Professor Egas Moniz - The Portuguese Nobel Prize in Medicine and Physiology | Faculdade de Medicina da Universidade de Lisboa

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September 2019

Professor Egas Moniz - The Portuguese Nobel Prize in Medicine and Physiology

Writing about Professor Egas Moniz is to remember 64 years after his death, the first and so far the only Portuguese to receive the Nobel Prize in Medicine. Possessing a plurality of skills, spirit of mission and commitment, he was a remarkable figure of Portuguese Neurology and Neurosurgery.

Professor António Egas Moniz was a noted physician, neurosurgeon, scientist, professor, lecturer, speaker, politician and statesman, as well as a biographer, writer and art collector, who bequeathed much of his valuable heritage to our country.

Prof. Egas Moniz – The Portuguese Nobel Prize Winner for Medicine and Physiology

António Caetano de Abreu Freire de Resende was born in “Casa do Marinheiro” ("House of the Sailor", later called the Egas Moniz House-Museum) in Avanca, a parish in the Estarreja municipality, on 29 November 1874, in a family of the rural aristocracy and died suddenly at the age of 81 at his home in Lisbon on 13 December 1955. He was buried in his homeland.

Egas Moniz_02 — Fig. 1 – “Casa do Marinheiro”/Egas Moniz House-Museum

He adopted the surname Egas Moniz at the insistence of the ecclesiastical Caetano de Pina Resende Abreu e Sá Freire, his paternal uncle and godfather, who was very interested in genealogies and was convinced that the family descended from Egas Moniz, our first King’s master and teacher, who, according to the history of Portugal, addressed the king of Leon and Castile with his family, with ropes around his neck, asking for forgiveness for his pupil’s failure. And with this surname he became known worldwide.

After studying under the guidance of his uncle at Padre José Ramos primary school in Pardilhó, Estarreja municipality, he attended the High School at the S. Fiel College of the Jesuits in Louriçal

He then began his academic career at the University of Coimbra in 1891 with the Preparatory Courses along with his first studies on Neurology under the guidance of his Master Augusto Rocha, which were later consolidated through the various internships he undertook in neurological clinics, as in Bordeaux where he worked with Pitras and Régis in the area of Psychiatry. Later in Paris, he also learned from great neurologists of his time such as Pierre Marie and Degérine.

He graduated in Medicine in 1899 and completed his Ph.D. at the same Faculty in 1901 with the thesis entitled "The Sexual Life-Physiology". In 1902 he presented “The Sexual Life-Pathology”, a work destined to exams to enter as a lecturer at the Faculty of Medicine of the University of Coimbra. These two works, quite bold for the time, were later annexed and published eleven years later under strong controversy and at the same time much sought after. Later, and according to Salazar’s government, this work could only be purchased with a medical prescription.

Egas Moniz_03 — Fig. 3 – Prof. Egas Moniz

Egas Moniz_05 — Fig. 4 – Copy of the work “The Sex Life”

In 1903, still at the Faculty of Medicine of the University of Coimbra, he became Full Professor and taught Anatomy, Physiology and later General Pathology. He was transferred to Lisbon in 1911, after the creation of the Faculty of Medicine of the University of Lisbon and was granted responsibility for Neurology with the position of Full Professor. It was a newly created subject in which he was the first Professor until he retired in 1944.

At the same time he was a student in Coimbra, he began his political activity, which was intense. A supporter of liberalism and a righteous Democrat, he disliked dictatorship. He was in some situations that caused him many problems and was even arrested. He was an MP in various legislatures before and after the Republic's establishment and his speeches were described as "energetic, convincing and sometimes exciting”.

He founded the Centrist Republican Party, which shortly afterwards was integrated into Sidónio Pais’ Party. He collaborated with this party and was Portugal's ambassador to Spain. He was a Minister of Foreign Affairs and in 1928 was appointed delegate of Portugal at the Peace Conference in Versailles.

Brain Angiography

It is unquestionably due to Egas Moniz his contribution to the development and worldwide visibility of medicine, but he has stood out especially in the areas of Neurology and Neurosurgery, as he was responsible for the invention of arteriography or brain angiography.

This practice, which he discovered after numerous X-ray experiments, was initially only performed on dogs. It was first performed successfully on living humans in 1927 and consisted of an intravascular injection of some chemicals. These substances caused opacity, which allowed to obtain a contrast, enabling for the first time the visualization of the brain arteries in order to diagnose and locate neoplasms, aneurysms, haemorrhages, vascular lesions and other brain malformations in humans, facilitating their subsequent treatment. This all-important invention for the diagnosis of brain injury has given rise to a much better understanding of the links between the brain and human behaviour, and the beginnings of brain surgery.

His findings were publicized, recognized and admired by the greatest neurologists of the time, giving him enormous international prestige, earning him the Oslo Prize in 1945.

Prefrontal Leucotomy

Years later, from 1935 onwards and at a time when scientific knowledge was still very poor and psychotropic drugs did not exist, Egas Moniz devoted himself to the treatment of various mental illnesses such as schizophrenia or anxiety, which he called prefrontal leucotomy and led to the emergence of psychosurgery. This treatment, which was initially performed with the introduction of pure alcohol, was replaced by a special instrument, which he called the leucotome, which made “cuts in the bundles of nerve fibres that connect the frontal lobe to other areas of the brain through holes made in the skull”.

This discovery has generated great interest all over the world. US neurologist Walter Freeman, who later called lobotomy to leucotomy, influenced by the results obtained by Egas Moniz performed several surgeries in the United States.

Although brain angiography, from a scientific perspective, is considered much more important than leucotomy and after Egas Moniz was nominated five times to the Nobel Prize for Medicine and Physiology, it was through lobotomy that on 27 October 1949, by decision of the Swedish Academy, he was awarded the much desired and deserved Nobel Prize with Swiss physiologist Walter Rudolf Hess.

Subsequently this type of intervention was very contested due to the serious side effects presented in patients who had undergone treatment, provoking in them behavioural changes, making them more apathetic and indolent, despite the decrease in the symptoms of the disease. Faced with these facts, the relatives of these patients intervened, demanding that the Nobel Prize be annulled.

Egas Moniz_08 — Fig. 8 – Nobel Prize Diploma

The Portuguese winner was informed of the Prize by telegram. Portugal, the small westernmost country in Europe, which lived in troubled times, was surprised and simultaneously proud of such a feat.

However, Egas Moniz was either ill or even prevented by the government at the time from going to Stockholm to receive the prize diploma and the medal. They were given to him on 3 January 1950 by the Minister of Sweden, Gustav Veidel, at a ceremony at the Master's house".

Egas Moniz_10 — Fig. 9 – Handing the Nobel Prize to Prof. Egas Moniz

Egas Moniz_11 — Fig. 10 – Prof. Egas Moniz

There were numerous tribute sessions to Prof. Egas Moniz held throughout the country for receiving the Nobel Prize from the municipalities, the Portuguese Medical Societies and the national press.

There was also news of congratulations and tribute sessions from various countries of all continents.

Aware of criticism of this technique, a year before his death Egas Moniz gave a defence lecture under the heading "Leucotomy is at stake".

Egas Moniz_12 — Fig. 12 – Publication "Leucotomy is at stake".

Psychosurgical techniques are still being used today, but they are much more sophisticated than at the time and only used in very special cases.

Prof. Egas Moniz, highly regarded both in Portugal and internationally, has been awarded numerous titles:

Honorary Distinctions

Honoris Causa Doctorate from the University of Lyon

Honoris Causa Doctorate from the University of Bordeaux

Grand Cross of Isabel the Catholic in Spain

Grand Cross of Instruction and Beneficence on 5 October 1928

Grand Cross of Santiago and Sword on 3 March 1945

Commander of the Union of Honour of France

Red Cross Honorary Medal of Germany

Grand Officer of the Order of the Crown of Italy

Oslo Prize - 1945

Nobel Prize - 1949

As a politician, Egas Moniz represented Portugal in various positions:

Member in various legislatures (1903-1917)

Minister of Portugal in Madrid (1917)

Minister of Foreign Affairs (1917-1918)

First President of the Portuguese Delegation to the Peace Conference in Paris (1918)

As a politician, Egas Moniz represented Portugal in various positions:

Member in various legislatures (1903-1917)

Minister of Portugal in Madrid (1917)

Minister of Foreign Affairs (1917-1918)

First President of the Portuguese Delegation to the Peace Conference in Paris (1918)

Among his many patients, the most famous was Fernando Pessoa who resorted to Prof. Egas Moniz in 1907, complaining of neurasthenia and fear of going insane. Finding nothing wrong in him, he recommended Swedish gym classes.

Mário de Sá-Carneiro, complaining of suffering from physical and psychological decoupling, was also seen by Egas Moniz.

Always reserved about his illnesses, in March 1939, when he was 64 years old, he was the victim of a shooting assault in his practice by a mentally ill patient who shot him with 8 shots following a paranoia crisis. Despite being in a serious condition, Egas Moniz later fully recovered. However, demonstrating the high qualities of our Nobel Prize as a naturally kind and understanding man, and most humane as a doctor, as a 1955 article in a Medical Publication states in relation to this episode, “… he was more concerned about the patient than with his own safety, fearing that the people would see the patient as a criminal. And he repeatedly told those around him that the perpetrator lacked responsibility and could only be considered as such”.

In the last years of his professional life and due to the disease (rheumatism and gout) that he suffered since adolescence, which sometimes left him incapacitated, the Neurosurgery of the Faculty of Medicine of Lisbon was passed on to the remarkable surgeon and his collaborator Prof. Almeida Lima.

He has published over three hundred scientific papers, in numerous national and foreign publications, mostly in French. He is the author of a vast and remarkable literary work, namely "Our House" and "Confidences of a Scientific Researcher", as well as several works about contemporary writers such as Júlio Dinis, Guerra Junqueiro or José Malhoa, as well as historical works on Abade de Faria and Pedro Hispano, the only Portuguese ordained pope by the name of John XXI.

Egas Moniz_13 — Fig. 14 – Publication “Our House”

In 1950, the Egas Moniz Studies’ Centre (CEEM) was founded at Júlio de Matos Hospital, which in 1957 was transferred to the Neurology Service of Santa Maria Hospital, where it still is. In addition to integrating various services related to this area, this Centre also includes the Egas Moniz Museum, which exhibits various manuscripts, original and personal pieces of the Nobel Prize winner, as well as a reconstitution of his office and a pastel painting depicting Egas Moniz wearing his Professor of the University of Coimbra’s costume, by José Malhoa, his personal friend, dated from 1932.

Egas Moniz_14 — Fig. 15 – Painting by Malhoa, 1932

Egas Moniz_15 — Fig. 16 – Reconstitution of the office of Prof. Egas Moniz

Also the house where Egas Moniz was born, in Avanca, from the 18th century, was rebuilt in the first quarter of the 20th century and in 2003 transformed into Egas Moniz House-Museum. Of extraordinary architectural beauty, with very rich furniture of various styles, it also has a vast collection of paintings by renowned authors, glasses, drawings, porcelains and silver objects including a cutlery set that belonged to the Marquis of Pombal, attesting the fine taste of its owner.

On various occasions over time, our country has honoured Prof. Egas Moniz, the first Portuguese to receive the Nobel Prize, giving his name to:

- Egas Moniz Hospital

- Egas Moniz Higher Institute of Health Sciences

- Several streets and squares across the country, including the avenue where Santa Maria Hospital is located

- Egas Moniz Building - The building belonging to the Faculty of Medicine of Lisbon and to the iMM, opened in 2004

- In order to foster the taste for “neurosciences and scientific production, the municipality of Estarreja and the Portuguese Society of Neuroradiology with the seal of the Portuguese Medical Society”, in 2015 created the Egas Moniz Bienal Prize, recalling one of the highest figures of national scientific culture.

- 10.000$00 note, as well as some Portuguese stamps with his portrait.

Egas Moniz_16 — Fig. 17 – 10.000$00 note, 1989

Egas Moniz_17 — Fig. 18 – Stamps depicting Prof. Egas Moniz, leucotomy and brain angiology

Egas Moniz_19 — Fig. 20 – Stamp depicting brain angiology and Malhoa's painting

Norman Dott (1897-1973), a celebrated Scottish neurosurgeon, wrote of Egas Moniz: “He was a kind, cultured Portuguese gentleman with a serene character, but with an instinct for active leadership, a historian, politician and a gourmet, a doctor, and especially a clinical therapist, who saw the suffering of his patients with intolerance, who was eager to help the sick".

As Norman Dott noted, Professor Egas Moniz was an exquisite gourmet, every Friday inviting his closest friends to auspicious dinners that were followed by card games, one of his favourite hobbies.

After his death there were several tributes to Prof. Egas Moniz and feelings of grief, both in Portugal and abroad. The year after this event, in March 1956, a tribute session promoted by the Society of Internal Medicine was held in the noble hall of Capuchos Hospital, with several speakers, including Profs. Mário Moreira and Miller Guerra.

In this session, Prof. Barahona Fernandes, a friend since childhood, concluded his speech by saying: “Egas Moniz suffered illnesses, campaigns, attacks, conflicts and duels. He triumphed in everything, confident in himself and in the life he knew how to carve, in grandeur, with taste, simplicity and humanity. Egas Moniz well deserves the tribute paid to him, harmonizing the authentic richness of the human who twinned with other men, with the refuge of geniality that placed him among the great forgers of progress”.