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Egas Moniz, Antonio (C De A F)

effects career introduced blood

(1874–1955) Portuguese neurologist who introduced cerebral angiography, and prefrontal lobotomy (which proved controversial).

Egas Moniz studied medicine at Coimbra, Bordeaux and Paris, and spent his career from 1911 as professor of neurology at Lisbon. Remarkably, he maintained an active business and political career as well as a medical one. From 1903 he was a Deputy in the Portuguese Parliament until 1917 when he was appointed Ambassador to Spain, and later that year he became Minister for Foreign Affairs and he was President of his Delegation at the Paris Peace Conference of 1918.

In 1920 he devised cerebral arteriography: injection into the brain of a non-toxic iodine compound (which acts as a contrast agent for X-rays; the heavy iodine atom absorbs them strongly) enabled some tumours, and deformities of the blood vessels, to be located.

In 1936 he introduced a surgical treatment (later called lobotomy) for schizophrenia: previously there was no effective treatment, and simple restraint or sedatives were used. Following up some surgical work done on chimpanzees which made them less aggressive, Moniz injected ethanol into the white matter of the frontal lobes (which extend from above the eyes to beyond the crown of the head) in patients with acute schizophrenia which deactivated and sclerosed the cells. He went on in 1937 to surgically sever a number of connections between the prefrontal region and other parts of the brain in another group of patients, finding that the procedure was simple, safe and effective in some cases. The method came to be widely used in the 1940s, in part because of the absence of alternatives (and in part also because of Moniz’s high reputation, perhaps). However, it cured few and left many apathetic and with degenerated personality. It is now little used, although more selective psychosurgery has a limited use. Also in 1937 Ugo Cerletti(1877– ) and LucioBini (1908– ) began to use electroconvulsive therapy (ECT) for acute depression, and this has retained a valued place in psychiatry. In 1952 the first modern antidepressant, chlorpromazine, came into use and has been followed by other drugs with similar effects, which have led to reduced use of the earlier methods. Moniz shared a Nobel Prize in 1949 with the physiologist W R Hess (1881–1973) who worked on blood flow and the regulation of respiration, and notably on the effects resulting from the insertion of fine electrodes into the brains of cats; stimulation of groups of cells in this way leads to reversible effects (flight, agression, sleep etc). This work has led to detailed mapping of the interbrain and hypothalamus by research groups worldwide since Hess began such studies in the 1920s.

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