30 
in the children with chronic malaria, cerebral convulsions. etc ; in 
the adults in the cachectic state and in the large number of pernicious 
cases. In children, crescents are not hard to find and this was the 
case with all our patients; quite 80 per cent. <>f OUT malignant tertian 
cases harboured gametocytes, often in very- considerable numbers. 
Benign tertian (Plasmodium vivax ) is fairly common, and was 
found in about 20 per cent, to 25 per cent, of our patient- Many 
cases of double tertian infection, causing a quotidian tvpe of fever, 
occur in Manaos, and a certain amount of confusion has occurred m 
the diagnoses until microscopic examination determined if the 
quotidian fever is due to PI. fraecox or PI. vivax. 
Quartan (.Plasmodium malariac) parasites were rarely cncoun 
tered in our patients ; in fact, all our specimens were obtained from 
cases coming from the Rio Purus, Rio Japura, and Rio Madeira. 
The clinical types of fever are quotidian, tertian. Continuous and 
quartan. Bilious remittent fever type is not ran- Algid and cerebnd 
types are quite common. Pneumonia, dysentery, haemorrhagic 
purpura, nephritis, neuritis, optic atrophy, have all been seen and are 
due to malignant tertian parasites. 
Many of the rivers of the State are famed for the extreme 
mahgnancy of them malarial fevers and the resistance of these to 
noted f he , 103 Acre> Javar >'' Madeira and Coary have long been 
noted for such types of fever, and examples of their malignancy 
o f ver “h " Sama C “ a HOSP ' tal A '****** <>T* 
eL eme de™ f en ° rmOUS ° f «=»«»* "Suiting * » 
? encountered » ca S e S c «,n S („ ** 
resistance to quinine" but we c^not clrttfy to^a" " “ phe " 0mCnal 
m ’sr 7^7- “ 
seen in Manaos. We have seen ' ,SeaSC ^ ^ t0 haVC bcen 
haemcglobinuria in Manaos. In T ^ ^ ° f genuine endemic 
observed attacks in a man u , ^ Ultos and Manaos we have 
the disease. A special waMi ° rCCentIy sufTered in Africa from 
the urines of all malignant ^ f ° F CaSCS ° f this disease and 
Javary and Madeira rivers were rolWt^ 8 ! eSpedally those from the 
to find any of the characteristic symptoms’ " ^ ^ 
W'a. tatai*,,.., 
quarter of 1909 
