Warwick Anderson teaches at the University of Wisconsin, Madison, where he is Chair of the Department of Medical History and Bioethics; Robert Turell Professor of Medical History and Population Health; and Professor of the History of Science, Science and Technology Studies, and Southeast Asian Studies. He is the author of The Cultivation of Whiteness: Science, Health, and Racial Destiny in Australia, also published by Duke University Press.

COLONIAL PATHOLOGIES

American Tropical Medicine, Race, and Hygiene in the PhilippinesBy Warwick Anderson

DUKE UNIVERSITY PRESS

Copyright © 2006 Duke University Press
All right reserved.
ISBN: 978-0-8223-3804-8

Contents

ACKNOWLEDGMENTS…………………………………………………..viiINTRODUCTION……………………………………………………..11. American Military Medicine Faces West…………………………….132. The Military Basis of Colonial Public Health………………………453. “Only Man Is Vile”……………………………………………..744. Excremental Colonialism…………………………………………1045. The White Man’s Psychic Burden…………………………………..1306. Disease and Citizenship…………………………………………1587. Late-Colonial Public Health and Filipino “Mimicry”…………………1808. Malaria Between Race and Ecology…………………………………207CONCLUSION……………………………………………………….227ABBREVIATIONS…………………………………………………….235NOTES……………………………………………………………237BIBLIOGRAPHY……………………………………………………..299INDEX……………………………………………………………343

Chapter One

AMERICAN MILITARY MEDICINE FACES WEST

On June 13, 1900, Captain S. Chase de Krafft, M.D., a volunteer assistant surgeon with the American forces in the Philippines, reported from his post at Balayan the death from “hemoglobinuric fever” of Private Glenn V. Parke of the 28th Regiment. In January, Parke had fallen out of a march “from physical exhaustion” and was sent to the hospital in Manila. When he rejoined his company a few months later he appeared to be well but soon succumbed to “malarial fever intermittent.” On the long, hot march to Balayan, Parke had fallen out again and was admitted to the post hospital with an acute attack of diarrhea. After daily doses of quinine and thrice-daily strychnine, the soldier soon returned to duty. But his malarial fever recurred: back in hospital he was “seized with a severe attack of bilious vomiting,” and later his urine was red and scanty. The bilious vomiting, diarrhea, and fever persisted, along with pain over the liver; his entire body was soon “saffron-colored.” His urine became darker and more concentrated. Within a few hours, the patient sank into delirium and then coma, dying early in the morning. Parke had told the surgeon he was twenty-three years old, though most suspected he was no more than twenty-one; in any case, his body was quickly buried in the north side of the cemetery at Balayan. De Krafft then turned his attention to ensuring the well-being of the remaining troops.

Tropical disease would take the lives of many U.S. soldiers during the Philippine-American War. From General Wesley Merritt’s assault on Manila on July 31, 1898, until the war gradually eased in 1900, more than six hundred soldiers were killed or died from wounds received in battle, and another seven hundred died of disease. The record of Parke’s clinical course presents in unusual detail an example of diagnosis and treatment in the medical corps of the U.S. Army during the first year of the campaign. The army surgeon in the field was still likely to attribute illness to exhaustion or reckless behavior and to favor explanations that implied a mismatch between bodily constitution and circumstance. In his extensive case notes, de Krafft nowhere mentions germs, even though the microbial causes of diarrhea and malaria had been established for many years. Parke’s feces were not cultured for bacteria; his blood was not examined for the malaria parasite. Instead, the surgeon carefully described the vitality and appearance of the patient, the strength of his pulse, the qualities of his dejecta, and the hourly variations in body temperature. The diagnosis was expressed not in terms of any causative organism but as a type of fever, a bodily response not identified with any inciting agent. In a tropical environment, in conditions that supposedly depleted white constitutions, the surgeon turned naturally to stimulants-strychnine, quinine, mustard plasters, and eggnog-to rally Parke’s resisting powers. There was no suggestion that a medication might attack directly a microbe or other specific cause. The surgeon hoped to restore his patient’s balance and vitality and thus combat the nonspecific challenges of overwork or feckless behavior in trying foreign circumstances.

The surgeon’s meticulous attention to this individual case reveals more than just the expediency and deftness required in clinical engagement under such grueling conditions. It also indicates medical priorities in the U.S. military at the outset of the war. In an elaborate epidemiological reconstruction of the effects of the Philippine-American War on the local population, Ken de Bevoise has estimated that the annual death rate in the archipelago, previously a high thirty per thousand, soared to more than sixty per thousand between 1898 and 1902, and that more than seven hundred thousand Filipinos died in the fighting or in concomitant epidemics of cholera, typhoid, smallpox, tuberculosis, beriberi, and plague. Displaced and destitute, sometimes crowded into reconcentration camps, ordinary Filipinos were especially vulnerable to disease. Endemic infection, previously contained, flared into epidemics; new diseases, some perhaps carried by invading troops, soon became rife. But the spread of disease among local communities was not, in the early stages of war at least, the main concern of the medical corps of an attacking army.

The job of a military surgeon, recently codified in the U.S. Army, was clearly delimited. During battle, the care and evacuation of sick and wounded soldiers would inevitably preoccupy the military surgeon; at other times, in the respite from the demands of surgical treatment of acute cases, the surgeon worked to ensure the sanitation of camps and the hygiene of troops. “A military surgeon who believes he is appointed for the sole purpose of extracting bullets and prescribing pills,” according to Captain Charles E. Woodruff, M.D., was “a hundred years behind the times.” The medical officer was also a sanitary inspector, responsible for the scrutiny of food, provision of adequate clothing, ventilation of tents, disposal of wastes, and the general layout and “salubrity” of camps. In the past, according to Woodruff, the military surgeon might have restricted himself to preventing and eradicating “hospital contagion”-gangrene among the wounded and fever (usually typhus) among long-term inmates-but now, in the “modern era,” he had a duty to provide for the well-being of troops. Thus de Krafft, after hastening the disposal of Parke’s body, had gone about trying to prevent other cases. “The army medical officer,” noted a contemporary observer, “ceased to be primarily a general practitioner in becoming the administrative officer of a sanitary bureau, with certain clinical duties when accident or the failure of prevention placed the individual soldier for special care in a hospital ward.”

In seeking to protect white soldiers, the military surgeon in the Philippine-American War repeatedly assayed the nature of the territory and climate and the character and behavior of troops and local inhabitants. Like medicine more generally, army sanitary science was heedful of environment, social life, and morality; always conservative, it tried to guard against any radical departure from the body’s accustomed locale and mode of existence. Alterations in living conditions, in patterns of human contact, and in exposure to different climates might exert a direct impact on the soldier’s body and temperament, or they might imply some perilous modification of his microbial circumstances. For troops like Parke, going to the tropics to fight a war meant encountering a peculiar new physical environment and exotic disease ecology. The conditions would be incongruent with those that whites experienced in most of the United States, and therefore potentially harmful in ways as yet undetermined. To predict and stave off disease, the medical officer had to understand the effect of an alteration in circumstances or habits on his charges and learn how to mitigate or combat the pathological concomitants of change and mobility. To stay healthy the soldier must either reassert his previous pattern of life or establish a different means of coping with the novel environment and deployment. Military medicine in the Philippines thus was predicated on appraisal of territory, climate, and behavior; it sought constantly to protect the vulnerable alien race from strange circumstances and dangerous habits and to teach presumably transgressive soldiers how they might inhabit a new place with propriety and in safety.

Most of the troops in the Philippines would describe themselves as white-the term crops up repeatedly in letters and reports-so it is tempting to regard military medicine, at least in part, as an effort to gauge white vulnerability and to strengthen white masculinity in trying foreign circumstances. Indeed, it often proves difficult to extricate concerns about the character of whiteness from fears of disease in the tropics. Would the white race degenerate and die off in a climate unnatural to it? Would the discord of race and place produce a deterioration of white physique and mentality that shaded into disease? Were the tropics inimical to the white man? Such questions still puzzled medical officers and soldiers alike. Most of the time, of course, military surgeons like de Krafft were preoccupied with alleviating disease and treating injuries. But sanitary duties ensured that medical officers would also strive to restructure and secure the boundaries of white masculinity in the colonial tropics, to determine how to preserve Anglo-Saxon virility and morality in a hostile region, a place bristling with physical, microbial, and native foes. As so often in the past century, the U.S. Army provided a model, an ideal space, for working out political and social problems that also beset the unruly public sphere-whether in the metropole or the colony. Thus the care and disciplining of white troops would come to serve as a test case for how to manage white American colonial emissaries and later as a guide to how natives might be reformed into self-disciplined “nationals.” In order to understand these subsequent transfers and substitutions it is necessary to take a closer look at the fighting white man and his tropical burden.

TO THE PHILIPPINES

Admiral George Dewey’s victory over the Spanish fleet in Manila Bay on May 1, 1898-one of the early engagements of the Spanish-American War-signaled the entry of a new colonial power into Southeast Asia. President WilliamMcKinleyhurriedlyarrangedtosendamilitaryexpedition,assembled mostly in the western states, to take possession of the Philippines. But by the time the U.S. Army arrived later in 1898, Spanish authority had collapsed, and Emilio Aguinaldo’s rebel forces had taken control of most of the provinces. The commander of the Spanish garrison in Manila surrendered to the expeditionary forces, and so Filipino troops, spurned as allies, decided to entrench themselves around the city. In the Treaty of Paris, signed on December 10, 1898,SpaindisregardedFilipinonationalistaspirationsandformallyawarded the United States sovereignty of the archipelago. During the next four years, AmericanforcesengagedinabitterandbrutalcampaignagainstthePhilippine insurrectos in order to secure the new possessions. The logic of westward expansion was to leave the United States with a Southeast Asian empire, one that would last another forty or so years. In supplanting Spain, America thus unexpectedly took its place in the region alongside the Dutch in the East Indies, the British in Malaya and Hong Kong, and the French in Indochina. But for U.S. colonialists, these older European imperial entanglements would more commonly constitute object lessons than models worth emulating.

The troops had arrived in an archipelago of over seven thousand islands, supporting a population of close to seven million people, most on the island of Luzon. With a mean annual temperature of eighty degrees Fahrenheit, an average humidity of 79 percent, and distinct wet and dry seasons, the climate of Manila assuredly is tropical, however one might imagine that indefinite quality. The rainy season lasts from June through November, after which the weather can be quite pleasant, tempered by sea breezes. Although Manila’s average temperature may be a little higher and its humidity a little less, it seemed to many Americans that the weather there might be similar to conditions prevailing in Rangoon, Bombay, and Calcutta. It was in any case a climate few Americans had experienced.

As Benedict Anderson has remarked, “Few countries give the observer a deeper feeling of historical vertigo than the Philippines.” In the late sixteenth century, the Spanish had occupied Luzon and made Manila their capital. After three hundred years of Spanish clerical colonialism, fewer than 10 percent of the local inhabitants were literate in Spanish, yet some of the Catholic religious orders-the Jesuits and Dominicans especially-had supported pioneering natural history and astronomical research, and from the seventeenth century had even sponsored universities in the archipelago. Thus Jos Rizal, novelist, physician, and nationalist, in the 1880s reflected that “the Jesuits, who are backward in Europe, viewed from here, represent Progress; the Philippines owes to them their nascent education, and to them the Natural Sciences, the soul of the nineteenth century.” Various religious orders had established hospitals for the poor, and colleges for the small mestizo and criollo elite. The San Francisco Corporation founded the San Lazaro Hospital in 1578, initially for the poor in general but after 1631 reserved for the increasing number of lepers. In Manila, the Hospital de San Juan de Dios, for the care of poor Spaniards, opened in 1596; and the Hospital de San Jos was established in Cavite in 1641. The University of Santo Toms, which the Dominicans founded in 1611, belatedly allowed the organization of faculties of medicine and pharmacy in 1871. Scientific and medical journals soon proliferated: the Boletn de medicina de Manila (1886), the Revista farmacutica de Filipinas (1893), the Crnicas de ciencias mdicas (1895), and others. Provincial medical officers, the mdicos titulares, were first appointed in 1876; and the Board of Health and Charity, equivalent to a public health department, was established in 1883 and expanded in 1886. Sanitary conditions in the capital were changing during this period. The government put sewers underground in Manila during the 1850s; in 1884, the Carriedo waterworks opened, giving the city the purest water in Southeast Asia. The central board of vaccination had been producing and distributing lymph since 1806; by 1898 there were 122 regular vaccinators-notoriously inept and lazy-passing the time in Manila and the major towns. In 1887, the Spanish colonial authorities set up the Laboratorio Municipal de Manila to examine food, water, and clinical samples-but evidently it was rarely used. Nonetheless, it is clear that recognizably modern structures of public health and medical care were taking shape in Manila and its immediate hinterland.

The 1870s had witnessed vast improvements in communication with Europe and an expansion of traffic between metropole and colony. From 1868, vessels could use the Suez Canal, reducing the journey between Europe and the Philippines from four months to one month by steamer. In 1880, cable linked Manila more closely to Europe than ever before. Better connections with Spain reduced the influence of foreign traders in Manila and encouraged Spaniards to move to the islands. In 1810, there had been fewer than four thousand peninsulares and Spanish mestizos in the archipelago, mostly clustered in Manila (compared to several million indios throughout the archipelago); in 1876, four thousand peninsulares and more than ten thousand mestizos and criollos lived in the Philippines; by 1898 the numbers had swelled to more than thirty-four thousand Spaniards, including six thousand government officials, four thousand army and navy personnel, and seventeen hundred clerics.

As they increasingly became committed to nationalism, science, anticlericalism, and political reform, a growing number of mestizos and criollos in the archipelago began to call themselves Filipinos and to represent themselves as ilustrados, or enlightened reformers. In part, the progressive sentiment, expressed first in the Propaganda movement, derived from Spanish liberal and secular agitation, which had culminated in the revolution of 1868-just as the conservative reaction in Spain was echoed in the Philippines after the 1872 Cavite rebellion. But local factors also contributed. The school reforms of 1863 had established a framework, still grossly inadequate, for a state system of primary education. Improved commercial opportunities allowed the expansion of the middle class; ambitious and progressive Filipinos began sending their sons to France and Spain for higher education; talented local candidates resented the peninsulares, who took most of the top government posts; and more efficient communication helped to break down regional separatism and conflict in the islands. Furthermore, racial distinctions became especially marked toward the end of the century, and there emerged “a tendency to thrust the native aristocracy into a secondary place, to compel them to recognize ‘white superiority,’ to a degree not so noticeable in the earlier years of Spanish rule.” Initially, local ambitions and resentments found expression in moderate groups such as Rizal’s Liga Filipina. But in 1892, Andrs Bonifacio organized the Katipunan, an anticlerical and anti-Spanish brotherhood that in 1896 led an insurrection against Spanish control. The friars attributed disaffection to “Franc-Masonera,” for them the epitome of everything pernicious in modern life; and the Spanish army attempted to suppress the rebellion, employing such brutality that even moderates turned against Spanish rule. But by time Aguinaldo was able to declare the Philippine Republic in 1899, the United States had claimed the archipelago.

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