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The malaria therapy (or malaria inoculation, and sometimes malariotherapy) is a medical procedure of treating diseases using artificial injection of
malaria parasites ''Plasmodium'' is a genus of unicellular eukaryotes that are obligate parasites of vertebrates and insects. The life cycles of ''Plasmodium'' species involve development in a blood-feeding insect host which then injects parasites into a verte ...
. It is a type of
pyrotherapy Pyrotherapy (artificial fever) is a method of treatment by raising the body temperature or sustaining an elevated body temperature using a fever. In general, the body temperature was maintained at 41 °C (105 °F). Many diseases were t ...
(or pyretotherapy) by which
high fever Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...
is induced to stop or eliminate symptoms of certain diseases. In malaria therapy, malarial parasites (''
Plasmodium ''Plasmodium'' is a genus of unicellular eukaryotes that are obligate parasites of vertebrates and insects. The life cycles of ''Plasmodium'' species involve development in a blood-feeding insect host which then injects parasites into a vert ...
'') are specifically used to cause fever, and an elevated body temperature reduces the symptoms of or cure the diseases. As the primary disease is treated, the malaria is then cured using
antimalarial drugs Antimalarial medications or simply antimalarials are a type of antiparasitic chemical agent, often natural product, naturally derived, that can be used to treat or to prevent malaria, in the latter case, most often aiming at two susceptible target ...
. The method was developed by Austrian physician
Julius Wagner-Jauregg Julius Wagner-Jauregg (; 7 March 1857 – 27 September 1940) was an Austrian physician, who won the Nobel Prize in Physiology or Medicine in 1927, and is the first psychiatrist to have done so. His Nobel award was "for his discovery of the therapeu ...
in 1917 for the treatment of
neurosyphilis Neurosyphilis refers to infection of the central nervous system in a patient with syphilis. In the era of modern antibiotics the majority of neurosyphilis cases have been reported in HIV-infected patients. Meningitis is the most common neurologic ...
for which he received the 1927
Nobel Prize in Physiology or Medicine The Nobel Prize in Physiology or Medicine is awarded yearly by the Nobel Assembly at the Karolinska Institute for outstanding discoveries in physiology or medicine. The Nobel Prize is not a single prize, but five separate prizes that, accord ...
.


Background

The beneficial effects of infections in mental problems were known in the Ancient world.
Hippocrates Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history of ...
in the 4th century BCE recorded bacterial infections such as dysentery and dropsy reducing the symptoms of madness; and that malaria (quartan fever) could stop epileptic convulsions.
Galen Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized as Galen () or Galen of Pergamon, was a Greek physician, surgeon and philosopher in the Roman Empire. Considered to be one of ...
in the 2nd century CE described a case of mental illness that ended after malarial infection. There are medical records from the 19th century which indicate that insanity stopped temporarily or permanently when the individuals had severe infections. Russian psychiatrist Alexander Samoilovich Rosenblum was the first to experimentally use infections for the treatment of psychosis. In 1876, he induced fever in psychotic individuals using malaria,
typhoid Typhoid fever, also known as typhoid, is a disease caused by '' Salmonella'' serotype Typhi bacteria. Symptoms vary from mild to severe, and usually begin six to 30 days after exposure. Often there is a gradual onset of a high fever over several ...
, and
relapsing fever Relapsing fever is a vector-borne disease caused by infection with certain bacteria in the genus ''Borrelia'', which is transmitted through the bites of lice or soft-bodied ticks (genus ''Ornithodoros''). Signs and symptoms Most people who are ...
. He claimed that he cured 50% of all those he treated. However, his work was not widely known as his publication in 1877 was in a small journal in
Odessa Odesa (also spelled Odessa) is the third most populous city and municipality in Ukraine and a major seaport and transport hub located in the south-west of the country, on the northwestern shore of the Black Sea. The city is also the administrativ ...
, Ukraine, and written in Russian. He also preferred not to spread his findings as he understood that it was a dangerous experiment and potentially controversial. It was, however, reported by J. Motschukoffsky in a German medical journal ''Centralblatt für die Medicinischen Wissenschaften'', but the underlying cause of how malaria cured psychosis was not understood, and Rosenblum's experiment remained unknown for several decades. Rosenblum never repeated the study or tried to develop specific method for the medical treatment. The importance of the study was realised only in 1938 when Austrian physician
Julius Wagner-Jauregg Julius Wagner-Jauregg (; 7 March 1857 – 27 September 1940) was an Austrian physician, who won the Nobel Prize in Physiology or Medicine in 1927, and is the first psychiatrist to have done so. His Nobel award was "for his discovery of the therapeu ...
discussed the research at the International Neurological Congress in London. In 1943, Samuel J. Zakon at the Northwestern University Medical School in Chicago, US, acquired the original paper of Rosenblum and published an English translation with commentary in the ''
Journal of the American Medical Association ''The Journal of the American Medical Association'' (''JAMA'') is a peer-reviewed medical journal published 48 times a year by the American Medical Association. It publishes original research, reviews, and editorials covering all aspects of bio ...
''. The commentary concluded:
Rosenblium .html" ;"title="lternative spelling">lternative spellingwas certainly the first to appreciate the curative effect of fever itself on the psychoses. He understood and reported on the value of malaria and typhoid in the treatment of mental disease. He was the first to inoculate psychotic patients with a febrile disease. Rosenblium, though practically forgotten for over half a century, must be acknowledged as the true pioneer in this field.


Rediscovery and clinical application

Although the priority of using malaria therapy in brain disorders is generally attributed to Rosenblum, the credit of developing malaria therapy as a standard medical practice and explaining the underlying scientific principle is to Austrian physician Julius Wagner-Jauregg. Wagner-Jauregg, working at the First Psychiatry Clinic at the Asylum of Lower Austria, investigated cases of brain disorders since 1883, publishing his first paper on psychosis in 1887 titled "''Über die Einwirkung fieberhafter Erkrankungen auf Psychosen''" ("The Effect of Feverish Disease on Psychoses"). He soon realised that a severe type of psychosis was related to neurosyphilis, an infection of the
central nervous system The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain and spinal cord. The CNS is so named because the brain integrates the received information and coordinates and influences the activity of all par ...
with
syphilis Syphilis () is a sexually transmitted infection caused by the bacterium ''Treponema pallidum'' subspecies ''pallidum''. The signs and symptoms of syphilis vary depending in which of the four stages it presents (primary, secondary, latent, an ...
(caused by a bacterium identified in 1905 as ''Spirochaeta pallida'', later renamed ''
Treponema pallidum ''Treponema pallidum'', formerly known as ''Spirochaeta pallida'', is a spirochaete bacterium with various subspecies that cause the diseases syphilis, bejel (also known as endemic syphilis), and yaws. It is transmitted only among humans. It is ...
''). Syphilis was at the time a deadly disease characterised by delusions, paralysis, and dementia; and known as "The Great Pox" and the "disease of the century." Neurosyphilis was prevalent in Europe during the 19th century, leading to an increased asylum population during this period. Wagner-Jauregg came to the conclusion that fever could cure psychosis after reviewing his own experiments and the historical accounts based on three phenomena: (a) the appearance of fever coincided with the disappearance of the symptoms of psychosis in medical history; (b) his findings that fever was the only possible cause for the cure of psychosis; and (c) although all psychotic individuals were not cured, the number of cures increased whenever malaria spread. He made three postulates: # The agent of treatment, febrile disease, while curing mental disorder, can still induce disease in healthy people. # Febrile disease strengthens (makes healthier) individuals with mental disorder. # Elevation of body temperature due to febrile disease is key to suppressing psychotic symptoms.


References

{{Reflist History of medicine Neuroscience Medical procedures Physical therapy Malaria