I'~SYCHOSURGERY is essentially a con~ tr ibution from the twentieth century. Although trephining for mental disturbance was performed for hundreds of years, serious efforts to understand the physical basis of behavior and to improve mental illnesses by surgery have been limited to relatively recent times. 19 The controversy which raged during the nineteenth century about the cerebral representation of speech initiated an acute interest in patients with lesions of the frontal lobe. 43 Certain of these patients, however, were found to have changes in their behavior rather than in their speech. One such pat ient was Phineas P. Gage. 35 He sustained one of the most remarkable injuries in the history of medicine. In 1848, an iron tamping bar, 43 inches in length and 11 inches in diameter, was accidentally blown through the left frontal portion of his brain. Gage surprisingly recovered from his injury, but he suffered a marked change in personality. Before his injury he had been intelligent, honest, reliable and shrewd. However, from the time of his accident until his death 12 years later, Gage showed defective judgment, irreverent behavior, capriciousness, and lack of consideration for his fellows25 Toward the end of the nineteenth century, when cerebral ablations were being performed in animals to prove or disprove the concept of cerebral localization, 41,44 changes in behavior were again noticed following injury to the frontal lobes. 4~ Hitzig, Horsley and Sch~ifer, Ferrier, and Goltz all agreed tha t ablation of portions of the cortex anterior to the excitable motor area in the dog, cat, and monkey was frequently followed by definite behavioral changes. 4~ In 1891, G. Burckhardt , the superintendent of a mental hospital in Switzerland, reported the first operations on the brain designed to change mental functions. 4,26 He . . . argued that a mental disturbance could be relieved by removal of that portion of the brain which normally carried out the specific function involved. Thus, he believed that auditory hallucinations might be abolished by removing the cortical representation of audition, namely, the temporal cortex. He operated upon 6 patients, removing in several stages cortex from the postcentral, temporal, and frontal regions on the left side. His patients were benefited. One was said to be recovered, although she died about a month after the operation under suspicious circumstances, which suggested suicide. Another was less disturbed, less violent, and more amenable to supervision, although his dementia was unchanged. He did not seem to have so many hallucinations nor to react so violently to them as formerly. Burckhardt emphasized that his purpose was not so much to cure the patient as to change him from a dangerous, sick person to a harmless one. This pioneering work was laid in barren soil and remained buried beneath the accumulating earth of medical literature until recent archival research uncovered it. Puusepp t~l] made the next attempt to solve the problem in 1910, but with so little success that he did not publish a report until the advent of prefrontal lobotomy. He transected the fibers between the parietal and frontal lobes unilaterally in 3 cases of mental disorder. These early attempts lacked the benefit of the exact neurophysiological studies of the functions of the frontal lobe, which were to be done in the next few decades. ''39