The influence of a biological therapy on physicians' narratives and interrogations: The case of general paralysis of the insane and malaria fever therapy, 1910-1950

Bulletin of the History of Medicine

Volumn 70, Issue 4, 1996, Pages 577-608

  Braslow, Joel T ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; AUSTRIA; HISTORY; HUMAN; HYPERTHERMIC THERAPY; MALARIA; NEUROSYPHILIS; PSYCHIATRY; UNITED STATES;

AUSTRIA; BIOLOGICAL PSYCHIATRY; CALIFORNIA; HISTORY, 19TH CENTURY; HISTORY, 20TH CENTURY; HUMANS; HYPERTHERMIA, INDUCED; MALARIA; NEUROSYPHILIS;

EID: 0030331008     PISSN: 00075140     EISSN: None     Source Type: Journal    
DOI: 10.1353/bhm.1996.0173     Document Type: Review

References (129)

1. Historians of psychiatry have become increasingly interested in therapeutics. For an excellent overview of the historiography of psychiatric treatments, see Andrew Scull, "Somatic Treatments and the Historiography of Psychiatry," Hist. Psychiatry, 1994, 5: 1-12.
2. For concise descriptions of biological therapies in the twentieth century, see Gerald Grob, Mental Illness and American Society, 1875-1940 (Princeton: Princeton University Press, 1983), pp. 293-308;
3. Gerald Grob, idem, From Asylum to Community: Mental Health Policy in Modern America (Princeton: Princeton University Press, 1991), pp. 124-56;
4. Gerald Grob, idem, The Mad Among Us: A History of the Care of America's Mentally Ill (New York: Free Press, 1994), pp. 178-89, 228-30.
5. Also see W. L. Jones, Ministering to Minds Diseased: A History of Psychiatric Treatment (London: Heinemann, 1983);
6. J. F. Cade, Mending the Mind: A Short History of Twentieth-Century Psychiatry (Melbourne: Sun Books, 1979).
7. There is also a growing literature focusing on specific somatic interventions - e.g., Elliot S. Valenstein, Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness (New York: Basic Books, 1986);
8. Jack Pressman, "Uncertain Promise: Psychosurgery and the Development of Scientific Psychiatry in America, 1935 to 1955" (Ph.D. diss., University of Pennsylvania, 1986);
9. David Crossley, "The Introduction of Leucotomy: A British Case History," Hist. Psychiatry, 1993, 4: 553-64;
10. Judith Swazey, Chlorpromazine in Psychiatry: A Study of Therapeutic Innovation (Cambridge: MIT Press, 1974);
11. F. E. James, "Insulin Treatment in Psychiatry," Hist. Psychiatry, 1992, 3: 221-35;
12. Philip R. Reilly, The Surgical Solution: A History of Involuntary Sterilization in the United States (Baltimore: Johns Hopkins University Press, 1991).
13. Patton State Hospital Medical Records Archive, Patton State Hospital, Patton, California.
14. See George M. Robertson, "The Discovery of General Paralysis," J. Ment. Sci., 1923, 69: 1-24;
15. Claude Quétel, History of Syphilis, trans. Judith Braddock and Brian Pike (Baltimore: Johns Hopkins University Press, 1992), pp. 160-65.
16. Joseph Collins, "General Paresis - Remarks on Its Present-Day Clinical Delineation," Med. Rec., 1898, 53: 181-87, quotations on p. 181.
17. For additional nineteenth-century descriptions of general paresis, see A. E. MacDonald, "General Paresis," Amer. J. Insan., 1877, 53: 451-82;
18. Reginald Farrar, "On the Clinical and Pathological Relations of General Paralysis of the Insane," J. Ment. Sci., 1895, 41: 460-82;
19. George F. Jelly, "General Paralysis of the Insane," Boston Med. Surg. J., 1884, 110: 217-20, 246-48.
20. Collins, "General Paresis" (n. 4), p. 182.
21. W. A. F. Browne, "New Cerebro-Psychical Diseases," Amer. J. Insan., 1875, 32: 198-210, quotation on p. 202.
22. See, for example, Thomas J. Austin, A Practical Account of General Paralysis, Its Mental and Physical Symptoms, Statistics, Causes, Seat, and Treatment (London: John Churchill, 1859), pp. 73-89;
23. Browne, "New Cerebro-Psychical Diseases" (n. 6), p. 200;
24. Nolan D. Lewis, Lois D. Hubbard, and Edna G. Dyar, "The Malarial Treatment of Paretic Neurosyphilis," Amer. J. Psychiatry, 1924, 81: 175-225.
25. MacDonald, "General Paresis" (n. 4), p. 467.
26. For the increasing importance of syphilis as a cause of paresis compare the following two articles: David Skae, "Contributions to the Natural History of General Paralysis," Edinburgh Med. J., 1860, 5: 885-905;
27. Horatio Wood, "Clinical Aspects of Cerebral Syphilis," Boston Med. Surg. J., 1884, 110: 196-200, 220-25.
28. W. H. B. Stoddart, "General Paralysis and Syphilis: A Critical Digest," J. Ment. Sci., 1901, 47: 441-58.
29. Emil Kraepelin, cited in Hideyo Noguchi and J. W. Moore, "A Demonstration of Treponema Pallidum in the Brain in Cases of General Paralysis," J. Exp. Med., 1913, 17: 232-38, quotation on p. 232.
30. Emil Kraepelin, General Paresis, trans. J. W. Moore (New York: Journal of Nervous and Mental Disease, 1913), p. 2.
31. Thomas S. Clouston, Unsoundness of Mind (New York: E. P. Dutton, 1911), p. 242.
32. Allen R. Diefendorf, "Etiology of Dementia Paralytica," Brit. Med. J., 1906, 2: 744-48.
33. Grob, Mental Illness (n. 1), pp. 188-89;
34. Valenstein, Great and Desperate Cures (n. 1), p. 28.
35. California, Statistical Report of the Department of Institutions of the State of California for the Year Ending June 30, 1942 (Sacramento: California State Printing Office, 1943), p. 48.
36. T. Claye Shaw, "Surgical Treatment of General Paralysis of the Insane," Brit. Med. J., 1891, 2: 581-83;
37. William W. Godding, "Active Treatment in General Paralysis of the Insane," Brit. Med. J., 1897, 2: 1407-9;
38. Lewis, Hubbard, and Dyar, "The Malarial Treatment" (n. 7), pp. 177-78.
39. C. E. Riggs and E. M. Hammes, "Shall We Treat the Paretic?" JAMA, 1917, 68: 194-98;
40. G. H. Monrad-Krohn, "Regarding the Treatment of General Paralysis," J. Ment. Sci., 1920, 66: 45-48;
41. Harry C. Solomon, "Is the Treatment of Patients with General Paralysis Worth While?" Boston Soc. Psychiatry Neurol., 1921, 54: 324-26.
42. "The Past Year's Medical Discoveries," New York Times, 7 May 1928, p. 18, col. 5.
43. For recent scholarship on fever therapy and Wagner von Jauregg, see Magda Whitrow, "Wagner-Jauregg and Fever Therapy," Med. Hist., 1990, 34: 294-310.
44. Whitrow recently completed a biography of Wagner von Jauregg: Magda Whitrow, Julius Wagner-Jauregg (1857-1940) (London: Smith Gordon/Japani Nishimaura, 1993).
45. Julius Wagner von Jauregg, "Über die Einwirkung fieberhafter Erkrankungen auf Psychosen," Jahrbücher für Psychiatrie, 1887, 7: 94-131;
46. see Julius Wagner von Jauregg, idem, "The History of the Malaria Treatment of General Paralysis," trans. Walter L. Bruetsch, Amer. J. Psychiatry, 1946, 102: 577-82.
47. Rudolph Kampmeier, "Wagner von Jauregg and the Treatment of General Paresis by Fever," Sex. Transm. Dis., 1980, 7: 142-44, quotation on p. 143.
48. Wagner von Jauregg, "History of the Malaria Treatment" (n. 20), p. 578.
49. History of the Malaria Treatment Ibid., p. 579.
50. Julius Wagner von Jauregg, "Über die Einwirkung der Malaria auf die progressive Paralyse," Psychiatrisch-neurologische Wochenschrift, 1918-19, 20: 132-34, 251-55.
51. Julius Wagner von Jauregg, "The Treatment of General Paresis by Inoculation of Malaria," J. Nerv. Ment. Dis., 1922, 55: 369-75, quotation on p. 371.
52. J. R. Driver, John A. Gammel, and L. J. Karnosh, "Malaria Treatment of Central Nervous System Syphilis," JAMA, 1926, 87: 1821-27.
53. Wagner von Jauregg, "Treatment of General Paresis" (n. 25), p. 374.
54. Wagner von Jauregg, "History of the Malaria Treatment" (n. 20), p. 580.
55. For the various methods of transporting malaria see "Mosquito Glands in Treatment of General Paralysis," Sci. Amer., 1933, 149(2): 76-77.
56. G. A. Lilly, "The Treatment of General Paralysis at Hanwell Mental Hospital," J. Ment. Sci., 1925, 71: 267-78.
57. For a standard method of malaria fever induction, see: Hiram H. Merritt, Raymond D. Adams, and Harry C. Solomon, Neurosyphilis (New York: Oxford University Press, 1946), pp. 406-7.
58. Maurice Ducoste, "Cerebral Malaria Inoculation in the Treatment of General Paralysis," in Fever Therapy: Abstracts and Discussions of Papers Presented at the First International Conference on Fever Therapy, ed. Walter Simpson et al. (New York: Paul B. Hoeber, 1937), pp. 148-50, quotation on p. 148.
59. Merritt, Adams, and Solomon, Neurosyphilis (n. 31), p. 397.
60. Driver, Gammal, and Karnosh, "Malaria Treatment" (n. 26), p. 1824. An interesting contrast to the apparently cavalier attitude toward this form of treatment was provided by Wagner von Jauregg, referring to Kraft-Ebing's 1897 report of Hirschl attempting to infect paretics with exudate from syphilitic chancres to determine whether or not they would contract primary syphilis: "Today this would be a matter of course, but [then] . . . Hirschl almost went to prison for his zealous scientific endeavors" ("History of the Malaria Treatment" [n. 20], p. 578).
61. William A. White to Watson W. Eldridge, 24 June 1930, in The Inner World of American Psychiatry, 1890-1940: Selected Correspondence, ed. Gerald Grob (New Brunswick, NJ.: Rutgers University Press, 1985), p. 124.
62. James F. McFadden, "Therapeutic Malaria in General Paresis," J. Missouri State Med. Assoc., 1927, 24: 525-28;
63. Franklin G. Ebaugh, "Treatment of Tabes and Cerebral Syphilis with Malaria," JAMA, 1928, 91: 1020-24;
64. Philip B. Matz, "The Treatment of Neurosyphilis by 'Inoculation Malaria' in the United States Veterans Bureau," J. Nerv. Ment. Dis., 1928, 68: 113-33;
65. H. B. Scott, "The Present Status of the Malarial Inoculation in the Treatment of Paresis," Kentucky Med. J., 1929, 27: 305-11.
66. For a good summary of the technique and complications of malaria fever therapy, see Merritt, Adams, and Solomon, Neurosyphilis (n. 31), pp. 406-16.
67. Driver, Gammal, and Karnosh, "Malaria Treatment" (n. 26), p. 1822.
68. See, for example, Clarke H. Barnacle, Franklin G. Ebaugh, and Jack R. Ewalt, "Treatment of Dementia Paralytica: Comparative Study of Combined Artificial Hyperpyrexia and Tryparsamide versus Therapeutic Malaria: A Preliminary Report," JAMA, 1936, 107: 1031-36;
69. Augustus S. Rose and Harry C. Solomon, "Neurosyphilis," Amer. J. Psychiatry, 1947, 103: 524-27.
70. Watson Eldridge, discussion in Paul A. O'Leary, "Treatment of Neurosyphilis by Malaria: Report on the Three Years' Observation of the First One Hundred Patients Treated," JAMA, 1927, 89: 95-100;
71. Eldridge et al., "Treatment of Paresis: Results of Inoculation with the Organism of Benign Tertian Malaria," JAMA, 1925, 84: 1097-1101.
72. Henry A. Bunker, "Recent Methods in the Treatment of General Paralysis: A Brief Survey," Amer. J. Psychiatry, 1929, 8: 681-94;
73. Paul A. O'Leary, "Treatment of Neurosyphilis by Malaria: Report on the Three Years' Observation of the First 100 Patients Treated," Proc. Staff Meet. Mayo Clin., 1927, 2: 98-99;
74. Udo J. Wile and Eugene A. Hand, "Ten Years' Experience with Malaria in Neurosyphilis: A Critical Appraisal," Amer. J. Syph. Gonor. Ven. Dis., 1936, 20: 630-45.
75. I consulted the following Index Medicus categories and then tabulated the total number of articles that contained a reference to fever therapy in the title: neurosyphilis; general paralysis; tabes dorsalis; syphilis; dementia praecox; malaria, therapeutic; epilepsy; gonorrhea; keratitis, interstitial; neuritis, congenital; sclerosis, disseminated; cancer, therapy; leukemia, lymphatic; tuberculosis, therapy; mycosis fungoides; polio, therapy. As these categories suggest, malaria was tried on a whole host of disorders. Unlike the results that physicians found with neurosyphilis, the use of malaria on other disorders proved to be quite disheartening. Consistent with this, the vast majority of the literature was on the treatment of general paresis.
76. John F. Mahoney, R. C. Arnold, and Ad Harris, "Penicillin Treatment of Early Syphilis: A Preliminary Report," Amer. J. Pub. Health, 1943, 33: 1387-91.
77. Francis Walshe, Diseases of the Nervous System Described for Practitioners and Students, 10th ed. (Edinburgh: E. & S. Livingstone, 1963), p. 192.
78. Lewis, Hubbard, and Dyar, "Malarial Treatment" (n. 7), p. 215.
79. Harry C. Solomon, "General Paresis: What It Is and Its Therapeutic Possibilities," Amer. J. Psychiatry, 1923, 79: 623-46, quotation on p. 636.
80. Honorio F. Delgado, "Treatment of Paresis by Inoculation with Malaria," J. Nerv. Ment. Dis., 1922, 55: 376-89.
81. A. E. Bennett, "Evaluation of Artificial Fever Therapy for Neuropsychiatric Disorders," Arch. Neurol. Psychiatry, 1938, 40: 1141-55.
82. Delgado, "Treatment of Paresis" (n. 46), p. 378.
83. Jay F. Schamberg and Anna M. Rule, "Therapeutic Effect of Hot Baths in Experimental Primary Syphilis in Rabbits," JAMA, 1927, 88: 1217-18.
84. For the first report of a successful artificial fever-producing device, see Clarence A. Neymann and S. L. Osborne, "Artificial Fever Produced by High-Frequency Currents, Preliminary Reports," Illinois Med. J., 1929, 56: 199-203.
85. Bennett, "Evaluation of Artificial Fever Therapy" (n. 47), p. 1142.
86. Leland E. Hinsie and Joseph R. Blalock, "Treatment of General Paralysis. Results in 197 Cases Treated from 1923-1926," Amer. J. Psychiatry, 1931, 88: 541-57;
87. Barnacle, Ebaugh, and Ewalt, "Treatment of Dementia Paralytica" (n. 38), pp. 1031-36;
88. Clarence A. Neymann, "The Effect of Artificial Fever on the Clinical Manifestations of Syphilis and the Treponema Pallidum," Amer. J. Psychiatry, 1936, 93: 517-32;
89. Walter M. Simpson, "Artificial Fever Therapy of Syphilis," JAMA, 1935, 105: 2132-40.
90. See, for example, Merritt, Adams, and Solomon, Neurosyphilis (n. 31), pp. 406, 414.
91. Allan M. Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States Since 1880 (New York: Oxford University Press, 1987), p. 160.
92. Frank Cross, "Friendly Fever," Good Housekeeping, February 1935, 100(2): 46-47, 175-78, quotation on p. 175.
93. Paul de Kruif, "The Pale Horror," Reader's Digest, April 1933, 22(132): 25-28, quotation on p. 25.
94. Paul de Kruif, "Machine Fever," Reader's Digest, May 1937, 30(181): 108-10, quotation on p. 108.
95. For more popular accounts of fever therapy, see: Paul de Kruif, "Found: A One-Day Cure for Syphilis," Reader's Digest, September 1942, 41(245): 10-14;
96. "One Malady Casts Out Another," New York Times, 7 July 1925, p. 18, col. 5;
97. "Fever as Friend," Sci. Amer., July 1935, 153(1): 40.
98. de Kruif, "The Pale Horror" (n. 56), p. 27.
99. de Kruif, The Pale Horror n. 56, p. 27. Ibid.
100. California, Fourth Biennial Report of the State Board of Charities and Corrections for July 1, 1908, to June 30, 1910 (Sacramento: California State Printing Office, 1910), p. 143;
101. California, Statistical Report of the Department of Mental Hygiene for the Year Ending June 30, 1950 (Sacramento: California State Printing Office, 1952), p. 31.
102. United States Public Health Service, A Survey of the Mental Institutions of the State of California (Sacramento: California State Printing Office, 1944), p. 25.
103. G. M. Webster, in California, Third Biennial Report of the Department of Institutions of the State of California for the Two Years Ending June 30, 1926 (Sacramento: California State Printing Office, 1926), p. 79.
104. California, Statistical Report of the Department of Institutions of the State of California for the Year Ending June 30, 1943 (Sacramento: California State Printing Office, 1944), p. 87. The Great Depression and World War II prevented physicians at Patton from using (at least to any significant extent) insulin shock therapy.
105. California, First Biennial Report of the Department of Institutions of the State of California, for the Two Years Ending June 30, 1922 (Sacramento: California State Printing Office, 1923), p. 112.
106. Patton med. rec. 15030, continuous notes, 1923. (For each medical record citation, I have provided the record number, the location of the citation in the record, and the year that it was written. In order to protect patient confidentiality, I have altered the medical record numbers; researchers with permission from the California Department of Mental Health may acquire the actual medical record numbers from me.)
107. Patton med. rec. 12345, continuous notes, 1919.
108. Patton med. rec. 10568, continuous notes, 1916.
109. Patton med. rec. 25806, continuous notes, 1923.
110. Patton med. rec. 13471, continuous notes, 1921 (emphasis added).
111. Patton med. rec. 15033, letter from sister to ward physician, 1923.
112. Patton med. rec. 15030, continuous notes, 1923.
113. G. M. Webster, in California, Sixth Biennial Report of the Department of Institutions of the State of California for the Two Years Ending June 30, 1932 (Sacramento: California State Printing Office, 1934), p. 46.
114. Patton med. rec. 34785, clinical staff conference, 1941.
115. Patton med. rec. 16903, continuous notes, 1931.
116. Patton med. rec. 26933, continuous notes, 1935 and 1941.
117. Patton med. rec. 22952, continuous notes, 1941.
118. Patton med. rec. 29324, clinical staff conference, 1937.
119. Webster, Sixth Biennial Report (n. 72), p. 46.
120. Patton med. rec. 24332, clinical staff conference, 1933.
121. California, Fifth Biennial Report of the Department of Institutions of the State of California for the Two Years Ending June 30, 1930 (Sacramento: California State Printing Office, 1931), p. 247.
122. California, Statistical Report of the Department of Mental Hygiene for the Year Ending June 30, 1945 (Sacramento: California State Printing Office, 1947), p. 61.
123. Patton med. rec. 32984, clinical staff conference, 1933.
124. Patton med. rec. 20336, clinical staff conference, 1930.
125. Patton med. rec. 24478, clinical staff conference, 1933.
126. Patton med. rec. 29324, clinical staff conference, 1937.
127. Patton med. rec. 12351, continuous notes, 1921.
128. Patton med. rec. 40782, clinical staff conference, 1945.
129. Stockton med. rec. 26377, autopsy summary for Langley Porter Clinic, 1950, Stockton State Hospital Medical Records Archive, Stockton Developmental Center, Stockton, California.