bilious  remittent  fever.  So  we  arrived  at  Rio 
Grande  do  Norte  and  went  back  to  Recife, 
having  obtained  no  reliable  information 
as  to  the  existence  of  yellow  fever. 
Some  days  after  our  return  to  Recife,  we 
again  visited  the  Isolating  Hospital  in  search 
of  cases  of  dysentery.  On  being  invited  to 
see  an  interesting  patient,  we  found  a  typical 
case  of  yellow  fever,  already  diagnosed  and 
conveniently  protected  from  blood-sucking  in¬ 
sects,  or  to  be  more  exact  protecting  them 
from  the  patient.  We  followed  up  this  case; 
the  disease  lasted  four  days  and  ended  in 
death.  This  patient  had  come  from  Natal 
in  Rio  Grande  do  Norte,  having  passed  the 
night  in  Guarabira  or  Independencia,  (in 
Parahyba);  he  became  ill  three  days  after  his 
arrival  at  Recife. 
The  patient  was  a  Syrian,  recently  come 
to  Brasil  (about  three  months  before).  During 
our  travels  through  these  two  States 
we  heard  of  another  case  of  yellow 
fever,  diagnosed  by  local  doctors.  We  belie¬ 
ve  that  there  is  an  endemical  occurrence  of 
uncharacteristical  yellow  fever  cases,  which 
pass  unnoticed,  the  patients  not  being 
isolated.  This  facilitates  the  infection  of  Ste- 
gomyiae  which,  by  biting  not  immune  peo¬ 
ple,  generally  strangers,  produce  the  severe 
forms.  It  is  quite  possible  that  countless  pa¬ 
tients,  classified  as  cases  of  bilious  remittent 
fever,  are  really  cases  of  mild  yellow  fever, 
and  that  instead  of  being  treated  as  impor¬ 
tant  cases  of  common  infections,  they  ought 
to  be  isolated  as  suspect  cases.  This  may 
be  the  only  way  of  putting  an  end  to  such 
bearers  of  virus,  forming  foci  of  infection 
for  the  transmitting  mosquito. 
On  leaving  the  State  of  Bahia,  we  were 
informed  by  Dr.  OCTAVIO  TORRES  that 
another  case  of  yellow  fever  had  been  veri¬ 
fied.  The  patient  was  a  priest  come  from  a 
town  in  the  interior  of  Sergipe  where  he 
had  been  nursing  a  colleague  suffering  from 
symptoms,  similar  to  those  he  now  showed 
himself. 
So  we  have  endemical  cases  of  yellow 
fever  and  a  very  large  quantity  of  Stegomyiae 
in  these  northern  States. 
72  - 
Paludistn. 
As  to  paludism,  we  did  not  observe 
anything  little  known  or  specially  noticeable. 
What  we  saw,  is  already  common  know¬ 
ledge.  Cases  of  malaria  and  Anophelinae  in 
every  part.  In  some  places,  there  were  exa¬ 
cerbations  of  the  endemic  in  the  form  of 
more  or  less  severe  epidemics.  This  has  hap¬ 
pened  of  late  in  Alagoinhas,  in  Parahyba 
and  in  Cachoeira  de  Paulo  Affonso.  We  ar¬ 
rived  with  the  impression  that  the  greater 
part  of  hypoemic  patients  suffered  from  ma¬ 
laria,  but  returned  convinced  that  two  thirds 
of  the  cases  of  anemia  are  due  to  ankylos¬ 
tomiasis  and  one  third  only  to  paludism.  Many 
patients  had  the  worm  in  the  intestine  and 
the  protozoon  in  the  blood.  We  even  found 
some  patients  suffering  from  the  five  most 
common  infections  which  are  the  heaviest 
scourges  of  Northern  Brasil:  ankylosto¬ 
miasis,  paludism,  syphilis,  dysentery  and  schis- 
tosomatosis.  The  latter,  although  the  mildest, 
is  nowadays  spreading  at  an  astonishing 
rate. 
Of  all  the  places  we  visited  in  the  North 
only  in  the  city  of  Propriá,  on  the  bank  oi 
the  São  Francisco  in  Sergipe,  was  there  any¬ 
thing  done  against  this  endemical  disease.  They 
were  filling  up  a  large  pool,  which,  besides 
being  a  breeding  place  of  Anophelinae,  was 
full  of  Planorbis,  infected  by  several  species 
of  cereariae;  the  same  pool  received  all  kinds 
of  refuse. 
Ankylostomiasis. 
This  scourge  is  a  true  calamity  in  the 
North.  One  may  say  that  85  %  of  the  co- 
prological  examinations,  made  in  the  interior 
of  these  Northern  States  show  the  presence 
of  Ankylostomum  eggs.  We  feel  sure  that  at 
least  70  °/o  of  the  individuals  who  furnished 
this  material,  really  suffered  from  ankylosto¬ 
miasis  while  the  others  were  only  bearers. 
All  the  clinical  forms  of  this  worm  di¬ 
sease  are  met  with.  It  is  quite  interesting  to 
see  how  other  lesions  which  intercurrently 
appear  in  patients  suffering  from  this  form  oi 
helminthiasis,  differ  from  the  usual  form  in 
