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===American leucotomy===
[[File:Lobotomy 1.jpg|thumb|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 Jackson Freeman II|Walter Freeman]], and his friend and colleague, the neurosurgeon, [[James W. Watts]].<ref>{{harvnb|Shorter|1997|p=227}}; {{harvnb|Pressman|2002|p=78}}</ref> 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.<ref name="Pressman 2002 76 Feldman 2001 649">{{harvnb|Pressman|2002|p=76}}; {{harvnb|Feldman|Goodrich|2001|p=649}}</ref> 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".<ref name="Pressman 2002 76 Feldman 2001 649" /> 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.<ref>{{harvnb|Pressman|2002|p=76}}; {{harvnb|Kotowicz|2005|p=94}}</ref> 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.{{sfn|Pressman|2002|p=73|ps=}} 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 [[neuropathology|neuropathological]] basis for insanity.{{sfn|Pressman|2002|pp=73–75|ps=}} 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".<ref>Quoted in {{harvnb|Pressman|2002|p=76}}</ref> 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.{{sfn|Pressman|2002|p=76|ps=}}
Upon receipt of Moniz's monograph, Freeman reviewed it anonymously for the ''Archives of Neurology and Psychiatry''.{{sfn|Pressman|2002|p=76|ps=}} Praising the text as one whose "importance can scarcely be overestimated",{{sfn|Pressman|2002|p=76|ps=}} 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.{{sfn|Pressman|2002|p=77|ps=}} 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.{{sfn|Pressman|2002|p=77|ps=}}
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