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A CASE OF CONGENITA MALARIA 135 CASEDE CONGENITAL MALARIA
Professor of the School o Medicine a Dahar Senegat
o the occasionis an acute perio os malaria, prematurelyshowed the besinnins os laboursains Thesain&were Stopped by the actionis quininein the malariat attach. Some time later thepatient has a new attach durins whichille sives birtha a live child theblood of hic a mel the blood of the chord, contained hematoZoa. Dolores E. a panish,oman. 25 years of age, arrived in Senesalin 9l8. horti aster ard contracte malaria. Since that time very irregula malaria attachs, about whicli the patient neveretroubled. Other pathologica antecedent of insignificant value No sisns of syphilis. In 9l9. rst regnan norma confinementis the right time, with et formed uiri vilio die flve month later rom Some unde
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l36 A CASEDE CONGENITAL MALARIA
Examinationis the blood shows the presenc O numerou hema- toetoa having the formis plasmodium praecox. The urine is purulent Bn contain ver numerous cocci During the Venins irregularabdominaliain os intermittent character and accompanted by uterine contractions Patient transferre to labour Ward.
From the 17th to the 22m December, that is 6 days, his patient thereiare absorbe I 2 oram os quinin hydrochlaricie. of them byintramuscula injection. A the fame time the onset os labour asstoppe and the severe malaria attac fro-which she was sufferins a forced under. Unfortunately, after eavin the Hospital the woman id notcontinue an treaiment an She was again selete with ain and
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A CASE OF CONGENITA MALARIA 137
malaria troubles. so that it was impOSSibi toratop premature labour. O the th Ianuar 1923. he thereiare came hac to the Maternit Hospital suffering once more in the abdomen Stistit uterine contractions are found Foeta hear sound good Generat condition satisfactorY T. 37.l Q. P. 75. Given urotropine and then quinine. uram in dicacheta. In the nisiit uterine contraction sat in intensi . At bout 3 in the orning the woman is transferre to thelabour,ard. Foeta hear Sound are good dilatation about the steteos a Mur hillin piece. Malaria attac staris almos immediatet with shiverin forine hour. An intramuscula injectionis 4ram os quinine hydrochloride
During the heat stas of the malariat attach, at q.304.m the patientsave iri to a livin child of the male Sex. eighins 2.200 gramS. Natura delivery the placenta,etshing 004rams. O terminationos delivery rene ed intramuscular injection os liram os hydrochlorate os quinine. Postdeliver period normat: iram os quinine in cacheis of 0. 50 graminach. O the fixit day after the confinement the patient leaves the hospitat. The prematuret bor child, of good physique, hows durins thedays follo ins his birili, excessive cyanosis and Coldness. OnauScultation the ear is found perfecti normal. The chil neverthelessshowed a particulari intense icterus, whicli appearedin the da after his birili and took iis course ithout laver.we have no further information either about the mollier or the childaster the les the Hospitat. In connection,ith his case, made som enquiries whichinabledus to trace ut here an example os congenita paludism, due to the tranSmission of the materna hematoetoon to the foetus throusti themedium of the placenta circulation. Doctor mer director of the Institute of Biolos of renchwest Africa was good enovsh to ake ur preparations and confirmour resulis for hicli, are indebie to him. He was particularly
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138 A CASEDE CONGENITA MALARIA
the childaavinibeenior durin the fui malariat sit of the mother. and weran therein schizontes of plasmodium praecox. c. O the tb Ianua , a ne filmo materna blood, in hich. in spite of the intensive quinine reaiment, hematoeto of the formplasmodium praecox are found the protoplasmis hic as irregularan strongi modihed by the actioni quinine. d. O that fame day the 7m Ianuary the seconstaster the birt of the child whicli atready showed an intens icterus, e too Some fit blood, an examinationis,hichiaverus the folio ins particulars:
Formula os leucocytes: polynuclear neutrophile . .
woman in the eight mont of pregnanc a suffere os longstandin Dom paludism, present premature onset os labour under the influence of a severe malaria attach. The labour,as toppedon the patient ein subjecte to quinin in large doses framsin 8 hoursa intramuscula administration . Nevertheles confinemen inhes place three eelis later, hil a malaria attac is in fui progress The presence of hematoeto is detected in the blood of the umbilica cord and again, two day after theatrih in the blood of the ne horn child, there is found the fame variet of hematoetoa, hicli ad been detected in the mollier and found in the blood of the umbilica cord. It is there ore ruina case of intra-uterine transmissionis the malariat infectio of the mothe to the foetus.
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EINIGES NEVERE AUS DEM GEBIETE DE PARASITOLOGIE. TR PISCHEN PATHOLOGIEM HYGIENE
B absolute certain result. The case materia mustis unde carefulobservation for at least ne ear Tertia patienis,ho received in the autum a Series of intravenou quinin injections, howed, after
per os o intravenousty and also the combination thereos led to equalresulis. The combinationis quinin with neo-salvarsan was like iseno Salasvard against relapse Methylen blue exhibited the fame resulis in combination it quinin assure quinin treaiment l). Intravenous injections ere indicated in coma, severe vomitin and disturbances of the digestive tract. Intravenous injections ac more speedit in arrestin an attach and require a minor quantityi quinine. It is notthe quantit os quinin whicli is decisive a resard the finaliutcome, but the duratio of the rectiment.
In tertiAn whicli staris in prins and summer treaiment houldae continue untii the arrivali cold weathe and then interrupte unti the periodis relapse then again continue for 2 to 3 monilis. In tropical malaria the reaiment should las Torri monilis. It hould e destrabie to sive the quinine one da before an on the actuat B of expected relHpse. Injections of adrenalinewere notfound capableos provokius an attach, but re sat materiallyrio assis the detectionis the parasites in the blood particularly
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lq0 MALARIA AN MALARIA PSYCHOSIS THE EFFECT OF MALARIA ON THE NERVOLIS SYSTEM ITH SPECIAL REFER CE TO THEMALARIA PSYCHOSIS
St. Elizabelli' Hospital Washington, D.C.
THE author concludes his article illi the folio in summaryan conclusions That there is a malaria psychosis an bedefinitet stated buti account of many actors it physiognomnis of necessit varied. of the determinant sivinum diverse mentat picture a be mentioned Alcohol severit of the attac per se, se of the patient atine onset of the malaria attach, even the acutenes o chronicit of the disease, and lastly hereditar taint. A se manifestations howeUer Hre quite constant Suchis initiat mental confusion oniric delirium and more rues complete delirium. The symptom os a malaria intoxication illicit Oniric delirium resemble hos of othe toxic infectious psychoses They are modihed some hati hepatorena insufficiency. Althous patienis it a materia psychosis are frequently Mundio have been alcoholi a the time of onset of the disease and althoughmalaria patients are capable of eas alcoholization, alcoholis hasno been ound tolera necessar Rccomynniment. Arabs, who were nodias a clas Alcoholic, wheneve they developeda malaria psychosis lacted the initiat delirium. while European withan Alcoholi inint, o the contrary, alway developed an initiat delirium This is o constant that severa observers have Ae itis an indicationi alcoholism. The severit of the malaria attach in a susceptibi individuat is on quantitative basis, an so determine his reaction. it a floridattac the quantit os malaria toximis greatly in excessis that os amild attach so that in the forme case we,ould expectvireater mentcti aberrations than in the alter. Depression has been mos frequenti observed in children.
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MALARIA AN MALARIA PSYCHOSIS 141
The menta symptom appearins illi therars infectionis malaria
2. Confusion with dream delirium, followed by amnesia datins Domthe onset o delirium and va in in iis completeness. In chroni malaria the individual attacks are les severe les notice- able generali takin the natur os a depresse menta state, and gradually hadins into a neurastheni Ο hysteroneuroti condition. nervous system illi hereditar tain is uitabie sol for the developmenti a malaria psychosis This and the malaria toxinfectio are in themselves capable of Settin u menta aberrations in patient, ut probabinas osten asino alcoholis is also present Thisin turn id the malaria intoxicatio an resulis in a mentalipset. Twelve cases of malaria in patient suffering rom severat different types of psychoses non-organicydidiot show added psychotic symp- toms. The fallure to elicit mental phenomena duoeto malariat intoxication, however, oes no detracciso the hereditary factor in malarialpsychoses Oid hospital cases on bach wards , no subject to thecareful scrutinnand stud that ne errand morem operui cases demand mistit easit develop somede ne mental Symplom unde a malariat attach and have these overtooked Asain, in non-organi cases Atreadyon a low menta levet, livin the well-protected lis of an institution. malaria infectio mistit conceivably be insuffcient to bring out aberr-Hnt menta reactions such reactions a mistitie terme significanton hiulier menta state bearin the brunt of a toxic infection. In ne case here illi reported paresis could noti definitetnruledout although the tendency was to belleve that his mentalipset was due t malaria. In his connectio it is interestin to note that Pil .uSin Don agners reaiment for senera paralysis, occasionalty notice acoustic hallucinations ideas of persecution delirious and calatoni states in hos subjet infected illi malaria. Ait heir symp- tom disappeares hen quinin HS GiVen. Pathologicalty of ouistandin importanc is the plussin of smallarterioles an capillaries in the brain and spina cord The thrombosiso embolis in perforatin arterioles, i no fatal, causes the most Seriou Consequences This tendenc to thrombosis an embolismparti explain the presence of almos any of the topographicat eurologica syndromes note occasionalty in the course of malaria Most interestins as et a most rare, is the development of motor aphasia, due to theilochin os capillaries surroundins Bro Siren.
The delirium is et explaine by the marke hyperemia of thell
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142 MALARIA AN MALARIA PSYCHOSIS
pia esseis, subarachnoid perivascular an pericellular paces, and
preeXiStin condition As Anemia cachexin physicali mental fatisue, the puerperium, insolatio an alcoholism, to the number of parasites preSent, the amount of toxin secrete and mos of all. to localigationo the toxi-infectio in the brain. In cerebra malaria the symptoms may simulate an brain disease, but the menta symptoms remo commensurate illi the cerebraltrauma due to the parasites per Se They are exasserated, andi intio a cerebra intoxication.
Neuritides, neuralsias hyperAlgesia, headaches and acute hyper- pyrextat attacks are but indications of the effectis malarial oxinsinperipheral and central neuroneS. Amnesia o malaria origin is conditioned by the lac os attention durins an after the initia delirium and is of varyin grades Onecas studied had an amnesia for si monilis. As forementione there is a difference of opinion o the exactclinica picture exhibited in a malaria psychosis From the first thereis a bradypsychia hic observers have found to progressu a frankdepression Maniacat ouibrealis, o frequently obserVed, an onlybe attribute to a constitutionat predisposition. Depression is alwaysin a in defrees in hos long affecte wit a malaria infection. On writer explained his fro the faci that most of his cases of malaria psychosis ere in omen, and theriare the more sive to depre Sion. Raciali speakins Iews, when affected with malaria have been Mund prone to a calatoni development. Severa observers have noted that the malariat mental confusion has for iis essentiat character, the accompaniment of certain symptoms,hic evolve toward dementia precox calatonia. In m firs case of malaria psychosis it was the consensus os opinion that the patient was a caseis calatonic dementia precOX. Each consultant, however, expresse som doub as to thedictgnosis, and wa won to sive malaria a the possibi cause of the development of the psychosis. Malaria ver a period of years, with a histor of rathe frequentovibreaks, is capable of brinsing on a marked neurastheni condition. Aside rom the possibi psychic effectis a chronic debilitatin infec tion, malaria attacks the emopoleti functio an vitiates it a iis Source thus makin the patient a fit subject for neurasthenia. Epileps and hysteria, accordin to good observers, are caused by malaria, and in preexistin condition the infectio Serve to aggravate the Symplom of both.
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MALARIA AN MALARIAL PSYCHOSIS 1 3
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14 MALARIA AND MALARIA PSYCHOSIS
44, 1685. de Bruti, M. H. Note surcle tremblement paludeen Buli de I Acad. de med. 1918. 7s 269.
Durdi an M. Duriremblement palustre. Presse med. 1906. 4 5l8. Fornaca, Glacinio Tremore da malaria, Roma. 1907 8, 15. Pope C. Chronic Malariat achexi and iis Relation to Neurasthenoid Conditions.
Boston Med. and Surg. Dur. 19lq. 70, 193. At inson I. F. Malaria an Aste ards Indian Med. Rec. 191 3. 33, 177. Musgrave, M. E. Amase of Masked Tertian ever illi Mari e Menta and Nervous Manifestations and with Unusuali New Parasites in the Peripherat Circulation Buli. Manila Med. Soci. 1911 3, 28. Hare Francis Pathologica Variations o Physiological Asomotor Action, illi Specia Reference to the Malariat Paroxysma Neuroses. Praccisioner. 1905. 5, 150. Marandon demonNel E. Revire de med. 1889 19, 2 l. Regnavit Hysteri et impaludisme Marseille med. 1890 27, 337. Roux Hysteri che u paludeen Le Caducee l902, 2, 47. Marandon de mons, ei. E. Rapporis dest hysteri et deri impaludisme. PreSSe med. l 900 2, 28 l. Pros. r. Magnerdaurem Treaiment of Generat Paresis by Inoculationis Malaria. Ioui . Ner . and Mens Dis. 1922 55, 369. De ado, M. F. Treaiment of Paresis by Inoculation with Malaria. Dur Nere and Mens Dis. 1922 55, 376. Pitca A. vo wasner's New reaimentis Genera Paralysis Lances. 1923. l. 19.
American Durnes of the medica sciences Philadelphia. 168 No. 3. Sept. 192q. p. 334-37 lin