Egas Moniz

From Wikipedia, the free encyclopedia

Please wikify (format) this article or section as suggested in the Guide to layout and the Manual of Style.

Remove this template after wikifying. This article has been tagged since October 2006.

António Caetano de Abreu Freire Egas Moniz (November 29, 1874 – December 13, 1955), pron. IPA: ['ɛgɐʃ mu'niʃ], was a Portuguese psychiatrist and neurosurgeon. He was born in Avanca, Portugal. He was the inventor of prefrontal leucotomy which was changed to lobotomy by American surgeons who introduced a larger severing of the neural fibres. It was used as a surgical approach to the radical treatment of several kinds of mental diseases; one of the several types of psychosurgery. For this work, Moniz received the Nobel Prize in 1949, jointly with the Swiss neurophysiologist Walter Rudolf Hess. He also developed in 1927 the technique of contrasted x-ray cerebral angiography to diagnose several kinds of nervous diseases, being recognised as the pioneer in this field.

Moniz studied medicine in the University of Coimbra and thereafter psychiatry in Bordeaux and Paris, France. Of special note is that he was not initially a student of neurology as it is nowadays recognised, although psychiatry was not distinct from neurology at this time. He returned to the University of Coimbra as Chairman of the Department of Neurology (1902), but soon left it to enter politics as a representative in the Portuguese parliament (1903-1917), as minister of Foreign Affairs (1918) and later as Ambassador to Spain, under the First Republic (1918-1919). He left politics, returned to the University of Lisbon, where, from 1921 to 1944, he was professor of Neurology. In 1927, he developed the technique of contrasted x-ray cerebral arteriography to diagnose several kinds of neurological disorders, such as tumors and arteriovenous malformations. He received the Oslo Prize for this discovery. The method is widely used today for the diagnosis of brain tumors and vascular diseases in the brain and other organs. It saved thousands of lives.

In 1936, Egas Moniz and his associate Almeida Lima developed for the first time a surgical technique to interrupt the nerve fibers which connect the thalamus (a relay for sensory information coming into the brain) to the prefrontal cortex (already known at the time as a brain structure involved in higher intellectual functions of the brain, and in emotions, as well). His technique was widely used around the world in the next decade, and Moniz received many honours and international recognition, culminating with the Nobel Prize.

The surgical approach subsequently fell into disrepute when Freeman in the US modified the technique using it undiscriminately in several patients. Since the technique was not standardized the results depended very much on the surgeon. In 1975 a paper in Archives of General Psychiatry, volume 32, pages 1041-7, by I.C. Bernstein et al, reported a follow-up study of 43 private psychiatric patients who underwent prefrontal lobotomies between 1948 and 1970. The authors found that 35 were "virtually free of symptoms that prompted the operation", 6 had "some improvement", and 2 "were unimproved". They commented, "There is general agreement that high social class is a favorable prognostic...The supportive social environment seen so often in a private patient population is, we suggest, an important factor in our relatively high rate of success as compared with series from state hospitals". This paper illustrates the variables that influenced the outcome. Drug treatments for mental illnesses are now the treatment of choice for mental illness. However, operations that are derivatives of leucotomy are still performed with technical improvements with good results on well selected patients. Neurosurgeons in Great Britain at the Wales University Hospital in Cardiff and at the Ninewells Hospital in Dundee have performed 56 and 34 of these operations respectively, during the last decade.

Dr. Moniz made an eventual complete recovery from a gunshot wound, sustained when one of his psychiatric patients sitting in front of him at his private practice opened fire. The patient gave vague reasons for the shooting saying he was unsatisfied with the dose of a drug Dr. Moniz had prescribed. He died in 1955, in Lisbon, Portugal, of natural causes.

His former country house became a museum where one can see his art collection. It can be visited in Avanca, in the north of Portugal