Introduction

Even before the cease-fire was established at Santiago halting the Spanish- American War, senior American officers recognized the near-catastrophic state of health in Cuba. Years of civil war, Spanish resettlement policies, and neglect by the Spanish colonial government resulted in the collapse of nearly all public health systems on the island. The situation was even worse in the rural backcountry, where sanitation and hygiene among the island’s mestizos was virtually non-existent. Added to this was the very real danger of endemic tropical disease, including yellow fever and malaria, as well as more familiar diseases such as dysentery and smallpox. The first task of the American forces in Cuba would be how best to improve these conditions. As Major General Leonard Wood recalled, the health risks were great indeed:

Yellow fever, pernicious malaria and intestinal fevers were all prevalent to an alarming extent. The city and surrounding country was full of sick Spanish soldiers, starving Cubans and the sick of our own army. The sanitary conditions were indescribably bad. There was little or no water available and the conditions were such as can be imagined to exist in a tropical city following a siege and capture in the most unhealthy season of the year. … The death rate among our own troops was heavy and the percentage of sick appalling. ¹