Ladislas J. von Meduna
Ladislas Joseph von Meduna was
born to a well-to-do family in Budapest, Hungary, in 1896. He studied medicine in Budapest from 1914 to 1921, his
studies being interrupted by military service in the Italian front from 1915 to 1918, during the First World War.
He was interested in pursuing medical research in neurology, and soon got an appointment to the Hungarian Interacademic
Institute for Brain Research, also in Budapest. There, he researched the structure and development of the pineal
gland and of microglia, the neuropathology of lead poisoning, avitaminosis and several other subjects. In 1927
he moved to the Psychiatric Institute and began clinical and research work in psychopathology.
Meduna's interest in treating schizophrenia with somatic therapies began with his work on the apparent antagonism
between this disease and epilepsy. He found that 16,5% of epileptic patients who developed psychotic symptoms had
a remission of epilepsy. The reverse association also seemed true: of more than 6,000 patients with schizophrenia,
only 20 had had epilepsy. There were anedoctal reports of cures of schizophrenia in patients who developed epileptic
seizures.
Meduna had then the idea that seizures could be used to treat schizophrenia. He tried several pharmacological agents
to safely induce convulsions, such as the alcaloids strychnine, thebaine, coramin, caffeine and brucin. Finally,
he discovered that camphor dissolved in oil was effective in animals as well as in humans. In order to experiment
treatment in real patients without putting his career at risk, however, Meduna had to use another psychiatric hospital,
at Lipotmezö, outside Budapest. On January 23, 1934, he tried the injection of camphor oil in a severe 33-year-old
catatonic patient. After just 5 treatments, catatonia and psychotic symptoms were abolished. Increasing his casuistics
to 26 patients, Meduna achieved recovery in 10 of them and improvement in 3 more (in other words, a 50% positive
results).
Soon, Meduna discovered pentylenetetrazol, or metrazol (brand name Cardiazol), a powerful convulsant agent, as
being more effective and quick-acting than camphor, and started using it in intramuscular and intravenous injections.
He published his results in 1935 and his results quickly provoked a commotion in psychiatry around the world, because
schizophrenia was then considered a hereditary and incurable condition. In 1939, he published in German a monograph
titled Die Konvulsionstherapie der Schizophrenie, describing
his results with 110 patients. He reported an astounding 95% remission rate in acute schizophrenic patients, and
of 80% in patients with less than one year duration of the disease. Longer durations of disease had increasingly
smaller effectiveness of metrazol therapy. His results were reproduced in many other centers around the world and
this form of therapy became commonplace, despite its harsh collateral effects. Meduna's work influenced the discovery
of a more stable, less detrimental and more effective form of convulsive therapy, by means of electroshock, which
was discovered by Italian researchers Ugo Cerletti and Lucio Bini, in Rome. Metrazol convulsive therapy was afterwards abandoned.
Meduna also developed carbon dioxide therapy. The patient had to breathe a mixture of 30% carbon dioxide and 70%
oxygen until becoming unconscious, the treatment being repeated several times weekly. Although it was effective
in relieving compulsive-obsessive disorders, iIt was not so effective as convulsive therapy, and it was abandoned.
With the increase of anti-semitism and the rise to power of National Socialism, Meduna emigrated to the USA in
the following year (1938), to become Professor of Neurology at Loyola University, in Chicago. One of his last contributions
to psychiatry was the study of confusional and dream-like states in psychoses (oneirophrenia). After the war, he
moved his research to the Illinois Psychiatric Institute, where he worked until his death in 1964.
To Know
More
From: The History of Shock Therapy in Psychiatry
By: Renato M.E. Sabbatini, PhD
Source: Brain & Mind Magazine, December 1997/March 1998