Pox (26 page)

No doubt American military doctors believed their dispatches presented realistic accounts of the beliefs and practices of a backward “Oriental” people. In fact, these dispatches drew upon a common Western language of medical high modernism that had developed in the long nineteenth-century era of nation-state formation and colonial expansion. Within the ever widening world of cross-cultural contact, European and American physicians measured the civilization of subordinate groups along a scale of sanitary evolution. Although in this case U.S. surgeons were talking about Filipinos they encountered in the zones of combat and occupation, the nineteenth-century medical literature teemed with strikingly similar descriptions of the “primitive” health practices of Native Americans on the western reservations, Mexican Americans in the southwestern borderlands, African Americans in the rural South, Puerto Ricans of the Cordillera Central, and the “new” immigrants from Southern and Eastern Europe streaming into America's industrial cities. European and American tropical medicine was embedded in a larger cultural and scientific process—one so homogeneous in its assumptions as to constitute a common project. Self-consciously modernizing nations used medical knowledge to comprehend, categorize, and govern the most marginal peoples within their territories. Tropical medicine was never merely a handmaiden of colonial domination, but it served that purpose exceedingly well.

Of course, for the Filipinos smallpox was not a figment of anyone's colonial imagination. The disease stole children from families. It left thousands blind or scarred. In the absence of effective preventive measures, smallpox was an unavoidable fact of life—like the passing of the seasons. According to American estimates, forty thousand Filipinos died annually from smallpox during the final years of Spanish rule and the early years of the Philippine-American War. Army surgeons working in the provinces reported that between one third and one half of the inhabitants had already suffered smallpox. Greenleaf reckoned that the children of the islands were “practically the only susceptible persons, the adult population being as a rule immune and representing the ‘survival of the fittest.'” Although smallpox did the greatest harm to the islands' poorest inhabitants, it did not spare the most elite. In March 1900, Aguinaldo's own infant son died of smallpox while in U.S. captivity in Manila.
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The Filipinos were not indifferent to the many diseases that afflicted their families. Popular conceptions of health, disease, and medicine varied from place to place in the archipelago, combining indigenous traditions with Christian teachings and Western medical ideas acquired from the Spanish. Filipinos did not simply reject Western medical ideas; they incorporated those that seemed to work into their own systems of belief. According to commonly held Filipino medical beliefs, diseases could be caused by natural events: smallpox was known to be a disease of the dry months and was expected to wash away with the rains. Or diseases could be brought on by supernatural forces; if smallpox persisted through the rainy season, local healers used rituals to appeal to the spirits. Americans expressed dismay at the Filipinos' practice of treating sickness and death as social events that required the close presence of friends and relatives. The occupiers used strong measures to compel Filipinos to remove the sick from their crowded huts, to promptly bury the dead, or destroy clothing contaminated with smallpox. Some Filipino practices must have fostered the spread of small-pox, but they also powerfully expressed the relationships of family to community and between the natural and supernatural orders.
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Many Filipinos had formed specific ideas about the various Western medical practices that the Spaniards had tried (usually halfheartedly) to introduce into their lives. Filipinos could be receptive to Western medical ideas and medicines—at least those that worked. Vaccination had not proven itself worthy of their confidence. In 1897, more than ninety years after Balmis first brought vaccine to the archipelago, the Spanish regime maintained a central vaccination establishment in Manila and employed 120 public vaccinators (
vacunadores
) in the various provinces. But many Filipinos spurned them. Traditional beliefs about the seasonal cycles of smallpox made vaccination seem unnecessary. Filipinos had all too often seen that even after the
vacunadores
did their work, smallpox returned. As Americans discovered, the tropical heat often rendered vaccine inert and thus ineffective. Filipinos had observed that vaccination sometimes spread skin diseases. In fact, the Spanish health authorities' use of the arm-to-arm method for propagating vaccine carried the real risk that syphilis and other infectious diseases might be transmitted from person to person. Reports coming in to the Spanish authorities from the provinces during the 1890s indicated that vaccination had been “completely discredited.”
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From the outset of the U.S. occupation of Manila, on August 13, 1898, the Army's top brass and medical officers were preoccupied with preserving the health of the troops. That in itself was a tall order. From 1898 to 1902, the Army reported a half-million cases of illness, more than four sick reports for every soldier who served. Every regiment suffered from dysentery, malaria, and venereal diseases. Typhoid fever and smallpox were continuing threats. While the Army's sickness data documented the suffering of white American soldiers, they also showed the power of soldiers to carry infection across the archipelago, transmitting pathogens between local disease environments that had previously been isolated from one another.
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As the bustling base of operations for the U.S. command—not to mention for American business interests—Manila topped the Americans' sanitary agenda. The first measures, as Colonel Greenleaf said, were “designed mainly with a view to the preservation of the health of the troops.” But the Army approached the cleanup of Manila with the determination of people planning to stay awhile. The commanding general established a board of health for the city, under the leadership of Major Frank S. Bourns, a surgeon with the U.S. Volunteers. The Atlanta physician possessed an exceptional knowledge of the Philippines, having spent four years there on two previous zoological and ornithological expeditions.
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By October 1898, Bourns's health board had nearly eighty employees, including a number of European-educated Filipino physicians. A few of the physicians, such as Dr. Trinidad H. Pardo de Tavera, had been members of Aguinaldo's government at Malalos. The board divided Manila into ten sanitary districts, appointing a local physician for each; hired eight municipal midwives; and established special hospitals for smallpox, leprosy, and venereal diseases. Working with the new American department of sanitation, the board cleaned streets, staged house-to-house inspections, and seized and burned the corpses of inhabitants who had died from contagious diseases. Bourns's activities extended beyond purely sanitary matters.
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As relations with Aguinaldo's independence movement deteriorated, late in 1898, Bourns began relying on the local physicians and his growing network of personal contacts to acquire, as he modestly put it, “a good deal of information not otherwise obtainable.” Bourns's talents were not lost on the Army generals, who assigned him to investigate reports of insurgent activities in the city and suburbs. By the time the first shots were fired in the Philippine-American War in February 1899, Major Bourns had established within the health board what he called a “little spy system, by which we were enabled to keep track, especially in the city, of everything that was going on on the insurgent line.” Information-starved U.S. military governments in both Puerto Rico and the Philippines exploited the wealth of local knowledge produced by sanitary campaigns. But Bourns pursued that aspect of a health officer's job with unusual intensity, blending epidemiological surveillance with outright espionage.
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The first scattered cases of smallpox had appeared among the U.S. troops in Manila in September. Surgeon General Sternberg reported that the men had been “visiting the huts of the natives, in many of which smallpox of a very malignant character was prevailing.” In November, as U.S. forces in the vicinity grew to 21,000 men, more cases appeared among them and also among the 2,000 Spanish prisoners in Manila. The Army's first response was to “protect the command by vaccination.” All the Spanish prisoners were vaccinated, and Major General Elwell S. Otis ordered the revaccination of all enlisted men in the islands. After much of the vaccine sent from San Francisco to meet this demand proved inert, Major Bourns reestablished the old Spanish vaccine farm in the city and started harvesting fresh lymph by inoculating local carabao (water buffalo). The situation worsened in December when smallpox infected the Twentieth Kansas Volunteers, killing ten. An investigation traced the origins of the outbreak to a cluster of native inhabitants who lived across the street. By this time, as one U.S. soldier recalled, the rising incidence of smallpox “caused the Army Medical Corps to view the general health and living conditions of the civil population as being pertinent to the well-being of the American command.”
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Bourns established a corps of city vaccinators, starting with six men, then doubling their number, then increasing them further after the new year as smallpox became epidemic in Manila. On the eve of war, Major General Otis sent Secretary of War Alger a dispatch on the health of the troops: “Smallpox causes apprehension. Entire command vaccinated several times. Twelve physicians engaged several weeks vaccinating natives.” Soon the suburbs of Manila were in flames, and terrified residents poured into the congested central city. In the Tondo district, seventy-five Filipinos died of smallpox in March. Bourns's corps aggressively enforced vaccination, meeting “considerable opposition” at first, applying force when necessary. In all, the corps vaccinated eighty thousand residents of Manila that winter. By the end of March, the danger appeared to be over. And by June, Bourns reported, “there were but 4 cases of smallpox in the entire city of Manila.”
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The Manila epidemic had demonstrated, to the satisfaction of the Army Medical Department, the importance of vaccinating not just the soldiers but the local inhabitants among whom they lived. It had been a costly lesson: from September 1898 through March 1899, the troops in Manila had suffered 236 cases of smallpox. Eighty-five of these were mild cases, reported as varioloid (smallpox modified by previous vaccination). But among the other 151 cases, more than half of the patients (77) had died, seeming to confirm that smallpox in this tropical zone was especially deadly to white men. The presence of
any
smallpox among the U.S. troops in Manila created a public relations problem for a War Department still reeling from the typhoid revelations. American newspapers reported the tragic deaths of young soldiers from the disease and advised parents to disinfect letters received from their boys in the islands. To Surgeon General Sternberg's chagrin, English antivaccinationists seized on the news that smallpox had broken out among the U.S. troops to cast doubt upon the efficacy of compulsory vaccination.
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But to Army officials, a strategy of wholesale compulsory vaccination—of the troops and the most proximate natives—had proven its merits. For the people of Manila, the U.S. vaccination campaign far exceeded anything they had experienced under their previous rulers. The Spanish regime's chief vaccinator had reported just 9,136 vaccinations performed in the city during the four years prior to October 1898. During the next five months, the U.S. military government vaccinated 80,000 inhabitants.
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The U.S. Army took the war beyond Manila to the provinces, across the central Plain of Luzon and to other islands. By 1900, Aguinaldo's forces adopted guerrilla warfare, which the Americans derided as uncivilized. The Army countered with increasingly violent tactics, including interrogation of suspected insurgents and spies using a form of torture known, in an especially perverse marriage of medical metaphor and military technique, as the “water cure.” The Medical Department had its hands full, establishing military hospitals, caring for the wounded, and moving with the line. Controlling infectious diseases remained a high priority. During 1899, the most deadly year of the campaign for the Army, 475 soldiers and officers died from wounds of battle, another 139 died from “other forms of violence,” and 709 succumbed to disease, “principally diarrhea and dysentery, small-pox and typhoid.” During the same year, nearly two thousand soldiers were sent home due to sickness. Throughout the war, smallpox weighed heavily on the minds of the military surgeons. They vaccinated the troops with great regularity.
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Preserving the health of the troops called for measures to sanitize their environment and the peoples who inhabited it. Many of the soldiers were stationed in one of five hundred garrison towns, which soon grew overcrowded with migrants fleeing the war-torn countryside. Stationed indefinitely in garrison towns, the troops mixed promiscuously with the inhabitants, consuming palm wine, gambling, and fraternizing. “The most crying need in the early days of our occupancy of the Provinces was to check the ravages of smallpox,” Greenleaf recalled. He advised the U.S. military governor, General Arthur MacArthur, that each garrison should have an army surgeon designated as “health officer,” “special orders being given for the vaccination of the population of the towns and neighboring barrios as far as the people could be reached.” As one U.S. colonial official reported, the garrison surgeons “had great latitude, and under their direction compulsory vaccination was usually enforced.” The surgeons also used “arbitrary military compulsion” to enforce “simple regulations as to cleaning streets, putting dirty premises in order, [and] tying up pigs.”
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