The threat from Havana: Southern Public Health, yellow fever, and the U.S. intervention in the Cuban struggle for independence, 1878-1898.

IN SEPTEMBER AND OCTOBER 1897 THE SOUTHERN UNITED STATES WAS gripped by a terror that shuttered businesses, paralyzed trade, and caused tens of thousands of people to abandon their homes and flee for their lives: the dreaded yellow fever had returned. Southerners had good reason to be afraid. It began with a high fever that lasted three or four days, with throbbing headaches and body aches, nausea, and chills. In most cases the fever would then subside, and the victim would slowly recover over the next few weeks. Many times, however, the break in the fever was, like the eye of a hurricane, a deceptive calm. The fever soon returned, and the body began to break down. The disease attacked vital internal organs, and, as the liver failed, the patient's skin and eyes turned yellow. The eyes, nose, mouth, and stomach started to bleed. The helpless victim then began to vomit repeatedly, the liquid black with digested blood. This last terrifying symptom signaled that death was near. The disease struck the young and strong as well as the old and infirm, afflicted rich and poor, visited well-kept households along with filthy ones, attacked blacks and whites, and, once present in a city, often spread from one neighborhood to the next in ways that defied prediction. Even a rumor of "yellow jack" inspired panic.

Decades of experience had taught southern health officials the source of this dreaded disease. The 1897 yellow fever epidemic, like many outbreaks before it, was of Cuban origin. Unlike previous episodes of infection, however, by the end of 1897 the U.S. government was determined to end the ongoing threat that yellow fever in Cuba posed to the health and economy of the southern states. The island would be invaded and the disease stamped out at its source.

This article traces the ongoing concerns in the United States with yellow fever in Cuba. The impact of the periodic epidemics of yellow fever that plagued the U.S. South during the latter half of the nineteenth century has been the subject of considerable scholarly attention. Some historians have extensively described the devastation caused by yellow fever epidemics. (1) The disease has also been found to be the central concern of public health officials in the South and the principal motivation for creating a nationalized board of health. (2) Additionally, scholars have explored the effects of yellow fever on interclass relationships and on the reconciliation of Civil War animosities. (3) However, historians have failed to note the influence of yellow fever in the South on U.S. international relations.

The historiography on the motivations for the entry of the United States into the war against Spain in Cuba is even more extensive than that on yellow fever. Most early works viewed the war as a humanitarian crusade to liberate Cubans from the chains of Spanish tyranny. (4) Cubans had been fighting the Spanish in various ways for decades. Stories about the despair of Cubans held in Spanish concentration camps moved ordinary Americans, but by the time of U.S. intervention the Spanish had ceased the forced movement of the population and had recalled to Spain the vilified General Valeriano Weyler, the architect of the reconcentration policy. The destruction of the oft-remembered Maine in Havana's harbor was once frequently cited as the event that led to the U.S. entry into the war between Spain and Cuba, but recent scholarship has debunked the importance of the ship in the turn of events. (5) As will be explained in more detail below, months before the explosion of the Maine, the U.S. minister to Spain had already met with European leaders to discuss the United States' intention to declare war against Spain. Other recent historians have pointed to the extensive and growing economic ties between the United States and Cuba and the long-standing fascination of many U.S. government officials with the idea of annexing the island, and there is convincing evidence that the negative effects of the ongoing Cuban struggle for independence on U.S. interests in trade and investment there played an important role in the decision to intervene. (6) But nineteenth-century U.S. policy makers also had a long preoccupation with Cuba for a reason that the scholarship on the period has overlooked: Havana was the principal source of the yellow fever epidemics that plagued the southern states.

This article remedies that oversight. It begins by reconstructing how southerners, sanitarians, and U.S. government officials became increasingly concerned with the threat from Havana posed by yellow fever over the latter decades of the nineteenth century. Next, it documents how these concerns led to calls for the U.S. annexation of Cuba, calls that grew more insistent as the risk to the South increased due to the rapid spread of the disease on the island during the Cuban War of Independence. The article then reveals how, when the deteriorating conditions in Havana produced the 1897 epidemic that again paralyzed the southern economy, yellow fever became an important motivation for the U.S. declaration of war against Spain in 1898. Fear of the devastation that yellow fever could cause the southern economy was not the only reason for U.S. intervention in Cuba. However, it was an important reason, one that works into larger concerns of U.S. economic growth, investment, and influence in the region.

After weeks of suspicions, the news broke on September 6, 1897: there was yellow fever in New Orleans] U.S. Army soldiers stationed there were quickly ordered to abandon the city and evacuate to the safety of Fort McPherson in Atlanta. (8) Within a week, "King Jack" had brought virtually all movement on the railroads to a halt for three hundred miles around New Orleans; only a few passenger trains were rolling, each carrying a full load of terrified refugees and bound directly for the safety of northern points. (9) The steamship trade similarly came to a halt; indeed, the U.S. Mint in New Orleans was shut down because there was no way to ship out the coins and currency to places in need. (10) Many observers attempted to argue that only recent arrivals to the city were panicked, but there was soon no denying that even native residents were scared. When the Board of Health began to convert a school to an emergency yellow fever hospital for "that class of unfortunate citizenship, who, being stricken with the yellow fever, may not find themselves in a position to be taken care of at home," fearful inhabitants of the surrounding neighborhood set fire to the building and repeatedly cut the firefighters' hoses as they attempted to save the structure. (11) It By the time cold weather began to quell the epidemic two months later, more than seventeen hundred cases of yellow fever had been diagnosed in the city, and the disease had claimed more than two hundred lives. (12)

Yellow fever--and so panic--spread across the South. When several suspicious cases of fever occurred in the town of Edwards, Mississippi, on September 13, the citizens of nearby Jackson evacuated en masse. The next day, half the residences of the state capital stood empty, and when seven cases at Edwards were definitively identified as yellow fever the following morning, most of the remaining inhabitants joined the exodus. (13) The state government, both daily newspapers, and most of the city's businesses were closed for the duration of the epidemic. The remaining residents adopted an absolute quarantine: no one, not even returning residents, could enter the city, regardless of whether they held a doctor's certificate attesting to their good health. (14) As further insurance against infection, a railroad bridge along the line between the city and Edwards was set on fire and completely destroyed. (15) The quarantine at Jackson was successful--no cases of yellow fever developed in the city--but until it was lifted six weeks later, the city was completely idled.

When word of the yellow fever outbreak in New Orleans reached Texas, the state government quickly imposed quarantine against all infected points. (16) Initially, the port at Galveston actually benefited from steamship traffic rerouted from New Orleans. On September 22, however, a fatal case of yellow fever was identified in Beaumont, to the northeast of Houston near the Louisiana border. (17) The news caused an eruption of local quarantines. When a suspicious case was found in Houston a few days later, hundreds of refugees swarmed the city's train stations. (18) Even yellow fever experts dispatched to Texas from New Orleans by the U.S. Marine Hospital Service were turned back in western Louisiana by a Winchester-toting mob that "threatened to tear up the track and burn the bridges before they would allow the train to go through." The doctors eventually reached Houston from the north via St. Louis instead. (19) When the disease reached Galveston, quarantine against the city forced the steamship companies to close entirely until the end of the epidemic. Only sixteen cases of yellow fever were diagnosed in Texas, with only a single death, but commerce was disrupted for weeks on end. (20)

The city leaders of Atlanta took a different stance with regard to the epidemic. Confident that the city's climate would prevent yellow fever from gaining a foothold, they announced that those fleeing from infected locations would be welcomed. During the first weeks of the epidemic, several hundred refugees took up this invitation each day, brought from across the South by the few trains still running. The arriving refugees were checked for symptoms before being permitted to enter the city, and any suspicious cases were removed to a quarantine camp outside the city for observation and treatment. (21) Fortunately the judgment of Atlanta's city leaders proved sound; the city remained free of yellow fever.

Other southern cities, however, found the risk of contagion posed by the refugees in Atlanta to be too great to hazard. In Alabama the cities of Huntsville, Decatur, Selma, Montgomery, and Mobile promptly raised a rigid quarantine barring all arrivals from Atlanta. Chattanooga, Charleston, and Wilmington quickly followed suit, as did many towns in Georgia. All backed up their proclamations, reminding at gunpoint those who forgot the prohibition of travel from Atlanta. (22) Business, as a result, slowed to a crawl. "The dead line has been drawn," complained the Atlanta Constitution after weeks of quarantine, "the mails have been practically stopped, the railways have all but suspended operations, and all forms of interstate traffic have been as good as abolished." (23) The effects of the yellow fever epidemic dragged down the stock prices of southern companies, and the entire New York market followed. (24)

In Alabama, however, the quarantine would prove as ineffective as it was costly. By mid-October yellow fever reached the capital, Montgomery, and panic ensued as thousands fled the city. "When old Vesuvius erupted and the people flew from the fast-creeping yellow lava, the terror in Pompei was probably a little more intense than it has been here since yellow fever has been announced to exist in Montgomery," reported one observer. "The stampede is positively astonishing." (25) Alabama cities and towns that had earlier erected quarantines against points in neighboring states then turned against each other, and the railroads and most other businesses soon came to a halt statewide. (26)

The epicenter of this human and economic catastrophe stretching the breadth of the South was the resort town of Ocean Springs on the Mississippi coast. Vacationers returning home to New Orleans and Mobile brought the disease with them; efforts by doctors and health officials in those cities to conceal the outbreak in order to prevent panic only succeeded in allowing the disease to spread. The sickness had earlier made its way through the inhabitants of Ocean Springs, slowly marching up one street and then the next during July and August; the town's Catholic and Presbyterian churches also appear to have been foci of infection. Most of the earliest cases, however, were among children. Several children contracted well-marked cases of yellow fever by mid-June; early that month the young son of one Mrs. Gonzales was among the first to fall ill. Mrs. Gonzales was Cuban, and her home also served as the Gulf Coast headquarters for Cuban insurgents who smuggled people and contraband between the United States and Havana, surreptitiously avoiding both the nearby Ship Island quarantine station and the Spanish authorities. In so doing, the insurgents brought with them yellow fever, which was always and notoriously present in Havana. (27)

The threat posed by yellow fever in Havana to the southern United States had first attracted the federal government's attention a generation before 1897, in the wake of the 1878 Mississippi Valley epidemic. Unlike the 1897 outbreak, which spread beyond Ocean Springs just two months before hard frosts brought it to an end, the 1878 epidemic had raged the entire summer. From New Orleans the disease spread up the river and outward along railroad lines, ultimately claiming victims in more than one hundred cities and towns. Over one hundred twenty thousand people were stricken; more than twenty thousand perished. The economic damages were also extensive. Commerce ground to a halt as panicked townspeople imposed self-help "shotgun" quarantines. Total economic losses were estimated to be at least one hundred million dollars; many put the figure as high as twice that amount. (28) U.S. health officials were convinced that the origin of the infection was Havana, noting that with the end of the Ten Years War on the island that year, hundreds of refugees had fled to New Orleans from Cuba. Contemporary sanitarians identified the precise source of the epidemic as the ship Emily B. Souder, a steamer from Havana whose passengers were allowed to disembark in New Orleans without passing through quarantine; two of its passengers were among the first to be diagnosed with yellow fever. (29)

Yellow fever had to be understood and controlled in order for the U.S. South to prosper. The epidemic prompted intense research on the disease. In the summer of 1879 the newly formed U.S. National Board of Health sent a group of experts, the Havana Yellow Fever Commission, to Cuba. Headed by New Orleans physician Stanford E. Chaille, the group was charged with studying yellow fever in Havana and other localities on the island where the disease was believed to be prevalent. "[I]t is believed," Chaille wrote, "that if mankind is ever to be protected from this scourge this must be accomplished by stamping it out at its very sources." (30) The commission's chief purpose was to determine the sanitary conditions that allowed yellow fever to flourish in Cuban ports and the measures, if any, that might be instituted to prevent ships bound for the United States from being infected with the disease. With the assistance of Cuban physicians, the visitors also studied the symptoms associated with yellow fever. (31)

It was widely believed at the time that yellow fever was a disease that lived in and was transmitted by filth, so the commission focused on the sanitary conditions of Cuba. It found sanitation in Havana and in other Cuban cities to be almost nonexistent. Most housing was poorly constructed, with little ventilation, and very crowded; many families lived in one-room apartments in ramshackle tenement houses. Less than one-third of Havana's population lived on paved streets. Most houses had simple privies for the disposal of human waste. "The effluvia therefrom pervades the houses, and the fluid contents saturate the soil and the soft porous coral rocks on which the city is built. Hence, all well-water is ruined, and every ditch dug in the streets exhales an offensive odor. Thus Havana may be said to be built over a privy." (32) What sewers existed emptied into the harbor and, with little circulation between the harbor and the open sea, simply settled to the bottom of the bay.

The mission of the Yellow Fever Commission was not only to study yellow fever but also to suggest policies that would protect the United States from the importation of the disease from Cuba. The simplest remedy to the problem of the spread of yellow fever from Havana to ports in the U.S. South was to encourage Spain to sanitize the city and make it safe for commercial vessels. But there was little chance that Spain would prove willing--or even capable--of taking up the issue. The sanitary infrastructure thought necessary, including a clean water supply, a sewer system, paved streets, and a thorough dredging of the harbor, was estimated to cost at least twenty million dollars, and the Spanish government, despite brutally high levels of taxation, was already unable to pay even the interest on its debts. (33) Because Spain would not take the steps required to control yellow fever in Havana, the task would fall to the Cubans themselves, the commission deduced: "Until their accomplishment (which the present generation will not live to witness) Havana will continue to be a source of constant danger to every vessel within its harbor, and to every southern port to which these vessels may sail during the warm season." (34) In the meantime, the United States had little choice but to protect itself from Cuba.

For this purpose the commission recommended several measures, beginning with a strict quarantine system. The Spanish government had itself established a "severe" quarantine in order to prevent yellow fever infection from traveling from Cuba to Spain. Lasting from May 1 to October 1 each year, the regulations affected all ships coming to Spain from Cuban ports, even those with bills of healthy As the Spanish quarantine seemed to be successful, the commission suggested that a similar quarantine was a viable option for the United States as well. Commerce could suffer, since restricting trade in this manner could reduce the amount of products sold and bought between the United States and Cuba. But the commission concluded that trade that did not occur during the yellow fever season could simply be conducted during the rest of the year. (36)

Ships that had been in Cuban ports, the commission suggested, should be disinfected and their cargoes quarantined before being allowed to enter U.S. ports. Moreover, because ships that tied up at Havana's wharves were more likely to become infected than those that remained farther out in the harbor, the U.S. doctors recommended that ships anchor away from the shore. (37)

Although the National Board of Health dissolved in 1883 after the U.S. Congress failed to reauthorize it in 1882, the board's quarantine recommendations were gradually adopted. A patchwork of local, state, and federal quarantine provisions grew and was integrated by the end of the 1880s. Quarantine stations operated by the U.S. Marine Hospital Service (USMHS) off the coast of Mississippi and Georgia and at Key West, together with state facilities in New Orleans and Mobile and along the Florida coast, disinfected incoming ships and provided a defensive line against the importation of yellow fever. (38)

But yellow fever seemed to ignore the system of controls established after 1878. In 1888, despite the network of disinfection stations, an epidemic in Jacksonville again spread panic throughout the U.S. South. As had happened a decade earlier, local quarantines disrupted commerce and had a devastating impact on business. (39) The origin of the infection was again traced to Havana. The American Public Health Association, composed of members from Canada, Mexico, and the United States, urged the U.S. government to take action in the face of this recurring threat from Havana. As a result, President Grover Cleveland dispatched George M. Sternberg, a U.S. Army bacteriologist who had been part of the 1879 commission, to Cuba to investigate the biological cause of the disease. Sternberg concluded that the various bacteria previously suggested to cause yellow fever had no correlation with the occurrence of the disease. The cause of yellow fever remained unknown. (40)

In December 1892 the Senate Committee on Immigration along with the Senate Committee on Epidemic Diseases and in cooperation with the House Committee on Immigration and Naturalization established a committee "to examine into the conditions of immigration from Cuba and the West India Islands, and the danger of the importation of epidemic and contagious diseases into the United States through immigrants from those islands." (41) The assembled senators and congressmen visited Havana, Key West, and Tampa. They found that travel between Cuba and Florida was extensive: as many as one hundred thousand people were estimated to travel back and forth each year. Given the unsanitary conditions in Havana and the constant presence of yellow fever in the city, this traffic posed a great risk to the United States. "The sanitary condition of Havana is a perpetual menace to the health of the people of the United States," the committee declared. (42) Moreover, the situation was likely to worsen further in the years to come:

   The island of Cuba, lying in the Gulf of Mexico and almost touching
   the shores of the United States, was regarded by all the great
   statesmen of our earlier history as an outpost of the United States,
   the key of the Gulf, and the necessary place of guard and protection
   for its commerce. It is one of the most fertile regions in the
   world, and has a future before it of great development. Its commerce
   with the United States must continually increase, and the interests
   of the American people will become more closely connected with the
   health and prosperity of the people of the island. (43)

The importance of Cuba to the commerce of the United States would only increase further "because of the certainty of the opening of one or more transits by waterways across the States of Central America," the legislators pointed out. (44) In order to protect the United States from the spread of contagious disease from Cuba, they recommended that Congress grant the president an appropriation of one million dollars and the authority "to suspend all immigration and commerce, when necessary," until any threatened epidemic had passed. Endemic yellow fever in Havana could not be tolerated indefinitely, they concluded: "The day is near at hand when 100,000,000 people will inhabit the United States, the most prosperous, free, and intelligent people of the world, cultivating peaceful relations with all nations, but powerful enough to demand justice, right, and protection for all the people of the Americas and the adjacent islands, and with the duty incumbent on them to initiate the policies which will best conduce to their just and fair commercial intercourse, to their mutual protection, and their progress in all the arts and sciences which promote the wellbeing of the great body of their people." (45)

The threat posed to the United States by Havana's endemic yellow fever grew rapidly in the years that followed, but not as a result of the expansion of commerce as predicted by the congressional committee. When Cuba's War of Independence began with the Grito de Baire on February 24, 1895, thousands of Spanish soldiers were sent to the island. The influx of these troops, the vast majority of whom had never before been exposed to yellow fever, led to a sharp increase in cases of the disease. "Nearly one-third of all the soldiers imported from Spain in Cuba have been sick and many of them have died," reported the New York Times on April 4, "Havana had sixty-six new cases of yellow fever yesterday. Of these, the majority were Spanish soldiers. All Americans are leaving Cuba, fearing the fever." (46) U.S. sanitary authorities watched the situation closely. "The insurrection in Cuba causes a condition of affairs unpleasant for the health officials to consider. Marine hospital officials declare that the shipment of several thousand new Spanish troops into Cuba, at this season of the year, none acclimated, is bound to precipitate an epidemic of yellow fever, the ill effects of which must, in a degree more or less severe, be felt in this country," the paper reported. (47)

In May Surgeon General Walter Wyman of the USMHS toured the quarantine stations along the south Atlantic seaboard to ensure that they were prepared for the increased threat of yellow fever from Cuba. (48) He continued on to Havana to examine the conditions there firsthand. No matter how dire the situation may have seemed, it was critical to avoid panic. Upon returning to Washington, he sought to assuage fears of an immediate epidemic: "at present there is no danger of an outbreak of yellow fever in Cuba, despite the presence of a large number of unacclimated Spanish troops," he announced. "The danger will arise later in the season, and it was to prepare against it that his trip was undertaken." (49)

The danger began to increase in June. The USMHS became concerned that a fleet of small fishing boats sailing from Havana was avoiding the quarantine measures that protected the U.S. South. Not only did these boats enter U.S. waters along the Gulf Coast and the south Atlantic coast to fish, Wyman warned, but they also smuggled tobacco, rum, and other goods. As smugglers, they necessarily came ashore at night, far from legal entry points, and without passing through disinfection at any quarantine station. These fishing boats were reported to dock in a part of the harbor in Havana known for its particularly unsanitary condition, directly above the outlet of the sewer serving the Cabanas barracks. Further, the crews were often new arrivals to Havana: they were not immune to yellow fever and so susceptible to infection. Both the crews and their illicit merchandise could carry yellow fever infection to the United States, the health officials feared. In addition, with the outbreak of war on the island, there was the possibility that Cuban insurgents and others would use the fishing boats to travel to the United States. "The danger of the introduction of yellow fever by this means has always been considered imminent, but this year it is particularly threatening by reason of the insurrection in Cuba," the surgeon general reported. (50)

To meet this threat, the U.S. Treasury Department dispatched four revenue cutters to patrol the coastal areas. These cutters sought out the illegal fishing boats by patrolling the coast and stopping at points where the Cuban vessels were known to congregate. When encountering any foreign ship, the cutters acted as quarantine regulators. Any foreign vessel found to be lacking the appropriate health documents was "to be seized and carried to the nearest quarantine station, there to be disinfected and held five days after disinfection, and afterwards to be delivered to the collector of the nearest port of entry." (51) Because the revenue cutters were too large to navigate the inlets where the Cuban fishing boats were likely to hide, they were outfitted with small, motor-driven launches that went out several days at a time to patrol these shallow waters. (52) Each cutter was also assigned a sanitary inspector from the USMHS, effectively making the ships mobile quarantine stations. The revenue-cutter patrols were maintained for the duration of the Cuban insurrection. (53)

These precautions seemed to be successful in preventing the importation of yellow fever from Havana into the southern United States during 1895, but as the war in Cuba intensified, Wyman grew even more concerned about the deteriorating health conditions on the island and the increasing threat that they presented to the United States. In the conclusion to the USMHS annual report for 1895, he expressed his fears. The port of Havana, he noted, was notoriously unsanitary and the site of numerous cases of yellow fever each year. Moreover, ships regularly left Havana for dozens of ports in the United States. (54)

The main problem in Havana, Wyman contended, was the harbor itself. The narrow entrance to the harbor prevented the tide from entering, and most of the harbor shore was made up of swamps, marshes, pools, and other shallow areas where the water did not circulate. (55) The wharves where U.S. vessels frequently docked were especially unsanitary. "There the wharves are not only a continuation of the city," D. M. Burgess, the USMHS sanitary inspector stationed in Havana, observed, "but they are in a very much worse sanitary condition than it is, for the sewers of the town debouche right under them, the timbers which support them entrapping all manner of filth and rendering what little tide-water current there might be entirely inefficient for any cleaning purpose." (56) The Tallapiedra and San Jose wharves, which managed much of the trade between the United States and Cuba, were located in what was identified as one of the most dangerous areas in the harbor: immediately above the sewer outlet of the military hospital where Spanish soldiers with yellow fever were treated. The Tallapiedra wharf, Burgess indicated, "in addition to its close proximity to the ever-infected military hospital with its dangerous sewerage, has all the liquid filth from all the slaughter houses of the city passing slowly under and near it. This is the most dangerous wharf here, and is the one to which many American and British vessels go to discharge lumber." Only slightly less dangerous was the San Jose Wharf, "with its hospital at either end and sewer from the military barracks, has also city sewers emptying under it." (57)

The dangers posed by docking at these wharves, Surgeon General Wyman insisted, could not be overstated. Many ships' captains were known to pay a substantial premium to unload to lighters in the open bay and so avoid the near-certain occurrence of yellow fever brought by tying up at a wharf. The threat was posed not only to the sailors themselves but also to the people of the United States, Wyman noted. Ship captains, wary of incurring yet another expense, often refused to leave a sick crew member behind when sailing from Havana because the city's hospitals charged between two and three hundred dollars to cover all possible expenses of a foreign patient. For this reason, many sailors infected with yellow fever were brought back to U.S. ports, forming "one of the most fruitful sources of danger to our Southern seacoast cities." (58)

Sanitarians and engineers had offered many plans to correct the insalubrious conditions of the harbor in Havana, from dredging and building canals to building walls and filling up the marshy areas. However, Wyman considered it unlikely that the Spanish administration would undertake such a massive project in a time of insurrection. There was only one way to secure "immunity from this dread pestilence" and still be able to continue commercial trade with Cuba, he concluded: "by intelligent sanitary work in our Southern seaports, namely, the providing of a thorough system of drainage and sewerage, good water supply, and municipal cleanliness; and also by demanding of our neighbors that their ports shall be made to be of as little danger to the people of the United States as the ports of this nation are to them." (59) After all, he stressed,

   Since 1862, more than a quarter of a century ago, our shores have
   been infected with yellow fever in each of twenty-six years. The
   source of the infection is known positively for nineteen years. Of
   the 19 yearly visitations 16 have been traced definitely to Habana,
   2 to Cuba and the West Indies, and 1 to Honduras. The records
   further show that in some years a number of places in the United
   States have been infected independently of one another from Habana,
   as, for example, in 1862, Key West, Fla., and Wilmington, N.C.; in
   1871, Cedar Keys, Tampa, and New Orleans, and in 1873, New Orleans
   and Pensacola. (60)

In short, the source of yellow fever infection in the United States was Havana.

As conditions worsened in Cuba, Wyman urged that the U.S. State Department take action to correct "the jeopardizing relation which [Havana] in particular constantly bears to the United States by reason of insanitary but remediable conditions, causing it to be a focus of the infection of yellow fever, the most subtle and dangerous of all the epidemic diseases, and one which annually threatens life and commercial prosperity in a large portion of the United States." (61) The situation was dire. Many U.S. sanitary officers, Wyman pointed out, insisted that the only safe course of action was to eliminate all contact with Cuba. (62) The United States should not continue to tolerate this state of affairs, Wyman wrote: "I wish as a sanitary officer, having in view the safety of the United States from visitations of yellow fever, to protest against these conditions, so strikingly in contrast with the sanitary enlightenment of the age, and so threatening to the commerce and lives of the people of other countries, and particularly our own." (63)

Secretary of State Richard Olney relayed Wyman's objections to the Spanish minister in Washington, Enrique Dupuy de Lome. The threat of yellow fever from Havana, Olney stressed, called "for sanitary precautions and measures of effective quarantine which bear onerously upon the intercourse of the United States and the chief commercial port of the Island of Cuba, through which the bulk of our Antillean commerce passes." The situation could not be ignored for long, Olney warned: "Sooner or later the problem of attacking the pestilential conditions which exist and have existed for more than a century at Habana will demand the attention not only of Spain, but of other endangered countries, with a view to devising an effective remedy for the state of things disclosed in Surgeon-General Wyman's report, and the gravity of the situation invites timely attention and action." (64)

Olney's warnings, however, went unheeded. With the war dragging on, the yellow fever situation only worsened in 1896. The Spanish strategy of concentrating troops in Cuban cities provided an ideal environment for the spread of yellow fever. Under the headline "Yellow Fever Aids the Rebels," the New York Times reported that the Spanish troops were stationed in the island's cities and towns and so were ravaged by yellow fever. The government there rigorously censored public health statistics, but "still it is known that the malady has extended all over the island, and the death rate is very great. In some places, as for instance, the military line, it is known that there are hundreds attacked with this terrible disease, and that it is increasing daily in alarming proportions." (65) Press reports of the spread of yellow fever in Cuba continued throughout the summer. (66)

The situation in Cuba worsened as the yellow fever season went on. By September the disease had infected so many Spanish troops in Havana that the authorities converted the sugar storehouses in Regla, across the harbor from the city, into makeshift yellow fever hospitals. (67) This step only heightened the concerns of USMHS officials. The buildings were certainly contaminated, they believed, and any sugar stored there before export to the United States would become infected, increasing the likelihood that the disease would spread to southern ports. (68)

Wyman stepped up his campaign to force Spain to control Havana's endemic yellow fever. At the September 1896 meeting of the American Public Health Association, he proposed a resolution directed squarely at the Spanish administration in Cuba. At his urging, the association's members resolved, "Whereas yellow fever is believed to be the most subtle and dangerous of all epidemic diseases ... That it is the duty of every government possessing seaports thus infected to institute such engineering and other sanitary measures as will remove this menace to the seaports of other nations." (69) He reinforced this message in an address at the Pan-American Medical Congress in Mexico City later that autumn. After stating his case that Havana was uniquely responsible for spreading yellow fever to ports throughout the western hemisphere, Wyman argued that the nations of North and South America should no longer idly submit to this threat. Havana was not the only port infected with yellow fever, he acknowledged, but addressing the most dangerous port first would yield the greatest gain in safety. "The time has come," he said, "when we should submit no longer to this annual trepidation concerning yellow fever and when the restrictions to commerce caused by infected seaports should be removed. And we should not fail to impress upon others their responsibility with regard to this public sentiment." (70)

The yellow fever situation in Cuba was indeed cause for worry. The war in Cuba provided ideal conditions for the spread of yellow fever in Havana and across the island, as illustrated in Figure 1. Havana suffered from 300 to 400 yellow fever deaths per year from 1889 to 1894, but the toll reached 553 in 1895, the first year of the war, before jumping to 1,282 in 1896 and 858 in 1897. (71) The increase was mostly attributable to the influx of Spanish troops. A USMHS inspector reported that of Havana's 181 yellow fever deaths in the month of June 1897, 175 were Spanish soldiers. (72) In the province of Santa Clara, where yellow fever caused approximately 150 deaths annually from 1889 to 1894, the disease claimed 540 lives in 1895 and then nearly tripled to 1,552 deaths in 1896 and 1,469 deaths in 1897. (73) In the port city of Santiago de Cuba, deaths from yellow fever rose from fewer than 100 in 1893 and in 1894 to 664 in 1895 and 1,002 in 1896. Observers in Santiago de Cuba confirmed that the primary cause of the sharp increase in yellow fever mortality was the number of unacclimated Spanish troops brought into the city to combat the insurgency. During 1895 and 1896, 1,601 Spanish soldiers were killed by yellow fever in Santiago de Cuba, but the disease claimed only 65 civilian lives during those two years, not many more than the average before the war. (74)

[FIGURE 1 OMITTED]

Other Cuban cities followed the same pattern of infection. Reports indicate that while there were 46 deaths of yellow fever in Cienfuegos in 1894 and 34 in 1895, the disease claimed 301 lives in 1896 and 115 in 1897. (75) As in the years before the war, yellow fever was rare in Matanzas in 1895, when there were only 3 reported deaths from the disease in the city. With the arrival of large numbers of Spanish troops and civilians relocated from the countryside, however, yellow fever fatalities reached 626 in 1896 and 127 in 1897. (76)

Despite the increased incidence of yellow fever in Cuba, the USMHS succeeded in preventing yellow fever from spreading to the U.S. South for the first two years of the Cuban struggle for independence. But in 1897 its measures failed. The revenue-cutter patrols notwithstanding, some Cubans frequently evaded the quarantine and landed in the United States along the Gulf Coast at night. It was one of these groups of insurgents that brought yellow fever to the resort town of Ocean Springs, Mississippi. (77) The result, as reported by Wyman, "was a well-defined epidemic of yellow fever in Ocean Springs, [which] spread to other states, with results which must still be fresh in the minds of all here present, of shotgun quarantines, disturbances of business, interruption of passenger traffic, hardships imposed on travelers, and all the other unhappy concomitants of a yellow-fever epidemic." (78)

That Cuba was the origin of the epidemic was widely reported in U.S. newspapers. The New York Daily Tribune noted on September 8 health authorities' theory that the disease "was carried over from Havana by certain mysterious Cuban visitors." Days later the paper accepted this theory as fact. (79) "Take the yellow fever scare in the south. The contagion was brought by refugees from Cuba," declared the Atlanta Constitution, quoting the health commissioner of Chicago. The U.S. government, the paper argued, should "demand of Spain that Cuba be purged of the conditions which have made it a plague spot for years and a menace to all surrounding countries." (80)

The overt response of the U.S. government, however, was to send yet another team of U.S. scientists to Cuba to study the cause of yellow fever. Their mission was of the utmost importance, Wyman wrote, "The discovery [of the specific cause of yellow fever] is one of the most vital interest and importance to the United States. More than 20,000,000 of our population live in a section of country which possesses all the natural conditions for the disease to become epidemic if once introduced. To prevent this the Government is compelled to maintain large and numerous quarantine establishments for the purpose of guarding against its introduction, and entailing expenses and hardship upon our maritime commerce." (81) The USMHS doctors assigned to the project, Eugene Wasdin and H. D. Geddings, made little progress before increasing tensions between the United States and Spain interrupted their research. (82) Other U.S. policy makers, unwilling to tolerate the continuing economic hardships suffered by the South due to Spanish neglect of the issue of yellow fever, had undertaken a more direct approach to remedying the problem.

Even before Wyman mounted his campaign to bring pressure on Spain to eliminate the threat to the U.S. South posed by yellow fever in Havana, many others had advocated stronger measures. Federal government officials, state sanitarians, and newspaper editors were among those who argued that the United States would not be free of this menace until it seized Cuba and itself eradicated the infection in Havana. These calls only grew louder as conditions on the island deteriorated and yellow fever again spread from Havana to the South.

The idea that the United States should acquire Cuba so as to ensure the health of the South had been considered in government circles for many years. In 1884 the New York Times reported that a State Department official had suggested "the real reason why the United States should obtain possession of Cuba is that it may furnish Havana with a system of drainage and stamp out yellow fever." (83) Soon after the Jacksonville epidemic of 1888, an officer of the Pennsylvania Board of Health similarly called for the annexation of Cuba in order to control the threat of yellow fever being imported from the island. After describing the constant travel between the United States and Havana, "one of the most notorious breeding-places of yellow-fever," and arguing that the only way to control the disease was to establish a good system of sewers and drains in the city, he noted that "[t]here is no hope that the Spanish government will ever undertake a work of this magnitude for a dependency." Under these circumstances, the "introduction of yellow-fever into the United States" would continue to be a "frequent occurrence." The U.S. government should act, he concluded: "A single widespread epidemic of yellow-fever would cost the United States more in money, to say nothing of the grief and misery which it would entail, than the purchase-money of Cuba." (84)

But the Spanish government had steadfastly rebuffed the notion of selling Cuba, and when insurrection again erupted on the island in 1895, its efforts to put down the rebellion made clear that it would not relinquish control without a fight. Yellow fever flourished in the devastation that ensued. The New York Journal, solidly in favor of U.S. intervention in the conflict, observed the increasing risk these conditions posed to the United States. The paper added pointedly, "The danger might be removed if American civilization with its sanitary ideas were to control the island." (85) With the outbreak of yellow fever in the South in 1897, the Journal was more explicit. "At at least one of the points at which yellow fever has appeared on our Gulf coast, and probably at the others, the disease is of Cuban origin. It prevails at Havana all the time," it railed. "Spanish shiftlessness and official imbecility have maintained at that port a nuisance that has threatened the health of the world.... The extirpation of Spanish rule in Cuba is a sanitary measure essential to the safety of the United States." (86)

Not surprisingly, many in the South shared this view. "It would have been, indeed, remarkable if the warm season of 1897 in our gulf coast States should have passed and yellow fever not have made its appearance," opined the Houston Daily Post when the presence of the disease in New Orleans became known.

   The communication with Cuba has been so close, so extensive and in a
   majority of cases so secret, we should naturally expect an infected
   visitor to slip in. Indeed, Cuba under Spanish rule, without
   anything like good sanitation, is a standing menace to the health of
   the Southern States of the Union and the Washington government has
   been repeatedly urged to present the Cuban question in this aspect
   among others to the Spanish authorities. That any heed would be
   given our protests in the premises is extremely problematical, and
   it is likely that the great Southern scourge will continue to find
   a habitat in Cuba and annually require extra quarantine precautions
   on our part, until American good sense and sanitation have free
   course in the Ever Faithful Isle. (87)

By the time the epidemic spread to Texas, the paper was even more blunt: "If annexing Cuba will result in eradicating yellow fever and quarantine, by all means let us annex it at once." (88)

The epidemic led even the Atlanta Constitution to abandon its previous opposition to U.S. involvement in Cuba. The USMHS planned to fumigate every infected building across the South to eradicate the disease and prevent a recurrent epidemic the next yellow fever season. Nevertheless, "it is idle to close our eyes to the fact that, so long as the United States government has no authority to fumigate Havana just so long will quarantines and fumigations on our coast and inland cities infected by refugees prove ineffectual." Even if yellow fever were eradicated in the South, the next ship arriving from Havana, where the disease was always present, would only infect it again. The city's natives were immune to the disease; even if the resources necessary to eliminate it were available, they had little reason to take the trouble.

   If there were no other argument in favor of the annexation of Cuba
   by the United States this would be entirely sufficient. It involves
   the safety of tens of thousands of men, women and children, to say
   nothing of the sacrifice of millions upon millions of money in the
   way of trade and commerce .... When our government has control of
   the sanitation of Havana and other Cuban ports, the danger of
   infection in this country will be reduced to a minimum; but until
   that time comes it will be impossible to prevent the appearance of
   the plague on our coasts. It is not only a question of dollars and
   cents, it is a matter of life and death. So long as the port of
   Havana blows the infection in this direction (through a funnel as it
   were), just so long will our measures of precaution, no matter how
   scientific and thorough, prove totally ineffectual.

The fumigation effort might yield the desired result for a year or two, allowing the people who fled in panic to return to their homes and prostrated businesses a chance to rebuild. However, the paper stated, any sense of security gained from the measure would be false. At any time a ship from Havana arriving in a southern port could reverse all of this progress, costing the lives of thousands and again throwing trade and commerce across the South into complete disarray. There was only one solution, according to the Constitution: "It is necessary, therefore, in the interests of all who are affected by an epidemic in the south that Cuba should be annexed, to the end that the plague, which has existed on the island for so many years, should be stamped out." (89)

The federal government had quietly reached a similar conclusion: the United States had no choice but to intervene in Cuba to end the threat of yellow fever. Some senators and congressmen had been advocating that the United States end Spanish rule over the island for this reason since the outbreak of fighting. Senator Wilkinson Call of Florida, for example, argued that, "Just as long as [Cuba] is kept under Spanish domination just so long will it be a constant menace to the health of the people of the United States." (90) But the leadership of both houses soon agreed that any discussion of U.S. interests in Cuba was unseemly and inappropriate while the Cuban people were suffering under Spanish tyranny, and proponents of intervention thereafter couched their arguments principally in humanitarian terms. (91) Later, however, when the Spanish had been ousted and U.S. control over the island secured, there was no longer a need for diplomatic and politic speech, and the legislators could be frank about their motivations. Townsend Scudder could then remind his fellow members of the House of Representatives that yellow fever had been among the central concerns of U.S. policy regarding Cuba:

   [O]ne of the chief reasons which justified this country's
   intervention to rescue Cuba from Spanish misrule is to be found in
   the fact that the deplorable sanitary condition of the island made
   it a dangerous nuisance. It was like having an open cesspool
   opposite one's front door. The thing had to be abated. Its existence
   was a standing menace to the welfare of the American people. It
   involved them in periodic plagues which cost hundreds of lives,
   great financial loss, and brought business over a large part of the
   country to a standstill. It had to be gotten rid of. (92)

The McKinley administration agreed. As the 1897 epidemic raged in the South, a new U.S. minister to Spain arrived in Madrid. Charged with making the U.S. case for an immediate resolution of the war in Cuba to the European powers before delivering an ultimatum from President McKinley to the Spanish government, Stewart L. Woodford met with the ambassadors of Great Britain, Russia, and Germany. (93) Foremost among the concerns he expressed was the ongoing threat of yellow fever that the continuing hostilities posed to the United States. Woodford reported to the secretary of state:

   I pointed out that nearly every epidemic of yellow fever in the
   United States has originated in Habana or at some point in Cuba,
   from which the disease has spread to our coast. I told him that
   owing to the bad sanitary conditions of Cuba and the peculiar
   formation of the harbor of Habana, which is never thoroughly
   washed out by the tides, this danger is great even in times of
   peace. That in war and with the present neglect of sanitary
   precautions at Habana and throughout Cuba, the danger is
   increased terribly. I see from the telegrams of the last few
   days that an immediate confirmation of my statements has come from
   points in Mississippi and Louisiana and possibly in Georgia and
   Texas. (94)

Only after emphasizing the constant danger of yellow fever did Woodford mention the personal losses of U.S. citizens who had invested in the island and the horrors of the Spanish concentration camps. Woodford stressed to each of the ambassadors that the role of the U.S. government was to secure peace in Cuba so as to protect the lives and commercial interests of U.S. citizens. (95) Years of fighting in Cuba had already led to one yellow fever epidemic in the southern United States. The U.S. government was poised to take action to prevent another.

On April 25, 1898, the United States declared war on Spain. The New York Times, reporting on a speech by a former surgeon general, reminded its readers that yellow fever in Havana had long provided sufficient justification for the war: "Any country which would carelessly allow such a disease-breeding centre to affect the ships of the world without any effort to improve the conditions deserved nothing better than the most severe and summary punishment." (96) The Spanish forces in Cuba, worn down by years of war with Cuban insurgents and ravaged by disease, quickly collapsed when faced by the fresh U.S. troops. By the end of July the war in Cuba was effectively over. After two decades of apprehension caused by the threat that yellow fever from Havana posed to the South, the United States at last had an opportunity to root out the disease at its source.

One of the first priorities of the occupation government was a massive cleanup to eradicate yellow fever. (97) As it was believed that yellow fever lived in filth and in materials infected by people sick with the disease, wide-ranging exertions were directed at cleaning the streets, the buildings, and the harbor of Havana. Although these measures improved the overall health of Havana's residents, yellow fever continued to strike in even the most affluent and cleanest of the city neighborhoods. (98) To succeed, U.S. sanitarians would need to understand the disease better; more research was essential.

In 1900 the U.S. Army Yellow Fever Commission working outside Havana confirmed that yellow fever was transmitted from one victim to the next not by filth or contaminated objects, but by mosquito bites. (99) By the end of 1901 the occupation government's mosquito-eradication measures had completely rid Havana and the rest of the island of the disease. (100) Before withdrawing a few months later, the United States insisted that the Cubans append a provision to their new constitution to ensure that the threat from Havana would never return. As part of the Platt Amendment to the Cuban constitution--and therefore, as a condition of U.S. military withdrawal from the island--the government of Cuba agreed that the island would be kept sanitary, "to the end that a recurrence of epidemic and infectious diseases may be prevented, thereby assuring protection to the people and commerce of Cuba, as well as to the commerce of the southern ports of the United States and the people residing therein." (101) As U.S. officials had hoped, the invasion of Cuba had brought the era of periodic epidemics of yellow fever in the South to an end.

(1) See for example John Duffy, Sword of Pestilence: The New Orleans Yellow Fever Epidemic of 1853 (Baton Rouge, 1966); Khaled J. Bloom, The Mississippi Valley's Great Yellow Fever

Epidemic of 1878 (Baton Rouge, 1993); and Jo Ann Carrigan, The Saffron Scourge: A History of Yellow Fever in Louisiana, 1796-1905 (Lafayette, La., 1994). I would like to thank Lou Perez Jr., Jim Hevia, Lars Schoultz, John Chasteen, Judy Farquhar, Kathryn Burns, D. Gorton, Jane Adams, Fred Salt, and the Journal of Southern History reviewers for their helpful comments on earlier versions of this article.

(2) James B. Speer Jr., "Pestilence and Progress: Health Reform in Galveston and Houston During the Nineteenth Century," Houston Review: History and Culture of the Gulf Coast, 2 (Fall 1980), 120-33; Margaret Warner, "Local Control versus National Interest: The Debate over Southern Public Health, 1878-1884," Journal of Southern History, 50 (August 1984), 407-28; John H. Ellis, Yellow Fever and Public Health in the New South (Lexington, Ky., 1992); Margaret Humphreys, Yellow Fever and the South (New Brunswick, N.J., 1992).

(3) Jo Ann Carrigan, "Privilege, Prejudice, and the Strangers' Disease in Nineteenth-Century New Orleans," Journal of Southern History, 36 (November 1970), 568-78; Edward J. Blum, "The Crucible of Disease: Trauma, Memory, and National Reconciliation during the Yellow Fever Epidemic of 1878," Journal of Southern History,. 69 (November 2003), 791-820.

(4) Examples include Robert Endicott Osgood, Ideals and Self-Interest in America's Foreign Relations: The Great Transformation of the Twentieth Century (Chicago, 1953), chap. 2; Frank Freidel, The Splendid Little War (Boston, 1958); Allan Keller, The Spanish-American War: A Compact History (New York, 1969); and David F. Trask, The War with Spain in 1898 (New York, 1981).

(5) Louis A. Perez Jr., The War of 1898: The United States and Cuba in History and Historiography (Chapel Hill, 1998).

(6) These include Philip S. Foner, The Spanish-Cuban-American War and the Birth of American Imperialism, 1895-1902 (2 vols.; New York, 1972); Jules R. Benjamin, The United States and Cuba: Hegemony and Dependent Development, 1880-1934 (Pittsburgh, 1977); Benjamin, The United States and the Origins of the Cuban Revolution: An Empire of Liberty in an Age of National Liberation (Princeton, 1990); Louis A. Perez Jr., Cuba and the United States: Ties of Singular Intimacy (Athens, Ga., 1990); and Perez, War of 1898.

(7) "Declared It Yellow Fever," New Orleans Daily Picayune, September 7, 1897, pp. 1-2.

(8) "Uncle Sam's Boys Abandon Jackson Barracks Because of the Fever Scare," ibid., September 14, 1897, p. 11; "Soldiers Were the First to Flee: Regiment of United States Artillery Comes Here Today," Atlanta Constitution, September 14, 1897, p. 1; "Refugees Flock Here for Safety: Trains From Infected Districts Are Crowded With Them," ibid., September 16, 1897, p. 3.

(9) "As Trainmen See It: The Great Fear Draws a Dead Line Three Hundred Miles from Here," New Orleans Daily Picayune, September 15, 1897, p. 7.

(10) "Mint in New Orleans Shut Off: The Government Unable to Ship Coin Wanted Elsewhere," New York Times, September 16, 1897, p. 1.

(11) "The Torch Applied as a Result of the Terror Among the People," New Orleans Daily Picayune, September 24, 1897, pp. 1 2. See also "The Mayor Stands Firm," ibid., September 25, 1897, pp. 1-2.

(12) "Quarantine's Farewell: The Frosts Everywhere Remove All Cause for Fear," ibid., November 5, 1897, p. 1; "The Daily Report," ibid., November 6, 1897, p. 10; "The Daily Record," ibid., November 7, 1897, p. 11.

(13) "Local Gossip of the Fever: A Great Many Families Get Out of the Town," Jackson Daily Clarion-Ledger, September 14, 1897, p. 1 ; "To the Citizens of Jackssn [sic]," ibid., September 15, 1897, p. 8; "Around and About Town: Many More People Are Leaving the City," Jackson Daily Bulletin, September 16, 1897, p. 1; "Jackson Gets a Swift Shake: Population of Mississippi's Capital Has Stampeded," Atlanta Constitution, September 16, 1897, p. 1. The Jackson Daily Bulletin, a two-page, three-column newspaper, was started on September 16 by "several of the can't-get-away Clarion-Ledger printers ... for the purpose of publishing reliable daily bulletins of the yellow-fever situation" (p. 1). For the next six weeks, it reported the telegraphic news on such topics as the progress of the yellow fever patients in Edwards, including those who had had episodes of black vomit; which residents had upcoming shifts on the quarantine guard and the curfew patrol; and the fishing exploits and occasional horse race of Jackson's idled citizens.

(14) "Around and About Town: Many More People Are Leaving the City," Jackson Daily Bulletin, September 16, 1897, p. 1.

(15) Jackson's mayor, Ramsey Wharton, assured the public of his confidence that "none of our citizens were engaged in any such lawlessness" and that the culprits would swiftly be brought to justice. "Mayor's Proclamation," ibid., September 18, 1897, p. 1. No arrests, however, were reported in subsequent issues of the paper.

(16) "Quarantine Established," Houston Daily Post, September 7, 1897, p. 3.

(17) "A Death at Beaumont," Galveston Daily News, September 23, 1897, p. 1 ; "The Beaumont Death," ibid., September 24, 1897, p. 1.

(18) "Houston Trains Off," ibid., September 28, 1897, p. 1.

(19) "Train Held Up at Rayne, LA: The Special with the Louisiana Doctors Not Allowed to Pass the Town," ibid., September 30, 1897, p. 2. See also "Experience of Dr. Guiteras: Never Saw More Fright Than in Rural Sections of Louisiana," ibid., October 1, 1897, p. 1.

(20) "Steamship Lines Suspend," ibid., October 12, 1897, p. 1: "Trade Paralyzed," New York Herald, October 12, 1897, p. 1; United States Marine-Hospital Service, Annual Report of the Supervising Surgeon-General of the Marine-Hospital Service of the United States for the Fiscal Year 1897 (Washington, D.C., 1899), 599, 621.

(21) "City's Gates Open to the Refugees: Atlanta Will Welcome All Who Come From Fever Districts," Atlanta Constitution, September 15, 1897, p. 1: "Refugees Reaching the City: One Hundred and Fifty Came in at 2 O'Clock This Morning," ibid., September 15, 1897, p. 1, "Refugees Flock Here for Safety: Trains From Infected Districts Are Crowded With Them," ibid., September 16, 1897, p. 3; "Will Inspect All Incoming Trains: Board of Health Holds Another Important Meeting," ibid., September 16, 1897, p. 3.

(22) "City's Gates Open to the Refugees: Atlanta Will Welcome All Who Come From Fever Districts," ibid., September 15, 1897, p. 1; "Decatur Won't Take Chances: Alabama Town Doubles Guard to Watch Incoming Trains," ibid., September 15, 1897, p. 1; "Huntsville Is Apprehensive: Rigid Quarantine Will Be Enforced by City Officials," ibid., September 15, 1897, p. 1: "Montgomery Fears Atlanta: Alabama Capital Quarantines the Georgia Statehouse Town," ibid., September 15, 1897, p. 1; "Charleston Has Quarantined: Palmetto State's Metropolis Guards Against Yellow Fever," ibid., September 15, 1897, p. 1; "Augusta Closes Her Doors," ibid., September 16, 1897, p. 3; "Selma Is Afraid of Atlanta: Declares Quarantine Against the Gate City," ibid., September 16, 1897, p. 3; "Will Shut Out Yellow Jack: Wilmington, N.C.,

Quarantines," ibid., September 16, 1897, p. 3; "Welcomed By a Shotgun: The Treatment Atlantians Are Subjected to in Charleston," ibid., September 27, 1897, p. 5.

(23) "A Plea for Reason and Common Sense," ibid., September 29, 1897, p. 4.

(24) "Stocks Were Heavy: Yellow Fever Affected Southern Roads, Whole List Sympathized," ibid., September 17, 1897, p. 8.

(25) "Three New Cases in Montgomery: The Citizens of the Alabama Capital Are Panic Stricken," ibid., October 20, 1897, p. 1. See also "Once Hated Town Now Their Home: People of Montgomery Flee To This City for Refuge," ibid., October 20, 1897, p. 3.

(26) "Railroads Stop All Their Trains: Not a Wheel Moved Yesterday Between Montgomery and Selma," ibid., October 19, 1897, p. 6.

(27) Edmond Souchon, "True Origin of the Epidemic of Yellow Fever," Journal of the American Medical Association, 35 (August 4, 1900), 309; J. H. White, "True Origin of the Epidemic of 1897," New York, January 29, 1898, in United States Marine-Hospital Service, Annual Report of the Supervising Surgeon-General of the Marine-Hospital Service of the United States for the Fiscal Year 1898 (Washington, D.C., 1899), 536-39.

(28) J[ohn] M. Woodworth, "A Brief Review of the Organization and Purpose of the Yellow Fever Commission," Public Health Reports and Papers Presented at the Meetings of the American Public Health Association, 4 (November 1878), 167-68; Stanford E. Chaille, "Report to the United States National Board of Health on Yellow Fever in Havana and Cuba," in House Executive Document, 40 Cong., 3 Sess., No. 8: Annual Report of the National Board of Health, 1880 (Washington, D.C., 1882), 72-73; "The Late Yellow Fever Epidemic," New York Times, November 30, 1878, p. 8. Two hundred million dollars was approximately 2.3 percent of the U.S. gross national product in 1878. See Nathan S. Balke and Robert J. Gordon, "The Estimation of Prewar Gross National Product: Methodology and New Evidence," Journal of Political Economy, 97 (February 1989), 84. For more recent accounts of the events of 1878 see Ellis, Yellow Fever and Public Health in the New South, esp. pp. 56-57; Humphreys, Yellow Fever and the South; and Bloom, Mississippi Valley's Great Yellow Fever Epidemic.

(29) "The Late Yellow Fever Epidemic," New York Times, November 30, 1878, p. 8. See also Ellis, Yellow Fever and Public Health in the New South, 38-39.

(30) Chaille, "Report to the United States National Board of Health on Yellow Fever in Havana and Cuba," 73.

(31) Ibid., 67.

(32) Dr. D. M. Burgess, U.S. sanitary and quarantine inspector, to a U.S. congressional committee, February 12, 1879, quoted ibid., 102.

(33) Ibid., 107.

(34) Ibid.

(35) Ibid., 83-84 (quotation on p. 83).

(36) Ibid., 83 87.

(37) Ibid., 108.

(38) On the development of southern quarantine measures in the 1880s, see Humphreys, Yellow Fever and the South, 113-30, 136.

(39) Ibid., 120-24.

(40) George M. Sternberg, Report on the Etiology and Prevention of Yellow Fever (Washington, D.C., 1890).

(41) Senate Reports, 52 Cong., 2 Sess., No. 1263: [Proceedings of the Cuba and Florida Immigration Investigation] (Serial 3072; Washington, D.C., 1893), i. (In the Serial Set Digital Collection this untitled document has been given the descriptive title Investigation of Disease Dangers of Immigration from Cuba.)

(42) Ibid.

(43) Ibid., i-ii.

(44) Ibid., ii.

(45) Ibid., iii.

(46) "Spanish Troops Ill in Cuba," New York Times, April 4, 1895, p. 5.

(47) "Safeguards Against Yellow Fever," ibid., April 4, 1895, p. 16.

(48) "Yellow Fever Threatened," ibid., May 12, 1895, p. 1.

(49) "Guards Against Yellow Fever," ibid., May 19, 1895, p. 16. See also "Precautions Against a Yellow Fever Epidemic," New York Daily Tribune, May 19, 1895, p. 4.

(50) Walter Wyman to the Secretary of the Treasury. June 8, 1895, in United States Marine Hospital Service, Annual Report of the Supervising Surgeon-General of the Marine-Hospital Service of the United States for the Fiscal Year 1895 (Washington, D.C., 1896), 344-45 (quotation on p. 344).

(51) Walter Wyman to C. F. Shoemaker, Chief, Revenue-Cutter Service, Treasury Department, June 17, 1895, ibid., 345-46.

(52) C. S. Hamlin, Assistant Secretary, Treasury Department, to Commanding Officer Revenue Steamer McLane, July 24, 1895, ibid., 346-47.

(53) The patrols paid particular attention to the state of Florida, which seemed to be the most likely landing point for the Cuban vessels, but also covered the rest of the Gulf and southern Atlantic states. For letters about patrolling Florida, see Walter Wyman to the Secretary of the Treasury, June 17, 1897; Walter Wyman to the Secretary of the Treasury, June 21, 1897; W. B. Howell, Treasury Department, to John W. Linck, Special Agent, June 25, 1897; and W. B. Howell, Treasury Department, to Commanding Officer U.S.S. Forward, July 21, 1897; for mention of patrolling other states see Walter Wyman to A. H. Glennan, June 22, 1897; all found in United States Marine-Hospital Service, Annual Report of the Supervising Surgeon-General of the Marine-Hospital Service of the United States for the Fiscal Year 1897, pp. 430-32.

(54) United States Marine-Hospital Service, Annual Report of the Supervising Surgeon-General of the Marine-Hospital Service of the United States for the Fiscal Year 1895, pp. 384-439.

(55) Ibid., 393 94.

(56) Sanitary Inspector D. M. Burgess, Marine Hospital Service, to Surgeon General, Marine Hospital Service, May 25, 1895, quoted ibid., 398.

(57) Burgess quoted ibid., 398-99.

(58) Ibid., 397-98.

(59) Ibid., 428.

(60) Ibid., 396.

(61) Walter Wyman to the Secretary of the Treasury, December 4, 1895, in United States Marine-Hospital Service, Annual Report of the Supervising Surgeon-General of the Marine-Hospital Service of the United States for the Fiscal Year 1896 (Washington, D.C., 1896), 387.

(62) Walter Wyman to the Secretary of the Treasury, December 4, 1895, ibid.

(63) Ibid., 389.

(64) Richard Olney to Enrique Dupuy de Lome, February 7, 1896, ibid., 391.

(65) "Yellow Fever Aids the Rebels," New York Times, June 6, 1896, p. 5.

(66) See, for example, "Scourged by Disease," ibid., July 21, 1896, p. 5; "Yellow Fever in Cuba," New York Daily Tribune, August 26, 1896, p. 1; and "Yellow Fever and Smallpox in Cuba," ibid., September 1, 1896, p. 2.

(67) D. M. Burgess to Walter Wyman, October 17, 1896, in United States Marine-Hospital Service, Annual Report of the Supervising Surgeon-General of the Marine-Hospital Service of the United States for the Fiscal Year 1896, p. 392.

(68) Ibid. Burgess's fears were reported in "Cuba Must Be Watched," New York Times, October 27, 1896, p. 5.

(69) The resolution is reproduced in "Report of Surg. P. H. Bailhache upon the Meeting of the American Public Health Association, at Buffalo, N.Y.," September 28, 1896, in United States Marine-Hospital Service, Annual Report of the Supervising Surgeon-General of the Marine-Hospital Service of the United States for the Fiscal Year 1896, pp. 16-18 (quotation on p. 18).

(70) "International Responsibility with Regard to Epidemic Diseases," address by Walter Wyman at the Pan-American Medical Congress, Mexico City, November 17, 1896, in United States Marine-Hospital Service, Annual Report of the Supervising Surgeon-General of the Marine-Hospital Service of the United States for the Fiscal Year 1897, p. 220.

(71) "Report of Vital Statistics of Havana, Year 1901," File 1901/275, Letters Received, 1899-1902, Records of the Military Government of Cuba, Record Group 140, National Archives at College Park, College Park, Md.; hereinafter cited as RG 140.

(72) W. H. Brunner, Assistant Sanitary Inspector, USMHS, to Walter Wyman, Surgeon General, July 6, 1897, Central File, 1897-1923, Records of the Public Health Service, Record Group 90, National Archives at College Park.

(73) Gobierno Civil de Santa Clara, "Memoria del estado de la provincia y resumen de los trabajos realizados con observaciones e indicaciones sobre la marcha administrativa de la misma," File 1899/1339, Letters Received, 1899-1902, RG 140.

(74) H. S. Caminero, Sanitary Inspector, USMHS, "A Report on Yellow Fever at Santiago de Cuba," June 1, 1897, in United States Marine-Hospital Service, Annual Report of the Supervising Surgeon-General of the Marine-Hospital Service of the United States for the Fiscal Year 1897, pp. 473-75. See also the comments on the history of yellow fever in Santiago found in M. J. Rosenau, Passed Assistant Surgeon, USMHS, to Supervising Surgeon General, USMHS, May 8, 1899, enclosed in Herman B. Parker, Assistant Surgeon, USMHS, to the Military Governor of Cuba, November 15, 1899, File 1899/2594, Letters Received, 1899-1902, RG 140.

(75) "Statement of Deaths Caused by Yellow Fever in Cienfuegos," in Jose M. Frias, Mayor, Cienfuegos, letter, July 15, 1899, File 1899/4285, Letters Received, 1899-1902, RG 140.

(76) The reported data for yellow fever deaths in Matanzas cannot always be made to exactly match the calendar year. For 1896 the number of deaths noted in the text occurred between January 1 and December 23, 1896; for 1897 they occurred between December 23, 1896, and January 19, 1898. United States Marine-Hospital Service, Annual Report of the Supervising Surgeon-General of the Marine-Hospital Service of the United States for the Fiscal Year 1895, p. 376; United States Marine-Hospital Service, Annual Report of the Supervising Surgeon-General of the Marine-Hospital Service of the United States for the Fiscal Year 1896, p. 378; United States Marine-Hospital Service, Annual Report of the Supervising Surgeon-General of the Marine-Hospital Service of the United States for the Fiscal Year 1897, p. 428; United States Marine-Hospital Service, Annual Report of the Supervising Surgeon-General of the Marine-Hospital Service of the United States for the Fiscal Year 1898, p. 584.

(77) Souchon, "True Origin of the Epidemic of Yellow Fever," 309.

(78) Surgeon General Walter Wyman, "Our Sanitary Obligations," March 22, 1900, quoted ibid., 308. For further details on the 1897 epidemic in the U.S. South see contemporary newspaper articles such as "Dr. Guiteras Reports," New York Daily Tribune, September 10, 1897, p. 7; and "The South and Its Invader," ibid., September 11, 1897, p. 6. For a recent account of the 1897 yellow fever epidemic in the U.S. South, see Humphreys, Yellow Fever and the South, 136-47.

(79) "The Yellow Fever Outbreak," New York Daily Tribune, September 8, 1897, p. 6; "The South and Its Invader," ibid., September 11, 1897, p. 6.

(80) "A National Board of Health," Atlanta Constitution, September 24, 1897, p. 4.

(81) Walter Wyman to the Secretary of the Treasury, Marine Hospital Service, August 30, 1897, in "Letters Addressed to the Secretary of the Treasury, Recommending an Investigation by Officers of the Marine-Hospital Service Into the Cause of Yellow Fever, with Special Reference to the Reported Discovery of the Yellow Fever Germ by Professor Sanarelli," in United States Marine-Hospital Service, Report of Commission of Medical Officers Detailed by Authority of the President to Investigate the Cause of Yellow Fever (Washington, D.C., 1899), 3.

(82) Their laboratory was completed only in mid-January 1898. They were ordered to leave Havana in March. As yellow fever was not generally prevalent during the early months of each year, the doctors had very little material with which to work. Eugene Wasdin, "Preliminary Report of Medical Officers Detailed by Direction of the President as a Commission to Investigate in Habana the Cause of Yellow Fever," November 1, 1898, in United States Marine-Hospital Service, Annual Report of the Supervising Surgeon-General of the Marine-Hospital Service of the United States for the Fiscal Year 1898, pp. 587-90; "Report of P.A. Surg. H. D. Geddings," November 1, 1898, ibid., 590-93.

(83) Untitled editorial, New York Times, July 16, 1884, p. 4.

(84) Benjamin Lee, "Do the Sanitary Interests of the United States Demand the Annexation of Cuba?" Public Health Papers and Reports. Vol. XV: Presented at the Seventeenth Annual Meeting of the American Public Health Association, Brooklyn, N.Y., October 22-25, 1889 ... (Concord, N.H., 1889), 51.

(85) Quoted in Joseph E. Wisan, The Cuban Crisis as Reflected in the New York Press, 1895 1898 (1934; reprint, New York, 1965), 213.

(86) "The Yellow Invader," New York Journal, September 8, 1897, p. 6.

(87) "As to Yellow Fever," Houston Daily Post, September 7, 1897, p. 4.

(88) Untitled editorial, ibid., October 13, 1897, p. 4.

(89) "Where To Fumigate--Havana," Atlanta Constitution, October 26, 1897, p. 6.

(90) "Will Ask Congress to Aid Cuba: Senator Call of Florida Will Push the Matter This Winter," Chicago Daily Tribune, September 14, 1895, p. 5. Call also pushed this argument on the open floor of the Senate, Congressional Record, 54 Cong., 1 Sess., 1969 (February 20, 1896).

(91) Cong. Record, 54 Cong., 1 Sess., 3575 (April 4, 1896).

(92) Cong. Record, 56 Cong., 2 Sess., 3370 (March 1, 1901).

(93) Stewart L. Woodford to Secretary of State John Sherman, September 13, 1897, October 4, 1897, and October 5, 1897, in United States Department of State, Papers Relating to the Foreign Relations of the United States, with the Annual Message of the President Transmitted to Congress, December 5, 1898 (Washington, D.C., 1901), 562-65, 573-79.

(94) Woodford to Sherman, September 13, 1897, ibid., 562. See also Woodford to Sherman, October 4, 1897, and October 5, 1897, ibid., 573, 576.

(95) Woodford to Sherman, September 13, 1897, ibid., 562-65. See also Woodford to Sherman, October 4, 1897, and October 5, 1897, ibid., 576, 579.

(96) "Dr. Hamilton and Fever," New York Times, May 5, 1898, p. 12.

(97) Leonard Wood, Military Governor of Cuba, to Elihu Root, Secretary of War, October 18, 1901, General Correspondence, 1901, Leonard Wood Papers (Manuscript Division, Library of Congress, Washington, D.C.).

(98) William C. Gorgas, "Report of Vital Statistics of the City of Havana made to Brigadier General Leonard Wood, Military Governor," File 1900/275, Miscellaneous Records of Various Agencies, 1899-1902, RG 140.

(99) Walter Reed et al., "The Etiology of Yellow Fever--A Preliminary Note" (1900), in Senate Document, 61 Cong., 3 Sess., No. 822: Yellow Fever." A Compilation of Various Publications ... (Serial 5919; Washington, D.C., 1911), 56-69. Carlos J. Finlay, a Cuban physician, had first identified the specific mosquito that transmitted the disease in 1881. Finlay, "El mosquito hipoteticamente considerado como agente de transmision de la fiebre amarilla," Anales de la Real Academia de Cieneias Medicas, Fisicas y Naturales de la Habana, 18 (1881), 147-69.

(100) "Disappearance of Yellow Fever from Havana, Cuba," read before the Academy of Medi cine, New York, (1902-1904), Addresses, Articles, and Reports, 1901-12, and Undated, William Crawford Gorgas Papers (Manuscript Division, Library of Congress).

(101) Article V, Platt Amendment, The Statutes at Large of the United States..., vol. XXXI (Washington, D.C., 1901), 898.

Ms. ESPINOSA is an assistant professor of history at Southern Illinois University Carbondale.