xv, 6 Haughwout et als: Mania with Plasmodium vivax 565 
Coolidge tube. 
Distance from targ. to skin, 30 centimeters. 
Hardness of tube, 9B. 
Milliamperes, 5. 
Exposure, 5 minutes. 
Filter, 2.5 millimeters, alum.; 7 millimeters of leather. 
Hampson radio. 
Area, entire spleen. 
On the afternoon of the same day we again examined the 
blood of the patient, and noted an increase in the mononuclears, 
and stippling of the erythrocytes that had not previously been 
reported, but no more parasites were seen until the following 
day, when one was discovered that was provisionally identified 
as Plasmodium vivax. 
Three days later there had been no apparent reduction in 
the size of the spleen. Blood examination showed a mononu- 
cleosis, an eosinophilia, and marked basophilic stippling of the 
erythrocytes. 
The delirium developed suddenly four days after that. The 
patient first became restless and showed evidence of some mental 
distress. When inquiry was made as to what troubled him, he 
merely pointed to his scrotum without offering any explanation 
as to the nature of the trouble. He was carefully examined 
but nothing wrong was discovered. The restlessness increased, 
the eyes became bloodshot, and eventually his condition lapsed 
into one of noisy delirium that continued night and day except 
at such periods when he was under the influence of opiates. 
He shouted and sang and finally became so violent that he had 
to be tied into bed. The patient bit both tongue and lips and 
spat bloody saliva upon all who came near him. He presented 
a truly pitiable if not shocking spectacle. From this time on 
there was- no change in the mental condition of the patient who 
virtually wore himself out in his tumultuous delirium. He re- 
fused all food and medicine, and his physical condition ac- 
cordingly declined very rapidly. On the day of the development 
of the first mental symptoms an unmistakable trophozoite of 
Plasmodium vivax was found in the blood. 
The number of parasites in the peripheral blood increased 
somewhat until from four to six could be counted in 100 oil- 
immersion fields. All were characteristic trophozoites of Plas- 
modium vivax. We failed to discover any of the questionable 
ring forms or any crescent gametocytes. The patient, who had 
been receiving iron, quinine, and strychnine up to the time his 
mania developed, was put on intramuscular injections of quinine 
