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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 tempera...

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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).[1] Many diseases were treated by this method in the first half of the 20th century.

The technique reached its peak of sophistication in the early 20th century with malariotherapy, in which Plasmodium vivax, a causative agent of malaria, was allowed to infect already ill patients in order to produce intense fever for therapeutic ends. The sophistication of this approach lay in using effective anti-malarial drugs to control the P. vivax infection, while maintaining the fever it causes to the detriment of other, ongoing, and then-incurable infections present in the patient, such as late-stage syphilis. This type of pyrotherapy was most famously used by psychiatrist Julius Wagner-Jauregg, who won the Nobel Prize for Medicine in 1927 for his elaboration of the procedure in treating neurosyphilitics.[2]

Use

Syphilis

Wagner-Jauregg's 1917 treatment method, also known as malariotherapy, involved the introduction of Plasmodium vivaxmalaria via injection into patients with advanced stages of syphilis.[2] Advanced syphilitic infection can invade the brain causing neurosyphilis, affecting neural performance and function, which can in turn lead to general paresis of the insane (GPI), a severely debilitating mental disorder. Doing so induced high-grade (103 °F, 39.4 °C or above) fever that was easily sustainable to eradicate invading spirochaetal bacterium Treponema pallidum, the pathogen responsible for syphilitic infection.[2][3] Successive rounds of treatment were required to fully eradicate the infectious bacteria, while simultaneously using quinine to treat the malaria infection.[2] Management of the fevers was risky as malaria fevers can sometimes cause death, but syphilis was a proliferate and terminal disease at the time with no other viable treatment.[2] This procedure was used to treat syphilis until penicillin was found to be a safer, more effective measure in the 1940s.[3]

The general paresis of the insane caused by neurosyphilis was effectively overcome by the method.[4]

Effectiveness

In 1921, Wagner-Jauregg reported impressive success and many other physicians attempting malaria-induced pyrotherapy made similar claims.[5] Later analyses have shown this might not have been true since approximately 60% would relapse within 2 years and 3–20% died from the resulting fevers.[5] Significant consideration should be used here, as syphilis was considered deadly and without other treatment options pyrotherapy was used as a heroic measure.

Later development

Ever since the effectiveness of malaria against neurosyphilis (called "progressive paralysis" in contemporary literature) was demonstrated, researchers had tried to look for a safer, possibly non-infectious alternative to malaria. In 1931, Wagner-Jauregg surmised that studies available by then appear to show that microbe-derived pyrogens appear to have a greater effect than pyrogens from other sources (e.g. Phlogetan). He found the state of the science used by then unconvincing as few were controlled experiments, but at the same time he believed it would be unethical to keep patients from accessing what he believed to be an effective procedure (malaria). This lead him to invent the use of alternation to generate treatment comparison groups in a study that compared malaria against Saprovitan and Pyrifer. Neither had a remotely comparable effect.[6]

Psychiatry

The success of malaria pyrotherapy against the insanity caused by neurosyphilis lead to an interest in using it for psychiatry, especially for schizophrenia. The risk of malaria was well-understood and many non-infectous agents were tried, including:[7]

  • Biological agents: milk, chemically modified milk protein (Phlogetan), tuberculin, chancre vaccine (Dmelcos), antityphus and smallpox vaccines, active saprophytic microbes (Saprovitan), E. coli protein extract (Pyrifer), Pseudomonas aeruginosa and Salmonella typhilipopolysaccharide (Pyrogenal [pirogenal])[7]
  • Chemical agents: sulfozinum (Sulfosin), subcutaneous turpentine essence (which provokes a fixation abscess), intravenous metals such as colloidal silver (Electrargol).[7]
  • Physical methods: hot baths and long-wave, short Hertzian wave, hot air, and infrared diathermy.[7]

Entre estos, el sulfozinum (azufre disuelto en aceite, inyección intramuscular) era el tratamiento preferido en la mayor parte del mundo: era bastante económico y parecía relativamente eficaz (al menos para la neurosífilis), siendo su principal inconveniente el dolor que provocaba en el paciente. Su eficacia en las psicosis no sifilíticas/funcionales era menos pronunciada, siendo en gran medida ineficaz para la esquizofrenia, completamente ineficaz para la epilepsia, pero ligeramente eficaz para el trastorno bipolar. No obstante, se consideraba útil en comparación con las otras opciones disponibles en aquel momento. [ 7 ]

El sulfozinum fue reemplazado cuando se dispuso de métodos más eficaces —penicilina para la neurosífilis, terapia de choque para el resto— en la mayor parte del mundo. La excepción es la Unión Soviética , donde mantuvo una presencia significativa en la psiquiatría soviética y en los aparatos represivos del Estado, convirtiéndose en un símbolo de la psiquiatría punitiva . Su uso sigue siendo esporádico en Rusia y las demás ex repúblicas soviéticas. [ 7 ]

(La Unión Soviética continuó el estudio de pirógenos alternativos. Uno que tuvo un uso considerable en psiquiatría fue Pyrogenal, [ 8 ] desarrollado en la década de 1950 por el Instituto Gamaleya de Moscú dirigido por Juan Planelles.) [ 7 ]

Referencias

  1. ↑ Revista Natuurwetenschap & Techniek , octubre de 2010.
  2. 1 2 3 4 5 Whitrow, Magda (julio de 1990). " Wagner-Jauregg y la terapia de la fiebre" . Historia de la Medicina . 34 (3): 294– 310. doi : 10.1017/s0025727300052431 . ISSN 0025-7273 . PMC 1036142. PMID 2214949 .   
  3. 1 2 Stamm, LV (junio de 2015). " Sífilis: tratamiento antibiótico y resistencia" . Epidemiología e infección . 143 (8): 1567– 1574. doi : 10.1017/S0950268814002830 . ISSN 0950-2688 . PMC 9507240. PMID 25358292. S2CID 40569302 .    
  4. ↑ Raju T (2006). "Cerebros calientes: manipulación del calor corporal para salvar el cerebro" . Pediatrics . 117 (2): e320–1. doi : 10.1542/peds.2005-1934 . PMID 16452338 . 
  5. ^ Daey Ouwens, Ingrid M.; Lente, C. Elisabeth; Fiolet, Aernoud TL; Ott, Alewijn; Koehler, Peter J.; Kager, Piet A.; Verhoeven, Willem MA (2017). "Terapia de la fiebre contra la malaria para la parálisis general de los locos: un estudio de cohorte histórico" . Neurología Europea . 78 ( 1– 2): 56– 62. doi : 10.1159/000477900 . ISSN 0014-3022 . PMID 28633136 .  
  6. ^ Wagner-Jauregg, Julius (1931). "Sobre el tratamiento de la infección de la parálisis progresiva" [ Ueber die Infektionsbehandlung der progresivan Paralyze ] . Münchener Medizinische Wochenschrift . 78 . Traducido por Tröhler, Ulrich: 4– 7.
  7. 1 2 3 4 5 6 7 Igual, M. Marco (2021). "Sulfosina, un fármaco centenario entre la terapia y el castigo" . Neurociencias e Historia . 9 (2): 55– 68.
  8. ^ Bangen, Hans (1992). Geschichte der medikamentösen Therapie der Schizophrenie . Berlín: Fiebertherapien, págs. 32-37. ISBN 3-927408-82-4.

Lecturas adicionales

  • Braslow, Joel T. (1997). Enfermedades mentales y curas corporales: Tratamiento psiquiátrico en la primera mitad del siglo XX . Berkeley, California: University of California Press. ISBN 0-520-20547-2.