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This is: Curing insanity with malaria, published by Swimmer963 on the LessWrong.
Sometimes the history of medicine is very, very surreal. For example, consider that in 1927, a physician named Julius Wagner-Jauregg received the Nobel Prize in medicine, for...deliberately infecting his patients with malaria. As a treatment for psychosis.
This often worked.
Well, it did kill around 15% of the patients, but it was nonetheless seen as a miracle cure.
General paralysis of the insane was first identified and described as a distinct disease in the early 19th century. It was initially thought to be caused by an ‘inherent weakness of character’. The initial symptoms were of mental deterioration and personality changes; patients suffered a loss of social inhibitions, gradual impairment of judgment, concentration and short-term memory. They might experience euphoria, mania, depression, or apathy. Delusions were common, including “ideas of great wealth, immortality, thousands of lovers, and unfathomable power” – or, on the more negative side, nihilism, self-guilt, and self-blame.
It was a progressive disease, and nearly always a death sentence. As the condition advanced, the patient would develop worsening dementia, motor and reflex abnormalities, and often seizures; death usually took 3 to 5 years from the initial symptoms. In the 19th century, cases of general paralysis could account for up to 25% of admissions to asylums.
Some physicians were drawing a connection between general paralysis and syphilis infection as early as the 1850s; however, it took until much later for this explanation to be generally accepted within the medical community, and full confirmation via pathology examinations of the brains of patients who had died of the disease would have to wait until 1913.
In 1909, an antisyphilitic drug compound was discovered via a process of trialing hundreds of newly synthesized organic arsenical chemicals, looking for one that would have anti-microbial activity but not kill the human patient; this was the first research team effort to optimize biological effects of a promising chemical, which is now the basis of a huge amount of pharmaceuticals research. Unfortunately, arsphenamine, also known as Salvarsan or “606”, was difficult to prepare and administer, and was still fairly toxic to the human patient as well as the syphilis.
Julius Wagner-Jauregg was a Viennese psychiatrist, but a psychiatrist with a particular interest in experimental pathology, and in brains. Already in the mid-1880s, he was noticing an odd pattern; many of his psychiatric patients were showing improvements in their mental condition after recovering from bouts of other illnesses that resulted in fever.
Wagner-Jauregg formed two hypotheses. One, some cases of insanity had ‘organic’, biological causes and were related to physical dysfunctions in the brain; two, one disease could be fought by another. He tried deliberately inducing fevers in his patients, by injecting them with tuberculin, a sterile protein extract from cultures of the tubercle bacillus responsible for tuberculosis. However, this was inconsistent at producing a fever, and the results were disappointing.
In 1917, a soldier ill with malaria was admitted to Wagner-Jauregg’s ward. No, I am not at all sure why a malaria patient was being treated in a psychiatric ward! And, apparently, neither was Wagner-Jauregg:
“Should he be given quinine?” [my assistant Dr. Alfred Fuchs] asked. I immediately said: “No.” This I regarded as a sign of destiny. Because soldiers with malaria were usually not admitted to my wards, which accepted only cases suffering from a psychosis or patients with injuries to the central nervous system.
Wagner-Jauregg would have known that malaria is especially likely to cause repeated, intermittent paroxysms of high fever. Also, unlik...
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