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cafes. In the hospital great difficulty is experienced in controlling 
the public patients from spitting about the wards. 
The authorities have a separate barrack for indigent patients 
suffering from tuberculosis. Unfortunately before this building was 
inaugurated some of the sisters of the order of Santa Anna became 
infected through nursing in the wards of the Santa Casa. 
Tuberculosis appears to run a rapid course among the poorer 
class natives as is to be expected since they suffer from overcrowding, 
insufficient and inappropriate food. Dried goat’s meat, salt cod 
and beans constitute a poor diet for patients suffering from this 
disease. 
We believe from the clinical and pathological material at our 
disposal that tuberculosis is already proving one of those dangerous 
diseases which are attacking the people of the interior of the State. 
Many of our cases were found to be suffering from malaria, and 
practically all of the indigent class harboured Necator americanus. 
With a combination of three such depressing diseases the prognosis 
for such patients is very gloomy. 
A league against tuberculosis is active in Rio de Janeiro and it 
is to be hoped that branches will be formed in the cities of Northern 
Brazil, so that the people may learn the elements of hygiene. 
PULMONARY DISEASES 
Bronchitis and Pneumonia are frequently met with in the rainy 
season. The prognosis is grave in cases of pneumonia. 
Pneumonia occurring in patients suffering from malaria is rare ; 
the cases seen were all infected with malignant tertian parasites. 
The mortality is high. Pneumonia as a complication of yellow fever 
is fortunately rare. Lobar pneumonia occurred in nine of our cases, 
and was responsible for seven deaths. 
WHOOPING COUGH 
Epidemics of this complaint attack the children in Manaos and in 
the interior. In Iquitos, Peru, in 1906 we found over 50 per cent, of 
the children had the disease, and that it was causing serious loss of 
life amongst the Indians in Peru. Broncho-pneumonia is a serious 
complication and causes a high mortality. 
D 
