Dr. John Fulton sat in his book-stuffed office at Yale, speaking into his Dictaphone. He’d purchased the device, a primitive voice recorder that allowed you to temporarily preserve audio on wax cylinders, in 1927, and it quickly became a treasured possession. It allowed him to maintain an impressive correspondence with hundreds of friends and colleagues all over the world, ranging from Robert Oppenheimer to Thornton Wilder to Alfred A. Knopf. Most evenings, accompanied by a good bottle of Madeira wine, he would spend three to four hours dictating letters. The next morning one of his secretaries would transcribe them, then bring them to him for his signature. On this particular evening, August 24, 1948, Fulton was composing a letter to Max Zehnder, a young Swiss physiologist. Zehnder had visited Fulton’s primate lab two years prior and had expressed interest in pursuing research there. His special area of expertise was the examination of “brain vessels under various pathological conditions,” such as exposure to toxic chemicals. Fulton had not been able to accommodate Zehnder then, but a new opportunity presented itself.
“My dear Zehnder,” he began. “I have a proposal which I think may appeal to you. It is this: The neurosurgical group at the Hartford Hospital, with the backing of Dr. Charles Burlingame, Director of the large psychiatric nursing home (the Institute of Living) at Hartford, is prepared to give you a staff appointment for a year which would guarantee your room and board during 1948–1949 with the understanding that you would be free to study their cases of frontal lobotomy.”
Fulton sweetened the pot by offering Zehnder a simultaneous staff appointment at Fulton’s own laboratory at Yale that, while unpaid, would look good on any young scientist’s résumé. Mostly, though, he stressed the remarkable nature of the research opportunity at the asylum. “Dr. Scoville, a well trained neurosurgeon, has developed techniques for undercutting the orbital surface for removing the anterior cingulate and for undercutting Brodmann’s areas 9 and 10. Dr. Burlingame has given Scoville unlimited access to his psychiatric material. They plan to carry out these procedures on several hundred cases during the year and they are eager for collaboration on the physiological side.”
The next morning one of Fulton’s secretaries transcribed the letter, and before presenting it to Fulton for his signature she made a mimeographed copy; that copy eventually migrated into the possession of the Yale archives, which stored it alongside Fulton’s other Z-surnamed correspondents in a gray acid-free box; that box was placed in front of me on a long wooden table in a hushed, high-ceilinged reading room one afternoon six decades after the letter was written.
—
Institutions have memories.
Some institutions, such as Yale, do a good job of keeping those memories alive, preserving their documents and allowing the particulars of their pasts to be called up and reexamined days or years or decades later. This doesn’t mean that their pasts are easy to understand or that their institutional memories are laid out in any sort of coherent narrative. They’re not. But that’s part of what makes archival research stimulating. It’s an active process, and to get anything out of it, you have to put a lot in. The “finding aids” that help you navigate an archive are only rough guides, and you never know what you’re going to unearth until you start looking. Sometimes you can get a little lost. I once spent most of an afternoon reading through yellowing newspaper clippings that Fulton had taped into a scrapbook, most of them chronicling recent scientific “discoveries,” such as the following Associated Press report from April 24, 1935:
“The old idea of [the] impassive, unemotional oriental was upheld by experiments described by Dr. G. M. Stratton of the University of California. He found white native Americans much more likely to react to their emotions than Chinese or Japanese. Emotions were tested by having a large, heavy hammer strike a hard blow within a few inches of the hand of men of each racial type. The Americans, generally speaking, had much less control over themselves when the hammer struck. They exhibited keen tendency to jerk their hands away, their blood pressure rose, their breathing speeded up, their pulse raced faster.”
But sometimes those chance encounters reveal unexpected connections, and if you follow these connections from one to the other, they’ll start to form a framework. In that way, institutional memories are just as subtly and complexly interconnected as human ones.
—
Max Zehnder accepted Fulton’s offer, but he didn’t last long at the Institute of Living. On January 6, 1948, about four months after taking up his position at the asylum, he wrote a letter of resignation to my grandfather, which he cc’d to John Fulton. Zehnder’s English was imperfect, but it’s clear that tensions between the Institute of Living superintendent, Charles Burlingame, and the Connecticut State Hospital superintendent, Benjamin Simon, had flared into some sort of turf war and that Max Zehnder had become either a pawn or a prisoner, depending on your perspective.
“Dear Dr. Scoville,” Zehnder began, “I take the opportunity to thank you for all your kindness extended to me during my stay at Hartford. You are well informed about the situation and some of the difficulties encountered and as a foreigner I do not wish to interfere in these questions as I am unaware of the background in which I had no interest to penetrate.” Among the difficulties Zehnder mentioned was that Superintendent Simon “declared me that I never could give any publication in connection with the Institute of Living in Hartford,” after which Superintendent Burlingame “declared me that I should not leave the Institute even not for going over to the Hartford Hospital unless Dr. Scoville would ask for permission.”
Most of Zehnder’s complaints, however, had to do with the research he had come to America to conduct. Some of the problems he’d encountered appeared to result from simple miscommunication. For example, one of the first things Zehnder did after arriving was to take a full survey of all the patients who’d received lobotomies, making “abstracts of all their histories writing by long hand and without help.” Then, after toiling for nearly a month, he discovered that “this whole survey was already made by the Connecticut Committee of Lobotomies,” making his own survey valuable only as “an excellent Exercise in English, but not as scientific work.”
More troubling to Zehnder was what he found when he reviewed the research being conducted in the Connecticut asylums. As far as he could tell, the lobotomy experiments lacked one of the cornerstones of the scientific method: proper controls. That is, the neurosurgeons and the neuroscientists who were cutting into patients’ brains had been trying to glean the effects, and potential benefits, of the operations by studying only those patients and failing to conduct crucial comparative studies on similar patients whose brains they’d left intact. Zehnder stressed that “all observations before this time lack of any objective control necessary for real scientific work” and that for “exact investigation of effects” future lobotomy researchers would “need a simultaneous registrating control.” As it was, Zehnder complained, “with the results of my work and the means employed I could not even reach the required standard of a scientifically serious publication.”
After reading Zehnder’s letter, I wanted to learn more about the apparently dysfunctional relationship between the two asylum administrators, Simon and Burlingame. I knew that Burlingame and Fulton were close—in one of the letters Fulton wrote to my grandfather, he referred to Burlingame as “Burlie”—and I wondered whether letters between them might shed light on the matter. So on my next visit to the Yale archives, I requested to see box number 28, which contained Fulton’s letters to and from B-surnamed individuals.
His correspondence with Burlingame turned out to deal mainly with scheduling the guest lectures that Fulton occasionally gave at the Institute of Living and shed no light on the tensions between the two old asylums. Frustrated at hitting a dead end, I rifled through some of the other folders in the box, which is how I stumbled upon Fulton’s correspondence with a man named Paul Bucy.
—
Dr. Paul Bucy was a neurosurgeon and neuropathologist at
the University of Chicago, but as a postdoc in the late 1920s he had spent six months in Fulton’s lab at Yale. The two stayed in touch, and as their relationship deepened, their letters acquired a sort of breezy informality and warmth that was lacking in a lot of Fulton’s other correspondence, which tended toward terseness. Bucy, unlike many in the scientific community, seemed unintimidated by Fulton and was willing to talk straight to him. For example, in 1948, Bucy sent Fulton a letter advising him that The Precentral Motor Cortex, a textbook Bucy had edited that included chapters by Fulton and a variety of other contributors, was being reissued. The letter was a boilerplate request for any revisions that Fulton might want to make. As a form letter, it was addressed “Dear Doctor,” and at the bottom there was a stamp instead of a real signature. Fulton immediately wrote back:
I have your bedbug letter signed with a rubber stamp about the new edition of your monograph on The Precentral Motor Cortex. Dear heavens, have you so many contributors that you are unable to write a personal letter and sign it yourself? You are really too young to go in for this sort of impersonal superficiality. If I weren’t so fond of you I wouldn’t have answered the letter.
Bucy responded with a pointedly handwritten note:
My dear John, It must be nice to feel that you have so many friends that you can afford to throw gratuitous insults at the few loyal ones who remain. Believe me, I remain, sincerely yours, Paul.
It was not surprising that they’d become close. Their scientific interests were in line: Both of them were devotees of the lesion method and believed the best way to illuminate brain function was by destroying portions of the brain. Like most people in Fulton’s lab, Bucy participated in the neurological lesioning of scores of primates while there—“I don’t know that anyone ever accomplished quite as much as you did in six months,” Fulton once wrote to him, “or who used so many monkeys”—and once Bucy left the lab he continued to mine the same vein, sectioning monkey brains in the service of science. At the University of Chicago, he teamed up with a similarly inclined German neurologist named Heinrich Klüver, and the two embarked on a fruitful campaign of vivisection, culminating in what they would declare, at the 1937 meeting of the American Physiological Society, to be “the most striking behavior changes ever produced in animals.”
Their breakthrough had come about almost completely by accident. Like many brain scientists then and since, Klüver was fascinated by mind-altering substances. This fascination wasn’t only clinical: Klüver often used himself as a test subject, ingesting massive doses of various drugs and then taking copious notes. Mescaline was his hallucinogen of choice, and he recruited Bucy to help him investigate its precise neurological effects. Since Klüver had noticed that humans and primates tended to make compulsive chewing motions while tripping on mescaline, he came up with a simple, if brutal, experimental approach: He would inject a number of macaque monkeys with the drug, then have Bucy remove various parts of their nervous systems. If the removal of a particular area caused the chewing motions to cease, he would take that as evidence that it was that particular area that mescaline acted upon.
Bucy first targeted the trigeminal nerves. This had no effect. Then he went after the facial nerves. The tripping monkeys continued their compulsive chewing. Lesioning both their trigeminal nerves and facial nerves didn’t do anything, either. Finally, acting on the vague hypothesis that mescaline-induced chewing motions might be etiologically related to the spasmodic mouth movements made by patients suffering from temporal-lobe epilepsy, Bucy opened the skull of a monkey named Aurora and removed most of her temporal lobes bilaterally, including her hippocampus, uncus, and amygdala.
Once again, this did not stop Aurora’s spasmodic chewing motions.
What it did do, however, was remarkable.
Aurora instantly acquired what Bucy and Klüver deemed “psychic blindness.” The macaque, they wrote, “seems unable to recognize objects by the sense of sight. The hungry animal, if confronted with a variety of objects, will, for example, indiscriminately pick up a comb, a bakelite knob, a sunflower seed, a screw, a stick, a piece of apple, a live snake, a piece of banana, and a live rat. Each object is transferred to the mouth and then discarded if not edible.” Aurora also developed a markedly more placid emotional affect, coupled with a loss of fearfulness and “increased sexual activity involving forms of heterosexual, homosexual and autosexual behavior.” These results indicated that the temporal lobes, about which very little was known, seemed to be involved with the emotions and the sex drive. They also appeared to have an effect on memory, at least if a lack of memory was what caused Aurora’s “psychic blindness,” her inability to recognize previously known objects. Still, it was difficult to know how to interpret these findings precisely. After all, Aurora couldn’t talk.
While Bucy was conducting his mescaline research with Klüver, he received a letter from Fulton complimenting him on his latest paper, which chronicled Bucy’s experimental lesioning of the carotid sinus nerve in human beings: “The observations are exceedingly interesting, and they illustrate, as so many of your papers do, the unusual opportunities which any alert-minded neurosurgeon has to do significant physiological work, if he only has the gumption.” Then Fulton gave his former student a piece of advice, suggesting that if he wanted “to start something new, ” he should look into the lobotomy, which Walter Freeman and James Watts had just begun performing in the United States. His advice had the phrasing of a hot stock tip: “I have an idea that in a year or so this will constitute one of the major phases of neurosurgery, and I think anyone in the field would do well to get in on the ground floor.”
As it turned out, Fulton was simultaneously offering the same tip to many other people, often using almost exactly the same words. In a letter he wrote to another former student the same week, he stated that he thought the lobotomy was “going to be a highly significant procedure” and that he “would like to see someone here in New Haven get in on the ground floor and do a group of such cases.” Then he added, “I feel certain that the procedure is justified.”
It is hard to overestimate the effect that the endorsement of John Fulton had on the spread of the lobotomy. He was the most famous physiologist of his era, and his words instantly imbued what was initially a fringe-dwelling procedure with a new respectability. Fulton’s proselytizing might have owed something to the fact that his own work with chimpanzees had inspired the procedure and that the lobotomy’s ascendance would inevitably raise his own stature, but it would be unfair to call his endorsement entirely self-serving. Fulton had an ego, but he was also a passionate scientist. He hungered to understand the brain, and everything he had done up to that point in his career, the hundreds of experiments involving thousands of apes, monkeys, rats, and mice, was in service to that fundamental pursuit. Now, suddenly, if it took hold, psychosurgery offered an entirely new way to pursue that line of research, one that would involve a very different sort of animal.
Bucy, like most of his peers, responded enthusiastically to Fulton’s suggestion. “I have been very much interested in what you have to say regarding the operations in psychotic states,” he wrote a few days after receiving Fulton’s letter. The fact that Freeman and Watts had begun performing lobotomies in the United States was news to Bucy, and he told Fulton that “it is not at all unlikely that we shall get going on something similar before long.” Bucy also made clear that he would approach the practice of psychosurgery in a manner that would please his mentor: “We will go at it, of course, primarily from the aspect of studying these people from a psychological and physiological standpoint and of finding out in what respect their condition has been altered by the operation. It seems to me that most that is to be gained here is from the standpoint of study, certainly at the present time.”
—
As his correspondence with Fulton continued, however, Bucy sounded several notes of caution.
To begin with, despite certain advantages humans had over other experimental test subjec
ts, they had certain drawbacks, too. For instance, there was the fact that lobotomy patients were, well, patients.
“In animal experimentation,” Bucy wrote, “one presumably always starts with a normal organism. At least that is the basis of the greater part of our animal experimentation. In the human cases, at the present time at least, such is never true.” Bucy noted that there were historical exceptions, such as “in ancient Egypt where criminals were submitted to vivisection,” but that in the present day, “so far as the patient is concerned, any experiments which we may perform are incidental to the care and treatment of disease. It is only for that reason that he submits himself to the experimentation.”
Then there was the matter of the neurosurgeons themselves. Bucy was grateful to Fulton for inspiring a new generation to be interested in more than “mere mechanics,” but he also worried that some of these surgeons were overreaching. He fretted about ambitious but oblivious men who “have had no real experience with investigation. They have no idea what the real scientific method or approach is. They know nothing about controls.”
Finally, its experimental utility aside, the question of how to objectively evaluate the costs and benefits of the lobotomy as a treatment remained unanswered. In 1948, a respected Swedish neurosurgeon named Gosta Rylander took a subjective approach, publishing a critical paper based on extensive interviews with the families of patients he’d lobotomized. The interviews described, in chilling terms, the subtle but fundamental changes his patients had undergone. As one mother of a young woman put it, “She is my daughter but yet a different person. She is with me in body but her soul is in some way lost.” Rylander’s paper generated lots of attention within the psychosurgical community and inspired another blunt, straight-talking letter from Bucy to Fulton. “Rylander’s statements are so obviously correct,” Bucy wrote, “that no intelligent person who was not blinded by his own enthusiasm could doubt them. Frontal lobotomy is a worthwhile procedure in certain situations. But the procedure exacts a price.”
Patient H.M. Page 13