Yulius Wagner-Yaureng Austrian physiologist and psychiatrist, Nobel Prize laureate 1927 Date of Birth: 07.03.1857 Country: Austria

Biography of Julius Wagner-Jauregg

Julius Wagner-Jauregg was an Austrian physiologist and psychiatrist, awarded the Nobel Prize in 1927. Born in Wels, Upper Austria, Julius was the son of Adolf Wagner, a civil servant. He enrolled at the University of Vienna in 1874 after completing his education at Schottengymnasium. During his time as a student, Wagner-Jauregg worked under the guidance of Solomon Stricker at the Institute of General and Experimental Pathology. He obtained his doctorate in philosophy in 1880 and became an assistant in Stricker's laboratory. It was during this time that he formed a lifelong friendship with Sigmund Freud, who also worked at the institute.

In 1882, Wagner-Jauregg left the institute but was unable to secure a position as an assistant professor at a hospital, as he had hoped. However, when he was invited to work with Max von Leidesdorf at the psychiatric clinic of the University of Vienna in 1883, he accepted the offer, even though he had never previously considered studying psychiatry. Wagner-Jauregg worked at the clinic for six years, obtaining qualifications as a neurology teacher in 1885 and a psychiatry teacher in 1887. While Freud became interested in studying the mechanisms of somatic symptoms influenced by existing mental deviations, Wagner-Jauregg focused on studying the physiological causes of mental illnesses, particularly cretinism and progressive paralysis.

Cretinism, a severe form of thyroid deficiency, can occur as an inherited condition or be associated with a lack of iodine in the environment. It leads to a slowdown in mental and physical development. Cretinism and goiter (enlargement of the thyroid gland) were widespread in Central Europe and other mountainous regions with low iodine content in the soil. Wagner-Jauregg studied the prevalence of endemic goiter and cretinism in southern Austria and noted the therapeutic effect of iodine treatment. In 1898, he proposed the use of iodized salt to prevent these diseases, and in 1923, the Austrian government decided to produce table salt with added iodine. A few years later, Emil Theodor Kocher and his colleagues convinced the Swiss government to adopt similar measures.

Progressive paralysis develops when pale spirochetes invade the central nervous system during the tertiary stage of syphilis. It leads to personality disintegration, paralysis, and eventually death. Although progressive paralysis is rare today, in the late 19th century, approximately 15% of all patients in psychiatric institutions suffered from this condition. Wagner-Jauregg became particularly interested in the rare cases of recovery, as he wrote later, "the study of cases of recovery in incurable diseases is of the greatest interest to a physician." He observed that these cases often occurred after the patient experienced an illness accompanied by high fever, such as typhoid. In 1887, Wagner-Jauregg hypothesized that psychoses could be treated with artificially induced fever. Initially, he studied the effects of fever on the course of mental illnesses in general, but soon turned his attention to patients suffering from progressive paralysis.

He had the opportunity to use malaria infection from such patients, as it causes recurring fevers. However, Wagner-Jauregg hesitated to intentionally induce this dangerous disease. After Robert Koch published data on the treatment of tuberculosis with tuberculin in 1890, Wagner-Jauregg infected some mentally ill patients with tuberculosis bacteria. However, the results were disappointing because tuberculosis fever was not intense or sustained enough to treat progressive paralysis. Furthermore, tuberculin did not cure tuberculosis and could even be dangerous in some cases.

In 1889, Wagner-Jauregg succeeded Richard von Krafft-Ebing as the professor of psychiatry at the University of Graz. Four years later, he returned to Vienna as the director of the psychiatric and neurological clinic. By this time, he had abandoned the tuberculosis infection method and attempted to treat progressive paralysis with various vaccines against fever-inducing diseases. The results were contradictory. Paul Ehrlich's development of Salvarsan (or arsphenamine) in 1910 proved to be more effective than previous methods of syphilis treatment, but it did not affect the disease in its advanced stage with developed paralysis. Several years later, when it was conclusively determined that malaria, especially the mild three-day form, could be completely cured with quinine, Wagner-Jauregg resumed his work using this disease. In 1917, he began implementing his proposal from 1887, infecting nine patients with progressive paralysis with the Plasmodium of the three-day malaria. The results surpassed expectations, with 85% of cases recovering when malaria therapy began early. Over the next few years, Wagner-Jauregg and his colleagues developed suitable doses and determined the necessary duration of fever before starting quinine treatment. Fortunately, fever induced by this method proved to be more susceptible to quinine treatment than malaria acquired through mosquito bites. Wagner-Jauregg's discovery represented significant progress in treating one of the most serious diseases in Western European countries. The exact reason for its success remains a subject of debate. Malaria infection stimulates the immune system, and high fever can directly lead to the death of spirochetes. Supporting the latter hypothesis is the fact that the treatment of progressive paralysis can sometimes be successful when the patient is warmed with a special electric warmer.

Malaria therapy, unusual by today's standards, was a common treatment method between the early 1920s and mid-1940s. The development of purified penicillin by Ernst B. Chain and Howard W. Florey (penicillin itself was discovered by Alexander Fleming in 1928) revolutionized syphilis treatment, and by the end of the 1940s, malaria therapy and treatment with Salvarsan became purely of historical interest.

In 1927, Wagner-Jauregg was awarded the Nobel Prize in Physiology or Medicine "for his discovery of the therapeutic value of malaria inoculation in the treatment of dementia paralytica." In his presentation speech, Wilhelm Wernstedt from the Karolinska Institute stated that "Wagner-Jauregg has given us a means for effectively treating a serious illness that until now has been considered resistant to all forms of therapy and incurable." A year after receiving the Nobel Prize, Wagner-Jauregg retired from the psychiatric and neurological clinic, where he had been director since 1893. In addition to his research work, which he continued until the end of his life, he actively participated in the development of laws protecting the mentally ill.

In 1899, Wagner-Jauregg married Anna Koch, and they had a son and a daughter. Considered somewhat introverted and reserved, he was respected for his ability to be tolerant of different scientific views. Julius Wagner-Jauregg passed away in Vienna on September 27, 1940. In addition to the Nobel Prize, he received the Cameron Prize and honorary titles from the University of Edinburgh (1935) and the University of Vienna.