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Butter

Butter is a dairy product made from the fat and protein components of churned cream. It is a semi-solid emulsion at room temperature, consisting of approximately 80% butterfat. It is used at room temperature as a spread, melted as a condiment, and used as a fat in baking, sauce-making, pan frying, and other cooking procedures.

Most frequently made from cow's milk, butter can also be manufactured from the milk of other mammals, including sheep, goats, buffalo, and yaks. It is made by churning milk or cream to separate the fat globules from the buttermilk. Salt has been added to butter since antiquity to help preserve it, particularly when being transported; salt may still play a preservation role but is less important today as the entire supply chain is usually refrigerated. In modern times, salt may be added for taste. Food coloring is sometimes added to butter. Rendering butter, removing the water and milk solids, produces clarified butter, or ghee, which is almost entirely butterfat.

Butter is a water-in-oil emulsion resulting from an inversion of the cream, where the milk proteins are the emulsifiers. Butter remains a firm solid when refrigerated but softens to a spreadable consistency at room temperature and melts to a thin liquid consistency at 32 to 35 C. The density of butter is 911 g/L. It generally has a pale yellow color but varies from deep yellow to nearly white. Its natural, unmodified color is dependent on the source animal's feed and genetics, but the commercial manufacturing process sometimes alters this with food colorings like annatto or carotene.

Etymology
The word butter derives (via Germanic languages) from the Latin butyrum, which is the latinisation of the Greek βούτυρον (bouturon). This may be a compound of βοῦς (bous), "ox, cow" + τυρός (turos), "cheese", that is "cow-cheese". The word turos ("cheese") is attested in Mycenaean Greek. The latinized form is found in the name butyric acid, a compound found in rancid butter and other dairy products.

Production
Unhomogenized milk and cream contain butterfat in microscopic globules. These globules are surrounded by membranes made of phospholipids (fatty acid emulsifiers) and proteins, which prevent the fat in milk from pooling together into a single mass. Butter is produced by agitating cream, which damages these membranes and allows the milk fats to conjoin, separating from the other parts of the cream. Variations in the production method will create butters with different consistencies, mostly due to the butterfat composition in the finished product. Butter contains fat in three separate forms: free butterfat, butterfat crystals, and undamaged fat globules. In the finished product, different proportions of these forms result in different consistencies within the butter; butters with many crystals are harder than butters dominated by free fats.

Churning produces small butter grains floating in the water-based portion of the cream. This watery liquid is called buttermilk, although the buttermilk most commonly sold today is instead directly fermented skimmed milk. The buttermilk is drained off; sometimes more buttermilk is removed by rinsing the grains with water. Then the grains are "worked": pressed and kneaded together. When prepared manually, this is done using wooden boards called scotch hands. This consolidates the butter into a solid mass and breaks up embedded pockets of buttermilk or water into tiny droplets.

Commercial butter is about 80% butterfat and 15% water; traditionally-made butter may have as little as 65% fat and 30% water. Butterfat is a mixture of triglyceride, a triester derived from glycerol, and three of any of several fatty acid groups. Annatto is sometimes added by U.S. butter manufacturers without declaring it on the label because the U.S. allows butter to have an undisclosed flavorless and natural coloring agent (whereas all other foods in the U.S. must label coloring agents). The preservative lactic acid is sometimes added instead of salt (and as a flavor enhancer), and sometimes additional diacetyl is added to boost the buttery flavor (in the U.S., both ingredients can be listed simply as "natural flavors"). When used together in the NIZO manufacturing method, these two flavorings produce the flavor of cultured butter without actually fully fermenting.

Types
Before modern factory butter making, cream was usually collected from several milkings and was therefore several days old and somewhat fermented by the time it was made into butter. Butter made in this traditional way (from a fermented cream) is known as cultured butter. During fermentation, the cream naturally sours as bacteria convert milk sugars into lactic acid. The fermentation process produces additional aroma compounds, including diacetyl, which makes for a fuller-flavored and more "buttery" tasting product.

Butter made from fresh cream is called sweet cream butter. Production of sweet cream butter first became common in the 19th century, when the development of refrigeration and the mechanical cream separator made sweet cream butter faster and cheaper to produce at scale (sweet cream butter can be made in 6 hours, whereas cultured butter can take up to 72 hours to make).

Cultured butter is preferred throughout continental Europe, while sweet cream butter dominates in the United States and the United Kingdom. Chef Jansen Chan, the director of pastry operations at the International Culinary Center in Manhattan, says, "It's no secret that dairy in France and most of Europe is higher quality than most of the U.S." The combination of butter culturing, the 82% butterfat minimum (as opposed to the 80% minimum in the U.S. ), and the fact that French butter is grass-fed, accounts for why French pastry (and French food in general) has a reputation for being richer-tasting and flakier. Cultured butter is sometimes labeled "European-style" butter in the United States, although cultured butter is made and sold by some, especially Amish, dairies.

Milk that is to be made into butter is usually pasteurized during production to kill pathogenic bacteria and other microbes. Butter made from raw milk is very rare and can be dangerous because it is made from unpasteurized milk. Commercial raw milk products are not legal to sell through interstate commerce in the United States and very rare in Europe. Raw cream butter is generally only found made at home by consumers who have purchased raw whole milk directly from dairy farmers, skimmed the cream themselves, and made butter with it.

Clarified butter

Clarified butter has almost all of its water and milk solids removed, leaving almost-pure butterfat. Clarified butter is made by heating butter to its melting point and then allowing it to cool; after settling, the remaining components separate by density. At the top, whey proteins form a skin, which is removed. The resulting butterfat is then poured off from the mixture of water and casein proteins that settle to the bottom.

Ghee is clarified butter that has been heated to around 120 °C (250 °F) after the water evaporated, turning the milk solids brown. This process flavors the ghee, and also produces antioxidants that help protect it from rancidity. Because of this, ghee can be kept for six to eight months under normal conditions.

Whey butter
Cream may be separated (usually by a centrifuge or a sedimentation) from whey instead of milk, as a byproduct of cheese-making. Whey butter may be made from whey cream. Whey cream and butter have a lower fat content and taste more salty, tangy and "cheesy". They are also cheaper to make than "sweet" cream and butter. The fat content of whey is low, so 1000 pounds of whey will typically give only three pounds of butter.

European butters
There are several butters produced in Europe with protected geographical indications; these include:
 * Beurre d'Ardenne, from Belgium
 * Beurre d'Isigny, from France
 * Beurre Charentes-Poitou (Which also includes: Beurre des Charentes and Beurre des Deux-Sèvres under the same classification), from France
 * Beurre Rose, from Luxembourg
 * Mantequilla de Soria, from Spain
 * Mantega de l'Alt Urgell i la Cerdanya, from Spain
 * Rucava white butter (Rucavas baltais sviests), from Latvia

History

Elaine Khosrova traces the invention of butter back to Neolithic-era Africa 8,000 B.C in her book. A later Sumerian tablet, dating to approximately 2,500 B.C., describes the butter making process, from the milking of cattle, while contemporary Sumerian tablets identify butter as a ritual offering.

In the Mediterranean climate, unclarified butter spoils quickly, unlike cheese, so it is not a practical method of preserving the nutrients of milk. The ancient Greeks and Romans seemed to have considered butter a food fit more for the northern barbarians. A play by the Greek comic poet Anaxandrides refers to Thracians as boutyrophagoi, "butter-eaters". In his Natural History, Pliny the Elder calls butter "the most delicate of food among barbarous nations" and goes on to describe its medicinal properties. Later, the physician Galen also described butter as a medicinal agent only.

Middle Ages
In the cooler climates of northern Europe, people could store butter longer before it spoiled. Scandinavia has the oldest tradition in Europe of butter export trade, dating at least to the 12th century. After the fall of Rome and through much of the Middle Ages, butter was a common food across most of Europe—but had a low reputation, and so was consumed principally by peasants. Butter slowly became more accepted by the upper class, notably when the Roman Catholic Church allowed its consumption during Lent from the early 16th century. Bread and butter became common fare among the middle class and the English, in particular, gained a reputation for their liberal use of melted butter as a sauce with meat and vegetables.

In antiquity, butter was used for fuel in lamps, as a substitute for oil. The Butter Tower of Rouen Cathedral was erected in the early 16th century when Archbishop Georges d'Amboise authorized the burning of butter during Lent, instead of oil, which was scarce at the time.

Across northern Europe, butter was sometimes packed into barrels (firkins) and buried in peat bogs, perhaps for years. Such "bog butter" would develop a strong flavor as it aged, but remain edible, in large part because of the cool, airless, antiseptic and acidic environment of a peat bog. Firkins of such buried butter are a common archaeological find in Ireland; the National Museum of Ireland – Archaeology has some containing "a grayish cheese-like substance, partially hardened, not much like butter, and quite free from putrefaction." The practice was most common in Ireland in the 11th–14th centuries; it ended entirely before the 19th century.

Industrialization
Until the 19th century, the vast majority of butter was made by hand, on farms. Butter also provided extra income to farm families. They used wood presses with carved decoration to press butter into pucks or small bricks to sell at nearby markets or general stores. The decoration identified the farm that produced the butter. This practice continued until production was mechanized and butter was produced in less decorative stick form.

Like Ireland, France became well known for its butter, particularly in Normandy and Brittany. Butter consumption in London in the mid-1840s was estimated at 15,357 tons annually.

The first butter factories appeared in the United States in the early 1860s, after the successful introduction of cheese factories a decade earlier. In the late 1870s, the centrifugal cream separator was introduced, marketed most successfully by Swedish engineer Carl Gustaf Patrik de Laval.

In 1920, Otto Hunziker authored The Butter Industry, Prepared for Factory, School and Laboratory, a well-known text in the industry that enjoyed at least three editions (1920, 1927, 1940). As part of the efforts of the American Dairy Science Association, Hunziker and others published articles regarding: causes of tallowiness (an odor defect, distinct from rancidity, a taste defect); mottles (an aesthetic issue related to uneven color); introduced salts; the impact of creamery metals and liquids; and acidity measurement. These and other ADSA publications helped standardize practices internationally.

Butter consumption declined in most western nations during the 20th century, mainly because of the rising popularity of margarine, which is less expensive and, until recent years, was perceived as being healthier. In the United States, margarine consumption overtook butter during the 1950s, and it is still the case today that more margarine than butter is eaten in the U.S. and the EU.

Worldwide production
In 1997, India produced 1470000 MT of butter, most of which was consumed domestically. Second in production was the United States (522000 MT), followed by France (466000 MT), Germany (442000 MT), and New Zealand (307000 MT). France ranks first in per capita butter consumption with 8 kg per capita per year. In terms of absolute consumption, Germany was second after India, using 578000 MT of butter in 1997, followed by France (528000 MT), Russia (514000 MT), and the United States (505000 MT). New Zealand, Australia, Denmark and Ukraine are among the few nations that export a significant percentage of the butter they produce.

Different varieties are found around the world. Smen is a spiced Moroccan clarified butter, buried in the ground and aged for months or years. A similar product is maltash of the Hunza Valley, where cow and yak butter can be buried for decades, and is used at events such as weddings. Yak butter is a specialty in Tibet; tsampa, barley flour mixed with yak butter, is a staple food. Butter tea is consumed in the Himalayan regions of Tibet, Bhutan, Nepal and India. It consists of tea served with intensely flavored—or "rancid"—yak butter and salt. In African and Asian nations, butter is sometimes traditionally made from sour milk rather than cream. It can take several hours of churning to produce workable butter grains from fermented milk.

Storage
Normal butter softens to a spreadable consistency around 15 °C (60 °F), well above refrigerator temperatures. The "butter compartment" found in many refrigerators may be one of the warmer sections inside, but it still leaves butter quite hard. Until recently, many refrigerators sold in New Zealand featured a "butter conditioner", a compartment kept warmer than the rest of the refrigerator—but still cooler than room temperature—with a small heater. Keeping butter tightly wrapped delays rancidity, which is hastened by exposure to light or air, and also helps prevent it from picking up other odors. Wrapped butter has a shelf life of several months at refrigerator temperatures. Butter can also be frozen to extend its storage life.

United States
In the United States, butter has traditionally been made into small, rectangular blocks by means of a pair of wooden butter paddles. It is usually produced in 4 oz sticks that are individually wrapped in waxed or foiled paper, and sold as a 1 lb package of 4 sticks. This practice is believed to have originated in 1907, when Swift and Company began packaging butter in this manner for mass distribution. Due to historical differences in butter printers (machines that cut and package butter), 4-ounce sticks are commonly produced in two different shapes:
 * The dominant shape east of the Rocky Mountains is the Elgin, or Eastern-pack shape, named for a dairy in Elgin, Illinois. The sticks measure 4+3/4 x and are typically sold stacked two by two in elongated cube-shaped boxes.
 * West of the Rocky Mountains, butter printers standardized on a different shape that is now referred to as the Western-pack shape. These butter sticks measure 3+1/4 x and are usually sold with four sticks packed side-by-side in a flat, rectangular box.

Most butter dishes are designed for Elgin-style butter sticks.

Elsewhere
Outside of the United States, butter is measured for sale by mass (rather than by volume or unit/stick), and is often sold in 250 g and 500 g packages.

Bulk packaging
Since the 1940s, but more commonly the 1960s, butter pats have been individually wrapped and packed in cardboard boxes. Prior to use of cardboard, butter was bulk packed in wood. The earliest discoveries used firkins. From about 1882 wooden boxes were used, as the introduction of refrigeration on ships brought about longer transit times. Butter boxes were generally made with woods whose resin would not taint the butter, such as sycamore, kahikatea, hoop pine, maple, or spruce. They commonly weighed a firkin - 56 lb.

In cooking and gastronomy
Butter has been considered indispensable in French cuisine since the 17th century. Chefs and cooks have extolled its importance: Fernand Point said "Donnez-moi du beurre, encore du beurre, toujours du beurre!" ('Give me butter, more butter, still more butter!'); Julia Child said "With enough butter, anything is good." Melted butter plays an important role in the preparation of sauces, notably in French cuisine. Beurre noisette (hazelnut butter) and Beurre noir (black butter) are sauces of melted butter cooked until the milk solids and sugars have turned golden or dark brown; they are often finished with an addition of vinegar or lemon juice. Hollandaise and béarnaise sauces are emulsions of egg yolk and melted butter. Hollandaise and béarnaise sauces are stabilized with the powerful emulsifiers in the egg yolks, but butter itself contains enough emulsifiers—mostly remnants of the fat globule membranes—to form a stable emulsion on its own.

Beurre blanc (white butter) is made by whisking butter into reduced vinegar or wine, forming an emulsion with the texture of thick cream. Beurre monté (prepared butter) is melted but still emulsified butter; it lends its name to the practice of "mounting" a sauce with butter: whisking cold butter into any water-based sauce at the end of cooking, giving the sauce a thicker body and a glossy shine—as well as a buttery taste.

Butter is used for sautéing and frying, although its milk solids brown and burn above 150 °C (250 °F)—a rather low temperature for most applications. The smoke point of butterfat is around 200 °C (400 °F), so clarified butter or ghee is better suited to frying.

Butter fills several roles in baking, including making possible a range of textures, making chemical leavenings work better, tenderizing proteins, and enhancing the tastes of other ingredients. It is used in a similar manner to other solid fats like lard, suet, or shortening, but has a flavor that may better complement sweet baked goods.

Compound butters are mixtures of butter and other ingredients used to flavor various dishes.

Nutritional information
Butter (salted during manufacturing) is 16% water, 81% fat, and 1% protein, with negligible carbohydrates (provided from table source as 100 g). Saturated fat is 51% of total fats in butter (table source).

In a reference amount of 100 g, butter supplies 717 calories and 76% of the Daily Value (DV) for vitamin A, 15% DV for vitamin E, and 28% DV for sodium, with no other micronutrients in significant content (table). In 100 grams, salted butter contains 215 mg of cholesterol (table source).

As butter is essentially just the milk fat, it contains only traces of lactose, so moderate consumption of butter is not a problem for lactose intolerant people. People with milk allergies may still need to avoid butter, which contains enough of the allergy-causing proteins to cause reactions.

Health concerns
A 2015 study concluded that "hypercholesterolemic people should keep their consumption of butter to a minimum, whereas moderate butter intake may be considered part of the diet in the normocholesterolemic population."

A meta-analysis and systematic review published in 2016 found relatively small or insignificant overall associations of a dose of 14g/day of butter with mortality and CVD, and consumption was insignificantly inversely associated with incidence of diabetes. The study states that "findings do not support a need for major emphasis in dietary guidelines on either increasing or decreasing butter consumption."

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The Star Beast (novel)

The Star Beast is a 1954 science fiction novel by Robert A. Heinlein about a high school senior who discovers that his extraterrestrial pet is more than it appears to be. The novel was originally serialised, somewhat abridged (as Star Lummox), in The Magazine of Fantasy & Science Fiction (May, June, July 1954) as Star Lummox and then published in hardcover as part of Scribner's series of Heinlein juveniles.

Plot summary
In the future, Earth has had interstellar spaceflight for centuries and has made contact with numerous extraterrestrial intelligent species. John Thomas Stuart XI, the teenage protagonist, lives in a small Rocky Mountain town, Westville, caring for Lummox, an extraterrestrial beast his great-grandfather had brought home. Lummox has learned how to speak, and has gradually grown from the size of a collie pup to a ridable behemoth—especially after consuming a used car. The childlike Lummox is perceived to be a neighborhood nuisance and, upon leaving the Stuart property one day, causes substantial property damage across the city. John's widowed mother wants him to get rid of it, and brings an action in the local court to have it destroyed.

Desperate to save his pet, John Thomas considers selling Lummox to a zoo. He rapidly changes his mind and runs away from home, riding into the nearby wilderness on Lummox's back. His girlfriend Betty Sorenson joins him and suggests bringing the beast back into town and hiding it in a neighbor's greenhouse. However, it is not easy to conceal such a large creature. Eventually, the court orders Lummox destroyed. City officials try several methods to kill Lummox but fail, as his alien physiology appears to be virtually invulnerable to ordinary weapons or poisons, and Lummox does not even realize they are attempting to execute him.

Meanwhile, at the Earth government Department of Spacial Affairs, Mr. Kiku, an experienced diplomat, is dealing with the Hroshii, a previously unknown, advanced and powerful alien race. They demand the return of their lost child, or they will destroy Earth. A friendly alien diplomat of a third species intimates that the threat is not an empty one. Initially, no one associates Lummox with the newcomers, in part due to the size difference (Lummox was overfed). Lummox is finally identified as important royalty of the Hroshii, as well as approximately female (the Hroshii have six sexes). It turns out that the relationship between John Thomas and Lummox is the only thing that saves Earth from destruction. From her viewpoint, during her centuries on Earth, the young but extremely long-lived Lummox has been pursuing a hobby: the raising of John Thomases. She makes it clear to the other Hroshii that she intends to continue doing so. This gives Mr. Kiku, the chief negotiator, the leverage he needs to pressure the aliens into establishing diplomatic relations. At the insistence of Lummox, the newly married John and Betty accompany her back to the Hroshii homeworld as part of the human diplomatic mission.

Reception
Damon Knight wrote: "This is a novel that won't go bad on you. Many of science fiction's triumphs, even from as little as ten years ago, are unreadable today; they were shoddily put together, not meant for re-use. But Heinlein is durable. I've read this story twice, so far – once in the Fantasy and Science Fiction serialized version, once in hard covers – and expect to read it again, sooner or later, for pleasure.  I don't know any higher praise."

Groff Conklin described the novel as "one of Heinlein's most enchanting tales." P. Schuyler Miller found The Star Beast to be "one of the best of 1954."

Editions
The F&SF serialization has a series of illustrations by Fred Kirberger (two covers plus black and white interior art). Although the secondary protagonist Mr. Kiku is clearly portrayed in the text as a black Kenyan, he is illustrated as a white man. None of Kirberger's art depicts Lummox or the other Hroshii except as vague shapes or textures at the edges of some scenes. The original Scribner's hardcover edition has cover art and a frontispiece by Clifford Geary that do depict Lummox.

Some paperback editions and the Science Fiction Book Club hard cover edition omit page 148 of Chapter VIII, "The Sensible Thing to Do", which was in the Scribner's edition and the magazine serialization. In this chapter, John Thomas rereads the entries in his great-grandfather's diary of how Lummox was found. Of significance on the omitted page is that:

"The diary skipped a couple of days; the Trail Blazer had made an emergency raise-ship and Assistant Powerman J. T. Stuart had been too busy to write. John Thomas knew why ... the negotiations opened so hopefully with the dominant race had failed ... no one knew why."

The rest of the page summarizes John Thomas' grandfather's family history, discussing the first John Thomas Stuart, who had retired as a sea captain. The history, as reprinted in the paperback and Science Fiction Book Club editions, then resumes with John Thomas Stuart, Junior.

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: The Star Beast (novel)


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Talk:Hamlet

Hamlet Date
For those interested in this question I will try to formulate my position here, as it keeps being reverted from the front page. Recently a few scholars have become very good at finding ingenious ways of fact checking some influential but in the end speculative conjectures in the field of Shakespeare and Renaissance studies. As a result some of the conjectures have been refuted and some beliefs have been revised. The dating of Hamlet at present is given on the page to sometime between 1599 and 1601, which is almost certainly wrong. My first attempt at a fix was to delete this, because it must now be considered active misinformation. When this was reverted by user:Xover, because the introduction was supposed to reflect the body of the text, I tried to insert a reference to the most thorough and study I have found in researching this:

"The most thorough attempt of dating Hamlet is done by Terri Bourus in her Young Shakespeare's Young Hamlet. She believes that the version in the First Quarto (Q1) is the one that Thomas Nashe alluded to in 1589, meaning that it was written before this. The version of Hamlet found in Q1 might thus be Shakespeare's first play. She thinks he made a major revision of this in 1602 to produce the version that is found in the First Folio. A minor revision of this was done in 1603/4 to produce the version found in the Second Quarto. The version of Hamlet that has later been canonized is a conflation of the versions in the First Folio and the Second Quarto."

Her book length analysis is impressive both for its methodology and for the completeness of the review. It is also quoted and discussed in every later attempt at dating Hamlet I have looked at, and I think giving her view would be an incremental improvement on the dating section as it is that hopefully others would expand with further sources, if they liked. This was again reverted by user:Xover, as he demands consensus on such changes. user:Xover is obviously very knowledgable on things Shakespeare in general, but equally obviously not an expert on this question in partucular. So I guess that now the present misinformation will be on the page until he has gotten up to speed on the subject.

Here are some of the sources I have read in researching this, which might interest others:

 * Jolly, Margrethe. The First Two Quartos of Hamlet: A New View of the Origins and Relationship of the Texts. McFarland, 2014.

 * Taylor, Gary, and Rory Loughnane. “The Canon and Chronology of Shakespeare’s Works.” In The New Oxford Shakespeare: Authorship Companion, edited by Gary Taylor and Gabriel Egan, 415–602, 2017.

 * Jackson, MacDonald P. “Vocabulary, Chronology, and the First Quarto (1603) of Hamlet.” Medieval & Renaissance Drama in England 31 (2018): 17–42. https://www.jstor.org/stable/26800525.

 * Dutton, Richard. Shakespeare, Court Dramatist. Kindle. Oxford: Oxford University Press, 2016.

There are other sources referenced in some of these that could also be of interest. I have researched this as background for my thesis, but cannot at share all my views here yet, as I am afraid the cheating robots will think I grabbed stuff off wikipedia. So hopefully somebody else will pick up the thread to get the dating section up to par. (If they can get it past the gate keeper, that is.)

Anagram
I suggest adding after the sentence ending with footnote 4, the observation, “Tellingly, Hamlet is an anagram of Amleth, and one achieved by simply moving the last letter.” Atomikiwi (talk) 04:27, 24 March 2024 (UTC)
 * Which reliable sources mention this? AndyJones (talk) 13:30, 25 March 2024 (UTC)

Character name misspelling
"Voltemand" is the spelling in the text, rather than "Voltimand".

title: Talk:Hamlet


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Lobotomy

A lobotomy or leucotomy is a discredited form of neurosurgical treatment for psychiatric disorder or neurological disorder (e.g. epilepsy, depression) that involves severing connections in the brain's prefrontal cortex. The surgery causes most of the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain, to be severed.

In the past, this treatment was used for treating psychiatric disorders as a mainstream procedure in some countries. The procedure was controversial from its initial use, in part due to a lack of recognition of the severity and chronicity of severe and enduring psychiatric illnesses, so it was said to be an inappropriate treatment.

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", although the awarding of the prize has been subject to controversy.

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. A large number of patients were gay men. More lobotomies were performed on women than on men: a 1951 study found that nearly 60% of American lobotomy patients were women, and limited data shows that 74% of lobotomies in Ontario from 1948 to 1952 were performed on female patients. From the 1950s onward, lobotomy began to be abandoned, first in the Soviet Union and Europe.

Outline
Historically, patients of lobotomy were, immediately following surgery, often stuporous 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.

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 mostly left emotionally blunted and restricted in their intellectual range.

The consequences of the operation have been described as "mixed". 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. A few people managed to return to responsible work, while at the other extreme, people were left with severe and disabling impairments. 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. On average, there was a mortality rate of approximately 5% during the 1940s.

The lobotomy procedure could have severe negative effects on a patient's personality and ability to function independently. Lobotomy patients often show a marked reduction in initiative and inhibition. They may also exhibit difficulty imagining themselves in the position of others because of decreased cognition and detachment from society.

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 behaviour, Freeman advised a system of rewards (ice cream) and punishment (smacks).

History
In the early 20th century, the number of patients residing in mental hospitals increased significantly while little in the way of effective medical treatment was available. 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. The new "heroic" physical therapies devised during this experimental era, including malarial therapy for general paresis of the insane (1917), deep sleep therapy (1920), insulin shock therapy (1933), cardiazol shock therapy (1934), and electroconvulsive therapy (1938), helped to imbue the therapeutically moribund and demoralised psychiatric profession with a renewed sense of optimism in the curability of insanity and the potency of their craft. 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.

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". For Roy Porter, once the doyen of medical history, 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. 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, were at least 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. Today, lobotomy has become a disparaged procedure, a byword for medical barbarism and an exemplary instance of the medical trampling of patients' rights.

Early psychosurgery

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. 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. Burckhardt's hypothesis was that by deliberately creating lesions in regions of the brain identified as association centers, a transformation in behaviour might ensue. 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. He reasoned, however, that removing material from either of the sensory or motor zones could give rise to "grave functional disturbance". 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. Intending to ameliorate symptoms in those with violent and intractable conditions rather than effect a cure, Burckhardt began operating on patients in December 1888, but both his surgical methods and instruments were crude and the results of the procedure were mixed at best. 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. Complications included motor weakness, epilepsy, sensory aphasia and "word deafness". Claiming a success rate of 50 percent, 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.

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. 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. "We have quoted this data to show not only how groundless but also how dangerous these operations were. We are unable to explain how their author, holder of a degree in medicine, could bring himself to carry them out ..."

The authors neglected to mention, however, that in 1910 Puusepp himself had performed surgery on the brains of three mentally ill patients, sectioning the cortex between the frontal and parietal lobes. 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. By 1937, Puusepp, despite his earlier criticism of Burckhardt, was increasingly persuaded that psychosurgery could be a valid medical intervention for the mentally disturbed. 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.

Development
Leucotomy was first undertaken in 1935 under the direction of the Portuguese neurologist (and inventor of the term psychosurgery) António Egas Moniz. First developing an interest in psychiatric conditions and their somatic treatment in the early 1930s, Moniz apparently conceived a new opportunity for recognition in the development of a surgical intervention on the brain as a treatment for mental illness.

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. 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. 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. At the 1935 Congress, with Moniz in attendance, Fulton and Jacobsen presented two chimpanzees, named Becky and Lucy who had had frontal lobectomies and subsequent changes in behaviour and intellectual function. 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. 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". 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.

Moniz began his experiments with leucotomy just three months after the congress had 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. 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. 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. 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. 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.

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. 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. 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. 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 with 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. Cases were reported where mental symptoms were alleviated following the surgical removal of diseased or damaged brain tissue. 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 those with the condition. 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. 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. This work, while influential, was not without its critics due to deficiencies in experimental design.

The first bilateral lobectomy of a human subject was performed by the American neurosurgeon Walter Dandy in 1930. The neurologist Richard Brickner reported on this case in 1932, relating that the recipient, known as "Patient A", while experiencing a blunting of affect, had no apparent decrease in intellectual function and seemed, at least to the casual observer, perfectly normal. Brickner concluded from this evidence that "the frontal lobes are not 'centers' for the intellect". 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. 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 as part of its deliberations, "a remarkable symposium ... on the functions of the frontal lobes". 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". This parallel symposium contained numerous papers by neurologists, neurosurgeons and psychologists; amongst these was one by Brickner, which impressed Moniz greatly, that again detailed the case of "Patient A". 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. 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.

Nor was Moniz the only medical practitioner in the 1930s to have contemplated procedures directly targeting the frontal lobes. 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. 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. 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". 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. 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. In Romania, Ody's procedure was adopted by Dimitri Bagdasar and Constantinesco working out of the Central Hospital in Bucharest. 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".

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, in essence he simply interpreted this new neurological research in terms of the old psychological theory of associationism. 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". As Moniz wrote in 1936: "[The] mental troubles must have ... a relation with the formation of cellulo-connective groupings, which become more or less fixed. The cellular bodies may remain altogether normal, their cylinders will not have any anatomical alterations; but their multiple liaisons, very variable in normal people, may have arrangements more or less fixed, which will have a relation with persistent ideas and deliria in certain morbid psychic states."

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", thus removing their fixed pathological brain circuits. Moniz believed the brain would functionally adapt to such injury. 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.

First leucotomies
On 12 November 1935 at the Hospital Santa Marta in Lisbon, Moniz initiated the first of a series of operations on the brains of people with mental illnesses. 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. As Moniz lacked training in neurosurgery and his hands were impaired by gout, the procedure was performed under general anaesthetic by Pedro Almeida Lima, who had previously assisted Moniz with his research on cerebral angiography. The intention was to remove some of the long fibres that connected the frontal lobes to other major brain centres. 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" so as to destroy the connecting fibres, or association tracts, and create what Moniz termed a "frontal barrier". 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. 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. For the ninth patient they introduced a surgical instrument called a leucotome; this was a cannula that was 11 cm in length and 2 cm in diameter. It had a retractable wire loop at one end that, when rotated, produced a 1 cm diameter circular lesion in the white matter of the frontal lobe. 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.

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. The patients were aged between 27 and 62 years of age; twelve were female and eight were male. Nine of the patients were diagnosed with depression, six with schizophrenia, two with panic disorder, and one each with mania, catatonia and manic-depression. Their most prominent symptoms were anxiety and agitation. The duration of their 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. Patients were normally operated on the day they arrived at Moniz's clinic and returned within ten days to the Miguel Bombarda Mental Hospital. A perfunctory post-operative follow-up assessment took place anywhere from one to ten weeks following surgery. 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". Moniz asserted that these effects were transitory and, 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.

Reception
Moniz rapidly disseminated his results through articles in the medical press and a monograph in 1936. Initially, however, the medical community appeared hostile to the new procedure. 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. 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, declaring that the patients who had been returned to his care post-operatively were "diminished" and had experienced a "degradation of personality". 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." 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. 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. 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.

Italian leucotomy
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, only six operations had been undertaken before 1942. 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.

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. 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. 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. The major centre for leucotomy in Italy was the Racconigi Hospital, where the experienced neurosurgeon Ludvig Puusepp provided a guiding hand. Under the medical directorship of Emilio Rizzatti, the medical personnel at this hospital had completed at least 200 leucotomies by 1939. Reports from clinicians based at other Italian institutions detailed significantly fewer leucotomy operations.

Experimental modifications of Moniz's operation were introduced with little delay by Italian medical practitioners. Most notably, in 1937 Amarro Fiamberti, the medical director of a psychiatric institution in Varese, first devised the transorbital procedure whereby the frontal lobes were accessed through the eye sockets. 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. 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. Fiamberti's innovation of Moniz's method would later prove inspirational for Walter Freeman's development of transorbital lobotomy.

American leucotomy
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. 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. 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". 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. 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. 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. 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". 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.

Upon receipt of Moniz's monograph, Freeman reviewed it anonymously for the Archives of Neurology and Psychiatry. Praising the text as one whose "importance can scarcely be overestimated", 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. 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.

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".

Transorbital lobotomy
The Freeman–Watts prefrontal lobotomy still required drilling holes in the skull, 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.

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 from his own kitchen and began testing the idea on grapefruit 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 centimetres (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 centimetres ($4/5$ in) into the brain, before being pivoted around 28 degrees each side, to cut outward and again inward. (In a more radical variation at the end of the last cut described, the butt of the orbitoclast was forced upward so the tool cut vertically down the side of the cortex of the interhemispheric 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.

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.) 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. 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 toward 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. An estimated 40% of Freeman's patients were gay men, lobotomized to change their sexual orientation.

Prevalence
In the United States, approximately 40,000 people were lobotomized and in England, 17,000 lobotomies were performed. According to one estimate, in the three Nordic countries of Denmark, Norway, and Sweden, a combined figure of approximately 9,300 lobotomies were performed. Scandinavian hospitals lobotomized 2.5 times as many people per capita as hospitals in the US. According to another estimate, Sweden lobotomized at least 4,500 people between 1944 and 1966, mainly women. This figure includes young children. And in Norway, there were 2,005 known lobotomies. In Denmark, there were 4,500 known lobotomies. In Japan, the majority of lobotomies were performed on children with behaviour problems. The Soviet Union banned the practice in 1950 on moral grounds. In Germany, it was performed only a few times. By the late 1970s, the practice of lobotomy had generally ceased, although it continued as late as the 1980s in France.

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." 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."

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."

The Soviet Union officially banned the procedure in 1950 on the initiative of Gilyarovsky. 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". By the 1970s, numerous countries had banned the procedure, as had several US states.

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.

Torsten Wiesel has called the award of the Nobel Prize to Moniz an "astounding [error] of judgment... a terrible mistake", and there have been calls for the Nobel Foundation to rescind the award; the Foundation has not done so, and its website still hosts an article defending lobotomy.

Notable cases

 * Rosemary Kennedy, sister of US president John F. Kennedy, underwent a lobotomy in 1941 that left her incapacitated and institutionalized for the rest of her life.
 * Howard Dully wrote a memoir of his late-life discovery that he had been lobotomized in 1960 at age 12.
 * Josef Hassid, a Polish violinist and composer, was diagnosed with schizophrenia and died at the age of 26 following a lobotomy performed on him in England.
 * Swedish modernist painter Sigrid Hjertén died following a lobotomy in 1948.
 * 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 some of his works.
 * 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.
 * In 2011, Daniel Nijensohn, an Argentine-born neurosurgeon at Yale, examined X-rays of Eva Perón and concluded that she underwent a lobotomy for the treatment of pain and anxiety in the last months of her life.

Literary and cinematic portrayals
Lobotomies have been featured in several literary and cinematic presentations that both reflected society's attitude toward the procedure and, at times, changed it. Writers and film-makers have played a pivotal role in turning public sentiment against the procedure.

 * 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".

 * Tennessee Williams criticized lobotomy in his play Suddenly, Last Summer (1958) because it was sometimes inflicted on homosexuals – to render them "morally sane". 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 her son. 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?".

 * 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."

 * In Sylvia Plath's 1963 novel The Bell Jar, the protagonist reacts with horror to the "perpetual marble calm" of a lobotomized young woman.

 * Elliott Baker's 1964 novel and 1966 film version, A Fine Madness, portrays the dehumanizing lobotomy of a womanizing, quarrelsome poet who, afterward, is just as aggressive as ever. The surgeon is depicted as an inhumane crackpot.

 * The 1982 biopic film Frances depicts actress Frances Farmer (the subject of the film) undergoing transorbital lobotomy (though the idea that a lobotomy was performed on Farmer, and that Freeman performed it, has been criticized as having little or no factual foundation).
 * In season 4 of BoJack Horseman there is a lobotomized character – Honey Sugarman

 * The 2018 film The Mountain centers on lobotomy, attitudes about mental health in general, in 1950s America. The protagonist, a young man whose mother had been lobotomized, takes a job as a medical photographer for a doctor whose character is loosely based on Freeman.

title: Lobotomy


text:
Talk:Analytic geometry

Relationship between algebra and geometry
''The relationship between algebra and geometry is nontrivial. There exist proofs of this relationship based on the theory of geometry and notions of geometric length.'' What does this mean? Richard Pinch 19:23, 26 October 2006 (UTC)

 * I've changed it to what I assume it meant. A mildly interesting point for our wonkish bretheren: can this metatheorem that everyone knows be given an accessible reference? Charles Matthews 21:24, 26 October 2006 (UTC)

 * It seems non-trivial. Euclidean geometry is consistent, yet the same cannot be said of arithmetic. Tarski's work comes to mind. So how do you quickly show that analytic geometry doesn't let you talk about the integers or rationals? Analytic geometry is routine and algorithmically decidable via Grobner bases, I think. — Preceding unsigned comment added by Amcfreely (talk • contribs) 02:12, 6 January 2007 (UTC)

 * (Deleting previous comment.) How silly of me. Of course, the metatheorem that Euclidean geometry = analytic geometry is proven somewhere in the course of Tarski's proof that Euclidean geometry is decidable. The key steps are to show that Tarski's axioms are interpretable in the theory of real closed fields and that there exists a decision-procedure for the latter via quantifier elimination. To clarify, Grobner bases provide more efficient algorithms for the second step. An immediate consequence is that elementary geometry is routine. Amcfreely 03:22, 6 January 2007 (UTC)

 * The line is true but has nothing to do here. — Preceding unsigned comment added by 220.255.2.166 (talk) 00:57, 30 November 2011 (UTC)

Too little info on the modern and advanced meaning
This article has Too little info on the modern and advanced meaning. Maybe this article should be renamed Analytic geometry(classical meaning) and a new article should be created Analytic geometry(modern and advanced meaning) — Preceding unsigned comment added by 220.255.2.141 (talk) 00:56, 30 November 2011 (UTC)

 * I really can not see an advantage to having words on the tin that don't match what is in the tin.  An article entitled "Analytic Geometry" should be about the modern subject of analytic geometry.   A separate article entitled "Co-ordinate Geometry" should be about, well how about, co-ordinate geometry.   Surely it would be obtuse to have it any other way, especially as this is an encyclopedia with an object of clarifying material.   FreeFlow99 (talk) 14:01, 1 December 2013 (UTC)

Analytic geometry vs Algebraic geometry
There is a lot of implicit mention of algebraic geometric concepts such as algebraic curves. To my knowledge analytic geometry is simply the study of coordinate systems. Perhaps this should be fixed. 67.252.103.23 (talk) 12:10, 11 March 2014 (UTC)

Negative Signs
Am I missing something extremely obvious, or is the very first illustration in this article (the one captioned "Cartesian coordinates") missing some negative signs? 2604:2000:EFC0:2:6101:CCF:CD4B:8D4E (talk) 23:50, 3 April 2018 (UTC)

 * Yes, it is missing negative signs. This illustration has been defective since Jan. 2015 and the creator of the diagram was aware of this as it is mentioned on the file page for this illustration. It probably should be removed. --Bill Cherowitzo (talk) 03:31, 4 April 2018 (UTC)

 * It has now been replaced (not by me) with a correct illustration. --Bill Cherowitzo (talk) 17:27, 4 April 2018 (UTC)

"Analytisk geometri" listed at Redirects for discussion
An editor has identified a potential problem with the redirect Analytisk geometri and has thus listed it for discussion. This discussion will occur at Redirects for discussion/Log/2022 February 14 until a consensus is reached, and readers of this page are welcome to contribute to the discussion. User:1234qwer1234qwer4 (talk) 06:05, 14 February 2022 (UTC)

title: Talk:Analytic geometry