58 CUBA AND PORTO ItICO 



If we compare these rates with that of London (18.8) or 

 those of some of the principal seaport cities in the United 

 States, it will he evident that there is ample room for 

 sanitary regeneration. 



The chief diseases causing death in Havana are, first, 

 tuberculosis; second, the group of intestinal diseases in- 

 cluding diarrhea, dysentery, and cholera infantum; and, 

 third, yellow fever, a disease which chiefly affects strangers. 

 Of these diseases the first class is world-wide, and need 

 not be discussed further than to say that its presence 

 here is favored by the prevalent humidity, and that 

 those affected with it should keep away from the wet 

 tropics in general. Of the second group of diseases, their 

 occurrence in Cuba is largely due to an ignorance of pre- 

 cautionary hygiene, concerning exposure, water, and food, 

 which is a little denser there than in our own country. 

 Their elimination is dependent upon education. The third 

 disease the horrible vomito, or yellow fever is a serious 

 problem, beyond individual control, and requiring the at- 

 tention of united governmental action. This disease is now 

 thoroughly established in Havana, which was at one time 

 " justly considered one of the most healthful localities on 

 the island." Parts of the city are permanently infected 

 with the germs of the disease, and are considered one of the 

 main foci from which it is spread, and the source of all of 

 its outbreaks in this country. 



The occurrence of this disease in Havana has been 

 studied in its every aspect by the highest medical officers 

 of our army and marine hospital service, and its probable 

 causes have been admirably set forth by Surgeon-General 

 Sternberg in the " Century Magazine " of August, 1898. It 

 is shown that the cause may not be the filthy condition of 

 the harbor so much as the densely crowded and unsanitary 

 condition of the houses of the poor, together with the 

 primitive disposition of the sewage. Of the various evils 

 recounted in connection with the subject of houses, there 

 are some which deserve special attention. Many facts 



