1927 Nobel Prize in Physiology or Medicine — Julius Wagner-Jauregg

What You Will Learn in This Article

You will understand the circumstances that led to the first Nobel Prize awarded in the field of psychiatry, and how the controversial practice of intentionally inducing malaria in patients with syphilis, to save them from the disease’s devastating effects on the brain, is viewed in today’s context.

Treating Disease with Disease

Wagner-Jauregg’s Nobel Prize story sounds extreme by today’s standards. Here’s what he did:

• Patients: Individuals infected with syphilis who, after a long period of the disease, had developed general paresis — a condition in which the syphilis bacteria had invaded the brain. Prognosis: death within a few months.
• Treatment: Intentionally injecting these patients with malaria parasites.
• Principle: The hypothesis that the high, recurring fevers (above 40°C) induced by malaria would kill the syphilis bacteria.
• Result: Significant recovery of mental function in a substantial number of patients, extending their lives by several years.

This was the first Nobel Prize in Physiology or Medicine awarded in the field of psychiatry. And today, living in an era where penicillin can cure syphilis in a matter of days, it is difficult to grasp just how extreme this story was.

Treating one disease with another – what kind of desperate circumstances would lead to such a practice?

The Zeitgeist — Before Penicillin, the Age of Syphilis

In 1927, the world was living through the last phase of a society ravaged by syphilis. Syphilis, which spread to Europe after Columbus’ voyages in the late 15th century, had plagued humanity for 400 years. Tertiary syphilis (neurosyphilis) gradually destroys the brain over 10 to 30 years after infection. Character changes, impaired judgment, delusions, paralysis, and death.

The number of people suffering from this disease was enormous. Statistics show that 20 to 30% of patients admitted to European mental hospitals had general paresis. Nietzsche, Schumann, Manet, and Schubert — there are many cases where syphilis is believed to have been a factor in the sudden deaths and mental breakdowns of famous figures.

In this situation, general paresis was considered essentially incurable. Salvarsan (1910, Ehrlich) was effective for early-stage syphilis, but it could not reach the syphilis bacteria that had already entered the brain.

Looking at the broader historical context, 1927 was in the last few years of the Roaring Twenties:

• Lindbergh's first solo transatlantic flight (May) — an era of popular heroism.
• The peak of the Jazz Age — the first feature-length sound film, The Jazz Singer (October).
• Trotsky's expulsion from the Soviet Union — the strengthening of Stalin's dictatorship.
• The Japanese financial crisis (March) — a prelude to the Great Depression two years later.

In Korea, 1927 was the year of the establishment of the Sin'ganhoe, a national movement organization that sought to unite the left and right wings. While psychiatrists in Europe were receiving the first Nobel Prize, intellectuals in Korea were looking for ways to cooperate beyond ideological differences.

Biographical Narrative — Between Psychiatry and Infectious Disease

Wagner-Jauregg was born in 1857 in Wels, Austria. After studying medicine at the University of Vienna, he initially conducted research in pathology and physiology before turning to psychiatry. This background shaped his approach – he was a person who viewed psychiatry as the pathology of the brain.

In the late 19th century, psychiatry was a hotbed of debate. While Freud sought to understand mental illness through the unconscious and psychoanalysis, Wagner-Jauregg was at the opposite extreme: all mental illness originates from the biological pathology of the brain. The two men were active in the same city, Vienna, but followed very different paths.

Wagner-Jauregg’s key observation occurred in the late 1880s in a psychiatric hospital. He observed that patients with mental illness who contracted other infections and experienced high fevers showed temporary improvement in their symptoms. Cases were recorded where patients suffering from typhus, erysipelas, and tuberculosis showed improved mental states after recovering from these diseases.

This observation had been made by other doctors before. However, Wagner-Jauregg began experiments to develop this observation into an intentional treatment method. He initially injected patients with syphilis with cultures of tuberculosis, but the results were not satisfactory.

In 1917, he tried malaria parasites. Malaria induces periodic and reproducible high fevers, and importantly, it could be terminated with quinine. In other words, he could control the duration and timing of the fever.

The initial results were astonishing. Six out of nine patients with general paresis showed recovery of mental function. In a disease that had previously resulted in 100% mortality, this success rate was revolutionary.

Key Achievement — The Idea of Treating Disease with Disease

Pyrotherapy: Fever Therapy

Wagner-Jauregg established what is now known as pyrotherapy, or fever therapy. The principle is simple:

1. Inject the patient with a controllable infection (malaria).
2. Allow the infection to induce repeated high fevers of 40-41°C.
3. These high fevers kill the syphilis bacteria (which are vulnerable to heat).
4. Terminate the malaria with quinine.

This protocol was adopted in psychiatric hospitals throughout Europe. The mortality rate of general paresis dropped dramatically. It became the only reliably effective treatment for the disease in the early 20th century.

The CS analogy fits naturally here. It is similar to injecting a controlled intrusion process into a damaged system to force a reboot. When a system is failing and about to die, the only way to save it is to completely shake up the functioning system with a shock reset. The shock itself is risky for normal users, but for a patient who is already dying, it was the last hope.

However, this analogy breaks down here. Software reboots are quick and have clear results, but pyrotherapy carried a significant risk of killing the patient. Early statistics showed that 15% of patients died from the pyrotherapy itself. It was an extreme gamble of “either get better or die.”

Empirical Results

Wagner-Jauregg’s success was supported by statistics. Of the patients with general paresis who received pyrotherapy at his clinic, 30 to 50% showed significant recovery of mental function and lived for several years, even decades. Given that the disease had previously resulted in complete mortality, this was the first truly effective treatment in psychiatry.

This result led to psychiatry itself being recognized as an academic discipline. Previously, psychiatry was a field of observation and classification, without effective treatment. Pyrotherapy demonstrated that psychiatry, like other medical fields, could provide effective treatment. The Nobel Prize was a recognition of this.

After Penicillin

However, this treatment method was short-lived. With the mass production of penicillin in 1943, syphilis became a disease that could be cured safely in a matter of days. Pyrotherapy was rapidly abandoned. Today, this treatment is only found in medical history textbooks.

A Controversial Legacy

There is a dark side to Wagner-Jauregg’s life. He was a staunch anti-Semite and supported the Nazi’s racial theories in the 1930s. Although he did not formally join the Nazi Party (because the Nazi Party was illegal in Austria at the time), he clearly sympathized with its ideology. His autobiography and letters clearly reveal this ideological stance.

This fact raises difficult questions about how we should view his Nobel Prize legacy today. His scientific achievements actually saved many lives. However, the ideology he espoused inflicted extreme suffering on Jewish scientists and patients during the Nazi era.

We have seen the case of Alexis Carrel (awarded the Nobel Prize in 1912), where scientific achievement and moral judgment are separate. Wagner-Jauregg is another case of this difficult dichotomy. We must recognize his discoveries and the lives they saved, while at the same time not forgetting the deaths caused by his ideology.

Using the CS analogy again, this is similar to the issue of open-source licenses and the social views of the author. A person who creates a useful library may have views that are very different from our own. When deciding whether to continue using that library, we must consider both the usefulness of the code and the social impact of the author.

Why It Matters

Wagner-Jauregg’s Nobel Prize was the first instance in which psychiatry was recognized as a field that could provide effective treatment. This recognition led to increased academic status and investment in research in psychiatry. Today, with the diverse range of treatments in psychiatry, such as antidepressants, antipsychotics, and treatments for bipolar disorder, the first step was pyrotherapy.

The broader significance is the demonstration of the principle of “daring to try unconventional solutions in extreme situations.” The idea of injecting a patient with another disease to save them from the first seems extreme by today’s standards, but it was the only option available at the time. This daring approach saved many lives before a safer treatment (penicillin) was developed half a century later.

The lessons we can learn are twofold:

Scientific Lesson: In truly desperate situations, we may need to try solutions that go against intuition. The idea of “treating disease with disease” is an example of this.

Moral Lesson: Even great scientists may not be great people. We must respect scientific achievements, but we must not suspend our moral judgment about the social impact of the person.

Even as you read this sentence, patients with mental illness are receiving various treatments somewhere in the world. Somewhere in the lineage of those treatments is the extreme experiment that began in a psychiatric hospital in Vienna 100 years ago.

Summary of the principles of pyrotherapy and the transition to the penicillin era: Utilizing the heat vulnerability of syphilis bacteria, malaria parasites were used to induce controlled fevers, treating neurosyphilis. Rapidly phased out after the advent of penicillin, it remains a pioneering example demonstrating psychiatry's capacity for effective treatment.

→ Experience it through coding: DevBench — System Forced Reboot and Risk Taking → Learn about the CS concept: DryBench — Shock Therapy and System Recovery