An elaborate code of Health Regulations, a volume of fifty pages, exists, but it is seldom or never referred to or its provisions carried out. Dairies prevail in many parts of the city, where twenty to thirty cows are kept in stalls in the same house where human beings live; livery stables are located in the most thickly settled parts of the city; dead dogs, cats, and other animals are left in the open streets for weeks; slops, filth, and night soil are thrown out of the windows and doors on the streets in the poorer localities and no kind of regard is paid to health regulations of any kind.

The condition of the harbour is gone into at length, one new fact being noted, to wit: that the water is so foul that the bottom cannot be seen two feet below the surface, while at Marianao, eight miles away, the bottom at twenty feet is plainly visible.

Both General Greene and Surgeon Davis are of the opinion that the harbour is not such a menace to health as are the cesspools, slaughter-house, and general filth of the city, and that it should come last in the cleaning process.

In recapitulation, General Greene says:

"From the foregoing it is apparent that the first steps toward sanitation are the improvement of the slaughter-house, the cleaning of cesspools, the inauguration of a proper system of street cleaning, and the devising and rigid enforcement of health regulations. I have therefore advised that immediately on taking possession of the city government a board be appointed, consisting of three army surgeons and two civilians--one from New York and one from Chicago--of long experience on the Health Boards in those cities; that this board study the sanitary conditions of the city and draw up a new code of sanitary regulations, including the management of the hospitals; and that this code be rigidly enforced by the new city police, a.s.sisted by such number of sanitary inspectors as may prove to be necessary. In this manner I believe that the sanitary conditions can be improved and the death-rate enormously reduced before the next rainy season sets in. The death-rate in October last was at the rate of 133 per 1000 per annum; in December it had been reduced to 106, and with only two deaths per week from yellow fever.

"In order completely to stamp out yellow fever it will be necessary to destroy a limited number of the worst infected houses occupied by the poorest cla.s.ses, to construct a system of sewers, and lay new pavements. This will involve a very large expenditure of money, and it is not at present clear how the city can raise this money.

It is probable, however, that a feasible financial scheme could be devised after thorough study, and in the meantime a commission of engineers should be appointed to study the problem, and either acquire the existing surveys by purchase, at a fair valuation, or else make new surveys, and a definite report covering the whole ground, so that the matter may be intelligently considered."

EXTRACTS FROM REPORT OF THE HAVANA YELLOW FEVER COMMISSION, 1879

TEMPERATURE

"This is conceded to be a climatic element of greatest importance, and the 'annual mean' to be the chief factor. Throughout the West Indies the mean annual temperature, near the sea, is from 78 degrees to 80, the mean daily range is only about 6 degrees, and the extreme annual range does not usually exceed 20 degrees. At Havana the mean annual temperature varies in different years from 77 degrees to 79; the mean temperature of the hottest months, July and August, varies from 82 to 85 degrees; and of the coldest months, December and January, from 70 to 76 degrees. The minimum temperature is very rarely as low as 50 degrees, and the maximum as rarely exceeds 100 degrees; in fact, the thermometer, in the shade, seldom rises above 94 degrees. There are no records nor any tradition of frost having ever occurred except on December 24 and 25, 1856. It is alleged that even in the spa.r.s.ely inhabited mountains in the east of Cuba, where the Tarquino peak reaches an alt.i.tude of about 8000 feet, frost rarely occurs, and snow never."

RAINFALL

"During the sixteen years, 1859-74, the average number of rainy days at Havana was 113; the minimum number, 97 days, occurred in 1869, and the maximum number, 141 days, occurred in 1862. The average amount of rain for the sixteen years was 49 inches, the minimum was 42.5 in 1861, and the maximum was 70 inches in 1867. The maximum amount of rain falling in any one season is from May to September, inclusive, but especially during August and September. The rain then descends with such rapidity that it runs off in torrents; but, as is seen, the usual belief that the annual rainfall is excessive is erroneous. The annual mean relative humidity varies in different years from about 73 to 74.5, and that of the different months of the year from 66 to 79; the minimum, occurring in any day of the year, may be as low as 34, and the maximum as high as 96. Evaporation is extremely rapid."

ANNUAL DEATHS IN HAVANA, 1870-79

----+-----------+-----------+----------------------------------------------- | | | | Deaths | | DEATHS BY | by all | | | | | Diseases | Deaths by | YELLOW FEVER. | SMALL POX.| CHOLERA.

| in the | all | | | | Military |Diseases in+-----------+-----------+-----------+----------- | and Civil | the Civil | Military | | Military | Military |Population.|Population.| and Civil | Civil | and Civil | and Civil | | |Population.|Population.|Population.|Population.

----+-----------+-----------+-----------+-----------+-----------+----------- 1870| 10,379 | 9,451 | 665 | 277 | 681 | 1,655 1871| 9,174 | 8,290 | 991 | 796 | 1,126 | ....

1872| 7,031 | 6,036 | 515 | 372 | 174 | ....

1873| 7,755 | 6,932 | 1,244 | 1,019 | 47 | ....

1874| 9,604 | 8,523 | 1,225 | 1,236 | 772 | ....

1875| 8,390 | 7,044 | 1,001 | 94 | 711 | ....

1876| 9,122 | 7,438 | 1,619 | 904 | 160 | ....

1877| 10,217 | 7,139 | 1,374 | 567 | 97 | ....

1878| 11,507 | 8,594 | 1,559 | 758 | 1,225 | ....

1879| 9,052 | 7,826 | 1,444 | 737 | 523 | ....

+-----------+-----------+-----------+-----------+-----------+----------- | 92,231 | 77,273 11,837 6,760 5,516 1,655 ----+-----------+-----------+-----------+-----------+-----------+-----------

"Spanish army losses to January 16, 1896:

Killed in action and died from wounds......... 405 Died from yellow fever........................ 3,190 All other diseases............................ 282 ----- 3,877

"Total mortality of Spanish army in Cuba in 1897 (from Public Health Report, U. S. Marine Hospital Service, April 29, 1898):

Died from yellow fever........................ 3,190 Deaths from yellow fever...................... 6,034 Deaths from enteric fever..................... 2,500 Enteritis and dysentery..................... 12,000 Malarial fevers............................... 7,000 All other diseases............................ 5,000 ------ Deaths from all diseases............. 32,534

"The above table ... clearly proves that 'the actual sanitary condition of the princ.i.p.al ports of Cuba' is very unfavourable, since, in recent years, their death-rates have ranged from 31.9 to 66.7. It also proves that the sanitary condition of the inland towns is very little, if at all, better than that of the seaports. The high death-rates of Guanabacoa and of Marianao are especially notable, because these suburban towns, within three and six miles of Havana, are summer resorts, and enjoy, especially Marianao, a high repute for salubrity.

Taking a general view of the death-rates for the total population of all the twenty towns in the above list--towns selected solely because the only ones which furnish reliable official reports, though many others were solicited, it will be found that twenty-six death-rates are given; that these range from 23.5 to 66.7, and that, while only eight of the twenty-six are under 35, twelve of them are 50 or more."

"The portion of the city in worst repute is the fifth district, and especially Jesus Maria, one of its wards. This is, to considerable extent, reclaimed swamp lands, filled in largely with street refuse and garbage. It fronts the bottom of the harbour. Its rough, unpaved streets are in many places almost impa.s.sable in wet weather, even to pedestrians. Great mud-holes, covered with green slime, and fit only for the abode of hogs, are numerous. The houses, as well as the streets, have an uncared-for, filthy, and disgusting appearance; and the sickly, anaemic residents look as dirty and cheerless as the streets and houses.

"The Punta or Colon wards in the third district--at least the portions which immediately front the sea--have a reputation almost as bad as the Jesus Maria ward. The foundation rocks were, during the last century, excavated to build fortifications, and these excavations were filled up with street refuse and garbage; hence this ward is, like Jesus Maria, to some extent, reclaimed land. These portions are alleged to be very unhealthful, while houses only six or eight blocks distant are not so; comparatively light rains flood the _banquettes_ and run into the houses. The streets are wider and the houses better than in Jesus Maria.

Some consider the location of the latter, at the bottom of the harbour, a chief cause for its unhealthfulness, but the unhealthy portion of the city now referred to fronts the sea.

[Ill.u.s.tration: THE PRADO AND INDIAN STATUE, HAVANA.]

"The Pueblo Nuevo ward, still farther to the west, also fronts the sea, and is built on a slope which attains an alt.i.tude of nearly seventy feet. Notwithstanding these advantages, it is very badly drained, and has, as it apparently deserves, an ill repute for healthfulness....

"The three suburban wards, Jesus del Monte, the Cerro, and Vedado, enjoy the best reputation for salubrity, and also for their freedom from yellow fever. Intelligent residents are readily found, who will a.s.sert with great a.s.surance that no one is ever attacked in these wards except those who have been elsewhere infected. The summit of Jesus del Monte has an alt.i.tude of 67 meters, or 220 feet, the highest point in Havana, or its immediate vicinity. However, there are few, if any, houses about the summit; the average level of the ward is only 80 feet, and more inhabitants live below than above this level. The natural drainage is excellent, the houses in the elevated portion occupy more ground and are better ventilated than in Havana."

GEOLOGICAL FORMATION

"The surface soil of Havana consists for the most part of a thin layer of red, yellow, or black earths. At varying depths beneath this, often not exceeding one or two feet, lie the solid rocks. These foundation rocks are (especially in the northern and more modern portion of the city, towards the coast of the sea and not of the harbour) quarternary and especially tertiary formation so permeable that liquids emptied into excavations are absorbed and disappear. In the southern and greater portion of the city, these rocks are of cretaceous formation, and so much less permeable that sinks and other excavations readily fill to overflowing. About twenty thousand persons or one-tenth of the population, live on land reclaimed from the sea, in large measure, by dumping on garbage and street refuse. Much of this reclaimed land was formerly mangrove swamps, and Havana still lies adjacent to these breeders of malarial poison. There are few if any towns in Cuba which are not subjected to malarial effluvia from mangrove or other swamps, and many of these suffer to greater extent than Havana."

Messrs. Ariza and Herrera reported a population of 3000 on the reclaimed parts of the first district, 5000 on parts of the third and fourth, 5000 on part of the fifth, and 600 on part of the sixth district.

THE CLEANSING OF THE HARBOUR

"The sanitarian cannot hesitate to advocate, for general reasons if not especially for yellow fever, the cleansing of the harbour, the cessation of daily additions to it of large ma.s.ses of filth, and the replenishment of it by constant currents of pure water. To accomplish the last, it has been much insisted on, in the United States, as well as in Cuba, that ca.n.a.ls should be dug. Out of Cuba it ought to be better understood that Havana is by no means deficient in highly educated, skilful, practical engineers, who are fully alive to the sanitary interests of the city, and to the merits of this especial subject. Among these, Colonel Albear stands pre-eminent, and in September, 1879, he delivered before the Academy of Sciences an extremely able address on this subject, which is so full of instruction, on other local conditions also of interest to the sanitarian, that this address has been translated and is presented, as a most interesting part of this report. Colonel Albear seems to have conclusively demonstrated the impracticability of these proposed ca.n.a.ls; and my own conviction is that if practicable they could not possibly place the small harbour of Havana in as favourable sanitary conditions as are by nature the large harbour of Matanzas and of Cienfuegos, where yellow fever none the less prevails."

DRAINAGE

"In Cuban cities, generally, good drainage is not found except in such comparatively inextensive parts where nature required little or no a.s.sistance. Even in Havana, the oldest and wealthiest city, the visitor is often astounded, especially in the rainy season, by impa.s.sable mud-holes, and green, slimy, stagnant pools in the streets and in the backyards. This condition was found even in the Pueblo Nuevo ward, which is located so admirably for good drainage that little labour would be required to make it perfect.

"Messrs. Ariza and Herrera reported: 'Havana has no sewers save in a few princ.i.p.al streets. These sewers have been built at interrupted intervals, without reference to any general plan for drainage. They are seldom cleaned and are generally obstructed in part or wholly with sediment or filth from the streets, and exhale offensive odours. As the sewers are few in number, the greater part of the water of the city empties through the streets, into the harbour or the sea; but the quant.i.ty flowing into the sea is comparatively small.' Mr. A. H. Taylor, a civil engineer, thoroughly informed on this subject, testified that the sewers of only three streets subserved any good purpose whatever, and that the remainder were so defective that the city would really be much better off without them. Through the gratings, which have large inters.p.a.ces, the dirt and refuse of the streets find such ready entrance that a number of these sewers were soon filled up, with apparently solid materials, to within a few inches of the surface openings. Since very few houses or privies are connected with sewers, these are less offensive than they would otherwise be, but no one who has seen them can find any words except of unhesitating condemnation for their grossly defective structure."

THE PAVING OF STREETS

"Less than one-third of the population live on paved streets, and these are well paved and kept as clean, it is believed cleaner, than is usual in the United States. The remainder live on unpaved streets, which for the most part are very filthy. Many of these, even in old and densely populated parts of the city, are no better than rough country roads, full of rocks, crevices, mud-holes, and other irregularities, so that vehicles traverse them with difficulty at all times, and in the rainy season they are sometimes impa.s.sable for two months. Rough, muddy, or both, these streets serve admirably as permanent receptacles for much decomposing animal and vegetable matter. Finally, not less, probably more, than one-half of the population of Havana live on streets which are constantly in an extremely insanitary condition, but these streets, though so numerous, are not in the beaten track of the pleasure tourist, in which capacity the writer, in 1856, spent ten days in Havana without witnessing many of the evils now testified to with emphasis."

DENSITY OF POPULATION

"Of the various evils recounted in connection with the subject of houses, there are two which deserve special attention. Many facts, besides those a.s.sociated with the holds of vessels, justify the belief that the growth of the poison of yellow fever is specially favoured in warm, moist, ill-ventilated places, where air is closely confined. The low-lying floors touching the earth, the small, densely packed houses, the unusually contracted ventilating s.p.a.ce in their rear, the large unventilated excavation for privies and sinks, all furnish, as is firmly believed, the most favourable breeding-places for the poison of yellow fever. In addition, statistics prove that in great cities subjected to their ordinary unfavourable conditions, the denser their population the sicklier and shorter-lived their inhabitants. Common-sense and experience unite to teach that the denser a population the more widespread and frightful the havoc of diseases, especially of communicable diseases. Elsewhere will be found a special report on the density of the population of Havana compared with numerous other cities, and it therein appears that more than three-fourths of the people of Havana live in the most densely populated localities in the world. A tropical climate renders this enormous evil still greater. Not only in Havana but throughout Cuba the average number of inhabitants to each house is unusually great, and this fact enables us better to understand the great prevalence in Cuba of those communicable diseases which its climate and other local conditions favour.

"The Registry Office in Havana reports that there are upwards of eighteen thousand fincas in this registry district, which comprises the village of Marianao in addition to the city of Havana.

"A finca is a piece of land, with definite boundaries or limits whether large or small, and whether it has buildings on it or not.

"Of the eighteen thousand fincas in the district about fourteen thousand have houses upon them, and the other four thousand being vacant lots in the city, or fincas rusticas, in the rural districts.