29 
symptoms of this disease. It is not remarkable then that these 
children, their constitutions already weakened by ankylostomiasis, 
should be attacked and exhibit severe types of malaria. 
The children who enter the Santa Casa are of course suffering 
from acute attacks of malaria, and exhibit the most severe symptoms 
of the disease. It is rare to find parents of the indigent class bringing 
their children to be treated for malaria; the gravity of the disease is 
not appreciated, and consequently the cases are well advanced. Blood 
examinations of the children admitted for various diseases show that 
50 per cent, to 70 per cent, are infected with malarial parasites. 
If a hut-to-hut inspection in the swampy areas of the suburbs be 
made, from 20 per cent, to 80 per cent, of the adults will be found to 
suffer from malaria, the number varying according to the season of 
the year, condition of trade, and locality. Allowing for the imported 
cases living in these districts, we estimate that 20 per cent, to 55 per 
cent, of the population residing in Moco, the Bosque, S. Ray m undo, 
Colonia Oliveira Machado, part of the Igarapes Cachoeirinha, Castel- 
hana, and western end of the Cearense Swamp suffer from malaria 
and can be ranked as indigenous cases. 
These people may be attending the dispensary of the Santa Casa, 
but generally they do not do so, preferring to take an occasional dose 
of quinine or to treat themselves with one of the numerous proprietary 
medicines of which there is an enormous sale in North Brazil. It is 
quite common to find a poor native with four or five brands of pills 
in his possession, squandering the money which ought to provide him 
with nourishing food on a small phial of expensive ‘ silver-gilt ’ pills. 
Malaria is most prevalent during the period of February to 
November; the number of cases begin to increase some two months 
after the commencement of the ‘ rains ’ (p. 9) and the rise of the 
Rio Negro (vide chart). The mortality is greater during the months o 
June, July, and part of August. It is in these months that the wards 
of the Santa Casa are overcrowded and the cases of pernicious malaria 
most numerous. In this period many of the imported cases from 
up-river arrive in Manaos. 
The parasites infecting the children and adults are malignant 
tertian , benign tertian and quartan , this last type being always 
imported. Malignant tertian ( Plasmodium praecox) are the prevailing 
parasites, and their destructive effect can be witnessed on all s.des ; 
