25 
If these people are not too ill they will go and live with their 
family or friends in a hut situated in an Anopheline region. Very 
little quinine is taken, though their blood may be laden with gameto- 
cytes. They lie about in hammocks with no mosquito nets, and 
consequently these ‘ gamete carriers ’ serve to infect Cellia albunana 
and C. argyrotarsis , which arc the common Anophelines of the 
swamps in the outskirts of Manaos. Thus the districts can be infected 
with the more virulent parasites of malaria. Generally the huts 
occupied by these ‘ gamete carriers ’ arc overcrowded with children 
and adults, and consequently at a later date the other inmates are 
attacked with the same form of fever. Our case books record many 
such instances. At Para a very serious epidemic of malaria occurred 
among the very poor inhabitants of certain districts, in which 
Anophelines abounded, by the return of labourers who had come 
down from the Alcoboga and Madeira-Mamore works, and who 
were suffering from very severe attacks of malignant tertian fever 
contracted in these districts. These labourers being heavily 
infected, and living under most abject conditions, served as efficient 
hosts for the parasites. Shortly after their arrival a great outbreak 
of malaria occurred, necessitating the appointment of a medical 
commission.* 
If we compare the malarial localities of Manaos with the figures 
obtained from a mosquito survey, we find that all the heavily infected 
localities represent those areas in which the greatest number of 
Anophelines are present throughout the year. In the city proper the 
number of Anophelines is not so great as compared with those in the 
suburbs, and therefore the number of new cases of malaria is far less 
than in localities such as Moco and Pensador. Moreover, the condition 
of the inhabitants of the city is better than that of the poorer natives 
living along the swamps. 
During our residence in Manaos we have examined many children 
and adults living in the suburbs, and especially those in malarial 
localities. As far as possible spleen palpation and blood examination 
was practised, and latterly an examination of the faeces was always 
made. Children do not object to being palpated, whereas the) \ ie\\ 
with apprehension the necessary preparations for making blood fihnv 
* Relatorio apresentado pala commiss&o nomeada para debellar a F 
impaludismo, reinante no Marco de Legua, Pedreira e Canudos. Be . P 
official do Estado do Pard, 1909. 
