Grand Plan: A battle against disease

Shahar Madjar, MD

Dr. Julius Wagner-Jauregg, an Austrian psychiatrist, considered himself an island of sanity surrounded by madness. In black-and-white photos of him, I see a man with an intense look in his eyes and a groomed mustache, a man who entertains daring ideas others would consider crazy.

When Julius became the Director of the Clinic for Psychiatry and Nervous Diseases in Vienna, he quickly realized that the situation was dire: many of his patients were suffering from the late stage of syphilis. Some of these patients developed delusions of grandeur. Such was the man Julius noticed when he entered the clinic one morning: the man was sitting on the floor, holding his head in his hands, his knees bent, and whispering: “I am Ferdinand, the Emperor of Austria.” Julius knew the man was a former banker whose name was Fritz.

Some of Julius’s patients were euphoric, some were depressed, others were manic. Their neighbors and their close relatives had brought them to the asylum, sometimes in the middle of the night. They remained institutionalized. They developed paralysis and dementia and madness. They were all destined to die a miserable death.

Years before, Julius had observed a woman that was miraculously cured of severe psychosis after an attack of erysipelas (a skin infection often accompanied by high fever). He learned that other physicians had similar observations, that patients were sometimes cured of their psychosis after an episode of high fever. Julius devised a grand plan to cure patients in the late stage of syphilis by infecting them with a different fever-causing disease — malaria.

In 1917, Julius heard of a soldier who was diagnosed with malaria. Here is what happened to the soldier before he met with Julius: a female Anopheles mosquito bit the soldier on his neck. Some of the mosquito’s saliva entered the soldier’s blood stream and with it thousands of microscopic parasites called plasmodium.

The parasites traveled through the soldier’s blood stream and entered the cells in his liver where the parasites multiplied and matured. The parasites then entered the blood stream of the soldier, and into the soldier’s red-blood-cells where they multiplied rapidly. The soldier’s red blood cells then burst releasing a large number of the parasites into the blood stream. These parasites infected other red blood cells. This process repeated itself.

Each time the parasites escaped his red blood cells, the soldier experienced waves of chills, followed by high fever, then by profuse sweating. These waves came about in an orderly fashion, every 36 hours. The soldier was exhausted. Without treatment he would have died. His doctor spoke with Julius and informed him of the soldier’s condition. Julius arrived promptly, but before he was about to treat the soldier for malaria, he drew a sample of his blood.

Julius hoped that the sample would contain enough of the malaria parasites to induce infection in his patients. He injected a small portion of the soldier’s blood into nine of his patients. He observed them as they developed the signs of malaria: chills and high fever. After several days, he treated them with quinine for their malaria and with Neosalvarsan for their syphilis. Two of the patients made full recoveries and were able to return to their homes and to their jobs. Four others demonstrated considerable, alas temporary improvement. Two were transferred to an asylum, and one died.

At that point, you are probably wondering what happened to the soldier. Unfortunately, I do not know. Did Julius even bother to check on the soldier’s condition? I just don’t know.

But this I know: considering the alternative, Julius’ results were encouraging enough for him to further pursue his plan. In 1921, he published an article reporting on more than 200 patients he treated in a similar way. Fifty of these patients were recovered sufficiently to return to their jobs. Ferdinand, the Emperor of Austria, went back to being Fritz, the banker.

In 1927, Dr. Julius Wagner-Jauregg was the first psychiatrist awarded the Nobel prize in Physiology or Medicine for his malarial treatment of neurosyphilis. Psychiatrists around the world rushed to replicate his results.

The legacy of Julius is not celebrated. There are three reasons for that: First, because his experiments with fever therapy were conducted on non-consenting patients. Second, because of Julius’ personal beliefs: he was an anti-Semite and a supporter of the Nazi movement (although his membership application to the Nazi Party was rejected, twice, because his first wife was Jewish). And third, because penicillin was discovered (in 1928, by Alexander Fleming).

Penicillin is still the first line of therapy for all stages of syphilis. Today, its use seems so sane, it is almost boring.

Editor’s note: Dr. Shahar Madjar is a urologist working in several locations in the Upper Peninsula. Contact him at smadjar@yahoo.com or at DrMadjar.com.