Wagner-Jauregg and fever therapy

Among the recipients of the Nobel prize for medicine and physiology are two psychiatrists.The first to be awarded the prize, in 1927, was the Austrian psychiatrist Julius Wagner von Jauregg for his malaria therapy for general paralysis of the insane (GPI).The second, in 1949, was the Portuguese neuro-surgeon Egas Moniz, who developed the operation of leucotomy for the treatment of severe, intractable, and progressive psychiatric disorders.The operation was often dangerous and brought with it undesirable side effects.Despite modification in the procedure, it has now been made largely obsolescent by the introduction of psychotropic drugs.Similarly, malaria therapy is no longer used for the treatment of paralytics, as this late stage of syphilis is now rarely seen because the disease is treated at an earlier stage with antibiotics.This paper examines the work that led to the award of the first psychiatric Nobel Prize to Wagner-Jauregg. WAGNER-JAUREGG'S SEARCH FOR EVIDENCEThe idea that fever can have a curative effect on mental diseases goes back to antiquity.Hippocrates mentioned the beneficial influence of a malaria infection on epilepsy (Quartana epilepsiae vindex) and Galen cited a case of melancholy cured as a result of an attack of quartan fever.1 Sydenham and Boerhaave knew of the beneficial effect of feverish illnesses on madness.According to Neuburger, Boerhaave2 claimed that he would be the greatest of all physicians if he could produce intermittent fevers as well as treat them.Pinel3 in his Treatise on insanity referred to quartan fever as a disorder operating to produce a "permanency of recovery".In a treatise on hysteria, P. Briquet described two cases in which phthisis caused hysteria to disappear and another in which cholera resulted in a temporary remission of hysterical attacks.4Esquirol in his book on mental diseases wrote that infectious diseases have a considerable effect on mental patients, indeed sometimes bringing about a complete cure.5 Maudsley referred to the "remarkable remission of the symptoms of insanity *