For the next 21 years, Freeman performed trans-orbital lobotomies almost exclusively. One of his earliest setbacks came at the end of 1947 in the case of a Washington-area police officer who hemorrhaged on both sides of the brain after the operation and was left seriously disabled, "never able to do more than the simplest tasks around the house," Freeman wrote. He later wielded his leucotome and hammer in state hospitals in South Dakota and Washington state, and from there to half of the other states. In the late 1940s at Western State Hospital in Steilacoom, Wash., Freemen met the movie actress Frances Farmer, according to Farmer's biographer William Arnold.

Farmer had been a patient there for five years, the victim of her family's intolerance of her unconventional and wild behavior. Whether Freeman lobotomized her remains unclear, though Arnold says he did. Farmer's relatives and Western State's staff psychiatrist at the time said it never happened, but Frank Freeman says his father verified Farmer's operation and identified her as the patient shown in the world's most famous lobotomy photograph, an oft-reproduced shot showing Freeman using his hairy and muscular arms to hammer the leucotome into a woman's eye at Western State as a crowd watched. Filmed interviews of Farmer made after her discharge from the hospital show a detached and flatly demeanored (though clearly intelligent) woman, an outcome consistent with lobotomy.

His cross-country trips in pursuit of lobotomy patients and his self-appointment as the trans-orbital procedure's international ambassador only heightened Freeman's sense of professional solitude - and caused him to commit serious errors of judgment. More than once he worked the leucotome forcefully enough to break it inside a patient's brain. At Cherokee State Hospital in Iowa, he accidentally killed a patient when he stepped back to take a photo during the surgery and allowed the leucotome to sink deep into the patient's midbrain.

Freeman had completed 400 trans- orbital lobotomies by 1949, and maintained a brisk pace of work for the next five years. He had already alienated psychiatrists by insisting that psychoses were actually organic brain disorders, and now he invaded the turf of neurosurgeons by performing brain operations and training other doctors lacking surgical certification to do so. The superintendents of state hospitals continued welcoming Freeman to their institutions, though, because some lobotomized patients went home and many of the others were easier to manage. "The noise level of the ward went down, 'incidents' were fewer, cooperation improved, and the ward could be brightened when curtains and flowerpots were no longer in danger of being used as weapons," Freeman wrote.

Any physician today using a therapy with an expected fatality rate Of 14 percent and offering no hope for improvement would probably end up in court if not in prison. (Freeman was never sued for lobotomy malpractice, although a suit was in preparation when he died.)

In 1967, Freeman received a visit from Helen Mortensen, a woman who had been one of his first 10 trans-orbital patients in Washington in 1946. She suffered a relapse of her psychiatric symptoms in 1956 and Freeman gave her a second operation. Now, after several more years of working productively, Mortensen wanted a third lobotomy.

Freeman did the surgery at Herrick Memorial Hospital in Berkeley, Calif., and severed a blood vessel in Mortensen's brain. Three days later, Mortensen died. The hospital revoked Freeman's surgical privileges. During the last five years of his life, he performed no more lobotomies. Freeman died from cancer on May 31, 1972, at the age of 76.

Freeman has been dead for 28 years, and most of the lobotomy patients who survived his treatment have followed him to the grave. Probably fewer than 20 brain operations are now conducted annually in the United States to treat psychiatric disorders. These procedures are not lobotomies; they most often use lasers or radiation to produce tiny lesions in the cingulate gyrus region of the brain, which has been connected with the development of obsessive-compulsive disorder (OCD). (Other operations that destroy parts of the brain are done to help reduce or eliminate tremors in Parkinson's patients.)

Nevertheless, Walter Freeman weighs heavily on the minds of a new generation of neuroscientists. They think about his promotion of lobotomy to treat a variety of unrelated disorders, his lack of interest in scientific verification of lobotomy's effectiveness, his patients' permanently altered personalities and emotional lives, and his recklessness, pride and craving for public attention.