Rico, reluctantly admitted there were cases of bubonic plague in the city and that the disease was taking on epidemic proportions. Most of the cases, and the first ones diagnosed, were in a working-class neighborhood in San Juan known as Puerta de Tierra. The neighborhood had long been known for its unsanitary, overcrowded housing and high rates of infectious diseases, which health officers frequently decried. Yet, through the years, officials had little compunction about using Puerta de Tierra, and the waters that surrounded it, as places to dump garbage, house people with infectious diseases, allow unsanitary docks and stables, quarantine sick animals, and dispose of animal carcasses. Bubonic plague apparently spread from the docks in Puerta de Tierra and was believed to be imported. US health authorities believed the disease had spread from the Canary Islands, but Port of Spain, Trinidad, and La Guaira, Venezuela, where cases had been reported, were also thought to be the origin. 1 The epidemic