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.
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.