Before 1959, Cuba possessed one of the most advanced medical civilizations in the hemisphere: a democratically elected National Medical College, a physicians' retirement law, private and mutualist hospitals covering the majority of the population, and an intellectual tradition reaching back to the sixteenth century. All of it was systematically destroyed in less than six years. Before the Fall reconstructs, with documentary rigor, what Cuba had before the revolutionary regime dismantled it, from Tomás Romay and the first scientific dissertation on yellow fever, to Carlos Juan Finlay and the discovery of the Aedes vector, to the exodus of three thousand physicians and the last free assembly of Cuban medicine in Santiago in December 1959. Written by family physician Enrique C. Fernández, MD, great-nephew of the last president of the National Medical College, this is not a nostalgic chronicle nor a family memoir, but the rigorous documentation of a medical civilization that existed, that contributed to universal medical thought, and whose destruction was not inevitable.