SANITARY WORK IN CUBA
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.
[Illustration: 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:
January ................................ 1,081
February ............................... 1,518
March .................................. 1,500
April .................................. 1,411
May .................................... 1,298
June ................................... 1,129
July ................................... 1,381
August ................................. 1,975
September .............................. 2,390
October ................................ 2,249
November ............................... 1,828
------
Total ............................ 17,760
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:
"Vienna, with its million and a half of population, has been called
the pest-hole of Europe, because of its death-rate of more than
twenty-five to the thousand; yet Havana, with less than one-sixth
of its population, has more deaths in one month than Vienna in
twelve. The deaths this year in Havana will outnumber those in
Chicago by probably five thousand, and will exceed the totals of
Boston, St. Louis, Baltimore, and San Francisco combined."
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:
"I now have the contract for cleaning the streets and have been
connected with the city government a long time. The present system
of cleaning the streets is a combination of old and new. When I
took up the work about five years ago, I ascertained that the
system was very deficient, so I went to New York and studied up the
matter. To begin with, the pavements were very bad. The automatic
street-sweepers cannot be used to advantage, though I have two
sweeping-machines. At night time my people go out with the
sweeping-machines and a sprinkler and clean the streets, and from
there the dirt is taken to the railroad cars and from the station
about nine miles from here, and there I do some business with it;
that is, I make a kind of fertilizer. I employ 230 men. We have no
furnace to burn up the garbage. I am now going to make a
proposition to the city council to clean the cities for the same
price and use crematories, doing it on the American plan. For
cleaning the city I am to be paid $2350.50 weekly, but I do not get
the money; they owe me $180,000. A year or two ago, by giving ten
per cent. to the city mayors, etc., I collected $20,000 in one
week. Immediately after I got the contract the aldermen called upon
me and directed my attention to certain articles in it, so that I
finally had to take these aldermen into partnership in order to
collect the money.
[Illustration: WATERMAN IN THE COUNTRY.]
"I have also had the slaughter-house privilege. I paid the city
council $800,000 per year for the privilege of collecting the
slaughter-house taxes, and one year I collected nearly $880,000,
out of which, of course, I had to pay my men. This has fallen off
a great deal. To slaughter cattle, you have to pay 4-1/2 cents per
kilo, $1 per head for the corral, $1.25 to kill and dress it, and
then 50 cents to take it to the market. The present slaughter-house
is a new one, and not very efficient at present, but it could be
made into a good one. All the refuse from the slaughter-house now
goes into the bay."
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:
"Here in this garbage reservation can be seen large numbers of
buzzards, feasting on dead horses or dogs, or perched on the
cemetery walls, waiting for fresh consignments. Extensive lagoons
and lakes of foecal matter taken from privy vaults lie spread
upon the ground. A small section of this reservation faces the bay,
and here the collector of the garbage has his living-quarters, in
an old tumble-down hut.
"The only cemetery is situated a mile and a half from the heart of
the city. It is surrounded by a wall twelve feet high, which
furnishes vault room. The cemetery is very small and the section
reserved for paupers is more than overcrowded. During my visit ten
graves were being dug. By actual measurement I found these graves
three feet in depth. Coffins are loaned by the municipalities to
paupers, and the bodies alone are buried. In these pauper graves
three bodies are buried, one over the other; and then, in less than
one year's time, they are reopened and made ready for new bodies.
Portions of skeletons were thrown out of each of the ten graves I
saw. In consideration of a dollar, a grave was opened for me, and I
counted four skulls. In closing up the graves, these bones are
packed around the new bodies. As a rule the topmost corpse is so
near the surface that the earth has to be banked up a foot in order
completely to cover it.
"_Water._--This is one of the most serious problems which confront
the municipal authorities of this city, and one of much concern to
us, if American troops are to be quartered there. The supply is
absolutely inadequate to the demands of the city. The hotels and a
few residences have cement cisterns built in the ground and use
rain-water; but the chief supply comes from a small (and said to be
badly polluted) stream, the Jicotea River, a small branch of the
Cannau. The water is pumped into two aqueducts; the principal one,
which is called after the Jicotea River, holds four hundred
thousand litres; a smaller one, the Bouffartique, holds three
hundred thousand litres. Pipes from these two aqueducts run through
a few of the streets, above ground, alongside the curbing. The
gates are open only two hours daily. The hospitals use this water,
after boiling. As a remedy for this condition, I am told, there was
a project to bring water from a point twenty miles distant, from
the falls of the Hanabanilla River, 1200 feet above the sea.
Absolute freedom from pollution was claimed. It was abandoned on
account of the war. The estimated cost for this work was
$1,000,000. The Jicotea aqueduct is simply a large open cistern,
built of rock and cement, attached to a brick building in which the
Spanish quartermaster has his stores. There are about two hundred
wells in the city, but infected, the privy sinks being within a few
feet.
"_Quarantine._--At a point nine miles from the city, on the western
shore, I found, in my opinion, an ideal location for a quarantine
station. The place, the Concha, owned by the Marquis de Apezteguia
as a winter resort, can be purchased. The palace, built on a
terrace near the water's edge, was burned by the insurgent forces.
A pier thirty to fifty feet can be built so that steamers can have
eight fathoms of water. An island about one-half a mile distant
could be used, and a hospital for infectious and contagious
diseases built.
"In concluding this report I wish to call your attention to the
probability of an extensive spread of smallpox in the interior. At
a town eight hours' ride from Habana to Colon, I saw beggars
convalescent from smallpox."
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:
"There can be no doubt that the ravages of tuberculosis could be
materially arrested by compliance with the laws of hygiene.
Infractions of civil law may or may not be punished, but
infractions of the laws of hygiene are inevitably paid for sooner
or later. In combating tuberculosis we must consider the air we
breathe, the food we eat, the roof that covers us, and the clothes
we wear. The disease should be recognised as contagious. Phthisical
patients should be kept in well-ventilated apartments; sputa should
be disinfected, and clothing and utensils used by such patients
should be disinfected."
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.
[Illustration: 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.