Journal Article

Fevered Decisions: Race, Ethics, and Clinical Vulnerability in the Malarial Treatment of Neurosyphilis, 1922-1953

Gambino, Matthew

2015

Overview

Syphilis occupies a unique position in the history of U.S. medicine and medical ethics. Given its widespread prevalence and variable presentation, syphilis was a major professional concern among late nineteenth‐ and early twentieth‐century physicians. Syphilis was also at the center of perhaps the most famous example of medical racism in our history, the U.S. Public Health Service Syphilis Study at Tuskegee, in which officials followed the natural history of the disease in a cohort of black men for forty years without offering treatment, even once penicillin became available. In this essay, I call attention to a less well‐known aspect of syphilis and its history. I examine one of the disease's most dreaded manifestations, neurosyphilis (also known as general paresis or general paralysis of the insane), and its treatment via malarial inoculation from the 1920s into the 1950s. The goal of this treatment, dramatic even to observers at the time, was to produce spiking fevers that would kill the syphilitic spirochete and arrest the disease process. My focus will be on developments at St. Elizabeths Hospital, a large‐scale federal psychiatric facility in the District of Columbia that served the city's residents and members of the U.S. military. Physicians at St. Elizabeths were the first in the United States to experiment with malarial fever therapy, treating their initial cohort of patients in December of 1922. Malarial fever therapy raised a host of ethical questions, rendered all the more complex from today's vantage point by efforts to understand them within the context of the time. What sorts of risks, both from malaria and via indirect exposure, might be deemed acceptable in the treatment of a devastating and almost invariably fatal disease? How ought researchers and clinicians to have approached the question of consent, itself an evolving concept in the early decades of the twentieth century, when the disease they were targeting impaired a patient's ability to reason effectively? Finally, at a time when segregated and inferior care for black Americans was the norm and when the black community bore a disproportionate burden of disease, who would have had access to malarial fever therapy, and at what cost?

• Publisher: Blackwell Publishing Ltd,The Hastings Center
• Subject: 20th century / African Americans / Anti-Bacterial Agents - history / Black people / Brain - microbiology / Coercion / Decision Making - ethics / Disease / Disease Progression / District of Columbia / Ethics / Ethics, Medical - history / Ethics, Research - history / Experiments / Fever / Health services / History / History, 20th Century / Hospitalization / Hospitals, Psychiatric - ethics / Hospitals, Psychiatric - history / Human Experimentation - ethics / Human Experimentation - history / Humans / Hyperthermia, Induced - ethics / Hyperthermia, Induced - history / Informed Consent - ethics / Informed Consent - history / Malaria / Malaria - etiology / Malaria - history / Malpractice - history / Medical decision making / Medical ethics / Medical treatment / Medicine / Mental Disorders - history / Mental Disorders - microbiology / Mental health services / Morals / Natural history / Neurosyphilis - history / Neurosyphilis - therapy / Paralysis / Patients / Penicillin / Penicillins - history / Physicians / Prisoners - history / Public health / Race / Racism / Sexual Behavior - ethics / Sexual Behavior - history / Syphilis / Terminal illnesses / Therapy / Treponema pallidum - isolation & purification / United States