Tuesday, March 21, 2006

Distortions about Egas Moniz' scientific life

There are several fantasies circulating regarding the career and personality of Egas Moniz. Elliot Valenstein in his book “Great and Desperate Cures”, says that Moniz’s main motive was to achieve in his declining years the recognition that a rather mediocre career had otherwise failed to bring, by gambling on the success of an operation so drastic that nobody else would dare to perform it. As a matter of fact, Egas Moniz was already world famous for his discovery of cerebral angiography, when he attempted psychosurgery. Before receiving the Nobel Prize, he was awarded the Oslo Prize for angiography, a method that was extended to other organs, which is still in use today, and which saved thousands of lives.

Valenstein also claimed that Moniz was inspired to undertake the operation by witnessing two monkeys, which had been made placid by lesions to their frontal lobes. Besides an extensive literature about the frontal lobes Moniz mentions in his memoirs not only the experiments of Fulton and Jacobson in chimpanzees but also those of Bechterew and Luzaro in dogs where the frontal lobes were removed resulting in a modification of the behavior of the animals. The truth is that Moniz was also inspired by the description of brain injuries suffered by soldiers during the First World War, and by the changes occurring in patients with tumors and other lesions of the frontal lobes; there was an abundant literature concerning the modifications in behavior subsequent to lesions of the frontal lobes either due to tumors or to mutilations suffered in combat. He had published in 1917 a book entitled "A Neurologia na Guerra" (Neurology during War) describing brain injuries and its consequences from data collected during the First World War. So as described below the reasoning was much more elaborate.

Egas Moniz first scientific contribution was the description of sexual behavior of human beings and its perversions collected from interviews. This work was published in a book entitled Sexual Life and constitutes several decades before Kinsey’s report in the USA, the first such description.

His second main contribution achieved in 1925, consisted in the visualization of the blood circulation of the brain. In the words of G.A. Donnan (The Lancet 1993, 341:796) “The technique of intra-arterial cerebral angiography has subsequently proved to be one of the commonest and most durable investigations in neurology”.

The descriptions, by Moniz himself, of the experiments that led finally to the application of angiography in medical practice, gives to the reader an excellent picture of what research is like. It took five years from the first experiment in dogs and human cadavers to the use of the technique in routine diagnosis. Moniz first used a 25% sodium iodine solution to obtain the X-ray contrast. Later in 1931 two of his followers used a thorium solution (thorotraste). This is described in his autobiography.

Angiography is important not only for the diagnosis and localization of brain tumors rendering them operable; it also allowed the elucidation of the circulatory network making possible the removal of aneurisms. For the first time it became possible to follow in the living organism a dynamic event, this was a revolution. The technique was rapidly extended to other areas and organs of the body, with vast implications for basic physiology, pathology, and for medical practice. The importance of a scientific achievement is measured in terms of the contribution it makes beyond the field where it was first performed; Angiography ranks among this type of achievements. Egas Moniz received the Oslo Prize for this contribution.

Angiography led to another important contribution, it concerned the study of internal carotid occlusion. We suggest the reading of the following paper: "The Neglected Research of Egas Moniz of Internal Carotid Artery (ICA) Occlusion". George W. Lowis and Alireza Minagar, Journal of the History of the Neurosciences: Basic and Clinical Perspectives, Volume 12, Issue 3, 2003, pages 286-291.
"Egas Moniz is generally remembered for having discovered cerebral angiography in 1927, and having introduced lobotomy as a form of treatment for mental illness in 1935. Less well known is his pioneering research on occlusive cerebrovascular disease, namely internal carotid artery (ICA) occlusion, as documented by cerebral angiography. It is our contention that the medical community has, until recently, largely overlooked this research. His neglected observations on ICA occlusion and the important diagnostic role played by angiography are reviewed. We propose to show how our paper differs from previous publications regarding Moniz's ICA occlusion contributions. Whereas most previous reviews have focused on either the role played by cerebral angiography in the diagnosis of ICA occlusion, or on the importance of Moniz's internal carotid occlusion observations, our review attempts to integrate both topics. We will tie Moniz's ICA occlusion research to his documented use of angiography."