566 
Philippine Journal of Science 
1919 
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 
= The patient had received treatment with oil of chenopodium for his 
hookworm infection soon after entering the hospital. 
