In 1927, The Nobel Prize in Physiology or Medicine was awarded to Dr. Wagner-Jauregg for “The Treatment of Dementia Paralytica by Malaria Inoculation.”
Dr. Wagner-Jauregg’s medical training was in the biological sciences and focused on zoology, pathology, and physiology. When he began his work at the First Psychiatry Clinic at the Asylum of Lower Austria in 1883, Wagner-Jauregg had access to a wide variety of patients suffering from mental illnesses; however, the opportunity to conduct research was limited by small facilities, inadequate resources, and his colleagues’ lack of interest in pursuing research . Despite this, Wagner-Jauregg began conducting research on brain anatomy and observing patients in the asylum, later publishing papers on paralysis and spinal cord damage . In 1883, shortly after starting his first psychiatry position at the clinic, he observed a woman being cured of severe psychosis after an attack of erysipelas, an acute bacterial skin infection typically accompanied by a high fever . While he would not formally work on fever therapy until 1917, this early case stuck with Wagner-Jauregg. He began conducting literature searches on the topic and published an article, “The Effect of Feverish Disease on Psychoses,” in 1887 . His past experiences and medical training in pathophysiology made him receptive to the idea of a biological cause for some forms of psychosis, and he reasoned that a therapeutic remedy should exist as well.
One form of psychoses was linked to neurosyphilis, which emerges during the tertiary stage of syphilis. Neurosyphilis, also known as the “disease of the century,” was a frightening, fatal disease marked by grand delusions, paralysis, and dementia . While neurosyphilis and GPI were used synonymously, the latter referred to the psychoses that emerged in the final stage of syphilis and the former included other symptoms such as spinal cord damage and ataxia . Even more disturbing, the incidence of neurosyphilis increased significantly during the 19th century and was one of the major factors in the increase of the asylum population during this time. Approximately 5 percent to 10 percent of all psychiatric admissions before 1945 were attributed to neurosyphilis; therefore, these individuals comprised a significant group within the asylum population . In addition, the disease predominantly afflicted middle-class males and the symptoms were obvious: paralysis in conjunction with dementia or psychosis. Once the patient became symptomatic, the end was near. Death, in most cases, was welcomed as the final respite from the horrifying symptoms of neurosyphilis. Consequently, malarial treatment played a role in the emptying of the asylums and provided a viable alternative for a previously hopeless disease. Ironically, it was neurosyphilis that contributed both to the demise of the first biological psychiatry and its resurgence after the discovery of fever therapy. As Shorter notes: “Following the model of neurosyphilis, they [the early biological psychiatrists] were trying to identify specific lesions in patients whose illnesses seemed to be primarily psychiatric rather than neurological” . In the early 20th century, psychological illness referred to any disease manifesting in symptoms of psychosis, mania, or depression, regardless of the causative agent of disease. Despite the fact that neurosyphilis was a side effect, an end stage of an infection caused by an organic agent, it was still considered the primary psychological illness of its time, hence the moniker of the “disease of the century.”
To read more, visit the following references:
“Julius Wagner-Jauregg – Nobel Lecture: The Treatment of Dementia Paralytica by Malaria Inoculation”. Nobelprize.org. Nobel Media AB 2014. Web. 18 Mar 2015. <http://www.nobelprize.org/nobel_prizes/medicine/laureates/1927/wagner-jauregg-lecture.html>
Tsay, Cynthia J. “Julius Wagner-Jauregg and the Legacy of Malarial Therapy for the Treatment of General Paresis of the Insane.” The Yale Journal of Biology and Medicine 86.2 (2013): 245–254. Print.