468 



HEALTH, NATIONAL BOARD OF. 



fever exists " ; " to be observed by the health 

 authorities of a place free from infection, hav- 

 ing communication with an infected place " ; 

 "concerning the course to be adopted in a 

 place already infected with yellow fever." 

 These publications carefully embody the best 

 sanitary and medical views of the day, and 

 give plain and sensible directions for practical 

 use. Reading them produces a conviction that, 

 well followed, they would not only stay the 

 progress of yellow fever, but increase the av- 

 erage of human health and life by eradicating 

 the cause of half the ills which flesh is heir to. 

 Inspectors and other employees of the Board 

 may have erred through too much zeal ; they 

 may have been too inquisitorial ; they may have 

 been rash in telegraphing cases which were 

 disproved by later diagnosis. In these ways 

 they may have produced panics and injured the 

 material interests of some communities, which 

 have already suffered too much. These are the 

 difficulties to be expected in the working of a 

 new and untried scheme. But they are errors 

 on the right side. The public has not here- 

 tofore been satiated with too much truth. In 

 the end it will work out good. Nothing is 

 more calming to apprehension than the certain- 

 ty that there is no concealment. The publica- 

 tions of the Board have had a wholesome effect 

 on public opinion in regard to sanitation. The 

 people have learned the difference between 

 dirt and filth, and, instead of resting satisfied 

 with superficial cleanliness, they are seeking 

 to eradicate the hidden evil. 



In the diversity of opinions, the weight of 

 testimony inclines to the view that yellow 

 fever is a specific disease not originating in 

 this country, but chiefly from the West Indies, 

 where it has its habitat. In order to make a 

 scientific examination of these important ques- 

 tions, the National Board organized a commis- 

 sion, composed of three physicians and a civil 

 engineer, to visit the island of Cuba, called 

 " the Havana Yellow Fever Commission of 

 the National Board of Health of the United 

 States." The Board instructed this Commis- 

 sion 1st, to ascertain the sanitary condition of 

 the chief ports of Cuba, and to determine how 

 to prevent the introduction of the cause of 

 yellow fever into the shipping ; 2d, to investi- 

 gate the pathology of yellow fever and the 

 changes and results which it produces in the 

 human body ; 3d, to obtain all information in 

 regard to the endemicity of yellow fever in 

 Cuba. In addition the Board enjoined them 

 to attack other unsolved and perhaps insoluble 

 problems in regard to the nature and natural 

 history of yellow fever. They were to experi- 

 ment on animals, and to seek to discover the 

 immediate cause of yellow fever other than 

 the production of the disease in man. Amply 

 supplied with apparatus, photographic, micro- 

 scopic, and chemical, for the prosecution of 

 these researches, the Commission sailed from 

 New York on the 3d of July, and arrived in 

 Havana on the 7th. The Captain - General 



furthered their aims in every way, and ap- 

 pointed twelve eminent physicians and savants 

 as an auxiliary commission to cooperate with 

 the American Commission during their stay, 

 and to continue the study of yellow fever after 

 their departure. Much valuable information 

 collected is due to the zeal with which these 

 learned and courteous gentlemen seconded 

 their American confreres. A circular con- 

 taining questions was distributed over the 

 entire island. The responses from Spanish 

 commissioners, American consuls, physicians, 

 and scientists furnished the Commission with 

 reports, the most extensive yet amassed touch- 

 ing yellow fever. 



The subjects proposed by the Board were 

 treated in the following order : 



I. The principal ports of Cuba from, which 

 shipments are made to the United States. The 

 " ports of entry " of Cuba are fifteen in num- 

 ber, of which eight are on the northern and 

 seven on the southern side. The island has 

 also two hundred minor ports on its coast-line 

 of 2,200 miles. Twenty-five hundred vessels, 

 carrying thirty thousand sailors, pass annually 

 from Cuba to the United States. More than 

 two fifths of these enter the port of New York. 

 In 1875 only 571 out of 2,236 sailed to the 

 eighteen ports south of Norfolk, which alone are 

 liable to yellow fever. The intercourse with 

 Cuba is largest during May and June, and de- 

 creases during the summer months. The peo- 

 ple of the United States may well ask them- 

 selves whether their welfare would not be 

 promoted by suspension of intercourse during 

 the dangerous months. In January, 1879, it 

 was stated before the Congressional committee 

 investigating the epidemic, that the restriction 

 on the West India trade of New Orleans in- 

 jured that city to the extent of $100,000,000. 

 This statement passed unchallenged. The to- 

 tal exports of Cuba in 1878 were $70,881,552. 

 Imports into New Orleans from Cuba amounted 

 to. $2,043,697. The United States is an indis- 

 pensable market to Cuba, and any loss arising 

 from the restriction of commerce to certain 

 months would fall chiefly on the shipping in- 

 terest. Sanitary hindrances to this trade do 

 not and will not cause loss to any great amount. 



II. The endemicity of yellow fever in Cuba. 

 Though it may be suspected that the sickness 

 which prevailed in Santo Domingo in 1493-'94, 

 and in succeeding years in various countries 

 bordering on the Caribbean Sea, was yellow 

 fever, the first unquestionable epidemic of this 

 fever occurred in 1640, in Guadeloupe. Its 

 first recorded appearance in Havana was in 

 1761. The next year Havana was captured 

 and held by English soldiers, and was ravaged 

 by another epidemic. Before 1761 Cuba was 

 noted for its salubrity. Yellow fever could 

 not have prevailed, if at all, to any great extent. 

 Since 1761 it has been present every year, and 

 it is therefore said to be endemic. Some au- 

 thorities aver that yellow fever was imported 

 from Africa in the slave-ships. Several thou- 



