On November 29, 1879, Portuguese neurologist António Egas Moniz was born. He is reknown as the developer of cerebral angiography. Moniz is regarded as one of the founders of modern psychosurgery, having developed the surgical procedure leucotomy — known better today as lobotomy — for which he became the first Portuguese national to receive a Nobel Prize in 1949 shared with Walter Rudolf Hess.
António Moniz was born in the northern coastal village Avanca, Estarreja, Portugal, the son of Fernando de Pina Rezende Abreu and Maria do Rosario de Almeida e Sousa. He attended Escola do Padre José Ramos and Colégio de S. Fiel dos Jesuítas, studied medicine at the University of Coimbra, then was trained in neurology in Bordeaux and Paris. In 1902, he became a professor in the Department of Neurology at the University of Coimbra, but soon left that post on entering politics in 1903. He established the Partido Republicano Centrista and represented it in the Portuguese parliament from 1903 to 1917. Later he was Portugal’s ambassador to Madrid (1917) and minister of foreign affairs (1918), in which function he attended the Paris Peace Conference, after World War I in 1919. Meanwhile, he continued to practice medicine and teach physiology and anatomy, and in 1911 he became a professor of neurology at the newly established University of Lisbon. He also worked for a time as a physician in the Hospital of Santa Maria, Lisbon.
In 1926, Moniz left politics entirely when António de Oliveira Salazar gained power following a military coup d’etat, and Portugal abandoned the liberal democracy that had allowed Moniz to flourish, and returned to medicine and writing full-time. In 1927 Moniz developed cerebral angiography (arteriography), a technique allowing blood vessels in and around the brain to be visualized. In various forms it remains a fundamental tool both in diagnosis and in the planning of surgeries on the brain. In cerebral angiography typically a catheter is inserted into a large artery (such as the femoral artery) and threaded through the circulatory system to the carotid artery, where a contrast agent is injected. A series of radiographs are taken as the contrast agent spreads through the brain’s arterial system, then a second series as it reaches the venous system. Prior to the advent of modern neuoroimaging techniques such as MRI and CT in the mid-1970s, cerebral angiographies were frequently employed as a tool to infer the existence and location of certain kinds of lesions and hematomas by looking for secondary vascular displacement caused by the mass effect related to these medical conditions. For this achievement, Moniz was nominated twice for the Nobel Prize. He also contributed to the development of Thorotrast, a suspension containing particles of the radioactive compound thorium dioxide, used as a radiocontrast agent in medical radiography.
Moniz had an idea that some forms of mental illness were caused by an abnormal sort of stickiness in nerve cells, causing neural impulses to get stuck and the patient to repeatedly experience the same pathological ideas. There was no empiric evidence for his theory, but Moniz pressed on. If the nerve fibers causing these morbidly fixed ideas could be destroyed, the patient might improve. In 1936, Moniz published his first report of performing a prefrontal leucotomy (lobotomy) on a human patient, a neurosurgical procedure that consists of cutting or scraping away most of the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain, and subsequently devised the leucotome, a surgical instrument for use in the procedure. He 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.” The operation, though successful in eliminating the symptoms of persons suffering from apparently incurable psychoses, is now known to have serious side effects, and Egas Moniz cautioned that it was a radical procedure to be followed only after all other forms of treatment had proved to be ineffective.
He also claimed that any behavioral and personality deterioration that may occur was outweighed by reduction in the debilitating effects of the illness. But he conceded that patients who had already deteriorated from the mental illness did not benefit much, and he did no long-term follow up. The procedure enjoyed a brief vogue, and in 1949 he received the Nobel Prize, for his discovery of the therapeutic value of leucotomy in certain psychoses.
In 1949, Moniz was shot by a patient, and subsequently used a wheelchair. He continued in private practice until 1955, when he died just as his procedure was falling into disrepute. The popularity of the procedure declined drastically in the 1950s and beyond. Evidence of serious side effects mounted with long-term studies. The use of newly developed Thorazine, the first nonsedating tranquilizer, reduced the perceived need for most lobotomies. Moniz also was a prolific author who wrote and published on a wide variety of subjects including Portuguese literature, sexology and two autobiographies. His assorted writings also include a biography of Padre Faria, a monk and hypnotist from the former Portuguese colony of Goa on the west coast of India; a biography of a Portuguese physician Pedro Hispano Portucalense who became Pope John XXI in the 13th century; and a book on the history of playing cards, reflecting Moniz’s interest in gambling.
At yovisto you can learn more about ‘Imagining the Brain‘ in a lecture by Richard Ivry.
References and Further Reading:
-  Egas Moniz – Biographical, at Nobelprize.org
-  Moniz develops lobotomy for mental illness, 1935, People and Discoveries
-  António Egas Moniz, Portuguese Neurologist, at Britannica Online
-  Siang Yong Tan, Angela Yip: António Egas Moniz (1874–1955): Lobotomy pioneer and Nobel laureate, Singapore Med J. 2014 Apr; 55(4): 175–176.