VIII. GENERAL HEALTH OF PARA 
The city of Para, or Belem do Para, is situated slightly south of the equator 
(lat. i° 26' 59" S., and long. 48 0 30' o" W.), and about seventy miles from the ocean. 
It is built on a tongue of slightly raised land, which forms a sort of flat ridge, at the 
end of which is the river front (Rio Guajara), and on either side are swampy, low- 
lying districts, into which the fringe of the city extends. The elevation, though 
very inconsiderable, is ample to give a very fair gradient for drainage ; at the same 
time the soil consists of sand, and through this much of the fallen rain water soaks 
away, where from traffic, etc., there is no coating of mud. The tide helps to cleanse 
the river front, the rise at spring being about ten feet ; but the wharfside bavs are 
sufficiently sheltered from the current to allow the accumulation of much filth, in 
places a bed of mud being exposed at the fall of tide. 
The general health and mortalitv in the city must be looked at from two stand- 
points, namely, that of the native and old resident and that of the newcomer. For 
the newcomer, as in other regions where yellow fever is endemic, is liable to undergo 
risks of becoming infected with this disease and to die of it ; consequently, especially 
in times ot considerable immigration of susceptible persons, the apparent death-rate is 
not a fair estimate of the mortality due to all the local conditions which affect the 
well-being of those who have resided long. There are no figures to show the 
extent of the yellow fever risk in Para ; but it is to be seen from the cases, with 
which we had to deal, that the city is extensively riddled with the disease, for we 
had cases from houses in all quarters, even out to the Marco da Legua ('a league 
from the city'). So that there was no part (at any rate during the later months 
of 1 900, when the considerable outbreak of the earlier months was on the wane) 
which one could confidently state was free from risk. Many of the milder cases 
pass unrecognized, and perhaps not a few of the more severe pass under other 
names ; the tendency in yellow fever districts is, for those in control, to endeavour 
to make as little as possible of the disease, ' so as to avoid giving the place a bad 
name.' Naturally nothing could better tend to foster the disease than such 
measures. The incidence of the fever on a given number of traceable individuals 
cannot always be given, but figures are extant in the case of an Italian dramatic com- 
pany, which visited Para in April, 1900, and shew that out of the company at least 
twenty-nine individuals became infected, and at least nineteen succumbed to the 
fever ; these include not only the lower grade of artists, but also some of the more 
reputable. 
Considering the situation of the city so near the equator, the climate is less hot 
than might be imagined ; the almost daily shower of rain, be it ' dry' or be it ' wet' 
season, conduces to produce this result. But at the same time it gives rise to the 
