Gottlieb Burckhardt
Encyclopedia
Johann Gottlieb Burckhardt (24 December 1836 - 6 February 1907) was a Swiss psychiatrist
and the medical director of small mental hospital in the Swiss canton
of Neuchâtel. He is commonly regarded as having performed the first modern psychosurgical
operation. He is often seen as a precursor to the Portuguese neurologist
, Egas Moniz
, who performed the first leucotomy, later known as lobotomy, in 1936.
. His father, August Burckhardt (1809–1894), was a physician. His mother was Katharina Jacot (1810–1843) from Montbéliard
in France. Burckhardt's parents were married in 1833 and his mother gave birth to seven children prior to her death in 1843. Gottlieb Burckhardt was the third eldest child. In 1844 his father married Henrietta Maria Dick (1813–1871). She had five pregnancies and three surviving children. Burckhardt attended secondary school in Basel. His medical studies were conducted at the Universities of at Basel
, Göttingen and Berlin. In 1860 he was conferred with a doctorate in medicine from the University of Basel. His doctoral thesis was on the epithelium
of the urinary tract. As a student, he was described as popular, outgoing and musically talented.
in internal medicine
and was granted the position of Privatdozent
at the University of Basel. The following year he married Elisabeth Heusler (1840–1896) and they had eight children together. In 1864, due to a diagnosis of pulmonary tuberculosis, Burckhardt was forced to give up his practice and he relocated to a southern locale near the Pyrenees. He recovered fully and published a study of climactic conditions in the region.
In 1866 Burckhardt returned to Basel and resolved to study the diseases of the nervous system
and their treatment with the new electrotherapies
. His interest in this field had been fostered by Karl Ewald Hasse
, a noted physician and friend of the Burckhardt family. In 1873 he was elected to the presidency of the Basel Medical Society. Two years later, in 1875, he received a post as a physician to the Waldau Psychiatric University Clinic in Berne and later that year he also published Die physiologische Diagnostik der Nervenkrankheiten (Physiological Diagnostics of Nervous Diseases), a 284 page monograph which detailed the results of his research on the use of electrotherapy for nervous disorders and the conductivity of the nervous system.
In 1876 he became a Privatdozent
at the University of Bern where he lectured on nervous and mental diseases. This marks a highly productive period in his career as he became a regular contributor to several medical publications including the Swiss periodical Korrespondenzblatt für Schweizer Ärtze and produced articles on a variety of psychiatric and neurological topics. In 1877 he published a historical treatment of psychiatric and psychological theories of the functional regions of the brain
. In this article he proposed that there were "cortical dispersion centres" which were "rooted in physiology and anatomy in the brain" and that these played a crucial role in the development of mental illness. Burckhardt drew inspiration for his hypothesis from recent advances which had shown the localisation of language faculties
in the brain and he believed that mental diseases were also traceable to specific cortical centres. In the application of internal medicine to psychiatry, his research activities extended to an exploration of the relationship between mental illness and bodily temperature, blood pressure and pulse. In 1881 he published on the relationship between cerebral movements and oxygen consumption and posited a connection between cerebral oxygen deprivation, pathological brain circulation and mental illness. While at Bern he also successfully submitted articles on the histological
preparation of brain cells, sensory aphasia ("word deafness"), the anatomy of the brain and cerebral localisation and forensic psychiatry
. From 1881 until his departure from the Waldau Clinic in 1882, Eugen Bleuler
, who coined the term schizophrenia
in 1908, served as his medical intern.
In August 1882 Burckhardt was appointed as the Medical Director of the Préfargier, a small but modern psychiatric clinic in Marin in the Swiss Canton of Neuchâtel. Prior to his arrival a laboratory was constructed at the clinic so that Burckhardt could continue his research into neuroanatomy
and psychophysiology
. In February 1884 he presented at the Préfargier asylum his findings on the heredity and the surface configuration of the brain. He continued to publish on psychiatric and neurological topics such as cerebral vascular movements, brain tumours and optic chiasm, traumatic hysteria, and writing disorders.
In 1888, Burckhardt began his series of topectomies when he surgically removed sections of the cerebral cortex
of six psychiatric patients under his care whose condition was deemed intractable. He presented his findings at a psychiatric conference in 1889 and published the results of the procedure in 1891 in the periodical Allgemeine Zeitschrift für Psychiatrie und psychischgerichtliche Medicin in an article entitled 'Uber Rindenexcisionen, als Beitrag zur operativen Therapie der Psychosen' ('Concerning cortical excision, as a contribution to the surgical treatment of psychosis'). This paper was his last significant medical publication.
Following the death of his wife and one of his sons, Burckhardt left his position at the Préfargier in 1896 and returned to Basel with the intention of setting up a sanatorium
. This plan came to fruition in 1900 when the Sonnenhalde Clinic was opened in Riehen
near Basel. Burckhardt served as the clinic's Medical Director from 1900 until 1904 and he remained a physician at the facility until his death in 1907.
. Their diagnoses were, variously, one of chronic mania
, one of primary dementia
and four of primäre Verrücktheit (primary paranoid psychosis). This latter diagnosis was, according to Berrios, "a clinical category that (anachronistically) should be considered as tantamount to schizophrenia". Burckhardt's case notes recorded that the patients all exhibited serious psychiatric symptoms such as auditory hallucinations, paranoid delusions, aggression, excitement and violence. The operations excised regions of the cerebral cortex
, specifically removing sections of the frontal, temporal, and tempoparietal lobes. The results were not overly encouraging as one patient died five days after the operation after experiencing epileptic convulsions, one improved but later committed suicide
, another two showed no change, and the last two patients became "quieter". This equated to a success rate of 50 per cent. Complications consequent to the procedure included epilepsy
(in two patients), motor weakness, "word deafness" and sensory aphasia
. Only two patients are recorded as having no complications.
The theoretical basis of Burckhardt's action rested on three propositions. The first was that mental illness had a physical basis and that disordered minds were merely a reflection of disordered brains. Next, the associationist viewpoint of nerve functioning which conceived the nervous system as operating according to the following threefold division of labor: an input (or sensory or afferent
) system, a connecting system which processed information and an output (or efferent or motor) system. The final assumption of Buckhardt's was that the brain was modular which meant that each mental module or mental faculty could be linked to a specific location in the brain. In accordance with such a viewpoint, Buckhardt postulated that lesions in specific areas of the brain might impact behavior in a specific manner. In other words, he thought that by cutting the connecting system, or second association state of brain's system of communication troubling symptoms might be alleviated without compromising either the nervous system's input or output systems. The procedure was aimed at relieving symptoms, not at curing a given mental disease. Thus, he wrote in 1891:
Burckhardt attended the Berlin Medical Conference of 1889, which was also attended by such heavyweight psychiatrists as Victor Horsley
, Valentin Magnan
and Emil Kraepelin
, and presented a paper on his brain operations. While his findings were subsequently widely reported in the psychiatric literature, the reviews were unremittingly negative and there was much ill ease generated by the surgical procedures he had performed. Kraepelin, writing in 1893, was scathing of Burckhardt's attempts, and stated that "he [Burckhardt] suggested that restless patients could be pacified by scratching away the cerebral cortex." While Giuseppe Seppilli, an Italian professor of neuropsychiatry
, remarked in 1891 that Burckhardt's view of the brain as modular did not "fit in well with the view held by most [experts] that the psychoses reflect a diffuse pathology of the cerebral cortex and [ran counter to] the conception of the psyche as a unitary entity".
Burckhardt wrote in 1891 that "Doctors are different by nature. One kind adheres to the old principle: first, do no harm (primum non nocere
); the other one says: it is better to do something than do nothing (melius anceps remedium quam nullum). I certainly belong to the second category". The response to this statement was provided by the French psychiatrist Armand Semelaigne when he wrote that "an absence of treatment was better than a bad treatment". After the publication of his impressive 81 page monograph on the subject in 1891, Burckhardt ended his research and practice of psychosurgery due to the ridicule he received from his colleagues over the methods he had employed.
Commenting on his monograph in 1891 the British psychiatrist William Ireland provided a succinct summation of his position:
Ireland, however, doubted that any English psychiatrist would have the "hardihood" to follow the path taken by Burckhardt.
Psychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
and the medical director of small mental hospital in the Swiss canton
Cantons of Switzerland
The 26 cantons of Switzerland are the member states of the federal state of Switzerland. Each canton was a fully sovereign state with its own borders, army and currency from the Treaty of Westphalia until the establishment of the Swiss federal state in 1848...
of Neuchâtel. He is commonly regarded as having performed the first modern psychosurgical
Psychosurgery
Psychosurgery, also called neurosurgery for mental disorder , is the neurosurgical treatment of mental disorder. Psychosurgery has always been a controversial medical field. The modern history of psychosurgery begins in the 1880s under the Swiss psychiatrist Gottlieb Burckhardt...
operation. He is often seen as a precursor to the Portuguese neurologist
Neurologist
A neurologist is a physician who specializes in neurology, and is trained to investigate, or diagnose and treat neurological disorders.Neurology is the medical specialty related to the human nervous system. The nervous system encompasses the brain, spinal cord, and peripheral nerves. A specialist...
, Egas Moniz
Egas Moniz
António Caetano de Abreu Freire Egas Moniz , known as Egas Moniz , was a Portuguese neurologist and the developer of cerebral angiography...
, who performed the first leucotomy, later known as lobotomy, in 1936.
Early life and education
Gottlieb Burckhardt was born on the 24 December 1836 into a well-known family living in the Swiss city of BaselBasel
Basel or Basle In the national languages of Switzerland the city is also known as Bâle , Basilea and Basilea is Switzerland's third most populous city with about 166,000 inhabitants. Located where the Swiss, French and German borders meet, Basel also has suburbs in France and Germany...
. His father, August Burckhardt (1809–1894), was a physician. His mother was Katharina Jacot (1810–1843) from Montbéliard
Montbéliard
Montbéliard is a city in the Doubs department in the Franche-Comté region in eastern France. It is one of the two subprefectures of the department.-History:...
in France. Burckhardt's parents were married in 1833 and his mother gave birth to seven children prior to her death in 1843. Gottlieb Burckhardt was the third eldest child. In 1844 his father married Henrietta Maria Dick (1813–1871). She had five pregnancies and three surviving children. Burckhardt attended secondary school in Basel. His medical studies were conducted at the Universities of at Basel
University of Basel
The University of Basel is located in Basel, Switzerland, and is considered to be one of leading universities in the country...
, Göttingen and Berlin. In 1860 he was conferred with a doctorate in medicine from the University of Basel. His doctoral thesis was on the epithelium
Epithelium
Epithelium is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. Epithelial tissues line the cavities and surfaces of structures throughout the body, and also form many glands. Functions of epithelial cells include secretion, selective...
of the urinary tract. As a student, he was described as popular, outgoing and musically talented.
Career
By 1860 Burckhardt had established a private medical practice in Basel. In 1862 he completed a post-doctoral habilitationHabilitation
Habilitation is the highest academic qualification a scholar can achieve by his or her own pursuit in several European and Asian countries. Earned after obtaining a research doctorate, such as a PhD, habilitation requires the candidate to write a professorial thesis based on independent...
in internal medicine
Internal medicine
Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...
and was granted the position of Privatdozent
Privatdozent
Privatdozent or Private lecturer is a title conferred in some European university systems, especially in German-speaking countries, for someone who pursues an academic career and holds all formal qualifications to become a tenured university professor...
at the University of Basel. The following year he married Elisabeth Heusler (1840–1896) and they had eight children together. In 1864, due to a diagnosis of pulmonary tuberculosis, Burckhardt was forced to give up his practice and he relocated to a southern locale near the Pyrenees. He recovered fully and published a study of climactic conditions in the region.
In 1866 Burckhardt returned to Basel and resolved to study the diseases of the nervous system
Nervous system
The nervous system is an organ system containing a network of specialized cells called neurons that coordinate the actions of an animal and transmit signals between different parts of its body. In most animals the nervous system consists of two parts, central and peripheral. The central nervous...
and their treatment with the new electrotherapies
Electrotherapy
Electrotherapy is the use of electrical energy as a medical treatment In medicine, the term electrotherapy can apply to a variety of treatments, including the use of electrical devices such as deep brain stimulators for neurological disease. The term has also been applied specifically to the use of...
. His interest in this field had been fostered by Karl Ewald Hasse
Karl Ewald Hasse
Karl Ewald Hasse was a German physician and professor of special pathology born in Dresden.He studied medicine at the Universities of Dresden and Leipzig, earning his doctorate in 1833. Later he continued his education in Paris and Vienna, and subsequently returned to Leipzig, where in 1836 he...
, a noted physician and friend of the Burckhardt family. In 1873 he was elected to the presidency of the Basel Medical Society. Two years later, in 1875, he received a post as a physician to the Waldau Psychiatric University Clinic in Berne and later that year he also published Die physiologische Diagnostik der Nervenkrankheiten (Physiological Diagnostics of Nervous Diseases), a 284 page monograph which detailed the results of his research on the use of electrotherapy for nervous disorders and the conductivity of the nervous system.
In 1876 he became a Privatdozent
Privatdozent
Privatdozent or Private lecturer is a title conferred in some European university systems, especially in German-speaking countries, for someone who pursues an academic career and holds all formal qualifications to become a tenured university professor...
at the University of Bern where he lectured on nervous and mental diseases. This marks a highly productive period in his career as he became a regular contributor to several medical publications including the Swiss periodical Korrespondenzblatt für Schweizer Ärtze and produced articles on a variety of psychiatric and neurological topics. In 1877 he published a historical treatment of psychiatric and psychological theories of the functional regions of the brain
Modularity of mind
Modularity of mind is the notion that a mind may, at least in part, be composed of separate innate structures which have established evolutionarily developed functional purposes...
. In this article he proposed that there were "cortical dispersion centres" which were "rooted in physiology and anatomy in the brain" and that these played a crucial role in the development of mental illness. Burckhardt drew inspiration for his hypothesis from recent advances which had shown the localisation of language faculties
Language center
The term language center refers to the areas of the brain which serve a particular function for speech processing and production.- Current scientific consensus :...
in the brain and he believed that mental diseases were also traceable to specific cortical centres. In the application of internal medicine to psychiatry, his research activities extended to an exploration of the relationship between mental illness and bodily temperature, blood pressure and pulse. In 1881 he published on the relationship between cerebral movements and oxygen consumption and posited a connection between cerebral oxygen deprivation, pathological brain circulation and mental illness. While at Bern he also successfully submitted articles on the histological
Histology
Histology is the study of the microscopic anatomy of cells and tissues of plants and animals. It is performed by examining cells and tissues commonly by sectioning and staining; followed by examination under a light microscope or electron microscope...
preparation of brain cells, sensory aphasia ("word deafness"), the anatomy of the brain and cerebral localisation and forensic psychiatry
Forensic psychiatry
Forensic psychiatry is a sub-speciality of psychiatry and an auxiliar science of criminology. It encompasses the interface between law and psychiatry...
. From 1881 until his departure from the Waldau Clinic in 1882, Eugen Bleuler
Eugen Bleuler
Paul Eugen Bleuler was a Swiss psychiatrist most notable for his contributions to the understanding of mental illness and for coining the term "schizophrenia."-Biography:...
, who coined the term schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
in 1908, served as his medical intern.
In August 1882 Burckhardt was appointed as the Medical Director of the Préfargier, a small but modern psychiatric clinic in Marin in the Swiss Canton of Neuchâtel. Prior to his arrival a laboratory was constructed at the clinic so that Burckhardt could continue his research into neuroanatomy
Neuroanatomy
Neuroanatomy is the study of the anatomy and organization of the nervous system. In contrast to animals with radial symmetry, whose nervous system consists of a distributed network of cells, animals with bilateral symmetry have segregated, defined nervous systems, and thus we can begin to speak of...
and psychophysiology
Psychophysiology
Psychophysiology is the branch of psychology that is concerned with the physiological bases of psychological processes. While psychophysiology was a general broad field of research in the 1960s and 1970s, it has now become quite specialized, and has branched into subspecializations...
. In February 1884 he presented at the Préfargier asylum his findings on the heredity and the surface configuration of the brain. He continued to publish on psychiatric and neurological topics such as cerebral vascular movements, brain tumours and optic chiasm, traumatic hysteria, and writing disorders.
In 1888, Burckhardt began his series of topectomies when he surgically removed sections of the cerebral cortex
Cerebral cortex
The cerebral cortex is a sheet of neural tissue that is outermost to the cerebrum of the mammalian brain. It plays a key role in memory, attention, perceptual awareness, thought, language, and consciousness. It is constituted of up to six horizontal layers, each of which has a different...
of six psychiatric patients under his care whose condition was deemed intractable. He presented his findings at a psychiatric conference in 1889 and published the results of the procedure in 1891 in the periodical Allgemeine Zeitschrift für Psychiatrie und psychischgerichtliche Medicin in an article entitled 'Uber Rindenexcisionen, als Beitrag zur operativen Therapie der Psychosen' ('Concerning cortical excision, as a contribution to the surgical treatment of psychosis'). This paper was his last significant medical publication.
Following the death of his wife and one of his sons, Burckhardt left his position at the Préfargier in 1896 and returned to Basel with the intention of setting up a sanatorium
Sanatorium
A sanatorium is a medical facility for long-term illness, most typically associated with treatment of tuberculosis before antibiotics...
. This plan came to fruition in 1900 when the Sonnenhalde Clinic was opened in Riehen
Riehen
Riehen is a municipality in the canton of Basel-Stadt in Switzerland. Together with the city of Basel and Bettingen, Riehen is one of three municipalities in the canton....
near Basel. Burckhardt served as the clinic's Medical Director from 1900 until 1904 and he remained a physician at the facility until his death in 1907.
Psychosurgery
In December 1888 Burckhardt, who had little experience of surgery, made one of the first forays into the field of psychosurgery when he operated on six patients, two women and four men aged between 26 and 51, in a private psychiatric hospital in SwitzerlandSwitzerland
Switzerland name of one of the Swiss cantons. ; ; ; or ), in its full name the Swiss Confederation , is a federal republic consisting of 26 cantons, with Bern as the seat of the federal authorities. The country is situated in Western Europe,Or Central Europe depending on the definition....
. Their diagnoses were, variously, one of chronic mania
Mania
Mania, the presence of which is a criterion for certain psychiatric diagnoses, is a state of abnormally elevated or irritable mood, arousal, and/ or energy levels. In a sense, it is the opposite of depression...
, one of primary dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
and four of primäre Verrücktheit (primary paranoid psychosis). This latter diagnosis was, according to Berrios, "a clinical category that (anachronistically) should be considered as tantamount to schizophrenia". Burckhardt's case notes recorded that the patients all exhibited serious psychiatric symptoms such as auditory hallucinations, paranoid delusions, aggression, excitement and violence. The operations excised regions of the cerebral cortex
Cerebral cortex
The cerebral cortex is a sheet of neural tissue that is outermost to the cerebrum of the mammalian brain. It plays a key role in memory, attention, perceptual awareness, thought, language, and consciousness. It is constituted of up to six horizontal layers, each of which has a different...
, specifically removing sections of the frontal, temporal, and tempoparietal lobes. The results were not overly encouraging as one patient died five days after the operation after experiencing epileptic convulsions, one improved but later committed suicide
Suicide
Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...
, another two showed no change, and the last two patients became "quieter". This equated to a success rate of 50 per cent. Complications consequent to the procedure included epilepsy
Epilepsy
Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...
(in two patients), motor weakness, "word deafness" and sensory aphasia
Aphasia
Aphasia is an impairment of language ability. This class of language disorder ranges from having difficulty remembering words to being completely unable to speak, read, or write....
. Only two patients are recorded as having no complications.
The theoretical basis of Burckhardt's action rested on three propositions. The first was that mental illness had a physical basis and that disordered minds were merely a reflection of disordered brains. Next, the associationist viewpoint of nerve functioning which conceived the nervous system as operating according to the following threefold division of labor: an input (or sensory or afferent
Afferent
Afferent is an anatomical term with the following meanings:*Conveying towards a center, for example the afferent arterioles conveying blood towards the Bowman's capsule in the Kidney. Opposite to Efferent.*Something that so conducts, see Afferent nerve fiber...
) system, a connecting system which processed information and an output (or efferent or motor) system. The final assumption of Buckhardt's was that the brain was modular which meant that each mental module or mental faculty could be linked to a specific location in the brain. In accordance with such a viewpoint, Buckhardt postulated that lesions in specific areas of the brain might impact behavior in a specific manner. In other words, he thought that by cutting the connecting system, or second association state of brain's system of communication troubling symptoms might be alleviated without compromising either the nervous system's input or output systems. The procedure was aimed at relieving symptoms, not at curing a given mental disease. Thus, he wrote in 1891:
[I]f excitation and impulsive behaviour are due to the fact that from the sensory surfaces excitations abnormal in quality, quantity and intensity do arise, and do act on the motor surfaces, then an improvement could be obtained by creating an obstacle between the two surfaces. The extirpation of the motor or the sensory zone would expose us to the risk of grave functional disturbances and to technical difficulties. It would be more advantageous to practice the excision of a strip of cortex behind and on both sides of the motor zone creating thus a kind of ditch in the temporal lobe.
Burckhardt attended the Berlin Medical Conference of 1889, which was also attended by such heavyweight psychiatrists as Victor Horsley
Victor Horsley
Sir Victor Alexander Haden Horsley was an accomplished scientist and professor. He was born in Kensington, London. He was educated at Cranbrook School, Kent and studied medicine at University College London and in Berlin, Germany , and in the same year started his career as a house surgeon and...
, Valentin Magnan
Valentin Magnan
Valentin Magnan was a French psychiatrist who was a native of Perpignan.He studied medicine in Lyon and Paris, where he was a student of Jules Baillarger and Jean-Pierre Falret...
and Emil Kraepelin
Emil Kraepelin
Emil Kraepelin was a German psychiatrist. H.J. Eysenck's Encyclopedia of Psychology identifies him as the founder of modern scientific psychiatry, as well as of psychopharmacology and psychiatric genetics. Kraepelin believed the chief origin of psychiatric disease to be biological and genetic...
, and presented a paper on his brain operations. While his findings were subsequently widely reported in the psychiatric literature, the reviews were unremittingly negative and there was much ill ease generated by the surgical procedures he had performed. Kraepelin, writing in 1893, was scathing of Burckhardt's attempts, and stated that "he [Burckhardt] suggested that restless patients could be pacified by scratching away the cerebral cortex." While Giuseppe Seppilli, an Italian professor of neuropsychiatry
Neuropsychiatry
Neuropsychiatry is the branch of medicine dealing with mental disorders attributable to diseases of the nervous system. It preceded the current disciplines of psychiatry and neurology, in as much as psychiatrists and neurologists had a common training....
, remarked in 1891 that Burckhardt's view of the brain as modular did not "fit in well with the view held by most [experts] that the psychoses reflect a diffuse pathology of the cerebral cortex and [ran counter to] the conception of the psyche as a unitary entity".
Burckhardt wrote in 1891 that "Doctors are different by nature. One kind adheres to the old principle: first, do no harm (primum non nocere
Primum non nocere
is a Latin phrase that means "First, do no harm". The phrase is sometimes recorded as .Nonmaleficence, which derives from the maxim, is one of the principal precepts of medical ethics that all medical students are taught in medical school and is a fundamental principle for emergency medical...
); the other one says: it is better to do something than do nothing (melius anceps remedium quam nullum). I certainly belong to the second category". The response to this statement was provided by the French psychiatrist Armand Semelaigne when he wrote that "an absence of treatment was better than a bad treatment". After the publication of his impressive 81 page monograph on the subject in 1891, Burckhardt ended his research and practice of psychosurgery due to the ridicule he received from his colleagues over the methods he had employed.
Commenting on his monograph in 1891 the British psychiatrist William Ireland provided a succinct summation of his position:
Dr. Burckhardt has a firm faith in the view that the mind is made up of a number of faculties, holding their seats in distinct portions of the brain. Where excess or irregularity of function occurs he seeks to check it by ablation of a portion of the irritated centres. He defends himself from the criticisms which are sure to be directed against his bold treatment by showing the desperate character of the prognosis of the patients upon whom the operations were performed ...
Ireland, however, doubted that any English psychiatrist would have the "hardihood" to follow the path taken by Burckhardt.