Egas Moniz Invents Leucotomy

The two main figures in psychosurgery were António Egas Moniz, the Portuguese
neurologist who invented lobotomy, and the well-known American
neuropathologist and neuropsychiatrist Walter Freeman, who roamed the
world convincing others to carry out the operations. The imperfect state of
knowledge of the brain in relation to insanity was expressed in two theories
of mental illness. A somatic (organic) theory of insanity proposed it to be of
biological origin. In contrast, a functional theory supposed life experiences
to cause the problems.
The somatic theory was shaped most by Emil Kraepelin, the foremost authority
on psychiatry in the first half of the twentieth century. Kraepelin distinguished
twenty types of mental disorder, including dementia praecox
(schizophrenia) and manic-depressive (bipolar) disorder. Kraepelin and his
colleagues viewed these diseases as genetically determined, and practitioners
of psychiatry developed complex physical diagnostic schema that identified
people with various types of psychoses. In contrast, Sigmund Freud was
the main proponent of the functional theory. Attempts to help mental patients
included ECT as well as surgical removal of tonsils, sex organs, and
parts of the digestive system. All these methods had widely varied success
rates that were often subjective. Further differences depended on which surgeon
used them. By the 1930’s, the most widely effective curative procedures
were several types of ECT and lobotomy (psychosurgery).
The first lobotomy was carried out on November 12, 1935, at a hospital in
Lisbon, Portugal. There, Pedro A. Lima, Egas Moniz’s neurosurgeon collaborator,
drilled two holes into the skull of a mental patient and injected ethyl
alcohol directly into the frontal lobes of her brain to destroy nerve cells. After
similar operations on several patients, the tissue-killing procedure was altered
to use an instrument called a leucotome. After its insertion into the
brain, the knifelike instrument, designed by Egas Moniz, was rotated like an
apple corer to destroy chosen lobe areas.

Egas Moniz—already a famous neurologist—named the procedure prefrontal
leucotomy. He won a Nobel Prize in Physiology or Medicine in 1949
for his invention of the procedure. Within a year of his first leucotomy,
psychosurgery (another term invented by Egas Moniz) spread through Europe.
Justification for its wide use was the absence of any other effective somatic
treatment and the emerging concept that the cerebral frontal lobes
were the site of intellectual activity and mental problems. The selection of
leucotomy target sites was based on two considerations using the position in
the frontal lobes where nerve fibers—not nerve cells—were most concentrated
and avoiding damage to large blood vessels. Thus, Egas Moniz targeted
the frontal lobe’s centrum ovale, which contains few blood vessels.
After eight operations—50 percent performed on schizophrenics—Egas
Moniz and Lima stated that their cure rates were good. Several other psychiatric
physicians disagreed strongly. After twenty operations, it became fairly
clear that psychosurgery worked best on patients suffering from anxiety and
depression, while schizophrenics did not benefit very much. The main effect
of the surgery was to calm patients and make them docile. Retrospectively, it is believed that Egas Moniz’s evidence for serious improvement in
many cases was very sketchy. However, many psychiatric and neurological
practitioners were impressed, and the stage was set for wide dissemination of
psychosurgery. 694