Biography of Julius Wagner-Jauregg
Julius Wagner-Jauregg won the Nobel Prize for physiology or medicine in 1927 "for his discovery of the therapeutic value of malaria inoculation in the treatment of dementia paralytica". He shared the honour with the Danish pathologist Johannes Andreas Grib Fibiger (1867-1928), who was awarded the prize "for his discovery of the Spiroptery carcinoma". Wagner-Jauregg's treatment of syphilitic meningoencephalitis, or general paralysis, by the artificial inoculation of malaria constituted the first example of shock therapy. The method brought a previously incurable fatal disease under medical control. He was the first psychiatrist to win the Nobel Prize.
Julius Wagner-Jauregg was born in Wels in Oberösterreich, the second of four children of Adolf Johann Wagner (born 1816), a civil servant from Silesia, and his wife, Ludovika. He had a brother, Fritz, and the sisters Adolfine and Rosa. However, the happy family life was shattered when his mother died in 1867. The girls were taken care of by a monastery, while the boys remained at home. Julius went to school in Krems, a small town on the Danube where his father had been moved. In 1872 his father was transferred to the Department of Finance in Vienna. Here Julius spent his last two years at school at the famous Schottengymnasium, a high school for boys which had been founded in 1807 as part of a Benedictine Abbey.
After graduating from the Gymnasium with distincton, Julius Wagner enrolled at the University of Vienna and began his studies in October 1874. There was no tradition for medicine in the family, but his father was said to have commented that he should study medicine, because he always used the opportunity to examine dead animals in order to find out what was inside. However, his father would have preferred him to choose philosophy, a shorter study, three years insted of five, and with the prospect of becoming a junior hight school teacher. He decided for medicine only shortly before entering the university, influenced by learning that two of his classmates, both having much poorer marks than him, had decided on the demanding study of medicine.
The University of Vienna was then still one of the World’s leading teaching institutions for medicine, counting many famous names among its lecturers. From the beginning Wagner-Jauregg was particularly influenced by the anatomist Joseph Hyrtl (1810-1894), and later the physiologist Ernst von Brücke.
In 1883, shortly before retirement, his father was ennobled and added the name Ritter von Jauregg, an adaptation of his mother’s maiden name, Jauernigg. At the end of World War I Austrians were deprived by law of their titles. But Julius Wagner Ritter von Jauregg was granted permission to use the hyphenated name Wagner-Jauregg.
The day they stormed the Bastille
While still a student, Wagner-Jauregg worked under Salomon Stricker (1834-1898) at the Institut für Allgemeine und Experimentelle Pathologie and became very skilled in performing animal experiments. Even before he took his final examination he had published two papers, one on the accelerating nerves of the heart which was published under both Stricker’s and his name in March 1978, and a second paper by stud. med. Julius Wagner on ”Contributions to the knowledge of the respiratory activities of the Nervus vagus”, published in 1879.
In his time, one year of military service was obligatory for students of medicine, but in January 1876 Wagner-Jauregg chose to ”volunteer” for medical service in the navy. Because of his fathers resistance - the Russian-Turkish was was threatening – it was not until October that year he began his service, in Garrison Hospital No. 1 in Vienna. When his year of service ended in September 1878, he continued his studies, and on July 14, 1880 he received his doctorate from the University of Vienna. In his memories, he writes that he remembered the day because it was the day of the storming of the Bastille – the day French national day.
From January 1, 1881, he was an assistant in Stricker’s laboratory, where he met Sigmund Freud (1856-1939), one year his junior. The two young men established a lifelong friendship, sayin ”Du” to each other instead of the formal ”Sie” which was common. Their friendship was strong enough to withstand not only great differences in their personalities and temperaments, but also in their later profound disagreements on a number of scientific questions. Their diagreements came to a climax when Freud witnessed in the process against him for maltreatment of wounded soldiers during Wolrd War I.
Wagner-Jauregg’s preferred speciality was internal medicine, and for some time he hoped to obtain an assistanship the clinic of Heinrich von Bamberger’s (1822-1888), who made him write an article about investigations into kidney disease and fuchsin. Disagreeing with the results Bamberger wanted to present, Wagner-Jauregg had the article published anonymously as a report, delibaerately omitting the author’s name. The attractive position under Bamberger was given to Edmund Neusser (1852-1912). Soon there was another opportunity, when Adalbert Duchek (1824-1882), head of the second internal clinic, died. Hermann Nothnagel (1841-1905) was appointed his successor, but again Wagner-Jauregg was turned down.
The accidental psychiatrist
Failing to obtain an assistantship in this discipline at either of Vienna’s teaching hospitals, Wagner-Jauregg planned to settle in Egypt. However, during an evening with two colleagues at a Vienna coffeehouse, professor extraordinary Ferdinand Frühwald (1854-1908) and Dr. Fröschl recommended that he apply for the vacant assistantship under Max von Leidesdorf (1818-1889) at the First Psychiatric Clinic, which was part of the Asylum of Lower Austria in Vienna – the Landesirrenanstalt. The next day he visited Leidesdorf, even though, as he later confessed, he knew nothing about psychiatry, which was not a compulsory subject in the medical syllabus at the time. He later commented upon his hasty decision that it had “harmed neither myself nor psychiatry.” In October 1882 he bought the Lehrbuch der Psychiatrie by Heinrich Schüle (1840-1916), and on December 23 he began working with Leidesdorf. He entered his new position formally on January 1, 1883, with a salary of 57 Gulden a month. On March 10, 1883, he became a member of the Gesellschaft der Ärzte in Wien.
In 1885, encouraged by Max Leidesdorf, he qualified as a Privatdozent in neurology. Two years later the dean, Hans Kundrat (1845-1893), reminded him that his venia legendu was only for neurology, not psychiatry, which would be a drewback if he wanted to apply for an academic chair. As a result, on June 16, 1887, Wagner-Jauregg also became a Privatdozent in psychiatry. That year Max Leidesdorf suffered a severe heart attack, and for the next two years Wagner-Jauregg took over his lectures and the running of the clinic.
The professor and the iodine
During his years as Max Leidesdorf’s assistant, Wagner von Jauregg established the two basic areas of his later research: the pathology of the thyroid gland, and the treatment of general paresis. In 1884 Leidesdorf suggested that he carry out some experiments on animals on the effect of removing the thyroid gland. Wagner-Jauregg immediately obtained a number of cats and exstirpated the thyroid. To his great surprise the animals immediately became severely ill, with convulsions and spasms in which the entire body became stiff. Almost without exceptions all the animals were dead within a few days.
This experiment occasioned his first appearance in the Medical Society. ”I packed some of the operated cats in a handbag and went to the meeting of the Gesellschaft der Ärzte and put my three cats on the table.” He published his experiments in number 25 and 30 of the Wiener medizinische Blätter 1884. Independent of Wagner-Jauregg, that same year the German phsyiologist Moritz Schiff (1823-1896), working in Florence, had made the same experiments and with the same results. This was one year after the Swiss surgeon Emil Theodor Kocher (1841-1917) announced his discovery of a cretinoid pattern in patients after total excision of the thyroid gland. However, due to a heavy workload and poor equipment, Wagner-Jauregg did not pursue this line of investigation at the time.
In September 1889 Wagner-Jauregg was appointed Richard Freiherr von Krafft Ebing’s (1840-1902) successor as professor extraordinary of psychiatry at the University of Graz. The conditions here were different from Vienna, with only 24 or 30 beds and unsatisfactory conditions for the male inmates. Sanitary conditions, too, were not convincing. When he lifted a floorboard, he discovered that the sickroom was above a rivulet – which proved to be the sewage canal for the hospital’s two buildings. In the room above him was the delivery clinic. In Graz his salary eventually rised to 350 Gulden a year.
Graz is the capital of the province of Styria, which was notorious for the incidence of cretinism. Wagner-Jauregg was a keen mountaineer, on his walks through the alpine valleys he became disturbed by the number of cretins he encountered.
He therefore resumed his researches into the role of the thyroid in cretinism, but this time he approached the problem from a different angle. During the summer months of 1892 he spent every Thursday afternoon and every Sunday visiting three areas in the province studying goiter and assessing the effects of treatment by iodine tablets. By 1898 he had become convinced that the regular intake of small amounts of iodine was prophylactic against the disease, and proposed that iodized salt be added obligatory to salt sold in areas in which goiter was endemic – a measure that the Austrian government put into force in 1923, some years after Switzerland had taken similar measures.
Fever is good for you!
While a member of the psychiatric staff (1883-1889) at the University of Vienna, working in the First Psychiatric Clinic, Wagner-Jauregg noted that persons suffering from certain nervous disorders showed a marked improvement in their mental state after contracting febrile diseases, such as erysipelas and typhus. His first encounter with the phenomenon that later earned him a Nobel Prize, was when a woman patient suffered an attack of erysipelas and subsequently recovered from a severe mental illness.
He developed the idea that fever might be of value in the treatment of psychosis, noting that "not rarely psychoses were healed through intercurrent infectious disease”, and he suggested that "one should intentionally imitate this experiment of nature". On this basis he undertook a series of methodical sickbed observations. At this same early date he also speculated whether malarial infection might be used to treat general paresis, or creeping paralysis, as it was then known.
The first to induce an infectious disease in a mentall ill patient was a phsycian named Rosenblum in Odessa, Russia. His findings were reported by a certain Oks in the Archiv für Psychiatrie und Nervenkrankheiten. This report concerns 22 cases of febris recurrens in the mentally ill. In eight of these cases there was a complete cure, while eight other cases showed a marked improvement.
Upon the death of Theodor Hermann Meynert (1833-1892) the Extraordinariat of Psychiatry in Vienna became vacant. In late September 1893 Wagner-Jauregg received a telegram from his father congratulating him upon the appointment as full professor of psychiatry and director of the Psychiatric and Neurological clinic at the Allgemeines Krankenhaus in Vienna. He first did not believe it, but few days later he received a decrete confirming the appointment. In this post he served as a member of the Austrian board of health, advising on all legislation concerning the mentally ill. It was during his tenure that modern laws, providing exemplary protection of the mentally incompetent, were formulated. In 1902 he succeeded Krafft-Ebing, who had succeeded Leidesforf as Extraordinarius of neurology and psychiatry at the University of Vienna.
Mosquito to the rescue
Despite the advances in the treatment of syphilis made in the early years of the twentieth century, the treatment of general paresis remained uncertain. Paul Ehrlich’s (1854-1915) Salvarsan was not effective against the disease in its most advanced form, in which it attacked the central nervous system, and paretics still constituted, in the 1910’s, some 15 percent of all patients in mental institutitons. The life expectancy of such patients was only three to four years.
Wagner-Jauregg decided to resume his experiments with the malarial treatment of paretics, especially since a number of studies had shown that malaria could be cured by the use of quinine. The great breakthrough came on June 14, 1917, when he for the first time injected a paralytic patient with tertian malaria. This and subsequent trials led to significant improvement of paretic patients, in some instances, to complete remissions.
For this procedure Wagner-Jauregg used blood obtained by syringe from the cubital vein of a wounded and shell shocked malarious soldier from the Macedonian front who had been admitted to his clinic. Of nine patients with general paralysis of the insane so treated, six were benefitted and three were still working four years later. However, all except two eventually suffered relapses. The method of fever-therapy was developed systematically from Wagner von Jauregg’s findings, and applied from 1919 on. A number of hypotheses were put forward to explain its effectiveness, but Wagner von Jauregg himself believed that the injected tertian malaria acted primarily by strenghtening the organism against the Spirochaeta pallida that causes syphilis, thereby increasing its resistance to the poisenous substances produced. The malaria fever-therapy was widely used throughout the 1920’s and 1930’s, despite the fact that it was not always effective, and not without dangers. Of four patients injected with a maliggnant type of malaria three died, despite large doses of quinine.
For this effort he won the Nobel Prize for physiology or medicine in 1927, the first psychiatrist to do so. These studies led to all the methods of stress therapy, electric shock, insulin etc. used in psychiatry. In the mid 1940’s his therapy was superseded with the introduction of antibiotics, particularly penicillin.
”Of course I was acquitted”
When World War I broke out, Wagner-Jauregg was 57 years old and free of any military duties. He had completed his obligatory military service in 1892 as ”Korvettenarzt” in the reserve. However, he had ample duties to perform in his hospital, which eventually had more than 90 beds. A major part of these were occupied by patients with gunwounds to the head. Besides his duties here, he was also active in Garnisonsspital Nr. II.
Many of his patients had lost their ability to speak, seemingly because of shell explosions, but still had the ability understand language. Wagner-Jauregg and his team were able to heal most of these patients, many of whom had been given up in other hospitals, within few days. There were heated discussion about the nature of the sufferings of these patients: were they psychological or physical? Wagner-Jauregg’s therapy for some of these soldiers, among them those he characterized as ”Zitterer” (trembler”) included electroconvulsive shock therapy.
In 1919 Wagner-Jauregg was accused of having maltreated soldiers with electric shocks. Among the experts witnessing before the invetigative commission was his old friend Sigmund Freud, who criticized Wagner-Jauregg's methods but exonerated him of the charge of having deliberately tortured patients. One of the expert witnesses who defended Wagner-Jauregg most effectively, was Emil Raimann (born1872). Wagner-Jauregg commented the outcome of the process: ”Of course I was acquitted”. And so were all the other defendants before the tribunal.
The great teacher
Wagner-Jauregg retired as director of the Vienna Psychiatric and Neurological Clinic in 1928, when he was succeeded by Otto Pötzl (1877-1962). He left behind him a great school of psychiatry and neurology: It is characteristic of his generosity of mind that during his tenure the most widely divergent trends in modern psychiatry developed within it. Unlike his dogmatic and intolerant friend Sigmund Freud, he he was tolerant of approaches to which he was not personally sympathetic (as, for example, Freudian psychoanalysis). His status as a teacher is reflected in the names of some of his students, many of whom became famous: Constantin Economo Freiherr von San Serff (1876-1931), Jan Pilcz (1870-1931), Josef Gerstmann (1887-1969), Hans Hoff (1897-1969), Johann Paul Karplus (1866-1936), Otto Kauders (1893-1949), Emil Raimann (1872-1949), Paul Ferdinand Schilder (1886-1940), Otto Pötzl, Giulio Bonvicini (born 1872) and Erwin Stransky (1877-1962).
In sickness - strength
In childhood Julius Wagner had typhoid fever, but gradually became quite athletic and exceptionally strong. However, during his student days he developed tuberculosis with haemoptysis. Not having the money to go to a sanatorium, he continued his studies, relaxing between classes in a nearby park until his haemoptyses ceased. He maintained a lifelong interest in athletics, performing regular clisthenics and weight lifting. According to his son Theodor, the professor had outperformed the champion weight lifter Jagendorfer by raising with his foot a 30 kilogram iron dumbbell from the floor to the seat of a chair. Wagner-jauregg was also addicted to chess, when the nights in Vienna were wintry he would often play with a friend by telephoneHe seldom slept more than five or six hours at night but always had a twenty minute nap after lunch.
Wagner-Jauregg was a member or honorary member of a large number of scientific bodies: Akademie der Wissenschaften in Wien, Kaiserlich-Leopoldinisch-Carolinisch Deutsche Akademie der Naturforscher in Halle, Kungliga Vetenskapsakademin in Stockholm, the Hungarian Academy of Sciences, Corresponding member of the Royal Akademie of Medicine in Torino, the Societyfor Psychiatry in Paris, the Society for Neurology in Paris, as well as honorary member of scieitific societies for psychiatry, neurology, syphilology, microbiology, roentgenology etc in Austria, Hungary, Germany, Italy, France, England, the Unites States of America etc. He received the freedom of the cities of Wels and Vienna, was honorary president of the Gesellschaft der Ärzte in Wien and the Verein für Psychiatrie und Neurologie in Vienna.
In later years it has come to light that Wagner-Jauregg was a national socialist (Nazi) and backed Hitler's program of racial hygiene. This has shocked Austria, where schools, roads and hospitals have been named in his honour.
In his obituary on September 29, 1940, the most extreme of the Nazi newspapers, Völkischer Beobachter, called him an ”upright German”, stating that ”Without his genetics the stock of ideas constituting the national socialist view of society is no longer conceivable” ("Seine Erbforschungen sind heute nicht mehr aus dem Gedankengebäude der nationalsozialistischen Gesellschaftslehre fortzudenken"). On April 21, 1940, shortly before the sterilization law came into force in Austria, Wagner-Jauregg applied a second time for membership in the NSDAP (Nationalsosialistische Deutsche Arbeiterpartei – the Nazi party). His first application had been in 1939 after calling for a ban on "people with mental diseases and people with criminal genes" from reproducing. His first application probably failed because his first wife, Balbine Frumkin, was Jewish.
- Die Tat is alles, nichts der Ruhm.