Medicine: Losing Nerves

Few things in medicine seemed as new and fashionable as nerve-cutting operations. All over the U.S., surgeons were cutting nerves in various parts of the body in the hope of relieving ulcers, hand sweating, high blood pressure, hiccups, drug addiction, schizophrenia. One hospital last week was booked solid for the next nine months with appointments for lobotomies (cutting nerves in the brain). There were similar waiting lists elsewhere, and many doctors were getting nervous about the whole subject. They asked: Has the nerve-cutting fad already gone too far; will people who are now getting their nerves cut some day wish they hadn’t?

Vagotomy, the most popular of all, is the vagus nerve operation for ulcers, developed by Chicago’s Dr. Lester R. Dragstedt (TIME, Aug. 26). Some 2,000 vagotomies have already been performed in the U.S.; Dr. Dragstedt is credited with 300. Properly done, the operation seems to be generally successful in stopping certain ulcers of the small intestine (Dr. Dragstedt does not recommend it for stomach ulcers).

The operation takes an expert. Unless all the nerve fibers are cut, it does not work. And surgeons have begun to argue fiercely about whether it is better to cut the nerves above or below the diaphragm. Another complication: cutting the vagus reduces the stomach’s ability to eliminate food, and further operations may be necessary to remedy that defect.

Alarmed by the problem of where vagotomy may eventually lead, two eminent authorities, Dr. Frank H. Lahey, head of Boston’s famed Lahey Clinic, and Dr. Russell S. Boles, of the University of Pennsylvania, last week proposed a five-year moratorium on vagotomies to see how the current cases turn out.

Lobotomy, a close second in popularity, is a tension-relieving brain operation (TIME, Dec. 23). More than 3,000 U.S. citizens have already had pre-frontal lobotomies, and the current rate is some 500 a year. The operation slices through a section of the frontal lobe, and is supposed to break up the disturbing mental patterns that have unbalanced the patient. In six out of ten cases lobotomy seems to be successful. But one patient in ten is relaxed too much by the operation; three in ten remain tense. Psychiatrists recommend the operation only for otherwise incurable psychotics. But at the chief U.S. lobotomy centers—George Washington University Hospital, Lahey Clinic, Boston Psychopathic—surgeons are being swamped by demands for lobotomy by alcoholics, criminals, frustrated businessmen, unhappy housewives and people who are just nervous.

Neurosurgeons find these candidates hard to discourage. Dr. Leo M. Davidoff, of Columbia’s College of Physicians and Surgeons, does very few lobotomies, warns patients sternly: “Although surgery is sometimes necessary, it is a barbaric form of therapy.” Says Dr. Winfred Overholser, chief of St. Elizabeth’s Hospital in Washington, D. C.: “The operation is very much overdone. It is even done on young people who have had no opportunity to try other forms of therapy. I look upon it as a mutilating operation. It puts out of commission the part of the brain that separates man from the higher anthropoids.”

Sympathectomy, cutting of the sympathetic nerves, is causing the most violent arguments of all. The operation is now prescribed for a wide variety of ailments, from excessive sweating to high blood pressure. Nobody knows how many thousands of sympathectomies surgeons perform each year; there are an estimated 1,000 in Manhattan alone. Admittedly the operation is a life-saver in many cases of gangrene, angina pectoris, hypertension. But some sympathectomies may make men sterile. And because a sympathectomy reduces pain, some doctors consider it insidiously dangerous, e.g., a patient could have a perforating ulcer without pain. The experts agree that sympathectomy, like the other nerve-cutting operations, is getting out of hand.