Kansas City, Kansas, United States
Atlanta, Georgia, United States
|Fig. 1. Ward 1 of Las Animas Hospital for yellow fever patients. First published in 1904 by Enrique Barnet in his monograph on Las Animas Hospital.3 Public domain.|
John Hay, U.S. Secretary of State under Theodore Roosevelt, described the Spanish-American War as “a splendid little war” because it was brief and resulted in relatively few casualties.1 The Treaty of Paris, formally signed on December 10, 1898, ended Spanish occupation of Cuba and established an interim U.S. military government, including a Department of Sanitation responsible for the control of tropical diseases such as yellow fever, smallpox, and cholera, which had ravaged the island for many years.
The Spanish had established barracks for engineers located on a hill named Las Animas. The U.S. military health authorities converted this facility into a military hospital. On November 20, 1899, it was converted into a municipal hospital and designated as Las Animas Hospital.2 Dr. Francisco Ferrer was appointed as its first director and Major William Gorgas (1854–1920) as U.S. Army inspector. The Department of Sanitation took over control of the hospital and named Major John W. Ross as director on September 7, 1900. In the same year, Dr. Juan Guiteras (1852–1925), a pathologist trained in the U.S., became director. From the beginning, Las Animas Hospital was dedicated to the control of infectious and contagious diseases.3
|Fig. 2. Dr. Juan Guiteras (1852–1925) portrait. Director of Las Animas Hospital 1903–1925. Reproduced with permission from University Archives and Records Center, University of Pennsylvania (UARC20070712010).|
Las Animas Hospital played an important role in the fight against yellow fever. Carlos J. Finlay (1833–1915) first proposed his theory that yellow fever was transmitted by mosquitoes in 1881. In the beginning, no one accepted his hypothesis and he was ridiculed as the “mosquito man.”4 A Yellow Fever Commission headed by Major Walter Reed (1851–1902) and aided by contract surgeons William Carroll, Jesse Lazear, and Aristides Agramonte, tested Finlay’s mosquito theory. They presented their findings in 1900, which proved Finlay was right.5 The world applauded this discovery and Finlay, Reed, Carroll, Lazear, and Agramonte became medical heroes.
Havana had been ravaged by yellow fever for at least 150 years. Dr. William Gorgas was Chief Sanitary Officer in Cuba and scarcely eight months after he implemented mosquito control measures in Havana, the city was declared free of yellow fever.7 Each case of suspected yellow fever was examined by a Yellow Fever Commission made of doctors Gorgas, Finlay, and Albertini; if confirmed, the victim was sent to Las Animas Hospital for further tests and treatment. A chart to record temperature and pulse was placed at the bedside and meticulous measurement of urinary output monitored. Nothing was given by mouth except for sips of champagne and occasionally phenacetin for high fever. This conservative treatment, according to Gorgas, was effective in keeping the mortality as low as 30 percent.6
|Fig. 3. A typical printed form from Las Animas Hospital used to detail the symptoms and vital signs of yellow fever patients. Reproduced with permission from private collection of David Schwartz.|
A more detailed description of the facilities and operation of Las Animas Hospital is given by former director Enrique Barnet:3
The pavilion for infectious diseases has room for 35 beds; 12 in each of the large wards and 8 and 3, respectively, in the other two….The yellow fever pavilion, without the wards now in the process of construction, have rooms for 28 beds, 8 in the central ward, used generally for convalescents. The four lateral rooms will accommodate easily 4 beds each and the two smaller rooms, 2 each. Very rarely do we place more than one or two patients in these rooms….The new pavilion will accommodate 12 beds, 2 in each ward. The technical personnel consists of 1) a medical director without salary; 2) a sub-director; 3) an assistant physician (when required). The ward service is performed by 1 chief nurse, 3 trained nurses, 3 assistant nurses and 7 ward attendants. The floors are made of tile and concrete. The ward furniture consists for each patient of a white enameled iron bed, a small table of the same material with glass top and 1 chair. The bed has a wire mattress, 2 sheets, 2 pillows and, as the case may be, a blanket or counterpane. Usually mosquito-bars are not used about the beds, because all windows and doors are carefully closed with copper wire gauze and the intercommunicating doors between the several apartments are similarly screened.
In the Yellow Fever pavilion (now Pavilion No. 1), Dr. Juan Guiteras…performed the inoculation experiments which confirmed the observations of the U.S. Army Commission….In the same pavilion 287 cases of yellow fever were treated and isolated in 1900, and 24 in 1901; these were the last manifestations of the disease upon the island, thanks to the same confirmed experiences and theories of Dr. Finlay.
|Fig. 4. A page from one of Dr. Carlos Finlay’s many laboratory notebooks, listing a group of yellow fever patients in 1899 and 1900. Reproduced with permission from private collection of David Schwartz.|
We shall consider now the procedure at the time of admission. The patient is removed from the ambulance with the same care exercised at the time of taking him in. He is given at once a cleansing bath with warm water and soap. For this purpose the patient is placed in bed on an oil-cloth and is rubbed with brush and cloth. The nails and mouth are very carefully cleansed….The patient is then dressed with a white linen bed-gown that opens in front and behind, and is at once visited by the physician. The general relief experienced by the patient soon after admission is remarkable. This is the result of three factors that are enjoined upon the patients, namely: cleanliness, silence and rest. We often note the lessening of the arterial tension, the fall of the temperature and the restful sleep that comes from the allaying of nervous excitement.
It is the duty of the [attendant] physician to start the clinical record of the patient with such notes as he may deem necessary for the clinical and the sanitary history of the case. After this the patient is constantly under observation. A record of the temperature, pulse and respirations is kept every three hours on a chart and on the daily clinical sheet; the latter also contains the record of all other phenomena: data about the urine, the feces, the blood, the bacteriological examination of secretions and exudates, and also the information concerning the medication and diet.
Careful attention is given to all sanitary details in the wards. The floors are scoured once a day, usually without, but sometimes with bichloride solution. The utensils used by the patients are immediately placed in boiling water. The excreta are disinfected and the spit boxes contain always a solution of bichloride of mercury, 1 to 1,000.
|Fig. 5. Congressional Gold Medal awarded to Private James Kissinger, first to volunteer for human experimentations on yellow fever. Reproduced with permission from private collection of David Schwartz.|
The bed clothing is frequently changed; always daily, sometimes several times a day. The bed gowns are very frequently changed.
|Fig. 6. A page from Las Animas Hospital medical chart of American nurse Clara Maass, dated August 24, 1901. Her death from yellow fever is noted to have occurred at 6:30 PM. Reproduced with permission from private collection of David Schwartz.|
The administration…is very careful to make no distinction between patients of different social standing. There are no privileged patients….The rich and the poor are all treated alike.
Finlay and Guiteras were interested in conferring immunity to yellow fever by inoculating human experimental subjects with attenuated virus loads using longer mosquito incubation periods and repeated bites. These experiments were carried out in the Department of Human Inoculations at Las Animas Hospital. Unfortunately, the intent to reproduce milder cases of yellow fever was unsuccessful and the death of several subjects, including American nurse Clara Maass (1876–1901), resulted in a public outcry and cessation of these activities.7 Guiteras was so affected by these deaths that he refused to authorize any more human inoculations, even discouraging public vaccination programs.8
Guiteras remained director of Las Animas Hospital for the next twenty years. During this period, important research activities also focused on malaria, filariasis, and hookworm. Additional studies included smallpox, typhoid fever, rabies, tetanus, diphtheria, mumps, measles, and scarlet fever.9 The first cases of poliomyelitis in Cuba were also diagnosed at this hospital. Guiteras was educated in the U.S. and obtained his medical degree at the University of Pennsylvania in 1873. He then entered the U.S. Marine Hospital Service in 1880, where he remained until he was named professor of pathology at the University of Pennsylvania and pathologist at Philadelphia Hospital. Guiteras demonstrated an insatiable scientific curiosity resulting in numerous publications, including a textbook of pathology written as a medical student and adopted as the official text at his alma mater.9
As the incidence of infectious diseases declined, Las Animas Hospital was no longer an indispensable institution and eventually a decision was made in 1970 to convert it into a pediatric hospital, Hospital Pediátrico Docente Centro Habana (Pediatric Teaching Hospital in Central Havana).2 Fortunately, remembrances by Enrique Barnet, Juan Guiteras, William Gorgas, Mario Lebredo, Aristides Aramonte, and other protagonists have attested to the crucial role played by Las Animas Hospital in the control and eradication of yellow fever in Havana, Cuba.2,3,6,9,10
- Freidel F. The Splendid Little War. Little, Brown and Company, 1958.
- Ibarra A. Nuestra historia. Hospital Pediátrico Docente Centro Habana. Infomed 1999–2021. https://instituciones.sld.cu/hpch/acerca-de-2/nuestra-historia/
- Barnet EB. El Hospital Las Animas. Habana: Junta Superior de Sanidad, 1904 (Spanish and English edition).
- Finlay CJ. The mosquito hypothetically considered as the agent of transmission of yellow fever. Presented to the Real Academia de Ciencias Médicas, Físicas y Naturales de La Habana, August 14, 1881. Reprinted in abridged form in Milit Med 2001; 166 (Suppl 1): 6–10.
- Reed W, Carroll J, Agramonte A, Lazear JW: The etiology of yellow fever: a preliminary note. Presented at the annual meeting of the American Public Health Association, Indianapolis, IN, October 24, 1900. Reprinted in Milit Med 2001; 166 (Suppl 1): 29–36.
- Gorgas WC. Notes on the treatment of yellow fever at Las Animas Hospital, the hospital of the Sanitary Department, during the epidemic of 1900 at Havana, Cuba. Journal of the Association of Military Surgeons of the United States, Carlisle, Pennsylvania, 1903.
- Gorgas WC. Sanitation in Panama. New York, NY: D. Appleton & Co., 1915.
- Chaves-Carballo E. Clara Maass, yellow fever and human experimentation. Milit Med 2013; 178:557–562.
- Espósito CR. Dr. Juan Guiteras. Apunte Biográfico. La Habana: Editorial “Cubanacan”, 1947, 345 pp.
- Agramonte A. The inside story of a great medical discovery. Milit Med 166 (Suppl 1), 68–78.
DR. CHAVES-CARBALLO is a pediatric neurologist and clinical professor emeritus, Department of History and Philosophy of Medicine, Kansas University Medical Center. He received his medical degree from the University of Oklahoma and trained in pediatrics and neurology at Mayo Clinic, Rochester, MN. His main research interest is the medical history of the Panama Canal and he has published several articles and books on tropical diseases, yellow fever, malaria and Darling.
DAVID A. SCHWARTZ, M.D., M.S. Hyg., F.C.A.P., is a Global Maternal Health Specialist with specialties in Obstetrical, Fetal & Perinatal Pathology, as well as Tropical & Emerging Infectious Diseases. He has long experience at understanding the anthropological, biomedical, epidemiological and public health aspects of emerging infectious diseases as they affect society, especially pregnant women, fetuses and children. He is involved with the researching of Zika, Ebola and COVID-19 pandemics as they affect pregnancy. Residing in Atlanta, Georgia, Dr. Schwartz is an editor of both a book series and many scientific journals. He is an Associate Editor of the Archives of Pathology and Laboratory Medicine, a journal whose Founding Editor was Dr. Ludvig Hektoen. Currently a Consultant in Perinatal Pathology, Dr. Schwartz has an interest in the history of epidemic diseases, particularly yellow fever and smallpox.
Highlighted in Frontispiece Volume 14, Issue 4 – Fall 2022