xv, 6 Haughtvout et als.: Mania ivith Plasmodium vivax 567 



to believe that all of them fell under treatment during the course 

 of active malarial infection, while it must be borne in mind that 

 ours was a chronic case showing no symptoms of active malaria. 

 Wurtz and van Malleghem say they could find no parasite save 

 Plasmodium vivax; while Hesse, according to the abstract, con- 

 tents himself with speaking of his cases as being "benign" ter- 

 tian, without naming the parasite. We are inclined to suspect 

 that he was dealing with Plasmodium falciparum infections. 



The possibility that the Roentgen rays in some manner precip- 

 itated the attack of mania might be borne in mind. We think 

 this extremely unlikely unless their application operated to ac- 

 tivate the parasite in some way — a thing that might possibly 

 come to pass. However, in the short series of cases of chronic 

 malaria that we have treated with the RoentgeH rays, this is 

 the only one that developed cerebral symptoms. 



Skinner and Carson, (4) who first undertook the treatment of 

 malaria with the Roentgen rays, report no such occurrence in 

 their series; nor does Pais, (3) nor Deutsch,(l) who followed. 

 Pais states his belief that new generations of the parasite appear 

 to display exalted virulence under the influence of the rays. If 

 this be true, we may have an explanation of the phenomena in 

 our case, although it must be borne in mind that the parasites 

 never were in the circulation in large numbers and that hyper- 

 pyrexia never developed. 



Whatever the explanation of this strange case we can only 

 repeat that painstaking search failed to disclose any evidence 

 of infection with Plasmodium falciparum, while the parasites 

 demonstrated in the circulating blood were unquestionably Plas- 

 modium vivax. 



REFERENCES 



1. Deutsch, Felix. Tiefelstrahlung der Milz bei Malaria. Wien. klin. 



Woch. 30 (1917) 207. 



2. Hesse, Walter. Malaria Comatosa und Malariameningitis bei Tertia- 



nafieber. Zentralbl. /. Innere Med. 39 (1918) 385. Abstracted in 

 Trop. Dis. Bull. 12 (1918) 351. 



3. Pais, A. Influence of Roentgen rays on malaria. Gazz. degli Ospedali 



e delle Clin. Milan. 38 (1917) 1121. 



4. Skinner, Bruce, and Carson, H. W. Curative influence of Roentgen 



rays in malaria. Brit. Med. Journ. No. 2617 (1917) 431. 



5. Wurtz, R., and van Malleghem, R. Acces graves chez des paludeens 



atteints de tierce dite benigne. C. R. Acad. Sci. 164 (1917) 797. 

 Abstracted in Trop. Dis. Bull. 11 (1918) 295. 



