SUPPLEMENT.

REMARKS ON CLIMATE IN CONNECTION WITH THE PREVALENCE OF
YELLOW FEVER.

which have such records.

The Commission is in possession of the meteorological records of Havana for twenty years, recorded in the metrical system, and occupying hundreds of printed pages. It has, in addition, records for one or more years of several other places, in fact of all of the few places From these records an expert in meteorology may possibly be able to add to our present knowledge. In the mean time, a few facts in reference to a subject which all concede has an essential connection with yellow fever seems imperatively called for in any consideration of the causation of the endemicity of this disease.

1. Temperature. The "annual mean" is conceded to be the factor of greatest moment in this connection. This, in Havana, varies in different years from 77° Fah. to 79°. The mean temperature of the hottest month varies from 829 to 849.5, and of the coldest month from 72° to 75°.7. While the minimum temperature is rarely as low as 50°, the maximum is as rarely 100°. There are no records, nor any recollection of frost having ever occurred, except on December 24 and 25, 1856. This, of course, has no reference to the sparsely inhabited mountains, some of which attain in the eastern end of the island an altitude of more than 8,000 feet.

Notwithstanding the unquestioned influence of heat, yellow fever is by no means always most prevalent when this is greatest. From Cuba to Guiana the disease has repeatedly prevailed with little severity during the hottest summers, and with great severity during the winter.

2. Rains and moisture.-The average annual rain-fall is about 50 inches, and the number of rainy days 102. There is no reason to believe that in any warm climate where there is abundance of water to evaporate there can ever be a lack of as much atmospheric moisture* as the yellow-fever poison probably does require. Dutroulan asserts, as to Martinique, "often after and during the driest season yellow fever has committed its greatest ravages." The same fact has been observed in other places.

3. Winds.-No connection has ever been established between the

prevalence of yellow fever and the prevalence of the wind from any
special quarter. While there is evidence that violent winds, storms,
or hurricanes exercise an unfavorable influence on those dangerously
sick with yellow fever, there is evidence fully as convincing that such
winds tend, as any currents of uninfected air must tend, to dilute
the poison, thus to diminish its activity, and thereby to reduce the
number of cases attacked.
4. Electricity.-Repeatedly, as in New Orleans and the South in 1878,
violent epidemics have been attributed to the absence of electrical
storms and to a diminution of the quantity of electricity in the air;
probably even oftener the reverse has been maintained, especially in

Vera Cruz and in the West Indies.

5. Magnetism. For a series of years the College of Belen in Havana kept a record of the variations of terrestrial magnetism. In 1868 Dr. Poggio, of the military hospital in Havana, made a careful terrestrial magnetism. "The result of a very careful investigation comparison, day by day, of the variations in both yellow fever and was total disappointment."

6. Ozone. In the severe epidemic from October, 1862, to February, 1863, at Santa Cruz, in the Canary Islands, ozonometrical observa tions were made, which tended to show an increase of ozone as the epidemic declined; and Dr. Fuzier, chief of the French military hospital at Vera Cruz, 1861-1865, also testifies to having "proved the feeble quantity of ozone in places which yellow fever prefers;" but until the chemical tests for ozone are more satisfactory, and such observations are repeatedly confirmed, science must maintain its skepticism.

the annually varying productiveness of animal life. Some of the
most thoughtful students of yellow fever, while conceding that no
one meteorological factor suffices to account for the propagation of
the disease, are yet very firmly convinced that there is some undeter-
mined combination of these factors which is essential. This convic-
tion is based on the fact that in places where yellow fever frequently
prevails as an epidemic there had been repeatedly present, without
giving rise to an epidemic, a combination of the three factors most
usual and important, namely, the presence of the poison, as proved by
cases of the disease, an ample supply of unacclimated persons, and a
persistence of apparently the very same insanitary local conditions
observed during seasons when the disease was epidemic.
It will be very difficult, if not impossible, to determine what may
be this supposed meteorological combination until vital statistics
have so greatly improved that the influence of all other disturbing
causes, such as the varying number of the unacclimated exposed to
the poison, the quality as well as quantity of the insanitary condi-
tions, &c., can be rigidly eliminated from the problem. Finally, it
should not be overlooked that climatic conditions may exercise a two-
fold influence, one favorable to the poison, the other favorable to pre-
paring the individual for its reception.

IV.

THE INSANITARY CONDITION OF THE PORTS OF CUBA AND THE CAUSES
THEREOF.

This subject will be illustrated sufficiently for present purposes by
the consideration of the four principal ports, Havana, Matanzas, Car-
been procured as to other ports indicating that their condition differs
denas, and Cienfuegos, and especially of the first. No facts have
from these four in any important particulars.
The actual sanitary condition of every place is best tested by its
annual death-rate, which necessitates for its calculation the number
of the population and the number of the deaths which occur every
year in this population. In Cuba it is unusually difficult to procure
these data. The last trustworthy official census published was for
the year 1862, (sometimes designated the census of 1861, also of 1863,)
and a copy of this could not be procured until a short time before the
commission's departure from Havana. The more recent census of
So much
1877 has not yet been published, and much delay and difficulty were
at times discrepant, data in manuscript from this census.
encountered in obtaining from official sources a few insufficient, and
care is required in handling these data of population that errors are
One is the error due to such
constantly committed by nearly all who treat the subject. Two fre-
a fact as that there is a district of Matanzas, in the city of Matanzas,
quent sources of error will be alluded to.
in the municipality of Matanzas, in the jurisdiction of Matanzas, in the
province of Matanzas, and some who state the population of Matanzas
mean one of these political divisions, while others mean another, and
there is frequent omission to desiguate which division is meant. An-
other error is due to the failure, often unavoidable, to keep the civil
apart from the military population.

Still greater difficulties are encountered in establishing the number of deaths which exactly correspond to any given population. The statistician is perplexed, not only by the confused mode of rethe prevailing Cuban custom of reporting deaths by church parishes, porting dead civilians and soldiers variably intermingled, but also by which do not correspond with the political divisions in the census of the population. This Cuban habit of thus living politically and dying religiously is most vexations to the statistician, if not to the moralist, and when considered in connection with other confusing perplexities, all recorded in the Spanish language, some idea may be formed of the care and labor required of one not conversant with this language to avoid being led astray. The following Statistical Table No. 9 has been compiled with such care that any errors which it may contain 7. Alkalinity of the air.-Dr. Carlos Finlay, a chemist and distinguished physician of Havana, claims to have discovered an impor- must be too trilling to invalidate the general results. But before tant correspondence between the prevalence of yellow fever and the proceeding to the examination of the mortality statistics of the four varying degree of alkalinity of the air at Havana and several adja-principal ports of Cuba a few words by way of introduction will prove instructive in reference to the cent places. This subject will hereafter receive the special attention of a member of this Commission.

DEATH-RATE OF CUBA.

In fine, science has thus far failed to prove the essential connection with yellow fever of any one meteorological factor, except heat; and what duration and degree of this are requisite is very indefinitely known. It should, however, not be forgotten that this indefiniteness of knowledge is by no means limited to yellow fever, but applies to other diseases, as also to the varying crops of vegetables and • The annual mean "relative humidity" varies in different years from about 73 to 74.3, and that of different months of the year from 66 to 79. TABLE NO. 9.-Statistics of the population, births, and deaths in four of the principal ports of Cuba for the years 1876, 1877, and 1878.

Dr. Melero published in 1878 an able article on the vital statistics of Cuba, apparently to "show that the mortality in this island is not so great as represented by many, and that the climate is not as deadly "It appears from these statistics that as it has been believed to be." the death-rate in Cuba in 1827 was 26, in 1846, 24, and in 1861, 32 per 1,000 population." The three years mentioned are those of the most reliable official censuses.

Havana3

Ports.1

Annual average of three years.

Civil population, census 1877.

Births or number of baptisms.

Deaths.

Years.

Death rate

per 1,000 population.

TABLE NO. 9.-Statistics of the population, births, and deaths in four of the principal ports of Caba for the years 1876, 1877, and 1878-Continued.

In 1877 Havana had 17,259 houses for about 206,000 civil and military population; Matanzas had 4,710, Cardenas 2,289, and Cienfuegos 1,929 houses. 2 Asiatics or Chinese are included in the "white" population, viz: 5,723 in Havana, 1,314 in Matanzas, 2,042 in Cardenas, and 669 in Cienfuegos. Asiatics were first introduced in 1847, and some 50,000 to 1873, about which date the importation ceased. There were about 22,000 in Cuba in 1877. 3 The reports, published in Havana, include in the annual deaths those of soldiers and sailors dying in the military hospitals; these deaths in the military population are excluded from this table: they were 1684 in 1876, 3,078 in 1877, and 2,913 in 1878.

4 In Cardenas yellow fever was unusually severe in 1879, and there were 479 deaths by all diseases to August 30.

5 In Cienfuegos 1879 was an unusually healthy year, yet the deaths to September 1 were 496, which indicate an annual death rate of 37 per 1,000 population. The high death rate of 67 in the above table conveys an exaggerated idea of its unhealthfulness, because in 1876 and 1877, in fact from the date of the insurrection, 1 868, Cienfuegos was frequented by many soldiers and refugees. It, however, has been found that its death rate during the five years, 1860-64, averaged 50 per 1,000 of the 9,950 population of the census of 1862.

The facts just stated in regard to the water supply, and to the soil, are potent and incessant causes for pollution of the air. Among other such causes will be mentioned those which have connection

with the streets and houses.

5. STREETS.

About four miles west of the entrance to the harbor of Havana the river Almendares empties into the sea. It is fed chiefly by springs, and the water is said by experts to be good. Since about 1600 Havana has received its chief supply from this small stream-first by means of the "Zanja," or water-course (in truth a ditch); second, in 1835, by the "Aqueduct of Ferdinand VII;" and third by the "Aqueduct of the Vento,* or of Isabel II," which, begun in 1859, has cost more than $3,000,000, and will require nearly as much more to complete. Although Havana now obtains its water through all three of these channels, these fail to furnish it with a supply adequate, either in quantity or quality. The uncompleted "Aqueduct of Isabel II" is a monument of the engineering skill of Colonel Albear, and if ever completed will furnish the city with an ample supply of pure spring-ordinary dimensions usually found in the United States. Matanzas, water. From the point where completed as much of this good water has been directed into the Aqueduct of Ferdinand VII as this has capacity to carry. Since this is totally insufficient, the water of the Zanja is still used, in whole or mixed in part with the other supply, throughout a large portion of the city. The water of the Zanja flows for some four miles through unprotected mud banks, the fluids from many houses drain into it, men and horses bathe, and dead bodies have been seen floating in it. It cannot be pure. But the impurity of this supply of water to a portion of the population is an evil slight in comparison to that which results from the inadequate supply of water of any kind to the whole population. So costly and so inadequate is this supply that very few houses of the working class are provided with it, and a large portion of the population purchase their water daily in kegs and carboys from street-vendors. This mode of obtaining water prevails in Matanzas, Cardenas, Cienfuegos, and many other places, and in most of these to even greater extent than in Havana.

The insanitary evils which result from this general insufficiency of water in a tropical climate are much greater than would ensue farther north. When bathing becomes difficult, and washing so exorbitant that it costs from twenty to thirty cents in gold to have a gentleman's shirt washed, it is not strange that personal cleanliness should be so little attended to that an unusually large portion of the people are offensive to the smell. This lack of cleanliness extends within the houses, into the unpaved streets, the stables, markets, and for the most part everywhere. Farther details are useless, as also insistance upon the pollution of the soil, and of the air, and of other manifest evils, which necessarily result from an insufficient supply of water. It should never be forgotten that "clean water, adequately used, is among the simplest, safest, best of antiseptics," and that the people of Havana and other cities are very insufficiently supplied with this antiseptic.

2. SOIL.

While a varying proportion of Havana, Matanzas, Cardenas, and Cienfuegos is built upon ground elevated from ten to one hundred feet above the level of the sea, another very considerable portion occupies the site of former mangrove swamps, which have been filled up, in large part, with the refuse and garbage from the streets. Swamps of this kind still lie contiguous to all of these cities. A very large proportion of the population live where the subsoil water is reached in from two to six feet of the surface, and it is very common to find privies wherein the contents rise and fall with the tide. In higher localities the thin surface soil and the foundation rockst beneath it are extremely porous, and permit a high degree of saturation from the subsoil water, from the frequent and abundant rains, and from excrementitial fluids. So great is this saturation, and the defective structure of the houses, that a moisture-mark is found high up on the walls even of many houses located from fifty to one hundred feet above the sea.

The older a Cuban city, or any part thereof, the narrower the streets. About one-fourth of the population of Havana live within the now demolished walls, and this "intramural" population possesses streets so narrow that on every corner is posted either "up" or "down," to indicate to all vehicles that they must pass only in the direction indicated. As time extended the city farther and farther beyond its walls the streets gradually became wider, until some attained the Cardenas, and Cienfuegos were founded subsequently to Havana, in the order mentioned; therefore Matanzas has many narrow streets, but not as narrow as Havana; Cardenas few, and Cienfuegos none. The narrower the streets the less well ventilated the houses thereon, and a large portion of Havana suffers severely from this cause. About one-fourth of the population of Havana live on paved streets, which are as well paved and kept as clean, probably cleaner, than is usual in the United States. The remainder live on unpaved streets, which for the most part are very filthy, and not a few of them are, at times, impassable in a vehicle. Rough, muddy, or both, many of them serve admirably as permanent receptacles for much decomposing animal and vegetable matter. In fine, more than half the population of Havana live on streets which are in a foully insanitary condition; but these streets, though so numerous, are not in the track of the pleasure tourist. In this capacity one of the members of this commission spent ten days in Havana in 1856, but never looked for, and therefore never saw, most of the evils which he now testifies to with emphasis.

6. HOUSES.

Four-story houses are the highest in Havana, and exceedingly rare; three-story houses are infrequent, and so few are the two-story houses that more than nine-tenths of all the houses were, in 1862, and are still, one-story houses. These one-story houses occupy very little space; they have no back-yards, properly so called, but a court or narrow vacant space into which sleeping-rooms open at the side; in direct contact with these are the kitchen, privy, and often the stables, which terminate this court. There are no storerooms, pantries, closets, or other conveniences for household supplies; but there are commonly four groceries on the corners of each square from which table supplies are procured at each meal. In Havana some of the floors, in Matanzas more, in Cardenas and Cienfuegos many, are of earth or of planks almost in contact with the wet soil. In Havana most of the floors are of brick or stone paving. Ventilation between the ground and the floor is almost unknown in Cuba. In every city most of the floors are on a level with the sidewalks, and many are even lower than the level of the streets. Most of the houses in Havana and many in other cities are of "mamposteria," or rubble masonry, which is very porous and absorbs readily, as the wall-moisture abundantly testifies. The roofs are of tile and excellent. The ceilings are high, and the doors and windows are generally very large; but this is true rather for the front and rear of the main building than for the side rooms which open into the court, and are also occupied as sleeping apartments. The privy is almost a part of the kitchen; it consists of an excavation which often extends several feet under the stone flags of the court; it is never emptied until it will hold no more, which seemed generally to be from five to ten years; it has no ventilating pipe, and belches forth its nauseous odors at times even to the front door. Nothing more unwholesome and disgusting than the privies of Havana and of Cuba generally can be conceived. They are so bad they cannot be worse. In juxtaposition with the privy is As a general rule good drainage is found in no parts of these cities, another excavation to receive the filthy refuse-water of the kitchen, except in the comparatively inextensive localities where nature has needed no assistance. One is often astounded by the impassable discharge of such water into the streets, except while it is raining. laundry, and household generally, for police regulations prohibit the mud holes, and by the green, slimy, stagnant water present in the This refuse-water is said to undergo a putrefaction which renders it streets and in the back yards of even a locality such as the Pueblo intolerably offensive. It notably aids the contents of the privy to Nuevo Ward of Havana, which is situated so admirably for good saturate the soil beneath the house. The kitchen is usually under drainage that but little labor would be required to make it perfect. the same open shed with the privy, and often in immediate contact A comparatively small number of the streets in the most densely with these is a stable. So near are horses kept to sleeping apartpopulated portions of Havana have sewers, some of which emptyments that farcy would be more frequent than it is if the horses were into the harbor and others into the sea. A well-informed civil engineer testified that the sewers of only three streets subserved any good More cheerless and comfortless houses than those occupied by the purpose, and that the remainder were so faulty that the city would be better off without them. Covered by grating having large inter-working classes and the people generally would be difficult to find. Since water is ill supplied the people are not more cleanly in their spaces, the dirt and refuse of the streets find such ready entrance that houses than in their persons. But as badly constructed and kept as a number of these sewers were seen filled up with solid materials to are their houses rent is rendered very high, as are also food and within a few inches of the grating. Since very few houses are connected with these sewers they are the less offensive, but no one who clothing, by taxation and by export as well as by import duties. As one illustration of this, when flour was $6 per barrel in the United has seen them can find any words, except of unhesitating condemnation, for their grossly defective structure. Etiologists have repeatedly States it cost in Havana $15.50. Owing to such causes most workassociated the causation of yellow fever with upturning of the earth, such small tenement-houses as have been described. It is very rare men, even those receiving from $50 to $100 wages per month, live in so that this is prohibited during the summer in some parts of the for a workingman to have a house, however small and mean, for the United States. If there be in Havana any such prohibition this was exclusive use of himself aud family. He is forced to rent out every certainly not enforced during the summer of 1879. room, reserving for his own family one, perhaps two. The result is

affected with it to a larger extent.

*Specimens are in possession of the National Board of Health,

that these little houses, occupying an unusually insignificant space of ground, are densely crowded. So that in every city the proportion of inhabitants to houses is enormous, especially when the diminutive size of these one-story houses is considered. The proportion of the civil and military population to the houses in Havana is nearly twelve to one. *

wonted putridity and phosphorescence of the water of its harbor
and it deserves record that while the former was present in 1879 the
latter was not. It is alleged that vessels of the British navy are for-
bidden to use this water on board for any purpose whatsoever.
On the eastern and southern shore there are some five depots for
ballast, which is often deposited on the very edge of the harbor, with
the lowest layer of the ballast in contact with the water, composed
for the most part of friable porous rocks and the dusty detritus
thereof, intermingled often with sand and earth, and the frequent
recipient of human excrements. This ballast, all the materials of
which freely absorb fluids and gases, should, in our present ignorance
of yellow fever fomites, be treated as dangerous.* Ballast from
places where yellow fever prevails has repeatedly given rise to justi
fiable suspicion that it was one of the agents for transplanting the
poison.

The sanitarian cannot hesitate to advocate the cleansing of the harbor, the cessation of daily additions to it of large masses of filth, and the replenishment of it by constant currents of purer water. To accomplish the last, canals have been advocated in the United States, as well as in Cuba. For the present, a brief reference to this subject will suffice. Havana is by no means lacking in highly edu terests of the city, and to the merits of this special subject. Among these, Colonel Albear, who is at the head of his profession, and vicepresident of the Academy of Sciences, &c., read before this society in September, 1879, a paper on this subject, which will soon be published in Cuba. He is said to have demonstrated, conclusively even to the advocates of these canals, that, even if constructed and at a necessarily enormous cost, they would altogether fail to accomplish any good purpose, and would tend, on the contrary, to aggravate present evils.

The condition of the houses has been poorly described if the description does not account for the fact that in the summer season a fæcal or urinary odor, due to men or horses, prevails generally, and that in traversing the streets a musty, nauseous, or fæcal odor is distinctly perceptible as it oozes from the doors and windows (which habitually open immediately on the streets) of almost every house. With time one's olfactory nerve becomes benumbed, and fails to give warning of the stench, if faint, of the privy and of the stable. There has been no intention to convey the idea that houses may not be found in New York and other American cities as foul as they can be, and, therefore, as foul as they are found in Cuba; but in the former these evil conditions are seen as exceptions, confined to narrow, disreputable limits, while in Havana these conditions in the "homes of the poor" are widespread and general. Moist, foul, stagnant air, confined low to the ground, is found everywhere, so everywhere can be seen the refuse of fruits and vegetable substances, fur-cated, skillful, practical engineers, fully alive to the sanitary innishing abundant materials for decomposition, while numerous turkey-buzzards, roosting on the trees and house-tops of populous cities, sufficiently testify to ample supplies for animal putrefaction. These gross insanitary evils are as abundant in Havana, where yellow fever always prevails, as in Canton and Bombay, where this disease never There is one more subject which deserves brief notice in connection with air-polluting causes and with theories maintained as to yellow fever. Sanitarians were greatly offended by the burial of the dead of Havana in its churches until 1806, when the "cemetery of Espada" was established outside the walls. In the course of years the growing city surrounded this cemetery, and to this was again attributed, among other insanitary evils, a bad influence on yellow fever. Overcrowded with more than three hundred thousand dead bodies it was closed in 1871, since when all the dead of Havana have been interred in the new "cemetery of Colon," which is admirably located and too distant from the population to exercise upon it any evil influence. It is noteworthy that there has apparently been no abatement in the prevalence of yellow fever.

occurs.

7. THE HARBOR.

It has now been shown that the actual sanitary condition of Havana and other Cuban ports is very bad; that the water supply is, in part, defective in quality and wholy insufficient in quantity, and that hygienic laws are so violated that many causes are in constant operation to grossly pollute the soil, the air, and the harbor. We are now prepared to consider the next subject, first reminding the reader that a violation of hygienic laws is prone to be followed by the worse results the warmer the climate and the denser the population-disastrous conditions, which approach their maxima in

Havana.

V. The means by which these insanitary conditions can be best made satisfactory. Pages 70-85.

VI. The means which can and should be adopted to prevent the introduction of the cause of yellow fever into the shipping at Cuban ports. Pages 86-108.

V.

THE MEANS WHEREBY THE INSANITARY CONDITION OF CUBAN PORTS
CAN BE BEST MADE SATISFACTORY.

To rectify the insanitary conditions of Havana and of other ports it is manifest that the causes thereof must be removed. Pure water must be supplied in unusual abundance to the poor as well as to the rich; the swamps and lowlands must be drained and raised with rock and earth instead of with garbage; old sewers must be reconstructed and new sewers be constructed to diminish subsoil moisture and subserve all other sanitary purposes which sanitation requires of them; the streets must be in large number widened, regraded, and so paved or repaired that they can be readily kept clean; the houses must be in very large proportion torn down and reconstructed on a be filled up and abandoned and a new system introduced; the stables must be removed, at least from close proximity to sleeping apartments; the harbor and its shore must be cleansed and kept so; and, finally, the filthy habits of the common people generally must be reformed and their ignorance of the means by which to protect themselves from disease must be fed with knowledge. To accomplish all this in Havana alone would require millions of money; but these these evils only in part. However, since the financial problem is a most important one some of its factors will be stated.

The beautiful harbor of Havana, adorned with surrounding hills which are surmounted by picturesque forts, and having diversified banks covered either with variously colored houses or with verdure encroaching upon the water, has three chief horns. It is three miles long from its entrance to the extreme limit of the most distant horn. The narrow entrance, some four hundred yards in width and twelve hundred in length, leads into the irregular bay, which may be said to average two-thirds of a mile in width and a little more than a mile in length. Its greatest depth is about thirty-six feet, but the anchorage ground for vessels drawing eighteen feet of water is very contracted, not exceeding one-half the size of the harbor. The number of vessels in this harbor in 1878 at any one time varied from forty-seven to two hundred and twenty-seven, and the average number exceeded one hundred, so that it is rare to see any one vessel more than a very few hundred feet distant either from another vessel or from the shore. The rise and fall of the tide does not exceed two feet, and the water is not otherwise replenished except by five or six little brooks, which are utterly insignificant except after a heavy rain. Though pleasing to the eye, though sufficiently commodious and remarkably safe for shipping, this harbor is to the sanitarian little more than an almost stagnant pond or great cloaca into which is daily discharged the refuse-comparatively little of it being fæcal-different plan; the excavations for privies and for refuse water must from more than one hundred thousand people with their domestic animals, all the filth from numerous vessels, the blood, offal, and other refuse from several hundred slaughtered animals, and the facal as well as other refuse from the chief military hospital, and probably from other houses which are rarely without some cases of yellow fever. A considerable portion of the city drains into the sea, and it would be well if all of it did, but engineers pronounce this impracticable. Much of the eastern and southern shores are desti-requisite millions expended in sanitary engineering would correct tute of wharves; many of these, where they do exist, are dilapidated, worm-eaten, rotten, and all of them serve as traps for entangling the abundant filth poured into the harbor. All along the shore, as in usual in seaports, this filth is very apparent, and this is most offensively the case along the southern shore where the water is more stagnant than elsewhere; where the harbor is fast filling up, and where the adjacent land is low. Notwithstanding these facts, the water of the harbor failed to pre-one-third of a much less prosperous population than has the United sent evidence, as is elsewhere stated, of special putridity, nor did it during the summer of 1879 manifest the remarkable phosphorescence usual at this season, and for which it has long been particularly noted. Several high authorities in the literature of yellow fever associate the unwonted prevalence of this disease at Havana with the un*In the chief cities of the United States, excluding New York, the number of persons to the dwelling varies from about 5.5 to 8.5.

The so-called river of Luyano is properly classed among these insignificant brooks.

It is estimated by experts in such matters that the sanitary engineer would require not less than $20,000,000 to correct some few of the most glaring insanitary evils-such as have relation to the water supply, the drainage, the sewerage, the paving of the streets, and to the harbor. Where is even this sum to come from? Spain, with States, owes a larger debt on which she cannot pay even the annual interest. Our people complain of the excessive national taxation imposed since 1861-'65; but Spain, by direct and indirect taxation, by onerous export as well as import duties, derives from the 1,400,000 people of Cuba, exhausted by the insurrection of 1868-78, more than six times as much revenue as the United States derives from an equal number of its population. Thus, the government renders exorbitant

*Many specimens of ballast are in possession of the National Board of Health.

house rent, (thereby causing overcrowding), food, clothing, and nearly
all other necessaries to healthy life, and discourages the construction
of more numerous and better houses, because these and all other evi-
dences of increasing prosperity insure renewed exactions from the
tax-collector.
"Since 1868 the annual expenditures of Cuba have far exceeded
the revenues," which even in time of peace are in greater part ab-
sorbed by the army and navy. Besides its full share of this vast
national or colonial burden, the city of Havana derives for its own
support, from its 195,000 population, an additional $1,700,000 annu-
ally. Who, having a knowlege of these factors in the financial prob-
lem, can answer from whence is to come the many millions of dol-
lars indispensable to render the insanitary conditions of Havana at
all satisfactory?
Including the financial together with all other requisites to the
end in view, the answer to the question "What can and should be done
to render the insanitary condition of Havana and other ports satis-
factory?" must be the same as would apply, unfortunately, to numer-
ous other places within as well as without the United States: The
people must be provided with means to become intelligent, enlight-
ened, especially in hygiene, prosperous, and sufficiently numerous to
eventually gain both the knowledge and the power necessary to
correct their insanitary evils. This is not only the best, but the only
means. Until their accomplishment (which the present generation
will not live to witness) Havana will continue to be a source of con-
stant danger to every vessel within its harbor, and to every southern
port which these vessels may sail to during the warm season.
While these are the conclusions of this Commission, there were
formerly many, and there are still some few, who, without personal
experience or extensive knowledge of this special subject, look upon
it in a much simpler light. They pronounce yellow fever "a nauti-
cal disease," and seem to believe that if means were adopted to rid
ships and harbors of the poison generated, as is alleged, and con-
tained in them, there would be an end of it. Since this view leads
to practical results of great sanitary importance, the facts in the
matter have been carefully examined in Cuba, and also the records
of the facts in other of the West Indies.

1. ORIGIN OF YELLOW FEVER IN SHIPS AND HARBORS.

localities on the land, he adds that the opinion of the French naval surgeons, as expressed in their official reports, is unanimous on this point. Finally he testifies that the better the anchorage of a vessel, the farther its distance from the shore and from centers of population, and the more absolute its non-intercourse with the shore, the more completely is such vessel protected from yellow fever. Béranger Féraud, though a distinguished ship-surgeon and the author of three able works on yellow fever, manifestly considers this alleged origin of the disease on ships so untenable that in his last work of 1878 he does not deem it necessary to specially consider the subject. However, when referring to the means for protecting ships he says: "Ships should be prevented, as much as possible, from communicating with the land, for the greatest number of sailors attacked come from ships in the docks, or are those who have most frequented the shore, while the ships most distant from the shore and from infected vessels escape." And it may here be added that the common experience of mariners in the ports of the West Indies teaches them specially to avoid the shore.

Dr. Fuzier, a French army surgeon in high official position during that most favorable period for observation, 1861 to 1865, when France occupied Mexico, and at that most favorable place for observation, Vera Cruz, denies absolutely the spontaneous origin of yellow fever on ships.

While such is the evidence derived from the highest French authorities, the experience in the Spanish navy is not less emphatic. Dr. De Caneda, a distinguished medical officer of this navy, long stationed in Havana, and president of the yellow-fever commission appointed by the Governor-General of Cuba to aid this commission, incidentally wrote, August, 1879, in an interesting report, not on this special subject: "It is frequently observed that the first cases on board ships of the Spanish squadron are of those persons whose duty calls them oftenest to the shore." Dr. De Caneda appointed Surgeons Goler, Medina, and San Roman from the naval sanitary corps at Havana as a special commission to report on the questions propounded by Dr. Chaillé, president of the United States commission. Their valuable report contains the following: This commission "is of the opinion that of the individuals of the navy, stationed in Havana, those most liable to contract yellow fever are those who inhabit the arsenal, and who frequent the wharves,"-"the farther the vessels are anchored from the wharves the less their danger of being attacked by yellow fever;" and the members regret they have not sufficient time to collect statistical facts in detail "to demonstrate beyond question the truths stated, and derived from their personal experience and judgment."

It may be premised that he whose knowledge of yellow fever is limited to its occurrence in any one place is an unsafe guide to general conclusions, and would be likely to improve these conclusions the more numerous the places included within his knowledge; that practitioners of medicine, obtaining their livelihood by their skill exclusively in the cure of disease, are by no means necessarily well instructed in the etiology and prevention of disease; and hence that far less deference is due to their authority than to that of those physicians who have studied yellow fever in many different places and have made its etiology and prevention their special study. Naval surgeons, and especially those among them charged with marine sani-esting letter which accompanies the table instructively summarizes tation, are of all other medical men best entitled to credence and confidence in this matter. Evidence from two such French witnesses will first be submitted, one of these being A. F. Dutroulau, "premier médecin en chef de la marine," who had more than twenty years' personal experience of yellow fever, particularly in Martinique, and the other being Béranger Féraud, who held the same high post in the French navy, and also had extensive personal experience. Each of them was charged at different epochs with the duty of preventing yellow fever on ships and in seaports; and while surrounded for years by special opportunities for observation, was required by imperative official duty to study particularly the causation and prevention of yellow fever.

Dutroulau calls attention to the suggestive fact that the absence of an epidemic in endemic localities and the comparatively good sanitary condition of such places have been the chief facts which have misled those who advocate the origin of yellow fever on ships. He might have added, as additional sources of this erroneous theory, the failures to observe and to report whether vessels cited as convincing examples of local origin had ever been in any infected locality or had ever had on board any source of infection, and the ignoring of the length of time the poison may lie dormant and then renew its activity. In regard to this, though our knowledge is still very indefinite, it none the less can present many proofs of the great tenacity of the poison to a locality once infected, and of the revivification of the poison after months of dormancy due to lowered temperature. Dutroulau also calls attention to the well-known fact that vessels employed in voyages to China and the East Indies, though subjected | to prolonged tropical heat and the worst insanitary conditions, the identical causes assigned for the origin of the disease on ships in the West Indies, have never been even accused of developing yellow fever on board.

Fortunately that able and zealous officer of the United States, Dr. D. M. Burgess, who had been earlier notified of the report desired by this commission, was enabled to collect statistical facts in detail and to present a very valuable tabular statement of these facts. The publication of this table is reserved for the final report, but the interthe results, and will be presented in full, after one necessary explanation. Dr. Burgess, as well as this commission, designates a vessel having one or more cases of yellow fever on board "infected," but both parties are well aware that while such a vessel should be regarded in practice as infected, yet it cannot, with rigid scientific accuracy, be so proved unless cases have developed on board within the time-say six days-since those attacked had opportunity to become infected by some place, thing, or person outside the vessel.

"No. 2 TACON STREET, HAVANA, CUBA, October 4, 1879. "STANFORD E. CHAILLÉ, M. D.,

"President of the Havana Yellow Fever Commission, &c. "DEAR SIR: Your communication soliciting answers to the following questions in regard to the infection of vessels by yellow fever, while lying in the harbor of Havana, is received. In reply I would say that since definite statistical data are very much wanting on this subject, more credence is asked for personal experience and observation than would be otherwise desirable.

"First question: Which vessels are more apt to be infected, those at wharves or those at anchor?'

Proceeding to facts of personal observation, Dutroulau testifies that after continued observations, dating from 1832, he was compelled to publish in 1851 that in not one single instance of many infected vessels did the disease originate on board. Subsequent special investigations from 1850 to 1857, as to all ships of war at Guyana and in the sea of the Antilles-of which ships a large number were infected-showed not one on which the disease originated spontane-anchor near the shore, or those more distant?' ously, or until after the vessel had anchored in an infected harbor. Asserting emphatically that ships get their infection from infected

"Twelve years of constant professional intercourse with, and observation of shipping while lying in this harbor, convince me beyond all question that those vessels which lie at wharves suffer incomparably the most. Even in winter, when no cases of the disease can be found on vessels anchored in the open bay, and which do not permit their crews to go ashore, it is not at all unusual to find that vessels lying at wharves are invaded by the disease. In the summer months vessels which discharge at wharves nearly all become infected, as a reference to the facts relating to the infection of the vessels in this harbor, recorded in the accompanying table, will verify. In this, it will be seen, that of thirty-one vessels which discharged at wharves during the months of July, August, and September, 1879, twentyeight became infected, only three escaping. One of the latter should be thrown out of the calculation, as its whole crew were acclimated. Thus it will be seen that only one vessel in fifteen at the wharves during these three months escaped infection.

"Second question: Which vessels are more apt to be infected, those at

"All of my observation, as well as the facts recorded in the accompanying table, sustain me in the assertion that the liability to infec