The prefrontal leukotomy procedure developed by Moniz and Lima was modified in 1936 by American neurologists Walter J. Freeman II and James W. Watts. Freeman preferred the use of the term lobotomy and therefore renamed the procedure “prefrontal lobotomy.” The American team soon developed the Freeman-Watts standard lobotomy, which laid out an exact protocol for how a leukotome (in this case, a spatula) was to be inserted and manipulated during the surgery. Get a Britannica Premium subscription and gain access to exclusive content. Subscribe Now lobotomyThe use of lobotomy in the United States was resisted and criticized heavily by American neurosurgeons. However, because Freeman managed to promote the success of the surgery through the media, lobotomy became touted as a miracle procedure, capturing the attention of the public and leading to an overwhelming demand for the operation. In 1945 Freeman streamlined the procedure, replacing it with transorbital lobotomy, in which a picklike instrument was forced through the back of the eye sockets to pierce the thin bone that separates the eye sockets from the frontal lobes. The pick’s point was then inserted into the frontal lobe and used to sever connections in the brain (presumably between the prefrontal cortex and thalamus). In 1946 Freeman performed this procedure for the first time on a patient, who was subdued prior to the operation with electroshock treatment.The transorbital lobotomy procedure, which Freeman performed very quickly, sometimes in less than 10 minutes, was used on many patients with relatively minor mental disorders that Freeman believed did not warrant traditional lobotomy surgery, in which the skull itself was opened. A large proportion of such lobotomized patients exhibited reduced tension or agitation, but many also showed other effects, such as apathy, passivity, lack of initiative, poor ability to concentrate, and a generally decreased depth and intensity of their emotional response to life. Some died as a result of the procedure. However, those effects were not widely reported in the 1940s, and at that time the long-term effects were largely unknown. Because the procedure met with seemingly widespread success, Moniz was awarded the 1949 Nobel Prize for Physiology or Medicine (along with Swiss physiologist Walter Rudolf Hess). Lobotomies were performed on a wide scale during the 1940s; Freeman himself performed or supervised more than 3,500 lobotomies by the late 1960s. The practice gradually fell out of favour beginning in the mid-1950s, when antipsychotics, antidepressants, and other medications that were much more effective in treating and alleviating the distress of mentally disturbed patients came into use. Today lobotomy is rarely performed; however, shock therapy and psychosurgery (the surgical removal of specific regions of the brain) occasionally are used to treat patients whose symptoms have resisted all other treatments.