From mercury to malaria to penicillin: The history of the treatment of syphilis at the Mayo Clinic, 1916-1955
http://www.imsdocs.com/syphilis.htmAfter Stokes' departure O'Leary became chairman of the department. Among his most important professional accomplishments were his participation in the organization of the American Academy of Dermatology and Syphilology, for which he served as the second president, and his editorship of the Archives of Dermatology and Syphilology. O'Leary (first row below, 2nd from left) was also a tireless champion for removing the stigma of syphilis in the mind of the public and gave countless talks across the United States before lay audiences for this purpose.
O'Leary's tenure oversaw numerous critical developments in the treatment of syphilis. The first was malaria therapy. For 30 years von Jauregg <9> advanced his concept of treating neuropsychiatric conditions with fever therapy, this culminated in his 1918 report on the treatment of five patients with neurosyphilis with the injection of malarial blood, an endeavor for which he would eventually receive the Nobel Prize. In 1924 O’Leary, Goeckerman and Parker <10> began treating Mayo patients with syphilis with malaria therapy and reported on 213 cases in 1927.
The administration of malaria therapy involved the intravenous inoculation of 5 to 10 ml of blood from a donor, smear-positive for Plasmodium vivax, to the recipient, in whom typical quartan malaria would shortly develop in the majority of cases. The patients were to have an optimum of 10 to 12 "febrile convulsions" until the attacks were aborted by the administration of quinine. Although not without attendant risks (O'Leary reported a mortality rate of 5% from the iatrogenic infection), <11> the results were dramatic. O'Leary wrote, "Experience with the fever treatment of Wagner von Jauregg during the last years in 213 cases…has definitely proved that it is the most valuable method of treatment suggested for paretic parenchymatous neurosyphilis...." After 3 years of follow-up, 50% of the first 100 patients were in "complete remission" (i.e., had returned to their previous occupation) whereas 18% had improved. O'Leary became one of the foremost practitioners of malaria therapy for syphilis, eventually supervised the treatment of thousands of patients, and acquired "as much experience as any man" in this technique, according to contemporary syphilologist Charles C. Dennie. <12> The lack of placebo-treated control subjects and rigidly predefined criteria for therapeutic end points prohibits a true assessment of therapeutic efficacy in the modern sense, <13> but it is clear that syphilologists of the time considered the treatment a breakthrough.