Julius Wagner-Jauregg Biography (1857-1940)
Wagner-Jauregg was born Julius Wagner on March 7, 1857, in the village of Wels, Austria. He was the oldest son of Ludovika Ranzoni and Adolf Johann Wagner, a government official. The family name became "Wagner von Jauregg" when Adolf Johann was raised to the nobility, but following the collapse of the Austro-Hungarian empire in 1918, the "von" was dropped.
While attending medical school at the University of Vienna, Wagner-Jauregg received thorough training in experimental biology and met the father of psychoanalysis, Sigmund Freud, who was studying at the Institute of General and Experimental Pathology. Despite Wagner-Jauregg's lack of interest in psychoanalysis, the two remained lifelong friends. In 1880 Wagner-Jauregg was awarded amedical degree for his thesis on the heart under conditions of acceleration.
Originally, Wagner-Jauregg hoped to practice general medicine, but when Vienna's two teaching hospitals turned him down, he reluctantly accepted a position as an assistant in the university's psychiatric clinic. Although he had little training in mental illness, he quickly became a qualified instructor in psychiatry and neurology. Wagner-Jauregg was a clinician, skilled in detailedobservation and careful case analysis. Using the latest techniques of animalexperimentation, he spent his life working to advance the biological understanding of mental illness. His first research entailed the investigation of howcertain chemicals stimulate breathing after strangulation.
In 1889 Wagner-Jauregg was appointed professor of psychiatry at the University of Graz and for the next four years studied the effect of the thyroid glandon behavior. An ardent vivisectionist, he discovered that when the thyroid was removed from a cat, the animal's behavior became convulsive and violent. Cretinism in humans, Wagner-Jauregg put forth in an early paper, was due to amalfunction of the thyroid. During his years in Graz, he travelled frequentlyin central and southeastern Austria studying peasants with goiter and foundthat small amounts of iodine reduced their hugely swollen necks. He urged thesale of iodized salt in alpine regions, a measure the Austrian government undertook belatedly in 1923.
In 1893 Wagner-Jauregg was made a full professor at the University of Viennaand appointed director of the Hospital for Nervous and Mental Diseases and the State Mental Asylum. As a member of the Austrian Board of Health, he helpeddraft important legislation protecting the rights of the mentally ill and regulating the certification of the insane. At his urging, psychiatry became acompulsory subject in the undergraduate curriculum.
While still only a medical assistant, Wagner-Jauregg had studied the beneficial effect of high fever on psychotic patients. For a monograph that he published in 1888, he surveyed instances where epidemics of typhoid, malaria, smallpox, and scarlet fever had swept through mental asylums. In 30 cases reaching back to antiquity, he described how bouts of high fever had brought dramatic relief in cases of melancholy, mania, and paresis. At the end of his monograph, Wagner-Jauregg suggested that malaria might be used experimentally to induce a "fever cure" in psychotic patients, although at the time he lacked theauthority to undertake so radical a treatment.
The monograph received little notice when it was published. In it, Wagner-Jauregg had formulated two bold hypotheses: first, that some psychoses were organic in nature, and second, that one disease might be employed to eradicate another disease. In Graz, he had produced fever with injections of tuberculin,a protein used to treat tuberculosis, until it was learned that tuberculin was unsafe. In Vienna, he injected paralytic patents with typhus vaccine and staphylococci but was disappointed by the results. Most of the cures proved tobe temporary, and patients soon relapsed.
It was not until World War I that conditions were ripe for a radical trial. By then a series of important discoveries had confirmed the link between paresis and syphilis. In 1905 researchers had identified the syphilis bacillus, Spirochaete pallida.A year later, the Wasserman test for syphilis revealed that paresis was a progressive disease of the brain caused by untreated syphilis. In Wagner-Jauregg's time, paresis accounted for 15% of the patients confined to mental hospitals. The disease was thought to be incurable and invariably ended in insanity, paralysis, and death within three to four years.
In the final years of World War I, Wagner-Jauregg was treating victims of shell shock when he encountered a soldier suffering from malaria. On June 14, 1917, Wagner-Jauregg used blood drawn from the malarial soldier to infect ninepatients suffering from paresis. Quinine, the medicine used to treat malaria,was withheld until each patient had endured seven to eleven attacks of fever. The results were astonishing. Six patients experienced a dramatic remissionof symptoms, and three were able to return to normal life. In 1919 Wagner-Jauregg began full-scale clinical trials.
At first, Wagner-Jauregg's reports were greeted with considerable skepticismby the medical community. Some physicians considered it unethical to deliberately induce a disease as serious as malaria. Others feared the outbreak of malaria epidemics in major metropolitan centers. But trials elsewhere producedsimilar results. Employing only a mild strain of malaria easily cured by quinine, mortality remained low while complete recovery was experienced by thirtyto forty percent of all patients. Patients who had only recently contractedsyphilis could be cured completely when the "malaria cure" was used in conjunction with injections of Salvarsan and Neosalvarsan, two drugs used to treatearly syphilis. In 1927 Wagner-Jauregg became the first psychiatrist to be awarded the Nobel Prize in physiology or medicine.
Safer methods of inducing fever were tried--preparations of colloidal sulfur,hot-water baths, and "fever cabinets"--but none had the high rates of success typical of malaria. Until the discovery of penicillin during World War II,malaria remained the preferred treatment for advanced syphilis. Medical opinion differed on just how the fever cure worked since it seemed unlikely that the fever killed all of the spirochete bacteria, which cause syphilis. Instead, it was believed that the stress produced by the malaria attack in some waystrengthened the body's defenses against the syphilitic infection. Stress treatments such as electroshock continue to play a role in the treatment of psychiatric disorders.
In 1928, one year after receiving the Nobel Prize, Wagner-Jauregg retired atthe age of seventy-one. He died on September 27, 1940, in Vienna at age eighty-four, shortly before the discovery of penicillin made his fever cure obsolete.