Egas Moniz, Antonio Caetano De Abreu Freire

(b. Avança, Portugal, 29 November 1874; d. Lisbon, Portugal, 13 December 1955)

neurology.

Egas Moniz, the son of Fernando de Pina Rezende Abreu and Maria do Rosario de Almeida e Sousa, was educated by his uncle, an abbé, before entering the University of Coimbra in 1891. He studied mathematics and considered a career in engineering before deciding to enter medicine; he received his M.D. degree in 1899. Selecting neurology as his specialty, Egas Moniz went to Paris and Bordeaux to study with the leading figures in neurology and psychiatry, such as J. F. F. Babinski, J. J. Dejerine, Pierre Marie, and J. A. Sicard. In 1902 he became professor at Coimbra and married Elvira de Macedo Dias. Egas Moniz was appointed to the chair of neurology at the new University of Lisbon in 1911, a position he held until his retirement in 1945. His honors included the Nobel Prize in physiology or medicine in 1949, honorary degrees from the universities of Bordeaux and Lyons, and awards from the Portuguese, Spanish, Italian, and French governments. He served as president of the Lisbon Academy of Sciences and was a member or honorary member of many other scientific societies, including the Royal Society of Medicine, the Academy of Medicine in Paris, and the American Neurological Association.

In addition to his scientific achievements, Egas Moniz was an accomplished historian, literary critic, and composer and had a distinguished career in politics. He was a deputy in the Portuguese Parliament from 1900 until his appointment as ambassador to Spain in 1917; he became foreign minister in 1918 and led Portugal’s delegation to the 1919 Paris Peace Conference. Egas Moniz retired from politics in 1919 after a political quarrel involved him in a duel.

Egas Moniz’ two most outstanding contributions to medicine were the diagnostic technique of cerebral angiography to locate brain tumors, and the first clinical use of psychosurgery. When he entered neurology, the method by which physicians attempted to use the still new technique of X-raying to locate intracranial tumors was the one developed by W. E. Dandy, involving the injection of air into the brain cavities. Seeking a more exact as well as a less hazardous technique, Egas Moniz began a series of cadaver experiments in which he injected various radiopaque solutions into the brain’s arteries. After mapping the normal distribution of the intracranial blood vessels, he introduced his method clinically in 1927, outlining with X rays the location and size of a patient’s brain tumor by the tumor’s displacement of injected arteries. Egas Moniz and his colleagues published over 200 papers and monographs on normal and abnormal cerebral angiography, and the technique has been refined and elaborated for the localization of tumors and vascular disorders throughout the body.

The Nobel Prize went to Egas Moniz “for his discovery of the therapeutic value of leucotomy in certain psychoses.” Early in his career he had worked with F. Regis on the problem of toxic psychoses and had become convinced that “only by an organic orientation can psychiatry make real progress.” In 1935, at the Second International Neurological Congress in London, he heard J. F. Fulton and G. F. Jacobsen discuss the effects of frontal leucotomy (surgical division of the nerves connecting the frontal lobes to the rest of the brain) on the behavior of two chimpanzees: the animals remained friendly, alert, and intelligent but were no longer subject to temper tantrums or other symptoms of the experimental neuroses that had been successfully induced prior to surgery.

On the basis of this work Egas Moniz and his young surgical colleague, Almeida Lima, worked out a frontal leucotomy technique that they felt might alleviate certain psychiatric conditions, particularly those dominated by emotional tensions. The report of their first clinical trials on mental hospital patients—no operative deaths and fourteen out of twenty patients “cured” or “improved”—created worldwide interest and debate over the possibility that mental illness could be corrected by operating on brains that are not organically diseased. Modifications of their psychosurgical procedure were employed widely for two decades, then declined in use with the advent of psychopharmacology. At the Nobel presentations in 1949, Herbert Olivecrona captured the significance of Egas Moniz’ work when he said:

Frontal leucotomy, despite certain limitations of the operative method, must be considered one of the most important discoveries ever made in psychiatric therapy, because through its use a great number of suffering people and total invalids have recovered and have been socially rehabilitated.

NOTE

The presentation speech by Olivecrona at the Nobel awards, 1949, is in Nobel Lectures. Physiology or Medicine, 1942–1962 (Amsterdam-New York, 1964), p. 246.

The techniques of frontal leucotomy or lobotomy pioneered by Egas Moniz in treating mental conditions were applied to the alleviation of intractable pain by W. H. Freeman and his colleagues in the mid-1940’s. Variations of the surgical procedure have been devised in an effort to minimize some of the undesirable personality changes that were found to follow leucotomy. Use of the procedure to treat conditions such as schizophrenia has declined greatly since the advent of tranquilizers and other psychopharmacological agents.

BIBLIOGRAPHY

I. Original Works. Egas Moniz’ writings include A vida sexual (fisiologia e patologia) (Coimbra, 1901); A neurologia na guerra (Lisbon, 1917); Um ano de politico (Lisbon, 1920); “L’encéphalographie artérielle: Son importance dans la localisation des tumeurs cérébrales,” in Revue neurologique, 2 (1927), 72–90; Diagnostic des tumeurs cérébrales et épreuve de l’encéphalographie artérielle (Paris, 1931); L’angiographie cérébrale, ses applications et résultats en anatomie, physiologie et clinique (Paris, 1934); “Essai d’un traitement chirurgical de certaines psychoses,” in Bulletin de l’Académie de médecine, 115 (1936), 385–392; Tentatives opératoires dans le traitement de certaines psychoses (Paris, 1936); Ao lado da medicina (Lisbon, 1940); Como cheguei a realizar a leucotomia pré-frontal (Lisbon, 1948).

II. Secondary Literature. See “Obituary. Antonio Egas Moniz, M.D.,” in Lancet (1955), 2 , 1345; and F. R. Perino, “Egas Moniz, 1874–1955,” in Journal of the International College of Surgeons, 36 (1961), 261–271.

Judith P. Swazey