He invented the lobotomy and an angry patient left him paralyzed: the story of the most controversial Nobel Prize in Medicine

The award was specifically “for his discovery of the therapeutic value of leucotomy in certain psychoses”.

In 1935, Egas Moniz introduced the prefrontal leucotomy at the Santa Marta Hospital, Lisboaas a treatment for serious psychiatric conditions. The technique sought to disrupt frontal connections to reduce agitation.

His idea went back to time immemorial: intervening on the skull for therapeutic purposes has ancient roots, from Neolithic trepanation to contributions from Hippocrates and Galen. In the modern era, animal experiments paved the way: in 1928 John Fulton reported behavioral changes in chimpanzees after frontal lesions, discovery that inspired Moniz.

What did the leucotomy consist of?

Leucotomy, often mentioned as lobotomy -although they are not exactly the same; lobotomy is more aggressive and promoted by the Americans Walter Freeman and James Watts – it was formulated as a psychosurgery aimed at sectioning frontal white matter, in the hope of relieving extreme symptoms.

Moniz applied it for the first time after studying experiments on primates. His procedure consisted of introducing a retractable metal loop through a cranial hole to section fibers of the frontal white matter.

He previously tried alcohol injections to damage nerve connections; Its objective was to reduce delusions, extreme anxiety and violent behavior in seriously ill patients..

Egas Moniz was recognized for discovering lobotomy and cerebral angiography.

The first patients operated on in Lisbon showed, according to Moniz, an apparent calm. «Almost as if they had woken up from a nap,» the neurosurgeon noted at the time.

Side effects

The truth is that the treatment caused severe effects and mortality, according to some reports.

Although his work emerged at a time when psychiatric treatments were very limited, his method violated fundamental ethical principles and left a tragic mark on thousands of lives.

Photo: bonkersinstitute (https://creativecommons.org/licenses/by/3.0)

Lobotomy spread rapidly during the 1930s and 1940s.. Tens of thousands of procedures were performed in the United States; It is estimated that between 45,000 and 50,000 lobotomies in total, and around 50,000 in that country alone (in some reports mortality reached appreciable figures, around 6% and up to 10% in specific series).

Clinical consequences included apathy, loss of initiative, behavioral alterations, seizures, and irreversible neurological damage.

Emblematic cases exposed the human dimension: Rosemary Kennedy She was left with reduced faculties and spent much of her life institutionalized after a lobotomy; Howard Dully He received the operation as a child. These stories personalized the human cost and sparked public criticism.

The arrival of psychotropic drugs in the fifties, with the chlorpromazine Among them, it changed the therapeutic map and caused the decline of lobotomy.

Over time psychic surgery was restricted to very selective procedures and with more precise stereotactic techniques. The experience left lessons about the need for strict indication criteria, rigorous follow-ups and ethical control in interventions that affect personality.

Paradoxically, Moniz was also a pioneer in cerebral angiographya much more useful and long-lasting technique that allowed the blood vessels of the brain to be visualized and remains a valuable medical tool. However, his name became primarily associated with lobotomy and the debate over the limits of science and medical ethics.

The request for withdrawal of the Nobel

At the institutional level, Moniz’s figure remains divided. On the one hand, his angiography transformed neurosurgical diagnosis and opened new paths in neuroradiology; on the other, his role in promoting leucotomy fueled calls for moral review and demands for critical homage.

In 1949 he received the Nobel Prize in Physiology or Medicine for this intervention and for his contributions in neuroradiology. The historical balance forces us to recognize technical contributions and remember the human price of a practice that, over time, largely fell into disuse.

However, families of lobotomized people requested the withdrawal of the Nobel and the historical comparison recalled abuses. The Nobel Foundation does not contemplate the revocation of awards, so the discussion remained in the public and academic arena.

An acknowledgment to Egas Moniz. Photo: Shutterstock

On his official website, Nobel acknowledges: «The operation became widespread during the 1940s and 1950s, but it became clear that it could cause serious personality changes. The use of lobotomy declined dramatically with the development of medications for mental illness in the 1950s.»

The tragic end of the expert

In 1939, when Moniz was 65 years old and already a renowned neurologist in Portugal, one of his psychiatric patients shot him several times in his office. The attacker – a man with serious mental disorders – apparently attacked him in a fit of paranoia, convinced that the doctor wanted to harm him.

The bullets hit his spine, leaving him partially paralyzed for life. From that moment on, Egas Moniz was forced to travel in a wheelchair, although he continued with his academic work and the promotion of his prefrontal leukotomy procedure.

The episode reinforced in him a harsh view of mental illness, which some biographers believe influenced his defense of lobotomies as a “last resort” to control violent behavior.

Despite the attack, Moniz remained active for several years. In 1949 he received the Nobel Prize in Medicine, which crowned his scientific career, although the recognition was already beginning to generate controversy. After the award, he gradually withdrew from public life due to his health.

He died on December 13, 1955, at the age of 81, in Lisbon, a victim of a internal bleeding. He was buried with state honors in Portugal, where for decades he was considered a national hero.