carrying a tamping iron.
He uses this to compact the gunpowder.
Now, what is supposed to happen is they pour the gunpowder in and then they put sand on top to reduce the risk of sparks.
Unfortunately, it appears on that particular afternoon, someone forgot to put the sand in.
So, what happens is when Phineas goes to compact the gunpowder.
He does one final strike ignites a spark and the tamping iron goes right through his cheek, out through the top of his head and flew 25 metres covered in gore down the track.
But this is the really astonishing thing - Gage survives.
He not only survives, but within a few months, he's back on his feet and appears to be completely normal, except for one big thing.
Astonishingly, he was able to walk and talk, but he underwent a radical personality change.
This perhaps gives you some indication of what happened to poor Phineas.
The spike went through his cheek and out through the top of his head, taking away the frontal lobe.
Beforehand he was regarded as sober, industrious.
Afterwards he was much more impulsive - rude, vulgar.
As his friends said, "Gage was no longer Gage".
The extent of Phineas's injury can be seen in this cast made while he was still alive.
What's significant about the injury is that while it affected his personality, it didn't stop him walking and talking.
Phineas Gage was dramatic proof of an idea called localisation - the brain is not some homogeneous pudding, but is made up of different parts doing different things.
Understanding localisation, the map of the brain, is essential for safe surgery.
The brain is so complex that researchers are still filling in details.
Today I am going to do my bit to help.
I'm feeling a bit nervous, even a little anxious, because today I'm going to take part in a rather strange experiment inside this building.
There they are going to interfere with my brain in ways I'm not entirely sure I'm going to enjoy.
Hello there!Michael.
Welcome! Come on through.
'Dr Joe Devlin from University College London is using electromagnets to map the brain.
' It should be fun! On my head, presumably.
Yes.
It's a good thing I can't see myself in the mirror as I suspect this is not my finest moment.
So this is the TMS device.
'Joe is going to use transcranial magnetic stimulation, or TMS, 'to interfere with my motor cortex - the bit that governs fine movements.
' .
.
so that we can stimulate the motor cortex.
It's strange, the idea that you are about to interfere with my brain.
There's a screening form to just make sure that it would be safe to proceed with the TMS.
"Have you suffered from epilepsy, convulsions? No.
" 'The powerful magnetic field will temporarily scramble my brain cells.
'If they hadn't done it on themselves many times, I'm not sure I'd be volunteering.
' I hope to see another Christmas! You bet.
Tip of the nose.
Bridge of the nose.
So now we can test 'Joe is calibrating his machine to images of my brain.
'This will allow him to pinpoint the area responsible for hand movements 'and then he'll put me through some tests.
' That's very cool.
I have to say that is very, very cool.
I Iike that.
So I write "writing is easy".
Ready?Yeah.
I just go on writing.
GodGod that is weird! So the fine motor control that's really critical in writing Is completely impossible when you do that!Completely impossible.
It's very odd when you lose voluntary control like that.
You have another test for me.
I face this with some trepidation, now.
This is normally quite an easy action.
I just go there Aah! Yep.
Terrific.
How difficult can it be?You ready? Yeah, I'm ready.
CLICKING Right.
I think the answer is quite difficult, isn't it? Bring on the next test.
So, if you want to go ahead and start doing some finger touching.
OK.
I can touch my nose.
I can keep this up for hours.
Excellent.
Yep.
So, I just keep going.
CLICKING It's pretty dramatic, yes? Quite dramatic, yes.
I was in serious danger of poking my eye out for a moment.
I thought I hadyes Very, very odd.
Do you want to do it again?Sure.
I find it very hard to believe.
This time.
This time.
Man against machine.
'TMS works by interrupting the signals going from my brain to my hand.
'It only works if it's applied precisely to the area of the motor cortex that controls hand movement.
'A centimetre left or right, and there'd be no effect.
' Blimey.
'The intense magnetic field swamps neural pathways in the motor cortex, 'making me lose control.
'It's almost like a stroke - only this is temporary.
' There you go.
That was complete lack of control.
Very strange.
I can write.
Writing is jolly easy.
Exactly.
It's back.
Wow! That was strange.
It demonstrates very clearly that you control a very small part of the brain and the rest of me is absolutely fine.
And the effect stops as soon as the magnetic field stops.
Absolutely.
So this is localization in action.
Precisely.
The information that Joe and his colleagues collect is creating an ever more detailed map of the brain and that map is of crucial importance to surgeons and patients in the operating theatre.
We're happy with that.
Now we need to find the areas where we think the lesion is.
Andrew McEvoy needs to establish exactly where he is in Kathryn's brain before he removes the vascular tumour.
There's a little brown discolouration between this rather unusual loop there.
And that's probably the cause of her epilepsy? Almost certainly the cause of her epilepsy.
What we have to do now is make sure that area I want to remove isn't performing some vital function for her so we'll stimulate all around it to make sure it isn't moving her leg or her hand or her face and make sure it is safe to remove.
Want a bit more to drink? Yeah, please.
Now, Kathryn, what you're going to get here now is every now and then you're gonna hear a little buzz.
'The danger with operating on the brain is that it's easy to cause collateral damage, 'which could leave an arm or leg permanently paralysed.
' OK, yeah.
Just hear a little buzz every now and then.
BUZZING Anything at all? No.
Same again.
BUZZING No.
Same again.
BUZZING Oh! Yes.
That's the one where I get the pins and needles.
Andrew is stimulating Kathryn's brain with an electrode to identify precisely the areas that control sensation and motor skills.
OK, fine, let's go up to 1.
5, please.
Same again, Kathryn.
BUZZING No.
BUZZING No.
BUZZING Yes.
What did you get then, Kathryn? Is this good?Yes, this is great.
Let's just see what this does, OK? BUZZING That was my face.
Right.
Kathryn, just for one second OK, Kathryn No, no, sweetheart I know it feels really strange.
Just upsets me when it's my face.
It's good we've found it because we know to leave that bit there.
I know it's horrible for you.
You're doing fantastically.
We don't need to do any more.
So what we've got here, this area here all moved the hand and arm.
This area here moved the foot, this area here moved the leg, and then as I came up behind the lesion, we had a little bit here that caused contractions in the face and then there was, directly behind the lesion, was an area that was causing eye deviation and interestingly she reports that's exactly how her seizures start.
Solet's go.
'Now that he has identified the area he can safely remove, 'Andrew is ready to cut out the vascular tumour.
' Nice tracing coming from the brain there.
'He's about to cut out parts of Kathryn's brain because he believes by doing so 'he will cure her problem and give her a better life.
'80 years ago, the same laudable intentions led surgeons down a dark and far more sinister path.
' Microscissors, please.
I've come here to California on the trail of one of the most infamous doctors of the 20th century - Dr Walter Freeman, the lobotomist.
Walter Freeman began practising as a doctor in the 1920s, going on to work in one of the vast institutions set up to house growing numbers of mentally ill people.
The shell-shocked victims of the First World War and inmates with dreadful psychiatric problems lived out their lives in what were known as "snakepits".
Psychiatric hospitals in the 1930s were terrible places to be as a patient.
And they were terrible places because they were places of hopelessness.
There were no effective treatments for most mental disorders.
For the most part, these hospitals warehoused patients for long periods of time, decades, even entire lives.
Freeman was horrified at the sheer waste of human potential.
Well, he started out with good intentions.
Here was a terribly serious problem and it wasn't getting any better, it was getting worse.
It was a public health problem.
Freeman was convinced that the root cause of many of the patients' problems lay in the physical structure of their brains.
So he decided to change them.
Appalled by what he was seeing in these "snakepits", Freeman now spent increasing amounts of time in the laboratory, cutting up brains, dissecting brains, examining brains, looking for differences.
This is the brain received through the courtesy of Washington Sanitarium.
Freeman thought that surgery could help patients far more than their current treatments.
.
.
cut off at the level of the middle of Spurred on by the growing understanding of what different regions of the brain do, he finally decided that the problem lay in a set of connections between the thalamus and the frontal lobe.
The pointer demonstrates the thalamus and the anterior thalamic radiation going to all parts of the frontal lobe.
Freeman believed if he could sever the connections between the thalamus and the frontal lobe, then this would dampen down all those awful emotions and it would, if you like, cure the patients.
He saw this as "surgery of the soul", a way of bringing the damned back to life.
But there was a problem.
Freeman was not himself a surgeon.
so he got together with a man who was - James Watts.
And together they started performing the operation they called "lobotomy".
A lobotomy involved opening the side of the skull at both sides and entering the brain using a tool called a leucotome.
It looked like a butter knife.
And Freeman and Watts would insert this tool into the brain through the side holes and attempt to cut some of the neural pathways connecting the frontal lobes of the brain to the thalamus.
Freeman and Watts reported about one third of their patients were improved by lobotomy, about one third were not affectedmuch and that the remaining third were worse off after their operations.
Freeman and Watts considered this to be a great success.
But the operation was so time consuming, they knew it could never make a significant impact on the vast numbers in the asylums.
So how was he going to get to all those people? He needed to find a way to make it simpler and much, much faster.
This is a camper van of the type that Walter Freeman used to take his kids on holiday in.
And inside this van is the answer to Walter Freeman's problem.
His solution, if you like, to all human ills.
Inside this camper van is Walter Freeman's contribution to the history of surgery.
The instrument that Walter Freeman chose for his new improved lobotomy was this - an ice pick.
The sort of thing you'd have found in every 1940s home.
It was absolutely perfect for what he needed it for.
It was hard.
It was tough.
It did the job.
So what Freeman did is he would anaesthetise the patient using ECT ELECTRIC SURGE .
.
then he would get his ice pick and a hammer and he would go into the brain through here.
I think I will try this on a skull rather than myself.
Here it is Watch closely.
He's going in here, he pushes the eyeball out of the way and he works his way back to a thin bit of bone right at the back.
And then what you do is you bop it, bop it through the skull Yeah, going through! Go in about 5cm and then you just squiggle it around.
He was much more adept than I was cos he would use two at the same time.
And then out it comes.
And according to Freeman, the only postoperative care the patient needed was a pair of dark glasses! Transorbital lobotomy was so simple, it could be done by anyone, anywhere, and in under ten minutes.
Freeman was so thrilled by his discovery, he got into his camper van and he drove off, crisscrossing the States 11 times in one year to show the doctors just what they could do.
Often Freeman would do as many as 25 transorbital lobotomies in a single day, one right after the other.
Freeman had some great exhibitionist tendencies - he would perform lobotomies left-handed even though he was right-handed.
He would sometimes perform them using a carpenter's mallet.
The operation I witnessed was shocking.
It was quick, it was easy, and it was diabolical! He lined up two women.
Then a quick My father went over and tickled the first one in the ribs.
She said, "Stop that!" He went over and tickled the ribs of the other one.
Uh-uh! She was paralysed on the left side.
Walter Freeman performed thousands of lobotomies.
His technique spread so widely that it's estimated that more than 100,000 people were lobotomisedwith mixed results.
They had their failures.
But there again, a remarkable number of those patients returned to their families and had some kind of a life.
Now it's certainly true that some of the patients became more docile and easier to handle.
But many of the others were so badly damaged, they could never take their place in the world.
And of course, some died.
This young man is one of lobotomy's success stories.
Cases like this encouraged Freeman to extend his practice.
He moved from using lobotomies as a last resort to using them on people who by anyone's standards were perfectly normal.
Howard Dully is a 59-year-old bus driver from San Jose, California.
He is also one of hundreds still alive who were lobotomized.
What makes Howard particularly unusual is the fact he was operated on by Walter Freeman when he was only 12 years old.
You always feel like a freak, a Frankenstein, different.
You don't ever totally get over it.
You suppress a whole lot of it, keep it inside.
Hi there! Howard, I would guess? Hi, I'm Howard Dully.
Hello, I'm Michael Mosley.
Glad to meet you.
And you.
So this is your childhood neighborhood, is it? Yes, it is.
Which way's the house? House is over in here.
What were you like as a child? Well, I wasn't an angel.
I was very rambunctious.
I liked to roam the streets a lot.
I liked to be alone.
I found out if I was alone, I didn't get in trouble, cos no-one was there to get me in trouble.
And I just wanted to be left alone, pretty much, you know.
Howard's mother died when he was just five years old.
His father married again, but Howard and his new stepmother Lou had a very difficult relationship.
I felt that she was trying to take the place of my mother, and I resented that, so How did she respond? She would punish me or do things to me that would aggravate me so it would just snowball.
She would do something to me and I would do something back and pretty soon it just got out of hand.
Their relationship got worse and worse, to the extent that Lou took Howard to see Dr Freeman.
It was just before his 12th birthday.
Do you think she had any appreciation of what a lobotomy would do? I don't know that she cared.
I think she just wanted a solution to me.
And whatever that solution brought, she was willing to accept.
This picture shows Howard undergoing his lobotomy.
I wasn't changed that much.
I still had my faculties and things.
She thought she was gonna get more of a docile, robotic type kid that she could control.
If the lobotomy was supposed to pacify Howard, it failed.
He became increasingly disruptive.
Unable to manage him, his parents sent him away from homeforever.
I had gone to several people's homes and then made a ward of the court and juvenile hall and since I didn't commit a crime, they sent me to Agnews at age 13, 14 years old.
And I was put in with adult mentally ill patients.
I was just a kid that had no place to go.
That's what they kept telling me.
"We have no place to send you.
" Then I went back to juvenile hall, back on the streets, got in trouble cos I didn't have any skills or know how to live.
And I went back to Agnews till I was 20.
It was either that or prison.
Do you think Walter Freeman stole something from you? I think he took my childhood.
I think he took my childhood and some of my adulthood.
Because I'm probably about 20 years or better behind the average person.
What I'd really like to do is I'd like to take you along to an MRI machine where we can have a look inside your brain, because I think you're an extraordinary individual, and I'd be very, very interested and I hope you arein what the MRI machine might reveal.
Well, thank you.
Comfy?Yeah.
'I am about to see the effects of lobotomy on a living brain.
' Now that We'll go with that.
'Imaging expert Dr Bob Dougherty has come to interpret the scan.
' Bob, have you actually scanned somebody who has had a lobotomy before? No, no, it hasn't been done with MRI.
Hasn't been doneat all.
So this is a first.
Be very interesting to see what the results are.
Of the 100,000 people who were lobotomized, Howard is the first to have a high resolution MRI scan and I feel privileged to be here.
I've seen into parts of you that no-one else has ever seen into.
I'll bet you have! Right, take a seat over here.
Take a seat.
So we have had a good look at your brain.
Oh, there I are! It is absolutely fascinating.
This is the front of his head, this is his eyebrow, his eye, his nose would be over here, the back of his head.
The knife should have gone in above the eye, and then you can see this black region, that's not normal.
That's abnormal, is it? That's abnormal.
So inside my head, I have a black hole.
There you go.
I got TWO of them! 'These huge black cavities were created by Dr Freeman's instruments.
' And on both sides.
Both sides.
What would that area normally be doing? So the frontal lobes are important for long-term planning - inhibition of a response.
One of the most obvious things that people who have damage in this part of the brain is they become very impulsive unable to control their impulses.
That's the paradox.
They put you through all that and they got the exact opposite of what they were hoping to achieve.
It would have made you worse, would have made you much more likely to misbehave.
Is that right? I would agree.
If you did this to an adult, I would expect them to be permanently impaired and not be able to control their impulses.
Ironically, it was probably Howard's youth that in the end prevented him from going completely off the rails.
His young brain was able to rebuild pathways responsible for impulse control and which govern reasonable behaviour.
A good thing about a young brain is that it is very adaptable.
You were young enough when it happened and perhaps some of the surrounding connections took over and helped compensate.
This is more than my mind wants to take in all in one time.
Takes a while to absorb, doesn't it? It does.
It does.
I have to say, I find it absolutely astonishing.
I looked at a number of scans but the only time I've seen anybody with anything like that, they have had a severe stroke and they were really incapacitated.
But you are just so completely normalwith a slightly exaggerated sense of humour! It's what kept me through it! But I am absolutely amazed that you are walking and talking and you are as fabulous as you are, granted the fact there is a hole that size in your brain.
It is really amazing - I mean, you are amazing.
Thank you.
It's been really fascinating.
It's been a real pleasuremeeting you.
Thank you.
'The tragedy is that when Howard was operated on in 1960, 'safer and more effective psychiatric treatments were widely available.
'Nonetheless, Freeman went on performing lobotomies for many more years, 'only stopping when he was 72.
' Freeman died not long after he did his last operation.
But the idea of using surgery to control behaviour was now so seductive that far from dying with him, it gained momentum.
During the Cold War, mind control became an active area of research.
Brainwashing proved to be a blunt tool, but brain surgery offered a more focused result.
In the mid-1960s, a procedure developed by Dr Jose Delgado took psychosurgery to a whole new level.
I was continually thinking about the brain, about the possibility to do research, about the possibility to go inside in the depth of the brain.
Rather than cutting things out of the brain as Walter Freeman had done, Delgado decided the best thing to do was to insert something into the brain.
At Yale, Delgado became fascinated by the idea that electrodes implanted in animals' brains could control aggressive behaviour.
In the summer of 1964, to perform a truly audacious stunt, he chose not a rat, nor a mouse, but a bull.
The owner says, "Well! You can do that with cats and monkeys.
"You can't do that with bulls, can you?" "I dunno.
Let's try.
" "Will you allow me to place electrodes in one of your brave bulls?" "Sure.
No problem! "But you will not be able to pacify him!" "I dunno.
Maybe not.
Let's try.
" Dr Delgado really did intend to stop an animal specially bred to be aggressive in its tracks.
This footage shows Dr Delgado in action.
We anaesthetized the animal.
We implanted electrodes in the head.
Next day the bull was normal and the bull was going around charging against anybody in the bull ringcompletely normal.
Then I thought, "I know a little about bullfighting.
I am going to test this by myself.
" Delgado leapt into the ring with an extremely dangerous animal, armed with nothing but a remote control.
He was betting his life that this would work.
The animal was few feet away.
I pushed a button in the radio stimulator and the animal really stopped completely.
It was frightening, but it was an experiment.
So, when the experiment was over, the bull was in very good health and I was in very good health also! So, no problem! Jose Delgado was jubilant and saw the success of his experiment as just the beginning.
That took us to another big step - if electrodes implanted in animals are possible, can we implant electrodes in the human brain? To many people, this vision of brain manipulation was not thrilling - it was downright terrifying.
It presented a nightmarish future where anyone who threatened the state could be controlled.
Far-fetched? In 1970, researchers from Harvard Medical School suggested using psychosurgery on black rioters, while others suggested putting implants into gay men to turn them straight.
Ethical approval proved impossible.
Funding for brain implant research fizzled out.
But the story of implants wasn't over.
Some of the things they talked about doing were horrific and yet it did in time lead to what is now one of the most brilliant and innovative branches of surgery there is - deep brain stimulation.
With your thumb and index finger, can you do nice big movements? This is Stuart Carter off medication.
Stuart Carter is 68 and has Parkinson's disease - a degenerative condition affecting movement.
In 2006, he went to the National Hospital for Neurology and Neurosurgery in London to be assessed for surgery.
OK, that's lovely, and back.
After ten years on medication, the effectiveness of the drugs was wearing off and Stuart was finding it increasingly difficult to move.
My balance is gone.
So standing upstanding erect is certainly quite a trouble.
It's as though you're a statue on a plinth and you can see the world going on around you - you're fixed.
Well, the facial muscles go into a locked position, effectively.
So I am looking out through a mask.
Stuart was offered the chance to have electrodes implanted in his brain to block the electrical signals which cause the symptoms of Parkinson's.
Good morning.
Good morning.
How are you? I hope you're better than I am.
Don't be so sure! Mr Marwan Hariz performed this groundbreaking surgery.
In conventional neurosurgery, you open and you see what you are doing.
You see the tumour, you see the aneurysm, the bleeding - you see what you do.
Here we don't see.
We are aiming at a target, an area in the brain that is very deep, in the basal ganglia - the base of the brain.
We are navigating in the dark.
Because Parkinson's disease lies so deep within the brain, inaccessible to the surgeon's knife, a new technique was developed to place the implants into the deepest parts of the brain.
No pain, just noise.
Mr Hariz drilled two holes in Stuart's skull through which he could insert the implants.
Once in place, they were connected to a test stimulator.
We have to stimulate with a little current here.
You might feel something.
You might feel nothing.
Whatever you feel, you tell us.
OK.
Feeling OK?Yes.
No special sensation?Tingling in my foot.
Which foot?Left.
OK.
Very good.
The twitching in Stuart's foot meant the implants were in the correct part of the brain.
Try as much as you can.
Try and open your two fingers.
There was a marked improvement.
Stuart could move more easily, but Mr Hariz had to make sure the electrodes had not affected his speech or concentration.
Very good.
OK.
Can you say after me, "This is the night train "crossing the border, bringing the cheques and the postal order"? "This is the night train crossing the border, bringing the cheques and the postal order.
" OK, good.
The electrodes were later connected to a battery stimulator inserted in Stuart's chest.
Hello, sweetheart.
Hello.
Well done.
Congratulations on getting through it.
Well done.
Well done.
It's now two years since Stuart's operation and I've come to see how he's getting on.
Good morning!Good morning.
I'm Stuart.
How are you? I'm well, thank you! Can we? Can you show me what would have happened before? Before they switched the stimulation on? What actually happens? In my case, it was a question of freezingOK.
.
.
rather than the traditional Parkinson's shakes.
Yes.
You would do what?Can you show me? Well, yes.
In those times I might come down to hereYes.
and I'd put my hand down there Yes.
.
.
but if you said to pick the hand upYes.
.
.
there would have been great difficulty.
You'd have been stuck to the spot.
In that sense, absolutely.
Right.
I would have to concentrate very hard indeed to get this hand moving.
Right.
And now, what can you do now that you couldn't do before? My facial muscles would not react Yes.
.
.
to emotion.
Right.
So that I was rather like a statue - not being able to express emotion.
That again was a release once the operation had been carried out.
I could then go into a situation and emote.
And that matters to me.
You have a very expressive face now.
You look very cheerful.
You radiate amusement and warmth and things like that.
Because it's the old me! Do you mind if we have a look at the operation scar?Of course.
So, where is it? It's obviously on the top of the head.
I'm wired for sound! Is this the wire here that leads on? Can you show me where it is?Yes.
There's the stimulator - which is in the pocket behind my collarbone.
That can be adjusted if necessary.
This is the equivalent of a pacemaker in a heart.
Is that right?Absolutely.
It's sending an electrical signal via the wire up here?Yes.
And then it goes where? Over the top.
Right.
The implant is there.
Is that right? Do you mind if I touch?Not at all.
You actually have two, don't you? Yes, both sides of the brain.
Horns that have been removed! Do you think about what it's doing to your brain? No.
I'm pleased with what it's doing to my brain because it's released me from the padded cell and I know the operation is not a cure by any means, but it has slowed down the progression of the disease.
With the drugs being a lot less than they were, I'm a free agent again.
You're a very free and lively agent! Thank you.
I really enjoyed meeting Stuart.
He is a fantastic man.
But he also changed my mind about deep brain stimulation.
Bbecause of its sort of dark and horrible history, I went in really quite sceptical, but now I can see its potential.
I can see where it will go.
I think it's actually an incredibly exciting area of neurosurgery.
Andrew McEvoy has now been operating on Kathryn's brain for three hours.
He's nearly ready to remove the vascular tumour which is causing her epilepsy.
So Andrew, how's it going? Everything's going very well.
I've gone all the way around where I think the abnormality is and I'm very close to just amputating that now.
Microscissors, please.
There we go.
OK.
Specimen.
That's it?Yes.
This is the main area of abnormality.
That's the cavernoma that was sitting in the brain.
That was causing all her problems? This was causing all her problems.
But they're not finished yet.
The risk when operating on the brain is always that patients may not emerge from surgery with all their functions intact.
So Kathryn has to be tested.
What we're gonna doCan I see you first, before we close up? Let's see you do some movements for me.
Can you bend your left leg for me? Bend it up? Perfect.
And lift your left arm up for me? Spread your fingers? Yes, I think so.
Your face is all right? You can move it?Yes.
Perfect.
Over the last 100 years of cutting, drilling and probing, surgeons have learnt a tremendous amount about how the human brain works, but that knowledge has been gathered at an appalling human cost.
And that raises the question - to what extent does the end justify the means? Operations like Kathryn's would certainly be unimaginable without the work of the early pioneers.
And in every branch of surgery, the dilemma of progress versus risk would have to be faced again and again.
Next time, I delve into the heart - from the daring but deadly early operations to modern cardiac surgery.
Surgery at the extreme.
Sophie has no heartbeat.
She has virtually no blood in her body and she is now as cold as a corpse.
I'll discover what the pioneers were up against.
I had to have police escorts totake my children to school.
And I'm going to repeat some classic experiments on myself.
HE SHOUTS
Chances are at some point in your life, you're gonna need it.
And when you do, thank your lucky stars you live now and not 150 years ago.
My name is Michael Mosley.
Ever since I was a young medical student attending my very first operation, I have loved surgery.
I am in awe of the skill and nerve required to operate on a living, breathing human being.
GROANS OF PAIN Surgery tests medical knowledge under the most extreme circumstances.
PAINED SHRIEKS But that knowledge has been paid for in human lives.
This series reveals surgery's evolution from butchery to brilliance.
It's a tale of courage and missed opportunity, pathos and bloodshed.
I want to start with the surgical assault on that most extraordinary of all our organs - the human brain.
Operating on the brain promised to cure not just the body, but the mind.
Good Lord! It created challenges which were taken up by some peculiarly obsessive, driven individuals.
The operation I witnessed was diabolical.
'I've had parts of my own brain interfered with.
'And uncovered something that has never been seen before.
' Inside my head I have a black hole.
And I've discovered how, after many false starts, the pioneers began a programme of research that is only now beginning to pay off in truly remarkable ways.
HIGH-PITCHED BUZZING Right, you're now removing the bone.
Yes.
And that's the covering of the brain.
How extraordinary.
How are you doing, Kathryn? I'm not too bad.
How are you? We're doing very well up here.
Good.
Hello!Hello! Is there a part of the brain you can remove that football bit from? Not in boys! Kathryn's sort of chatting away happily and yet he's just probing away at the brain.
It really is quite extraordinary.
They get paid far too much money to kick a ball about.
'Kathryn has to be awake so that her surgeon, Andrew McEvoy, 'can monitor her responses as he operates.
' I like watching horseracing.
Do you ever go to the ballet? 'This operation, at the National Hospital for Neurology 'and Neurosurgery in London, is at the forefront of what is technically possible.
' What exactly is her problem? She has two problems.
The first is that she has focal epilepsy.
The second is that she has a cavernoma that could bleed in the future and cause a brain haemorrhage.
We're just trying to stop the bleeding.
Thank you.
'28 year-old Kathryn Proctor, a florist, has been having epileptic fits 'because of a cavernoma - an abnormal cluster of blood vessels in her brain.
'Epilepsy has forced Kathryn to give up work.
'If Andrew McEvoy can remove the abnormal area, she should be cured.
' You'll see lots of little arteries that we have to take as we get.
You're now revealing what I actually recognize as a brain.
Exactly.
They've just gone through and revealed the brain.
It's really, really extraordinary to see it.
You're doing just fine! When you see the care and precision and knowledge and all the instruments around here, it makes you wonder about the sheer nerve that 19th century surgeons must have had to open up the black box and probe inside.
'The truth is that few did.
'120 years ago, the brain was considered by most 'to be too complex and risky to operate on.
'But an obsessive young American was about to change that.
' Take some big deep breaths in and out through your mouth.
In through your nose, out through your mouth 'I've come to Yale University in the United States to find out more about the man 'who almost single-handedly created what we now call neurosurgery.
'His name was Harvey Cushing and he was so focused on his work 'that he refused to cancel an operation even when told that his son had died in a car accident.
' Wow! Is this where Yale keeps its treasures then? Well, you know, this appeared to be the safest place.
'Professor Dennis Spencer is a leading neurosurgeon and guardian of Cushing's archive at Yale.
' It's a bit like coming down into Tutankhamen's grave - apart from all the pipes.
Oh, more special than that.
More special than that.
This is really the legacy of Cushing.
Right.
So, it's cardboard boxes largely, by the looks of things.
I don't No, not quite like that.
Good Lord! Wow.
How many?Must be 1,000 jars collected over 30 years of his career.
How extraordinary.
All his patients.
Patients who willed their brains to him when they died.
'Cushing preserved more than a thousand brains - 'all of them from his own patients.
' I've never ever seen anything like this before in my life.
It's an extraordinary collection - probably unduplicated anyplace.
'Cushing started his collection in 1902, shortly after he began to operate on brains.
' So, what was the state of neurosurgery at the time? Surgery on the brain was just completely in the Dark Ages.
There were general surgeons who sometimes had the audacity to try to open the head to relieve pressure or to take out an obvious mass.
And they generally failed.
Mortality was 60%, 70%.
Cushing saw this as his stake - his way to go forward.
He wasn't put off by the fact that everybody else had failed? He was not.
He loved it! This is what he wanted to do.
The head is where the revolution is going to happen, and that's what I wanna do Rightand I'm gonna do that.
'Harvey Cushing's desire to master brain surgery was all-consuming.
' What did he have to sacrifice to make him successful, if you like? He sacrificed his family.
He sacrificed the kind of intimacy that we think should be normal in a large family.
Five children.
He couldn't really return that kind of love.
He was quite cold, wasn't he? He just had to concentrate on his discipline.
He was much more devoted in fact to his patients than he was to his family.
Now this is presumably a negative.
It is.
What's wrong with this guy? This man has acromegaly, which is an overproduction of growth hormone from the pituitary, and one of the first kinds of tumours that Cushing was able to diagnose.
I gather that somebody said that the pituitary gland was the only thing that he ever loved.
It could have been! I've got more over here I can see.
Let's have a look at these.
This must be growth hormone again.
Yes.
This demonstrates the connection that Cushing spent so much of his time at the hospital with his patients and with his discipline to the detriment of his relationship with his family.
'One of the main obstacles confronting Cushing and his peers was the extraordinarily high risk 'that the patients would bleed to death on the operating table.
'The brain has over 600 kilometres of blood vessels 'and uses nearly a litre of blood every minute.
' The scalp and the brain and the bone are all extremely bloody.
So just getting in usually exsanguinated the patient - they would bleed to death opening the skin, opening the skull.
Where others looked for grand solutions or gave up, Cushing focused methodically, pedantically, patiently, on a series of minute adaptations.
He devised small clips made from household wire which he used to stem blood flow in tiny arteries and veins.
He adapted a pneumatic cuff, normally used to measure blood pressure to make a tourniquet that could reduce blood flow to the scalp.
Here he is using huge arrays of artery clamps to stop bleeding.
He was an absolute tyrant in the operating theatre, demanding from his staff the same high standards he expected from himself.
He was changing a field.
This is a big change moment because basically nobody knows what they are doing.
He was revolutionizing a field.
He was making brain surgery possible.
Wow! Thank you very much.
You've been absolutely fantastic.
I'm glad.
I've enjoyed showing you our collection.
It is an extraordinary one.
What a man.
What an extraordinary man.
Harvey Cushing's systematic approach cut operating deaths from 70% to 10%.
His work gave other surgeons the confidence to try and "open the box".
But though they could now open the skull and remove obvious tumours, much of the time they really didn't know what they were looking at, let alone what they were doing.
The precise workings of the brain were still a mystery.
This is some brain, some pig brain, fresh from the abattoir.
'It is surprisingly similar to human brain, 'and illustrates just what these early surgeons were up against.
' This is only a section of it, but it's very small.
It is incredibly gelatinous - it feels like, sort of, cold tapioca pudding.
It's very soft.
You feel like you could just crush it in your hand.
It's surprisingly tender.
Just looking at it, you'd never know which parts did what.
And that was a problem for surgeons.
When they were operating - trying to remove a tumour or perhaps a foreign body, they might inadvertently remove a vital part of the brain that left the patients incapacitated, paralysed and often dead.
Like any explorer, what surgeons really needed was a decent map.
Down the years, many people have contributed to the mapping of the brain.
For me, one man in particular stands out.
His story begins 160 years ago, on the East Coast of America, with what I think is one of the strangest and most curious incidents in the whole history of surgery.
It's 1848 and 25 year-old Phineas Gage is a foreman working on the construction of the railways.
He's described as smart, energetic and iron willed.
An unfortunate description in the light of what is about to happen to him.
Little does he know he is about to become medical history.
On September 13th, 1848, Phineas and his gang are preparing the way for some new tracks.
That day they are laying explosives.
So Phineas is carrying a tamping iron.
He uses this to compact the gunpowder.
Now, what is supposed to happen is they pour the gunpowder in and then they put sand on top to reduce the risk of sparks.
Unfortunately, it appears on that particular afternoon, someone forgot to put the sand in.
So, what happens is when Phineas goes to compact the gunpowder.
He does one final strike ignites a spark and the tamping iron goes right through his cheek, out through the top of his head and flew 25 metres covered in gore down the track.
But this is the really astonishing thing - Gage survives.
He not only survives, but within a few months, he's back on his feet and appears to be completely normal, except for one big thing.
Astonishingly, he was able to walk and talk, but he underwent a radical personality change.
This perhaps gives you some indication of what happened to poor Phineas.
The spike went through his cheek and out through the top of his head, taking away the frontal lobe.
Beforehand he was regarded as sober, industrious.
Afterwards he was much more impulsive - rude, vulgar.
As his friends said, "Gage was no longer Gage".
The extent of Phineas's injury can be seen in this cast made while he was still alive.
What's significant about the injury is that while it affected his personality, it didn't stop him walking and talking.
Phineas Gage was dramatic proof of an idea called localisation - the brain is not some homogeneous pudding, but is made up of different parts doing different things.
Understanding localisation, the map of the brain, is essential for safe surgery.
The brain is so complex that researchers are still filling in details.
Today I am going to do my bit to help.
I'm feeling a bit nervous, even a little anxious, because today I'm going to take part in a rather strange experiment inside this building.
There they are going to interfere with my brain in ways I'm not entirely sure I'm going to enjoy.
Hello there!Michael.
Welcome! Come on through.
'Dr Joe Devlin from University College London is using electromagnets to map the brain.
' It should be fun! On my head, presumably.
Yes.
It's a good thing I can't see myself in the mirror as I suspect this is not my finest moment.
So this is the TMS device.
'Joe is going to use transcranial magnetic stimulation, or TMS, 'to interfere with my motor cortex - the bit that governs fine movements.
' .
.
so that we can stimulate the motor cortex.
It's strange, the idea that you are about to interfere with my brain.
There's a screening form to just make sure that it would be safe to proceed with the TMS.
"Have you suffered from epilepsy, convulsions? No.
" 'The powerful magnetic field will temporarily scramble my brain cells.
'If they hadn't done it on themselves many times, I'm not sure I'd be volunteering.
' I hope to see another Christmas! You bet.
Tip of the nose.
Bridge of the nose.
So now we can test 'Joe is calibrating his machine to images of my brain.
'This will allow him to pinpoint the area responsible for hand movements 'and then he'll put me through some tests.
' That's very cool.
I have to say that is very, very cool.
I Iike that.
So I write "writing is easy".
Ready?Yeah.
I just go on writing.
GodGod that is weird! So the fine motor control that's really critical in writing Is completely impossible when you do that!Completely impossible.
It's very odd when you lose voluntary control like that.
You have another test for me.
I face this with some trepidation, now.
This is normally quite an easy action.
I just go there Aah! Yep.
Terrific.
How difficult can it be?You ready? Yeah, I'm ready.
CLICKING Right.
I think the answer is quite difficult, isn't it? Bring on the next test.
So, if you want to go ahead and start doing some finger touching.
OK.
I can touch my nose.
I can keep this up for hours.
Excellent.
Yep.
So, I just keep going.
CLICKING It's pretty dramatic, yes? Quite dramatic, yes.
I was in serious danger of poking my eye out for a moment.
I thought I hadyes Very, very odd.
Do you want to do it again?Sure.
I find it very hard to believe.
This time.
This time.
Man against machine.
'TMS works by interrupting the signals going from my brain to my hand.
'It only works if it's applied precisely to the area of the motor cortex that controls hand movement.
'A centimetre left or right, and there'd be no effect.
' Blimey.
'The intense magnetic field swamps neural pathways in the motor cortex, 'making me lose control.
'It's almost like a stroke - only this is temporary.
' There you go.
That was complete lack of control.
Very strange.
I can write.
Writing is jolly easy.
Exactly.
It's back.
Wow! That was strange.
It demonstrates very clearly that you control a very small part of the brain and the rest of me is absolutely fine.
And the effect stops as soon as the magnetic field stops.
Absolutely.
So this is localization in action.
Precisely.
The information that Joe and his colleagues collect is creating an ever more detailed map of the brain and that map is of crucial importance to surgeons and patients in the operating theatre.
We're happy with that.
Now we need to find the areas where we think the lesion is.
Andrew McEvoy needs to establish exactly where he is in Kathryn's brain before he removes the vascular tumour.
There's a little brown discolouration between this rather unusual loop there.
And that's probably the cause of her epilepsy? Almost certainly the cause of her epilepsy.
What we have to do now is make sure that area I want to remove isn't performing some vital function for her so we'll stimulate all around it to make sure it isn't moving her leg or her hand or her face and make sure it is safe to remove.
Want a bit more to drink? Yeah, please.
Now, Kathryn, what you're going to get here now is every now and then you're gonna hear a little buzz.
'The danger with operating on the brain is that it's easy to cause collateral damage, 'which could leave an arm or leg permanently paralysed.
' OK, yeah.
Just hear a little buzz every now and then.
BUZZING Anything at all? No.
Same again.
BUZZING No.
Same again.
BUZZING Oh! Yes.
That's the one where I get the pins and needles.
Andrew is stimulating Kathryn's brain with an electrode to identify precisely the areas that control sensation and motor skills.
OK, fine, let's go up to 1.
5, please.
Same again, Kathryn.
BUZZING No.
BUZZING No.
BUZZING Yes.
What did you get then, Kathryn? Is this good?Yes, this is great.
Let's just see what this does, OK? BUZZING That was my face.
Right.
Kathryn, just for one second OK, Kathryn No, no, sweetheart I know it feels really strange.
Just upsets me when it's my face.
It's good we've found it because we know to leave that bit there.
I know it's horrible for you.
You're doing fantastically.
We don't need to do any more.
So what we've got here, this area here all moved the hand and arm.
This area here moved the foot, this area here moved the leg, and then as I came up behind the lesion, we had a little bit here that caused contractions in the face and then there was, directly behind the lesion, was an area that was causing eye deviation and interestingly she reports that's exactly how her seizures start.
Solet's go.
'Now that he has identified the area he can safely remove, 'Andrew is ready to cut out the vascular tumour.
' Nice tracing coming from the brain there.
'He's about to cut out parts of Kathryn's brain because he believes by doing so 'he will cure her problem and give her a better life.
'80 years ago, the same laudable intentions led surgeons down a dark and far more sinister path.
' Microscissors, please.
I've come here to California on the trail of one of the most infamous doctors of the 20th century - Dr Walter Freeman, the lobotomist.
Walter Freeman began practising as a doctor in the 1920s, going on to work in one of the vast institutions set up to house growing numbers of mentally ill people.
The shell-shocked victims of the First World War and inmates with dreadful psychiatric problems lived out their lives in what were known as "snakepits".
Psychiatric hospitals in the 1930s were terrible places to be as a patient.
And they were terrible places because they were places of hopelessness.
There were no effective treatments for most mental disorders.
For the most part, these hospitals warehoused patients for long periods of time, decades, even entire lives.
Freeman was horrified at the sheer waste of human potential.
Well, he started out with good intentions.
Here was a terribly serious problem and it wasn't getting any better, it was getting worse.
It was a public health problem.
Freeman was convinced that the root cause of many of the patients' problems lay in the physical structure of their brains.
So he decided to change them.
Appalled by what he was seeing in these "snakepits", Freeman now spent increasing amounts of time in the laboratory, cutting up brains, dissecting brains, examining brains, looking for differences.
This is the brain received through the courtesy of Washington Sanitarium.
Freeman thought that surgery could help patients far more than their current treatments.
.
.
cut off at the level of the middle of Spurred on by the growing understanding of what different regions of the brain do, he finally decided that the problem lay in a set of connections between the thalamus and the frontal lobe.
The pointer demonstrates the thalamus and the anterior thalamic radiation going to all parts of the frontal lobe.
Freeman believed if he could sever the connections between the thalamus and the frontal lobe, then this would dampen down all those awful emotions and it would, if you like, cure the patients.
He saw this as "surgery of the soul", a way of bringing the damned back to life.
But there was a problem.
Freeman was not himself a surgeon.
so he got together with a man who was - James Watts.
And together they started performing the operation they called "lobotomy".
A lobotomy involved opening the side of the skull at both sides and entering the brain using a tool called a leucotome.
It looked like a butter knife.
And Freeman and Watts would insert this tool into the brain through the side holes and attempt to cut some of the neural pathways connecting the frontal lobes of the brain to the thalamus.
Freeman and Watts reported about one third of their patients were improved by lobotomy, about one third were not affectedmuch and that the remaining third were worse off after their operations.
Freeman and Watts considered this to be a great success.
But the operation was so time consuming, they knew it could never make a significant impact on the vast numbers in the asylums.
So how was he going to get to all those people? He needed to find a way to make it simpler and much, much faster.
This is a camper van of the type that Walter Freeman used to take his kids on holiday in.
And inside this van is the answer to Walter Freeman's problem.
His solution, if you like, to all human ills.
Inside this camper van is Walter Freeman's contribution to the history of surgery.
The instrument that Walter Freeman chose for his new improved lobotomy was this - an ice pick.
The sort of thing you'd have found in every 1940s home.
It was absolutely perfect for what he needed it for.
It was hard.
It was tough.
It did the job.
So what Freeman did is he would anaesthetise the patient using ECT ELECTRIC SURGE .
.
then he would get his ice pick and a hammer and he would go into the brain through here.
I think I will try this on a skull rather than myself.
Here it is Watch closely.
He's going in here, he pushes the eyeball out of the way and he works his way back to a thin bit of bone right at the back.
And then what you do is you bop it, bop it through the skull Yeah, going through! Go in about 5cm and then you just squiggle it around.
He was much more adept than I was cos he would use two at the same time.
And then out it comes.
And according to Freeman, the only postoperative care the patient needed was a pair of dark glasses! Transorbital lobotomy was so simple, it could be done by anyone, anywhere, and in under ten minutes.
Freeman was so thrilled by his discovery, he got into his camper van and he drove off, crisscrossing the States 11 times in one year to show the doctors just what they could do.
Often Freeman would do as many as 25 transorbital lobotomies in a single day, one right after the other.
Freeman had some great exhibitionist tendencies - he would perform lobotomies left-handed even though he was right-handed.
He would sometimes perform them using a carpenter's mallet.
The operation I witnessed was shocking.
It was quick, it was easy, and it was diabolical! He lined up two women.
Then a quick My father went over and tickled the first one in the ribs.
She said, "Stop that!" He went over and tickled the ribs of the other one.
Uh-uh! She was paralysed on the left side.
Walter Freeman performed thousands of lobotomies.
His technique spread so widely that it's estimated that more than 100,000 people were lobotomisedwith mixed results.
They had their failures.
But there again, a remarkable number of those patients returned to their families and had some kind of a life.
Now it's certainly true that some of the patients became more docile and easier to handle.
But many of the others were so badly damaged, they could never take their place in the world.
And of course, some died.
This young man is one of lobotomy's success stories.
Cases like this encouraged Freeman to extend his practice.
He moved from using lobotomies as a last resort to using them on people who by anyone's standards were perfectly normal.
Howard Dully is a 59-year-old bus driver from San Jose, California.
He is also one of hundreds still alive who were lobotomized.
What makes Howard particularly unusual is the fact he was operated on by Walter Freeman when he was only 12 years old.
You always feel like a freak, a Frankenstein, different.
You don't ever totally get over it.
You suppress a whole lot of it, keep it inside.
Hi there! Howard, I would guess? Hi, I'm Howard Dully.
Hello, I'm Michael Mosley.
Glad to meet you.
And you.
So this is your childhood neighborhood, is it? Yes, it is.
Which way's the house? House is over in here.
What were you like as a child? Well, I wasn't an angel.
I was very rambunctious.
I liked to roam the streets a lot.
I liked to be alone.
I found out if I was alone, I didn't get in trouble, cos no-one was there to get me in trouble.
And I just wanted to be left alone, pretty much, you know.
Howard's mother died when he was just five years old.
His father married again, but Howard and his new stepmother Lou had a very difficult relationship.
I felt that she was trying to take the place of my mother, and I resented that, so How did she respond? She would punish me or do things to me that would aggravate me so it would just snowball.
She would do something to me and I would do something back and pretty soon it just got out of hand.
Their relationship got worse and worse, to the extent that Lou took Howard to see Dr Freeman.
It was just before his 12th birthday.
Do you think she had any appreciation of what a lobotomy would do? I don't know that she cared.
I think she just wanted a solution to me.
And whatever that solution brought, she was willing to accept.
This picture shows Howard undergoing his lobotomy.
I wasn't changed that much.
I still had my faculties and things.
She thought she was gonna get more of a docile, robotic type kid that she could control.
If the lobotomy was supposed to pacify Howard, it failed.
He became increasingly disruptive.
Unable to manage him, his parents sent him away from homeforever.
I had gone to several people's homes and then made a ward of the court and juvenile hall and since I didn't commit a crime, they sent me to Agnews at age 13, 14 years old.
And I was put in with adult mentally ill patients.
I was just a kid that had no place to go.
That's what they kept telling me.
"We have no place to send you.
" Then I went back to juvenile hall, back on the streets, got in trouble cos I didn't have any skills or know how to live.
And I went back to Agnews till I was 20.
It was either that or prison.
Do you think Walter Freeman stole something from you? I think he took my childhood.
I think he took my childhood and some of my adulthood.
Because I'm probably about 20 years or better behind the average person.
What I'd really like to do is I'd like to take you along to an MRI machine where we can have a look inside your brain, because I think you're an extraordinary individual, and I'd be very, very interested and I hope you arein what the MRI machine might reveal.
Well, thank you.
Comfy?Yeah.
'I am about to see the effects of lobotomy on a living brain.
' Now that We'll go with that.
'Imaging expert Dr Bob Dougherty has come to interpret the scan.
' Bob, have you actually scanned somebody who has had a lobotomy before? No, no, it hasn't been done with MRI.
Hasn't been doneat all.
So this is a first.
Be very interesting to see what the results are.
Of the 100,000 people who were lobotomized, Howard is the first to have a high resolution MRI scan and I feel privileged to be here.
I've seen into parts of you that no-one else has ever seen into.
I'll bet you have! Right, take a seat over here.
Take a seat.
So we have had a good look at your brain.
Oh, there I are! It is absolutely fascinating.
This is the front of his head, this is his eyebrow, his eye, his nose would be over here, the back of his head.
The knife should have gone in above the eye, and then you can see this black region, that's not normal.
That's abnormal, is it? That's abnormal.
So inside my head, I have a black hole.
There you go.
I got TWO of them! 'These huge black cavities were created by Dr Freeman's instruments.
' And on both sides.
Both sides.
What would that area normally be doing? So the frontal lobes are important for long-term planning - inhibition of a response.
One of the most obvious things that people who have damage in this part of the brain is they become very impulsive unable to control their impulses.
That's the paradox.
They put you through all that and they got the exact opposite of what they were hoping to achieve.
It would have made you worse, would have made you much more likely to misbehave.
Is that right? I would agree.
If you did this to an adult, I would expect them to be permanently impaired and not be able to control their impulses.
Ironically, it was probably Howard's youth that in the end prevented him from going completely off the rails.
His young brain was able to rebuild pathways responsible for impulse control and which govern reasonable behaviour.
A good thing about a young brain is that it is very adaptable.
You were young enough when it happened and perhaps some of the surrounding connections took over and helped compensate.
This is more than my mind wants to take in all in one time.
Takes a while to absorb, doesn't it? It does.
It does.
I have to say, I find it absolutely astonishing.
I looked at a number of scans but the only time I've seen anybody with anything like that, they have had a severe stroke and they were really incapacitated.
But you are just so completely normalwith a slightly exaggerated sense of humour! It's what kept me through it! But I am absolutely amazed that you are walking and talking and you are as fabulous as you are, granted the fact there is a hole that size in your brain.
It is really amazing - I mean, you are amazing.
Thank you.
It's been really fascinating.
It's been a real pleasuremeeting you.
Thank you.
'The tragedy is that when Howard was operated on in 1960, 'safer and more effective psychiatric treatments were widely available.
'Nonetheless, Freeman went on performing lobotomies for many more years, 'only stopping when he was 72.
' Freeman died not long after he did his last operation.
But the idea of using surgery to control behaviour was now so seductive that far from dying with him, it gained momentum.
During the Cold War, mind control became an active area of research.
Brainwashing proved to be a blunt tool, but brain surgery offered a more focused result.
In the mid-1960s, a procedure developed by Dr Jose Delgado took psychosurgery to a whole new level.
I was continually thinking about the brain, about the possibility to do research, about the possibility to go inside in the depth of the brain.
Rather than cutting things out of the brain as Walter Freeman had done, Delgado decided the best thing to do was to insert something into the brain.
At Yale, Delgado became fascinated by the idea that electrodes implanted in animals' brains could control aggressive behaviour.
In the summer of 1964, to perform a truly audacious stunt, he chose not a rat, nor a mouse, but a bull.
The owner says, "Well! You can do that with cats and monkeys.
"You can't do that with bulls, can you?" "I dunno.
Let's try.
" "Will you allow me to place electrodes in one of your brave bulls?" "Sure.
No problem! "But you will not be able to pacify him!" "I dunno.
Maybe not.
Let's try.
" Dr Delgado really did intend to stop an animal specially bred to be aggressive in its tracks.
This footage shows Dr Delgado in action.
We anaesthetized the animal.
We implanted electrodes in the head.
Next day the bull was normal and the bull was going around charging against anybody in the bull ringcompletely normal.
Then I thought, "I know a little about bullfighting.
I am going to test this by myself.
" Delgado leapt into the ring with an extremely dangerous animal, armed with nothing but a remote control.
He was betting his life that this would work.
The animal was few feet away.
I pushed a button in the radio stimulator and the animal really stopped completely.
It was frightening, but it was an experiment.
So, when the experiment was over, the bull was in very good health and I was in very good health also! So, no problem! Jose Delgado was jubilant and saw the success of his experiment as just the beginning.
That took us to another big step - if electrodes implanted in animals are possible, can we implant electrodes in the human brain? To many people, this vision of brain manipulation was not thrilling - it was downright terrifying.
It presented a nightmarish future where anyone who threatened the state could be controlled.
Far-fetched? In 1970, researchers from Harvard Medical School suggested using psychosurgery on black rioters, while others suggested putting implants into gay men to turn them straight.
Ethical approval proved impossible.
Funding for brain implant research fizzled out.
But the story of implants wasn't over.
Some of the things they talked about doing were horrific and yet it did in time lead to what is now one of the most brilliant and innovative branches of surgery there is - deep brain stimulation.
With your thumb and index finger, can you do nice big movements? This is Stuart Carter off medication.
Stuart Carter is 68 and has Parkinson's disease - a degenerative condition affecting movement.
In 2006, he went to the National Hospital for Neurology and Neurosurgery in London to be assessed for surgery.
OK, that's lovely, and back.
After ten years on medication, the effectiveness of the drugs was wearing off and Stuart was finding it increasingly difficult to move.
My balance is gone.
So standing upstanding erect is certainly quite a trouble.
It's as though you're a statue on a plinth and you can see the world going on around you - you're fixed.
Well, the facial muscles go into a locked position, effectively.
So I am looking out through a mask.
Stuart was offered the chance to have electrodes implanted in his brain to block the electrical signals which cause the symptoms of Parkinson's.
Good morning.
Good morning.
How are you? I hope you're better than I am.
Don't be so sure! Mr Marwan Hariz performed this groundbreaking surgery.
In conventional neurosurgery, you open and you see what you are doing.
You see the tumour, you see the aneurysm, the bleeding - you see what you do.
Here we don't see.
We are aiming at a target, an area in the brain that is very deep, in the basal ganglia - the base of the brain.
We are navigating in the dark.
Because Parkinson's disease lies so deep within the brain, inaccessible to the surgeon's knife, a new technique was developed to place the implants into the deepest parts of the brain.
No pain, just noise.
Mr Hariz drilled two holes in Stuart's skull through which he could insert the implants.
Once in place, they were connected to a test stimulator.
We have to stimulate with a little current here.
You might feel something.
You might feel nothing.
Whatever you feel, you tell us.
OK.
Feeling OK?Yes.
No special sensation?Tingling in my foot.
Which foot?Left.
OK.
Very good.
The twitching in Stuart's foot meant the implants were in the correct part of the brain.
Try as much as you can.
Try and open your two fingers.
There was a marked improvement.
Stuart could move more easily, but Mr Hariz had to make sure the electrodes had not affected his speech or concentration.
Very good.
OK.
Can you say after me, "This is the night train "crossing the border, bringing the cheques and the postal order"? "This is the night train crossing the border, bringing the cheques and the postal order.
" OK, good.
The electrodes were later connected to a battery stimulator inserted in Stuart's chest.
Hello, sweetheart.
Hello.
Well done.
Congratulations on getting through it.
Well done.
Well done.
It's now two years since Stuart's operation and I've come to see how he's getting on.
Good morning!Good morning.
I'm Stuart.
How are you? I'm well, thank you! Can we? Can you show me what would have happened before? Before they switched the stimulation on? What actually happens? In my case, it was a question of freezingOK.
.
.
rather than the traditional Parkinson's shakes.
Yes.
You would do what?Can you show me? Well, yes.
In those times I might come down to hereYes.
and I'd put my hand down there Yes.
.
.
but if you said to pick the hand upYes.
.
.
there would have been great difficulty.
You'd have been stuck to the spot.
In that sense, absolutely.
Right.
I would have to concentrate very hard indeed to get this hand moving.
Right.
And now, what can you do now that you couldn't do before? My facial muscles would not react Yes.
.
.
to emotion.
Right.
So that I was rather like a statue - not being able to express emotion.
That again was a release once the operation had been carried out.
I could then go into a situation and emote.
And that matters to me.
You have a very expressive face now.
You look very cheerful.
You radiate amusement and warmth and things like that.
Because it's the old me! Do you mind if we have a look at the operation scar?Of course.
So, where is it? It's obviously on the top of the head.
I'm wired for sound! Is this the wire here that leads on? Can you show me where it is?Yes.
There's the stimulator - which is in the pocket behind my collarbone.
That can be adjusted if necessary.
This is the equivalent of a pacemaker in a heart.
Is that right?Absolutely.
It's sending an electrical signal via the wire up here?Yes.
And then it goes where? Over the top.
Right.
The implant is there.
Is that right? Do you mind if I touch?Not at all.
You actually have two, don't you? Yes, both sides of the brain.
Horns that have been removed! Do you think about what it's doing to your brain? No.
I'm pleased with what it's doing to my brain because it's released me from the padded cell and I know the operation is not a cure by any means, but it has slowed down the progression of the disease.
With the drugs being a lot less than they were, I'm a free agent again.
You're a very free and lively agent! Thank you.
I really enjoyed meeting Stuart.
He is a fantastic man.
But he also changed my mind about deep brain stimulation.
Bbecause of its sort of dark and horrible history, I went in really quite sceptical, but now I can see its potential.
I can see where it will go.
I think it's actually an incredibly exciting area of neurosurgery.
Andrew McEvoy has now been operating on Kathryn's brain for three hours.
He's nearly ready to remove the vascular tumour which is causing her epilepsy.
So Andrew, how's it going? Everything's going very well.
I've gone all the way around where I think the abnormality is and I'm very close to just amputating that now.
Microscissors, please.
There we go.
OK.
Specimen.
That's it?Yes.
This is the main area of abnormality.
That's the cavernoma that was sitting in the brain.
That was causing all her problems? This was causing all her problems.
But they're not finished yet.
The risk when operating on the brain is always that patients may not emerge from surgery with all their functions intact.
So Kathryn has to be tested.
What we're gonna doCan I see you first, before we close up? Let's see you do some movements for me.
Can you bend your left leg for me? Bend it up? Perfect.
And lift your left arm up for me? Spread your fingers? Yes, I think so.
Your face is all right? You can move it?Yes.
Perfect.
Over the last 100 years of cutting, drilling and probing, surgeons have learnt a tremendous amount about how the human brain works, but that knowledge has been gathered at an appalling human cost.
And that raises the question - to what extent does the end justify the means? Operations like Kathryn's would certainly be unimaginable without the work of the early pioneers.
And in every branch of surgery, the dilemma of progress versus risk would have to be faced again and again.
Next time, I delve into the heart - from the daring but deadly early operations to modern cardiac surgery.
Surgery at the extreme.
Sophie has no heartbeat.
She has virtually no blood in her body and she is now as cold as a corpse.
I'll discover what the pioneers were up against.
I had to have police escorts totake my children to school.
And I'm going to repeat some classic experiments on myself.
HE SHOUTS