This Month in Psychiatry: Looking Back to Look Forward
–Series Editor, Greg Eghigian, PhD
At the turn of the 20th century, general paralysis of the insane (GPI) was the scourge of psychiatry, regarded as a death sentence of the worst kind. The rapid descent into dementia was a tragedy for patients and their families. An effective cure was discovered in 1917 by Dr Julius Wagner-Juarreg in Vienna.1 The treatment involved infecting the patient with malaria; the resulting high fevers were believed to kill off the syphilis organisms. Malariotherapy rapidly spread to other countries, but Australian psychiatry did not appear to be in any rush to follow the trend.
Based in Melbourne, Dr Reginald Spencer “Reg” Ellery had a precipitous introduction to psychiatry, being the subject of a Royal Commission in 1925 on the basis of his efforts to improve conditions at Kew Asylum. Exonerated, he was sent to Sunbury Hospital where he worked with Dr John Adey. Open to new ideas, Adey asked Ellery to try malariotherapy on a group of 10 GPI patients.
Several of the patients were too ill for the trial, reducing the number of participants to 6. A seaman with benign tertian malaria helpfully turned up at Melbourne Hospital and provided a blood specimen. On May 26, 1925, a male general with paresis “far gone in dementia and his doom sealed in a progressive paralysis” was subjected to the new treatment, followed by the other 5. Three patients had such a good response they could be discharged from hospital; the other 3 died.2
Malariotherapy did not cure GPI, but it restored a virtually normal life to patients who otherwise faced death within a short time. Largely forgotten now, malariotherapy was swamped by decades of psychoanalysis.3 In contrast, malariotherapy led to a significant change in the relationship between psychiatrist and patient, ending the therapeutic nihilism that dominated psychiatric treatment for centuries.4
Several decades later, Ellery said that to discharge 3 patients out of 10 “may seem a mere nothing,” but the importance lay in being able to administer treatment to those in whom “a lingering death was certain.” Malariotherapy was “the first plank over the moat” that separated mental hospital alienists from the rest of the medical profession.5 After this, psychiatry would never be the same.
Dr Kaplan is Clinical Associate Professor at the Graduate School of Medicine, Wollongong University and Research Fellow, History Department, Stellenbosch University, South Africa. He reports no conflicts of interest concerning the subject matter of this article.
1. Brown EM. Why Wagner-Jauregg won the Nobel Prize for discovering malaria therapy for general paresis of the insane. History Psychiatry. 2000;11:371-382.
2. Ellery RS. On the treatment of general paralysis of the insane by malaria. Med J Australia. 1926;11:401-404.
3. Shorter E. A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. London: Wiley; 1998: 192.
4. Braslow JT. Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century. Los Angeles: University of California Press; 1997.
5. Ellery RS. The Cow That Jumped Over the Moon: Private Papers of a Psychiatrist. Melbourne, Australia: FW Cheshire; 1956.