Bilateral blind rostral leucotomy has been shown to be an adequate operation for the relief of many tense psychoneurotic and depressive states (McKissock, 1951; Pippard, 1955); the operation gave worthwhile results in about two-thirds of such cases in a series which included many who were unsuitable. This paper is concerned with the results in 27 cases operated on more than once.

Four patients had already had standard leucotomies with inadequate relief of symptoms; an open rostral leucotomy in one of these, a young ruminative schizophrenic, made no obvious difference. Another schizophrenic had a rostral G leucotomy to divide fibres in the inferior medial quadrant which might have been missed by the earlier standard operation (Sargant, 1953). Afterwards she no longer needed maintenance E.C.T. to keep her at a good level; reduction in tension which followed this limited incision, and the greater ease with which she could be cared for in hospital certainly suggests that a limited operation on the medial side may well be considered in some cases in which standard leucotomy has failed, and certainly before undertaking anything as drastic as Freeman and Watts' (1950) radical operation.

Another patient similarly submitted to a rostral G leucotomy had slowly relapsed after an initially successful standard leucotomy for a chronic tension state. He had, however, been left with a marked intellectual deficit and troublesome urgency of micturition and, if anything, his deficits were increased after the second leucotomy, without any useful relief of symptoms.