UNDERLYING the prosperity and happiness of the people of any country is health, for without it there can be no strength, no energy, no success, even if all other conditions be favourable. This is true of every section of the world, and is notably true of Cuba, which with almost every advantage that nature could bestow has ever been feared for its malarious diseases, the fatal typhus, and the dreaded “yellow jack,” which acknowledges no master save the frost. For years the world has quarantined against Havana, and other cities have drawn away from this sister in the tropics as from one plague-stricken. Yet this condition is not of nature’s making, but of man’s, and by man shall it be changed into something better. Spain in herself was a tyrant contagion and everything she touched became diseased and rotten to its vitals. And this terrible condition was not only physical, but moral, for moral uncleanness is sure always to follow physical uncleanness. This truth constitutes a corollary out of which has grown the maxim, “Cleanliness is next to Godliness.”

The first consideration, then, with the American authorities who have undertaken to clean Spain’s Augean Stables in Cuba is sanitation; and already the best thought and knowledge and experience we have are being brought to bear upon the stupendous task before us.

STREET VIEW, SANTIAGO DE CUBA. FROM A PHOTOGRAPH BY J. F. COONLEY, NASSAU, N. P.
STREET VIEW, SANTIAGO DE CUBA.
FROM A PHOTOGRAPH BY J. F. COONLEY, NASSAU, N. P.

As has been stated, Cuba is not naturally unhealthful for a hot, wet country; and among the mountains in its interior and in many places along the coasts, removed from the filthiness of aggregated population, the average mortality is not higher than it is in lands of better repute for healthfulness, and the general health is quite as good. As might be expected, there is not that strength and robustness of physique characterising the people of the higher latitudes, nor is the climate conducive to the pink-and-white health of northerners; but though the people are less rugged of constitution and frame and lungs, and lack the outward signs of northern health, they are by no means constant subjects for physicians’ care and they are anything but chronic candidates for the cemetery. Even in the nasty cities they are not all so, for there are many who are able to have their own houses well located, and to adopt modern methods of sanitation for their own private use. But the public health is not considered of importance, and there is not a city in Cuba which is not wofully lacking in good water, good drainage, and good health. One or two towns, which in America would have a contagion flag run up over them, are so much cleaner than the average that in every description of them by any writer appears the statement that they are said to be the cleanest towns in Cuba. It may be said in this connection that the towns are not large.

Beginning with Havana, the capital of the country and the largest city in it, the stories of its great filthiness can scarcely be believed by those who have seen the place upon the surface and moved about in beautiful parks, in brilliant cafÉs, on the lovely drives, and elsewhere, among pleasure-loving people, all clothed in their clean white suits and smoking their dainty cigarettes. Yet Havana is viler than words can express; and the vileness has slopped over until her harbour is a veritable cesspool, whose waters are deadly, and whose bottom is so covered with filth that ships will not drop their anchors in it, because it is necessary to clean and disinfect them before they can be taken on board. Havana has been in Spain’s possession for four hundred years, and that harbour is a typical result of Spain’s good government. In the city itself the poor people are huddled in ill-built houses—there are only about eighteen thousand houses in the entire place—more densely than in any city of the world, on narrow streets without sewerage, upon the surface of which garbage and all kinds of refuse are thrown. No attention is paid to ventilation. The houses are built so low that the floors rest upon the soft, damp—in many places swampy—ground; the material is a porous conglomerate which absorbs moisture as a sponge does. Sinks are totally inadequate or absent. Water is not sufficiently supplied, and there is scarcely any effort by the authorities to exercise that care and provision for the public well-being which is characteristic of every properly governed city in the world. As an indication of what might be expected from such a condition of affairs the following table, prepared for American officials by the Havana Department of Sanitation showing the number of deaths for the first eleven months of 1898, is cited:

And this out of a population of about 200,000, in which there were only a few, if any, reconcentrados to starve to death. During this period there were only 2,224 births, showing a net loss of 14,336, or about seven per cent. of the population; a condition of health which would produce a panic in a northern city as soon as the figures were known. Speaking of these figures, Captain Davis, who has been inspecting hospitals, prisons, and public buildings under General Greene, says:

New York City at this rate would have a death-roll of 270,000 a year and London 450,000, and the deaths in the United States, which are now about 1,000,000 a year, would be about 7,000,000. Of course the figures for 1898 are greatly in excess of other years, owing to the war and the generally disturbed condition of affairs, but even in the healthiest years the death-rate was two or three times greater than the average of other cities.

The leading diseases are consumption, a common disease in hot, wet countries; diarrhoea, dysentery, cholera infantum, and fevers, worst of which is the yellow fever, which is present in Havana every month of the year, although much worse at certain times than at others. It is said that portions of Havana are permanently infected by yellow-fever germs, but Surgeon-General Sternberg, Dr. Wyman, Supervising Surgeon-General of the Marine Hospital Service, and other authorities say that by proper sanitary regulations and careful quarantining, the city may be made free of the disease and kept so, as is the case in Jamaica, where the English have had control for years. The work of sanitation will be difficult and expensive, and years will be required to accomplish it, but it must be done before Havana’s future is assured. Sewers are few and far between, and those which exist are filled with refuse from the streets and are never cleaned, as the odours that rise from them constantly most disagreeably testify. They empty into the bay. Most of the drainage is surface, and as the city lies so low that a heavy wind across the waters of the bay will inundate many of the streets, it will be understood that the drainage is sluggish, and that what should be carried off by water is usually left to be rotted and dried by the sun—except in the rainy season, when it rots without drying. Much of the lower part of the city is built on swamp and “made-land,” and what this means for the health of those who live upon it needs no elucidation.

The following statement, made by JosÉ M. Yzquierdo, civil engineer, of Havana, under date of September 28, 1898, will throw some light upon street-sweeping contracts in Havana, show why the work cannot be properly done, and also indicate the part that the city authorities have always taken in the good cause:

What is true of Havana is true in lesser degree of the other cities and towns of the Island, the degree being governed chiefly by the difference in size; the larger the town, the nastier it is.

Cienfuegos, which, by the way, is the most promising town in the Island, in the commercial sense, is notoriously ill policed, and is a sprouting-ground for all manner of diseases. A report dated November 21, 1898, made by D. E. Dudley, Sanitary Inspector, U.S.M.H.S., notes the fact that its elevation above sea-level is only about eight feet and it is surrounded by a belt of lowlands from eight to ten miles wide. The streets are seventy feet wide, unclean, and out of repair, and in the wet season are fields of nasty mud. There are three sewers, one from the Hotel Union, and another from buildings in the same block, and the third and only public sewer is from the Civil Hospital. The first two of these sewers empty into the bay at the steamer wharf, about two feet above the water-line, and when the wind is in the right direction the gases and vile odours are blown back into the buildings, filling them with stenches. The Hotel Union, the Charity Hospital, and a few private dwellings have modern water-closets, but elsewhere over the city the houses have shallow privy sinks, which are emptied at night and the contents dumped against the cemetery walls. Around the cemetery is also the dumping-ground for garbage, dead animals, and all the refuse of the city, the disposal of which is not under any especial authority. This dumping-ground is a mile and a half from the Hotel Union. Dr. Dudley says:

During the first ten months in 1898 the total number of deaths in Cienfuegos was 3626, out of a population which before the war was 21,500; adding soldiers and reconcentrados, it might be said to be 25,000, and at these figures a monthly death-rate of 362 is something fearful to contemplate. Estimating the deaths for a year at 4144, we have a rate of 166 per 1000. In the ten years ending December 31, 1889, reported by Dr. Luis Perna, over fifty per cent. of the deaths were from infectious and contagious diseases due almost entirely to bad or no sanitation. During the same year the births exceeded the deaths by 1982, a much better showing than in Havana, the difference there being 12,433 against the population in four years, and in Matanzas, 2397 lost in eight years.

Of the effect of proper sanitary regulations and personal attention on tuberculosis, Dr. Perna says:

Matanzas is situated on high ground, with the rivers San Juan and Yumuri running through it, and the natural facilities for drainage are excellent; but only two streets have sewers, and these drains have few or no connections with buildings. The water supply is of excellent quality, from springs seven miles away; but only two thousand of the five thousand houses take it, and the majority of the people prefer to buy water from street vendors, who are quite as likely to get it from fever-infected wells as elsewhere. There are public fountains, but those who need Cuban water most are too lazy to carry it home. Privies and sinks are more numerous than modern closets, and are handled as elsewhere, with the usual results. The streets are narrow (thirty feet wide), dirty, and unpaved; in the wet season they are vile. The houses are built of porous stone, which absorbs the dampness; the floors, laid on the ground, are overflowed by the rains, and their smell at all times is difficult to describe and dangerous to health. The deaths per year for 1895 were 1465, with a nominal population of 50,000, although it was cut to 35,000 by the insurrection; in 1896, 2399; in 1897, 6795; and in 1898, to September, 3901—which fearful figures may be accounted for by the fact that Matanzas was the centre for reconcentrados, and they died like sheep—eighty per cent. of them from starvation. The only disinfection that could reach this condition was applied to Spain by the United States, and there will never be any more epidemics of starvation in Cuba, or any more reconcentrados, for that matter. But even without her reconcentrado population, Matanzas is no health resort, and the cleansing hand must be applied to her early and rigorously.

MARIANAO WATER VENDOR
MARIANAO WATER VENDOR

Cardenas, a city of twenty thousand people, more or less, is set down in the midst of a swamp, rarely more than ten feet above sea-level, and oftener only three or four. Its narrow streets are lacking in pavements or sewers. Lying contiguous to the south-east side of the city are more than thirty thousand acres of swamp, a fecund breeding-ground for typhus-and yellow-fever germs. Twenty years ago a commission was appointed to inquire into the construction of a canal to drain this swamp into the Anton River, but at this present date no canal is in sight, and the fever germs go merrily on in their work of supplying the cemeteries with subjects. The water supply is good, but many of the people prefer to buy dangerous well-water from street vendors, because of its cheapness. At Cape Hicacos, near Cardenas, are extensive salt-pits, the chlorides of which are supposed to act as a disinfectant, and that immediate locality is said to be the most healthful along the coast.

Puerto Principe, a town of forty thousand inhabitants, the largest of the inland cities, is situated on high ground, well watered and well drained, and though antiquated and utterly lacking in modern conveniences or sanitary regulations, as they are known among northern people, is so much more healthful than other Cuban towns as to warrant a milder animadversion than in the case of others. Yellow fever is only known sporadically, if at all, and contagion and infection are so much less flourishing than in the coast towns that Puerto Principe seems positively healthful in comparison, albeit in an American community the condition of the city would warrant the impeachment of any board of health having control of its sanitation.

Santiago de Cuba, with a population of, say forty thousand, is next to Havana in importance among the cities of Cuba, and has been accumulating filth since 1514, when the first Spaniards settled there. Just what nearly four hundred years of Spanish sanitation means is better imagined than experienced. Moreover, its location is down among hills which shut off the breeze, and in summer the city becomes intolerably hot and dangerous to health. It is situated on a hillside, with a landlocked bay before it, removed from all sea or coast currents, and for 384 years the drainage of the town—not by sewers, for they do not exist—has gone into this bay, until its bottom and waters are vile beyond expression. In the city itself filth everywhere prevails—or did prevail until the United States authorities took charge, since which time Governor Wood and his assistants have done an amount of cleaning up that is as wholesome as it is difficult to accomplish. This work has been so vigorously prosecuted and the results so beneficial that a chapter has been devoted to the subject. It is said that in time man may become accustomed to any condition of life, and the dozen generations of Santiagoans seem to have got used to their town, for its ordinary death-rate was but 29.8 per 1000, with an increase to 33 to 35 when yellow fever or smallpox became more violent than usual. In 1895 the death-rate went up to 51.2 per 1000, and in 1896 to 82.77. Four thousand people died in that year, and this is the last record known. This large increase was due to the presence of unacclimated troops from Spain, and though it may explain the high death-rate, it scarcely can excuse a sanitary condition which is so fatal to Spanish soldiers, who have had experience with Spanish sanitary regulations in their own country until they ought to be almost used to it. In 1896 there were 372 deaths from yellow fever and 509 from smallpox. Santiago has one inventive sanitarian in the person of Dr. Garcia, who, five years ago, devised a “cold box” for the case of yellow-fever patients. As is known, the frost will kill the germs of yellow fever; and as natural frost is impossible in Cuba Dr. Garcia hit upon the idea of producing artificial cold. His device is simple enough. The main feature is a small house, say five feet by seven, and six feet high, which is practically a refrigerator, with double roof and walls for packing the ice. A window is put in for light, and the patient is laid in his bed in a temperature of about freezing. He has no attendants inside, except when needed, and he is watched through the window. This method usually kills or cures the patient in from twelve to thirty-six hours. At first the box was not successful, for condensation practically drowned the patient out; but that was remedied by draining the water off. There is a great difference of opinion in relation to the efficacy of this treatment; some physicians entirely disapproving it, while others as strongly recommend it.

What may be done for the proper sanitary regulation of Santiago is a serious problem, as, owing to the distance from the sea and the landlocked character of the bay, the sewage, which may be easily drained down the sloping streets of the town, is bound to remain near the shore. For the present, Major Barbour, Superintendent of the Santiago Street Department, disposes of the sewage by sprinkling it with petroleum and burning it.

Manzanillo, population nine thousand, with a large and beautiful military plaza, has filthy streets and no public improvements of any kind looking to the health or comfort of the people; and the people seem to like it. The streets are unpaved, and Manzanillo mud is an alliterative term which has become a household word for the nastiest mud on the Island. The town is twenty feet above the bay, with hills to the rear, and near it are great swamps filled with mosquitoes and malaria, which spread themselves abroad in every direction.

Guantanamo, population nine thousand, seven miles inland, one hundred and fifteen feet above the bay of the same name, is situated on the river Guaso, and might be easily and thoroughly drained; but no efforts have been made in that direction, and malaria and fevers prevail. With any kind of decent care, the city could be made as healthful as any in the same latitude.

Pinar del Rio, the capital of its province, with 5500 population, is situated 25 miles from the sea, 160 feet above it, and on a hill 70 feet high. It is in the midst of the famous Vuelta Abajo tobacco district, and it might be made a clean town; but its streets are narrow and filthy, its people are a mixture of French and African, and it is a reflection on the great American Republic, in that it was founded in 1776.

Batabano, the southern seaport of Havana, thirty miles away, in its narrow, dirty streets presents a condition of neglect and nastiness suggesting that it is also a receptacle for the surplus refuse of the capital.

Guanabacoa, a high and beautifully located city of twenty-five thousand people, just outside of Havana, several degrees cooler than the capital city, in the midst of pleasant breezes and cool groves, has narrow, filthy streets, no pavements, no public improvements, small houses with no modern conveniences, huddled together, and is a dozen times worse than if nature had not done so much for it.

GÜines and Marianao are so much cleaner and sweeter than any other towns as to make one wonder why they are the exception instead of the rule.

Possibly it is hardly fair to call attention to or animadvert upon the sanitary regulations and conditions of Santa Clara, an inland city and capital of Santa Clara Province, seeing that in ten and a half months of 1897 there were over one hundred thousand deaths in the province, of which nearly one third occurred in Santa Clara district. These were chiefly reconcentrados, and show that there are some things Spanish even worse than Spanish sanitation. The town has a population of twenty thousand, is situated in a healthful locality, and while little has been done toward public health, there is no yellow fever.

As with the cities and towns above mentioned, with the two exceptions named, so of all Cuban aggregations of population. Everywhere there is ignorance, carelessness, filth, disease, and death, and only education, care, and time can remedy the evil. It may not, cannot be that Cuba will ever enjoy the robuster health of the north, but she can be clean, and to that end must every ability of knowledge, labour, and means be directed, not only by those who are in authority, but by those whose direct welfare is at stake.

Outside of the cities, conditions prevail which will be more difficult, if not in many cases impossible, to remedy. Much of the Island along the coasts is swampy; there malaria and fevers breed, and these sections, if not capable of drainage, must be deserted by man, and left to the alligators, toads, and lizards. Many of the swamps may be drained and the land converted into fields yielding rich harvests; these should be given the proper attention. In many places the tropical forests are of such dense and tangled growth that no sunlight ever penetrates them, and here, after nightfall, deadly miasmas arise, full of poison and disease. Vast areas of such forests are filled with valuable timber, and when these woods are cleared and converted into money, and the sunlight can get in and exercise its saving grace upon the land, a wonderful improvement will follow.

Back from the coasts, particularly in the eastern part of the Island, the land is high and well drained, with mountains in some portions rising from five thousand to eight thousand feet above the level of the sea. While the heat and humidity incidental to the latitude prevail all over the Island, they are much less in the uplands than along the coast, and the climate for half the year is very agreeable and the air has a brilliant clearness that has become famous. Over all these lands there should be in the future a population which should develop into a contradiction of the tradition that the people of the tropics live because they are too lazy to die.