Wagner von Jauregg (or Wagner-Jaur Egg) Julius
WAGNER VON JAUREGG (OR WAGNER-JAUR EGG) JULIUS
(b. Wels, Austria, 7 March 1857; d. Vienna, Austria, 27 September 1940), psychiatry.
Wagner von Jauregg was the son of a civil servant. He entered the University of Vienna medical school in 1874 and, while still a student, worked under Salomon Stricker at the Institut für Allgemeine und Experimentelle Pathologie. After receiving the doctorate in 1880, he became an assistant in Stricker’s laboratory, where he met Sigmund Freud, one year his junior. The two young men established a lifelong friendship strong enough to withstand not only the great differences in their personalities and temperaments, but also their later profound disagreements on a number of scientific questions.
Wagner von Jauregg came to psychiatry by chance when, after failing to obtain an assistantship at either of Vienna’s teaching hospitals, he seized upon an opportunity to work under Max von Leidesdorf at the university psychiatric clinic in 1883. Although his decision had been a hasty one, he later observed that it had “harmed neither myself nor psychiatry.” He quickly found his way in the new subject and by 1885 qualified as a teacher of neurology and, two years later, as a teacher of psychiatry.
During his years as Leidesdorf’s assistant, Wagner von Jauregg established the two basic areas of his later research: the pathology of the thyroid gland, and the treatment of general paresis. In 1884 he had observed the remarkable behavior—including aggressive lunging, convulsions, and spasms—of cats that had been subjected to thyroidectomy. In 1889, upon succeeding Krafft-Ebing as professor of psychiatry at the University of Graz, Wagner von Jauregg undertook further studies of the function of the thyroid gland and stated his view that the phenomena of cretinism were caused by the impairment of failure of thyroid function. (These findings were later published in Jahrbuch für Psychiatrie, 12 , 102–107, and 13 , 17–36.) He also traveled throughout Styria studying goiter and assessing the effects of treatment by iodine tablets. By 1898 he had become convinced that the regular intake of small amounts of iodine was prophylactic against the disease, and proposed that iodized salt be sold in areas in which goiter was endemic—a measure that the Austrian government put into force in 1923, some years after Switzerland had taken similar measures.
Wagner von Jauregg’s work in the treatment of general paresis began in 1887. He then noted that when psychiatric patients contracted infectious, febrile diseases, such as erysipelas or typhus, their mental state was substantially improved after the fever abated. He was consequently led to wonder if psychoses might be treated by inducing fever, and undertook a series of methodical sickbed observations. At this same early date he also speculated whether malarial infection might be used to treat general paresis, or creeping paralysis, as it was then known. In a series of experiments, he began infecting patients with tuberculosis, since Koch had, in 1890, made public his findings on tuberculin, and Wagner von Jauregg thought it too dangerous to induce malaria itself. He had some success, but achieved permanent remission in only a minority of patients.
In 1893 Wagner von Jauregg was called back to Vienna as full professor of psychiatry and director of the Psychiatric and Neurological Clinic. In this post he served as a member of the Austrian board of health, advising on all legislation concerning the mentally ill. It was during his tenure that modern laws, providing exemplary protection to the mentally incompetent, were formulated. At the same time, he carried on his own research on the febrile treatment of general paresis, utilizing staphylococci, streptococci, and typhus vaccines, but was unable to improve upon his results.
Despite the advances in the treatment of syphilis made in the early years of the twentieth century, the treatment of general paresis remained uncertain. Ehrlich’s Salvarsan was not effective against the disease in its most advanced form, in which it attacked the central nervous system, and paretics still constituted, in the 1910’s some 15 percent of all patients in mental institutions. The life expectancy of such patients was, moreover, only three to four years. Wagner von Jauregg therefore decided to resume his experiments with the malarial treatment of paretics, especially since a number of studies had shown that malaria could be cured by the use of quinine. On 14 June 1917 he for the first time injected a paralytic patient with blood taken from a patient with tertian malaria; this and subsequent trials led to significant improvement of paretic patients and, in some instances, to complete remissions.
The method of fever-therapy was developed systematically from Wagner von Jauregg’s findings, and applied from 1919 on. A number of hypotheses were put forward to explain its effectiveness, but Wagner von Jauregg himself believed that the injected malaria acted primarily by strengthening the defense of the organism against the Spirochaeta pallida that causes syphilis, thereby increasing its resistance to the poisonous substances produced. The malaria fever-therapy was widely used throughout the 1920’s and 1930’s and in 1927 Wagner von Jauregg received the Nobel Prize for his part in its development. It was superseded in the mid-1940’s with the introduction of antibiotics, particularly penicillin.
In addition to providing a remedy for a previously incurable disease, Wagner von Jauregg’s work served as the basis for the acquisition of new knowledge about the biology of the malarial parasites. Through his experiments it was, for example, learned that Plasmodium vivax, the agent of benign tertian malaria, which normally produces the first attack of fever about fourteen days after infection, can have a latency period of as long as forty weeks should the infection occur in autumn, so that the first onset of fever then occurs the following spring or summer.
Wagner von Jauregg retired as director of the Vienna Psychiatric and Neurological Clinic in 1928. He left behind him a great school of psychiatry and neurology; it is characteristic of his generosity of mind that during his tenure the most widely divergent trends in modern psychiatry developed within it. He was tolerant of approaches to which he was not personally sympathetic (as, for example, Freudian psychoanalysis), and the richness and diversity of the psychiatric thinking that flourished in his school is reflected in the names of his students, including Konstantin von Economo, Hans Hoff, Johann Paul Karplus, Otto Kauders, Otto Pötzl, Emil Raimann, Paul Ferdinand Schilder, and Erwin Stransky.
I. Original Works. Wagner von Jauregg’s works include “über die Einwirkung fieberhafter Erkrankungen auf Psychosen,” in Janrbuch für Psychiatire und Neurologie, 7 (1887), 94–134; “Zur Reform des Irrenwesens,” in Wiener Klinische Wochenschrift, 14 (1901), 293–296, Passim; Beiträge zur Ätiologie und Pathologies des endemischen Kretinismus (Vienna, 1910), with Friedrich Schlagenhaufer; Myxödem und Kretinsmus (Vienna-Leipzig, 1912); “Über die Einwirkung der Malaria auf die progressive Paralyse,” in Psychiatrischneurologische Wochenschrift,20 (1918-1919), 132–134; Fieber und Infektionstherapie (Vienna-Leipzig, 1936); and Lebenserinnerungen, L. Schölnbauer and M. Jantsch, eds. (Vienna, 1950).
II. Secondary Literature. On Wagner von Jauregg and his work, see J. Gerstmann, Die Malariabehandlung der progressiven Paralyse (Vienna, 1925); H. Hoff, in Wiener klinische Wochenschrift, 62 (1950), 888–889; J. P. Karplus, “Experiment und Klinik,” in wiener medizinische Wochenschrift82 (1932), 373–375; O. Pötzi, in Wiener klinische Wochenscrift, 50 (1937), 277; L. Schönbauer and M. Jantsch, “Julius Wagner Ritter von Jauregg,” in K. Kolle, ed., Grosse Nervenärzte (stuttgart, 1956), 254–266, with partial bibliography and secondary literature; E. stransky, in Wiener medizinische Wochenschrift, 77 (1927), 1515-1516; and W. Weygandt, in Münchener medizinische Wochenscrift, 74 (1927), 547–548.