antecedents of many of these cases, a history of mild intermittent fever will often be elicited; or it will be found that the patient had been living in some highly malarious locality.
In the course of what seemed to be an ordinary malarial attack the body temperature, instead of stopping at 104° or 105° F., may continue to rise and, passing 107°, rapidly mount to 110° or even to 112°. The patient, after a brief stage of wild maniacal or, perhaps, muttering delirium, becomes rapidly unconscious, then comatose, and dies within a few hours, or perhaps within an hour, of the onset of the pernicious symptoms.
Comatose.—— Or the patient, without hyperpyrexia, the thermometer perhaps not rising above 104°, or even lower, may lapse into coma. The coma may pass away with crisis of sweating; on the other hand, an asthenic condition may set in and death from collapse supervene.
Other cerebral forms.—— Besides these hyperpyretic and comatose conditions, other forms of cerebral attack may occur in the course of malarial fevers. Thus, there may be sudden delirium ending in coma and, perhaps, death: convulsive seizures of an epileptic or of a tetanic character, with or without delirium or coma forms especially common in children, and too often misdiagnosed and with fatal consequences; conditions simulating cerebro- spinal meningitis; delusional insanity; dementia; various forms of apoplectic-like conditions and of paralysis, complicated, it may be, with aphasia. Seizures of this description, if not fatal, may eventuate in permanent psychical disturbances. Temporary debility, or even complete loss of memory, may succeed severe malarial infection.
Embolism of cerebral capillaries.—— These cerebral attacks are now explained, and it appears to me correctly explained, by the supposition, founded on actual post-mortem observation, that they depend on embolism by the malaria parasite of the capillaries of the various nerve centres involved (Plate II., Fig. 2) ; in hyperpyrexia, the thermic centres; in
