From the table on page [71] it will be seen that for ten years preceding our occupation of Havana there had been an average of more than five hundred deaths per year from this disease in the city; that in 1900, two years after we had taken possession of the city there were 310 deaths from yellow fever. A further search of the mortality statistics shows that yellow fever had existed in Havana continuously from the year 1762. This was the year during which Havana was besieged and captured by the English forces. The troops were largely made up of colonials from the North American colonies, and they suffered severely from yellow fever. For two hundred years before this time Havana had been subject to epidemics of yellow fever, but from 1762 up to the year 1901, there was probably not a single day when Havana did not have a case of this disease within its bounds.

In February, 1901, the measures above described were begun. Under these measures yellow fever rapidly disappeared, and in September of that year, the last case of yellow fever occurred. With one exception there has been no case of this disease in Havana since that date.

The work directed against mosquitoes had an equally good effect upon malaria. While the work done with the view of getting rid of the stegomyia was effective to a certain extent against the anopheles, the principal anti-anopheles work was executed in the suburbs of the city. It is a general rule that malaria does not occur in the heart of a city, but generally in its outlying districts. The reasons for this will become evident when I describe anti-malarial work in one of our future chapters.

Deaths from Malaria in the City of Havana

YearNo.YearNo.YearNo.YearNo.
187126218822231893246190444
187231618831831894201190532
187332918841961895206190626
187428818851011896450190723
187528418861351897811190819
187633418872691898190719096
187742218882081899909191015
187845318892281900325191112
18793431890256190115119124
18803841891292190277
18812511892286190351

It will be seen from this table that before the year 1901 Havana had yearly from 300 to 500 deaths from malaria, rising as high in 1898 as 1,900 deaths. Since 1901 there has been a steady decrease in the malarial death rate until the last year of the table, 1912, when there were only four deaths. Four deaths from malaria in a city of the size of Havana, about 300,000 population, means the extinction of malaria in that city. For the island of Cuba is in the tropics, and there are many malarious localities through the country districts. Havana is the metropolis of Cuba, and has in its environs the largest and best equipped hospitals of the country, as well as the most distinguished surgeons and physicians. The sick, therefore, are brought from the country in considerable numbers, and a great many cases of malaria are brought in among these outside sick. The tables quoted above include all persons who died within the limits of the city of Havana, whether they came from the outside, or were residents of the city; whether they died in the large hospitals of the city, or in private houses.

Four deaths in one year from malaria can very safely be put down as coming from the outside, and it can with equal safety be said that by 1912, malaria had become as completely extinguished in Havana, as had yellow fever in 1902.

The extinction of malaria, however, did not attract anything like the attention that the extinction of yellow fever had aroused. The work of Dr. Ronald Ross and his co-workers with the anopheles mosquito, and of Reed and his associates with the stegomyia, undoubtedly gave the knowledge whereby the practical extinction of malaria and yellow fever was accomplished at Havana, but the accomplishment of this work with regard to yellow fever was the event which attracted the greatest attention. It seems almost providential that we had all the machinery at hand whereby the discoveries of the Reed Board could be immediately tested and demonstrated. Here was a large city of 250,000 inhabitants in which yellow fever had been endemic for one hundred and fifty years. The American Army had been in control of the city for two years, and the Health Department was thoroughly organized and equipped and under the charge of a medical officer of the regular Army. Dr. Reed himself was strongly impressed with the advantage it had been to him to have his discoveries given so thorough and conspicuous a test, and wrote me to that effect many times.

There has been a great deal of discussion as to who deserves the credit for this great discovery. Undoubtedly Reed and his Board brought all the threads together and actually made the great discovery, but Finlay, Sternberg, Carter and others, started the spinning of many of these threads. Like all great discoveries everywhere it was gradually led up to by many workers.

Nothing is more true than the following quotation from one of Huber’s papers: