A Reminder To Drive Responsibly0

With its mission to reduce the impact of substance abuse and mental illness on communities around the nation, the Substance Abuse and Mental Health Services Administration (SAMHSA) is a public health agency within the Department of Health and Human Services. A new survey from SAMHSA provides some sobering statistics for everyone to consider this holiday season.

According to SAMHSA, in the past year an estimated 13.2% of individuals 16 or older drove under the influence of alcohol. Within this same group, 4.3% drove under the influence of illicit drugs. The survey highlights differences state-by-state, ranging from the highest levels of drunk driving (Wisconsin at 23.7%) and driving under the influence of illicit substances (Rode Island at 7.8%) with the lowest levels of drunk driving (Utah at 7.4%) and driving under the influence of illicit substances (Iowa at 2.9%). … Read more →

Lost Hospital Series — The Lobotomy0

Every year since 1901, the Nobel Prize has been awarded for achievements in physics, chemistry, physiology or medicine, literature, and for peace. For many, the prize represents the ultimate recognition one can receive in for a lifetime of work.

In 1949, a European doctor won the Nobel Prize for his research and work understanding the human brain.  Dr. Antonio Caetano Deabreau Freire Egas Moniz received the award for discovering the therapeutic value of leucotomy in certain psychoses, more commonly known as the pre-frontal lobotomy.

As early as 1890, German scientist Friederich Golz surgically removed the temporal lobe in dogs, noting that it resulted in a calmer, tamer canine.  In 1892, Swiss physician Gottlieb Burkhardt removed parts of the cortex in six schizophrenic patients, although his work was highly criticized by the medical community.  As a result, very few psychosurgeries were conducted over the next four decades.

In the 1930’s, medicine started to understand the relationship between the temporal and frontal cortex of the human brain in the control of certain emotions, such as aggression. In 1935, Yale University scientist Carlyle Jacobsen observed this connection in chimpanzees after surgically altering their frontal and prefrontal cortex through lobotomy.

Dr. Moniz, at the time professor at the University of Lisbon Medical School, started to perform similar operations to treat psychiatric patients with paranoia and obsessive-compulsive disorders.  Dr. Moniz surgically cut the nerve fibers that connect the frontal and prefrontal cortex to the thalamus (a deep part of the brain responsible for relaying sensory information to the cortex).

Working with a neurosurgeon, Dr. Moniz developed a surgical procedure called “Leukotomy” (white matter cutting). By burrowing several small holes into both sides of the brain, Dr. Moniz and his neurosurgeon could insert a special wire knife and sever accordingly.

Initially, Dr. Moniz’ work was not well received by the medical community, but later revitalized by American physician Walter Freeman. Using Dr. Moniz’ techniques in the United States in 1936, Dr. Freeman was convinced of the procedure’s success, and he lobbied to ensure this practice was embraced by the entire medical community.

Dr. Freeman and another physician ultimately perfected what was to be known as the “Freeman-Watts Standard Procedure, which included a very precise protocol for the insertion of the specialized knife (the “leukotome”) into the brain.

Dr. Freeman convinced the world that the prefrontal lobotomy should be used in mental institutions as a valid therapeutic procedure. Unhappy with the mess the procedure created, however, Dr. Freeman embraced the work of an Italian doctor who had developed a way to enter the frontal lobe through a surgical opening in the roof of the eye orbits.

This method — referred to as “ice-pick lobotomy” — required surgical trepanning by inserting an ice pick through the skin (using a hammer and a single “push” to tap the ice pick and perforate the skin, tissue, bone, and meninges). Although the patient was under local anesthesia, the procedure caused some witnesses, including neurosurgeons and psychiatrists, to faint.

This did not stop the success of lobotomies in the U.S. and around the world. Between 1939 and 1951, more than 18,000 lobotomies were performed in the U.S. and tens of thousands more worldwide. Unfortunately, the procedure was commonly abused as an ordinary means to control behavior and not as a last-resort measure. The identified victims from this surgical procedure included prison inmates, problematic family members, and political opponents.

By 1950, critics of the lobotomy started to gain ground. Scientific evidence in support of the procedure’s success was lacking (about one third of the patients improved, one-third stayed the same, and one-third deteriorated). Given the irreversible damage patients had after the procedure, the medical community needed another option. The eventual use of new antipsychotic and anti-depression medication in the 1950’s provided this alternative, and the use of lobotomies started to decline.

The lobotomy in its original form is now rare, although psychosurgery is still performed in many countries as a last resort to control violent behavior. Indeed, even the Soviet Union outlawed the lobotomy in 1940 (based upon ideological and not humanitarian reasons because it turned “an insane person into an idiot.”). By the 1970s, many U.S. states, as well as numerous other countries, had banned the procedure.

1977 the U.S. Congress created the National Committee for the Protection of Human Subjects of Biomedical and Behavioral Research to investigate certain allegations that psychosurgery procedures (including the lobotomy) were used in violation of basic human rights. The committee ultimately concluded that in some rare instances (and if properly performed), psychosurgery could have positive effects. Today, psychosurgeries are still practiced, but very rare.

Photographs from ScienceBlogs.comVanguardSculptureServices.com, and NEJM.

A Different Kind of Hospital Safety0

According to statistics from the Centers for Disease Control and Prevention, there are approximately 1.7 million injuries per year due to workplace assaults, representing 18% of all violent crime in the United States.

A recent article appearing in the Journal of the American Medical Association (JAMA) focuses on the 73 homicides that occurred in health care settings, as well as the 20 in hospitals. Comparing the 12 physicians and 15 nurses who were victims in a health care environment with the taxi drivers and cashiers, the study notes that the rate of assaults among health care professionals is 8 in 10,000, compared with 2 in 10,000 for the private sector in general. … Read more →

Have a Happy, Head-Injury Free, Holiday Season1

This holiday season experts warn of a somewhat unexpected threat that can disrupt holiday cheer at any time. Never underestimate the risk of head injury related to hanging, and then taking down, holiday decorations.

“Given that ladders contribute to nearly 20,000 head injuries a year, it is not surprising that there would be this documented head injury trend in December and January when people are using ladders to decorate their homes,” said Gail L. Rosseau, MD, from the American Association of Neurological Surgeons (AANS).

According to AANS, in 2009 an estimated 1.5 million people were treated in U.S. hospital emergency rooms for head injuries related to ordinary household items. … Read more →

New Transplant Procedure Never Misses a Beat0

Andrea Ybarra is part of a small, unique group who share one very special thing in common: they all received a “beating heart” transplant. Mostly done in Europe, this special procedure places the donor heart in a special box that keeps it warm and “alive” (i.e., beating) outside the human body. “I felt peaceful when I woke up. I wasn’t scared,” said the patient. “It felt like the heart was a part of me all the time.”

For over four decades, since 1967, heart transplant technology has been limited to organ recovery teams using ice coolers and airplanes to race between donor and recipient locations. These teams simply inject a chemical into the heart so it stops, and the ice preserves its integrity for about 4 to 6 hours at best. Indeed, the longer the process takes from start to finish, the greater the recipient’s changes of death or heart disease. … Read more →

Lost Hospital — Robert F. Kennedy Medical Center, Hawthorne, California4

Robert F. Kennedy Medical Center in Hawthorne, California was founded in 1926 as a maternity hospital. Dedicated to serving the community around it, the hospital proudly honored its mission statement:

(1) to deliver high quality, affordable health services with compassion the surrounding communities; (2) to provide direct care for the poor and disenfranchised; and (3) to partner with others in the community to improve the overall quality of life. … Read more →

Lost Hospital — The Massachusetts Hospital for Dipsomaniacs and Inebriates, Foxborough, Massachusetts0

The Massachusetts Hospital for Dipsomaniacs and Inebriates, located in Foxborough, Massachusetts, was founded in 1893. In its time, Foxborough Hospital was a pre-eminent institution for treating alcoholism, which by the end of the 1800s was perceived to be a growing problem in the United States.

Society’s method for dealing with alcoholism at the time was either jail or mental hospitals, but both were ineffective in keeping habitual alcoholics sober. Specialized “inebriate asylums” were designed to restrain the patient and eliminate any cravings for alcohol. … Read more →

Lost Hospital — Hissom Memorial Center, Sand Springs, Oklahoma0

As far back as 1909, Oklahoma first established services for individuals with mental disabilities (Oklahoma became a state in 1907).

Fifty years later, the Oklahoma legislature recognized the need to expand its mental health services, especially since the two existing facilities charged with the task were old and overcrowded.

In 1959, using land donated by Mr. and Mrs. Wiley Hissom, the construction of a new facility began near Sand Springs, Oklahoma. Built on 85 acres over a period of five years, and at an expense of $7 million, the Hissom Memorial Center opened on March 7, 1964. … Read more →

New York City Tests Home Organ Recovery Program0

New York City is testing a pilot program in an attempt to increase the number of organs available for human transplant. A special until in the City will now monitor 911 calls for people who may be dying (such as heart attack victims).

If the patients cannot be saved before transport to a hospital, this new city team will take over and try to save the kidneys. Most patients who die outside of a hospital environment are not candidates for organ recovery.

Organ recovery refers to the removal, preservation and use of human organs and tissue from the bodies of the recently deceased to be used in surgical transplants on the living. … Read more →