{{Short description|Raising body temperature for medical purposes}} {{About||treatments using heat for pain relief and rehabilitation|Heat therapy|use of heat to treat cancer|Hyperthermia therapy}} {{Infobox medical intervention | name = Pyrotherapy | synonym = therapeutic fever | image = Fever_Therapy_New_Orleans_Marine_Hospital_WPA190402.jpg | caption = Patient being treated with "fever therapy" in a Kettering hypertherm cabinet, U.S. Marine Hospital, New Orleans, 1937 | alt = | pronounce = | specialty = <!-- from Wikidata, can be overwritten --> | synonyms = | ICD10 = | ICD9 = | ICD9unlinked = | CPT = | MeshID = | LOINC = | other_codes = | MedlinePlus = | eMedicine = }}
'''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).<ref>''Natuurwetenschap & Techniek Magazine'', October 2010.</ref> 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.<ref name=":0">{{Cite journal |last=Whitrow |first=Magda |date=July 1990 |title=Wagner-Jauregg and fever therapy |journal=Medical History |volume=34 |issue=3| pages=294–310 |doi=10.1017/s0025727300052431 |pmid=2214949 |pmc=1036142 |issn=0025-7273 |doi-access=free}}</ref>
==Use== === Syphilis === Wagner-Jauregg's 1917 treatment method, also known as malariotherapy, involved the introduction of ''Plasmodium vivax'' malaria via injection into patients with advanced stages of syphilis.<ref name=":0" /> 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.<ref name=":0" /><ref name=":1">{{Cite journal|last=Stamm|first=L. V.|date=June 2015|title=Syphilis: antibiotic treatment and resistance |journal=Epidemiology & Infection |language=en |volume=143 |issue=8 |pages=1567–1574 |doi=10.1017/S0950268814002830 |issn=0950-2688 |pmc=9507240 |pmid=25358292 |s2cid=40569302}}</ref> Successive rounds of treatment were required to fully eradicate the infectious bacteria, while simultaneously using quinine to treat the malaria infection.<ref name=":0" /> 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.<ref name=":0" /> This procedure was used to treat syphilis until penicillin was found to be a safer, more effective measure in the 1940s.<ref name=":1" />
The general paresis of the insane caused by neurosyphilis was effectively overcome by the method.<ref>{{cite journal | author = Raju T | title = Hot brains: manipulating body heat to save the brain | doi= 10.1542/peds.2005-1934 | journal = Pediatrics | volume = 117 | issue = 2 | pages = e320–1 | year = 2006 | pmid = 16452338 | doi-access = free }}</ref>
==== Effectiveness ==== In 1921, Wagner-Jauregg reported impressive success and many other physicians attempting malaria-induced pyrotherapy made similar claims.<ref name=":2">{{Cite journal |last1=Daey Ouwens |first1=Ingrid M. |last2=Lens |first2=C. Elisabeth |last3=Fiolet |first3=Aernoud T. L. |last4=Ott |first4=Alewijn |last5=Koehler |first5=Peter J. |last6=Kager |first6=Piet A. |last7=Verhoeven |first7=Willem M.A. |date=2017|title=Malaria Fever Therapy for General Paralysis of the Insane: A Historical Cohort Study|journal=European Neurology |volume=78 |issue=1–2 |pages=56–62 |doi=10.1159/000477900 |pmid=28633136 |issn=0014-3022 |doi-access=free}}</ref> 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.<ref name=":2" /> Significant consideration should be used here, as syphilis was considered deadly and without other treatment options pyrotherapy was used as a heroic measure.{{Citation needed|date=August 2021}}
==== 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.<ref name=WJ31>{{cite journal |last1=Wagner-Jauregg |first1=Julius |journal=Münchener Medizinische Wochenschrift |date=1931 |volume=78 |pages=4-7 |url=https://www.jameslindlibrary.org/wagner-jauregg-j-1931/ |translator-last1=Tröhler|translator-first1=Ulrich |trans-title=Ueber die Infektionsbehandlung der progressiven Paralyse|title=On infection treatment of progressive paralysis}}</ref>
=== 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:<ref name="Igual21">{{cite journal |last1=Igual |first1=M. Marco |title=Sulfosin, a centennial drug between therapy and punishment |journal=Neurosciences and History |date=2021 |volume=9 |issue=2 |pages=55-68 |url=https://nah.sen.es/index.php/en/issues/past-issues/volume-9/issue-2/sulfosin-a-centennial-drug-between-therapy-and-punishment}}</ref> * 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 typhi'' lipopolysaccharide (Pyrogenal [pirogenal])<ref name="Igual21"/> * Chemical agents: sulfozinum (Sulfosin), subcutaneous turpentine essence (which provokes a fixation abscess), intravenous metals such as colloidal silver (Electrargol).<ref name="Igual21"/> * Physical methods: hot baths and long-wave, short Hertzian wave, hot air, and infrared diathermy.<ref name="Igual21"/>
Among these, sulfozinum (sulfur dissolved in oil, intramuscular injection) was the preferred treatment in most parts of the world: it was fairly cheap and appeared relatively effective (at least for neurosyphilis), the main downside being the pain that it inflicts on the patient. Its effectiveness in non-syphilitic/functional psychoses was less pronounced, being largely ineffective for schizophrenia, completely ineffective for epilepsy, but slightly effective for manic depression. Nevertheless, it was considered useful in comparison to the other options at the time.<ref name="Igual21"/>
Sulfozinum was replaced when more effective methods – penicilin for neurosyphilis, shock therapy for the rest – became available in most of the world. The exception is the Soviet Union, where it maintained a significant presence in Soviet psychiatry and in repressive apparatuses of the state, becoming a symbol of punitive psychiatry. It remains sporadically used in Russia and the other former Soviet republics.<ref name="Igual21"/>
(The Soviet Union did pursue the study of alternate pyrogens. One that saw considerable use in psychiatry was Pyrogenal,<ref>Bangen, Hans (1992). ''Geschichte der medikamentösen Therapie der Schizophrenie''. Berlin: Fiebertherapien, pp. 32–37. {{ISBN|3-927408-82-4}}.</ref> developed in he 1950s by Moscow’s Gamaleya Institute directed by Juan Planelles.)<ref name="Igual21"/>
== Citations == {{reflist}}
== General and cited references == * {{Cite book |author=Braslow, Joel T. |year=1997 |title=Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century |location=Berkeley, Calif. |publisher=University of California Press |isbn=0-520-20547-2}}
Category:History of medicine Category:Therapy