António Egas Moniz

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Lore & Background

Moniz was born in Avanca, Estarreja, Portugal, as António Caetano de Abreu Freire de Resende. He attended Escola do Padre José Ramos and the Jesuit-run College of Saint Fidelis, then studied medicine at the University of Coimbra, 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 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. His 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 Paris Peace Conference. He retired from politics in 1919 following a duel resulting from a political quarrel. In 1926, at age 51, Moniz 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. In his initial tests, Moniz used strontium and lithium bromide in three patients, but the experiment failed and one patient died. After a set of trials in rabbits, dogs, and cadaver heads, he achieved success using 25% sodium iodide solution on three patients, developing the first cerebral angiogram. He presented his findings at the Neurological Society in Paris and the French Academy of Medicine in 1927. He also contributed to the development of Thorotrast for use in the procedure. For psychosurgery, Moniz thought that mental illness originated from abnormal neural connections in the frontal lobe, describing a 'fixation of synapses.' He referenced experiments by Yale physiologists John Farquhar Fulton and C.F. Jacobsen, who found that removing the frontal lobes of a chimpanzee made it calmer and more cooperative. 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 Pedro Almeida Lima to test the procedure. 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. 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.

Reader's Guide

Egas Moniz's significance lies in two major contributions: cerebral angiography and prefrontal leucotomy. Angiography revolutionized the diagnosis of brain tumors and vascular conditions, leading to two Nobel Prize nominations in this area. Leucotomy, for which he won the 1949 Nobel Prize 'for his discovery of the therapeutic value of leucotomy in certain psychoses,' was initially seen as a breakthrough. In the first set of 20 surgeries, Moniz reported a total of seven cures, seven improvements, and six unchanged cases. He judged the results acceptable in the first 40 or so patients, 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 conceded that patients who had already deteriorated from the mental illness did not benefit much. 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. Critics accused Moniz of understating complications, providing inadequate documentation, and not following up with patients. Well-known experts, including psychologist Elliot Valenstein, and neurologist Oliver Sacks, were particularly critical of Moniz's methods and him earning the Nobel Prize. There have been calls to rescind Moniz's Nobel Prize, especially from family members of patients who 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, and his country house in Avanca is now a museum. In 2020, a biographical made-for-television film was produced by RTP2 titled 'O Ego de Egas' ('The Ego of Egas'), which explores Moniz's work and motives.

Did You Know?

• Moniz was jailed on two separate occasions as a student activist for participating in demonstrations, and a third time while serving as Dean of the Medical School for preventing police from settling a student-run protest.
• He retired from politics in 1919 following a duel that resulted from a political quarrel.
• In his initial cerebral angiography experiments, Moniz used strontium and lithium bromide on three patients, but the experiment failed and one patient died.
• Moniz never performed a leucotomy surgery himself, partly because he had limited use of his hands as a complication of gout.
• In 1939, Moniz was shot multiple times by a patient with schizophrenia.