António Egas Moniz

In 1911, he became professor of neurology in Lisbon until his retirement in 1944.

António Egas Moniz studied at University of Coimbra and University of Lisbon. The recorded working language is Portuguese. The field of work recorded is neurologist. Employment is recorded with University of Coimbra and University of Lisbon. Positions recorded include ambassador and Minister of Foreign Affairs. Distinctions recorded are Grand Cross of the Order of Merit of Portugal, honorary doctor of the University of Bordeaux, doctor honoris causa from the University of Lyon and Grand Cross of the Military Order of Saint James of the Sword.

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 he 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. Moniz's 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.

• Illustration — Portrait of Egas Moniz in the doctoral regalia of the University of Coimbra, 1932, by José Malhoa 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. During his experiments, Moniz injected radiopaque dyes into brain arteries and took X-rays to visualize abnormalities. In his initial tests, Moniz used strontium and lithium bromide in three patients with a suspected tumor, epilepsy, and Parkinsonism, 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. Moniz presented his findings at the Neurological Society in Paris and the French Academy of Medicine in 1927. He was the first person to successfully visualize the brain using radiopaque substances, as previous scientists had only visualized peripheral structures. He also contributed to the development of Thorotrast for use in the procedure and delivered many lectures and papers on the subject. His work led to the use of angiography to detect internal carotid occlusion, as well as two Nobel Prize nominations in this area.

Moniz thought that mental illness originated from abnormal neural connections in the frontal lobe. He described a "fixation of synapses," which in mental illness, was expressed as "predominant, obsessive ideas." Moniz also referenced the experiments of 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. In addition, Moniz observed "changes in character and personality" among soldiers who had had injuries to their frontal lobes. 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 on a group of 20 patients, mainly with schizophrenia, anxiety, and depression. The surgeries took place under general anesthesia. 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. In the first set of surgeries, Moniz reported a total of seven cures, seven improvements, and six unchanged cases. 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. Instructed by Moniz, Lima performed ten of the first twenty surgeries by injecting absolute alcohol to destroy the frontal lobe. Later on, Moniz and Lima developed a new technique using a leucotome, a needle-like instrument with a retractable wire loop. By rotating the wire loop, they were able to surgically separate white matter fibres. Moniz 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." He also claimed that any behavioral and personality deterioration that may occur was outweighed by reduction in the debilitating effects of the illness. He conceded that patients who had already deteriorated from the mental illness did not benefit much. 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." Critics accused Moniz of understating complications, providing inadequate documentation, and not following up with patients. After his initial procedures, other physicians, such as Walter Jackson Freeman II and James W. Watts, adopted a modified technique in the United States and renamed it "lobotomy."

Moniz was a prolific writer, publishing work in Portuguese literature, sexology, and two autobiographies. Upon graduating from medical school, he gained notoriety for publishing a series of controversial books, called A Vida Sexual (The Sexual Life). His other writings included biographies of Portuguese physician Pedro Hispano Portucalense and José Custódio de Faria, a monk and hypnotist. In the field of medicine, Moniz published 112 articles and 2 books on angiography alone. He also wrote on neurological war injuries, Parkinson's disease, and clinical neurology.

In 1939, Moniz was shot multiple times by a patient with schizophrenia. He continued in private practice until 1955. Moniz died from an internal haemorrhage on 13 December 1955.

• Grand Cross of the Order of Saint James of the Sword (3 March 1945) • Grand Cross of the Order of Instruction and of Benefaction (5 October 1928)

• Commander of the Legion of Honour (France) • Grand Officer of the Order of the Crown of Italy (Italy) • Grand Cross of the Order of Isabella the Catholic (Spain)

• Egas Moniz House Museum in Avanca (in Portuguese) • World of Scientific Discovery on Antonio Egas Moniz • Neurosurgery for mental disorder: past and present • By L F Haas Neurological stamp Egas Moniz (1874–1955) www.jnnp.com *