5i 
RECOMMENDATIONS 
We suggest that the sanitary authorities be empowered: — 
I. ( a ) To make a spleen census of all children in the city and 
suburbs of Manaos, and that this should be repeated every three 
to six months. 
K b) That at the same time the haemoglobin percentage of all 
children should be ascertained, and those showing marked 
anaemia should have their faeces examined for ankylostomes. 
(c) That all children suffering from enlarged spleens or 
ankylostomes should be given free quinine and thymol. 
(d) That a supply of quinine tablets, specially coloured in 
order to prevent the sale of the State quinine, should be given 
to each school teacher or responsible person in the localities 
of the poor, and that such quinine should be available for the 
inhabitants of the locality. 
( e) That, once a week, a free clinic should be held in each of 
the large districts of S. Raymundo, Colonia Oliveira Machado, 
Moco and Pensador or Flores. That so far as possible attention 
should be directed to the treatment of malaria and cases of 
ankylostomiasis. It should be remembered that what the 
department desires to attain, is to cure the children and adults 
of malaria and rid them of ankylostomes. Simple preparations 
of quinine , thymol , arsenic and iron are quite as efficient as 
expensive combinations of the same. 
Severe cases of these diseases and patients suffering from 
other ailments should be directed to apply for treatment to the 
outdoor department or wards of the Santa Casa de Misericordia. 
II. ( a ) That separate cards should be published by the State 
giving a few simple facts about malaria, ankylostomiasis and 
tuberculosis and emphasising the dangers incurred by neglecting 
treatment. 
(i b ) That one of these cards appropriate for the disease from 
which he is suffering should be filled in with the name of the 
patient and should be given him to use as his identification 
card for the suburban clinic and hospital dispensary. 
