3i 
cases of typical blackwater fever have occurred amongst the people 
employed in constructing the Madeira-Mamore Railway in the vicinity 
of Porto Velho on the Rio Madeira. During 1908 we had opportunity 
of observing many severe cases of malaria which were brought fi om 
the Madeira-Mamore Railway to Manaos and treated in the wards 
of the Santa Casa, but we failed to find a case of blackwater amongst 
these men, either in the wards or post-mortem room. Among the 
working-force are Cubans and workmen, engineers, etc., brought from 
Cuba and the Isthmus of Panama, both blackwater fever regions. 
These men were brought to the Madeira river about 1908. It is of 
interest to record that the Booth Steamship Company* in its long 
connection with the Amazon region, never carried a case of 
blackwater until November, 1909, when a severe case was observed in 
a Spaniard who had been working up the Madeira river in the railway 
camp. We hear that other cases have been treated m Manaos 
(1909-10.) 
YELLOW FEVER 
This disease in 1856 attacked two-thirds of the population of the 
State; in 1861 another epidemic occurred. The fever appears to 
have been severe in 1899 and 1900. 
For the foreigner this is the most serious of all the diseases to 
which he is liable in Manaos. The foreign population of the State is 
chiefly resident in Manaos, and the number of foreigners is sufficiently 
large to make the disease a very serious one. 
We have already reported the overcrowding which prevails in 
certain of the streets of the city. These houses and barracks arc 
mostly inhabited by Portuguese, Italian and Spanish labourers, ?nc a 
great many of the newly arrived immigrants settle in these streets 
until employment is secured or a home arranged for. 
We have shown that Siegomyia calofus abounds in all quarters o^ 
the city and that its existence in such numbers is due largely to t tie 
habits of the citizens. The foreigner is equally culpable, as his house 
or office provides numerous breeding places for the mosquito. 
We acknowledge the efforts of the sanitary authorities to stamp 
out this disease. They inspect the houses and endeavour to abolis 1 
* By permission of Dr. Melville Davidson, Medical Superintendent, Booth Steam¬ 
ship Company. 
