“Give me the power to produce fever and I’ll cure all disease”

Parmenides, 500 BC.

Belief in the curative power of feverish illnesses on mental diseases dates back to antiquity.

Hippocrates spoke of the beneficial effect of fever on epilepsy and Galen cited the cure of a melancholic patient after an attack of quartan fever. During the 18th century, physicians began to send their patients to Fens to contract malaria to cure them of their insanity. However, it was not until the late 19th century that fever therapy began to gain widespread popularity and attract the support of distinguished physicians, including Maudsley and Esquirol.

In 1917, Austrian psychiatrist Julius Wagner von Jauregg announced the discovery of malaria fever therapy, a cure for general paralysis of the insane (GPI).

GPI is the late manifestation of systemic syphilis, a disease that was one of the great scourges of Victorian and Edwardian society. An estimated 10% of the population were infected with syphilis, and GPI accounted for nearly 2500 deaths each year and onefifth of all admissions to mental hospitals.

Conflict surrounded whether GPI had an organic or functional cause, and its syphilitic cause was not defined until 1913.

In the initial confusion over its cause, and the absence of any effective treatment however, the burden of this disease fell on psychiatry, a specialty dominated at this time by therapeutic pessimism. Few patients in the vast mental asylums were perceived as curable and doctors had little faith in the prevailing array of aggressive therapeutics for insanity.

Jauregg’s interest in the use of fever therapy as a treatment for GPI arose after observing a psychiatric patient recover after an attack of erysipelas.

He began his research with tuberculin, but as evidence mounted as to its toxicity, Jauregg looked to other sources of infection for fever, and a chance event led him towards malaria. A soldier from the Macedonian front with an injury to his nerves also had malaria.

Jauregg took the opportunity to inoculate several general paralytics with the malaria-infected blood. The results were encouraging.

Jauregg’s theories on which he had based his work were generally unfounded. They focused mainly on the different properties of bacterial proteins or toxins to explain the favourable effect of fever.

He never attempted to explore the possible mechanisms behind this phenomenon in any depth, and his belief in malarial fever therapy seems to have been largely based on empirical evidence. The treatment of one fatal disease by another might seem bizarre and unethical. In its heyday, however, malaria fever therapy was undisputedly heralded as a revolutionary breakthrough in the treatment of a previous feared fatality. Indeed, although it offered only a 30% chance of complete remission and a 30% chance of death, the treatment was widely adopted and used until the introduction of penicillin in the 1950s. As a bizarre treatment in psychiatry it does not stand alone, and its discovery marked the advent of a wave of successive somatic “shock” therapies, whose effect remains profound.

I thank David Bradley for initially providing me with the incentive to pursue this study. I also thank MaryFissell for her invaluable support and guidance during mystudies.