Pox (21 page)

 

The eyes of the Western world were upon the Americans. But the gazes of the Filipinos would haunt them more: those “silent sullen peoples . . . [s]hall weigh your God and you.”
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Whether or not they read Kipling, American leaders would come to accept the essential terms of his poem. The moral and political legitimacy of the entire colonial enterprise rested upon the capacity of the colonizers to deliver—not just natural resources, markets, and strategic ports to the metropole, but also freedom from ignorance, famine, and disease to the nation's new subject peoples.

At the turn of the twentieth century, the United States of America, born of a colonial revolt against England, followed in Britannia's wide wake and became, in the words of William Howard Taft, “a colonizing and colony-holding people.” Taft was in a good position to know. He served, in close succession, as America's first “civil governor” of the Philippines, secretary of war, and president. In contrast to its long history of conquest and empire-building across North America, the United States had for the first time taken possession of foreign territories without any serious intention of incorporating them into the political nation as states. For Taft and other defenders of overseas expansion, the success of U.S. health interventions in the tropics proved, before all the world, the morally progressive and technologically superior character of American colonialism. Army surgeons and U.S. health officers in Cuba, Puerto Rico, the Philippines, and the Panama Canal zone labored mightily to reduce the incidence of many terrible infectious diseases, including yellow fever, malaria, bubonic plague, beriberi, leprosy, and smallpox.
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“We expended many lives and much money in the Spanish War, and in the discharge of the responsibilities that have followed that war,” President Taft told a rapt audience at the Medical Club of Philadelphia in 1911. “But they are as nothing compared with the benefits to the human race that have already accrued and will continue to accrue from the discoveries made under the conditions and necessities which the exigencies of that war and the governmental burdens following it presented.” Pointing to American “sanitary achievements” in the tropics, expansionists argued that the new possessions, rather than repudiating the values of self-determination expressed in the republic's founding, demonstrated the nation's desire to spread the blessings of liberty and modernity to dark corners of the globe. This belief has remained a touchstone in the ideology of American empire ever since.
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None of this, however, had been part of the original war plan. The celebrated American sanitary campaigns originated in a far more limited objective: to protect the health of U.S. troops. A cluster of historical factors raised the stakes involved in meeting even that objective. The Spanish War was the first American war to be fought in the era of the bacteriological revolution. The Medical Department of the U.S. Army was under considerable pressure to show how the scientific advances made in the field of medicine since the Civil War would benefit the soldiers under its care. Alas, the department had already failed the soldiers as they assembled for war. In a grotesque public scandal for the department and the McKinley administration, the mainland encampments had become centers of infection and death.
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The intensity with which U.S. military surgeons conducted their sanitary work in the Caribbean and Pacific was heightened, too, by deeply held cultural beliefs that the tropics posed untold hazards for civilized white men. A new discipline—“tropical medicine”—had risen up to address precisely this concern. As
The Baltimore Sun
opined, European and American physicians “look forward to a time when vast regions of the globe, now desert, or inhabited only by inferior races, will afford safe homes for the people of temperate climates.” Medical science seemed to hold the key to white settlement and further commercial exploitation of Latin America, Asia, and Africa. But American tropical medicine was still young in 1898, and, after the debacle of the assembly camps, military surgeons viewed their duties in Cuba, Puerto Rico, and the Philippines with deep apprehension.
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With great challenges, though, came unparalleled opportunities for the exercise of American health authority. While keeping infectious diseases at bay—including the virulent smallpox that broke out in all three areas after the landing of U.S. troops—the Americans acquired a new mastery of what the brigade surgeon Azel Ames called “the science and art of colonial government.” Like the mobile surgeons of the U.S. Marine-Hospital Service, who at that moment were fighting smallpox in the American South, the doctors of the Army Medical Department aspired to use the latest medical knowledge to fight disease. But unlike C. P. Wertenbaker and his colleagues, U.S. military surgeons in the new overseas domain possessed broad national authority and the resources of an army. For the occupying Americans, the vaccination campaigns in particular became a means to gather vital data on the local topography, political institutions, and indigenous peoples—making those exotic tropical places legible to their new rulers.
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In the American system of government, guarding the public health was the most elemental action a state could take under its police powers; the almost unlimited legal authority to ward off epidemics had often been compared by the courts to the right of any government to protect its own people from invasion. In the tropical possessions, that old analogy quickly became superfluous. Absent the institutions of popular sovereignty and due process (which the Americans planned to withhold until the indigenous peoples proved themselves fit for a measure of self-government), police power
was
military power. The Army's sanitary campaigns far exceeded the normal bounds of the police power, which by a long American constitutional tradition had always been assumed to originate in sovereign communities of free people. In America's overseas sanitary campaigns, the scale and scope of governmental power were greater, the colonial space was different, and the fact that an institution of the national government, the Army, was undertaking these measures was altogether revolutionary.
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By any honest measure, the achievements of U.S. military medicine in the overseas possessions were extraordinary, even when they did not meet the Americans' own ever-rising expectations. Within just a few short years, the Army Medical Department could fairly boast that its surgeons had cleaned up the old Spanish colonial cities and made major discoveries in the etiology and prevention of yellow fever, beriberi, and other terrible diseases. These discoveries took place in Army camps, native villages, and colonial laboratories, using the full intellectual arsenal of the bacteriological revolution. But in the eyes of many Army medical men, it was the fight against smallpox—using the older technology of compulsory vaccination on a hitherto unimaginable scale—that showcased the full humanitarian promise of U.S. military medicine. For the Medical Department's original mission, to protect the troops from disease, unexpectedly gave rise to the first glimmerings of a grander vision. Uninhibited American power might one day eradicate the ancient scourge of smallpox from entire regions of the globe.
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A
s the first major U.S. military action since the germ theory of disease gained broad acceptance in the medical profession, the war with Spain should have been a milestone in military medicine. And, in important respects, it was. The decades since the Civil War had witnessed the creation of modern health departments in the major U.S. cities, a greater recognition of the importance of aseptic practices in the treatment of wounds, and, in 1895, the discovery of X-rays. During the Civil War, Army surgeons had still probed bullet wounds with unsterilized instruments and unwashed fingers. By 1898, most Army doctors and volunteer nurses knew better. On the battlefield, they wrapped soldiers' wounds in antiseptic dressings. In the field hospital, they used X-rays to locate bullets and assess damage to bones. At the operating table, they followed aseptic techniques. The results (aided by the introduction of small-caliber bullets) were extraordinary. The death rate of wounded U.S. troops during the Spanish War was the lowest in military history: fully 95 percent recovered. And blessedly rare in this war were the heroic amputations that had moved Walt Whitman to poetry during his stint as a hospital volunteer with the Union Army (“the smell of ether, the odor of blood”). As Army Surgeon General George M. Sternberg reported with pride after the Spanish War's end, his surgeons had performed only thirty-four amputations in a wounded list of some sixteen hundred men.
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Notwithstanding these achievements, the record of the Army Medical Department during the Spanish War was a public disgrace. “Now that actual fighting is over,” wrote Dr. Carroll Dunham in the
American Monthly Review of Reviews
, “it is undeniable that failure adequately to safeguard the health of the American troops is the one blot on an otherwise fair account.” In an era of rising expectations about the power of preventive medicine, the department failed to conserve the health of the troops. Only 345 U.S. soldiers died from wounds of combat during the war; 2,565 men died from disease. The ratio of disease fatalities to combat deaths (more than 7 to 1) exceeded those of the Mexican-American War (6.5 to 1) and the Civil War (2 to 1). Tens of thousands of U.S. soldiers spent the Spanish War in the department's ill-equipped hospitals, suffering from preventable infectious diseases. The vast majority of the men who died in this overseas war never left the mainland.
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Established in 1818, the U.S. Army Medical Department consisted during peacetime of a small corps of professional officers, reinforced during time of war or emergency by state-appointed surgeons from the volunteer militias and civilian physicians hired on contract. For centuries, medical men had marched with armies, but their status had always been less than heroic. In eighteenth-century Prussia, army doctors still shaved the officers of the line. The very title of “surgeon”—invoking both civilian status and the rough craft of stitching wounds and removing bullets and limbs from wounded soldiers—was viewed as a put-down by some nineteenth-century Army medical officers. The official duties of the U.S. Army surgeon did consist, first and foremost, of evacuating and treating troops wounded on the battlefield. But in the age of modern sanitary science, the duties did not stop there. America's best-known citizen-soldier, Theodore Roosevelt, saluted the profession as a bastion of manly heroism in a feminized age, noting that the surgeons' job required them to be not merely doctors and soldiers but “able administrators.” Responsible for the health of thousands of troops in camps and crowded transport trains and ships, the modern Army surgeon was necessarily a public health officer, charged with examining the recruits (rejecting those unfit for duty), vaccinating the line, securing pure food and water, and preaching modern hygiene to line officers and troops.
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Under Surgeon General George Miller Sternberg (1893–1902), an internationally recognized epidemiologist who published the first American textbook on bacteriology in 1896, the surgeons of the Army Medical Department aspired to a high degree of professionalism. Like many of the department's senior officers, Sternberg, a Civil War veteran, had honed his medical skills in the late nineteenth-century campaigns against the Indians in the American West. By the 1890s, new candidates for the corps learned their trade in the classroom. They had to take a rigorous entrance exam; in 1897, only 6 out of the 140 applicants passed. The surgeons underwent a five-month program of postgraduate education at the Army Medical School in Washington, where they studied bacteriology, sanitary chemistry, pathology, and military hygiene under a faculty that included such leaders in the discipline as John Shaw Billings and Walter Reed. Reed's academic title—professor of clinical and sanitary microscopy—captured the dramatic changes in military medicine since the Civil War. The microscope and bacteriological culture had taken their places alongside the scalpel and saw as tools of the trade.
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On the eve of the war with Spain, the professionalization of the Army Medical Department was still a work in progress. As was the case with practitioners in many other disciplines at the turn of the century, including law and civilian medicine, the military surgeons' claims to the rigor and status of a science outpaced the workaday reality. Under U.S. military law, neither their medical credentials nor their commissioned ranks entitled medical officers to command in the line. The surgeons could only make recommendations regarding camp sanitation to the line officers, who decided whether to implement them. In the past, many line officers had shown little patience with regimental surgeons, insisting that their intrusions interfered with military discipline. During the Civil War, one Union Army colonel had shrugged off his medical officer's complaint that the camp smelled of excrement, insisting the stench was “inseparable from the army. . . . [I]t might properly be called the patriotic odor.” (No wonder Whitman recalled that war as “nine hundred and ninety-nine parts diarrhea to one part glory.”) By 1898, many line officers and soldiers had grown more respectful of the surgeons' expertise, and the medical corps consequently wielded greater authority over camp conditions. But the national military school still did not offer a course in hygiene. And the advance of scientific medical knowledge since the Civil War had eliminated neither the patriotic odor nor the old tension between line officers and their medical men.
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