The Nobel Prize winner who conducted experiments without consent

Julius Wagner-Jauregg took psychiatric patients who couldn’t move and intentionally infected them with malaria, and then won a Nobel Prize for it.

Bust of Julius Wagner-Jauregg  in the Arkadenhof of the University of Vienna (photo credit: Wikimedia Commons)
Bust of Julius Wagner-Jauregg in the Arkadenhof of the University of Vienna
(photo credit: Wikimedia Commons)

In 1927 the Nobel Prize in Medicine was awarded to the psychiatrist Julius Wagner-Jauregg, making him one of only two psychiatrists to ever win this prestigious award. But that wasn’t the only unusual feature of his win. The reason was also unconventional, even controversial. Wagner-Jauregg won the Nobel Prize in Medicine for intentionally infecting psychiatric patients suffering from paralysis from malaria.

Wagner-Jauregg was a lecturer in psychiatry and director of the Neuropsychiatric Clinic at the University of Graz in Austria in the early 20th century. In 1917 he noticed an interesting phenomenon. Some patients who were hospitalized in his ward due to insanity and also paralysis showed an almost miraculous improvement in their condition after they became ill and developed a fever. So naturally, he started doing experiments on the other patients in the ward, as was customary and ethically acceptable at the time. It’s unpleasant to think of it this way, but medical ethics, like many other issues, is a matter of time and place.

Wagner-Jauregg believed that if he intentionally infected psychiatric patients with fever, it might alleviate and perhaps even completely cure their symptoms. The belief that fever can improve the condition of the mentally ill or cure them altogether was neither new nor the domain of Wagner-Jauregg only; it had existed for decades before and even served as treatment in some cases. It was called pyrotherapy (heat therapy). So why did he receive an award for this method?

What Wagner-Jauregg managed to do is develop a reliable and (relatively) safe method of causing fever in psychiatric patients and prove by scientific standards that it really works, and their condition did improve. To achieve this result he tried all sorts of things, including infecting patients with rosehip infection, a common bacterial infection in the skin, but in the end, he focused on a classic, wide-spread disease: malaria.

Malaria isn’t a mild disease - not now, and certainly not in the early twentieth century.  Mortality rates from the disease at that time could have reached as high as 20%. But the paralyzed patients in the ward were in advanced stages of syphilis. Syphilis is a contagious venereal disease that in its later stages causes its patients general paralysis following the spread of the infection to the brain. As the disease progresses, the patient becomes tired and weaker, until eventually his body organs fail and he dies.

 Nobel prize (credit: FLICKR) Nobel prize (credit: FLICKR)

Contract malaria or die of syphilis?

For these patients, the associated risk of contracting malaria, by which time they had already been treated with quinine plus medical supervision in a hospital, was lower than the alternative of letting syphilis spread through their bodies without intervention and a future of slow, paralyzing and agonizing death. In other words, they didn’t have too much to lose, but remember that they also didn’t have much choice as Wagner-Jauregg didn’t ask the patients for informed consent.

Already in its first year, Wagner-Jauregg’s experimental treatment yielded positive results, and other physicians also began to apply it. According to estimates the effectiveness of the experimental treatment stood at 30-40%. The specific strain used to infect his patients with malaria, Plasmodium vivax, caused patients to develop high and prolonged fever, which was effective in relieving the advanced symptoms of syphilis. And the pyrotherapy treatment he developed was used for several decades as an accepted and common method of treatment for severe cases of syphilis until the 1950s when it was replaced by penicillin treatment.

Supported Hitler, rejected by the Nazi Party

Wagner-Jauregg’s old age, unfortunately, spoils the successes of his youth a little. In his later years (he died in 1940) he was influenced by extreme German nationalism and was an adherent of Hitler. He even tried to work for the Nazi party but was refused because his first marriage was to a woman of Jewish descent. Like other physicians of his time and environment, Wagner-Jauregg believed in Nazi racism and eugenics, the theory that one’s race gives someone superior physical characteristics. Also, he was antisemitic and supported the forced sterilization of people with cognitive issues such as Down Syndrome, the mentally ill, and criminals.