In 1878, thousands of refugees fled Cuba during the tail end of the Ten Years' War for independence from Spain — and with them they carried yellow fever. Despite government efforts, including the Quarantine Act, which gave the Marine Hospital Service authority to quarantine infected ships, New Orleans quickly fell victim to a yellow-fever epidemic. By the end of the year, 5,000 people had died in Memphis alone. In total, the Mississippi Valley counted 20,000 deaths.