Dr. JO5E A. LOPEZ DEL VALLE 
THE DEVELOPMENT 
O F 
SANITATION AND CHARITIES IN CUBA 
DURING THE LAST SIXTEEN YEARS 
( 1H99-1914 ) 
READ BEFORE THE III CUBAN NATIONAL MEDICAL CONGRESS 
HELD AT HAVANA, CUBA, DIC. 1=6 1914 
PUBLISHED BY THE SECRETARIA DE SANIDaD Y BENEFICENCIA 
HAVANA, CUBA 
Librery and Press "LA MODERNA POESIA" 
OBISPO 129 To 139 
1914 Dr. JOSE A. LOPEZ DEL VALLE 
THE DEVELOPMENT 
O F 
SANITATION AND CHARITIES IN CUBA 
DURING THE LAST SIXTEEN YEARS 
( 1899-1914 ) 
READ BEFORE THE III CUBAN NATIONAL MEDICAL CONGRESS 
HELD AT HAVANA, CUBA, DIC. 1=6 1914 
PUBLISHED BY THE SECRETARIA DE SANIDaD Y BENEFICENCIA 
HAVANA, CUBA 
Librery and Press "LA MODERNA POESIA" 
obispo 129 To 139 
1914 GENERAL WILLIAM C. GORGAS. 
Sanitary Officer for Havana and Surgeon of the United States Army.-Organizer 
of the Department of Sanitation.- (From 1899 to 1902). THE DEVELOPMENT OF SANITATION AND CHARITIES IN CUBA 11 
DURING THE LAST SIXTEEN YEARS 
(1899-1914) 
Dr. Jose A. LOPEZ DEL VALLE 
Mr. President, and Fellow Members of this Congress: 
Within a few brief days, on the first day of the coming month of 
January, sixteen years will have elapsed since the creation of our Na- 
tional Department of Sanitation, by the American Government of In- 
tervention, and it seems, gentlemen, that the time has arrived when 
we, making a slight halt in our career and without laying down our 
arms of combat for that purpose, should turn our mental vision back- 
wards, in order to cast an affectionate glance over the rugged road 
already traversed, which by good fortune and to the glory of Cuba and 
her sons, constitutes a page in history, which redounds to the honor of 
our native land and to the cause of our common humanity, and to us 
lias been confided the duties of chroniclers of those deeds, in spite of 
our lack of the needful qualifications for such a task arising from the 
fact that since the very biginning of the creation of our present orga- 
nization, we have been only enthusiastic soldiers of the rank and file; 
but there remains with us, the satisfaction of having duly complied 
with our duty and having been witnesses and modest participants in 
those grand battles for the welfare and progress of humanity. Let this, 
therefore, be the cause which justifies our labor, and the kindness of 
companions who listen to us, will generously supply whatever may be 
our deficiencies in the following relation, viz: 
On the 1st of January 1899, the American Goverment of Inter- 
vention, assumed the administration of public affairs in the Island of 
Cuba, and the first and most important task to which it directed its 
attention and energies was the sanitation of Havana and the establish - 
ment of hygienic conditions in all parts of it. The most serious problem 
which at that time occupied the attention of the Goverment in sanitary 
matters,, the "palpitating actuality" in all such questions, was 
without any doubt, "yellow fever", a disease which constantly 
scourged the principal cities, towns and sea-ports of Cuba, constitu- 
ting a barrier which up to that time had been unsurmountable, and 
which prevented the development and progress of this country. 
1) Read before the III Cuban National Medical Congress held at Havana, Cuba, 
Die. 1-6, 1914. 4 
The foreigner, non-inmune to the disease looked at us from afar 
with horror, justly fearing that he might fall a victim to this so-called 
yellow endemic, in case he ventured to visit us. 
Important and valuable elements kept aloof from our shores, 
giving to other more fortunate parts of the World on account of their 
being more healthful, the inestimable treasure of their labors, ener- 
gies and talents, while over Cuba there hung like a curse the mourn- 
ful phantom of yellow fever. 
And if in "our foreign relations'', we had that powerful obstacle, 
which prevented our development and progress which decimated the 
lives of foreigners who came to our soil and the Cuban children who 
were not inmune from the infection, the permanent existance of 
yellow fever among, us, constituting a black stain on the statistics of 
morbidity and mortality; neither did we lack, and unfortunately in 
the "interior", other grave and serious problems to solve. 
The small-pox, malaria, dysentery, typhoid fever, infantile 
tetanus, glanders and many and varied other diseases, swept with 
hopeless periodicity over our inhabited districts, putting Cubans fire- 
sides in mourning, reaping lives and calling down upon us the stigma 
of being a backward people in the pathway of progress and culture. 
The American Government of Intervention, had therefore, before 
it on commencing its tasks in Cuba, deep and and interesting transcen- 
dental hygienic questions to solve. It was necessary to attack them at 
their sources, to count on great' and powerful energies, extraordi- 
nary support, unlimited resources and exceptional faculties in order 
that these elements combined, should kindle the spark of genius, 
which creates and accompanies the effective measures of reform, 
that evil influences destroy. 
The first-to create, give life to, and organize new sanitary ser- 
vices which had to be placed on solid foundations and the campaign 
against infectious diseases. The second-to destroy old and vicious 
practices, erroneous beliefs and ideas, which in mournful partnership 
with the sad influences emanating from what is called "vested inte- 
rests" proved to be formidable obstacles in the way of the work of 
improvements, social, personal and collective. 
Fortunately, the Goverment of Intervention, had at its command 
for the noble task it had assumed, all of the elements necessary for 
triumph; on the one hand, the firm decided and tenacious purposes of 
those who composed it, to dedicate to the sanitary campaign, all of 
the necessary means and resources at their command and at whatever 
the cost might, in order to archieve success; and on the other hand the 
noble and generous support given to this great work by the sons of 
our native land, who from the first moment of the reform movement, 
without hesitating over sacrifices, nor checked by the difficulties which 
attend all new enterprises, hastly presented themselves, and convin- 
ced of the glorious termination which awaited their labors, gladly 
assumed, each one of them, the post assigned him in the campaign. 
Some of these, professional practising physicians of high repute, DR. CARLOS J. FINLAY. 
Chief Sanitary Officer and President of the Superior Board of Sanitation, and at the 
present time Honorary President of that corporation.- (From 1902 to 1907). 5 
were placed at the front of the firing lines, as directors, others acted 
as soldiers in the advanced trenches-and all, as good soldiers faith- 
fully performed their respective duties. 
The public, with marvellously correct foresight, willing seconded 
the work begun, giving it the warmth of zealous and desinterested 
cooperation, the people discharged their civic duties without any 
written law requiring them to do so, and cheerfully submitted 
to the, at times, severe sanitary requirements. Before the era 
of light and hygienic progress, which had been initiated, this 
worthy people held wide open the doors of their soul as well as that 
of their homes, in order to facilitate, first, the sanitary work and 
afterwards take an active and decisive part in it. The most severe 
orders were obeyed by all cheerfully, and with good will. 
At late hours of the night the dwellers in infected houses were 
dislodged and the poor occupant of such a place, without money or 
other resources and not knowing where to obtain it, without a fire- 
side, and without shelter of any kind, wandered aimlessly through the 
streets awaiting the expiration of the time required for the disin- 
fection of his humble home and did this, without protest, without 
asking for any indemnization for what he had been called upon to 
endure. 
The Cuban physician, from the one. designated to occupy an 
important official position, to the one who devoted himself exclusively 
to his own private practice, from the one who received fees for his 
services, to the one who lent his aid on account of the scientific 
enthusiasm, constituted the most powerful auxiliaries, which the 
government of the Anierican Intervention had in its sanitary labors. 
It is only difficult, but impossible for the sanitary authorities- to 
carry on a succesful campaign against infectious diseases without the 
spontaneous and active cooperation of physicians in the exercise of 
their private practice for they are the ones called upon to state where 
the infection breaks out and manifests itself; that is to say, where 
the remedy should be applied promptly and efficiently and this coo- 
peration on the part of the medical fraternity, which at times required 
the exercise of great generosity, has never been witheld by them, nor 
have they ever failed in their alliance to the Sanitary authorities of 
their country which owes an inestimable debt of gratitude to these 
companions for the sacrifices of their personal interests, which they 
have made upon the altar of the general welfare of the entire com- 
munity. This altruistic proceedure on the part of the private practi- 
tioner, is all the more worthy of admiration when it is remembered 
that with his "report'' of a case of infectious disease he .may lose, in 
certain cases, the client who pays him well for his services, on their 
being sent to an Isolation Hospital, and in some cases he may suffer 
ever greater economic troubles, for in some instances his clients may 
feel annoyed at his report of a case of infectious diseases in their 
neighborhood and refuse to retain him any longer in his professional 
character to his further and greater pecuniary loss. 
The Sanitary movement, therefore, had from its inception the 6 
aid of these powerful aides, the medical fraternity and the people in 
general and as a whole; that is to say, it had the support of one of the 
most necessary elements to success in any attempt to bring about 
improved sanitary conditions. "Public Opinion'', which in Cuba is 
formed in the first place, by the special adaptability of our people in 
conforming to the requirements of their surroundings-by their 
desire for progress-their eagerness for advancement-by the vivid- 
ness of their imagitation of the people of this wonderful tropical 
country, which causes them to quickly comprehend which is the proper 
road to pursue:-by the never ending advice of the medical element of 
the land, and by the aid of the political and professional press, one of 
the most powerful factors of success in every work of civilization and 
culture. 
Such, gentlemen, were the formidable elements which the Pro- 
visional Government of the United States, in Cuba, had at its dispo- 
sition on organizing the Department of Sanitation of the City of 
Havana, and it was not venturesome to predict that success would 
crown their efforts in thus seeking to improve public health conditions. 
During the first three months after the establishment of the 
Department, the only branch of it put into working order was the S'a- 
nitary Inspection of the houses and public establishments of Havana. 
One hundred professional medical men, dedicated themselves with 
ardor to this necessary work. All of the buildings in the city were 
visited, the work necessary to put them in sanitary conditions was 
duly pointed out and to every fireside the "good news" of the 
coming "new epoch" was carried, and the teaching of hygienic mea- 
. sures, was commenced. A great propaganda of sanitary education was 
made. 
The visits for sanitary inspection showed the tremendous and 
fearful sources of disease, infection and misery, which existed in this 
capital. The veil covering the cancerous ulcer was drawn aside 
leaving it exposed to view. At the same time, the Bureau of Demo- 
graphic Statistics, was stablished, and the Bureau of Orders, Archi- 
ves and Correspondence, were also organized in a rudimentary and 
imperfect manner. If we have to comply faithfully with our mission 
as impartial historians, we must confess, that in the beginning, there 
was no uniform plan of proceedure, nor was there any systematic 
method in the work done, nor any firm, safe and scientific direction of 
the sanitary affairs, but the good will which mutually existed between 
those who gave orders, and those whose duty it was to obey them, fully 
made up for the lack of proper organization. 
In April 1899' in the suburb of Casa Blanca, the first two cases 
of yellow fever which had been registered under the new government, 
appeared; this event caused the cry of alarm, the spark which announ- 
ced that the fire which was supposed to be extinct, was latent, and 
only hidden in the ashes of the past disasters. 
With all the urgency the case demanded, the service of disinfec- 
tion and sanitation was organized, the work of doing so being con- 
fided to us, and we were also entrusted with the direction and mane- 
gem ent. One of Gen. Gorgas' assistants, and to whom belongs the glory of having given a great 
impulse to the work against Tuberculosis in Cuba.- (From 1899 to 1902). 
DR. C. J. FURBUSH. 7 
The infected house in Casa Blanca were destroyed by fire. The 
sanitary brigades, afterwards went through the city, street by street, 
carrying out the important work of cleaning and disinfecting with 
brilliant success in the reduction of mortality in general, and the re- 
sulting effects served as a practical, material and well executed lesson 
in hygiene. 
In June, 1900 the American Goverment appointed an Experi- 
mental Comission, made up of members of the Medical Corps of the 
Army, which commission among its other labors undertook to verify 
the discovery of the genial Cuban Finlay, concerning the trasmissiop 
of yellow fever by means . of the sting or bite of the mosquitp 
"Stegomya Fasciatus" which theory with the faith born of conviction, 
he had sustained some twenty years. Another illustrious Cuban, Dr. 
Aristides Agramonte, was a member of *that commission and is the 
only one of it who is still alive. 
That is to say, that to Cuba belongs the honor of being the birth 
place of that sapient character who, with the brilliancy of his genius, 
illumined the path which had to be followed in order to reach absolute 
scientific truth in regard to the trasmission of yellow fever, and upon 
which its prophilaxies may be placed on a firm basis. 
The discovery of Finlay, placed on his august brow the crown of 
inmortality; and it also filled Cuba, his native land with glory-and 
we, the sons of this prolific soil should feel proud of these facts and 
especially so, as to another Cuban, Dr. Aristides Agramonte, belongs 
the satisfaction of having taken a leading part in the official experi 
mental labors for the verification of Finlay's theories. 
The Experimental Commission issued its report in the month of 
February 1901. Consequently the sanitary campaign initiated in 1899 
against the yellow fever infection, in consequence' of cases which 
prevented themselves at that time, was not based on Finlay's disco- 
very nor on the report of the experimental commission. In an 
empirical manner, the work of dissinfection as a remedy against 
yellow fever was carried on, employing in these cases the same general 
means as are used in other infections diseases. Those were attacked 
and isolated and kept from contact with others. The houses were 
dissinfected, employing for this purpose copious flushings of solutions 
of bichloride of mercury, and they were afterwards subjected to the 
vapors of formaldehyde. 
The yellow fever infection, however, far from being eradicated 
by these means, on the contrary spread throughout the city. The in- 
fected mosquitoes fled from the noise and bustle and from the watery 
solutions and escaped into nearby houses. The means and methods for 
combatting this disease were multiplied. The sanitary measures adop- 
ted by the American Government were principally and almost solely 
intended for the extirpation of yellow fever, and to 'that end it 
employed its most laudable efforts but as such endeavors were not 
based upon true prophilatic principles; they broke ineffectually upon 
the hard rock of error. 8 
The sanitary labors in general; the cleaning up of the entire city, 
a work of transcendental importance gave the most satisfactory 
results in the way of reducing general mortality as applied to other 
diseases and especially to pulmonary tuberculosis, but Yellow Fever 
continued its invading march with a slow, but firm and secure step. 
In the year 1900, two important commissions were created. The first 
being that concerning vaccine virus, and the other being charged 
with the duty of combatting the ravages of glanders, and tubercu- 
losis among animals. The first of these commissions established the 
general headquarters for vaccine virus, issued order No. 165 and di- 
rected general vaccination and made it compulsory and to the second 
commission is due the credit of establishing a stable of observation 
for sanitary purposes with its lazaretto for the isolation of glandered 
animals and with excellent regulations for the cure of these infectious 
diseases. 
With these commissions, the field of sanitary operations was 
amplified, giving attention to. two preventable diseases which were a 
scourge and a shame for Cuba. The Commission on Vaccine Virus, 
issued order No. 165 and in virtus of its wise precepts vaccination and 
revaccination "anti variolosa'' was made obligatory in Cuba; and 
thanks to this prudent and preventative measure, small pox has been 
eradicated in our territory, and while the practice of vaccination is 
rigidly enforced, the 'dramatic" epidemics of- small pox which in 
past epochs ravaged Cuban soil, will be avoided. 
The pursuit, isolation and sacrifice of glandered animals, the 
inspection of stables, the timely application of hygienic laws concer- 
ning glanders, will soon put an end to this infectious diseases, the 
existance of which, without any doubt whatever,, is a stain upon the 
sanitary statistics of any civilized city in which it is permitted to prevail. 
On the 6th of May and the 9th of July of 1901, there appeared, the 
first sanitary order concerning the extermination of mosquitos, they 
being then officially recognized as the agents for the transmission of 
yellow fever and an effective campaign against the infection was 
commenced. 
To the to day General, but at that time Major, William C. Gorgas, 
belongs the glory of initiating measures in accordance with the require- 
ments of Finlay's discovery. The Sanitary Department under the 
expert, scientific and honorable direction of Dr. Gorgas, organized in 
due form the campaign against the mosquito. Brigades for the petro- 
lization, canalization and ditching whereever required, were formed. 
The houses were visited by inspectors specially charged to prevent the 
existance of any uncovered deposit or container of water, and to re- 
quire that all such receptacles be'provided with mosquito proof covers. 
The workmen provided with their cans sprinkled crude petroleum 
in all places where mosquitoes might find breeding places, ditches 
were drained and cleaned out, and creeks, gutters and vacant lots were 
all subjected to the necessary treatment required in their respective 
cases and the proceedings for the disinfection for yellow fever were COLONEL J. R. KEAN. 
Sanitary Adviser to the Provis:onal Governor, and author of the decree which 
nationalized the Sanitary Services.-(From 1906 to 1908). 9 
radically changed. With marvellous success mosquitoes in infected 
houses and the neighboring ones, are destroyed by fumigating them 
with insecticides and yellow fever scientifically attacked in its last 
redoubts, flaps its black wings and disappears from Cuba. 
Gorgas had assistant medical men of high repute, Cuban as well 
as foreign and among the latter we cite the names of Havard, Furbush, 
Lyster, Shocking, Le Prince and Mac Cloran, and proceeded with 
notable skill to organize on an excellent plan the different offices of 
the Department of Health. 
He gave impulse to the compilation of Sanitary and Demographic 
Statistics; he ampliafied and placed upon solid foundations the Bureau 
of Sanitary and Medical Inspection, and those of Orders, Fines and 
Archives. He established the practice of medical inspection of those 
attacked by transmissible diseases, the " Medico-Escolar " and 
Bromatology. 
On the initiative of Dr. Furbush, the Dispensary for sufferers 
from lung complaints was created, and the work of the Sanatorium 
"La Esperanza" was commenced, in accordance with the plans of 
Majors Havard, and with the cooperation of "The League Against 
Tuberculosis", the first steps were taken against this tremendous 
disease. The "golden age" of the Department of Health of the city of 
Havana began with Gorgas, Havard and Furbush, and for the glory 
of Cuba, for from there being any lack of prestige, the Department 
has steadily progressed in all of its varied ramifications until it lias 
reached the high degree of perfection which it now enjoys. 
On the establishment of the Cuban Republic, Gorgas and Furbush 
were succeeded by Finlay and Barnet, who in accord with the Superior 
Board of Health, improved and amplified the varied services of the 
Department, extending their benefits as far as possible to all of the 
territory of the Republic, establishing for this purpose in conformity 
with order No. 159, of 1902, Local Boards of Health in the different 
municipal districts of the country. 
Up to this date, may, 1902, it may be said that the operations of 
the Sanitary Department were limited to the municipal districts 
of Havana and Santiago de las Vegas. 
In some other localities-Santiago de Cuba, Cienfuegos, Matan- 
zas and Santa Clara, there were officers of the Medical Corps of the 
American Army, who directed and supervised certain sanitary work 
and medical inspection, but they did not depend upon nor were they 
delegates or representatives of the Sanitary Department of Havana, 
as they acted independently of it, according to local necessities and of 
recognized urgency. 
The only branch, which had from the commencement of the Ame- 
rican Intervention any national organization with its own proper laws 
and regulations, was that of the Maritime Sanitation (Quarantine Ser- 
vice), but its operations were entirely independent of the Land Sani- 
tation, and with no administrative connection with it. The Special 
Commissioners of the Vaccine Virus, of Glanders, and the. Special 10 
Hygiene, also, were not dependencies of the above mentioned Depart- 
ment, but each one of them had automatic powers. It was, therefore, 
within the province of the Finlay-Barnet Regime to execute order No. 
169, and implant the first44National Terrestial Sanitary Organization". 
The Superior Board of Health and its delegates, Local Health Officers, 
commenced their labors and soon the shining light of hygiene reached 
the extreme portions of the Republic, illumining all parts of it, al- 
though in but in an slightly effective manner. 
Finlay and Barnet, maintained in a most effective manner all of the 
sanitary services, and commenced with great zeal the campaign 
against paludic fever, puerperal septicaemia and infantile tetanus. 
Finlay originated the 4 4 Aseptic packages for the Cure of the Umblical 
Cord," after child birth, and to the Superior Board of Health, is due 
among other works of great value, the Sanitary Ordinances, now in 
force, which were promulgated in February, 1906 and of which Dr. 
Barnet was the adviser and compiler, and who as a member and 
Secretary of the Board was always in the first rank during the debates 
of that organization. Up to the time, no general code of sanitary regu- 
lations had existed, nor had the different sanitary dispositions and 
orders been compiled, and it can be said that the operations in 
connection with the sanitary matters, were carried on without any 
44written law of a general character", so that the public did not know 
in a precise and concise manner how to act in order be within the 
scope of the hygienic laws. 
At the begining the sanitary organization from 189'9 to 1902, the 
sanitary orders with the exception of those concerning Quarantine, 
Immigration, Vaccination and a few other special ones-were discre- 
tional that is to say orders dictated according to the personal ideas of 
the head of the Department and put in force, invocating in each case? 
the name and powers of the Military Governor; at other times, the City 
Council was appealed to in order to force obedience to these orders as 
though they were Municipal Ordinances. 
The sanitary legislation was initiated with the laws and regulations 
of Quarantine in 1899, and by those of Immigration, in 1900. Sanitary 
laws to cover special cases such as those concerning Yellow Fever, 
Vaccination, Glanders and Special Hygiene were afterwards dictated. 
Up to May 1902, when Order 159 was promulgated, and later its by- 
laws, or Sanitary ordinances, rules and regulations, there was not a 
single law or sanitary ordinance which was applicable in all cases. 
The ordinances came, therefore, when needed to fill a vacum in 
Sanitary Organization, and to give it "legal and effective life", 
equitable and in harmony with the requirements and orders of the 
Sanitary Department. 
The Superior Board of Health, published under the direction of 
Dr. E. B. Barnet, with the colaboration of other notable medical men, 
"The Manual of Sanitary Practice", a work of truly transcendental 
value giving the most important information and instructions. The 
work contained chapter on the etiology, symptomatology, clinical One of the organizers of Cuban sanitation. Now Director of Health. 
DR. JUAN GUITERAS. 11 
forms an tlie prophylaxis of most frequent trasmissible diseases in 
Cuba, as well as a description of the organization and progress of its 
principal sanitary organizations. 
For the space of four years, from 1901 to 1905, the Republic was 
kept free from yellow fever, but at the end of that time, in October, 
1905, it reappeared in Havana, imported from New Orleans, it deve- 
loped quickly and spread rapidly throughout the country. 
The infection was propagated in the interior of the Republic, its 
greatest ravages occuring in Santiago de Cuba, Cienfuegos, San Ni- 
colas and on different sugar plantations, and in the towns of the Pro- 
vince of Santa Clara. Under the direction of the Superior Board of 
Health, with Finlay and Barnet as its chief moving spirit, and under 
Kean and Guiteras; later on, an energetic and effective campaign 
against yellow fever, was organized, which, after titanic efforts 
succeeded in again extinguishing it on Cuban soil. 
We have shown that during the period of the first government of 
American Intervention, from the first of January 1899, to the 20th of 
May, 1902, the land sanitary service, lacked a national organization, 
and even laws to govern it in a uniform manner and give it proper 
faculties and rights, besides which, the Sanitary Department was 
limited in its operations to Havana, Guanabacoa, Marianao and San- 
tiago de las Vegas; in other towns of Cuba, sanitary matters were 
carried on by the City Councils, or local municipal authorities, which 
with the exception of Santiago de Cuba, Cienfuegos, Cardenas, Ma- 
tanzas, and some few other exceptional cases, gave little or no attention 
to such matters and allowed only the most ridiculous and insignificant 
sums for the expense of sanitary work in their respective, towns. 
The Goverment of the American Intervention, desiring the orga- 
nization, in a uniform manner of all Sanitary matters throughout the 
entire island, with laws to aid and give it legal force to its operations, 
promulgated at about the same time it was ready to turn the govern- 
ment over to the Republic of Cuba, Order No. 159 of 1902, in 
virtue of which the office of the Superior Chief of the Sanitary Ser- 
vice, was created with such powers as would enable him to secure 
compliance with all sanitary orders, and requirements throughout the 
entire island. The Superior Board of Health, which was given the 
necessary authority to undertake the ''study of the causes which 
produced diseases and which become epidemic among human beings 
and animals and published the results of the investigations concerning 
the causes which produce paludic fever, the effect it has on public health, 
with accompanying conditions, customs, localities, as well as the bever- 
ages and medicines consumed". 
It was urged upon the Superior Board of Health, that it should 
request the Executive Power in its turn, to transmit to the Legislative 
Powers, the changes, additions, etc. which were required in sanitary 
laws and regulations, and that the Board should | be endowed with 
ample faculties, and powers to exact information, reports, dates and 
antecedents from the directors and managers of charitable institutions. 12 
mid that it should also be given power to exact from corporations, 
compliance with all orders concerning sanitary officers. 
The Superior Board of Health had the direction of the sanitary 
affairs of a general character, to which it added the rights and duties 
of the old time Special Commissioners on Vaccine Virus, and Glanders. 
The Board also had conferred upon it, the supervision of the different 
medical and sanitary methods applied to Tuberculosis, Special Hygie- 
ne and Leprosy. 
The Superior Board of Health had ample powers, and its resolu- 
tions have an executive character. It was compossed of a Superior 
Chief Sanitary Officer, as President, and eleven members, divided into 
two clases, effective and honorary. The first were, the Chief Sanitary 
Officer; the President of the Commission on Special Hygiene, and 
three members, one resident in Havana, one representing the western 
and the other eastern part of the Island of Cuba. 
As honorary members with voice but without vote, in the procee- 
dings of the Board, there were the Chief Medical Officer of the Port of 
Havana, later Chief of the Maritime Sanitary Service; the President 
of the League Against Tuberculosis, and a representative for each one 
of the following institutions, viz: The Academy of Sciences, the Natio- 
nal University, the Board of Education and the Faculty of the School 
of Law. * 
On being duly constituted, the Superior Board of Health, pro- 
ceeded in accordance with the law which had created it, to dictate the 
sanitary measures of a general character which were to be applicable 
to all of the different municipal districts, and also to recommend the 
adoption of the wisest means for the protection and preservation of 
public health. 
It published books, phamphlets, circulars and leaflets in order to 
popularize scientific and proper methods of proceedure in all that 
applies to sanitary matters, and gave its attention to pulmonary tu- 
berculosis, diptheria, infantile tetanus anl it combatted epizootic 
complaints which decimated domestic animals. 
The Board of Health, organized the National Laboratory, fitting 
it up with all the necessary resources and appliances for the prepara- 
tion of serums and vaccines lymph for gratitious distribution. 
The administration of the sanitary matters in different munici- 
pal districts, was confiled by Order No. 159 to the Local Boards of 
Health of each Municipality, which were formed by the Local Chief 
Sanitary Officer, as President and Executive Officer, the Chief of 
Special Hygiene Service, and two representatives appointed by the 
municipality and approved by the Superior Board of Health as mem- 
bers. These Local Boards of Health, were governed by the general 
sanitary regulations adopted by the Superior Board, of which they 
were delegates. 
Besides exacting compliance with the hygienic precepts of a ge- 
neral character, the local Boards were charged with the supervision DR. FERNANDO MENDEZ CAPOTE. 
Director of Charities. 13 
of public health in its districts, but under the jurisdiction and 
government of the Superior Board. 
Order No. 159 decreed that the current expenses of the Local 
Boards, as well as the cost of all other sanitary services should run for 
the account of and be borned by their respective municipalities, with 
the exception of Havana, which would continue to be borned by the 
State. 
The municipalities of the Republic following a traditionary custom, 
did not include in their estimates of expenses (budgets) a sufficient sum 
to cover the cost of these important services, and for this all powerful 
reason, for the most absolute lack of the means of life, the Local 
Boards and with them, the Local Chief Sanitary Officers, were unabled 
to perform their functions and duties, and were so to speak, "tied hand 
and feet" and without the necessary elements of combat. 
There existed, on the theoretical ground, a very complete sanitary 
organization and it seemed at first sight on considering the matter only 
from what was written concerning it, that the sanitary problem in 
Cuba had been solved, because a law existed which required that sani- 
tary services should be established in all parts of the Republic, and 
which should be executed in what appeared to be a complete and 
finished manner. 
But, nevertheless, on the basis of tangible facts and in practice it 
turned out that the well conceived precepts of order No. 159, could not 
have effective application because of certain powerful reasons, among 
which, the absolute lack of resources was the principal one. The 
municipalities, in place of providing the material elements necessary 
for the work, left the Local Boards of Health unendowed, and they led 
a languid life with anemic conditions on account of misery. 
Tn Havana, the sanitary campaign was mantained in full vigor, 
the services were improved and made more extensive, for all expenses 
incurred by the Sanitary Department in its work was borne by the 
State, and thanks to this provisory measure, the capital was well 
defended against infectious diseases, and far from losing the prestige 
already gained, the sanitary organization, under the wise guidance of 
the men appointed by the Government to direct and manage its affairs, 
was enabled to infuse new impulses and greater encouragement in to 
those in charge of its various and varied services. 
We have seen already that unfortunately the same conditions did 
not exist or prevailed in other parts of the nation. The Local Boards 
of Health, had neither the necessary economic resources to attend to 
the important services required of them, nor had they the authority 
and independence necessary for free and oportune action. They were 
subordinate to local political interests, and for these reasons the 
effort of the central power, lacked force, and its endeavors to mantain 
an energetic and well sustained sanitary situation in all parts of the 
Republic proved unavailing. 
These certain and grave facts, were made conspiscuosly manifest 
on endeavoring to organize a vigorous campaign against the yellow 14 
fever scourge in the towns in the interior of the Republic, where the 
disease was invading in a threatening manner important centers of 
population and industry. The Superior Board of Health promptly 
responded to the exigencies of the situation, with special commissions, 
and with men and material hastened to the seat of peril, where the in- 
fection was "drowned", but no sooner was this done in one place, than 
the "Sanitary Brigade'', had to hurry off to some other infected spot, 
leaving, the place just placed in sanitary conditions to fall back after 
the danger had passed, into the same condition that almost always had 
existed. It was a case which required an "urgent remedy" and which 
lacked prophilaxis and "posterior treatment". 
At the time of this outbreak of yellow fever, infectious diseases 
appeared,- paludic and typhoid fevers and diptheria. Severe outbreaks 
of these diseases were overcome by the intervention of the Central 
Sanitary Office, but later on sporadic cases of these diseases, in chronic 
form, claimed their victims, while the sanitary department was not in 
proper condition, and had not the power to combat them in a decisive 
manner. 
These particulars, clearly showed the imperious necessity of 
"nationalizing" the sanitary services and of placing them under the 
personal responsability of a "local sanitary authority'', with powers 
and elements necessary to direct and develop it with energy and 
efficiency. 
Two distinguished Cuban physicians,.Doctors Malberty and Alba- 
rran, who were representatives to Congress, the former from Havana 
and the latter from Santa Clara, had already studied and considered 
this particular. Dr. Malberty, introduced a bill in Congress provi- 
ding for the creation of a Department of Public Health, but it was 
never promulgated as a law. 
To Colonel Jefferson Randolph Kean, Sanitary Advisor of the 
Provisional Government of the United States in Cuba, belongs the 
glory of having been the author of the decree of nationalization of the 
sanitary services of the Republic of Cuba, and of properly equipping 
and sustaining the local sanitary offices throughout the entire island. 
Order No. 159, of 1902, which was the organic sanitary law, had the 
grave defects of which we have herein lightly touched upon, and which 
did not produce the favorable results which its authors had predicted, 
was followed by Decree No. 894 of 1906, which organizes in a precise 
and practical manner the different sanitary dependencies, equipping 
them with the necessary elements for maintaining its accounts with 
the State, unifying the service and placing them all under the inme- 
diate direction of a chief and a National Beard of Health. 
The local boards of health of Order No. 159, which lacked the 
means of existance, and the elements necessary for combat, which 
did not have the requisities powers for exercising an effective 
authority, so that a proper idea of the responsability for the progress 
of the entire sanitary services should be diffused among the entire 
corps composing it, were succeded by the Local Chief Health Officers DR. ENRIQUE B. BARNET. 
One of the organizers of Cuban sanitation. Member and Secretary of the 
Superior Board of Sanitation; Executive Officer of the Department of Sanitation with Finlay, 
and at the present time Chief of the Section of Library and Publications of the Deparment. 15 
of the Kean decree, with all the resources, rights, authority and res 
ponsability pertaining to their positions respectively. 
Sanitary conditions in the interior of the Republic began at once 
to prevail, and so to speak, became an accomplished fact when this 
opportune, wise and practical law became applicable. 
It may be said that from the year 1906 in which the Decree for 
the nationalization of all matters pertaining to sanitation became 
effective, new and vigorous life was engendered in the field of work 
among the sanitary organizations in different towns in Cuba, which 
with the exception of Havana, Regia, Guanabacoa, Marianao, Santia- 
go de las Vegas, Matanzas, Cienfuegos, Cardenas, Santiago de Cuba 
and some few others lacked a real and effective sanitary organization 
and administration.. 
Decree 894 of 1906, created the National Board of Health, under 
the jurisdiction of the Office of the Secretary of the Interior, and was 
made up of the following entities, viz: 
(a) A National Chief Sanitary Office]-. 
(b) A National Board of Health. 
(c) The individuals and materials necessary for the office and 
institutions of the Department. 
(d) A local chief health officer for each one of the municipalities 
of the Republic with the individuals and materials necessary 
for the execution of the sanitary ordinances. 
(e) The temporary employes necessary for preventing and 
combatting endemic diseases. 
The National Chief Sanitary Officer, was the President ami 
Executive of the National Board of Health, and was charged with the 
supervision of all the sanitary services of the Republic, to make out the 
estimates (budgets) for the expenses of the Department, to exact 
compliance with the prevailing sanitary laws, regulations and 
dispositions, as well as with the resolutions of the Board of Health. 
There was also confided to him the direction of Hospitals of Isolation 
and there was given him authority to establish interior quarantine 
and exact compliance with the sanitary orders, by the fnnctionaries 
of State, Province or Municipality. 
The National Board of Health, was composed of the Chief 
Sanitary officer, as President', and the Chief Clerk of the Department, 
as Secretary; the other member being the President of the Commis 
sion on Infectious Diseases, the President of the Commission of 
Special Hygiene, the Local Health Officer of Havana, an engineer and 
a lawyer. 
The Board was charged with the supervision in general of the 
various matters connected with public health to exact due observance 
of all sanitary laws as well as those which regulates the exercise of the 
profession of medicine and surgery, pharmacy and veterinary and 
dental surgery. 
It was moreover the duty of the Board to carry on investigations 
and studies concerning epidemic diseases, to publish the result of such 16 
studies and to compile and distribute popular instructions in order to 
make scientific knowledge common among the people, and to employ 
persons necessary for special sanitary services, or experts to carry on 
direct special studies relating to preventable diseases. 
There was confided to the National Board of Health, executive 
powers for the government and administration of sanitary matters in 
genera], which were called to the attention of the Superior Board of 
Health, of Order 159', and every thing connected with the services of 
Tuberculosis, Special Hygiene, Leprosy, Vaccination, Anti-Varioloid 
Laboratories, Dispensaries, and Tuberculosis Sanatoriums. Decree No. 
894, preconceived the idea that all sanitary officers pertaining to each 
municipality, should be administered by a Local Chief Health Officer, 
as the representative in his municipal dist ricts, of the National Depart- 
ment of Health-, and who was to act under the direction of the Chief 
Sanitary Officer of the Republic, and among the duties and rights of 
Hie Local Chief Sanitary Officers were inclued. 
(a) The appointment of necessary assistants, according to the 
classification established in Decree 894. 
(b) The establishment and maintenance of the following 
services, viz: 
The cleaning and sprinkling of the streets. 
The collection of garbage and other refuse. 
The public and private disinfection. 
The filling in and drainage of lands. 
The Local Chief Sanitary Officers are required to watch over the 
public health of their respective districts, and to exercise general 
supervision over sanitary matters, to apply and exact compliance with 
Hie ordinances, regulations, circulars and other dispositions of the 
Department. 
Decree No. 894, provided that all expenses incurred by the various 
services created by it, should be borne by the State, with the exception 
that the municipalities should contribute to the payment of these 
expenses to the amount of ten per cent of their receipts and this 
prudent and well conceived idea in that efficient law is the secret of 
the extraordinary success archieved by it. 
Thanks to that effective organization, to the execellent law which 
protects it, and to the elements of economic order provided for it tin1 
National Department of Health, at whose head figured Kean, Finlay, 
Guiteras and Barnet, with the illustrious members of the National 
Board of Health, could undertake with positive powers for triumph, 
the most ardous and difficult sanitary campaigns. 
There was organized in all parts of the Republic, in a most 
complete manner,'the campaign against yellow fever, paludic fever and 
other infections. There was established even in the most remote regions 
of the Republic, the services of Medical and Sanitary Inspection, of 
Disinfection. Statistics, (Correspondence and Sanitary.. Archives, of 
Orders and Fines, as well as the enlarging and extending of work 
connected with the street cleaning and sprinkling and the collection First Secretary of Sanitation and Charities.-(From Jan. 1909 to Nov. 1909). 
DR. MATIAS DUQUE. 17 
and disposition of garbage. The campaign against mosquitoes was 
organized and began with vigor; suceeding, thanks to these well 
directed labors in again eradicating yellow fever from Cuban soil, 
which disease like a fearful phantom passed over the confines of the 
Republic, sowing grief and death in its path. 
With the nationalization of sanitary operations, and with the 
unification of such labors, began the work of positive sanitation and 
begining about of hyginic conditions in Cuba. 
AH Cubans should keep in affectionate remembrance Colonel 
Kean, the grand organizer of Cuban sanitary methods, and the good 
and modest man, who consacrated with all his soul, his greatest talents 
to the improvement of sanitary conditions in Cuba. May the expres 
si on of our gratitude reach him on the wings of affection. 
Sanitary authority, the necessary economic resource with laws to 
uphold, and with a people dispossed to lend their aid, are needed in 
order to faithfully fulfill the duty of watching over public health. 
The prolific field of hygiene should not be limited by a narrow 
horizon, but should be left free and untramelled, and its sphere of 
action extended, for hygiene has to protect man from the moment of his 
conception in the maternal womb to beyond what seems to be the limit 
of human affairs, up to the time of his death! 
Hygiene in its marvellous advancement, in its noble aspiration to 
better the condition of man, to procure for him the enjoyment of a 
strong and vigorous life, to free him from perils which might 
compromise his existance, to enact laws to prevent disease, accidents 
while at labor, fatigue and misery, to provide for him a confortable 
home, cheerful and economical, were each individual may find his 
existance placid and agreeable and free from diseases, which paralyze 
his efforts in life's struggle. 
Hence sanitary authority is called upon to apply hygienic precepts 
to give them national and administrative life, to apply proper means 
to the end sought, and has, in the discharge of its mission in defense of 
public health, to dedicate its time and attention to two principal 
points, the first is to "prepare the ground'', that is the citizen and put 
him in a situation that such diseases cannot break through his lines of 
defense, so that he may always conquer in the struggle carried on 
between tin* microbe which attacks and the phagoecyte which defends 
him. 
In order to reach this beautiful termination of sanitary labor, it is 
necessary that man should be carefully protected from the time he is 
conceived in the maternal womb, by bestowing proper hygienic 
attention upon the mother, later it is necessary to look after his food, 
clothing and hygienic surroundings ;• arriving at the age of puberty, it 
is necessary to follow and watch over him in the school-room, 
directing him afterwards in the exercise of his trade, profession or 
commercial pursuits, to which he dedicates himself, exacting adequate 
hygienic conditions in the house in which he resides, the factory or 
office in which he is employed; the place in which he spends his leisure 18 
hours, the neighborhood and town in which he lives, without ever 
abandoning him, and endeavoring always to surround him with 
conforts, sane pleasures and enjoyable environments, thus driving 
from his side the cause of disease and of affection. The second problem 
to the solution of which sanitation has to direct its attention, is the 
infectious diseases which threaten life and to mantain settled districts 
in a condition of cleanliness, aboundantly supplied with good potable 
water, proper drainage, complete urbanization, hygienic construction 
pf public buildings and private residences with all accessories pertain- 
ing to them, and thus, as far as possible mantaining these "interme- 
diate agents'' free from infection, in order to break the "infecting 
chain" by depriving them of their links. 
The real positive defense of a populated district against deter- 
mined infectious diseases, must have for its base the prevention of the 
existance of such "intermediate agents" and the opportune use of 
vaccine virus, and inmuni zing serums, in cases where these remedies 
are necessary. 
To day, with the facility and rapidity of comunications which 
exist between distant countries, independently separated each from 
the others; the exigencies and necessities of trade and commerce, the 
exact knowldge which now have of certain transmissible diseases, it is 
not possible to confidently expect that the application of quarantine 
laws and regulations, however rigid and faithfully executed can 
protect us from the arrival at our shores of certain infectious diseases 
imported from abroad. 
The real and effective triumph of modern hygiene has been the 
ascertaining with exact and almost mathematical prescision the inti- 
mate mechanism of certain infections. Bacteriology, with its prodigious 
progress, with its marvellous discoveries, has withdrawn the dense 
veil which the ignorance of the past epochs had drawn over the etiology 
of the most formidable preventable diseases, establishing by experim- 
ent and clinical research upon a solid foundation the bases of modern 
prophilaxis. 
The empiricism of quackery of past times and the dangerous 
calculations and vacillations, born of errors on the part of the hygienist 
of by gone days, have been superseeded by the firmness, and certaintity 
of modern sanitary methods which should proceed without doubt and 
free from uncertaintities, like the man conscious of his powers, certain 
as to the sources of his knowledge, and firm in his creeds, for these 
rest upon scientific truths proven upon the unyielding anvil of 
experiment and practice, and it is necessary for the sanitarian, taking 
advantage of these scientific researches to carry them to the field of 
practice in the defense of public health, and cause them to be complied 
with in the interest of the general welfare, and that, gentlemen, is 
certainly one of the fundamental principles of modern sanitary 
practice and its true significance. 
We must agree that it is necessary to mantain the populace well 
defended against cholera, by other means besides the appropiate ■ Secretary of Sanitation and Charities and President of the Committee on Sanitary Affairs 
of the House of Representatives. At the present time a member of Congress for 
Havana province.- (From November 1909 to May 1913). 
DR. MANUEL VARONA SUAREZ. 19 
application of quarantine laws and regulations, to supply it with pure 
water, well chosen and distributed. We should not consider a city of 
great commercial importance, and of a great floating population, abso- 
lutely free from the danger of the Bubonic plague, unless, in addition to 
quarantine laws, we organize ajid mantain in proper manner the 
"cold blooded" campaign against rats; also the certain defenses 
against small pox, is to keep the people well vaccinated against the 
infection. 
And in regard to yellow fever and paludic complaints, neither 
the vigorous application of quarantine laws and regulations, nor the 
isolation of these attacked by these diseases is sufficient, it is necessary 
that the scene of operations, be kept free from mosquitoes, especially 
stegomyas and anopheles. 
The evidence of the truth of the above statements were brought 
forth during the epidemic of yellow fever in Cuba from 1905 to 1906. 
We, with the results obtained, during the first campaign, that of 1901, 
in which the most flattering efforts followed the rapid and adequate 
isolation of those attacked and the fumigation of infected houses, and 
we attributed to these practices the supremacy in that kind of work and 
to them we devoted our preferent attention, relegating to a place of 
secondary importance "petrolization", and the campaign against 
mosquitoes in general, and for this reason, and in consequence of the 
fact that in the towns of Cuba there are immense swarns of stogomyas, 
yellow fever in 1905 took on a fearful increment aided by the many and 
varied means which are always opened for the development of 
epidemics when proper steps are mot taken to supress the sources of 
propagation of disease. 
Typical cases unknown to the sanitary authorities, ambulatory 
cases of those whose condition is made known only after they have 
passed through a town and have infected it, on account of diagnosis too 
long delayed by symbiosis, or the lack or exacerbation of symptoms 
which are considered as pathogenomic. Patients who are without me- 
dical assistance, and other analogous cases are those which can spread 
an epidemic and carry it from one locality to another, rendering the 
efforts to dominate it sterile, when such efforts are not especially 
directed to the absolute dominion of the "intermediate agent'' to which 
sanitary measures can be more effectively applied. 
It is honorable to confess, that at the commencement of the yellow 
fever epidemic in 1905, the Sanitary Department had not been able to 
organize in the Republic, a general and effective campaign against 
mosquitoes, on account of the substancial defects of Order No. 159, and 
the lack of the monetary elements necessary to make it efective, and 
from the erroneous supposition, furthermore, that the campaign should 
be commenced and carried on by isolating those attacked with the 
disease, and by disinfecting the infected houses. 
The first and most positive demostration of the indisputable 
efficacy of the nationalization of Cuban sanitary matters, according to 
the plans of Kean, contained in Decree No. 894 of 1906 was the power 20 
to establish in all parts of the Republic, provided with sufficient 
resources in money, men and material, was the service of the extinction 
of mosquitoes; with which, the control of yellow fever and the 
decrease of paludic fevers were archieved. The Cuban sanitary service 
could then be developed on a firm and secure basis and could organize 
and mantain its different branches, duly provided with all indispen- 
sable necessaries. The prophilaxis of preventive diseases could then 
be established on the modern conquests of hygiene, and for these 
reasons the nationalization of all sanitary measures, was the most 
certain step towards further advance which up to that time had ever 
been taken, for bringing about healthful conditions in this beautiful 
and blessed land. 
Fortunately, the Provisional Government of Cuba, far from 
halting on the road it had commenced towards sanitary progress, 
continued its onward march, dictating laws and regulations for the 
improvement of its various services, and stimulated by the great 
benefits already produced, created in 19'09, on amending the Organic 
Law of the Executive Power, the "Department of Sanitation and 
Charities''. 
With the promulgation of that laws, which established a Depart- 
ment of Sanitation and Charities, we have arrived at the full develop- 
ment of our health and charitable organizations, and have reached a 
decree of advancement and perfection, such, that Cuba is placed in 
the first rank among the most advanced nations of the earth, which 
bestows the most careful attention upon these important and trascen- 
dental matters. 
The evolution of health and charities among us, in its legal aspect, 
may be condensed in the following form, viz: in the previous epochs 
from 1899 to 1902, the powers and faculties were vested in the Chief 
Sanitary Officer, who dictated measures of an urgent character, which 
could not be based on a any previous legislation; from 1902 to 1906. 
these fuculties were conferred upon "collective" organizations, that 
is, upon the Superior Board of Health, the Central Board of Charities, 
the Local Boards of Health, and the Boards of Patrons and Special 
Sanitary Commissioners. 
In 1906, Kean, initiated sanitary legislation inspired on his own 
"personal responsability" theory; this legislation created a local health 
officer, in place of the old time local boards of health. It concentrated 
in the National Board of Health the powers of Special Commissions and 
goes on marking out the new route of making "unipersonal" the 
duties and rights of officials of health and charities, an advantegeous 
practice with a saving tendency, as it makes it easy to govern such 
matters, and gives birth to a true conception of responsability and 
duty. 
The Superior Board of Health of Order No. 159 of 1902, and the 
National Board of Decree No. 894, which were "consultive" and 
"executive" organizations, were succeeded by the National Board of 
Health and Charities of the Organic Law of the Executive Power in DR. ENRIQUE NUnEZ. 
Professor of Havana Uniersity- At the present time Dr. Nunez, holds the Sanitation and 
Charities portfolio. 21 
1909, which is a consultive body of the Department of Sanitation and 
Charities. The organic law comers upon the Secretary of the Depart- 
ment, the powers io supervise the different services and dependencies 
of health and charities, which are placed under his superior direction 
and peisonal responsabiLty, in this manner unified, well regulated and 
directed, the divers matters connected with health and charities are 
easily managed, giving them a course of procedure, fixed, well defin.d 
and harmonius, as is demanded by uniform scientific judgement. 
According to the precepts of the Organic Law of the Executive 
Power, the office of the Department Sanitation and Charities is divided 
in its, functions, into two different branches, that of health and that of 
charities, which with the National Board of that division, constitutes the 
superior organizations of these important components of the Public 
Administration. 
To the Board of Sanitation, belongs the duty of the supervision 
of the different organizations and dependencies of a health nature, 
and of institutions and estabishments of a hygiene character, such as 
are lazarettuses, isolation hospitals, bacteriological laboratories and 
those where serums, vaccines ]ymph, etc. are prepared. 
This Board in the exercise of its official functions, directs the 
local health officers, and has the necessary faculties for exacting from 
them periodical reports concerning the progress of their respective 
labors, together with such memoranda and records as may be judged 
necessary for the good of the service. 
The Sanitary. Directory, is made up of the following Bureaus, viz: 
First. Central. 
Second. Sanitary Services of Havana. 
Third. General Matters and Quarantine. 
Fourth. Special Hygiene. 
Fifth. Statistics, Correspondence and Archives. 
Sixth. Personnel, Properties and Accounts. 
Through the Chief Clerk of the principal office, these bureaus 
send reports to the Director of Sanitation, concerning the inspections 
made of the sanitary service of the Republic; of the municipal sanitary 
service which requires the interevention of the Department; of Labo- 
ratories, Isolation Hospital, as well as those for infectious diseases; 
Dispensaries; Sanatoriums»for Tuberculosis, headquarters for Vaccine 
Virus; of compliance with the regulations for the exercise of the 
professions of Medicine, Veterinary, Pharmacy, Dentistry Obstetrics, 
Vaccination, Undertaking; laws which regulate noxious or dangerous 
establishments; matters relating to the Quarantine service and the 
preparation of sanitary and demographic statistics of the Republic. 
To the Directorate of Charities, is given charge of all matters 
relating to the inspection of Institutions and Establishments of a 
charitable nature, subject to the jurisdiction of the Secretary's office, 
with authority to exact from the functionaries in charge of them all 
information concerning their respective establishments that may be 
considered necessary. The Director of Charities under the authority of 22 
the Secretary, has charge of all matters relating to official or govern- 
mental charities, having the inherent rights and duties connected with 
the tutelage of abandoned children. 
The Bureaus which make up the Directorate of Charities, are the 
following, viz: 
First. Administration and Inspection. 
Second. Hospitals and Asylums. 
Third. Minors. 
Fourth. Personnel, Property and Accounts. 
These organizations have within their own proper sphere of 
action, that of reporting to the Directorate, all matters administrative 
and legal connected with the charitable institutions under the jurisdic- 
tions of the Department of Sanitation and Charities, as well as every- 
thing connected with the administration of properties belonging to the 
Department of Public Charities; matters of a technical character 
connected with the administration of properties belonging to the 
Department of Public Charities; matters of a technical character 
connected with the Hospitals and Schools for Nurses; technical inspec- 
tion of Asylums and establishments of charities; matters connected 
with the care and correction of abandoned and deliquent minors; qnd 
the placing of them in respectable families; of minors under the pro- 
tection of public charities, including those found in Preparatory 
Schools and those who are discharged from Reformatory Schools. 
As a consultive body, the Department of Sanitation and Charities, 
has the National Board, which has a special duty, that of watching over 
the security and good conditions of charitable institutions, as well as 
the proper investment of funds donated, to the State for charitable 
purposes on the recommendation of the Secretary of Sanitation and 
Charities, together with such inspections as may be deemed necessary, 
in order to obtain the security and due progress of these services. The 
members of the National Board, have the right to examine, at any time, 
the results of inspection made of charitable establishments, as well as 
the reports sent in by the functionaries of said institutions, and also 
all documents relating to ther condition and progress. It is within the 
sphere of action of the National Board, to study all projects and 
resolutions of a sanitary character, and to submit its opinion concern- 
ing them. It should investigate and setforth for the consideration of 
the Secretary, the effects of existing sanitary laws and regulations, 
indicating to him, for his recommendation to the National Congress, 
such changes and additions as in his opinion should bo introduced into 
the sanitary laws and regulations. 
It is the duty of the Board to listen to the committies in represen- 
tation of trade and commerce, or other interests, who have complaints 
or reclamations to make for such injuries as they may receive (or 
have received) from the application of sanitary measures at present 
in force, or projected and make out, as a result of its study, a report to 
be submitted to the Secretary for his descision thereon. 
Whenever the Secretary considers it necessary, the Board may The National Board cf Sanitation and Charities meeting in session. 
The Commission on Infectious Diseases. 23 
. . O' 
investigate misdemeanors committed in charitable institutions, or the 
complaints made against the functionaries attached to them, in which 
case, it can take sworn testimony, claim the presentation of books and 
documents, cite witnesses and take such other steps as may be neces- 
sary to arrive at the truth in the matter. 
The office of the Secretary of Sanitation and Charities, has also 
the assistance of the service of the General Inspection of Sanitation 
and Charities, of which there are two General Inspectors, one for each 
branch. It is the duty of these general inspectors to exercise the 
inherent functions of their office, according to the interventions of 
the Secretary. 
It has medical inspectors appointed to the service for the purpose 
of securing compliance with the measures resolved upon. 
The Directors of Sanitation and Charities have also special 
medical inspectors whose duty is to make periodical visits to the insti- 
tutions of health and charities in order to inform themselves as to 
their condition and how they are conducted. 
The sanitary affairs of each municipal district, are in charge of 
the Local Health Officer who are responsible for the execution of all 
ordinances, regulations and Circulars of the Department of Sanita- 
tion; the imposition of fines, which may be necessary for lack of com- 
pliance with, or the infraction of the those regulations; domiciliary 
sanitary inspections of buildings, private residences as well as public 
establishments; to enforce strict application of the regulations 
concerning the installation of sanitary appliances; approval of plans 
and projects for the construction of buildings, and the installation of 
water faucets, drains and appliances for sewerage; the work of 
disinfection in general; matters in connection with infantile hygiene, 
and all particulars concerning public health in their respective dis- 
tricts. At present there are one hundred and seven local health officers, 
and eighty-seven appendices or special sanitary services for small 
towns in existance in the Republic of Cuba. 
Whenever the interest of public health so demands, the Secretary 
of Sanitation and Charities has powers to create special Sanitary 
Services in order to combat epidemic diseases, employing for that 
purpose such sums es may be necessary for the payment of men, 
material and appliances made use of in such additional public 
services, besides which, he can appoint expert functionaries, who 
under the title of "Special Commissioners" act rapidly and en- 
ergetically to combat such sources of infection as my present themsel- 
ves. The Secretary has also the power to dictate all the orders which he 
may deem oportune for the establishment of Interior Quarantine, and 
other measures for isolation, disinfection and inspection which in his 
judgment are required in defense of the public health. 
On the re establishment of the Republic in the year 1909, the 
Organic Law of the Executive Power was put in vigor and consequently 
in accordance with its provisions, the Department of Sanitation and 
Charities was created, Dr. Matias Duque, being the one designated to 24 
hold that office, and he, with great activity established the different 
services especified in that law, besides which, he organized the Section 
of Scientilc Studies and Investigations, which sections was most compet- 
ently carried on by Dr. Mario G, Lebredo; he created the Directorate of 
National Sanitary Engineering; he amplified the service of "Medico- 
Escolar", and organized the Corps of Nurses of the Tuberculosis Dis- 
pensary and the Section of Library and Publications, this latter section 
having charge of the preparation of the Official Bulletin of the Depart- 
ment a notable publication, which on account of its great merit, has 
been the herald of our culture to the entire world. 
At the head of this Section, figures Dr. E. B. Barnet, one of the 
organizers and directors of Cuban Sanitary operations. To Dr. Duque, 
belongs the honor of having been the first Secretary of the Department, 
and having demostrated ardor and good judgment in his official acts. 
To occupy the office of Director of Sanitation, Dr. Juan Guiteras, 
was chosen and who from the beginning of our sanitary organization, 
had given it his valuable aid and services, first as member of the 
Yellow Fever Commission, and afterwards as President of the Com- 
mission of Infectious Diseases and Director of Hospital "Las Animas" 
and member of the Superior and National Board of Health. 
Dr. Guiteras continues, to the advantage of the service, and the 
benefit of public health, at the head of the Direction of Health, dedicat- 
ing to Cuba, and the noble cause for which he is so eminently qualified, 
the fruits of his grand talents, his great knowledge and extensive 
experience in sanitary matters. He is a modest warrior of positive 
merits, who daily undertakes rude tasks in the fight against infectious 
diseases. He has been one of the most efficient colaborators in our 
great sanitary work and his services, of inestimable value have always 
been given in a spirit of true devotion to science. 
The Direction of Charities, has been since its creation in 1902, up 
to the present time, successfully occupied by the Messrs Juan Miguel 
Pla, the former and competent secretary of the extinct Central Board 
of the Division; by Dr. Pedro Sanchez del Portal, battler and active 
politician; by Dr. Matias Duque, ex Secretary, and by Dr. Fernando 
Mendez Capote, a laborious and very notable physician, who from the 
time he has discharged the duties of positions of high authority as 
Mayor of Cardenas and as representative in the National Congress, 
demostrated the firmness of his character and his love of the cause of 
all that is good. 
Dr. Jorge Vega Lamar, succeeded Dr. Barnet in the position the 
latter had held in the Sanitary Department, and a few'months later the 
former was succeeded by Dr. Eugenio Sanchez Agramonte, a general 
in the Army of Liberation, a distinguished physician who had been 
Director of Public Charities, and formally Chief Sanitary officer in the 
Cuban army during the war for Independence. 
Dr. Sanchez Agramonte, lover of the cause of public health, work- 
ed assiduosly, and was a member of many scientific commissions; later Part of the building on Tacon street, which was first occupied by the De partment of Sanitation in 1890. 25 
on lie was succeeded by Dr. Luis Adam Galarreta, who still holds'the 
position and who labors energetically and most competently. 
In October 1909 Dr. Manuel Varona Suarez, Representative in 
Congress and President of the Committee on Health and Charities in 
that body, was appointed Secretary of Sanitation and Charities. 
Dr. Varona proceeded with notable skill in giving great impulse 
to the different organizations of health and charities. He personally 
inspected the local health offices and the various charitable institutions 
of the Republic, duly attending to their needs and ampliying as far as 
lay in his power, their sphere of action, and carrying to ah of them the 
warmth of his scientific enthusiasm. 
In accordance with a special law of Congress, he enlarged and 
improved the Sanatorium "La Esperanza", and reformed numerous 
hospitals, amply endowing them. Among his useful proyects figured 
that of transferring of Hospital San Lazaro for lepers; the construc- 
tion of a hospital for advanced Tuberculosis patients and of the Natio- 
nal Asylum. He warmly aided the work of Drs. Hernandez and 
Ramos, and created the Bureau of Homiculture. 
Varona Suarez gave his preferent attention to the problems 
connected with Pulmonary Tuberculosis; with the water supply of 
towns and to the great work of popular hygienic education, and one of 
the most important factor in all labors of a sanitary nature. He 
created special wards for advanced tuberculosis patients in the hospi- 
tals of the Republic, and was resolving with flattering success different 
problems connected with that disease and formulated a complete plan 
to organize Special Tuberculosis Services. He studied the reforms 
needed in the Sanitary Ordinances, prepared the new ones adapted to 
each locality, promulgated the regulations applicable to pharmacy in 
conformity with the law which governs that profession*; prepared and 
published the regulations concerning the installation of sanitary 
appliances; those concerning the general inspection ordered by the 
Department of Sanitation and Charities and the provincial sanitary 
inspections; he created the corps, of Sanitary Police destined to the 
service of isolation and vigilance over those attacked with transmis- 
sible diseases. 
As a counsellor of the President of the Republic, he took part in 
the preparation of the message of the Executive to Congress, 
soliciting the promulgation of laws for the campaign against.Tuber- 
culosis, the organization of the service of Homiculture m conformity 
with the results of the investigations of Doctors Eusebio Hernandez 
and Domingo Ramos; the reconstruction of the general asylum for 
lunatics, in order to convert it into a model establishment. He was 
also careful in seeing that the Republic should be represented in 
a dignified manner in the different foreign medical congresses, and 
published works dedicated to popular hygiene; the amplification of 
the "Six O'Cloock Closing" Act; for the purpose of improving the 
condition of the dwelling places of commercial clerks and employees, 
and to afford them opportunies for bettering their living conditions 26 
considered generally, as a governmental and hygienic measure of the 
highest sanitary and social importance. He recomended and obtained the 
incorporation with that of Department of Sanitation of the Bureau of 
Immigration by means of which great advance was made in the 
completion of sanitary action He published in accordance with a 
decree of the Provisional Government, the works of Dr Finlay, and 
established the Immigration station in Santiago de Cuba and at the 
Key Juan Vicente, in Nipe Bay. 
Varona Suarez, consacrated his fecund and happy initiations to 
the beautiful task of well doing and practical charity, carrying out 
numerous and most useful measures for the benefit of general 
salubrity 
In hours of anxiety over bad conditions existing in different 
parts of Cuba on account of disasters which had afflicted them, Varo- 
rona Suarez, hastened to remedy, as far as possible, such direful 
conditions, carrying with him official pecuniary aid, coupled with 
the inexhaustible kindness of his own generous heart. 
The organization of public charities in Cuba as well as that 
public health is now so precise and complete, that within a few 
hours after the occurance of any serious disaster or catastrophe, 
oven in the most distant parts of the Republic, the aid and assistance 
of the Central Power reaches the stricken ones, to attend to an cure 
the wounded, and to difuse in all parts consolation and hope 
And Varona Suarez, in addition to being faithful to the duties 
incumbent upon him, inspired by his love for all that is good and 
noble, and by his zeal and enthusiasm in every act of charity, hastened, 
in those moments of sadness, to sister regions to attend to an relieve 
their misfortunes. His proceedure connected with the calamities which 
occured in Pinar del Rio, and during the inundation of Batabano, 
constitute pages of glory in his life's career and in the history of Cu- 
ban charities, which he himself has woitten with his enthusiasm and 
with his love! 
During more than three years, from the 30th of October 1909 to 
the 20th of May 1913, Dr. Varona Suarez, remained at the head of the 
head of the Secretary's office, resigning that position at the termina- 
tion of the constitutional period of the incumbency of General Gomez, 
as President of the Republic, and of whose cabinet Dr. Varona Suarez, 
was a member. 
On the 20th of May, 1913 Dr Varona Suarez, was succeded in 
office by Dr. Enrique Nunez, Professor in the National University, and 
who bad contributed, by his knowledge and experience to the national 
sanitary organization, as member of the Superior and National Boards 
of Health, positions which he held in virtue of his being President of 
the Commission of Special Hygiene. 
Dr. Nunez, interpreting the most ernest desires of General Meno- 
cal, President of the Republic, and prompted by his own convictions, 
proceeded as soon as he had taken charge of his office, to organize the 
service of Infantile Hygiene, creating the "Menocal Asylum", for Part of the Maestranza building which the Department of Sanitation occupied until 1910. 27 
children under fourteen years of age and the Nursey (creche) "The 
Child Jesus", ("El Nino Jesus"); giving all of his aid official and 
personal, to the different organizations devoted to the protection of 
helpless infancy. 
Through the zeal with which he pursued his official labors in this 
direction, a great social movement was developed in favor of infancy, 
and private nuseries (creches) were established for the daily care of 
infants, as well as the Central Consultories for Infantile Hygiene, and 
that of the "Hospital Nuestra Senora de las Mercedes". 
The services for the protection, official and private, of pregnant 
women, and children unduly provided for were extended, and made 
more vigorous, as a measure of well known efficacy in combatting the 
alarming mortality among the Cuban children, occasioned in the most 
absolute majority of cases by Enteritis in children under two years old, 
a disease which decimates our infantile population and figures with 
terrifying frequency in our statistics of mortality. 
The task of trascendental importance, that of educating Cuban 
mothers in the care they should observe while pregnant, in the defense' 
of their lives and that of the product of conception, was commenced. " 
Practical lessons were given to mothers of families, concerning 
the attention demanded by children under two years of age, in reference 
to their proper alimentation and hygienic conditions, which should 
surround them. Physicians and Nurses in special Dispensaries and in 
the domiciles of those to be instructed, with this useful practice and 
redeeming instruction 
Among the measures adopted to solve the problem of Enteritis in 
children under two years of age, figured that of the inspection of 
wet-nurses in accordance with sanitary laws governing their profes- 
sion, watching over the milk supply of towns, due care of the hygiene 
of the domicile and of the child, and the sanitary preparation of the 
mother, so that she should know the danger of that disease, and be 
made aware of the measures to be adopted in order to prevent it. 
Dr. Nunez, created the "Colony of Infantile Sanitary Defence'' in 
the Encampment of Triscornia for two hundred sickly children, for the 
purpose of attending to their physical development, and in order that 
they should receive a practical lesson in hygiene. For two months this 
colony flourished with flattering success, and children who had entered 
it anemic, thim, weak, infected with vermin and of ill mannered habits, 
left it clean, strong, lively and well instructed sanitary. It was a 
powerful work of hygiene and of education. 
Through the efforts of Dr. Nunez, official protection was obtained 
for two most meritorious private institutions, the "Granja Nuestra 
Senora de la Caridad" (The Summer School of Our Lady of Charity), 
the establishment of which is due to the superlatively meritorious Dr. 
Manuel Delfin; and for the "Bando de Piedad" (Band of Mercy), to 
which the Secretary of Sanitation and Charities ceded an edifice, suita- 
ble for the installation of its Offices, Dispensary, Asylum and 
Consultory. 28 
Dr. Nunez understood the ardous and thorny task of putting the 
properties of the Department of Charities into a throughly sanitary 
condition, undauted by the magnitude of the undertaking and undis- 
mayed by the greatest of the many obstacles which presented them- 
selves; 
He transferred the offices of the Department to a building 
belonging to the government; and for that purpose he adequately 
fitted up the comodious building known under the name of "Las Viu- 
das" (The Widows). 
Dr. Nunez, attacked with descision and extraordinary firmness, 
the ardous labor of cutting at the root, one of our social evils, public 
prostitution and the laws governing it which from old time colonial 
days had figured as an institution subject to the patronage of the State, 
which for this reason recognized the existance of tin1 "Social cancer'' 
and in a certain sense protected it, or to use the official phrase: 
"tolerated it". 
It was necessary to carry out the work of social sanitation, all of 
the energy and preseverance of Dr. Nunez, were enlisted and with the 
keen knife of the surgeon, he amputated with serenity and firmness 
that gangrenous net work which infected our social ambient. 
To Nunez, is due the successful efforts for bringing to a happy 
termination the questions concerning that work of transcendental 
importance; the construction of the National Hospital "Calixto G-ar- 
cfa", which will be erected upon the site of the present existing ruinous 
and anti hygienic hospital "Number One", and which will demostrate 
to Cubans and the strangers from abroad who visit it, how zealously 
the Government of Cuba watches over and shelters those unfortunates 
ones who as are overcome in the struggle of life. 
Near this hospital, there arises, imposing and grand, that of 
"Nuestra Senora de las Mercedes", an exemplary institution, which is 
always presented as a model, and which in great part owes its 
existance to the altruistic labors of Dr. Emiliano Nunez de Villavicen- 
cio, father of the present Secretary of Sanitation and Charities. Pro- 
vidence has desired to bring about on that piece of soil, the reunion of 
two institutions of piety, consacrated to all that is good, and to 
instruction concerning it, and these two institutions, will owe their 
existance to the initiative steps taken by two Cuban physicians, one of 
whom is following the beautiful example set by his father. 
Dr. Nunez, inspired the message of the President to Congress, 
recommending the creation of small hospitals for quarantine in 
different towns of the Republic, repeating his laudable efforts for the 
installation of the hospitals for children and for the creation of four 
asylums for old and destitute persons; projects which are now being 
considered by the Legislative Powers, and there is also under conside- 
ration a resolution providing that when lottery tickets have obtained 
prizes, and the amounts due on them, have not been collected by the 
owners of the tickets or their representatives, the proceeds of all such 
unpaid premiums shall be made use of for charitable purposes. Privately owned building, at San Lazaro and Belascoin 
streets, which was occupied by the Department of Sanitation and 
Charities from 1910 to 1913. 29 
Like Varona Suarez, Dr, Nunez, insists on the necessity of the 
reconstruction of the State Insane Asylum, as its present bad sanitary 
condition provokes much adverse public comment and is the cause of 
much preventable and unnecessary suffering on the part of the inmates 
confined there. 
Among the projects which Dr. Nunez, has under consideration, is 
the creation of a central school for nurses, which will include those 
which now exist in different hospitals; the construction of buildings 
suitable for hospitals in Bayamo, Ciego de Avila, and Victoria de las 
Tunas, which at present are installed in inadequate buildings owned by 
private individuals. 
Workingmen's Insurance, an institution of great advantage to the 
working classes and which contributes to the defense of his health and 
general welfare is also the subject of much study and consideration on 
the part of the Secretary, in order that a duly considered and well 
worded Presidential message may be presented to Congress, for the 
purpose of implatning this prudent measure in Cuba. 
Dr. Nunez, at present discharges the duties of the office of Secre- 
tary of the Department of Sanitation and Charities. 
Our condition as employees in that office, does not permit us to 
eulogize as it merits, his honorable and energetic procedure, but faith- 
ful to our purpose to duly note the most salient facts, and those which 
display themselves in most conspiscuos manner our sanitary develop- 
ment. We have not hesitated to set forth the improvements which are 
due to him and if any one can discover such eulogies in our discourse, 
they do not come from any impure motive on our part, but to the labors 
of Dr. Nunez, and not to our mention of them, are due those applauses 
and congratulations. 
Cuban sanitary matters during the epochs of Varona Suarez and 
of Nunez, have been subjected to rude tests, from which they have 
always come forth triumphant, demostrating the excellence of the 
organization; the intellectual capacity of its directors and employees, 
and the zeal displayed by our government in the solution of all pro- 
blems connected with the public health giving them the scrupulous care 
which their importance demands. 
Cuba has triumphed in those jousts of knowledge, of labor and of 
experience. Its sons have proven before the entire world that they are 
held, as a people who march in the vanguard of progress and civiliza- 
tion. 
While Dr. Varona Suarez, was Secretary in November 1911, he 
had notice of an outbreak of yellow fever in Banes, in the Province of 
Oriente. The notice was received on Sunday, and in two days time, 
which is required for the transportation of men and material the 
barracks occupied by those attacked by the disease, had been fumigated 
and the corresponding sanitary action duly executed. Later on the 
cases were proven to be negative, but the activity and energy of the 
Sanitary Department were demostrated, together with the efficacy of 30 
the organization, and the rapidity and prescision of the working of the 
sanitary mechanism. 
Tn July 1912, three cases were discovered in Havana which proved 
to be of Bubonic Plague. Dr. Varona Suarez organized with surprising 
rapidity, extraordinary services to combat the infection, not hesitating 
to furnish all resources necessary to undertake a rigorous campaign 
against this fearful disease. 
The service of deratization was organized, and those of cleaning 
and disinfecting, and the medical and sanitary inspection of public 
buildings and private residences were rigidly enforced. 
In 1911 we were threatened with the invasion of an epidemic of 
cholera and the Department, with Dr. Varona Suarez at its head, de- 
mostred its skill and activity. It prepared and arranged the forces 
necessary to save Cuba from that infection. The lazarattus or quaran- 
tine station at Mariel, being given an adequate aqueduct. 
Later on, in March 1941, Dr. Nunez, being Secretary, a new out 
break of Bubonic Plague occured, and in the City of Havana, 24 cases 
were registered, one case in San Jose de las Lajas, one in Artemisa, and 
one in the roadway of Quines; of these 27 cases terminated in deaths. 
In Santiago de Cuba, 10 cases occured and in Aceite, Caney, four 
eases were registered, making up a total of 14 cases of the Plague in 
Oriente, of which three were fatal. 
The Plague, although propagated in the interior of the Republic, 
was quickly stamped out, conquered by the opportuness, eficcacy and 
proper direction of the organized sanitary services. 
In the month of November of the present year, 1914, there occured 
in Havana three cases of small pox, which infection was rapidly 
dominated and confined to a single ward of the city, on account of there 
being put in force the law of compulsory Vaccination and revaccina- 
tion. The Secretary's office, the City Council, private individuals and 
the entire people, responded nobly to the requirements of the sanitary 
authorities and putting in force that, redeeming'and preventive prac- 
tice of vaccination and revaccination, Cuba again exhibited to the 
entire world a beautiful example of her most excellent organization of 
Health and Charities, in virtue of which transmissable diseases may 
be combatted with flattering success, limiting to the place in which they 
originate, the most fearful epidemics. To assist promptly and efficiently 
at distant localities, and defend whenever it may be necessary, 
threatened public health and to succor and sustain the unfortunates 
overcome in the struggle for existance, constitutes the mission of .our 
sanitary and charitable organizations. 
The development of Cuban sanitation and charities has been slow, 
of firm and steady progress. From "nothing" in January 1899, 
when the American Goverment created the Department of Sanitation 
and Charities of Havana, of a relatively small sphere of action and 
limited to this capital. Later on its services were ampliled and extended, 
and in 1902, the first steps were taken to extend sanitary benefits to 
all parts of the Republic. State=owned building which is at the present time occupied by the Department of Sanitation and Charities. 31 
In 1906, the Department and National Board of Health was crea 
ted, and in 1909, the Department of Sanitation and Charities was esta- 
blished, Cuba being the first nation that could present the harmonious, 
complete and excellent organization in which all branches of public 
health and charities are united, and placed under the personal direc- 
tion of a Secretary, who is. a member of the cabinet, and responsible for 
the progress of the services confided to him. 
The Secretary of Public Works, who is in charge of important 
branches of sanitation, accompanies the Secretary of Sanitation and 
Charities in his onward and upward march toward perfection, and 
contributes to the improvement of sanitary conditions in all parts of 
the Republic. 
Since the year 1899', the Department of Public Works has 
organized in a most complete manner the services of cleaning and 
sprinkling of streets and the collection of and disposal of garbage in 
Havana and other principal towns in Cuba. It improved our roadways 
and other means of communications, repairs and cleans our streets in 
such manner as to call forth just applause. This street cleaning service 
is one of the positive factors in the general work of hygiene under 
taken. Promenades are constructed, parks laid out, infected ditches are 
canalized, marshy grounds filled in, and the capital cities of Cuba and 
especially Havana, commence to take on the features of the most 
advanced civilized, culture and refined centers of population, the wide 
world over. 
The Department of Public Works continues its great undertakings. 
.It constructs aqueduct and improves those already constructed, sewers 
and paves the streets of towns, and the white ribbons of roadways are 
extended through green and fertile plains, hills and dales, carrying in 
their course urbanization, progress and wealth. 
The different secretaries of the Executive Rower in Cuba, reach- 
ing public sentiment, and aware of the advantages and benefits which 
arise from an improved condition of public helth, which means general 
welfare, cooperate as far as possible in the great work of sanitation. 
The Secretary of State constantly gives out information concerning the 
existing sanitary conditions in foreign countries, and furnishes valua- 
ble facts and notes having reference to these conditions. The Secretary 
of Government exacts from the City Councils their proper attention to 
sanitary matters in the districts under their respective jurisdiction. 
The Secretary of Public Instruction, requires the education of the 
rising generation in accordance with the principles of modern hygiene. 
The Secretary of the Treasury, furnishes the funds necessary to defray 
the expenses of carrying on sanitary campaigns. The Secretary of 
Agriculture, Commerce and Labor, attends with zeal to the problems 
connected with diseases among cattle and other domestic live stock, 
and their epizootic laboratories, prepare and distributes gratis vaccine 
virus, and popular instructions for combatting epidemic diseases 
among animals. The Secretary of Justice, demands proper execution of 
the sanitary laws and regulations and in a general way all of the depart- 32 
ments of the government cooperates with zeal and descision with the 
Secretary of Sanitation and Charities, in his beautiful labor of protect- 
ing public health. 
The action of private individuals forms an active and most impor- 
tant part of this work of general benefit. The propietors of urban 
properties have transformed their residences, beautifying the cities 
by their own personal efforts, and have constructed wards of modern 
hygienic buildings the architectural elegance of which compares fa- 
vorably with that of the most advanced nations in this respect. They 
approve of sanitary orders and promptly, complay with them, and 
never present any obstacles in the way of carrying them out. 
The private organizations, associations and institutions, have1 
followed the public and official ones in the path of progress. The pri- 
vate health resorts and hospitals are being amplified by the construc- 
tions of sumptuous and hygienic buildings destined to the use of their 
patients. 
The hospital San Francisco de Paula of Havana, was transferrd in 
1909' from the old ruinous, ramshackle barracks it then occupied to 
modern edifice especially constructed for the purpose in Jesus del 
Monte, and duly provided with all necessary modern appliances. In 
1908, the Hospital "Caymari" of Manzanillo was inagurated. This 
hospital owes its existance to the generous legacy of a most worthy 
Cuban named Caymari, whose name it bears. 
The Asylum for Asistics, which was found in an infected house 
in this city, constituting a fearful source of infection and an offense 
against the ornate, has just been inagurated in its new edifice in San 
Miguel del Padron. 
The private Hospitals (Casas de Salud) "Balear", "Canaria" 
and the Sanatorium "Malberty", have already acquired sites upon 
vhich they will soon build their hospitals, which will be up to date in 
every respect. 
In all parts of the Republic, there are established general and 
private surgical clinics, equipped with the modern conquests of sani- 
tary science. Many of them being models among that class of establish- 
ment. 
All above set forth, goes to show that the great work of trans- 
formation of all matters pertaining to sanitation and charities, beco 
me, so to speak, national now that the different elements which go to 
make up Cuban nationality, take part in it, official, as well as perso 
nal, all in friendly rivalry, striving to reach the highest degree of pro- 
gress and perfection. 
Such has been described only in imperfect outlines, our sanitary 
evolution, and the generous labor of renowned medical men, foreign 
and native, who have directed and continue to direct our sanitary 
affairs. The triumph already archieved and those which have to be 
reached in the future, redound to the benefit of humanity and to the 
honor of our native land. Entrance of the Department's building. Court yard of the building of the Department of Sanitation. Office of the Secretary. 
A general view of the Department of Sanitation and Charities. A general view of the Department of Sanitation and Charities. "Nuestra Senora de las Mercedes" Hospital. "San Francisco de Paula" Hospital. Entrance of the Sanatorium "La Esperanza". A general view of the pavillions of the Sanatorium "La Esperanza". Entrance of the Modern Chinese Asylum. A general view of the Asylum. Plans for the new National Hospital "Calixto Garcia" now in the course of construction. Pains for the new Military Hospital at Camp Columbia. "Las Animas" Hospital. Dr. Guiteras, Director and Dr. Cartaya, Vice Director. 
Entrance of the Triscornia Encampment. DR. FRANCK E. MENOCAL. 
Commissioner of Immigration. Immigration Department, Triscornia. Hotel for Immigrants. 
The "Duque" Laboratory for Study and Scientific Research. The present Hospital No. i. 
Library of the Department of Sanitation. Dr. Barnet, Chief of the Section and his 
assistants. DR. HUGO ROBERTS. 
Chief Quarantine Officer- Building in construction for the Laboratory Scientific Studies and Investigations, within the grounds of "Las Animas" Hospital, 
and of which Dr. Mario G. Lebredo, is the head. Another view of the Laboratory under construction General Vaccine Biireiu. Director of the General Vaccine Bureau, and of those who prepared Order No. 165, 
which declared vaccination obligatory. 
DR. VICENTE DE LA GUARDIA. The "Tamayo" Dispensary, where there is also located the Central Consultory of Infantil Hygiene. The Dispensary for Tuberculosis. Monument which is to be erected in the Court=yard of the Department of Sanitation 
and Charities, in honor of the genial Finlay. 33 
There remains for our solution various and very complicated 
"internal" sanitary problems, which we have to attack with renewed 
energy; the struggle against Tuberculosis, Cancer and Typoid fever. 
We have to presevere in the grand work of infantile hygiene, and of 
sanitary propaganda, in order to dominate infectious diseases, which 
effort require the conscientious support of the public, in the official 
sanitary labors carried in order to dominate them. 
It is necessary to amplify the services of milk inspection in or- 
der to obtain the chemical and bacteriological purity required in this 
article, and to secure proper hygienic conditions in its transporta- 
tion, manipulation and sale. The bromatological inspection in gene- 
ral, in order to exact the good quality of food stuffs and brevages 
and to undertake the work of obtaining by means of wise laws, cheap 
and hygienic domiciles for poor peoples, as well as to lower the price 
of alimentary substances of prime necessity. 
On extending our glace over the brilliant results arch'ieved by 
Cuban sanitation and charities, and observing the triumph obtained 
by them in the course pursued in order to reach perfection, our souls, 
as Cuban become elated with legitimate pride at the thought of being 
citizens of a nation which displays such laudable efforts in the pro- 
motion of the health of her sons, the most durable foundation for ths 
prosperity and wealth of her people.