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Psychiatric Times begins a new series: “Looking Back to Look Forward: This Month in Psychiatry.” Contributors from across the globe will take the opportunity to point out both notable and neglected figures, topics, and developments in the history of psychiatry.
Looking Back to Look Forward
This Month in Psychiatry
With this issue, Psychiatric Times begins a new series: “Looking Back to Look Forward: This Month in Psychiatry.” As part of this series, contributors from across the globe will take the opportunity to point out both notable and neglected figures, topics, and developments in the history of psychiatry. Our hope is that it will inspire a deeper look into the specific topic, the history of mental health, and help us to look forward.
Series Editor Gregory Eghigian, PhD
Professor of Modern History, Penn State University
Dr Julius Wagner-Jauregg
In December 1927, Viennese psychiatrist Dr Julius Wagner-Jauregg received a Nobel Prize for his work on induced febrile illness to treat the psychosis and neurological consequences of syphilis (dementia paralytica). The first psychiatrist to win the Nobel Prize, Wagner-Jauregg began his investigations in 1887.1
In the early 20th century, neurosyphilis was regarded as incurable; it led to insanity and death. Syphilis, once known as the great masquerader of clinical medicine, was a worldwide public health menace for hundreds of years before Treponema pallidum was discovered as the infectious agent in 1905.2 Prior to the discovery of T pallidum, Wagner-Jauregg was fascinated by cases of remitted psychosis in which the clinical history included a febrile infectious illness preceding improvement. While the infectious agent was not known when he began his work in the 1880s, there were associations between syphilis, dementia, and progressive paralysis. The standard treatments for syphilis-mercury, iodine, and arsenic, for example-were ineffective and toxic.3 Accordingly, Wagner-Jauregg sought a safer approach.
Inspired by longstanding observations of improved psychosis with fever and encouraged by Robert Koch’s work on isolating tuberculin, Wagner-Jauregg began researching an effective agent to raise body temperature. Tuberculin, alone or in combination with mercury or arsenic, was not clinically satisfactory because many patients relapsed, he told a medical group in Budapest in 1909.
In 1917, he turned to malaria-induced fever. As he recalled, “I singled out as a particular advantage of malaria that there is the possibility of interrupting the disease at will by the use of quinine, but I did not then anticipate to what degree these expectations from induced malaria would be fulfilled.”3,4
Wagner-Jauregg inoculated nine neurosyphilis patients with blood from a soldier with malaria in 1917. This strain of malaria did not cause severe illness, but it did cause an elevated body temperature of 40â to 41â (104° to 105.8°F). The results of his clinical experiments exceeded expectations-including the remission of neuropsychiatric symptoms-in the majority of participants. Furthermore, the induced malarial illness could be halted with quinine without reversing any improvement in psychosis.
Wagner-Jauregg continued to use the technique, reporting on 200 cases in 1922.4 He insisted that physicians use fever induction early in the course of illness and abandon older methods, stating: “It has become apparent that it is unwise to employ other methods of treatment against paralysis before the malaria treatment, as this means time wasted.”
Wagner-Jauregg began a revolution in psychiatry. In 1927, there were many famous names in psychiatry (eg, Kraepelin, Bleuler, and Freud), all of whom were overlooked for the Nobel Prize. Their contributions were more theoretical, whereas fever therapy for neurosyphilis had immediate empirical support.5
Penicillin was discovered in 1928, and eventually rendered fever therapy for syphilis obsolete. (It did, however, earn a Nobel Prize for three scientists in 1945.) The next psychiatrist to win a Nobel Prize in Medicine was Eric Kandel, who earned the prize for his work on the physiological basis of memory storage in neurons in 2000.
Dr Weiss is the Robert L. Sadoff Clinical Professor of Forensic Psychiatry, Perelman School of Medicine, University of Pennsylvania.
Group for the Advancement of Psychiatry Committee on Arts & Humanities: David Sasso, MD, MPH (committee chair), Assistant Clinical Professor in the Child Study Center, Yale University School of Medicine; Anish Ranjan Dube, MD, MPH, Volunteer Clinical Faculty, University of California, Irvine; Donald Fidler, MD, FRCP-I, Professor Emeritus, West Virginia University; Andrew Lustbader, MD, Associate Clinical Professor in the Child Study Center, Yale University School of Medicine; Chris Snowdy, MD, Associate Program Director, USC Psychiatry Residency and Child Psychiatry Fellowship; John Tamerin, MD, Greenwich, CT; Kenneth J. Weiss, MD; and , and Helena Winston, MD, Consult-Liaison Psychiatry Fellow, University of Colorado.
1. Wagner-Jauregg J. The treatment of dementia paralytica by malaria inoculation. Nobel Lecture. December 13, 1927. Available at https://www.nobelprize.org/prizes/medicine/1927/wagner-jauregg/lecture/. Accessed November 7, 2019.
2. Tampa M, Sarbu I, Matei C, et al. Brief History of syphilis. J Med Life. 2015; 7(1):4-10.
3. Wagner-Jauregg J. The history of the malaria treatment of general paralysis, comment and translation from the German by WL Bruetsch. Am J Psychiatry. 1946; 10295):577-582.
4. Wagner-Jauregg J. The treatment of general paresis by inoculation of malaria. J Nerv Ment Dis. 1922;55(5):369-375.
5. Brown EM. Why Wagner-Jauregg won the Nobel Prize for discovering malaria therapy for General Paresis of the Insane. History of Psychiatry. 2000;11:371-382.