Very little preparation is needed for the operation.
A patient who comes to the clinic after breakfast can, if all goes well, expect to leave by the following afternoon. The operation can be done under general anesthetic, but electro-shock is preferred because of its familiarity to the psychiatrist. The procedure is performed during the stage of post-convulsive coma. Electrodes are applied and the first shock is given, lasting about 40 seconds. When the patient shows signs of returning consciousness, a second convulsion is administered. In general, three successive convulsions are necessary, however a single one may be sufficient for older patients. Meanwhile, in a sturdy young person four or even six convulsions may be administered without danger.
Once the convulsions have subsided, a nurse holds a towel over the nose and mouth of the patient. The operator lifts the upper eyelid and gently inserts the leucotome into the orbital cavity, aiming it parallel with the nasal bridge. He drives the point through the orbital plate, and at a depth of 5 cm swings the handle far in the lateral direction. He then returns the instrument to a slightly oblique position, still parallel with the bony ridge of the nose, and drives it two centimeters further. Steadying the patient’s head, he then moves the handle of the instrument about 20 degrees medially and 30 degrees laterally. In this latter position he strongly elevates the handle of the instrument, often fracturing the orbital plate in the process. He then returns the instrument to the parasagittal plane. It should be noted that the instrument, upon removal, appears completely clean. There should be no damage visible to the patient following the procedure.
At this point, the personality, individuality, and cognitive faculties of the patient will have been completely severed from the rest of the brain, transforming them once again into a productive member of society.