URÆMIC AND TROPHIC DEATHS FOLLOWING LEUCOTOMY: NEURO-ANATOMICAL FINDINGS

Little has been published concerning the occurrence of delayed operative death after bilateral prefrontal leucotomy. The term " delayed operative death" in relation to leucotomy was introduced by Meyer and McLardy (1948; 1949) in analysing undesirable clinical sequele suffered by patients submitted to leucotomy who had survived the danger of fatal operative haemorrhage, and whose brains had in due course come under systematic investigation at the Maudsley Research Laboratory. I have elsewhere (McLardy, 1948) described how I deduced from a study of the brains and clinical records of 101 leucotomy cases that probably as high a proportion of " the leucotomized population" dies a delayed operative death within five months of the operation as from hxmorrhage within two weeks of the operation. In these three previous studies it was shown that delayed operative death was clearly related to the post-mortem finding of leucotomy lesions extending posterior to prefrontal domains in both hemispheres. It was not attempted, however, to decide whether the most responsible part of the lesions might be damage to the premotor regions, the putamen, the caudate nucleus, the posterior parts of the orbital region, or structures lying between any of these. Such a more precise anatomical analysis has now been carried out on a larger series of cases. The findings, which are tabulated and discussed in the present paper, seem to provide strong evidence that at least bilateral substantial damage to agranular orbital cortex, or to the region of the subcallosal fasciculus at certain levels, is fatal.