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António Caetano de Abreu Freire Egas Moniz (29 November 1874 – 13 December 1955), known as Egas Moniz (), was a Portuguese
neurologist Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal c ...
and the developer of
cerebral angiography Cerebral angiography is a form of angiography which provides images of blood vessels in and around the brain, thereby allowing detection of abnormalities such as arteriovenous malformations and aneurysms. It was pioneered in 1927 by the Portugue ...
. He is regarded as one of the founders of modern psychosurgery, having developed the surgical procedure ''leucotomy''better known today as ''
lobotomy A lobotomy, or leucotomy, is a form of neurosurgical treatment for psychiatric disorder or neurological disorder (e.g. epilepsy) that involves severing connections in the brain's prefrontal cortex. The surgery causes most of the connections t ...
''for which he became the first Portuguese national to receive a
Nobel Prize The Nobel Prizes ( ; sv, Nobelpriset ; no, Nobelprisen ) are five separate prizes that, according to Alfred Nobel's will of 1895, are awarded to "those who, during the preceding year, have conferred the greatest benefit to humankind." Alfr ...
in 1949 (shared with Walter Rudolf Hess). He held academic positions, wrote many medical articles and also served in several legislative and diplomatic posts in the Portuguese government. In 1911, he became professor of neurology in Lisbon until his retirement in 1944.


Early life and training

Moniz was born in Avanca,
Estarreja Estarreja ( or ) is a municipality in Portugal. The population in 2011 was 26,997, in an area of 108.17 km2. It had 22,746 eligible voters in 2006. The only city in the municipality is Estarreja, which is in the urban parish of Beduido. The c ...
, Portugal, as António Caetano de Abreu Freire de Resende. He attended Escola do Padre José Ramos and the Jesuit-run College of Saint Fidelis and studied medicine at the
University of Coimbra The University of Coimbra (UC; pt, Universidade de Coimbra, ) is a public research university in Coimbra, Portugal. First established in Lisbon in 1290, it went through a number of relocations until moving permanently to Coimbra in 1537. The u ...
, graduating in 1899. For the next 12 years, he served as a lecturer for basic medical courses at Coimbra. In 1911, he became a neurology professor at the University of Lisbon, where he worked until his retirement in 1944. His uncle and godfather, Father Caetano de Pina Resende Abreu e Sá Freire, convinced his family to change his surname to Egas Moniz since he was convinced that the Resende family was descended from medieval nobleman Egas Moniz o Aio.


Politics

Politics was an early passion for Moniz. He supported a republican government, diverging from his family's support for the monarchy. As a student activist, he was jailed on two separate occasions for participating in demonstrations. While serving as Dean of the Medical School at the University of Lisbon, he was arrested a third time for preventing police from settling a student-run protest. Antonio Moniz was a Freemason. Moniz's formal political career began when he was elected to parliament in 1900. During World War I, he was appointed the Ambassador to Spain, and afterward, he became Minister for Foreign Affairs in 1917, and in 1918 led the Portuguese delegation to the
Versailles Peace Conference The Palace of Versailles ( ; french: Château de Versailles ) is a former royal residence built by King Louis XIV located in Versailles, about west of Paris, France. The palace is owned by the French Republic and since 1995 has been managed, u ...
. He retired from politics in 1919 following a duel resulting from a political quarrel.


Research


Cerebral angiography

In 1926, at age 51, Moniz retired from politics and returned to medicine full-time. He hypothesized that visualizing blood vessels in the brain with radiographic means would allow for more precise localization of brain tumors. During his experiments, Moniz injected radiopaque dyes into brain arteries and took X-rays to visualize abnormalities. In his initial tests, Moniz used strontium and lithium bromide in three patients with a suspected tumor, epilepsy, and Parkinsonism, but the experiment failed and one patient died. In the next set of trials, he achieved success using 25% sodium iodide solution on three patients, developing the first cerebral angiogram. Moniz presented his findings at the Neurological Society in Paris and the French Academy of Medicine in 1927. He was the first person to successfully visualize the brain using radiopaque substances, as previous scientists had only visualized peripheral structures. He also contributed to the development of
Thorotrast Thorotrast is a suspension containing particles of the radioactive compound thorium dioxide, ThO2; it was used as a radiocontrast agent in clinical radiography in the 1930s to 1950s. It is no longer used clinically. Thorium compounds produce ...
for use in the procedure and delivered many lectures and papers on the subject. His work led to the use of angiography to detect internal carotid occlusion, as well as two Nobel Prize nominations in this area.


Prefrontal leucotomy

Moniz thought that mental illness originated from abnormal neural connections in the frontal lobe. He described a "fixation of synapses," which in mental illness, was expressed as "predominant, obsessive ideas." Moniz also referenced the experiments of Yale physiologists John Fulton and C.F. Jacobsen, who found that removing the frontal lobes of a chimpanzee made it calmer and more cooperative. In addition, Moniz observed "changes in character and personality" among soldiers who had had injuries to their frontal lobes. Moniz hypothesized that surgically removing white matter fibers from the frontal lobe would improve a patient's mental illness. He enlisted his long-time staff member and neurosurgeon Almeida Lima to test the procedure on a group of 20 patients, mainly with schizophrenia, anxiety, and depression. The surgeries took place under general anesthesia. The first psychosurgery was performed in 1935 on a 63-year-old woman with depression, anxiety, paranoia, hallucinations, and insomnia. The patient experienced a rapid physical recovery, and two months later, a psychiatrist noted that she was calmer, less paranoid, and well oriented. In the first set of surgeries, Moniz reported a total of seven cures, seven improvements, and six unchanged cases. Moniz never performed a surgery himself, partially because of his lack of neurosurgical training but also because he had limited use of his hands as a complication of gout. Instructed by Moniz, Lima performed ten of the first twenty surgeries by injecting absolute alcohol to destroy the frontal lobe. Later on, Moniz and Lima developed a new technique using a leucotome, a needle-like instrument with a retractable wire loop. By rotating the wire loop, they were able to surgically separate white matter fibres. Moniz judged the results acceptable in the first 40 or so patients he treated, claiming, "Prefrontal leukotomy is a simple operation, always safe, which may prove to be an effective surgical treatment in certain cases of mental disorder." He also claimed that any behavioral and personality deterioration that may occur was outweighed by reduction in the debilitating effects of the illness. He conceded that patients who had already deteriorated from the mental illness did not benefit much. The procedure enjoyed a brief vogue, and in 1949 he received the
Nobel Prize The Nobel Prizes ( ; sv, Nobelpriset ; no, Nobelprisen ) are five separate prizes that, according to Alfred Nobel's will of 1895, are awarded to "those who, during the preceding year, have conferred the greatest benefit to humankind." Alfr ...
"for his discovery of the therapeutic value of leucotomy in certain psychoses." Critics accused Moniz of understating complications, providing inadequate documentation, and not following up with patients. After his initial procedures, other physicians, such as
Walter Jackson Freeman II Walter Jackson Freeman II (November 14, 1895 – May 31, 1972) was an American physician who specialized in lobotomy. Early years Walter J. Freeman was born on November 14, 1895, and raised in Philadelphia, Pennsylvania, by his parents. Freema ...
and James W. Watts, adopted a modified technique in the United States and renamed it "lobotomy."


Writing

Moniz was a prolific writer, publishing work in Portuguese literature, sexology, and two autobiographies. Upon graduating from medical school, he gained notoriety for publishing a series of controversial books, called ''A Vida Sexual'' (The Sexual Life). His other writings included biographies of Portuguese physician Pedro Hispano Portucalense and José Custódio de Faria, a monk and hypnotist. In the field of medicine, Moniz published 112 articles and 2 books on angiography alone. He also wrote on neurological war injuries, Parkinson's disease, and clinical neurology.


Later life and death

In 1939, Moniz was shot multiple times by a patient with schizophrenia. Subsequently, Moniz used a wheelchair. He continued in private practice until 1955. Moniz died from an internal haemorrhage on 13 December 1955.


Legacy

After Moniz's death, antipsychotic medications were developed and put into use, and leucotomies fell out of favour. Moniz's legacy suffered towards the end of the 20th century, as leucotomies were then perceived overwhelmingly negatively, thought of as an outdated experimental procedure. Well-known experts including Elliot Valenstein, a psychologist, and
Oliver Sacks Oliver Wolf Sacks, (9 July 1933 – 30 August 2015) was a British neurologist, naturalist, historian of science, and writer. Born in Britain, Sacks received his medical degree in 1958 from The Queen's College, Oxford, before moving to the Uni ...
, a neurologist, were particularly critical of Moniz's methods and of his Nobel Prize. There have been calls to rescind Moniz's Nobel Prize, especially from relatives of family members that underwent leucotomies. However, others have defended Moniz for his scientific contributions, stressing the need to examine his legacy in context. In his native Portugal, Moniz is highly regarded, being featured on commemorative banknotes and postage stamps. A statue of him stands outside the Faculty of Medicine of the
University of Lisbon The University of Lisbon (ULisboa; pt, Universidade de Lisboa, ) is a public research university in Lisbon, and the largest university in Portugal. It was founded in 2013, from the merger of two previous public universities located in Lisbon, th ...
, and his country house in Avanca is now a museum. In 2020, a
biographical A biography, or simply bio, is a detailed description of a person's life. It involves more than just the basic facts like education, work, relationships, and death; it portrays a person's experience of these life events. Unlike a profile or c ...
made-for-television film was produced by
RTP2 RTP2 (''RTP dois'') is a Portuguese free-to-air television channel owned and operated by state-owned public broadcaster Rádio e Televisão de Portugal (RTP). It is the company's second television channel, and is known for broadcasting cultural, ...
titled ''O Ego de Egas'' ("The Ego of Egas"), which explores Moniz's work and motives.


Important publications

According to the
Nobel Prize The Nobel Prizes ( ; sv, Nobelpriset ; no, Nobelprisen ) are five separate prizes that, according to Alfred Nobel's will of 1895, are awarded to "those who, during the preceding year, have conferred the greatest benefit to humankind." Alfr ...
, his more important publications are: *''Alterações anátomo-patológicas na difteria'' (Anatomo-pathologic changes in diphtheria), Coimbra, 1900. *''A vida sexual (fisiologia e patologia)'' (Physiological and pathological aspects of sex life), 19 editions, Coimbra, 1901. *''A neurologia na guerra'' (Neurology in war), Lisbon, 1917. *''Um ano de política'' (A year of politics), Lisbon, 1920. *''Júlio Diniz e a sua obra'' (
Júlio Dinis Júlio Dinis, pseudonym of Joaquim Guilherme Gomes Coelho (14 November 1839 – 12 September 1871) was a Portuguese doctor and poet, playwright and novelist. He was the first great novelist of modern Portuguese middle-class society. His novels, ...
and his works), 6 editions, Lisbon, 1924. *''O Padre Faria na história do hipnotismo'' (Abbé Faria in the history of hypnotism), Lisbon, 1925. *''Diagnostic des tumeurs cérébrales et épreuve de l'encéphalographie artérielle'' (Diagnostics of cerebral tumours and application of arterial encephalography), Paris, 1931. *''L'angiographie cérébrale, ses applications et résultats en anatomic, physiologie et clinique'' (Cerebral angiography, its applications and results in anatomy, physiology, and clinic), Paris, 1934. *''Tentatives opératoires dans le traitement de certaines psychoses'' (Tentative methods in the treatment of certain psychoses), Paris, 1936. *''La leucotomie préfrontale. Traitement chirurgical de certaines psychoses'' (Prefrontal leucotomy. Surgical treatment of certain psychoses), Turin, 1937. *''Clinica dell'angiografia cerebrale'' (Clinical cerebral angiography), Turin, 1938. *''Die cerebrale Arteriographie und Phlebographie'' (Cerebral arteriography and phlebography), Berlin, 1940. *''Ao lado da medicina'' (On the side of medicine), Lisbon, 1940. *''Trombosis y otras obstrucciones de las carótidas'' (Thrombosis and other obstructions of the carotids), Barcelona, 1941. *''História das cartas de jogar'' (History of playing-cards), Lisbon, 1942. *''Como cheguei a realizar a leucotomia pré-frontal'' (How I came to perform leucotomy), Lisbon, 1948. *''Die präfrontale Leukotomie'' (Prefrontal leucotomy), Archiv für Psychiatrie und Nervenkrankheiten, 1949.


Distinctions


National orders

* Grand Cross of the Order of Saint James of the Sword (3 March 1945) * Grand Cross of the Order of Instruction and of Benefaction (5 October 1928)


Foreign orders

* Commander of the
Legion of Honour The National Order of the Legion of Honour (french: Ordre national de la Légion d'honneur), formerly the Royal Order of the Legion of Honour ('), is the highest French order of merit, both military and civil. Established in 1802 by Napoleon ...
(France) * Grand Officer of the Order of the Crown of Italy (Italy) * Grand Cross of the
Order of Isabella the Catholic The Order of Isabella the Catholic ( es, Orden de Isabel la Católica) is a Spanish civil order and honor granted to persons and institutions in recognition of extraordinary services to the homeland or the promotion of international relations a ...
(Spain)


See also

*
Angiography Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins, and the heart chambers. Modern angiography is perfor ...
* Pulmonary angiography *
Neuroimaging Neuroimaging is the use of quantitative (computational) techniques to study the structure and function of the central nervous system, developed as an objective way of scientifically studying the healthy human brain in a non-invasive manner. Incr ...


Notes


References


External links


Egas Moniz House Museum in Avanca (in Portuguese)World of Scientific Discovery on Antonio Egas MonizNeurosurgery for mental disorder: past and present
*By L F Haa
Neurological stamp Egas Moniz (1874–1955) www.jnnp.com
* {{DEFAULTSORT:Moniz, Antonio Egas 1874 births 1955 deaths 19th-century Portuguese physicians 20th-century Portuguese physicians Ambassadors of Portugal to Spain Commandeurs of the Légion d'honneur Foreign ministers of Portugal Government ministers of Portugal Grand Crosses of the Order of Saint James of the Sword Knights Grand Cross of the Order of Isabella the Catholic Legislators in Portugal Lobotomy Nobel laureates in Physiology or Medicine People from Aveiro District Portuguese neurologists Portuguese Nobel laureates Portuguese people with disabilities University of Coimbra alumni