December 19, 2011
When Lobotomy Was Seen as Advanced
By BARRON H. LERNER, M.D.
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 awarded the 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 in schizophrenia 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.
Dr. Barron H. Lerner, professor of medicine and public health at Columbia University Medical Center, is the author, most recently, of “One for the Road: Drunk Driving Since 1900.”
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Aseguran que a Eva Perón le hicieron una lobotomía poco antes de morir
Lo afirma un profesor de Medicina de la Universidad de Columbia en un artículo para el New York Times; la operación se le habría practicado en 1952, poco antes de su muerte, para que no padeciera dolor por el cáncer terminal que sufría
El diario estadounidense The New York Times publicó una sorprendente nota firmada por el profesor de Medicina y Salud Pública de la Universidad de Columbia Barron H. Lerner en la que afirma que Eva Perón fue sometida poco antes de morir a una lobotomía para evitarle sufimiento por el cáncer terminal que padecía.
Según el artículo, a Evita se le diagnosticó un cáncer cervical avanzado en agosto de 1951. A pesar de haber sido sometida a una cirugía y radioterapia, la segunda mujer del entonces presidente Juan Domingo Perón murió en julio de 1952 a los 33 años.
De acuerdo al diario estadounidense, "en 2005, el neurocirujano húngaro George Udvarhely, quien aseguraba haber asistido a Eva en los 50 y después se mudó a la Escuela de Medicina John Hopkins, habló por primera vez en público sobre la lobotomía a la que Evita fue sometida por el dolor que le causaba el cáncer terminal. Pero no fue hasta que un neurocirujano de Yale, el doctor argentino Daniel E. Nijensohn, comenzó a investigar la aseveración del doctor Udvarhelyi, que la evidencia comenzó a acumularse".
"La investigación del doctor Nijensohn, que será publicada pronto en la revista World Neurosurgery y recientemente fue posteada online, revela varias evidencias sugestivas . Nijensohn confirmó detalles de la historia del doctor Udvarhely y encontró a otros contemporáneos de Eva que dijeron que fue sometida a una cirugía para el dolor", afirma la nota.
El Dr. Nijensohn también revela información que indica que el doctor James L. Poppen, un neurocirujano experto en el uso de lobotomía en enfermedades incurables, había sido convocado para operar a Evita en el verano de 1952. Rayos X efectuados al cráneo de Eva mostraban muescas en los lugares donde se hacen las lobotomías.
Siempre según el diario estadounidense, el doctor Nijensohn cree que la lobotomía fue efectuada en mayo o junio de 1952, lo que significa que Evita ya habría sido operada en el momento de su última aparición pública, en una limusina durante la segunda asunción de su esposo.
El artículo sugiere que tal vez Evita no supiera los detalles sobre la operación que le practicaron. Y también pone en duda que la lobotomía haya servido para calmarle el dolor. El autor de la nota asegura que en ese tiempo existía otro tratamiento para evitar el sufrimiento de este tipo de pacientes: el uso agresivo de opiáceos como la morfina, pero que los médicos "temían que los pacientes se volvieran adictos".
Fuente: La Nación
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