A Case of Malaria with Acute Mania

On the 17th July last, a male, aged about 24 years, suddenly developed an attack of acute mania needing physical restraint. I was called in to see the man and found him with the following symptoms:? The patient had to be controlled in bed by four attendants; he was talking foolishly but articulated distinctly; his eyes were shut and he resisted their being opened; Babinski's and Kernig's signs were negative. On enquiry I learnt that he had had a mild attack of fever a few months back, which may have been malaria, but he recovered without any medical help. On this account I thought it possible the present attack might be due to malignant malaria. The temperature was 99.4?F. and the pulse rate was 110 per minute, heart beat ' tictaclungs normal, and spleen, and liver were not palpable. Blood films were taken for microscop'ic examination and quinine bihydrochloride, grains xv, was given intramuscularly. A few doses of alkaline mixture with sedatives and a dose of calomel were given at night; cold application to the head was advised. I was informed in the night at about 11 p.m. that the symptoms were not so violent as before, only the temperature rose to 101 ?F. I did not interfere further during the night.