malleted 5 centimeters (2 in) into the frontal lobe, and then pivoted 40 degrees at the orbit perforation so the tip cut toward the opposite side of the head (toward the nose). The instrument was returned to the neutral position and sent a further 2 centimeters ( in) into the brain, before being pivoted around 28 degrees each side, to cut outward and again inward. (In a more radical variation at the end of the last cut described, the butt of the orbitoclast was forced upward so the tool cut vertically down the side of the cortex of the interhemispheric fissure; the "Deep Frontal Cut".) All cuts were designed to transect the white fibrous matter connecting the cortical tissue of the prefrontal cortex to the thalamus. The leucotome was then withdrawn and the procedure repeated on the other side. Freeman performed the first transorbital lobotomy on a live patient in 1946. Its simplicity suggested the possibility of carrying it out in mental hospitals lacking the surgical facilities required for the earlier, more complex procedure. (Freeman suggested that, where conventional anesthesia was unavailable, electroconvulsive therapy be used to render the patient unconscious.) In 1947, the Freeman and Watts partnership ended, as the latter was disgusted by Freeman's modification of the lobotomy from a surgical operation into a simple "office" procedure. Between 1940 and 1944, 684 lobotomies were performed in the United States. However, because of the fervent promotion of the technique by Freeman and Watts, those numbers increased sharply toward the end of the decade. In 1949, the peak year for lobotomies in the US, 5,074 procedures were undertaken, and by 1951 over 18,608 individuals had been lobotomized in the US. Prevalence In the United States, approximately 40,000 people were lobotomized and in England, 17,000 lobotomies were performed. According to one estimate, in the three Nordic countries of Denmark, Norway, and Sweden a combined figure of approximately 9,300 lobotomies were performed. Scandinavian hospitals lobotomized 2.5 times as many people per capita as hospitals in the US. According to another estimate, Sweden lobotomized at least 4,500 people between 1944 and 1966, mainly women. This figure includes young children. And in Norway, there were 2,005 known lobotomies. In Denmark, there were 4,500 known lobotomies. In Japan, the majority of lobotomies were performed on children with behaviour problems. The Soviet Union banned the practice in 1950 on moral grounds. In Germany, it was performed