5g6 Philippine Journal of Science ww 



and urea, but he failed to show the slightest beneficial effects 

 from them except for the disappearance of the parasites from 

 the peripheral blood. Twenty-four hours before death adrena- 

 lin was administered in the hope of forcing the parasites out of 

 the spleen and into the circulation, but without success. Three 

 days before death the temperature, which had varied between 

 the subnormal and the normal, rose to 38° C, and a few hours 

 before death it reached 39° C. The day before death, the dif- 

 ferential leucocyte count made by one of us (F. G. H.) showed 

 78 per cent polymorphonuclear neutrophiles, 7 per cent lympho- 

 cytes, 14 per cent large mononuclear leucocytes, and 1 per cent 

 eosinophiles. 2 



The patient gave no history of previous attacks of mania, and 

 the necropsy failed to disclose any evidence of syphilis. No 

 Wassermann test was made. 



DISCUSSION 



The case presented features that frankly puzzled us. In the 

 literature available to us we can find no case that strictly paral- 

 lels it. Our search for data in the literature has been somewhat 

 complicated by the fact that many authors speak in general 

 terms of cerebral symptoms complicating "tertian malaria" 

 without specifying the species of parasite involved. The term 

 is useful enough in a clinical sense, but many writers in re- 

 cording results which may have to be considered by others seem 

 to forget, for the time being, the well-known fact that tertian 

 fever may be caused by infection with either Plasmodium vivax 

 or Plasmodium falciparum. 



We have, however, run across a few cases of recent occurrence 

 in which the writers seem to have satisfied themselves of the 

 occurrence of cerebral symptoms in so-called "benign" tertian 

 fever. Among these will be found four cases reported from 

 Macedonia by Wurtz and van Malleghem(5) and two by Hesse (2). 

 In the report of Wurtz and van Malleghem, three of the patients 

 developed violent delirium followed by unconsciousness; the 

 other became cyanosed and unconscious following a period of 

 vomiting. Both of Hesse's cases died. One developed acute 

 cerebral symptoms which culminated in delirium on the fourth 

 day; the other ran a course as a chronic relapsing meningitis. 

 We have only been able to obtain these reports in abstract and 

 therefore cannot thoroughly compare the cases. We are inclined 



2 The patient had received treatment with oil of chenopodium for his 

 hookworm infection soon after entering the hospital. 



