lobotomies; others died. They operated on an alcoholic lawyer and Rhodes scholar who escaped from the hospital on Christmas Eve and was found, drunk, in a downtown Washington bar.

Freeman and Watts headquartered their increasingly lucrative private practice in a house at 2014 R St. SW. Watts occupied an office at ground level, their assistant manned the first floor, and Freeman worked upstairs. Lobotomy Patient No. 157 once returned to threaten their lives and two others pulled guns on Freeman when he recommended psychosurgery.

As much as some of Freeman's colleagues lamented the practice of damaging healthy brain tissue in order to treat mental illness and the absence of scientific evidence that lobotomy actually worked, doctors were even more critical of Freeman's hunger for public recognition. More than once, AMA members tried to censure him for advertising his services, which was then considered an unethical practice for physicians. The suspect advertising appeared, his accusers said, in the colorful lobotomy exhibits Freeman set up every year from 1939 through the early '40s at the annual AMA convention. Freeman targeted his displays not at other doctors, but at the press.

Nurses who cared for Freeman-Watts patients immediately after the operations grew accustomed to dealing with people who needed to be retaught how to eat and use the bathroom. The patients often made clumsy passes at their caregivers, urinated on their shoes, sat unmoving for hours, stubbornly refused to follow instructions and behaved childishly. Nurses learned that spanking and tickling could reliably distract patients from delusions and perceived threats. The most famous failure of Freeman and Watts from this period is Rosemary Kennedy (JFK's sister), who was probably the first mentally retarded person to receive a lobotomy and who has needed full-time care for the past 6o years.

Freeman believed that many of these changes were not only acceptable, but also therapeutic. He saw laziness, indifference and dullness as signs that the overcharged emotional impulses of the thalamus had successfully been derailed. The less that patients paid attention to their own troubles, the better.

Officials at state mental hospitals and veterans hospitals across the country also found the trade-offs acceptable. (An exception was William Alanson White, superintendent of Freeman's own St. Elizabeths, who never allowed lobotomies in the hospital during his tenure.) Lobotomy arrived on the scene at a time when these institutions overflowed with patients, many of them servicemen who developed mental illnesses during World War II, with no reliable courses of treatment ahead of them. Mental health practitioners desperately needed new therapies.

By 1945, however, Freeman was starting to doubt the effectiveness of his standard lobotomy procedure. The damage it caused was undeniable. Its cost and requirement of a skilled neurosurgeon limited its application. Freeman was also rethinking the standard wisdom that lobotomy should be the therapy of last resort. He suspected that people who had been seriously disordered for more than five years were usually too far gone to be helped, and that lobotomy might work best for patients in the early stages of psychiatric illness.

His research led him to the work of Amarro Fiarnberti, an Italian psychosurgeon who eliminated the need for boring holes into the skull by breaking through the easily accessible bone at the rear of the eye socket and injecting alcohol or formalin into the brain. Again practicing on cadavers, Freeman altered this technique by replacing the injection with the cuts of a sharp instrument - first an ice pick from his kitchen whose handle bore the name of the Uline Ice Company and later a type of leucotome that he designed and always carried with him in a felt-lined case.