YELLOW FEVER EXPEDITION 
555 
arrangement for ventilation. The poorer class mostly live in dark dens in the city 
not arranged tor through ventilation ; in the outskirts there are some terraces of 
cottage quarters, though as one proceeds out detached palm-thatched huts are the 
rule. In the latter the people keeps things clean and tidy, with the exception of free 
expectoration on the dried mud floors; but more within the city the quarters are often 
very filthy. As a race the Brazilian is of cleanly habit, so far as personal washing 
and linen go. The almost universal use of the ' rede ' (a kind of hammock) instead 
of bed for sleeping may conduce to the reputed absence of bugs and the comparative 
rarity of fleas, although these must be constantly imported by the indigent immigrant 
from the slums of Portuguese, Spanish, and Italian towns. 
Hospitals. Lastly, a word must be said about the hospitals. A large general 
hospital, Santa Casa de Misericordia, has been built in the Umarizal quarter of the 
city. The large wards seem airy, well kept, and clean. The basement is also used 
for wards, and though well kept the conditions of light and air are not so good. 
Copious water supply is ensured by pumping up into large storage tanks. There is 
also an elaborately decorated and furnished committee room, the expense of which 
might well have been foregone to admit of the introduction of more immediate 
necessities. The chief fault is one of omission, for there is no provision for keeping 
out mosquitoes ; large numbers of blood filled mosquitoes are to be found any day in 
the dark corners ; there can be no question that all window spaces and doorways should 
be protected with permanent wire gauze nettings. In a hospital it is not possible or 
advisable to have individual nettings for each patient ; with the movements a certain 
number of gnats would be almost certain to effect an entrance, these could easily be 
dealt with by inaugurating a brigade of convalescents armed with small ' butterfly nets ' ; 
perhaps, in certain instances, such as malarial and filarial cases of diseases, the patients 
might be kept in a specially guarded ward ; the same would be done in yellow fever 
suspects. At the same time all breeding places for mosquitoes in the neighbourhood 
ought to be kept under survey. With such improvements in many ways the hospital 
may well bid as a model hospital for tropical cities. 
Also under state or municipal control are the isolation hospitals for yellow fever 
and smallpox ; the latter was not seen, and the former is deserving of praise in its 
cleanliness and brightness. Better water supply arrangements are urgently needed, 
and what has been said of making the Santa Casa mosquito proof, can only be repeated 
here. The nursing is done by the sisters of an Italian sisterhood (Sta Anna) in all 
these hospitals ; the people, perhaps, hardly realize how much they are indebted to 
the devotion and care of these good women, who come out at considerable personal 
risk to minister to the sick, and not a few have added tc the death roll, chiefly of 
yellow fever. The isolation for leprosy (Asilo dos Alienados) is situated away in the 
forest, and consists of a number of huts and houses with a common refectory, etc. 
There is also an asylum for lunatics out at the Marco da Legua ; this was not visited, 
