Unlocking the brain: attempts to improve mental function of microcephalic retarded children by "craniotomy"

"Is it sufficient glory to don a white apron and swing a carbolized knife and is therein a sufficient indication to let daylight into a deformed cranium and on top of a hopelessly defective brain, and to proclaim success because the victim consented not to die of the assault? Such rash feats of indiscriminate surgery, if continued, moreover in the presence of fourteen deaths in thirty-three cases, are stains on your hands and sins on your souls. No ocean of soap and water will cleanse those hands, no power of corrosive sublimate will disinfect the souls." These passionate words, delivered by Abraham Jacobi, the father of American pediatrics, at the International Congress in Rome in 1893, and later in the article "Non nocere" (42), epitomize the growing antagonism to the attempts by many prominent surgeons to improve the gloomy fate of severely retarded, microcephalic children by "liberating" their brains from their presumed bony chains by "linear craniotomy." This article portrays how the fallacious 19th-century concepts of the relationship between the capacity of the cranial cavity and intelligence, backed by "scientific racism" together with the changing attitude toward retarded and malformed children, generated a surgical solution for microcephalic idiocy. It describes how hopeful surgeons, neurologists, and pediatricians, encouraged by the advances in anesthesia and asepsis, lost their judgment and disregarded logic and evidence. They generated a wave of enthusiasm and hope that soared from the United States and France through the British Isles, Europe, and as far as Ceylon and Australia to end in a ripple of bitter disgrace under caustic criticism, leaving a scar on the recently budding field of neurological surgery.