I am writing with regard to the article “Will Antibiotic Fulfill Psychosis-Fighting Promise?’’ in the August 17 issue and its discussion of inflammation in schizophrenia. It is useful to view what appears to be a surprising phenomenon.

A common observation by physicians who practiced in the large state hospitals in the first two-thirds of the 20th century was that when patients who had often been psychotic for decades developed an infection with fever, they would recover and then revert back to their prior state once the infection was cured.

The recovery was often so dramatic that one could observe “the time standing still” symptom as the patient asked “Where am I?” They asked questions or made statements related to events/people long past, as if they were current. This phenomenon was so notable that early in the 20th century various methods were used to induce fever; for example, cause a sterile abscess with injection of turpentine oil.

Building on these observations in 1917, Dr. Wagner-Jauregg introduced malarial treatment for neurosyphilis. Later typhoid vaccine was used, and then the InductoTherm Fever Cabinet and the Kettering hypertherm.

The outcome of the study of the blood cytokines with minocycline treatment of schizophrenia will be most valuable. However, it may be that minocycline alters a substance found only in the spinal fluid and/or that the antibiotic itself acts as a cytokine.

JOSEPH ROBERT COWEN, M.D.
Baltimore, MD