Julius Wagner-Jauregg

Julius Wagner-Jauregg (Wels, 1857 - Vienna, 1940) was an Austrian physician and one of the most prominent psychiatrists of his era. In 1927 he became the first psychiatrist to win the Nobel Prize in Physiology or Medicine. He was trained in the clinical tradition of Central European medicine, where psychiatry was closely tied to neurology and pathology. His lasting importance lies in proposing that certain mental illnesses could be treated by inducing fever, an approach that changed the outlook for a condition that had almost always been fatal.

He was born Julius Wagner, and the family took the name Wagner von Jauregg when his father was granted a noble title in 1883. The name was later shortened to Wagner-Jauregg after the empire dissolved in 1918. He studied medicine at the University of Vienna from 1874 to 1880, where he worked with Salomon Stricker in the institute of general and experimental pathology. After a period in the Viennese psychiatric clinic, he succeeded Richard von Krafft-Ebing at the clinic in Graz in 1889, where he began research on goitre, cretinism and iodine. In 1893 he returned to Vienna as professor and director of the psychiatric clinic, succeeding Theodor Meynert, and held the post until his retirement in 1928. One of his students and assistants was Constantin von Economo.

For much of his career he worked on pyrotherapy, the idea that fever could alter the course of some psychoses. At first he used streptococci and tuberculin, with poor results. In 1917 he tried inoculating patients with progressive paralysis, a form of dementia linked to neurosyphilis and then usually terminal, with malaria parasites. The method rested on the observation that high fevers could cure syphilis. It worked, but it was dangerous: malarial treatment killed roughly 15 per cent of patients, and it is no longer used. The parasites could be controlled afterwards with quinine. This work earned him the Nobel Prize in 1927, and in 1935 the University of Edinburgh awarded him its Cameron Prize for Therapeutics.

His research went well beyond fever therapy. He studied the function of the cardiac nerves and the physiology of the thyroid, and treated cretinism with thyroid preparations. He also applied severe electric shocks to soldiers he believed were feigning mental illness to avoid returning to the front, and many of them died. After the war a criminal inquiry was opened against him, and Sigmund Freud intervened to save his career. He advocated eugenics and, in his last years, moved towards German nationalism and Nazism. A denazification commission in Austria later found that his application to join the Nazi Party had been refused on racial grounds, since his first wife was Jewish. His legacy is therefore divided between a real therapeutic advance and his support for racist ideas that are unacceptable today.