The white cut: Egas Moniz, lobotomy, and the Nobel prize

In the beginning

Egas Moniz, an outstanding neurologist who had been nominated twice for the Nobel prize for his development of the cranial angiogram with his surgical associate, Almeida Lima, performed the first lobotomy in 1935. Lobotomy means “the incision of a lobe,” but in this context it is simply the destruction or removal of the prefrontal lobes of the cortex of the brain, an option of last resort used to treat some forms of mental disorder that did not respond to other treatments. He wasn't a trained surgeon, and since his hands were deformed by gout he did not often do the surgery himself.1 “However, there is no doubt that it really was Moniz who initiated and managed to inspire enthusiasm for the importance of prefrontal leucotomy in the treatment of certain psychoses,” wrote his contemporary, the psychiatrist Bengt Jansson.2

Within months, prefrontal leucotomies (leucotomy, meaning “white cut,” is an old name for lobotomy) were being done all over the world. As another contemporary said, “Seldom in the history of medicine has an experimental procedure been so promptly adapted to the treatment of patients everywhere.”3 Moniz received several honours and was finally awarded the Nobel prize in 1949. “It might turn out that his thinking was not very sophisticated,” …