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Julius Wagner-Jauregg MD (1857 - 1940)

October 8, 2018

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History of Medicine
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Julius Wagner-Jauregg MDPhoto credit: Unknown - Universitat Graz, http://www.uni-graz.at/en/print/uarc1www_wagnerjauregg.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=8156046

Julius Wagner-Jauregg (7 March 1857-27 September 1940) was an Austrian physician, who won the Nobel Prize in Physiology or Medicine in 1927, and is the second psychiatrist to have done so. His Nobel award was "for his discovery of the therapeutic value of malaria inoculation in the treatment of dementia paralytica".

Julius Wagner-Jauregg was born Julius Wagner on 7 March 1857 in Wels, Upper Austria, the son of Adolph Johann Wagner and Ludovika Jauernigg Ranzoni. His family name was changed to "Wagner von Jauregg" when his father was given the title of "Ritter von Jauregg" (a hereditary title of nobility) in 1883 by the Austro-Hungarian Empire. Hence he retained the name Julius Wagner Ritter von Jauregg until 1918 when the empire was dissolved, and nobility was abolished. The family name was then contracted to "Wagner-Jauregg". He attended the Schottengymnasium in Vienna before going on to study Medicine at the University of Vienna from 1874 to 1880, where he also studied with Salomon Stricker in the Institute of General and Experimental Pathology. He obtained his doctorate in 1880 with the thesis "L'origine et la fonction du coeur accelere." He left the institute in 1882. After leaving the clinic, he conducted laboratory experiments with animals, which was practiced very little at this time. From 1883 to 1887 he worked with Maximilian Leidesdorf in the Psychiatric Clinic, although his original training was not in the pathology of the nervous system. In 1889 he succeeded the famous Richard von Krafft-Ebing at the Neuro-Psychiatric Clinic of the University of Graz, and started his research on Goitre, cretinism and iodine.

In 1893, Wagner-Jauregg became Extraordinary Professor of Psychiatry and Nervous Diseases, and Director of the Clinic for Psychiatry and Nervous Diseases in Vienna, as successor to Theodor Meynert. A student and assistant of Wagner-Jauregg during this time was Constantin von Economo. Ten years later, in 1902, he moved to the psychiatric clinic at the General Hospital and in 1911 he returned to his former post. His main work was related to the treatment of mental disease by inducing a fever, an approach known as pyrotherapy. In 1887 he investigated the effects of febrile diseases on psychoses, making use of erisipela and tuberculin (discovered in 1890 by Robert Koch). Since these methods of treatment did not work very well, he tried in 1917 the inoculation of malaria parasites, which proved to be very successful in the case of dementia paralytica (also called general paresis of the insane), caused by neurosyphilis, at that time a terminal disease. It had been observed that some who develop high fevers could be cured of syphilis. Thus, from 1917 to the mid-1940s, malaria induced by the least aggressive parasite, Plasmodium vivax, was used as treatment for tertiary syphilis because it produced prolonged and high fevers (a form of pyrotherapy). This was considered an acceptable risk because the malaria could later be treated with quinine, which was available at that time. This discovery earned him the Nobel Prize in Medicine in 1927.

Wagner-Jauregg main publication was a book titled Verhutung und Behandlung der progressiven Paralyse durch Impfmalaria (Prevention and treatment of progressive paralysis by malaria inoculation) in the Memorial Volume of the Handbuch der experimentellen Therapie, (1931). The technique was known as malariotherapy; however, it was dangerous, killing about 15% of patients, so it is no longer in use. Wagner-Jauregg also administered thyroid and ovarian preparations to young psychotic patients who had experienced delayed puberty, which led to the development of their secondary sexual characteristics and diminished psychosis. Other patients were deemed schizophrenic because of excessive masturbation, where Wagner-Jauregg sterilized them, resulting in an "improved" condition.

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