The British Journal of Psychiatry

In 1949 the Portuguese neurologist Antônio Caetano de Abreu Freire Egas Moniz was jointly awarded the Nobel Prize in medicine with the Swiss physiologist Walter Hess. At the 1935 International Neurological Conference in London, Moniz encountered the work of Fulton and Jacobsen who had observed behavioural changes in chimpanzees following removal of the frontal lobes. Together with Almeida Lima, Moniz initially adapted the technique for humans by drilling holes in the skull and injecting alcohol into the frontal lobes. The procedure of parietal prefrontal leucotomy was later developed, involving severing fibre tracts between the thalamus and the frontal lobes with a retractable wire loop or ‘leucotome’. The American psychiatrist Walter Freeman further developed this by accessing the frontal lobes through the eye sockets (trans-orbital leucotomy or lobotomy). The procedure was eventually abandoned as a therapy for schizophrenia with the advent of the phenothiazines. Dr Egas Moniz became an invalid and retired (1945) after he was shot in the spine by one of his patients. He died in Lisbon in 1955.

Antônio Caetano de Abreu Freire Egas Moniz, father of psychosurgery.

Above: The surgeon is cutting the pathways in the left upper quadrant with a sweeping incision using the precision leucotome.

Below: (1) Sweeping incisions made with the precision leucotome are (2) deepened with a wider blunt knife – the radial stab incisor.

Images courtesy of the Institute of Psychiatry Library, King’s College London