Ugo Cerletti and the discovery of Electroshock.
An imaginary interview by Francesco Bollorino*, Rossella Valdre*,
Maria Vittoria Giannelli Ph.D**. *University of Genoa, Department of Psychiatry,
**University of Genoa, Department of Neurology.
Summary The authors, basing their work on original documents,
present a reconstruction of the discovery of electroconvulsive therapy by Prof. Ugo
Cerletti and his team. An imaginary interview takes place between an interviewer and the
Italian Professor, in his study at the University of Rome in 1940, two years after the
introduction of E.S.
April 1940, Rome I meet Professor Ugo Cerletti in his study
at the University of Rome. He is a tall, smart and friendly man, who lookes younger than
his 63 years. Since he brought out his Electroshock therapy, two years ago, Prof. Cerletti
has become world famous. For those who are unaware of his origins I will provide below
some biographical information, before reporting the content of our dialogue.
Ugo Cerletti, the son of an agricultural engineer, was born in
Veneto, at Conegliano, on September 26th, 1877. He studied Medicine at Rome and Turin. He
specialized in mental and neurological diseases attending the relevant European
"sanctuaries". First of all he stayed with Pierre Marie and Dupr« in Paris,
then with Kraepelin, Nissl and Alzheimer in Heidelberg and Munich. Cerletti devoted
himself to research and technological innovation, inventing before the First World War,
the white, camouflage winter suits that were used by the Italian Army. He became the Head
of the Neurobiological Institute, which is attached to the mental Institute of Milan.
In 1924 he was given a lecturing post in Neuropsychiatry in Bari.
From there he moved to Genoa in 1928 where he took over the Professorship fron Enrico
Morselli and finally, in 1935, he came to Rome University to occupy the prestigious chair
of Director of the Department of Mental and Neurological Diseases.
Q. "Professor, this time two years ago, together with your
team you started experimenting with Electroshock as a therapy for mental illness. Would
you like to tell us how you made such a discovery"?
A. "The story of Electroshock is quite straightforward. Like
every other neurologist, I have always given prime importance to the study of epilepsy,
since it is linked to many areas of Neurology and Psychiatry. Besides, in 1931, in Genoa,
I carried out some research on the sclerotic lesion of Hammon's horn, which is
characteristic of this illness. I decided to handle this problem by carrying out
experiments on animals. After repeatedly inducing epileptic fits in these animals for
short and long periods of time I would then study the reactions of their Hammon's horn
from a histopathological point of view. In order to avoid brain damage I didn't adopt
direct methods of stimulation or use convulsive toxics. I used, instead, the method
employed by many physiologists, especially on dogs, where an epileptic fit is induced by
passing an electric current of 125 volts through the body.
Q. "Was it difficult to perfect this technique?"
A. "During the first attempts I lost many dogs due to atrial
fibrillation following the electric shock. Then I learned to dose times better and
therefore obtained a very large number of case histories. On the basis of the semiology of
the attacks, I thought it was important to prove beforehand their absolute correspondence
to the standard epileptic fit suffered by man and in 1934, I got a student of mine, called
Chiauzzi, to publish a piece of work concerning the technique perfected by us. In 1935 I
moved here to Rome and took up the experimentsonce more, along with my assistant Doctor
Bini. In order to avoid killing the animals we perfected a simple mechanism. which
measured both how long it took for the current to pass through the body and also its
Q. "How did you progress from these studies on epilepsy,
induced by electric shocks, to the application of this technique in the treatment of human
A. "It was, in fact, during these years that the convulsive
therapy for schizophrenia, using an injection of Cardiazol appeared. I immediately tried
out this treatment on our patients together with the therapy using hypoglycaemic coma. The
daily confrontation with the dogs who had been made epileptic by Electroshock treatment
naturally gave me the idea of a possible similar application on man. However, this idea
was, for a long time, only considered in theory, because all our knowledge concerning the
noxious effects of strong electric currents on the human organism made us reject any
Q: "What was it that made you change your mind?"
A: "One day I heard that at the Rome slaughterhouse "they
were killing pigs with the electric current used for lighting". And it was almost as
if to justify to myself my own inertia that I decided to go to the slaughterhouse to
witness these "electroexecutions". I saw some butchers moving about among the
pigs, holding in both hands a large pair of pincers, which had at both ends two discs,
spiked with small, blunted, metallic tips. When they got near to the animals, they opened
the jaws of the pincers and quickly grasped the front part of the pig's head between the
tips of the discs. 70-80 volts were then sent through the electric cable. As soon as the
animals had been got hold of, they fell rigid to the ground without even uttering a sound
and shortly after, began to present general clonic shocks. Once on the ground, the butcher
made a deep incision in their necks so that the pigs bled to death before regaining
Q: "Therefore it was not true that they killed the pigs by
A:" Certainly not. The current did not serve that purpose. It
was simply to eliminate as humanely as possible, any form of suffering while the animals'
throats were being cut".
Q:"What did you do next?"
A: "I asked for -and obtained -from the man in charge of the
slaughterhouse a permit, which allowed me to use the big electric pincers. I tried them
out many times on animals to see the effects of the current passing through various
dimensions of heads and I was able to confirm what we had discovered in dogs, namely, that
at tensions ranging from 70 to 125 volts, the brain can stand the current well, even when
the passage time was substantially increased. In fact, all the pigs regained
consciousness, even if there were a few, which were slow in doing so. Those that were
subjected to the electric current for several seconds, when the convulsive attack was
over, managed to stand up after a few awkward attempts and join their companions as if
nothing had happened".
Q: "What conclusion did you draw from this experience?"
A: "What I saw and experimented at the slaughterhouse on a
considerable number of pigs corresponded exactly to what we had discovered with the dogs.
That is to say that the passing of an alternating current of 125 volts through the head
for a fraction of second causes epileptic forms of attacks which don't endanger life and
which don't cause any relevant problems. Since we were dealing with mammals of a notably
different size and structure and, since I had been able to widely experiment with
different methods of application to the head and also with very long times of application,
without any apparent danger, my presumption seemed more justified. This presumption was
that we could do likewise with humans, applying the electric current as we had studied,
without much danger to the patient. So I decided to go ahead and try it out".
Q: "When did this happen?"
A: "It happened two years ago, in April 1938. At that time the
Police sent a man in his forties to our Department. He had been stopped at the railway
station while he was wandering from one train to another without a ticket. As this person
was behaving in a very odd way, answering questions put to him in a very strange language
which was completely incomprehensible, he was sent to us. Here we were able to gather that
he was suffering from hallucinations and delirious ideas about being under some kind of
influence. Apart from that, he was lucid and well oriented but, at the same time,
apathetic and lacking in willpower. He passively adapted to life on the ward, where he was
almost always found lying contentedly on his bed murmuring in his jargon. We diagnosed him
as schizophrenic. The somatic examination showed that his general physical condition was
good. It was on this patient that I carried out my first experiment with
Q: "Would you like to explain the procedure of that first
attempt?" A: "Having fixed two electrodes, which were well soaked in saline
solution, with an elastic band to the frontal parietal area, we cautiously started with a
low current: 80 volts for 1/5 of a second. Once the charge was sent, the patient
immediately gave a jump, accompanied by a stiffening of all his muscles, which were
semiflexed. Then the patient fell back onto the bed without losing consciousness. He
immediately started singing at the top of his voice and then he calmed down".
Q: "What was your reaction?"
A: "We were all very emotional. We realized that we had already
dared a lot, but it was also clear that, bearing in mind our experiences with animals, we
had kept the voltage too low and therefore we considered repeating the experiment and
increasing the voltage. Somebody suggested leaving the patient to rest and postponing
another dose until the following day. Suddenly the patient, who had obviously been
listening to what we were saying, said in a clear and serious voice : "Not another
one! You will kill me!"
Q: "How did you react?"
A: "I must confess that, given the situation and the great
responsibility, this explicit, unequivocal warning coming from a patient, who up until a
moment before could not make himself understood in his enigmatic jargon, somewhat shook my
determination, moreso because one of the others present again proposed suspending the
experiment. However, the fear of giving in to a superstitious idea made me decide. I put
the cap on the patient again and we sent a charge of 110 volts for 1/5 of a second. The
patient immediately had a very brief general spasm and, after an instant had the most
common type of epileptic seizure. We all waited with bated breath during the tonic phase
and were truly depressed during the whole of his apnoea, where there was an interruption
in breathing and a deathlike cyanosis of the face - which, if upsetting in a spontaneous
epileptic fit, seemed to us, in this case, distressingly unending. Finally, after a croaky
inspiration and the first clonic jerks, the blood circulated better in our veins and we
saw to our great satisfaction, the characteristic reawakening "in stages" of his
consciousness. The patient sat up and looked at us calmly and smiled as if to ask us what
we wanted with him. We asked him. "What has happened to you"? and he replied
"I don't know, perhaps I have been sleeping".
Q: "Did you continue the treatment on this patient?"
A:"Certainly. On May 25th after 6 Electroshocks he appeared to
the doctors as respectful and orderly, he was lucid, had clear ideas and he no longer
expressed himself in neologisms. We were even able to get exact information from him
regarding himself and his previous illnesses. After 11 complete and 9 incomplete
electroshocks, the man could be termed as being cured or, to be more precise, according to
the most prudent terminology in use, he showed a "complete remission". Not only
did the hallucinations and delirious ideas disappear, along with a complete normalization
of his behaviour, but it was also very comforting to see in him a spontaneous desire to
make himself useful and a spirit of initiative, which was reflected in a continuous and
truly concrete will to help other patients and the nurses. He was discharged on 19th June,
Q: "Given the result of that first attempt, I imagine that
during these two years you have continued experimenting".
A: "Certainly. We have carried out thousands of shocks on
patients suffering from different mental pathologies and at the same time, we have
continued experimenting on animals to try and understand on the one hand the activating
mechanism of the therapy and any irreparable organic alterations caused to the brain; on
the other, the therapeutic indications".
Q: "Would you like to tell me briefly about the conclusions
you have drawn from all your experiences to date?"
A: "Electroshock does not seem to cause irreversible lesions to
the brain. Compared with other techniques it is easier to use, less dangerous and
requiring the minimum of expense. The two pathologies which up to now have given optimal
therapeutic results using shock and paticularly E.S. are, schizophrenia, especially in
initial acute forms and even more, manic-depressive phrenosis especially in its depressive
form. As far as the activating mechanism is concerned I have formed this idea:
electroshock violently arouses all those nervous reactions, which belong to the field of
cerebral functions philogenetically organised to guard and defend life. The violent
activation of the above-mentioned mechanisms has the effect of powerfully reviving,
stimulating and bringing back onto an active level, all the neuro-psychism that is
composed of reflex, instinctive and affective reactions which make us function well in our
relationships with others, yet which lies dormant and inert in mental illnesses like
schizophrenia and serious forms of depression. These however, are only working hypotheses
on which it would be worth working and matching one's strength in future in order to
better understand the activating mechanism of Electroshock and to find possible new
Q: "I would like to thank you very much for devoting me some
of your time and I hope I will be able to talk to you again on this subject". A:
"It's been a pleasure. I also hope to discuss this subject again, perhaps comparing
my own experiences with those of other people who have tried out my discovery.
Cerletti, U. (1940) L'Elettroshock. Rivista Sperimentale di
Frenatria. Vol I, 209- 310
Postel, J, QuËtel, C, (1983) Histoire de la Psychiatrie, Editions
Privat, Toulouse, 602-603