Saturday, 7 July 2018

Julius Wagner-Jauregg's Nobel Prize for Syphilis Treatment

In 1927, Austrian psychiatrist Julius Wagner-Jauregg received the Nobel Prize in Medicine for curing some patients with brain damage from syphilis by infecting them with malaria (Yale J Biol Med, June, 2013;86(2):245–254).  He got the idea of causing very high fevers to cure syphilis after he saw a woman apparently cured of schizophrenia when she suffered a very high fever and terrible rash on her skin caused by erysipelas, an infection with streptococcal bacteria.  

Ten to thirty years after a person is infected with syphilis, the spirochete bacteria can invade the brain to damage a person's thought process, behavior, mood and ability to reason.   Wagner-Jauregg was correct in treating psychiatric disease with biological methods, but because he was a Nazi, he has not been recognized as a groundbreaker for medical treatments for mental disease.  

Who was Julius Wagner-Jauregg? 

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 only 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". Wagner-Jauregg was a scientist whose scientific studies showed that:
• iodine deficiency causes cretinism (lack of growth in childhood),
• giving iodine can cure an enlarged thyroid, and 
• giving a patient malaria could treat the brain damage caused by syphilis.  

Scientists later learned that a prolonged, high fever does not cure non-syphilitic schizophrenia, even if it can kill the germ that causes syphilis.  

The Nobel Prize-Winning Experiment

In 1917, Wagner-Jauregg injected blood from a German soldier infected with malaria into nine of his patients who were suffering from paresis, schizophrenic-like brain damage caused by syphilis. After 7-12 days of very high fevers, the patients were given quinine to treat the malaria and Neosalvarsan to treat syphilis.  One died, two were sent to insane asylums, and six improved dramatically. 

However, four of these six later suffered further brain damage, but two recovered completely (Psychiatrike. 2013;24(3):208-12).  Subsequent studies showed that about 50 percent of patients responded to this fever treatment and improved enough to be released from insane asylums. Of those released from the asylum, 50 percent had no recurrence, but about 15 percent died from complications of malaria (Science. 2013;342(6159):686). 

Temperatures above 105.8 F (41 Celsius) for at least six hours can kill the bacterium that causes syphilis. However, the brain can be permanently damaged by temperatures that high for that long. 

On the Road to a Cure for Syphilis

Approximately five to ten percent of all psychiatric admissions before 1945 were due to syphilis of the brain, which affected predominantly middle-class males to cause dementia, psychosis, paralysis and death.   Paul Ehrlich, another Nobel Prize winner, discovered Salvarsan to treat syphilis and also used methylene blue to treat malaria.  In the 1950s, derivatives of methylene blue called phenothiazines were found by the French company Rhone Poulenc to treat mental disorders.  That was followed by chlorpromazine and other drugs to treat mental disorders.  

Prior to Wagner-Jauregg’s reports of treating schizophrenia from syphilis with malaria, doctors had no effective treatment for that disease. Giving patients malaria was just about the only treatment that allowed some insane asylum patients to return to their normal lives (Am J Psychiatry. 1946;02:577-582).  It allowed psychiatry to become an accepted medical specialty because it showed that schizophrenia at last had a treatable cause, killing the bacterium that causes syphilis.  

In 1928, Alexander Fleming noted that mold could prevent the bacterium Staphylococcus from growing in a petri dish. In 1939, Howard Florey and Ernst Chain extracted and purified penicillin and all three were awarded the Nobel Prize in Medicine. Today all cases of syphilis can be cured as long as an infected person is diagnosed and treated properly and early enough.   

Syphilis Symptoms

Syphilis is transmitted during vaginal, anal or oral sex with an infected person.  An unborn child can get it from an infected mother.  You do not get syphilis from doorknobs, toilet seats, swimming pools, clothing, bathtubs, or silverware. 

Primary Syphilis: From 10 to 90 days after sex with an infected partner, a person usually develops a painless single skin ulcer called a chancre in the genitals, anus or mouth.  It usually goes away after a week or two with no treatment whatever.  Many infected people develop no chancre at all and have no other symptoms. 

Secondary Syphilis: Two to eight weeks after being infected, a person may develop a non-itchy rash, usually reddish-brown spots on the bottoms of the feet and on the palms of the hands.  Other symptoms can include a sore throat, fever, swollen lymph glands, headaches, fatigue, muscle aches, warts on the genitals, loss of appetite and joint pain. If you are treated properly with antibiotics, you should be cured.  However, if you do not receive treatment, you can suffer tertiary syphilis with permanent incurable damage.  

Tertiary Syphilis: Ten, twenty or more years later, the bacterium can grow in and destroy any part of the body. It can cause blindness, dementia, schizophrenia, paralysis, loss of feeling, arthritis, ruptured blood vessels and liver damage.  

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1 comment:

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