That some psychoses show amelioration under the influence of intercurrent febrile disorders (e.g., typhus, malaria, recurrent fever, or the acute exanthemata) is an old and well established dictum. From a review of two hundred cases of this description collected and studied by Wagner von Jauregg (Wiener Med. Wochenschr., Feb. 28, 1895), it appears that cure or improvement will most probably ensue when the subject is not too far advanced in years and when the mental affection has not existed for too long a period, though cases of old standing insanity have been recorded in which recovery ensued under these conditions. This curative action of febrile disorders on insanity stands on a level with the therapeutic action of other affections on certain diseases, notably those of nervous type, e.g., the effect of malaria on epilepsy, of small-pox on optic nerve atrophy (Mauthner), of typhus on progressive muscular atrophy, etc., and further to elucidate the matter we must bear in mind that various infective disorders (e.g., influenza) are capable of inducing organic changes in the nerve-elements, changes which may be readjusted by a regenerative process in these elements. By this de- and re-generation the elements may, it can easily be surmised, be so favourably modified that the physical malady which expressed itself in a psychosis becomes nullified. The effect of an induced infection on insanity has shown itself in a few isolated instances, the results being, however, imperfect and insufficiently uniform for deduction. It would be interesting to know the issue of a general successful vaccination of all the inmates of a large asylum, whether any cases could be shown to have improved mentally, for the objections to be urged against a series of experiments with bacteria products (i.e., the chemical bacterial derivatives) are sufficiently evident. Wagner von Jauregg, however, has boldly experimented with the chemical bacteria product known as tuberculin, a preparation he employs owing to its easy procurability and its known effect on the human organism. For treatment with tuberculin those cases were selected in which an unfavourable prognosis was being established owing to their long duration and the inception of characteristic signs of mental degeneration. In its application there naturally had to be considered the possibility of the antecedent presence of tubercular infection and the individual predisposition thereto, which it is well known is of great variability. The initial dose was 1 mgr. In the non-tuberculous subjects habituation to the medicament soon ensued, so that an increase of dosage early became necessary. He estimated future dosage by the intensity of the febrile reaction. Any further habituation to the chemical product necessitated the employment of the bacterial product in extract form, a reason why other important proofs with other bacteria cultures, e.g., of bacillus pyocyaneus, etc., had to be suspended. The results obtained by this method appear according to Wagner von Jauregg to be most encouraging. Improvement is said to ensue in some cases most speedily, but in the greater number, to obtain a fairly satisfactory result, a prolonged treatment is necessary. Three cases have been reported as having been wholly cured by this means, while some have improved to such a degree that ultimate restoration to mental health might be reasonably anticipated. In the three cases reported cured the insanity had existed for three years in one and for two in each of the others. With the mental there was a corresponding physical improvement, and no ill effects appear to have followed the treatment.
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