xv, 6 Haughwout et a Is.: Mania with 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 shoit series of cases of chronic 
malaria that we have treated with the Roentgen 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. f. 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. 1 1 (1918) 295. 
