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Egas Moniz

"father of psychosurgery"

Egas Moniz

Antonio Caetano de Abrue Freire was born in Avanca, Portugal, on November 29, 1874, the son of Fernando de Pina Rezende Abreu and Maria do Rosario de Almeida e Sousa. "Egas Moniz" is the name given him by his godfather when Moniz was an infant, honoring a legendary figure who fought with the Portuguese resistance against the Moors in the 12th century, and that is the name he went by his entire life.

Moniz received his Bachelor's degree in mathematics from the University of Coimbra in 1895, and his Doctor of Medicine from that same institution in 1899. Selecting neurology as his specialty, he then went to Paris and Bordeaux to study with the leading figures in neurology and psychiatry, such as Joseph Jules François Félix Babinski, Joseph Jules Dejerine, Pierre Marie, and Jean Athanase Sicard. He became a Professor of Neurology at Coimbra in 1902, and remained there until assuming the Chair in Neurology at the University of Lisbon in 1911.

In addition to his university work, Moniz also became involved in politics, serving in the Portuguese Parliament from 1903 to 1917. He left Parliament to serve as Ambassador to Spain (1917), and then as Minister for Foreign Affairs (1917-1918). He served as President of the Portuguese Delegation at the Paris Peace Conference in 1918, and signed the Treaty of Versailles on behalf of Portugal. He left politics after his party was deposed in 1920.

Returning to the University of Lisbon, Moniz redirected his attention to neurological research. 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 the American neurosurgeon Walter Edward Dandy, involving the injection of air into the brain cavities. Seeking a more exact as well as a less hazardous technique, Moniz began a series of cadaver experiments in which he injected various radioactive solutions into the brain’s arteries. After mapping the normal distribution of the intracranial blood vessels, he introduced his method clinically 1927, outlining with X-rays the location and size of a patient’s brain tumor by the tumor’s displacement of injected arteries. Known as cerebral angiography, Moniz's technique is still a valuable tool in the diagnosis of intracranial diseases, and has also been refined and elaborated for the localization of tumors and vascular disorders throughout the body.

In 1935, at the Second International Neurological Congress in London, Moniz heard physiologist John Farquhar Fulton and animal physiologist Carlyle Jacobsen discuss the effects of frontal leucotomy (the surgical division of the nerves connecting the frontal lobes to the rest of the brain) on the behavior of two chimpanzees. According to them, 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 induced prior to surgery. Moniz believed that the procedure could also be used to treat mental disorders in humans.

Moniz realized that certain psychoses, particularly degenerated schizophrenia and severe paranoia, involve recurrent thought patterns that dominate normal psychological processes. He reasoned that, severing the nerve fibers between the frontal lobes, known to be closely associated with psychological responses, and the thalamus, might force a transformation of existing thought patterns to more normal ones, allowing a more normal life for the patient. On November 12, 1935, he and and his assistants made the first attempts at this type of psychosurgery. Using local anesthetics, they drilled several holes in the patient's skull, first injecting adrenalin and novocain, then pure alcohol. The object was to destroy the fibers that connect the frontal lobes, the area they believed to be most immediately concerned with social behaviour. Their patient, a female asylum inmate, appeared to be less agitated and overtly paranoid than she had been before, although she was also more apathetic than Moniz had hoped. She had a few physical side effects such as nausea and disorientation, but overall struck Moniz as much improved. After seven patients, Moniz switched to cutting the lobe with a wire, and this is the procedure now known as prefrontal lobotomy.

In 1936, Moniz published very positive results of his first 20 operations on patients who had suffered from anxiety, depression, and schizophrenia. Though his follow-up was mainly within the first few days of surgery and his determination of "improvement" was rather subjective, his publication was well received. It seemed to offer evidence of the benefits of psychosurgery, and prefrontal lobotomy remained a major "tool" for the treatment of mental disorders until being supplanted by drugs and other therapies in the 1960's. Moniz's work earned him the 1949 Nobel Prize in Physiology/Medicine, which he shared with Swiss physiologist Walter Rudolf Hess (who was recognized "for his discovery of the functional organization of the interbrain as a coordinator of the activities of the internal organs").

Egas Moniz continued to conduct research and practice medicine until shortly before his death, which came at Avanca on December 13, 1955.

SOURCE
Nobel Prize www.nobelprize.org

SEE ALSO
Nobel Prize in Physiology/Medicine

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This page was last updated on 07/02/2017.