António Egas Moniz
Portuguese neurologist who developed cerebral angiography and prefrontal leucotomy.
António Caetano de Abreu Freire Egas Moniz (29 November 1874 – 13 December 1955), commonly called Egas Moniz, was a Portuguese neurologist best known for inventing cerebral angiography. He is also considered a pioneer of modern psychosurgery, having created the leucotomy—often referred to as a lobotomy—which earned him the Nobel Prize in 1949, making him the first Portuguese citizen to win that award (he shared it with Walter Rudolf Hess). Over his career, he held academic roles, published numerous medical papers, and served in various legislative and diplomatic positions within the Portuguese government. In 1911, he became a neurology professor in Lisbon, a post he kept until retiring in 1944.
Moniz was born in Avanca, Estarreja, Portugal, as António Caetano de Abreu Freire de Resende. He studied at Escola do Padre José Ramos and the Jesuit-run College of Saint Fidelis, then pursued medicine at the University of Coimbra, graduating in 1899. For the next twelve years, he taught basic medical courses at Coimbra. In 1911, he moved to the University of Lisbon as a neurology professor, remaining there until his retirement in 1944. His uncle and godfather, Father Caetano de Pina Resende Abreu e Sá Freire, persuaded the family to change his surname to Egas Moniz, believing the Resende family descended from the medieval nobleman Egas Moniz o Aio.
Politics engaged Moniz early on. He backed a republican government, unlike his family’s monarchist leanings. As a student activist, he was jailed twice for joining demonstrations. While serving as Dean of the Medical School at the University of Lisbon, he was arrested a third time for stopping police from breaking up a student protest. His formal political career began with his election to parliament in 1900. During World War I, he was appointed Ambassador to Spain; afterward, he became Minister for Foreign Affairs in 1917, and in 1918 led the Portuguese delegation to the Paris Peace Conference. He left politics in 1919 after a duel sparked by a political dispute.
At age 51, in 1926, Moniz returned to full-time medical research. He believed that using X-rays to visualize brain blood vessels would help locate brain tumors more precisely. In experiments, he injected radiopaque dyes into brain arteries and took X-rays to spot abnormalities. His first tests, using strontium and lithium bromide on three patients (suspected tumor, epilepsy, and Parkinsonism), failed, and one patient died. After trials on rabbits, dogs, and cadaver heads, he succeeded with a 25% sodium iodide solution on three patients, creating the first cerebral angiogram. He presented these results to the Neurological Society in Paris and the French Academy of Medicine in 1927. He was the first to successfully image the brain with radiopaque substances—earlier scientists had only imaged peripheral structures. He also helped develop Thorotrast for the procedure and gave many lectures and papers on it. His work enabled angiography to detect internal carotid occlusion and earned him two Nobel Prize nominations in this area.
Moniz theorized that mental illness stemmed from abnormal neural connections in the frontal lobe. He described a “fixation of synapses” that, in mental illness, showed up as “predominant, obsessive ideas.” He cited experiments by Yale physiologists John Farquhar Fulton and C.F. Jacobsen, who found that removing a chimpanzee’s frontal lobes made it calmer and more cooperative. He also noted “changes in character and personality” in soldiers with frontal lobe injuries. Moniz proposed that surgically cutting white matter fibers in the frontal lobe could improve mental illness. He enlisted his longtime colleague, neurosurgeon Pedro Almeida Lima, to test the procedure on twenty patients, mostly with schizophrenia, anxiety, and depression. Surgeries were done under general anesthesia. The first psychosurgery took place in 1935 on a 63-year-old woman with depression, anxiety, paranoia, hallucinations, and insomnia. She recovered quickly physically, and two months later a psychiatrist reported she was calmer, less paranoid, and well oriented. In that initial group, Moniz recorded seven cures, seven improvements, and six unchanged cases.
Moniz never performed a surgery himself, partly because he lacked neurosurgical training and partly because gout limited the use of his hands. Following Moniz’s instructions, Lima carried out ten of the first twenty operations by injecting absolute alcohol to destroy frontal lobe tissue. Later, Moniz and Lima developed a new method using a leucotome—a needle-like tool with a retractable wire loop—which they rotated to separate white matter fibers. Moniz deemed the results acceptable in the first forty or so patients, stating, “Prefrontal leukotomy is a simple operation, always safe, which may prove to be an effective surgical treatment in certain cases of mental disorder.” He argued that any behavioral or personality deterioration was outweighed by the reduction in the illness’s debilitating effects, though he admitted that patients already deteriorated from the illness saw little benefit. The procedure became briefly popular, and in 1949 he received the Nobel Prize “for his discovery of the therapeutic value of leucotomy in certain psychoses.” Critics accused Moniz of downplaying complications, providing poor documentation, and failing to follow up with patients.
- born
- 29 November 1874
- died
- 13 December 1955
- field
- Neurology, psychosurgery
- nationality
- Portuguese
- known_for
- Cerebral angiography, prefrontal leucotomy (lobotomy)
Verified Timeline
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.
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