Two Solitudes: Wilder Penfield, Ewen Cameron, and the Search for a Better Lobotomy.

In the 1940s, Wilder Penfield carried out a series of experimental psychosurgeries with the psychiatrist D. Ewen Cameron. This article explores Penfield's brief foray into psychosurgery and uses this episode to re-examine the emergence of his surgical enterprise. Penfield's greatest achievement - the surgical treatment of epilepsy - grew from the same roots as psychosurgery, and the histories of these treatments overlap in surprising ways. Within the contexts of Rockefeller-funded neuropsychiatry and Adolf Meyer's psychobiology, Penfield's frontal lobe operations (including a key operation on his sister) played a crucial role in the development of lobotomy in the 1930s. The combination of ambiguous data and the desire to collaborate with a psychiatrist encouraged Penfield to try to develop a superior operation. However, unlike his collaboration with psychiatrists, Penfield's productive working relationship with psychologists encouraged him to abandon the experimental "gyrectomy" procedure. The story of Penfield's attempt to find a better lobotomy can help us to examine different forms of interdisciplinarity within biomedicine.

The Reign of the Ventilator: Acute Respiratory Distress Syndrome, COVID-19, and Technological Imperatives in Intensive Care.

In the early phase of the COVID-19 pandemic, a dispute arose as to whether the disease caused a typical or atypical version of acute respiratory distress syndrome (ARDS). This essay recounts the emergence of ARDS and places it in the context of the technological transformation of modern hospital care-particularly the emergence of intensive care after the 1952 Copenhagen polio epidemic. The polio epidemic seemed to show the value of manual positive-pressure ventilation, leading to the proliferation of mechanical ventilators and the expansion of intensive care units in the 1960s. This created the conditions of possibility for ARDS to be described and institutionalized within modern intensive care. Yet the centrality of the ventilator to descriptions and definitions of ARDS quickly made it difficult to conceive of the disorder outside the framework of mechanical ventilation and blood gas levels, or to acknowledge the degree to which the ventilator was a source of iatrogenic injury and complications. Moreover, the imperative to understand and treat ARDS with mechanical ventilation set the stage for the early confusion about whether patients with COVID-19 should receive mechanical ventilation. This history offers many crucial lessons about how new technologies can lead to new and valuable therapies but can also subtly shape and constrain medical thinking. Moreover, ventilators not only changed how respiratory disorders were conceived; they also brought new forms of respiratory illness into existence.