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cabbages, etc., have to be imported from Europe, and therefore are 
accounted luxuries. The supply of fresh milk is limited, as all 
milking-cows have to be imported, and it is chiefly used by invalids 
and rich residents. Practically all the milk is boiled before being 
consumed. 
Artificial ice of excellent quality is manufactured. The more 
universal employment of refrigerators would be encouraged if the 
price of ice was reduced. 
The slaughter-houses along the Igarape da Cachoeira Grande and 
the central markets in the town are of recent construction and 
admirably serve their purpose. The sale of meat, fish and turtle, 
etc., is under medical inspection, and an efficient supervision is 
maintained. 
The Santa Casa de Misericordia is the sole public hospital in 
Manaos for the reception of indigent patients. The institution was 
designed for about 160 beds, but this accommodation is inadequate, 
as the hospital has to care for the numerous patients arriving from 
the interior of the State. The wards are overcrowded for many 
months in the year, but despite such difficulties the patients are well 
attended to. Numerous improvements have been instituted, and a 
fully equipped operating theatre, outdoor and maternity departments, 
and a separate barrack for tuberculous cases, enhance the value of this 
hospital. The institution is managed by a lay committee who appoint 
a large staff of the local medical men, assisted by the Sisters of the 
Order of Santa Anna, to attend to the various departments. The 
medical work of the expedition was carried on in this hospital, and 
after an associateship of three and a half years, we can warmly testify 
to its excellence. 
The Sociedade de Beneficiencia Portugueza conducts a well- 
planned hospital for the needs of the Portuguese colony. Mosquito 
bars are furnished for all the patients, and wire gauze screened 
observation and isolation wards are provided for the treatment of 
their yellow fever cases. 
A small isolation hospital well removed from the city is used tor 
small-pox patients and a few indigent lepers. A State lunatic asylum 
is in course of erection. 
Another small hospital is maintained by the Federal authorities 
for the treatment of the Federal troops. 
