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By mitsubishi · Posted
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By mitsubishi · Posted
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By mitsubishi · Posted
Dont forget to like and subscribe to the scammer section on traders labotomy Lobotomy From Wikipedia, the free encyclopedia Jump to navigation Jump to search Not to be confused with Lobectomy. Lobotomy "Dr. Walter Freeman, left, and Dr. James W. Watts study an X ray before a psychosurgical operation. Psychosurgery is cutting into the brain to form new patterns and rid a patient of delusions, obsessions, nervous tensions and the like." Waldemar Kaempffert, "Turning the Mind Inside Out", Saturday Evening Post, 24 May 1941.[1] Other names Leukotomy, leucotomy ICD-9-CM 01.32 MeSH D011612 [edit on Wikidata] A lobotomy, or leucotomy, is a form of psychosurgery, a neurosurgical treatment of a mental disorder that involves severing connections in the brain's prefrontal cortex.[2] Most of the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain, are severed. It was used for psychiatric and occasionally other conditions as a mainstream procedure in some Western countries for more than two decades, despite general recognition of frequent and serious side effects. While some people experienced symptomatic improvement with the operation, the improvements were achieved at the cost of creating other impairments. The procedure was controversial from its initial use in part due to the balance between benefits and risks. Today, lobotomy has become a disparaged procedure, a byword for medical barbarism and an exemplary instance of the medical trampling of patients' rights.[3] The originator of the procedure, Portuguese neurologist António Egas Moniz, shared the Nobel Prize for Physiology or Medicine of 1949 for the "discovery of the therapeutic value of leucotomy in certain psychoses",[n 1] although the awarding of the prize has been subject to controversy.[5] The use of the procedure increased dramatically from the early 1940s and into the 1950s; by 1951, almost 20,000 lobotomies had been performed in the United States and proportionally more in the United Kingdom.[6] The majority of lobotomies were performed on women; a 1951 study of American hospitals found nearly 60% of lobotomy patients were women; limited data shows 74% of lobotomies in Ontario from 1948–1952 were performed on women.[7][8][9] From the 1950s onward lobotomy began to be abandoned,[10] first in the Soviet Union[11] and Europe.[12] The term is derived from Greek: λοβός lobos "lobe" and τομή tomē "cut, slice". Contents 1 Effects 2 History 2.1 Early psychosurgery 2.2 Development 3 Reception 3.1 Italian leucotomy 3.2 American leucotomy 3.3 Transorbital lobotomy 4 Prevalence 5 Criticism 6 Notable cases 7 Literary and cinematic portrayals 8 See also 9 Notes 10 Citations 11 Sources 12 External links Effects I fully realize that this operation will have little effect on her mental condition but am willing to have it done in the hope that she will be more comfortable and easier to care for. Comments added to the consent form for a lobotomy operation on "Helaine Strauss",[n 2] "a patient at an elite private hospital".[13] The purpose of the operation was to reduce the symptoms of mental disorders, and it was recognized that this was accomplished at the expense of a person's personality and intellect. British psychiatrist Maurice Partridge, who conducted a follow-up study of 300 patients, said that the treatment achieved its effects by "reducing the complexity of psychic life". Following the operation, spontaneity, responsiveness, self-awareness, and self-control were reduced. The activity was replaced by inertia, and people were left emotionally blunted and restricted in their intellectual range.[14] The consequences of the operation have been described as "mixed".[15] Some patients died as a result of the operation and others later committed suicide. Some were left severely brain-damaged. Others were able to leave the hospital, or became more manageable within the hospital.[15] A few people managed to return to responsible work, while at the other extreme people were left with severe and disabling impairments.[16] Most people fell into an intermediate group, left with some improvement of their symptoms but also with emotional and intellectual deficits to which they made a better or worse adjustment.[16] On average, there was a mortality rate of approximately 5 percent during the 1940s.[16] The lobotomy procedure could have severe negative effects on a patient's personality and ability to function independently.[17] Lobotomy patients often show a marked reduction in initiative and inhibition.[18] They may also exhibit difficulty putting themselves in the position of others because of decreased cognition and detachment from society.[19] Immediately following surgery, patients were often stuporous, confused, and incontinent. Some developed an enormous appetite and gained considerable weight. Seizures were another common complication of surgery. Emphasis was put on the training of patients in the weeks and months following surgery.[20] Walter Freeman coined the term "surgically induced childhood" and used it constantly to refer to the results of lobotomy. The operation left people with an "infantile personality"; a period of maturation would then, according to Freeman, lead to recovery. In an unpublished memoir, he described how the "personality of the patient was changed in some way in the hope of rendering him more amenable to the social pressures under which he is supposed to exist". He described one 29-year-old woman as being, following lobotomy, a "smiling, lazy and satisfactory patient with the personality of an oyster" who could not remember Freeman's name and endlessly poured coffee from an empty pot. When her parents had difficulty dealing with her behavior, Freeman advised a system of rewards (ice-cream) and punishment (smacks).[21] History Insulin shock therapy administered in Helsinki in the 1950s In the early 20th century, the number of patients residing in mental hospitals increased significantly[n 3] while little in the way of effective medical treatment was available.[n 4][27] Lobotomy was one of a series of radical and invasive physical therapies developed in Europe at this time that signaled a break with a psychiatric culture of therapeutic nihilism that had prevailed since the late nineteenth-century.[28] The new "heroic" physical therapies devised during this experimental era,[29] including malarial therapy for general paresis of the insane (1917),[30]deep sleep therapy (1920), insulin shock therapy (1933), cardiazol shock therapy (1934), and electroconvulsive therapy (1938),[31] helped to imbue the then therapeutically moribund and demoralised psychiatric profession with a renewed sense of optimism in the curability of insanity and the potency of their craft.[32] The success of the shock therapies, despite the considerable risk they posed to patients, also helped to accommodate psychiatrists to ever more drastic forms of medical intervention, including lobotomy.[29] The clinician-historian Joel Braslow argues that from malarial therapy onward to lobotomy, physical psychiatric therapies "spiral closer and closer to the interior of the brain" with this organ increasingly taking "center stage as a source of disease and site of cure."[33] For Roy Porter, once the doyen of medical history,[34] the often violent and invasive psychiatric interventions developed during the 1930s and 1940s are indicative of both the well-intentioned desire of psychiatrists to find some medical means of alleviating the suffering of the vast number of patients then in psychiatric hospitals and also the relative lack of social power of those same patients to resist the increasingly radical and even reckless interventions of asylum doctors.[35] Many doctors, patients and family members of the period believed that despite potentially catastrophic consequences, the results of lobotomy were seemingly positive in many instances or, at least they were deemed as such when measured next to the apparent alternative of long-term institutionalisation. Lobotomy has always been controversial, but for a period of the medical mainstream, it was even feted and regarded as a legitimate last resort remedy for categories of patients who were otherwise regarded as hopeless.[36] Today, lobotomy has become a disparaged procedure, a byword for medical barbarism and an exemplary instance of the medical trampling of patients' rights.[3] Early psychosurgery Gottlieb Burckhardt (1836–1907) Before the 1930s, individual doctors had infrequently experimented with novel surgical operations on the brains of those deemed insane. Most notably in 1888, the Swiss psychiatrist, Gottlieb Burckhardt, initiated what is commonly considered the first systematic attempt at modern human psychosurgery.[37] He operated on six chronic patients under his care at the Swiss Préfargier Asylum, removing sections of their cerebral cortex. Burckhardt's decision to operate was informed by three pervasive views on the nature of mental illness and its relationship to the brain. First, the belief that mental illness was organic in nature, and reflected an underlying brain pathology; next, that the nervous system was organized according to an associationist model comprising an input or afferent system (a sensory center), a connecting system where information processing took place (an association center), and an output or efferent system (a motor center); and, finally, a modular conception of the brain whereby discrete mental faculties were connected to specific regions of the brain.[38] Burckhardt's hypothesis was that by deliberately creating lesions in regions of the brain identified as association centers a transformation in behavior might ensue.[38] According to his model, those mentally ill might experience "excitations abnormal in quality, quantity and intensity" in the sensory regions of the brain and this abnormal stimulation would then be transmitted to the motor regions giving rise to mental pathology.[39] He reasoned, however, that removing material from either of the sensory or motor zones could give rise to "grave functional disturbance".[39] Instead, by targeting the association centers and creating a "ditch" around the motor region of the temporal lobe, he hoped to break their lines of communication and thus alleviate both mental symptoms and the experience of mental distress.[40] Ludvig Puusepp c. 1920 Intending to ameliorate symptoms in those with violent and intractable conditions rather than effect a cure,[41] Burckhardt began operating on patients in December 1888,[42] but both his surgical methods and instruments were crude and the results of the procedure were mixed at best.[39] He operated on six patients in total and, according to his own assessment, two experienced no change, two patients became quieter, one patient experienced epileptic convulsions and died a few days after the operation, and one patient improved.[n 5] Complications included motor weakness, epilepsy, sensory aphasia and "word deafness".[44] Claiming a success rate of 50 percent,[45] he presented the results at the Berlin Medical Congress and published a report, but the response from his medical peers was hostile and he did no further operations.[46] In 1912, two physicians based in Saint Petersburg, the leading Russian neurologist Vladimir Bekhterev and his younger Estonian colleague, the neurosurgeon Ludvig Puusepp, published a paper reviewing a range of surgical interventions that had been performed on the mentally ill.[47] While generally treating these endeavours favorably, in their consideration of psychosurgery they reserved unremitting scorn for Burckhardt's surgical experiments of 1888 and opined that it was extraordinary that a trained medical doctor could undertake such an unsound procedure.[48] The authors neglected to mention, however, that in 1910 Puusepp himself had performed surgery on the brains of three mentally ill patients,[n 6][51] sectioning the cortex between the frontal and parietal lobes.[52] He had abandoned these attempts because of unsatisfactory results and this experience probably inspired the invective that was directed at Burckhardt in the 1912 article.[48] By 1937, Puusepp, despite his earlier criticism of Burckhardt, was increasingly persuaded that psychosurgery could be a valid medical intervention for the mentally disturbed.[n 7][54] In the late 1930s he worked closely with the neurosurgical team of the Racconigi Hospital near Turin to establish it as an early and influential centre for the adoption of leucotomy in Italy.[55] Development Egas Moniz Leucotomy was first undertaken in 1935 under the direction of the Portuguese neurologist (and inventor of the term psychosurgery) António Egas Moniz.[n 8][59] First developing an interest in psychiatric conditions and their somatic treatment in the early 1930s,[60] Moniz apparently conceived a new opportunity for recognition in the development of a surgical intervention on the brain as a treatment for mental illness.[41] Frontal lobes The source of inspiration for Moniz's decision to hazard psychosurgery has been clouded by contradictory statements made on the subject by Moniz and others both contemporaneously and retrospectively.[61] The traditional narrative addresses the question of why Moniz targeted the frontal lobes by way of reference to the work of the Yale neuroscientist John Fulton and, most dramatically, to a presentation Fulton made with his junior colleague Carlyle Jacobsen at the Second International Congress of Neurology held in London in 1935.[62] Fulton's primary area of research was on the cortical function of primates and he had established America's first primate neurophysiology laboratory at Yale in the early 1930s.[63] At the 1935 Congress, with Moniz in attendance,[n 9] Fulton and Jacobsen presented two chimpanzees, named Becky and Lucy who had had frontal lobectomies and subsequent changes in behaviour and intellectual function.[64] According to Fulton's account of the congress, they explained that before surgery, both animals, and especially Becky, the more emotional of the two, exhibited "frustrational behaviour" – that is, have tantrums that could include rolling on the floor and defecating – if, because of their poor performance in a set of experimental tasks, they were not rewarded.[65] Following the surgical removal of their frontal lobes, the behaviour of both primates changed markedly and Becky was pacified to such a degree that Jacobsen apparently stated it was as if she had joined a "happiness cult".[64] During the question and answer section of the paper, Moniz, it is alleged, "startled" Fulton by inquiring if this procedure might be extended to human subjects suffering from mental illness. Fulton stated that he replied that while possible in theory it was surely "too formidable" an intervention for use on humans.[66] Brain animation: left frontal lobe highlighted in red. Moniz targeted the frontal lobes in the leucotomy procedure he first conceived in 1933. That Moniz began his experiments with leucotomy just three months after the congress has reinforced the apparent cause and effect relationship between the Fulton and Jacobsen presentation and the Portuguese neurologist's resolve to operate on the frontal lobes.[67] As the author of this account Fulton, who has sometimes been claimed as the father of lobotomy, was later able to record that the technique had its true origination in his laboratory.[68] Endorsing this version of events, in 1949, the Harvard neurologist Stanley Cobb remarked during his presidential address to the American Neurological Association that, "seldom in the history of medicine has a laboratory observation been so quickly and dramatically translated into a therapeutic procedure." Fulton's report, penned ten years after the events described, is, however, without corroboration in the historical record and bears little resemblance to an earlier unpublished account he wrote of the congress. In this previous narrative he mentioned an incidental, private exchange with Moniz, but it is likely that the official version of their public conversation he promulgated is without foundation.[69] In fact, Moniz stated that he had conceived of the operation some time before his journey to London in 1935, having told in confidence his junior colleague, the young neurosurgeon Pedro Almeida Lima, as early as 1933 of his psychosurgical idea.[70] The traditional account exaggerates the importance of Fulton and Jacobsen to Moniz's decision to initiate frontal lobe surgery, and omits the fact that a detailed body of neurological research that emerged at this time suggested to Moniz and other neurologists and neurosurgeons that surgery on this part of the brain might yield significant personality changes in the mentally ill.[71] As the frontal lobes had been the object of scientific inquiry and speculation since the late 19th century, Fulton's contribution, while it may have functioned as source of intellectual support, is of itself unnecessary and inadequate as an explanation of Moniz's resolution to operate on this section of the brain.[72] Under an evolutionary and hierarchical model of brain development it had been hypothesized that those regions associated with more recent development, such as the mammalian brain and, most especially, the frontal lobes, were responsible for more complex cognitive functions.[73] However, this theoretical formulation found little laboratory support, as 19th century experimentation found no significant change in animal behaviour following surgical removal or electrical stimulation of the frontal lobes.[73] This picture of the so-called "silent lobe" changed in the period after World War I with the production of clinical reports of ex-servicemen who had suffered brain trauma. The refinement of neurosurgical techniques also facilitated increasing attempts to remove brain tumours, treat focal epilepsy in humans and led to more precise experimental neurosurgery in animal studies.[73] Cases were reported where mental symptoms were alleviated following the surgical removal of diseased or damaged brain tissue.[52] The accumulation of medical case studies on behavioural changes following damage to the frontal lobes led to the formulation of the concept of Witzelsucht, which designated a neurological condition characterised by a certain hilarity and childishness in the afflicted.[73] The picture of frontal lobe function that emerged from these studies was complicated by the observation that neurological deficits attendant on damage to a single lobe might be compensated for if the opposite lobe remained intact.[73] In 1922, the Italian neurologist Leonardo Bianchi published a detailed report on the results of bilateral lobectomies in animals that supported the contention that the frontal lobes were both integral to intellectual function and that their removal led to the disintegration of the subject's personality.[74] This work, while influential, was not without its critics due to deficiencies in experimental design.[73] The first bilateral lobectomy of a human subject was performed by the American neurosurgeon Walter Dandy in 1930.[n 10][75] The neurologist Richard Brickner reported on this case in 1932,[76] relating that the recipient, known as "Patient A", while experiencing a flattening of affect, had suffered no apparent decrease in intellectual function and seemed, at least to the casual observer, perfectly normal.[77] Brickner concluded from this evidence that "the frontal lobes are not 'centers' for the intellect".[78] These clinical results were replicated in a similar operation undertaken in 1934 by the neurosurgeon Roy Glenwood Spurling and reported on by the neuropsychiatrist Spafford Ackerly.[79] By the mid-1930s, interest in the function of the frontal lobes reached a high-water mark. This was reflected in the 1935 neurological congress in London, which hosted[79] as part of its deliberations,[79] "a remarkable symposium ... on the functions of the frontal lobes."[80] The panel was chaired by Henri Claude, a French neuropsychiatrist, who commenced the session by reviewing the state of research on the frontal lobes, and concluded that, "altering the frontal lobes profoundly modifies the personality of subjects".[78] This parallel symposium contained numerous papers by neurologists, neurosurgeons and psychologists; amongst these was one by Brickner, which impressed Moniz greatly,[77] that again detailed the case of "Patient A".[79] Fulton and Jacobsen's paper, presented in another session of the conference on experimental physiology, was notable in linking animal and human studies on the function of the frontal lobes.[79] Thus, at the time of the 1935 Congress, Moniz had available to him an increasing body of research on the role of the frontal lobes that extended well beyond the observations of Fulton and Jacobsen.[81] Nor was Moniz the only medical practitioner in the 1930s to have contemplated procedures directly targeting the frontal lobes.[82] Although ultimately discounting brain surgery as carrying too much risk, physicians and neurologists such as William Mayo, Thierry de Martel, Richard Brickner, and Leo Davidoff had, before 1935, entertained the proposition.[n 11][84] Inspired by Julius Wagner-Jauregg's development of malarial therapy for the treatment of general paresis of the insane, the French physician Maurice Ducosté reported in 1932 that he had injected 5 ml of malarial blood directly into the frontal lobes of over 100 paretic patients through holes drilled into the skull.[82] He claimed that the injected paretics showed signs of "uncontestable mental and physical amelioration" and that the results for psychotic patients undergoing the procedure was also "encouraging".[85] The experimental injection of fever inducing malarial blood into the frontal lobes was also replicated during the 1930s in the work of Ettore Mariotti and M. Sciutti in Italy and Ferdière Coulloudon in France.[86] In Switzerland, almost simultaneously with the commencement of Moniz's leucotomy programme, the neurosurgeon François Ody had removed the entire right frontal lobe of a catatonic schizophrenic patient.[87] In Romania, Ody's procedure was adopted by Dimitri Bagdasar and Constantinesco working out of the Central Hospital in Bucharest.[83] Ody, who delayed publishing his own results for several years, later rebuked Moniz for claiming to have cured patients through leucotomy without waiting to determine if there had been a "lasting remission".[88] Neurological model The theoretical underpinnings of Moniz's psychosurgery were largely commensurate with the nineteenth century ones that had informed Burckhardt's decision to excise matter from the brains of his patients. Although in his later writings Moniz referenced both the neuron theory of Ramón y Cajal and the conditioned reflex of Ivan Pavlov,[89] in essence he simply interpreted this new neurological research in terms of the old psychological theory of associationism.[61] He differed significantly from Burckhardt, however in that he did not think there was any organic pathology in the brains of the mentally ill, but rather that their neural pathways were caught in fixed and destructive circuits leading to "predominant, obsessive ideas."[n 12][91] As Moniz wrote in 1936: For Moniz, "to cure these patients," it was necessary to "destroy the more or less fixed arrangements of cellular connections that exist in the brain, and particularly those which are related to the frontal lobes,"[93] thus removing their fixed pathological brain circuits. Moniz believed the brain would functionally adapt to such injury.[94] A significant advantage of this approach was that, unlike the position adopted by Burckhardt, it was unfalsifiable according to the knowledge and technology of the time as the absence of a known correlation between physical brain pathology and mental illness could not disprove his thesis.[95] First leucotomies The hypotheses underlying the procedure might be called into question; the surgical intervention might be considered very audacious; but such arguments occupy a secondary position because it can be affirmed now that these operations are not prejudicial to either physical or psychic life of the patient, and also that recovery or improvement may be obtained frequently in this way Egas Moniz (1937)[96] On 12 November 1935 at the Hospital Santa Marta in Lisbon, Moniz initiated the first of a series of operations on the brains of the mentally ill.[97] The initial patients selected for the operation were provided by the medical director of Lisbon's Miguel Bombarda Mental Hospital, José de Matos Sobral Cid.[98] As Moniz lacked training in neurosurgery and his hands were crippled from gout, the procedure was performed under general anaesthetic by Pedro Almeida Lima, who had previously assisted Moniz with his research on cerebral angiography.[n 13][100] The intention was to remove some of the long fibres that connected the frontal lobes to other major brain centres.[101] To this end, it was decided that Lima would trephine into the side of the skull and then inject ethanol into the "subcortical white matter of the prefrontal area"[96] so as to destroy the connecting fibres, or association tracts,[102] and create what Moniz termed a "frontal barrier".[n 14][103] After the first operation was complete, Moniz considered it a success and, observing that the patient's depression had been relieved, he declared her "cured" although she was never, in fact, discharged from the mental hospital.[104] Moniz and Lima persisted with this method of injecting alcohol into the frontal lobes for the next seven patients but, after having to inject some patients on numerous occasions to elicit what they considered a favourable result, they modified the means by which they would section the frontal lobes.[104] For the ninth patient they introduced a surgical instrument called a leucotome; this was a cannula that was 11 centimetres (4.3 in) in length and 2 centimetres (0.79 in) in diameter. It had a retractable wire loop at one end that, when rotated, produced a 1 centimetre (0.39 in) diameter circular lesion in the white matter of the frontal lobe.[105] Typically, six lesions were cut into each lobe, but, if they were dissatisfied by the results, Lima might perform several procedures, each producing multiple lesions in the left and right frontal lobes.[104] By the conclusion of this first run of leucotomies in February 1936, Moniz and Lima had operated on twenty patients with an average period of one week between each procedure; Moniz published his findings with great haste in March of the same year.[106] The patients were aged between 27 and 62 years of age; twelve were female and eight were male. Nine of the patients were diagnosed as suffering from depression, six from schizophrenia, two from panic disorder, and one each from mania, catatonia and manic-depression with the most prominent symptoms being anxiety and agitation. The duration of the illness before the procedure varied from as little as four weeks to as much as 22 years, although all but four had been ill for at least one year.[107] Patients were normally operated on the day they arrived at Moniz's clinic and returned within ten days to the Miguel Bombarda Mental Hospital.[108] A perfunctory post-operative follow-up assessment took place anywhere from one to ten weeks following surgery.[109] Complications were observed in each of the leucotomy patients and included: "increased temperature, vomiting, bladder and bowel incontinence, diarrhea, and ocular affections such as ptosis and nystagmus, as well as psychological effects such as apathy, akinesia, lethargy, timing and local disorientation, kleptomania, and abnormal sensations of hunger".[110] Moniz asserted that these effects were transitory and,[110] according to his published assessment, the outcome for these first twenty patients was that 35%, or seven cases, improved significantly, another 35% were somewhat improved and the remaining 30% (six cases) were unchanged. There were no deaths and he did not consider that any patients had deteriorated following leucotomy.[111] Reception Moniz rapidly disseminated his results through articles in the medical press and a monograph in 1936.[103] Initially, however, the medical community appeared hostile to the new procedure.[112] On 26 July 1936, one of his assistants, Diogo Furtado, gave a presentation at the Parisian meeting of the Société Médico-Psychologique on the results of the second cohort of patients leucotomised by Lima.[103] Sobral Cid, who had supplied Moniz with the first set of patients for leucotomy from his own hospital in Lisbon, attended the meeting and denounced the technique,[112] declaring that the patients who had been returned to his care post-operatively were "diminished" and had suffered a "degradation of personality".[113] He also claimed that the changes Moniz observed in patients were more properly attributed to shock and brain trauma, and he derided the theoretical architecture that Moniz had constructed to support the new procedure as "cerebral mythology."[113] At the same meeting the Parisian psychiatrist, Paul Courbon, stated he could not endorse a surgical technique that was solely supported by theoretical considerations rather than clinical observations.[114] He also opined that the mutilation of an organ could not improve its function and that such cerebral wounds as were occasioned by leucotomy risked the later development of meningitis, epilepsy and brain abscesses.[115] Nonetheless, Moniz's reported successful surgical treatment of 14 out of 20 patients led to the rapid adoption of the procedure on an experimental basis by individual clinicians in countries such as Brazil, Cuba, Italy, Romania and the United States during the 1930s.[116] Italian leucotomy In the present state of affairs if some are critical about lack of caution in therapy, it is, on the other hand, deplorable and inexcusable to remain apathetic, with folded hands, content with learned lucubrations upon symptomatologic minutiae or upon psychopathic curiosities, or even worse, not even doing that. Amarro Fiamberti[117] Throughout the remainder of the 1930s the number of leucotomies performed in most countries where the technique was adopted remained quite low. In Britain, which was later a major centre for leucotomy,[n 15] only six operations had been undertaken before 1942.[119] Generally, medical practitioners who attempted the procedure adopted a cautious approach and few patients were leucotomised before the 1940s. Italian neuropsychiatrists, who were typically early and enthusiastic adopters of leucotomy, were exceptional in eschewing such a gradualist course.[55] Leucotomy was first reported in the Italian medical press in 1936 and Moniz published an article in Italian on the technique in the following year.[55] In 1937, he was invited to Italy to demonstrate the procedure and for a two-week period in June of that year he visited medical centres in Trieste, Ferrara, and one close to Turin – the Racconigi Hospital – where he instructed his Italian neuropsychiatric colleagues on leucotomy and also oversaw several operations.[55] Leucotomy was featured at two Italian psychiatric conferences in 1937 and over the next two years a score of medical articles on Moniz's psychosurgery was published by Italian clinicians based in medical institutions located in Racconigi, Trieste, Naples, Genoa, Milan, Pisa, Catania and Rovigo.[55] The major centre for leucotomy in Italy was the Racconigi Hospital, where the experienced neurosurgeon Ludvig Puusepp provided a guiding hand.[n 16][55] Under the medical directorship of Emilio Rizzatti, the medical personnel at this hospital had completed at least 200 leucotomies by 1939.[121] Reports from clinicians based at other Italian institutions detailed significantly smaller numbers of leucotomy operations.[55] Experimental modifications of Moniz's operation were introduced with little delay by Italian medical practitioners.[122] Most notably, in 1937 Amarro Fiamberti, the medical director of a psychiatric institution in Varese,[123] first devised the transorbital procedure whereby the frontal lobes were accessed through the eye sockets.[122] Fiamberti's method was to puncture the thin layer of orbital bone at the top of the socket and then inject alcohol or formalin into the white matter of the frontal lobes through this aperture.[124] Using this method, while sometimes substituting a leucotome for a hypodermic needle, it is estimated that he leucotomised about 100 patients in the period up to the outbreak of World War II.[123] Fiamberti's innovation of Moniz's method would later prove inspirational for Walter Freeman's development of transorbital lobotomy.[124] American leucotomy Site of borehole for the standard pre-frontal lobotomy/leucotomy operation as developed by Freeman and Watts The first prefrontal leucotomy in the United States was performed at the George Washington University Hospital on 14 September 1936 by the neurologist Walter Freeman and his friend and colleague, the neurosurgeon, James W. Watts.[125] Freeman had first encountered Moniz at the London-hosted Second International Congress of Neurology in 1935 where he had presented a poster exhibit of the Portuguese neurologist's work on cerebral angiography.[126] Fortuitously occupying a booth next to Moniz, Freeman, delighted by their chance meeting, formed a highly favourable impression of Moniz, later remarking upon his "sheer genius".[126] According to Freeman, if they had not met in person it is highly unlikely that he would have ventured into the domain of frontal lobe psychosurgery.[127] Freeman's interest in psychiatry was the natural outgrowth of his appointment in 1924 as the medical director of the Research Laboratories of the Government Hospital for the Insane in Washington, known colloquially as St Elizabeth's.[128] Ambitious and a prodigious researcher, Freeman, who favoured an organic model of mental illness causation, spent the next several years exhaustively, yet ultimately fruitlessly, investigating a neuropathological basis for insanity.[129] Chancing upon a preliminary communication by Moniz on leucotomy in the spring of 1936, Freeman initiated a correspondence in May of that year. Writing that he had been considering psychiatric brain surgery previously, he informed Moniz that, "having your authority I expect to go ahead".[130] Moniz, in return, promised to send him a copy of his forthcoming monograph on leucotomy and urged him to purchase a leucotome from a French supplier.[131] Upon receipt of Moniz's monograph, Freeman reviewed it anonymously for the Archives of Neurology and Psychiatry.[131] Praising the text as one whose "importance can scarcely be overestimated",[131] he summarised Moniz's rationale for the procedure as based on the fact that while no physical abnormality of cerebral cell bodies was observable in the mentally ill, their cellular interconnections may harbour a "fixation of certain patterns of relationship among various groups of cells" and that this resulted in obsessions, delusions and mental morbidity.[132] While recognising that Moniz's thesis was inadequate, for Freeman it had the advantage of circumventing the search for diseased brain tissue in the mentally ill by instead suggesting that the problem was a functional one of the brain's internal wiring where relief might be obtained by severing problematic mental circuits.[132] In 1937 Freeman and Watts adapted Lima and Moniz's surgical procedure, and created the Freeman-Watts technique, also known as the Freeman-Watts standard prefrontal lobotomy, which they styled the "precision method".[133] Transorbital lobotomy Orbitoclast, used in transorbital lobotomy[n 17] The Freeman-Watts prefrontal lobotomy still required drilling holes in the scalp, so surgery had to be performed in an operating room by trained neurosurgeons. Walter Freeman believed this surgery would be unavailable to those he saw as needing it most: patients in state mental hospitals that had no operating rooms, surgeons, or anesthesia and limited budgets. Freeman wanted to simplify the procedure so that it could be carried out by psychiatrists in psychiatric hospitals.[135] Inspired by the work of Italian psychiatrist Amarro Fiamberti, Freeman at some point conceived of approaching the frontal lobes through the eye sockets instead of through drilled holes in the skull. In 1945 he took an icepick[n 18] from his own kitchen and began testing the idea on grapefruit[n 19] and cadavers. This new "transorbital" lobotomy involved lifting the upper eyelid and placing the point of a thin surgical instrument (often called an orbitoclast or leucotome, although quite different from the wire loop leucotome described above) under the eyelid and against the top of the eyesocket. A mallet was used to drive the orbitoclast through the thin layer of bone and into the brain along the plane of the bridge of the nose, around 15 degrees toward the interhemispherical fissure. The orbitoclast was malleted 5 centimeters (2 in) into the frontal lobe, and then pivoted 40 degrees at the orbit perforation so the tip cut toward the opposite side of the head (toward the nose). The instrument was returned to the neutral position and sent a further 2 centimeters (4⁄5 in) into the brain, before being pivoted around 28 degrees each side, to cut outwards and again inwards. (In a more radical variation at the end of the last cut described, the butt of the orbitoclast was forced upwards so the tool cut vertically down the side of the cortex of the interhemispherical fissure; the "Deep Frontal Cut".) All cuts were designed to transect the white fibrous matter connecting the cortical tissue of the prefrontal cortex to the thalamus. The leucotome was then withdrawn and the procedure repeated on the other side.[citation needed] Freeman performed the first transorbital lobotomy on a live patient in 1946. Its simplicity suggested the possibility of carrying it out in mental hospitals lacking the surgical facilities required for the earlier, more complex procedure. (Freeman suggested that, where conventional anesthesia was unavailable, electroconvulsive therapy be used to render the patient unconscious.)[137] In 1947, the Freeman and Watts partnership ended, as the latter was disgusted by Freeman's modification of the lobotomy from a surgical operation into a simple "office" procedure.[138] Between 1940 and 1944, 684 lobotomies were performed in the United States. However, because of the fervent promotion of the technique by Freeman and Watts, those numbers increased sharply towards the end of the decade. In 1949, the peak year for lobotomies in the US, 5,074 procedures were undertaken, and by 1951 over 18,608 individuals had been lobotomized in the US.[139] Prevalence In the United States, approximately 40,000 people were lobotomized. In England, 17,000 lobotomies were performed, and the three Nordic countries of Denmark, Norway, and Sweden had a combined figure of approximately 9,300 lobotomies.[140] Scandinavian hospitals lobotomized 2.5 times as many people per capita as hospitals in the US.[141] Sweden lobotomized at least 4,500 people between 1944 and 1966, mainly women. This figure includes young children.[142] In Norway, there were 2,005 known lobotomies.[143] In Denmark, there were 4,500 known lobotomies.[144] In Japan, the majority of lobotomies were performed on children with behavior problems. The Soviet Union banned the practice in 1950 on moral grounds and Japan soon followed suit. In Germany it was performed only a few times.[145] By the late 1970s, the practice of lobotomy had generally ceased, although it continued as late as the 1980s in France.[146] Criticism As early as 1944 an author in the Journal of Nervous and Mental Disease remarked: "The history of prefrontal lobotomy has been brief and stormy. Its course has been dotted with both violent opposition and with slavish, unquestioning acceptance." Beginning in 1947 Swedish psychiatrist Snorre Wohlfahrt evaluated early trials, reporting that it is "distinctly hazardous to leucotomize schizophrenics" and that lobotomy was "still too imperfect to enable us, with its aid, to venture on a general offensive against chronic cases of mental disorder", stating further that "Psychosurgery has as yet failed to discover its precise indications and contraindications and the methods must unfortunately still be regarded as rather crude and hazardous in many respects."[147] In 1948 Norbert Wiener, the author of Cybernetics: Or the Control and Communication in the Animal and the Machine, said: "[P]refrontal lobotomy ... has recently been having a certain vogue, probably not unconnected with the fact that it makes the custodial care of many patients easier. Let me remark in passing that killing them makes their custodial care still easier."[148] Concerns about lobotomy steadily grew. Soviet psychiatrist Vasily Gilyarovsky criticized lobotomy and the mechanistic brain localization assumption used to carry out lobotomy: "It is assumed that the transection of white substance of the frontal lobes impairs their connection with the thalamus and eliminates the possibility to receive from it stimuli which lead to irritation and on the whole derange mental functions. This explanation is mechanistic and goes back to the narrow localizationism characteristic of psychiatrists of America, from where leucotomy was imported to us."[149] The USSR officially banned the procedure in 1950[150] on the initiative of Gilyarovsky.[151] Doctors in the Soviet Union concluded that the procedure was "contrary to the principles of humanity" and "'through lobotomy' an insane person is changed into an idiot."[152] By the 1970s, numerous countries had banned the procedure as had several US states.[153] In 1977 the US Congress, during the presidency of Jimmy Carter, created the National Committee for the Protection of Human Subjects of Biomedical and Behavioral Research to investigate allegations that psychosurgery—including lobotomy techniques—was used to control minorities and restrain individual rights. The committee concluded that some extremely limited and properly performed psychosurgery could have positive effects.[154] There have been calls in the early 21st century for the Nobel Foundation to rescind the prize it awarded to Moniz for developing lobotomy, a decision that has been called an astounding error of judgment at the time and one that psychiatry might still need to learn from, but the Foundation declined to take action and has continued to host an article defending the results of the procedure.[155][5] Notable cases See also: Category:Lobotomised people. Rosemary Kennedy, sister of President John F. Kennedy, underwent a lobotomy in 1941 that left her incapacitated and institutionalized for the rest of her life.[156] Howard Dully wrote a memoir of his late-life discovery that he had been lobotomized in 1960 at age 12.[157] New Zealand author and poet Janet Frame received a literary award in 1951 the day before a scheduled lobotomy was to take place, and it was never performed.[158] Josef Hassid, a Polish violinist and composer, was diagnosed with schizophrenia and died at the age of 26 following a lobotomy.[159] Swedish modernist painter Sigrid Hjertén died following a lobotomy in 1948.[160] American playwright Tennessee Williams' older sister Rose received a lobotomy that left her incapacitated for life; the episode is said to have inspired characters and motifs in certain works of his.[161] It is often said that when an iron rod was accidentally driven through the head of Phineas Gage in 1848, this constituted an "accidental lobotomy", or that this event somehow inspired the development of surgical lobotomy a century later. According to the only book-length study of Gage, careful inquiry turns up no such link.[162] In 2011, Daniel Nijensohn, an Argentine-born neurosurgeon at Yale, examined X-rays of Eva Peron and concluded that she underwent a lobotomy for the treatment of pain and anxiety in the last months of her life.[163] Literary and cinematic portrayals Lobotomies have been featured in several literary and cinematic presentations that both reflected society's attitude towards the procedure and, at times, changed it. Writers and film-makers have played a pivotal role in turning public sentiment against the procedure.[5] Robert Penn Warren's 1946 novel All the King's Men describes a lobotomy as making "a Comanche brave look like a tyro with a scalping knife," and portrays the surgeon as a repressed man who cannot change others with love, so he instead resorts to "high-grade carpentry work".[164] Tennessee Williams criticized lobotomy in his play Suddenly, Last Summer (1958) because it was sometimes inflicted on homosexuals—to render them "morally sane".[5] In the play a wealthy matriarch offers the local mental hospital a substantial donation if the hospital will give her niece a lobotomy, which she hopes will stop the niece's shocking revelations about the matriarch's son.[165] Warned that a lobotomy might not stop her niece's "babbling," she responds, "That may be, maybe not, but after the operation who would believe her, Doctor?"[166] In Ken Kesey's 1962 novel One Flew Over the Cuckoo's Nest and its 1975 film adaptation, lobotomy is described as "frontal-lobe castration", a form of punishment and control after which "There's nothin' in the face. Just like one of those store dummies." In one patient, "You can see by his eyes how they burned him out over there; his eyes are all smoked up and gray and deserted inside."[164] In Sylvia Plath's 1963 novel The Bell Jar, the protagonist reacts with horror to the "perpetual marble calm" of a lobotomized young woman.[164] Elliott Baker's 1964 novel and 1966 film version, A Fine Madness, portrays the dehumanizing lobotomy of a womanizing, quarrelsome poet who, afterwards, is just as aggressive as ever. The surgeon is depicted as an inhumane crackpot.[167] The 1982 biopic film Frances depicts actress Frances Farmer (the subject of the film) undergoing transorbital lobotomy (though the idea[168] that a lobotomy was performed on Farmer, and that Freeman performed it, has been criticized as having little or no factual foundation).[169] See also Psychiatry portal Bilateral cingulotomy destruction of a part of the brain Bioethics and Medical ethics Frontal lobe disorder Frontal lobe injury Psychosurgery History of psychosurgery in the United Kingdom Notes Walter Rudolf Hess, who was the joint winner with Moniz of the Nobel Prize in 1949 for his work on the function of the midbrain, had no involvement with leucotomy.[4] A pseudonym A 1937 report detailed that in the United States there were then 477 psychiatric institutions with a total population of approximately 451,672 patients, almost half of whom had been resident for a period of five years or more.[22] The report also observed that psychiatric patients occupied 55 per cent of all hospital beds in America.[22] Conditions within US mental hospitals became the subject of public debate as a series of exposes were published in the 1940s.[23] A 1946 Life magazine article remarked that the nation's system of mental hospitals resembled "little more than concentration camps on the Belsen pattern";[24] a point the piece emphasized with documentary photography that depicted patient neglect and dilapidated material conditions within psychiatric institutions.[25] Ugo Cerletti, the Italian psychiatrist and joint inventor with Lucio Bini of electroconvulsive therapy, described psychiatry during the interwar period as a "funereal science".[26] Likewise Egas Moniz, the inventor of leucotomy, referred to the "impotência terapeutica" (therapeutic impotence) of existing therapeutic remedies during the 1930s.[27] The patient he thought improved subsequently committed suicide.[43] According to Puusepp, the three patients were suffering from manic depression or considered "epileptic equivalents".[50] Puusepp admitted to his 1910 experimentation with psychosurgery in a 1937 publication.[53] At that point he had completed a series of 14 leucotomies to relieve aggressive symptoms in patients. Convinced that the results had been positive in these cases, he felt that further research into psychosurgery was warranted.[52] Professor of neurology at the University of Lisbon from 1911 to 1944, Moniz was also for several decades a prominent parliamentarian and diplomat. He was Portugal's ambassador to Spain during World War I and represented Portugal at the postwar Versailles Treaty negotiations,[56] but after the Portuguese coup d'état of 1926, which ushered in the Ditadura Nacional (National Dictatorship), the Republican Moniz, then 51 years old, devoted his considerable talents and energies to neurological research entirely. Throughout his career he published on topics as diverse as neurology, sexology, historical biography, and the history of card games.[57] For his 1927 development of cerebral angiography, which allowed routine visualisation of the brain's peripheral blood vessels for the first time, he was twice nominated, unsuccessfully, for a Nobel Prize. Some have attributed his development of leucotomy to a determination on his part to win the Nobel after these disappointments.[58] The American neuropsychiatrist Walter Freman also attended the Congress where he presented his research findings on cerebral ventriculography. Freeman, who would later play a central role in the popularisation and practice of leucotomy in America, also had an interest in personality changes following frontal lobe surgery.[52] The patient suffered from meningioma, a rare form of brain tumour arising in the meninges.[75] Brickner and Davidoff had planned, before Moniz's first leucotomies, to operate on the frontal lobes to relieve depression.[83] Moniz wrote in 1948: 'sufferers from melancholia, for instance, are distressed by fixed and obsessive ideas ... and live in a permanent state of anxiety caused by a fixed idea which predominates over all their lives ... in contrast to automatic actions, these morbid ideas are deeply rooted in the synaptic complex which regulates the functioning of consciousness, stimulating it and keeping it in constant activity ... all these considerations led me to the following conclusion: it is necessary to alter these synaptic adjustments and change the paths chosen by the impulses in their constant passage so as to modify the corresponding ideas and force thoughts along different paths ...'[90] Lima described his role as that of an "instrument handled by the Master".[99] Before operating on live subjects, they practised the procedure on a cadaver head.[84] It was estimated by William Sargant and Eliot Slater that 15,000 leucotomies had been performed in the UK by 1962.[118] The 14 leucotomies reported by Puusepp in his 1937 paper were performed at the Racconigi Hospital.[120] Walter Freeman had originally used ice picks for his modified form of the leucotomy operation that he termed transorbital lobotomy. However, because the ice picks would occasionally break inside the patient's head and have to be retrieved, he had the very durable orbitoclast specially commissioned in 1948.[134] Frank Freeman, Walter Freeman's son, stated in an interview with Howard Dully that: "He had several ice-picks that just cluttered the back of the kitchen drawer. The first ice-pick came right out of our drawer. A humble ice-pick to go right into the frontal lobes. It was, from a cosmetic standpoint, diabolical. Just observing this thing was horrible, gruesome." When Dully asked Frank Freeman, then a 79-year-old security guard, whether he was proud of his father, he replied: "Oh yes, yes, yeah. He was terrific. He was really quite a remarkable pioneer lobotomist. I wish he could have gotten further."[136] Rodney Dully, whose son Howard Dully had had a transorbital lobotomy performed on him by Walter Freeman when he was twelve years old, stated in an interview with his son that: "I only met him [Freeman] I think the one time. He described how accurate it [transorbital lobotomy] was and that he had practised the cutting on, literally, a carload of grapefruit, getting the right move and the right turn. That's what he told me."[136] Citations Kaempffert 1941, p. 18. "Lobotomy: Definition, Procedure & History". Live Science. Retrieved 28 June 2018. Raz 2009, p. 116 Nobelprize.org 2013. Sutherland 2004 Levinson, Hugh (8 November 2011). "The strange and curious history of lobotomy". BBC News. BBC. Johnson, Jenell (17 October 2014). American Lobotomy: A Rhetorical History. University of Michigan Press. pp. 50–60. ISBN 978-0472119448. Retrieved 12 August 2017. El-Hai, Jack (21 December 2016). "Race and Gender in the Selection of Patients for Lobotomy". Wonders & Marvels. Retrieved 12 August 2017. "Lobotomies". Western University. Retrieved 12 August 2017. Kalat, James W. (2007). Biological psychology (9th ed.). Belmont, California: Wadsworth/Thomson Learning. p. 101. ISBN 9780495090793. Retrieved 21 December 2015. Zajicek, Benjamin (2017). "Banning the Soviet Lobotomy: Psychiatry, Ethics, and Professional Politics during Late Stalinism". Bulletin of the History of Medicine. 91 (1): 33–61. doi:10.1353/bhm.2017.0002. ISSN 1086-3176. PMID 28366896. Gallea, Michael (Summer 2017). "A brief reflection on the not-so-brief history of the lobotomy". BCMedical Journal. 59: 302–304. Archived from the original on 7 February 2019. Retrieved 4 February 2019. Quoted in, Pressman 2002, p. 48 Partridge 1950, pp. 470–471 Cooper 2014, pp. 143-154. Valenstein 1997, pp. 499–516 Szasz 2007, pp. 151–172 Freberg 2010, pp. 416–417 Shutts 1982 Noyes & Kolb 1962, pp. 550–555 Raz 2013, pp. 101–113 Feldman & Goodrich 2001, p. 650; Mashour, Walker & Martuza 2005, p. 411 Maisel 1946; Wright 1947; Deutsch 1948;Feldman & Goodrich 2001, p. 650; Pressman 2002, pp. 148–150 Albert Q. Maisel, "Bedlam 1946, Most U.S. Mental Hospitals are a Shame and a Disgrace," Life 20 (1946), pp 102–103, quoted in Pressman 2002, p. 149 Pressman 2002, p. 148–149. Shorter 1997, p. 218. Gross & Schäfer 2011, p. 5 Swayze 1995, pp. 505–515;Hoenig 1995, p. 337; Meduna 1985, p. 53 Pressman 2002, p. 200 Brown 2000, pp. 371–382. Shorter 1997, pp. 190–225; Jansson 1998 Healy 2000, p. 404; Braslow 1995, pp. 600–605; Braslow 1997, pp. 89, 93 Braslow 1997, p. 3. Cooter 2012, p. 216 Porter 1999, p. 520. Pressman 2002, p. 428; Raz 2009, pp. 116, 129 Gross & Schäfer 2011, p. 1; Heller et al. 2006, p. 727; Joanette et al. 1993, pp. 572, 575; Kotowicz 2008, p. 486; Manjila et al. 2008, p. 1; Noll 2007, p. 326; Reevy, Ozer & Ito 2010, p. 485; Steck 2010, pp. 85–89; Stone 2001, pp. 79–92; Suchy 2011, p. 37; Mareke & Fangerau 2010, p. 138; Ford & Henderson 2006, p. 219; Green et al. 2010, p. 208; Sakas et al. 2007, p. 366; Whitaker, Stemmer & Joanette 1996, p. 276 Berrios 1997, p. 68 Berrios 1997, p. 69 Berrios 1997, p. 69, 77 Tierney 2000, p. 26 Whitaker, Stemmer & Joanette 1996, p. 276; Berrios 1997, p. 69 Stone 2001, p. 80. Berrios 1997, p. 70 Manjila et al. 2008, p. 1. Kotowicz 2005, pp. 77–101 Bechterev & Puusepp 1912; Kotowicz 2008, p. 486 Kotowicz 2005, p. 80; Kotowicz 2008, p. 486 Quoted in Berrios 1997, p. 71 Feldman & Goodrich 2001, p. 149 Kotowicz 2005, p. 80; Kotowicz 2008, p. 486; Berrios 1997, p. 71 Feldman & Goodrich 2001, p. 649 Puusepp 1937 Kotowicz 2008, p. 486 Kotowicz 2008, p. 477 Tierney 2000, p. 23 Tierney 2000, p. 25; Tierney 2000, pp. 22–23; Kotowicz 2005, pp. 78 Shorter 1997, p. 226; Tierney 2000, pp. 25 Doby 1992, p. 2; Tierney 2000, pp. 25 El-Hai 2005, p. 100 Berrios 1997, p. 72 Pressman 2002, pp. 13–14, 48–51, 54–55; Berrios 1997, pp. 72–73; Shorter 1997, p. 226; Heller et al. 2006, p. 721 Heller et al. 2006, p. 721 Pressman 2002, p. 48. Pressman 2002, p. 48; Heller et al. 2006, p. 721 Pressman 2002, p. 48; Berrios 1997, p. 73 Berrios 1997, p. 73 Pressman 2002, p. 48–50 Pressman 2002, p. 50 Berrios 1997, pp. 72–73 Pressman 2002, pp. 48–55; Valenstein 1997, p. 541 Pressman 2002, p. 51, 55 Pressman 2002, p. 51 Bianchi 1922; Pressman 2002, p. 51; Levin & Eisenberg 1991, p. 14 Pressman 2002, p. 52; Kotowicz 2005, p. 84 Brickner 1932 Kotowicz 2005, p. 84 Quoted in Pressman 2002, p. 52 Pressman 2002, p. 52 Quoted in Freeman & Watts 1944, p. 532 Pressman 2002, p. 53 Valenstein 1990, p. 541 Valenstein 1997, p. 503 Feldman & Goodrich 2001, p. 650 Quoted in Valenstein 1990, p. 541 Valenstein 1990, p. 541; Feldman & Goodrich 2001, p. 650; Kotowicz 2008, p. 478 Berrios 1997, p. 77; Valenstein 1990, p. 541; Valenstein 1997, p. 503 Quoted in Valenstein 1997, p. 503 Gross & Schäfer 2011, p. 1 Quoted in Berrios 1997, p. 74 Kotowicz 2005, p. 99; Gross & Schäfer 2011, p. 1 Quoted in Kotowicz 2005, p. 88 Quoted in Feldman & Goodrich 2001, p. 651 Berrios 1997, p. 74 Kotowicz 2005, p. 89 Moniz 1994, p. 237. Kotowicz 2005, pp. 80–81; Feldman & Goodrich 2001, p. 650 Gross & Schäfer 2011, p. 2; Kotowicz 2008, p. 482 , Gross & Schäfer 2011, p. 2 Tierney 2000, p. 29; Kotowicz 2005, pp. 80–81; Gross & Schäfer 2011, p. 2 Pressman 2002, p. 54 Finger 2001, p. 292. Kotowicz 2005, p. 81 Feldman & Goodrich 2001, p. 651 Jansson 1998; Gross & Schäfer 2011, p. 2; Feldman & Goodrich 2001, p. 651. For Moniz's account of the procedure see, Moniz 1994, pp. 237–239 Kotowicz 2005, p. 81; Feldman & Goodrich 2001, p. 651; Valenstein 1997, p. 504 Berrios 1997, p. 75 Kotowicz 2005, p. 92 Berrios 1997, p. 75; Kotowicz 2005, p. 92 Gross & Schäfer 2011, p. 3 Berrios 1997, p. 74; Gross & Schäfer 2011, p. 3 Kotowicz 2008, p. 482 Quoted in Kotowicz 2008, p. 482 Kotowicz 2008, p. 482–483 Kotowicz 2008, p. 483 Feldman & Goodrich 2001, p. 652; Kotowicz 2005, p. 81 Quoted in El-Hai 2005, p. 182 Kotowicz 2008, pp. 486 n.1; Sargant & Slater 1963, p. 98 Kotowicz 2008, pp. 476–477 Puusepp 1937; Kotowicz 2008, pp. 477, 486 Kotowicz 2008, pp. 477, 487 Kotowicz 2008, p. 478 El-Hai 2005, p. 182 El-Hai 2005, p. 182; Finger 2001, p. 293; Weiss, Rauch & Price 2007, p. 506 Shorter 1997, p. 227; Pressman 2002, p. 78 Pressman 2002, p. 76; Feldman & Goodrich 2001, p. 649 Pressman 2002, p. 76; Kotowicz 2005, p. 94 Pressman 2002, p. 73 Pressman 2002, pp. 73–75 Quoted in Pressman 2002, p. 76 Pressman 2002, p. 76 Pressman 2002, p. 77 Finger 2001, p. 293 Acharya 2004, p. 40 El-Hai 2005, p. 184. 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Macmillan, M.. An Odd Kind of Fame: Stories of Phineas Gage. MIT Press; 2000. ISBN 0-262-13363-6. Mareke, Arends; Fangerau, Heiner. Deep brain stimulation in psychiatric disorders. In: Fangerau, Heiner; Jörg, Fegert; Mareke, Arends (eds). Implanted Minds: The Neuroethics of Intracerebral Stem Cell Transplantation and Deep Brain Stimulation. Verlag; 2010. ISBN 978-3-8376-1433-6. Martin, Douglas. Janet Frame, 79, Writer Who Explored Madness. The New York Times. 30 January 2004 [Retrieved 17 November 2007]. Mashour, George A.; Walker, Erin E.; Martuza, Robert L.. Psychosurgery: Past, Present, and Future. Brain Research Reviews. 2005 [archived 17 January 2013];48(3):409–419. doi:10.1016/j.brainresrev.2004.09.002. PMID 15914249. Meduna, L.J.. Autobiography of L.J. Meduna. Convulsive Therapy. 1985;1(1):43–57. PMID 11940805. Moniz, Egas. Prefrontal Leucotomy in the Treatment of Mental Disorders (1937) American Journal of Psychiatry 1844–1944. American Psychiatric Publishing; 1994. 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Cockroach From Wikipedia, the free encyclopedia Jump to navigation Jump to search This article is about the insect. For other uses, see Cockroach (disambiguation). Cockroach Temporal range: 145–0 Ma PreЄ Є O S D C P T J K Pg N Cretaceous–recent Common household cockroaches A) German cockroach B) American cockroach C) Australian cockroach D&E) Oriental cockroach (♀ & ♂) Scientific classification Kingdom: Animalia Phylum: Arthropoda Class: Insecta Superorder: Dictyoptera Order: Blattodea Families Blaberidae Blattidae Corydiidae Cryptocercidae Ectobiidae Lamproblattidae Nocticolidae Tryonicidae Cockroaches are insects of the order Blattodea, which also includes termites. About 30 cockroach species out of 4,600 are associated with human habitats. About four species are well known as pests. The cockroaches are an ancient group, dating back at least as far as the Carboniferous period, some 320 million years ago. Those early ancestors however lacked the internal ovipositors of modern roaches. Cockroaches are somewhat generalized insects without special adaptations like the sucking mouthparts of aphids and other true bugs; they have chewing mouthparts and are likely among the most primitive of living neopteran insects. They are common and hardy insects, and can tolerate a wide range of environments from Arctic cold to tropical heat. Tropical cockroaches are often much bigger than temperate species, and, contrary to popular belief, extinct cockroach relatives and 'roachoids' such as the Carboniferous Archimylacris and the Permian Apthoroblattina were not as large as the biggest modern species. Some species, such as the gregarious German cockroach, have an elaborate social structure involving common shelter, social dependence, information transfer and kin recognition. Cockroaches have appeared in human culture since classical antiquity. They are popularly depicted as dirty pests, though the great majority of species are inoffensive and live in a wide range of habitats around the world. Contents 1 Taxonomy and evolution 2 Description 3 Distribution and habitat 4 Behavior 4.1 Collective decision-making 4.2 Social behavior 4.3 Sounds 5 Biology 5.1 Digestive tract 5.2 Tracheae and breathing 5.3 Reproduction 5.4 Hardiness 6 Relationship with humans 6.1 In research and education 6.2 As pests 6.2.1 Control 6.3 As food 6.4 In traditional and homeopathic medicine 6.5 Conservation 7 Cultural depictions 8 References 9 External links Taxonomy and evolution A 40- to 50-million-year-old cockroach in Baltic amber (Eocene) Cockroaches are members of the order Blattodea, which includes the termites, a group of insects once thought to be separate from cockroaches. Currently, 4,600 species and over 460 genera are described worldwide.[1][2] The name "cockroach" comes from the Spanish word for cockroach, cucaracha, transformed by 1620s English folk etymology into "cock" and "roach".[3] The scientific name derives from the Latin blatta, "an insect that shuns the light", which in classical Latin was applied to not only cockroaches, but also mantids.[4][5] Historically, the name Blattaria was used largely interchangeably with the name Blattodea, but whilst the former name was used to refer to 'true' cockroaches exclusively, the latter also includes the termites. The current catalogue of world cockroach species uses the name Blattodea for the group.[1] Another name, Blattoptera, is also sometimes used.[6] The earliest cockroach-like fossils ("blattopterans" or "roachids") are from the Carboniferous period 320 million years ago, as are fossil roachoid nymphs.[7][8][9] Since the 19th century, scientists believed that cockroaches were an ancient group of insects that had a Devonian origin, according to one hypothesis.[10] Fossil roachoids that lived during that time differ from modern cockroaches in having long external ovipositors and are the ancestors of mantises, as well as modern blattodeans. As the body, hind wings and mouthparts are not preserved in fossils frequently, the relationship of these roachoids and modern cockroaches remains disputed. The first fossils of modern cockroaches with internal ovipositors appeared in the early Cretaceous. A recent phylogenetic analysis suggests that cockroaches originated at least in the Jurassic.[10] The evolutionary relationships of the Blattodea (cockroaches and termites) shown in the cladogram are based on Eggleton, Beccaloni & Inward (2007).[11] The cockroach families Lamproblattidae and Tryonicidae are not shown but are placed within the superfamily Blattoidea. The cockroach families Corydiidae and Ectobiidae were previously known as the Polyphagidae and Blattellidae.[12] Dictyoptera Blattodea Blattoidea Termitoidea (Termites) Termitidae Rhinotermitidae Kalotermitidae Termopsidae Hodotermitidae Mastotermitidae Cryptocercoidae Cryptocercidae (brown-hooded cockroaches) Blattidae (Oriental, American and other cockroaches) Blaberoidea Blaberidae (Giant cockroaches) Ectobiidae (part) Ectobiidae (part) Corydioidea Corydiidae (Sand cockroaches, etc) Nocticolidae (Cave cockroaches, etc) Mantodea (Mantises) Termites were previously regarded as a separate order Isoptera to cockroaches. However, recent genetic evidence strongly suggests that they evolved directly from 'true' cockroaches, and many authors now place them as an "epifamily" of Blattodea.[11] This evidence supported a hypothesis suggested in 1934 that termites are closely related to the wood-eating cockroaches (genus Cryptocercus). This hypothesis was originally based on similarity of the symbiotic gut flagellates in termites regarded as living fossils and wood-eating cockroaches.[13] Additional evidence emerged when F. A. McKittrick (1965) noted similar morphological characteristics between some termites and cockroach nymphs.[14] The similarities among these cockroaches and termites have led some scientists to reclassify termites as a single family, the Termitidae, within the order Blattodea.[11][15] Other scientists have taken a more conservative approach, proposing to retain the termites as the Termitoidea, an epifamily within the order. Such measure preserves the classification of termites at family level and below.[16] Description Domino cockroach Therea petiveriana, normally found in India Most species of cockroach are about the size of a thumbnail, but several species are bigger. The world's heaviest cockroach is the Australian giant burrowing cockroach Macropanesthia rhinoceros, which can reach 9 cm (3.5 in) in length and weigh more than 30 g (1.1 oz).[17] Comparable in size is the Central American giant cockroach Blaberus giganteus.[18] The longest cockroach species is Megaloblatta longipennis, which can reach 97 mm (3.8 in) in length and 45 mm (1.8 in) across.[19] A Central and South American species, Megaloblatta blaberoides, has the largest wingspan of up to 185 mm (7.3 in).[20] Head of Periplaneta americana Cockroaches are generalized insects, with few special adaptations, and may be among the most primitive living neopteran insects. They have a relatively small head and a broad, flattened body, and most species are reddish-brown to dark brown. They have large compound eyes, two ocelli, and long, flexible antennae. The mouthparts are on the underside of the head and include generalized chewing mandibles, salivary glands and various touch and taste receptors.[21] The body is divided into a thorax of three segments and a ten-segmented abdomen. The external surface has a tough exoskeleton which contains calcium carbonate and protects the inner organs and provides attachment to muscles. It is coated with wax to repel water. The wings are attached to the second and third thoracic segments. The tegmina, or first pair of wings, are tough and protective, lying as a shield on top of the membranous hind wings, which are used in flight. All four wings have branching longitudinal veins, and multiple cross-veins.[22] The three pairs of legs are sturdy, with large coxae and five claws each.[22] They are attached to each of the three thoracic segments. The front legs are the shortest and the hind legs the longest, providing the main propulsive power when the insect runs.[21] The spines on the legs were earlier considered to be sensory, but observations of the insect's gait on sand and wire meshes have demonstrated that they help in locomotion on difficult terrain. The structures have been used as inspiration for robotic legs.[23][24] The abdomen has ten segments, each with a pair of spiracles for respiration. Segment ten bears a pair of cerci, a pair of anal styles, the anus and the external genitalia. Males have an aedeagus through which they secrete sperm during copulation and females have spermathecae for storing sperm and an ovipositor through which the ootheca is laid.[21] Distribution and habitat Cockroaches are abundant throughout the world and live in a wide range of environments, especially in the tropics and subtropics.[25] Cockroaches can withstand extremely cold temperatures, allowing them to live in the Arctic. Some species are capable of surviving temperatures of −188 °F (−122 °C) by manufacturing an antifreeze made out of glycerol.[26] In North America, 50 species separated into five families are found throughout the continent.[25] 450 species are found in Australia.[27] Only about four widespread species are commonly regarded as pests.[28][29] Cockroaches occupy a wide range of habitats. Many live in leaf litter, among the stems of matted vegetation, in rotting wood, in holes in stumps, in cavities under bark, under log piles and among debris. Some live in arid regions and have developed mechanisms to survive without access to water sources. Others are aquatic, living near the surface of water bodies, including bromeliad phytotelmata, and diving to forage for food. Most of these respire by piercing the water surface with the tip of the abdomen which acts as a snorkel, but some carry a bubble of air under their thoracic shield when they submerge. Others live in the forest canopy where they may be one of the main types of invertebrate present. Here they may hide during the day in crevices, among dead leaves, in bird and insect nests or among epiphytes, emerging at night to feed.[30] Behavior A cockroach soon after ecdysis Cockroaches are social insects; a large number of species are either gregarious or inclined to aggregate, and a slightly smaller number exhibit parental care.[31] It used to be thought that cockroaches aggregated because they were reacting to environmental cues, but it is now believed that pheromones are involved in these behaviors. Some species secrete these in their feces with gut microbial symbionts being involved, while others use glands located on their mandibles. Pheromones produced by the cuticle may enable cockroaches to distinguish between different populations of cockroach by odor. The behaviors involved have been studied in only a few species, but German cockroaches leave fecal trails with an odor gradient.[31] Other cockroaches follow such trails to discover sources of food and water, and where other cockroaches are hiding. Thus, cockroaches have emergent behavior, in which group or swarm behavior emerges from a simple set of individual interactions.[32] Daily rhythms may also be regulated by a complex set of hormonal controls of which only a small subset have been understood. In 2005, the role of one of these proteins, pigment dispersing factor (PDF), was isolated and found to be a key mediator in the circadian rhythms of the cockroach.[33] Pest species adapt readily to a variety of environments, but prefer warm conditions found within buildings. Many tropical species prefer even warmer environments. Cockroaches are mainly nocturnal[34] and run away when exposed to light. An exception to this is the Asian cockroach, which flies mostly at night but is attracted to brightly lit surfaces and pale colors.[35] Collective decision-making Gregarious cockroaches display collective decision-making when choosing food sources. When a sufficient number of individuals (a "quorum") exploits a food source, this signals to newcomer cockroaches that they should stay there longer rather than leave for elsewhere.[36] Other mathematical models have been developed to explain aggregation dynamics and conspecific recognition.[37][38] Cooperation and competition are balanced in cockroach group decision-making behavior.[32] Cockroaches appear to use just two pieces of information to decide where to go, namely how dark it is and how many other cockroaches there are. A study used specially-scented roach-sized robots that appear to the roaches as real to demonstrate that once there are enough insects in a place to form a critical mass, the roaches accepted the collective decision on where to hide, even if this was an unusually lit place.[39] Social behavior When reared in isolation, German cockroaches show behavior that is different from behavior when reared in a group. In one study, isolated cockroaches were less likely to leave their shelters and explore, spent less time eating, interacted less with conspecifics when exposed to them, and took longer to recognize receptive females. Because these changes occurred in many contexts, the authors suggested them as constituting a behavioral syndrome. These effects might have been due either to reduced metabolic and developmental rates in isolated individuals or the fact that the isolated individuals hadn't had a training period to learn about what others were like via their antennae.[40] Individual American cockroaches appear to have consistently different "personalities" regarding how they seek shelter. In addition, group personality is not simply the sum of individual choices, but reflects conformity and collective decision-making.[41][42] The gregarious German and American cockroaches have elaborate social structure, chemical signalling, and "social herd" characteristics. Lihoreau and his fellow researchers stated:[32] “ The social biology of domiciliary cockroaches ... can be characterized by a common shelter, overlapping generations, non-closure of groups, equal reproductive potential of group members, an absence of task specialization, high levels of social dependence, central place foraging, social information transfer, kin recognition, and a meta-population structure.[32] ” Sounds Some species make a hissing noise while other cockroaches make a chirping noise. The Madagascar hissing cockroach produces its sound through the modified spiracles on the fourth abdominal segment. Several different hisses are produced, including disturbance sounds, produced by adults and larger nymphs; and aggressive, courtship and copulatory sounds produced by adult males.[43]Henschoutedenia epilamproides has a stridulatory organ between its thorax and abdomen, but the purpose of the sound produced is unclear.[44] Several Australian species practice acoustic and vibration behavior as an aspect of courtship. They have been observed producing hisses and whistles from air forced through the spiracles. Furthermore, in the presence of a potential mate, some cockroaches tap the substrate in a rhythmic, repetitive manner. Acoustic signals may be of greater prevalence amongst perching species, particularly those that live on low vegetation in Australia's tropics.[45] Biology Digestive tract Cockroaches are generally omnivorous; the American cockroach (Periplaneta americana), for example, feeds on a great variety of foodstuffs including bread, fruit, leather, starch in book bindings, paper, glue, skin flakes, hair, dead insects and soiled clothing.[46] Many species of cockroach harbor in their gut symbiotic protozoans and bacteria which are able to digest cellulose. In many species, these symbionts may be essential if the insect is to utilize cellulose; however, some species secrete cellulase in their saliva, and the wood-eating cockroach, Panesthia cribrata, is able to survive indefinitely on a diet of crystallized cellulose while being free of micro-organisms.[47] The similarity of these symbionts in the genus Cryptocercus to those in termites are such that these cockroaches have been suggested to be more closely related to termites than to other cockroaches,[48] and current research strongly supports this hypothesis about their relationships.[49] All species studied so far carry the obligate mutualistic endosymbiont bacterium Blattabacterium, with the exception of Nocticola australiensise, an Australian cave-dwelling species without eyes, pigment or wings, which recent genetic studies indicate is a very primitive cockroach.[50][51] It had previously been thought that all five families of cockroach were descended from a common ancestor that was infected with B. cuenoti. It may be that N. australiensise subsequently lost its symbionts, or alternatively this hypothesis will need to be re-examined.[51] Tracheae and breathing Like other insects, cockroaches breathe through a system of tubes called tracheae which are attached to openings called spiracles on all body segments. When the carbon dioxide level in the insect rises high enough, valves on the spiracles open and carbon dioxide diffuses out and oxygen diffuses in. The tracheal system branches repeatedly, the finest tracheoles bringing air directly to each cell, allowing gaseous exchange to take place.[52] While cockroaches do not have lungs as do vertebrates, and can continue to respire if their heads are removed, in some very large species, the body musculature may contract rhythmically to forcibly move air in and out of the spiracles; this may be considered a form of breathing.[52] Reproduction Cockroaches use pheromones to attract mates, and the males practice courtship rituals, such as posturing and stridulation. Like many insects, cockroaches mate facing away from each other with their genitalia in contact, and copulation can be prolonged. A few species are known to be parthenogenetic, reproducing without the need for males.[22] Female cockroaches are sometimes seen carrying egg cases on the end of their abdomens; the German cockroach holds about 30 to 40 long, thin eggs in a case called an ootheca. She drops the capsule prior to hatching, though live births do occur in rare instances. The egg capsule may take more than five hours to lay and is initially bright white in color. The eggs are hatched from the combined pressure of the hatchlings gulping air. The hatchlings are initially bright white nymphs and continue inflating themselves with air, becoming harder and darker within about four hours. Their transient white stage while hatching and later while molting has led to claims of albino cockroaches.[22] Development from eggs to adults takes three to four months. Cockroaches live up to a year, and the female may produce up to eight egg cases in a lifetime; in favorable conditions, she can produce 300 to 400 offspring. Other species of cockroaches, however, can produce far more eggs; in some cases a female needs to be impregnated only once to be able to lay eggs for the rest of her life.[22] The female usually attaches the egg case to a substrate, inserts it into a suitably protective crevice, or carries it about until just before the eggs hatch. Some species, however, are ovoviviparous, keeping the eggs inside their body, with or without an egg case, until they hatch. At least one genus, Diploptera, is fully viviparous.[22] Cockroaches have incomplete metamorphosis, meaning that the nymphs are generally similar to the adults, except for undeveloped wings and genitalia. Development is generally slow, and may take a few months to over a year. The adults are also long-lived, and have survived for as much as four years in the laboratory.[22] 3 millimeter cockroach nymph Female Periplaneta fuliginosa with ootheca Empty ootheca American cockroach oothecae Hardiness Cockroaches are among the hardiest insects. Some species are capable of remaining active for a month without food and are able to survive on limited resources, such as the glue from the back of postage stamps.[53] Some can go without air for 45 minutes. Japanese cockroach (Periplaneta japonica) nymphs, which hibernate in cold winters, survived twelve hours at −5 °C to −8 °C in laboratory experiments.[54] Experiments on decapitated specimens of several species of cockroach found a variety of behavioral functionality remained, including shock avoidance and escape behavior, although many insects other than cockroaches are also able to survive decapitation, and popular claims of the longevity of headless cockroaches do not appear to be based on published research.[55][56] The severed head is able to survive and wave its antennae for several hours, or longer when refrigerated and given nutrients.[56] It is popularly suggested that cockroaches will "inherit the earth" if humanity destroys itself in a nuclear war. Cockroaches do indeed have a much higher radiation resistance than vertebrates, with the lethal dose perhaps six to 15 times that for humans. However, they are not exceptionally radiation-resistant compared to other insects, such as the fruit fly.[57] The cockroach's ability to withstand radiation better than human beings can be explained through the cell cycle. Cells are most vulnerable to the effects of radiation when they are dividing. A cockroach's cells divide only once each time it molts, which is weekly at most in a juvenile roach. Since not all cockroaches would be molting at the same time, many would be unaffected by an acute burst of radiation, although lingering radioactive fallout would still be harmful.[52] Relationship with humans Cockroaches in research: Periplaneta americana in an electrophysiology experiment In research and education Because of their ease of rearing and resilience, cockroaches have been used as insect models in the laboratory, particularly in the fields of neurobiology, reproductive physiology and social behavior.[31] The cockroach is a convenient insect to study as it is large and simple to raise in a laboratory environment. This makes it suitable both for research and for school and undergraduate biology studies. It can be used in experiments on topics such as learning, sexual pheromones, spatial orientation, aggression, activity rhythms and the biological clock, and behavioral ecology.[58] Research conducted in 2014 suggests that humans fear cockroaches the most, even more than mosquitoes, due to an evolutionary aversion.[59] As pests The Blattodea include some thirty species of cockroaches associated with humans; these species are atypical of the thousands of species in the order.[60] They feed on human and pet food and can leave an offensive odor.[61] They can passively transport pathogenic microbes on their body surfaces, particularly in environments such as hospitals.[62][63] Cockroaches are linked with allergic reactions in humans.[64][65] One of the proteins that trigger allergic reactions is tropomyosin.[66] These allergens are also linked with asthma.[67] About 60% of asthma patients in Chicago are also sensitive to cockroach allergens. Studies similar to this have been done globally and all the results are similar. Cockroaches can live for a few days up to a month without food, so just because no cockroaches are visible in a home does not mean they are not there. Approximately 20-48% of homes with no visible sign of cockroaches have detectable cockroach allergens in dust.[68] Cockroaches can burrow into human ears, causing pain and hearing loss.[69][70] They may be removed with forceps, possibly after first drowning with olive oil.[71][72][73] Control Many remedies have been tried in the search for control of the major pest species of cockroaches, which are resilient and fast-breeding. Household chemicals like sodium bicarbonate (baking soda) have been suggested, without evidence for their effectiveness.[74] Garden herbs including bay, catnip, mint, cucumber, and garlic have been proposed as repellents.[75] Poisoned bait containing hydramethylnon or fipronil, and boric acid powder is effective on adults.[76] Baits with egg killers are also quite effective at reducing the cockroach population. Alternatively, insecticides containing deltamethrin or pyrethrin are very effective.[76] In Singapore and Malaysia, taxi drivers use pandan leaves to repel cockroaches in their vehicles.[77] Few parasites and predators are effective for biological control of cockroaches. Parasitoidal wasps such as Ampulex wasps sting nerve ganglia in the cockroach's thorax, temporarily paralyzing the victim, allowing the wasp to deliver an incapacitating sting into the cockroach's brain. The wasp clips the antennae with its mandibles and drinks some hemolymph before dragging the prey to a burrow, where an egg (rarely two) is laid on it.[78] The wasp larva feeds on the subdued living cockroach.[79][80] Another wasp which is considered a promising candidate for biological control is the ensign wasp Evania appendigaster which attacks cockroach oothecae to lay a single egg inside.[81][82] Ongoing research is still developing technologies allowing for mass-rearing these wasps for application releases.[83][84] Cockroaches can be trapped in a deep, smooth-walled jar baited with food inside, placed so that cockroaches can reach the opening, for example with a ramp of card or twigs on the outside. An inch or so of water or stale beer (by itself a cockroach attractant) in the jar can be used to drown any insects thus captured. The method works well with the American cockroach, but less so with the German cockroach.[85] A study conducted by scientists at Purdue University concluded that the most common cockroaches in the US, Australia and Europe were able to develop a “cross resistance” to multiple types of pesticide. This contradicted previous understanding that the animals can develop resistance against one pesticide at a time.[86] The scientists suggested that cockroaches will no longer be easily controlled using a diverse spectrum of chemical pesticides and that a mix of other means, such as traps and better sanitation, will need to be employed.[87] As food See also: Entomophagy and Cockroach farming Although considered disgusting in Western culture, cockroaches are eaten in many places around the world.[88][89] Whereas household pest cockroaches may carry bacteria and viruses, cockroaches bred under laboratory conditions can be used to prepare nutritious food.[90] In Mexico and Thailand, the heads and legs are removed, and the remainder may be boiled, sautéed, grilled, dried or diced.[88] In China, cockroaches have become popular as medicine and cockroach farming is rising with over 100 farms.[91] The cockroaches are fried twice in a wok of hot oil, which makes them crispy with soft innards that are like cottage cheese.[92][93] Fried cockroaches are ground and sold as pills for stomach, heart and liver diseases.[94] A cockroach recipe from Formosa (Taiwan) specifies salting and frying cockroaches after removing the head and entrails.[95] In traditional and homeopathic medicine In China, cockroaches are raised in large quantities for medicinal purposes.[96] Two species of cockroach were used in homeopathic medicine in the 19th century.[97] Conservation See also: Depopulation of cockroaches in post-Soviet states While a small minority of cockroaches are associated with human habitats and viewed as repugnant by many people, a few species are of conservation concern. The Lord Howe Island wood-feeding cockroach (Panesthia lata) is listed as endangered by the New South Wales Scientific Committee, but the cockroach may be extinct on Lord Howe Island itself. The introduction of rats, the spread of Rhodes grass (Chloris gayana) and fires are possible reasons for their scarcity.[98] Two species are currently listed as endangered and critically endangered by the IUCN Red List, Delosia ornata and Nocticola gerlachi.[99][100] Both cockroaches have a restricted distribution and are threatened by habitat loss and rising sea levels. Only 600 Delosia ornata adults and 300 nymphs are known to exist, and these are threatened by a hotel development. No action has been taken to save the two cockroach species, but protecting their natural habitats may prevent their extinction. In the former Soviet Union, cockroach populations have been declining at an alarming rate; this may be exaggerated, or the phenomenon may be temporary or cyclic.[101] One species of roach, Simandoa conserfariam, is considered extinct in the wild. Cultural depictions Main article: Cockroaches in popular culture Madagascar hissing cockroaches kept as pets Cockroaches were known and considered repellent but useful in medicines in Classical times. An insect named in Greek "σίλφη" (silphe) has been identified with the cockroach. It is mentioned by Aristotle, saying that it sheds its skin; it is described as foul-smelling in Aristophanes' play Peace; Euenus called it a pest of book collections, being "page-eating, destructive, black-bodied" in his Analect. Virgil named the cockroach "Lucifuga" ("one that avoids light"). Pliny the Elder recorded the use of "Blatta" in various medicines; he describes the insect as disgusting, and as seeking out dark corners to avoid the light.[102][103]Dioscorides recorded the use of the "Silphe", ground up with oil, as a remedy for earache.[103] Lafcadio Hearn (1850–1904) asserted that "For tetanus cockroach tea is given. I do not know how many cockroaches go to make up the cup; but I find that faith in this remedy is strong among many of the American population of New Orleans. A poultice of boiled cockroaches is placed over the wound." He adds that cockroaches are eaten, fried with garlic, for indigestion.[104] Several cockroach species, such as Blaptica dubia, are raised as food for insectivorous pets.[105] A few cockroach species are raised as pets, most commonly the giant Madagascar hissing cockroach, Gromphadorhina portentosa.[106] Whilst the hissing cockroaches may be the most commonly kept species, there are many species that are kept by cockroach enthusiasts; there is even a specialist society: the Blattodea Culture Group (BCG), which was a thriving organisation for about 15 years although now appears to be dormant.[107] The BCG provided a source of literature for people interested in rearing cockroaches which was otherwise limited to either scientific papers, or general insect books, or books covering a variety of exotic pets; in the absence of an inclusive book one member published Introduction to Rearing Cockroaches which still appears to be the only book dedicated to rearing cockroaches.[108] Cockroaches have been used for space tests. A cockroach given the name Nadezhda was sent into space by Russian scientists as part of a Foton-M mission, during which she mated, and later became the first terrestrial animal to produce offspring that had been conceived in space.[109] Because of their long association with humans, cockroaches are frequently referred to in popular culture. In Western culture, cockroaches are often depicted as dirty pests.[110][111] In a 1750–1752 journal, Peter Osbeck noted that cockroaches were frequently seen and found their way to the bakeries, after the sailing ship Gothenburg ran aground and was destroyed by rocks.[112] Donald Harington's satirical novel The Cockroaches of Stay More (Harcourt, 1989) imagines a community of "roosterroaches" in a mythical Ozark town where the insects are named after their human counterparts. Madonna has famously quoted, "I am a survivor. 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