*4 
infantile diarrhoeas, tuberculosis, bronchitis and pncumntn.i, tvphoi 
fever and small-pox. 
On none of the vast rivers flowing through the State of Amazonas 
are there any public hospitals, and the doctors practising in the 
settlements in the interior are few in number considering the vast 
extent of territory. Manaos has therefore to serve .i-> a hospital base 
for all the up-river commerce. 
Every steamer brings diseased persons from the interior nf the 
State; many of them are already in the advanced 
beri-beri, ankylostomiasis, etc. Their health undermined by the 
ravages of malaria and the privations they have had to undeigo, 
many of them suffering from lack of sufficient nourishment 
starvation is not an uncommon occurrence in the interior during the 
season of low river, when it is frequently impossible to send up 
p vision.-,), these people often arrive in Mandos in a most precarious 
condition Many are admitted to the wards of the Santa Casa de 
■ seneordia in a moribund state and thereby raise the death-rate of 
e ho S p lta i and the chy Qf Man , os The mo ^ f<(rtonate oncs mah 
davs a nr/‘ eCOV , ery ' occu Py in ^‘ hc beds Of the hospital for many 
many recovl^w" f " the medical a " d "ursmg staff that » 
Madeira taken ' C ^ ^ “ many “ fiftCen men from thc R, ° 
suffer^ w J n - an Un “ nsci °- condition from a steamer, all 
a subsequent mortality of a " d yet W,th 0nly 
MALARIA 
fern L“ n e ;‘r h te °! , the Valence of malaria in Mans, 
g -en. If we c : nfi t our mtt 15 ** ^ ™ 
disease in the suburbs wp 1 ° t0 * lose found suffering from th 
^ er mg as t he y do as many Amazonens* 
go and live outside the eitv n a ° n rc1,Irn ' n £ from the interior wi 
infected. C ' ty and so 'atse the number of persons foun 
collector is of a neretbty'Trove' "’ h ° hap P ens to be a rubbe 
'“trict, going up the different ^ ^ frec fuently change hi 
acqu.rmg fresh infections, 'fever - v"* 35 em P lo >' m ent offers am 
as t e result of having to work up-rive^ C ° ns,dered a necessary evi 
