By BARRON H. LERNER, M.D.
Published: December 19, 2011
Most of us recall lobotomies as they were depicted in the movie “One Flew over the Cuckoo’s Nest”— horrifying operations inappropriately used to control mentally ill patients. But in the 1950s, surgeons also used them to treat severe pain from cancer and other diseases. Now a Yale researcher has uncovered surprising new evidence of a famous patient who apparently received a lobotomy for cancer pain during that time: Eva Perón, the first lady of Argentina, who was known as Evita. The story is an interesting, sad footnote in the history not only of lobotomy, but of pain control.The nature of Perón’s illness was initially shrouded in silence. Her doctors diagnosed advanced cervical cancer in August 1951, but as was common at the time, the patient was told only that she had a uterine problem. According to the biographers Nicholas Fraser and Marysa Navarro, secrecy was so paramount that an American specialist, Dr. George Pack, performed Perón’s cancer operation without her or the public ever knowing. He entered the operating suite after she was under anesthesia.
Despite surgery, radiation and chemotherapy, Perón gradually worsened, dying in late July 1952 at age 33. Only then was it revealed that she had died of cervical cancer, although details of her treatment, including Dr. Pack’s involvement, remained concealed.In a 1972 biography, Erminda Duarte, Perón’s sister, claimed she had suffered intense pain and distress.When used for psychiatric illness, lobotomy was once seen as a huge advance. Dr. Egas Moniz, a Portuguese neurologist who developed the procedure in the 1930s, was awardedthe Nobel Prize in Physiology or Medicine in 1949. Surgeons performed many types of lobotomies, but most involved severing nerves that ran from the frontal lobes to other parts of the brain to disrupt supposedly faulty connections that had developed inschizophrenia or depression.Lobotomies for mental illness fell out of favor in the 1960s because of the development of effective antipsychotic medications, misuse of the procedure and a growing unease among doctors with the confusion and stupor that resulted from the operation.But the earliest practitioners of lobotomy saw another potential benefit: relief from severe and resistant pain. Lobotomy, the New York neurosurgeon Dr. Sidney W. Gross wrote in 1953, was a “valuable and humane” procedure that reduced pain by blunting patients’ emotional reactions to it. Even advocates acknowledged it could make patients “childish, dull, apathetic, with little capacity for any emotional experiences.” They simply believed such a state was preferable to constant pain.In 2005, the Hungarian-born neurosurgeon Dr. George Udvarhelyi, who claimed to have assisted in Perón’s care in the 1950s and later moved to the Johns Hopkins School of Medicine, publicly discussed for the first time a lobotomy he said Perón received for intractable cancer pain a few months before her death. But it wasn’t until a Yale neurosurgeon, Dr. Daniel E. Nijensohn, himself an Argentine, began to research Dr. Udvarhelyi’s assertion that evidence began to accumulate.Dr. Nijensohn’s research, to be published soon in the journal World Neurosurgery and recently posted online, turned up several pieces of suggestive evidence. He confirmed details of Dr. Udvarhelyi’s story and found other contemporaries of Perón who had said she had had surgery for her pain.Dr. Nijensohn also unearthed information indicating that Dr. James L. Poppen, a neurosurgeon at the Lahey Clinic in Boston and an international expert on the use of lobotomy for intractable pain, had been summoned to operate on Perón in the summer of 1952. X-rays of Perón’s skull, Dr. Nijensohn found, showed indentations in the areas where lobotomies were usually performed.Dr. Nijensohn believes that a lobotomy was performed in May or June of 1952, meaning that Perón may have already had the procedure at the time of her last public appearance, riding in a limousine at her husband’s second inaugural.If Perón indeed had a lobotomy, was she aware of what the doctors — with the permission of her husband, President Juan Domingo Perón — planned to do? Perhaps not, given the efforts to conceal her fatal diagnosis in general.And could a lobotomy actually have helped ease Peron’s suffering? Dr. Nijensohn is not sure. But many patients who were lobotomized in those days reported relief.“After the operations,” Dr. Frank J. Otenasek, a neurosurgeon at Johns Hopkins, told The Baltimore Sun in 1947, “patients either said they were not suffering or that the pain did not bother them.”One of the ironies of Dr. Nijensohn’s story, if true, is that another method already existed for treating Perón’s pain: aggressive use of opiates like morphine. Doctors of the era, however, so feared that their cancer patients would become addicted to these drugs that they saw lobotomy as a suitable alternative.Today, our understanding of cancer pain has certainly changed. The liberal use of narcotics, accompanied by other medications to treat side effects, is seen as appropriate, not indicative of untoward behavior by patients.Indeed, one of the most successful innovations in pain treatment is a pump that allows cancer patients to give themselves enough medication to dull the pain but to remain alert. Medicine’s goal today is to enable patients to take active roles in their care rather than be acted upon.
Most of us recall lobotomies as they were depicted in the movie “One Flew over the Cuckoo’s Nest”— horrifying operations inappropriately used to control mentally ill patients. But in the 1950s, surgeons also used them to treat severe pain from cancer and other diseases.
Now a Yale researcher has uncovered surprising new evidence of a famous patient who apparently received a lobotomy for cancer pain during that time: Eva Perón, the first lady of Argentina, who was known as Evita. The story is an interesting, sad footnote in the history not only of lobotomy, but of pain control.
The nature of Perón’s illness was initially shrouded in silence. Her doctors diagnosed advanced cervical cancer in August 1951, but as was common at the time, the patient was told only that she had a uterine problem. According to the biographers Nicholas Fraser and Marysa Navarro, secrecy was so paramount that an American specialist, Dr. George Pack, performed Perón’s cancer operation without her or the public ever knowing. He entered the operating suite after she was under anesthesia.Despite surgery, radiation and chemotherapy, Perón gradually worsened, dying in late July 1952 at age 33. Only then was it revealed that she had died of cervical cancer, although details of her treatment, including Dr. Pack’s involvement, remained concealed.
In a 1972 biography, Erminda Duarte, Perón’s sister, claimed she had suffered intense pain and distress.
When used for psychiatric illness, lobotomy was once seen as a huge advance. Dr. Egas Moniz, a Portuguese neurologist who developed the procedure in the 1930s, was awardedthe Nobel Prize in Physiology or Medicine in 1949. Surgeons performed many types of lobotomies, but most involved severing nerves that ran from the frontal lobes to other parts of the brain to disrupt supposedly faulty connections that had developed inschizophrenia or depression.
Lobotomies for mental illness fell out of favor in the 1960s because of the development of effective antipsychotic medications, misuse of the procedure and a growing unease among doctors with the confusion and stupor that resulted from the operation.
But the earliest practitioners of lobotomy saw another potential benefit: relief from severe and resistant pain. Lobotomy, the New York neurosurgeon Dr. Sidney W. Gross wrote in 1953, was a “valuable and humane” procedure that reduced pain by blunting patients’ emotional reactions to it. Even advocates acknowledged it could make patients “childish, dull, apathetic, with little capacity for any emotional experiences.” They simply believed such a state was preferable to constant pain.
In 2005, the Hungarian-born neurosurgeon Dr. George Udvarhelyi, who claimed to have assisted in Perón’s care in the 1950s and later moved to the Johns Hopkins School of Medicine, publicly discussed for the first time a lobotomy he said Perón received for intractable cancer pain a few months before her death. But it wasn’t until a Yale neurosurgeon, Dr. Daniel E. Nijensohn, himself an Argentine, began to research Dr. Udvarhelyi’s assertion that evidence began to accumulate.
Dr. Nijensohn’s research, to be published soon in the journal World Neurosurgery and recently posted online, turned up several pieces of suggestive evidence. He confirmed details of Dr. Udvarhelyi’s story and found other contemporaries of Perón who had said she had had surgery for her pain.
Dr. Nijensohn also unearthed information indicating that Dr. James L. Poppen, a neurosurgeon at the Lahey Clinic in Boston and an international expert on the use of lobotomy for intractable pain, had been summoned to operate on Perón in the summer of 1952. X-rays of Perón’s skull, Dr. Nijensohn found, showed indentations in the areas where lobotomies were usually performed.
Dr. Nijensohn believes that a lobotomy was performed in May or June of 1952, meaning that Perón may have already had the procedure at the time of her last public appearance, riding in a limousine at her husband’s second inaugural.
If Perón indeed had a lobotomy, was she aware of what the doctors — with the permission of her husband, President Juan Domingo Perón — planned to do? Perhaps not, given the efforts to conceal her fatal diagnosis in general.
And could a lobotomy actually have helped ease Peron’s suffering? Dr. Nijensohn is not sure. But many patients who were lobotomized in those days reported relief.
“After the operations,” Dr. Frank J. Otenasek, a neurosurgeon at Johns Hopkins, told The Baltimore Sun in 1947, “patients either said they were not suffering or that the pain did not bother them.”
One of the ironies of Dr. Nijensohn’s story, if true, is that another method already existed for treating Perón’s pain: aggressive use of opiates like morphine. Doctors of the era, however, so feared that their cancer patients would become addicted to these drugs that they saw lobotomy as a suitable alternative.
Today, our understanding of cancer pain has certainly changed. The liberal use of narcotics, accompanied by other medications to treat side effects, is seen as appropriate, not indicative of untoward behavior by patients.
Indeed, one of the most successful innovations in pain treatment is a pump that allows cancer patients to give themselves enough medication to dull the pain but to remain alert. Medicine’s goal today is to enable patients to take active roles in their care rather than be acted upon.
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