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Features of this copy which may be bibliographically unique, whidi may alter any of the images in the reproduction, or which may significantly change the usual method of filming are Coloured covers / Couvaftera da couleur □ Covers damaged / Couvartura widommagte □ Covers restored and/or laminated / Couvwtura rastmiria etfou p^iojlia I Cover title missing / Le titre de couverture manque I Colowadmapa/CaitesgtegrapMquasanoouieur □ Coloured ink (i.a. other than bhia or bbwk) / Encia da ooidaur (la. autre que Uaua ou note) □ Cokxirtd ptetcs and/br Phjsteations / Ptanchat et^ Muatiationa an couiaiM' □ Bound with other mslarW/ RaM avee d'ai^raa documams □ Only edition avaiiabia / Saula icttion disDoNbIa □ Tight birxfing may cause shadows or distortion along interior margin / La reliure serrde peut causer de I'ombre ou de la distorsion le long de la marge intMcura. I I Blank leaves added during restorattons may appear wttttin tl>e text. Whenever possibla,tt)ase have been omitted from filming / II se peut que certaines pages blanches ajout^es lors d'une restauration ^ipMdssant dans la texte, mais, lorsqua Atatt poasfeit, eaa pagaa n'ont pas «ti MniM. □ A(Mitk>nal comments / Commantairaa aupiMmantaifas: L'Institut a microfilm^ le meilleur axamplaira qu'il lui a 6\6 possible de sa procurer. Las dAtsHs da cat axem- plaira qui sont paut-Mre unkjuea du point da vua bibii- ogrephlque, qui peuvent modifiar una image reproduite. ou qui peuvent exigar una modificatton dana la mdtho- da nonnala (la flRwov iont biiMquia okdaiaoui. 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Thft item it filmed at the reduction ratio checked below / C* documtnt eat film4 «u taux da rMuction indiquA ciHieaaoua. lOx 14x 18x 22x 26x 30x I I I I I I I I I I I I I I I 1^1 I I I I FT- 12x lex 20X 24x 28x 32x Tha copy filmsd h«r« hat bMii wproduotH thanks to ttia ganaroaity of: Otlar LHmry. ■NiaiH uniTCmiy, ttnnwwm Tho Imagas appaaring hara ara tha baat quality poaaibia considaring tha condition and lagibiiity of tha original copy and in icaaping wMl filiMkng eontract apaeM icationa. L'axamplaira f ilmA fut rip to d ui t griea i ia ginAroaiti da: (Mar Librwy. MnnB Uwi'ifiitv MontiMl Laa imagas suivantat ont M raprodultaa avac la plus grand soin, compto tanu da la condition st da la nattat* da raxampiaira film*, at an conform iti avac laa conditions du eontrat da Original copiaa in printad papar eovara ara filmad tha laat paga with a printad or illuatratad improa> sion, or tha back eovar «whan appropriata. All othar original copiaa ara filmad baginning on tha first paga with a printad or Uhiatratad impraa- Laa axamplairaa originaux dont ia couvartura an papiar aat imprim4a sont fllmSi an com man^ant par la pramiar plat at an tarminant soit par la damiira paga qui comporta una ampraints d'imprassion ou d'illustration. soit par la sacond plat, aalon la caa. Toua laa autraa axamplairaa OfighiaiM aofit fHwida an aotiHiiaii^aiit par la pramlira paga qui comporta una amprainta d'impraasion ou d'illustration at an tarminant par la darhlAra paga qui i Tha laat racordad frama on aach microficha ahaH contain tha symbol (moaning "CON- TINUiO'1, or tha sym bol ▼ ( m aa w l ii g "fMO"). Un daa symbolaa suivants ipparaltra sur la dandAfa imaga da chaqua microficha. salon la eaa: la syw hoia ^ sigwWa "A SUIVfIt". la Mapa, plataa. ctiarta. ate., may ba filmad at diffarant raduction ratios. Thosa too iarga to ba antiraiy included in ona axpoaura ara filmad baginning in tha uppar laft hand eomar. Ml ta right and top to bottom, as many framaa aa raquirad. Tha following diagrama illustrata tha Laa ewtas. pianehaa. taMaaux. ate., pauvant *tra filmis k das taux da reduction diffArants. Lorsqua la document ast trap grand pour fttra raproduit an un saul cliche, ii ast filmA k partir ito I'angia supMaur gaucha, da gaucha i droita, at da haut an baa, an pranwit la nombra d'imagas nteassaira. Laa dlegrawiwas suhrants HhMtrant ia nt4thoda. 1 2 3 4 5 6 MEDICAL NOTES OF A TRIP TO CUBA. AN ADDRESS DKUVEBKD TO THE STUDENTS' MKDICAi, 80CU.ry OF fStkHCU J. SHBraiBD, MiK MBDIOAL NOTSB OF A TRIP TO CUBA. Fbakm J. fiMM— m-i itiK AN ADDBB88 DKUVKMB) 10 TOB nVom IttDICAL MORT » I«t Aut, TO Sir William Van Home asked me to acconip«, him on a tnp to Cuba, promising me that I dK>uld Bee Cuba Til i" InT Phil^elphi. an Norember 8th and reached Santiago the wue rule of General Wood. The town ia an example to all town. ta^U« It h« become a sanatorium. Drains have been made and strwte «««d with aephalt, a sanitary corps keepa the street, clean, moi pushing »>all waggon, pick up every scrap of dirt, ^^mrjha^^ tTi? Tl!^' '"^ '""^ collectionTThi., ZT- ew, » net dow tt the ap«BM of the City but fund, .re derived I behove, from the CMtom. duties, aenvea, i Yellow fever ha. been enUrely aboluAed, no G«»e ha. occ.Ted for over 18 months .«d if the .oe^o theoiy of the tran.mi.rion of tie rdlow fever » true, no cnne can or gi„«to thoro and if yellow fever to nTo ? f^rT ^ importation. The S«.ti.go Province nra^ ^ " i*" ?T ^^^^^ the experiment. ^ n LIS: ^rrrtlefil"""? ^^«V^7ara.itrrthe disease. Zrl^Z^^^T ''^"^^ development in the body of ^mo«iu,to before the latter I ,able of conveying infeetioTTto P«iod amar. to be not le« than 12 da,.. A numberTTldST doet«» «.d athe,^ wteUtted to th. tart i being oitten by 1^.,^^ f who had alremiy fed on yellow fever patioiita, and H6.71 per (wnt. wera infet ied, their inoooiaUon p«nod being 2 to 6 cUya. Tbia diaeoTwj is importMit for qnwuitiM b oalj mtfol in SovUieni porto wbm this kind of monquito i-xiots and di(infeetk» of cloihiag uid betiisf k • work of (iupererogation. The mmv of the inoM|uito ia the Cmhg faaeu^, and the hooMa hi Santiago whkh have been regarded u centres ..f infection for Yellow Fever (and were destroyed by General Wood), were only so becauN they huilwrwl ih\» dun{,'erou8 iuaect. To aboliiih yellow ferer it ia important to prevent tho mosquito biting the yellow ferar patient, and o* eouw to deairoy tiie mosquito, a procedure not characterised by liny ffreat di->rrw of .simplicity, in fact, ratlier a 'big contract.' If yellow fever cases can be auoceasfuily protected ftom tha moaqnto bj wire acreena, eto., then the moequitoi having ao more p«tienta to bita won't be able to manufacture tlie j)arasite all by themselves— in fact it needs a combination of mosquito and patient to do this. The ex- creta of the patient have no pow« of conveying Uie disease. Dr. Finlay of Havana long ago asserted that moaqoitoa apiMd this dtaaaaa and ht made experiments to prove his case. The number of deathx from yellow fever in Havana in IMO WM 310, in 1896 1,882 died of this disease which only attacks forcignera, nativaa being, it is said, immune. Dr. Guiteraa of Havana, however, says that tho reason yellow fevor penilsU so constantly in that many very mild cases occur amongst native Cubana and colored peopla, and that these caaae are not reoogniced as yellow fever bat thoagfat to ba jnalaria or other diseases. The foreigners attacked were AmeriOHH and Spaniards. But 1 have wandered away from Santiago. The temperature variea little all the year round. It ia peipetaal summer in Cuba, the winter months being only a few degrees cooler than the summer, 80* to 90°, the average temperature, and the air is charged with moisture which makes exertion in the heat of the day unpleasant Santiago ia situated at the foot of a beautiful bay and fsdreM by bigh biHa (t.OOO to 3,000 ft.). There is a lower and an upper part of tho town ; in the upper part on a high ridge is aitnatad the General Hospital containing 300 beds, under the charge of Dr. CastiUo and his aaaiatants. Dr. Castillo ia a brother of ilie CktVemor of Santiago Province and was a prominent man during the Revolution and did much for the cause of liberty in Cuba He is a man of re- markably fine presence and of brilliant aUIitiea. He waa edacatad in the United States and for a time was a surgeon in the American Navy end art-jmpanied one of the Search Expeditions to the North Pole as surgeon. When the Americans took Santiago he was with them, and on the epidemic of typhoid and yellow fever breaking Mt, this boa- s l^tal whnk had been ■ bpuiah miliUry hoepiUl, was nuide uw of. But M it Wi Ihouxhl 10 bo mi iniut-faMl with yttllow (evur •« lu be iUu- g roui 1.) AiBc ricani it wai handed over by Uenenl Wo«4 t» Dr. Caa tilJo to be iu«d aa a i^efal ii^pital for nativaa who liava pracUcallj «U M^KTO felooti in their vabia, ami liOM>e sru immune lo yellow lever. The place it arranged in large pavilions round a central gqiiare con- taining kanti/ul treea and flowering rfaniba. In thia part of the Ciiutrjr aU Ibt bnildinga are of one gtmj and thia Itospiui in no excep- tion to the mil'; there are no problemg of ventilation and heating to wrestle wilh, tverything it built for lummer. Tlie hoapital ia clean and well umnaged and much good woA ia diHW. Or. CMillo baa ktely bad aeveral rucceisful caseit of extir|iation of the uterus of which I law two rapidly recovering. He hu8 collected money enough to build » steam laundry and expetts to light the place with elwttidty when h» geU hia plant for the laundry, lie han aUo nearly completed a very good diildna'a hoapital, the money for which he bimaelf collected, I aa v some caoes of malaria there, all apparently originating oataide the city and I am told by Cuban medical men that beeidea the ordin- ary malaria thera ia a pemieious type somewhat like the 'Black water Fever" of Africa, al«> ihere are uccAaional mm o( typhoid though theae are not nnmeroua. There ia a ferer seen not infrequently in Onbn ilhIA b B«t aakrit, beeaue H doaa not yidd to quinine, nor are organisms of malaria in the blood, nor yet is it typhoid for the blood does not react to any tyi^oid teat It ia ohtiactaiaad bj hi^ tan^an- ture and great {noatratieB mi bvt mOt aaona to W knowm about H. A eystematic investigation is needed to determine its nature. Whilst at Santiago Dr. Castillo aaked me to perform soma op«nM^i«es. The first case I openrtad oa «m ona 4rf oMnwtiOB of the bowei* i^Mi had lasted four days and was most interesting been e it turne»l out t be • case of pro-peritcneal heraia with gangrenous bowel. 1 Itad to raaect about a foot and a-half of the mtaatiBa. an stoat rhe opatatfam wall and when I left was progressing favorably. Anotlitr awe waa aa eoormoua osteo-sarcoma of the lower jaw in a woman, frou whom I removed the greater part of the lower jiwr. In tUa, as X ^ ways do in tumonia of the neck, I freed the «ower part first, securing tte Uood veaids, and then foond no difBcolty in disarticulating the jaw and removing the growth and it together. Patients in Cuba seon to stand operationa fairiy well, thouj^, ^dbaUy owing to the poor food thejr coaamw, do not alaad kae of Uood Hi. operating rooB was well equipped and wdl lighted, qidte flMdm ia atwy tUff •Bd beeidea this it is fly and dast proof. Thne are qnita » aambCT itf lepora ia Saatiago, tea* tOO X wm tdd, 4 •ad I MW M>TmI in Iho utrwtii. Ther»> in a biuuII Iioiim iitluthed to tkt hmpital whiih Inm four It pnt in it, nil i-orly fi«t'ti. 1 vigjted the I«gp«r llM|ittul in JlttVMiu aad ww incwt iotanstcd tbenin. It it etikd *V$m HcM^tal de Htin IjHaro," and vaa foundMi in mi, by Don rttiro AIcj;ri'. 'I'Ik |ir.M iil Imildinj,' and r.>uiiilulii)ii iJuUm from 185J3 and ulthougti it gt U grunts (rum the Uuvurnment and the City (till it is chiefly niiifmrtad by tieqantt and ^Mtiem. Ai om goea into the front doorway ont' lin(l^ oiusi lf in Ihi- jtorlico of a lar^i' tliurdi. Thia iiart in free to the imblie. On enlering the chureh one mnm on «Mh aida of the chancfl tran^'ipti' M'parated from the church by a ld|^ irm railing in which tha lepera ait and attend service and uIho at the aame time can aee their friendi who come to the ehunh. The women un; on one side and tha men on the other. The hospital, the pariliona of wliieh are aronad a huge court, cuntwM lUO patienta in all atagea of tha diaeue. The onei npetaira an the far adranced caiex and eon- fiaad to llif ir beds, iielpiesn, blind and niiiimed people, whoge gad utate maket one shudder to see and whose only hope is a speedy death. The eorridora on the gronnd floor are peopled by lepen who can more about, they eat in a roninion dining room and seem moderntely liappy. I taw many of the romparaiivt ly early eases chiefly of the anesthetic tubercular variety. The medical head of the hospital 1 did not aa«, Dr. Manuel Alfonzo, but everything seemed in perfect order and very clean. The nnrsing department is in charge of u community of nuns who alco look after the feeding of patients and dispensing. I wm taken about by the Mother Superior and a Sister. The Sister wu a duimiag wobmb, Mght and talkattre, and hailed from Limerick, Ire- land, she told me that up to the time the Americans came she had not tpvken English for 20 years, and had abnoat forgotten how to speak it; she had, however, preserved intaet • vwy riefa Iriah brogue vhidi was de- lightful to hear in Cuba. She informed mo that since the nuns had charge not one of them had ever contracted leprosy nor had any of tha assistants, although they had been in charge for ow 76 yarn. In her experience several eases hud bem diaehMKed eared, (awnimagi* ^1 being the great remedy. I took several photographs of the lepers and they aeonad rather to like it than otherwise. There was one native American patient, he had been living for years in Cuba and contracted the disease in I'orto Principe. It is said the (iovornment of General Wood in the near future intends to remove the lepers to an adjacent island. The patiatta themselves object because they will not be able to see their friends. At present patients cannot be compclUd to go to a hospital and their entry IB purely voluntary, but ome they inter are not allowed to leave. There •eema to be a genml impretnon in Cuba that ^ eating haa amnathing 99 f to do with th« proiliictjon of Am ttMM% tUt It dw tta apiaioB Mr. Johnathan llutchiwn. I wu much iiit«rMt«d. whik in Bavtat, hi tiM hoqiitaU thm. Ont iMgt public hMpital in the outukirti. it Umiik riinodflled and a con- ■idtnUa amount of money in being ipont by th« Uovemment to make the warda and equipment the moat modtfB. Tlik iadodaa • |«md»y, IB •laotrtc light plant and a mo»t modern up-to-date oiterating f9tm. Tb» mmbg ia in charge of American ladies who are endearor- ing to train Cuban girli at nurw-a. iH« hospital waa undergoing 2^** ^ ^"^ not aec «! ■ mI ,uj tnonble au8picea,bat I mw imrm m i me graatly. I » abdominal operation in which every modem aieptic preeaui.. u wai taken. There lanbo another hoapitia. No. I, which waa oooapied by Spanish Niffim dwtef the ww. It coniiatt of a nnmber of detached wooden pavilions connected by gallerit*. It can be made to accommodate 8,000 patients. American nunee reign here also and ereiything wu dean and in p rfaet mder. The operating nem waa modern, especially as regards gynspoology. The Yellow Ferer HoqiiUl I did not visit. Or. Femandes, the president (rf tlie Pui-AnMriean Medical Con- gnu which met recently in Havana, spent a day taking me about. Wt visited the Medical School, which consists chiefly of claw rooms and a dental department which was well-eiiuipped with modem dental chairs. The dissecting roon was oaall and contained only a tety few taUes on which there w» a couple of sul)jectH. At the time I was there there waa no dissecf going on by the studint*, hut some of the demonstra- tors were hard work making «">nif very beautiful preparations ot the foot ajid kroe. I also Tinted with Dr. Femandei a large building on ik» TOiiwsity gronnda wUdi has recently been handed over to the Medi' ■ "acuity Vor Laboratories : there was a flno histological labora- tory in Hie process of e<)aip..ient but I saw but little piOTiaion, beyond rooma, for piqr^tlogy, ekmMry or pathology. Kueams were em- spicuous by their absence. In the hoa^tala there were no ar r a ngeme nts by which students could •ae eperattuna and I eonld not gather that there was any special clinical teaching. Dr. Fernandez is one of the most progressive of men. He has a large laboratory and library at the top of hio house, he has skilled men trained in Pasteur's laboratory, eimthinally ciperinenting, making antitoxines for diphtheria and tetanus and examining pathological spe- dmena. He keeps four horses below stairs from which he gets the aenun, all the horses looked in perfect condition, one espcmlly wUtit he has had for two or three years and from whom some hundreds of ^oaitaef Hood fecva bain drawn, is espocially lively ami hoallby. Dr. 6 Feniandes did all this at his own expense and at first gave all his anti- toxins away, but now he charges for it at cost; his laboratory ia made much use of by the practitioners in HaTana. He has un iinmenae medical library and is the Editor of "The Cronica Medico-(iuirurgica de la Ilabana." Dr. D. J. Santos FenMndo^ ia the moat promineiit ophthalmic surgeon in Cuba. I visited also two privaie .Spmiish lio.spiials, one conducted i>y the Association (le Dcpcndicntcs (VI Couicrcis do In llatmim. Tlii» Society has a magnificent hospital in beautiful grounds called the " Quinta de Sahid la Porisima Concepsion." The tawpital eonsiBts of separate buildings, a large administration l)«ilding, a large building containing a complete hydropathic establishment hot and cold water in every form and hot air and steam baths with all kinds oi Ataches, whidi arc num- aged by the director from a kind of pulpit; wpaiatc buildings for males and females and a very fine new operating theatre. This Society is very wealthy and has been in existence for years. It started first as a cottage hospital as its name 'Quinta' implies, and soon it grew larger and larger until it reached its present size. Each member pays $1..50 a month, or $18.00 a year, and as there are 13,000 members, their in- come is about $234,000 a year. They iiave a surgeon-in-chief and physician-in-cheif who are each paid $8,000 or $4,000 a year, and their assistants in proportion. Each member of the Association is entitled to a private ward and free medical and surgical attendance when ill. He can have his own doctor in preference to the regular surgeon or phy- sician of the establishment. lie can recommend anyone to tliis Hos- pital to one bed. Although there are some 200 beds, when 1 visited the place there were only 50 patients actually being traated. I visited another similar institution kept up entirely by natives of Asturias in Spain. This was not so modem as the' one I have ju8(t described but has most charming gronnda witii a wondetfnl ccrflection of tropical trees .about it and lovely gardens. It has occurred to me that such a society for the establishment of an infectious hospital would be of advantage here. Let each member pay a stated sum into the society yearly, this would entitle him to one bed for himself or any nmnber of his household. A membership of say 2,000 at $10 per an- num would give $20,000 a year, for which a moderately sized hospital could be run. It would be like an insurance against iniectioua dia- ease and when such diseases did come to ns we could send members 18 jmn of age go naked. Babies, even of the better classes, never wear clothes The tower daaaea live in huts made from the palm tree, the roof is formed from the leaves, the sides from the trunk, and the bark is used to (Bvide the rooms and fill up the cnTices. Doors and windows are usuaUy nmopeniiigsekMedwithiiiatB. The people sleep usuaUy in hammock^ Although perhaps the best tobacco in the world is grown hi Ciha, ^!!IZ.°'t'** '"'"^ ^° ^° '^^^ tJ^* tobacco «wslwlea I visited the proprietors did not smoke. Smoking, however, IS very prevaOcnt among the lower cksses. They raise thdr own to- bacco and make their own dgarattea and cigars. Women smoke as mm* as mm, and it is no uneommon sight to see a procession of women with baskets or water jars on their beads, and in the mouth of eaeb one a huge black cigar and douda of smoke obscuring their swarthy coun- tenaneea. It seems to agree with fliem, for they all look well and happy. ^ a town in the centre of Cuba one of my friends got Ul, with what, I taow not He had amre headaebe, Tomiting, backache and a very high temperature. I saw him and advised him to get a local doctor, as I was not acquainted with the tnpicd favera. My friend, who had spent so«M n jaara in tbo tropica, waa sure he bad yellow fever, as he had aeea many cases. The local doctor examined him carefully, and aflernamining the urine, said it was not ydlow ferar. but eoold 8 not wy what it was. They i-est their diagnoBis of yollow fovcr entirely on the fact of there being albumin in the nrine. A» he waa in an unconilortable liok'l, 1 wtnl to tlio S\y.iuhh private Iwi^ital, became a subscriber and arranged for i.iy frieiMl to liave a private ward. But before remoring him I had to have tta» doctor of the hoq>ital f«e him and tlie two liad a consultation which lasted some 80 oi 40 minutea, and waa held in voluble Spanidi over the bedaicle of my friend, who underatood and spoko Spanieh perfectly. During the consultation innumerable cigarettes weaw consumed, and the patient waa ganroanded by a halo of smoke. After a time the ctmsnltation waa traneferred to the next room, and my friend to'd me that the hospital <)octor Mud that ho had yellow f^rer, but the other held to his first opinion.- Having the cnrriapfe at the door, I called to one of the doctors, who spoke French, and said I was going to take my friend to the hospital whatever the disease was. They submitted to my decision with Spanish politenesa (for a Spaniard wouid rather be accused r)f murder than impoliteness), and T took my friend to the hospital, where the doctors fought out the diagnosis for several days; in fact, untU my friend waa out of d«g«r, aa they said if ho livod over the fifth tMk08 occur, tor it is well known thai numliors of eases of yellow fever have no albumin in the urine. Again, many cases of yeilow faver are, 1 believe, so mild that ihey are iinrefOgiilsaMe. The doctors in Cuba, except in Havana, do not seem alive to the blood examination in malaria and typhoid fever, if they used this oftener they would, I believe, cxt-lmlo more casen of so called yellow fever. Havana is a hoautiful city, but still undraincd, but they are now undertaking a huge system of drainage and paving, which will, it is said, when completed, make Havana a veritable sanatorinm. Cuba is a wondoi-ful country for the raising of all forms of food. Before the war good lieef could easily be got very cheaply, and immense herds fattened on the rich guinea and parana grass, whiA growa so luxuriantly in 'he province of Santinpo. .\s a rule, the cowa give bttt little milk, and butter is not made in any quantity; the feed goes to beei^ not milk. Imported Imttor in tina ia Mad everywhere, and tko 9 tinned cnam and ctrndensed nulk. Oleo-margarine ig very popular because it never gets tainted. In the hospitale all the milk I saw was boiled immediately on receipt; they do not seem to hare yet introduced IVntenrisation. I seTend times had my attention drawn to the thick .veliow crust which formed on the boiled milk, and vdiich was pro- nounced beautiful cream. All kinds of fruits are most abundant, oranges, limes, grape frait, eurta*d apples, alligator pears, bananas ami plantuiox, wtpudiltuM^mu^piea, «t«., mm! bm^ otkar kinds th» MMaos of which I lorget. CoeM4iil water is maeh noouBmided as a dinietic. Itiscmlynsed wken clear and limpid in the green cocoa-nut. Banau-a are never eaten raw, always roasted or boiled, taking the place of bread. Sweet potatoes grow well, but the Yuca root is the fsTtnite snbstitate for the potatoe. It is these roots from which tapioca is made. It struck me as very curious that so much pork and ham was eaten in such a hot climate but every hut has its quota ot pigs. These m of the nsw- back varieity, and are semi-transposed at certain seasons of the y«ar; however, when the nuU of the Royal palm are ripe and ready to &11, the pigs congregate about the trunks