After reviewing the historical aspect of this question from the time of Hippocrates down to our days, the author gives the results of his clinical experience. He classifies clinically the intellectual disorders which are associated with, or due to, malaria into—(a) those which accompany the febrile attacks; (b) those which occur during the intervals, as well as during the attacks, of chronic malaria; (c) those which are observed in the course of intermittent fevers and pernicious attacks; (d) disorders which appear during the malarial cachexia. Great stress is laid upon the predisposing causes as compared with the immediate or exciting cause—the poison; the malarial parasite provokes simple hyperæmias; other pathological alterations beyond this are, according to the author, related to the predisposition of the organism. The close relation to alcoholic toxæmia is emphasised. Among the general conclusions are—(a) malaria lights up morbid predispositions (neurasthenia, hysteria, psychoses), or a general or local disorder present in a latent state; it may aggravate disorders already active; (b) the delusional state of malaria is provoked by hallucinations; (c) according to the degree of excitability of the individual, the condition of predisposition, and the activity of the malarial poison, four degrees of malarial toxæmia may be distinguished: (1) excitement, (2) anaesthesia, (3) coma, (4) paralysis; (d) acute forms of insanity occur but rarely in malaria; (e) beyond the melancholic type and the maniacal type there is a third type of insanity, often seen following upon a febrile attack—the mixed depressive and excited type; (f) psychical disorders in the course of chronic malaria are rare, while the occurrence of psychoses, which are said to appear some time after the disappearance of malaria, is doubtful.
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