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In the years following the 1898 U.S. intervention in the Cuban war with Spain, the American forces occupying Cuba worked ceaselessly to control the dreaded yellow fever in Havana and the rest of the island. But, like the public health campaigns of other colonial powers, these efforts were not an expression of medical beneficence. As elsewhere, public health in Cuba served the needs of the colonizer rather than the colonized: to protect commerce, maintain the labor force, safeguard troops and colonial administrators, and justify colonial rule. The eradication of yellow fever in Cuba—an unprecedented success of colonial public health—achieved for the United States nearly all of these goals. American public health efforts in Cuba were a colonial enterprise that provided economic and political benefits to important supporters of the American imperial state, demonstrated that American imperialism could succeed where European powers had failed, and so inspired further American colonial expansion in the region. There is little conclusive evidence of when yellow fever first appeared in Havana, but by the nineteenth century it was undoubtedly continuously present. In a typical year, yellow fever claimed hundreds of lives in the city, and it was very rare that more than a few days went by without at least one new case being identified. In particularly bad years, over six hundred people could succumb to the disease within just one hot, rainy, summer month. Yellow fever was one of the most dreaded diseases of the high imperial age. The onset of the disease was marked by a fever that lasted for several days before breaking; for many, this development meant that they could begin to slowly recover . For some, however, the fever would soon return. With it came the disease’s most characteristic symptoms: jaundice and black vomit. As the liver failed, the victim’s skin and eyes turned yellow. Hemorrhaging of the eyes, nose, gums, throat, stomach, and intestines was common. The internal bleeding caused most A Fever for Empire U.S. Disease Eradication in Cuba as Colonial Public Health mariola espinosa 288 patients who reached this stage of the disease to suffer bouts of uncontrollable retching; terrifyingly, the clotted blood turned the regurgitated liquid black. Few of those who experienced the black vomit ever recovered. Ignorance compounded fears: even those who had spent years studying yellow fever seemed to have little understanding of how it was transmitted. With the development of germ theory in the latter half of the nineteenth century, many doctors believed that a thorough cleaning would render a location safe. Yellow fever, however, continued to strike even in well-kept neighborhoods. Many pointed to the lack of circulation in Havana’s harbor as the source of the disease. But ships that anchored in the middle of the harbor and kept their crews aboard were much less likely to develop cases of yellow fever than those that docked and allowed sailors to enter the city.1 After the American intervention in the Cuban struggle for independence from Spain, the army immediately began an intense campaign against yellow fever in Havana and other Cuban cities. Despite great exertions, the fight against the disease met with little initial success. But then a team of American military doctors charged with investigating its cause took up and confirmed an elaborate version of a much-ridiculed theory put forward by a Cuban doctor, Carlos Finlay, decades earlier: that a particular house-dwelling species of mosquito was the only means by which the disease made its way from one victim to the next. Redirecting the efforts against yellow fever toward mosquito eradication had quick results. Within months, the disease was completely eliminated in Havana. By May 1902, when the U.S. Army departed, no cases of yellow fever had occurred anywhere on the island for over half a year. Even after withdrawing its troops, the United States closely monitored conditions in Cuba for any sign of yellow fever and demanded that the newly installed Cuban government continue and expand efforts to ensure that the disease would not recur. When, in late 1905, political disorder disrupted these efforts and yellow fever again appeared in Havana, it was not long before the U.S. Army was sent back to quell the unrest. During the next three years, the occupation government expended over one-tenth of Cuba’s national income on measures to eradicate this small outbreak and eliminate conditions favorable to the disease.2 These...

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