In 1907, Wertenbaker happily returned with his family to his native Virginia to run the Service station at Norfolk. In the final years of his career, he would become well known to African American educators, ministers, physicians, and nurses for his efforts to organize rural black farmers and church groups into state and local “anti-tuberculosis societies.” In classic Wertenbaker fashion, he wrote up a detailed “Plan of Organization” for creating these societies. But the essence of the plan was to mobilize African Americans at the grassroots to fight a deadly infectious disease. By the time of Wertenbaker’s death, of kidney disease, in 1916, southern blacks had founded five state leagues and numerous local societies.85
C. P. Wertenbaker’s grave lies in a well-shaded area of the University of Virginia cemetery, not far from the resting places of the eleven hundred Confederate soldiers buried there during the Civil War. The remains of C. C. Wertenbaker, who outlived Charlie by two years, lie nearby. The words on Charles Poindexter Wertenbaker’s tombstone remember a son of the Confederacy who, along with hundreds of other traveling medical men of the United States Marine-Hospital Service, carried the influence of the national government across the South. The inscription reads: “As Soldier, Doctor, and Officer for Twenty Eight Years of the National Health Service His Good Works are Imperishable.”86
In the years after Wertenbaker left Wilmington, he saw many of the reforms he had advocated come to pass. Local, state, and federal health authorities placed a greater reliance on public education in their work. A new federal system, established in 1902 and run by the U.S. Public Health and Marine-Hospital Service’s National Hygienic Laboratory, regulated the manufacture of smallpox vaccine and the proliferating array of new vaccines, sera, and antitoxins on the market. And Congress gave the Service greater authority to standardize and coordinate the control of infectious disease at the local and state levels. No revolution had taken place. But reform surely had come.
At the turn of the century, there existed as yet only a few areas of the American domain where the authority of the nation reigned supreme in the field of public health. Foremost among them were the new colonial possessions acquired by the United States in the Spanish-American War of 1898. In those distant spaces, medical officers of the United States Army exercised powers of a scale and scope that C. P. Wertenbaker could scarcely have imagined.
FOUR
WAR IS HEALTH
Windswept and weather-beaten, the city of Iloilo stood upon unpromising marshland near the southeastern tip of Panay, in the vast Pacific waterworld of the Philippine archipelago. The center of the islands’ sugar trade, for decades the old Spanish port had sent forth from its deep harbor steamships bearing that prized commodity, as well as hemp, sapanwood, coffee, mangoes, and mother of pearl. The people of Iloilo were known for their habit of resistance to outside authority, be it the Kingdom of Spain, the Catholic Church, or, now, the United States. In December 1898, Emilio Aguinaldo’s Filipino independence movement set up a military stronghold there. By October 1899, when the Twenty-sixth U.S. Volunteers stepped ashore, Aguinaldo’s insurrectos had already been driven out, but they remained entrenched not far from the city.1
The Twenty-sixth was a regiment of New England militiamen. They had recently undergone a crash course in the geography of American expansion. Their journey began two months earlier in Boston. They traveled by train across the continental United States to San Francisco. Encamped in the late summer fog of the Presidio, they learned that smallpox had broken out in a neighboring regiment, which was swiftly quarantined on Angel Island. After a fresh round of vaccinations, the Twenty-sixth crowded aboard the Grant, a 454-foot transport ship that carried them across more than seven thousand miles of Pacific Ocean to Manila Bay, with a stopover for coal in Honolulu, the premier port of newly annexed Hawaii. Last, they steamed thirty-six hours from Manila to arrive here, in Iloilo. Their mission was to man the U.S. garrison and establish order.2
A Boston Globe reporter named J. N. Taylor had traveled with the Twenty-sixth all the way from Massachusetts. “The city was very dirty—oozy with it,” he recalled. Of pressing concern to the U.S. command, small-pox raged in the city, killing more residents every day. Prior to the arrival of the Twenty-sixth, smallpox, known by its local name, buti, seemed to be accepted as a fact of life. Few of the inhabitants had ever been vaccinated, and they made no effort to isolate the sick.3
On the advice of the U.S. health officer on the scene, the soldiers set about enforcing a “progressive policy” of sanitation, “giving Iloilo a bath and a scrubbing.” They set up a smallpox hospital outside the city and removed the sick from their families. Soldiers inspected homes, cleaned out decrepit privy vaults, and introduced a new system of dry earth closets. The troops moved with particular force upon an expanse of shacks that stretched a quarter mile from the old Spanish palace to the Jaro bridge. The district housed one thousand of Iloilo’s poorest residents, among whom, Taylor noted, “fully 700 were pock-marked.” The soldiers leveled the district.4
Risking fines or imprisonment, many Ilonggos resisted the American sanitary campaign, which, as Taylor had to admit, did require “a radical change in the sanitary conduct of their homes.” The Army’s effort to enforce vaccination proved so unpopular that the soldiers found it “necessary to round up the inhabitants with guns to inoculate them.”5
Within three months of the Twenty-sixth Regiment’s arrival, Iloilo seemed to Taylor a city transformed. The offensive odors had abated. Small-pox was disappearing. Even the attitude of the Ilonggos appeared to be softening. Many now called upon the health inspector’s office, children in hand, and asked to be vaccinated. Taylor could imagine a time when, with a little more sanitary work (draining the city’s swamps was the obvious next project), Iloilo might make a perfectly salubrious home for white men.
“There seems to be no good reason why Iloilo should not be as healthy as Boston,” he said.6
Where soldiers go, plagues follow. Since the age of Alexander, the annals of war had known no truer axiom. Mobilizing armies uprooted young men from great cities and remote villages, previously distinct epidemiological environments, and threw them together in crowded camps where the air reeked of waste and the water teemed with the unseen agents of cholera and typhoid. Across the millennia, seasoned generals had fairly expected diseases to take more lives than spears, swords, or guns. Rarely did those expectations go unmet. Beneath the staggering death toll of the American Civil War, in which some 620,000 Union and Confederate soldiers perished, lay the familiar but little understood handiwork of microbial pathogens: nearly twice as many soldiers had died from disease as from combat.7
When army camps grew up near centers of population, microbes circulated indiscriminately between soldiers and civilians. Soldiers on the march carried smallpox across continents, as the Spanish conquistadores had done in the Americas. The Franco-Prussian War of 1870–71 unleashed a European pandemic of pox that killed more than 500,000 people. Wars disrupted entire societies, causing famine and poverty, displacing populations, and destroying fragile systems of sanitation—all of which increased people’s vulnerability to disease. As catastrophic events, wars and the epidemics they made sometimes became indistinguishable from one another, making it hard for the soldiers and civilians caught in their crossfire to reckon which invasion was the defining one. After witnessing the plagues and carnage of the devastating Crimean War (1853–56), the Russian surgeon Nikolai Ivanovich Pirogoff concluded, “War is a traumatic epidemic.”8
And so it took some gall for Rudyard Kipling, well known to Americans as “the unofficial poet-laureate of the British Empire,” to imagine that a modern imperial army could be a force for public health, rather than an instrument of apocalypse. In his most famous poem, Kipling wrote:
Take up the White Man’s Burden
The savage wars of peace—
Fill full the mouth of Famine
And bid the sickness cease.
Published simultaneously in the L
ondon Times and the American McClure’s Magazine in February 1899, “The White Man’s Burden” was reprinted in newspapers across the United States. Even Kipling’s friend, New York governor Theodore Roosevelt, judged it “poor poetry” in a letter to Senator Henry Cabot Lodge of Massachusetts, though the “Rough Rider” added that Kipling’s lines “made good sense from the expansionist viewpoint.”9
At the moment of the poem’s publication, Lodge was exhorting his colleagues in the Senate to ratify the Treaty of Paris, a document that would officially end the Spanish-American War of 1898 and bring the former Spanish colonies of Puerto Rico, Guam, and the Philippines under U.S. rule. (In keeping with the Teller Amendment, enacted on the eve of war, Congress forswore annexation of Cuba; U.S. control of the island would end, officially, in 1902.) But even as the senators made their speeches, a new American war with Emilio Aguinaldo’s Philippine Republic was beginning in the suburbs of Manila, a city that, as American anti-imperialists pointed out, lay halfway around the world—five weeks’ voyage by steamship—from the U.S. mainland. Kipling appealed to a divided American people, urging them to “take up” their destiny as white colonial rulers in the Philippines. The purpose, he assured them, was noble: to deliver the blessings of Anglo-Saxon civilization, including freedom from want and disease, to that far-off archipelago and its “new-caught sullen peoples, Half-devil and half-child.”10
A native of British India, Kipling seemed at peace with the glaring ironies of colonial public health, with its frank uniting of idealism and violence. Some of his contemporaries were less untroubled. “It is a bad pedagogy to teach people at the point of a bayonet,” objected G. Stanley Hall, the eminent American psychologist and educator. But according to the expansionist viewpoint—informed by the long record of British colonialism and America’s own experience with westward expansion—sometimes bayonets were exactly what the situation required.11
In a previous story, “The Tomb of His Ancestors,” Kipling paid sardonic tribute to the British compulsory vaccination campaigns in nineteenth-century India. An industrious young British military officer, John Chinn, the latest in his family line to serve the Raj in central India, tricks the Bhil people—who “seemed to be almost as open to civilization as the tigers of [their] own jungles”—to bare their arms to “the vaccine and lancets of a paternal Government.” But it was hard work. The Bhils had kidnapped and beaten the first government vaccinator (an Indian) sent to do the job. The clever Englishman succeeded only by playing on the group’s superstitions. In “The White Man’s Burden,” Kipling cautioned the Americans to expect only heartache for their selfless efforts in the Orient:
And when your goal is nearest
(The end for others sought)
Watch sloth and heathen folly
Bring all your hope to nought.
Vaccinating U.S. troops aboard the Australia, bound for Manila in 1898. From Harper’s Weekly, July 16, 1898. COURTESY OF THE NATIONAL LIBRARY OF MEDICINE
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.”12
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.13
“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.14
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.15
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.16
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.17
In the American system of government, guarding the public health was the most elemental action a state could take under its police po
wers; 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.18
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.19
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