Annual report of the National Board of Health. 1879

APPENDIX B.

THE HAVANA COMMISSION.

PRELIMINARY REPORT OF THE HAVANA YELLOW-FEVER COMMISSION OF THE NATIONAL

BOARD OF HEALTH, SUBMITTED NOVEMBER 18, 1879, BY S. E. CHAILLÉ, M. D., CHAIRMAN, AND G. M. STERNBERG, M. D., U. S. A., SECRETARY.

This report is submitted in accordance with the following resolution of the commission adopted September 25, 1879, and subsequently approved by the National Board of Health:

"Resolved, That, subject to the approval of the National Board of Health, the chairman and secretary be appointed a committee to draw up a concise preliminary report, stating the general results accomplished by the commission; also, that each member make a detailed report of his own work in the investigation; which special reports shall be made with such detail and labor as may be consistent with the views of the National Board of Health and with the opportunities of the several members for the further study of the subjects which have especially engaged their attention in Havana." The memorandum of instructions for the commission appointed by the National Board of Health to visit the island of Cuba for the purpose of investigating certain points connected with the prevalence of yellow fever in that island, states that in organizing the commission the National Board has more especially in view the following desiderata:

First. To ascertain the actual sanitary condition of the principal ports in Cuba from which shipments are made to the United States, more especially the ports of Havana and Matanzas, to determine how these sanitary conditions can best be made satisfactory, and more especially as to what can and should be done to prevent the introduction of the cause of yellow fever into the shipping of these ports.

Second. To increase existing knowledge as to the pathology of yellow fever, that is, as to the changes and results which it produces in the human body.

Third. To obtain as much information as possible with regard to the so-called endemicity of yellow fever in Cuba, and the conditions which may be supposed to determine such endemicity. This of course involves a careful examination of neighboring localities where the disease does not appear to have its cause permanently localized. The three points above referred to are believed to be those which will most certainly yield results to scientific investigation, and which therefore should receive the special attention of the commission.

But in addition to these the National Board of Health desires that the commission shall consider certain problems relating to this disease; problems which may be entirely insoluble, but which nevertheless are of such importance that an effort should be made to decide whether the National Board of Health will be justified in undertaking the labor and expense which will probably be required to obtain anything like a complete solution of them, if such solution is at all possible. These problems relate to the nature and natural history of the cause of yellow fever, and the most important preliminary investigation on this point is to ascertain some means of recognizing the presence of the immediate cause of yellow fever other than the production of the disease in man. These means might, for example, be the production of some special phenomena in some of the lower animals, or it might be the finding of a special microdeme in all yellow-fever cases, and no others. It is obvious that if it is found possible to produce some specific symptoms in some one of the lower animals by exposing such animals in localities known to be capable of producing the disease in man, and thus establish a physiological test of the presence of the cause of the disease, we may even hope to be able to determine the nature and the natural history of this cause, although prolonged investigation may be necessary to effect it.

With the time and means which the National Board of Health can at present put at the disposal of the commission no complete investigation is possible. All that is hoped for is that the commission will be able to obtain some grounds for a positive opinion as to whether it is probable that such an investigation would put us in possession of the test referred to.

It is not proposed to go into details as to the modes of attacking this problem; but one thing is insisted on, and that is that as far as possible what is done shall be so done and so recorded that it need not be done again hereafter.

It is expected that the commission will organize itself and devise for itself the methods and order of carrying out the work above indicated. It is desired that the report to be furnished the board shall be made by the members jointly as a commission. In other words, it is expected that each member will be careful to verify the results obtained by the other members, or to note distinctly the absence of such verification. H. Ex. 10-3

The following extract from letter of June 26, 1879, contains further instructions: "It is the wish of the National Board of Health that the work above specified under several distinct heads should engage the earnest attention of all members of the commission until such work is completed, to the exclusion of all other lines of investigation, such, for example, as the clinical observation and record of cases."

The following resolutions of the National Board of Health, dated June, were received:

"Resolved, That Dr. G. M. Sternberg, Dr. S. E. Chaillé, T. S. Hardee, C. E., and Dr. J. Guiteras, appointed to make investigations at Havana, Matanzas, and other places in Cuba, be, and are hereby, directed to complete their organization under the title of "The Havana Yellow-Fever Commission of the National Board of Health of the United States,' by the election of a permanent chairman, and secretary, who shall be disbursing officer of the commission, and by the adoption of rules governing the commission.

"Resolved, That a quorum to transact business shall be three, and its action shall be binding upon individual members.

"Resolved, That all official communications to the National Board of Health from the commission shall be signed by the president and secretary.

Resolved, That when the commission has effected a permanent organization, it shall transmit to the National Board of Health its plan of organization, including all its rules, and thereafter shall regularly transmit weekly reports of progress."

In compliance with the foregoing instructions, received June 20, "The Havana Yellow-Fever Commission of the National Board of Health of the United States" was organized by the election of Dr. S. E. Chaillé as chairman, and Dr. G. M. Sternberg as secretary, and by-laws were adopted for the government of the commission.

At a meeting of the commission held in Washington, D. C., on the 23d of June, the following resolutions were adopted:

"Resolved, That Dr. Chaillé and Colonel Hardee be appointed a committee to conduct that portion of the investigation indicated in memorandum of instructions, No. 1, under headings "First" and "Third," and Drs. Sternberg and Guiteras a committee to conduct that portion of the investigation indicated in the same memorandum under heading "Second," and under additional instructions following "Third," and relating chiefly to the nature and natural history of the yellow-fever poison.

"Resolved, That each committee procure before sailing such apparatus and appliances as will be required in that portion of the investigation under its immediate direction."

The National Board of Health, had some time previously, after consultation with Surgeon J. J. Woodward, U. S. A., ordered the following microscopic apparatus, viz: One army stand of Zeutmyer (Philadelphia); one large stand of Powell & Leland (London), with eye-pieces, achromatic condenser, &c., and the following objectives: 4-inch, 2-inch, 1-inch, and -inch, dry, of Powell & Leland; -inch and 6-inch, glyeerine immersion, of Spencer & Sons (Geneva, N. Y.); -inch, oil imm rsion, of Zeiss (Jena, Germany); also a heliostat of Keith's pattern by Kübel (Washington, D. C.).

Unfortunately the Powell & Leland apparatus and the Spencer objectives were not delivered until some time after the departure of the commission, and not received in Havana until the 28th of August, when but little more than a month remained of the time allotted to the investigation. An ample supply of apparatus and accessories for microscopical and chemical work, and a full stock of photographic material, was also procured in advance of the time of sailing, and, by the liberal policy of the Board of Health the commission has been fully supplied with everything necessary for carrying out the instructions given it.

These instructions are, however, so comprehensive and the time allotted to the investigation has been so short that the members of the commission would fear that they have fallen short of the expectations of the board, notwithstanding the fact that they have given their best efforts to the accomplishment of the responsible duties assigned them, were it not that the following paragraph occurs in the memorandum of instructions under which they have acted: "With the time and means which the National Board of Health can at present put at the disposal of the commission no complete investigation is possible," &c.

The three medical members of the commission, with Mr. Rudolph Matas, clerk, and Mr. Henry Mancel, photographer, sailed from New York, per steamship City of Washington, on the 3d of July, and arrived in Havana on the evening of the 7th. Colonel Hardee joined the commission in Havana on the 18th of August and returned to New Orleans September 20.

Immediately after arriving in Havana the commission established its office and laboratory in the upper story of the San Carlos Hotel, where very suitable rooms, overlooking the harbor, and conveniently located with reference to the hospitals, were found at a moderate rental. The commission was also influenced in selecting this hotel as its headquarters by the fact that Mr. H. C. Hall, United States consul-gen

eral, and Dr. Daniel M. Burgess, an American physician practicing in Cuba (since appointed United States sanitary inspector of the port), resided here. To these gentlemen and to Mr. A. H. Taylor, an American civil engineer located in Havana, the commission is indebted for innumerable favors. All of these gentlemen have manifested a lively interest in the investigation, and from their long residence in Cuba and intimate knowledge of the city of Havana, its harbor, and inhabitants, they have been able to render constant and valuable assistance. Soon after its arrival in Havana the commission, accompanied by Consul-General Hall, made an official call upon the captain-general, Don Ramon Blanco, Marquis of Peña Plata. At this interview the commission learned with pleasure that instructions had already been received from the home government " to extend to it all necessary facilities for prosecuting its work. Both on this occasion and by his subsequent acts, the captain-general evinced a willing zeal in carrying out his instructions which could only have come from a personal interest in and appreciation of the work in which the commission was engaged.

Shortly after this interview the captain-general appointed an auxiliary commission, constituted as follows:

President-Dr. Marcelina Astray de Canada, sub-inspector, first rank. of the naval board of health, honorary chief of civil administration, member of the superior board of health of the island, &c.

Members Dr. Felipe F. Rodriguez, professor of anatomy, member of the Havana Academy of the Medical, Physical, and Natural Sciences, &c.; Dr. Vincente Luis Ferrer, secretary of the superior board of health of the island, &c.; Dr. Vincente Benitez Valdez, member of the Havana Academy, member of the superior board of health, &c.; Dr. Joaquin Garcia Lebredo, member and founder of the Havana Academy, correspondent of the Royal Academy of Medicine of Madrid, &c.; Dr. Antonio Pardinas, sub-inspector of the military health department, director of the military hospital, &c.; Dr. Casimiro Rome, sub-inspector, first class, brevet chief of the military board of health, staff officer of the captain-general, &c.; Dr. Raphael Fleitas, director of the military health park, sub-inspector, of second class, director of the Hygienic Hospital; Dr. Charles Finlay, member of the Academy of Medical, Physical, and Natural Sciences; Dr. Serafin Gallardo, professor of clinical medicine in the University of Havana; Dr. Francisco Zayas; Dr. Emiliano Nunez de Villavicencia, member of the academy, director of the Civil Hospital of San Felipe y Santiago, and secretary of the Spanish commission for the study of yellow fever.

The object in appointing this commission was that through it the United States commission might obtain promptly such information and assistance as was required, and also that there might be a permanent organization in Havana to continue the study of yellow fever after the departure of this commission. Much valuable information has been received through the Spanish commission, and to several of its members we are especially indebted. To the president, Dr. Canada, the director of the military hospitals, Dr. Pardenas, the foreign corresponding secretary of the "Academia," Dr. Charles Finlay, and to Dr. Felipe Rodriguez we are under many obligations. For the purpose of securing as soon as possible information as to the sanitary condition of the principal seaports and, inland towns of Cuba, a circular was issued by the commission soon after its arrival, embodying the instructions received from the National Board of Health, and propounding questions based upon them. The response to this circular has been the receipt of so large a number of valuable reports from the Spanish commission, from United States consuls, and from eminent physicians, that your commission has in its possession more extensive and instructive data referring to yellow fever in Cuba than have ever before been collected.

The commission held weekly meetings while in Cuba, and in compliance with its instructions made a weekly report to the National Board of Health, giving a brief account of the progress of the investigation, and reporting such facts and observations as seemed of greatest importance.

The last formal meeting of the commission in Cuba was held September 25. At this meeting the following resolution was adopted:

In compliance with this resolution, which has received the approval of the National Board of Health, it is the intention of the committee in this preliminary report to record only the most important facts obtained and the general results of the investigation, leaving details and the discussion of unsettled problems to the individual reports of members, to be submitted hereafter.

In addition to acknowledgments already made, the commission desires to express its obligations to the following gentlemen:

Col. R. Ceréro, of the Spanish army, commander of the engineers of the Plaza; Rev. Father Vines, director of the meteoological observatory of the College of Belen ; Dr. José R. de Armona, Marianao; Dr. Juan Antonio Beltran, Marianao; Dr. E. A. Calves, Matanzas; Dr. A. G. Del Valle, Guanabacoa; Dr. A. Cuervo, Sancti Spiritus; Dr. José Forus, Marianao; Dr. Esteban Navea, San José de las Lajas; Dr. A. W. Reyes, Guanabacoa; Dr. P. Selsis, Havana; Dr. Nicolas de la Peña, medical director of hospitals, Sagua la Grande; Messrs. Ariza & Herrera, city architects, Havana.

The clerk of the commission, Mr. Rudolph Matas, and the photographer, Mr. Henry Mancel, have performed their duties in a most zealous and satisfactory manner. Dr. Abraham Morojan, of Cuba, a recent graduate of the University of Pennsylvania, rendered valuable services as interpreter and assistant in post-mortem and other work.

REPORT.

The first and third articles of the official instructions of the National Board of Health to the Havana yellow-fever commission required it to investigate the following six among other subjects, and these six will be considered in the following order:

First. The principal ports of Cuba from which shipments are made to the United States.

Second. The endemicity of yellow fever in Cuba.

Third. The causation of this endemicity.

Fourth. The actual sanitary condition of Havana, Matanzas, and other Cuban ports. Fifth. The means by which the sanitary condition of Havana, Matanzas, and other Cuban ports can be best made satisfactory.

Sixth. What can and should be done to prevent the introduction of the cause of yellow fever into the shipping at Cuban ports.

THE PRINCIPAL PORTS OF CUBA FROM WHICH SHIPMENTS ARE MADE TO THE UNITED STATES.

Cuba, situated less than one hundred miles from the southern extremity of Florida, with the Tropic of Cancer between them, varies in width from 20 to 135 miles, having an average breadth of 52 miles, extends in length 783 miles, and, with its small adjacent and dependent islands, occupying 47,278 square miles, is a little larger than the State of New York. Its extensive coast line of 2,200 miles is noted for the number and excellence of its harbors.

Cuba has more than 200 ports. On the northern coast there are not less than eleven of these rated as of the first, and twenty-two of the second class; and on the southern coast, five of the first and six of the second class. Of these forty-four principal ports, only fifteen are "ports of entry" from which shipments are made to foreign countries, and hence only these fifteen are of any interest in connection with the infection of vessels.

Of the fifteen "ports of entry" eight are on the northern and seven on the southern coast. Those on the northern coast, passing from west to east, are Havana, Matanzas, Cardenas, Sagua la Grande or Sagua, Caibarien (the seaport of Remedios), Nuevitas (a seaport of Puerto Principe), Gibara or Jibara (a seaport of Holguin), and Baracoa, which was the first European settlement (1512) in Cuba, and is the present principal port of the fruit trade.

The seven "ports of entry" on the southern coast, passing from east to west, are Guantanamo, Santiago de Cuba or Cuba, Manzanillo, Santa Cruz, Zaza or Sasa or Tunas de Zaza, Trinidad, and Cienfuegos. These fifteen "ports of entry” are important to the commercial interests of the United States in the following order, beginning with the most and ending with the least important: Havana, Matanzas, Čardenas, Sagua la Grande, Cienfuegos, Baracoa, Caibarien, Guantanamo, Trinidad, Santiago de Cuba, Manzanillo, Nuevitas, Gibara, Zaza, and Santa Cruz. From the five ports first mentioned are cleared three-fourths of all the vessels which sail from Cuba to the United States, but for reasons which will subsequently appear the port of Havana alone is of greater importance to the sanitarian than all the others.

The following table will serve to illustrate the relative commercial importance of these ports. It requires a brief preliminary explanation. While the table refers solely to American vessels it must not be forgotten that about one-third of the trade from Cuba to the United States is carried on in foreign vessels, so that the statistical facts given refer to only about two-thirds of this trade. Further, these facts are perfect for only ten of the fifteen ports, for the reasons that the United States consuls at Guantanamo, Zaza, and Manzanillo failed to forward the necessary reports, that at Gibara this *The report from Manzanillo has been received, but subsequent to the compilation of the table.

country has no consul, and that Santa Cruz not only has no consul but also is of so little consequence that during the past year no American vessel has either arrived at or sailed from it; therefore Santa Cruz is omitted:

TABLE NO. 1.*-Statement of the number of American vessels, their average tonnage, and the number of their crews, sailing from the ports of Cuba to the United States during the year ending December 31, 1878.

*Tables Nos. 1, 3, and 4 have been compiled from reports kindly furnished through Mr. H. C. Hall, United States consul-general at Havana.

A Cuban report for the ten years, 1868-'77, shows that the total number of vessels of all nations which entered the port of Havana varied during said ten years from 1,650 to 2,194 per annum, the annual average being 1,803; and that of these, 717 to 944 were American, the annual average being 800. It is to be remembered that many American vessels sail from Havana to other ports besides to those of the United States.

Average number of vessels clearing annually.

Similar data for other years and to July, 1879, indicate that this table for 1878 represents a fair annual average of recent years; and, if the figures reported for American shipping be increased one-third for the foreign shipping, it appears that there annually pass from Cuba to the United States not less than 2,500 vessels, carrying some 30,000 sailors. What number of persons in addition to these 30,000 sailors pass annually to the United States from Cuba is not known, but it was found that from 4,000 to 6,000 passengers travel every year between the United States and the single port of Havana.

While these facts seem to reply sufficiently not only to the question, "What are the principal ports of Cuba?" but also to the question, "What is the amount of intercourse with and relative importance of these ports?" it has been deemed essential, in connection with present or future quarantine and other sanitary regulations, to investigate three other questions subordinate to the main one. These are, 1. What is the amount of intercourse between each of the various ports of Cuba and each of the various ports of the United States? 2. During what seasons of the year is this intercourse greatest and least? 3. What is the value of this intercourse to the United States? On these three questions much detailed information has been gathered, which is deemed too lengthy for presentation in this preliminary report. However, a sufficient number of facts will be presented to promote an intelligent appreciation of these subjects.

1. WHAT IS THE AMOUNT OF INTERCOURSE BETWEEN EACH OF THE VARIOUS PORTS OF CUBA AND EACH OF THE VARIOUS PORTS OF THE UNITED STATES.

The comparative intercourse between the various ports of the United States and all the ports of Cuba is fairly illustrated in the following table, which, however, refers to a year during which the amount of intercourse was less than the usual annual average.

An official report of 744 foreign vessels sailing from Cuba to the United States during one year states that 367 of these were Spanish, 288 were British, and the remaining 89 belonged to ten other

nationalities.

« Претходна Настави »

Књиге