Julius Wagner-Jauregg

1857-1940

Austrian Psychiatrist

In 1927 Julius Wagner-Jauregg was awarded the Nobel Prize for medicine or physiology for his attempts to treat patients who had syphilitic paresis, or dementia paralytica, by inducing fevers using malaria inoculations. His early research on shock therapy led to experiments on the effect of fever on mental illness.

Julius Wagner, the son of Ludovika Ranzoni and Adolf Johann Wagner, an Austrian government official, studied at the Schottengymnasium in Vienna. He began his medical studies in 1874 at the University of Vienna, where he became interested in microscopy and experimental biology. To immerse himself in these new areas of research, he served as assistant to Salomon Stricker at the Institute of General and Experimental Pathology from 1874-1882. Additionally, Wagner and Sigmund Freud (1856-1939) shared many scientific interests and became lifelong friends. In 1880 Wagner was awarded a Ph.D. for his thesis on the heart. His father was granted the title "Ritter von Jauregg" in 1883, at which point Julius became Wagner von Jauregg. Titles of nobility were eliminated with the breakup of the Hapsburg Empire in 1918 and Julius changed his name to Wagner-Jauregg. He married Anna Koch in 1899; together they had a son and a daughter.

After working in the Department of Internal Diseases at the University of Vienna, Wagner-Jauregg became an assistant to Max von Leidesdorf in the psychiatric clinic. Despite his lack of training in either psychiatry or neurology, Wagner-Jauregg became very interested in these fields. In 1885 he was considered qualified to teach neurology. By 1888 he was also teaching psychiatry. When Leidesdorf became ill in 1887, Wagner-Jauregg served as director of the clinic. Two years later, he was appointed professor of psychiatry and neurology and director of the neuropsychiatric clinic at the University of Graz. After his appointment to the staff of the State Asylum, he returned to Vienna as "extraordinary professor of psychiatry and nervous disease" and director of the university clinic.

One of Wagner-Jauregg's lesser known, but very valuable, studies involved the relationship between cretinism and goiter. He attributed these conditions to a malfunction of the thyroid gland and investigated the benefits of glandular extracts and the addition of iodine to table salt. The importance of this work was not fully recognized until the 1920s, when the Austrian government began formally requiring the use of iodized salt.

Wagner-Jauregg was also interested in trauma, nerve action, and shock therapy. His experiments on shock therapy led him to consider the possible value of fever in the treatment of mental illness. In 1887 he published his first paper on the effects of fevers on psychosis. According to Wagner-Jauregg, the mental state of his patients seemed to improve after they recovered from a febrile illness. He thought patients with paresis, or dementia paralytica associated with advanced syphilis, particularly benefited from episodes of high fever. At first, he preferred to induce fevers with tuberculin, which Robert Koch (1843-1910) had recently introduced as a possible remedy for tuberculosis, but this substance had dangerous side effects. By 1917 he concluded that the pyretic agents he had been using did not produce a permanent cure. He then decided to test malaria therapy, confident that, after he had cured the patient of syphilitic paresis, he could cure the malaria with quinine. Blood from a patient suffering from malaria was used to inoculate nine syphilitic patients; six seemed to improve significantly. Until penicillin became widely available after World War II, malaria induction remained one of the standard treatments for neuro-syphilis. Physicians generally reported improvement in 30-40% of their patients, especially patients in the early stages of the disease.

LOIS N. MAGNER