Freeman's transorbital lobotomy method did not require a neurosurgeon and could be performed outside of an operating room, often by untrained psychiatrists without the use of anesthesia by using electroconvulsive therapy to induce seizure and unconsciousness.

[2] Freeman and his procedure played a major role in popularizing lobotomy; he later traveled across the United States visiting mental institutions.

After four decades Freeman had personally performed possibly as many as 4,000 lobotomies on patients as young as 4, despite the fact that he had no formal surgical training.

[6] Burckhardt's experimental surgical forays were largely condemned at the time and in the subsequent decades psychosurgery was attempted only intermittently.

[8] His new "leucotomy" procedure, intended to treat mental illness, took small corings of the patient's frontal lobes.

[10] One year after the first leucotomy, on September 14, 1936, Freeman directed Watts through the very first prefrontal lobotomy in the United States on housewife Alice Hood Hammatt of Topeka, Kansas, who suffered from anxiety, insomnia, and depression.

[8][9] By November, only two months after performing their first lobotomy surgery, Freeman and Watts had already worked on 20 cases including several follow-up operations.

[3] By 1942, the duo had performed over 200 lobotomy procedures and had published results claiming 63% of patients had improved, 23% were reported to be unchanged and 14% were worse after surgery.

[8] In 1937, Fiamberti, the medical director of a psychiatric institution in Varese, first devised the transorbital procedure whereby the frontal lobes were accessed through the eye sockets.

[8] His new procedure allowed him to perform lobotomies without the use of anesthesia, because he used electroconvulsive therapy to induce seizure: "[Freeman] used a mallet to tap an orbitoclast (a slender rod shaped like an icepick) through the orbital roof.

[12] After four decades Freeman had personally performed possibly as many as 4,000[13][14][15] lobotomy surgeries in 23 states, of which 2,500 used his ice-pick procedure,[16] despite the fact that he had no formal surgical training.

[20] Freeman was known for his eccentricities and he complemented his theatrical approach to demonstrating surgery by sporting a cane, goatee, and narrow-brimmed hat.

[1] At the time, it was seen as a possible treatment for severe mental illness, but "within a few years, lobotomy was labeled one of the most barbaric mistakes of modern medicine.