The formation and implementation of tropical medicine in the colonies bolstered the confidence of the Americans, who attributed their new-found vigor and mobility to their resilient racial makeup and the recalcitrance of certain ailments to the unhygienic customs of “primitive” peoples lower down on the evolutionary ladder who did little or nothing to control pathogens.67 In the Canal Zone, this translated into a self-fulfilling prophecy because it was the quarters and districts of the whites, engineers and laborers, where mosquitoes were most vigorously attacked. Eradication methods often followed a colonial logic of immunity, where European Americans believed that they required prophylaxis because of a presumed lack of exposure to tropical diseases, while assuming that darker-skinned laborers had usually already acquired resistance, particularly to yellow fever. The sad irony, of course, was both that such theories of racial immunity negated the complexity of disease ecologies and diasporas, and that, many times, the arrival of European Americans instigated the very conditions that gave rise to epidemics, thus determining the contours and even inventing the field of tropical medicine. In the Canal Zone, the homes of West Indian workers were not systematically screened, standing water was often left untouched in their neighborhoods, and treatment for other, equally deadly diseases, such as pneumonia or dysentery, was given only haphazardly. Thus, in the appendices at the back of President Theodore Roosevelt’s glowing 1906 report on Panama and the wonderful results of the health crusade, the mortality figures actually revealed that “the white worker and his family were indeed faring extremely well; otherwise, for the vast black majority, the picture was alarming.” From January to October 1906, for instance, 17 whites died per 1,000, as opposed to 59 blacks per 1,000. This meant that West Indians were dying three times as fast as whites. If “it was no longer a whiteman’s graveyard,” it was only slightly “less deadly than it ever had been for” blacks.68
The message—of American prowess, medical might, and white superiority—pervaded the PPIE and was frequently applied to the westward settlers who had remade California and catapulted San Francisco to global prominence. In his address titled “The Physician as Pioneer,” the president-elect of the American Academy of Medicine, Dr. Woods Hutchinson, credited the colonization of the Mississippi Valley to the discovery of quinine, which had stymied malaria, and then told his audience that for progress to proceed apace in the current “age of the insect,” the stringent sanitary regime imposed and perfected by Gorgas in the Canal Zone was the sine qua non.69 From opening to closing day, a chorus acclaiming Gorgas and American colonial sanitation could be heard at the PPIE. As the exposition’s official handbook proclaimed: “The completion of this herculean task marks an epoch in the history of the world. A gigantic battle against floods and torrents, pestilence and swamps, tropical rivers, jungles and rock-ribbed mountains has been fought—and WON!”70
THE MANY FRONTIERS OF CLAUDE C. PIERCE
The colonial circuits that linked public health and sanitation in Cuba, the Philippines, and the Canal Zone to the PPIE were busy highways, certainly traveled by Gorgas, but perhaps no more so than by Claude C. Pierce. Born in Tennessee in 1878, Pierce received his degree from Chattanooga Medical College and joined the USPHS in the lower ranks in 1900 after serving in the Spanish-American War. In 1904 he was sent to Panama where he worked his way up from assistant to senior surgeon, first acting as a quarantine officer and, starting in 1913, as the superintendent of Colon Hospital.71 For more than a decade, Pierce fought typhoid, plague, and yellow fever in the Canal Zone. In 1915, he brought this experience in tropical medicine to San Francisco, where he served as chief sanitary officer for the duration of the PPIE.
As a uniformed health officer fresh from the occupation of Panama, Pierce, and his USPHS colleagues, treated the fairgrounds much like a zone under martial law. For instance, when the USPHS arrived on the scene months before opening day, one of its preliminary tasks was to carry out a comprehensive medical census of all persons on the premises according to age, sex, and occupation, evaluate them for hookworm and trachoma, and, if necessary (as mandated by a recently passed USPHS regulation), vaccinate them against smallpox.72 Once the exposition had begun, Pierce and his underlings surveyed the buildings, scrutinized concession stands, hung antispitting signs on buildings, and assessed the public bathrooms, all the while searching for vermin, locating pools of standing water, and regularly testing the drinking supply for bacteria. For example, for the month of April, Pierce reported that he applied borax to fertilized soil to discourage fly breeding, turned off and oiled water fountains to destroy mosquito larvae, inspected in total 244 concessions and structures, and reinspected the Joy Zone, avenues, and stockyards more than six hundred times, ultimately pinpointing 125 problems that needed fixing.73 When he found sick individuals, he sent them to the Exposition Hospital, which was run by the USPHS and operated both as a critical care center and an exhibit. It boasted four wards, an operating room, an anesthetizing room, a waiting room, an X-ray machine, a laboratory, electric massage machines, urine and blood analysis kits, two spiffy Cadillac ambulances, and personnel close to fifteen, including several attending physicians and nurses, technicians, orderlies, and a maid.74 While the PPIE was being built, the Exposition Hospital tended to injured workers, and from the day the first brick was laid to the last day of demolition, more than seven thousand people were treated or hospitalized, sometimes repeatedly, by the USPHS.75 The Exposition Hospital also fostered the circulation of modern medical thought at its library, where professionals could peruse a collection of more than one thousand books or borrow from a stereopticon archive of eight thousand lantern slides, many produced during health campaigns in the field.76
This demonstration hospital was accompanied by USPHS exhibits, six of which won medals, including one gold medal and one grand prize, from the PPIE’s international jury committee.77 These didactic displays detailed the organization and mission of the USPHS, illustrated epidemiological patterns and surveillance techniques, and even featured a habitat of living breeding mosquitoes.78 Pierce oversaw all of the USPHS exhibits, the largest of which covered 5,250 square feet in the Palace of Liberal Arts and aimed to present in a “popular and comprehensive way, easily understood by the general public, the latest methods of preventing the common communicable diseases.”79 It highlighted more than a dozen conditions, including typhoid, tuberculosis, rabies, Rocky Mountain spotted fever, and syphilis. Through morality tales (of negligent “silent” carriers, which echoed the melodrama of Typhoid Mary) and positive examples (of wharves properly guarded against rats and securely muzzled rabid dogs), the USPHS instructed its viewers in the basics of bacteriology and made the concealed universe of germs visible through magnified drawings of microorganisms and the anthropomorphism of creatures such as the liver fluke and whip worm.80
Aside from the USPHS sites, fairgoers could tour many other booths that emphasized public health and hygiene. In the Palace of Education, the state of New York outlined its sewage disposal system, Baltimore portrayed its methods of water filtration, and the U.S. Children’s Bureau foregrounded the virtues of scientific motherhood and pasteurized milk while its contracted physicians examined children and dispensed free child rearing advice to parents. Throughout the fair, visitors could not witness these medical advances without reference to their colonial connections. For example, not far from the tables on which babies were weighed and measured by the Children’s Bureau stood the award-winning Rockefeller exhibit on hookworm transmission, a display sent by the “republic of Cuba” on tropical medicine that underscored “diseases peculiar to the tropics of the Western Hemisphere,” and the Philippine Bureau of Health’s installation, which aspired to show “the progress made in health conservation and sanitation since the advent of the Americans.”81
Figure 1. Demonstration models for controlling plague, from the U.S. Public Health Service exhibit, directed by Claude C. Pierce, at the Panama-Pacific International Exposition, San Francisco, 1915. Source: W. C
. Rucker and C. C. Pierce, United States Public Health Service Exhibit at the Panama-Pacific International Exposition, San Francisco, 1915. Supplement no. 27, USPHS Reports (Washington, D.C.: Government Printing Office, 1915).
If medical knowledge was absorbed by the lay public as they walked the palaces, it was articulated and discussed at the more than thirty meetings grouped together during the “Medical and Hygiene Period” in the last two weeks of June. So vast were the numbers, so many the lectures, and so distinguished the figures that journeyed to San Francisco for the occasion that Todd referred to it as “the greatest period of medical conventions in the world’s history.”82 That the priorities of tropical medicine dominated these meetings was to be expected at an exposition devoted to the Panama Canal and in a city preoccupied with the specter of plague. As soon as PPIE managers started to map out the event schedule, they began to contact preeminent physicians, asking for their input and collaboration. In 1912, for example, James A. Barr, in charge of conventions and conferences, wrote to Dr. William F. Snow, then director of California’s board of health, to request his help in guaranteeing that medical groups sign up for the exposition. Barr began his entreaty: “Tropical diseases are already far too common in San Francisco, and California. With the opening of the Panama Canal we shall have a flood of immigration from Southern Europe, and other parts of the world, bringing all sorts of diseases into our midst. In fact, the opening of the Canal is certain to bring many sanitary problems to the front in San Francisco, and California generally.”83 It was this kind of anxiety, which constituted the flip side of unbridled optimism about scientific advancement, that had prompted Moore to obtain a pledge from Surgeon General Rupert Blue, his ally from the 1908–9 plague eradication campaign, that the USPHS would strictly oversee all sanitary matters at the PPIE. For many physicians and observers, acquiring overseas possessions entailed the tropicalization of the United States, a prospect that in turn demanded full-scale prophylaxis against vectors of ailments such as hookworm and yellow fever and, by extension, those deemed most likely to harbor them. Akin to fears about the incorporation of the “mongrel races” into the body politic that gripped many fin-de-siècle anti-imperialists (and cautious imperialists), physicians worried about the epidemiological ramifications of colonialism.
Among the organizations in attendance during the “Medical and Hygiene Period” were the Spanish American War Nurses, the Pan-American Medical Congress, the American Medical Association, the Medical Association of the Isthmian Canal Zone, the American Society for Tropical Medicine, and the American Social Hygiene Association (ASHA), each of which helped to put tropical medicine center stage during the last two weeks of June.84 For instance, Victor C. Vaughan, dean of the University of Michigan Medical School, who had joined forces with Reed and other medical officers during the Spanish-American War to fight typhoid fever, called the American Medical Association meeting to order, which adjourned with the election of Blue as incoming president.85 According to Helen Dare, a popular San Francisco Chronicle columnist, the American Medical Association meeting was one of the “most interesting, important and vital to public welfare” at the fair and provided an opportunity to recognize that the “greatest achievement of modern civilization,” the building of the canal, would have been impossible without the great strides in medical science made by the Americans, especially Gorgas in his brilliant war against mosquitoes.86
Blue also took part in the conference of the American Society for Tropical Medicine, which Gorgas had cofounded five years after the annexation of Cuba, Puerto Rico, and the Philippines. Invoking the narrative of medico-military conquest that bridged the Panama Canal and the PPIE, the society’s secretary, John M. Swan, stated that the exposition was
planned to commemorate the connection of the Atlantic Ocean with the Pacific Ocean across the isthmus of Panama. We must not forget that the French would have constructed this canal had it not been for mosquitoes, malaria, and yellow fever. The low forms of life which are responsible for the development of these diseases in the human body and their transmission from man to man are indifferent to race, creed, or social position. It is solely because the sanitary department of the canal commission has made it possible for non-immune men to work without the dangers of acquiring infections of this type that the task has been accomplished.87
The scientific skill of the United States was also touted at the Pan-American Medical Congress, where its president, Dr. Charles L. Reed, delivered a lengthy address praising the hemispheric security ensured by the 1823 Monroe Doctrine and “the combined genius of American medical scientists, Latin and Anglican,” in quelling tropical diseases, above all yellow fever, in the Canal Zone.88
Nonetheless, behind such declarations of the overarching magnanimity of the United States and its egalitarian leadership in a global quest against indiscriminate microscopic enemies lay worries about vulnerability and contagion that were entangled with the racialism of the era. In many ways, associations between particular racial groups and diseases were counterintuitive. If bacteriology had shown anything, it was that microbes and their vectors happily transgressed all social and national lines and that, as San Francisco’s plague eradication campaign demonstrated, the extirpation of germs necessitated broad-based campaigns in which everyone participated and cooperated. Tropical medicine, however, was deeply connected to the production of colonial and racial difference, so much so that in the transition from miasmatic to germ theories of transmission, assumptions of the backwardness and pathology of colonized peoples remained largely intact, now seen as the result of unclean habits and even genetic propensity for infection or immunity rather than climate or environment.89 It is not surprising that at the PPIE, where doctrines of racial superiority and inferiority were ubiquitous—expressed and encountered in murals, statutes, concessions, and de facto segregation—a white supremacist interpretation ultimately won the day. For instance, as Reed’s lecture ultimately disclosed, his understanding of Pan-American medical progress was based not on a common cause among hemispheric equals but rather on the enlightened effects of “Aryan blood” in American lands.90 Moreover, for Reed and many of his colleagues, the ultimate goal of the “practical application” of new scientific knowledge was the “betterment of human efficiency through the physical and, consequently, the mental development of the race.”91 Indeed, the biases of tropical medicine, which were already tethered to social Darwinism and Victorian anthropology, insinuated themselves into the race betterment movement during its incipient formation, eventually leaving imprints on eugenics, especially in the American West.
This relationship between tropical medicine and race betterment had layered repercussions in the continental United States, affecting how immigrants often negatively experienced health, illness, and even daily life. In the 1920s, for example, based on the supposition that particular ethnic, racial, or national groups were more likely to be afflicted with certain conditions, fecal samples were routinely demanded of the Chinese who landed at Angel Island to screen for hookworm and other parasites.92 More directly, the week after the PPIE ended, Pierce was ordered to Laredo, Texas, to investigate several incidences of typhus fever on the border, an inquiry that eventually led to the imposition of a harsh quarantine against Mexico that lasted more than two decades and perpetuated stereotypes of Mexicans as dirty and lousy.93 Pierce was instrumental in fusing tropical medicine and race betterment and implementing colonial strategies of disease control and containment throughout the American West.94 Guided by more than a decade of experience in quarantine and sanitation in Panama, he diligently set up and assiduously directed the USPHS exhibits, scrupulously assessed the grounds for any signs of germs or disease, and shared his epidemiological and experimental knowledge with other practitioners.95 Undoubtedly, Pierce performed an important public health function at the fair and helped to keep potential outbreaks in check. Yet his sanitation work was permeated by burgeoning ideas of eugenics and human difference. For example, in August 1915,
Stanford’s chancellor, David Starr Jordan, the horticulturist Luther Burbank, and Pierce were the guests of honor at a luncheon hosted by the Race Betterment Foundation.96 The fact that Pierce availed himself of this opportunity to lecture on typhoid fever and the proper disposal of human excreta suggests the affinity between race betterment and tropical medicine at the PPIE.97
“OF THE GREATEST IMPORTANCE TO HUMANITY”
On most afternoons during the fair, at 3:00 in Theater No. 1 at the Palace of Education Dr. A. J. Read could be found holding forth on topics such as “Heredity and Environment” and “Diet and Health.”98 When he was done, Read walked back to his headquarters at the Race Betterment booth, where he was “in almost constant attendance to give information and advice.”99 This exhibit, which won a bronze medal for “illustrating evidences and causes of race degeneration and methods and agencies of race betterment,” made eugenics a daily feature of the PPIE.100 According to Read, it attracted more than one thousand visitors each day, many of whom returned twice; some even six or eight times.101 It comprised six booths that displayed medical equipment, charts detailing the degenerative effects of alcohol and “race poisons,” rules of healthy living and eating, a list of eugenics organizations, and an assortment of instruments used by physicians to gauge the physiological and biological capacity of humans from conception to adulthood.102 Among the latter was the “New Laughlin Gyotometer” for determining “various hereditary results from parent combinations,” which had probably been devised by the superintendent of the Eugenics Record Office, Harry H. Laughlin.103 To relieve fatigue and stress, visitors could sit in two battery-operated vibrating chairs typical of the electrotherapy and hydrotherapy offered at John Harvey Kellogg’s Battle Creek Sanitarium.104 Todd wrote that this display “caught the eye of every visitor.” Echoing PPIE motifs, its statues were “large plaster casts of Atlas, and Venus, and of Apollo, Belvedere type, to advertise the human race at its best, and get that race interested in its glorious past and possible future.”105
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