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 fœcal 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.”