A neurologist, Antonio Egas Moniz was the first Portuguese scientist to receive the Nobel Prize in Physiology or Medicine, awarded to him in 1949 for his work on developing the prefrontal leucotomy as therapy for certain psychoses or mental disorders.
Antonio Egas Moniz was born in Avança, Portugal, November 29, 1874. Although his parents Fernando de Pina Rezende Abreu and Mariado Rosario de Almedia é Sousa named him Antonio Caetano de Abreu Freire, he adopted the surname Egas Moniz at the request of his uncle Abbé Caetano de Pina Rezende Abreu, who believed the family was connected to a medieval nobleman of that name. This uncle, a clergyman, oversaw Egas Moniz’s education during his primary school years at the Escola do Padre José Ramos. After finishing high school at the Colegio de S Fiel dos Jesuita, Egas Moniz entered the University of Coimbra at the age of 17 (in 1891) to study medicine. He specialized in neurology, held internships in Bordeaux and Paris, and graduated in medicine from the University of Coimbra in 1899 at the age of 25. Two years later he completed a doctorate, focusing his thesis on the physiology and pathology of sexual life, a two-art work that was published as one volume in 1913.
In 1902, Egas Moniz married Elvira de Macedo Dias and also became a professor at the Faculty of Medicine at the University of Coimbra, where he taught anatomy, physiology, and general pathology.
At the same time, however, Egas Moniz devoted himself to politics. While a student, he had been an activist supporting a republican form of government in opposition to the monarchy. Before and after the First Republic was established in 1910, Egas Moniz served in the national legislature. In 1917, he was named Ambassador to Spain and then Minister of Foreign Affairs. In that capacity, Egas Moniz led the Portuguese delegation to the Paris Peace Conference at the end of Word War I and was Portugal’s signatory to the Treaty of Versailles.
In 1919, Egas Moniz retired from politics and recommitted himself to the world of science. Even while active in politics, since 1911 Egas Moniz had been a full professor at the Faculty of Medicine at the University of Lisbon. By the time Egas Moniz left the world of politics, several scientists around the world had begun to investigate different possible methods to conduct brain imaging, including injecting air into the vascular system of the brain to create a contrast to be visible by x-ray. Egas Moniz began research using radio-opaque solutions or dyes instead of air to create this contrast. Experimenting first with animals, he and his colleague Almeida Lima found that sodium iodide (25% solution) could make vascular branches in the brain visible on x-ray to be able to identify and localize brain tumors, aneurysms, vascular lesions, and other intracranial conditions. In 1927, Egas Moniz presented his findings on this technique to the Neurological Society in Paris and the French Academy of Medicine. This technique came to be known as cerebral angiography. Between 1928 and 1937, Egas Moniz was nominated three times for the Nobel Prize for his work on cerebral angiography but did not receive the award at that time. Instead, he won the Oslo Prize in 1945.
In the 1930s, Egas Moniz turned his attention to a possible treatment for certain psychoses like schizophrenia. He had noticed that some soldiers who had suffered injuries to their frontal lobes experienced personality changes. He thought that partially disconnecting the frontal lobe (which is associated with psychological responses) from the thalamus (which is the relay center for sensory impulses at the center of the brain) might reduce several symptoms of some mental disorders. As Egas Moniz was not well trained in neurosurgery and had gout that affected his hands, he worked again with his colleague Almeida Lima. After first attempts to use injections of absolute alcohol to destroy part of the frontal lobe, the colleagues created a needle-like device with a retractable loop to surgically separate white matter fibers. This procedure, first known as a prefrontal leucotomy, was adopted and modified by other physicians, especially in the United States, as a lobotomy. Although successful in eliminating symptoms in some patients, the procedure had serious side effects, so that Egas Moniz warned that it only should be used if no other treatments were effective. At the time, there were no medications that could be used with severe psychoses, so without the procedure some cases of psychoses would have been incurable.
In recognition of his work on prefrontal leucotomy, in 1949 Egas Moniz was awarded the Nobel Prize for Physiology and Medicine for his discovery of the therapeutic value of leucotomy in some psychoses. That year, Walter Rudolf Hess of Switzerland also was awarded the prize, for his discovery of the functional organization of the inter brain as a coordinator of the activities of the internal organs.
Although the work recognized by the Nobel Prize has gone into disrepute due to the negative side effects associated with leucotomy or lobotomy, his work on brain imaging continues to be very valuable. Cerebral angiography was the most effective method to reveal intracranial conditions until the development of computed tomography (CT or CAT scan) and magnetic resonance imaging (MRI) in the 1970s and 1980s.
By the time Egas Moniz received the Nobel Prize, he had retired from his position in the neurology department at the University of Lisbon. He had been shot by a patient suffering from schizophrenia in the late 1930s and was paralyzed at the age of 65. Although confined to a wheelchair, Egas Moniz continued in private medical practice until his death at age 82 in 1955, in the rural home where he had been born.
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