colonial pathologies

colonial pathologies
American Tropical Medicine, Race,
and Hygiene in the Philippines

Warwick Anderson

duke university press durham and london 2006

∫ 2006 Duke University Press

All rights reserved

Printed in the United States of America

on acid-free paper $

Designed by Heather Hensley

Typeset in Sabon by Keystone Typesetting, Inc.

Library of Congress Cataloging-in-

Publication Data appear on the last printed
page of this book.
Contents

acknowledgments vii

introduction 1

1. American Military Medicine Faces West 13

2. The Military Basis of Colonial Public Health 45

3. ‘‘Only Man Is Vile’’ 74

4. Excremental Colonialism 104

5. The White Man’s Psychic Burden 130

6. Disease and Citizenship 158

7. Late-Colonial Public Health and Filipino ‘‘Mimicry’’ 180

8. Malaria Between Race and Ecology 207

conclusion 227

abbreviations 235

notes 237

bibliography 299

index 343
Acknowledgments

A s my interest in the entwined histories of American tropical medicine

and racial thought has endured now for most of my career, the intel-

lectual debts that have accumulated are countless. Only the most pressing can

be acknowledged here. Charles Rosenberg and Rosemary Stevens guided my

first studies of colonial public health at the University of Pennsylvania. At

Harvard, Allan Brandt, Arthur Kleinman, Evelynn Hammonds, and Mary

Steedly helped me to reshape and develop many of my arguments. Colleagues

in the Department of Anthropology, History and Social Medicine at ucsf,

and in the History Department at Berkeley—in particular, Adele Clarke,

James Vernon, Philippe Bourgois, Vincanne Adams, Tom Laqueur, Sharon

Kaufman, and Dorothy Porter—encouraged me to return to the book manu-

script and provided inspiration and support. At Madison, I benefited greatly

from the advice of colleagues in the Department of Medical History and

Bioethics and at the Center for Southeast Asian Studies. Conversations with

Judy Leavitt, Rick Keller, Mike Cullinane, Al McCoy, Courtney Johnson,

Victor Bascara, and Maria Lepowsky proved especially valuable. Jean von

Allmen, with characteristic efficiency, ensured I had time for writing.

Bob Joy, Dan Doeppers, and Barbara Rosenkrantz read earlier versions of
the book manuscript and peppered me with their questions, challenges, and
doubts. I may not have responded adequately to all of their queries, but
without their engagement the book would be the poorer. I was fortunate to
have such generous and careful readers.
It was the enthusiasm and support of Vince Rafael that enabled me to
complete this book. He and many other scholars of the Philippines, especially
Michael Salman and Paul Kramer, have guided me through new territory and
provided intellectual sustenance.
I would also like to thank Michelle Murphy, Jono Wearne, Matt Klugman,
Martin Gibbs, Chris Shepherd, Peter Phipps, Dan Hamlin, and Kiko Benitez
for research assistance. Kiko, too, read much of the manuscript and gave me
helpful advice. Gabriela Soto Laveaga assisted with translation of some of the
Spanish material and pointed me to Latin American analogies.
Without the enthusiasm and persistence of Ken Wissoker at Duke Univer-
sity Press, it is unlikely that I would ever have completed this book. Ken and
Anitra Grisales have smoothed the path to publication and allayed most of
the author’s anxieties along the way.
This project was supported financially through a fellowship from the So-
cial Science Research Council and the American Council of Learned Societies.
I received travel grants from the Rockefeller Archive Center, the University of
Pennsylvania, Harvard University, the Pacific Rim Research Program of the
University of California, and the University of Wisconsin-Madison.
I am grateful for the assistance of archivists and librarians at the University
of Pennsylvania, the College of Physicians of Philadelphia, the American
Philosophical Society, the Countway Medical Library and other Harvard
libraries, the U.S. National Archives and Records Administration, the Library
of Congress, the History of Medicine Division of the National Library of
Medicine, the Bentley Library at the University of Michigan, the Bancroft
Library at the University of California-Berkeley, the Kalmanowitz Library
at ucsf, the Hagley Museum and Library, the Alan Mason Chesney Archives
at Johns Hopkins University, the Wisconsin Historical Society Library, the
Ebling Library of the University of Wisconsin-Madison, the Rockefeller Ar-
chive Center, the U.S. Army Military History Institute at Carlisle Barracks,
the Massachusetts Archives, the Philippine National Archives, and the Rizal
Library at Ateneo de Manila.
I have presented portions of this work at numerous institutions over the
past fifteen years: through comment and discussion on these occasions, the
book has emerged much improved. Sections of it have also benefited from the

viii acknowledgments
remarks of editors and anonymous reviewers for the following journals: Crit-
ical Inquiry, the Bulletin of the History of Medicine, the American Historical
Review, Positions, and American Literary History.
Above all, I want to thank family and friends for gracefully putting up with
my peculiar preoccupation with the history of colonial medicine—my own
family, of course, but also the family of Ken and Rochelle Goldstein, who
looked after me in Philadelphia. It is to the memory of Kenneth S. Goldstein
that this book is dedicated.

acknowledgments ix
 Lingayen Gulf Baguio
Pacific Ocean

Luzon
Bataan
Peninsula Manila
Manila Bay

Mindoro Marinduque

Culion
Masbate Samar

Panay
Leyte
Cebu

Palawan Negros
Bohol

Mindanao
Sulu Sea
Lake
Lanao

Zamboanga

Jolo Sulu
Archipelago

map 1. Philippine archipelago.

 introduction

T
‘‘ he only things that matter in this fallen world,’’ Rudyard Kipling ad-

vised his friend W. Cameron Forbes in 1913, ‘‘are transportation and

sanitation.’’∞ Forbes, the governor-general of the Philippines and a fastidious

Harvard man, believed that the greater of these was sanitation. Indeed, since

the defeat of Spanish forces in the archipelago in 1898, the American colonial

authorities had eagerly taken up the burden of cleansing their newly acquired

part of the Orient, attempting to purify not only its public spaces, water,

and food, but also the bodies and conduct of the inhabitants. According to

Victor G. Heiser, who was director of health in the Philippines from 1905 to

1915, it had to be understood that ‘‘the health of these people is the vital

question of the Islands. To transform them from the weak and feeble race we

have found them into the strong, healthy and enduring people that they may

yet become is to lay the foundations for the successful future of the country.’’≤

American military and civil health officers thus dedicated themselves to regis-

tering and refashioning Filipino bodies and social life, to forging an improved

sanitary race out of the raw material found in the Philippine barrio. Hygiene

reform in this particular fallen world was intrinsic to a ‘‘civilizing process,’’

which was also an uneven and shallow process of Americanization.

 I want in this book to recapture the civic vision of medicine and science in a
specific colonial setting. That is, I would like to describe how the political
rationality of American colonialism became manifest in a technical discourse
on bodily practice, mundane contact, and the banalities of custom and habit. I
am suggesting, in particular, that in framing disease potential, medical offi-
cers might also assemble a flexible, and sometimes unstable, framework for
constituting racial capacities and colonial bodies.≥ Experiencing hygiene
thus could also be a means of experiencing empire and race. Indeed, racial-
ized agency was constructed and contested in the colonial Philippines more
through the projects of hygiene and bodily reform than any other means—
certainly more so than through esoteric anthropological debate.∂
In the Philippines during the first years of the twentieth century, military
medical officers developed a novel, and at first distinctively American, under-
standing of the tropics and the bodies inhabiting the region. The exigencies of
guerilla combat in the archipelago had reshaped the American medical offi-
cer’s knowledge of risk and containment, of stress and fit, suggesting new
methods of tropical disease control and population management. Fears of
contagion, of the pathological consequences of contact with native races,
largely supplanted older assumptions of environmental danger, of the haz-
ards of geographical displacement. The mismatch of race and place—which
once had suggested the inevitable degeneration of Europeans in conditions
of moist heat—soon seemed less threatening to invading whites than con-
tact with diseased or meretriciously ‘‘healthy’’ natives. Disease prevention, in
these circumstances, required behavioral and bodily reform of local inhabi-
tants, the sort of discipline and surveillance that could turn raw army recruits
into obedient and hygienic soldiers. Segregation, with the construction of
hygienic enclaves for whites, generally seemed impractical in the Philippines.
In order to contain microbial insurrectos, the Philippine barrio would instead
come to resemble a well-ordered American army camp.∑ New germ theories
informed emerging techniques of population management; microbiologists
provided the intelligence and monitored the progress of hygiene reform, fol-
lowing a colonial military logic.
When military medical officers later marched confidently into the civil
health service, the rules of sanitary engagement changed little. As Reynaldo C.
Ileto puts it, ‘‘The image of the conquering soldier soon became transformed
into that of the crusading sanitary inspector.’’∏ Bodily and behavioral reforms
came to be promoted less as techniques of pacification than as part of a
civilizing project, as the development of ‘‘republican’’ virtue and self-restraint

2 introduction
among Filipinos, or simply as progress and modernization.π By 1902, the well-
ordered laboratory, more than the army camp, appeared to represent the
exemplary site for modern Filipino bodies and culture: the archipelago was
frequently characterized as a laboratory of hygienic modernity. American
medical officers linked the attainment of Filipino self-government to cor-
poreal and cultural transformation, to the establishment of hygienic identities
in the colonial laboratory, but most of them expected the process would take
generations. They triaged Filipinos as infantile, immature subjects, unready
yet for self-government of body or polity—as formes frustes stalled on the
trajectory from native to citizen.∫ In the colonial setting, the racializing of
liberal governmentality implied the conditions of its deferral.Ω Accordingly,
American administration of disease control and medico-moral uplift, the civi-
lizing project, would have to continue indefinitely. Many Filipinos, however,
thought otherwise, and by the 1920s they had secured control of the health
service, changing its patterns of deployment. American medical officers dis-
persed, some back to the army, others to colonize the emerging international
health services and the urban public health departments of the United States,
adapting Philippine techniques as they went.
This book charts the colonial development and deferral of what might be
called ‘‘biomedical citizenship.’’∞≠ Feminist scholars have argued that citizen-
ship in Europe and North America has in practice been differentiated by
gender; they point to attempts (always partial and flawed) to construct a
masculine public sphere of abstract rights and a feminine private sphere of
affect, desire, and embodiment.∞∞ The apparently disembodied individual cit-
izen of modernity conventionally was predicated on a white, male norm.
Nancy Stepan has therefore suggested that in the colonial setting ‘‘the his-
tory of embodiment must be seen as part of the story of citizenship and its
limits.’’∞≤ In the Philippines, this means tracking the development of civic
bacteriology—following medical bureaucrats as they quickly moved from
mapping biological difference onto a ‘‘tropical’’ territory to mapping human
difference and civilizational potential in the new American possessions. Mi-
crobiology rapidly became civic destiny, organized into a typology that posi-
tioned immature native germ-carriers (and distributors) against responsible,
clean, yet especially vulnerable whites.∞≥ But on this occasion the taxonomy
was not fixed: some Filipinos might eventually be trained to behave hygieni-
cally; they could, so it seemed, metamorphose into recovering natives and
therefore embark on the career of the probationary citizen-subject, on be-
coming modern. Progressive American medicos imagined themselves even-

introduction 3
tually, many generations hence, producing germ-free Filipino citizens: it is in
this sense that colonial hygiene became a liberal strategy of deferral, not
exclusion.∞∂
Racial hygiene in the Philippines was a harbinger of development regimes
elsewhere. By the 1920s, other colonial states were not just policing the
boundaries of civility but extending them, canalizing and mobilizing the bod-
ies and cultures of the colonized along with those of the colonizers. A per-
functory and still largely typological social evolutionism was suggesting new,
though faint and fraught, trajectories for native subjectivity, fresh possibilities
for the technologies of self-government. Frequently, American activities in the
Philippines seemed to offer models for such scientific and progressive inter-
vention. But historians of colonial medicine who focus on the nineteenth
century or perhaps on less liberal regimes generally have not analyzed this
distinctive late-colonial mode of population management and identity forma-
tion. Ann Laura Stoler, for example, has argued that in the Dutch East Indies
during this period, ‘‘native and mixed-blood ‘character’ was viewed as fixed
in a way that European ‘character’ was not’’—even though she recognizes
that in other ways the ‘‘social geography of empire underwent profound
restructuring in the early-twentieth century.’’∞∑ Toward the end of Colonizing
the Body, David Arnold observes that after 1914 biomedical ideas and prac-
tices began to exert more influence over the identities and relationships of the
Western-educated Indian middle class as well as ‘‘to infiltrate and inform
public debate and political language to a quite remarkable degree.’’∞∏ But he
does not elaborate on this concluding insight. If many historians of colonial
medicine appear thus to stop prematurely, historians of international health
services and developmental states may start their narrative too late. For exam-
ple, Frederick Cooper, like most other African historians, assumes that the
developmentalist, or ‘‘modernizing,’’ colonial state dates only from the 1940s
(as it may well in sub-Saharan Africa, though not elsewhere).∞π What I want
to do here, then, is to suggest continuities between the late-colonial civilizing
process and international development projects—that is, I want to trace the
genealogy of development back to the medical mobilization of civic potential
in the Philippines in the early twentieth century.∞∫
American hygienists were, in effect, bringing the adult Filipino into the co-
lonial public sphere as both menace and mimic—‘‘half devil and half child,’’
as Kipling put it in his verse ‘‘The White Man’s Burden.’’ In framing a Filipino
social body, medical officers claimed authority over the most private of daily
activities; personal and domestic life became constituents of the public per-

4 introduction
formance of personal and domestic hygiene.∞Ω The Filipino emerged in this
medico-moral vision as an immature, contaminating type, but also as a poten-
tially reformable one if subject to the right techniques of the body. Thus the
construction of colonial boundaries, which were always too porous anyhow,
was often less compelling than the fabrication and management of colonial
trajectories.≤≠ The sense of menace—‘‘a difference that is almost total but not
quite’’—could shade into an obsession with mimicry, ‘‘a difference that is
almost nothing but not quite.’’≤∞ In Philippine public health programs during
this period, such figures of paranoia and narcissism, expressed in terms of
potential for contamination or as gradations of civic virtue, are held in ten-
sion with each other.
The examination of the corporeal contingencies of civic status represents
the lower stratum of an emerging body of literature on identity formation in
the Philippines under the Spanish and American regimes. Reynaldo C. Ileto
has reconstructed Philippine revolutionary mentality and traced the invention
of ‘‘the Filipino’’ in the late nineteenth century. In White Love, Vicente L.
Rafael described the American colonial interest in racializing Filipinos and
their history.≤≤ During the past few years, Michael Salman has identified the
Philippine prison as a site for creating self-governing subjects, for the produc-
tion of citizens, laborers, and commodities. Paul Kramer implicates anthro-
pology and exhibitions in the construction of a new colonial order in the
archipelago.≤≥ Of course the historian of medicine has to work with the mark-
ings of bodies, Filipino and American, and especially their orifices and excre-
tions, the more private and intimate parts of colonial power. It seems to me
that what we all do, in our various ways, high and low, is reveal the con-
struction of a ‘‘sensationalized racial contrast’’ in the Philippines and explain
how colonial subjects, thus rendered visible and accessible, would then be
trained or prepared for conversion or assimilation, an end indefinitely de-
layed.≤∂ As Michael Taussig, in a different context, once put it, ‘‘The frontier
provides the setting within which the problem of discipline magnifies the
savagery that has to be repressed and canalized by the civilizing process.’’≤∑
Or one might say that in the colonial laboratory of the Philippines, American
health officers were licensed to express a fascination with that which the
native cannot be allowed fully to repress.
In imagining their new colony as a laboratory of hygiene and modernity,
American medical officers were indulging in a form of magical thinking,
creating sympathetic associations in the hope of changing the world. For most
colonial bureaucrats, the laboratory not only was an appealing representa-

introduction 5
tional space, but also seemed to allow a manipulation of the scale of things, so
that macro may become micro and then be magnified again.≤∏ This scalar
technology proved especially alluring in a colonial setting, where so much
seemed macroscopically complex or otherwise uncontrollable until trans-
lated into docile specimens. But conditions in the archipelago could never
become thoroughly laboratory-like. Most Filipinos failed to feel the attrac-
tion of a laboratory, and not even the more fastidious of Americans really
wanted to spend all their lives in one. The rhetoric of the ‘‘colonial labora-
tory’’ lingered, but the sense of control it expressed was often belied in the
turmoil of the Philippine public sphere, where the laboratory might either be
unknown or deemed irrelevant or mistaken.≤π Rather than a site of absolute
control, the real laboratory was, for Filipinos, more likely a site of contesta-
tion, negotiation, or apathy. But the laboratory did, nonetheless, exert some
influence on local conditions; eventually it helped to shape the way Filipinos
thought about their bodies and their society; and it adjusted and regulated
spatial practice, even if it was never completely hegemonic.
In the colonial arena of public health work, the brashness and bluster of
white American males as well as their moments of diffidence and self-distrust
are revealed with startling clarity. American medical officers in the Philippines
were all white men, whereas in the United States during this period some
women had begun to infiltrate public health departments. A few American
women served as medical missionaries, but they remained marginal to the
clubs and offices of Manila. Filipino women increasingly resorted to nursing,
and some others graduated from the local medical schools, but their presence
was not felt in high-status public health activities until the early 1920s. The
Bureau of Health was thus predominantly a distant theater for the rehearsal
and performance of white American male virtue.
Begun as a study of the colonial inculcation of hygiene and civic decorum
in Filipinos, the book has become, perhaps more penetratingly, an exami-
nation of the distressed and assertive colonial culture of bourgeois white
males—which was always more than simply a vessel for paranoia and narcis-
sism, though it was that too.≤∫ As they investigated, treated, and attempted to
discipline allegedly errant Filipinos, American medicos were revealing pre-
viously hidden aspects of their own characters and disclosing their fears and
anxieties in alien circumstances. Most of the colonial health officers had
graduated from the reformed, scientific medical schools of major eastern
universities; many had transferred directly into the civil health services from
the army medical department; some moved up through the ranks of the ex-

6 introduction
panding U.S. Public Health Service. They tended to see themselves as progres-
sive and pragmatic representatives of modern American science—a labora-
tory science they hoped to substitute for politics. They clung to Protestant
rectitude, affirmed the manly ideals of self-mastery and restraint, and ex-
pressed contempt for softness. They extolled relentless industry and strenu-
ous physical activity in circumstances that seemed inimical to such virtues.
Obsessed with systematic documentation and the marshalling of fact, they
demonstrated confidence in the power of bureaucratic intervention and tech-
nology to transform Philippine environment and society.≤Ω The American
tropics presented special opportunities for progressive bureaucratic activities,
but also their testing ground. Many American scientists and physicians—
some of them unmarried or socially isolated—found the conditions ex-
tremely trying, and a few of these ‘‘prosthetic Gods’’ broke down, lost their
nerve, and became unmanned.≥≠ In the tropics, then, American scientists and
physicians felt compelled to reinvent their whiteness and harden their mas-
culinity. Alongside the science of native pathology, health officers developed a
positive and perhaps sadly overassertive science of white physiology and men-
tality. White male bodies and white male minds were repeatedly differentiated
from those of Filipinos and insulated from apparently hostile and degenera-
tive surroundings, especially from moist heat, germs, and Filipino social life.
Physicians sought to construct a white corporeal armature—a hard, sporty
indifference—to their multiply challenging milieu. But often their whiteness
and manliness proved disappointingly fragile or corruptible.≥∞
In order to appreciate the scope of this book, it is important to consider the
‘‘colonial’’ as a process and category in the history of medicine and public
health more generally. By this I mean more than the mere accumulation of
homologies or family resemblances, the notion that if it looks like something
else it must somehow be related—that all medicine, for example, is somehow
colonial in its relation to the body of the patient.≥≤ Rather, I am suggesting
that one can put together a specific genealogy of metaphors, practices, and
careers that links the colony with the metropole and with other colonies, that
one might follow people, technologies, and ideas as they move from one site
to another. The medical doctors and bureaucrats I write about were itiner-
ants, with a global view of things that historians, so preoccupied with the
local and constrained by nation or region, are only now coming to appreciate.
In a generally uncritical, unreflective way, these colonial technicians were
prepared to find the modern in the colony, the colonial in the metropole. In
this case, the traffic between the United States and the Philippines, the Pacific

introduction 7
crossing, enables us to recognize that colonial technologies of rule could also
be used to develop the ‘‘nation’’ and its various disciplines in both locations.≥≥
The experience of empire allowed American scientists and physicians to bring
many colonial bureaucratic practices—and even a new sense of themselves—
back to urban health departments in the United States and elsewhere between
1910 and 1920. José David Saldivar, among others, has urged us to look at
the borderlands between the United States and Mexico as ‘‘the spaces where
the nation begins and ends.’’≥∂ But we should remember that the colonial lab-
oratories of the Philippines, Puerto Rico, and Hawaii also were borderlands,
where many ‘‘experts’’ were experimenting with various national bodies, in-
cluding their own.≥∑
In the first part of the book, I describe the engagement of American military
medicine with the tropics during the Philippine-American War. The whiteness
and the manliness of most American troops seemed both more visible and
more vulnerable in a torrid struggle against Filipinos; the task of the military
medical officer was to prevent and treat disease and degeneration in these
conditions. Many of the medical practices examined in chapter 1, especially
those focusing on care of the body and disposal of excrement, anticipated
later colonial preoccupations. In chapter 2, I suggest that the strategies and
tactics of colonial warfare against guerilla forces favored a rapid extension of
military hygiene into Philippine social life. The administrative logic of pacif-
ication, or crowd control, implied the laying down across the tropical terrain
of sedimentary strata of disciplinary structures, including military hygiene. It
is within this new bureaucratic matrix that bacteriology and parasitology
began to acquire political and civic significance.
Focusing on research under the emerging civil regime, chapter 3 explains
the gradual medical exoneration of the tropical environment as a directly
pathogenic agent (for the white physical body if not for mentality) and the
growing racialization of germ carriage and distribution. Both research pro-
grams had begun during the war, but they were augmented during civil gov-
ernment in the laboratories of the Manila Bureau of Science and the Army
Board for the Study of Tropical Diseases. It appeared that so long as they
followed military stipulations of hygiene, whites had little to fear from the
climate; rather, the Filipino was now figured in colonial science as a dan-
gerous and promiscuously contaminating racial type and the major threat to
white health. The following chapter continues to explore the biopolitical
implications of this racialized tropical pathology. Chapter 4 considers in par-
ticular the colonial health officer’s obsession with native excrement—how the

8 introduction
image of the ‘‘promiscuous defecator’’ was used to mark racial and social
boundaries as well as to indicate just how porous and imperiled these distinc-
tions could be. I describe here the mapping of purity and danger onto white
American and Filipino bodies, with a concomitant differentiation of colonial
space and social life into the laboratory and the unsanitary market, the toilet
and the field, Clean-Up Week and the disorderly fiesta.
When white American medicos set out to reshape public space and private
activities in the Philippines, they did so with an assertiveness that often
proved delusory and poignant. To amplify a theme running through the first
half of Colonial Pathologies, chapter 5 returns to the anxieties and insecuri-
ties of the white American bureaucrats who were attempting to discipline
Filipino bodies and promote civic virtue in the tropics. Even as they dis-
paraged Filipinos and demanded that this ‘‘inferior’’ race try ineptly to be-
come more like them, white males found themselves enfeebled, baffled, and
thwarted. Colonial nerves repeatedly undermined colonial assertion. Con-
ventionally, American males attributed their own mental and moral deterio-
ration to the strain of conducting civilized brain-work in a humid climate; but
by the 1920s, some psychological experts had begun to discount devitaliza-
tion as a cause and instead found evidence of an internal personality disorder,
an individual maladaptation to civilized social life, a return of the repressed.
Just as a few ‘‘natives’’ supposedly were to acquire a relatively spineless super-
ego, the destabilizing tropics had become lodged deep within the minds of
civilized white men.
Enfeebled or not, public health officers remained capable of changing the
lives of many Filipinos. Chapter 6 considers the Culion leper colony, an exem-
plary combination of army camp, laboratory, and small American town and a
site for the biological and civic transformation of those considered most
unclean and least socialized. Deemed marginal to Philippine society, lepers
appeared ironically to be the most eligible for modern biomedical citizenship.
Through hygiene and treatment protocols linked to civic performance, lepers
in the exemplary microcolony were expected to achieve ‘‘emancipation’’ in
advance of the nonlepers of the macrocolony. Of course, the model lepers
at best were only in remission and thus merely incipient or probationary
citizens; they were deemed unsatisfactory mimics of white practices, mere
dressed natives. Culion, like the rest of the archipelago, was in practice an
island where cure and self-government remained asymptotic projections, not
validated attainments.
The remainder of the book describes, in various ways, the disintegration,

introduction 9
repair, and persistence of the white American grid of racial intelligibility in
the colonial Philippines. Racial typologies became increasingly unstable and
unsatisfying through the 1920s and 1930s, and the texture of ideas about
race, culture, and environment proved ever more friable. White males became
unnerved, Filipino ‘‘mimicry’’ made them uneasy, and enthusiasm for techno-
logical solutions came to displace confidence in race management. Internal
contradictions, deficiencies, and discomfort exercised the most corrosive in-
fluences on racial frameworks during this period, not explicit local resistance
and refusal or liberal reaction to North American eugenics or, later, to Nazi
race policies.
These last two chapters examine the Rockefeller Foundation hookworm
and malaria programs in the Philippines during the 1920s and 1930s. The
leaders of the hookworm project regarded it as a means of medically re-
colonizing the archipelago after the Filipinization of the health department.
In chapter 7, I examine their medical effort—beyond Culion—to reiterate
hybrid, imitative subject positions for Filipinos. Most strikingly, Rockefeller
emissaries regarded the Filipino bureaucrats who had supplanted Americans
as flawed or profane copies of white experts: Filipinos were still seductively
attesting to their developmental delay, their unreadiness for self-government.
Therefore only Americans were eligible to lead programs of hygiene reform,
to undertake the task, as Ruth Rogaski puts it, of ‘‘connecting the privy to the
nation.’’≥∏ And yet, an awareness of supposed Filipino mimicry, an uncanny
sense of the copy, could also subvert Americans’ self-confidence, revealing
again the brittleness of their own masterful identity. In contrast, the leaders of
the malaria program—described in chapter 8—eventually tried to circum-
vent, rather than openly disparage and reform, local culture. This final chap-
ter suggests that in the emerging international health services ideas of race
were not so much abandoned as pragmatically nudged aside in favor of the
exploration of regional ecologies and an emphasis on technical intervention.
Indeed, when it seemed necessary to bring the ‘‘human factor’’ back into the
equation, a rackety version of the older racial hygiene often reemerged in
international health and development programs, at least until the invention of
medical anthropology in the 1960s.
It may seem at first that I am writing in opposition to science, hygiene, and
civic virtue. In order to avoid such misunderstanding, I feel obliged to express
my enthusiastic personal and professional affiliation with all three enter-
prises. But I remain interested in how estimates of hygiene have framed racial
and civic identities, how hygiene reform has mobilized people, made them

10 introduction
more tractable, and enabled them to think differently about their bodies,
social life, and place in the world. In this case, I am especially interested in
the typological construction of hygiene and civic potential for white Ameri-
cans and Filipinos, that is, in the way hygiene once took specific racial form,
and how this convenient racial biology came for a time to represent human
destiny.

introduction 11
 Fort Stotsenburg

Subic Bay
Bataan
Peninsula
Manila
Manila Bay
Fort McKinley

Mariveles
Corregidor (Fort Mills) Laguna Bay
Caballo (Fort Hughes)

El Fraile (Fort Drum)

Carabao (Fort Frank)
Cavite Province

map 2. Military installations around Manila.

Chapter One

american military medicine faces west

O n June 13, 1900, Captain S. Chase de Krafft, m.d., a volunteer as-

sistant 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 Ma-

nila. 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 bili-

ous vomiting,’’ and later his urine was red and scanty. The bilious vomit-

ing, diarrhea, and fever persisted, along with pain over the liver; his entire

body was soon ‘‘saffron-colored.’’ His urine became darker and more con-

centrated. 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 re-
maining 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 hun-
dred 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 constitu-
tion and circumstance. In his extensive case notes, de Krafft nowhere men-
tions 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 tem-
perature. 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 con-
stitutions, 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. mili-
tary 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, previ-
ously a high thirty per thousand, soared to more than sixty per thousand
between 1898 and 1902, and that more than seven hundred thousand Fili-
pinos died in the fighting or in concomitant epidemics of cholera, typhoid,
smallpox, tuberculosis, beriberi, and plague.∂ Displaced and destitute, some-
times crowded into reconcentration camps, ordinary Filipinos were especially
vulnerable to disease. Endemic infection, previously contained, flared into

14 american military medicine faces west

epidemics; new diseases, some perhaps carried by invading troops, soon be-
came 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 extract-
ing 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 sur-
geon 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.’’π
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 depar-
ture 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 circum-
stances. 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

american military medicine faces west 15

figure 1. U.S. troops on the road to Malalos, 1899 (rg 165-pw-81608, nara).

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 con-
stantly 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

16 american military medicine faces west

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 disciplin-
ing 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.’’Ω 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
William McKinley hurriedly arranged to send a military expedition, 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 expedi-
tionary 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, Spain disregarded Filipino nationalist aspirations and formally awarded
the United States sovereignty of the archipelago. During the next four years,
American forces engaged in a bitter and brutal campaign against the Philippine
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

american military medicine faces west 17

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 condi-
tions 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 six-
teenth century, the Spanish had occupied Luzon and made Manila their capi-
tal. 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 sup-
ported pioneering natural history and astronomical research, and from the
seventeenth century had even sponsored universities in the archipelago. Thus
José 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 José was
established in Cavite in 1641. The University of Santo Tomás, 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 Boletín de medicina de Manila (1886), the Revista farma-
céutica de Filipinas (1893), the Crónicas de ciencias médicas (1895), and
others. Provincial medical officers, the médicos 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 condi-
tions in the capital were changing during this period. The government put
sewers underground in Manila during the 1850s; in 1884, the Carriedo wa-
terworks 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

18 american military medicine faces west

figure 2. Manila street scene, Binondo 1899 (rg 165-pw-35-9, nara).

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.∞∑ None-
theless, 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 Eu-
rope 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 clus-
tered in Manila (compared to several million indios throughout the archipel-
ago); in 1876, four thousand peninsulares and more than ten thousand mes-
tizos and criollos lived in the Philippines; by 1898 the numbers had swelled to
more than thirty-four thousand Spaniards, including six thousand govern-
ment officials, four thousand army and navy personnel, and seventeen hun-
dred clerics.∞∏

american military medicine faces west 19

 As they increasingly became committed to nationalism, science, anticleri-
calism, 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.∞π In part, the progressive sentiment, ex-
pressed 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 sepa-
ratism and conflict in the islands. Furthermore, racial distinctions became
especially marked toward the end of the century, and there emerged ‘‘a ten-
dency 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,
Andrés 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-Masonería,’’ 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.∞Ω But by the time Aguinaldo was able to declare the
Philippine Republic in 1899, the United States had claimed the archipelago.
José Rizal, the so-called First Filipino, was one of the leaders of the rising
generation of nationalists. From the Jesuits at the Ateneo de Manila Rizal had
received a solid grounding in the sciences, even if he subsequently argued that
Jesuit education had seemed progressive only because the rest of the Philip-
pines was mired in medievalism. But at Santo Tomás, studying science, he
found that the walls ‘‘were entirely bare; not a sketch, nor an engraving, nor
even a diagram of an instrument of physics.’’ A mysterious cabinet contained
some modern equipment, but the Dominicans made sure that Filipinos ad-
mired it from afar. The friars would point to this cabinet, according to Rizal,
to exonerate themselves and to claim that it was really ‘‘on account of the
apathy, laziness, limited capacity of the natives, or some other ethnological or

20 american military medicine faces west

figure 3. Interior of the Spanish Bilibid Hospital. Courtesy of the Rockefeller Archive
Center.

supernatural cause [that] until now no Lavoisier, Secchi, nor Tyndall has
appeared, even in miniature, in this Malay-Filipino race!’’≤≠ (Still, it should be
recalled that nowhere else in Southeast Asia was education available at such
an advanced level.)≤∞ In 1882, Rizal traveled to Spain to study medicine, and
he later visited France and Germany. He was astonished and embarrassed by
the political and scientific backwardness of the imperial power. In Europe,
medicine, political activism, and the writing of his brilliantly sardonic novels
occupied most of his time, but after Rizal returned to the Philippines and was
confined at Dapitan, he also began collecting plants and animals and discov-
ered new species of shells.≤≤ During this period, Rizal engaged in a copious,
self-consciously enlightened correspondence with Ferdinand Blumentritt, the
Austrian ethnologist, and translated into Spanish many of his works on the
Philippines.≤≥ For Rizal, a commitment to science and reason informed patri-
otism, and patriotism implied a scientific orientation to the world. Unim-
pressed, the clerical-colonial authorities executed the First Filipino in 1896.
Rizal did not live to see the United States completing the work of Spain and
crushing the nationalist forces. The Philippine-American War would directly
and indirectly cause widespread sickness, injury, and suffering as well as
destroy much of the recently constructed apparatus of education and public

american military medicine faces west 21

health in the archipelago. The nascent, weak public health system broke
down completely, the Filipino sick and wounded overwhelmed local hospi-
tals, vaccination ceased altogether, and colleges and universities either closed
or struggled to graduate students. Thus as Americans assumed control they
found little evidence of previous scientific and medical endeavor and felt
justified in representing the Spanish period as a time of unrelieved apathy,
ignorance, and superstition, in contrast to their own self-proclaimed moder-
nity, progressivism, and scientific zeal.

the army medical department

When John Shaw Billings addressed the graduating class of the Army Medical
School in 1903, he celebrated the great progress in military medicine he had
observed over the past fifty years. Billings recollected that the president of the
Army Medical Board who examined him in 1861 had been inclined to remi-
nisce along the same lines, praising the recent introduction of anesthesia and
the new operations for excision of joints. The examining surgeon in those
days had heard of the clinical thermometer and the hypodermic syringe but
doubted that either would prove useful. The young physician, soon to join the
Army of the Potomac, was asked to describe ‘‘laudable pus’’ and the best
means of securing healing by second intention. He was questioned on the
means of preventing malaria and typhoid fever among troops. ‘‘If I had re-
ferred to bacilli, hematozoa, flies and mosquitoes, as you would probably do,
I don’t think I should have passed.’’ Just as the symbol of the old military
surgeon was the scalpel, his new emblem ought to be the microscope. ‘‘Forty
years ago the microscope was mainly used by physicians as a plaything, a
source of occasional amusement,’’ Billings recalled. ‘‘Today the microscope is
one of our most important tools.’’≤∂ Although the bookish sanitarian was
perhaps overestimating the bacteriological grasp of most military surgeons
and ignoring the difficulties of using the new techniques in the field, it was
true that during the previous forty years the role of the army medical officer
had changed beyond recognition.
The intellectual and professional transformation of military medicine en-
compassed both its therapeutic and its prophylactic aspects. The new medical
officer combined clinical duties with administrative tasks designed to prevent
disease outbreaks, or at least to provide early warning of them. Of course, in
times of war it was still the care of the sick and wounded that took most of the
time and energy of the military surgeon. Since the Civil War, changes in the
combat zone and in medical technology had transformed the scope and char-

22 american military medicine faces west

acter of these clinical duties. By the 1890s, antiseptic methods prevailed in
the operating room, primary union could be secured in gunshot wounds,
depressed skull fractures were operable, and wounds of the intestine, once
considered beyond surgical relief, on occasion were sutured in risky laparoto-
mies. The military surgeon was more confident and optimistic than ever be-
fore in his ability to intervene clinically. General George M. Sternberg, m.d.,
the surgeon general of the army and the president of the Association of Mili-
tary Surgeons, in 1895 observed that his colleagues, as a consequence of these
advances, would have ‘‘to devote much more time to individual cases than
was thought necessary during our last war.’’≤∑ The army needed more medical
staff, with better training, and it needed more ambulance officers and sanitary
assistants to take on the first-aid work. The trained surgeon could then move
from the firing line, where staunching hemorrhage was the most that could be
done, to the new field hospital, where he now might operate.≤∏
If all had gone well, by the time the wounded soldier arrived at a distant
field hospital, an elastic bandage (or, more likely, the old-fashioned tourni-
quet) would have been applied on the firing line to stop any hemorrhage, and
at the dressing stations bleeding vessels tied with ligatures of catgut or silk and
wounds plugged with gauze.≤π In the field hospital, the patient might receive
opium to relieve pain and to prevent the ‘‘depression of shock,’’ though some
medical officers preferred to administer alcohol by mouth, enema, or hypo-
dermic injection, on occasion combining it with nitroglycerine. At the hos-
pital, surgeons took special care to remove any foreign bodies, any contami-
nants, and they would enlarge the wound if necessary. ‘‘One speck of filth, one
shred of clothing, one strip of filthy integument left in ever so small a wound
will do more harm, more seriously endanger life, and much longer invalid the
patient, than a wound half a yard long in the soft parts, when it is kept
aseptic,’’ warned one military sugeon.≤∫ If the campaign had been long and
severe, with the soldiers hard-pressed and huddled together without bathing
facilities or changes of clothing, ‘‘they are quite apt to get into a horrible
condition of filth and the presumption will be in favor of every wound being
infected and apt to do badly.’’≤Ω In such conditions, conservative treatment
was often fatal, and any attempt at asepsis would be better than none.
Of course strict asepsis was usually impossible in the field. And even when
antiseptics were available, it was sometimes hard to find the large quantities
of pure water required to dilute them. ‘‘You can imagine our horror,’’ a
surgeon recalled, ‘‘to find ourselves in the midst of a dozen or two operations
with dirty, bloody hands and instruments, blood, vomited matter and other

american military medicine faces west 23

filth strewn on the ground, and no water to clean up.’’≥≠ Nor was it easy to
keep boiling water clean on an open campfire: the smoke would rise and
spread dirt and soot on it. Operations in the open and even in tents would
quickly be covered in dust if the wind rose, often making even ‘‘the antiseptic
lotions look like mud.’’≥∞ The exigencies of battle left no time for microscopic
examinations or bacteriological cultures: the surgeon depended still on his
senses and acted in response to his disgust with obvious filth and foreign
matter. For surgeons, even those trained in microbiology, dirt simply implied
the presence of germs of infection. And on the firing line and in the field
hospital, dirt was everywhere.
Increasingly, between battles and skirmishes, the military surgeon per-
formed sanitary duties too. ‘‘The progress and popularization of sanitary
science were such that commanding officers did not dare to pass unnoticed
the suggestions of their medical officers,’’ noted a contemporary observer
(and an inveterate optimist).≥≤ The sanitary science of the military officer was
still, in practice, largely predicated on knowledge of the geographical land-
marks of disease, although empirical suspicions of unhealthiness could in
theory be tested bacteriologically. Most physicians at the end of the nine-
teenth century expected to find a specific microbial pathogen for each disease,
but these etiological agents, even the more cosmopolitan bacteria, might still
have a distinctive geographical distribution. Captain Edward L. Munson,
m.d., in his massive Theory and Practice of Military Hygiene, conceded that
mosquitoes might transmit malaria, but still he wondered if drinking water
from marshes or swamps would also give rise to the disease.≥≥ Professor
J. Lane Notter, an international expert on military hygiene, advised an au-
dience of medical officers that, while each disease is ‘‘due to a specific micro-
organism,’’ all diseases ‘‘like plants and animals, can only flourish within
certain geographical limits.’’≥∂ Qualities of soil, water, and climate gave some
pathogens sustenance and not others: the sanitary officer therefore continued
to monitor the situation and ventilation of the camp. For the moment, bac-
teriology might adjust or extend the preexisting framework of geographical
pathology; it would take another decade or more to dismantle the old concep-
tual edifice altogether.
Medical geographers during the nineteenth century had suggested a great
many landmarks to identify pathological agency. For most of the century
scholars had assumed that the environment might exert a direct noxious effect
on the human constitution, with the exact outcome depending ultimately on
hereditary and behavioral factors.≥∑ But since the 1870s, it seemed that in-

24 american military medicine faces west

direct mechanisms—microbiological mediators of physical and social cir-
cumstances—would incite most diseases.≥∏ This presented a practical prob-
lem for the military surgeon in the field since conditions were not stable
enough for a detailed, painstaking search for microbial nuisances. Medical
officers rarely had easy access to a laboratory, and microscopes and culture
media were scarce; nor was there time to wait for bacteriological confirma-
tion of pathogenic organisms. In order to act expeditiously, the military physi-
cian often fell back on the old, timeworn geographical settings and correlates
of pathology.≥π
In practice, then, bacteriology had touched little more than the margins of
the military surgeon’s spatial imagination. Munson advised that the location
of the camp was ‘‘a matter of the greatest importance in maintaining the
health and efficiency of troops,’’ but this precept was rarely put to bacterio-
logical test. Thus Munson drew on commonplace empirical knowledge when
remarking that ‘‘newly ploughed ground should never be employed for camp-
ing purposes, although a site which has long been under cultivation is usually
healthful.’’ He generally recommended a pure, dry, sandy soil: ‘‘Exhalations
from damp ground are powerfully depressing to the vitality of the human
organism, and favor the occurrence of rheumatism and neuralgia as well as
the invasion of the system by infectious germs, certain of which best retain
their vitality and perpetuate their kind amid such environment.’’≥∫ More fas-
tidiously still, Colonel C. M. Woodward advised his fellow surgeons that the
ground for camp should be elevated, bordering on a rapidly running stream,
and away from any swamps. Every tent must be raised during the day to
permit free circulation of air. ‘‘Company quarters,’’ he advised, ‘‘should al-
ways be kept thoroughly policed and freed from all appearance of evil—that
is, all scraps of paper and refuse of any kind should not be allowed to collect
on or about quarters or in camp, for although they may not be positively
unsanitary in their presence, they look so.’’≥Ω Professor Notter urged medical
officers to avoid valleys so narrow that the air stagnates, ground immediately
above marshes, and fresh clearings. ‘‘Dampness of soil adds immeasurably to
camp diseases’’; but he argued that sandy soils also ‘‘act prejudiciously both
by not disinfecting these organic matters and by their drying power, so that
when clouds of sand are raised by the wind, these clouds carry particles of
organic matter.’’ Men should never be allowed to sleep below the level of the
ground, in excavated tents, ‘‘exposed to ground-air emanations.’’∂≠ The de-
caying of organic material in the soil suggested the presence of pathogenic
germs—but on few occasions were these suppositions tested.

american military medicine faces west 25

 Colonel Dallas Bache, m.d., expected that ‘‘certain sanitary interrogato-
ries will be put to any important situation, and the replies carefully consid-
ered,’’ before a place was chosen for camp: ‘‘manifestly a very great range of
questions upon climate, soil, water, and waste disposal must be met.’’∂∞ Evi-
dence pointed, for instance, to a ‘‘malady of the wind’’—as of the sea—
requiring the hygienist to consider carefully the lay of the land and its ventila-
tion. The attributes of the soil, including its texture, temperature, and water
and mineral content, also had ‘‘well-established or highly probable relations
to health,’’ contributing to the origin or spread of many diseases.∂≤ ‘‘We can-
not afford to neglect the evidence,’’ Bache warned his colleagues in 1895,
‘‘that makes a close ally of the soil with malaria, and proclaims it the nursery
of neuralgia, catarrhs, rheumatism, and consumption; more constant and
insidious foes to the military community than the Indian.’’ He suggested that
the new science of bacteriology had simply indicated that the soil ‘‘offers itself
as a culture medium or refuge in general terms’’ for the agents of cholera,
typhoid fever, diarrhea, and dysentery.∂≥ These diseases might lurk in the
environment, ready to subvert the soldier’s health.
Conditions of military life also drew attention to the health threats of
overcrowding and the need for meticulous group discipline and personal
hygiene. Thus concern with the management of populations would often
accompany territorial appraisal on the march. Just as the new bacteriology
might be superimposed on old landmarks of geographical pathology, so too
might it give further pathological depth to old fears of bad behavior and
unregulated social contact. The danger of contracting venereal disease, espe-
cially from prostitutes of another race, was well recognized, but increasingly
it was suspected that even nonvenereal social contact with one’s peers might
prove risky.∂∂ Therefore the bodies and habits of soldiers, as much as the
territories they passed over, needed constant surveillance and care. It was
important, from the beginning, to ensure that recruits derived from sturdy
and reliable stock. Since the 1880s, all recruits went through a physical exam-
ination and a cursory assessment of mentality and character before enlist-
ment. The advantage of this procedure, according to Bache, was that it re-
jected ‘‘material that would swell the death and discharge rates.’’∂∑ ‘‘A man
who is incapable of sustaining the fatigue of a four-mile march,’’ noted Colo-
nel Herbert Burrill, m.d., ‘‘would be an incubus on the rapid movement of
troops.’’∂∏ Worse, he was also more susceptible to disease, whatever its cause,
and perhaps more likely to pass it on. Munson observed that ‘‘recruits must
be of trustworthy physique and sound constitution before the military char-

26 american military medicine faces west

acter can be developed, and the physically, mentally and morally defective are
hence to be uniformly rejected as unfit for service.’’ The army would take
sober men from the ‘‘lower walks of life and the laboring classes’’ and train
their character and body.∂π Those resistant to military discipline must be
excluded. In his revision of Tripler’s Manual, Colonel Charles R. Green-
leaf, m.d., an assistant surgeon general of the army, insisted that no recruits
be drawn from the ‘‘vagrant and criminal classes.’’∂∫ Munson, too, advised
against admitting ‘‘men whose physical faults render them unfit for duty and
susceptible to disease, whose undetected affections may be transmitted to
others or whose moral obliquities induce malingering and desertion.’’∂Ω
Military surgeons knew from experience that physical training and disci-
pline could transform eligible raw material into good soldiers. As Munson
wrote, ‘‘Strength, activity, endurance and discipline, combined with sound
bodily health, are the first requisites of the soldier.’’ These qualities, he ar-
gued, were ‘‘the foundation upon which the whole structure of military effi-
ciency rests.’’ But mental and moral training must always accompany physical
development; otherwise the recruit would become just ‘‘sluggish muscle piled
on the back of a listless and indifferent mind and an irresolute and halting
will.’’ Instead, the ideal citizen-soldier should be ‘‘of manly character, willing,
brave, steadfast, zealous, enthusiastic, of good humor, and possessed of initia-
tive.’’ Munson wanted thus to make ‘‘the man in the ranks a part of an
intelligent machine to act at the voice of a commander.’’∑≠ This efficient per-
formance demanded an education in temperance and self-restraint. In accor-
dance with the emphasis on a simple mode of life, the soldier was advised
against dietary indiscretion and alcohol abuse. It was important more gener-
ally to regulate intake and excretion to achieve a balance of the bodily system.
The soldier’s clothing, for example, ought to ensure that he maintained a
stable temperature and evaded heatstroke, fatigue, and any diseases brought
on by chill. The army ration would deliver a balanced diet of protein, starch,
fat, and salts.∑∞
The well-trained soldier was expected to recognize and avoid sanitary
hazards, especially those related to disposal of excreta. Munson, throughout
his career in the army, and later as advisor to the Bureau of Health in the
Philippines, would warn of the dangers of promiscuous defecation, a failing
that at least seemed readily disciplined in white soldiers. Experience had
convinced him that ‘‘the care of latrines is a most important factor in the
preservation of the health of the command.’’ Indeed, ‘‘raw troops living like
savages in their disregard of sanitary principles, without moving camp as

american military medicine faces west 27

often as do these savages, cannot fail to be scourged by epidemic disease as a
result of their ignorance and neglect.’’ Education and camp inspection were
unremitting; ‘‘camp police’’ would discipline those who refused to find the
distant latrines.∑≤ In the military service, the removal of excreta and the main-
tenance of personal cleanliness would normally receive more emphasis than
in white civilian life, in recognition of the special health risks of shared and
often crowded living conditions. The personal hygiene of soldiers in the line
was regulated as never before. Since the 1880s, far in advance of the British
army, all military posts in the United States had provided bathing facilities for
troops. Each American soldier was now required ‘‘to wash the face, head,
neck and feet once daily, cleanse the hands prior to each meal and bathe his
entire body at least as often as once in five days.’’ His personal cleanliness and
propriety had become ‘‘a constant object of solicitude on the part of his
superiors.’’∑≥
When epidemics broke out among troops, as they often did despite even
the best policing, the military hygienist set about to inquire into their history
and predisposing causes and then recommend measures of control. In the
1890s, the sanitary officer could draw on a large repertoire of interventions.
These included isolation of the diseased, prevention of crowding, purifying of
food and water, avoidance of unripe or decomposing vegetables, eradication
of ‘‘soil pollution,’’ whitewashing or burning of infected localities. destruc-
tion of infected articles. disinfection of privies, urinals, sinks, and drains,
checking of ventilating appliances, protection from dampness, the daily airing
of bedding, healthy amusements and exercise, prevention of intemperance
and promiscuity, and, in the case of smallpox, vaccination.∑∂ It was gradually
becoming more likely that the surgeon would seek to identify a microbial
cause of the epidemic and, if successful, attune his response accordingly. In the
summer of 1898, when typhoid, or camp fever, spread among the troops
assembling in the United States to fight the war with Spain, General Sternberg
appointed a board of investigation that included Major Walter Reed, m.d., to
show what could be done with new scientific techniques.∑∑ The board visited
all the large camps in the United States, studying the water supply, the quality
and quantity of food, the nature of the soil, the arrangement and size of tents,
the location of sinks, and the disposal of human waste. ‘‘Scientific investiga-
tions of the blood,’’ including application of the Widal test for the typhoid
organism, indicated that most of what had passed for ‘‘malarial fever of a
protracted variety’’ should have been diagnosed as typhoid. Frequently, the
presence of typhoid was deliberately hidden: ‘‘in one command the death-rate

28 american military medicine faces west

from indigestion was put down as fifteen percent.’’∑∏ The board carefully
assessed the various proposed explanations for the epidemic. They concluded
it derived not from sending northern men into a southern climate or from the
locality or simply the massing of so many men in one place. Rather, the cause
was ‘‘camp pollution,’’ that is, the improper disposal of excreta. On hearing
of this conclusion, Sternberg recommended to the adjutant general that sub-
ordinates clean up the camps, discourage flies, and sterilize the excreta of
typhoid cases.∑π But by then the disease had mostly run its course.
At the end of the nineteenth century, an education in the principles of
modern hygiene was supposed to inform the military surgeon’s sanitary work.
When a candidate passed the medical department’s competitive examina-
tions, he had to attend a four-month (later eight-month) course at the Army
Medical School in Washington, D.C. Sternberg had established the school in
1893 to teach army regulations, customs of service, examination of recruits,
care and transportation of the wounded, and field hospital management.
Special emphasis was placed on military hygiene and sanitation and on ‘‘clini-
cal and biological microscopy, particularly as bearing on disinfection and
prevention of disease.’’∑∫ Billings taught military hygiene, Reed instructed
students in bacteriology, Major Charles Smart, m.d., was in charge of sani-
tary chemistry, and Professor C. W. Stiles lectured on parasites in man. Ac-
cording to Dr. Charles H. Alden, the school’s director, the courses provided
for ‘‘a study of Hygiene in all its various branches, of air and water and their
impurities, clothing, food, exercise, barrack and hospital construction, sewer-
age and drainage, sanitary chemistry and practical bacteriology.’’ Laboratory
work was a prominent feature of the course, supposedly ‘‘consuming most of
the students’ time.’’∑Ω
In 1898, at the beginning of a long tropical war in the Philippines, the army
medical service appeared to exercise more influence over the care of troops
than ever before. Even if the medical department’s grasp on bacteriology was
still weak at times, its organizational structure was stronger than ever. At the
outbreak of the Spanish-American War the department consisted of 177 com-
missioned officers and 750 enlisted men. A permanent sanitary organization
was attached to each regiment. For every 1,000 of strength, there were now
3 medical officers, 1 hospital steward, 2 acting hospital stewards, 1 nurse,
1 cook, and 3 orderlies; 2 company bearers were detailed for every 100 men
on the line. Each division, 10,000 men strong, was provided with a field
hospital, including 9 medical officers and 27 privates, members of the hospi-
tal corps, male nurses or ‘‘sanitary soldiers,’’ who cared for the sick and

american military medicine faces west 29

wounded.∏≠ In the recent past, line and staff were inclined to scorn medical
officers for their attempts to ‘‘coddle’’ soldiers. But this attitude was changing.
The military surgeon possessed the authority accorded to his rank, the grow-
ing dignity of his profession, and now the freshly minted currency of lab-
oratory science. Woodruff found that he rarely needed to compel ordinary
soldiers ‘‘to get well,’’ for they would ‘‘readily submit to all reasonable restric-
tions and methods of treatment, and many unreasonable ones too.’’∏∞ The
military surgeon toward the end of the nineteenth century was gaining confi-
dence in his new expertise, grappling with bacteriology, and attempting to
incorporate novel pathogens into familiar patterns of environmental and so-
cial etiology. But his skills would be severely tested abroad, among the foreign
disease ecology of the tropics.

american military medicine in the tropics

The warfare around Manila at first was mostly of a continental type, with the
deployment of columns and the entrenchment of positions. The medical de-
partment was hard-pressed with the care of wounded and the establishment
of divisional or general hospitals, though some public health work did begin
soon after the occupation of Manila. During the first year of the war, the
medical service concentrated on surgery and devising an easily movable front
line, a more or less constant means of supply and evacuation, and well-
determined depots for the sick in the general hospitals. The volunteer sur-
geons and those from the National Guard generally proved unprepared for
war conditions. According to Lieutenant Colonel John van Rensselaer Hoff,
m.d., the leading administrative reformer in the sanitary bureau, there was,
among regimental medical officers and hospital stewards, ‘‘scarcely an officer
or man who possessed the slightest knowledge of medico-military matters.’’
Indeed, the medical department was ‘‘quite as much in need of training in the
theory of the special military work of the sanitary corps, as were the troops of
the line in their routine of ‘fours right and fours left.’ ’’∏≤ Lieutenant Colonel
Jefferson D. Griffiths, m.d., the medical director of the Missouri National
Guard, found his new circumstances particularly challenging. ‘‘As surgeons,’’
he recalled, ‘‘we thought we could amputate a limb. We were familiar with
laparotomies, and had an idea that we were fully competent to deal with the
necessities of the occasion. Many of us even thought we knew something
about the proper sanitation of camps, and disinfection.’’ But after a few weeks
in the military, ‘‘we found our ignorance was sublime.’’∏≥
Most of the surgeons streaming into military service found themselves in

30 american military medicine faces west

figure 4. Square at Malalos, March 1899 (rg 165-pw-3h, nara).

Griffith’s predicament. In particular, the contract surgeons had no special

training in military hygiene and knew nothing of army administrative proce-
dures. So pressing was the need for surgeons that the rigorous physical and
professional examinations for entry into the medical department had been
suspended. Few volunteers possessed Henry F. Hoyt’s experience of frontier
medical practice and knowledge of modern hygiene. The ‘‘red-haired Indian-
fighter,’’ as he called himself, had set up a practice in New Mexico and tended
railway workers there, before becoming commissioner of health for St. Paul,
Minnesota, where he vaccinated widely and opened a bacteriology labora-
tory. Assigned as chief surgeon in the Second Division, Eighth Army Corps,
Hoyt arrived in Manila in December 1898. The general advance of the army
on Aguinaldo’s trenches around the city was his first experience under fire.
Wearing a white cork East India helmet, ‘‘being fearful of sunstroke in the
tropics under a campaign hat,’’ the medical officer gave first aid to the
wounded and then sent some back for ‘‘aseptic surgery.’’∏∂ Regulations called
for two men of the hospital corps to carry each litter, but Hoyt soon saw that
‘‘even six white men’’ could not manage it ‘‘in that hot, humid tropical cli-
mate,’’ and he recommended that ‘‘Chinese coolies’’ be substituted.∏∑ The
army continued to advance through ‘‘rough country and impenetrable

american military medicine faces west 31

jungle,’’ all the while dodging brisk sniper fire, leaving transportation for the
wounded far in the rear. The retreating army had destroyed the bridges, and
ambulances could not cross the streams. Although the railway track was
quickly repaired, Aguinaldo had kept most of the rolling stock. But using ‘‘a
bunch of Igarote [sic] prisoners as motive power,’’ Hoyt was able to improvise
boxcars as ambulances for the wounded. When a fierce battle outside Malalos
left four Americans dead, thirty wounded, and eleven with ‘‘heat exhaus-
tion,’’ he even tried ferrying the casualties by canoe.∏∏
In May 1899, Hoyt established the first field hospital in the islands. He se-
lected five ‘‘commodious houses’’ and connected them with a bamboo porch,
an expedient that won praise from Senator Albert Beveridge when he visited.
Soon afterwards, an ambulance brought Simon Flexner and Lewellys Barker,
a pathologist and a physician from the Johns Hopkins University, keen to
study tropical disease. According to Hoyt, they were like most young Ameri-
can men, ‘‘wild to get a taste of real war at the front.’’∏π But they did not linger.
Hoyt himself had by then tasted rather too much of the Philippines. During
the advance from Malalos he was ‘‘seized with a severe attack of amebic
dysentery’’ and ‘‘fainted away.’’ Sent to the new convalescent hospital on
Corregidor Island, he grew worse and was ordered home. ‘‘The change and
sea air did wonders,’’ and, as he neared his homeland, he began to gain
strength.∏∫
Lieutenant Franklin M. Kemp, m.d., also remembered clearly his first time
under fire, as the army attacked Aguinaldo’s trenches. Kemp, like Hoyt an
experienced hygienist, had arrived in Manila in August 1898 and spent the
next few months in ‘‘the teaching of men to save their lives, or those of their
comrades when wounded.’’ During his daily drill and lecture, Kemp gave the
men practical instruction in minor surgery, first aid, and transportation of the
wounded. ‘‘They were taught to regard the first aid packet as their most
precious possession, after their rifle.’’∏Ω On the night of February 4, 1899, as
the American forces moved out of Manila, Kemp stationed the hospital corps
with litters along the Singalong Road and was soon busy dressing the
wounded who staggered out from the brushwood. As they retreated, Filipinos
kept up a ‘‘constant and severe cross-fire,’’ yet ‘‘the hospital corps men seemed
to be ubiquitous, going from one pit to another, across open spaces, appar-
ently bearing charmed lives.’’π≠
By April, when the army was advancing on Santa Cruz, Laguna, Kemp had
learned to put the hospital corps five or ten paces in the rear of each company,
with Chinese bearers a further hundred yards behind. The Chinese were

32 american military medicine faces west

proving themselves better able to withstand the intense heat than American
litter-bearers, and with ‘‘the usual Oriental stoicism’’ they often worked ‘‘ap-
parently beyond the limits of human endurance.’’ They were under the charge
of a private in the hospital corps ‘‘who could swear volubly in Chinese and
was further assisted by a huge navy revolver and a big stick.’’π∞ For two weeks
the troops moved through country that had never carried wheeled transporta-
tion before: they were compelled to make roads, build bridges, and ford
rivers, with little to guide them. But Kemp and his corps were by then pre-
pared for such conditions: ‘‘My coolies would have the locality all cleaned up
before the train arrived, the carts containing the medical, the surgical and the
sterilizing chests coming next. In a few minutes the division field hospital
would be established and in thorough running order, rounds made, operating
table improvised and all dressings and operations performed. Ambulances
would be parked and cleaned and made ready for instant use.’’π≤
And before long, they would pack up and move on again. After crossing the
Pasig River, the troops endured the hardest day’s march that Kemp could re-
member. All day, under fire from the enemy, they trudged across rolling land,
‘‘destitute of water,’’ covered with ‘‘rank weeds and grass to one’s waist,’’
intersected with deep ravines, with absolutely no shade and a temperature of
110 degrees Fahrenheit. ‘‘Water gave out early in the morning,’’ Kemp wrote;
‘‘tongues were so swollen that one could not speak; men dropped down in
simple heat exhaustion or in convulsions, not one at a time, but in squads of
five or six.’’ Even in the seasoned 14th Infantry, almost 40 percent of the
complement succumbed that day.π≥ Kemp was kept busy in his improvised
hospital till late at night.
Lieutenant Colonel Henry Lippincott, m.d., the chief surgeon for the Divi-
sion of the Pacific and Eighth Army Corps, recalled that the wounded and sick
generally did well during the early stages of the Philippines campaign, and the
medical department performed its duties ‘‘cheerfully and efficiently.’’π∂ ‘‘Of
course we had excellent surgeons on the firing line’’—men like Hoyt and
Kemp—who ‘‘saw the wounded were well cared for before transportation,
whether by ambulance, rail, or water, to the First Reserve [Hospital], and the
men arrived in as good condition as could be expected.’’π∑ Lippincott had
converted the Spanish military hospital into the First Reserve Hospital in
August 1898, a few days after the fall of Manila. Erected just twelve years
earlier, the hospital accommodated between eight hundred and a thousand
patients. The wards seemed well constructed ‘‘and very large and roomy, but
the location [was] bad owing to the swampy surroundings.’’ Not surprisingly,

american military medicine faces west 33

figure 5. Wounded arriving in Manila, c. 1899 (rg 200-pi-46a, nara).

the ‘‘sewer and closet arrangements, like everything of the kind in Manila,
were unsanitary,’’ but they were soon altered to resemble ‘‘the good features
of the hospitals in America.’’ Initially, all the sick and seriously wounded
came to this large hospital, but less than a month later Lippincott established
the Second Reserve in an abandoned convent, for the overflow from the First
Reserve. In November 1898, the Corregidor Hospital opened on a site that
Lippincott described as ‘‘a model spot for a large hospital.’’π∏ The environ-
mental conditions of the island seemed to revitalize most American soldiers:
the temperature was ten degrees below Manila’s, there was no malaria, shade
trees abounded, and the saltwater bathing was excellent.
Yet medical conditions were not as satisfactory as Lippincott implied.
Lieutenant Colonel Alfred A. Woodhull, m.d., Lippincott’s successor as chief
surgeon in Manila, reported that the two reserve hospitals were ‘‘swollen out
of all proportions,’’ and barracks had to be used for the overflow.ππ He was
disturbed above all by the condition of the First Reserve Hospital: ‘‘The
hospital grounds have been in a wretched state of police; the Hospital Corps
seems to have neither system nor order for its control; there is no dining room,
no proper facilities for the preparation of food or its distribution . . . the wards
that I have incidentally passed through have been dirty and in poor order,
they are horribly overcrowded and insufficiently manned.’’π∫ He had found a
‘‘large and foul bathroom and privy’’ next to the main kitchen; many of the

34 american military medicine faces west

wards were ‘‘polluted with the remains of food.’’πΩ During the wet season, the
tent wards were awash with water, ‘‘literally an ankle deep.’’∫≠ Lieutenant
Conrad Lanza, confined to the hospital in June 1899, complained that the
army ration he received was ‘‘uneatable’’ and members of the hospital corps
were ‘‘habitually disrespectful and inattentive.’’∫∞ Nurse Mary E. Sloper al-
leged that the sputum of tuberculosis patients overflowed receptacles onto the
floor; and the two large jugs in the center of the ward, filled daily with fresh
drinking water, contained bugs and worms in the slime at the bottom. Ac-
cording to Nurse Sloper, patients slept in dirty linen, discarded by previous
inmates, and their bodies were never washed.∫≤ Conditions in hospitals out-
side Manila were scarcely better. The hospital at Corregidor remained under
canvas six months after its establishment. The field hospitals proved woefully
inadequate too. ‘‘There are innumerable regimental hospitals that in my judg-
ment are pernicious,’’ Woodhull lamented, ‘‘but which are authorized and
supported. These are rendezvous of idlers and malingerers made possible
merely because efficient medical officers, or in fact any at all, cannot be as-
signed to them.’’∫≥
Others echoed Woodhull’s complaints of inadequate medical staffing.
Hoyt repeatedly pointed out the deficiencies in personnel, ambulances, and
transportation at the front. He could count on only two surgeons on duty
with each regiment when, for ‘‘service in the tropics,’’ there should be at least
three. Kenneth Fleming, in the hospital corps, wrote to his ‘‘dear ones at
home’’ to tell them that ‘‘the Stuerd is sick and the Dr. is in Bunate and that
leaves me in a pretty tight place but their is nothing much to do hear but hold
sick call and I can atend to one company . . . I havent killed any body yet and I
don’t intend to do that.’’∫∂ Major General H. W. Lawton criticized the scarcity
of medical attendants in his division: ‘‘At present one surgeon is forced to
travel a line of mud and water . . . a distance of some four miles by road in
performance of his duties, and he is far from being well himself.’’ To send
someone to his assistance would leave another command entirely without
medical services.∫∑ In response to these and other complaints, Sternberg dis-
patched more contract surgeons and hospital corps. But soon after arriving,
many of them would fall ill. Of the medical officers ‘‘actually on duty in
Luzon, seven are disqualified on account of sickness,’’ Woodhull reported,
and many others had been ‘‘placed upon selected duty on account of their
health.’’ The chief surgeon found himself constantly shifting the remaining
healthy medical officers from one battalion to another. It was difficult to keep
up. Woodhull’s first knowledge of an expedition was often ‘‘an announce-

american military medicine faces west 35

figure 6. U.S. Ambulance Corps, c. 1899 (rg 200-pi-11c, nara).

ment from [the regiment] that it was moving off with an inadequate medical
force.’’∫∏ Sternberg sent out even more contract surgeons, but within months
Woodhull was listing another twenty-five vacancies, each case a result of
‘‘sickness,’’ ‘‘gastro-enteritis,’’ ‘‘dysentery,’’ ‘‘repeatedly breaking down,’’ or
just ‘‘weakened health.’’∫π
The duties of those medical officers who remained fit were long and ar-
duous. During the wet season the roads they traveled became quagmires, and
on crossing the rice fields ‘‘not infrequently the officers are wet up to their
waists even when it is not raining.’’ The daily sick call often took several
hours when companies were scattered across many miles of defenses. ‘‘The
weather is always warm,’’ Woodhull reported, ‘‘and the atmosphere is gener-
ally humid, so that when the sun is unobstructed its direct rays are distress-
ing and it is always oppressive in the field.’’∫∫ Woodhull found many of his
contract surgeons lacking in aptitude and industry under these conditions.
Among them was a man who had worked well in the field but had ‘‘no more
judgment than to turn over sick call to his wife’’ and therefore marked him-
self as ‘‘certainly not the sort of person from whom the best service can be
obtained.’’ Indeed, Woodhull constantly expected ‘‘to hear of his breaking
down.’’ Another was ‘‘notoriously frail physically’’ and ‘‘exceedingly slow
and over-cautious.’’ Others appeared to be malingering or else just ‘‘dead
wood.’’ ‘‘It is very trying,’’ Woodhull wrote, ‘‘to be credited with such as these

36 american military medicine faces west

figure 7. Operating station, c. 1899 (rg 165-pw-g, nara).

and expected to get good work out of them.’’∫Ω Most of the contract surgeons
were merely ‘‘young men of small personal experience,’’ and very few had
made ‘‘a special study of the diseases of this climate.’’Ω≠

the racial economy of the tropics

In January 1900, Lieutenant P. C. Fauntleroy, m.d., proudly described his
Second Division field hospital at Angeles, which then consisted of nine adjoin-
ing dwellings, all connected by bamboo and nipa covered ways. The water
from the well seemed pure enough, but even so Fauntleroy made sure it was
always filtered and boiled. The hospital bedding was regularly disinfected and
boiled to prevent the spread of tinea, measles, and other skin irritations.
Fauntleroy suspected that the origin of the many cases of malaria and intesti-
nal disease he encountered was ‘‘to be found in the constant exposure while
on the march and especially on outpost duty at night, to the prevailing condi-
tions natural to this section, and to the flooding of the land for agricultural
purposes,’’ which had made the ground damp. ‘‘Irregular and often hasty
eating of food’’ may have added to the level of morbidity.Ω∞ These environ-
mental and behavioral explanations did not mean that the medical officer
discounted germs as the causes of disease; it was just that germs seemed to

american military medicine faces west 37

possess older geographical and moral correlates. In perplexing cases of fever,
Fauntleroy would look for malaria parasites in the blood, but generally he
could discern clear clinical signs—often a distinctive rash or fever pattern—
indicating a specific disease and excusing him from deploying the microscope.
Lippincott reported that most of the ‘‘diseases incidental to the tropics’’
could be encountered in the Philippines. Dysentery was always present; lep-
rosy was common, and enteric fever, or typhoid, ‘‘long ago became fastened
to the coast line.’’ The ‘‘inordinate activity of the skin’’ made severe ‘‘dermatic
affections’’ nearly universal among white soldiers. ‘‘Slight injuries often result
in long unhealed ulceration,’’ the chief surgeon noted, ‘‘and this is due to
excessive perspiration with its attending debility.’’Ω≤ Vaccination and revac-
cination of the troops against smallpox ‘‘of a type especially severe to the
white’’Ω≥ and endemic among Filipinos went on ‘‘as systematically as the drills
at a well-regulated post.’’Ω∂ ‘‘Malarial poisoning’’ was widespread, though
not nearly as malignant as first feared; all the same, many regiments, beset
with sporadic outbreaks, had required quinine prophylaxis. Not surprisingly,
the wet season was the harbinger of death and disease, since ‘‘the camps were
not only quagmires, but the soldiers were often drenched for days together.’’
The results of this miserable predicament were dysentery, persistent diarrhea,
rheumatism, enteric fever, and more malaria. During 1899, the worst year of
the campaign, 36 officers and 439 soldiers were killed or died from wounds
received in action, 8 officers and 131 soldiers died from ‘‘other forms of
violence,’’ and 16 officers and 693 men fell to disease, principally diarrhea
and dysentery, smallpox and typhoid. Additionally, more than 1,900 soldiers
were transferred back to the United States on account of sickness. The Ameri-
can army in the Philippines therefore lost through death, discharge, or trans-
fer almost 14 percent of the average mean strength present (which was a little
under 28,000 men). The sick rate—a more accurate measure of the incapacity
of an army—was of course much higher.Ω∑
Although it was now generally accepted that ‘‘climate cannot generate
fever no more than it can generate plants and animals,’’ most physicians and
their patients continued to believe that tropical conditions would reduce an
alien race’s general resistance to disease and present it with novel microbial
pathogens for which it was unprepared.Ω∏ Malaria had become prevalent
among white troops because ‘‘the depressing influence of the tropical climate
lessens the individual’s normal resisting powers and thereby prepares a favor-
able soil for the invasion of parasites.’’Ωπ Even familiar, cosmopolitan diseases
exerted a more deleterious effect in the devitalizing tropics. Smallpox ‘‘in this

38 american military medicine faces west

latitude and longitude,’’ according to Hoyt, was ‘‘very fatal, especially to the
white man.’’Ω∫ The experience of Major Charles F. Mason, m.d., in treating
typhoid among American soldiers in the Philippines convinced him that ‘‘the
disease is more severe than in the temperate zone, and more fatal in its re-
sults.’’ΩΩ Sternberg warned, ‘‘The spread of diarrhea and dysentery is indi-
rectly promoted and their danger aggravated by the alternate heat and rains
of a tropical climate and by the lowering of vital powers consequent on heat
exhaustion.’’∞≠≠ Notter, too, had observed that ‘‘the mortality from enteric
fever in hot climates is always more than in temperate zones,’’ owing no
doubt to ‘‘the diminished resistant power of the individual.’’ The more potent
‘‘undermining factors’’ appeared to be youth and recent arrival in the foreign
environment. Yet he had also noticed how ‘‘prolonged residence in a hot cli-
mate doubtless deteriorates the system’’ and led to the diminution of Anglo-
Saxon ‘‘energy’’—though he hastened to assure his readers that ‘‘the influence
of ‘climate’ as a direct etiological factor of cholera or enteric fever . . . is
baseless in fact.’’∞≠∞
The encounters of military surgeons in the Philippines seemed to confirm
that the white race was likely to degenerate and sicken in the tropics. Accord-
ing to Greenleaf, ‘‘the principal medical feature’’ of the San Isidro campaign in
April 1899 was the ‘‘severe physical hardship’’ white troops endured: ‘‘The
very bullock trains had to be helped by hand, under intense heat and at-
mospheric humidity.’’ As a result, many soldiers succumbed to exhaustion,
and 530 of them, almost 15 percent of the command, were admitted to the
field hospital. Such incidents reinforced the conviction, held by physicians
and ordinary soldiers alike, that ‘‘the Anglo-Saxon cannot work hard physi-
cally in the tropics without suffering physical harm from the sun and cli-
mate.’’∞≠≤ This meant in practice that only Filipinos and Chinese should per-
form heavy manual labor, such as lugging ambulance litters. But what was
fighting a war if not a form of hard labor? Few medical officers doubted that
the typical white soldier, marching and fighting ‘‘under very exhausting con-
ditions of country and climate,’’ could not ‘‘endure the same amount of nerve
tension and physical strain that he can in a temperate zone.’’ ‘‘Recuperation
and convalescence in this climate are slow,’’ reflected Greenleaf, and ‘‘were an
epidemic of any character to occur among men in that condition, its effects
would probably be very disastrous.’’∞≠≥ In Mason’s opinion, ‘‘the great major-
ity of white men in the tropics suffer a gradual deterioration of health and
year by year become less and less fit for active service.’’∞≠∂ American so-
journers might watch as ‘‘the sun cast long fingers of light’’ through the

american military medicine faces west 39

banana palms; they might gaze on ‘‘a blue sky, a gray beach, besprinkled with
beautifully tinted shells’’—but they were never allowed to forget the ‘‘gener-
ally accepted fact that [whites] cannot permanently adapt to the climatic
conditions of this zone.’’∞≠∑
The mental and moral qualities of the white race, finely attuned to a more
stimulating environment, seemed especially likely to jangle and twang in trop-
ical circumstances. The common enervation might on occasion slide into
serious mental disorder. In the opinion of Surgeon Joseph A. Guthrie, ‘‘The
Philippine sun seems to have a powerful influence upon the body, an over-
stimulating effect, like unto the surcharged x-ray, penetrating the skin along
the nerve fibers and exerting its influence upon the entire nervous system.’’∞≠∏
Munson, in contrast, was convinced that tropical service inevitably caused ‘‘a
depression of vital and nervous energy’’ and bred ‘‘nostalgia, ennui and dis-
content’’ among nonnative troops. Soon they became ‘‘wearied, fagged, and
unable to concentrate their ordinary amount of brain power on any one sub-
ject.’’∞≠π Episodes of the ‘‘depressing condition known as nostalgia,’’ brought
on by fighting far from home in a foreign climate, occurred regularly, espe-
cially among the less worldly rural recruits. ‘‘In individual cases of illness,’’
Greenleaf reported, ‘‘nostalgia became a complication that aggravated origi-
nal disease and could not be removed while the patient remained in the
islands.’’∞≠∫ ‘‘The sudden transfer to a foreign land,’’ recalled Major Louis
Mervin Maus, m.d., ‘‘separation from sweethearts, wives and family, the
constant influence of conversation regarding the horrors of tropical diseases
and climate, mental forebodings as to evil happenings, produced in a large
number of the men, unaccustomed to absence from home, nostalgia which
gradually merged into mental depression, apathy, loss of vitality, neuras-
thenia, melancholia and insanity.’’∞≠Ω Reeling between overstimulation and
depression, the common soldier was struggling to maintain his usual equable
temperament. At home, many came to believe the heat had driven men mad.
In February 1900, the Evening Star in Washington, D.C., warned that ‘‘dur-
ing the last three months nearly 250 demented soldiers have been sent across
the continent [to Washington] and it is said that 250 more will arrive soon
from Manila. In nearly all cases the men are violently insane.’’∞∞≠
In 1902, reviewing the lessons of recent tropical service, Munson con-
cluded that there was ‘‘ample proof that tropical heat and humidity produce
marked changes in body-function which exert an effect adverse to the health
and existence of all but the native-born.’’ Heat and humidity increased Euro-
pean body temperature and perspiration while reducing pulse rate, blood

40 american military medicine faces west

pressure, and urine production. The number and function of ‘‘red blood
corpuscles’’ diminished in whites transplanted to the tropics. Therefore, even
if they avoided specific disease, ‘‘residence in hot climates, under circum-
stances of ordinary life, has an adverse effect on the white race.’’ Speaking
from experience, Munson could not doubt that ‘‘the Anglo-Saxon branch of
the Teutonic stock is severely handicapped by nature in the struggle to colo-
nize the tropics.’’∞∞∞ It mattered little whether Providence or evolutionary
mechanism had matched race to climate: whatever the explanation, whites in
the tropics were out of place, and degeneration and disease would be the
natural rewards of environmental transgression.
The apprehensions and anxieties of American medical officers were hardly
novel. Most medical authorities and social theorists in the nineteenth century
held that the boundaries within which an individual could stay healthy and
comfortable coincided with the region in which his race had long been situ-
ated. To venture beyond this natural realm in any circumstances seemed
hazardous; to go abroad and fight a war on treacherous ground was to court
disaster. For the past century, medical geographers had discussed whether
Europeans might adapt themselves, or acclimatize, to a tropical environment
—and the answer was still, even in the 1890s, unsettled. A general sense of
climatic anxiety and pessimism pervaded the medical and colonial literature.
Thus E. A. Birch, in Andrew Davidson’s Hygiene and Diseases of Warm
Climates, explained to his readers that a tropical climate would always be ‘‘in-
imical to the European constitution.’’ A continued high temperature seemed
to produce in the white body ‘‘an excessive cutaneous action, alternating
with internal congestions.’’ Although ‘‘the effort of nature is to accommodate
the constitution to the newly established physiological requirements,’’ there
would be an inherent racial limit to this functional adjustment.∞∞≤ It comes as
no surprise that the conventional concern about racial displacement was
applied to the Philippines. Benjamin Kidd, an English social Darwinist, be-
lieved that ‘‘the attempt to acclimatize the white man in the tropics must be
recognized as a blunder of the first magnitude. All experiments based on the
idea are foredoomed to failure.’’ On the eve of the U.S. Army’s invasion of the
Philippines, Kidd pointed out that ‘‘in climatic conditions that are a burden to
him, in the midst of races in a different and lower stage of development;
divorced from the influences that have produced him, from the moral and
political environment from which he sprang, the white man . . . tends to sink
slowly to the level around him.’’ For in the tropics, ‘‘the white man lives and
works only as a diver lives and works under water.’’∞∞≥

american military medicine faces west 41

 But not all was lost on diving into the tropics. Medical officers in the
Philippines gradually became more confident that proper attention to per-
sonal hygiene at least slowed the decay of the white racial constitution in a
foreign environment. Thus the care of the body and the tempering of behavior
might preserve and supplement the white soldier’s powers of resistance and so
mitigate the presumed transgression against nature. In other words, personal
hygiene would perhaps allow alien Americans to function as if in sealed
hermetic microenvironments, to equip themselves with a sanitary armature
against the climate. Evidently, if a white American soldier was to withstand
his depleting circumstances, his ‘‘habits, his work, his food, his clothing, must
be rationally adjusted to his habitat’’—not to make him like the locals but to
protect him from going native. The basic precepts of tropical hygiene were
simple enough: avoid the sun, stay cool, eat lightly, drink alcohol in modera-
tion or not at all. In Mason’s experience, ‘‘errors of diet, abuse of alcoholics,
chilling after over-heating, especially at night, excessive fatigue, and the use of
the heavy cartridge belt’’ had all been ‘‘powerful disposing factors’’ to invalid-
ing and death in the tropics.∞∞∂
The proper attire, diet, and conduct of American troops in the Philippines
excited much expert commentary. Captain Matthew F. Stelle, m.d., in dis-
cussing the appropriate dress for a soldier in the tropics, admitted he had
scarcely heard of khaki before 1898, but since then it had rapidly replaced
blue as the distinctive coloration of the U.S. soldier. The lighter color, which
deflected the sun, certainly seemed better adapted to the tropics. But he re-
mained convinced that the old campaign hat used in the Philippines absorbed
and concentrated the sun’s rays and was ‘‘the most certain, rapid and perma-
nent hair-eradicator that was ever invented.’’∞∞∑ Mason confirmed the hat’s
evil effects. He reported that a thermometer placed under a felt campaign hat
registered 100.2 degrees, but under a khaki hat, left out in the sun, it never
exceeded 92 degrees. His conclusion was that the campaign hat was ‘‘not fit
for tropical service.’’∞∞∏
When Stelle first ventured into the tropics, it seemed he was asked at least
forty times a day, ‘‘Have you got an abdominal bandage?’’ ‘‘People were daft
on the subject,’’ he said. Although he later came to believe that ‘‘no greater
fake was ever perpetrated’’ and that it was ‘‘a bad habit, a vice, a disease,’’ he
had become addicted to it, as had so many others, and ‘‘nothing but death can
rescue us.’’∞∞π Guthrie was equally convinced that the popular flannel abdom-
inal bandage was unnecessary, yet he continued to advise Americans in the
tropics to protect their abdomen with a blanket when sleeping, to prevent

42 american military medicine faces west

them ‘‘chilling’’ through evaporation of sweat.∞∞∫ Members of the Philippine
Commission, the new executive government, also concluded that the ‘‘ab-
dominal band is necessary for perhaps fifty percent of Anglo-Saxons. One can
try to do without it, but if one develops diarrhea, the best thing to do is wear
it.’’∞∞Ω Captain Woodruff, however, expressed his objections to abdominal
bands and other warm clothing with characteristic bluntness: ‘‘We are less in
danger of chills,’’ he declared, ‘‘than of being devoured by polar bears.’’ The
white man in the tropics could not cool off day or night, no matter how hard
he tried. In these circumstances, ‘‘as little clothing as possible is the rule, and
that clothing should be such as to interfere in no way whatever with getting
rid of surplus heat.’’∞≤≠
The effort to formulate the ideal ration for the white man in the tropics
was similarly predicated on the perceived need to prevent the accumulation of
excessive heat and thus restore the preexisting balance of the white constitu-
tion. Munson wanted more vegetables and less protein and fat in order to
avoid ‘‘hyper-stimulation of the liver.’’∞≤∞ Surgeon Hamilton Stone argued
that in the tropics, ‘‘where the excretory organs are always overtaxed,’’ there
was a marked tendency ‘‘for us to eat too much,’’ especially the bulletproof
army hardtack, some of it rumored to be left over from the Civil War.∞≤≤
Greenleaf, however, did not see any need to change the quantity of the tropi-
cal ration but suggested a decrease in the meat component and an increase in
cereals. If the ‘‘nitrogenous and fatty elements’’ were reduced, then the diet
would approximate that which sustained the local inhabitants.∞≤≥ But Wood-
ruff, not surprisingly, challenged this objective too. ‘‘If we eat like natives,’’ he
predicted, ‘‘we will become as stupid, frail and worthless as they are.’’ The
real reason disease seemed so severe in the tropics was, he thought, that ‘‘the
white man is exhausted by idleness and insufficient food and has no resis-
tance.’’ Experience had shown him that ‘‘the tropical heat causes a great
expenditure of nervous and muscular force,’’ so to balance this, to ‘‘supply the
wastes and help to prevent exhaustion,’’ more animal food was required, not
less.∞≤∂ Such debates over white nutrition, dress, and behavior in the tropics
would continue for the next twenty years.

manly white tropical soldiers

American whiteness and masculinity were both more readily discerned and
more highly valued in the tropics than at home; they appeared at once more
vulnerable and more necessary.∞≤∑ The figure of ‘‘whiteness,’’ whether defi-
cient or overassertive, became a means through which Americans declared

american military medicine faces west 43

their presence in the Philippines. The white troops endured fatigue, fever, and
nostalgia, all of which seemed to sap or undermine the race’s reserves of
energy and character. They often felt out of place, not in sympathy with
tropical circumstances. Their medical officers attributed racial deterioration
and disease to a mismatch between bodily constitution and environment—
sometimes the environment was directly noxious, at other times it was micro-
biologically mediated. Soldiers felt awry and uncomfortable; their doctors
confirmed and further specified the pathological consequences of displace-
ment into a foreign climate and exotic disease ecology.
If whites were proving so vulnerable to tropical conditions, what was to be
done? Medical officers sought to limit the troops’ contact with microbes, espe-
cially the unfamiliar ones that appeared to prevail in the new territory. More-
over, they attempted to manage the selection, conduct, clothing, diet, and per-
sonal hygiene of soldiers in order to build up resisting powers and strengthen
the constitution. In multiple ways, then, the military sanitarian was delimiting
the boundaries of whiteness in the Philippines, counterposing it to an un-
wholesome and morbific climate and ecology and thus refiguring what it
would mean to be a real white man—a vigorous American citizen-soldier—in
the tropics. Evidently, remaining or becoming successfully white in the tropics
was going to entail continual medical surveillance and discipline.
Facing west from California’s shores, some Americans observed their
whiteness become more visible again, this time in relation to the multiply
threatening tropical milieu. Frederick Jackson Turner claimed that the strug-
gle with savages and wilderness on the continental frontier transformed Euro-
peans into Americans.∞≤∏ As that frontier closed, a new one opened on the
other side of the Pacific, one markedly more militarized and medical. In the
crucible of the Philippines ‘‘borderlands,’’ American whiteness and masculin-
ity would again be refashioned: now it was the medical officer who took
charge of the process and determined the results.

44 american military medicine faces west

Chapter Two

the military basis of colonial

public health

C arl von Clausewitz once remarked that although politics and warfare

follow the same logic they use a different grammar.∞ Colonial public

health, as it emerged in the Philippines under the American regime, would

come to share both logic and grammar with the military sanitary bureau.

That is, the mode of action and disciplinary tactics employed by military

surgeons to ensure the hygiene and propriety of white troops were invoked,

toward the end of the war, to manage the civilian population of the ar-

chipelago. New practices of colonial warfare, which required the attraction

and pacification of local communities, fostered a transfer of contemporary

military-medical strategies of crowd control. Military surgeons, who once

had focused attention on raw American recruits, moved into the civil health

authority and began to retrain Filipinos in the discipline of hygiene and to

render sanitary their barrios, or ‘‘encampments.’’ The new tropical medicine

that developed in the Philippines was therefore as much a manifestation of

military administrative logic as an expression of the rising enthusiasm for

germ theories. Military strategy and practices of population management,

more than laboratory science, would give distinctive form to modern public

health in the Philippines. Indeed, the introduction of laboratory methods

was dependent upon, and not responsible for, the administrative reform of
crowd control and personal conduct in American colonial medicine.
In this chapter I want to chart a military genealogy of modern tropical
hygiene.≤ It is necessary, then, to focus on the development of colonial war-
fare, with its distinctive and novel tactics and styles of deployment. Doctrines
of colonial warfare, devised in the 1890s, differed from those of continental
engagement. Colonial wars generally were fought in remote countries over
large areas of unknown territory: the aim was not the destruction of the
enemy, but, as Jean Gottman suggests, the ‘‘organization of the conquered
peoples and territory under a particular control.’’ ‘‘Instead of bringing death
into the theater of operations, the aim [was] to create life within it.’’≥ In 1900,
Hubert Lyautey summarized the new principle of colonial strategy: avoid the
column and replace it with ‘‘progressive occupation.’’ ‘‘Military occupation,’’
he wrote, ‘‘consists less in military operations than in an organization on the
march.’’ The goal was to cover new territory with a network of disciplinary
structures, including a network of hygiene. Colonial warfare at the turn of the
century was thus recognized as being inseparable from administration. Ac-
cording to Lyautey, ‘‘the occupation deposits the units in the soil like sedimen-
tary strata’’—it created a new, more favorable terrain.∂ In this sense, the
strategy and tactics of modern tropical public health might repeat and en-
hance colonial military strategy and tactics.∑ Moreover, in a colonial war,
with dispersed and mobile military forces whose goal was reformation of the
population, there was a special emphasis on developing intelligence (which
after all is nothing more or less than military and medical analysis of foreign
bodies) and a pressing need for communication, standardization, and regis-
tration. These military and medical requirements gave rise to a characteristic
form of administration, and it was within this structure that bacteriology and
parasitology eventually would be recognized as useful tools.
Fought initially in a conventional continental style, the Philippine-
American War late in 1899 assumed more the character of colonial warfare,
as Filipinos began to avoid fixed engagements and turn to skirmishes and
other guerilla tactics.∏ In the archipelago, and especially in the main island
of Luzon, colonial warfare would, toward the end of the campaign, thus
become the major conduit through which the administrative practices of
the army sanitary bureau flowed into and recanalized a subject population.
The notion that colonialists might keep themselves healthy behind a cordon
sanitaire—the sense that a sanitary enclave might protect them from environ-
mental and social nuisances—was not completely abandoned, but it gradu-

46 military basis of colonial public health

ally gave way to efforts, which still to some appeared quixotic, to reform the
presumed morals and behavior of ‘‘native races,’’ to recultivate the social ter-
rain.π The practice of progressive occupation signaled a shift from disregard
of the health of local inhabitants to meticulous attention to their personal
and domestic hygiene, from enclavist alienation to disciplinary extension. In
creating a new public health in the tropics, American colonialists were com-
mencing a ‘‘civilizing’’ project—a ‘‘nation-building’’ program—that might, in
the distant future, transform their new subjects into approximate, if not to
their minds authentic, citizens.

from military hygiene to

colonial public health
‘‘After things are more settled there is ample time for the germologist,’’ wrote
Surgeon Joseph A. Guthrie: in the meantime, ‘‘there are macroscopic topics of
more consequence.’’∫ Guthrie’s views were common among medical officers
during the first year or so of the Philippines campaign: neither their train-
ing nor the exigencies of war permitted extensive microbiological investiga-
tion, while attention to the older landmarks of pathology and to sustaining
the soldier’s resisting powers seemed to work well enough. The surgeon ini-
tially concentrated on environmental risk and constitutional vulnerability, on
knowing the territory and watching his men, on assaying a soil both literal
and metaphoric—rarely did he focus on germs, the new seeds of disease. But
by the time Guthrie was writing, military conditions had improved for the
Americans, the war was dwindling into skirmishes with guerilla bands, and
resort to bacteriology was becoming more frequent. The new military circum-
stances in which microbes were, in a sense, discovered in the Philippines—or
at least finally made salient in a war against disease—would confer a deeper
social and political meaning on these agents. Germs were no longer mere
concomitants of environmental threat: increasingly they might be located in
local fauna, which included Filipinos, and tracked through local biological
and social networks. After 1900, medical strategies and military tactics de-
rived from mutually reinforcing renditions of the need to contain and disci-
pline the hostile and increasingly mobile agents in the region, whether germ or
insurrecto.
With the advance of the army into Luzon, the settled conditions Guthrie
and others sought were gradually imposed. As Aguinaldo resorted to gue-
rilla tactics, the strategy of General Arthur MacArthur, the army’s field com-
mander, came to resemble more and more Lyautey’s doctrine of colonial

military basis of colonial public health 47

warfare. Thus MacArthur emphasized research and intelligence, that is, the
surveillance of the enemy; the column was divided into small fighting units;
and the control of populations became more important than the defeat of
opposing forces. Destruction was minimized, and a network of disciplinary
institutions was laid down, a new terrain was produced, or settled, in step
with the advance. MacArthur was obsessed with drill and discipline, clear
channels of authority, explicit record keeping, and neatness of dress in sub-
ordinates; he found it hard to deal with civilians unless they conformed to
military style. Civilians had to be rendered obedient, not with armed force but
through administration. ‘‘We have to govern them,’’ he wrote, ‘‘and govern-
ment by force alone cannot be satisfactory to Americans.’’Ω
After 1900 more than five hundred army posts were scattered over the
archipelago in an effort to hold enemy territory. As General George M. Stern-
berg, m.d., reported, ‘‘This change in the character of the service required of
the troops had an important bearing on the medical administration.’’∞≠ The
medical officers who once had concentrated at the general hospitals dispersed
with the regiments. There were not enough for each garrison in a district
to possess its own physician, so hospital corpsmen were often assigned to
smaller detachments and subposts. As the army advanced, MacArthur or-
dered all towns and villages to conform to stringent health standards. He set
up municipal and provincial boards of health to manage sanitary conditions
and to enforce stipulations of hygienic behavior. Local military surgeons from
a nearby post or on secondment organized and watched over the boards.
‘‘The sanitary condition of the garrisoned towns and villages is described as
having been execrable,’’ Sternberg noted. ‘‘Filth of all kinds underlay and
surrounded the houses, and the hogs were not the only scavengers.’’∞∞ Major
L. Mervin Maus, m.d., writing from northern Luzon, imparted that ‘‘owing
to the hostile condition of the country and the facilities offered for harboring
insurrectos and ladrones, etc., the division commander decided to garrison all
the principal pueblos in the limits of the division.’’ Maus too found that
‘‘the sanitation of the towns was extremely bad when our troops entered
them. The habitations of the natives as a rule were surrounded by filth of
all kinds—slops, garbage, fecal accumulations, rubbish, and other débris.
Weeds and rank vegetation were allowed to grow along the fences, in the
yards, and in the streets.’’ But post commanders spoke severely with local
officials and soon ‘‘a great reformation was accomplished.’’∞≤ Similarly, Ma-
jor Franklin A. Meacham, m.d., reported from Tarlac that ‘‘the policing of the
grounds around the barracks and buildings occupied by troops is excellent

48 military basis of colonial public health

and is regularly done.’’ This had set a good example for the local inhabitants,
who were exhorted to follow it. ‘‘Where troops are stationed such policing is
done by the presidente of the town and by the cabezas of the barrios, under
instructions from the commanding officers.’’ As a result, ‘‘countless unsani-
tary evils among the natives have been remedied.’’∞≥
As Lieutenant Colonel Alfred A. Woodhull, m.d., had advised in the many
editions of his Notes on Military Hygiene, it was ‘‘the direct duty of officers of
the line in whose hands is the machinery of control, to maintain the whole ter-
ritory of occupation as unpolluted as a parade ground.’’∞∂ Major Edward L.
Munson, m.d., recommended that ‘‘a complete new sanitary machine, ap-
plicable to the special conditions encountered, must be established without
delay,’’ even though in colonial settings this apparatus frequently met with
disfavor or passive opposition. Such resistance required the military medical
officer with civil ambitions to demonstrate ‘‘high capacity for organization
and administration, combined with good judgment, discretion, force of char-
acter and tact.’’∞∑ Munson himself attempted to display these qualities as a
medical officer in Manila (1902–04), instructor in military hygiene at Fort
Leavenworth, acting director of health in the Philippines (1914), editor of
Military Surgeon, health advisor to governor-general Leonard Wood in the
archipelago (1922–25), and finally as commandant of the Medical Field Ser-
vice School at Carlisle Barracks, Pennsylvania.∞∏ His career thus sutured to-
gether military and colonial hygiene, and he found no impediment to the
transfer of military practices into the colonial civil regime. In particular, he
liked to make analogies between ‘‘military efficiency’’ and ‘‘industrial morale’’
—military drill and discipline therefore were applicable ‘‘with little or no
modification to the industrial problems of civil life.’’ Munson believed mili-
tary and civil ‘‘morale work’’ was fundamentally a ‘‘science of human engi-
neering.’’ Reform of customs and habits and improvement in morale could
make good soldiers and better citizens. But experience showed him that for
some races, including African-Americans and Filipinos, ‘‘it takes time to
abandon old standards and establish new, even with the assistance of the
cohesion under pressure of the military environment.’’∞π Just as well, then, so
it seemed to Munson and his colleagues, American tutelage had some time yet
to exert its impact in the archipelago.
From the earliest days of their occupation of Manila, the army set about
cleaning up the capital. The interim military Board of Health for Manila,
organized by Major Frank Bourns, m.d., in September 1898, had developed
the basic arrangements for sanitation and health care delivery in the city. It

military basis of colonial public health 49

divided the city into ten districts and appointed a municipal physician to
each—again, usually detailed from the military. Lieutenant Harry Gilchrist
conducted a census of the city in 1899, providing a demographic inventory
that informed later medical activities. During this period, separate hospitals
for smallpox, leprosy, and venereal diseases were established, and a veterin-
ary corps organized. A municipal dispensary opened in late 1899.∞∫ Colonel
Charles R. Greenleaf, m.d., reported that the Manila Board of Health, domi-
nated by army officers, had

made great progress in cleaning the streets of the city, in removing filth that has
been accumulating for years, and in regulating, to a certain extent, the purity of
the food supply; it has practically stamped out smallpox by forcible vaccination
and revaccination, where it was necessary, and held in check the progress of
bubonic plague, that, after lodgment in other tropical cities, has speedily be-
come epidemic and caused a frightful mortality; but its work has of necessity
been superficial, and the good results can only be maintained by a vigorous
support from the military authorities, and by a liberal supply of funds.∞Ω

Dean C. Worcester, a notoriously rancorous member of the Philippine Com-

mission and later the secretary of the interior in the civil government, went
out of his way to praise the efforts of Bourns, an old friend, in ‘‘waging war
upon the more serious ailments that threatened the health of the soldiers and
the public.’’≤≠
An extensive system of sanitary inspectors checked for violations of the
regulations. Each of the ten Manila sanitary districts now boasted an Ameri-
can medical officer and subordinate Filipino inspectors, a sanitary corps,
responsible for each division. Since the 1870s, the army medical department
had performed sanitary inspections of the troops, and now these procedures
were transferred over to the civil sphere so as to enable surveillance of the
local inhabitants. Munson, referring to military hygiene, remarked that ‘‘the
skilled sanitary officer should be of methodical and industrious habits, com-
petent in observation, impartial in judgment and conscientious in action.’’
Civil sanitary inspectors required the same qualities. According to the colo-
nial military hygienist, ‘‘men, manners, mind, diet, dress and discipline all fall
legitimately within the province of the sanitary inspector.’’≤∞ As it was in
military life, so it would be in civil affairs.
The new civil Board of Health for the whole of the Philippine Islands,
established in 1901, included the commissioner of public health and the chief
health inspector, with the chief surgeon of the U.S. Army in the Philippines

50 military basis of colonial public health

 figure 8.
U.S. sanitary inspectors
(rg 350-p-e41.3, nara).

and the chief quarantine officer of the U.S. Public Health and Marine Hospi-
tal Service as honorary members. This body drafted legislation to control the
practice of medicine, dentistry, pharmacy, and veterinary science and super-
vised the new provincial and municipal boards of health.≤≤ Policy came from
above, but the demands of routine work and personal contact often led to
considerable flexibility in the actual administration of public health. The local
health boards—over three hundred of them by then—were responsible for
the prosecution of any violations of the sanitary laws and enforced the regula-
tions of the national board. The Filipino elite took charge of these boards,
mediating between the government and local society, although there was
usually an army post surgeon nearby to supervise them.≤≥ After 1903, the
Filipino doctors who headed the boards were sent to Manila to undergo a
training program to fit them for their responsibilities. Through these off-
shoots the national Board of Health extended its operations to every munici-
pality in the archipelago.≤∂
Maus, detailed from the army’s medical department, became the first ‘‘civil’’
commissioner of public health.≤∑ Just one of a cavalcade of military medical
officers passing confidently into the civil service, Maus found that his new
appointment entailed few changes in the scope and character of his work.

military basis of colonial public health 51

According to Greenleaf, Maus during the war had ‘‘established an efficient
working system, restored order, replenished supplies, established hospitals,
and procured reports that had long been neglected.’’≤∏ As health commis-
sioner, he worked eighteen hours a day combating new epidemics of bubonic
plague and cholera, writing new health ordinances, attempting to isolate
lepers and control venereal disease.≤π But soon after taking up his new post,
he fell out with Worcester, who accused him of insubordination and dishon-
esty. Maus claimed Worcester was annoyed merely because the desk of his
brother-in-law, Paul Freer, had been removed from the health commissioner’s
office.≤∫ Eventually Maus was forced out: ‘‘I submitted my resignation,’’ he
recalled, ‘‘feeling I could no longer occupy a position which was subjected to
such unpleasant surveillance and criticism.’’≤Ω But Worcester’s attempt to as-
sert control over the Board of Health was short-lived.
In late 1902, Major Bourns was recalled to take temporary charge of the
board until Major E. C. Carter, m.d., could take over as commissioner of
public health.≥≠ Soon after taking up his duties, and believing that the Board
of Health had by then established ‘‘a reasonable control of sanitary affairs in
Manila,’’ Carter set out to obtain accurate information on the sanitary condi-
tions of the provinces and to secure a public health service in these outlying
regions. He realized that ‘‘specially trained men’’ were required in order to
collect ‘‘reliable data.’’≥∞ To this end, a number of physicians were selected
and trained as sanitary inspectors. The board piled up detailed reports on the
condition of markets and stores, disposal of garbage, the ‘‘situation’’ of the
villages and the character of the ‘‘terrain,’’ water supply, prevalent diseases,
local ordinances and laws on sanitary matters, the ‘‘customs and habits’’ of
the people as they affected health and sanitation, and the diseases found
among cattle and other domestic animals. Scarcely a village evaded this rigor-
ous scrutiny. ‘‘As each township was visited and inspected,’’ Carter recalled,
‘‘a sanitary map of the Philippines’’ was gradually compiled—a topography
both medical and military.≥≤

‘‘what alchemy will change the

oriental quality of their blood?’’
Reporting to President Theodore Roosevelt, Elihu Root, the secretary of war,
observed that the army, ‘‘utilizing the lessons of the Indian wars, . . . has
relentlessly followed the guerilla bands to their fastnesses in mountain and
jungle and crushed them.’’ The American military was displaying ‘‘splendid
virile energy’’ in difficult tropical conditions; ‘‘individual liberty, protection of

52 military basis of colonial public health

 figure 9. ‘‘Uncle Sam’s
new-caught anthropoids’’
(Literary Digest, August
20, 1898). Courtesy of the
University of Wisconsin Library.

personal rights, civil order, public instruction, and religious freedom have
followed its footsteps.’’≥≥ According to Root, the military thus became a
liberal reformist force, attracting and pacifying Filipinos and rendering them
more docile and amenable to American control. Roosevelt happily endorsed
the message. He had already boasted that the army in the Philippines was
proving itself ‘‘a great constructive force, a most potent implement for the up-
building of a peaceful civilization.’’≥∂ In 1902, Roosevelt would insist that the
aim of the war in the Philippines was ‘‘the triumph of civilization over forces
which stand for the black chaos of savagery and barbarism.’’ ‘‘Our armies do
more than bring peace, do more than bring order,’’ he continued. ‘‘They bring
freedom.’’≥∑ Later that year, Roosevelt returned to this theme. In the Philip-
pines, he declared, ‘‘the soldier’s work as a soldier was not the larger part of
what he did. When once the outbreak was over in any place, then began the
work of establishing civil administration.’’≥∏ On another occasion he noted
that ‘‘too much praise can not be given to the army for what it has done in the
Philippines both in warfare and from an administrative standpoint in prepar-
ing the way for civil government.’’≥π
The republican language of civic virtue infused the rhetoric of imperialists

military basis of colonial public health 53

and anti-imperialists alike.≥∫ Roosevelt saw annexation of the Philippines as
the latest installment of the westward expansion that had forestalled corrup-
tion in the American republic and renewed independent virtues such as self-
reliance, industry, and temperance.≥Ω Even as imperialism thus benefited the
United States, there was a dim prospect of it also promoting civic virtue, with
eventual citizen competence and self-government, among Filipinos. But many
anti-imperialists regarded empire as a threat to the republic because it might
permit the incorporation of races utterly incapable of self-determination.
They feared that Filipinos, who seemed permanently unable to maintain or-
derly governments in the Anglo-Saxon fashion, might join the union. William
Jennings Bryan, among others, warned that Filipinos could not become citi-
zens without endangering the republic. He saw no reason to exercise sov-
ereignty over an alien race in a forlorn attempt to elevate it: ‘‘Does history
justify us in believing that we can improve the condition of the Filipinos and
advance them in civilization by governing them without their consent and
taxing them without representation?’’∂≠ Imperialism was at variance with
constitutional government. The islands should be abandoned and Filipinos
left to their own primitive devices.
Regardless of anti-imperialist warnings, the goals of American colonial
government would be frankly reformist. With the development of modern
legal, medical, and commercial infrastructures and the instilling of bourgeois
and democratic values, traditional patterns of social organization were ex-
pected to dissolve, and Filipinos to become reconciled to U.S. control.∂∞ Of
course, neither soldier-administrators nor their nonmilitary successors ex-
pected Filipinos would soon achieve the civic objectives they had been set.
Thus Roosevelt reflected that ‘‘it is a very difficult matter, practically, to apply
the principles of an orderly free government to an Oriental people struggling
upward out of barbarism and subjection.’’∂≤ The president was ‘‘extremely
anxious that the natives shall show the power of governing themselves’’—but
he expected that such accomplishment would take several generations of
tutelage. ‘‘The only fear is lest in our over-anxiety we give them a degree of
independence for which they are unfit, thereby inviting reaction and disas-
ter.’’∂≥ It was, he mused, ‘‘a task requiring infinite firmness, patience, tact,
broadmindedness.’’∂∂
William H. Taft, the first civil governor of the Philippines, heartily agreed
with the president, though he warned that Filipinos were a ‘‘sensitive people’’
who rankled at the label of ‘‘savage.’’∂∑ All the same, ‘‘lacking the American
initiative, lacking the American knowledge of how to carry on a government,

54 military basis of colonial public health

 figure 10. ‘‘The white man’s
burden’’ (Harper’s Weekly,
September 20, 1899). Courtesy of
the Wisconsin Historical Society.

any government there must be a complete failure until by actual observation

and practice, under the guidance of a people who know how to carry on a
government, who understand the institutions of civil liberty, there may be
trained a Filipino element.’’ The Ohio Republican thought he knew how to
carry on a government; he had been doing so through the Philippine Commis-
sion since the middle of 1900, teaching Filipinos ‘‘what individual liberty is
and training them to a knowledge of self-government.’’ ‘‘We have a hope,’’ he
testified, ‘‘that with the imitative character of the people, with their real de-
sire for improvement . . . we can carry out an experiment and justify our
course.’’∂∏ But, like Roosevelt, he felt it would take many generations to lift
them up to civilization. Part of this uplift would be hygienic. Thus ‘‘the grad-
ual teaching of the people the simple facts of hygiene, unpopular and difficult
as the process of education has been, will prove to be one of the great bene-
fits given by Americans to this people.’’ Eventually, then, with American
guidance, Filipinos might show themselves to be ‘‘capable of exercising the
self-restraint and conservatism of action which are essential to political stabil-
ity.’’∂π Self-government was evidently as much a personal need as a politi-
cal goal.

military basis of colonial public health 55

 Bernard Moses, a Berkeley professor of political science and member of
the Philippine Commission, had shaped Taft’s views on native development.
An expert on Spanish-American history, Moses frequently reflected on the
problem of educating ‘‘an alien race, whose thoughts are not our thoughts,
and whose motives it is not always easy for us to understand.’’ For Moses,
‘‘the facts of race distinction’’ lay at the foundation of colonial administra-
tion. Local customs and habits might take generations to change, but he
believed Americans had already managed to ‘‘infect’’ Filipinos ‘‘with the fever
of progress.’’∂∫ Through association with ‘‘a higher form of life,’’ the ‘‘depen-
dent body is drawn into the current of a superior nation’s life, and is carried
along by the momentum of its progress.’’∂Ω However, after millennia of ‘‘bar-
barism’’ and subjection to the autocratic control of Spain, Filipinos lacked the
‘‘political instinct’’ of Anglo-Saxons. It would be necessary to eradicate the
‘‘inordinate conceit’’ of the mestizo—‘‘his inexperience, his half-knowledge
was the basis of his confidence’’—and to govern the archipelago for many
decades before ‘‘habit established by long practice will supplement his knowl-
edge and furnish him certain direction in the conduct of his affairs.’’∑≠ Inde-
pendence, if granted within forty years, would inevitably mean a return to
barbarism.
Professional orators such as Senator Albert J. Beveridge, a Republican
from Indiana, captured eloquently the case for continued civic tutelage of
Filipinos. In 1900, Beveridge declaimed that Filipinos were ‘‘a barbarous race,
modified by three centuries of contact with a decadent race’’; therefore they
were not capable of ‘‘self-government in the Anglo-Saxon sense.’’ ‘‘What
alchemy,’’ he asked, ‘‘will change the Oriental quality of their blood, in a
year, and set the self-governing currents of the American pouring through
their Malay veins?’’∑∞ Having just returned from the islands, Beveridge was
convinced that many years of example would be required before Filipinos
were fully instructed in ‘‘American ideas and methods of administration,’’ for
‘‘in dealing with Filipinos we are dealing with children.’’ Moreover, he be-
lieved that God had marked ‘‘the American people as His chosen Nation
finally to lead in the regeneration of the world,’’ to rescue it from wilderness
and savage men.∑≤ Accordingly, if puerile natives were as yet incapable of self-
government, then they must carefully and gradually be taught how to do it,
whether they liked it or not: ‘‘We govern Indians without their consent, we
govern our territories without their consent, we govern our children without
their consent.’’ Invigilation and constant discipline must accompany the inevi-
table ‘‘march of the flag.’’∑≥

56 military basis of colonial public health

 As Beveridge implied, there were obvious continental models, or ana-
logues, for insular reformation. Taft, for example, lamented that the ‘‘Ne-
groes’’ freed after the Civil War had never been ‘‘trained to self-support or
self-help.’’ He argued that education and ‘‘industrial independence’’ might
promote some progress of the ‘‘Negro race’’ and the ‘‘Filipino people’’: ‘‘ad-
vancement along that path opens up to both the possibility, indeed, the cer-
tainty of attaining all other ideals, intellectual, political, and moral.’’∑∂ Roose-
velt was somewhat less confident of African-American capacities, but he was
able to discern parallels between the civilizing of American Indians and of
Filipinos. Indeed, the president believed that the civilizing of Indians might
result in ‘‘their ultimate absorption into the body of our people,’’ though ‘‘this
absorption must and should be very slow.’’∑∑ Eventually, civilized Filipinos
would attain self-government, while civilized Indians might become eligible
for American citizenship. It seemed possible that hygiene, education, and in-
dustry would in time uplift both groups of ‘‘savages,’’ turning natives into
proletarians. From the 1880s the government had been making an effort to
transform displaced American Indians into docile, property-owning, Chris-
tian subjects: citizenship was granted to those who took up allotments on the
reservations, and a few children attended boarding schools, such as the Car-
lisle Indian Industrial School in Pennsylvania.∑∏ But Roosevelt and many
others still felt that Indians would continue to represent a challenge to the as-
similative capacities of American society. ‘‘Some Indians can hardly be moved
forward at all,’’ he wrote. ‘‘Some can be moved both fast and far. . . . A few
Indians may be able to turn themselves into ordinary citizens in a dozen years.
Give to these Indians every chance; but remember that the majority must
change gradually, and that it will take several generations to make change
complete.’’∑π Organized through the civil Bureau of Indian Affairs, plans for
Indian assimilation remained underfunded, halfhearted, and specious.
After Aguinaldo’s resort to guerilla warfare late in 1899, the U.S. army,
including the medical department, also readily recognized the similarity of
Indian and Filipino. Scattered across the archipelago in posts and garrisons,
medical officers often remarked on how fighting in the Philippines now called
to mind the occupation of ‘‘Indian country’’ before the coming of the rail-
roads, in advance of the cultivation and settlement of the West.∑∫ Indeed,
officers and enlisted men in the Philippines, on occasion, would even refer to
Filipinos as Indians and squaws. But there were limits to such analogies. To
most it was evident that Christian, urban Filipinos were not roaming hea-
thens. When Taft famously claimed ‘‘it is possible for us to govern them as we

military basis of colonial public health 57

govern the Indian tribes,’’ he was alluding not to ‘‘lowland’’ Tagalogs, but to
the non-Christian Moros in the southern Philippines. He continued, ‘‘They
are nowhere near so amenable to education, to complete self-government, as
are the Christian Filipinos.’’ Moreover, colonial warfare in the Philippines
differed significantly from the Indian wars. For example, in the United States
the Sioux and Cheyenne had been forced onto reservations, and whites took
their land; in the Philippines, such displacement was as undesirable as it was
impractical. In America, the alleged civilizing of Indians on the reservations
was hardly more than gestural and decorous, a poor excuse for expropriation
of land. There, pauperism and dependency prevailed, tuberculosis was rife,
and agency physicians were scarce and found little time or enthusiasm for
hygiene reform.∑Ω In the Philippines, though, hygiene and civic discipline
emerged as part of a specific military strategy and were enforced with preci-
sion and care. The army and the emergent colonial state thus attempted an in-
tensive reform and disciplining of Filipinos in situ, to render them more docile
and amenable to distant American control. The U.S. government conferred
the status of national—not quite colonial subject and not quite citizen—on
American Indians and Filipinos, but different colonizing processes meant that
the implications of this term, especially its implied potential for develop-
ment and self-government, would diverge in North American and insular
settings.∏≠

microbial insurrectos
‘‘However much beclouded by sentiment and humanitarianism they may be,’’
Munson wrote in 1911, ‘‘the motives primarily actuating the sanitary service
are, after all, tactical and economic.’’ Moreover, sanitary tactics were ‘‘always
to be regarded as consequent upon and subordinate to general military tac-
tics.’’∏∞ It was necessary to obtain good information on the strength, position,
and movements of human and microbial enemies, on the character of the
terrain, and on where casualties have fallen or are likely to fall. New bac-
teriological techniques could be used to probe the enigmatic foreign environ-
ment and to investigate the purity of water and food; or they might also help
to locate pathogenic agency within insect and human populations. In the
Philippines, bacteriology emerged as a practical tool just when military tactics
began to focus on the organization of the population. The earlier medical
concerns about terrain, climate, and bodily constitution persisted, but interest
in the threat posed by the local fauna became more intense and soon domi-
nated medical strategy, as it did military tactics. Bacteriology, as it developed

58 military basis of colonial public health

in the matrix of colonial warfare, became especially helpful in registering
individuals and populations: it could generate a standardized documentary
record that provided intelligence on past human behavior and monitored
conformity to the rules, or discipline, of modern hygiene—whether the sub-
jects were raw recruits to the army or ‘‘savages.’’ In 1899, the little bac-
teriological investigation that occurred in the Philippines had interrogated the
perplexing environment and errant or ailing American troops; by 1905, bac-
teriology abounded, and it focused mostly on Filipino bodies, generally re-
vealing their defiance of civilized military hygiene or their apparent indif-
ference to such discipline.
The distinctive disease ecology that the microscope was revealing in the
tropics incorporated Filipinos—as ‘‘natural’’ hosts and carriers of the mi-
crobes with which they had evolved—into a network of pathological causa-
tion. Filipinos were thus armed—only to be disarmed—with a weapon more
insidious than any rifle. ‘‘The Filipinos are never free from contagious dis-
eases of one form or another,’’ warned Lieutenant Colonel Henry Lippincott,
m.d., ‘‘and we can never be sure that they are not bringing infection into
our midst.’’∏≤ According to Maus, Americans were campaigning against ‘‘a
densely ignorant race of people, who had as little knowledge or respect for the
abc’s of sanitation as the American Indian at home.’’∏≥ Medical officers for a
time forbade contact with the ‘‘natives.’’ No matter how clean Filipinos might
look or smell, they were still to be distrusted, still potentially unhygienic
insurrectos. ‘‘The natives do not keep their hands clean, although it is said
their bodies are washed daily,’’ wrote Guthrie; ‘‘at all events, they are not
microscopically clean.’’∏∂
Americans felt they battled invisible foes, whether guerilla or microbe, that
could merge with ease into the luxuriant natural realm or into a disorderly
social world. ‘‘One day we may be fighting with thousands of their people
[and] the next day you can’t find an enemy, they are all ‘amigos,’ ’’ Captain
Delphey T. E. Casteel complained. ‘‘They have hidden their rifles and may be
working for you for all you know.’’∏∑ In a guerilla war, the army took up the
slogan ‘‘There are no more amigos.’’∏∏ As for Major C. J. Crane, every thicket
suggested to him the presence of a treacherous Filipino. Insurgents were ‘‘hid-
ing in the mangroves or swamps’’ or disappearing into ‘‘rank vegetation and
dense undergrowth.’’ In ‘‘this struggle with an unseen yet imminent danger,’’
it appeared that ‘‘every Filipino is our enemy,’’ and ‘‘even the dogs seemed
trained to bark peculiarly at an American.’’∏π An intelligence officer reported
from Biñan that Filipinos ‘‘are at this date outwardly friendly to the Ameri-

military basis of colonial public health 59

figure 11. Animal necroscopy room, Army Pathological Laboratory, c. 1900
(Johns Hopkins University Commission). Courtesy of the Alan Mason Chesney
Archives, Johns Hopkins University.

cans, but secretly aid the insurrection.’’∏∫ Indeed, all the fauna in the archi-
pelago, whether human or nonhuman, seemed increasingly duplicitous, ready
at any moment to come into focus, to sting, to infect, to shoot. Had not
Lippincott warned his fellow surgeons that all Filipinos, like the swamp-
dwelling mosquitoes, were potentially carriers of destructive, hidden infec-
tion? Guthrie preferred a more explicit analogy. ‘‘The glands of the skin are
the individuals in a regiment,’’ he explained. ‘‘Weaken the individuals and the
regiment deteriorates.’’ In the Philippines, he continued, ‘‘there is in reserve an
array of living things to prey upon the poor alien’s depleted cuticle.’’ For
example, ‘‘insects prevail in vast quantities, their stings and bites add to the
enemy’s strength, and so we must prepare against many foes.’’∏Ω
Most Americans on arriving in the Philippines, according to Surgeon Guth-
rie, soon became convinced that ‘‘the air, water, soil, the whole earth and its
sundry encumbrances (living and dead)’’ were actually ‘‘reeking in germs.’’
Thus the visitor ‘‘contracted along with his ‘Philipinitis,’ ‘germania.’ ’’π≠ While
Guthrie treated the ambit claims of the ‘‘germologists’’ with skepticism, many
of his colleagues had begun to search for local microbial pathogens and to
reveal their passage through human and insect life. From the beginning, the

60 military basis of colonial public health

First Reserve Hospital had possessed a small diagnostic laboratory, but it
faltered when its first director contracted typhoid and rapidly succumbed to
the disease.π∞ The eventual successor, Richard P. Strong, found himself pre-
occupied with performing autopsies and making cultures of blood, feces, and
urine along with other clinical services—when he was not laid up with Malta
fever. But in 1900, Strong, a recent Johns Hopkins graduate afire with en-
thusiasm for the new bacteriology, was appointed to an army board to investi-
gate the diseases of the archipelago.π≤ As hostilities dwindled to skirmishes
with bands of partisans, more time and personnel might be spared for re-
search. Strong developed his earlier, relatively perfunctory studies of dysen-
tery; W. J. Calvert investigated the transmission of plague; and Joseph J. Curry
attempted to elucidate the cause of the regional fevers, especially those ‘‘un-
influenced by quinine administered in large doses.’’π≥ After repeated blood
examinations and the use of the Widal test, Curry was able to diagnose many
hitherto obscure fevers as typhoid—the rest unfortunately remained obscure.
Strong, however, successfully identified an amoeba as the cause of much of the
dysentery commonly experienced in the islands. Several other cases that came
to autopsy were infected with a microorganism that grew to resemble the
standard culture of Shiga’s Bacillus dysenteriae, which had been sent from
Japan. Stirred by these achievements, Strong and his colleagues set out resolu-
tely to animate microbiologically the tropical environment and its macro-
scopic life forms. He boasted to Sternberg that ‘‘the English as yet apparently
have no good laboratory in the East, and they have expressed considerable
surprise that one has been established and so thoroughly equipped here.’’π∂
From 1900, Manila had a municipal laboratory, derived from the army’s
hospital laboratory, and before long other bacteriological laboratories were
cropping up across the archipelago.

the colonial politics of epidemic disease

The first major test of American bacteriology in the Philippines was an out-
break of bubonic plague late in 1899. The disease arrived from Hong Kong
and persisted at a low level in the archipelago until 1906. Forty-eight cases
occurred in Manila in February 1900; a year later sanitary inspectors re-
ported twenty-seven cases.π∑ Alexandre Yersin had identified the plague bacil-
lus in Hong Kong in 1894, but because the organism, rarely found in the
bloodstream, could be extracted only from the obvious buboes, the diagnosis
was still made mostly on clinical grounds. Moreover, the discovery of a cause
did not, in this case, imply any one mode of transmission. Some physicians

military basis of colonial public health 61

still regarded plague as directly contagious; others, like Patrick Manson, be-
lieved it derived from contact with clothing, soil, and refuse—the bacillus had
recently been found in rats, but Manson regarded them as mere ‘‘multipliers
of the virus.’’π∏ By 1904, Maximilian Herzog at the Bureau of Science in
Manila would wonder if rats and their fleas might actually spread the disease,
but he concluded that Bacillus pestis most likely gained entry to the body
through skin and mucous membranes.ππ
The early sanitary response to plague in Manila involved both control of
personal contact and a campaign against rats. All vessels arriving in the is-
lands were inspected for human cases and for rodents, and if they came from
an affected port they were quarantined. The Board of Health demanded that
those suffering from the disease be isolated; the sickroom was disinfected with
corrosive sublimate or carbolic acid, and ‘‘all valueless clothing and other
effects’’ were burned. It recommended that the public drink only boiled water,
obey ‘‘the rules of general hygiene,’’ and regularly remove any trash. ‘‘Wear-
ing of shoes and stockings,’’ the board advised, ‘‘is an important factor in
preventing plague gaining an entrance into the body through wounds.’’π∫ But
humans were not the only targets of the public health officers. ‘‘In view of the
association between plague and rodents,’’ the nascent Board of Health set
about waging an ‘‘incessant war’’ against the animals. It told house-owners to
replace wooden floors with more sanitary concrete ones, to remove all refuse,
and to burn any rat manure. Squads of rat-catchers fanned out over the city,
visiting each house and setting traps or laying out bane. They concentrated on
areas that had produced the heaviest caseload and examined the associated
disease ecology, attempting to confirm etiological suspicions in the bacteriol-
ogy laboratory. The presence of plague bacilli in some of the local rats seemed
to corroborate their suspected role in the transmission of the disease. In Feb-
ruary 1902 alone, the squads delivered more than twenty thousand rats to the
government laboratory, which examined almost ten thousand microscopi-
cally for bacilli and found thirteen infected.πΩ
During April 1901, the Board of Health sent medical practitioners a letter
drawing their attention to the previously unrecognized phenomenon of ‘‘am-
bulatory plague.’’ It appeared that this condition was frequently encountered
among the Chinese, ‘‘who keep up much longer in severe illness than any
other races here.’’ A Chinese might fall dead in the street without evident
cause, without obvious buboes—just as the rats were doing. ‘‘That such cases
are true plague,’’ the board reported, ‘‘is borne out by the recent investiga-
tions of the Board of Health, autopsies resulting in the finding of the plague

62 military basis of colonial public health

bacillus and the characteristic pathological changes.’’∫≠ Laboratory investiga-
tion in some cases could now prove more sensitive than clinical observation
and focus attention on hitherto unsuspected human elements. While the pres-
ence of buboes remained pathognomic, ‘‘the absence of buboes [did] not ex-
clude plague.’’∫∞ Physicians were expected to watch out for meretriciously
healthy Chinese and Filipinos and employ the bacteriology laboratory to re-
veal scarcely symptomatic carriers, who were ‘‘scattering and implanting the
disease throughout the islands.’’∫≤ Where plague was involved, there would
be no more amigos.
On March 21, 1902, Worcester heard that two patients at San Juan de
Dios Hospital, both Filipino, were suffering from cholera—Strong had con-
firmed the diagnosis when he observed the comma bacillus in hanging drop
slides in the laboratory. Within a day, another fourteen typical cases were
identified, many of them dying soon after diagnosis. Official notification of
the spread of the disease into Hong Kong had been received a few weeks
before, so news of the outbreak in Manila was not altogether unexpected. In
an attempt to block the entry of cholera into the archipelago, Dr. Victor G.
Heiser, the chief quarantine officer, had prohibited the importation of green
vegetables from southern China.∫≥ Whether unexpected or not, the new epi-
demic represented another serious challenge to the civil health administra-
tion. ‘‘Unfortunately,’’ recalled Worcester, ‘‘there was no one connected with
the medical service of the islands who had any practical experience in dealing
with cholera, and we [would have] to get this as we went along.’’∫∂ In meeting
this challenge, the public health administration was to assume a definite and
durable form.
Cholera had visited the archipelago at regular intervals during the past
hundred years. In response to the epidemic of 1882, the Spanish colonial
authorities had stepped up the cleaning of streets, vacant lots, and public
buildings and established four hospitals for the sick. Believing the disease to
be miasmatic in origin, health officials lit fires with tangal, a type of mangrove
bark, and tar at the foci of infection. Burial corps lurched through the mud of
the streets, emerging out of the smoke with the bodies of the dead stacked on
their carts. After a brief service, held outside the church gates, the corpses
were covered with quicklime to counter noxious emanations and buried with
haste. For personal prophylaxis, the mourners, priests, and those who la-
bored to collect the bodies filled quills with camphor and placed them in
their mouths. In the city and the provinces, the enveloping crisis mocked the
government’s plans for an orderly response. People fled in panic, hygienic

military basis of colonial public health 63

figure 12. Burning the cholera-infected district of Farola (rg 350-p-e44.2, nara).

precautions were abandoned, and few victims received medical attention.

Eventually the epidemic had died down of its own accord.∫∑
In contrast to the earlier Spanish response to cholera, American measures
designed to suppress the disease in 1902 placed as much emphasis on control-
ling personal contact and social life as on a general cleanup and spiritual suc-
cor. With the development of bacteriology, health officials could trace the
path of the cholera vibrio and use this intelligence to intervene in daily life and
curtail its spread. Fears of diffuse emanations from the environment and the
dead had lost much of their power. Instead, suspected cases and their contacts
were isolated, removed from their homes, and placed in a temporary tent hos-
pital on the grounds of San Lazaro Hospital, or else concentrated in the
military ‘‘protection zone’’ at Santa Mesa Heights.∫∏ With quarantine strictly
enforced around Manila, no one could trespass the city limits without written
permission of the health authorities. Officers of the Board of Health went
from house to house, day and night, rooting out cases, confiscating and de-
stroying dubious foodstuffs. Nor were more general environmental measures
neglected. Americans, too, lit fires, not mere bonfires to clear the miasmatic
air but great consuming blazes that reduced to ashes the nipa palm houses at
infected foci.∫π The ‘‘less dangerous’’ wooden houses of the more affluent

64 military basis of colonial public health

figure 13. Cholera detention barracks, San Lazaro (rg 350-p-e42, nara).

were simply whitewashed to disinfect them, and the inhabitants forcibly bathed
in a bichloride solution. Patrols of sanitary inspectors and cavalry guarded the
Marikina River, the main source of water for the city.∫∫
But the comma bacillus continued to spread. From March 20 until the end
of the month, 94 Filipinos, 6 Chinese, and 1 American were infected. By
April, 15, 275 cases of cholera had occurred within Manila, with 215 deaths,
including 5 Americans.∫Ω Corporal Richard Johnson, with the 48th Volun-
teers, recalled that the cholera epidemic gave Americans ‘‘more scare than
anything coming from the insurrectors, because with them we could defend
ourselves with rifle and bullets, but cholera was an enemy whose presence we
were unaware of until his fatal stroke.’’Ω≠ More resources were committed to
combat the disease. The Board of Health sought the advice of Munson, a
military hygienist already famed for his ‘‘administrative and organizing abil-
ity, sound judgment, initiative, and forcefulness of an unusual order.’’Ω∞ The
Philippines division commander ordered 31 medical officers to report for
duty with the civil health service. Some were detailed as sanitary inspectors or
quarantine officers, others took charge of the cholera hospital and detention
camps, and a few ventured out to the provinces to take control of the pueblos
where the disease had broken out. Each sanitary inspector was supplied with

military basis of colonial public health 65

a disinfecting spray pump, disinfectants, and ‘‘a corps of men versed in that
special work.’’Ω≤ Similarly, the staff at the cholera hospital and the detention
camps would resort to internal antisepsis to treat the sick. Patients received
enemata containing 1/1000 benzozone as well as the more conventional ‘‘hy-
perdermics of strychnia,’’ hot water bottles, and general symptomatic reme-
dies. Benzozone, an experimental drug discovered by Dr. Paul Freer at the
Manila Bureau of Science, promised ‘‘excellent results in the treatment of this
dreaded disease,’’ but it was to prove distressing and useless.Ω≥ Most cholera
patients died, and their corpses were cremated, though some, as before, were
covered in quicklime and buried in sealed casks.
Provincial centers invoked quarantine regulations in an effort to halt the
spread of the disease, but postwar population movements and food shortages
meant that protective barriers were constantly flouted. When cholera found
its way to Biñan, the local authorities took to cleaning and disinfecting the
victims’ houses; they tried also to isolate all contacts for five days. But after a
physician from the Board of Health came to set up a detention camp and a
cholera hospital, the contacts ‘‘fled to all parts of the pueblo, and its barrios,
taking the disease with them wherever they went.’’Ω∂ To make matters worse,
rumors about house burnings circulated. The public uproar caused the aban-
donment of plans for a detention camp. Surgeon George D. De Shon found
‘‘the sanitary work of combating this disease among an ignorant and super-
stitious people, impoverished by war, locusts and rinderpest, and embittered
by conquest . . . an extremely difficult task.’’Ω∑ In general, medical officers
attempted, like Captain C. F. de Mey, ‘‘to rule with a rod of steel.’’ While their
power was never absolute, they expected to become ‘‘the commanding officer
of a city when that city is threatened with or has an epidemic.’’Ω∏
Although cholera terrified the Americans stationed in the islands, it was
principally a disease of the Filipino poor—and it was the poor, too, who
endured the heaviest burden of American sanitary intervention. Fearing the
destruction of property, the dissolution of bonds of family, and the infliction
of painful and apparently pointless experimental treatments, many Filipinos
tried to conceal suspected cases. Maus detected a feeling among the natives
that ‘‘the disease was colic, probably resulting from the use of green rice, and
that the Americans resorted to these extreme measures unnecessarily, and
probably for purposes of revenge.’’Ωπ His wife complained that ‘‘one can
scarcely realize what it meant to feed and water this horde of ignorant, panic-
stricken people.’’Ω∫ Luke Wright, the acting governor-general, reported that
‘‘ignorant natives resent our modern methods of dealing with cholera.’’ΩΩ

66 military basis of colonial public health

figure 14. Line-pail brigade, Manila, during cholera epidemic
(rg 350-p-e44.21/2, nara).

Rather than report a case, many Filipinos were prepared to take affected
relatives or friends into the rice fields during the night, or occasionally they
might dispose of the dead by throwing them into the Pasig River or burying
them secretly. This resistance did have some effect. During May, Maus de-
cided to abolish the detention camps and instead to isolate all contacts in their
houses.∞≠≠
The poor might resist ‘‘passively,’’ but the Filipino elite, already accom-
modating themselves to the new regime, could voice their objections and
make them heard. Evidently, the apparently arbitrary cruelty, accompanied as
it was by restrictions on commerce, incensed Filipinos at all levels of society.
Dr. T. H. Pardo de Tavera, one of two Filipinos on the Philippine Commis-
sion, wrote to Governor Taft, warning that ‘‘the people fear the Board of
Health a great deal more than they fear the epidemic. The sanitary inspectors,
white, brown, black, civil and military have committed and still commit all
kinds of abuses.’’ From the provinces he had heard complaints ‘‘against the
barbarities committed by health agents.’’ At Pasig, for example, the provincial
treasurer ‘‘set fire to a house where a victim of the cholera had died and the
flames extended to two neighboring houses,’’ while the provincial inspector

military basis of colonial public health 67

went about with ‘‘a gun on his shoulder in order to intimidate the people to
make them obey sanitary laws.’’∞≠∞ Pardo de Tavera, as a physician, appreci-
ated the need for such laws and supported their rigorous enforcement, but he
could not condone the accompanying brutality and disruption. Like other
Filipinos (and even Worcester), he had found Maus especially abrasive and
severe; but Carter, following Munson’s advice, would prove a little more
conciliatory, at least toward local elites. It was later believed that Munson’s
style of dealing with ‘‘people of different races whose manners and customs
are alien to ours’’ had enabled the Board of Health ‘‘to obtain active public
support, instead of opposition, even for the extremely stringent measures
which were necessary during the cholera campaign.’’ This ability ‘‘to handle
difficult situations without arousing opposition, and to secure not only ac-
quiescence, but enthusiastic cooperation’’ would become an even more valu-
able quality, though still a rare one, in the health department after 1902.∞≠≤
Americans frequently used their modern laboratory to confirm and further
specify previously vague etiological suspicions. Regulations prohibiting the
peddling of all drinks and cooked foods on the streets had come into force at
the outset of the epidemic. Subsequently, Strong’s laboratory examined many
samples of food, along with some flies snared in infected dwellings. As ex-
pected, the microscope revealed cholera vibrios in much of the cooked rice
that was left exposed and attached to some bluebottle flies. ‘‘These flies,’’
observed Maus, ‘‘are commonly bred along the side of the esteros, which are
emptying grounds for numberless private sewers and latrines. . . . Cases which
have been observed along the banks of certain esteros may be accounted for
by food infection from blue-bottle flies.’’∞≠≥ On the basis of this intelligence
from the laboratory, the Board of Health inaugurated a campaign against
insects and the unsanitary human practices, especially those involving defeca-
tion, that were allowing them to multiply and spread disease.
Within a year, the epidemic abated. After June 1902, the number of deaths
in Manila from cholera steadily diminished; in January 1903, only 4 suc-
cumbed.∞≠∂ Before the disease finally was checked in Manila there were 5,581
cases and 4,386 deaths, while in the provinces more than 150,000 were in-
fected and perhaps as many as 100,000 died.∞≠∑ Even in May 1902, Louis D.
Baun, a teacher, wrote to his mother, ‘‘The cholera seems to be on the de-
crease, but the authorities look after every case closely. The Dr. said yesterday
that the Spanish doctors claim it is not cholera at all; not enough people have
died. They do not take into account all the means that the Americans have
used to prevent its spread.’’ He went on, ‘‘Another sanitary inspector just

68 military basis of colonial public health

figure 15. Fighting cholera with wholesale disinfection. Courtesy of the Rockefeller
Archive Center.

showed up. . . . They certainly are doing enough inspecting.’’∞≠∏ As the mor-
bidity and mortality from cholera fell during 1902, the quarantine around the
city was lifted, and a number of sanitary inspectors left the health service. The
Board of Health had by then developed a basic organization and mode of
action—an administrative apparatus forged in the crucible of colonial war-
fare and melded with the new bacteriology—that would prove exceptionally
durable.

‘‘an entire nation had to be rehabilitated’’

‘‘At the end of the Spanish-American War,’’ Victor G. Heiser later noted, ‘‘the
United States was confronted with large responsibilities in the field of tropical
sanitation . . . an entire nation had to be rehabilitated.’’∞≠π It seemed obvious
to Heiser, who was director of health in the Philippines from 1905 until 1915,
that ‘‘as long as the Oriental was allowed to remain disease-ridden, he was a
constant threat to the Occidental who clung to the idea that he could keep
himself healthy in a small disease-ringed circle.’’∞≠∫ Thus he hoped to trans-
form the Filipinos from ‘‘the weak and feeble race we have found them into
the strong, healthy and enduring people they may yet become.’’∞≠Ω His method
required the modification of personal habits of Filipinos—to render them
more self-disciplined—as well as an old-fashioned attention to environmen-
tal nuisances. Heiser undertook the rigorous enforcement of vaccination,

military basis of colonial public health 69

hygiene education, isolation of the diseased, quarantine, sewage disposal,
improvement of housing, clothing, and nutrition, water and food examina-
tion. He introduced periodic health checkups and ensured the distribution of
effective doses of quinine. By 1912, his Bureau of Health had a staff of three
thousand, two hundred of whom were physicians. He had a small army of
sanitary inspectors in the field preparing detailed reports on every town in the
islands, daily during epidemics, weekly otherwise. In these circumstances
Heiser boasted of his ‘‘almost military power’’ and pointed to his ‘‘sanitary
squads.’’∞∞≠ ‘‘Necessarily,’’ Heiser recalled, ‘‘we had to invade the rights of
homes, commerce and parliaments.’’∞∞∞
Heiser did not come from the military but from an institution in part
modeled on it: the U.S. Public Health Service (phs). An orphan who had lost
his German-American parents in the Johnstown floods, Heiser put himself
through Jefferson Medical College and then studied bacteriology and hygiene
in order to pass the Marine Hospital Service (later phs) examination. He
soon made a name for himself devising a more efficient system for medical
inspection of immigrants from southern Europe. An ascetic and authoritarian
functionary, Heiser found the administrative goals and strategies of the phs
entirely congenial. He had entered a career corps with military ranks and
uniforms and an emphasis on drill, hierarchy, and efficiency. Walter Wyman,
the surgeon general of the phs, had recently compiled a manual of procedure
that reduced to writing every step in the handling of correspondence, ac-
counts, appointments, and other administrative tasks.∞∞≤ Responsibilities and
authorizations, whether for routine transactions or policy matters, had to be
set down in detail, as they were in the military, and in the civil health service in
the Philippines. Heiser was thus preadapted to the military model of the
Philippine health service and would accept without hesitation the advice
of more experienced medical officers like Munson, Maus, and Carter. For
Heiser, the Philippines would prove ‘‘a huge laboratory in which my collabo-
rators and I could work out an ideal program.’’∞∞≥
The laboratory was emerging as an ideal discursive space, an exemplary co-
lonial site—a symbol of control, purity, and precision that initially was far
more significant than the routine practices of bacteriological investigation
that went on within it. Colonial military tactics and protocols of population
management remained fundamental in disciplining Filipinos, and the army
camp still presented an appealing image, but the laboratory implied an even
greater capacity for intervention and manipulation. For Heiser and his col-
leagues, their representation of the Philippines as tropical laboratory sug-

70 military basis of colonial public health

gested an ability to vary scale from macro to micro: it meant they might treat
its inhabitants as though they occupied the sterile, hygienic space of experi-
mental practice. But the notion of the Philippines as a laboratory suggested a
discursive possibility, not an accomplished technical transformation. Achieve-
ment of this ideal would still depend on their application of administrative
techniques to manage colonial populations more than on expert knowledge of
bacteriology and parasitology. Not that knowledge of microbiology was irrel-
evant to efforts to ‘‘wash up’’ the Orient. It would provide useful intelligence
and determine the location and direction of public health maneuvers: micro-
biological reconnaissance identified the causes and carriers of disease, tested
for compliance with the rules of personal and domestic hygiene, and registered
populations. But laboratory science alone would not imply any one course of
action. The Philippine health service remained, above all, an organization on
the march: when cholera broke out, military administrative logic suggested it
seek intelligence, send out sanitary squads, burn houses, and isolate trouble-
makers, in the same way the army had suppressed or diverted insurrectos in
the archipelago.
Preventive measures also were markedly homologous. New doctrines of
colonial warfare demanded intense surveillance and discipline of local popu-
lations: it was supposed that reform of the social and moral terrain, a pol-
icy of attraction and transformation, would pacify and subjugate the na-
tives, turn supposed savages into docile, disciplined subjects. It was no longer
enough to protect and bound, militarily and medically, a colonial garrison or
enclave: the goal now was to occupy and organize a territory and a people,
cultivating new forms of life, regenerating customs and habits within the new
‘‘protection zones.’’ This did not mean coddling local populations, any more
than military surgeons were coddling troops: the notion of attraction in colo-
nial warfare did not connote enticement; rather, it implied an involuntary,
magnetic force. ‘‘Health in the tropics,’’ Heiser argued, ‘‘is largely a matter of
observing simple hygienic rules rather than of climate.’’∞∞∂ Just as raw recruits
to the army were trained and transformed into disciplined soldiers, so might
the medical officer and sanitary inspector attempt to reeducate Filipinos, to
make them proper, retentive colonial subjects. Through the discipline of hy-
giene, Filipinos might eventually become properly self-governing. Of course,
there was little expectation that Filipinos really did possess the capacity for
hygiene that even the most ignorant rural American troops could demon-
strate; hence full hygienic citizenship would in practice be deferred, and colo-
nial supervision and training continue indefinitely.

military basis of colonial public health 71

 Colonial warfare was not the only influence on the emergence of American
public health in the Philippines, but it was a powerful adjuvant, promoting
the growth of features that might otherwise have turned vestigial. Since the
1870s, interest in social pathology had developed in North America and
Europe at the expense of older concerns with geographical and climatic deter-
minants of disease.∞∞∑ In the Philippines, the exigencies of colonial warfare
would further focus attention on mobile human agency. Similarly, the op-
timistic interventionism of the military surgeon at the end of the nineteenth
century should not be separated from the rise of Progressivism and social re-
form movements in the United States during this period.∞∞∏ But the medical
officer’s self-confidence and assertiveness would give specificity and added
impetus to these more general, diffuse reformist trends. The increasingly
widespread recourse to business models and programs for administrative
efficiency also was mirrored in the transformation of military bureaucracy;
but in the Philippines it was the military that became the sole direct means
whereby these organizational changes generated a health service.∞∞π The idea
of ‘‘the gospel of hygiene,’’ the plan to evangelize a Catholic or heathen
population, must have struck a chord with American colonial officials, most
of whom were Protestant; but it was colonial warfare that made proselytiza-
tion a military and medical necessity. Colonial warfare was, at least in part, a
manifestation of broader social and political developments at the end of the
nineteenth century, but it became the first major conduit channeling these
general principles and practices into the Philippines health service.
There are perhaps many routes to modern tropical hygiene, each winding
through a different colonial terrain. It is difficult, then, to generalize from
the intimate symbiosis of public health and colonial warfare in the Philip-
pines. Certainly the political, professional, and military situation in the Phil-
ippines was unusual. The United States was trying to set up its first colonial
health service at the same time as it waged a war of progressive occupation;
there were no enclavist medical traditions or existing colonial bureaucracies
to overcome; and ambitious American imperialists regarded themselves as
uniquely efficient, reformist, and scientific. It was not, as they frequently
pointed out, the British Empire—it was especially not India. But American
administrators worked hard to represent the Philippines as the model colonial
health service. Worcester was delighted to observe ‘‘the impact of American
methods on those previously in vogue in neighboring colonies. At first our
efforts to make Asiatics clean up . . . were viewed with mild amusement, not
unmixed with contempt; but the results we obtained soon aroused lively

72 military basis of colonial public health

interest.’’∞∞∫ According to Heiser, it was ‘‘generally conceded that the medical
literature produced in the Philippine Islands is more voluminous, and has a
greater scientific value than that of all the other countries combined. These
writings have also had an important role in molding opinion with regard
to medical and sanitary matters of other portions of the Orient.’’∞∞Ω Thus
Worcester and Heiser tried hard to make the colonial military diction of
hygiene in the Philippines the lingua franca of modern tropical medicine.

military basis of colonial public health 73

Chapter Three

‘‘only man is vile’’

W hen Andrew Balfour spoke to the London Society of Tropical Med-

icine and Hygiene in 1914, his subject was ‘‘Tropical Problems in

the New World,’’ and he had new information that would startle some of

his audience and reassure others. Balfour announced that Captain Weston

Chamberlain, m.d., of the Army Board for the Study of Tropical Diseases in

the Philippines had recently reported on his investigations of the ‘‘physio-

logical activity of Americans in these islands and the influence of tropical

residence on the blood.’’ It seemed probable that the tropical climate itself

exercised no harmful influence on the white residents. ‘‘By far the larger

part of the morbidity and mortality in the Philippines is due to nostalgia,

isolation, tedium, venereal disease, alcoholic excess, and especially to in-

fections with various parasites.’’∞ Chamberlain’s laboratory studies thus chal-

lenged long-held medical theories of inevitable white degeneration in the

torrid zone. During the military campaigns at the turn of the century and

under the new civil regime, American physicians had carefully monitored

their white patients for any signs of such deterioration. Public health offi-

cials and army surgeons sought to protect whites from insalubrious circum-

stances, regulating their clothing, diet, housing, and personal conduct. Now it
seemed that such concern had been either redundant or remarkably effica-
cious: whites were not—not yet, anyway—especially degenerate or unmanly
in the Philippines. They either had been robust enough to prosper anywhere
all along or were now insulated sufficiently well not to register the change
in milieu.
In the new laboratories of the Bureau of Science in Manila, Chamberlain
and his colleagues were translating colonial governance into the positive lan-
guage of biomedical science, expressing their confidence in the racial resil-
ience of white male colonialists, and their anxieties about the bodies and
customs of ordinary Filipinos.≤ As they studied the blood and the physio-
logical activity of white males in the tropics, scientists allayed older fears of
physical (if not mental) deterioration in a foreign realm. Whiteness and man-
liness seemed tougher, or at least more readily armored, than any of the army
surgeons in the early days of the Philippines campaign had ever expected. At
the same time, the modern laboratory was demonstrating repeatedly that
alien blonds and brunets had more to fear from contact with a variety of
native fauna—some evidently diseased and some meretriciously healthy—
than from exposure to rays of the tropical sun. Scientists in Manila con-
firmed and elaborated earlier concerns about the dangers of insurrectos and
insects, giving further microbiological effect to their respective bolos (knives)
and stings. Together, the Bureau of Science and the Army Board for the Study
of Tropical Diseases produced a white male body that was more or less indif-
ferent to tropical relocation and European and Malay racial bodies with ap-
parently natural, though not necessarily fixed, differences in disease carriage
and susceptibility. That is, science helped to reframe the boundaries of white-
ness in the Philippines, neutralizing or overcoming environmental contain-
ment and making racial contact ever more salient and medically significant.
It is important to give equal weight to these two trends in colonial bio-
medical research: the exoneration of the tropical milieu and the racializing of
pathogen distribution. Both emerged during the military period, the first a
result of rising faith in the effectiveness of sanitary management of troops, the
second a result of the strategic premises of guerilla warfare among settled
populations. With pacification, both research programs were taken up and
amplified in the biological laboratories of the civil Bureau of Science and the
army board, the bureau mostly (though not exclusively) focusing on Filipino
pathology and the board on white physiology. Colonial scientists like Cham-
berlain sought to reconfigure environment and race in the tropics, helping to
resolve old fears of racial displacement and to reinforce anxieties about racial

‘‘only man is vile’’ 75

contamination. When Balfour finished reporting to the Society of Tropical
Medicine, Sir Ronald Ross, probably the most distinguished tropical scientist
in the audience, rose to endorse Chamberlain’s findings and to confirm that
the white races, striving to conquer savages, need not fear foreign climates:
the unsanitary ways of local inhabitants were far more menacing.≥ As Balfour
observed, science might yet demonstrate the truth of the couplet ‘‘Where
every prospect pleases / And only man is vile.’’∂

the white man’s climatic burden

During the American military campaign, fear of the deleterious effect of the
climate on the white race was for a time expressed in an especially raw and
accentuated manner. Such concern had earlier pervaded Spanish medical the-
ory, and it lingered in the American colonial bureaucracy until well into the
twentieth century. The Spanish colonial commitment to neo-Hippocratic doc-
trines, which assumed a dynamic interaction of human bodies and their en-
vironment, is not surprising. It was after all a commonplace of nineteenth-
century European medical theory that a race’s temperament and physiology
were adapted to its place, and any dislodgement would imply hazard. This
‘‘ethnic moral topography,’’ as David Livingstone describes it, accorded with
popular beliefs about the need to stay in harmony with one’s circumstances.∑
But the persistence into the twentieth century of this vision of races and
proper places is perhaps more remarkable. Even as scientists were postulat-
ing theories of harder, more robust heredity and identifying microbiological
rather than physical causes of disease, ideas of environmental fit and stress
continued to appeal to the public and to many doctors. Thus the experience of
discomfort and nostalgia in foreign lands for many years still popularly con-
noted pathological sequelae, whatever the staffs at the bureau and the board
might say.
The Philippines had long ago established a reputation as an unsavory spot
even for southern Europeans. In the middle of the nineteenth century, as the
number of Spanish in the archipelago multiplied, some physicians speculated
on the effect of the climate on Mediterranean physique and mentality. In
1857, Dr. Antonio Codorniu y Nieto, a sanitary officer with the military gar-
rison in Manila, considered ‘‘the nature of the modification of the human
body in the Islands’’ and especially the potential for ‘‘degeneration of the
race.’’∏ He observed that ‘‘Europeans who arrive in the country as adoles-
cents, full of virility, especially suffer the effects of acclimatization; new condi-
tions modify their temperament in certain ways, generally in relation to the

76 ‘‘only man is vile’’

constitution, and influence their growth and development.’’ For all Spanish
sojourners, ‘‘acclimatization in the Philippines means alteration in the organ-
ism as it is tested in a trying, humid climate: the loss of digestive activity,
diminution of respiration, impoverishment of metabolism, and in sum, a
tiring of the blood that gives rise to nervousness, of the sort one sees in the
local races.’’ Codorniu was particularly worried about the insidious disease of
nostalgia, ‘‘which consists of a state of moral suffering, of sadness and desper-
ation, attacking most Europeans, but principally those engaged in a military
career.’’π The precise outcome of tropical residence depended on the initial
quality of the constitution and the part of the islands where one resided.
Eventually, though, all aliens would degenerate unless revived in a cooler
climate: ‘‘The European who decides to stay in this country for an indefinite
period must do what is needed to refresh his blood, that is, he must move after
six to eight years to a temperate country, staying there as long as necessary to
restore his temperament; thus he will recover his dash and enough vitality to
counteract another period of enervation in a hot and humid climate.’’∫
When Fedor Jagor, a German ethnologist, traveled through the archi-
pelago in the late 1850s he found the long-term Spanish residents ‘‘unedu-
cated, improvident and extravagant.’’ In the fertile, torrid zone—a ‘‘lotus-
eating Utopia,’’ according to the ethnologist—they had adopted the slack
standards of the natives. The hospitality of nature had made them louche and
dissolute. As the Spanish residents acclimatized to the Philippines, they were
sinking into ‘‘a disordered and uncultivated state,’’ gradually becoming indis-
tinguishable from the natives. In Jagor’s opinion, only the Spanish and Por-
tuguese possessed the constitutional wherewithal to take root in tropical
countries in this lamentable way; northern Europeans like him would sicken
and die before they degenerated and so must limit themselves to brief visits.Ω
At the end of the century, just as they were about to be displaced from the
islands, a few Spanish commentators would come to express greater confi-
dence in their ability to withstand tropical circumstances. Dr. Victor Suarez
Caopalleja, for example, still expected that dampness combined with high
temperatures might produce ‘‘paludic’’ fevers and mental and physical fatigue
in whites. He saw some of his compatriots become ‘‘pusillanimous,’’ pessimis-
tic, ‘‘pathologically selfish,’’ and melancholy in the Philippines.∞≠ He could
detect ‘‘modifications in the individual and in the race, characterized by in-
dolence, submissiveness and laziness, which follow the febrile activity of the
first few days, and a certain apathy especially for anything that does not lead
to fortune.’’ There were many cases of ‘‘facial pallor, sometimes earthy yellow

‘‘only man is vile’’ 77

skin tone; thinness, pronounced sunken eyes; loss of appetite; restless sleep; a
general sense of fatigue that permeates all limbs.’’ But Suarez now believed
this doleful condition might be prevented or alleviated with proper attention
to hygiene. ‘‘The fortified body subject to good methods of hygiene is a safe
harbor undisturbed by common illness, and difficult even for epidemics to
assault. Take care that the skin, which shields the organism,’’ advised the
doctor, ‘‘functions well—the result of plentiful water and a wise disposi-
tion.’’∞∞ Fortunately, the Philippines were not nearly as insalubrious as most
other tropical countries and certainly not as uncomfortable for whites as West
Africa was proving. For Suarez, writing in 1897, the biological prospects for
Spaniards in the Philippines had never looked better.
On their arrival in the archipelago, American military and civil leaders
reiterated older Spanish fears of degeneration in the tropical climate. The
prospect seemed especially grim, as we have seen, for white soldiers, who
labored hard in such hostile, foreign conditions. But even members of the
executive government could feel imperiled. In 1902, Governor William H.
Taft attested that ‘‘the tropical sun induces leisurely habits,’’ and so was
utterly antithetical to vigorous Anglo-Saxonism. It was ‘‘dangerous for Amer-
icans to expose themselves to the midday sun.’’ For most of the day, the harsh
tropical sun would ‘‘not permit the European or American to exercise under it
with impunity. There is no doubt about that.’’∞≤ (Then again, Taft, a famously
obese man, had never shown much inclination for exercise in his native Ohio
either.) The governor was especially worried about the effect of the climate on
white women and children: ‘‘The nervous strain upon adult females due to the
high temperature . . . is great, and at the end of two years they ought to go and
be refreshed in a cooler climate.’’ He recommended too that white children
head north to temperate lands after they reached the age of fourteen: other-
wise they grew up ‘‘so rapidly that they become weedy in their make-up.’’∞≥
Evidently, Taft believed there was no hope of permanent white settlement in
the tropics. Nature had decreed that white itinerants or sojourners, not set-
tlers, would administer the American colonial state. In every picture of Philip-
pine progress there would remain ‘‘a somber background of a baneful climate
making it impossible for the American or the European to live in health and
strength in the islands for any length of time.’’∞∂
When Hubert Howe Bancroft surveyed ‘‘the new Pacific’’ in 1899, he
observed that in the tropics ‘‘the heat is trying, being moist, and the air too
often malarious.’’ The historian of the American West concluded, ‘‘While for
a time and with care the several races may live anywhere on the globe, unless

78 ‘‘only man is vile’’

it be at or near the poles, the white man cannot live and labor permanently in
the tropics.’’ Accordingly, ‘‘we may give ownership but not the occupation
of the tropics to the white race.’’∞∑ Other commentators on the new em-
pire echoed Bancroft’s misgivings. Charles Morris, in his imperial handbook,
announced that although no serious diseases were prevalent in the islands,
‘‘most of the deleterious effects upon whites are direct results of the tropical
severity of the climate.’’∞∏ The Reverend William Elliot Griffis, an expert on
Japan and the Far East, went further in climatic disparagement. ‘‘Many re-
gions in the tropics,’’ he warned, ‘‘are like a steam bath, and the heat and
moisture together are oppressive beyond the power of the Anglo-Saxon to
endure.’’ Ever skeptical toward expansionism, Griffis thought it proved that
‘‘the tropics were never meant for the white man to live in or to greatly
concern himself about.’’∞π
Some medical authorities initially endorsed Taft’s pessimism. Sitting in a
stuffy room of the Manila audencia in July 1899, the Philippine commis-
sioners had questioned two visiting American medicos on the biologically
correct form of American tropical imperialism. ‘‘We would like to know
particularly,’’ the commissioners asked Simon Flexner and Lewellys Barker,
‘‘what effect the climate and maladies would have on Americans coming here,
whether they could endure the climate or not.’’∞∫ The pathologist and the
physician, on leave from Johns Hopkins and still on their tropical tour, had
bad news. ‘‘The climate,’’ lamented Barker, ‘‘seems to affect Americans espe-
cially with regard to their assimilation. People who have lived here a long time
grow gradually pale. . . . Women especially grow pale, and the European
children have a tendency to anemia.’’ White Americans might live in the
tropics a few years, but they should never try to labor there: ‘‘I think a great
many men would sicken, and if they tried it for two or three generations
without replenishment from home, to use a slang expression, they would
peter out.’’ Barker had endured the climate for some months before giving his
testimony and so could speak with conviction: ‘‘Someone had said that here
the sun is always dangerous, and I am inclined to think so. I have felt it
very much.’’∞Ω
For many Americans in the civil government, their experiences of discom-
fort and fatigue in the tropics still readily translated into portents of disease
and degeneration. Typically, Herbert Ingram Priestley, a teacher in Nueva
Caceres [Naga City], found he had ‘‘some little trouble getting acclimated.’’≤≠
Soon after arrival, he ‘‘went out a little too late and the heat was sickening. It
makes one sick at his stomach,’’ he wrote to his mother (November 10, 1901).

‘‘only man is vile’’ 79

A year later he reported that ‘‘the doctor says the climate is wearing on me and
I guess it is. I am down to 166 lbs and tho’ I have a normal appetite and rest
normally with a little aid from drugs, I have some very unpleasant half hours
of profuse sweating, with nervous morbid apprehensions which are especially
trying to a person of my sensitive temperament’’ (October 19, 1902). He felt
that ‘‘the air seems to contain very little ozone, and the steady high amount
of perspiration, with the never ending drag on one’s vitality, seems to pre-
dispose one to colds’’ (December 21, 1902). But he hung on until October
1904. A sense of discomfort and displacement also afflicted Emily Bronson
Conger, an otherwise self-possessed nurse known appropriately as Señora
Blanca. On first encountering the heat of the tropics ‘‘one gasps like a fish
out of water and vows with laboring breath: ‘I’ll take the next steamer home,
oh, home!’ ’’ The climate of the Philippines ‘‘seemed beyond physical en-
durance . . . exhaustion without relief. The only time one could get a breath
was about five o’clock in the morning; in the middle of the day the sun’s rays
are white-hot needles . . . and even if one carries an umbrella the heat pierces
directly through.’’ She felt the pores of her pale skin had been ‘‘weakened by
excessive exudation,’’ leaving her exposed to all the evils of the region.≤∞
In 1905, Fred W. Atkinson, the superintendent of education, observed that
long residence in the Philippines caused ‘‘loss of memory’’ and ‘‘loss of ability
to spell.’’ ‘‘Caucasians grow pessimistic and suspicious after a few years’ stay;
and those who do not stand the climate are apt to become hypersensitive and
hypercritical.’’ Dengue fever prevailed during the period of acclimation, and
intestinal disorders were common thereafter. By eating good food, following
regular habits, consuming no alcohol, and avoiding the midday sun, while at
the same time limiting their mental and physical exertion, whites might live in
the Philippines for a few years without too much suffering. But tropical condi-
tions meant that ‘‘no extensive settlements of Americans in the archipelago
are likely to be made for years to come, if ever; extensive colonization by us
seems to be precluded.’’≤≤
Major Charles E. Woodruff, m.d., confirmed the apprehensions of Atkin-
son and other colonial bureaucrats. A disaffected and irritable medical officer,
Woodruff dedicated himself to warning his more complacent fellows of the
dangers of tropical light for blonds and brunets. He contended that exposure
to the ‘‘actinic,’’ or ultraviolet, rays of the tropical sun led to racial decay and
degeneration. The actinic rays, he argued, produced ‘‘some kind of chemical
breaking up which renders [the cell] paretic,’’ leading at first to a misleading
sense of ‘‘stimulation,’’ but soon followed by a chronic ‘‘low vitality of tis-

80 ‘‘only man is vile’’

sues.’’ Not surprisingly, then, the poorly pigmented ‘‘blonds suffer in the
Philippines more than brunets, have higher grades of neurasthenia, break
down in larger numbers proportionately, and in many ways prove their unfit-
ness for the climate.’’≤≥ In an influential monograph, Woodruff explained that
the white race should never live closer to the equator than fifty degrees: ‘‘Even
in New Zealand and Australia the native white families are already dying out
or kept alive by constant new importation from home.’’≤∂ Accordingly, the
white man should not try to colonize the Philippines, for colonization was
doomed to fail biologically. Instead, Woodruff advocated a ‘‘commensalism’’:
a careful expansion into the tropics based on mutual aid.≤∑
In 1913, soon after he arrived in the Philippines, Francis Burton Harrison,
the new Democrat-appointed governor-general, received a letter from Wood-
ruff warning him to stay out of the sunlight. ‘‘Mrs. Harrison and I,’’ re-
sponded the governor-general, ‘‘are making it a point to keep indoors at least
during the hours of noon and three o’clock, and to keep ourselves and our
children out of the strong sunlight all the time that it is possible.’’≤∏ Mark
Twain once had pilloried American efforts to shine the light of civilization on
‘‘the person sitting in darkness’’—but now, ironically, it seemed it was the
white imperialist who would be compelled to recline in the gloom.≤π

white physiology in the tropics

With longer tropical experience, some American medicos gained confidence
in white robustness, or at least in the race’s ability to insulate itself from
insalubrious physical circumstances. Wallace de Witt, m.d., found the Philip-
pines’ climate ‘‘very enervating, lowering the natural resistive power against
disease.’’ But like an increasing number of his colleagues, the medical officer
attributed most disease to failure to obey ‘‘a few simple sanitary laws’’—
especially those relating to contact with unhygienic Orientals—and generally
exonerated climate as the prime culprit.≤∫ William S. Washburn, m.d., the
chairman of the Philippine civil service board, believed that the archipelago
was actually more ‘‘comfortable and hygienically favorable for the treatment
of many diseases’’ than any other country at that latitude. In any case, he
could cite a number of scientists who had argued that ‘‘the European may,
under proper sanitary conditions, transplant himself anywhere.’’≤Ω Indeed, it
now seemed that ‘‘evidence is accumulating that the rate of mortality among
the white race now living in the tropics is less than that of the native popula-
tion.’’ In the past too much reliance was placed on military statistics. ‘‘Disease
and death invariably accompany the invasion of an army into any country,’’

‘‘only man is vile’’ 81

he told the congress of the Philippine Islands Medical Association, ‘‘whether
it be in the temperate or in the torrid zone.’’ But as conditions stabilized and
‘‘hygienic living’’ became established, rates of white morbidity and mortality
declined: ‘‘Regular habits, the leading of a temperate life, and the absence of
indulgence in excesses, have much to do with one’s health in any country.’’≥≠
In conclusion, Washburn quoted Major General Leonard Wood, m.d., the
governor of Moro province and a former Rough Rider, who believed that
‘‘Americans can live and do good work where any other white race can. A
moral life, with plenty of hard work, will be found to counteract in most cases
the so-called de-moralizing effects of the Philippines climate.’’≥∞
Laboratory scientists in the archipelago soon began to capitalize on the
dispute between white racial possibilists and environmental pessimists. In
1905, Dr. John McDill, the president of the American-dominated Philippine
Islands Medical Association, advocated further analysis of the ‘‘vast amount
of clinical material under the control of the Bureau of Science’’ in order to
determine if the tropical climate would undermine white physiology. For ‘‘if
the United States is to continue its governmental relations indefinitely, the fact
that Americans can lead healthful lives in the Philippines is important of
itself.’’≥≤ Created in 1905 from a reorganization of the Bureau of Govern-
ment Laboratories, the Manila Bureau of Science provided a haven for those
medical officers who sought a career in research. From their headquarters in
Manila, army and civilian scientists sought to reinscribe the archipelago, pro-
ducing rigorous environmental descriptions, detailed ethnographies, labora-
tory reports, discussions of sanitary engineering and architecture, and ex-
tensive physiological investigations. Statistics and scientific rationality were
supposed to supplant anecdote and mere experience. From 1906, the inves-
tigations of the second Army Board for the Study of Tropical Diseases supple-
mented the bureau’s work. Until it was temporarily disbanded in 1914, the
board would take advantage of ‘‘the vast field for original research which has
been opened up for our medical officers by service in the tropics.’’≥≥ Its scien-
tists undertook diagnostic work for the army, collected specimens for the
Army Medical School, and conducted experiments on white soldiers and Fili-
pino scouts, investigating unknown fevers, the microbial carriage of healthy
men, and the acclimatization of blond and brunet recruits.
Scientific research in the Philippines contributed to at least a partial dis-
solution of the sense of tropical peril that had accumulated over the pre-
vious century. Some investigators at the Bureau of Science challenged directly
the notion that the tropics represented a distinctive pathological site. They

82 ‘‘only man is vile’’

figure 16. Bureau of Science, Manila (rg 350-p-e27-32, nara).

decried Woodruff’s theories of special actinic danger. Hans Aron argued that
‘‘the spectrum of the sun’s rays does not extend much, if any, further into the
ultraviolet in Manila than in Northern climates.’’≥∂ His colleague H. D. Gibbs
concurred, having demonstrated that ‘‘when the normal intensities are com-
pared, the light of the tropics is no different from any other region.’’≥∑ When
Alfred O. Shaklee exposed his experimental monkeys to the sunlight of Ma-
nila he found they died from heatstroke after varying periods, depending
more on the proximity of a fan than on any quality of the sun’s rays. Evi-
dently, exposure to direct sunlight caused such an increase in body tempera-
ture that the poor animals succumbed to hyperpyrexia, just as they would in
temperate climates. In every case, Shaklee noted, those with darker pelts died
more quickly than those with light fur, on account of their greater absorption
of heat.≥∏ Therefore the ‘‘white organism’’ might not inherently be a trans-
gressor against tropical nature.
Perhaps the most striking demonstration of the dangers of pigment envy
was the remarkably influential test of colored underwear. In 1907, concerned
about Woodruff’s claims, Lieutenant Colonel W. T. Wood, the inspector gen-
eral of the army in the Philippines, asked the army board to conduct a long-
term study of orange-red clothing to see whether white Americans might arti-

‘‘only man is vile’’ 83

ficially adapt themselves to tropical conditions.≥π The army had always been
interested in sunstroke and fatigue on the parade ground, even in temperate
regions, so the study of acclimatization in the tropics seemed an obvious out-
let for its scientific energies. Over the following three years, James M. Phalen
and his fellow investigators supplied five hundred soldiers with orange-red
long underwear and compared their well-being in the course of a year with
another group wearing conventional white undergarments. Each man had his
own case record, detailing age, height, nativity, hair and eye color, com-
plexion, and length of tropical service. The investigators regularly measured
the research subjects’ weight, pulse, and respiratory rate—while some re-
cruits were followed more closely with blood pressure readings to determine
the ‘‘effect of short exposures to the sun.’’ Astoundingly, men attired in the
orange-red lingerie, far from being protected, showed marked changes due to
heat, such as loss of weight, and falls in hemoglobin and blood pressure, all
worse than among achromatic controls. Moreover, most of the research sub-
jects hated their colorful garb, finding it itchy and heavy, and tried to discard
it altogether. Phalen concluded that colored underwear was more receptive to
heat rays than white, since wearers had complained so bitterly of greater heat
and perspiration. He expressed the opinion that ordinary khaki clothing pro-
vided enough protection from the sun’s rays, without any of the evils of
colored underwear.≥∫ In this case, to have color had actually been disabling in
the tropics.
Until the board began taking the temperature of white men in the tropics,
most authorities had believed that European metabolism increased near the
equator. As early as 1839, John Davy published his observations of the mouth
temperature of seven healthy young Englishmen on a voyage to Ceylon. He
found that Europeans became hotter as they passed from a temperate zone
into the tropics, and those long resident there generated abnormally high
temperatures.≥Ω Thirty years later, Alexander Rattray confirmed the rise in
metabolism, but he based this conclusion on recordings of the mouth temper-
ature of only a few young men as they sailed from London to Bahia, Brazil.∂≠
Chamberlain, however, took three thousand mouth temperatures at quarterly
intervals from six hundred healthy American soldiers in the Philippines and
found no appreciable variation with season or complexion. The average tem-
perature hardly differed from that of white men living in the United States.
‘‘The matter is of some importance,’’ Chamberlain suggested, ‘‘in the selecting
of recruits and civil service employees for tropical countries.’’∂∞
The impact of white displacement to the tropics on blood pressure, or

84 ‘‘only man is vile’’

‘‘tension,’’ was more ambiguous. Evidently it was important that white men
maintain their tension in a potentially depleting, relaxing tropical environ-
ment. As Phalen and H. J. Nichols surmised, ‘‘If loss of physical or mental
tone is measurable in objective terms it has seemed to us that blood pressure
readings should show it.’’∂≤ In 1910, W. E. Musgrave and A. G. Sison, from
the Bureau of Science, examined 97 white Americans, 10 Sisters of Charity,
and 40 Filipinos, all of them resident in Manila. The investigators concluded
that a long stay in the tropics reduced blood pressure—Filipinos showed by
far the lowest tension—perhaps as a result of decreased peripheral resis-
tance.∂≥ But Chamberlain disputed these findings in the following year. He
took the pressures of 992 American soldiers, making 5,368 observations, and
he concluded that ‘‘the average blood pressure of 115 to 188 millimeters
found in these large bodies of men differed little, if any, from the accepted
standard among males of the same age in a temperate zone.’’ The indefati-
gable researcher conceded that temporary variations might still occur, such as
a rise on exertion or a fall due to flushing of the skin, similar to the effect of a
hot bath in a temperate country. But these changes would prove evanescent
and certainly not pathognomic of tropical life.∂∂
Another commonplace of the old medicine of warm climates was that the
‘‘quality’’ of European blood deteriorated in moist heat. Europeans in equa-
torial outposts often appeared unnaturally pale and sallow, the likely victims
of ‘‘tropical anemia.’’ Most experts assumed that the ‘‘thinness and poorness’’
of the blood—an incontrovertible sign of racial degeneration—derived from
climatic conditions alone.∂∑ But not until the early twentieth century was the
microscope used to reveal the constituents of white blood in the tropics. After
Chamberlain performed 1,718 red cell counts and 1,433 hemoglobin estima-
tions from 702 American soldiers, he found that the figures ‘‘do not differ
from the normal at present recognized for healthy young men in a temperate
zone.’’∂∏ Most cases of anemia in the tropics were the result of malaria or
hookworm, and with proper hygiene these parasites might be avoided.
Still, Chamberlain and Captain Edward Vedder did detect a few regional
abnormalities in the blood of white soldiers and Filipinos. In each group, but
especially among Filipinos, the total number of leukocytes, the white blood
cells, was less than expected, while the number of eosinophils, yellow-staining
blood cells, was higher than it should have been. Moreover, when the com-
position of the diminished white cells was analyzed, the investigators discov-
ered that the ‘‘less-mature’’ polymorph fraction of the total count was greater
than that found in healthy Europeans living in a temperate climate.∂π Cham-

‘‘only man is vile’’ 85

figure 17. Biological laboratory, Bureau of Science (rg 350-p-e57-20, nara).

berlain felt that this ‘‘disturbance of the normal proportions of different varie-
ties of leukocytes is probably common to most primitive and semi-civilized
peoples in the tropics.’’ He concluded, ‘‘We may therefore look upon Igorots
(and probably most Filipinos) as having a chronically increased percentage of
eosinophiles and small lymphocytes.’’∂∫ The coincidence of blood picture and
supposed racial morphology is marked: Filipinos showed an abundance of
yellow-staining cells and fewer white cells, which were in any case mostly
small or immature. But the scientists did not regard this pattern—unlike the
later discovery of the abo blood groups—as a primary racial characteristic;
rather, they interpreted it as a feature secondary to disease carriage. Of
course, the behavioral propensity to acquire and spread disease organisms
might still have a biological substrate organized by race, but the emergence of
a similar pattern in whites suggested that blood picture was at best a very
unstable and indirect racial marker. Chamberlain and his colleagues chose to
regard this pattern not as evidence of degenerative change per se but as an
effort to cope with an increased load of specific pathogens. Thus similarities
in the blood pictures of Filipinos and whites resident in the topics merely
indicated that American standards of hygiene were becoming more lax or that
colonial emissaries were making too much contact with the locals—and not
that a process of irreversible climate-induced degeneration was under way.∂Ω

86 ‘‘only man is vile’’

 American scientists in the tropics were refiguring white males as resil-
ient or well-armored bodies, surrounded by a relatively harmless, exploitable
physical environment. The chief threat to their health appeared to come from
contact with disease-dealing natives and insects—and, as army medical of-
ficers had shown, such proximity to potentially pathogenic local ‘‘fauna’’
might be limited or rendered innocuous through meticulous hygiene. This
white corporeal self-assertion implied the production of an alienated, or de-
natured, type of body, one that was almost impervious to physical circum-
stance. The influence of climate on mentality, however, was not so readily
dismissed: the specter of ‘‘tropical neurasthenia’’ would, as we shall see, con-
tinue to haunt even the most optimistic proclamations of a white conquest of
the region and to menace the promoters of a global white civilization.∑≠ But
the laboratory studies in Manila had at least discounted older anecdotal and
crudely empirical accounts of inevitable European physical degeneration in
the tropics.∑∞ In the tropical laboratory, the dirty, humid, complex environ-
ment, with its diverse animal and human populations, had been converted
into controllable specimens and measurements, simplified and standardized,
and then further consolidated as figures in the scientific paper. Bruno Latour,
writing about Louis Pasteur, has observed that ‘‘in this series of displace-
ments, no one can say where the laboratory is and where the society is.’’∑≤ But
even as the laboratory suggested a variation in the scale of colonial society
and environment, not everyone was convinced, or ‘‘enrolled’’ in the activity,
and some hardly noticed what was happening. It was perhaps premature for
Victor Heiser to claim in 1906 that already in the Philippines ‘‘the microscope
supplanted the sword, the martial spirit gave place to the research habit.’’∑≥
The process of making the whole archipelago laboratory-like would continue
for some time yet.

immunities of empire
In the early years of the twentieth century a new language of immunity largely
substituted for increasingly discredited talk of the risks of acclimatization. Of
course, older theories of racial acclimatization were, in a sense, already based
on assumptions about natural immunity, or susceptibility, to place and cli-
mate. But immunity was a term rarely invoked in discussions of acclimatiza-
tion. It was not until the development of germ theories in the late nineteenth
century that the word immunity seemed to find the right culture medium and
began to proliferate, giving rise to new variants such as acquired immunity
and sanitary immunity. This fin-de-siècle mobilization of immunity did not,
however, leave behind all racial traces: the supposition that racial difference

‘‘only man is vile’’ 87

would somehow shape disease occurrence and expression proved remarkably
resilient. Whereas before native races had been deemed naturally fitted to
their proper place and therefore normally in a state of health, now it seemed
more likely that these races had acquired immunity—with some perhaps
inherited—to the specific germs that happened to prevail there.
The novel idea that immunity might be acquired through exposure to a
specific microorganism in infancy generally received a facile racial gloss.∑∂
Washburn discerned that ‘‘natives of the Philippines eat and drink with com-
parative impunity articles of food and water, the use of which by white men is
disastrous.’’∑∑ Examples of such default from individual acquired immunities
to broad racial typologies are legion. William B. Freer, a schoolteacher and
occasional doctor to his charges, observed that smallpox ‘‘is never entirely
absent from the Philippines, but so many generations of Filipinos have experi-
enced it that it does not, as a rule, go badly with them. But woe to the
American who contracts the disease. He invariably suffers severely, and the
malady usually takes its most malignant form, that known as ‘black small-
pox.’ Such cases are nearly always fatal.’’∑∏ Freer’s brother, Dr. Paul C. Freer,
the director of the Bureau of Science, explained the apparent immunity of
Filipinos to local ailments as ‘‘a process of heredity [in which] the substances
that confer certain types of immunity on individuals of a race have been
produced by a course of development concomitant with the other manifesta-
tions of immunity.’’∑π Therefore, over many generations, the acquired immu-
nities of the indigenous people to the diseases that surrounded them had in
effect become natural, heritable, and racial.
The apparent racial homogeneity of lowland Filipinos aided early medical
efforts to construct a simple dichotomy of white susceptibility and native
immunity. The views of Colonel L. Mervin Maus on Philippine racial types
were conventional in this regard. Apart from some highland, or isolated,
‘‘Negritoes’’—the Igorots most famously—‘‘the native Filipino belongs to the
Malay race, or the Oceanic Mongols. . . . Ethnologically, the natives through-
out the archipelago are identical.’’∑∫ Robert Bennett Bean, the professor of
anatomy at the new Philippine Medical School, regarded Filipinos as a dis-
tinct type, though he quibbled about the presence of elementary ‘‘Iberian’’
and ‘‘Primitive’’ varieties. Unusually, Bean tried to differentiate disease pro-
clivities within the race, observing that Iberian Filipinos, who demonstrated
some Spanish ancestry, were ‘‘more susceptible to all diseases but especially to
tuberculosis than the Primitive. This may be indicative that the European and
Filipinos offspring of the Iberian type is less resistant to disease in the tropics

88 ‘‘only man is vile’’

than is the aboriginal type on its own soil and in its natural environment.’’∑Ω
Bean expected that the Iberian element would therefore soon breed out and
ultimately disappear. But to most scientists and physicians, the anatomist’s
distinctions shaded into pedantry: the polarities of white and colored framed
their understanding of disease distribution.
Even as the absolute vulnerability of the white race to tropical disease—
if no longer to climate—was repeatedly asserted, the absolute exemption
of Filipinos from local ailments was soon questioned. With the consolida-
tion of the U.S. hold on the archipelago and with burgeoning interest in
developing Filipino labor, it was becoming clear that Filipinos in fact suc-
cumbed to tropical disease at least as frequently as white Americans, if for
different reasons. Many medical officers had noticed Filipino frailty quite
early. Nonetheless, a few commentators continued to dismiss concerns about
native health. Ralph Buckland, for instance, asserted that ‘‘they are attacked
by light illnesses of short duration, all of which worry the sufferers almost to
distraction.’’∏≠ But Mary H. Fee noticed that her students were afflicted with
‘‘boils and impure blood and many skin diseases. Consumption [tuberculosis]
is rife, and rheumatism attacks old and young alike.’’∏∞ Malaria was common,
though often surprisingly mild, and when plague and cholera swept the is-
lands, they scourged Filipinos more than Americans. The extent of Filipino
illness and infirmity nevertheless came as a revelation to W. Cameron Forbes,
the patrician governor-general. When Forbes visited the new medical school,
Paul Freer showed him a ‘‘rather gruesome dissection’’ and then ‘‘pointed out
that as a result of the first one hundred autopsies they could state positively
that the physically diseased condition of the Filipino was such that he abso-
lutely couldn’t do the work that a well man could.’’∏≤ Forbes found this
information on racial liability disconcerting.
Evidently Filipino racial immunity, whether innate or acquired was less
absolute than many had first thought. William Freer gave a socioeconomic
explanation for the peculiar Filipino susceptibility to local disease: with the
decline in agriculture during the war, most people ate poorly, and ‘‘when
attacked by disease they succumb quickly because, already weakened by hun-
ger, their power of resistance is not sufficient to withstand the ravages of
fever.’’∏≥ Such sensitivity to historical and contemporary misfortune is rare.
Most others attributed this newly recognized liability to moral failings, which
generally were framed as inherently racial, though perhaps not fixedly so. For
if the locals were acquiring diseases that their race presumably had hitherto
resisted, then they must surely have become very depraved indeed. After all,

‘‘only man is vile’’ 89

figure 18. Philippine General Hospital (rg 350-p-e25.5, nara).

Filipinos should have had a long process of exposure and adaptation on their
side, unlike any whites that succumbed; Americans, in contrast, were more
likely the innocent victims of immigration. To Señora Blanca and others,
evidence of tropical disease among Filipinos implied that their naughty, child-
like charges must have been wallowing in filth, enough to overcome their
supposed racial immunity. ‘‘And I looked at them,’’ she recalled, ‘‘saying to
myself, as I so often did, ‘You poor miserable creatures, utterly neglected,
utterly ignorant and degraded’. . . . No wonder that the diseased, the de-
formed, the blind, the one-toed, the twelve-toed, and monstrous parts and
organs are the rule rather than the exception.’’ The Ohio nurse wanted to ‘‘dip
them into some cleansing caldron’’ but resisted the impulse, for ‘‘charity be-
gins at home.’’∏∂ Others would more readily intervene, of course, though their
methods were never quite so harsh.
Scientific evidence of Filipino disease carriage repeatedly reinforced fears
of racial contact—a phobia that the guerilla war had already amplified, if
not prompted. Laboratory intelligence was confirming again and again mili-
tary suspicions that there were no amigos. Just as it became common knowl-
edge that many Filipinos were manifestly unwell, scientists in the archipel-
ago were also revealing more widespread and hitherto disguised carriage of

90 ‘‘only man is vile’’

microbial pathogens. Even healthy Filipinos might be spreading the local
germs to which whites were especially vulnerable. The contraction of venereal
disease from apparently healthy prostitutes provided an increasingly plausi-
ble model for the transmission of most tropical diseases. When Chamberlain
reported on an outbreak of venereal disease among soldiers at Pangasinan in
1904, he observed that even prostitutes ‘‘listed as clean probably contained
some gonococci, and that those who were marked as infected nonetheless
were patronized by soldiers.’’∏∑ The germs or parasites for many other dis-
eases might also be carried secretly. Malaria organisms could now be found
‘‘commonly’’ in the blood of ‘‘healthy’’ lowland Filipinos, especially chil-
dren.∏∏ Chamberlain reported that 92.5 percent of Igorots showed enteric
parasites in their stools, while 95.9 percent of Filipinos were infected, though
usually asymptomatic.∏π P. E. Garrison claimed he had discovered ‘‘one of the
most striking instances in the history of medicine of a population almost
universally infested with animal parasites.’’∏∫ A local population, then, pos-
sessed at best only a limited clinical resistance to local disease—just enough to
render a large number of them carriers, and a few of them victims, of sur-
rounding microbial pathogens.
Major Charles Woodruff, as chief surgeon of the department of Luzon, in
1903 had issued a circular warning that perhaps one in five Filipino scouts
carried the malaria parasite. Yet they ‘‘never had any symptoms of the disease
whatever, the organisms apparently being harmless through racial immu-
nity.’’ Even though the Filipinos were unharmed, ‘‘they are a source of fatal
infection to white men, who do not possess this racial immunity.’’ ‘‘You are
therefore to consider,’’ Woodruff ordered, ‘‘all apparently healthy native sol-
diers as possible sources of fatal infection to whites.’’ He went on to suggest
that natives with malaria would not benefit from treatment with quinine, as
the malaria germs in their blood lacked the vitality they acquired in nutritive
white blood. Whites, however, always needed copious quinine.∏Ω
It was during this period that Patrick Manson, the founder of tropical
medicine, changed his mind about liability to typhoid: in 1914 he decided
that natives no longer seemed to enjoy absolute immunity, and the disease
was ‘‘by no means uncommon among all classes.’’π≠ In 1915, in his book
Infection and Immunity, Victor C. Vaughan reported that evidence from the
colonies suggested that ‘‘variations in susceptibility among the races is not so
great as once believed’’: more thorough research had revealed that malaria
was ‘‘highly prevalent’’ among Africans; and if there was any immunity to
yellow fever, it was acquired by light exposure in early infancy.π∞ By 1920

‘‘only man is vile’’ 91

figure 19. Operating room, Philippine General Hospital (rg 350-p-e28-6, nara).

Aldo Castellani and Albert Chalmers had concluded that native races at best
were ‘‘partially immune hosts [who] act as reservoirs or carriers,’’ enabling
‘‘the parasite to complete its life-cycle without producing marked pathologi-
cal changes in the host.’’π≤ Racial immunity proved imperfect, thus fashioning
native races as biological reservoirs to contain local disease organisms. Ac-
cordingly, we find emerging the figure of the meretriciously healthy carrier of
disease—a condition of pathogenicity that in the tropics would always be
associated with racial difference, however this was marked.
If previous subclinical exposure of individuals—or adaptation of the race’s
ancestors—had fashioned Filipinos as potential reservoirs of tropical patho-
gens, to white Americans it seemed that unhygienic racial custom and habit
would ensure that this potential was realized. An appreciation of supposedly
insidious cultural practices, especially those concerning defecation and eat-
ing, soon supplemented the emerging biological understanding of disease
transmission and acquisition. Generally regarded as primitive and foolish,
Filipino customs took on a more intimate and frightening significance. The
race’s patterns of behavior explained not only its unexpectedly vitiated immu-
nity; they also suggested a source of danger for the utterly unprepared white
immune system. Thus Filipino customs and habits would now prompt a sense

92 ‘‘only man is vile’’

of danger as much as thoughts of impurity. It appeared the natives were
unable or unwilling to take necessary precautions against acquiring, trans-
porting, and distributing the disease organisms most virulent to whites.
For James A. LeRoy, the Filipino’s ‘‘shocking ignorance of sanitary prin-
ciples as regards his house and community’’ was still chiefly a problem for the
Filipino—it accounted for the evident impairment of the race’s immunity to
local pathogens. Although unhealthy habits might explain the deficit in Fili-
pino labor power and attest to racial immaturity, they caused LeRoy no
anxiety.π≥ But other Americans felt more threatened by the proximity of dis-
eased Filipino bodies and ‘‘disease-dealing’’ Filipino behavior. Edith Moses,
the wife of the secretary for public instruction, found that rendering her house
sanitary required ‘‘continuous oversight’’ of ‘‘twelve ignorant, superstitious
Orientals’’; when cholera struck in 1902, she ‘‘hosed off the ‘China boys’ and
Filipinos with disinfectants’’ to prevent the spread of germs. ‘‘I made their
eyes stick out with fright by describing a cholera germ. . . . They go about with
their mouths shut tight, scarcely daring to open them lest a microbe pops into
them.’’π∂ Few accounts of domestic colonial life during this period fail to
discuss the treacherous behavior and embodiment of servants.
The search for ‘‘healthy natives’’ as sources of disease—their microbiologi-
cal interrogation—was intrinsic to the new tropical hygiene. If Filipinos once
were thought to be completely immune to typhoid, now their race was prima
facie evidence of germ carriage. When the disease appeared at Camp Eldridge
between July and October 1909, the post surgeon attempted to determine the
source of the infection. The first suspects were nearby natives, but the presi-
dent of the local Board of Health, ‘‘an American resident of the town since
1902 and a physician,’’ knew of no recent cases in Los Baños.π∑ Attention
then turned to the detection of ‘‘one or more typhoid bacillus excretors in the
command’’—but fecal specimens were negative. All the same, the post sur-
geon thought it wise to ensure that additional measures ‘‘were taken to pre-
vent the contamination of food from excreta.’’ Guards at the latrines checked
that ‘‘all deposits are promptly covered with a liberal amount of dry earth and
that each man washed his hands after defecation in a one percent solution of
tricresol.’’π∏ Dishes and food were screened from flies, drinking water was
thoroughly boiled, the use of raw native vegetables was forbidden, and ‘‘two
natives employed in the company as dishwashers were dismissed,’’ although
producing negative specimens.
In practice, the term healthy native referred to a deceptive appearance,
not to any exemption from disease carriage. It usually implied a qualifier:

‘‘only man is vile’’ 93

figure 20. Dean C. Worcester with provincial governors and doctor ‘‘starting his trip
through the wild man’s country.’’ Courtesy of the Rockefeller Archive Center.

apparently. When typhoid broke out at Ludlow Barracks, the post surgeon
reported that ‘‘my first effort was to discover a possible carrier. The natives
and kitchen force around Co. ‘I’ were tested for ‘Widal’ reaction and later the
cooks of other companies were examined.’’ππ No asymptomatic carriers were
detected. Yet the surgeon decided, regardless of any bacteriological result,
to issue orders ‘‘forbidding natives, laundrymen, etc., to sleep under bar-
racks. . . . Natives were prohibited from touching or eating from any dish used
by soldiers.’’π∫ Although it was later determined that the typhoid epidemic
arose from drinking of contaminated water, and no native disease carriers
had ever been identified, his report concluded, in part, that ‘‘natives are un-
controlled as to their personal hygiene and are undoubtedly a source of dis-
ease. Malaria, filarial diseases, cholera, dysentry [sic] and hookworm diseases
as well as typhoid must be distributed by these natives who as laundrymen,
kitchen and dining room servants, woodchoppers and private servants swarm
around every barracks.’’πΩ
Physicians did not hesitate to magnify the threatening microbial pathology
that lurked within native bodies. Malaria, the most typical of tropical dis-
eases, provides the best example. Wherever microscopy was undertaken, it
revealed that many Filipinos harbored ‘‘so-called latent malaria.’’∫≠ Charles
Craig, a member of the army board detailed to Fort William McKinley, sought
out the cause of the high incidence of malaria among enlisted men at the post.

94 ‘‘only man is vile’’

His suspicions led him first to examine blood specimens, taken ‘‘somewhat at
random’’ from natives in a nearby town. These indicated that ‘‘the same
general latent infection of Filipinos, both children and adults, which has been
observed elsewhere in the Islands, exists in this community’’: 28 of 45 adult
Filipinos and 87 of 180 children had latent infections.∫∞ Craig concluded, ‘‘In
view of the well-known proclivity of the native soldiers for sleeping out of
quarters and the convenient location of the native houses which shelter their
wives and children, who take no precautions against mosquitoes, it is not
surprising that latent malaria exists.’’∫≤ The results had confirmed the impres-
sion, now common, that ‘‘the greatest source of danger to the white man in a
malarial locality lies in the native population, especially in the native chil-
dren.’’ Therefore, it would be ‘‘futile’’ to attempt to ‘‘rid any locality of malaria
so long as the native element in the question is neglected.’’∫≥

toward a sanitary immunity

What, then, was to be done? In theory, new research on the individual im-
mune response to specific disease might be harnessed to confer on everyone an
appropriate stock of antibodies and white cells. Paul Freer extolled experi-
ments based on the idea that ‘‘a natural immunity may be increased or one
which is scarcely existent may be rendered apparent and protective by the
introduction of cells, or the products of these cells.’’ In pursuit of this goal, the
serum laboratories of the Bureau of Science produced an enormous variety of
trial vaccines and sera—but their use remained limited.∫∂ Whether for techni-
cal, financial, or administrative reasons, colonial health authorities preferred
to rely on sanitary engineering and stipulations of personal hygiene to control
the transmission of pathogens. Automatic immunological protection might
have made behavioral reform seem avoidable.∫∑ Until 1915, smallpox vac-
cination was the only large-scale program of biological protection in the
archipelago.
In the early twentieth century, the enforcement of stipulations of personal
and domestic hygiene was by far the major concern of the mature public
health department. The basic assumption was that purer personal, domestic,
and social life might confer on Filipinos a new sanitary immunity, augment-
ing the partial or inadequate physiological immunity that permitted disease
carriage. Victor G. Heiser, for example, imagined himself ‘‘washing up the
Orient’’—and not just vaccinating it. Public health measures involving train-
ing, discipline, and surveillance focused increasingly on the regulation of
personal conduct as a means to control the transmission of newly identified

‘‘only man is vile’’ 95

figure 21. Vaccinating schoolchildren. Courtesy of the Rockefeller Archive Center.

microbial pathogens. But the peculiar and refractory social life of the Fili-
pinos supposedly complicated the sanitary officer’s task. Heiser lamented the
profusion of their ‘‘incurable habits.’’ He cited as obstacles the ‘‘unsuitable
dietary of the people, their peculiar superstitions concerning the contraction
of the disease, their almost unshakable fear of night air as a poisonous thing, a
fear which has kept their houses tightly closed at night for generations past,
their habit of chewing betel nut which has made the custom of expectorating
in public . . . universal.’’∫∏ Without an acquired biological protection, ‘‘they
will have to be first cured of their superstitions, which is as great a task as
converting them to new religion; houses will have to be open at night, betel
nut chewing gradually abolished, and then a gigantic anti-spitting crusade
begun, and, last of all, comes the Herculean task of rousing them out of their
inertia.’’∫π Health authorities reached out to those who had not yet contracted
disease to emphasize ‘‘they live in constant danger of infection’’ and to point
out that ‘‘the path of safety lies in the maintenance of good general health
through the observance of simple rules of right living.’’∫∫ The prevention of
infectious disease thus chiefly required the treatment of pathological social
habits—not, primarily, vaccination or even the improvement of environmen-
tal, economic, or industrial conditions.
Colonial health officers in the Philippines were thus among the first advo-

96 ‘‘only man is vile’’

cates of what came to be known in the United States as the new public health.
In 1902, on his return from Havana, Cuba, Charles V. Chapin, m.d., the
influential superintendent of health in Providence, Rhode Island, deplored the
fact that in the United States so ‘‘little stress was laid on personal uncleanli-
ness’’ and too much still on ‘‘filth.’’ Like many colonial medical officers,
Chapin now believed that ‘‘personal cleanliness is the most important factor
in the prevention of the infectious diseases.’’∫Ω A few years later, in the ‘‘Fetich
of Disinfection,’’ he pointed to the danger of the healthy carriers of disease,
who ramified further the risk of contact between infected and uninfected. ‘‘It
is our duty,’’ he wrote, ‘‘to teach that hygienic salvation can only be at-
tained through the good works of personal cleanliness.’’Ω≠ Similarly, Charles-
Edward Amory Winslow, another votary of the new public health, warned in
1914, ‘‘It is people, primarily, and not things, that we must guard against.’’Ω∞
But this was old news in Manila. Gradually, in the continental United States
too, the emphasis of local health work would shift from sanitation and en-
vironmental intervention toward a focus on the individual and the manage-
ment of population. The discovery of ‘‘Typhoid Mary’’ in 1907 served to
amplify concerns about the role of healthy carriers in the spread of disease.Ω≤
But in the Philippines, the public health service had been almost from the
beginning predicated on the identification and control of dangerous individ-
uals and the regulation of social contact.
As president of the United States, W. H. Taft also tended to attribute the
origin of reformist American sanitary science to the stimuli of the Spanish-
American War and the need to pacify and purify the Philippines. Advances in
the tropics ‘‘brought to the attention of the whole country the necessity for
widespread reform in our provisions for the maintenance of health and the
prevention of disease at home.’’Ω≥ Having to deal with disease-carrying Fili-
pinos, he told an international congress on hygiene in 1912, had made clear
the need for ‘‘an additional branch of general education in the matter of the
hygiene of the home and of the individual.’’ Initially, the purpose was simply
to make the region ‘‘habitable for white people.’’ But now, colonial medical
authorities were ‘‘engaged in the work of developing the tropical races into a
strength of body and freedom from disease’’—even though the Filipinos’
‘‘natural laziness and resentment at discipline make the enforcement most
difficult.’’Ω∂ Hygiene reform in the Philippines was nonetheless a model for
what might yet be achieved in North America.
The new public health that emerged at the edge of empire was considerably
more racialized in character and military in inspiration and style than the

‘‘only man is vile’’ 97

versions developing at a slower pace along the northeastern seaboard of the
United States. The colonial Bureau of Health had absorbed the army medical
department’s commitment to drill, discipline, and bodily reform—and its dis-
regard of the existing civic structures and sources of power. In the Philippines,
the public health officer could generally work out an interventionist program
with fewer constraints than in the major urban centers of the United States.
Moreover, in the colony, the interventionist health officer would always be as
sensitive as any southern U.S. physician to the boundaries of race—in this
case, to the distinction of native and alien—as he campaigned against per-
sonal uncleanliness and sought to regulate social contact. Race was also a
salient in the North American war against infectious disease, yet it seems
rarely quite as pervasive and encompassing as in colonial skirmishes. In San
Francisco, certainly, epidemics of smallpox and bubonic plague and fears of
venereal disease and leprosy had since the late nineteenth century caused the
public health department to focus on the dangers of Chinatown and later on
the personal pathogenicity of Chinese bodies.Ω∑ Some physicians, especially
those in the South, worried too that African-Americans might be fearsome
vectors of disease. In 1903, for example, William Lee Howard, a Baltimore
physician, argued that ‘‘there is every prospect of checking and reducing these
[infectious] diseases in the white race, if the race is socially—in every sense
of the term—quarantined from the African.’’Ω∏ Also, during the first decade
of the twentieth century, U.S. immigration authorities became ever more likely
to view the bodies of poor, non-Anglo immigrants as potentially diseased or
as potential carriers of disease.Ωπ But in the Philippines, the race card had
trumped all others—even class was secondary. In the United States, the pat-
terns of disease carriage would often appear more complex, and still also more
readily circumscribed by older methods of isolation and quarantine.
American medical efforts to inculcate civic virtue in Filipinos, to improve
the race in order to limit disease transmission, should also be distinguished
from the more conventional forms of colonial public health practiced in the
region. The adjacent French empire in Indochina intermittently displayed an
assimilationist sensibility, but education in hygiene did not really develop
there until the 1920s, although the Saigon Board of Health, established only
in 1907, did issue some health pamphlets before then. Despite the French
republican substrate and some colonial ‘‘mimétisme,’’ it seems that the ‘‘ré-
éducation délicate’’ that Laurence Monnais-Rousselot describes exerted little
influence on the local population until the 1930s.Ω∫ Similarly, the British colo-
nial medical authorities in Malaya and the Dutch in the East Indies demon-

98 ‘‘only man is vile’’

strated little commitment till the 1920s to health education and the modifica-
tion of personal conduct. Although the Dutch had proclaimed an ‘‘ethical
policy’’ for their vast territories at the beginning of the century, interest in
‘‘social evolution’’ and welfare remained scanty in the East Indies until after
World War I.ΩΩ Nearby Siam, later Thailand, was not formally colonized, but
local officials observed British and American health policies closely and fre-
quently sought advice from Malaya and the Philippines. Germ theories infil-
trated Bangkok around 1901, yet for some decades they were adapted to an
older tradition of environmental reasoning. No Thai texts on personal and
domestic hygiene circulated before 1918, and attention to ‘‘population’’ and
‘‘national hygiene’’ languished through the 1920s.∞≠≠ Even Japanese ‘‘scien-
tific colonialism’’ in Taiwan, north of the Philippines, avoided social engineer-
ing during this period, concentrating instead on the creation of ‘‘healthy
zones’’ for vulnerable colonizers. From 1897, Gōtō Shinpei, a Japanese physi-
cian who had trained in bacteriology in Germany and come to admire Prus-
sian state medicine, advised the colonial government on sanitation, but his
‘‘sanitary police’’ and surveillance system remained limited to the healthy
zones. It proved hard to extend this infrastructure to rural areas until the
1930s.∞≠∞ British India, of course, was even more lamentably enclavist during
this period: the leaders of the colonial medical service pressed for more efforts
in health education and rural hygiene after World War I, but achieved little
before the 1930s.∞≠≤
In developing a distinctive new public health that would modify Filipino
customs and habits, whether through education or regulation, the Bureau of
Health was attempting to imbue a distrust of the body and its products, a
dread of personal contact, and a respect for American sanitary authority.
Health authorities targeted toilet practices, food handling, dietary customs,
housing design; they rebuilt the markets, using more hygienic concrete, and
suppressed the unsanitary fiestas; they assumed the power to examine Fili-
pinos at random and to disinfect, fumigate, and medicate at will.∞≠≥ Strict
enforcement of the rules of personal and domestic hygiene promised multiple
benefits: local populations, less manifestly unwell, would work more effi-
ciently and be less likely to carry disease organisms, and they would present
fewer dangers to Europeans (whose own disease-carrying capacity generally
was ignored). In this sense, tropical public health was principally a milita-
rized form of industrial hygiene, first for the colonizer and then for the la-
boring colonized. And clearly the policy of education and supervision had
other advantages. Its goal of nurturing self-control among Filipinos offered to

‘‘only man is vile’’ 99

figure 22. Interior of district health station. Courtesy of the Rockefeller Archive Center.

absolve the authorities from responsibility for both major environmental and
social alteration, including the arranging of segregation—so promising the
great financial savings never far from a colonial administrator’s thoughts.
Moreover, the reform of personal and domestic hygiene accorded in the most
progressive style with the new science of disease causation, transmission, and
acquisition.
Most Americans in the Philippines believed it would take many genera-
tions to replace traditional Filipino customs and habits—which seemed al-
most as characteristic of the race as any morphological feature—with the
‘‘spirit of hygienic thoughtfulness,’’ as Dr. W. E. Musgrave called it.∞≠∂ It was
hard enough to turn raw white recruits into disciplined soldiers—how much
harder to make citizens out of supposed savages? The path of hygiene even-
tually led to civilization, but traffic along it would be slow. The good news
was that Filipinos at least seemed to possess the biological potential to be-
come civilized. When Maximilian Herzog, a pathologist at the Bureau of
Science, weighed the brains of Filipinos who died in Bilibid prison, he found
they were not much lighter than European brains. ‘‘As a race,’’ he reminded
the readers of the American Anthropologist, ‘‘they are of course less mature in
mental, moral, and ethical development; they are more childlike, and their
power of inhibition is not strongly developed.’’ But his anatomical findings

100 ‘‘only man is vile’’

should encourage ‘‘those among Filipinos as well as among the American
people who claim that the Filipinos as a people may be educated to the same
degree of civilization as the Western nations.’’∞≠∑
Observing the early failures to inculcate American excretory habits in Fili-
pinos, Dr. Allan J. McLaughlin lamented, ‘‘It requires a long time completely
to change the habits of a people and it will probably require another genera-
tion to complete the work.’’∞≠∏ When the ‘‘native custom’’ of eating with one’s
fingers was not easily suppressed, Heiser saw ‘‘years of discouraging struggle
ahead of us before they can be broken of so fixed a habit, the menace of which
as yet is entirely beyond their comprehension.’’∞≠π Dr. Thomas W. Jackson,
having lived ‘‘surrounded by Filipino neighbors’’ in a provincial town, where
it had been ‘‘impossible to avoid an intimate knowledge of their manner of
life,’’ endorsed the general pessimism. The first seven years of American con-
trol had seen only minimal improvement in the condition of the market, the
disposal of garbage, and in ‘‘such personal habits as defecation, urination,
expectoration, and eating with the fingers.’’ Jackson concluded that the teach-
ings of sanitary principles might be the ‘‘necessary and preliminary founda-
tion’’ for disease prevention, but the introduction of such sanitary teachings
‘‘into the home by schoolchildren must be a slow and tedious process, un-
likely to produce results within a generation.’’∞≠∫ Until then, close super-
vision and regulation would be warranted. In the opinion of an editor of the
Cablenews-American, for the moment ‘‘only by force can the lower classes of
natives’’ be made to abstain from food and drink ‘‘laden with germs.’’ Despite
noble educational efforts, ‘‘the densely ignorant adult native persists in com-
passing his own death’’ and the deaths of innocent Americans, although ‘‘with
the coming generation this fatal ignorance will largely pass.’’∞≠Ω

immune children of the tropics—

or native disease-dealers?
The change in the understanding of racial immunities and disease-dealing
proclivities is perhaps most vividly illustrated in attitudes toward African-
American soldiers in the tropics and Filipino scouts. In 1900, Nathaniel
Southgate Shaler, a geographer and the dean of Harvard’s Lawrence Scientific
School, had proposed that the ‘‘troops which are required for Federal ser-
vice in tropical lands might well be recruited from the Negroes’’; with their
families, these soldiers would soon become ‘‘permanently and contentedly
established in Luzon and elsewhere in the colonies.’’∞∞≠ Shaler believed these
‘‘children of the tropics’’ would make excellent troops—‘‘at least as infantry-

‘‘only man is vile’’ 101

men’’—because the African-American constitution, unlike the white, was
preadapted to the tropical climate.∞∞∞ In the Philippines, the distinguished ge-
ographer’s advice was redundant. During the previous two years, the United
States had already been using African-American and Filipino scouts to sup-
press resistance to its occupation of the archipelago. To Captain R. L. Bullard,
one of the ‘‘white men of good standing’’ who commanded the 30th Alabama
Volunteer Infantry (Negroes), it had long been plain that ‘‘Negro volunteers’’
were more immune to the regional ailments than white soldiers. Indeed, the
disparities between colored and white were ‘‘so great that they almost require
the naturalist and do require the military commander to treat the Negro as a
different species.’’∞∞≤ And yet, even as black troops ‘‘could accomplish the
most amazing amount of work’’ in such trying conditions, they unfortunately
showed a natural tendency to ‘‘go in parties, they herd’’; and ‘‘in the lonely
duty of the sentinel this herding peculiarity becomes a positive fault.’’∞∞≥ Evi-
dently, Negro troops, as children of the tropics, could never attain the civi-
lized individuality of white citizen-soldiers. Filipino scouts proved more
abundant and somewhat more independent, though similarly resistant to the
tropical diseases and climate of their ancestral realm. Captain Charles D.
Rhodes observed that local troops were ‘‘able to drink all kinds of water with
impunity, and the common intestinal disorders are unknown’’; they were
susceptible perhaps only to ‘‘calentura or break-bone fever.’’∞∞∂ As the Fili-
pino soldier ‘‘stands in the rice-fields, knee-deep in mud and water, during the
working hours of day after day, one almost believes that years of exposure
have made him amphibious. The factor of sickness among soldiers made of
such material will not cause the surgeon much uneasiness.’’∞∞∑ And for a short
time it did not.
Significantly, the enthusiasm of Shaler and others for ‘‘Negro colonization’’
of the Philippines proved evanescent. In the Voice of the Negro, T. Thomas
Fortune had argued that black Americans could best hold up the flag in the new
island possessions since, ‘‘all in all, the Afro-Americans in the Philippines stand
the climate better and are on terms of better and more helpful understanding
with the Filipinos than are white Americans.’’∞∞∏ But the belief that black
Americans, like Filipinos, were naturally suited to the tropics and its disease
environment soon became, for whites, more a cause of concern than an excuse
for complacency. Increasingly, the old confidence in racial acclimatization, the
notion of races and proper places, was giving way to fears that all allegedly
tropical races lacked proper sanitary standards—they had not yet developed a
‘‘sanitary immunity.’’ Doubts soon surfaced about the African-American sol-
dier’s ‘‘moral stamina’’ and a perceived tendency to ‘‘fraternize’’ with ‘‘native

102 ‘‘only man is vile’’

women.’’∞∞π Medical officers now pointed out that any natural affinity for
Filipino customs and habits, combined with any residual inherited advantage
in disease resistance, was likely to produce only more carriers of the diseases
prevalent in the tropics. African-American troops within a few years had gone
from being regarded as preadapted immune or acclimated children of the
tropics to representing augmentations of the vast native reservoir of disease.
The enthusiasm of tropical physicians for hunting microbes, their preoc-
cupation with tracing the distribution of the ‘‘exciting cause’’ of each disease,
can obscure the persistence of hereditarian thought in medicine. But one
finds, on closer inspection, that theories of racial predisposition and custom
continued to suggest the contours for new disease maps, even if the lines so
described by race have shifted. To be sure, immunity to local disease appeared
more often to be acquired by exposure to specific germs during the individ-
ual’s childhood; little was inherited solely through descent. And whatever
immunity happened to be acquired was more likely to be partial than abso-
lute. But the physiological adaptation of local inhabitants to surrounding dis-
ease seemed to have fashioned a natural reservoir for microbes, many of them
entirely new to foreigners. The tendency of so-called primitives to acquire,
to retain, and to spread portable pathogens—the racialization of pathogen
distribution—appeared more important than ever before. Although cultural
in character, this was regarded as a behavioral predisposition organized fun-
damentally by race. Thus it was the essentialized race culture—more than
older notions of independent racial physiologies—that in the early twen-
tieth century became the major salient in the war against disease-dealing
native bodies.
Increasing confidence in science and hygiene was gradually helping to
displace white somatic anxieties in the tropics. More and more it seemed that
the alien race, following stipulations of hygiene—basically of the sort learned
in the military—could survive near the equator without degenerating and
perhaps without contracting, or at least without succumbing to, the local
diseases. But this consoling routine was also part of a new political order, for
medical optimism implied the need to intervene in the most intimate aspects
of private life. If the great modern experiment in racial mobility was to suc-
ceed, Filipinos, even more than white Americans, would have to submit to
reformation of personal conduct and social mores. In magnifying microbes as
social actors, American physicians made Filipino bodies and Filipino be-
havior, both framed by adapted racial typologies, subject to ceaseless medical
inspection, training, and discipline. Thus began the intimate workings of
modern tropical hygiene.

‘‘only man is vile’’ 103

Chapter Four

excremental colonialism

H uman wastes, the Bureau of Health warned Filipinos in 1912, ‘‘are

more dangerous than arsenic or strychnine.’’ Scientists had proven

that ‘‘dysentery, typhoid fever, cholera, and kindred diseases are conveyed to

a person, regardless of whether he be king or peasant, with minute organisms

that, probably, have passed through the bowels of another person.’’ Accord-

ingly, all Filipinos should learn to treat their ‘‘evacuated intestinal contents as

a poison,’’ taking care to avoid contact with them or spreading them about.∞

Unlike Americans, Orientals seemed to lack control of their orifices. ‘‘The

native and Chinese population,’’ lamented Dr. Wallace de Witt, ‘‘tend mark-

edly to decrease the general hygienic surroundings by reason of their unclean

habits.’’≤ It was clear to Dr. Thomas R. Marshall, among others, that ‘‘the

Filipino people, generally speaking, should be taught that . . . promiscuous

defecation is dangerous and should be discontinued.’’≥ Ideally, Americans

would train Filipinos to behave as meticulously and as retentively as any

responsible white individual.

The importance of excrement in the modern medical calculus of risk is

not surprising. Of all the manifold sources of germs—whether blood, urine,

mucus, saliva, pus, water, air, or soil—feces appeared to public health officers
the most abundant and most dangerous, just as to an earlier generation of
physicians those places permeated by an odor of human waste had been
the most feared.∂ Through much of the nineteenth century, medical officers
demonstrated special sensitivity to excremental odors, and their twentieth-
century successors, although discounting the morbidity of stenches in favor of
the danger of germs, continued to identify human waste as a rich store of
pathology. Only now, with the development of a bacteriological frame of
mind, the dire consequences of feces would seem to derive more from direct
physical contact than from any noxious emanation, that is, from any olfac-
tory action at a distance. In the past, prevention of disease had mostly re-
quired avoidance of morbific sites or their cleansing and deodorization: the
belated toilet training of adults had been rare and generally was regarded
as unrewarding. Now, however, prevention usually would mean behavior
change, improvement in personal cleanliness and the care of the body, as well
as a shrinking from indiscriminate human contact. It meant reticence and
containment, discretion and interment, more than simple deodorization and
ventilation. But despite such permutations, the crucial link between excre-
ment and danger proved remarkably resilient.∑
When Charles V. Chapin urged health officers to trace infection not to
things and places but to persons, he gave them special instructions to treat ‘‘all
fecal matter as suspicious.’’∏ According to the new public health doctrine,
feces provided a major conduit for germs from the manifestly unwell or
healthy carriers to those previously uninfected. Chapin was demanding more
attention to the personal element in disease transmission and greater efforts to
reform the behavior of those who flouted the rules of hygiene. Of course,
military hygienists had clearly anticipated both the civil health officer’s inter-
est in excrement as a vehicle for germs and his enthusiasm for behavior re-
form. The health officer in the Philippines did not need Chapin to tell him to
treat fecal matter, especially that of other races, as suspicious; nor did he need
instruction in the proper training of miscreants. The army surgeon’s special
preoccupation with the disposal of excrement and the need for discipline of
new recruits presented a compelling model for colonial practice. Edward L.
Munson had warned of ‘‘raw troops living like savages in their disregard
of sanitary principles,’’ spreading feces around the camp, but he expected
that unremitting inspection and training would eventually reform them.π The
same techniques might be applied to degraded Filipinos. Some of the more
liberal and progressive colonial bureaucrats hoped that the race would re-
spond to such surveillance and education, that it would eventually internalize

excremental colonialism 105

the practice of personal hygiene and come to govern itself. Only it seemed the
time frame for such response would have to be greatly extended.
In this chapter I want to consider the colonial health officer’s obsession
with ectopic excrement—with ‘‘matter out of place.’’∫ In the Philippines,
American physicians used the body’s orifices and its products to mark racial
and social boundaries as well as to indicate how easy it would be to assail such
enclosures. Waste practices became a potent means of organizing a heretofore
diffusely threatening foreign population. That is, the colonial state came to be
delineated on racialized bodies (Filipino or white) and behaviors (promiscu-
ous or retentive); it was intimately reduced to orifices (open or closed) and
dejecta (visible or invisible). In this new orificial order, American bodily con-
trol legitimated and symbolized social and political control, while the ‘‘pro-
miscuous defecation’’ of Filipinos indicated their position on a lower bodily
and civilizational stratum. As Americans issued formal directives and de-
signed toilets, they imagined Filipinos inadvertently subverting their hygienic
abstractions and defecating regardless. Such promiscuous defecation seemed
potentially to mock and transgress colonial boundaries at the same time as it
confirmed the necessity and value of such demarcations.Ω It was allowing
germs to cross between the races in unsegregated Manila and thus to endan-
ger lawful, innocent Americans. A sense of the porosity of the colonial mem-
brane lent force to those health officers who sought to constrain the delin-
quent microbial traffic. Thus physicians extended their power to inspect and
regulate the personal cleanliness and the social life of naturally erring Fili-
pinos, whose toilet practices in particular seemed to require ceaseless supervi-
sion and discipline.
My argument is that through somatic control and moral training, the
colonial state attempted to shape the bodies and conduct of Filipinos and
Americans.∞≠ Racial type was manifested in bodily function and pathological
potential, on which medicos put a gloss of civilizational status. If they wanted
recognition from the public health department, Filipinos were expected to
confess their uncleanliness, to voice their barbarity, and to make themselves
available for hygienic salvation. Of course many either refused to do so or
remained indifferent to medical opinion. Others, despite their misgivings,
appeared to go along with the racialized performance of abjection.∞∞ After the
confession of rottenness, Filipinos might eventually be raised and perhaps
admitted to a sort of probationary sanitary citizenship.∞≤ Ideally, then, the
colonizing process would resemble a civilizing process, a training of childlike
Filipinos in the correct techniques of the body, rationalized as hygiene.∞≥

106 excremental colonialism

White Americans, in contrast, would be obliged to perform a transcendence
of their lower bodily stratum, to act as though they inhabited a more formal,
expressive body. Their personal and domestic hygiene had to be immaculate.
The labor of civilization called for constant self-discipline among American
residents of the tropics: the rationale for territorial possession would thus be
predicated on unsustainable self-possession.∞∂
To attempt at this distance to determine the ‘‘true’’ pattern of Filipino and
American excretory practices is unprofitable at best. Even if such a reckoning
were possible, its results would contribute little to our understanding of the
contemporary meaning of medical subject positioning in the Philippines. We
may assume that Filipinos frequently transmitted pathogens—but so too did
Americans; no doubt Filipinos, as much as Americans, constructed bounda-
ries and transgressions with ‘‘matter out of place.’’ But it is American asser-
tion that suffuses the historical record. Here I would like to find out what was
at stake politically in performing an American sublime and a Filipino abject.
How was pathology embodied? How were excretory habits racialized? What
did it mean to promote personal hygiene above environmental sanitation?
And perhaps most important: in what productive forms might bodily control
extend colonial modernity?

colonial embodiment, from abject to sublime

Sent to Surigao in 1902, Dr. Henry du Rest Phelan, a medical officer with the
U.S. Army, found the town to be a ‘‘most charming and delightful spot’’ on a
‘‘picturesque’’ site. But its sanitary condition alarmed him. Filth abounded.
The tiendas, or stores, were ‘‘all more or less filthy,’’ the promenade in front of
them ‘‘a lounging place for idlers of both sexes.’’ The ground beneath the
houses was covered with ‘‘filth of all kinds, human excrement included’’;
weeds had sprouted up in the streets; and garbage accumulated in vacant lots.
That the islands had recently endured a brutal war and massive social dis-
ruption meant little to Phelan: the problem seemed one of innate Filipino
fecklessness and lack of civilization. ‘‘They appear to me,’’ he reported, ‘‘like
so many children who need a strong hand to lead them in the path they are to
follow.’’ Filipinos were willfully polluting the soil, even around their own
houses. Accordingly, Phelan, ‘‘necessarily somewhat autocratic,’’ began his
‘‘crusade against filth.’’ In a short time, ‘‘the roads were clean, the marshes
drained, the houses purified, and the inhabitants impressed with the necessity
of adopting new rules of hygiene.’’ And when, despite this transition from
squalor to cleanliness, the mortality rate climbed, Phelan wryly concluded

excremental colonialism 107

that the transition itself ‘‘could have given the community a shock sufficient to
cause such a thinning out of its ranks.’’∞∑
Over the following decade, bacteriologists from the Bureau of Science and
the Army Board for the Study of Tropical Diseases found widespread carriage
of disease organisms among local inhabitants, even those who were appar-
ently healthy. Filipino bodily wastes seemed typically to contain parasites and
bacteria. In combating the cholera outbreak of 1915, Munson identified Fili-
pino vibrio carriers as ‘‘not only the most numerous but the most insidious
and dangerous sources of infection.’’ His laboratory men had painstakingly
collected and examined Filipino stools: the procedures for extracting these
specimens gave even Munson pause: ‘‘The work meant invasion of the ac-
cepted rights of the home and of the individual on a scale perhaps unprece-
dented for any community. The collection of the fecal specimens necessarily
might fairly be regarded as repulsive to modesty. Add to this the facts that the
search was made among persons apparently healthy to themselves and others
who could scarcely fall even within the class of suspects, and that those found
positive were subjected to all the inconveniences of isolation, separation from
family, loss of earning capacity, etc.’’∞∏ In 1909 alone, the hard-pressed staff of
the Manila Bureau of Science had examined over 7,000 fecal specimens,
almost all from Filipinos; and then in 1914, at the beginning of the cholera
epidemic, they were overwhelmed by more than 126,000 jars of feces.∞π
Vulnerable foreigners would be wise, it was thought, to treat all Filipinos
as potentially infected and dangerous and to limit contact with native bodies
and their contents until the race was cleaned up. Yet avoidance of contact
was not easy in the largely unsegregated colonial society; Filipino behav-
ioral change, if possible, therefore seemed imperative.∞∫ When P. E. Garri-
son, for example, detected almost universal carriage of parasites among low-
land Filipinos, he urged authorities to reform ‘‘the methods of the disposal of
the excreta customary among the Filipino people.’’∞Ω Captain Benjamin J.
Edger, m.d., recalling his sanitary experiences in the Philippines, observed,
‘‘Even in the houses of the wealthiest cities of Luzon, Lipa, Batangas Province,
the lavatory and sink are in close proximity to the kitchen. Not until the
American occupancy was the effort made to dispose of the excreta, even by
the wealthiest classes.’’≤≠ An American physician declared that ‘‘the cleaning
of the Augean stables was a slight undertaking in comparison with purifying
the Philippines. . . . No imagination can make the Filipino customs with
respect to [defecation] worse than actuality.’’≤∞ But reform there must be.
In 1909, the model disease survey of the town of Taytay pointed to many

108 excremental colonialism

figure 23. An unsanitary yard: ‘‘A home without a latrine causes the spread of many
diseases.’’ Courtesy of the Rockefeller Archive Center.

peccant waste disposal customs. Richard P. Strong and his colleagues re-
ported that most residents in the mornings would empty, in any convenient
place, vessels containing their excreta; or else they defecated in the bushes at
the edge of town. Only a quarter of the dwellings had separate outhouses, and
even these were generally holes in the floor, through which human waste
dropped onto the ground, where the pigs scavenged it.≤≤ The investigators felt
that modification of such customs and habits—a civilizing process—would
take some time and effort, but still it must be attempted. Captain Edger
claimed that ‘‘principally through American Army officers the Filipino race
has been shown we are clean and mean to keep our surroundings clean.’’ Al-
though the struggle would be long and hard, he hoped, like Strong and others,
that Filipinos might eventually follow the white American example. He re-
flected that ‘‘constant association and influence of Americans is bound to
have its beneficial effects on the Filipino. He advanced from almost a savage
state to the better advanced progressive Spanish methods by force. It is almost
impossible to tell what he will do in coming years when given the advantage
of free American ways and liberality.’’≤≥ American ‘‘liberality’’ would create
the desire among Filipinos to imitate whites and seek self-government of their
bodies and habits.

excremental colonialism 109

 Since contact with native bodies or their excreta now implied medical risk
for white Americans, servants warranted relentless scrutiny and regulation. At
times, the ‘‘half-naked, dark-skinned creatures’’ employed by Edith Moses
gave her the impression of being ‘‘trained baboons,’’ especially a ‘‘monkey-like
coolie’’ who polished the narra (hardwood) floors. On other occasions, how-
ever, her servants were simply ‘‘like children,’’ fun loving and filthy. ‘‘In spite of
all my lectures and my practice,’’ she lamented, ‘‘our Chinese do not under-
stand the first principles of sanitary cleanliness.’’≤∂ Nevertheless, Moses per-
sisted in her efforts to teach her servants to avoid handling food, to set tables
decorously, to dispose of their wastes fastidiously, and to wash their hands
regularly. She house-trained them. Similarly, Emily Bronson Conger despaired
that ‘‘it never occurs to [Filipinos] to wash their hands,’’ and they never used
soap or towels. ‘‘They rub their bodies sometimes with a stone,’’ she noted. ‘‘It
does not matter which way you turn you see hundreds of natives at their toilet.
One does not mind them more than the caribou [caribao, buffaloes] in some
muddy pond, and one is about as cleanly as the other.’’≤∑
Conger claimed indifference to these infractions, but her peers did not:
most were convinced that such uncivilized, indeed dangerous, behavior re-
quired reformation. Thus, in Lilian Hathaway Mearns’s Philippine Romance,
the heroine, Patricia, expresses the nobility of her character when she assures
her suitor that ‘‘everyday I have made a visit to the barrio, and have preached
soap and water without ceasing.’’≤∏ In the interests of hygiene and the Ameri-
can way of life Patricia was teaching supposedly barbarous Filipinos to con-
tain their bodily wastes and not spread them around. Less noble, perhaps,
were the methods of Mr. and Mrs. Campbell Dauncey. When they moved to
Iloilo, Mrs. Dauncey was appalled to find that her new house was next to ‘‘a
rabbit warren of low-class Filipinos, who keep all sorts of animals in the
rooms, and throw all their refuse out into the narrow alley between this and
the next house.’’ She put out bowls of disinfectant to ward off her new neigh-
bors, but to no avail. Far more effective was her husband’s response to these
‘‘transgressions of the laws of cleanliness and decency.’’ He followed the
simple plan of ‘‘leaning out of the window when the people below do any-
thing he does not like, and calling them ‘Babuis’ [pigs], or ‘sin verguenza’
[without shame] in a very loud voice, which they don’t like at all.’’≤π
If the anus was a synecdoche for the medicalized Filipino body, the mouth
just as surely symbolized American presence—in the case of the Daunceys,
English presence.≤∫ In this sense, American physicians were doubly spokes-
men for the body. Unlike Filipinos, they produced abstractions, by mouth and

110 excremental colonialism

by hand, not waste—or, at least, not dangerous and visible waste. White
Americans talk, write, report, police, supervise servants, hunt, fish, and fight:
but after reading the medical documents produced in the Philippines in the
first decade of the century, one suspects they rarely, if ever, went to the toilet.
Whatever happened to their lower bodily functions? These retentive colonial-
ists seem to imagine themselves to have achieved a sort of transcendence of
the natural body. American bodies become abstracted from the filthy exuber-
ance of the tropics, represented as truly civilized models for Filipinos.≤Ω But
this American sublime demanded relentless self-discipline; and, in this sense,
the disparagement and civilizing of Filipinos would also be a labor of Ameri-
can repression.≥≠

the laboratory and the market

The medical laboratory in the tropics was as much sign as signifier of differ-
ence. In focusing on the laboratory as an idealized representational space, we
are inclined to forget that this modern workplace had its own distinctively
abstract spatial texture.≥∞ It was a delibidinized place of white coats, hand
washing, strict hierarchy, correct training, isolation, inscription—in short, a
place of somatic control and closure, organized around the avoidance of
contamination. Just as the laboratory’s spatial representations—its reports
and scientific papers—reduced the tropics (the lower regional stratum) to a
series of controllable, visualized specimens and abstracted intelligence, so
the spatial practices producing these inscriptions depended on its workforce
(mostly young, single males) transcending the lower bodily stratum, setting
themselves apart from the filth outside. The laboratory thus became a distinc-
tive and discriminating locus of colonial modernity.
As early as July 1901 the Philippine Commission had established a Bureau
of Government Laboratories—the forerunner of the Bureau of Science—
consisting, initially, of a biological and a chemical section.≥≤ The biological
laboratory was expected to provide ‘‘adequate facilities for investigation into,
and scientific report upon, the causes, pathology and methods of diagnosing
and combating the diseases of man and of domesticated animals’’ as well as to
perform any routine biological work required by other government depart-
ments.≥≥ The chemistry laboratory investigated food, drug, and plant com-
position and mineral resources. Paul C. Freer, the first director of the bureau,
declared that the new Manila laboratories provided ‘‘a position for the higher
type of educated American investigator, not only for the actual material re-
sults which he may obtain, but also for the benefit which will accrue by his

excremental colonialism 111

very presence in the community.’’≥∂ Indeed, Freer never tired of extolling the
value of scientific work in the Philippines. Nor did he hesitate to point out
that ‘‘the work is of so difficult a nature, so important, and, if imperfect
methods are used, so subject to error, that a poor equipment both in the
literature of medical biology and in apparatus would be the precursor of
failure.’’ He thus presented his demands for ‘‘the highest type of trained inves-
tigators, a complete library, and exceptional facilities.’’≥∑ In 1904 he got his
‘‘properly equipped biological laboratory,’’ with large rooms (‘‘well lighted
without direct sunlight’’) and a supply of microscopes, incubators, sterilizers,
microtomes, glassware, stains, chemicals, and small animals. The new labora-
tory buildings, decorated externally in a modified Spanish style, occupied a
fine site on the old Exposition Grounds near the heart of the city.
Laboratory design was predicated on a transcendence of the tropical en-
vironment. A modern power plant provided the rooms with vacuum, air
pressure, and steam and supplied light to all the laboratory buildings. To
ensure good ventilation and coolness in the two-story building, on each floor
the rooms were grouped on either side of a large, main corridor ten feet wide
and running the entire length of the building. When the hallway was open,
Freer noticed that ‘‘a breeze is almost continually passing through it, generally
supplying a suction as it passes the doors of the individual laboratories so that
a constant circulation of air is produced.’’≥∏ The largest part of the building
was the main laboratory structure, facing toward the south and divided into
two symmetrical portions, one for the biological laboratory and the other for
the chemical laboratory. In the rooms of the biological wing, a microscope
table ran along the entire window front. So that ‘‘the strange breezes which
prevail in this country’’ should not play havoc with materials on this work-
table, the windows were placed well above the desks.≥π In the center of the
room, two tables afforded ample space for the general work of the laboratory,
particularly for heating, filtering, and distilling. Along another wall of each
biological room was a chemical worktable furnished with gas, water, and
vacuum. A hood occupied the opposite wall; its flue extended up into the attic
and connected with the main exhaust tanks, producing a strong artificial
draft. On the ground floor a special room was given over to the preparation of
culture media: here steam was provided for sterilizers and the main auto-
claves of the building. Each floor of the biological wing included a room
for the refrigerating boxes and for the incubators, each heated by Bunsen
burners. A separate house behind the biological wing held the cages of the
experimental animals.

112 excremental colonialism

 To assess accurately the tropical environment and to gauge the character of
its inhabitants, the investigators, all correctly trained ‘‘higher types,’’ needed
to compare new specimens with standard reference material. The museum
was therefore one of the more important sections of the laboratories. Typical
examples of anatomical and histological pathology were carefully preserved,
along with a collection of local parasites and insects.≥∫ But the scientific li-
brary was perhaps of even more use to investigators trying to formalize and
abstract the apparent chaos of the tropics. The scope of the library meant that
‘‘no one need fear a lack of literature’’ in Manila.≥Ω This ‘‘central depository of
scientific books for the entire Government’’ boasted an extensive holding of
monographs and periodicals.∂≠ An assiduous researcher could find there all
the major British, German, and French publications dealing with tropical
science. But constant vigilance was required to protect this defining resource
from tropical depredation. The environment it codified threatened constantly
to consume it. ‘‘Books must be inspected daily,’’ Freer lamented, ‘‘and wiped
off very frequently during the rainy season, on account of the mold.’’ Rapa-
cious insects, particularly cockroaches, could destroy overnight the texts that
stigmatized them. To protect the books, the covers were varnished, and the
legs of the bookcases rested in cans of petroleum. Freer took comfort in
the fact that white ants had never attacked the library, although they came
very close.∂∞
Colonial bureaucrats sometimes hopefully described the whole of the ar-
chipelago as a living laboratory; then again they might despair of ever achiev-
ing such control. ‘‘The Philippines may be considered today as a laboratory,’’
declared James A. LeRoy in 1906, ‘‘where an experiment with important
bearings of the ‘race problem’ is being conducted.’’∂≤ Decades later, Joseph R.
Hayden, a vice governor of the islands, reflected that ‘‘one of the great
achievements of the period [was] that within the Philippine government an
essentially scientific attitude should have been substituted for the unscientific
ways of Spanish days.’’∂≥ Americans hoped that with much time and effort the
disorder and promiscuity of the islands might be subdued, so that colonial
space might come to resemble the controlled conditions of the modern labo-
ratory. Yet this expansionist trajectory, in which the laboratory is imagined
simply as a territorializing technology, can disguise a more complicated scalar
politics. At times, it was equally important to make a distinction between
colony and laboratory, if only to emphasize the superior culture of American
modernity and how much more progress Filipinos and their country had yet
to make. The flexible scale of the colonial laboratory—its capacity to magnify

excremental colonialism 113

and diminish its focus—allowed a play of differentiation and assimilation. At
one moment the whole of the archipelago and its inhabitants seemed to con-
stitute a living laboratory; at another, the place and its people were woefully
unlike the conditions and the life forms characteristic of a modern laboratory.
At one moment, no one knew where the laboratory was and where society
was; at another it was all too clear.∂∂
Indeed, outside the laboratory even higher types might still be contami-
nated and transformed. That most of the American laboratory workers, all
college graduates, lived in small rooms and ate out at the local restaurants
appalled Freer. After all, this risked exposing the Americans as slaves of
intimate activities involving contamination and excretion. ‘‘In a country like
this where hygienic surroundings are of the highest importance and where
sickness causes such a large decrease in the normal efficiency of a working
force, it is highly desirable that members of a staff should be able to find
suitable and healthful accommodations upon their arrival.’’∂∑ Above all, it
was imperative that young American scientists avoid the filth of Philippines’
markets. Seen as a center of pollution and disorder, the market was evidently
the antithesis of the laboratory. Regarded as a negation of American for-
mality, the open market, like the grotesque Filipino body, appeared ever in
need of scientific reformation.∂∏
For many American colonialists, the Philippine marketplace conjured up
fascinating images of chaos, sensuality, and danger, however bland the social
life of these public spaces may in fact have been.∂π The marketplace, especially
the large, overcrowded city market, Divisoria, was readily represented as a
locus of promiscuous contact and contamination, a space quite unlike the
ideal laboratory that was formally documenting its dangers. If Americans
were scorned and ridiculed, surely they were most exposed—most open to
such an inversion of colonial relations—in the marketplace. This necessarily
perverted place was recognized as a place of risk, both symbolically and
materially so. LeRoy found that ‘‘unless there be rigid and efficient super-
vision,’’ the markets were ‘‘foci of infection.’’ Whenever he wandered through
these places, Nicholas Roosevelt assumed that ‘‘many varieties of intestinal
germs and parasites may lurk in most foods.’’ For Daniel R. Williams, the
markets were simply ‘‘unwholesome and death-dealing plazas.’’ ‘‘No one who
has not traveled in the Orient can conceive of the noise and confusion,’’ Wil-
liam Freer wrote of Manila’s street life. ‘‘Words fail utterly to describe it.’’∂∫
But how to render this teeming, promiscuous environment more
laboratory-like? Just as the laboratory had constructed—or rather, informed

114 excremental colonialism

and rationalized—the problem of contact, so it offered solutions. When Kath-
erine Mayo visited the ‘‘Isles of Fear,’’ as she called the Philippines, in the early
1920s she was pleased to note the strict control of potential ‘‘disease carriers’’
in hotels and restaurants: no servant could handle food ‘‘without a health
certificate showing he was free from germs likely to convey disease.’’∂Ω Wash-
ing and disinfecting of hands were constantly emphasized. Governor James F.
Smith was himself convinced that cholera attacked only those ‘‘people drink-
ing from esteros, eating with fingers and refusing to recognize the importance
of sanitary laws.’’∑≠ In order to protect consumers in the public sphere, new
sanitary markets were constructed in Manila. The buildings, all of the sup-
posedly hygienic reinforced concrete, were ‘‘supplied with ample water fa-
cilities, enabling them to be kept scrupulously clean.’’∑∞ Sanitary inspectors
patrolled the aisles, checking regularly to ensure that the stallholders wore
clean clothes, kept their hands spotless and their nails trimmed, and used only
clean white wrapping paper.∑≤ To prevent shoppers from engaging in ‘‘the old
custom of handling one piece of meat after another with the fingers,’’ forks
were provided. In case this was not enough, meat was placed in ‘‘substantial
screen cages made of copper wire with sliding doors,’’ in this way protecting it
further, not only from ‘‘promiscuous handling but also from contamination
by flies.’’ Such modern markets, constructed throughout the archipelago, be-
came ‘‘educational features . . . doing much to spread the doctrine of cleanli-
ness throughout the Islands.’’∑≥
Despite improvements to the water supply, sanitary inspectors still de-
tected ‘‘bacilli of the colon type’’ in samples of drinking water dispensed in
the tiendas. The director of health therefore stipulated that in order to be
licensed each tienda must have a teakettle ‘‘for rendering water sterile.’’ In-
structions printed in Spanish, Tagalog, and Chinese required the kettle, filled
from the city pipes, to ‘‘boil violently’’ for at least fifteen minutes before it was
poured.∑∂ The Bureau of Health also recognized that the common drinking
cup served to transmit several kinds of infectious diseases. In institutions and
churches the necessity of the individual cup appeared urgent. A disposable
cup was the only practical and progressive solution. The bureau suggested a
method of making an individual drinking cup from a square sheet of tough
paper. ‘‘Inmates of institutions soon learn to make their own cups,’’ Dr. Vic-
tor G. Heiser reported, ‘‘and take great delight in the thought of protective
cleanliness which is afforded by their use.’’∑∑
When the author of Interesting Manila first visited the city in 1900 he
observed that the tiendas were ‘‘so open to the street as to be practically in the

excremental colonialism 115

figure 24. New type of concrete market. Courtesy of the Rockefeller Archive Center.

highway,’’ and those of the Chinese were ‘‘always repulsive and dirty.’’ But
after ten years they were far cleaner, better enclosed—more safely ‘‘interest-
ing.’’ As for the markets, ‘‘before the days of American sanitation,’’ he re-
called, ‘‘the condition of these places was always indescribably bad, but mod-
ern regulations and efficient inspectors have changed all this to comparative
cleanliness and good order.’’∑∏ Similarly, Frank G. Carpenter remembered
that in 1900 the largest marketplace in Tondo ‘‘consisted of ten acres of rude
sheds, roofed with straw matting or galvanized iron laid upon a framework of
bamboo poles.’’ But by 1920 it was a building of concrete and steel, hosed
down every night.∑π It was nearly as clean and orderly as a laboratory.

the toilet in the tropics

To combat apparent racial obstacles to behavior change—to the civilizing
process—health experts vigorously promoted educational and publicity proj-
ects in the second decade of the twentieth century. The Philippine health
service began issuing a semiweekly bulletin, never more than a page in length,
dealing with some topical public health question. This was published in all
the daily papers in English, Spanish, and Tagalog and mailed to medical
officers and other government officials throughout the islands. From 1915,
women’s clubs conducted pious discussions on maternal and infant welfare
and issued their own bulletins. Sanitary commissions visited selected towns,
surveying health conditions in the community; giving practical demonstra-

116 excremental colonialism

tions of how to prepare balanced diets from the local food supply and in-
structing the local inhabitants in personal hygiene, home cleanliness, and the
care of the sick. The health service also maintained permanent exhibits of
model sanitary houses, sanitary methods of sewerage disposal, and sanitary
and unsanitary barrios. Photographs, ‘‘moving pictures,’’ parade floats, and
(in 1921) a ‘‘health-mobile’’ that was sent out to fairs and fiestas illustrated
modern methods of hygiene.∑∫ Cartoons in English and Tagalog also showed
promise as effective means of persuading infantilized Filipinos to change
their unhygienic habits. Warnings about the poisonous nature of fecal matter,
the evils of handling food, the dangers of ‘‘the promiscuous spitting habit’’
abounded. No wonder, then, that when exercise was advised it was ‘‘for the
purposes of enabling the body to eliminate its waste products and become
clean.’’∑Ω The general message was that Filipino bodies were especially dirty
and infected—had not the microscope shown it to be so?—and that personal
contact and loose behavior would only distribute their filth.
The public schools became a major sanitary venue. Teachers compiled a
‘‘health index’’ for every child in their class. The Bureau of Education’s ide-
alized ‘‘healthy child’’ had a ‘‘well-formed body,’’ ‘‘clean and shining hair,’’ ‘‘a
clear skin of good color,’’ ‘‘ears free from discharge,’’ ‘‘a voice of pleasing
quality,’’ ‘‘an amiable disposition,’’ and so on.∏≠ A premium was thus placed
on the Filipino child’s formal, expressive qualities. Furthermore, every child
was to be weighed once a month, and the height measured at least twice a
year. If anything was amiss, the teacher reported it to the local health officer.
But this was not enough. It was also the duty of a teacher to ‘‘instruct pupils to
care for themselves and to put into practice both in the school and at home
miscellaneous health principles.’’∏∞ The transcendence of the lower bodily
stratum was also to animate everyday life. Through correct training, children
would learn of the dangers of raw vegetables, impure water, poorly ventilated
houses, a sedentary way of life, and deformed posture. Every child had to
carry a clean handkerchief, drink at least a cup of milk each day, sleep from
ten to twelve hours a night under a mosquito net, bathe daily, wear shoes, and
wash his hands before eating—and never touch the food. So that the noncon-
taminating abstract space of the classroom should be faultlessly extended—
to stabilize a new sense of embodiment and new habits—health experts urged
that ‘‘the construction of a toilet, either in his own home or in that of a
neighbor, be a project for each seventh-grade boy.’’∏≤
Toilets soon were cropping up everywhere. The Bureau of Health from the
beginning had urged all Filipinos to treat their ‘‘evacuated intestinal contents

excremental colonialism 117

figure 25. Calisthenic drill by three thousand children at the Manila Carnival,
1915 (rg 350-p-cd-2-1, nara).

as a poison,’’ taking care to avoid contact with them. ‘‘Let those who are able to
put in septic tanks and flush closets do so’’—all others should install a pail
closet, at a cost.∏≥ In the smaller communities in which cholera had prevailed
in the early 1900s, sanitary officers had found the pail system to be effective,
although it seemed initially that ‘‘the cost of maintenance and inspections as
a regular measure is prohibitive and only warranted by emergency condi-
tions.’’∏∂ In the poorer towns, which had no sewer or pail system, every house-
holder had to ‘‘dig a simple pit closet and to cover each fecal deposit promptly
with lime or fresh earth.’’∏∑ But public health officials hoped that widespread
use of the pail could be made feasible and affordable elsewhere. Heiser sug-
gested that a pail system might even be profitable in routine conditions if it was
installed along ‘‘with an after-treatment of the night soil which would render it
suitable for fertilizing mulberry trees, thus promoting the silk industry.’’ He
was, however, vehemently opposed to the plan ‘‘followed in many Oriental
countries’’ of letting out private contracts for the collection of night soil from
private residences, for it was ‘‘established custom’’ to use this untreated waste
to fertilize vegetables—often with mixed cultures of amoebae, cholera bacilli,
and other pathogens.∏∏ If the profit motive was insufficient, then taxation
might make the pail system commonplace. Householders soon had to choose

118 excremental colonialism

between paying quarterly charges of 7.50 pesos for individual pails kept on the
premises or 1 peso to use the public pail system.
Much attention had been given to the design of a cheaper and more effi-
cient ‘‘sanitary pail.’’ The bureau recommended a raised frame of four posts
set at a height that allowed an ‘‘ordinary five-gallon kerosene can’’ to be
slipped under the bottom of the seat. By covering the hole with a self-closing,
hinged seat, the designers had carefully ensured that no flies or other insects
could gain access to the contents. But the ‘‘container for the can has the ad-
vantage of being entirely open, which fact secures good ventilation and leaves
no opportunity for the collection and retention of disagreeable odors,’’ an
unfortunate consequence of the superceded boxlike designs.∏π The ordinary
carabao cart could haul far more of the light cans than it could the old-
fashioned wooden pails, so the costs of collection were also much reduced.
With the savings, an attendant could be hired to supervise ‘‘a suitably located
central pit’’ where the contents of the cans were dumped.∏∫
Even after improvements in efficiency and reductions in cost, many years
passed before the pail system was widely used. The poorer sections of Manila
continued to depend on a few scattered public collections of ‘‘unsanitary
closets’’ or none at all long after the more prosperous sections were sewered.∏Ω
Until the 1920s, approved systems of waste disposal remained a rare sight in
the provinces. When David Willets visited the Batanes Islands in 1913 he
reported bluntly, ‘‘A suitable method for disposing of human excrement is
lacking.’’ Water closets were very rare, ‘‘and furthermore the people have not
learned to use them.’’π≠ But if the local inhabitants continued to disregard
sanitary advice and regulation, sanitary officers could still, when emergencies
arose, forcibly disinfect them and their surroundings. When Allan McLaugh-
lin took charge of the sanitary response to the Manila cholera outbreak of
1908, he organized over six hundred men into disinfecting squads that went
about spraying carbolic over dwellings and ‘‘liming all closets and places
where fecal matter existed or was likely to be deposited.’’ Each day in the
‘‘strong material districts,’’ squads disinfected the closets, while ‘‘in the light
material districts, the effort to disinfect the dejecta of the entire popula-
tion necessitated the disinfection of entire districts. It was necessary to dis-
infect practically the whole ground area.’’π∞ Anyone who tried to obstruct
the disinfectors was arrested and fined. The amount of disinfectant dispersed
was enormous: more than 150,000 pounds of lime and 700 gallons of car-
bolic acid were used. When the entire stock of disinfectant in the islands
was gone, supplies had to be ordered from Hong Kong. When they ran out

excremental colonialism 119

figure 26. Filipino sanitary inspectors (rg 350-bs-1-4-175 [bs 9834], nara).

of lime, squads took to digging ditches and cleaning up the yards until new
stocks came in.
By 1920 forcible disinfection was no longer a major part of the sanitary
response to enteric diseases. Filipinos were generally obeying the provisions
of sanitary code that required ‘‘any building of whatever character’’ to include
‘‘adequate privies or toilet accommodations, constructed according to plans
approved by the director of health.’’ A sanitary inspector could now demand
to see, at the very least, ‘‘a pit not less than one and a half meters in depth,
securely covered by a slab of stone or concrete . . . a seat, provided with a
cover, so devised to close automatically when not in use; a vertical conducting
pipe . . . leading from the seat to within the pit; and a vent pipe not less than
ten centimeters in diameter leading from the pit to one meter above the eaves
of the building.’’ The capacity of the pit was set liberally at one cubic meter for
each resident. Though ‘‘adequate facilities for ventilation’’ were crucial, this
‘‘Antipolo toilet’’ was not permitted to ‘‘communicate’’ with any other room
and had to have ‘‘a tight-fitting door.’’π≤

from fiesta to clean-up week

José Rizal has provided us with an almost rhapsodic account of a Filipino
fiesta in the 1890s. To the community, on the eve of the fiesta, it seems ‘‘the air

120 excremental colonialism

is laden and saturated with gladness.’’ And on the day, while ‘‘everything is
confusion, noise, uproar,’’ it is an amiable confusion, not at all contaminating
or threatening. Banners float and wave in the streets as processions pass by;
the community gathers to watch, join in the parades, sing, dance, and attend
the cockfights and the games of chance. People saunter about at will. In the
plaza, on a bamboo stage, the comedy from Tondo begins its songs, dance,
and mimicry. Members of the audience are dressed in their best clothes, and,
according to Rizal, a scent ‘‘of powder, of flowers, of incense, of perfume’’
permeates the town. If, in the pushing and the crush of the crowd, one caught
a whiff of ‘‘human animal,’’ this contact with one’s fellows was more to be
cherished than feared. And so the romance of the fiesta continues, until at the
end of the day ‘‘the lights and variegated colors distracted the eyes, melodies
and explosions, the ears.’’π≥
But Mrs. Dauncey had quite another impression of the fiesta of 1904 that
commemorated the death of Rizal. The crowds ‘‘swarmed out’’ into the town
of Iloilo in the evening. ‘‘They hang out flags and lanterns,’’ she reported,
‘‘and every Filipino knocks off what little work he ever does, and crawls about
on the streets and spits . . . while the women slouch along in gangs with
myriads of children.’’π∂ To her eyes it was a time of promiscuous, animalistic
contact. In June 1900, Edith Moses, newly settled in Manila, had heard of the
dangers of such gatherings. ‘‘Many officers seem to think that the fiesta is a
mask for an uprising on a large scale,’’ she wrote, ‘‘and all American women
and children have been warned not to go into the streets.’’ Clearly the fiesta
represented a challenge to the American control of colonial public space, if
not to the actual institutions of government. And though skeptical of the
‘‘dangerous fiesta,’’ Mrs. Moses later imagined ‘‘insurrectos whispering under
my bed and coming up the ladder,’’ invading even her domestic refuge, her
personal enclosure.π∑ Thus the communal fiesta appeared an earthy, open site
for the subversion of American colonial modernity.
To the materialists in the Bureau of Health the uncontrolled fiesta meant
principally a concentration of ‘‘an extraordinary amount of foodstuffs, most
of which are improperly prepared and handled, and exposed to contamina-
tion.’’π∏ It sometimes involved the congregation of sick, often infected, people
at some religious shrine. The ‘‘lack of sanitary preparation to accommodate
the crowds’’ thus dispersed diseases across the archipelago. In order ‘‘to meet
this menace,’’ the Bureau of Health demanded that local authorities provide
‘‘clean, disinfected, and otherwise supervised’’ convenience stations where
people concentrated, a clean water supply, and food prepared and served ‘‘in

excremental colonialism 121

figure 27. Parade, Manila Carnival, 1908 (rg 350-p-ua-14, nara).

a cleanly manner.’’ππ To ensure this occurred at Antipolo during the pilgrim-

age to the shrine of ‘‘Nuestra Señora de la Paz y Buen Viaje’’ in 1915, the
Bureau of Health had dispatched an auxiliary corps of sanitary inspectors. As
a result, ‘‘instead of proving a menace to the people of the town,’’ the event
became ‘‘a means for educating and improving them.’’π∫ But the bureau did
not have the resources to supervise all the local fiestas.
In 1907, inspired by the success that year of Major General Leonard Wood’s
Wild West performance in the capital’s streets, the colonial government de-
cided to establish an ‘‘institutional Carnival’’ in Manila as an alternative to
insidious, uncontrolled fiestas. The first such ‘‘Oriental adaptation of the far-
famed customs of the south of France, of Italy, Spain and Latin America’’
occurred in February 1908. Conceived as an allegorical event, the theme of the
pageants, displays, sports, and revelry was the visit of the Monarch of the
West to the Monarch of the East. The latter, played by young Manuel Gomez,
‘‘with his gorgeously attired court and retainers, embarked in gaily bedecked
and richly ornamented barges and water craft of all description’’ to welcome
the Occidental potentate, Captain George T. Langhorne, who stormed into
Manila Harbor accompanied by the American fleet.πΩ Over the following
days, revelers participated in parades along with the monarchs and the non-

122 excremental colonialism

Christian tribes, attended sideshows and circuses, danced at balls, and engaged
in sporting contests. According to G. A. O’Reilly, the director of the carnival, it
was evident that ‘‘the Oriental . . . does not, as the Occidental, merely play a
carnival part, but actually lives it.’’∫≠ Harry Debnam recalled that on the
arrival of the Monarch of the West ‘‘the spirit of carnival seemed to take hold
and intoxicate with its queer and enticing flavor of mirth and good-fellowship.
No one was offensive; no one too boisterous.’’ The festivities culminated in the
crowning of the king and queen of the carnival on the last night. Few would
have been surprised to find that no persons were better fitted to take up these
duties than the Monarch of the West and his captivating consort, Miss Mar-
jorie Colton. The dancing continued till dawn. ‘‘Never before in the history of
the islands,’’ gushed Debnam, ‘‘had anything been so magnificent, so thor-
oughly cosmopolitan, and so successful.’’∫∞ Smith, the retiring governor gen-
eral, also felt the carnival was a ‘‘magnificent success,’’ with 128,000 paid
admissions: he was especially impressed that ‘‘perfect order prevailed.’’∫≤
In the following years, however, the carnival became ever more commer-
cial, educational, and martial; industrial displays, military parades, and ath-
letic contests came to dominate proceedings. Thus the prospectus for the
carnival of 1909 states, ‘‘It has definitely been decided by the Carnival Asso-
ciation that, while the Carnival features proper shall be brought out in their
most attractive form, the great effort of the Carnival . . . will be along indus-
trial lines.’’ It was above all an opportunity to illustrate how ‘‘there has been
planted in Manila a government machine in which the most modern ideas
have been incorporated.’’∫≥ The incoming governor general, W. Cameron
Forbes, thought that Filipinos still enjoyed themselves and behaved ‘‘in a most
orderly and decorous manner, in spite of the fact that fancy masks, disguise,
and the throwing about of confetti permitted a license in conduct in which
one might have expected a letting down of the barriers of convention to a
degree which might have proved disagreeable.’’ All the same, he went on,
‘‘next year it is proposed to limit the masking, confetti, jollification and enter-
tainment features of the Carnival to the last three or four days and to devote
the first four or five days to an industrial, agricultural and commercial ex-
hibit.’’∫∂ In fact, the most significant aspect of the carnival of 1910 was the
presence of soldiers. Forbes believed the review of eight thousand troops at
the conclusion of festivities ‘‘ought to be quite impressive and not to any
harm, as it is advisable to let the natives know that the troops are here.’’∫∑
Indeed, the military procession turned out, he wrote to the secretary of war, to
be ‘‘a beautiful affair, beautifully carried out, and I think most opportune.’’∫∏

excremental colonialism 123

figure 28. King of the Orient, Manila Carnival, 1908 (rg 350-p-ua-6, nara).

Despite the wishful thinking of its promoters, initially it proved difficult to

interest Filipinos in the annual carnival. In 1908, only the American press
gave the event much coverage. The Spanish and Tagalog newspapers took a
few years to recognize its news value. At first, the carnival publicist was
unsure whether this inattention derived from ‘‘lack of appreciation of the
importance of the carnival to Manila, or . . . lack of sympathy or hostility to
the carnival project.’’∫π In later years, hostility was clearly evident. In 1911,
for example, an editorial in La Vanguardia condemned the imminent car-
nival, which, ‘‘rather than the celebration of the memory of the pompous
festivals of paganism adopted frantically by all people, appears to be and is an
outpouring of positivism and speculation’’ dominated by a search for profit.
‘‘It is truly marvelous simplicity to see in the carnival of the Americans one
atom of [Filipino] energy and activity.’’ The radical paper urged its readers
instead ‘‘to hold a great purely Filipino carnival festival.’’∫∫ A few days later,
however, the more moderate La Democracia argued that an alternative car-
nival was far too provocative and would fail without majority support.∫Ω The
Municipal Board refused to let any alternative carnival take place in 1911. In
the following year, hostility focused instead on the repeated exhibition of
‘‘savage tribes’’ at the carnival, a reminder of Dean C. Worcester’s shaming

124 excremental colonialism

display of Igorots at the St. Louis Exposition of 1904.Ω≠ El Ideal complained
that ‘‘the public will be obliged this year like previous years to witness the not
very edifying spectacle of a legion of savage men, torn from their forests and
haunts to be the object of derision and ridicule of ‘civilized people.’ ’’ The
pavilion of the Mountain Province would again become ‘‘The Temple of
Nakedness.’’Ω∞ The editor of La Vanguardia was even more incensed:

Without them [the mountain people], the wise ones and the pontiffs of coloni-
zation do not feel themselves satisfied with their profound anthropological
investigation. Without them, in brief, the general level of our life would be
uniform, monotonous, and entirely equal to the lives of cultured people, and
this is not good, nor does it serve the theory of the ineptitude of the [lowland
Filipino] people, nor does it consecrate the principle of the superiority of races,
nor can it in any manner excite the curiosity and fondness for novelties of the
tourists.Ω≤

Forbes soon relented and insisted on clothing the visiting Igorots, but the
newspapers continued to express their disgust with the efforts of the admin-
istration to lump Christian Filipinos with mountain heathens.Ω≥ In later years,
hostility to this Wild East show became more muted, though there remained
many Filipinos who found it demeaning or just plain boring.
By February 1918, the reformed ‘‘big fiesta’’ was a lavish occasion, a Red
Cross Carnival resembling a small city. Designed to ‘‘combine pleasure with
the noble spirit of business and democratic understanding between all who
live and trade in the Orient,’’ the carnival now consisted of a patriotically
decorated piazza, commercial establishments, including a few ‘‘curious Chi-
nese concessions,’’ a motor industry display housed in ‘‘buildings constructed
in Roman style,’’ a merry-go-round, some instructive government exhibitions,
and an auditorium ‘‘where the Queen of the Great Festival is crowned.’’Ω∂ The
‘‘atmosphere of patriotic solemnity’’ was supposed to ‘‘convince people that
the Red Cross Carnival was not merely an occasion for mirth and frivolity.’’
One imagines that after watching the parade of Red Cross women who re-
flected on their faces ‘‘the beautiful rays of Christian charity and unbounded
patriotism,’’ the ‘‘martial columns’’ of school cadets, and ‘‘the allegorical
floats of the different establishments, institutions of learning and bureaus of
Insular Government’’ the attentive crowd found its sense of frivolity was
indeed suitably muted. But just in case, the eager revelers had been told to wait
until the end, ‘‘when they could throw confetti right and left without offense
or undue familiarity and when they could feel to have come in tacit under-

excremental colonialism 125

figure 29. Queen of Electricity, Manila Carnival, 1908 (rg 350-p-ua-2, nara).

standing to enjoy themselves without encroaching the unwritten code of good

manners.’’ Not, one suspects, a carnival Rizal would have appreciated. In-
deed, one irreverent reporter observed that the conspicuous presence of re-
cruiting stations ‘‘gave the general atmosphere of merriment an aspect of the
grim reality of life in army camps.’’Ω∑
Of all the exhibitions, perhaps the most elaborate and the most telling was
the Philippine Health Service’s display of a Sanitary Model House, complete
‘‘to the minutest detail’’ with an exemplary water closet: ‘‘Beautifully sur-
rounded by a flower and vegetable garden, [the model] made a lasting impres-
sion on thousands of home lovers.’’Ω∏ Perhaps more reliable is the description
of the carnival as ‘‘one big gambol’’—even if such unadulterated pleasure was
illicit—followed by a dutiful admonition to ‘‘those of us who have spent the
last eight evenings dancing, throwing confetti and visiting side-shows’’ to take
a little time to view the government exhibitions. These were as ‘‘instructive’’
as ever, the breezy report noted, which ‘‘leaves very little to be said.’’Ωπ More
prudish commentators lamented the behavior of dedicated revelers. While
many of the subversives who took part in ‘‘the hubbub, the jollities, the
fooleries, and the emptying-purses’’ were students, it seems they had little
time for the edifying structures of the Red Cross Carnival. Rather, students

126 excremental colonialism

went straight for the ‘‘hurly-burly dancing, pitching handfuls of confetti at
some giggling lasses’’ or they strolled ‘‘around the city of mirth throwing a few
centavos here and there . . . to the fake freaks of nature exhibited in the side-
shows.’’ Evidently this institutional carnival could in reality scarcely contain
the carnivalesque, let alone reform it. As a result of such ‘‘unbridled plea-
sure,’’ the students awoke the next morning ‘‘haggard-looking,’’ with ‘‘a dull
head, unable to concentrate their minds on their lessons.’’Ω∫ If only—one
hears the reproach—they had lingered longer at the Sanitary Model House.
While the Manila carnival occurred in February each year, Clean-Up Week,
the other alternative to the traditional fiesta, usually took place the week
before Christmas. Promising ‘‘the sanitation and the beautification of the
Philippine towns,’’ it was chiefly a time for ‘‘the cleaning of private and public
premises, the gathering and burning of rubbish . . . the construction of drains,
the repair of fences, the trimming of hedges, the construction of toilets.’’ΩΩ In
the past, it had been ‘‘the custom to have a municipal clean-up before town
fiestas’’; but what used to be merely preparation for a festival had become the
raison d’être of community activity.∞≠≠ In this sense, it was promoted as a
‘‘nation-wide’’ revival of a ‘‘good custom of our grandfathers, only to be done
in a more systematic way.’’∞≠∞ The first such celebration of Hygeia took place
in 1914—to a ‘‘distinct lack of cooperation and interest on the part of every-
body.’’∞≠≤ But eagerness picked up after 1920, when the government began
offering one hundred pesos to any ‘‘charitable or social institution in a town in
each province, which will make the best effort to have the greatest number of
houses and lots cleaned and improved.’’∞≠≥ By 1922, Clean-Up Week was well
observed. It had been divided into special days, including weed-rubbish day,
draining day, privy day, repairing day, scrubbing day, and house furnishings
day. On privy day, of course, all were expected to build or repair their toilets.
The week opened with decorous parades and band music and closed with
speeches and prizes. A policeman, often assisted by a teacher or councilor,
went about with standardized forms scoring all dwellings and shops in the
district. ‘‘Line up, folks,’’ the Filipino townspeople were exhorted. ‘‘Roll up
your sleeves. Get ready for the great national event.’’∞≠∂
By the 1930s, the institutional carnival and Clean-Up Week, along with
the laboratory, the concrete market, and the flush toilet, had come to repre-
sent sites of civilized public and private life in the Philippines, special places
of nation building.∞≠∑ As Nick Joaquin put it, ‘‘How could a silly old fiesta
or a superstitious procession be culture at all? In the 1930s culture was
the ‘streamlined,’ the ‘up-to-date,’ jitterbugs and jive, Mickey Rooney slang,

excremental colonialism 127

figure 30. Parade of American troops in Manila. Courtesy of the Rockefeller Archive
Center.

Flatfoot Floogie with the Floy-Floy, swing music and the rhumba, and every-
thing ge-noo-wine made in America.’’∞≠∏ Nevertheless, many Filipinos, like
Joaquin, continued to find a useable past in the bowels of Manila’s Intra-
muros, in the older local and Spanish traditions, while addressing Americans
in the special civic terms they understood and rewarded.

the colonial laboratory as ritual frame

American physicians in the early twentieth century sought to ensure that the
colonial Philippines was inhabited with propriety. The new tropical hygiene,
informing an expanded apparatus of surveillance and regulation in the archi-
pelago, worked to reproduce in parallel the formalized body and the abstract
space of colonial modernity. The enforcement of this imperforate orificial
order would lead, ideally, to a seamless reformation of supposedly grotesque,
open Filipino bodies and to a reterritorialization of the marketplace and the
old fiesta, both of which had figured in the American imaginary as places of
promiscuous, threatening contact. As Americans attempted to erase or ab-
stract their corporeality, Filipinos had become the chief and most generous
sources of contaminating matter. Represented as uncivilized, even bestial,
Filipinos often were seen as ‘‘promiscuous defecators,’’ transgressing colonial

128 excremental colonialism

safe havens, imperiling the innocent Americans who were trying valiantly to
transcend their lower bodily stratum.
How convincing was this assumption of transcendence? Americans clearly
were still fascinated by defilement and the boundaries, both social and spatial,
it marked in a manner so excitingly assailable. Much as they denied it, Ameri-
cans were themselves victims of the abject, for even as Filipinos were iso-
lated and disinfected, the rejected Other could never be radically excluded
from the colonialists’ own embodiment. This secret rottenness remained a
‘‘non-assimilable alien,’’ an abiding structure within even the most apparently
abstracted of bodies, always there to disturb and unnerve as much as to
constitute American identity. And so it was that the effort to suppress this
abject Other, this alter ego, required relentless self-control and sublimated
productivity—the development and further expansion, that is, of a conflicted
colonial modernity.
American scientists, as we have seen, collected obsessively any specimens
of Filipino feces they could lay their gloved hands on. Indeed, for scientists in
the Philippines native excrement was as practically creative as it was poten-
tially destructive. If Filipinos could not spread their feces on their fields, and
ordinary Americans could not touch the stuff, the ‘‘ritual frame’’ of the labo-
ratory permitted accredited scientists to smear the pulverized, reduced mate-
rial on their microscope slides and agar plates with abandon. Thus when E. L.
Walker and Andrew W. Sellards conducted their investigations into the etiol-
ogy of dysentery, they did not hesitate to feed their Filipino ‘‘clinical material’’
with organisms cultured from the stools of acute cases and carriers of the
disease and to analyze their subjects’ feces for the answer to the problem.∞≠π
The decent, delibidinized, closed space of the modern laboratory had con-
ferred on shit the ‘‘epistemological clarity’’ of just one more specimen among
many. On the resulting abstractions and inscriptions depended the colonial
scientists’ reputation and career prospects. ‘‘Within the ritual frame,’’ Mary
Douglas reminds us, ‘‘the abomination is . . . handled as a source of great
power.’’∞≠∫ Not surprisingly, it would propel Richard P. Strong from Manila,
where he had helped sort out the cause of dysentery, to the first chair of
tropical medicine at Harvard.

excremental colonialism 129

Chapter Five

the white man’s psychic burden

F or all their polo playing, sweaty tennis matches, consumption of red

meat, and celebrated dedication to the strenuous life, senior American

colonial administrators in the Philippines could still discern in themselves

great vulnerability and tenderness. While it now seemed that with proper

hygiene their bodies might resist physical decay and degeneration in tropical

climes, their mental apparatus continued to appear distinctly fragile. Pre-

occupied with fighting germs and disciplining Filipino cleanliness—with dis-

seminating civilization and republican virtue—most Americans nonetheless

remained convinced that tropical displacement might destabilize their minds

and morale. Few of the outwardly hardened white bureaucrats did not at

some point break down or become ‘‘unnerved’’ and thus ‘‘unmanned.’’ Near-

ing the end of his term, Governor-General W. Cameron Forbes, a former

Harvard football hero and a commanding number 2 on the polo team, had to

retire to his sickbed ‘‘worn out.’’ ‘‘I had worked my head until I had what they

call brain-fag,’’ he scrawled in his journal. His physician, Richard P. Strong,

known as ‘‘medico stocky’’ and a dashing number 1 at polo, thought Forbes’s

condition serious.∞ But Strong had been suffering too. ‘‘Dr. Strong ought to

have quite a rest from his arduous service of nearly 14 years in the tropics,’’
Forbes wrote. ‘‘He broke down under the strain last year.’’≤ Also in 1912, Dr.
Percy Ashburn of the Army Board for the Study of Tropical Diseases noted
that ‘‘it is a matter of common belief that men, as well as women, do ‘go to
pieces,’ and become neurasthenic in the Philippine Islands.’’≥ Even those trop-
ical physicians who had come to scoff at the notion of a physiological degen-
eration of the white race still conceded, reluctantly, that some mental and
moral deterioration might occur. Their white patients never doubted it. The
Americans’ overpowering sense of mental stress in alien and disagreeable
surroundings was not easily dispelled. As late as 1926, Nicholas Roosevelt
warned his readers that ‘‘there are certain psychopathic and neurasthenic
effects of living in the tropics,’’ the results of ‘‘nerves frazzled from heavy, hot
moisture.’’ ‘‘In Manila,’’ he wrote, ‘‘there is a disease called ‘philippinitis’ or
forgetfulness which makes many persons unable to recall common occur-
rences within a few hours.’’∂
As a novel and at first distinctively white American disease syndrome
characterized by a depletion of ‘‘nerve force,’’ neurasthenia had gained in
popularity since the late 1860s.∑ In 1867, George M. Beard, a New York
neurologist, offered a plausible materialist explanation for the plethora of
vague symptoms, from fatigue to dyspepsia, that afflicted Americans in their
efforts to cope with modern civilization (epitomized for him by steam power,
the telegraph, the periodical press, the sciences, and the mental activity of
women). The mechanistic metaphors initially invoked to explain the condi-
tion suggested that the human organism produced only a limited amount of
nervous force: if the capacity was low or the demands excessive nervous
function could become overloaded, and the system would then break down.
The precise quantum of nerve force an individual possessed was a function of
a hereditary endowment organized by race and gender. The disease seemed to
attack the most refined and productive members of society, the caretakers of
civilization: Beard thought Anglo-Saxons and non-Catholics in the prime of
life were particularly susceptible. In general, men became neurasthenic from
overwork, competition, and economic acquisitiveness; and women suc-
cumbed through dissipating their more limited neural vitality in study or
excessive socializing.
The nervousness of American men in the tropics (whether ‘‘tropical neur-
asthenia’’ or ‘‘philippinitis’’ or ‘‘brain-fag’’) was formally recognized soon
after 1898; during the next decade it became commonplace among senior
colonial officials; and then in the 1920s it mostly burned out.∏ Its history
parallels the establishment of the civil government in the Philippines, reaching

the white man’s psychic burden 131

epidemic proportions when the expatriate colonial bureaucracy was most
extensive and declining with the eventual Filipinization of the service. Thus
the framing of tropical neurasthenia in the Philippines affords us an especially
revealing view onto the contours of American colonial culture.
This chapter builds, in the first part, on the history of nineteenth-century
colonial psychiatry, and, in the second part, on the history of colonial psycho-
analysis. Tracing the self-reflections of Lieutenant Colonel Fielding H. Gar-
rison, m.d., I draw together these separate histories, as he did, and suggest
more broadly how these disciplines may have shaped perceptions of colonial
placement. Most accounts of early colonial psychiatry have focused on medi-
cal constructions of native insanity or on Europeans interned in colonial
asylums, but tropical neurasthenia has not fitted easily with either of these
historical interests.π Neurasthenia was deemed, at first, a normal consequence
of white displacement; and it rarely required admission to an asylum, al-
though repatriation might be recommended. In effect, it potentially rendered
all colonialists outpatients, not inmates. But the ambulatory character of this
psychopathology, its distance from outright lunacy, later made it the ideal
subject for psychoanalysis, which was spreading through the tropics during
the 1920s. A reformulated neurasthenia thus figures in historical accounts of
colonial psychoanalysis, although even in this literature the primary focus has
more often been the psychoanalysis of native elites and cultures.∫
The medical shaping of nervousness, initially mechanistic in character,
later psychodynamic, contributed to the cultivation of whiteness and mas-
culinity in American colonial culture. The new American colonies in the
tropics, as we have seen, presented both a special resource for white male self-
fashioning and its testing ground.Ω In this novel setting, the convergence of
ideas of bourgeois masculinity with ideas of whiteness and civilization be-
comes startlingly obvious, even as the nervy instability of the combination is
revealed with equal clarity. American males, drawn often from the expanding
university system (especially from Michigan, California, and Johns Hopkins),
argued that they were fit to govern Filipinos because they were racially supe-
rior and more manly and, it followed, more civilized than their charges.∞≠ This
is hardly surprising: such connections between masculinity and empire have
become a postcolonial commonplace. Ashis Nandy has linked the British
obligation to fashion a more rigid masculinity with colonial domination in
South Asia; for Ronald Hyam, the British Empire demonstrated a ‘‘culture of
the emphatically physical’’; and Mrinalini Sinha has described ‘‘the imperial
constitution of colonial masculinity.’’∞∞ In a series of essays on the ‘‘cultivation

132 the white man’s psychic burden

of whiteness’’ in the Dutch East Indies, Ann L. Stoler studied the colonial
production of bourgeois civility through discourses of race and gender. She
emphasizes the diversity within the category of the colonizer and the at-
tendant ‘‘problematic political semantics of ‘whiteness’ ’’ in colonial society.
While not explicitly addressing the framing of colonial masculinities, Stoler
observes that ‘‘degeneracy characterized those who were seen to veer off
bourgeois course in their choice of language, domestic arrangement, and
cultural affiliation.’’ Poor whites were the failures of empire.∞≤ In this chapter,
though, I argue that the term degenerate, usually indicating a discomposing of
white masculinity, attached not just to subordinate and marginal colonialists:
even the more civilized and apparently masterful of white men might break
down and lose their nerve.
Colonial insecurities cannot be isolated from the uncertainties of those
white bourgeois males who remained in the United States during this period.
Historians of the Progressive Era have attributed American obsessions with
manhood, the frontier, the strenuous life, and the great outdoors to a ‘‘mas-
culinity crisis’’ that developed at the end of the nineteenth century. In the
face of increasing dependence on bureaucracies, more opportunities for lei-
sure, working-class competition, and the rise of an assertive women’s move-
ment, many middle-class men found it hard to affirm the manly ideals of self-
mastery and restraint.∞≥ Yet it could also be said that manhood was not so
much under threat during this period as being remade. Gail Bederman, for
instance, suggests that the moral dimension of manhood became muted as
anxieties about fin-de-siècle social change amplified a fascination with male
aggression, muscularity, athletics, and virility.∞∂ Although it is tempting to
follow Bederman and infer a tension between the ideals of manly self-restraint
and masculine virility and to recognize a trend from one to the other, in a
sense these tropes of masculinity were fashioned as a physiological amalgam.
According to conventional wisdom, a strenuous life built up the nerve force
necessary for the maintenance and advancement of civilization. A failure to
develop physical force thus led inevitably to neurasthenia, the result not of
civilization, but overcivilization, the exclusive focus on brain-work at the
expense of body-work. Elemental simplicity—‘‘intrepidity, contempt of soft-
ness, surrender of private interest, obedience to command,’’ as William James
put it—might correct the vices of overrefinement and overcivilization.∞∑ Not
surprisingly, the rising concern with the dangers of overcivilization presented
special difficulties in the new U.S. colonies, where white males regarded them-
selves as emissaries of civilization in an environment inimical to both mental

the white man’s psychic burden 133

and physical exertion. Thus colonial breakdown, labeled tropical neuras-
thenia, came to represent the true, protracted weight of the white man’s
burden.∞∏
It is tempting, then, to find in the notion of tropical neurasthenia, with its
unsettling of ideals of masculinity and whiteness, the beginnings of an auto-
critique of colonialism. The recognition of white male nervousness in the
tropics would seem to suggest an ambivalence toward colonial expansion and
the civilizing process, a discomfort or anxiety that must be somehow as-
suaged. But the political and social meaning of this colonial ambivalence is
not self-evidently subversive. Mechanistic and, later, psychodynamic explan-
atory frameworks recognized the contradictions of colonial displacement,
gave them a voice, and in expressing these conflicts often managed also to
contain or deflect them. Psychology (in this period, anyhow) was more a
salvage operation than critique. A diagnosis of tropical neurasthenia began
the process of reconditioning failed colonial identity, not subverting it. Vi-
cente Rafael has described a masterful ‘‘white gaze’’ in the Philippines: ‘‘spa-
tially it is a gaze that surveys and catalogs other races while remaining un-
marked and unseen itself; temporally, it is that which sees the receding past of
non-white others from the perspective of its own irresistible future.’’∞π Al-
though I would argue that this white masculine gaze was often more a ner-
vous glance than a commanding stare, it would be all too easy to overstate the
political significance of this white American admission of fragility and ambiv-
alence.∞∫ My main concern here is not the distilling of any subversive potential
from colonial breakdown; rather, it is to see how the medical framing of
colonial nerves allows us to sample ‘‘empire as a way of life’’—with all its
normal heterogeneity and instability built in.∞Ω

‘‘it is no light burden for the white man’’

Even at the Army Medical Library in Washington, D.C., Lieutenant Colonel
Garrison sometimes felt worn out and nervous. From the beginning of the
century, he had spent long hours compiling the Index Medicus and in the
evenings wrote historical articles—his Introduction to the History of Medi-
cine was for many decades the most authoritative survey available in En-
glish.≤≠ Garrison regarded his correspondence with his friend H. L. Mencken
as a respite from all this wearying bibliographic drudgery. Through classical
allusion, disquisition on music, and reverence for German culture, he tried
to demonstrate in these strangely ornate and coquettish letters that he was
not just another physician with an ‘‘unfurnished mind’’ (July 4, 1925). An

134 the white man’s psychic burden

unlikely Bohemian, Garrison shared Mencken’s admiration for the German
composers and a worship of Friedrich Nietzsche and even at one point dared
to recommend Sigmund Freud to his skeptical correspondent (August 21,
1921). His ambitions always thwarted at the library, Garrison came to feel he
needed a change of scene. When ordered to the Philippines in 1922, he as-
sured Mencken it would be ‘‘a nice vacation after 31 years of official drudgery,
and a good chance to see the East and come back via Europe.’’ As he was
attached ‘‘as literary scribe to the Board to Investigate Tropical Diseases,’’ he
expected, through his clerical duties, to learn something about tropical medi-
cine too. Garrison was fifty-one years old. ‘‘I think the change will give a sort
of goat-gland stimulation to the poor worn-out bean or cerebrum,’’ he wrote
just before departing (April 13, 1922).≤∞
He was sadly mistaken. ‘‘I am stacking up fairly well,’’ he noted in his first
letter from Fort Santiago, ‘‘but perspiring as I do, the Klima is a sort of
Shylock that exacts a pound of flesh a day, while the humidity and monotony
are so depressing that I am 1/16 what I used to be mentally. I do all the mili-
tary work satisfactorily—anyone could—but have to take calomel weekly, as
being of the perilous disposition described by fortune-tellers: ‘no sense of
humor, homicidal tendencies and an overly conscientious disposition.’ I feel
quite homicidal most of the time, but Bilibid prison is a dreary sort of place so
I will postpone action until I get back to the States’’ (May 3, 1922). Although
the facetious tone soon vanished, he remained ‘‘utterly worn out and neuras-
thenic’’ for the rest of his stay in the Philippines. ‘‘When I struck this place,’’ he
recalled, ‘‘I was totally unacclimated to that old bromide, the humidity, and
the tedious period of getting the body temperature adjusted to the beastly
outside atmosphere, or rather lack of it, [so] my reaction was one prolonged,
unintermittent growl at being badly stung’’ (December 11, 1922). He found it
‘‘impossible to do anything worthwhile in this strange devitalizing climate. It
inhibits thinking of an orderly kind, and, worse still, it superinduces a le-
thargic forgetfulness’’ (March 24, 1924).
But the climate was not the only provocation. Filipinos got on his nerves,
and Americans were not much better. ‘‘The average American hombre,’’ he
declared, ‘‘is either a lean reflective pig or an unreasoning fanatic’’ who
‘‘wouldn’t know Schiller from a wombat’’ (April 28, 1924). The climate and
the banal social life together seemed to ‘‘corrode’’ his nervous system. ‘‘Were
it not for the liquid refreshment available hereabouts, which, as in the case of
Themistocles, ‘makes us forget,’ life would be diabolically unendurable’’ (De-
cember 11, 1922).≤≤ Toward the end of his stay in the Philippines, Garrison

the white man’s psychic burden 135

 figure 31. Fielding H. Garrison,
1917. Courtesy of the National
Library of Medicine.

mused yet again on his ‘‘sufferings’’ in the tropics: ‘‘I have lived from day to
day in this environment in a state of lowered vitality, like the man in Edgar
Poe’s poem who felt his life ebbing and oozing away as he poured out sand on
the seashore, but even so, that is due to my age and metabolism, and when the
foaming beakers of spiritus cerevisae are brought up in the siesta hour, I can
say, with my old Bremen acquaintance, ‘Ich habe gutes Bier zu trinken.’ Better
come over and try it’’ (May 12, 1924). Mencken wisely declined the offer.
Garrison was one of the last American males to admit to neurasthenia in
the tropics: though the formulation of his symptoms is conventional, his
clinical course was not. Usually it had taken a few years to become neurasthe-
nic. David P. Barrows, the superintendent of education in the Philippines and
a keen anthropometrist, remained vigorous from 1903 until 1906. Then,
aged thirty-three, he found he was more irritable, with poor concentration:
‘‘if a good vacation in a cool climate restores my endurance,’’ he noted in his
journal, ‘‘I shall be content.’’ But the next year was no better. ‘‘In my office
work my dictating is now halting, confused and badly put together—a great
change from say 1903–4–5,’’ he wrote. ‘‘This is in part due to the nervousness
which assails me at my work and sometimes makes clear thinking and expres-
sion almost impossible for me.’’ Despite hiking, riding, and reading Rudyard

136 the white man’s psychic burden

Kipling, the future president of the University of California was ‘‘consistently
not in very good health’’ throughout 1908 and so returned to Berkeley the
following year.≤≥ Nerves in the tropics could mean anything from Barrows’s
lack of concentration to Herbert I. Priestley’s disabling morbid apprehen-
sions. As a teacher in Nueva Caceres [Naga City], Priestley began having
‘‘morbid spells’’ in October 1902, but he quieted down with bicycle riding
and bromides. ‘‘The doctor says the climate is quite wearing on me, and I
guess it is,’’ he noted. ‘‘I am worn thin, and my nerves are a little out of gear
from the climate but I believe that if I hadn’t been so foolish as to wear
nainsook and cotton I wouldn’t have felt my nerves so much.’’ And soon after
the new year, he observed that ‘‘of course I am nervous and upset tonight, and
my notion is pessimistic, but I don’t recover from my nervousness as fast as
I should like.’’ Priestley, who thought his ‘‘sensitive temperament’’ set him
apart from many of the ‘‘hard, sporty’’ Manila types, left the next year.≤∂
Colonel Valery Havard, m.d., in reviewing the effects of the Philippine
climate on Americans soon after their occupation of the archipelago, had
been especially concerned that the atmospheric humidity prevented free evap-
oration of perspiration, forcing the white organism to reduce its production
of heat in order to maintain a physiological equilibrium. The result of ‘‘this
necessary tropical regime’’ was a loss not only of heat, but of nervous energy
too. ‘‘The loss of energy,’’ he observed, ‘‘is chiefly felt by the mental faculties:
there is a diminution of capacity for intellectual labor, an inability to do work
requiring continued concentration.’’ Although the northerner might carefully
avoid the recently identified tropical pathogens, he must ‘‘resign himself to the
loss of more or less of his bodily and mental activity.’’≤∑ Thus for an older
generation of physicians, who still assumed some responsibility to observe
and aid the body’s regulation of intake and excretion, the inability to dissipate
heat from the closed bodily economy implied a compensatory scaling down of
energy production.
Younger medical colleagues, trained in a more reductionist method, had a
more tenuous attachment to the notion that disease might derive from such
mechanistic mismatches of racial constitution and alien environment. Their
ontological orientation drove them to seek out a particulate cause for every
disorder.≤∏ Major Charles E. Woodruff, m.d., as we have seen, warned ‘‘blond
races’’ of the specific dangers of concentrated light. The complex and fragile
mental apparatus of blonds and brunets seemed especially susceptible to the
noxious actinic rays that pervaded the tropics.≤π In its later, more sophisti-
cated form, Woodruff’s argument would echo the militant degenerationism of

the white man’s psychic burden 137

Bénédict Augustin Morel and Cesare Lombroso.≤∫ ‘‘The instrument for ex-
tinction of men in unnatural climates,’’ he declared in 1909, ‘‘is degeneration
in its modern sense, and it is brought about in the tropics by nervous exhaus-
tion.’’ The white man might now be able to avoid tropical infection, but he
would always be prone to nerve weakness, flippantly called philippinitis. The
causes of this debility were ‘‘overwork, vicious conduct, and the thousands of
things which lower vitality.’’ As a result, ‘‘low tropical savages are the fittest
for their environment, and the strenuous white man is the unfit.’’≤Ω
When Woodruff sought to explain with reductionist solar and racial theo-
ries the epidemic of neurasthenia he witnessed among white males in the
Philippines, he was also trying to fashion a coherent, appealing hypothesis for
his (and many others’) experiences of despair, illness, and incompetence in the
tropics. Woodruff, who, as noted, was an irascible man frequently admon-
ished by his superior officers, had himself been repatriated from the Philip-
pines in 1904 suffering from chronic amebic dysentery and neurasthenia.
Ordered back to the Philippines in 1909, he again developed there a ‘‘mucus
colitis’’ and neurasthenia (‘‘cerebrospinal type’’), and consequently he de-
manded a posting to a more temperate climate. But in 1910 Percy Ashburn
examined him back in San Francisco and found him in good physical condi-
tion. The medical board commented, rather snidely, that ‘‘in view of Lt.-Col.
Woodruff’s well known opinions as to the injurious effects of tropical cli-
mates upon white men and his marked disinclination to expose himself to
such influences, it is appreciated that a return to Manila might result in a
considerable degree of mental perturbation and distress.’’ They sent him back
anyhow, for a ‘‘trial,’’ and he was repatriated again in 1912 and retired for
disability in 1913. He died two years later, in his fifties, no doubt convinced
that in doing so he was proving his hypothesis.≥≠ Although his theories and his
experience had been unusually extreme, Woodruff’s forebodings would con-
tinue to haunt even the most confident of tropical hygienists. Ashburn himself
eventually conceded the dangers of tropical neurasthenia, though he thought
it always preventable.
Like many others, Dr. Louis Fales found Woodruff’s theory of actinic
agency ‘‘perhaps a little indefinite’’ and was not ready to discard entirely
Havard’s physiological explanation, but he too had no doubt that, whatever
the cause, after a few years’ residence in the tropics ‘‘the white people be-
come a race of neurasthenics.’’ Fales had observed for himself how Americans
in the Philippines soon fell into ‘‘a state of semi-invalidism.’’ Brain-work in
these circumstances seemed an especially effective means of further depleting
the tropical resident’s climatically diminished reserves of nerve force. Ameri-

138 the white man’s psychic burden

can males in the Philippines ‘‘cannot easily concentrate their minds on their
work,’’ he declared; ‘‘they become easily fatigued, and they cannot do the
efficient work they were formerly capable of doing.’’ The syndrome was re-
cited as a litany: irritability and peevishness; troubled sleep, bad headaches,
and poor appetite; a lack of concentration; an inability to plan for the future;
molehills became mountains; urgent matters were deferred indefinitely; and
morbid introspection eventually prevailed. The symptoms resembled those
of neurasthenia in the United States, except that vasomotor signs, such as
‘‘angioneurotic edema,’’ were more common in the tropics, and neurasthenics
from the Philippines recovered as soon as they moved to a temperate cli-
mate.≥∞ The future looked especially grim for white children, who were reck-
lessly endangered by long residence in the torrid zone: ‘‘Born of neurasthenic
parents, they will inherit an organism lacking in nerve force; being forced to
live in an enervating climate, their small reserve will be still further drawn
upon, and in a generation or two there will result a race with little resem-
blance to the mother stock, small, puny, weak-minded, in fact a degenerate
race which would soon cease to exist if new stock did not continually come
from the home land.’’≥≤ Thus in Fales’s opinion, degeneration challenged any
fond hopes for permanent white American control of the tropics.
When Ellsworth Huntington at Yale proposed his ‘‘climatic hypothesis of
civilization’’ as the core of the ‘‘new science of geography,’’ he drew in part
upon the research of Woodruff and Fales. They had used medical science to
show that the environment could influence the global distribution of ‘‘human
energy.’’ In particular, Huntington identified the deterioration of character
they had described—‘‘weakness of will’’—as a crucial problem for the white
man in the tropics. This fecklessness led frequently to a ‘‘tropical inertia,’’
typically manifested as ‘‘lack of industry, an irascible temper, drunkenness,
and sexual indulgence.’’ If any should try to work too hard, they became
‘‘nervous and enfeebled.’’≥≥ Thus male nervousness in the tropics came to be
represented (and, to an extent, exonerated) as an unfortunate but under-
standable failure of character—letting down the side of manly civilization,
but perhaps the side was physiologically a forlorn hope in such a climate. In
the early twentieth century this failure meant, in effect, the lack of exercise of
the will over habit, a temporary slippage of racial and manly duty.≥∂ For-
merly disciplined, strenuous Anglo-Saxon males routinely became enervated,
louche, and irresolute in the tropics. And yet reproach was always mixed with
sympathy as the process was represented as basically a natural one, though on
occasion complicated by personal recklessness.
Both Fales and Woodruff had also speculated on the delicate constitutions

the white man’s psychic burden 139

of white women, which evidently rendered them especially vulnerable to the
alien tropical environment. Most American women in the Philippines, ac-
cording to Fales, ‘‘become nervous, irritable, anemic, lose weight, suffer with
neuralgia, spells of faintness, sleep poorly, and almost invariably are trou-
bled with menorrhagia and dysmenorrhea.’’≥∑ After a year in the archipelago,
Francis B. Harrison, the new governor-general, reported, ‘‘My wife has stood
the climate as well as any American woman can, but that is not saying much; I
consider this climate an unqualified detriment to American women and I
believe that a year is about all that any of them should stay here without
taking a more or less long vacation leave.’’≥∏ As men succumbed to the climate
and the onerous demands of administrative duties, women like Mrs. Harrison
were victims of the climate and their excessive sociability and depletive re-
productive tract. In theory, then, degenerating women should have abounded
throughout the American tropics. Dr. W. W. King in Puerto Rico thought, for
example, the tropical humidity inevitably caused a special ‘‘atony’’ of white
female bodies. It was because American women in the tropics ‘‘menstruate
more abundantly’’ than in the United States; they felt the lack of ‘‘accustomed
society, pleasures and diversions’’ more keenly than the men; and ‘‘house-
keeping where customs and language are strange and where servants are
inefficient and uncleanly has its thousand and one little difficulties and wor-
ries that need to be seen to be appreciated.’’≥π
Yet accounts of tropical neurasthenia among women are surprisingly rare.
Described in medical texts—and sometimes by their husbands—as pallid,
weak, and nervy, without exception they appear in their own personal recol-
lections as robust and competent.≥∫ Perhaps white women were reluctant to
admit to a nervousness that was formulated (for them) so explicitly as an
index of biological and intellectual inferiority. White American men in the
tropics evidently could attest to the mental strain formalized in their diagnosis
of male neurasthenia and so ratify an etiology that suggested their superior
status. American women were understandably less ready to assent to a condi-
tion that marked principally a disorder not of an overtaxed mental apparatus
but of a leaky reproductive tract. Female neurasthenia in the tropics signified
a basic biological maladaptation that could not possibly be circumvented. A
white man could rest from brain-work or mitigate it through exercise, but a
white woman could not avoid her uterus. In medical treatises on neurasthe-
nia, she thus became a physiological pariah in the tropics: biologically, this
region was no place for a white woman or for the style of domesticity that her
presence signified.≥Ω

140 the white man’s psychic burden

 A neurasthenic disposition was less commonly attributed to the military in
the islands, perhaps because regular exercise and other virile activities com-
pensated for what little brain-work they had to do.∂≠ Only a few officers,
the self-consciously intellectual ones, were prepared to assert their nervous-
ness. Lieutenant Colonel Eli Huggins, a convinced anti-imperialist and a poet,
was appointed military governor of Ilocos Sur in 1901 after a distinguished
Indian-fighting career (during which he had compelled the surrender of Rain-
in-the-Face). ‘‘I am not in harmony with my environment over here,’’ he
lamented. ‘‘In fact there is a horrible jangling discord.’’ Fortunately, the trans-
lator of Théophile Gautier and Alfred de Musset was sent home within the
year.∂∞ More commonly, young (and less civilized) soldiers developed mild
psychoses, nostalgia, or delerium tremens. Thus a private in the 19th infantry
was repatriated in 1901 with ‘‘paranoia,’’ believing his officers had been
persecuting him. He was excitable, with ‘‘an abnormal development of Ego’’
and a ‘‘fixed delusion of his own ability,’’ telling everyone about his ideas for a
machine of perpetual motion and an ‘‘absurd’’ plan for ‘‘rifles which should
fire some chemical preparation the gases from which would overpower the
enemy.’’∂≤ A private in the 5th infantry was ‘‘excellent’’ until he went to the
Philippines, where he ‘‘indulged excessively in alcoholics’’ and began to ‘‘la-
bor under delusions of persecution’’ and develop an ‘‘acute melancholia.’’∂≥ It
seems that when an enlisted man was exposed to the tropical sun he was more
likely to show melancholia or paranoia than neurasthenia—a flattened affect
or a psychosis, but not an overcivilized nervousness.
Filipinos, typically, went mad or ran amok. Conventionally, the ‘‘Malay
race’’ was prone to disorders of emotional repression followed by excess and
abandon, in contrast to the elite white colonialist’s exhaustion of emotional
expression and lack of ‘‘nerve vigor.’’ In 1901, John D. Gimlette described the
male native’s tendency to succumb to homicidal mania after a period of de-
pression and brooding. This disorder was triggered by a realization that his
life had been beset by misfortune and insult. It culminated in the hypersensi-
tive sufferer running amok, killing anyone he met, until he was slain.∂∂ Most
commentators on amok regarded the condition as revealing a combination of
infantile misjudgment, deficient self-control, and primitive reflex. It demon-
strated the Filipino’s vanity and immaturity, his racial jealousy and pathologi-
cal sense of honor. Waves of passion eroded the rudiments of rationality,
leading to an impulsive, random killing spree. Some Muslims in the southern
Philippines, called juramentados, seemed especially susceptible to losing their
wits and running amok.∂∑ This tendency to go on a rampage suggested to

the white man’s psychic burden 141

many white observers that most Filipinos, especially Moros, lacked the sus-
tained self-control and capacity for reason necessary to become fully civilized.
Speaking in 1909 on ‘‘the nation and the tropics,’’ William Osler im-
pressed upon his audience that ‘‘it is no light burden for the white man to
administer this vast trust.’’ Despite the great advances in tropical sanitation
and the consequent reduction in transmission of the region’s disease organ-
isms, Osler, that model physician, doubted that the higher-order transplanted
Anglo-Saxon, laboring to impose order on the ‘‘blossom-fed Lotophagi,’’
could maintain his characteristic ‘‘hardy vigor.’’∂∏ The white man might live
among the banana palms—he might trade and, for a time, even fight boldly—
but it was likely that the manly character of the white race would degenerate,
and civilization would not thrive in the tropics.

hijinks at baguio
Foreigners in India, in Java, in Ceylon during the nineteenth century had felt
their strength and their sense of physiological balance restored in settlements
where the ‘‘conditions approximate in atmosphere and climate those of the
temperate zone.’’ Americans in the Philippines therefore counted themselves
fortunate in gaining access to Baguio, a town at an elevation of approximately
five thousand feet in the mountains of Luzon, ‘‘a rolling country filled with
groves of pine trees and grass, in which the temperature rarely goes below
40 degrees and never goes above 80 degrees in the shade.’’∂π Finding the
prospect enticing, the government in the early years of the twentieth century
had extended the railway north of Dagupan and from the end of the line
constructed a road to Bagiuo, at a cost of over two million dollars. To take
advantage of the ‘‘health-giving influence of the climate,’’ it established a
sanitarium, a number of hospitals, and Camp John Hay, a brigade post ‘‘for
the recuperation of our soldiers.’’ Americans in the islands found these in-
stitutions furnished ‘‘for a very moderate cost a healthful regimen and diet.’’∂∫
Cameron Forbes regarded Baguio as ‘‘a place to which people exhausted or
debilitated by their sojourn in the heat below may come and renew their
strength and vigor and increase the number of their red corpuscles.’’∂Ω He
helped set up a country club, which boasted a golf course and a polo field.
Fred Atkinson, the secretary of public instruction, praised this ‘‘summer re-
sort for the recuperation of those government officials who from the effects of
the climate become run down.’’ He had noticed that the ‘‘cooler, cloudier
atmosphere makes outdoor life and exercise possible and furnishes just that
stimulating force which is never found in the capital.’’∑≠ John F. Minier, a

142 the white man’s psychic burden

figure 32. Dining at the Baguio Country Club, 1908 (Dean C. Worcester Collection).
Courtesy of the University of Michigan Museum of Anthropology.

supervisor of schools, found that ‘‘the cool climate caused me to gain several
pounds which I lost as soon as coming back to the lowlands.’’∑∞ Some were
more eloquent. According to Frank G. Carpenter, in the mountains ‘‘every
breath is filled with champagne, and so invigorating that new blood seems to
flow through my veins.’’∑≤ On arriving in Baguio, Dean Worcester, the secre-
tary of the interior, observed that ‘‘this climate always does wonders for me
when I have been or am ill, and I do not see why it should not keep me well if I
could have more of it.’’∑≥ So sure was he that the ‘‘delightful coolness and
bracing air afford heavenly relief to jangling nerves and exhausted bodies,
worn out by overwork and by a too prolonged sojourn in tropical lowlands’’
that he later retired permanently to the hills. ‘‘No development which has
occurred in the Philippines during the past thirty years,’’ he concluded, ‘‘rests
upon a sounder foundation than Baguio.’’∑∂
The indications for treating sick white Americans in the hills, initially so
broad, soon became more limited. Not all cases benefited from elevation.
Between October 1905 and January 1908, seventy cases of refractory dysen-
tery came to Camp John Hay.∑∑ Forty-four of these returned ‘‘apparently
cured’’—with those whose disease had progressed least responding more
promptly to ‘‘the stimulus of the climate.’’ ‘‘On the other hand,’’ H. R. Hoff
reported, ‘‘in cases of long standing where often pathologic changes have

the white man’s psychic burden 143

figure 33. Baguio picnic party, 1904 (Dean C. Worcester Collection). Courtesy of the
University of Michigan Museum of Anthropology.

occurred in the intestines improvement has been slow, as indeed would be the
case in any climate.’’∑∏ A visit to Baguio seemed rather more permanently
favorable for malarial cases: of thirty-seven cases treated, thirty-six returned
to duty with no relapses. Anemia secondary to other diseases also appeared to
benefit from treatment in the equable environment of Camp John Hay. But
the most dramatic improvement often took place in cases of neurasthenia,
with twelve out of seventeen patients returning to duty during this period,
even though most of these later suffered a relapse. Hoff concluded that ‘‘neur-
asthenia developed under climatic conditions incident to the Philippine Is-
lands is very apt to recur when the person affected returns to the place in
which the disease first originated.’’∑π Most of these patients would recover
completely only when permanently repatriated.
While a sense of the deleterious effects of a tropical climate was never
entirely erased, over the next decade or so other factors such as the irrita-
tion of colonial social life would come to appear as more important contribu-
tors to bad nerves. Not surprisingly, public health officials increasingly em-
phasized those aspects of the problem that were most preventable or treat-
able. It would, of course, be infinitely more easy to reform negligent conduct
or to circumvent the multiple vexations arising from racial proximities than

144 the white man’s psychic burden

to alter the climate. When Victor G. Heiser broke down in 1908 after sup-
pressing a cholera epidemic in the islands, he identified the immediate cause of
his illness as ‘‘the continuous efforts over the past five years of overcoming the
passive resistance of the Oriental to health measures.’’ The mental effort of
dealing with the natives, he complained, had left him ‘‘mentally fagged out
and physically weak.’’∑∫ Heiser later concluded (without recalling his own
susceptibility) that philippinitis—the ‘‘mental and physical torpor, forgetful-
ness, irritability, lack of ambition, aversion to any form of exercise’’ of which
so many of his compatriots complained and which they blamed on climate—
was in fact the result of the ‘‘direct violation of hygienic laws, especially those
governing the production and dissipation of body heat.’’∑Ω The answer to his
own nervousness had been a better diet, more tennis, and opposition to the
irritating Filipinization of the health service: he did not choose to leave the
tropics for another seven years.
By the 1920s, the years of Garrison’s neurasthenia, medical officers in the
tropics had become convinced that relentless supervision and regulation of
personal and domestic hygiene, with emphasis on manly restraint and strenu-
ous exertion, promised to prevent or limit any local pathology, mental or
physical. Colonialists thus tried, more optimistically than ever before, to
build up hermetic microenvironments, enclosures that allowed free play for
the masculine virtues. It seemed likely that such an iatrocratic colonialism
might circumvent tropical neurasthenia, making it little more than an object
lesson, a token of pessimism. In effect, the diagnosis had become a means of
containing or disciplining breakdown, a means of recovering a faltering civi-
lized identity in the tropics. By attending to the rules of personal, domestic,
and public hygiene and carefully regulating social life, complete acclimatiza-
tion of the American male was possible; and if acclimatization was possible,
so too was a manly white civilization.
It is therefore hardly surprising that within a few decades few extolled the
curative properties of Baguio’s climate, even for nervous conditions. Many
did, however, continue to believe that manly activities in the bracing air were
effective prophylaxis against tropical neurasthenia—but it was the activity
and not the air that seemed to do the trick.∏≠ While patients with chronic
dysentery, malaria, and anemia still filled the wards of Camp John Hay, their
conditions seemed to respond better to specific therapeutics than to any mete-
orological adjustments to constitutional tone. Baguio had become principally
a place where senior colonial administrators might renew their strength and
vigor through a combination of rest and exercise and so harmonize their

the white man’s psychic burden 145

figure 34. Officers’ Club, Camp John Hay, Baguio (rg 350-p-qa-1-5, nara).

jangling nerves. Much as it may have provided some relief from a disagreeable
climate, Baguio came to represent above all a deliverance from colonial re-
sponsibility. The perceived advantages of Baguio derived as much from its
distance from the bureaucratic routines of Filipinized Manila as from any
avoidance of humidity or actinic rays. When managerial force began to fail,
the discipline of strenuous activity in the open air seemed to offer hope of
recuperation. Playing polo and tennis, hunting and fishing still gave many
Americans a visceral sense of their regenerating an overstrained, depleted
nervous economy. The annual regimen of diet, rest, exercise, and cleanliness,
often supplemented by nerve tonics such as strychnine and bromides, seemed
immensely restorative and toughening. Forbes, Atkinson, Worcester, and oth-
ers all felt themselves becoming more decisive and resolute after a month of
the moderately strenuous life in the hills. Charles Burke Elliot noticed an
improvement in his mood a few days after reaching Baguio: ‘‘As my head
ceases to ache my ambition returns and I am already planning many things
which are to be done on my return.’’∏∞
How then to justify the expense of a hill station after the tropical in tropi-
cal neurasthenia has largely become vestigial? As climate gradually loses med-
ical significance, even for nervousness, so too does the rationale for manly
society in the hills become susceptible to challenge and ridicule. In 1911, the

146 the white man’s psychic burden

editor of El Ideal decried the excesses of ‘‘Baguio the sublime.’’ ‘‘Baguio is
sublime because of its geographical isolation,’’ he wrote, ‘‘it is sublime be-
cause in it dwell the intangible ones, because the plebeians do not get there,
because the voice of the people which is raised to those heights is lost in
space.’’ It was not therapeutic; it was not even toughening: ‘‘The high digni-
taries of [the] regime’’ found there ‘‘a wide field for spiritual meditations and
the full satisfaction of their bodies. Power is fond of softness.’’∏≤ Recourse
to Baguio had become a sign of individual weakness, and although repre-
sented by Americans as a recuperative site and disciplinary locus, the hill sta-
tion came instead to resemble a haven of dissolution. The strenuous life had
turned into white mischief. The governor-general and other members of his
Buccaneers Club engaged happily in song, fancy dress, and gay repartee.
While Americans ‘‘brag of Puritanism,’’ their actions belied any ideals of
character and manliness. When Forbes held a party for some British visitors
‘‘it took the form of an impromptu carnival, circus and sports in the field, and
people prominent in Baguio society entered for all the events on the program.
Clowns were provided in the persons of Richard P. Strong, Captain Mitchell,
and Messrs P. G. McDonnell, Edward Bowditch and Conrad Hathaway, and
a clown polo match was played. . . . Major General J. Franklin Bell joined the
governor general and many society people in a race in which eight men sat
astride a large pole, to the huge satisfaction of the large crowd.’’∏≥ Activities
at Baguio had become a caricature of manliness; and if they were therapeutic
at all, then it was the sort of remedy that better disclosed weakness than
repaired it.

from depleting milieu to rotten core

Fielding Garrison’s breakdown had always suggested more to him than the
temporary overstrain, in a depleting climate, of a refined mental apparatus.
Its meaning was not fully contained in the notion that one was manfully, if
with faltering steps, trying to carry the burden of civilization. Not simply a
potentially avoidable physiological failing of the white race in an alien land,
neurasthenia became for him a sign of willful individual disaffection with
modern life, evidence of deep-seated mental conflict, of the family drama.
Secretly, he came to suspect that his nervousness indicated not an overper-
meable outer membrane, but a rotten core—his own internal tropics. And
yet, Garrison’s Freudian revisions of the meaning of his tropical nervousness
illustrate further the complexity and redundancy of any mental derangement.
No one frame, mechanistic or psychodynamic, would fit permanently his
disorder.

the white man’s psychic burden 147

 To the skeptical Mencken, Garrison had rendered his nervousness in terms
consistent with earlier environmental etiologies of tropical breakdown, even
though he, being better informed than most of his military colleagues, must
have known how dated such materialist assumptions had become. Humidity
and social frustration clearly retained some conventional and phenomenolog-
ical appeal as causes of devitalization, and perhaps he thought Mencken
would appreciate their literary resonance. But Garrison himself was too so-
phisticated to believe the theories he proffered; or, at least, too taken with a
new psychological formalism to regard physiological disturbance as sufficient
explanation for fragmentation of identity. In an extraordinary memorandum
book he wrote while in the Philippines, he interrogated his own internal
psychological processes, his ‘‘unconscious.’’ But he kept this self-analysis to
himself. Scrawled across the lines in pencil, the memoranda are a potent,
disturbed, and disturbing pastiche of quotation, précis, statistics, confession,
and philosophical speculation. Each note merges with the next: ‘‘thyroid in
myxoedema’’ runs into Mendelism, into ‘‘causes of low blood pressure,’’ into
Ezra Pound on democracy, into the Golden Bough, Baudelaire, ‘‘Masoch-
ismus in Am. male,’’ somatotypes, syphilis in the Middle Ages, ‘‘schizoid
types,’’ ‘‘schizothymia,’’ homosexuality, Jews as ‘‘hereditary profiteers,’’ fri-
gidity in albino women, impotence, marriage, ‘‘Wundt and Freud on tabu,’’
Manila, racial types, infantile sexuality, the Oedipus complex, penis size,
ideas as ‘‘sublimated sex instinct,’’ D. H. Lawrence, Sherwood Anderson,
Frank Harris, and Gertrude Stein—an intertextual series delivered in pre-
cisely that order. There are few discernable boundaries: quotations end as
vehicles for self-revelation without any indication of the point at which Gar-
rison’s thoughts began to wander; Latin, Greek, French, German, Spanish,
and English often cluster on one page; the line breaks are erratic; banal self-
assertion is mixed with complex and innovative historical analysis, all within
the space of a few pages. Through this stream of consciousness, Garrison was
seeking a new formulary for his disorder.∏∂
The first memoranda are mostly medical and literary. And then, after
fifteen pages or so: ‘‘I wish to be protected from my enemies but from myself,
my vices and passions, no!’’ There follow a few more pages of clinical notes,
and then:

Look out for the stenographers the

cuties sit in your lap and invite you by their
willing manner to take them out to dinner
& first thing you know along comes a shyster

148 the white man’s psychic burden

 lawyer with a breach of promise blackmail
prospectus
didnt fall for a skirt but for a mesh-bag
[x] being raped
Villa Palagonin
Chinese musical records
—‘‘the undiscovered secret of perpetual
motion might after all be lust.’’

This merges into a summary of an article on ‘‘Heredity of homosexuals,’’

signaling the beginning of Garrison’s sexual reflections, which soon come to
dominate the text. Often he will begin with a quotation or a synopsis, but
after a few lines ‘‘one’’ will be crossed out and replaced with ‘‘I’’:

offshoot of an outworn and inbred

stock, the son of a mother who was
physically gummy and mentally
asthmatic—aunts one I damned
puffballs, rickety

This is followed by ‘‘a clever practical race the Jews,’’ and a little later, ‘‘I fear
my mother—makes me feel inferior in intelligence—a shriveled old woman
nearly mad with an image of human futility.’’ And then:

Callow idealist—American
whipping post of sadistic Puritanism
she cat—

At the end of a summary of E. M. Forster’s A Passage to India, Garrison

writes, ‘‘Letter: Dear Dr. Aziz: I wish you had come into the cave. I am an
awful old hag and it’s my last chance.’’
In fracturing Garrison’s racial, sexual, and professional identity, the mem-
oranda seem at first to frustrate any effort at coherent reconstruction. Where
has the manly white physician gone? Who is it that scribbles, ‘‘Creative minds
opposed to the Army regimen the creative ones go morbid. Scares you when
you stop long enough to think. The answer is: don’t stop long enough to
think; just whistle in the dark . . . The skin of which you think so highly is no
good. It smells disagreeably to my nose. I knew in the dark that your skin was
white. caliente cubierto nagging woman.’’ And who, then, launches into an
account of a prostitute with a fur coat who resembles ‘‘a rabbit who has had
an extensive career’’?

the white man’s psychic burden 149

 I’ve needed my body so little in my career.
Where does she act?
In an old-fashioned piece of furniture with 4 posts.
I ate so much rabbit I hopped just like a kangaroo.
I said kanga
I mean roo

This leads inexorably to a discussion of Hippocrates on humors and, later, to

a recounting of a biological classification of races, followed by Isadora Dun-
can and Freud again on ‘‘pansexualism.’’ For Garrison,

sex knowledge is the key to the world

Erotic periods are also the most inhibited (erotically)
Inhibited periods are the most erotic
why because there is ambivalence
shameful and erotic feeling in us.

Bibliographic drudgery—brain-work—did not mean an excessive drain on a

limited supply of nervous force: Garrison was trying to get it to mean a
destabilizing and unsustainable repression of the sex instinct, but experience
and fantasy repeatedly exceeded his explanatory capacity. If Garrison could
recognize himself at all, it was as one of civilization’s discontents, not as a
dutiful representative of the white race vulnerable to nervous depletion in a
steamy, sunny environment.∏∑

the white man’s dirty secret

Garrison may not have understood himself, or entirely recomposed himself,
but at least he thought he knew there was ‘‘no individuality as a unity but
complex,’’ and repression was never complete. He could privately invoke the
new psychoanalytic theories to explain, or work through, his sense of mental
fragmentation. The psychodynamic formula he turned to offered a more com-
plex structuring of identity than the conventional diagnostic complex of trop-
ical neurasthenia, yet both descriptions presupposed a mental apparatus of
superior refinement, and both offered hope of its eventual reconditioning
through individualizing therapeutic interventions. Although altered in form,
from materialist to psychodynamic, the recourse to psychological explana-
tion continued to erase the colonial specificity of his disclosures and thus
displace the social and political setting of the breakdown. In Garrison’s letters
to Mencken, a frustrating military relocation had merely exposed an over-
civilized white male’s physiological settings to a devitalizing climate; in his

150 the white man’s psychic burden

memoranda, he revealed a complex internal psychopathology, probably dat-
ing from infancy, that again attested to his cosmopolitan overcivilized condi-
tion. The former was probably more respectable; the latter was increasingly
legitimate for an intellectual and thus not particularly reassuring to most
colonial officials.
Garrison’s tentative Freudian speculations prefigured a more general psy-
chodynamic understanding of tropical nervous breakdown. Before leaving
for Manila, his bibliographic duties and literary ambitions had exposed him
to Freud’s work on the neuroses, at a time when few colonial medical officers
would have understood the first principles of psychoanalysis. Some elite prac-
titioners in the United States had become interested in Freud’s ideas after his
visit to Clark University in 1909.∏∏ But it was not until World War I that
psychodynamic explanations—usually emphasizing notions of the uncon-
scious, repression, and mental conflict—began to supplant the older mecha-
nistic theories of constitutional degeneration. The scale of the problem of
‘‘shellshock’’ had been crucial in unsettling physicalist etiologies and sub-
stituting for them a relatively autonomous complex of psychological causa-
tion.∏π By the middle of the 1920s, a number of younger colonial psycholo-
gists were prepared to draw an analogy, perhaps one of dubious legitimacy,
between shellshock and tropical breakdown.
Increasingly, it seemed that most examples of tropical neurasthenia were
to be counted among the psychoneuroses, with their underlying causes lo-
cated in internal mental conflict. In 1924, Commander Joseph C. Thompson,
recently stationed at Guam, declared that so-called tropical neurasthenia was
‘‘the result of a conflict in the patient’s mind. This conflict is regularly between
the desires created by the repressed libido and the demands of the cultural
environment of the individual.’’∏∫ When a person encountered the demands of
social life, he could react in two very different ways. The ‘‘reality method’’
was to ‘‘attack the problem at hand, bring to bear upon it all the conscious
efforts of training and education,’’ and so dispose of it with ‘‘virility, efficiency
and happiness.’’ The other type of behavior was a ‘‘flight from reality,’’ lead-
ing to ‘‘the entire gamut of human frailty and neurotic symptoms’’ (322).
These unvirile symptoms were ‘‘compensations on the part of the organism
for a repressed wish,’’ a longing which relates ‘‘invariably and inexorably to
unsated desires and mismanagement of the procreation instinct of the individ-
ual, in that no neurosis ever takes place in a person whose sexual life is
normal’’ (323). To control these boiling internal pressures, Americans in their
own land had become dependent on such diversions as ‘‘five-o’clock teas,

the white man’s psychic burden 151

large moving picture productions amid certain chair comforts and organ or
orchestral accompaniments, theater going, terminating in cabaret climaxes,
and ball-room dancing’’ (323–24). But in some parts of the tropics they were
deprived of these distractions and so ‘‘there comes to the surface a curious set
of what Adler terms ready-at-hand neurotic symptoms’’ (324). The ‘‘pictur-
esque’’ terms previously attached to this ‘‘deprivation neurosis’’ should now
be abandoned. To attribute ‘‘philippinitis’’ or ‘‘guamitis’’ to ‘‘physical mate-
rial situations . . . would in itself be a flight into phantasy of so extravagant
a nature that no medical officer in the Navy could be counted upon to con-
cur in the concept’’ (322). Instead, patients should now have their internal
psychological disorder explained to them, for a ‘‘psychoneurosis only thrives
in a mind that is ignorant of the underlying unconscious motive for the ail-
ment’’ (327).
Thompson urged his fellow tropical physicians to avoid the old diagnosis
of neurasthenia, as Freud had decided to reserve this term for actual neuroses
in which somatic pathogenic agents act at the same time the symptoms are
manifested. Neurasthenia, warned Thompson, was now frequently attrib-
uted to ‘‘overindulgence in the sexual act, and a medical officer should be very
careful in appending this diagnosis to a health record, especially in the case of
bachelors.’’∏Ω But this caution was not always heeded. Thus in response to
Major Hugh W. Acton’s spirited, if conservative, defense of the humidity
hypothesis in 1927, Major V. B. Green-Armytage daringly asserted that there
were in fact three main causes of tropical neurasthenia in the British Empire:
masturbation, coitus interruptus, and sexual starvation. The notion that it
was due to ‘‘not wearing a solar topee’’ was ‘‘drivel.’’ He was sure that over 70
percent of white males in the colonial service were masturbating regularly;
and it was ‘‘extremely common in females in hot weather.’’ Coitus interruptus
was also lamentably widespread. Sexual starvation developed when happily
married men were separated from their wives. ‘‘Under such conditions,’’
Green-Armytage wrote, ‘‘when a married man tried to lead a ‘straight life,’
he became the subject of an inferiority complex, which resulted in psychic
trauma.’’π≠ Lieutenant Colonel Owen Berkeley Hill, one of the founders of the
Indian Psychoanalytic Society, later commended Green-Armytage for his ap-
preciation, unsophisticated though it may have been, of the ‘‘sexual factor’’ in
the etiology of neurasthenia. ‘‘From my own experience, as well as from much
study of neurological literature’’ he wrote, ‘‘I have reached an almost un-
shakeable belief in the correctness of the Freudian theory that real neurasthe-
nia arises solely through a conjunction of an excess of efferent stimulation.’’

152 the white man’s psychic burden

But he wanted to distinguish the new ‘‘real neurasthenia’’ from ‘‘all those
subjective feelings of physical ill-being’’—from the more prevalent psycho-
neuroses—which ‘‘arise secondarily from a repercussion of thwarted libido
upon secondary erogenetic zones.’’π∞ Thus tropical neurasthenia was a psy-
choneurosis, not a real neurasthenia, and it had little to do with the tropics
per se.
These images of the variously sexualized and repressed white male, while
not calculated to reassure worn-out colonial administrators or to impress
local nationalists, still worked to erase, or at least to exonerate, the colo-
nial setting of a breakdown. There is nothing distinctively colonial about
these individualized psychopathologies: they are everywhere abstracted from
social and historical determinations. And even though psychodynamic theo-
ries could be taken to indicate a less homogeneous identity, to locate, in ef-
fect, the destabilizing tropics within European mentality, it was evident that
white male subjectivity, if sadly conflicted, was still of the greatest complexity.
White males at least possessed something—civilization—that repressed their
primitive sex instincts: that is, unlike most natives (as yet) they had a super-
ego. The medical challenge was not how to remove the supposed repression,
but how to manage this internal binary opposition, just as previously the goal
had been to cope with the external depletive climate. If some white males
proved maladapted to their higher tasks, then they must be retrained.
As nervousness increasingly was associated with sex, a diagnosis of tropi-
cal neurasthenia, whatever the theoretical associations with the burdens of
civilization, became for its sufferers less a mark of mental distinction than a
badge of personal shame. The white man’s dirty secret was replacing the
white man’s burden. Tropical neurasthenia was acquiring a rather smutty
ring, and no amount of clinical detachment could cleanse it. It is therefore not
surprising that many attending physicians and their patients (especially more
prudish and prudent Britons) continued to affirm the older, more comforting
physical explanations. When the bishop of Singapore wrote to the British
Medical Journal in 1926 wanting to know the cause of the ‘‘upset of mental
balance’’ so common in the tropics, fourteen medical men offered answers,
all different and none with a Freudian taint. The physicians cited humidity,
strong sunlight, eye defects, worry, hyperemia of the brain, north wind, baro-
metric pressure, electrical content of the atmosphere, food, alcohol, constipa-
tion, native servants, and smoking. Moderate exercise remained the best pro-
phylaxis.π≤ But Berkeley Hill and other modernist psychiatrists derided such
old-fashioned, materialist explanations. Berkeley Hill thought this sophistry

the white man’s psychic burden 153

indicated just ‘‘how almost hopelessly ignorant we are about a state of affairs
which no one can deny is of some considerable importance.’’ He personally
was convinced that Europeans in the tropics were prone to ‘‘a neurotic syn-
drome, the central symptom of which is a state of hyperexcitation manifested
in a general irritability or a condition of morbid anxiety.’’ The prime etiologi-
cal factor in this anxiety-neurosis was a voluntary abstinence from sexual
intercourse. If this could not be remedied (through concubinage, for exam-
ple), then psychoanalytic treatment was indicated. Freud was right, and per-
sisting with physicalist euphemism did no more than assuage mentally unbal-
anced patients with unscientific and misleading consolation.π≥
Psychodynamic theories did not produce anything like the earlier, pre-
Freudian collective repertoire of assumption about the mind and the body.
Indeed, the new psychological speculation rivaled microbiology in its alienat-
ing lack of self-evidence. The causes of mental disease had become as arcane
and insensible and internal as the minute organisms that were supposed to be
causing physical ailments. At the same time, theories of unconscious mental
conflict did provide a body of specialized knowledge around which a psychi-
atric profession could organize itself. As this specialty became increasingly
autonomous during the 1920s and 1930s, its reference group was more likely
to include international colleagues than colonial officials. Articles on mental
disorders in the tropics began to appear in general psychiatry journals, not in
colonial medical publications. Experts on nervous diseases in the colonies had
realized that their postcolonial future depended more on professional legiti-
macy than on local administrative service. If they must choose between of-
fending colonial bureaucrats and appearing old-fashioned and ignorant, then
they would jettison their soothing function in the interests of intellectual
respectability. Since most psychiatrists had no intention of hanging around
colonial outposts, during their brief tropical sojourns they did not see any
need to show special respect to the modesty of their fellows. Increasing inde-
pendence had allowed them to locate sexual ambiguity and otherness deep
within the personalities of colonial administrators, even as they promised
through psychotherapy to discipline the conflict they had discerned between
civilization and the savage within.

the true terrain of civilization

Breaking down in the tropics had once indicated an ephemeral failure of the
will: a depletion in the racial allotment of nerve force that was not altogether
discreditable in such trying circumstances. If the climate’s burden on race and

154 the white man’s psychic burden

gender proved unendurable, those who succumbed could console themselves
with the knowledge that they were, for a short time, the innocent victims of an
inexorable biological process. Try as they might to avoid it, decay would still
lurk in the humidity and actinic rays of the tropics. Unless they had flagrantly
disregarded hygienic stipulations, the temporary victims of tropical neuras-
thenia could be absolved of blame—if anything, they had fulfilled their civi-
lizing duties too meticulously. But in the 1920s tropical neurasthenia came to
signify a pathology of the will itself, an actual deformity of personality: the
destabilizing tropics had, in a sense, become internalized everywhere in the
minds of white men. No longer was the main problem a physical mismatch
between the white male’s refined mental apparatus and an alien, depleting
climate; the predicament was by then represented as a personal maladaption
to civilized social life. Once a discomforting, though temporary, mark of
distinction and self-sacrifice for tropical white men, a diagnosis of nervous
debility now more likely signified an individual’s internal psychological am-
bivalence and conflict.
Although considerably different in form and consequence, both mechanis-
tic and psychodynamic theories shared during this period an assumption that
the true terrain of civilization was the mind of the bourgeois white male. The
threat to civilization might come from outside (the tropical climate) or from
inside (the unconscious), but the locus of its target did not change. The medi-
cal problem was how best to educate or to discipline this civilized mind, how
to harden it against internal and external enemies. The widely dispersed fol-
lowers of Beard and Freud aimed to maintain or to recover, in significantly
divergent ways, an exemplary colonial identity at once manly, white, and
civilized. But in admitting a sensitivity or fragility of the generic white man (if
chiefly to mark his superiority and retrieve it), psychological theories might
now seem to prefigure a critique of colonial modernity. Like all family ro-
mances, however, such a genealogy should be received with skepticism. If
there is a critique of colonialism within colonial psychology in this period it is
a muted one, with the specificity of colonial history and politics conveniently
erased. The stimulus to breakdown is repeatedly displaced onto the environ-
ment or internalized; its signs and symptoms are structured as manifestations
of a personal crisis, not as evidence of political or social disorder. White men
might become destabilized, but their problems were not allowed, in any se-
rious way, to subvert the civilizing process, even in its colonial setting.
All the same, these medical efforts to codify and contain disturbed identity
did still permit some play in many Americans’ understanding of their colonial

the white man’s psychic burden 155

placement. For example, one might conclude with Woodruff that tropical
neurasthenia allowed only a political commensalism and doomed to failure
any direct colonial presence; or one might argue, like Heiser, that unrelenting
self-discipline would circumvent the condition and so permit high-quality
American brain-work in the tropics. It was a question of how white males,
resident or distanced, might civilize the tropics and of whether that region
deserved their best efforts—they remained the best possible agents of civiliza-
tion. When Colonel Joseph R. Darnell saw James Fugate, the governor of
Jolo, in 1926, he observed a ‘‘thin nervous man of middle age’’ who ‘‘seemed
to dissipate energy in a nervous haste to accomplish things, as though fearing
that the passage of time would find him less capable of carrying on.’’ Colonial
optimism always won out over colonial pessimism during this period, but it
was nevertheless an endlessly prevaricating sort of optimism. ‘‘There was
something pathetic about the thin, wistful white man,’’ Darnell recalled, ‘‘al-
most alone in a brown man’s country, standing on the dock and waving us
goodbye.’’π∂
A diagnosis of colonial nervousness was never likely to generate coherent
resistance or subversion. Far from providing an independent oppositional
discourse, tropical neurasthenia did more to recuperate than to decompose
colonial authority. And yet, it must be assumed that the practice of break-
down often exceeded the framing capacity of theory. The full meaning of
colonial nervousness might sometimes be deferred by eloquent materialist
analogy or psychodynamic speculation, but never indefinitely. Such formulas,
whether conventional or novel, provided Garrison with only transient sat-
isfaction: his memoranda are abundant, irreconcilable supplements to his
tightly drawn theories of mental derangement. When an American man in the
colonial Philippines broke down, he experienced himself as multiply frag-
mented, gone ‘‘to pieces,’’ his carefully nurtured identity as a manly white
colonial emissary fractured. What, then, was happening in his moments of
fragmentation, before the re-collection of himself as a recovering neurasthe-
nic or neurotic? The answer, if there is one, is probably inimical to history, for
any narrative of breakdown will seek to find coherence where there may be
none.π∑ We lack evidence of embodied memories of colonial culture and can-
not now observe directly the signs of the body, although we still might read
Garrison’s memoranda, in their deranged social and political specificity, their
disjunctures and excesses, as constantly exceeding the reach of his recovery.π∏
Of course, even this bizarre testimony, given all its disturbance, has emerged
already heavily medicalized. But when Garrison notes that the white skin

156 the white man’s psychic burden

which he and many of his colleagues paraded was no good—‘‘it smells dis-
agreeably to my nose’’—neither the mechanistic nor the psychodynamic theo-
ries he favored could fully account for such an incident of putrescence.
After the 1920s, reports of tropical neurasthenia among Americans in the
Philippines are rare, mostly because few white males remained in the archi-
pelago, but perhaps also because those who stayed on were reluctant to
translate their experiences of disorder and nervousness into Freudian terms. If
breakdown had to be articulated it was generally managed through casual
recursion to the mismatch between mental apparatus and climate.ππ At the
same time, an epidemic of neurasthenia was now recognized among another
group in the colonial Philippines, one hitherto racially exempt from any dis-
eases of civilization. The diagnosis was made available as an object lesson to
‘‘educated natives.’’ When W. E. Musgrave, the director of the Philippine
General Hospital, discussed his ‘‘clinical notes’’ on tropical neurasthenia, he
emphasized for the first time the special susceptibility of elite Filipinos. ‘‘Few
natives,’’ he had determined, ‘‘are mentally constituted to withstand the nor-
mal stress of Western civilization which so many of them adopt.’’ This was
strikingly illustrated in the Philippines, where twenty years of inculcating
‘‘Occidental methods’’ of hygiene and conduct had led to widespread neuras-
thenia among the ‘‘younger generation of more progressive Filipinos.’’ The
imitation of ‘‘Western methods of energy, application and efficiency’’ came at
great cost. The local race had been happier in a state of nature. For the native,
Musgrave concluded, prevention of nervous debility ‘‘consists in holding his
ambitions and energies within his natural bounds and resting before the
breaking point is reached.’’π∫ While adapted to manual labor in the topics,
Filipinos evidently did not yet exhibit the mental discipline or self-mastery
required to manage civilization in such a climate. According to doctors like
Musgrave, civilization in the tropics would, for some time yet, remain the
white man’s special burden.πΩ

the white man’s psychic burden 157

Chapter Six

disease and citizenship

I n May 1906 the Coast Guard cutter Polilio passed the massive limestone

cliffs of Coron and negotiated a channel through the Calamianes Islands

to the new leper colony at Culion, an isolated outpost in the far west of

the Philippines archipelago. Almost 400 leper pioneers disembarked there;

mostly they were young adults, some were adolescent. By the end of 1910, a

further 5,000 had followed the same route, though more than 3,000 died

soon after arrival, and another 114 somehow escaped their doleful exile.∞

Inevitably, some leper women gave birth in the colony—sometimes the father

was unknown, but more commonly after 1910 the coupling was sanctioned

by marriage at the old Culion church. American colonial officials had struc-

tured the leper colony as a laboratory of therapeutics and citizenship, a place

where needy patients were resocialized, where they performed somatic recov-

ery alongside domestic hygiene and civic pride. Thus Filipino leper families

lived in small houses in the new ‘‘sanitary barrio,’’ washing and scrubbing,

tending their gardens, voting in local elections, making cheap goods for ex-

port, participating in baseball games, receiving regular injections of chaul-

moogra oil for their disease, and having nonleprous children.

For a while the medical authorities kept these exemplary families intact.
But evidently fears of contamination had not completely evaporated in the
tropical theater of hygiene, and from 1915 nonleprous children lived apart
from their families at the Balala nursery. After 1927, efforts intensified to
remove children at a younger age, though separation at birth remained rare.
Every Sunday, leprous parents could view their separated offspring through a
glass barrier, until at the age of two the infants were either adopted or sent to
the Welfareville Institution in Manila. Estela A., for example, was born in
1925, the daughter of two inmates, and in 1927 a middle-class Filipino family
in Manila adopted her. A few months later her adoptive father wrote to the
Protestant minister at Culion to reassure him that Estela was healthy and
happy and that they were bathing her twice daily.≤ In the interests of medical
and civic reformation the state had taken lepers from their families and loved
ones, subjecting them to a combined regimen of treatment and educational
uplift; now it removed their nonleprous children and sought to give them
ready-made hygienic identities in Manila.
The Culion leper colony demonstrated a distinct political rationality: it
was predicated on a form of biological and civic transformism in which the
contaminated became hygienic, and ‘‘savages’’ might become social citizens.
In the ritual frame of the colonial, or protonational, institution, liberal med-
icos amalgamated corporeal deficiency with perceived cultural failings, in
particular a lack of civilization. They then sought to treat these fused condi-
tions, to set their charges on a single trajectory from illness to health and from
primitive to civilized.≥ That is, the identity of inmates, or patients, was as-
signed to one pole of a dichotomy or, more ambiguously, to the ground
between, and these figures were expected dutifully to traverse toward the
further pole. In a sense, American officials were staging a binary opposition
between themselves and the ‘‘typical leper’’ and then asking the leper to re-
solve this typological difference through a personal conversion, so demon-
strating that the affliction, the failing, was not absolutely irredeemable. Of
course, the end point of this imagined trajectory was in practice unreachable:
the leper was only ever in remission. Despite its professed goals, the colonial
reformatory thus produced—not eliminated—the in-between. It excelled in
fashioning estranged, marginal men and women, in making contaminated
bodies and second-class citizens. It was, in this sense, the place for an asymp-
totic projection of cure and citizenship. Only bourgeois white males were
qualified truly to reach the end point of civilization, and even they, as we have
seen, might occupy it nervously in the tropics.
Identified as lepers, banished from their communities, the colonists of

disease and citizenship 159

Culion became the improbable subjects of intensive medical reformation and
retraining in civic responsibility. Individuated through treatment protocols,
lepers were expected to work diligently, tend their gardens, perform in brass
bands, play baseball games, vote responsibly, and police themselves. Long-
standing intimate relations were to be abandoned and reforged as abstract
attachments to categories of progress, modernity, and nation. This was what
the emancipation of lepers at Culion really meant. Medical officers urged
their inmates or patients to forget traditional affective ties to family and
community; they warned against nostalgia and praised those who looked
forward to the hygienic future, to incorporation into a whitelike, though
allegedly generic, citizenry.∂ Leprosy itself thus was translated into a language
of modernity, of civic consciousness, of public interest—a vocabulary that
both imperial officials and many Filipino nationalists could share.∑ In the late
colonial reformatory, civic performance became more important than blood
ties, hygiene more significant than kinship, or so at least the liberal medi-
cal vanguard in charge of these institutions would claim. In fact, neither
the medical officers nor their charges could ever jettison completely their
older—in a sense nonmodern or at least völkisch—attachments to commu-
nity and race.
The new affective ties to state abstractions, or to the agents of the state,
were rarely as intense as the progressive colonial intelligentsia had hoped.
When Dr. Victor G. Heiser began his leper-collecting trips in the Philippines
he claimed there was little resistance to the removal of the afflicted, in part, he
thought, because of the successful inculcation of fear of the ‘‘loathsome’’
disease. ‘‘When it is remembered,’’ Heiser wrote, that removal ‘‘often in-
volved the lifelong separation of wife from husband, sister from brother,
child from parents, and friend from friend, it will be appreciated that for-
bearance was necessary under such circumstances.’’∏ After having abducted
them, Heiser regularly sought out the company of those lepers he meant to
reform. On the day he left the archipelago, he confided to his diary his feelings
for those he had so assiduously classified and displaced: ‘‘There is much
sadness,’’ he wrote, ‘‘that as yet I do not live in the hearts of the people . . . I
wonder if I will ever be understood and if the lepers will sometime look upon
me as their friend.’’π His regret is a vivid expression of the pathos of the
progressive colonial bureaucrat.
Ann L. Stoler has recommended that we examine the ways in which ‘‘inti-
mate matters, and narratives about them, figured in defining the racial coordi-
nates and social discriminations of empire.’’∫ In this chapter I consider the

160 disease and citizenship

 figure 35.
Leper child and nurse at
Culion (rg 350-p-j6.1, nara).

institutional management of probationary national subjects as an example of

‘‘the distribution of appropriate affect.’’Ω This requires an expansion of the
historical understanding of the making of intimacy to encompass the expert
and habituated benevolence of the state. It is often forgotten that in the
name of public health the state is licensed to palpate, handle, bruise, test,
and mobilize individuals, especially those deemed dangerous or marginal or
needy. Moreover, in the twentieth century, an emphasis on personal and do-
mestic hygiene allowed an exceptionally intense surveillance and disciplining
of subject populations, and this in turn involved a refashioning of interactions
and intimacies within these populations. Much of the prevailing attention to
the quantity and quality of population—of which eugenics was just a small
part—can thus be viewed as an effort to reshape identities and relationships,
to reforge affective ties. Accordingly, I want to consider leper treatment in
terms of the making of intimacy with the colonial state and the making of
intimacy for the colonial state.

the leper collection

Michel Foucault has described how, gradually, ‘‘an administrative and politi-
cal space was articulated upon a therapeutic space; it tended to individualize

disease and citizenship 161

bodies, diseases, symptoms, lives and deaths; it constituted a real table of
juxtaposed and carefully distinct singularities.’’∞≠ He was referring to the
development of the modern clinic; lepers remained for him representatives of
the unproductively confined: ‘‘While leprosy calls for distance, the plague
implies an always finer approximation of power to individuals, an ever more
constant and insistent observation.’’∞∞ Foucault wondered what would hap-
pen, though, if one were ever to ‘‘treat ‘lepers’ as ‘plague victims,’ project the
subtle segmentations of discipline onto the confined space of internment,
combine it with the methods of analytical distribution proper to power, indi-
vidualize the excluded, but use procedures of individualization to mark exclu-
sion.’’∞≤ At Culion, for the first time, lepers did become subjects of such
intensive surveillance and discipline. In the past, lepers might be segregated
and excluded from civil society—the colony at Molokai, Hawaii, established
in 1866, represented the best contemporary model of unproductive isolation.
Once isolated, lepers at colonial institutions of this sort generally were ne-
glected, except by missionaries who quickly discerned they might be espe-
cially susceptible to the gospel. According to Megan Vaughan, leprosy in
Africa had ‘‘offered to missionaries the possibility of engineering new African
communities’’ for the performance of collective, tribal identities.∞≥ Such col-
lectivization would seem to present an impasse to the engineering of individu-
alized leper-citizens. The progressive medical officers who established the
Culion colony tried instead to deregionalize and abstract Filipino lepers as
separate national subjects. They fought against any grouping of lepers into
Visayans, Tagalogs, Moros, and so on, preferring to figure their patients as in-
dividualized, if standardized, cases of leprosy. Rita Smith Kipp has remarked
that during this period ‘‘new therapeutic approaches to leprosy lessened the
evangelical uses’’ among the Karo people of Sumatra.∞∂ But in the Philippines,
the production of the individual civic subject—surely a form of evangelism—
was predicated on such medicalization, on the spread of the ‘‘gospel of hy-
giene’’ and modern chemotherapeutics.
For most of the Spanish colonial period in the Philippines, medical author-
ities had assumed that leprosy was hereditary. Accordingly, the rare instances
of isolation of sufferers occurred more often for aesthetic and social reasons
than for medical purposes. The disease was identified in the archipelago in the
early seventeenth century, and since then it had spread rapidly. The Francis-
cans took charge of charity work among lepers, building several asylums and
hospitals for the severely afflicted. Institutions such as the San Lazaro Hospi-
tal, north of the old walled city of Manila, and the Cebú Leprosarium offered

162 disease and citizenship

a refuge for those who sought it, along with palliative care in the last stages of
their illness. In some of the larger towns groups of lepers often lived together
in separate bamboo and nipa shacks. But the Spanish colonial regime did not
try to isolate lepers from their communities in order to prevent the spread of
the disease or to eliminate it.∞∑
Toward the end of the nineteenth century, as we have seen, most medical
scientists and clinicians came to favor social explanations of disease transmis-
sion, though hereditarian assumptions were never entirely abandoned. Sick-
ness might now appear to spread from person to person, but the hereditary
proclivities of certain groups still seemed to make them more likely to partici-
pate in this process. Thus germs to which one group of people appeared
especially susceptible might lodge covertly in the meretriciously healthy bod-
ies of another group or race. One race might demonstrate some immunity,
relative or absolute, to a disease; another would seem utterly vulnerable to the
same microbe.
G. A. Hansen’s announcement of the discovery of the bacillus of leprosy,
Mycobacterium leprae, in 1873 signaled the entry of leprosy into the emerg-
ing etiological mainstream. Its presence in the nasal scrapings of suspects—
regardless of clinical signs—came to suggest, to the more scientifically in-
clined of medical and civic authorities at least, the need to isolate the victim,
or carrier, and to engage in relentless efforts to remove the contaminating
germ from the population. When Dr. N. C. MacNamara described leprosy in
the early 1890s he emphasized that the old assumption of the ailment’s simple
hereditary nature had been discredited over the past few decades. ‘‘Pathol-
ogy,’’ he declared, ‘‘has at last led us to recognize the fact that leprosy is
the effect of a micro-organism.’’ Most physicians now believed that the dis-
figuring and disabling granulomatous disease was communicable, though not
readily so. Therefore, MacNamara concluded, ‘‘strict isolation of lepers must
be the proper and only way of stamping it out.’’ Yet his experiences in India
had suggested that ‘‘the religious feeling, customs and habits of the natives, as
well as the number of lepers . . . all prevent the government from attempting
to introduce a system of compulsory segregation in that country.’’∞∏ When Dr.
James D. Gatewood reported to the surgeon general of the U.S. Navy in 1897
on the latest international conference on leprosy, he assured his superior
that no one doubted any longer the disease’s cause or its contagiousness. All
therapeutic experiments so far had failed; the general opinion was that ‘‘in
isolation is found the only safeguard’’ against what he called ‘‘the hideous
sister of syphilis and tuberculosis.’’ Only the English resisted isolation, re-

disease and citizenship 163

garding it as impractical in their colonies.∞π In 1898, Sir Patrick Manson
agreed that leprosy was basically a ‘‘germ disease,’’ although he suspected that
‘‘bad food and bad hygienic circumstances’’ were predisposing influences.
Transmission of the mycobacterium probably required prolonged and ‘‘inti-
mate personal contact.’’ In the first edition of his classic text, Manson para-
phrased MacNamara’s apparently quixotic call for rigorous segregation of
sufferers.∞∫ And in the 1914 edition not much had changed, except that Man-
son began to cite medical authorities who had ‘‘very sagaciously and truly
remark[ed] that leprosy is more especially a disease of semi-civilization’’; that
is, ‘‘when the savage begins to wear clothes and live in houses he becomes
subject to the disease.’’ Thus the best way to control the condition was either
to complete the civilizing process or never to begin it. If the goal was accelera-
tion of the evolutionary trajectory from tribal to peasant to proletarian, then
ideally this should be attempted in an isolated colony.∞Ω
As commissioner of public health in 1902, L. Mervin Maus had led the
campaign to find a distant island on which to establish a leper colony. A
committee of inquiry, including Dean C. Worcester, studied a number of
locations and concluded that Culion ‘‘afforded an ideal site for the proposed
colony, and furnished abundant and suitable lands for agriculture and stock
raising.’’ Water was available, and the harbor was extensive and safe. The
population of three hundred or so nonleprous ‘‘poor day laborers’’ could be
moved to an adjacent island. The committee believed that ‘‘nowhere else in
the archipelago can there be found an island so healthful, extensive and
fertile, which has so small a population.’’ It urged the government to preserve
the island for lepers, with land ‘‘to be set apart for every leper willing and able
to cultivate the soil’’ and houses to be built for the accommodation of male
and female lepers in ‘‘two widely separated areas.’’≤≠ At this stage, Worcester
insisted that the ‘‘leprous women will be kept by themselves and an effort
made to keep the men from getting at them.’’≤∞ The work of constructing
an entire new town suitable for two or three thousand lepers took time.
The dormitories, the hospital, the school, the theater, the dining halls, and
kitchens were not ready until 1906.
Heiser, on assuming control of public health in the Philippines in 1905,
urged all medical officers to take a census of lepers in their region and report
their findings to him. He estimated there were more than six thousand lepers
distributed over the archipelago, and each year some twelve hundred more
contracted the disease. A review of the recent medical literature convinced
him that only isolation and experimental treatment could accomplish the

164 disease and citizenship

figure 36. Leper ward, San Lazaro (rg 350-p-e38.2, nara).

eradication of leprosy in the islands. ‘‘This policy,’’ he observed, ‘‘at first sight
seems to impose many hardships upon the lepers themselves and their imme-
diate relatives and friends, but it is believed to be fully justified not only by the
fact that hundreds may be annually saved from contracting leprosy, but also
that the victims may be given as pleasant a life as possible.’’≤≤
The lepers at the San Lazaro Hospital in Manila and at the Cebú Lepro-
sarium awaited the completion of Culion with trepidation. In 1903, Dr. H. B.
Wilkinson at San Lazaro reported that his patients ‘‘rarely or never get well,
but are usually fairly content and happy, especially since the rumor of their
transfer to Culion has faded away.’’≤≥ Over two hundred lepers occupied an
ample, clean building—they saw no reason to move to some isolated island.
But their departure had merely been delayed a few more years. Among the
earliest of the inmates consigned to Culion was a ‘‘Spanish-mestizo’’ boy,
Eliodore G., who had entered San Lazaro in 1901, at the age of seven. Two of
his brothers and two sisters had died of leprosy. Eliodore had noticed a red spot
of his left hip, and later other spots appeared on his cheeks and ears. The lab-
oratory determined that he was ‘‘positive microscopically’’ for leprosy. Like
many others in San Lazaro he had no one willing to care for him in his barrio.
Treated experimentally with radiation and medications, the reluctant colonist

disease and citizenship 165

remained positive microscopically after his transfer to Culion and died there
within ten years—as one of Heiser’s ‘‘prisoners of hope.’’≤∂ The formulation of
the boy’s record is conventional: Eliodore G. has been abstracted from his
surroundings as a leper, and his life is further translated into a medical vocabu-
lary. He has been silenced in the medical narrative, his existence reduced to a
diagnosis. And yet, the same case record has made him visible; it has mobilized
him as an individual in need of bodily and social reform.
Once all institutionalized lepers such as Eliodore G. were transferred to
Culion, Heiser began to collect those still living in their local communities. A
year or so before the visit of the ‘‘leper ship,’’ the government began an
education campaign in each region to inform lowland Filipinos of the ‘‘man-
ner in which leprosy spreads and the improved conditions under which lepers
themselves would live at Culion.’’ Doctors from the Bureau of Health gave
lectures on leprosy and showed photographs and films of the colony. Teach-
ers discussed the government’s leprosy work with their students and encour-
aged them to identify hidden cases.≤∑ Heiser was convinced Filipinos must be
taught that ‘‘the leper who concealed his disease was a constant and deadly
menace to the community in which he lived.’’≤∏ In his journal, he noted that
‘‘the keynote to success [is] to educate the masses to a fear of the disease.’’≤π It
is hard to know whether he succeeded. When Charles Everett MacDonald, an
unusually curious medical officer, asked people on Samar how leprosy was
acquired, they attributed it to dependence on a diet of fish. No one believed it
was infectious. The inhabitants also observed that it made the afflicted im-
mune to cholera, tuberculosis, and some ‘‘strange fevers.’’ The lepers Mac-
Donald encountered there, though ‘‘much deformed,’’ seemed ‘‘happy and
content.’’≤∫ On the other hand, Corporal Richard Johnson of the 48th Volun-
teers reported that Culion was ‘‘a dismal word to the people of the Philip-
pines,’’ and lepers dreaded their exile ‘‘more than they dreaded the disease
itself.’’ ‘‘Sometimes the unfortunates were hunted down like criminals,’’ John-
son wrote, ‘‘and it was a sad experience to relatives and friends to see them
taken away to a living death among unsympathetic strangers.’’ An easygoing
‘‘drifter,’’ Johnson had docked with supplies at the colony on Christmas Eve,
1907. That year he would spend a ‘‘gloomy Christmas day at Culion.’’≤Ω
Beginning with the outlying islands, Heiser and his colleagues proceeded
to examine and classify suspect lepers. At an arranged date, the provincial
governors and municipal presidents would gather all known lepers to meet
the ship at the harbor. The district health officer usually had made a prelimi-
nary diagnosis. The leper boat always brought at least three physicians, one of

166 disease and citizenship

figure 37. Leper boys at Culion, 1920s. Courtesy of the Rockefeller Archive Center.

whom was especially qualified in the diagnosis of leprosy, and all of them had
to be satisfied that the label was correct before a leper was taken to Culion.
In addition, a microscopist from the Bureau of Science examined the nasal
scrapings of each leper, seeking to identify Mycobacterium leprae. After these
precautions had been taken against error, the boat loaded the confirmed cases
and sailed toward Culion.≥≠ By 1913 Heiser could claim that every recogniz-
able leper in the archipelago was confined; over eight thousand had been sent
to Culion, and thirty-five hundred were still alive. As the incubation period
for the disease might last as long as twenty years, new cases would continue to
develop. Nonetheless, the Philippines ‘‘enjoy[ed] the distinction of being the
only oriental country where complete segregation is being attempted.’’≥∞
‘‘They say of Doctor Heiser,’’ Eleanor Franklin Egan wrote in the Saturday
Evening Post in 1918, ‘‘that he has handled with bare hands from two to three
thousand lepers in all the horrible stages of that most horrible of all diseases;
and I myself have seen him pick up a helpless leper in his arms and carry him
aboard the leper ship to be taken to Culion with as little apparent concern for
his own safety as he would display under the most ordinary circumstances.’’≥≤
Fashioning himself as a secular and uninfected Damien, Heiser regarded the
scientific treatment of leprosy at Culion as his major legacy to the islands. ‘‘As
long as [the leper colony] remained in his care,’’ wrote a fawning Katherine
Mayo, ‘‘it challenged the world’s admiration.’’≥≥ Heiser spent a large part of

disease and citizenship 167

each year between 1905 and 1914 sailing from port to port, collecting leper
suspects, examining them, and exiling the confirmed cases at Culion. As he
put it, ‘‘Some people collect postage stamps or cloisonne. I started collect-
ing lepers.’’≥∂

the personal hygiene of the microcolony

In the Culion ‘‘museum’’ today one finds thousands of case histories, now
dusty and insect ridden, piled on benches and on the floors. Each is prefaced
with a photograph, followed by an account of the initial presentation, the
family and social history, and progress, which was correlated with treatment,
usually with chaulmoogra oil, and laboratory findings. The case record of
José E. tells us he was admitted to Culion in 1913, at the age of twenty-three,
having suffered from leprosy for eight years in Ilocos Sur. His signs were the
white patches on his back and arms, thickening and contractures of the fin-
gers, and an ulcer on his left foot. After receiving chaulmoogra oil for a
decade he became ‘‘bacteriologically negative’’ and was paroled two years
later. Or take the case of Marcelo A., who in 1909, at the age of fifteen, was
taken from Batangas. He had nodules on his back, shallow scars on his legs, a
fallen nasal bridge, and no eyebrows. For awhile he was bacteriologically
negative but in his early twenties showed more ‘‘activity.’’ After treatment
with chaulmoogra oil and two years of negative findings he was paroled in
1926—but he had nowhere to go and was soon readmitted. Then there is the
case of Alfredo F., who was born at Culion after his parents were sent there
and soon acquired the disease, developing reddish patches on his cheeks and
lower abdomen. In 1926, after years of chaulmoogra oil injections, Alfredo,
now an adolescent, was ready for discharge—but he too had nowhere to go.
Each person has become a distinct case; each has acquired a standardized
individuality in the medical record. And in each of these cases, the future has
been structured as a prognosis. The Culion leper colony had thus become a
total institution.≥∑
In the hermetic world of Culion, in that infinitely detailed colonial minia-
ture, lepers would repeatedly reaffirm their diagnosis and demonstrate their
rectitude, in the hope of gaining the recognition that might confer both fur-
ther medical relief and further moral elevation. Culion combined features of
an army camp with aspects of an American small town. The government built
a town hall, a store, a general kitchen, a jail, a school, and the Leper Club,
which contained ‘‘a piano, a pool table, and many newspapers, some recent,
and miscellaneous discarded ‘charity’ magazines and books unintelligible

168 disease and citizenship

figure 38. Culion Leper Colony (rg 350-bs-1-4-169 [bs 12675], nara).

except for the pictures.’’≥∏ Visitors approaching the town by water received ‘‘a
most unfavorable first impression of a dreary, parched, poverty-stricken set-
tlement on stony, unproductive hillsides.’’ But the physicians who worked at
Culion, while conceding some ‘‘distinctly unfavorable features,’’ felt that the
‘‘simple, orderly, not uncheerful lives of the inmates’’ greatly modified the
visitors’ initial misgivings.≥π Moreover, Culion soon became, according to
Heiser’s successor, J. D. Long, ‘‘the most sanitary town in the Philippines.’’≥∫
Life in the island reformatory—whether in the male and female dormitories
or the ‘‘sanitary barrio’’—was organized around the routinized, yet individu-
ated treatment of leprosy. Every week the inmates went dutifully to the clinic,
where they received an injection of chaulmoogra oil.
Culion became famous as a laboratory for the chemotherapy of leprosy. In
the 1890s, MacNamara had achieved only poor results treating the disease in
India: he had tried moving lepers to a ‘‘healthy and bracing district,’’ improv-
ing their sanitary condition, and even rubbing chaulmoogra oil into the skin
two or three times a day—to no avail. Nerve stretching and tubercle excision
provided local amelioration at best. ‘‘Efforts must be directed,’’ MacNamara
concluded, ‘‘to discovering some chemical substance which will kill the lep-
rosy bacillus.’’≥Ω A few years later, Manson enjoined ‘‘scrupulous attention
to personal and domestic hygiene,’’ frequent bathing, and ‘‘the free use of
soap.’’∂≠ Although many of his colleagues had favored doses of chaulmoogra

disease and citizenship 169

oil, and others had recommended ichthyol, hypodermics of perchloride of
mercury, and thyroiden, Manson could not help wondering if the success they
claimed for these remedies had derived instead from a remission in the dis-
ease’s naturally fluctuating course. In his opinion, there was nothing yet spe-
cific for leprosy ‘‘in the sense that mercury and iodide of potassium are spe-
cific in syphilis.’’∂∞
After 1910, Heiser and his colleagues in the Philippines were trumpeting
the effectiveness of a new preparation of chaulmoogra oil that could be given
by hypodermic injection. Although it would take ‘‘many years and exhaustive
experimentation’’ to establish the fact definitely, it appeared this gift of ‘‘West-
ern science’’ had relieved at least a few dozen lepers in the islands. Uncertain
still if this was the true specific for leprosy, Heiser nevertheless believed it
promised ‘‘more consistently favorable results than any other that has come
to our attention.’’∂≤ Dr. John Snodgrass, the colony’s resident physician, could
cite the case of a twenty-seven-year-old Filipino admitted to Culion in May
1909.∂≥ Smears made from lesions on the nose and ears showed leprosy ba-
cilli. Beginning in August 1909, he received ‘‘vaccine therapy’’ for one year
but showed no signs of improvement. Between September and November
1910, he took crude chaulmoogra oil by mouth until he could no longer
tolerate it, after which he was tried on the new injectable form. His condition
improved dramatically, all the lesions disappearing by May 1911. For the
next year ‘‘he remained negative microscopically.’’∂∂
By 1914, even Manson was extolling the benefits of chaulmoogra oil when
given hypodermically, as in the Philippines. He had seen the marked clinical
improvement—but other laboratory studies had tempered his confidence in
the drug’s true specificity. Reports indicated that bacilli were ‘‘just as abun-
dant in the nodules during and after as before treatment.’’∂∑ A new drug,
nastin in benzoyl chloride, had promised more etiological specificity in labo-
ratory investigations, but so far the clinical effect was ‘‘dangerous to life,’’ a
problem that unfortunately ‘‘imposed limitations upon the general use of the
remedy.’’∂∏ Indeed, limitations were so severe that its use was restricted to a
few painful clinical trials. Thus in 1918 Heiser could claim, with a degree of
self-satisfaction, that ‘‘chaulmoogra oil alone has stood the test of time.’’∂π
Having unrivaled clinical experience of the drug, he was convinced that its
hypodermic administration, though it might occasionally cause ‘‘fever and
cardiac distress,’’ offered lepers their best hope of continued remission. All the
same, he insisted that his patients take 2 percent hot bicarbonate baths every
other day.∂∫ If lepers still could conventionally be classed as unclean and

170 disease and citizenship

dangerous, then medical treatment might eventually remove their taint and
purify their bodies.
Rituals of modern citizenship, closely bonded to therapeutic protocols,
pervaded the leper colony. ‘‘The lepers,’’ Heiser observed, ‘‘are given all pos-
sible liberty, and are, to a large extent, controlled by regulations which they
themselves make.’’∂Ω Medical facts and social potential were amalgamated:
as part of the treatment, the diseased were supposed to govern themselves.
Heiser regarded the leper colony as ‘‘a microcosm, but on a very small scale
indeed.’’∑≠ The community elected its own mayor and council; from 1908,
women voted, the earliest female suffrage in Southeast Asia. Leper police saw
that the town was ‘‘kept in good sanitary condition’’ and made ‘‘arrests of
offenders against their own ordinances.’’∑∞ Leper sanitary inspectors, under
the command of a nonleprous chief, also helped to maintain sanitary order in
the colony. A leper brass band greeted new arrivals and gave occasional
concerts—Heiser once joked that they were so enthusiastic they ‘‘literally
played their fingers off.’’∑≤ Several times a year, the lepers put on a play;
indeed, they ‘‘took eagerly to dramatics,’’ recalled the director of health.∑≥
And twice a month in the large concrete theater, patients would dress up to
watch ‘‘very cheap films.’’∑∂ ‘‘The disease does not deprive its victims of their
desire to look well and to please,’’ observed Dr. Alan J. McLaughlin. ‘‘Lepers
love neckties and handkerchiefs, and things that are pretty and attractive.’’∑∑
Athletic gatherings, though held rarely, elicited considerable enthusiasm for
baseball. ‘‘That they possess the true American baseball spirit,’’ wrote Snod-
grass, ‘‘was demonstrated at one of the games when both teams attacked the
umpire with ball bats.’’∑∏
The tiresome emphasis on performance animated social life and medical
protocols throughout the colony: lepers at Culion were regularly on stage in
therapeutic and civic dramas. The diseased body was repeatedly exposed to
public view, as if to justify the disciplinary apparatus of the colony. Test-
ing and treatment (especially injections) were generally performed on these
bodies as a display of sovereignty for an audience of other lepers. And if
medicine had to be seen to be done, so too did citizenship: treatments of the
body and of social life all required enactment. A theater, for plays not opera-
tions, was one of the first buildings in the civic center of the colony: while the
staff often directed, the players and the audience were lepers. It was not
enough that they were represented as responsible patients or incipient citi-
zens: they had to perform themselves as the subjects of civic narratives.∑π
Medical authorities expected lepers to work diligently in between their

disease and citizenship 171

figure 39. Leper brass band, Culion (rg 350-bs-1-4-177 [bs 995], nara).

doses of chaulmoogra oil—indeed the treatment was supposed to enhance

their industrial capacity. In front of each house, for instance, was a small
flower garden, ‘‘and every effort is being made to instill a sufficient civic pride
in the lepers to maintain them; but so far these efforts have not met with much
success.’’∑∫ Some tried raising cattle or started ‘‘tiny sugar plantations.’’ In
order to produce the ‘‘conditions prevailing in ordinary communities,’’ a store
and, later, two bakeries and an ice cream parlor were opened to sell the lepers’
manufactures. So that the money handled by lepers never reached the outside
world, the authorities coined a special currency to serve as the medium of
trade.∑Ω Many of the afflicted remained capable of carrying out simple domes-
tic duties for a small salary: cooking, cleaning, dressmaking, taking care of
streets, making repairs to buildings, and so on.∏≠ But Heiser lamented that
‘‘contractions of the limbs, destruction of tissue, losses of fingers and toes . . .
and general debility’’ meant that only a few lepers performed sufficient man-
ual labor to supply food for themselves. The bulk of the food was still pre-
pared in a large kitchen by leper cooks. ‘‘Usually the leper is so depressed that
he takes no interest in anything,’’ Heiser reflected. ‘‘All he has to look forward
to is the half-lingering hope that he may be among the very few who are to get
well.’’∏∞ It seemed to him that most lepers remained ‘‘naturally apathetic’’ and

172 disease and citizenship

dependent on government aid. Yet ‘‘the streets must be swept, the garbage
cans emptied, assistance rendered at the hospital, and supplies carried.’’∏≤
When Heiser observed the neglect of civic responsibilities he ‘‘held a little
meeting with the residents affected and asked them to attend to this matter,
and they promised to do so.’’∏≥ The director of health expected a more meticu-
lous and hopeful observance of the treatment regime in the future.
Even a carceral and probationary citizenship will provide a language of
entitlement. As early as 1912, some of the less introspective lepers were writ-
ing to the Manila newspapers to complain about the neglect of their rights.
The campaigning editors of La Vanguardia questioned Heiser’s representa-
tion of the leper colony as ‘‘a model administration where men and women,
more advanced than the rest of the archipelago, enjoy the fullest suffrage,
voting as equals for the election of officials . . . [where] they have the best
sanitary service, police, schools, gardens, walks, abundant and healthy food,
and everything characteristic of modern life and comfort.’’ Recent protests
from the inmates had undermined the view that Culion was ‘‘a happy com-
munity in the full-exercise of self-government.’’∏∂ It seems that the food was
poor, the housing was overcrowded, the police were oppressive, and the
newspaper often censored. One leper lamented that he was ‘‘composed of
lentils and salt up to the crown of [his] head.’’ Others complained about
forced labor on public works.∏∑ The lepers addressed the government in a
language of civic entitlement, arguing that their corner of the archipelago,
‘‘abandoned by the hand of God but not the hand of Mr. Heiser,’’ was appar-
ently not the ‘‘earthly paradise’’ for lepers he had promised.∏∏ While Heiser
and other Americans insisted on calling Culion the Island of Hope, Filipinos
knew it as ‘‘la Isla del Dolor.’’
Hope was the theme of Who Walk Alone, Perry Burgess’s popular account
of the experiences of a solitary white American leper at Culion during this
period. For Burgess, an advertising man trying to raise money for the leper
colony, the island was a place of idealized aspiration, where abject embodi-
ment might eventually be transcended. The story concerned ‘‘Ned Langford,’’
a soldier in the Philippine-American War who had mixed too closely with an
upper-class Filipino family, thus becoming an innocent and sympathetic vic-
tim of the disease. After abandoning his own family and changing his name,
he admitted himself to Culion in order to get as far as possible from America.
On his arrival, a tall, white doctor met him: it was Heiser, as ‘‘slender and lithe
as an athlete.’’ ‘‘Life appeared a continual frolic’’ to this physician, and op-
timistically he told Ned that recovery from the disease was now possible.

disease and citizenship 173

figure 40. Culion theater, 1925. Courtesy of the Rockefeller Archive Center.

Heiser—or James Marshall, as Burgess called him—‘‘liked Filipinos and he

expected great things of them in the future.’’ It seemed this ‘‘busy man with
the welfare of millions in his hands, knew mankind as a whole.’’∏π Ned tried
not to disappoint the director of health. Assigned a separate house, he in-
stalled a sink, a shower, and a septic tank. With other responsible lepers he
took his treatments regularly: ‘‘I liked to study their faces, trying to guess
what they were thinking as they winced under the thrust of the needle. Was it
simple resignation? Or—was it hope?’’ Like Heiser, Ned realized how impor-
tant it was to work; when lepers were ‘‘idle it was much more difficult not to
lose hope.’’∏∫ Uninspired, they would stop taking their treatments.
Who Walk Alone becomes more exciting, though no less pious, with the
arrival of Vicente, a ‘‘malcontent and political agitator’’ from Cebú. His ad-
vanced disease correlated with his ‘‘surly and critical’’ demeanor, and soon he
fell in with ‘‘a gang averse to work.’’∏Ω Vicente began strutting about the
colony shouting for independence and calling for the death of the physicians.
With the help of Ned and other dutiful lepers, the miscreant was eventually
arrested and imprisoned. Burgess then has Ned opine, ‘‘Lepers we were, but
we were also citizens, not criminals deprived of our right to vote, but citi-
zens.’’π≠ Yet tragically, Ned died soon after his return to America, during his
transfer to the Carville leprosarium, his disease uncured, and his rights not
fully restored—what hope, then, for refractory Filipino lepers like Vicente?
Despite the author’s intentions, dolor still won out over promise at Culion.

174 disease and citizenship

 Nevertheless, Culion became a model reformatory, influencing activities at
Molokai and shaping the administrative apparatus of the new U.S. Federal
Leprosarium at Carville, Louisiana. Although Hawaiian lepers had been ex-
iled to the settlement at Kalaupapa, on the north side of Molokai, since 1866,
it was only after the U.S. government assumed control in 1909 that inmates
were disciplined and managed as at Culion. When Frederick Hoffman toured
Molokai in 1915 he found a clean, hygienic town, with stores, churches,
playgrounds, a baseball field, a music stand, and a movie theater. The six
hundred or so lepers lived in small houses surrounded by pleasant gardens;
they were supposed to work every day in the fields. Compared to Culion,
research and treatment efforts were still meager, but in all other respects it
now resembled the Philippine Island of Hope.π∞ The impact of Culion on
Carville was even more tangible. Since 1894 a run-down state leper home,
Carville was transformed in 1917 into the Federal Leprosarium. Its establish-
ment was in part a response to fears that returning soldiers and immigrants
from places like the Philippines were bringing leprosy back into the United
States—though the mainland had never been entirely free of the disease.
Dr. Oswald E. Denny, the first director of Carville, had worked at Culion,
and, according to Zachary Gussow, he re-created ‘‘an atmosphere of strict
discipline’’ and a ‘‘quasi-military structure’’ in Louisiana.π≤ For the next six-
teen years, Denny strove to implant a new Culion in the bayou.

a colonial obsession
After Heiser resigned as director of health in 1915, he often returned to the
archipelago, as director for the East of the International Health Division of
the Rockefeller Foundation, and he continued to attempt to tinker with the
health system. In the 1920s he became especially attentive to developments
in the Philippines, advising and supporting his old friend and political ally
Leonard Wood, m.d., who had been appointed governor-general. In particu-
lar, Heiser impressed on Wood the need for leprosy work. He was so persua-
sive that after 1922 more than one-third of the Philippines health budget was
allocated to Culion, which then boasted six thousand residents in an archi-
pelago of more than ten million people. Medical staffing improved at the
colony, and treatment became more rigorous and sophisticated, allowing
more paroles for inmates during this period.π≥ As the number of ‘‘negatives’’
increased and few were prepared to go home, the population of the ‘‘negative
barrio,’’ later called barrio Osmeña, swelled, causing hardship and misery
when the poor inland soils repeatedly yielded sparse harvests.π∂

disease and citizenship 175

 During the 1920s, Wood became increasingly fascinated by the prospect of
rehabilitating the inmates of Culion. He visited the island sixteen times as
governor-general and immersed himself in the recent research on leprosy
therapeutics. He hectored nationalist politicians, asserting that until they
could take care of their lepers, Filipinos would not be fit for self-government.π∑
But when members of the Philippine Senate visited Culion in 1922, they
concluded it was a useless dissipation of funds, a peculiar American extrava-
gance in a poor and needy archipelago. Manuel L. Quezon, the president of
the Senate, was especially bitter. He compared the expense of reforming six
thousand lepers with the pittance spent on the prevention of tuberculosis, a
disease that killed some thirty thousand Filipinos each year. In 1923, Quezon
told the annual meeting of the Philippine Islands Medical Association that the
expenditure on the colony ‘‘for experimental purposes’’ was excessive. The
medical results did not seem to justify the continued suffering and isolation of
the lepers. Quezon was most concerned that tubercular patients were not
separated from nontubercular lepers—he was stunned that even at Culion
tuberculosis prevention and treatment were neglected.π∏ Obsessed with lep-
rosy, Americans appeared indifferent to ‘‘the tremendous ravages which this
dreadful plague [of tuberculosis] is causing to the Philippine Islands.’’ The
nationalist politician regretted that there was ‘‘more interest here in doing
things which promote immediate results, real or apparent, things that are so
spectacular as to lend themselves to wide publicity calculated to invite univer-
sal commendation and to secure recognition as world achievements.’’ The
more tedious and unrewarding problems, such as tuberculosis prevention,
elicited only Filipino commitment. ‘‘We have an army of doctors and nurses
and well-paid experts in Culion . . . but what has been done by the Philip-
pine Health Service to fight tuberculosis?’’ππ The repeated hospitalization of
Quezon during this period for bronchitis and other manifestations of tuber-
culosis, and his death from consumption at Saranac Lake, New York, in 1944,
lend further poignancy to his pleas.π∫
Heiser and his colleagues would not allow the agitation of nationalist
politicians to discompose them. Having staked his reputation on the rehabili-
tation of lepers, the former director of health made sure to monitor carefully
developments at Culion. When he visited the colony in 1931, for example, he
found the inmates ‘‘much more contented than formerly.’’ They seemed to
have settled down to the routines of therapy and hygiene. But he was sad-
dened that so many of his efforts had been forgotten. Even worse, ‘‘the name
of Mr. Worcester, who probably did more for leprosy than anyone else in the

176 disease and citizenship

Philippines, has been replaced with the name of Rizal on the plaza that was
named after him.’’πΩ The following year, however, when Heiser visited again,
the entire colony turned out, and ‘‘several leper orators hailed our arrival in
the most felicitous terms.’’ Doctors still dispensed chaulmoogra oil, the hospi-
tal had been extended, and concrete barracks had largely replaced the nipa
buildings. Heiser observed that many of those who became bacteriologically
negative were still refusing to leave.∫≠
During this period lepers also held several meetings demanding an end to
segregation; they asserted that leprosy was not nearly as contagious as the
health department had claimed, and they had a right to freedom of move-
ment. Medical facts and social potential thus had become linked for doctors
and patients alike. The attendant physicians were threatened, and a few in-
mates called for a strike.∫∞ In 1932, three hundred young men had forced their
way into one of the female dormitories in protest against the reintroduction of
restrictions on leper marriages: on this occasion, ‘‘the Culion police force was
too small to disperse the ardent swains, who refused to pay attention to the
law forces.’’∫≤ But the most popular forms of civic activism—or performance
—were the petition and the public hearing. At Culion, in July 1935, the vice-
governor-general Joseph Hayden listened to the fractious lepers as they pre-
sented their complaints. Ernesto S., invoking ‘‘individual rights and liberties
of individuals,’’ demanded that everyone receive a gratuity since they had all
been brought to Culion against their will; Ciriaco S. P. protested against the
reduced appropriation for the colony; Graciano A. directed attention to the
dilapidated conditions of the school buildings; and Rufino M. noted that
lepers ‘‘clean and cultivate’’ land without hope of owning it. In response,
Hayden told the lepers he could now see that although they were still ‘‘af-
flicted,’’ they ‘‘nevertheless, live in a well-ordered, well-directed, and well-
operated community.’’ He had been impressed by the review of scouts, pio-
neers, and police, and so he would consider their demands.∫≥

biomedical citizenship and the distribution

of affect in the carceral archipelago
In the Philippines leper colony, inmates were positioned as desiring and de-
serving treatment and civilizing. As the most needy and most malleable mem-
bers of a marginal or disparaged population, they seemed the most eligible
candidates for a coeval process of medicalization and civilization. Those most
rejected from the society that Americans sought to reform appeared most
amenable to the civilizing process. The iatrocratic disciplines of the leper

disease and citizenship 177

colony were not supposed to reproduce the denigrated Filipino social body
but rather were meant to normalize American ideals of civic responsibility, to
attach recovering lepers to the colonial state and its agents. Accordingly, exile
to Culion was represented not as the deprivation of liberty but as its cre-
ation. In the controlled environment of the microcolony—in that exemplary
space—scientific experts watched over the disciplining, the bodily and moral
reform, of those with ‘‘curable’’ yet chronic disease. Progressive intellectuals
in the colonial and protonational state regarded the pathology of semiciviliza-
tion as remediable, so long as those so afflicted were prepared to learn sup-
posedly white ways of relating to the body, to family, and to authority. For
Heiser and other medical officers, the most intimate activities of the body and
the most intimate of human interactions were open to view and available for
refashioning. The trajectory from ‘‘savage’’ (or leper) to citizen thus implied a
reconfiguring of intimacies with one’s own body and the bodies of others—a
remaking of the private. It entailed at the same time a realignment of affect
away from traditional family bonds and toward state abstractions like prog-
ress, modernity, and civilization.
Citizenship was linked symbiotically to corporeal metamorphosis, but the
successful achievement of both was endlessly postponed. The result was a
deferred and incomplete citizenship, as repressive as it was liberating: civic
and medical responsibilities were always more salient at Culion than civil
rights. As an exemplary part of the colonial process of modern subject forma-
tion, such carceral citizenship permitted no history beyond an individual’s
standardized medical history, and it sanctioned little public self-assertion: the
leper-citizen was to become an individualized case record, oriented away
from a messy past of illness and superstition toward a contained, therapeutic
future. Citizenship at Culion thus was predicated on displacement, erasure,
and transcendence of native embodiment in private and domestic life. Config-
ured as moral reformation, medical protocol, and race elevation, this simu-
lated citizenship would mostly be conferred as a discipline and only occasion-
ally demanded as a right. Even those paroled from Culion required continued
monitoring: they were in remission, not cured, and they were nationals, not
full citizens. Their identities and relationships, their affective ties, were never
as modern as hoped. The recovering lepers had, in effect, been left in national-
ism’s waiting room.∫∂
Despite its flaws and disappointments, Culion remained the best model in
the archipelago for ‘‘the making of men out of savages, the regeneration of a
conquered people by the conquerors by teaching them the benefits of labor

178 disease and citizenship

and industry.’’∫∑ Lepers would be ‘‘taught to speak, and to reason, and to . . .
get their rights as citizens among those who have been so long their supe-
riors.’’∫∏ It was the progressive colonial official’s ‘‘work of civilization . . . of
regeneration and instruction,’’ organized through a multitude of individual
medical careers.∫π In the microcolony, in the controlled laboratory of subject
formation, the supposedly docile lepers might yet be enrolled in American
modernity in advance of the nonleprous. To understand the American colo-
nial project it was necessary to study Culion, for the leper colony had become
an allegory of the prospects of the macrocolony. In the 1930s, as the Philip-
pines moved toward self-government under U.S. guidance, the concentrating
of lepers at Culion fell out of favor. Instead, new treatment stations scattered
across the archipelago and a new leprosarium at Cebú allowed lepers to lead
responsible, healthful lives while still integrated in their community.∫∫ Once
expressively localized at Culion, the civilizing process was thus dispersed
through the thickening carceral texture of the archipelago.∫Ω

disease and citizenship 179

 Chapter Seven

late-colonial public health

and filipino ‘‘mimicry’’

B
‘‘ ut what an imitator the Filipino is!’’ wrote Victor G. Heiser, after visit-

ing a hospital in Sulu, during an investigatory trip he conducted in

1916 for the International Health Board of the Rockefeller Foundation.∞ Just

a year earlier Francis Burton Harrison, the new governor-general of the Phil-

ippines, had accepted Heiser’s resignation from his post as director of health.

Now the wily, authoritarian hygienist, supported by the Rockefeller Founda-

tion, had an opportunity to return to the archipelago and make life difficult

for those who sought, prematurely in his opinion, to ‘‘Filipinize’’ the Ameri-

can colonial bureaucracy.≤ In general, it was evident to him that health work

had been degraded in his absence. The town of Legaspi, for example, had no

latrines and was ‘‘filthy in the extreme.’’ Heiser felt that Filipino infiltration

of the public health service now meant that ‘‘politics seems to dominate

everything for the worst.’’≥ In Manila, ‘‘the dead spirit seems to pervade

everything.’’∂ All that remained was a corps of pathetic native imitators of

American public health, carelessly supervising lower-class imitative natives in

the barrios. ‘‘There is a great inefficiency,’’ Heiser remarked, ‘‘and the ma-

chine is big and ponderous and the fuel does little more than oil the wheels,

and progress is small, but this is to be expected with native control.’’∑ As they
all went dutifully, slowly through the motions, producing unfaithful copies of
the American originals, Heiser watched, gleefully reporting on their deficien-
cies. ‘‘In leaving Manila,’’ he wrote, it was ‘‘a satisfaction to see the indestruc-
tible monuments of cement which I left on the landscape and which they will
be unable to destroy.’’∏
Wherever he went in the colonial Philippines, Heiser found imitation,
theatricality, ornament, and politics. At times he was heartened by Filipino
enthusiasm for his projects. ‘‘Hookworm treatment is very popular with the
people,’’ he reported on a later visit in 1925. They ‘‘have become greatly
interested in its prevention; now that they understand how it is transmitted
they are voluntarily building large numbers of latrines.’’π He was thrilled by
local efforts to follow practices he regarded as typically American. But often
these latrines would turn out to be quite different from what he had imagined:
‘‘The question of superstructure is left entirely to the householder’s wish and
it is amazing to see the numbers of directions into which this feature de-
velops.’’∫ Nor were Filipinos seating themselves on their new toilets quite to
his satisfaction. Heiser urged the local Rockefeller emissary, Dr. C. H. Yaeger,
to modify the bowl design ‘‘to make it impossible to sit on except in the
desired position.’’Ω Out in the field, boring holes for yet more latrines, Yaeger
himself was never sure when locals were making fun of his hygiene enthusi-
asms or subverting his projects. In one town, they wanted to make a ‘‘wood
carving of someone boring a latrine and suggested me. Well a joke is a joke
and I didn’t know if they were serious or not but took it in good spirit. What a
reputation!’’∞≠
I return in this chapter to the colonial excremental vision not so much to
indulge in toilet humor as to discuss imitation and difference in the new
hygienic order, focusing on the role of mimicry in a colonial development
project. In chapters 3 and 4 I described an American poetics of pollution in
the colonial Philippines, a racializing of germ theories that conventionally
contrasted a clean, ascetic American body with an open, polluting Filipino
body. From the early twentieth century, public health officers argued that
Filipinos, evolving with local pathogens, would surely have been fashioned as
natural reservoirs of disease organisms, containers that racial customs and
habits kept filled to the brim. Filipinos, then, were cast along with other local
fauna as disease dealers—even apparently healthy Filipinos might secretly
carry the invisible pathogens from which supposedly pure and cleanly bour-
geois Americans were typically exempt and to which they seemed typically
more vulnerable. Natives would thus appear as meretriciously healthy car-

public health and filipino ‘‘mimicry’’ 181

riers and transmitters of local diseases, while those Americans who fastidi-
ously restricted local contact were represented as innocent victims. As the
American lower bodily stratum was erased or abstracted in tropical hygiene,
the poorer class of Filipino, like other natives, became the chief source of
contamination and danger. In other words, the new tropical hygiene develop-
ing at the end of the nineteenth century had led to an anthropomorphic
mobilization of disease agency in the tropics as elsewhere, giving pathological
depth and interiority to older racial and class stereotypes. I call this a poetics
in order to emphasize the way in which colonial public health officers at-
tempted to close the structure of medical metaphor and omit any relations of
these imputative texts to political practice. The closed system of equivalence
and opposition served to erase any historical or social context for disease pat-
terns, substituting instead contrasting natural typologies, a poetics of purity
and danger.∞∞
The Manichean opposition in the medical text—the contrast of a white
bourgeois American body, a formally expressive body, with a Filipino gro-
tesque body—proved in practice excitingly assailable and perhaps necessarily
unsustainable. American self-possession was always fragile, as we have seen,
and no matter how repressed, a secret rottenness kept resurfacing in even the
most apparently abstracted of bodies, disturbing and reconstituting Ameri-
can identity. American males repeatedly broke down in the tropics, going
native or becoming neurasthenic or nostalgic. On the other hand, a few select
Filipinos seemed ever more reformable, perhaps able through correct training
to transcend their lower bodily stratum and thus eventually to become eligible
for social citizenship. Positioned at the polluting pole of a binary typology,
Filipinos were expected to confess their putrescence, to announce their desire
for civilization or modernity, and to make themselves available for reforma-
tion. Medical and civic discourses were thus overlaid upon each other. The
American civil authorities treated Filipinos as infants in need of, and capable
of responding to, bodily training and guidance in proper behavior, that is,
subject to a ‘‘benevolent assimilation’’ into a sort of American adulthood. In
heeding the gospel of hygiene, some Filipinos, with lepers in the vanguard,
might therefore be given limited civic rights, becoming probationary citizen-
subjects. As President Woodrow Wilson remarked in relation to American
duties in the Philippines, ‘‘Self-government is a form of character and it fol-
lows upon the discipline which gives a people self-possession, self-mastery,
and the habit of order and peace. . . . No people can be ‘given’ the self-control
of maturity. Only a long apprenticeship of obedience can secure them this

182 public health and filipino ‘‘mimicry’’

precious possession.’’∞≤ Unlike most other colonial powers at the time, the
American regime thus began to supplement a project of native homogeniza-
tion with limited individuation and developmentalism—evidently, the copy
was becoming as interesting as any typological construction of difference.
The moral reform of the newly recognized individual was linked symbioti-
cally to bodily reform, but the satisfactory achievement of both normaliza-
tions could, as Heiser attested, be endlessly deferred. Native imitations of
American citizenship appealed to the narcissistic demands of colonial offi-
cials, but these performances usually appeared immature and unfaithful, that
is, in need of further surveillance and discipline.∞≥
I would like to extend this analysis and in this chapter consider further the
role of mimesis in the colonial civilizing process.∞∂ I will focus on the Rocke-
feller campaign to prevent hookworm infection in the Philippines during the
early 1930s, as this project demonstrates a medical effort to produce hy-
brid, imitative subject positions for Filipinos and indicates the ways in which
‘‘mimicry’’ sometimes might expose these constructions.∞∑ In the latrine busi-
ness we can see the white man off-loading his burden, making hygienic sub-
jects who participate in that subject-making, sometimes parodically. The
story takes place during a period of rising nationalism and anti-Americanism
in the Philippines, so the relations of colonial hygiene and citizenship become
especially clear.
I have referred to this as a colonial civilizing project, for that is the goal to
which American bureaucrats in the Philippines aspired, but in the 1940s this
task would come to be called development. This chapter may therefore be
read as an account of a colonial precursor of the development discourse that
proliferated after World War II.∞∏ The early effort to produce and implement
development knowledge would prove immensely influential, shaping later
Rockefeller Foundation policies and stimulating other international agencies
to conduct similar projects. Although development was soon taken up more
widely by local elites and used as nationalist rhetoric, here it still appeared to
offer, to Heiser and others, recolonizing possibilities. Indeed, one might argue
that development never quite discarded the colonial legacy that pervades this
story; it often seemed to repeat the older dichotomies of modernity and tradi-
tion, science and ignorance, global and local, purity and danger—only to
characterize the subjects of development as arrested at stages in the traverse
between these opposites. Much of development remained, at heart, a civiliz-
ing mission, disempowering local communities, demanding that the native or
the underdeveloped person follow a single track toward a unique Western

public health and filipino ‘‘mimicry’’ 183

modernity, not really expecting that this distant prospect, the light on the hill,
would ever be reached.

a new order of colonial hygiene

In 1916, Victor Heiser, believing that the Filipinization of the colonial bu-
reaucracy was premature, took special care to visit Sulu. The year before, the
American health officer for the province, Dr. Ivan B. Hards, had approached a
visiting U.S. congressman to tell him that since Heiser had left office, the
Filipino civil authorities were grossly neglecting a cholera epidemic.∞π But
when Governor Harrison investigated these allegations, Major L. A. I. Chap-
man, the commanding officer of the local barracks, reported that Hards,
perhaps ‘‘more interested in maintaining a paid civil practice,’’ had himself
shown ‘‘but little interest in the cholera situation.’’∞∫ Hards now ‘‘emphati-
cally’’ denied having suggested earlier that his Filipino superiors disliked him
reporting the facts. ‘‘I have always been instructed by telegram and letters
from my official superiors,’’ he assured the authorities, ‘‘to report all cases of
cholera occurring anywhere within the province.’’∞Ω Harrison regarded the
accusation, now retracted, as typical of the attempts of Heiser and other
health officers to ‘‘discredit and destroy the work of distinguished members of
their own corps.’’ ‘‘Among the most annoying and vexatious incidents in the
establishment of the civil regime here,’’ the governor-general wrote to Wash-
ington, D.C., ‘‘has been the effort of certain medical officers to discredit the
newly appointed civil officers of the public health service.’’ Hards resigned
from his post late in 1915 and returned to the United States. Harrison re-
placed him with his deputy, Dr. Marcelino Gallardo. Unlike Hards, Gallardo
was reputed to have ‘‘distinguished himself during the Sulu cholera epidemic’’
and displayed ‘‘a correct understanding of the fundamentals of combating
cholera in accordance with the best modern practice.’’≤≠ Yet it was Gallardo
who prompted Heiser, as he passed through Sulu, to exclaim, ‘‘What an
imitator the Filipino is!’’
Before 1914, Filipino physicians had generally occupied junior positions
in medical institutions under the control of the Philippine government. All six
senior officers of the Bureau of Health in 1913 were American; the only
Filipino division chief was Dr. Manuel Gomez of the statistics department. At
the Philippine General Hospital, Dr. Fernando Calderón was chief of the
obstetrics section, but Americans managed the other five units. The senior
officers of the bureau’s inspection division were, with few exceptions, Ameri-
can physicians, but their assistants all were Filipino. Only two of the seven-

184 public health and filipino ‘‘mimicry’’

figure 41. Dr. Luna, Dr. Heiser, Dr. Fajardo, Dr. Gallardo, Jolo Hospital, 1916.
Courtesy of the Rockefeller Archive Center.

teen inspectors in the field were Filipino, yet all of the nine junior inspectors
were locals. Of the twenty-seven district health officers, a lower-status job in
the medical service, no more than three were American.≤∞ All of the senior
instructors at the new Philippine medical school were foreigners. Similarly, at
the Bureau of Science, the senior researchers were American or European.
The first article by a Filipino published in the Philippine Journal of Science—
Calderón’s discussion of obstetric practice in the archipelago—did not ap-
pear until 1908; the following year, Filipinos were junior authors of only
seven of the forty-seven papers presented in the journal. In 1913, Filipino
investigators contributed to no more than four of the journal’s forty-one
medical articles.
During this period, Heiser and Dean C. Worcester repeatedly emphasized
the current incapacity of Filipino physicians for high office and their need for
unremitting supervision and tutelage.≤≤ American colonialists thought it pos-
sible that Filipinos, after learning the ‘‘whys and wherefores’’ of modern
hygiene and sanitation, would eventually develop the skills and the sense of
responsibility American physicians recognized in themselves, but that goal
still seemed far off.≤≥ Meanwhile Filipinos should occupy junior positions in
which they could observe and imitate the more accomplished foreigners.

public health and filipino ‘‘mimicry’’ 185

Heiser took great pleasure in recalling a trip to the United States with Dr.
Francisco Calderón—then ‘‘being groomed for an important administrative
position’’—whom he watched over ‘‘as though I was his keeper.’’ According
to Heiser, his charge was at a loss in modern society, unable ‘‘to conform to
American notions of propriety.’’≤∂ ‘‘Things moved far too rapidly for him,’’
and when Calderón addressed medical gatherings Heiser was convinced he
‘‘scarcely knew the meanings of the words.’’≤∑ Later, despite Heiser’s mis-
givings, his Rotpeter became the dean of the Philippine medical school and
president of the University of the Philippines.≤∏
Heiser may have found support among some of the Filipino elite for his
critical appraisal of their accomplishments. For example, T. H. Pardo de
Tavera, the token Filipino physician on the Manila Board of Health and the
Philippine Commission, had often thanked the Americans for promoting and
institutionalizing the ilustrado anticlerical project. ‘‘America came to the Phil-
ippines to aid them, to sustain them and to give them the principles of liberty
and free government,’’ he wrote in 1902.≤π A founder of the Federal Party and
editor of La Democracia, Pardo de Tavera hoped that one day the Philippines
would be ready to become another state in the Union. According to Pardo de
Tavera, Filipinos had not yet achieved the necessary ‘‘triumph over one’s
self’’—they mostly remained ‘‘infected with the leprosy of superstition [con-
tagiodos con la lepra de la superstición].’’ He argued that attainment of true
self-government was not unlike the formation of ‘‘hygienic consciousness [el
sentimiento de la higiene].’’ At first this sentiment had ‘‘existed in a latent state
and we did not see, feel, or notice it because of lack of preparation.’’ Gradu-
ally, Filipinos had come to clamor for more hygiene, but they had not yet
reached American standards. In time, they would learn to imitate the ‘‘regime
of liberty, industry, work and logical mentality [mentalidad lógica].’’≤∫ Fil-
ipinos, Pardo de Tavera assured the graduates of the University of the Philip-
pines in 1921, eventually would be ‘‘capable of following the infinite, progres-
sive, and ascendant road of civilization,’’ so long as they abandoned the
‘‘national type’’ and acquired American customs and habits. He urged the
graduates to develop the qualities of ‘‘confidence in one’s own self, of appre-
ciation, respect and love for work, of hygiene and care of our body, of dis-
regard for suffering.’’ ‘‘Let us therefore lay aside sentimental patriotism,’’ he
declared, ‘‘and let us adopt scientific patriotism.’’≤Ω But after Pardo de Ta-
vera’s death in 1925, Heiser encountered few Filipinos who shared his disdain
for their attainments, his sense of their unreadiness for self-government.
As governor-general, W. Cameron Forbes had demonstrated great reluc-

186 public health and filipino ‘‘mimicry’’

tance to confer much responsibility on supposedly feckless Filipinos. In 1905,
Forbes wrote to his old friend William James, wondering if the philosopher
had ever ‘‘traveled around the world on a recently developed map and figured
out how many countries there are in the torrid zone and in the neighborhood
of the equator . . . and how many of them maintain self-government unsup-
ported by men from the temperate zones.’’≥≠ Forbes was convinced Filipinos
as yet were ‘‘without the sinews necessary to maintain a position among the
nations of the world.’’≥∞ Although a committed anti-imperialist, James sus-
pected this was indeed true, while he hoped the American emissary would at
least nurture the soul of the Filipino. Occurring at a time when the United
States was relying on a ‘‘collaborative compromise’’ with local elites to secure
control of the islands, this exchange has a rather sad, detached, and self-
serving tone. If he did not know in 1905, it must soon have become clear to
Forbes that Filipinos continued to dominate commercial, professional, and
political activities, even if they were excluded from the military, the American
clubs, and the higher levels of the colonial bureaucracy. The local elites, even
when they were not as complicit as Pardo de Tavera, proved capable of
tolerating an American rhetoric of superiority, so long as they were allowed to
get on with business.≥≤
The enrollment of educated Filipinos in the institutions of American medi-
cine, initially so gradual, accelerated greatly after 1914. The new U.S. presi-
dent, Woodrow Wilson, had been elected on a platform that proposed early
independence for the Philippines. Conventionally, Wilson argued that Ameri-
cans should give Filipinos ‘‘a moral government which would moralize and
sublimate their ideals’’; having accepted the ‘‘compulsion of American char-
acter,’’ locals might become true partners in government.≥≥ According to Wil-
son, the trajectory from savage to bureaucrat was already more or less ac-
complished, their apprenticeship was virtually over—an attainment that the
Republican Forbes and his acolytes would still dispute. It came as no surprise,
then, that soon after Harrison, a Democrat congressman from New York,
replaced Forbes, he quickly announced his commitment to complete the Fili-
pinization of the colonial bureaucracy. The reformist governor-general de-
clared portentously that ‘‘a new era is dawning. We place within your reach
the instruments of your redemption. The door of opportunity stands open
and under Divine Providence the event is in your hands.’’≥∂ Harrison regarded
the American colonial officials as a ‘‘stuffy body of restless, ambitious and
adventurous young men,’’ ill-suited to their self-appointed task as tutors of
supposedly ignorant Filipinos. He suspected that ‘‘as the attractions of Philip-

public health and filipino ‘‘mimicry’’ 187

pine life grew upon American officials, so grew their willingness to believe in
the incapacity of Filipinos for office.’’≥∑
The number of American officials in the islands, including physicians and
teachers, fell from 2,600 in 1913 to 614 in 1921.≥∏ The drop-off resulted in
part from a deliberate policy of replacing Americans with Filipinos, but also
was the consequence of Americans leaving to fight in the European war and of
inveterate retentionists giving up in disgust at the drive toward independence.
In 1916, the U.S. Congress passed the Jones Act, which extended the powers
of the Philippine legislature, confirmed plans for early self-government, and
disturbed those American colonial officials who doubted that Filipinos were
ready to assume such responsibilities. When Heiser left the islands, he had
been appalled that ‘‘many Filipinos were lifted into positions which they were
not qualified to fill.’’ His imitative subordinates had not yet got their act
together. Heiser had been prepared to allow locals to ‘‘direct the lesser units of
government and, as they showed fitness, to turn over to them the higher
units,’’ but Harrison seemed to believe that ‘‘the only way for people to learn
how to govern was to let them do the governing as they wished.’’≥π Worcester,
also isolated by the drift toward self-government, had resigned as secretary of
the interior in 1913, ‘‘firmly convinced that Filipinos are where they are today
only because they have been pushed into line, and if outside pressures were
relaxed they would steadily and rapidly deteriorate.’’ The task of ‘‘training
physicians, surgeons and sanitarians so that the public health may be ade-
quately protected’’ was not yet, he claimed, complete. ‘‘Shall they,’’ he asked,
‘‘be left to stagger on alone, blind in their own conceit?’’≥∫
Worcester campaigned strongly against the Filipinization of the health
service, and he enlisted expatriate friends and colleagues in the fight. The
changes so incensed Dr. H. L. Kneedler, a physician who had worked as an
insurance examiner in Manila since the American occupation and was an
associate of Worcester, that he wrote to President Wilson, warning that the
‘‘weak puny bodies’’ of Filipinos would never be ‘‘transformed into a healthy
vigorous race’’ if the ‘‘natives’’ were allowed to take over. When Kneedler first
arrived, after the Philippine-American War, he had found the city’s water
grossly polluted; forty thousand or more died each year from smallpox; the
lack of sewers meant that ‘‘noxious odors and gases were being constantly
liberated’’; five thousand lepers were at large; and malaria prevailed. ‘‘Those
in charge of sanitation under these obstacles soon learned,’’ Kneedler wrote,
echoing Heiser, ‘‘that the passive resistance of the Oriental is a much more
subtle and difficult force to overcome than the active opposition so frequently

188 public health and filipino ‘‘mimicry’’

encountered among the inhabitants of the temperate zone.’’ Nevertheless, a
‘‘system of sanitation’’ had been established, despite the ‘‘many efforts to
avoid enforcement by the native Filipinos.’’≥Ω And now this apparently child-
like race was taking over again.
Dissent from Harrison’s Filipinization policy was expressed privately at
the highest level. Charles H. Yeater, the vice governor and no friend of the
chief executive, wrote to Daniel R. Williams, warning that the Bureau of
Health ‘‘through the almost total elimination of American doctors, has al-
ready opened the way for the spread of epidemic and endemic diseases ever
lurking for a foothold in the tropics.’’ There were fewer than twelve American
physicians in the whole archipelago. ‘‘Of the Bureau of Science,’’ he went on,
‘‘which has done and was doing such wonderful work in original research,
and discoveries relating to tropical diseases and their cure . . . now ‘shot to
pieces’ and largely marking time.’’ The basic problem was that the Malay race
was incapable of forming nations—everyone knew this. Filipinos were gener-
ally ‘‘poor, ignorant, superstitious, and shiftless.’’ ‘‘However much we might
like to do so,’’ Yeater reflected, ‘‘we cannot override ethnological truth nor
hurdle the processes of evolution. The laws of nature are immutable. . . . If the
Malay is to escape his inheritance it must be by the same road we have
traveled, and history records that the journey was a slow and painful one.’’∂≠
Heiser and most of his compatriots continued to find in the failures to
enforce smallpox vaccination, the recurrences of cholera, and a rising death
rate in the archipelago evidence of the unreadiness for office of the Filipinos
they had trained. American papers unsympathetic to the Democratic admin-
istration declared that ‘‘the full harvest of the ‘new era’ is now in the reaping
in the Philippines.’’ ‘‘The Filipinization wind,’’ warned the New York Herald,
had caused the incidence of plague to ‘‘jump’’ in the islands.∂∞ Even the in-
creasingly Filipinized health service conceded that in Manila the mortality
rate for each one thousand inhabitants—42.28 in 1903, at the end of the war,
but as low as 24.48 in 1913—had risen in 1918 to 46.33, and in 1919 was
27.55.∂≤ To Heiser this was a clear indictment of Filipino management. But
Dr. Vicente de Jesús, the acting director of public health, had another expla-
nation: the influenza pandemic in 1918 had exacted a heavy toll in lives and
caused a ‘‘weakened organic resistance’’ to other diseases among the popula-
tion.∂≥ New outbreaks of smallpox were the result of a wearing off of the
immunity conferred in the general vaccination of 1905, the only truly thor-
ough campaign the Americans ever carried out in the islands. Cholera had
appeared again, as it usually did, for the archipelago had never been free of

public health and filipino ‘‘mimicry’’ 189

the disease. De Jesús was confident that 1920 would show some improvement
in the Philippine death rate. Using the now-standard sanitary methods, chol-
era had been checked and smallpox was again under control. ‘‘Health condi-
tions are returning to normal,’’ he reported, ‘‘and with the increasing effi-
ciency of this Service on the one hand, and on the other, with the population
becoming better enlightened regarding hygiene and sanitation and readier
therefore to respond to and cooperate with our efforts, the steady decrease in
the death rate observed during the pre-grippal years will no doubt be recorded
again.’’∂∂
A few pro-Filipino American bureaucrats also defended the Filipinization
of the health service. General Frank McIntyre, chief of the Bureau of Insular
Affairs, noted that ‘‘unfortunately, cholera has visited the Philippine Islands
every year since 1902.’’ To charges of increased friction at the Philippine
General Hospital, he replied that Heiser’s earlier policies had probably caused
the trouble, and currently care was as effective as ever, with no shortage of
clinical material.∂∑ All things considered, ‘‘the great public health work in the
Philippines is going on and it is being extended as rapidly as the resources of
the government will permit.’’∂∏ Winfred T. Denison, the secretary of the inte-
rior, felt that the ‘‘venom’’ with which Heiser and Worcester ‘‘discussed the
‘fitness’ of the Filipinos, both here and at home, has been a dreadful misfor-
tune to everyone concerned.’’∂π In 1914, Denison wrote to Teddy Roosevelt
explaining that ‘‘what aroused my indignation was an apparent desire of the
American colony to ride roughshod over the Filipinos in a tyrannical spirit,
made unusually intense by racial difference.’’ In fact, he continued, cholera
had broken out when Heiser was still on duty, and unusual flooding had
disseminated it: Colonel Edward L. Munson, m.d., later brought it under
control, in cooperation with Filipino doctors. The health department had
isolated cholera carriers for ten days in San Lazaro hospital—‘‘you can imag-
ine what a storm such a policy would arouse in New York City, and you
undoubtedly remember the difficulties of Typhoid Mary’s case.’’∂∫ After hear-
ing that Richard P. Strong was telling people in Boston that the health service
had been ‘‘wrecked,’’ Denison wrote to David P. Barrows at the University of
California to let him know that ‘‘the service is intact, and I believe in better
shape than it ever has been, and it has also been put on the basis of better
understanding with the legislature and Filipino physicians. They have been
backing up sanitation in a very satisfactory way.’’∂Ω
Following the election of Warren Harding as president in 1920, Harrison
was recalled, in 1921. The new U.S. administration appointed Forbes and

190 public health and filipino ‘‘mimicry’’

General Leonard Wood, m.d., both of them professed foes of rapid Filipiniza-
tion, to report on conditions in the archipelago. Not surprisingly, they con-
cluded that ‘‘the orderly process of promotion of proved efficiency from the
less important positions was changed to a hurried Filipinization, placing Fili-
pinos in nearly all of the higher positions.’’ The report condemned the lack of
hospitals and dispensaries, inadequate appropriation for sanitary work, and a
shortage of properly trained doctors, nurses, and sanitary workers. It added
that the ‘‘excellent health service which previously existed has become largely
inert; much of the personnel remained, but it has lost the zeal and vigor which
formerly characterized it.’’∑≠
Heiser liked to think that the ‘‘Harrison bonfire which had blazed so
merrily for many years and round which the Filipinos had danced so blithely,
finally flickered and went out, leaving only dead ashes.’’ Having attached
himself to the Wood–Forbes mission, Heiser took pleasure in visiting the
islands again, once more ‘‘in harness at the old job of hauling the Filipinos out
of the slough.’’ He felt warmly welcomed in Manila by his ‘‘prize cholera
fighter,’’ De Jesús, who ‘‘seemed overjoyed at my return to share his respon-
sibilities.’’ ‘‘He had already had a desk placed beside his,’’ Heiser recalled,
‘‘and offered to retire temporarily while I was there. I was never more touched
than by this demonstration of trust.’’∑∞ But despite the Wood–Forbes mis-
sion’s criticisms of Filipinization and Heiser’s immense capacity to patronize
local colleagues, the process continued even after General Wood was ap-
pointed as governor-general. By 1925, only 1.5 percent of the civil service (not
including teachers) was American.∑≤ It was about this time Heiser began
organizing the Rockefeller hookworm campaign in the Philippines, a scheme
that would become a means of recolonizing health work in the archipelago, of
reintroducing American discipline and American role models. For Heiser and
many other American bureaucrats there was only one right way to manage
the colony and only one way to inhabit it with propriety; Filipinos necessarily
were unfaithful or inadequate imitators of this model.
Rizal and others among the first generation of ilustrados had linked sci-
ence and medicine to militant nationalism: for them, to be scientific repre-
sented an authentic affiliation with modernity, and it indicated the capacity
for independence of mind and therefore of polity. But the following genera-
tion, which included De Jesús and the Calderón brothers, had largely un-
coupled science and militancy: they were more likely to regard themselves as
bureaucratic functionaries, efficiently managing the colonial state. Science
was a matter of state and rarely excited thoughts of the nation any longer. For

public health and filipino ‘‘mimicry’’ 191

figure 42. Class in biology, Manila. Courtesy of the Rockefeller Archive Center.

Rizal, medicine had radical political implications; for De Jesús, it meant hy-
giene reform of the masses.∑≥ But even though medicine came to be shorn
of nationalist significance, Filipino public health officials resisted imagining
themselves as mere mimics of Americans. Rather, they believed they could
normalize state medicine in the Philippines in a way foreign colonizers could
never achieve. In a sense, they had identified American colonial public health
officers, not themselves, as the profane copy. They wanted to administer
mundane state medicine, not colonial medicine; they wanted to be ordinary
scientific professionals, not scientific radicals.
Many Filipino medical bureaucrats thus resisted following U.S. prescrip-
tions, but without drawing radical nationalist lessons from this refusal. It was
still the opinion of many Americans, including Heiser, that Filipinos could not
yet evade fully their unhygienic racial habits: thus any Filipino, until proved
otherwise, would remain a contributor to tropical pathology. Educating out
such ingrained habits would, it seemed, take generations; in the meantime
only the strictest regulation would control them. But this made little sense to
De Jesús and other members of the Filipino elite. For them, disease stigma
more properly belonged not to race but to social class. Thus while Heiser
continued to look askance at Filipino customs and habits, De Jesús argued for
the ‘‘unsanitary habits of the masses as the largest factor in the transmission of

192 public health and filipino ‘‘mimicry’’

cholera and other intestinal diseases, such as eating with the fingers, care-
lessness in the disposal of excreta.’’ The bad behavior was the same, the
ideal techniques of surveillance, persuasion, and enforcement altered little,
but a simple racial understanding of tropical disease transmission dropped
out of most Filipino epidemiological theory. It had become ‘‘the masses,’’ not
the race, ‘‘as yet untouched by either example or precept.’’∑∂ When Dr. Eu-
genio Hernando rehearsed the dogma of the ‘‘new public health’’ in 1919, the
racial concerns that had pervaded earlier tropical accounts of the subject
were absent: he confined his remarks to the individual (of any race) and
contact with infective discharges.∑∑ Thus if cholera continued to be spread in
the provinces, it seemed to the urban Filipino elite that this was because ‘‘the
poorer classes’’—and not their educated compatriots—continued to drink
water contaminated by others of their low social stratum.∑∏ When infant
mortality was finally recognized as a problem in the 1920s, Fernando Cal-
derón blamed it on the superstitious and faulty maternity practices of the
lower classes.∑π
The natural resistance to hygiene reform that Heiser took to be racial and
illicit was, for many Filipino physicians, at once social and comprehensible.
De Jesús, for example, repeatedly urged that the sanitary code ‘‘be given a
certain flexibility, so that the application of certain regulations would be left
to the discretion and sound sense of the district health officer.’’∑∫ But sanitary
regulations might, on other occasions, still be enforced severely. In 1914, De
Jesús had thought that the only effective way to eradicate cholera in the
provinces was ‘‘through a trained central force sent from Manila and operat-
ing under direct supervision of the Bureau of Health in cooperation with the
Constabulary.’’∑Ω But if an apparent sanitary crisis could still elicit a military
style of prevention, Filipino medical officers were more commonly claiming
an increased sensitivity to local social values. A senior health official in 1929
observed that the conquest of disease ‘‘is so closely bound up with the eco-
nomic condition and personal habits of the people that improvement must
necessarily come gradually with sympathetic guidance and education.’’ He
incensed the great interventionist Heiser when he continued, ‘‘Few things
arouse greater resistance and antipathy than efforts to enforce changes in the
daily lives of people and the conditions that surround them, and it is but
natural that they should resist measures which, so far as they can see, are
devised solely to make them unhappy and uncomfortable.’’∏≠ Such remarks
prompted Heiser to reflect yet again on what poor imitators the Filipino
physicians had proven to be.

public health and filipino ‘‘mimicry’’ 193

the germ of laziness
Under the American civil regime, the biological laboratory of the Bureau of
Science assiduously examined specimens taken from the new tropical terri-
tory and from the bodies that inhabited it. Each day, scientists assayed more
than 100 samples of body fluids and excretions, mapping the pathological
terrain of the archipelago, identifying the racial salients of disease. In 1909
alone, the scientists examined 701 specimens of blood, over 900 urine speci-
mens, and more than 7,000 fecal specimens.∏∞ When the influx of Filipino
material had indicated a widespread, and often asymptomatic, pathogen car-
riage, the scientists attributed this condition to inherently racial ‘‘customs and
habits,’’ not to social disadvantage. The search for occult germ carriage be-
came an obsession of the biological laboratory. It prompted C. L. Cole in
1907 to survey the ‘‘natives of the Philippine Islands’’ for the presence of the
hookworm, Necator americanus; P. E. Garrison organized a more orderly
study of the ‘‘animal parasites of man’’; J. M. Phalen and H. J. Nichols re-
ported on the distribution of Filaria nocturna among the local inhabitants;
R. E. Hoyt presented the results of 300 examinations of feces ‘‘with reference
to the presence of amoebae’’; Garrison and Llamas described the intestinal
worms of 385 Filipino women and children in Manila; and E. R. Stitt studied
the intestinal parasites of Cavite province.∏≤ At Heiser’s request, Dr. David
Willets went to the Cagayan valley, where he made nearly 7,700 fecal exam-
inations.∏≥ But even as many of these studies demonstrated widespread hook-
worm carriage in the archipelago, Heiser, while director of health, would do
little to prevent it.
American doctors in Puerto Rico were treating hookworm infestation far
more seriously. A year or so after the American occupation of the island,
Dr. Bailey K. Ashford had identified hookworm as the cause of the anemia
that prevailed there. Ashford knew of the work of Charles Wardell Stiles, who
claimed he had found hookworm in the stools of poor whites in the southern
United States in the 1890s.∏∂ The pattern of behavior of this novel pathogen
was soon established. Entering humans through the skin, usually through
bare feet, the parasite eventually reaches the intestines by way of the trachea,
esophagus, and stomach. Once in the duodenum, worms fix themselves to the
intestinal walls and feed from the bloodstream, in time causing a marked
anemia. Blood loss might produce the symptoms of pallor, tiredness, and
fatigue—thus hookworm became popularly ‘‘the germ of laziness.’’ The in-
fected person, unknowingly, excretes thousands of ova each day, and if depos-

194 public health and filipino ‘‘mimicry’’

ited on warm, moist soil, the eggs generate infective larvae that seek another
host. While Stiles thought he had found Anchylostoma duodenale in the
southern United States, Ashford’s worm was a new type, later called Neca-
tor americanus. Returning to Puerto Rico in 1902, Ashford, together with
Dr. W. W. King, set aside two wards of the Ponce hospital for hookworm
patients; the following year, the governor, William H. Hunt, allocated five
thousand dollars for hookworm prevention and treatment (an unpleasant,
nauseating thymol mixture). ‘‘An intelligent combination of educational and
prohibitory measures,’’ the program expanded further in 1904, resulting in
the establishment of the Hookworm Commission of Puerto Rico, which used
mobile field hospitals and clinics to distribute information and provide treat-
ment.∏∑ When Ashford returned to the United States in 1906, the commission
continued its work, led by Puerto Rican physicians, and by 1910 more than
250,000 people had been treated in an effort to eliminate the germ that was
sapping their industry and efficiency.∏∏
In the United States, Stiles had been talking to Frederick T. Gates, the
advisor of John D. Rockefeller, about the frightening prevalence of the germ
of laziness in southern regions. Rockefeller, eager to promote health and
industry, decided in 1909 to fund a Sanitary Commission for the Eradication
of Hookworm Disease, appointing Stiles as scientific secretary and Wickliffe
Rose as administrative secretary. Hearing of Ashford’s work in Puerto Rico,
Rose visited the colony in 1910, hoping to use the hookworm commission as
a model for health work in the southern United States. He was impressed with
the Puerto Rican program, which combined educational and dispensary ac-
tivities. During the next few years, the Rockefeller Commission set up similar
organizations in each southern state. Led by a director of sanitation, who
reported to the state board of health and to the commission, a corps of
inspectors, microscopists, and laboratory technicians engaged in educational
campaigns, diagnostic investigations, and the dispensing of thymol. Working
mostly through newspapers, fairs, and the public schools, they produced
articles, pamphlets, cartoons, and circulars and delivered stirring lectures.
They traveled from town to town, putting up exhibits of the hookworm,
displaying models of sanitary houses and latrines, and exhorting the public to
avoid the germ of laziness—it was a form of hygienic evangelism that often
echoed the tent revival meetings.∏π The local sanitary officers tended to racial-
ize the message, though their more extreme opinions rarely received endorse-
ment from the commission. Dr. Charles T. Nesbitt, for example, pointed to
the African origin of the parasite and suggested a likely affinity between it and

public health and filipino ‘‘mimicry’’ 195

African-Americans: ‘‘The hookworms, so common in Africa, which are car-
ried in the American Negroes’ intestines with relatively slight discomfort,
were almost entirely responsible for the terrible plight of the southern white.
It is impossible to estimate the damage that has been done to the white
peoples of the South by the diseases brought by this alien race.’’∏∫ Nesbitt
interpreted such racial susceptibilities as evidence of the need to separate
vulnerable, valuable whites from the bowels of African-Americans. Stiles, in
contrast, suggested that this ecological détente meant that ‘‘the white man
owes it to his own race that he lend a helping hand to improve the sanitary
surroundings of the Negro.’’∏Ω
Although the campaign followed, in broad outline, earlier work in Puerto
Rico, significant deviations soon became evident, especially in its relations
with southern whites. The promoters of the ‘‘gospel of hygiene’’ in the United
States took special care to enroll local medical doctors and to appoint sanitary
officers who already claimed the respect of their white communities. Such
sensitivity to local concerns had been rare in the colonial setting when Ameri-
can officers were program managers. Moreover, Rose and others in the South
chose to emphasize dispensary work more than sanitary reform: they recog-
nized the need for behavioral reform and a privy construction program but
conceded that social changes among white citizens would have to be vol-
untary, not compulsory, as in the colony. The sanitation and treatment of
African-Americans, however, were frequently forced and blatantly colonial
in style.
By 1914, Gates was satisfied that the sanitary commission had alerted
white southerners to the microbial peril. As the hookworm campaign stimu-
lated the growth of a network of state and local public health agencies, his
attention shifted to global health work. The new International Health Com-
mission (later Board) of the Rockefeller Foundation needed a means of entry
into the colonial tropics, and hookworm seemed to offer ready access, just as
it had in the southern United States. The hookworm campaign might prove to
be a tool permitting ingress to a colony, or a new state, and a means of
enabling the Rockefeller Foundation to build, or rebuild, a broader health
program. Rose soon became the head of an international hookworm pro-
gram, setting up campaigns first in Egypt and then northern Australia, both
modeled on the sanitary commission’s work in the United States. When pass-
ing through Manila in 1914, Rose recruited Victor Heiser, the disaffected
director of health, and made him director for the East of the International
Health Board. Rose reported that Heiser’s ‘‘demonstration that the super-

196 public health and filipino ‘‘mimicry’’

figure 43. ‘‘An old Spanish type of toilet.’’ Courtesy of the Rockefeller Archive Center.

stitious and fixed customs of Asiatic natives can be transformed’’ was ‘‘one of
the very best things he accomplished.’’π≠ Heiser, who had paid little attention
to hookworm until then, would soon demonstrate that he could also become
an indefatigable warrior in the sanitary battle against the germ of oriental
laziness.
When Heiser’s successor, Dr. J. D. Long, compiled the annual report of the
Philippine Health Service for 1915, he scarcely mentioned hookworm, but he
did include a lengthy consideration of persistent ‘‘soil pollution’’ in the archi-
pelago. While climate and terrain had been exonerated as causes of ill health in
the tropics, as elsewhere, it seemed native customs and habits might yet pol-
lute and render dangerous the otherwise salubrious soil. As noted in chapter 4,
Health officers feared that Filipino ‘‘promiscuous defecation’’ would spread
the germs of typhoid and cholera—hookworm no doubt figured in their
concerns, but they rarely focused on it. Attempts to install a pail system of
toilets in the Philippines had failed, since it was difficult to ‘‘secure personnel
for the repulsive work of collecting, dumping, and cleaning the pails, and any
part of the system from the pail closet to the pit where final disposal is made,
may easily become a nuisance if there is the slightest relaxation of sanitary
precautions or lack of intelligent supervision.’’π∞ The sophisticated privies
favored by the Rockefeller Sanitary Commission in the United States would be

public health and filipino ‘‘mimicry’’ 197

far too expensive for an impoverished colony. Health authorities in the Philip-
pines had initially resorted to a simple pit in which body wastes were depos-
ited and covered with earth or lime, but this rapidly became a breeding place
for flies. The new Antipolo closet was cheap and more effective, though Long
feared the typical Filipino excretory system would soon overload it, and he
warned against its use in public buildings. The director of health believed that
the providing of better toilets would eventually be ‘‘far reaching beyond cal-
culation in the education of the rising generation, who will continue the
sanitary habits inculcated during their period of school life. . . . When this has
come about, the nightmare of waterborne epidemics and the economic ineffi-
ciency due to intestinal parasites will have disappeared.’’π≤
Soon after leaving office in the Philippines, Heiser announced that ‘‘effort
should be continued to control intestinal parasites, to extend malaria control
work as rapidly as the field studies warrant, to encourage the use of latrines,
and other campaigns to make friends for the health department.’’π≥ Under
his direction, the Philippines activities of the International Health Board,
through to the early 1930s, would concentrate on medical and nursing educa-
tion, hookworm eradication, and malaria control. Heiser thought these proj-
ects would prove the most effective means to ‘‘promote self-help and pros-
perity in a needy, (I must admit it!) exasperating, and hitherto irreconcilable
people.’’π∂ In 1922, the foundation loaned Dr. William S. Carter to the medi-
cal school at the University of the Philippines, where he acerbically evaluated
and supervised the training of Filipino doctors. Later that year, the first field
experiments in malaria control began, initially managed by W. D. Tiedeman
and then by J. J. Mieldazis and Paul F. Russell. They would develop a malaria
program that involved surveys, field research, control demonstrations, and
the training of medical and subordinate personnel.π∑
In particular, the Rockefeller Foundation thought it could do better at
toilet training refractory Filipinos than the increasingly Filipinized health ser-
vice, with its ‘‘imitative’’ Filipino doctors—allegedly less fastidious and vigi-
lant than Americans—who now were largely in charge of the civilizing mis-
sion. A hookworm survey conducted in 1922 indicated that infection had
increased during the previous ten years; Filipinos apparently were still pol-
luting the soil and avoiding latrines, especially in rural areas. Heiser la-
mented,‘‘The habits of the people are such that the control of intestinal borne
diseases is extremely difficult.’’π∏ When Dr. Charles N. Leach visited Cebú in
1923, on behalf of the International Health Board, he reported that almost
80 percent of the inhabitants harbored hookworm; and yet, during the past

198 public health and filipino ‘‘mimicry’’

few years, twenty-six thousand people had received treatment with carbon
tetrachloride, an effective vermifuge, though sometimes toxic to the liver.ππ
Leach advocated the ‘‘frequent instruction of school children residing in in-
fected areas regarding the dangers of soil pollution and the methods by which
hookworm disease can be avoided.’’ He hoped, too, for more mass treatment
with carbon tetrachloride.π∫
Traveling through the southern islands in 1922, Munson, the aging mili-
tary hygienist, reported that ‘‘some of the sanitary inspectors are unques-
tionably inert and incompetent.’’ They were permitting widespread soil pollu-
tion and did little to encourage latrine construction.πΩ Heiser also thought the
problem was not a lack of money, but the failure of Filipinos to offer ‘‘intel-
ligent and forceful direction.’’ There were too many councils, committees,
and advisors and not enough American know-how and efficiency.∫≠ It seemed
to Heiser that the Rockefeller Foundation might make available a better
model of health work, just as his old health service had once served as an
exemplar of proper conduct. At the medical school, Carter was finding it
‘‘discouraging to try to do something for people who will not do anything for
themselves, and I am free to say that the inertia of these people passeth all
understanding.’’∫∞ He regretted that ‘‘these people are so blinded by their
mistaken ideas of patriotism that they cannot see things in the light of effi-
ciency.’’∫≤ That the Filipino was a mere perfunctory imitator of American
medical ideals became a Rockefeller litany. Of course, this was exactly what
Heiser wanted to hear. In 1927, Dr. E. B. McKinlay, a representative of the
International Health Board, confirmed that ‘‘it is most difficult to stimulate
the native worker to do more than his daily routine work. . . . The scientific
tone is in general very low.’’ ‘‘All will agree that the mass of Filipinos represent
an inferior race,’’ he wrote to Heiser. ‘‘They are not in a position to know
what’s best for them.’’∫≥
It was not until the late 1920s that the Rockefeller Foundation began to
sponsor rural health demonstrations and sanitation studies in the islands. In
1928, Dr. C. F. Moriarty first suggested to Heiser the establishment of a
demonstration unit for rural sanitation in Cavite province, a poor, malarious
region accessible from Manila. A model system, it would make available
clean water, a sanitary excreta disposal system, antilarval methods of malaria
control, dispensaries, immunization programs, education, and propaganda.
‘‘The Filipino is not usually capable of independent judgment due to his
environment and relative lack of culture,’’ warned Moriarty. ‘‘He must have a
routine program and should be taught only one method for each task.’’∫∂ The

public health and filipino ‘‘mimicry’’ 199

 figure 44.
‘‘Build a bored-hole
latrine.’’ Courtesy
of the Rockefeller
Archive Center.

following year, the town of Calauan, in Laguna province, was chosen as the
site for the first demonstration unit, in part because it had a death rate of
sixty-four for every thousand people, compared with twenty-six to twenty-
eight per thousand in other rural areas. The pioneer primary health care
project would improve the water supplies, investigate the suitability of vari-
ous sanitary latrines, replace the sanitary inspectors with public health nurses,
develop the school health program, enforce immunization, and ensure better
mother and baby care. Heiser specifically instructed Yaeger to get rid of the
male Filipino sanitary inspectors and have the more pliant nurses conduct
‘‘repeated intensive house-to-house public health education.’’∫∑ He hoped
that the Laguna unit would soon be ‘‘coming to grips by intimate personal
contact with health problems.’’∫∏ By the end of the year, Yaeger could report
that police were dealing with unsanitary nuisances and nurses were promot-
ing personal and domestic hygiene, giving ‘‘special emphasis to the impor-
tance of using latrines.’’ He was in charge of a special ‘‘boring squad’’ and was
delighted to point out that, thanks to the Rockefeller Foundation, ‘‘now
latrines are being built every day.’’∫π
Yaeger set up another demonstration unit at Navotas, in Rizal province, in
1931, where he concentrated again on ousting feckless sanitary inspectors

200 public health and filipino ‘‘mimicry’’

and boring holes for latrines. A few years earlier, when Yaeger had investi-
gated health work at Daet, he found that the local sanitary officers spent a lot
of time on ‘‘general inspection,’’ which meant ‘‘loafing if we judge by re-
sults.’’∫∫ Both he and Heiser wanted to remove them, but they met consider-
able opposition. ‘‘ ‘Replacement by nurses,’ ’’ he wrote to an insistent Heiser,
‘‘I suppose I would dream that if latrines didn’t interfere. I have had all kinds
of verbal promises and suave agreements, and even letters and resolutions on
the sanitary inspector problem, but excuses come in persistently.’’∫Ω Heiser
became more impatient and demanded some clear evidence of success. Yaeger
simply asserted that substituting public health nurses had already led to excel-
lent results. ‘‘This is as we expected,’’ Heiser replied. ‘‘Nurses are so much
better trained, have superior access to the family, and do not have to serve as
assistants to the doctors.’’Ω≠ But Paul Russell pointed out there was great
resentment of nurses ‘‘for enforcing the regulations regarding sanitary toilets’’
and ignoring local sensitivities.Ω∞ One of these nurses has described how she
went about her duties. Ignacia Limjuco promoted the importance of cleanli-
ness and correct eating; she warned against overcrowding and poor ventila-
tion; she was dedicated to the propagation of school hygiene and the ‘‘proper
disposal of excreta.’’ As a nurse she demanded assent to modern science, to
the knowledge that an individual was ‘‘an arsenal of germs’’ and that the
mouth was nothing more than ‘‘the gateway of infection.’’Ω≤ In 1933, though,
the provincial council stopped its part of the funding of nurses like Limjuco
and spent the savings on the carnival. ‘‘They evidently preferred carnival ex-
hibits,’’ lamented Yaeger, ‘‘to saving babies and other public health work.’’Ω≥
According to the Rockefeller emissaries, male Filipinos remained disobedient,
willful, and childlike, fond of entertainment, decoration, and political gam-
bits. They still did not know what was best for them.
‘‘Politics, personal opinions, the retrenchment policy of government,’’ ex-
plained Yaeger, ‘‘seemed to come up daily, and without any official power on
my part made the work seem almost hopeless.’’Ω∂ Indifference and opposition
meant he was far from his goal of one hundred thousand bored holes. At
times Yaeger was optimistic: ‘‘The spectacle of boring and particularly of
blasting is one which appeals strongly to the people. . . . This appeal to the
imagination is an important aid in attempting to persuade a community to
install a large number of latrines. There is nothing dramatic about the old pit
latrine.’’Ω∑ But more often he was disappointed. ‘‘In one instance,’’ he re-
ported, ‘‘too much insistence on latrine installation resulted in an anonymous
letter threatening the life of the district health officer.’’Ω∏ Just before it closed

public health and filipino ‘‘mimicry’’ 201

 figure 45. ‘‘Sanitary nurse.’’
Courtesy of the Rockefeller
Archive Center.

in 1934, Yaeger admitted that the Rizal health unit had been nothing but ‘‘a
little volcano.’’Ωπ
In 1930, Heiser had met with Dr. Jacobo Fajardo, the new director of
health in the Philippines, and tried to impress on him that ‘‘the ultimate
success of health work in the Philippines would depend upon the degree of
education of the masses and that the best hope there lies in a sound school
health program.’’Ω∫ The need for education and reform was a truism of pro-
gressive public health, and Filipinos were already well aware of its impor-
tance. A few years earlier, Dr. Agerico B. M. Sison had urged the state to teach
proper care of the body and fastidious behavior in the public schools. ‘‘The
masses need to be informed of the rudiments of hygiene and public health,’’ he
wrote. It was crucial that more effort be made to ‘‘inculcate the principles of
hygiene and sanitation in the more plastic minds of the school-children.’’ΩΩ As
Fajardo announced in the commencement address at the nursing school in
1931, ‘‘Many of our major health problems now, such as infant mortality,
tuberculosis and respiratory diseases, can only be satisfactorily solved with
the aid of personal hygiene, which means an alteration in daily habits of the
individual, and such alteration can be accomplished by one means—educa-
tion.’’ Fajardo wanted each nurse to become ‘‘exemplary as a good citizen,

202 public health and filipino ‘‘mimicry’’

interested always in the best solution of public questions, social and health
problems, and in everything that pertains to the community.’’∞≠≠ But Filipino
doctors, nurses, teachers, and the subjects they were supposed to be molding
would find that the achievement of self-government, of corporeal and social
citizenship, was difficult to validate: for Americans like Heiser it was never
quite satisfactory, always immature, and poorly imitative.
As Americans registered the performance of hygienic citizenship as inade-
quate or partial or perfunctory, they took it to imply that continued sur-
veillance and discipline were required in the colony. For example, as Yaeger
observed, most of the teachers whose responsibility it was to educate children
about latrines themselves lived in houses without privies. ‘‘It is almost un-
believable,’’ he wrote to Heiser, ‘‘to think that the very teachers who are
following health education department instructions can keep talking latrines
to the students and not make an attempt to live in houses with latrines them-
selves.’’ The idea of privy-deficient teachers pretending to preach sanitation
disturbed and unsettled him. They did not seem to take the message seriously.
He could see no excuse ‘‘for a single teacher being allowed to teach without
having a latrine.’’∞≠∞ Toward the end of his stay in the archipelago, Yaeger
reported he was ‘‘very much disappointed in the results among the people
in general of public health education. Perhaps I expect too much.’’∞≠≤ The
Rockefeller health advisor did not believe most Filipinos were ready for self-
government, whether of the body or the polity. ‘‘Level-headed persons in
general,’’ he mused, ‘‘see only a gloomy future if the present provisions for
independence are not changed.’’∞≠≥ In 1933, after dinner in Manila, Heiser
too found himself ‘‘rather exhausted this evening after a full day of struggling
with the Malay mind.’’∞≠∂ As the archipelago moved toward independence in
1935, the Rockefeller Foundation decided to cut its losses and close down its
programs.
‘‘I was none too well impressed with the zeal or the manner in which our
activities were conducted,’’ Heiser reported in 1931 to Colonel F. F. Russell,
the director of the International Health Board. ‘‘I suppose the tropics have a
tendency to promote apathy.’’∞≠∑ Privately, Heiser noted that ‘‘our own work
lacked logical planning, initiative and punch. . . . [Paul] Russell was more
interested in traveling somewhere than thinking of practical malaria control.
Yaeger, while doing brilliant things in the mechanics of boring holes, lacked
perspective in spreading the work on an island-wide basis.’’∞≠∏ Yaeger had
never bothered to establish the baseline for the rural health programs, so it
was impossible to ascertain their effectiveness. Heiser criticized his junior

public health and filipino ‘‘mimicry’’ 203

figure 46. Hookworm dispensary, Las Piñas, Rizal. Courtesy of the Rockefeller
Archive Center.

colleague’s ‘‘inability properly to set forth his work on paper.’’∞≠π The Ameri-
cans had themselves been shown up as illogical and lacking in initiative and
perspective; Yaeger was demonstrating a childish fascination with boring
holes everywhere. Filipino imitations of American hygiene had drawn atten-
tion to the inadequacy of the American models—were perhaps the Rocke-
feller emissaries themselves mimics? After all, elite Filipinos were fond of
saying that the Americans were no more than flawed copies, crude imitators,
of Europeans.
Americans were anxious about revealing any affiliation with the practices
they regarded as typically Filipino. Paul Russell had frequently complained
that ‘‘local doctors will not get their feet muddy except in cases of urgent
personal necessity, as when being chased by beast or potent superior of-
ficer.’’∞≠∫ But his criticisms of others often turned on himself. Heiser remarked
wryly that ‘‘the itinerary of your southern trip includes many of the Islands’
best fishing places, at all of which there seems to be a dearth of malaria-
transmitting Anopheles.’’∞≠Ω Neither Yaeger nor Russell would leave anything
of value behind in the Philippines. Others fared much worse, breaking down
or ‘‘going native.’’ Moriarty, according to Heiser, ‘‘did nothing the first five or
six months except consume alcohol.’’ He refused to go out on field trips and

204 public health and filipino ‘‘mimicry’’

indicated he would like a job in India, where, it was suspected, ‘‘if no re-
sults followed the blame could be put on religion, caste, and superstition.’’∞∞≠
Heiser interviewed him in Manila. ‘‘After a long diatribe against Filipino inef-
ficiency and unreliability, and the impossibility of obtaining results,’’ Heiser
reported, ‘‘I asked [Moriarty] point blank how much his drinking habit had
interfered with his work.’’∞∞∞ Moriarty resigned on the spot. But eventually
Heiser too would suffer from his interactions with the poor Filipino imitators.
His disparaging of their political activities and ceaseless self-promotion drew
attention to his own intrigues and egotism. In 1934, F. F. Russell forced him to
resign, having tired of his irritability, his scheming, his resentment of rivals,
and his claims, as a cacique of tropical hygiene, to own the Orient.∞∞≤ Who,
then, was imitating whom? Who was not imitative?

uncanny hygiene
Nancy Tomes has argued that in the United States during this period ‘‘notions
of public health citizenship . . . offered a seemingly neutral ground for build-
ing consensus, for purposes of both inclusion and exclusion.’’∞∞≥ Heiser had
dreamed of fabricating such self-possessed hygienic citizens in the Philippines,
and he had promised that, in the indefinite future, needy natives would be
transformed into a respectable proletariat. But it was hardly a neutral ground,
and frequently it seemed to him that Filipinos were subverting his designs,
that they remained incomplete, unfinished; he was fond of representing local
inhabitants as unstable hybrids, dressed natives, childish imitators. No lon-
ger simply the polar opposites of bourgeois Americans in civic decorum,
Filipinos allegedly were becoming flawed or profane copies.∞∞∂ Repeatedly
Heiser imagined hybrid Filipinos seductively attesting to their unreadiness for
self-government. In order to reveal more clearly their poor mimesis of Ameri-
can hygiene, Heiser tried to create islands of good conduct and rigorous
discipline in the archipelago, supervised by American doctors. The health
demonstration units in Rizal province were utopian medical microcolonies
designed, like the Culion leper colony, to produce, in the distant future, citi-
zens who avoided promiscuous contact and forswore irresponsible habits. As
usual, Heiser expected, and indeed hoped, that American supervision and dis-
cipline would have to go on for generations before such a goal was achieved.
The medical marking of mimicry, the insistence on it as a sign of developmen-
tal delay, thus functioned still to limit boundary crossing in the Philippines
and worked to defer the entry of Filipinos into civic modernity. If Filipinos,
even Filipino doctors, were so obviously and so poorly imitative, then they

public health and filipino ‘‘mimicry’’ 205

had not yet developed a fully adult American subjectivity, and could not yet
be counted as authentic citizens.
‘‘Infantile mentality is that of the men who demand for their people their
immediate, complete and absolute independence!’’ The nationalist politician
Claro M. Recto was addressing the Philippine Senate in 1933. ‘‘Maturity of
judgment that of those who favor the law of colonialism! What thoughts are
these?’’∞∞∑ When Recto spoke to the graduating class of the University of the
Philippines, some thirty years after Tavera had offered a homily on the danger
of ignorantismo, he condemned his compatriots for ‘‘parroting the slogans
and mimicking the gestures of American foreign policy.’’∞∞∏ He also lamented
that ‘‘many of our countrymen have assiduously cultivated a servile mental-
ity.’’ But ‘‘those of us who pretend to be Americans risk only the ridicule and
laughter of their so-called brothers behind their backs.’’∞∞π
At the same time, a critical awareness of mimicry, of the uncanny sense of
the copy, could also challenge the boundaries of citizenship in the colony.
Supposedly mimetic performance might serve, at this deeper level, to reveal
the artificiality, the play, of conventional distinctions between native and
other, to illuminate and make strange the ‘‘cultured self’’ of colonized and
colonialist—in the case of the latter, to disturb a narcissistic overvaluation of
his own mental processes, to eat away at his sense of authenticity and control.
There were moments when the whole project of colonial hygiene and bodily
reform came to appear a little silly, and self-proclaimed models of fastidious
conduct realized that they looked foolish, inadequate, and self-deceiving.
Surrounded by perceived imitation, the constructedness of their own identity
was, on occasion, revealed to colonial officials and Rockefeller emissaries in
the Philippines. In imagining profane copies of themselves, they would expe-
rience an uncanny doubling. In 1919, Sigmund Freud had described the un-
canny as the secretly familiar that has been repressed and then returns in a
distorted form.∞∞∫ In particular, the figure of the Filipino imitator of hygiene
was revealing what ought to have remained hidden, that which Americans
had sought to overcome or repress in themselves: their own supposedly infan-
tile or primitive or underdeveloped elements, the abject that returns repeat-
edly to disturb identity.

206 public health and filipino ‘‘mimicry’’

Chapter Eight

malaria between race and ecology

A s early as the 1920s, ideas of racial difference were losing some of their

explanatory power in Philippine medical science. For most Filipino

physicians, hookworm had become a disease of poverty, not the manifesta-

tion of Filipinos’ innate incapacity for hygiene—not, therefore, a sign of

racial inferiority. Leprosy seemed ever more curable, and soon individual

lepers might assume their rights as citizens beyond the confines of Culion.

Self-government of body and polity was increasingly related to educational

and economic improvement. The latrine had joined the ballot box as a do-

mestic possibility. As the old racial impediments to progress began to dis-

solve, some medicos gained confidence in the capacity of Filipinos—even the

masses—to inhabit the archipelago with propriety. There was less reason

than ever to assert that the race would be permanently arrested somewhere on

the imagined trajectory from native to citizen. At the same time, white men-

tality could seem just as generic and mundanely conflicted as any other: tropi-

cal neurasthenia was dwindling into Freudian neurosis. Moreover, whites

were not the only people capable of elaborate brain-work; not all natives were

entirely slaves to their id. Of course, many experts were still resisting any

such decline in the valence of race. The changes in scientific reasoning were
gradual, at times scarcely perceptible. American discussions of hygiene, in
particular, still regularly invoked allegedly racial customs and habits and
biological limits to reform. But social, economic, and ecological explanations
of disease, and indeed of civilizational achievement, did nonetheless gain
some ground during the 1920s, and not only in the Philippines.
In the late 1920s, even Victor G. Heiser could on occasion be diverted from
the familiar comforts of racial prejudice. In conversations with Filipino physi-
cians, he too began occasionally to identify the masses, not the race, as the
focal point of hygiene education.∞ During the Depression, the old race warrior
told Theodore Roosevelt, Jr., then governor-general of the islands, that ‘‘lift-
ing the economic level . . . would probably do more for the health of the
Philippines than any other measure.’’≤ Improved nutrition would reduce beri-
beri directly and moderate the impact of other diseases. According to Heiser,
the International Health Board of the Rockefeller Foundation had avoided
efforts to involve the Philippines government in a tuberculosis campaign ‘‘on
account of its great cost and the probability of poor results so long as the
economic standards of the Islands are so low.’’≥ But more commonly, Heiser
still clung to theories that postulated inherent racial limits to Filipino ac-
complishment in hygiene. Social and economic explanations had begun to in-
filtrate his etiological reasoning and to contaminate his health advice, yet
they never entirely displaced the racial disparagement so commonplace in his
work. In his accounts of the civic status of lepers, the toilet habits of all
Filipinos, and the attainments of local physicians, race would keep reasserting
its prominence well into the 1930s.
The response to malaria—never a major interest of Heiser’s—perhaps
illustrates best the more general and gradual displacement of race and the
rising enthusiasm for ecological investigation and technical intervention. In
the early twentieth century, the racial factor had still dominated explanations
of malaria outbreaks: control of the disease was predicated on the identifica-
tion and treatment of native carriers of the causative plasmodium. Thus Ma-
jor Charles Woodruff, as we have seen, warned in 1903 that asymptomatic
Filipino soldiers were the main ‘‘source of fatal infection to white men’’ in the
Philippines, since the foreigners lacked their racial immunity.∂ Others pointed
to the dangers posed by apparently healthy Filipino children, most of them
loaded with malaria parasites. When Dr. Charles Craig investigated an out-
break of malaria at Fort William McKinley, he concluded that ‘‘the greatest
source of danger to the white man in a malarial locality lies in the native
population, especially in the native children.’’ Therefore, it would be futile

208 malaria between race and ecology

to attempt to ‘‘rid any locality of malaria so long as the native element
in the question is neglected.’’∑ If Camp Stotsenberg was always malarious,
it must have been because the local, apparently healthy inhabitants consti-
tuted a persistent reservoir of plasmodia upon which the Anopheles mosquito
might draw. But by the 1920s, the contribution of this ‘‘native element’’ had
virtually disappeared from the etiological calculus. Instead, malariologists,
mostly from the Rockefeller Foundation, were focusing on mosquito dis-
tribution and behavior and on the influence of agricultural development on
vector population and patterns. They were testing new larvicides, such as
Paris Green, and manipulating the environment in order to control, or even
eradicate, mosquitoes. Technological enthusiasm was displacing racialist an-
thropology as the chief determinant of what might be achieved. Dosing reluc-
tant races with quinine was not forgotten, but mosquito control usually came
to take priority.
Race was not so much deconstructed and abandoned as put aside in favor
of the exploration of local ecologies. The human factor, whether defined as
race, population, or community, had simply come to seem a less important
part of the malaria equation. This hardly represented an explicit critique of
the idea of race. Indeed, as we have seen in previous chapters, where hygiene
and human development were concerned race could remain very much in
play. Ecological and technical approaches thus came to supplement, not to
substitute for, racialist assumptions in international health and development
before World War II. Nowhere is this odd symbiosis more evident than in the
tensions between the Rockefeller Foundation’s efforts to control hookworm
racially and malaria ecologically in the colonial Philippines.

race or ecology?
The relative merits of quinine and vector control had been disputed since the
1890s. It had become clear by then that quinine, used as a general febrifuge
since the seventeenth century, was also a specific toxin for the malaria para-
sites, or plasmodia, which Alphonse Laveran identified in 1880. Patrick Man-
son soon suggested a role for mosquitoes in the transmission of plasmodia,
modeled on his mosquito-vector theory of filariasis, but he continued to be-
lieve that humans ingested the parasites only after mosquitoes deposited them
in water. In 1897, however, Ronald Ross reported from India that he had
found malaria parasites in the bellies of Anopheles, and the next year he
determined that the mosquitoes could transmit them directly to birds.∏ These
discoveries implied two key measures that might reduce the spread of ma-

malaria between race and ecology 209

laria: dosing of affected or vulnerable populations with quinine; and the
control or eradication of Anopheles. More of a naturalist than most physi-
cians, Ross advocated further investigation of the mode of life of mosquitoes,
which would inform efforts to destroy them.π But it took some time before
this ecological advice was heeded in the colonial Philippines: malaria control
in the archipelago initially tended to follow racial contours, tracing familiar
lines of human isolation and selective dosing with quinine.
Malaria was endemic in the Philippines, causing significant mortality and
much more widespread morbidity. On occasion, war, famine, or development
could whip it up into major epidemics: in 1903, after the Philippine-American
War, more than one hundred thousand people died of malaria—even in the
1930s, though, more than ten thousand were succumbing to the disease each
year.∫ The parasite was primarily vivax, though falciparum was well repre-
sented too. The mosquitoes that carried plasmodia evidently preferred the
foothills, where mountain streams emerge from the jungles, for there ma-
laria was most prevalent. Unlike many other mosquito vectors, they avoided
swamps and marshes, so drainage never made any impact on the disease’s
incidence. It seems unlikely that Manila, a low-lying metropolis, was ever
malarious, though it felt as though it should be, and there were always cases
in the city’s hospitals.
From the beginning of the occupation, the U.S. Army recommended mos-
quito netting for its soldiers and on rare occasions prophylactic quinine for
those stationed in especially malarious places. At the Lucena Barracks men
were court-martialed for not using their mosquito nets properly.Ω But the
mosquito bars proved difficult to set up in field tents, and in any case their
mesh was often too wide and their coverage inadequate. Weston Chamberlain
complained that on some mornings he caught as many as forty engorged
mosquitoes within these course, short nets.∞≠ Not surprisingly, then, attention
turned to the nearby meretriciously healthy native hosts of the malaria para-
site. In 1904, Major W. D Crosby, m.d., reported from Camp Stotsenberg,
‘‘There are a few cases of malaria, which will appear at this post which it is
apparently impracticable to prevent, and these are the cases in which the men
are infected in the native barrios in the evening. The barrios are situated on
running water and the malaria mosquitoes are very numerous, and these are
mostly infected mosquitoes, from the fact that most of the natives are full of
malaria.’’∞∞ Crosby’s accurate identification of the mosquito’s habitat was
prescient, but like his colleagues he believed that vector control was impracti-
cal. Instead, he recommended the separation of troops from infected Filipinos
and regular dosing of the whole barrio with quinine.

210 malaria between race and ecology

 When a new battalion arrived at Camp Stotsenberg in 1906, the soldiers,
like others before them, soon found their mosquito bars were ineffective; and
before long, more than 150 troops came down with malaria. The authorities
decided to move the men into hastily constructed bamboo quarters, but evi-
dently the new buildings ‘‘harbored mosquitoes and permitted them to breed
in bamboo joints.’’ As more men contracted the disease, the post commander
finally decided to issue prophylactic quinine, and within days the outbreak
was controlled.∞≤ At the same time, sanitary officers filled in or oiled stagnant
pools and covered or screened receptacles for drinking water. In order to
eliminate malaria from the camp, the investigating surgeon thought ‘‘the re-
moval of all native barrios existing within the reservation’’ would eventually
be necessary.∞≥ During this period, Craig, in a series of papers, established—
or rather, reconfirmed—the menace to the soldier of the native carrier of
malaria.∞∂ Around Camp Stotsenberg, for example, 50 percent of the Filipino
children and 60 percent of adults had latent malarial infection.∞∑ The army
would therefore continue to insist on mosquito netting in the barracks and a
cordon sanitaire around its bases; and when this policy failed, it demanded
the treatment or removal of any Filipinos in the vicinity of soldiers.
Unlike the army, the Bureau of Health initially expressed little concern at
the prevalence of malaria in the islands. In part, this complacency reflected the
relative rarity of clinical malaria in the capital; and in part it indicated the
gravity of the threat from other diseases, such as cholera, smallpox, leprosy,
and dysentery. Still, some perfunctory, and perhaps misdirected, efforts even-
tually were taken to reduce malaria transmission. In 1905 the bureau re-
ported extensive oiling of mosquito breeding places in Manila. It recom-
mended, too, that the fetid moat around Intramuros be filled to reduce the
chances of malaria infection—at the time it seemed a typical site for the
breeding of malarial mosquitoes.∞∏ Yet malaria was not transmitted in Ma-
nila. After 1906, the bureau decided instead to distribute free quinine to
Filipinos across the archipelago in the hope this would reduce the incidence of
the disease. More than two million doses of quinine were distributed during
1910 just in the provinces of Albay and Ambos Camarines. The schools
began a vigorous educational campaign, emphasizing the danger of mos-
quitoes and the need for netting at night. No one, though, was sure if these
projects had any impact on the death rate; few seemed to care. In general,
Heiser did not regard malaria as a disease of spectacular importance, or its
possible control as offering any enhancement of his reputation. He was more
concerned with leprosy.
Around 1910, a few of the health officers and scientists in the Philippines

malaria between race and ecology 211

began to investigate mosquito control more seriously. C. S. Ludlow gradually
elucidated the character of the Philippines Culicidae, differentiating the vari-
ous species, while others attempted to determine which of them transmitted
malaria. When outbreaks occurred, more emphasis now was placed on mos-
quito reduction than on quinine treatment or prophylaxis. At the Olongapo
naval base, one man in ten was unfit for service because of malaria during the
year 1910. The narrow mosquito nets gave imperfect protection. But once
breeding places were filled and cleared and quarters thoroughly screened, the
admission rate for malaria plummeted.∞π A year later, inspectors from the
Bureau of Health reported that San José, Mindoro, suffered a 40 percent
morbidity from malaria. Long known as ‘‘the white man’s grave,’’ Mindoro
had for three hundred years resisted the efforts of Europeans and Americans
to exploit its exceptionally fertile soil. The health officers proposed control
measures that mostly targeted mosquitoes, including drainage, clearing of
vegetation, screening of doors and windows, and oiling of stagnant water—
though quinine prophylaxis still had a place. Of all these measures, effective
screening was probably responsible for the subsequent (evanescent) dip in
malaria mortality.∞∫ A later investigating team did reassert the importance of
the ‘‘systematic treatment of all persons (compulsory if necessary) harboring
the malaria parasite’’ and the prevention of reinfection by ‘‘the importation of
malaria-free laborers and by restricting the intercourse between inhabitants
of the protected zone and infected persons in nearby territory.’’ But quaran-
tine and compulsory treatment seemed too difficult to organize. Instead, the
Mindoro plantation companies took up the more practical recommendations
for the reduction of anopheline mosquitoes, which the investigators had sug-
gested would finally break the chain between the infected and the ‘‘non-
immune’’ person.∞Ω
After 1912, the Bureau of Health conducted successive campaigns to re-
duce mosquito numbers in Manila, fining householders who allowed any
stagnant water to collect or any rank vegetation to grow. A bulletin from the
bureau, issued in 1913, urged all residents to destroy the breeding places of
mosquitoes: no water should be left standing for more than forty-eight hours
before it was drained or oiled. The bureau also recommended that houses be
fumigated regularly with sulfur, or else smudge fires might be lit to smoke out
the insects. But ‘‘since it is a difficult matter to eradicate mosquitoes entirely,’’
residents were still advised to consider taking prophylactic quinine. Above all,
anyone sick with malaria must always be kept under nets and screens, away
from any surviving mosquitoes.≤≠ That same year, the bureau proudly an-

212 malaria between race and ecology

nounced the arrival in the archipelago of mosquito-eating fish from Hono-
lulu.≤∞ By 1914, health authorities had come to the conclusion that ‘‘at best, of
course, quinine distribution can only be palliative and the problem resolves
itself into preventing the breeding of mosquitoes that carry malaria.’’≤≤
Also in 1914, E. L. Walker and M. A. Barber described experiments that
had determined the susceptibility of four Philippine Anopheles to malaria
infection. They found that the minimus-flavirostris subgroup (which they
called febrifer) was by far the most prone to midgut infections with plasmo-
dia.≤≥ This mosquito was abundant in the shaded brooks of Laguna, though it
also frequented irrigation ditches with overhanging banks. It liked to breed in
fresh, flowing water in ditches, brooks, and rivers and enjoyed resting at the
banks of streams and the edges of islets of grass. The investigators regarded as
futile, therefore, older efforts to combat the mosquitoes who favored stagnant
pools and rice fields: these were not the malarial culprits. Barber and his
colleagues recommended that ‘‘antimalarial measures should be based upon a
thorough anopheles and malaria survey, and those measures should be em-
ployed which will best meet the conditions. The best single measure is the
destruction of the larvae of malaria carriers, and in this work the breeding
places of the stream-breeder should receive first attention.’’≤∂ Even so, for the
following decade most medical officers did not heed this advice, preferring to
resort conventionally to the drainage of swamps, marshes, and still water in
order to reduce mosquito numbers—or, simply, to quinine.
The equivocation between mosquito control and quininization was hardly
unique to the Philippines. Most colonial health officers in the early twentieth
century were prepared to try many different measures to reduce malaria, but
they were often constrained by ecological ignorance or financial pressures.
Metropolitan theorists could afford to be more abstract and absolute, usually
demanding either mosquito control or quinine and segregation.≤∑ Robert
Koch, who led a German malaria expedition to East Africa and New Guinea
in 1898–99, had been the leading advocate of systematic mass prophylaxis
with quinine. He firmly believed that partially immune native children repre-
sented a reservoir of infection for nearby white men and urged colonial au-
thorities to dose them thoroughly with quinine. A trial at Stephansort, New
Guinea, in 1900 proved successful, although too expensive to become rou-
tine. British malariologists, often with Indian experience, continued to heed
Koch’s advice, in part because it resonated with long-standing racial assump-
tion, clinical interest, and enclavist practice. Thus J. W. W. Stephens, a lecturer
in tropical medicine at Liverpool, warned that malaria is a contagious disease.

malaria between race and ecology 213

Moreover, ‘‘the source of the contagion . . . lies in the fact that in the tropics
the native population, especially the child population, carries malarial para-
sites in its blood; that it does so often while presenting not the least outward
sign of sickness. It is this apparently healthy but actually highly infected
population which is the greatest source of malarial parasites, and hence of
danger to the European.’’ Stephens disputed the practicality and value of
mosquito control, urging instead the use of netting, limited quinine pro-
phylaxis, and segregation, especially the ‘‘removal of native bazaars with their
infected population from the vicinity of European barracks.’’≤∏
Ronald Ross, in contrast, was an untiring advocate of mosquito control
measures. He could cite the moderately successful experiment in Freetown,
Sierra Leone, in 1901 in which the number of mosquitoes diminished and
malaria incidence seemed to fall for a time. But he was dismayed when his
opponents pointed to the attempt, in 1902, to reduce mosquitoes at Mian
Mir, in India—the enterprise appeared to him halfhearted, and more mos-
quitoes soon displaced the few eliminated. ‘‘Work like this at Mian Mir only
tends to arrest enthusiasm in the cause without really adding anything definite
to our knowledge,’’ he claimed.≤π More than twenty-five years later he was
still lamenting that ‘‘it was probably the worst type of country for a test case.’’
According to Ross, ‘‘doctors to the right of me, doctors to the left of me,
laughed at the mere notion of reducing mosquitoes.’’≤∫ More inspiring was
Malcolm Watson’s somewhat quixotic attack on Malayan mosquitoes. In
1901, as government surgeon in Klang District, Selangor, Watson decided it
was unrealistic to expect feckless Chinese to take quinine regularly, so he
embarked upon a campaign of drainage and filling. It proved a ‘‘fortunate
choice’’ and soon rendered the adjacent town of Port Swettenham far less
malarious. A few years later, Watson associated his success with the more
celebrated efforts to eradicate mosquitoes from the Panama Canal Zone—
which were ‘‘without question the most brilliant achievement in Preventive
Medicine which the tropics, and for that matter the whole world, has seen.’’≤Ω
Ross, in reflecting on Watson’s work, also endorsed his view of the impor-
tance of Panama as an example. It suggested to him that colonial administra-
tion was changing: ‘‘We are passing away from the older period of incessant
wars and great military or civil dictatorships into one of more minute and
scientific administration.’’≥≠
Few medical officers in the Philippines would have followed closely the
debates over mosquito control and quininization; but they all knew about
William Gorgas’s campaign to eradicate mosquitoes from Panama.≥∞ As

214 malaria between race and ecology

chief sanitary officer of Havana, Cuba, at the end of Spanish-American War,
Major Gorgas had based his campaign against yellow fever on the recent
confirmation—by Walter Reed, James Carroll, and Jesse Lazear of the U.S.
Army and Aristides Agramonte—of Carlos Finlay’s theory that the mosquito
Culex fasciatis (later Aedes aegypti) was the transmitter of the disease.≥≤
Gorgas therefore put yellow fever patients in screened rooms, removed water
receptacles, and burned pyrethrum in the houses—soon Havana was free of
yellow jack and also far less malarious. In charge of sanitary work in the
Panama Canal Zone, Gorgas continued his fight against the mosquito. When
Ross visited Gorgas in 1904, he found a ‘‘spare, resolute man of the best
type,’’ a progressive sanitary officer committed to eliminating the vector of
malaria.≥≥ Gorgas insisted on draining marshes and swamps, cutting brush
and grass, oiling still water, spreading soluble larvicide, screening quarters,
and swatting adult mosquitoes. The measures proved effective, reducing ma-
laria and allowing the construction of a canal, though too expensive for
regular use. Here, nonetheless, was a model of successful disease control
through ecological intervention—decades later, Paul F. Russell recalled the
‘‘tremendous impression that Gorgas made by his sanitary victories in Ha-
vana and Panama.’’≥∂
While the British (apart from Ross and Watson) still tended to regard
malaria as a racial disease, Americans after 1910 were becoming more inter-
ested in its ecological character. No doubt the American tendency derived in
part from the shining example of Gorgas; but experience in the Philippines
was also confirming their predilection for technical intervention into the pat-
terns of life of the relevant mosquitoes. Of course, in practice, local health
officers would continue to try both quinine and vector control—and anything
else that seemed worthwhile at the time—in order to subdue malaria. There
were no methodological purists in the field. Still, as Lewis Hackett, from the
International Health Board, recollected, the British leaned toward mitigation
and Americans increasingly came to push for mosquito eradication.≥∑

rockefeller expertise
Like hookworm, malaria was a familiar disease in the southern parts of
the United States. Although its range and incidence had diminished during
the late nineteenth century, malaria still killed thousands of Americans each
year. From 1912, Henry R. Carter, who had served in Panama with Gorgas,
and R. H. von Ezdorf, both from the U.S. Public Health Service, began plan-
ning experiments in malaria control in the South. They established a malaria

malaria between race and ecology 215

headquarters at Mobile, Alabama, and organized pilot programs at Roanoke
Rapids, North Carolina, and Electric Mills, Mississippi, using the conven-
tional, pragmatic combination of drainage, screening, and quinine. By 1915,
Wickliffe Rose, the director of the International Health Commission of the
Rockefeller Foundation, was expressing interest in developing more rigorous
field trials of mosquito control and quininization in the South. Malaria, like
hookworm, appeared to offer the foundation a means of seeding state health
activity in the poorer parts of the country.≥∏
Rose emphasized the importance and practicality of prevention either ‘‘by
protecting people from being bitten by mosquitoes, or by destroying the
parasite in the blood of the human carrier.’’≥π In 1916, a field experiment
at Crossett, a low-lying lumber town in southern Arkansas, concentrated
on Anopheles reduction, through drainage of breeding places and removal
of undergrowth and vegetation. ‘‘A serious menace to health and working
efficiency,’’ malaria accounted for almost 60 percent of medical attendances
in the county. The first effect of the vector control measures was the virtual
elimination of mosquitoes as a pest; and within six months it was evident
that malaria incidence had declined by more than 70 percent. The Rocke-
feller Foundation reproduced this field trial in other Arkansas towns over
the following two years and found a similar alleviation of morbidity. Rose
concluded that ‘‘malaria control in such communities, considered merely as
a business proposition, pays.’’≥∫ It cost far less to reduce mosquito num-
bers than to pay doctors’ bills, which were just a small part of the total cost
of malaria. Outside the towns, however, mosquito control was less cost-
effective. Screening, along with occasional quinine, appeared more practical.
Rose reported on a field trial of screening at a group of cotton plantations
near Lake Village, Arkansas, a region with high malaria incidence. The cabins
on the plantations were ramshackle and difficult to protect against mos-
quitoes, but carpenters managed to cover most of the holes with galvanized
wire cloth. Within a year, the infection rate had dropped from 12 percent to 4
percent, at little cost to the plantation owner.≥Ω
Inevitably, the Rockefeller Foundation became entangled in the racial poli-
tics of malaria in the South. As in the Philippines, the idea of the typical
malaria carrier had racial intonations; like Filipinos, African-Americans came
to be represented as a biological type that favored plasmodial carriage. Many
physicians in the South were more interested in the elimination of human
carriers than in apparently expensive and perhaps futile mosquito control.∂≠
At the urging of Dr. C. C. Bass, a New Orleans physician, the Rockefeller
Foundation therefore began in 1916 a field trial of quininization in Bolivar

216 malaria between race and ecology

County and later in Sunflower County, Mississippi. A survey of thirty thou-
sand Bolivar residents revealed that malaria carriers were common: evidently
treatment of acute attacks with quinine or ‘‘chill tonics’’ had not sterilized the
blood of most victims. The project leaders ensured that carriers received
adequate quinine dosages for eight weeks to destroy the parasites. In Sun-
flower County, a patchwork of sluggish streams, bayous, and swamps, blacks
outnumbered whites by four to one, and the predominant industry was cot-
ton. Malaria was endemic, some 70 percent of all sickness disability on the
plantations being attributed to this disease alone. A Rockefeller survey in
1918 indicated that more than 40 percent of tenant farmers suffered from
clinical malaria within the previous twelve months, and a further 20 percent
carried plasmodia. All those who had contracted malaria or who carried the
disease parasite received eight weeks of supervised treatment. A marked de-
cline soon occurred in malaria cases, but the demonstration proved too ex-
pensive and difficult to sustain. The investigators despaired that blacks were
not intelligent enough to take medicine without instruction.∂∞ Rose, however,
maintained high hopes for further field investigations of various strategies of
malaria control in the South and perhaps in the Philippines.
When Heiser amplified Rockefeller Foundation involvement in the Phil-
ippines in the 1920s, after the installation of Leonard Wood as governor-
general, malaria control was among the programs he developed. The Philip-
pine experiments in mosquito suppression thus paralleled—and sometimes
anticipated—the more celebrated Rockefeller work in Italy. Heiser assigned
W. D. Tiedemann, a sanitary engineer, to malaria control in the Philippines in
1922, two years before the establishment of the Stazione Sperimentale per la
Lotta Antimalarica in Italy. By 1928, Rockefeller activities in the archipelago
were coalescing into the new School of Sanitation and Public Health in Ma-
nila, whereas the Italian Instituto di Sanità Pubblica did not open until 1934.
Darwin H. Stapleton has argued that the attempt to eradicate Anopheles from
Sardinia in the 1940s ‘‘became a source of standards by which eradication
efforts throughout the world were measured.’’∂≤ One of the leaders of the
Sardinian efforts was Paul F. Russell, who learned his skills in the Philippines
years earlier. The standards he enforced in the Mediterranean were hard-won
Philippine lessons. Heiser had made sure that the International Health Board
of the Rockefeller Foundation used the Philippines, his old stamping ground,
as a test bed for many of its international health projects, whether in racial
development (as in hookworm prevention) or ecological intervention (as in
malaria control).∂≥
On arriving in the archipelago, Tiedemann set about establishing a labora-

malaria between race and ecology 217

tory in Los Baños and conducting malaria and mosquito surveys in nearby
towns. The survey was always the initial technology of malaria control, just
as the census had been the first tool of the health service and intelligence the
necessary primary activity of an advancing army. In surveying the Del Car-
men section of Pampanga province, Tiedemann found plentiful Anopheles,
widespread malaria, and inadequate treatment facilities. Two freshwater spe-
cies, A. minimus and A. ludlowii, seemed the most dangerous vectors of the
malaria parasite. Tiedemann experimented with various methods of larval
destruction, including poisons, top minnows (Dermogenes), and cannibalis-
tic mosquito larvae (Lutzia fuscana)—but only the new Paris Green seemed
to have any effect.∂∂ He discounted the extensive use of quinine as a pro-
phylactic measure, since he believed it would require military discipline for it
to be taken regularly, and that now appeared unlikely.∂∑ Tiedemann’s suc-
cessor, J. J. Mieldazis, another sanitary engineer, also endorsed the use of
Paris Green in vector control. In 1924, Mieldazis and his staff of sixteen,
including a field director, a microscopist, inspectors, and sanitary engineers,
began to expand the malaria control demonstration in the Del Carmen area.
They collected Anopheles, studying the mosquitoes’ habitat and characteris-
tics, and confirmed the effectiveness of Paris Green. In surveys of Mindoro,
Bataan, Culion, and Laguna, Mieldazis found plenty of malaria, especially
along the rivers and streams favored by A. minimus.∂∏ ‘‘I am convinced,’’ he
wrote in 1928, ‘‘that control of malaria here means control of the A. minimus
breeding places only. We can now determine whether a community is malar-
ious simply by the presence of minimus.’’∂π
On the surface, it was a meritorious scheme: A. minimus larval control
with Paris Green and minor drainage, and, secondarily, carrier elimination
with targeted use of quinine or plasmodin. But when Heiser visited the con-
trol demonstrations in Pampanga, he privately expressed skepticism and frus-
tration: the projects seemed too costly, and their efficacy was not proven. ‘‘It
was,’’ he wrote, ‘‘difficult to judge the value of control work owing to the
constantly shifting population.’’∂∫ In particular, it proved impossible to de-
termine how many deaths there were from malaria, as few autopsies were
performed. Moreover, ‘‘the doctors do not care to do field work, and labor-
ers and inspectors become lax and control measures are not dependable.’’∂Ω
Laborers, struggling with the blower, were not fastidious in spraying Paris
Green, and probably fewer than 15 percent of those given quinine actually
took it.∑≠ While the incidence of the disease fell where larval control was
attempted, so too was it falling elsewhere without any intervention. In a

218 malaria between race and ecology

figure 47. Spraying Paris Green, 1926. Courtesy of the Rockefeller Archive Center.

statistical review of the project at the Rockefeller Foundation, Persis Putnam

declared that the reports from Mieldazis and C. F. Moriarty, his field director,
were ‘‘more unsatisfactory than any I have attempted to work with,’’ and she
condemned their ‘‘lack of system.’’ The accuracy of the figures was dubious,
and no one had provided an adequate control site.∑∞ In response, Heiser
weakly defended Mieldazis, arguing that he had accomplished ‘‘more impor-
tant work than the reports indicate.’’∑≤ But in 1929, when C. H. Yaeger
interrupted his latrine boring to act as a temporary replacement for Miel-
dazis, he complained that even after a thorough review of the data he could
not ‘‘draw any conclusions as to why malaria has increased or decreased in
any area.’’∑≥ Publicly, Yaeger put a positive veneer on the shambles: ‘‘Malaria
control work during the past couple of years has been done for the purpose of
demonstrating practical control measures, and not as a detailed scientific
study of the malaria problem. These early demonstrations led the way to
increased activity to control the disease throughout the Philippines.’’ In an
attempt to justify the lack of complete records and controls, he claimed that
‘‘the fact was that people were suffering from malaria and we wanted to give
them relief.’’∑∂
Cost was always a special concern for Heiser. Typically, he calculated that
if the malaria control measures came to encompass the archipelago it would

malaria between race and ecology 219

cost over seventeen cents per capita, when the total expenditure on health
work was currently twenty-seven cents per capita.∑∑ He later concluded there
was ‘‘a very general feeling that much money has now been spent . . . on
studies and so little accomplished in controlling the disease. The great out-
standing obstacle to control is its cost.’’∑∏ While the present expense of vector
control schemes appeared to rule out their broad application, Heiser believed
they might still prove useful in specific government projects, private haci-
endas, and commercial enterprises.
‘‘We are coming to the conclusion,’’ Heiser wrote in 1927 to Jacobo Fa-
jardo, the director of health, ‘‘that after the method of control has once been
thoroughly established it should be carried out by the regular health service
and not by a specially organized malaria squad.’’∑π Evidently, Heiser was
eager to off-load the malaria control project and to limit his staff in the
Philippines to occasional field surveys and the training of local physicians,
nurses, and inspectors. The Philippine Health Service, with Rockefeller sup-
port, obligingly established a new malaria control section, with Dr. C. Mana-
lang as director. It took over the troubled demonstration units and set up
others at Calauan, Laguna; San José, Mindoro; Zamboanga, Mindanao; and
Novaliches, Rizal. These units continued to concentrate on mosquito surveys
and spraying the habitat of A. minimus with Paris Green. But it was tedi-
ous, expensive, and unrewarding work. Manalang was never sure if a fall in
malaria incidence was the result of natural fluctuations, quinine, or Paris
Green. The rates normally increased again soon afterward anyhow.∑∫ The
U.S. Army was having more success with vector eradication. After thoroughly
applying Paris Green to Camp Stotsenberg—and after thirty years of futile
intervention—the number of malaria admissions to the hospital finally had
fallen dramatically, from four hundred each year to fewer than twenty.∑Ω

paul russell and the ecology of control

Paul Russell arrived in Manila late in 1929, with instructions to replace E. B.
McKinley as the Rockefeller Foundation’s ‘‘laboratory man’’ at the ailing
Bureau of Science and to find time to conduct experiments on malaria con-
trol. Heiser and other Rockefeller emissaries liked to deplore the decline in
scientific standards at the bureau since Filipinos came to dominate it. In
particular, during the Depression they worried that it was turning into a
merely practical institution, driven by industrial needs. Russell confirmed that
there was in the archipelago ‘‘no longer any government laboratory in which
pure research in theoretical science may be pursued.’’ The Bureau of Science

220 malaria between race and ecology

had degenerated into ‘‘a fourth-rate museum, a testing and measuring labora-
tory, an uninspired manufactory of germs and vaccines, and a place where
men will play at industrial research.’’∏≠ In contrast, he was supposed to repre-
sent the exemplary white American scientist. As Selskar M. Gunn, at the
Rockefeller Foundation, put it, ‘‘Through excessive Philipinization [sic] of the
staff and weak direction, it [the Bureau of Science] has deteriorated enor-
mously and its future as a research institute seems to me very dubious.’’∏∞
Only Americans like Russell, an ‘‘activator of research,’’ according to Heiser,
might salvage it.∏≤ Indeed, regardless of the obstacles, Russell soon began
investigations into the transmission of malaria among birds, the model Ross
had used thirty years before.
Russell initially sought to distance himself from the sloppy fieldwork of the
Rockefeller demonstration units, now under the authority of the Philippines
Health Service. ‘‘The records of past work,’’ he wrote to Heiser, ‘‘are a hope-
less mess from which it is practically impossible to ascertain anything at all.’’
Even though he felt sure that ‘‘the previous work here has had a very benefi-
cial and stimulating effect on malaria control,’’ it was not an effect that would
ever prove scientifically demonstrable.∏≥ Before long, though, Russell was
taking more interest in malaria control projects. He agreed with Governor
Roosevelt that ‘‘malaria control as an activity of the Health Service should
follow soil sanitation and anti-tuberculosis (including nutritional) endeavors.
But malaria control requires a great deal of attention, nevertheless.’’ Russell
soon recommended a new, more localized scheme, one with greater commu-
nity participation. To Paris Green he would add more effective treatment with
quinine, the use of netting, and educational efforts. ‘‘The present centralized
unit control system,’’ he told Heiser, ‘‘has proved to be a total failure.’’∏∂
Sending out a special control unit from the central government paralyzed
local initiative—‘‘or if by some miracle it does reduce the malaria there is a
prompt recurrence when the unit leaves a year or two later.’’ Instead, Russell
wanted to engage community leaders, not lazy, fee-obsessed Filipino medicos,
and develop a corps of ‘‘unimaginative laborers under lay supervision.’’ ‘‘I feel
strongly that control work must be locally desired and locally carried out,’’
the young malariologist concluded. ‘‘The work of a central malaria control
division should be advisory, experimental and instructive.’’∏∑
Despite his professed disdain for previous demonstration projects, Russell
soon embarked on his own control program. But the project at the Iwahig
Prison Colony, on Palawan, necessarily would lack the community involve-
ment he had earlier stipulated. Nonetheless, just as the nearby microcolony at

malaria between race and ecology 221

figure 48. Dr. Paul F. Russell and local personnel, Manila 1933. Courtesy of the
Rockefeller Archive Center.

Culion had proven to be an exemplary site for the ‘‘recovery’’ of lepers, so the
microcolony at Iwahig might demonstrate the technics of malaria control—
only without genuine local initiative and leadership. The great advantage of
Iwahig was that the prisoners did not move about much and were easily
controlled. The Spanish had settled there long ago, but intermittent fever
eventually caused them to abandon the site. After the prison colony was
established in 1904, it was never free of malaria, despite the health services’
regular efforts to control the disease with prophylactic quinine and drainage
works.∏∏ Russell had noticed Iwahig in 1933 while touring the southern is-
lands, fishing and collecting mosquitoes. Heiser urged him to try out his new
control scheme at the prison colony: ‘‘Unless malaria can be controlled at
Iwahig, where the personnel is under discipline, the prospects for doing it
elsewhere in the Philippines are not very encouraging.’’∏π Russell had access to
decades of medical records at Iwahig and a docile population to work on, so
he could make sure his demonstration project produced valid results. He
organized the prison authorities to spray Paris Green, dosed the inmates with
Atebrin, a new antimalaria drug, told them about the role of mosquitoes in
transmitting disease, introduced netting, and continued drainage operations.
By early 1935, when the project was abandoned, the incidence of malaria had
fallen greatly.∏∫

222 malaria between race and ecology

 At the time, Russell believed it was pointless to administer quinine outside
the disciplined conditions of an institution like Iwahig. ‘‘All available evi-
dence,’’ he wrote, ‘‘indicates that drug control of malaria is impossible from a
practical standpoint in the Philippines as elsewhere.’’∏Ω According to Russell,
‘‘The difficulties of getting a large group of civilians to take anti-malarial
drugs systematically are as insurmountable in these Islands as elsewhere.’’π≠
He disagreed with Manalang, who now favored quininization, believing the
masses would adhere to a drug regimen if it was explained to them; Paris
Green, in contrast, Manalang thought either ineffective or too costly.π∞ Rus-
sell, in response, argued that the demonstration projects had proven the value
of larval control—or ‘‘species sanitation,’’ as it was now called—and bitter
experience indicated that Filipinos could not be trusted with quinine. ‘‘There
is no evidence that without larval control malaria rates can be lowered much
below their present level in these Islands,’’ Russell concluded. ‘‘Control in
decades rather than years should be expected.’’ Moreover, in the tropics, ‘‘no
more permanence may be anticipated in malaria control than in road repairs
or water sterilization.’’π≤ In a dig at his Filipino colleagues in the health ser-
vice, Russell insisted that such long-term control must be carried out by
engineers and entomologists, ‘‘and not by physicians, who in the Eastern
Tropics, at least, show little aptitude for such work.’’ Echoing Heiser, the
Rockefeller emissary remarked, ‘‘The average physician, whether or not he is
called a health officer, dislikes to get his hands, his feet, or his white collar
muddy and he is rarely qualified for anti-mosquito supervision.’’π≥
When the International Health Division began to withdraw from the Phil-
ippines in 1934, Russell took the unexpended funds with him to Madras,
India, where he continued his experiments in malaria control. Initially, he
was dismayed that ‘‘dogma and superstition’’ prevailed in India even more
than in the Philippines. But he praised incipient efforts to eliminate mosquito
breeding places across the subcontinent. Although the ‘‘so-called ‘lesson’ of
Mian Mir’’ had delayed larval destruction in India, health authorities were
slowly coming to recognize its value. In contrast, the attempt to use quinine to
control malaria was an abject failure. Since 1933, at Memari in the Bengal
Presidency, a treatment experiment had struggled along. ‘‘As in all other
control-by-treatment experiments thus far recorded, so in Memari, such ad-
verse factors as the opposition of quacks and some physicians, expense and
practical difficulties of distribution, and the usual public aversion to repeated
dosage with any drug, however freely offered, have combined to curtail
sharply the results theoretically possible.’’ Instead, Russell planned to set up a

malaria between race and ecology 223

trial of mosquito control, using ‘‘naturalistic methods’’ adapted to the local
ecology, just as he had in the Philippines.π∂ At Kasangadu, in the Madras
Presidency, Russell and Fred W. Knipe began to spray with a pyrethrum
mixture in order to kill the adult vector species, which preferred houses and
outhouses for daytime rest. Human infection rates soon fell from 68 percent
to 24 percent, but it seemed that the cost, while modest, still was more than
most South Indian villages could sustain.π∑

new ‘‘dangerous races,’’ new wars

‘‘An outstanding need in the Tropics today,’’ Russell wrote in 1933, ‘‘is an
automatic or biological weapon, with which to attack malaria-carrying mos-
quitoes.’’π∏ Throughout his career, Russell would use towns, villages, and
rural areas as field laboratories in which to test such putative biological weap-
ons, whether Paris Green or, later, dichloro-diphenyl-trichloroethane (ddt).
He sought, above all, a technological fix, an intervention into the local micro-
bial ecology which visiting experts, like himself, might engineer and monitor.
Despite his claims, community participation was usually less salient in these
plans than technical skill and data security. In the multitude of mosquito-
control laboratories scattered across the tropics, Russell and his colleagues
from the emerging international health services would try to alter the intimate
relations of malaria parasite and vector, frequently discounting or even aban-
doning intervention into resistant local cultures.ππ Thus neglect of the ‘‘hu-
man factor’’ in malaria transmission perpetuated earlier disparagement of
native races: it was predicated on a deep pessimism about the capacity of
natives to behave responsibly or to follow instructions. Despite some dif-
ferences with Heiser, Russell shared his superior’s disdain for native com-
petence and trustworthiness. Heiser, however, persisted in perfunctory and
often showy efforts to reform supposedly inadequate and refractory race
cultures; Russell instead was more likely to circumvent them altogether, turn-
ing to ecological explanation, which decentered humans, and to techniques of
modern biological warfare, targeting insects.π∫ It was not until the develop-
ment of medical anthropology in the 1960s that a nonracialized method of
accounting for the human factor was added to the calculus of malaria control.
The war against mosquitoes therefore was distinct from the older pacifica-
tion and attraction strategies that Heiser and other hygienists had waged
since the later stages of the Philippine-American War. The new war did not
require the laying down of sedimentary strata of disciplinary institutions
across occupied territory; it did not demand the surveillance and reformation
of local customs and habits. Above all, it was not a technique of human

224 malaria between race and ecology

population management: it did not try to change people. Rather, the new
campaign drew on models of continental warfare, as experienced in World
War I, with their emphasis on the maintenance of fixed positions, acquisition
of territory, and defeat or extermination of enemy forces. The attraction and
assimilation of humans was less important than the killing of mosquitoes.
During the 1920s and 1930s, then, these more traditional military meta-
phors, strategies, and tactics came to supplement in international health work
those derived from combat with guerilla forces, from small wars doctrine.
Methods of hygiene administration and population management, or race
development, persisted, as we have seen, in hookworm campaigns, and in the
delivery of child and maternal health services. But the fight against mala-
ria, yellow fever, and dengue increasingly resembled a pitched battle against
mosquitoes.πΩ
Russell’s experiences in the Philippines and India could be duplicated else-
where. From 1924, L. W. Hackett had directed the Rockefeller Malaria Ex-
periment Station in Italy, where he too set up ‘‘practical experiments in pre-
vention.’’ It was not long before the ‘‘use of larvicides became the measure on
which most reliance was placed.’’ Malaria in Sardinia and Calabria was not
‘‘driven back’’ before 1926, when ‘‘the almost miraculous efficiency of Paris
Green . . . saved the day.’’ To the health officer, Hackett expounded, ‘‘the
malaria problem presents itself as a sort of nocturnal traffic in gametocytes
and sporozoites. . . . The physician seeks a drug to cure the disease, the health
officer a means to suppress transmission.’’∫≠ Elsewhere, Hackett observed
that the ‘‘presence of malaria had nothing to do with latitude or standard of
living, or any other social or physical character,’’ only with the density of the
‘‘dangerous races’’ of Anopheles.∫∞ Therefore, it was against these dangerous
races—insect, no longer human—that the war must now be fought. After the
introduction in the 1940s of ddt, an amazingly effective residual insecti-
cide and larvicide, Hackett and Russell realized they now possessed the ‘‘bio-
logical weapon’’ they were seeking. Along with Fred L. Soper, who had led
Rockefeller efforts to eradicate A. gambiae from Brazil, Hackett and Russell
initiated a trial of ddt in Sardinia after World War II. Although the mosquito
persisted in small numbers, malaria was eliminated from the island.∫≤ By the
1950s, afire with enthusiasm for their new technology, malariologists were
confidently forecasting the global eradication of the disease.∫≥ Russell, like
many other disease ecologists, then began to warn of the dangers of human
overpopulation and urge the regulation of reproduction in the tropics—thus
concern for the quality and quantity of native populations kept resurfacing.∫∂
In the new war on nature, the previously homogeneous tropical environ-

malaria between race and ecology 225

ment was disaggregated and reconnected in unconventional ways. Russell,
for example, could point to a hitherto unsuspected ecological affinity between
Assam and the Philippines, as both were places where minimus was the vector
of the malaria parasite. Sardinia had become comparable with Malaya, Mis-
sissippi with Kenya. Accordingly, general, abstract concepts such as climate
were fragmenting into a series of specific microenvironments, engendering
new distinctions and associations. ‘‘Local malaria problems,’’ Russell in-
sisted, ‘‘must be solved largely on the basis of local data. It is rarely safe to
assume that the variables in one area will behave in the same way as they do in
another area, however closely the two regions may seem to resemble each
other in topography and climate.’’∫∑ In these emerging, multiform networks
of correspondence and difference, generic classifications like ‘‘the tropics’’
became less meaningful than ever. ‘‘Everything about malaria,’’ Hackett cau-
tioned, ‘‘is so molded and altered by local conditions that it becomes a thou-
sand different diseases and epidemiological puzzles. Like chess, it is played
with a few pieces, but is capable of an infinite variety of solutions.’’∫∏ To
explain malaria, and many other so-called tropical diseases, the environment
had been reintroduced as a factor in the etiological equation, but it was now a
far more animated and piecemeal concept than the older notions of place and
milieu that had prevailed in medical geography.
In 1935, Richard P. Strong, by then professor of tropical medicine at
Harvard, observed that diseases like malaria, dengue, and yellow fever were
compelling fresh attention to local ecologies, to competing and commensal
populations of micro- and macroparasites. Multiple, particular environments
appeared more than ever to exert indirect influences on disease, furnishing
‘‘unsanitary conditions, and especially, the parasites which cause and the
insects which transmit infectious disease.’’∫π As F. Macfarlane Burnet argued
in 1940, ‘‘The necessity for the ecological outlook on disease is probably more
clearly evident in relation to . . . insect-borne diseases than elsewhere.’’ Medi-
cal geography in the early twentieth century had largely been subsumed into
the racial pathology that prevailed in the colonial Philippines; now notions of
race were themselves being partially displaced in favor of a more complex and
realistic ecology. ‘‘Native populations,’’ as Burnet put it, ‘‘remain the passive
objects of a vast ecological experiment,’’ an experiment that only visiting
experts could identify, monitor, and regulate.∫∫

226 malaria between race and ecology

conclusion

D uring the 1930s, under the direction first of Dr. Jacobo Fajardo and

then Dr. José Fabella, the Philippine Health Service concentrated

on social welfare, tuberculosis control, mental hygiene, maternal and infant

health, and the education of ‘‘the masses.’’ Spurred on by enthusiasm for

the doctrines of social medicine—which recognized socioeconomic causes of

disease—Filipino physicians departed from the straight path of racial hygiene

to which Dr. Victor G. Heiser had pointed and from the narrower ecological

route that Dr. Paul F. Russell was taking.∞ Theirs was predominantly a pro-

gram of state medicine or national hygiene, similar to those undertaken in

postcolonial settler societies such as the United States itself and Australia to

the south.≤ Gone was the simple, though mobile, dichotomy of white Ameri-

can and Filipino; instead, class structure joined finer, generally unspoken

internal gradations of ancestry and color to frame public health interven-

tion. Of course, many continuities also were evident: colonial methods and

practices had come to haunt national health services. The emphasis on per-

sonal and domestic hygiene persisted, along with an assumption that medical

facts determined civic potential. Civilized or hygienic behavior, control of

bodily functions, limits on social contact, all still indicated eligibility for
social citizenship—only now, being Filipino did not necessarily imply natural
faultiness or deficiency in these qualities. That depended much more on class
position, though disparagement of people in the hills and on the southern
islands lingered. With the election in 1935 of Manuel L. Quezon as the first
president of the Philippines Commonwealth, under U.S. sovereignty, this nor-
malization of state medicine gained pace in the archipelago. Expenditure on
public health more than doubled within a few years, and services extended
further into rural areas. It comes as no surprise that the new government
boasted that it had constructed more than one hundred thousand latrines: by
the 1930s, the privy was nowhere more firmly affixed to the nation.≥
After the Japanese invaded in January 1942, the health service, hospitals,
and medical schools initially maintained their activities. Claro M. Recto, that
staunch opponent of U.S. imperialism, became the commissioner of educa-
tion, health, and public welfare, while Dr. Eusebio D. Aguilar continued as
director of health, until he died at the hands of the Japanese in 1945. It was
not long, however, before the health services and other resources were har-
nessed to the needs of the invading forces. The commandeering of the means
of communication and transport gravely hindered centralized public health
work. Waste disposal was not strictly monitored, and latrine building was
abandoned. Tuberculosis, malaria, and dysentery became rife. The lepers at
Culion, quarantined and neglected, soon were starving, and hundreds died.
As food became scarce across the archipelago, many medical students, nurses,
and doctors drifted from the cities to the country to live off the land with their
relatives. Then, when Allied forces returned to the Philippines early in 1945,
fierce fighting destroyed many hospitals and other facilities. Under the com-
mand of General Douglas MacArthur, the U.S. Army restored public health
control across the archipelago, as it had more than forty years before under
the command of his father. Each division contained a Philippine Civil Affairs
Unit, directed by a civil affairs officer and a medical officer. The Civil Affairs
Units reestablished hospitals and health offices and brought Atebrin, peni-
cillin, pentothal sodium (an anesthetic), and blood substitutes to the ravaged
islands. Doctors and nurses moved back to the cities and resumed their work.
After the Philippines achieved formal independence in 1946, the U.S. Public
Health Service invested heavily in hospitals and rural health centers through-
out the archipelago, rebuilding much of the infrastructure lost in the war. But
the weakness, decentralization, and corruption of the postwar Philippine
state would always greatly hamper public health activities.∂ The prestige of
public health work plummeted, and few doctors chose to join the poorly

228 conclusion
supported bureaucracy—another example, perhaps, of the ‘‘normalization’’
of state medicine.
And yet, even in the United States, such normal, or national, public health
still could demonstrate colonial features and inspiration.∑ Urban health ser-
vices in America that targeted immigrants and minorities were, in part, legacies
of empire. Colonial influences had been symbolic and direct. After 1910, few
health departments in the United States could resist referring to American
sanitary achievements in Panama and aligning their own efforts with those of
Colonel William C. Gorgas, m.d., and other heroes of tropical medicine. As
late as 1918, the director of the Illinois Department of Public Health was re-
peating Hermann Biggs’s truism that ‘‘public health is purchasable,’’ a fact that
‘‘can be illustrated no better than in the construction of the Panama canal.’’∏
In the early twentieth century, the logic of some medical careers connected
American metropolitan health much more directly with colonial engage-
ments. Military surgeons in the Spanish-American War, once demobilized,
often found they had developed a taste for preventive medicine and applied
their energies and new skills to public health, rather than to the retail aspects
of the profession. A decade or so later, many colonial bureaucrats, repatriated
as the result of Filipinization, moved into senior positions in city and state
health departments. In 1912, the U.S. Public Health Service chose Dr. Rupert
Blue as surgeon general in preference to Heiser, but within a few years the
colonial reject had the satisfaction of refusing an offer to direct the New York
City Department of Public Health. Instead, his old friend Dr. Haven Emerson
set about reforming administrative procedures in New York, having to en-
dure Heiser’s insistent advice and reiteration of Philippine lessons.π Dr.
William E. Musgrave, the director of the Philippines General Hospital, fled to
San Francisco in 1917 after some disaffected nurses tried to poison him, and
he became a leading hospital administrator and professor of tropical medi-
cine at the University of California—he, too, constantly proffered advice
to local health authorities.∫ In the Milwaukee public health department
from 1913 to 1914, Dr. Louis Schapiro applied lessons from his time in
Bontoc to improve further the personal hygiene and vaccination rates of the
inhabitants of ‘‘the healthiest city.’’ But he longed for the tropics and soon left
Wisconsin for Costa Rica, where he directed the Rockefeller hookworm cam-
paigns.Ω Such examples of professional mobility could be multiplied further.
Many American public health officers during this period were pragmatic
cosmopolitans: they roamed the Pacific and the Western Hemisphere, trans-
lating and adapting models of modern preventive medicine, and with them

conclusion 229
the mixed predicates of race and class, their careers building an intricate
web, an informal and converging network, of colonial and national health
services.
The influence of the colonial Philippines on the new public health in the
United States varied considerably across the country: it might be negligible, as
in Chicago; filtered and mediated but still detectable, as in San Francisco; or
profound, as in Boston.∞≠ In general, the medical experience of empire served
to amplify or channel existing features of domestic public health work, to
reshape or extend structures and policies already in place, rather than intro-
ducing wholly new procedures and goals. In particular, colonial experience
tended to focus more attention on the fault lines of race and force recognition
of the need to intervene more vigorously to reform the personal and domestic
hygiene of those on the margins of society, to propel them into civic and
medical trajectories.
The career of Dr. Allan J. McLaughlin epitomizes the metropolitan reach
of the colonial bureaucrat. As deputy director of health in the Philippines,
McLaughlin had demonstrated the importance of cholera carriers in spread-
ing the disease and warned against promiscuous defecation by inferior races.
After his appointment as commissioner of health for Massachusetts in 1914,
this evangelist of personal hygiene ‘‘set the pace and direction for reorga-
nization’’ of the public health department.∞∞ Proving himself a ‘‘physician
skilled in sanitary science and experienced in public health administration,’’
McLaughlin recruited full-time district health officers, created a new divi-
sion of hygiene, and improved operational efficiency and transparency.∞≤ He
wanted the public health department to run like a ‘‘well-regulated business,’’
as it had, unimpeded, in the Philippines, and to ensure this he introduced
formal administrative procedures and organizational charts. His colonial ex-
periences had made him aware of the need for a ‘‘wider application of the
principles of personal hygiene by the individual citizen himself’’ and sensitive
to opportunities to carry sanitary instruction into the home, especially those
of immigrants and minorities.∞≥ McLaughlin appointed visiting nurses and
arranged for a physical and mental survey of every schoolchild in the state.
The hygiene division delivered health lectures, set up exhibitions, and pub-
lished educational pamphlets: its first, revealingly, was on mosquitoes and
malaria—the insect was a summer nuisance, but the disease was rare in New
England. By 1918, when he resigned to take up the position of an assistant
surgeon general of the U.S. Public Health Service, McLaughlin had more or
less adapted the Philippine Health Service to Massachusetts. To be sure, class

230 conclusion
mattered more than it had in the colony, and the main target of preventive
medicine was now the urban white child. But whether in Manila or Boston,
McLaughlin tried earnestly to convince all his charges, Filipino, American-
born, and immigrant, that ‘‘there is more romance in the achievements of
right living than in all the other episodes of glamorous lives.’’∞∂
Public health, military medicine, and industrial hygiene all could be, at
least in part, surrogates of colonial health services in the United States. De-
spite the efforts of Dr. Richard P. Strong and Dr. Andrew W. Sellards at
Harvard and Colonel Charles F. Craig, m.d., at Tulane, tropical medicine
itself did not flourish in North America.∞∑ The military legacy, of course, is not
surprising: as we have seen, the links between the army and colonial medicine
were lasting, intense, and multiform. Military medical officers readily tra-
versed the health services of empire and returned to army or navy posts. For
example, Craig and Weston P. Chamberlain became commandants of the
Army Medical School after their colonial rotation; Edward L. Munson alter-
nated instruction in military hygiene at the Army Service Schools in Fort
Leavenworth with advice to the Philippine government and ended his career
as commandant of the Medical Field Service School at Carlisle Barracks; P. C.
Fauntleroy taught hygiene at the Army Medical School; P. E. Garrison di-
rected the Naval Medical School. The training camp and the colony had come
to resemble each other; raw recruits and natives displayed a striking affinity,
even if they were credited with disparate capacities for discipline and im-
provement. Military hygiene had become a transferable skill and a widely
available mechanism of modern government.
The logic of the colonial medical officer’s career could also bridge fields
that now seem much more distinct and separate than military and colonial
medicine. Struggling to make a living in tropical medicine back in the United
States, some repatriated physicians instead contributed to the further de-
velopment of the new specialty of industrial hygiene. Munson had drawn
attention to military hygiene as a resource for managing the domestic work-
force, and many former colonial bureaucrats, once in the United States, rec-
ognized the sense of his precepts. Dr. John R. McDill, the first president of the
Philippine Islands Medical Association, became professor of surgery at the
Medical College of Wisconsin, but by the 1920s was advising the Federal
Board for Vocational Education in Washington, D.C. More strikingly, in
1938, the National Association of Manufacturers (n.a.m.) made Heiser its
consultant on ‘‘healthful working conditions.’’ After his forced retirement
from the International Health Division of the Rockefeller Foundation, Heiser

conclusion 231
had written An American Doctor’s Odyssey, which proved immensely popu-
lar, selling half a million copies and breathing new life into the genre of
medical tales from the tropics.∞∏ As a celebrity physician, Heiser urged work-
ers to take personal responsibility for preventing injury and sickness in Amer-
ican industry. On behalf of the n.a.m., he organized clinics for local manufac-
turers’ groups at which he extolled the benefits of vitamin supplementation,
regular exercise, and personal hygiene. Accidents, he argued, were usually the
result of worker carelessness, fatigue, and malnutrition. Heiser’s goal was
to help management use its personnel to greatest advantage in production.
He believed that the physician’s mission in the factory was ‘‘as bold and as
adventurous as in any of nature’s jungles.’’∞π Later, during World War II,
the aging colonial medico turned his attention to improving stamina on the
home front, addressing radio audiences and writing pamphlets, urging white
Americans to enhance their diets and ‘‘toughen up’’ to meet the Nazi chal-
lenge.∞∫ Throughout this period he continued to express disdain for African-
American capacities.∞Ω
The repatriation of white American physicians after 1910 anticipated by a
decade the mass immigration of Filipino workers to the United States. As
nationals, Filipinos could not legally be excluded, so during the 1920s they
flocked to California’s shores. Historians of migration have observed a racial-
ization of Filipinos and Mexicans during this period—in particular, the dis-
paragement of the foreigners’ hygiene, along with warnings of their innate
propensity to spread diseases that would threaten white communities.≤≠ But
American health officers had fabricated this stigma long before in the colony,
and later exported it back to the United States, where it might be applied to
all immigrants. Filipinos, in particular, arrived already medicalized and ra-
cialized. Whereas in the colonial Philippines such stereotypes had prompted
hygiene education and race improvement—the civilizing project—in the con-
tinental United States they more often elicited calls for exclusion and repatria-
tion, which perhaps indicates the limits of influence of the liberal colonial
model and of ideals of republican virtue more generally. But then, even the
most reformist of physicians always recognized that there was little return on
the disciplining of some human material: enforcing the hygiene of allegedly
inferior races often seemed a frustrating and thankless task, to be undertaken
only when no alternative presented itself. After the passage of the Tyddings
McDuffie Act of 1934, which created the Philippines Commonwealth, Fili-
pinos were reclassified as aliens, and their entry to the United States was
restricted. But the postwar exchange visitor program and the relaxation of
immigration criteria in the 1960s permitted the influx of thousands of Fili-

232 conclusion
pino nurses and a few physicians. By the end of the twentieth century, Ameri-
can nursing care was becoming markedly Filipinized.≤∞
The focus on Pacific crossings—from the United States to the Philippines
and vice versa—should not obscure widespread efforts to translate American
colonial medical practices elsewhere in Asia and the Western Hemisphere. A
complex circulation and repatterning of practices of public health emerged,
flexibly coupled with ideas of race and development, and as these models
passed from place to place they would be readjusted before moving on. Out of
this play of assertion and caution came alterations in the style and form of the
hygienic management of populations and in the manipulation of the environ-
ment as well as in the self-fashioning that public health work engendered.
While director for the East of the Rockefeller International Health Board,
Heiser attempted to reshape health services in more than forty countries,
supporting more efficient and interventionist bureaucracies, directing atten-
tion to racial hygiene and health instruction, and developing medical and
nursing education. Other Philippines medical officers followed his example.
After working in Manila and at Culion, Dr. John E. Snodgrass took over the
Rockefeller hookworm scheme in Ceylon, seeking through latrine building
and hygiene reform to improve the productivity of plantation laborers.≤≤
Dr. John D. Long, Heiser’s successor as director of health in the Philippines,
shuffled between Manila and San Francisco, where he repeatedly led the
Public Health Service’s response to disease outbreaks, before joining the Pan-
American Sanitary Bureau in the 1920s. Making analogies between colonial
discipline and urban health in Asia and the Americas, he drafted the Pan-
American Sanitary Code in 1923–24 and later wrote national health codes
for Chile, Panama, and Uruguay, based on a Philippines model.≤≥ Dr. Paul F.
Russell, as we have seen, turned away from the frustrations of ‘‘race develop-
ment’’ and concentrated on manipulating the nonhuman elements of disease
ecology, on fighting mosquitoes. His Philippine experiences directed him to-
ward specific disease eradication campaigns, which necessarily became global
in scope, abrogating colonial and national boundaries.
Thus the international health services, as they came to be known after
World War II, derived in part from various Philippine models and approaches.
A mosaic of influences gave rise to a mosaic of responses to disease threats,
global and local. Such were the multiple sequels of Philippines colonial public
health: in the archipelago, social medicine and national hygiene; in the United
States, urban health services, industrial hygiene, and military medicine; and in
Asia and Latin America, national and international health services, ecological
intervention, and racialized development regimes.

conclusion 233
Abbreviations

ama American Medical Association

apa American Philosophical Society

bmj British Medical Journal

ihb International Health Board

jama Journal of the American Medical Association

jams Journal of the Association of Military Surgeons

jmsi Journal of the Military Service Institution of the United States

nara United States National Archives and Records Administration

nlm National Library of Medicine

phs Public Health Service

pjs Philippine Journal of Science

pma Philippine Medical Association

rac Rockefeller Archive Center

rf Rockefeller Foundation

rfa Rockefeller Foundation Archives

rg Record Group

tams Transactions of the Association of Military Surgeons

Note on citations: Citations to records in nara are generally in the following form:
record group-(subgroup)-series-folder.
Notes

introduction
1. Rudyard Kipling to W. Cameron Forbes, August 21, 1913, Forbes papers, bMS Am
1364, Houghton Library, Harvard University. Kipling was an active promoter of
U.S. intervention in the Philippines: see his ‘‘The White Man’s Burden.’’
2. Heiser, ‘‘Unsolved Health Problems,’’ 177. My focus here is on colonial hygiene and
health education; I pay relatively little attention to clinical medicine and psychiatry
and less to other healing traditions in the Philippines.
3. Rosenberg, ‘‘Framing Disease.’’ On the social body, see Poovey, Making a Social
Body. For other accounts of the racializing of pathology, see Gilman, Difference and
Pathology; O’Connor, Raw Material; Craddock, City of Plagues; and Shah, Con-
tagious Divides.
4. Stoler and Cooper, ‘‘Tensions of Empire’’; Dirks, ed., Colonialism and Culture;
Thomas, Colonialism’s Culture. Also Arnold, Colonizing the Body; Packard, White
Plague, Black Labor; Vaughan, Curing Their Ills; and Comaroff and Comaroff,
Ethnography and the Historical Imagination.
5. Importantly, the model is not the concentration camp, described hyperbolically in
Agamben, Homo Sacer. That is, I am describing the biopolitics of colonial subject
formation, not a thanatopolitics.
6. Ileto, ‘‘Outlines of a Non-linear Emplotment,’’ 110.
7. On the ‘‘civilizing process,’’ see Elias, The Civilizing Process. Adas finds in the colo-
nial Philippines ‘‘the fullest elaboration of America’s civilizing mission ideology’’ but
disassociates it from ideas of race (Machines as the Measure of Men, 406; and
‘‘Improving on the Civilizing Mission?’’). On the colonial inculcation of civic virtue,
see Conklin, A Mission to Civilize. Fieldhouse briefly alludes to the United States
attempting ‘‘to fit her colonies into a republican framework’’ (The Colonial Empires,
343). Cannell suggests that ‘‘Americans demanded from their colony the evidence of
the growth of a ‘democratic’ civic sensibility of a certain kind’’ (Power and Intimacy,
203). On the persistence of the rhetoric of republican civic virtue in American cul-
ture, see Furner, ‘‘The Republican Tradition’’; Pickens, ‘‘The Turner Thesis and Re-
publicanism’’; and Cohen, The Reconstruction of American Liberalism. It is impor-
tant to recognize the overlap, or mutual reinforcement, of republicanism, corporate
liberalism, and Christian social gospel in the United States during this period: see
Hofstadter, ‘‘Cuba, the Philippines and Manifest Destiny.’’ Anti-imperialists (such as
William Jennings Bryan) and imperialists (such as Theodore Roosevelt) debated
whether an empire would endanger American republicanism or reinvigorate it (at
least forestall its corruption) as continental expansion once had—see chapter 2. Of
 course, the practice of republicanism in the Philippines was necessarily limited by the
various racialist frameworks into which it was fitted.
8. Public health officers homogenized ‘‘the Filipino’’ in this period, ignoring Chinese or
Spanish ancestry, contrasting the emerging type with the homogeneous white Ameri-
can type. The so-called non-Christian tribes were regarded as irredeemable and
therefore the province of anthropology, not medicine. My usage of triage differs
somewhat from Visvanathan’s in ‘‘On the Annals of the Laboratory State,’’ 272.
9. On discipline, see Foucault, Discipline and Punish; on governmentality, see Foucault,
The History of Sexuality. Volume 1, and ‘‘Governmentality.’’ See also Scott, ‘‘Colo-
nial Governmentality.’’
10. Anderson, ‘‘Leprosy and Citizenship.’’ For other uses of the concept, see Porter,
Health, Civilization and the State, chapter 12; Ong, ‘‘Making the Biopolitical Sub-
ject’’; Briggs with Mantini-Briggs, Stories in a Time of Cholera. In Life Exposed,
Petryna also explores the entwining of identity, rights, and diagnosis but argues that
those who suffered most from the nuclear disaster at Chernobyl gained most social
capital.
11. Smith-Rosenberg and Rosenberg, ‘‘The Female Animal’’; Pateman, The Sexual Con-
tract; Young, ‘‘Polity and Group Difference’’; and Scott, Only Paradoxes to Offer.
On the continuing ‘‘partial citizenship’’ of migrant Filipina domestic workers, see
Perreñas, ‘‘Transgressing the Nation-State.’’
12. Stepan, ‘‘Race, Gender, Science and Citizenship,’’ 65. See also Mohanty, ‘‘Under
Western Eyes’’; and Spivak, In Other Worlds.
13. On the tendency to produce Manichean dichotomies in colonial discourse, see
Fanon, Black Skin, White Masks; and Said, Orientalism.
14. On European historicism as a means of saying ‘‘not yet’’ to the colonized, see
Chakrabarty, Provincializing Europe. On liberal strategies of exclusion, see Mehta,
‘‘Liberal Strategies of Exclusion’’; and Parekh, ‘‘Liberalism and Colonialism.’’ Mehta
observes that the ‘‘liberal theorist in the broad structure of his or her theoretical
enterprise works in a way quite akin to the modern doctor,’’ in that the prescription is
adjusted to ‘‘the minimally constitutive features of the human body’’ (82n).
15. Stoler, Carnal Knowledge and Imperial Power, 138. Indeed, Stoler sees increasing
segregation and exclusion during the 1920s and 1930s (77, 111).
16. Arnold, Colonizing the Body, 280. Prakash, in contrast, describes the ‘‘unbridgeable
gap’’ between the colonial state and its subjects in India during this period (Another
Reason, 157).
17. Cooper, ‘‘Modernizing Bureaucrats, Backward Africans, and the Development Con-
cept.’’ Cooper has also observed that ‘‘the idea of empire as a transformative mecha-
nism is indeed available, but one has to be careful about how one locates it’’
(‘‘Modernizing Colonialism,’’ 8). See also Packard, ‘‘Visions of Postwar Health and
Development.’’
18. In this sense, the American colonial state in the Philippines was ‘‘late’’ from the
outset: see Darwin, ‘‘What Was the Late-Colonial State?’’ For an account of Filipino
nationalist developmentalism during the late-Spanish period, see Ileto, ‘‘Outlines of a
Non-linear Emplotment.’’

238 notes to introduction

19. Studies of colonial intimacy and affect and of the framing of the private usually
emphasize the biopolitics of transgressive sex: here I am suggesting that we recognize
that the care of the body, medical examination, and personal and domestic hygiene
all reconfigure intimacy, affect, and privacy. See Stoler, ‘‘Tense and Tender Ties.’’
20. This may also explain the relatively relaxed legal attitude toward interracial sex in
the Philippines, compared to many other colonial locales and to many of the U.S.
states. See Stoler, Carnal Knowledge and Imperial Power.
21. Bhabha, ‘‘Of Mimicry and Man,’’ 158. As Bhabha also puts it, ‘‘Almost the same but
not white’’ (156).
22. Ileto, Pasyon and Revolution; Rafael, White Love.
23. Salman, ‘‘The United States and the End of Slavery in the Philippines, 1898–1914’’;
Kramer, ‘‘The Pragmatic Empire’’ and ‘‘Making Concessions’’; Go and Foster, eds.,
The American Colonial State in the Philippines; and McFerson, ed., Mixed Blessing.
See also the chapter on the Spanish-American War in Jacobson, Whiteness of a
Different Color; and Hoganson, Fighting for American Manhood.
24. ‘‘Sensationalized racial contrast’’ is from Kramer, ‘‘Making Concessions,’’ 96. Most
of these works also focus on lowland Christian Filipinos, especially Tagalogs, and
not Moros, hill tribes, or the substantial Chinese community.
25. Taussig, Mimesis and Alterity, 156.
26. Latour, ‘‘Give Me a Laboratory and I Will Raise the World’’; and Pandora’s Hope.
See also Cunningham and Williams, eds., The Laboratory Revolution in Medicine.
27. The laboratory metaphor still has some appeal: see Visvanathan, ‘‘Lineages of the
Laboratory State’’; Rabinow, French Modern, 117, 289; and Wright, The Politics of
Design in French Colonial Urbanism, 306. According to Prakash, the colonies were
‘‘underfunded and overextended laboratories of modernity’’ (Another Reason, 13).
Conklin argues, though, that the ‘‘colonies were never just laboratories, they were
sites, however unequal, of conflict and negotiation between colonizer and colonized’’
(Mission to Civilize, 5). On the related idea of the colony as ‘‘an object of experimen-
tation,’’ see Mbembe, On the Postcolony, 2.
28. Stoler, Race and the Education of Desire; and Anderson, The Cultivation of White-
ness. As McClintock suggests, ‘‘The invention of whiteness . . . is not the invisible
norm but the problem to be investigated’’ (Imperial Leather, 8). In the Philippines
after the first few years of occupation, white, or simply American, was the preferred
self-designation, not Anglo-Saxon, which seems predominantly to have been a U.S.
metropolitan political discourse during this period, though occasionally an ironic
counterdiscourse among elite Filipinos. See Martellone, ‘‘In the Name of Anglo-
Saxondom’’; and Kramer, ‘‘Empires, Exceptions, and Anglo-Saxons.’’
29. On progressivism and the efficiency movement in the United States, see Haber, Effi-
ciency and Uplift; Wiebe, The Search for Order; Galambos, ‘‘The Emerging Organi-
zational Synthesis’’ and ‘‘Technology, Political Economy and Professionalization’’;
Skowronek, Building a New American State; and Rodgers, ‘‘In Search of Progressiv-
ism.’’ On the development of an increasingly instrumentalist and scientific bureau-
cracy in Washington, D.C., and its links to republicanism and progressivism, see
Lacey, ‘‘The World of the Bureaus.’’ Abinales argues that ‘‘nothing in the existing

notes to introduction 239

 work on American colonialism examines the effect of the Progressive Movement on
the colonial state’’ (‘‘Progressive-Machine Conflict,’’ 157). But see, for education
policy, May, Social Engineering in the Philippines.
30. On the ‘‘prosthetic Gods’’ of modernity, see Freud, Civilization and Its Discontents,
28–29.
31. This is, then, a story of the successes and failures of techne in the tropics and the
ineluctable presence of pathos—the techne and pathos of the colonized and the
colonialist. See Heidegger, The Question Concerning Technology.
32. Thomas has criticized the use of ‘‘colonial discourse’’ as a ‘‘global and transhistorical
logic of denigration’’ and called for ‘‘an understanding of a pluralized field of colo-
nial narratives, which are seen less as signs than as practices’’ (Colonialism’s Culture,
3, 8). See also Anderson, ‘‘The ‘Third-World’ Body’’ and ‘‘Postcolonial Histories of
Medicine.’’
33. On the absence of empire in American historiography, see Williams, ‘‘The Frontier
Thesis and American Foreign Policy.’’ Kaplan has also observed that ‘‘the study of
American culture has traditionally been cut off from the study of foreign relations’’
(‘‘Left Alone with America,’’ 11). Desmond and Domínguez have urged us to ‘‘chart
the integral international flow of cultural products, material goods, and people
across United States borders as a constitutive element of United States history and
national identities’’ (‘‘Resituating American Studies,’’ 487).
34. Saldivar, ‘‘Looking Awry at 1898,’’ 388. See also Adelman and Aron, ‘‘From Border-
lands to Borders.’’
35. Julian Go urges us to study ‘‘how imperial or cross-colonial connections shaped the
efforts and self-fashioning of U.S. colonial agents’’ (‘‘Introduction,’’ 25).
36. Rogaski, Hygienic Modernity, 3.

1. american military medicine faces west

1. Capt. S. Chase de Krafft to Chief Surgeon, Manila, June 13, 1900, rg 112-e26-75139,
nara.
2. George S. Sternberg, Surgeon General, to Adjutant General, April 2, 1900, p. 6, rg
94-318183, nara. The mean strength in this period was 27,712. The annual death
rate from disease was therefore 17.1 for each 1,000 of strength, compared to 39.38
in Puerto Rico, and 61.15 in Cuba. In the first eighteen months of the Civil War, the
annual death rate from disease was 52.27 (p. 7).
3. While quinine was catching on as a specific for malaria in the 1890s, it was still used
more generally as a stimulant and febrifuge, as it had been for a century or more.
4. De Bevoise, Agents of Apocalypse, 11, 13. De Bevoise attributes the high annual death
rate since 1860 to a combination of social disruption, changing agricultural patterns,
and improvements in transport, giving rise to epidemics of cholera, malaria, small-
pox, and rinderpest (a cattle disease). Any epidemiological review of the Spanish
period is difficult because records are so scarce and unreliable—as a result, com-
parisons between Spanish and American colonial public health tend to favor the
former. For local epidemiological reconstructions of the war years, see May, Battle for
Batangas; and Smallman-Raynor and Cliff, ‘‘The Epidemiological Legacy of War.’’

240 notes to chapter 1

 5. Ashburn, A History of the Medical Department of the United States Army; Gillett,
The Army Medical Department, 1865–1917; and Cirillo, Bullets and Bacilli.
6. Woodruff, ‘‘Military Medical Problems,’’ 227. Woodruff identifies a significant
trend, but, as usual, he overstates the point. Even during the U.S. Civil War, sanita-
tion was not unimportant. See, for example, Woodward, Outline of the Chief Camp
Diseases; and Hammond, A Treatise on Hygiene.
7. Smart, ‘‘Medical Department of the Army,’’ 193.
8. See Horsman, Race and Manifest Destiny; and Jacobson, Whiteness of a Different
Color. On the impact of colonial cultures on the structuring of bourgeois white
masculinity more generally, see Stoler, Race and the Education of Desire. I discuss
black American soldiers in the Philippines in chapter 3.
9. Hobsbawm has written that military service became a mechanism more generally for
‘‘inculcating proper civic behavior, and, not least, for turning the inhabitant of a
village into the patriotic citizen of a nation’’ (The Age of Empire, 304–05).
10. LeRoy, The Americans in the Philippines; Hofstadter, ‘‘Manifest Destiny and the
Philippines’’; Cosmas, An Army for Empire; Gates, Schoolbooks and Krags; Trask,
The War with Spain; Miller, ‘‘Benevolent Assimilation’’; Linn, The United States
Army and Counter-Insurgency and The Philippines War. In June 1898, the Philip-
pine Expeditionary Force became the Eighth Army Corps. A corps consisted of three
divisions plus artillery and cavalry, and each division consisted of three brigades, a
brigade being three regiments. Initially only one-quarter of the force was regular
army, the rest having volunteered. In the spring of 1899, the volunteers of ’98 were
mustered out and replaced by thirty-five thousand men of the new volunteer regi-
ments. By autumn ’99 there were still sixty-five thousand troops in the Philippines,
more than thirty thousand of them volunteer. In March 1900 the Department of the
Pacific became the Division of the Philippines, with four geographical departments,
each divided into military districts. Even in late 1901 more than forty-five thousand
U.S. soldiers remained in the archipelago.
11. This is the way it was characterized in Washburn, ‘‘The Relation Between Climate
and Health.’’ A medical doctor, Washburn became chairman of the Philippine Civil
Service Board.
12. Anderson, The Spectre of Comparisons, 227.
13. Water from the Marikina River was pumped into a reservoir at San Juan and then
piped into the city, to public water taps and residences (only 1,825 by 1902). See D. F.
Doeppers, ‘‘Water, Milk, and Chocolate versus Coffee,’’ unpublished ms., 2003.
Sanitary engineering was more advanced in the United States, but it should be noted
that three-quarters of the urban population of New England was served by public
waterworks. In 1890, only 1.5 percent of the American urban population was sup-
plied with filtered water, 40 percent by 1914 (Rosen, Preventive Medicine in the
United States, 46).
14. Bantug, A Short History of Medicine in the Philippines, 64–77; and Marcelo C.
Angeles, ‘‘History of the Public Health System in the Philippines,’’ c. 1967, 1–4,
Archives Section, Department of Health, Republic of the Philippines.
15. Lopes-Rizal, Annual Report of the National Research Council, 159.
16. LeRoy, ‘‘The Philippines, 1860–1898.’’ Under the Spanish regime, mestizo meant a

notes to chapter 1 241

 person of mixed Spanish–local ancestry or mixed Chinese–local ancestry; penin-
sulares were Spaniards from Spain; criollos were persons of Spanish ancestry born in
the Philippines; and indios were descendants of the original inhabitants. There were,
in addition, mountain peoples—Igorots, for example—and Moros, the Islamic peo-
ples of the south. For a revealing account of Spanish colonial racial classifications,
which were becoming more stringent and influential toward the end of the century,
see Comisión Central de Manila, Memoria complementaria de la sección 2 del pro-
grama. This was produced for the Philippine Islands Exposition in Madrid—in it,
indios are treated as degenerate or inferior but not inherently pathogenic.
17. Schumacher, The Propaganda Movement; and Ileto, Pasyon and Revolution.
18. LeRoy, Philippine Life in Town and Country, 98.
19. LeRoy, ‘‘Philippines, 1860–1898.’’ See also Agoncillo, The Revolt of the Masses; and
Zaide, The Philippine Revolution.
20. Rizal, El Filibusterismo, 141. I have altered the quotation slightly in accordance with
the original text. On Rizal and other leading nationalist physicians, see Guerra, El
Médico Político, chapter 6.
21. Schumacher, ‘‘Philippine Higher Education.’’
22. Bantug, ‘‘Rizal and the Progress of the Natural Sciences.’’
23. Schumacher, ‘‘Rizal and Blumentritt.’’
24. Billings, ‘‘The Military Medical Officer,’’ 350, 353. Billings established the collection
that became the basis of the National Library of Medicine and later was the founding
director of the New York Public Library. See Garrison, John Shaw Billings; and
Chapman, Order Out of Chaos.
25. Sternberg, ‘‘Presidential Address,’’ 15. Sternberg, who briefly trained with Koch in
1886, had been surgeon general since 1893: see Sternberg, George Miller Sternberg;
and Gibson, Soldier in White. Although Sternberg is chiefly remembered for his
promotion of laboratory science and discovery of the pneumococcus, he was equally
concerned with improving training in medico-military administration. In 1898 he
wrote that ‘‘physicians and surgeons from civil life, however well qualified profes-
sionally, as a rule, are not prepared to assume the responsibilities of medical officers
charged with administrative duties and the sanitary supervision of camps’’ (quoted in
Sternberg, George Miller Sternberg, 200–201). The Association of Military Sur-
geons of the United States was established in 1891; the Transactions of its meetings
later became jams and then Military Surgeon.
26. The army surgeon in the past had often depended on chance to find shelter for the
wounded, though Tilton had built hospital huts at Valley Forge and Erwin used tents
as a field expedient at Shiloh in 1862.
27. Halley, ‘‘First-aid to the Wounded.’’
28. Ibid., 131.
29. Woodruff, ‘‘Military Medical Problems,’’ 231.
30. Boekmann, ‘‘Some Remarks about Asepsis,’’ 229.
31. Ibid., 230.
32. Smart, ‘‘Medical Department of the Army,’’ 193. On late-nineteenth-century im-
provements in colonial military hygiene and their epidemiological consequences, see
Curtin, Death by Migration.

242 notes to chapter 1

33. Munson, The Theory and Practice of Military Hygiene, 115. The other important
guides to American military hygiene in this period—both indebted to Munson—
were Ashburn, The Elements of Military Hygiene, and Havard, Manual of Military
Hygiene.
34. Notter, ‘‘On the Sanitary Methods,’’ 113, 112.
35. The most influential of the nineteenth-century medical geographers was undoubt-
edly Hirsch, especially the revised, expanded, and much-translated second edition of
his Handbuch der Historisch-Geographischen Pathologie. On medical geography in
general, see Grmek, ‘‘Géographie médicale’’; Ackerknecht, History and Geography
of the Most Important Diseases; Valenčius, ‘‘Histories of Medical Geography’’; and
Barrett, Disease and Geography.
36. Hirsch suggested that some geographically distributed diseases might be biologically
mediated, that is, arise from associated plant or animal life. In the early twentieth
century, Clemow claimed that most had proven to be mediated, in The Geography of
Disease, esp. 5. In the interval between these publications, the great discoveries of the
microbial causes and insect transmission of many diseases were made: for example,
Robert Koch had identified the cholera bacillus in 1882 and the tubercle bacillus in
1883; Alphonse Laveran had discovered the plasmodium of malaria in 1880, and
Ronald Ross identified Anopheles as its vector in 1897. Patrick Manson had found
filariae in Aedes in 1882, but filarial transmission was still thought to be diffusedly
environmental until the 1890s. See Worboys, Spreading Germs.
37. But for an effort to explain the techniques of bacteriology, see Woodruff, ‘‘The
Military Uses of Bacteriology.’’
38. Munson, Theory and Practice of Military Hygiene, 336, 338, 339.
39. Woodward, ‘‘The Sanitation of Camps,’’ 144.
40. Notter, ‘‘On Sanitary Methods,’’ 116, 116–17, 117.
41. Bache, ‘‘The Location of Sites,’’ 415, 416.
42. Ibid., 417, 416.
43. Ibid., 419, 420.
44. See Munson, Theory and Practice of Military Hygiene, esp. chapter 17. Munson
noted that ‘‘venereal infection, especially that of a syphilitic nature, appears to take
place more certainly, and to assume a much more severe character, when relations are
entered into between individuals of different racial characteristics’’ (828). He recom-
mended the regulation of prostitution and the frequent inspection of soldiers, mea-
sures he introduced into Philippines. More generally see Levine, ‘‘Venereal Disease,
Prostitution and the Politics of Empire.’’
45. Bache, ‘‘Location of sites,’’ 429. Some examination of recruits had occurred earlier,
but it was not systematic and rigorous until the late nineteenth century. See, for
example, Henderson, Hints on the Medical Examination.
46. Burrill, ‘‘Is It Expedient to Have a Physical Examination?’’ 137.
47. Munson, Theory and Practice of Military Hygiene, 1, 3.
48. Greenleaf, An Epitome of Tripler’s Manual, 7. Greenleaf asserted that ‘‘the recruit
must be effective, able-bodied, sober, free from disease, and of good character and
habits’’ (9). As assistant surgeon general during the 1890s, Greenleaf had reorga-
nized record keeping, the entry examinations, and the table of medical supplies (see

notes to chapter 1 243

 his file, rg 94-521acp90, nara). On his assistance to John van Rensselaer Hoff in the
organizing of the hospital corps in 1887, see Henry S. Greenleaf, ‘‘The Medical
Corps U.S. Army: A History of its Establishment. Excerpts from the Correspondence
of Brig. General Charles R. Greenleaf,’’ in C. R. Greenleaf papers, MS C91, History
of Medicine Division, nlm.
49. Munson, Theory and Practice of Military Hygiene, 1.
50. Ibid., 33, 71, 72.
51. See Notter, ‘‘On Sanitary Methods,’’ 113; and Munson, Theory and Practice of
Military Hygiene, chapters 5 and 6.
52. Munson, Theory and Practice of Military Hygiene, 384, 393, 400.
53. Ibid., 589, 590.
54. Greenleaf, ‘‘Practical Duties of an Army Surgeon.’’
55. The other members were Major E. O. Shakespeare, m.d., and Dr. Victor C. Vaughan:
see Reed, Vaughan, and Shakespeare, Abstract of the Report of the Origin and
Spread of Typhoid Fever; and Vaughan, ‘‘Typhoid Fever Among the American Sol-
diers.’’ Reed later became celebrated for his work with the Yellow Fever Commission
in Cuba, which associated transmission of the disease with a particular mosquito.
On the typhoid outbreak, see Cosmas, An Army for Empire, chapter 8. The initial
response to the epidemic was generally condemned: almost twenty-one thousand
soldiers contracted the disease, and about fifteen hundred died (Reed, Vaughan and
Shakespeare, Abstract of Report, 185–86, 190–92).
56. Vaughan, ‘‘Typhoid Fever,’’ 85, 85–86.
57. As Sternberg pointed out, ‘‘It was not the site [of the camp] but the manner of its
occupation which must be held accountable for the general spread of disease among
the troops’’ (Report of the Surgeon-General of the Army, 110). Reed and Sternberg
also took the opportunity to insist on command responsibility for health and educa-
tion of line officers in hygiene (introduced at West Point in 1904–05).
58. Smart, ‘‘Medical Department of the Army,’’ 200. See also Traub, ‘‘Military Hygiene.’’
59. Alden, ‘‘The Special Training of the Medical Officer,’’ 676, 683. Defects in training,
revealed in the winter of 1890–91 in the campaign against the Sioux, had led to the
establishment of a school for the training of sanitary corps at Fort Riley, Kansas. In
1892, a system for the examination of assistant surgeons was introduced. The Prus-
sian military medical school had been founded in 1795 (reformed 1818); the French
military medical school at Val de Grâce dates from 1852; and the British Army
Medical School, the model for the U.S. school, was established in 1860, after the
disaster of the Crimean War. John Farley observes that the U.S. Army Medical School
gave more time to bacteriology and hygiene and less to parasitology and helminthol-
ogy than the Liverpool and London schools of tropical medicine, both founded in
1899 (Bilharzia, chapter 2). Considering the known disease distribution in the tem-
perate part of the United States, which it also served, this is not surprising. On the
U.S. Army Medical School, see Craig, ‘‘The Army Medical Service’’; Lull, ‘‘The Days
Gone By’’; and Nichols, ‘‘Notes on the History of the Laboratories of the Army
Medical School.’’ Most of the regular army surgeons in 1898 would not have at-
tended the Army Medical School, and only a few National Guard medical officers
had trained there.

244 notes to chapter 1

60. Hoff, ‘‘Sanitary Organization in the United States Army.’’ See also his ‘‘Scheme of
Military Sanitary Organization.’’
61. Woodruff, ‘‘Military Medical Problems,’’ 221. From the 1880s, army regulations
had required the post or line commanding officer to forward medical reports on the
health of command without amendment, though comment was permitted. This con-
siderably enhanced the influence of the medical officer.
62. Hoff, ‘‘Some Steps in the Organization,’’ 112, 114.
63. Griffith, ‘‘Hospital Experience in the War with Spain,’’ 161. One of the few articles in
tams to deal with tropical disease before 1898 was Foster, ‘‘Notes by a Medical
Officer in the East.’’ Foster concentrates on antiquated British methods of surgical
antisepsis, but he does observe that ‘‘all over the tropics fever is a matter of course,’’
and it appalls him that ‘‘east of Cairo water closets become very rare; I do not believe
there are a dozen in all of India’’ (367, 365).
64. Hoyt, Frontier Doctor, 322. See also Hoyt, ‘‘Observations Upon and Reasons for a
More Complete Physical Examination.’’ During this period, occupational medicine
and military medicine were emerging in parallel as specialties, and some physicians,
like Hoyt, worked in both.
65. Hoyt, Frontier Doctor, 323.
66. Ibid., 333, 335.
67. Ibid., 346. For more on Flexner and Barker, see chapter 3.
68. Ibid., 353. From Corregidor Hoyt wrote, ‘‘I don’t seem to recuperate in this climate
and I know that I will if I go to the States’’ (Hoyt to Adjutant General, August 6,
1899, rg 94-272956, nara). A few years later, Hoyt returned with his family and
stayed at Nueva Caceres (now Naga City) until his son was badly burned, and the
family had to go back to the States.
69. Kemp, ‘‘Field Work in the Philippines,’’ 73, 74.
70. Ibid., 75.
71. Ibid., 78, 77, 80. The use of Chinese bearers was banned in 1900, as they were
deemed a deterrent to the employment of Filipino workers.
72. Ibid., 80.
73. Ibid., 81. In such conditions, the consumption of contaminated water often led to
illness.
74. Lippincott, ‘‘Report of Lt.-Col. Henry Lippincott,’’ 263. He also observed,‘‘The
Spaniards have given little attention to sanitary matters, so that coming from our
country to this, one is reminded of the advantages our people have in the United
States’’ (264).
75. Lippincott, ‘‘Reminiscences of the Expedition,’’ 172–73. See also Lippincott, ‘‘Medi-
cal and Sanitary History of the 8th Army Corps,’’ January 31, 1899, rg 112-
e26-39109-182, nara; and Gillett, ‘‘Medical Care and Evacuation During the Phil-
ippine Insurrection.’’
76. Lippincott, ‘‘Reminiscences of the Expedition,’’ 170, 171.
77. A. A. Woodhull to Sternberg, May 24, 1899, rg 112-e26-57592-e, nara. Greenleaf,
Lippincott, and Woodhull had all served in the medical corps since the Civil War.
Lippincott had distinguished himself with Custer’s forces against Black Kettle’s
Cheyennes at the battle of Washita. Woodhull relieved Lippincott, who was sick

notes to chapter 1 245

 from dysentery and malaria, on April 18, 1899 (rg 94-4414acp72, nara). Ac-
cording to William H. Welch, Woodhull was ‘‘something of stickler for forms and
ceremonies in military matters’’ but ‘‘a thoroughly good man’’ (Welch to Simon
Flexner, March 17, 1899, Welch papers, folder 12, box 16, Alan Mason Chesney
Archives, Johns Hopkins Medical School; on Woodhull’s career, see rg 94-5620
acp1876, nara). By August 1899 there were 1,682 men in the First Reserve and 35
vacant beds (Woodhull to Sternberg, August 28, 1899, rg 112-e26-57592-5, nara).
In September, nipa huts in the Manila suburbs accommodated a further 2,000
sick (Major-General Elwell S. Otis to Adjutant General, September 6, 1899, rg
112-e26-57592-4, nara). By April 1900 there were fewer demands on the hospitals:
in Manila the hospitals accommodated 1,460 patients, with 760 vacant beds; and in
the country there were approximately 3,500 patients with 500 vacant beds (C. R.
Greenleaf to Sternberg, April 23, 1900, rg 112-e26-57592-107, nara).
78. Woodhull to Sternberg, June 4, 1899, rg 112-e26-57592-c2, nara.
79. Woodhull to Adjutant General, May 23, 1899, rg 112-e26-57592-8, nara.
80. Woodhull to Sternberg, October 25, 1899, rg 112-e26-57592-45, nara.
81. Lanza to Adjutant General, June 20, 1899, rg 112-e26-57592-8, nara.
82. Mary E. Sloper, ‘‘Arraignment of the Medical Department in the Philippines,’’ Janu-
ary 31, 1899, rg 112-e26-56797-j, nara.
83. Woodhull to Sternberg, May 24, 1899, rg 112-e26-57592-c, nara. By No-
vember 1899 a hospital of bamboo and nipa was erected at Corregidor, but it still
lacked a kitchen and mess hall (Woodhull to Sternberg, November 16, 1899, rg
112-e26-57592-56, nara).
84. Letter, January 25, 1900, in Spanish-American War Survey—U.S. Hospital Corps,
W 1149, U.S. Army Military History Institute, Carlisle Barracks, Penn. Soon though,
Fleming fell apart: ‘‘The dyarrhaea has been running or was running up till the time
the dysentary broak out about 2 months on me’’ (July 27, 1900).
85. Hoyt to Sternberg, March 1, 1899, rg 112-e26-57592-o, nara; and Lawton to
Adjutant General, July 1, 1899, rg 112-e26-57592-j, nara. See also Henry I. Ray-
mond to Adjutant General August 29, 1899, rg 112-e26-57592-20, nara.
86. Woodhull to Sternberg, June 19, 1899, rg 112-e26-57592-s, nara. For the surgeon
general’s responses, see Sternberg to Woodhull, July 19, 1899, rg 112-e26-57592-c,
and August 7, 1899, rg 112-e26-57592-s, nara.
87. Woodhull to Sternberg, August 15, 1899, rg 112-e26-57592-14, nara. In February
1900, 28 medical officers were on sick report, and Greenleaf, the chief surgeon of the
troops in the field, asked for a further 40 surgeons (Greenleaf to Sternberg, February
10, 1900, rg 112-e26-57592-85, nara). At the time, the number of military sur-
geons in the Philippines was 191; by April 1900, the number was 239, approximately
4 for each 1,000 of strength (Surgeon General to Adjutant General, July 26, 1900, rg
112-e26-57592-86, nara).
88. Woodhull to Sternberg, September 28, 1899, rg 112-e26–57592-31, nara.
89. Woodhull to Sternberg, November 28, 1899, rg 112-e26-57592-63, nara.
90. Woodhull to Sternberg, January 30, 1900, p. 34, rg 112-e26-57592-76, nara.
91. P. C. Fauntleroy to Sternberg, January 1, 1900, rg 112-e26-57592-78, nara. For

246 notes to chapter 1

 another detailed account of the First Reserve, see Kulp, ‘‘A Manila Military Hospi-
tal,’’ esp. 228–31.
92. Lippincott, ‘‘Reminiscences of the Expedition,’’ 171–72.
93. Lippincott to Sternberg, January 30, 1900, p. 5, rg 112-e26-57592-76, nara.
94. Lippincott, ‘‘Reminiscences of the Expedition,’’ 172.
95. Lippincott to Sternberg, January 30, 1900, pp. 15, 26–27, rg 112-e26-57592-76,
nara. In 1898, there were 1,902 admissions to sick report for every 1,000 of
strength in the Philippines, 1,777 by disease and 138 by injury—the overall sick
rate and mortality rate (24/1,000) were much lower than in Cuba (where the Fifth
Army Corps had initially been disorganized, and yellow fever and a more lethal
form of malaria prevailed). In the Philippines, malaria and diarrhea contributed
most to the sick report, but typhoid caused most deaths. In 1899, the sick rate in the
Philippines rose to 2,396/1,000: 2,206 from disease and 241 from injury. The
increase was primarily due to more diarrheal disease and malaria. The mortality
rate rose to 31/1,000 but the contribution of disease to this rate fell, since there was
considerably less typhoid (Sternberg, Report of the Surgeon-General of the Army,
1900, 86). Between 1898 and 1902, 3,693 U.S. soldiers died of disease, and
449,918 were admitted to the sick list (‘‘Statistics from the Office of the Surgeon
General,’’ rg 112-e26-10086-m, nara).
96. Notter, ‘‘On Sanitary Methods,’’ 118.
97. J. J. Curry, ‘‘The Diseases of the Philippine Islands: Report to the Surgeon General,’’
c. 1900, p. 31, rg 112-e26-68075-g, nara.
98. Hoyt, ‘‘Appendix,’’ 262.
99. Mason, ‘‘Notes from the Experiences of a Medical Officer,’’ p. 309.
100. Sternberg to Adjutant General, April 2, 1900, p. 11, rg 94-318183, nara.
101. Notter, ‘‘On Sanitary Methods,’’ 118, 112.
102. Greenleaf to Sternberg, January 30, 1900, pp. 13, 14, rg 112-e26-57592-76, nara.
In this report, Greenleaf pointed out that ‘‘direct heat to the lower back of the head,
and the spine, means increased susceptibility to illness, even when actual illness
does not result’’ (p. 31). His observations were probably influenced by the long-
standing military interest in sunstroke in temperate regions: see Brown, ‘‘The Ef-
fects and Treatment of Heat and Sunstroke.’’
103. Greenleaf to Sternberg, January 30, 1900, pp. 14–15, rg 112-e26-57592-76,
nara. Lt. Col. Parker confirmed the climatic problems: ‘‘The air lacks vitality;
undue exertion exhausts the men and takes the heart out of them. . . . A march of 12
or 15 miles in this country is a forced march’’ (‘‘Some Random Notes on the
Fighting in the Philippines,’’ 319).
104. Charles F. Mason, ‘‘Observations upon Diseases in the Tropics,’’ p. 1, rg 112-
e26-77851, nara.
105. Palmer, ‘‘Notes on Luzon,’’ 228–29. For a critique of theories of a climatic ‘‘death
trap,’’ see L. M. Maus, ‘‘Military Sanitary Problems in the Philippine Islands,’’
September 1, 1908, p. 1, rg 112-e26-18668-27, nara.
106. Guthrie, ‘‘Some Observations While in the Philippines,’’ 143.
107. Munson, Theory and Practice of Military Hygiene, 860, 908. There was perhaps

notes to chapter 1 247

 one subject that soldiers still concentrated on: Munson noted that ‘‘the genital
function’’ seemed to increase in the tropics, but that ‘‘excesses in venery are espe-
cially trying to the unacclimated’’ (910).
108. Greenleaf to Sternberg, January 30, 1900, p. 18, rg 112-e26-57592-76, nara.
109. L. M. Maus, ‘‘Military Sanitary Problems in the Philippine Islands,’’ September 1,
1908, p. 16, rg 112-e26-18668-27, nara. Mason also observed malignant nostal-
gia: ‘‘Men became morbid and homesick. When they did get sick they thought of
nothing but home, and if the disease proved intractable and they had set their hearts
on going home, it was death not to send them (‘‘Medical Officer in the Tropics,’’
310). Sternberg reported, ‘‘Home sickness prevailed to a considerable extent in
some of the regiments, causing depression of spirits and aggravating trivial ail-
ments’’ (Sternberg to Adjutant General, April 2, 1900, p. 4, rg 94-318183, nara).
These must have been among the last examples of the medical diagnosis of nostal-
gia: see Rosen, ‘‘Nostalgia.’’ On the cognate problem of ‘‘shell shock’’ during World
War I, see Stone, ‘‘Shellshock and the Psychologists.’’
110. Anon., ‘‘Insane Soldiers Coming,’’ Evening Star, February 13, 1900, clipping in rg
112-e26-57592-143, nara. Nurse Alice Burrell was worried that on the steamer
home there were ‘‘several insane soldiers on board. Result of disease and exposure
in the P.I.’s’’ (Diary, June 8, 1900, ms. 81–1, UCSF Archives). In fact, in the six
months to June 30, only 101 ‘‘insane soldiers’’ went home (Greenleaf to Surgeon
General, July 13, 1900, p. 2, rg 112-e26-57592-143, nara).
111. Munson, Theory and Practice of Military Hygiene, 854, 858, 860, 861.
112. Birch, ‘‘Influences of Warm Climates on the Constitution,’’ 4, 19. See Livingstone,
‘‘Human Acclimatisation: Perspectives on a Contested Field,’’ ‘‘Climate’s Moral
Economy,’’ and ‘‘Tropical Climate and Moral Hygiene’’; Kennedy, ‘‘The Perils of
the Midday Sun’’; and Harrison, Climates and Constitutions.
113. Kidd, The Control of the Tropics, 48, 54.
114. Mason, ‘‘Medical Officer in the Tropics,’’ 309.
115. Stelle, ‘‘Some Notes on the Clothing,’’ 17. See also Birmingham, ‘‘Some Practical
Suggestions of Tropical Hygiene.’’
116. Mason, ‘‘Medical Officer in the Tropics,’’ 312–13. See also Renbourn, ‘‘Life and
Death of the Solar Topi.’’
117. Stelle, ‘‘Some Notes on the Clothing,’’ p. 22. See also Renbourn, ‘‘The Spine Pad.’’ I
am grateful to Robert Joy for directing me to this reference (and many others).
118. Guthrie, ‘‘Observations in the Philippines,’’ 148.
119. Philippine Commission, Report of the Philippine Commission to the President,
1900, 161.
120. Woodruff, ‘‘Hygiene in the Tropics,’’ 297. Woodruff, a military surgeon since 1887,
was considered clever but troublesome. At Missoula, a senior officer concluded,
‘‘He is not fit to command the hospital detachment, nor does he know his duties
as a subordinate’’ (Wesley Merritt to Major Schwan, September 21, 1891, rg
94-1946apc 87, nara). In 1901, his commander at Fort Riley, Kansas, admonished
him. See chapter 5.
121. Munson, Theory and Practice of Military Hygiene, 878. See also Munson, ‘‘The
Ideal Ration.’’

248 notes to chapter 1

122. Stone, ‘‘Our Troops in the Tropics,’’ 367.
123. Greenleaf to Sternberg, January 30, 1900, pp. 35–36, rg 112-e26-57592-76,
nara. See also Birmingham, ‘‘Some Practical Suggestions’’; and Seaman, ‘‘Observa-
tions in China and the Tropics.’’
124. Woodruff, ‘‘Tropical Hygiene,’’ 298. Greenleaf wryly observed, ‘‘The soldier craves
and gets, some way or other, the food he has been accustomed to eat at home, and
he eats plenty of it; he wants meat twice or three times a day and he eats bacon or
uses it in some form or other in his cooking whenever he can get it. He will not eat
rice’’ (Greenleaf to Sternberg, July 13, 1900, p. 4, rg 112-e26-57592-143, nara).
125. For another aspect of the relations between the Philippine war and American manli-
ness on the home front, see Hoganson, Fighting for American Manhood. More
generally, see Mrozek, ‘‘The Habit of Victory.’’ I discuss American manliness in the
Philippines in more detail in chapter 5.
126. Turner, ‘‘The Significance of the Frontier in American History.’’ See also Coleman,
‘‘Science and Symbol in the Turner Frontier Hypothesis.’’

2. the military basis of colonial public health

1. Von Clausewitz, On War, 603. Foucault inverted another of Clausewitz’s apho-
risms when he wrote that ‘‘politics is the continuation of war by other means’’
(‘‘Society Must be Defended,’’ 15). Foucault went on to argue that war is a ‘‘matrix
for techniques of domination’’ (46).
2. Ileto has described the sanitary response to the cholera epidemic of 1902 in Manila
as war by other means, in ‘‘Cholera and the Origins of the American Sanitary
Order.’’ In his comments on Ileto’s paper, Arnold notes, ‘‘The involvement of the
military in the medical interventionism of the imperial period is one of its most
striking features’’ (‘‘Introduction: Disease, Medicine and Empire,’’ 19). According
to Arnold, in South Asia during this period, ‘‘the institutional connections between
the military and state medicine were close and enduring,’’ and the army and jails
provided models for ‘‘the wider colonization of Indian society by Western medi-
cine.’’ These were, he writes, ‘‘exemplary sites, perceived as models of how Western
medical and sanitary practices might—in theory at least—be deployed in the wider
society’’ (Colonizing the Body, 62, 61, 114). And yet, Feierman has observed that
‘‘the most important stream of early colonial biomedicine is one to which scholars
have paid little attention: military medicine’’ (‘‘Struggles for Control,’’ 120).
3. Gottman, ‘‘Bugeaud, Galliéni, Lyautey,’’ 235, 246. Rabinow discusses the influence
of colonial warfare on French modernity and urbanism in French Modern. It is
striking the extent to which the doctrine of colonial warfare appears to anticipate
Foucault’s Discipline and Punish.
4. Lyautey, ‘‘Du rôle coloniale de l’armée.’’ See also Lyautey, ‘‘Du rôle social de l’offi-
cier’’; Galliéni, La Pacification de Madagascar; and Callwell, Small Wars. For the
development of U.S. tactics, see Utley, Frontier Regulars; Jamison, Crossing the
Deadly Ground; and Bickel, Mars Learning.
5. More generally, Lawrence has argued that disciplines of hygiene in the Royal Navy
helped to shape medicine’s ‘‘governmental’’ involvement (‘‘Disciplining Disease’’).

notes to chapter 2 249

 Cooter has identified the (very different) model of the Prussian military, with its tight
efficiency and hierarchical control, as a model for orthopedic surgery at the end of
the nineteenth century (Surgery and Society in Peace and War). See also Sturdy,
‘‘From the Trenches to the Hospitals at Home’’; and Harrison, ‘‘The Medicalization
of War.’’
6. Gates, Schoolbooks and Krags; May, ‘‘Filipino Resistance to American Occupation’’;
Filiberti, ‘‘The Roots of U.S. Counterinsurgency Doctrine’’; Linn, The U.S. Army and
Counterinsurgency in the Philippine War; and Birtle, ‘‘The U.S. Army’s Pacification
of Marinduque.’’ Ironically, after the Philippine-American War there was no system-
atic effort by the U.S. Army to develop formal small wars doctrine, and it resumed an
obsession with continental warfare. But see Hamilton, ‘‘Jungle Tactics’’; Bullard,
‘‘Small Maneuvers’’; and Bickel, Mars Learning. More generally, see Linn, Guard-
ians of Empire. The legacy of colonial warfare in the Philippines was therefore
primarily medical, not military.
7. Munson, ‘‘The Civil Sanitary Function of the Army Medical Department.’’
8. Guthrie, ‘‘Some Observations While in the Philippines,’’ 142.
9. Quoted in Young, The General’s General, 265. MacArthur had translated Isobelo de
los Reyes’s Guerilla Tactics: Surprises, Ambuscades, and Attacks on Convoys in
1899.
10. Sternberg, Report of the Surgeon-General of the Army, 1900, 94.
11. Ibid., 98.
12. Maus, ‘‘Report of Major L. M. Maus,’’ 123.
13. Meacham, ‘‘Report of Major Franklin A. Meacham,’’ 139.
14. Woodhull, Notes on Military Hygiene for Officers of the Line, 315.
15. Munson, ‘‘Civil Sanitary Function of the Army Medical Department,’’ 274, 290.
16. Smith, ‘‘Edward L. Munson, m.d.’’ The ‘‘Munson last’’ was the army’s official boot
from 1912 to 1942. In 1914, Munson declined a permanent appointment as director
of health in the Philippines, saying he would rather go to Alaska than stay longer in
the tropics (rg 94-2115acp1893, nara). But he returned for three years in the
1920s. After retirement in 1932, Munson became professor of preventive medicine
at the University of California Medical School.
17. Munson, The Management of Men, 735, 36, 70.
18. Board of Health, Manual of the Board of Health. See also Greenleaf, ‘‘A Brief State-
ment of the Sanitary Work Accomplished’’; Fales, ‘‘The American Physician in the
Philippine Civil Service’’; and Gillett, ‘‘U.S. Army Medical Officers and Public Health
in the Philippines.’’
19. Greenleaf to Adjutant-General, Division of the Philippines, May 21, 1900, in Stern-
berg, Report of the Surgeon-General of the Army, 1900, 99.
20. Worcester, The Philippines Past and Present, 333. Bourns, who had accompanied
Worcester on his zoological expeditions to the Philippines in the early 1890s, proved
much more amenable to his friend’s plans than most of the other medical officers.
Worcester, a zoologist from the University of Michigan, was secretary of the interior
from 1901 until 1913: see Sullivan, Exemplar of Americanism; and Stanley, ‘‘ ‘The
Voice of Worcester Is the Voice of God.’ ’’

250 notes to chapter 2

21. Munson, Theory and Practice of Military Hygiene, 944, 946.
22. Report of the Secretary of the Interior to the Philippine Commission for the Year
ending August 31, 1902 (Manila: Bureau of Public Printing, 1902), 6–7.
23. Ileto has argued that in practice ‘‘the new colonial order, in fact, merely reproduced
the classic Philippine pattern of principalia-dominated, sanitary towns, whose out-
skirts faded into a world of ‘uncontrollable,’ ‘disorderly’ or ‘subversive’ elements’’
(‘‘Cholera and the Origins of the American Sanitary Order,’’ 142).
24. On November 1, 1905, the Board of Health would become the Bureau of Health
(Act 1407). Over the following year district health officers were substituted for the
provincial boards of health, thus permitting the director of health a more effective
personal control over local actions (Act 1487, May 16, 1906). This act gave the
director of health power ‘‘to revoke, or modify any order, regulation or bylaw, or
ordinance of a local board of health or of any municipality, except in the City of
Manila, concerning any matter which in his judgment affects the public health.’’ In a
general reorganization of the colonial administration, the Bureau of Health in turn
became the Philippine Health Service (phs) on July 1, 1915 (Act 2468). The phs, like
its precursors, exercised administrative supervision over hygiene and sanitation in
the islands through its divisions of general inspection, sanitation, hospitals, statistics,
district nursing, and publicity and hygiene.
25. Maus was thus head of the Board of Health. The other members were H. D. Osgood,
sanitary engineer; Dr Franklin A. Meacham, chief sanitary inspector; Dr Paul C.
Freer, superintendent of government laboratories; and Manuel Gomez, secretary.
The Manila Board of Health was established by Act No. 157, Philippine Commis-
sion, July 1, 1901 (rg 350-3465-0, nara). Act No. 187, on August 5, 1901, trans-
ferred the staff of the Manila board to the Board of Health for the Philippine Islands
(rg 350-3465-1, nara). Maus, a graduate of the University of Maryland, had joined
the medical department in 1874 and served in the Dakota and Arizona territories
before becoming chief surgeon of the 7th Army Corps in Havana and then chief
surgeon of the department of northern Luzon and commissioner of public health
(June 1900–August 1902). He was again chief surgeon for the army in the Philip-
pines from 1907 till 1909. Notorious for his bad temper, Maus was also a vigorous
campaigner for prohibition and eugenic sterilization. According to Brigadier General
George H. Torney, the surgeon general, Maus was ‘‘one of the most disgruntled
members of the medical corps and . . . a selfish, self-seeking officer. . . . He is
constantly seeking favors for himself, and I have been informed by medical officers
that when serving in the Philippines he persecuted officers who were not in accord
with his views’’ (Memorandum, 1913, rg 112-e26-18668, nara). Maus regarded
Torney as a deliberate and malicious liar (Maus to Adjutant General, January 12,
1914, rg 112-e26-476acp82, nara).
26. Charles Greenleaf, 1900, quoted in Robert D. Gorodetzer, ‘‘A Concise Biography of
Col. Louis M. Maus,’’ p. 9, box 2, Halstead-Maus family papers, Archives of the U.S.
Army Military History Institute, Carlisle Barracks, Penn.
27. Maus organized examinations and mandatory treatment in isolation hospitals for
prostitutes. His allowance of a ‘‘tolerance zone’’ for prostitution antagonized mis-

notes to chapter 2 251

 sionaries, who prevented the issuing of certificates, though the examinations con-
tinued. See Maus, ‘‘Venereal Diseases in the United States Army’’; and Dery, ‘‘Pros-
titution in Colonial Manila.’’
28. Worcester to W. H. Taft, governor, September 6, 1902, and June 26, 1903, rg
112-e26-476acp82, nara.
29. Maus to Adjutant General, October 29, 1903, rg 112-e26-476acp82, nara. Maus
reflected that ‘‘anyone serving under Mr. Worcester could not fail to note his vindic-
tive and overbearing spirit, or his personal prejudices, and on account of his general
manner and personal bearing, I have never heard anyone speak favorably of him’’
(Maus, Sworn Statement, November 26, 1906, p. 9, rg 112-e26-476acp82, nara).
30. According to Sternberg’s ‘‘efficiency report’’ in 1901, Carter was a ‘‘very zealous and
competent officer’’; see Carter’s personnel file, rg 94-5059acp86, nara. Carter, a
graduate of the University of Virginia and a courteous man of military bearing,
arrived in the Philippines on July 29, 1902, and would stay until 1905, when his
health broke down (W. H. Taft to Carter, March 31, 1905, rg 94-5059acp86,
nara). In 1882 he had been a surgeon with the Chihuahua campaign, and in 1885–
86 he accompanied an expedition into Mexico in search of hostile Apaches.
31. Carter, ‘‘Sanitary Conditions,’’ 544.
32. Ibid., 544–45. Similarly, the director of the census of 1903 was Major General J. P.
Sanger.
33. Root, ‘‘Report for 1902,’’ 261. In 1901, Surgeon J. O. Skinner had written to Root,
reporting on conditions in the Philippines: ‘‘The natives appear to me to be utterly
incapable of self-government in any proper form. . . . I do not believe the present
generation can ever appreciate much less absorb and assimilate American ideas and
institutions. . . . While a very few of them have been able to memorize and repeat,
parrot-like, the wording of our Constitution and Declaration of Independence, nei-
ther they nor their followers have, in my opinion, the proper conception of the
provisions and purposes, the privileges and penalties of these instruments’’ (rg
350-59-26, nara).
34. Roosevelt, ‘‘Message of the President of the U.S., Communicated to the Two Houses
of Congress at the Beginning of the First Session of the 57th Congress,’’ 590. For
Roosevelt’s complex views on race, see Dyer, Theodore Roosevelt and the Idea of
Race; Bederman, Manliness and Civilization; and Gerstle, American Crucible. On
Roosevelt and the Philippines, see Alfonso, Theodore Roosevelt and the Philippines.
35. Roosevelt, ‘‘At Arlington, Memorial Day, May 30, 1902,’’ 59, 65.
36. Roosevelt, ‘‘At the Banquet Tendered for Gen. Luke E. Wright, at Memphis, Ten-
nessee, Nov. 19, 1902,’’ 206.
37. Roosevelt, ‘‘Message of the President of the U.S., Communicated to the Two Houses
of Congress at the Beginning of the Second Session of the 57th Congress,’’ 628. As
Ashburn put it, ‘‘Military officers were made governors general of countries, gover-
nors of provinces and towns, and it is interesting to note that there was a general
parallelism between their success in their jobs and their ability to visualize, grasp,
and control the sanitary evils which afflicted the countries’’ (A History of the Medical
Department of the United States Army, 227).
38. Appleby, Liberalism and Republicanism in the Historical Imagination; Brugger, Re-

252 notes to chapter 2

 publican Theory in Political Thought; and Cohen, The Reconstruction of American
Liberalism.
39. Pickens, ‘‘The Turner Thesis and Republicanism.’’
40. Bryan, Bryan on Imperialism, 55. See also Schurz, For American Principles and
American Honor; Stillman, Republic or Empire?; and Smith, Commonwealth or
Empire? See also Lasch, ‘‘The Anti-imperialists, the Philippines and the Rights of
Man’’; Beisner, Twelve Against Empire; Shirmer, Republic or Empire?; and Welch,
Response to Imperialism.
41. On the policy of ‘‘attraction,’’ see Stanley, A Nation in the Making; and Owen, ed.,
Compadre Colonialism.
42. Roosevelt, ‘‘At the Coliseum,’’ 95.
43. Roosevelt, ‘‘Message of the President of the U.S., Communicated to the Two Houses
of Congress at the Beginning of the First Session of the 57th Congress,’’ 570.
44. Roosevelt, ‘‘At the Coliseum,’’ 95.
45. Affairs in the Philippine Islands: Hearings before the Committee on the Philippines
of the United States Senate. Senate Document 331, 1st Session, 57th Congress, 1902.
3 vols. (Washington D.C.: Government Printing Office, 1902), 1:270–71. The Taft
commission, which included Worcester, Wright, Henry C. Ide, and Bernard Moses,
arrived in June 1900, although the full transfer of power did not occur until July
1901. Taft was governor from June 1900 until December 1903. He was later presi-
dent (1908–12) and then chief justice of the United States. See Pringle, The Life and
Times of William H. Taft. His successors, Wright (1903–05), Ide (1906), James F.
Smith (1906–09), and W. Cameron Forbes (1909–13), largely endorsed Taft’s as-
sessment of Filipino character—as did most other Americans in the archipelago.
Peter Stanley quotes the editor of the (Manila) Cablenews, August 8, 1907, on this
point: ‘‘If a race, through ignorance or perverseness, will not heed the advice of
civilized nations about, it must be cared for as a child by its step-mother or a wild
beast by the keeper who cages it but treats it humanely’’ (A Nation in the Making,
107–8).
46. Affairs in the Philippine Islands, 1:61, 322, 343.
47. Taft, ‘‘The Work of the United States in the Philippines,’’ 243, 240. Even in 1921,
colonial officials like Frank Carpenter, the executive secretary of the insular govern-
ment, were still recommending ‘‘the political reconstruction of Asia upon the basis of
our institutions, the saving of the world to Occidental civilization and thereby, we
may hope, the survival of our race’’ (Carpenter to General Leonard Wood, July 30,
1921, quoted in Stanley, A Nation in the Making, 107).
48. Moses, ‘‘Education of a Stranger’’ (address at Berkeley, August 28, 1903), Moses
papers, c-b 994, Bancroft Library, University of California-Berkeley.
49. Moses, ‘‘Control of Dependencies,’’ 87. Moses claimed that distinctively liberal
American colonialism ‘‘recognizes racial differences, but at the same time it finds in
the less developed races other sentiments than fear to which it may successfully
appeal’’ (95).
50. Moses, ‘‘American Control of the Philippines’’ (ms., c. 1913), Moses papers, c-b
994, Bancroft Library, University of California-Berkeley.
51. Beveridge, ‘‘Our Philippine Policy,’’ 65, 71. Moses felt that ‘‘Senator Beveridge is

notes to chapter 2 253

 undoubtedly a bright but superficial person, but his conceit as manifested at times
was oppressive’’ (Diaries, vol. 5, September 1, 1901, Moses papers, c-b 994, Ban-
croft Library, University of California-Berkeley). On Beveridge, see Braeman, Albert
J. Beveridge. One of the major awards offered by the American Historical Associa-
tion honors Beveridge.
52. Beveridge, ‘‘Our Philippine Policy,’’ 73, 85.
53. Beveridge, ‘‘March of the Flag,’’ 49, 50.
54. Taft, ‘‘Progress of the Negro,’’ 320, 328.
55. Roosevelt, ‘‘Message of the President of the U.S., Communicated to the Two Houses
of Congress at the Beginning of the Second Session of the 57th Congress,’’ 639.
56. See Hoxie, A Final Promise; and Berkhofer, The White Man’s Indian. Hoxie points
to the influence of Henry Lewis Morgan’s ideas of social evolution and his postulated
trajectory from savagery to barbarism to civilization.
57. Roosevelt, A Book Lover’s Holidays in the Open, 51. During his presidency Roose-
velt was also interested in immigration restriction in order to ensure the homogeneity
of the U.S. population: see Higham, Strangers in the Land; Kraut, Silent Travelers;
and Jacobson, Whiteness of a Different Color.
58. See, for example, Sternberg, Report of the Surgeon-General of the Army, 1900, 95.
See also Utley, Frontier Regulars; Olch, ‘‘Medicine in the Indian-fighting Army’’; and
Gillett, The Army Medical Department, chapter 3. It is important to understand that
while the army was rarely responsible for the care of reservation Indians, it quickly
took up early Philippine public health provision. (Health care on the reservations
was the responsibility of the Bureau of Indian Affairs, which despite identical initials
had no connection with the Bureau of Insular Affairs, responsible for the Philip-
pines.) In Facing West, Drinnan, however, emphasizes similarities more generally in
the acquisition and government of Indian territories and the Philippines.
59. In 1900, there were eighty-three agency physicians and two hospitals for some two
hundred thousand American Indians. In general, those physicians who were not
utterly feckless concentrated on treating advanced tuberculosis. Jones contrasts the
neglect of Native American health, especially the prevention of disease, with the more
efficient, and separate, medical care of troops on the frontier, conducted by officers
who soon would work in the Philippines (Rationalizing Epidemics, esp. chapter 6).
Indian health care remained neglected until President Taft, returned from the Philip-
pines, in 1912 set out to improve conditions on the reservations. He had learned
that ‘‘the tide can be turned, that the danger of infection among the Indians themselves
and to the several millions of white persons now living as neighbors to them can be
greatly reduced’’ (‘‘Special Message to Congress, Sept. 12, 1912,’’ quoted in Jones,
Rationalizing Epidemics, chapter 6). See also Kunitz, ‘‘The History and Politics of U.S.
Health Care Policy for American Indians’’; and Trennert, White Man’s Medicine.
60. But see Williams, ‘‘United States Indian Policy and the Debate Over Philippine
Annexation.’’
61. Munson, The Principles of Sanitary Tactics, 35, 37.
62. Lippincott to Sternberg, March 31, 1899, p.7, rg 112-e26-57592-a, nara.
63. Maus, ‘‘Military Sanitary Problems in the Philippine Islands,’’ September 1, 1908,
p.7, rg 112-e26-18668-27, nara.

254 notes to chapter 2

64. Guthrie, ‘‘Observations on the Philippines,’’ 148.
65. D. T. E. Casteel to wife, 14–20 October, 1900, Casteel papers, U.S. Army Military
History Institute, Carlisle Barracks, Penn., quoted in Linn, United States Army and
Counter-Insurgency, 17. Casteel also observed that ‘‘The defense of the enemy was
natural undergrowth as far as seen, they firing from within the edge of the woods’’
(Report of Action at Tanay, January 26, 1900, rg 350-764-284, nara).
66. Young, General’s General, 253.
67. Crane, ‘‘The Fighting Tactics of Filipinos,’’ 497, 502, 506, 503.
68. Report, November 16, 1901, p. 4, rg 395-2423, nara. The anonymous officer
continued: ‘‘By reason of the rough and wooded character of its terrain, [the sur-
rounding country] gives protection to bands of insurgents and ladrones.’’
69. Guthrie, ‘‘Observations on the Philippines,’’ 144.
70. Ibid., 141.
71. Lippincott, ‘‘Reminiscences of the Expedition,’’ 172.
72. J. J. Curry to Commanding Officer, First Reserve Hospital, January 2, 1900, rg
112-e26-57592-69, nara; Greenleaf to Sternberg, January 3, 1900, rg 112-
e26-57592-69, nara. For a report on the laboratory activities, see Strong to Chief
Surgeon, Division of the Philippines, October 15, 1900, rg 112-e26-68075-e, nara.
Strong later became director of the biological laboratory of the Philippine Bureau of
Science and the first professor of tropical medicine at Harvard. See Chernin, ‘‘Rich-
ard Pearson Strong and Manchurian Epidemic of Bubonic Plague’’; Cueto, ‘‘Tropical
Medicine and Bacteriology in Boston and Peru’’; and Anderson, ‘‘Richard Pearson
Strong.’’
73. Curry, ‘‘The Diseases of the Philippine Islands: Report to the Surgeon General,’’ c.
1900, p. 9, rg 112-e26-68075-g, nara.
74. Strong to Sternberg, January 3, 1901, rg 112-e26-68075-j, nara. In late 1899 and
early 1900, after disengaging from Hoyt at the front, Simon Flexner and Llewelys
Barker had conducted research on cadavers at the First Reserve Hospital laboratory,
trying to isolate microorganisms. See Flexner and Barker, ‘‘Report of a Special Com-
mission Sent to the Philippines’’ and ‘‘The Prevalent Diseases in the Philippines’’; and
Barker, ‘‘Medical Commission to the Philippines.’’ Barker was ‘‘deeply impressed by
the excellent organization of the medical and surgical work of the Army’’ (Time and
the Physician, 66). For the correspondence between W. H. Welch and Flexner, see
Welch papers, box 16, folder 12, Alan Mason Chesney Archives, Johns Hopkins
Medical School.
75. Maus, ‘‘Monthly Report of the Board of Health for the Philippine Islands,’’ February
1902, rg 350-3465-4, nara. For the international context, see Edger, The Present
Pandemic of Plague.
76. Manson, Tropical Diseases (1898), 152.
77. Herzog, The Plague, 19. W. G. Liston of the Indian Medical Service had documented
rat-flea transmission of plague in 1902–3. On presumed modes of transmission, see
also Infectious Diseases: Period of Incubation, Quarantine and Infection; Sources of
Infection. Health Bulletin No. 1 (Manila: Bureau of Printing, 1903).
78. Headquarters’ Provost Marshall General, Office of the Board of Health, Circular
Letter No. 11, June 30, 1901, rg 350-3234-2, nara.

notes to chapter 2 255

79. Maus, ‘‘Monthly Report of the Board of Health for the Philippine Islands,’’ February
1902, p. 2, rg 350-3465-4, nara.
80. Office of the Board of Health, Circular Letter No. 5, ‘‘Ambulatory Plague,’’ April 8,
1901, rg 350-2394-2, nara. The notion of ambulatory plague was later challenged
in Herzog and Hare, Does Latent or Dormant Plague Exist?
81. Office of the Board of Health, Circular Letter No. 3, ‘‘A Brief Synopsis of Bubonic
Plague for Early Diagnosis,’’ March 7, 1901, rg 350-2394-2, nara.
82. Office of the Board of Health, Circular Letter No. 5, ‘‘Ambulatory Plague,’’ April 8,
1901, rg 350-2394-2, nara. By 1908, the consensus was that fleas were the vectors
of the plague bacillus and rats its usual host.
83. Report of the Secretary of the Interior to the Philippine Commission, for the Year
Ending August 31, 1902 (Manila: Bureau of Public Printing, 1902), 13–14, 27.
Cholera was reported in India in 1900; within a year it had spread to the Straits
Settlements; in March 1901 it was found in Hong Kong. The disease later attacked
Batavia in June and entered Yokohama a few months afterward. See Major Charles
Lynch, ‘‘Asiatic Cholera,’’ Circular No. 24, Headquarters Division of the Philip-
pines, April 11, 1902, rg 350-4981-5, nara; and Marshall, Asiatic Cholera in the
Philippines Islands.
84. Worcester, The Philippines Past and Present, 334. See also his History of Asiatic
Cholera in the Philippine Islands. His comments were meant as a reflection on
Maus’s competence: for Maus’s response, see Maus to Adjutant General, December
21, 1908, rg 94-1488119-b, nara.
85. On the Spanish response to cholera in 1882 (and later in 1888–89), see Capelo y
Juan, Manila, la Higiene y el Cólera; del Rosario and Lopez Rizal, Some Epidemio-
logical Features of Cholera in the Philippines, esp. 3–6; Bantug, A Short History of
Medicine in the Philippines under the Spanish Regime, 64–77; Marcelo C. Angeles,
‘‘History of the Public Health System in the Philippines,’’ c. 1967, Department of
Health Archives, Republic of the Philippines, 1–4; and Enrico Azicate, ‘‘Medicine in
the Philippines: An Historical Perspective,’’ M.A. thesis, University of the Philip-
pines, 1989, 72–83. The files in ‘‘Memorias Médicas,’’ Philippine National Archives,
Manila, contain much valuable information. De Bevoise estimates that 10 percent of
the population of Manila died in the 1882 epidemic (Agents of Apocalypse, chapter
7). Agents of Apocalypse covers the Spanish response in more detail.
86. In April, the cholera section of San Lazaro was abandoned because of ‘‘ground
infection’’ and the patients all moved out to Santa Mesa, which was closed in May.
Afterward a cholera hospital was established in Ermita, closer to the city. Captain E.
A. Southall took charge of the hospital even though he was ‘‘suffering from chronic
dysentery the whole time.’’ See Maus, Report of the Board of Health for the Philip-
pines Islands and the City of Manila, April 1902, 2. See also Ileto, ‘‘Cholera and the
Origins of the American Sanitary Order’’; and Sullivan, ‘‘Cholera and Colonialism in
the Philippines.’’
87. Headquarters Division of the Philippines, General Orders No. 66, March 25, 1902,
rg 350-4981-4, nara; Ken de Bevoise, ‘‘The Compromised Host: The Epidemio-
logical Context of the Philippine-American War’’ (ph.d. dissertation, University of
Oregon, 1986), 166–69. The burning of dwellings continued a well-established mili-

256 notes to chapter 2

 tary practice designed to deter collaboration with insurrectos. When Captain D. C.
Cabell came to Albay in June 1901, he detected support from local villagers for the
insurrectos, so he recommended that ‘‘orders be given to burn all these houses and
bring in their occupants’’ (Cabell to Adjutant, Subdistrict of Albay, June 23, 1901,
rg 350-2423, nara).
88. Maus, Report of the Board of Health for the Philippines, March 1902, 1–3. See also
the health regulations issued by Maus on April 10, 1901 (rg 350-3465-7, nara).
89. Maus, Report of the Board of Health for the Philippines, March 1902, 1, 3. The
high case mortality suggests either low host resistance (perhaps a result of malnutri-
tion or concomitant infection) or a failure to diagnose or report mild cases. For
sensitive American accounts of the epidemic, see Fee, A Woman’s Impressions of
the Philippines, 220 f.; Moses, Unofficial Letters of an Official’s Wife, 221–42; and
Mrs. W. H. Taft, Recollections of Full Years, 253–60.
90. Johnson, who fancied himself a ‘‘squaw man,’’ did however develop ‘‘a fascination
for [the Philippines’] pleasant clime as a whole, and some feeling of attachment
toward these people who were generally hospitable and easy to become friendly
with’’ (‘‘My Life in the Army, 1899 to 1920’’ [Typescript 1952, rev. 1960], 63, 102,
U.S. Army Military History Institute, Carlisle Barracks, Penn.).
91. Winfred T. Denison, secretary of interior, to Major-General Thomas H. Barry,
August 31, 1915, rg 94-2115acp93, nara.
92. Maus, Report of the Board of Health for the Philippines, March 1902, 2.
93. Ibid. If not carefully diluted, benzozone burned the mucosa of the gastrointestinal
tract.
94. Edger, ‘‘Special Report,’’ pp. 1–3, rg 112-e26-90497-19, nara, quoted in De
Bevoise, ‘‘Compromised Host,’’ 249. The medical officer was following the orders
issued as Headquarters Division of the Philippines, General Orders No. 66, March
25, 1902, rg 350-4981-4, nara.
95. George De Shon papers, U.S. Army Military History Institute, Carlisle Barracks,
Penn. See also the 1902 diary of Perry L. Boyer, m.d., at the U.S. Army Military
History Institute, Carlisle Barracks, Penn.
96. C. F. de Mey, ‘‘Cholera Report, May 30, 1902,’’ in Dean C. Worcester, ‘‘Annual
Report of the Secretary of the Interior to August 31, 1902,’’ in Reports of the Philip-
pine Commission, 1902 (Washington D.C.: Government Printing Office, 1903),
412–13.
97. Maus, Report of the Board of Health for the Philippines, March 1902, 2.Worcester
described opponents of the measures as ‘‘a few evil-intentioned persons, both for-
eign and native, who welcomed every opportunity to make trouble’’ (Philippines,
Past and Present, 335).
98. Anna Page Russell Maus, ‘‘Old Army Days’’ (Typescript, c. 1920s), Halstead-Maus
family papers, U.S. Army Military History Institute, Carlisle Barracks, Penn., n.p.
Mrs. Maus claimed her husband had to ‘‘fight tropical diseases among a people
utterly ignorant of the first principles of sanitation and infection.’’
99. Wright to Elihu Root, secretary of war, July 20, 1902, p. 8, Elihu Root papers, c
164, Library of Congress, quoted in De Bevoise, ‘‘Compromised Host,’’ 240–41.
100. Maus, Report of the Board of Health for the Philippines, March 1902.

notes to chapter 2 257

101. Pardo de Tavera to W. H. Taft, May 5, 1902, rg 350-3465-5, nara. Pardo de
Tavera was an honorary, and uninfluential, member of the Board of Health. He had
studied medicine at Santó Tomás and the Sorbonne and became involved in the
Philippine nationalist movement. Anticlerical and liberal, he quickly moved to
collaborate with the American colonial state. In 1899 he founded La Democracia
and became the first president of the Colegio médico-farmacéutico de Filipinas;
the following year he set up the generally agreeable Federal Party. See Guerra, El
Médico Político, 150–52.
102. Winfred T. Denison to Major-General Thomas H. Barry, August 31, 1915, rg
94-2115acp93, nara.
103. Maus, Report of the Board of Health for the Philippines, April 1902, 2.
104. Ibid., May 1902, 1; and ibid., January 1903, 3.
105. Worcester, History of Asiatic Cholera. The end of the epidemic was not officially
declared until April 1904.
106. Louis D. Baun to mother, May 13, 1902, Baun letters, ms 80–75 z, Bancroft
Library, University of California-Berkeley.
107. Heiser, An American Doctor’s Odyssey, 34.
108. Ibid., 37. The threat to the ‘‘Occidental’’ was never far from the minds of the senior
American administrators. According to Taft, ‘‘If the United States is to continue its
governmental relations with the Philippines for more than a generation, and its
business and social relations indefinitely, the fact that Americans can lead healthful
lives in the Philippines is important of itself’’ (Special Report of W. H. Taft, 281).
109. Heiser, ‘‘Unsolved Health Problems,’’ 177.
110. Ibid., 172.
111. Heiser, An American Doctor’s Odyssey, 151.
112. Williams, The United States Public Health Service; Mullan, Plagues and Politics;
and Fairchild, Science at the Borders. The origins of the phs were actually in the
Coast Guard, a paramilitary organization, and its institutional power within the
United States remained marginal during most of this period.
113. Heiser, An American Doctor’s Odyssey, 77. See Anderson, ‘‘Victor George Heiser.’’
As director of quarantine in the islands (1903–05), Heiser had acquired a reputa-
tion as a zealous, tightfisted bureaucrat. Luke Wright, the governor, was ‘‘anxious
to have Heiser chief of Bureau of Health speedily with a view to cutting expenses for
the next fiscal year. Do not wish to hurt Carter’s feelings by suggesting return.
Could you not order him [Carter] home for duty?’’ (Wright to Secretary of War,
March 29, 1905, rg 350-3267-18, nara). Heiser’s first impressions of Filipinos
had been bad: he wrote to his cousin Sue, ‘‘The little brown brothers as they are
called, are a lazy shiftless lot. The only thing the men seem to take an interest in is
chicken fights and about all the women do is smoke big black cigars. It is mighty
seldom that you can catch any of them at work’’ (June 5, 1903, Heiser papers,
American Philosophical Society, B:H357.p).
114. Heiser, An American Doctor’s Odyssey, 76.
115. I discuss this development in more detail in The Cultivation of Whiteness, chap-
ter 2.
116. Haber, Efficiency and Uplift; and Wiebe, The Search for Order. Wiebe argues that

258 notes to chapter 2

 ‘‘the heart of progressivism was the ambition of the new middle class to fulfill its
destiny through bureaucratic means’’ (166).
117. The emblematic text is Taylor, Principles of Scientific Management. See Galambos,
‘‘The Emerging Organizational Synthesis in American History,’’ and ‘‘Technology,
Political Economy and Professionalization.’’ On the general move to efficiency and
business models in medicine during this period, see Rosen, ‘‘The Efficiency Cri-
terion in Medical Care’’; Kunitz, ‘‘Efficiency and Reform in the Financing and
Organization of American Medicine’’; Vogel, ‘‘Managing Medicine’’; Madison,
‘‘Preserving Individualism in the Organizational Society’’; and Sturdy and Cooter,
‘‘Science, Scientific Management, and the Transformation of Medicine in Britain.’’
118. Worcester, Philippines, Past and Present, 354.
119. Heiser, ‘‘Sanitation in the Philippines,’’ 133.

3. ‘‘only man is vile’’

1. Balfour, ‘‘Tropical Problems in the New World,’’ 83. Balfour had recently returned
from the Sudan, where he was director of the Wellcome Tropical Research Labora-
tories; he became director of the London School of Hygiene and Tropical Medicine.
Balfour was referring to Chamberlain, ‘‘Observations of the Influence of the Philip-
pine Climate on White Men,’’ 429; and ‘‘Some Features of the Physiological Ac-
tivity of White Races.’’
2. May has described the contribution of American educators to colonial governance
in Social Engineering in the Philippines.
3. Ronald Ross, ‘‘Discussion,’’ in Balfour, ‘‘Tropical Problems,’’ 110.
4. Balfour, ‘‘Tropical Problems,’’ 86. This is a minor misquotation of Bishop Heber’s
hymn, extolling Ceylon. Balfour, however, remained skeptical; see his ‘‘The Prob-
lem of Acclimatization.’’
5. Livingstone, ‘‘Climate’s Moral Economy.’’
6. Codorniu y Nieto, Topografía Médica, 10, 32. On the related concern about the
degeneration of European horses in the archipelago, see Bankoff, ‘‘A Question of
Breeding.’’
7. Codorniu y Nieto, Topografía Médica, 37, 109, 46.
8. Ibid., 121.
9. Jagor, Travels in the Philippines, 25, 29, 263. Thus were southern Europeans impli-
cated in the myth of the lazy native: see Alatas, The Myth of the Lazy Native.
10. Suarez Caopalleja, La salud del Europeo, 33, 74. Interestingly, Suarez is also con-
cerned with the acclimatization of criollos to Spain, an indication of the mobility of
population between the parts of the empire. For a more pessimistic contemporary view
of Spanish prospects in the tropics, see Gonzalez, Filipinas y sus inhabitantes. Yet even
as Gonzalez asserts that the European ‘‘can be considered as a truly exotic plant in that
burning soil,’’ he boasts of his eight years of good health in the archipelago (25).
11. Suarez Caopalleja, La salud del Europeo, 78, quotations on 88. Still, Suarez
thought that acclimatization would always effect at least a slight modification in
Spanish bodies and mentality. He regarded the inaptitude of criollos and mestizos
for science as an especially telling sign of intellectual deterioration (88).

notes to chapter 3 259

12. Affairs in the Philippine Islands: Hearings before the Committee on the Philippines
of the United States Senate. Senate Document 331. 57th Congress, 1st Session, 1902
(Washington, D.C.: Government Printing Office, 1902), 3 vols., 1:343, 395.
13. Affairs in the Philippine Islands, 1:391, 395.
14. Taft, ‘‘Special Report of the Secretary of War on the Philippines,’’ 281.
15. Bancroft, The New Pacific, 251, 403, 430.
16. Morris, Our Island Empire, 355. Morris was a prolific Aryanist and a biographer of
Theodore Roosevelt.
17. Griffis, America in the East, 47, 46–47.
18. Report of the Philippine Commission to the President, 4 vols., in Senate Journal,
56th Congress, 1st session, January 31, 1900, 2:231.
19. L. F. Barker in Report of the Philippine Commission, 2:237, 238, 239. Later in San
Francisco, on their way back to the East Coast, Flexner and Barker reported on the
response to the epidemic of bubonic plague in that city.
20. Herbert Ingram Priestley to mother, October 6, 1901, Herbert Ingram Priestley let-
ters 1901–04, 94/13 cz, Bancroft Library, University of California-Berkeley. Priest-
ley became a historian of the Spanish empire in North America and the director of
the Bancroft Library at Berkeley. (I discuss Priestley’s nervousness in more detail in
chapter 5.)
21. Conger, An Ohio Woman in the Philippines, 50, 133–34. Conger later trained as an
osteopath.
22. Atkinson, The Philippine Islands, 151, 146. Large-scale white colonization was not,
it seems, seriously contemplated in Washington, D.C. But see R. Macarthy Wil-
liamson to Roosevelt, November 29, 1906—on the use of Italian migrants—in rg
350-873-2, nara. In response to A. J. Garrissen’s plans to colonize Mindanao (Janu-
ary 9, 1912), Colonel Frank Macintyre, the chief of the Bureau of Insular Affairs,
wrote, ‘‘The Philippine government encourages the taking up of its public lands, by
homestead, lease, or purchase, and will use every facility at its command to protect
anyone engaged in any legitimate enterprise in the Islands’’ (rg 350-873-3, nara).
23. Woodruff, ‘‘The Neurasthenic States Caused by Excessive Light,’’ 1006. I discuss
Woodruff’s theories of ‘‘tropical neurasthenia’’ in more detail in chapter 5. For Wood-
ruff’s career and many contretemps, see rg 94-1946apc87, nara. Taft in a letter to
Worcester (February 26, 1914) refers to ‘‘that fellow Woodruff, of the Medical Corps,
who went crazy on the subject of colors in the tropics’’ in D. C. Worcester papers,
Aa/2/Ac, box 1, Bentley Historical Library, University of Michigan.
24. Woodruff, The Effects of Tropical Sunlight Upon the White Man, 278.
25. Woodruff, Expansion of Races, 257, 274. Jordan in Imperial Democracy had made
similar claims, though they lacked Woodruff’s medical rationale. The natural histo-
rian (and president of Stanford University) wrote that ‘‘civilization is. . . . suffocated
in the tropics,’’ (45) and the torrid zone was ‘‘Nature’s asylum for degenerates’’ (93).
‘‘The Anglo-Saxon in the tropics deteriorates through the survival of the indolent
and the loss of fecundity’’ (95).
26. Harrison to Woodruff, November 7, 1913, letters, box 36, Francis Burton Harrison
papers, Library of Congress. See also Woodruff to Harrison, August 26, 1913.

260 notes to chapter 3

27. Twain, ‘‘To the Person Sitting in Darkness.’’
28. De Witt, ‘‘A Few Remarks Concerning the Health Conditions of Americans in the
Philippines,’’ 56. De Witt ended his career as brigadier general and an assistant to the
surgeon general.
29. Washburn, ‘‘The Relation between Climate and Health,’’ 499, 505. Washburn relied
in particular on the optimistic views of Felkin, On the Geographical Distribution of
Tropical Diseases.
30. Washburn, ‘‘The Relation between Climate and Health,’’ 506, 507, 513.
31. Wood, quoted in ibid., 515.
32. McDill, ‘‘Presidential Address,’’ quoted in Taft, ‘‘Special Report of the Secretary of
War on the Philippines,’’ 281. On the history of the Philippine Islands Medical
Association, see Stauffer, The Development of an Interest Group, chapter 1; and de
la Cruz, History of Philippine Medicine.
33. Surgeon General, U.S. Army, to Chief Surgeon, Division of the Philippines, June 13,
1906, rg 112-68075-25, nara. I have described the first Army Board (1899–1902)
in chapter 2; a later board (1922–30) was housed in the Bureau of Science. Among
the more important figures on the army boards were Lt. Richard P. Strong, Capt.
Percy F. Ashburn, Lt. Charles Craig, Capt. James M. Phalen, Capt. Edwin D. Kil-
bourne, Maj. Weston P. Chamberlain, and Capt. Edward D. Vedder. On the board,
see Ashburn and Craig, ‘‘The Work of the Army Board for the Study of Tropical Dis-
eases’’; [Ashburn], ‘‘A Synopsis of the Work of the Army Medical Research Boards’’;
and Gillett, The Army Medical Department, 1865–1917, chapter 11. The board
confirmed the mosquito theory of dengue transmission and did important work on
the nutritional basis of beriberi.
34. Aron, ‘‘Investigations of the Action of the Tropical Sun,’’ 102.
35. Gibbs, ‘‘A Study of the Effect of Tropical Sunlight upon Men,’’ 92.
36. Shaklee, ‘‘Experimental Acclimatization to the Tropical Sun.’’
37. James M. Phalen and H. J. Nichols, ‘‘Outline of an Experiment for US Soldiers
Serving in the Philippines,’’ 1909, rg 112-68075-68, nara.
38. Phalen, ‘‘An Experiment with Orange-red Underwear.’’
39. Davy, Researches, Physiological and Anatomical, 1:812.
40. Rattray, ‘‘On Some of the More Important Physiological Changes Induced in the
Human Economy by Change of Climate.’’
41. Chamberlain, ‘‘Observations of the Influence of the Philippine Climate.’’ See also his
‘‘Some Features of the Physiological Activity of White Races.’’
42. Phalen and Nichols, ‘‘Outline of an Experiment.’’
43. Musgrave and Sison, ‘‘Blood Pressure in the Tropics.’’ Musgrave, the director of the
Philippine General Hospital, later became professor of pediatrics at the University of
California in San Francisco. The Filipinos in this study were students and local
police.
44. Chamberlain, ‘‘A Study of the Systolic Blood Pressure and the Pulse Rate,’’ 481.
45. See Davidson, ed., Hygiene and Diseases of Warm Climates, and Daniels and Wilkin-
son, Tropical Medicine and Hygiene.
46. Chamberlain, ‘‘The Red Blood Corpuscles and the Hemoglobin of Healthy Adult

notes to chapter 3 261

 American Males,’’ 484. Chamberlain was challenging the pathological findings of a
colleague, Lt. W. A. Wickline. See Wickline to Chief Surgeon, Department of Luzon,
June 24, 1907, rg 112-e26, 48453, nara.
47. Chamberlain and Vedder, ‘‘A Study of Arneth’s Nuclear Classification of Neutro-
phils in Healthy Adult Males.’’ During this period Vedder and Chamberlain were
also investigating the dietary causes of beriberi and the use of rice polishings in its
treatment. See Vedder, Beriberi.
48. Weston P. Chamberlain, ‘‘Quarterly Report of the US Army Board of Study,’’ June
30, 1910, rg 112-68075-81, nara.
49. We now know that the eosinophilia was a result of hookworm infection: see chapter
7.
50. See chapter 5.
51. See the summary in Havard, Manual of Military Hygiene, chapter 57. This optimism
in part reflected and confirmed a more general medical confidence in European self-
projection in the tropics, which emerged with the new tropical medicine in Britain at
the end of the nineteenth century. See, for example, Sambon, ‘‘Remarks on Acclima-
tization in Tropical Regions.’’ It also perhaps indicates the earlier medical success, a
generation or more before, in the United States in dissolving southern distinctiveness
and creating a more homogeneous national disease habitat: see Warner, ‘‘The Idea of
Southern Medical Distinctiveness.’’
52. Latour, ‘‘Give Me a Laboratory and I Will Raise the World,’’ 154.
53. Heiser, ‘‘The Progress of Medicine in the Philippines.’’
54. For other examples of the recuperation of racial categories through the study of
acquired immunity, see Sternberg, Infection and Immunity, 24; and Clemow, The
Geography of Disease, 5. For an account that mutes the racialism of ‘‘acquired
immunity,’’ see Mendelsohn, ‘‘Medicine and the Making of Bodily Inequality.’’
55. Washburn, ‘‘Health Conditions in the Philippines,’’ 273.
56. Freer, The Philippine Experiences of an American Teacher, 188.
57. Freer, ‘‘A Consideration of Some of the Modern Theories of Immunity,’’ 74.
58. Louis Mervin Maus, ‘‘Military Sanitary Problems in the Philippine Islands,’’ Septem-
ber 5, 1908, p. 4, rg 112-e26-18668-27, nara. (This is the typescript of a lecture
presented at the annual meeting of the American Association of Military Surgeons.)
59. Bean, The Racial Anatomy of the Philippine Islanders, 513. Bean became professor
of anatomy at Tulane.
60. Buckland, In the Land of the Filipino, 231.
61. Fee, A Woman’s Impressions of the Philippines, 236.
62. W. Cameron Forbes, Journals, October 19, 1907, 2:324–25, Forbes papers, fMS Am
1365, Houghton Library, Harvard University, Cambridge, Mass.
63. Freer, Philippine Experiences, 144.
64. Conger, Ohio Woman, 159, 51, 148.
65. W. P. Chamberlain to Surgeon General, June 24, 1905, rg 112-e26-72605-31, nara.
As Robert Joy points out, the first person to document carrier status (ironically, his
own) was Brigadier General George M. Sternberg, m.d., in ‘‘A Fatal Form of Sep-
tacemia in the Rabbit Produced by Subcutaneous Injection of Human Saliva.’’ Frie-

262 notes to chapter 3

 drich Loeffler identified diphtheria carriers in 1884. On the development of the idea
of carrier status in the 1890s by Robert Koch and William H. Park, see Winslow, The
Conquest of Epidemic Disease, chapter 16.
66. P. E. Garrison et al., ‘‘Medical Survey of Taytay.’’ On the ‘‘latent malaria’’ of Phil-
ippine scouts, see James M. Phalen to C. E. Woodruff, March 4, 1903, rg 112-
e26-77872-33, nara.
67. Chamberlain et al., ‘‘Examination of Stools and Blood among the gorots.’’
68. P. E. Garrison, ‘‘The Prevalence and Distribution of the Animal Parasites of Man in
the Philippine Islands,’’ 205.
69. Headquarters, Third Brigade, Department of Luzon, Circular No. 7, March 2, 1903,
rg 112-e26-77872-33, nara.
70. Manson, Tropical Diseases (1914), 368.
71. Vaughan, Infection and Immunity, 179. Zinsser discusses the limitations of the im-
munities of race in Infection and Resistance, chapter 3.
72. Castellani and Chalmers, Manual of Tropical Medicine, 115.
73. LeRoy, Philippine Life in Town and Country, 54.
74. Moses, Unofficial Letters of an Official’s Wife, 222.
75. Chief Surgeon, Philippines Division, to Surgeon General, December 31, 1909, gr
112-e26–24508–120, nara. See also the ‘‘Report on Typhoid Fever,’’ September 30,
1909, rg 112-e26-68075-73, nara.
76. Chief Surgeon, Philippines Division, to Surgeon General, December 31, 1909, p. 13,
gr 112-e26-24508-120, nara.
77. Quoted in Chief Surgeon, Philippines Division, to Surgeon General, December 31,
1909, p. 21, rg 112-e26-24508-120, nara. On the use of the Widal test to diagnose
typhoid, see Heiser, ‘‘Typhoid Fever in the Philippine Islands.’’
78. Quoted in Chief Surgeon, Philippines Division, to Surgeon General, December 31,
1909, p. 17, rg 112-e26-24508-120, nara.
79. Quoted in Chief Surgeon, Philippines Division, to Surgeon General, December 31,
1909, p. 23, rg 112-e26-24508-120, nara.
80. Craig, ‘‘Observations upon Malaria,’’ 525. Craig is better known for his work on the
parasitic amoebae of man.
81. Ibid.
82. Charles F. Craig, Report, quoted in Chief Surgeon, Philippines Division, to Surgeon
General, March 7, 1908, p. 10, rg 112-e26-24508-38, nara.
83. Craig, ‘‘Observations upon Malaria,’’ 525.
84. Colonial scientists also conducted extensive vaccine and therapeutic experimenta-
tion on Filipino prison inmates during this period. Perhaps the most notorious of
these studies was Richard P. Strong’s inoculation of twenty-four inmates at Bilibid
with a new live cholera vaccine that had somehow become contaminated with plague
organisms. A virulent plague culture had been accidentally mixed with the cholera
cultures. All the men sickened, and thirteen died. After an investigation, Strong was
exonerated. Strong had, though, conducted the inoculations ‘‘in the convalescent
ward [where] he ordered all the prisoners there to form a line . . . without telling them
what he was going to do, nor consulting their wishes in the matter’’ (‘‘Report of the

notes to chapter 3 263

 General Committee,’’ 1 March 1907, p. 11, rg 350-4341-21, nara). Neither cholera
nor plague was prevalent in the prison at the time. The investigating committee
suggested that Strong had forgotten ‘‘the respect due every human being in not
having asked the consent of persons inoculated.’’ It enjoined the governor-general to
order that no one would be subjected to ‘‘experiment without prior determination of
the character of that experiment by authorities . . . nor without having first gained
the expressed consent of the person subject to it’’ (‘‘Report of the General Commit-
tee,’’ March 1, 1907, p. 18, rg 350-4341-21, nara). See Chernin, ‘‘Richard Pearson
Strong and the Iatrogenic Plague Disaster.’’ Chernin (1001) points out that Strong’s
earlier study of plague immunization (1905), also conducted without consent, has
been presented as a case study in human experimentation in Katz, Experimentation
with Human Beings.
85. Antityphoid immunization was available from 1911 for troops stationed in the Phil-
ippines, but not for Filipinos (and not for American civilians either): see Frederick
Russell, The Results of Anti-Typhoid Vaccination in the Army.
86. Heiser, ‘‘Unsolved Health Problems,’’ 174–75.
87. Ibid., 175.
88. Annual Report of the Bureau of Health for the Philippine Islands, July 1, 1912–June
30, 1913 (Manila: Bureau of Printing, 1913), 61.
89. Chapin, ‘‘Dirt, Disease and the Health Officer,’’ 21, 24. A report on Chapin’s visit to
Havana can be found in the Providence Medical J. 2 (1902): 103–05. Chapin, a
friend of William Crawford Gorgas, paid close attention to colonial public health
work. See also Cassedy, Charles V. Chapin and the Public Health Movement.
90. Chapin, ‘‘The Fetich of Disinfection,’’ 75. See also Chapin, Sources and Modes of
Infection.
91. Winslow, ‘‘Man and the Microbe,’’ 9. Winslow was professor of public health at
Yale.
92. Leavitt, Typhoid Mary. On the new public health, see Hill, The New Public Health;
Rosen, A History of Public Health; Rosenkrantz, Public Health and the State; Lea-
vitt, Healthiest City; Rogers, ‘‘Germs with Legs’’; Duffy, The Sanitarians; and Porter,
Health, Civilization and the State. Nancy Tomes also describes a shift in interest from
dust and fomite infection to a concern with healthy carriers and contact infection
during the first two decades of the twentieth century. See Tomes, The Gospel of
Germs. Tomes tends to emphasize the ways in which germs overcame social divi-
sions, rather than sharpened them.
93. Taft, ‘‘Address of President Taft,’’ 505.
94. Ibid.
95. Shah, Contagious Divides. See also Trauner, ‘‘The Chinese as Medical Scapegoats in
San Francisco’’; McClain, ‘‘Of Medicine, Race and American Law’’; and Craddock,
City of Plagues.
96. Howard, ‘‘The Negro as a Distinct Ethnic Factor in Civilization,’’ 424, quoted in
Fredrickson, The Black Image in the White Mind. A few other southern physicians
began to urge ‘‘the development and upbuilding of the minds, morals and bodies of a
‘child race,’ ’’ in order to protect whites from Negro tuberculosis’’ (Harris, ‘‘Tuber-

264 notes to chapter 3

 culosis in the Negro,’’ 837). See also Galishoff, ‘‘Germs Know No Color Line’’;
Brown, ‘‘Purity and Danger in Color’’; and Abel, ‘‘From Exclusion to Expulsion.’’
97. Kraut, Silent Travelers; Markel, Quarantine!; and Fairchild, Science at the Borders.
See also Higham, Strangers in the Land.
98. Monnais-Rousselot, Médecine et Colonisation, 170, 165.
99. Manderson, Sickness and the State; and Gouda, Dutch Culture Overseas.
100. Davisakd Puaksom, ‘‘Modern Medicine in Thailand: Germ, Body, and the Medi-
calized State’’ (Unpublished ms., c. 2004).
101. Liu, ‘‘Building a Strong and Healthy Empire’’; and Lo, Doctors Within Borders.
102. Arnold, Colonizing the Body. Operating through the Rockefeller Foundation, Hei-
ser and other ex-Philippines health officers had a profound influence on these re-
gional developments in the 1920s and 1930s: see Conclusion.
103. See, for example, Anon., ‘‘Stand Off Heiser’s Men at the Point of a Gun: Filipino
Family in Santa Cruz Would Die Rather than Be Disinfected,’’ Manila Times (July
1, 1907), 1.
104. Musgrave, ‘‘Progress of Medicine in the Philippines,’’ 143.
105. Herzog, ‘‘The Brain Weight of Filipinos,’’ 42, 47.
106. McLaughlan, ‘‘The Suppression of a Cholera Epidemic in Manila,’’ 55.
107. Heiser, ‘‘Unsolved Health Problems,’’ 176.
108. Thomas W. Jackson, ‘‘Sanitary Conditions and Needs in Provincial Towns,’’ pjs 3b
(1908): 431–38, at 432, 435–36.
109. Cablenews-American (May 30, 1909).
110. Shaler, ‘‘The Future of the Negro in the Southern States,’’ 151. On Shaler, the
‘‘forefather of American geography,’’ see Livingstone, ‘‘Science and Society.’’
111. Shaler, ‘‘The Transplantation of a Race,’’ 521. Shaler was surprised at how well
Africans—those ‘‘tropical exotics’’—had acclimatized to North America. They had
withstood their ‘‘trials of deportation in a marvelous way,’’ with no particular
liability to disease or impairment of fecundity (514). He supposed this was because
slave-owners had sensitively managed their health and breeding (518).
112. Bullard, ‘‘Some Characteristics of the Negro Volunteer,’’ 29. When Arthur A. Sny-
der, m.d., volunteered as a surgeon with one of the ‘‘immune regiments,’’ the sur-
geon general asked him if he was ‘‘an immune.’’ As he was white, his application
initially was rejected—he had to be ‘‘an immune or nothing.’’ Later he received a
posting in a nonimmune regiment. See Arthur Augustine Snyder, ‘‘Experiences of a
Contract Surgeon,’’ ms., n.d., p. 1, Spanish-American War Survey, U.S. Army Mili-
tary History Institute, Carlisle Barracks, Penn.
113. Bullard, ‘‘Some Characteristics of the Negro Volunteer,’’ 30–31. Bullard had en-
sured that ‘‘men with a larger proportion of white blood [were] rejected’’ (30). See
also Gatewood, Black Americans and the White Man’s Burden, esp. 297–309.
114. Rhodes, ‘‘The Utilization of Foreign Troops in Our Foreign Possessions,’’ 6, 7. The
exception refers to what we now know as dengue.
115. Ibid., 7. See also Seaman, ‘‘Native Troops for Our Colonial Possessions.’’
116. Fortune, ‘‘The Filipino,’’ 202–3. Roosevelt had appointed Fortune in 1902 to inves-
tigate labor and race relations in the insular possessions. Also in favor of Negro

notes to chapter 3 265

 colonization was Scarborough, ‘‘The Negro and Our New Possessions.’’ Opposed
was Lemus, ‘‘The Negro and the Philippines.’’ By 1903, there was little official
interest in the idea. See Moore, ‘‘Senator John Tyler Morgan and Negro Coloniza-
tion in the Philippines’’; and Gatewood, Black Americans.
117. Congressional Record, 57th Congress, 1st Session, May 7, 1902, 5103. But studies
continued. See, for example, the report of the comparative fitness of white and
colored troops in Assistant Surgeon General to Chief of Staff, U.S. Army, April 27,
1907, rg 112-e26-48453-d, nara.

4. excremental colonialism
1. Bureau of Health, The Disposal of Human Wastes in the Provinces, 4–5
2. De Witt, ‘‘A Few Remarks Concerning the Health Conditions of Americans in the
Philippines,’’ 56.
3. Marshall, Asiatic Cholera in the Philippine Islands, 9.
4. See especially Corbin, The Foul and the Fragrant. Laporte has suggested that ‘‘ap-
prenticeship in smelling [was] directed entirely toward excrement’’ (Histoire de la
Merde, 60) and that the rise of a strong state led to the privatizing and constrained
circulation of smell-producing excrement.
5. Vigarello argues that the microbe ‘‘materialized’’ the risk previously associated with
odor, in Concepts of Cleanliness, 203. On ‘‘excremental vision,’’ see Brown, ‘‘The
Excremental Vision.’’
6. Chapin, ‘‘Dirt, Disease and the Health Officer,’’ 21.
7. Munson, The Theory and Practice of Military Hygiene. See chapter 1.
8. Douglas, Purity and Danger, 35. William James, in his lecture ‘‘The Sick Soul,’’ also
refers to the challenge that ‘‘matter out of place’’ presents to any system—‘‘evil’’ can
thus be represented as ‘‘an alien unreality, a waste element, to be sloughed off and
negated,’’ and the ‘‘ideal’’ is ‘‘marked by its deliverance from all contact with this
diseased, inferior, and excrementitious stuff’’ (113). Of course James warns us
against ‘‘medical materialism,’’ that is, reducing symbolic systems to a medical
explanation. (James was a friend and correspondent of some of the senior colonial
administrators in the Philippines, in particular W. Cameron Forbes.)
9. See Stallybrass and White, ‘‘The City: The Sewer, the Gaze and the Contaminating
Touch,’’ in The Politics and Poetics of Transgression.
10. The emphasis of this chapter differs slightly from a previous version: see Anderson,
‘‘Excremental Colonialism.’’ See also Mbembe, ‘‘The Banality of Power’’; Lee, ‘‘Toi-
let Training the Settler Subject’’; and Esty, ‘‘Excremental Postcolonialism.’’
11. On abjection, ‘‘which modernity has learned to repress, dodge or fake’’ (26), see Kris-
teva, Powers of Horror. She describes the abject as ‘‘something rejected from which
one does not part, from which one does not protect oneself as from an object’’ (4).
12. See, for example, Heiser, ‘‘Sanitation in the Philippines.’’ On the necessary pre-
liminary performance of rottenness, see De Certeau, ‘‘The Institution of Rot,’’ in
Heterologies, 42.
13. Elias, The Civilizing Process. Bourdieu has argued more generally that the reforma-
tion of manners ‘‘extorts the essential while seeming to demand the insignificant,’’

266 notes to chapter 4

 ensuring that ‘‘the concessions of politeness always contain political concessions’’
(Outline of a Theory of Practice, 90).
14. On the body as a medium of social expression, see Mauss, ‘‘Techniques of the Body.’’
The relation I am sketching here between the ‘‘technologies of domination of others’’
and the ‘‘technologies of the self,’’ Foucault, in his later work, has called ‘‘govern-
mentality.’’ See ‘‘Governmentality’’; ‘‘The Political Technology of Individuals’’ in
Technologies of the Self; ‘‘Body/Power,’’ in Power/Knowledge; and Discipline and
Punish.
15. Phelan, ‘‘Sanitary Service in Surigao,’’ 3, 7, 6, 18, 17, 10, 17.
16. Munson, ‘‘Cholera Carriers in Relation to Cholera Control,’’ 5, 9. See also Shöbl,
‘‘Observations Concerning Cholera Carriers.’’
17. Paul C. Freer, Eighth Annual Report of the Director of the Bureau of Science, For the
Year Ending August 1, 1909 (Manila: Bureau of Printing, 1910), 16. Alvin J. Cox,
Thirteenth Annual Report of the Director of the Bureau of Science, For the Year
Ending December 31, 1914 (Manila: Bureau of Printing, 1915), 11, 12.
18. Sanitary engineering—the construction of sewers and a clean water supply—offered
to limit contact with native excreta, but these major projects did not much alter
conditions in Manila until 1910, and then only in the more prosperous districts. In
the rest of the archipelago, behavior change remained the only alternative—and a
cheaper one too.
19. P. E. Garrison, ‘‘The Prevalence and Distribution of the Animal Parasites of Man,’’
p. 208.
20. Benjamin J. Edger, ‘‘Some Medical and Sanitary Experiences’’ [c. 1904], p. 7, rg
112-e26-72605-27, nara. See also ‘‘Report of Major Franklin A. Meacham, chief
surgeon 3rd military district of the Department of Northern Luzon, to Chief Sur-
geon Department of Northern Luzon, May 31, 1900,’’ in Sternberg, Report of the
Surgeon-General of the Army, 1900, 140.
21. Chamberlin, The Philippine Problem, 113–14.
22. Strong et al., ‘‘Medical Survey of the Town of Taytay.’’
23. Edger, ‘‘Some Medical and Sanitary Experiences,’’ 5, 15.
24. Moses, Unofficial Letters of an Official’s Wife, 14, 16, 221, 226. More generally, see
Rafael, ‘‘Colonial Domesticity.’’
25. Conger, An Ohio Woman in the Philippines, 51, 70.
26. Mearns, A Philippine Romance, 77. Naturally, Patricia felt out of place among these
‘‘barbarous people just emerging from centuries of superstition, fear and medi-
evalism’’ (36).
27. Dauncey, An Englishwoman in the Philippines, 242. Mrs. Dauncey, a terrible English
snob, lamented that the manners of bourgeois white Americans were those of ‘‘ordi-
nary European peasants’’ (12), and she disparaged the ‘‘half-finished, skin-deep,
hustling modernity of Americanized Manila’’ (133). It seemed to her ‘‘a pity that such
rough diamonds should represent to these natives the manners and intellect of a great
and ruling white nation’’ (13).
28. On the grotesque, defecating body and its opposite, see Bakhtin, Rabelais and His
World. Bakhtin, however, argues for the authenticity of the grotesque folkloric, and
the communal bodies he describes are isolated by the fracture lines of class, not race.

notes to chapter 4 267

29. Haraway describes a similar masculine American relation to the natural world in
‘‘Teddy Bear Patriarchy: Taxidermy in the Garden of Eden, New York City, 1908–
1936,’’ in Primate Visions.
30. The ‘‘American sublime’’ is a rhetorical sublime, not the metaphysics of the un-
presentable. It is a colonial displacement of the ‘‘sublimated spectacle of national
empowerment’’ that Wilson has described in American Sublime and in ‘‘Techno-
euphoria and the Discourse of the American Sublime,’’ 208.
31. Lefebvre, The Production of Space, esp. 285–91. Lefebvre describes the production
of abstract space from the sixteenth century, as it in part supplanted the ‘‘space of
accumulation,’’ typically the marketplace.
32. See rg 350-3466-0, nara. Act No. 607 (June 30, 1903) transferred the serum labo-
ratory of the Board of Health to the Bureau of Government Laboratories. Act No.
1407 (October 26, 1905) reorganized the laboratories into the Bureau of Science. See
Velasco and Baens-Arcega, The National Institute of Science and Technology, 1901–
1982; Quisumbing, ‘‘Development of Science in the Philippines’’; and Anderson,
‘‘Science in the Philippines.’’
33. Act No. 156, section 2, rg 350-3466-0, nara.
34. Act No. 156, section 2, p. 10, rg 350-3466-0, nara.
35. Freer, Description of the New Buildings of the Bureau of Government Laboratories,
8.
36. Ibid., 13. This is the original building, still standing on the campus of the Philippines
Medical School. In 1912, a new wing was opened to contain a division of mines, the
section of fisheries and fish products, the entomological collections and laboratories,
and a new herbarium and library. See Paul C. Freer, Tenth Annual Report of the
Director of the Bureau of Science, for the year ending August 1, 1911 (Manila:
Bureau of Printing, 1912), 3–5.
37. Freer, Description of the New Buildings, 21.
38. Freer, Third Annual Report of the Director of the Bureau of Science, 1903–04
(Manila: Bureau of Printing, 1904), 16–18.
39. Freer, Description of the New Buildings, 29. Freer described the herbarium as ‘‘a
card catalogue of the economic and scientific aspects of Philippine botany’’ (Fourth
Annual Report of the Director of the Bureau of Science, 1904–05 [Manila: Bureau of
Printing, 1905], 4).
40. Freer, Third Annual Report, 1903–04, 11.
41. Ibid., 26.
42. LeRoy, Philippine Life in Town and Country, 290.
43. Hayden, The Philippines: A Study in National Development, 644.
44. Latour, ‘‘Give Me a Laboratory and I Will Raise the World.’’
45. Freer, Third Annual Report, 1903–04, 24.
46. Bakhtin, Rabelais, 23.
47. Although such places do not seem to have retained the ‘‘utopian folk element’’—the
reveling, games, clowning, and so on—that Bakhtin found in an earlier European
carnivalesque, entering the market undoubtedly continued to produce a discomfort-
ing sense of a suspension of hierarchy, a sense of freedom and familiarity (Bakhtin,
Rabelais, 217–76). See Stallybrass and White, Transgression, on the carnivalesque as

268 notes to chapter 4

 a mode of understanding (6–19). They suggest that ‘‘repugnance and fascination are
the twin poles of the process in which a political imperative to reject and eliminate
the debasing ‘low’ conflicts powerfully and unpredictably with a desire for this
Other’’ (4–5). This vulnerable assumption of superiority actually depends on the
construction of the low Other.
48. LeRoy, Philippine Life in Town and Country, 54; Roosevelt, The Philippines: A
Treasure and a Problem, 233; Williams, The United States and the Philippines, 125;
and Freer, The Philippine Experiences of an American Teacher, 7–8. For a similar
account of the ‘‘filth’’ and the ‘‘swarming masses of people’’ in primitive markets, see
Lévi-Strauss, Tristes tropiques, 143–45.
49. Mayo, The Isles of Fear, 174. According to the Proposed Sanitary Code, 1920, Sect.
49, ‘‘Every person engaging in the dispatching, transportation, handling or manipu-
lation of food products . . . shall be provided with a certificate from the district health
officer . . . [to] show that he is in good health and he is not a carrier of pathogenic
germs’’ (22).
50. J. F. Smith to Secretary of War, November 22, 1908, rg 350-3465-91, nara. In the
early 1900s, when Buckland visited the Visayas, he found ‘‘not a knife, fork, nor
spoon, nor a tumbler in the whole barrio. I had to eat with a piece of bamboo cut in
the form of a paddle’’ (In the Land of the Filipino, 184).
51. Heiser, Annual Report of the Bureau of Health of the Philippine Islands, July 1,
1912–June 30, 1913 (Manila: Bureau of Printing, 1914), 29.
52. Fox, Handbook for Sanitary Inspectors.
53. Heiser, Annual Report of the Bureau of Health of the Philippine Islands, July 1,
1912–June 30, 1913 (Manila: Bureau of Printing, 1914), 29–30. Heiser argued that
the ‘‘habit of eating with the fingers’’ was the ‘‘largest factor in the transmission of
cholera and intestinal diseases’’ (‘‘Unsolved Health Problems,’’ 176).
54. Heiser, Annual Report, 1912–13, 28. The tienda proprietors generally were a cause
of considerable concern: ‘‘The tienda owner . . . shall wear clean clothes with or
without an apron. The hands must be kept clean and the finger nails short and well
trimmed.’’ So too were street peddlers: ‘‘The peddler must be neatly dressed. His
hands should be clean and the nails short’’ (Bantug, Gabriel, and Aguelles, A Simple
Manual for Sanitary Inspectors, 12, 14).
55. Heiser, Annual Report, 1912–13, 67–68.
56. [Miller], Interesting Manila, 191. In more ways than the metaphysical, then, ‘‘the
Anglo-Saxon lives in the concrete, the Oriental in the shadows’’ (17).
57. Carpenter, Through the Philippines and Hawaii, 24.
58. John D. Long, director of health, to W. H. Greenleaf, Jan. 7, 1918, rg 350-3465-97,
nara, provides a detailed account of these activities. See also Vicente de Jesús, ‘‘Cir-
cular W-82,’’ Philippine Health Service, Manila, Nov 20, 1924, rg 350-3465-132,
nara; and Heiser to commissioner of education, Dept. of the Interior, Washington,
D.C., Sept. 27, 1913, rg 350-3465-55, nara.
59. John D. Long to W. H. Greenleaf, Jan. 7, 1918, rg 350-3465-97, nara.
60. Bureau of Education and Philippine Health Service, Health: A Manual for Teachers,
consolidates instructions to teachers from the previous decade.
61. Ibid., 33.

notes to chapter 4 269

62. Ibid., 49.
63. Ibid., 5. On the development of the water closet in the late nineteenth century, see
Wright, Clean and Decent; and Goubert, The Conquest of Water, 91–97. The water
closet is an invention of the last decades of the nineteenth century: Wright goes so far
as to call 1870 the ‘‘annus mirabilis of the water closet’’ (201). On the enclosure of
the bathroom as a private space, from 1880 onward, see Vigarello, Concepts of
Cleanliness, 215–25.
64. Heiser, ‘‘Unsolved Health Problems,’’ 173.
65. Bureau of Health, Cholera Measures, 4.
66. Heiser, ‘‘Unsolved Health Problems.’’
67. Disposal of Human Wastes, 5–7.
68. Ibid., 7–9.
69. Large parts of Manila were sewered between 1905 and 1910. See Annual Report of
the Municipal Board of the City of Manila (Manila: Bureau of Printing, 1910), 81.
70. Willets, ‘‘Conditions Affecting Batanes Islands,’’ 51. Still, one was less likely to be as
embarrassed on the boat to Capiz as Buckland was in 1903: ‘‘A walk around the deck
failed to disclose any of the conveniences that Americans have come to regard as
absolute necessities. There was not a sign of a bathroom nor even of a lavatory any
place on the main deck’’ (Land of the Filipino, 62).
71. McLaughlin, ‘‘The Suppression of a Cholera Epidemic in Manila,’’ 49, 50.
72. Bureau of Health. Proposed Sanitary Code, 15–17. The director of health in his
report for the fiscal year 1919 had urged ‘‘preferential attention [be] given to the
disposal of human wastes’’ (p. 15, rg 350-3465-108, nara). A further description of
the ‘‘Antipolo system of toilet’’ is provided in Tianco (under the direction of Long),
Philippine Health Service Sanitary Almanac for 1919 and Calendars for 1920 and
1921, 13, 16–19.
73. Rizal, Noli Me Tangere, 166–92.
74. Dauncey, An Englishwoman in the Philippines, 52.
75. Moses, Unofficial Letters, 45, 17, 67. On public gatherings as sites of resistance, see
Ileto, Pasyon and Revolution.
76. Bureau of Health, ‘‘Sanitary Measures in Connection with Local Fiestas,’’ Provincial
Circular No. 124, Oct. 6, 1915, rg 350-3465-86, nara. On the dangers of fiestas,
see also Marshall, ‘‘Asiatic Cholera,’’ 8.
77. Bureau of Health, ‘‘Sanitary Measures in Connection with Local Fiestas.’’
78. Ibid. See also Annual Report Bureau of Health for the Philippine Islands, 1912–
1913, 33.
79. The Philippines Carnival, Manila, February 3–8, 1908, rg 350-5453-2, nara.
Gomez was the son of the Filipino statistician at the Bureau of Health.
80. O’Reilly, ‘‘Manila’s Grand Annual Carnival,’’ 55. O’Reilly, ironically, concluded:
‘‘Come, ye globe trotters, and enjoy our contagious enthusiasm!’’ (59).
81. Harry Debnam, ‘‘The Philippine Carnival: Being an Official Report of its Organiza-
tion, Purpose and Success,’’ pp. 14, 26, rg 350-5453-9, nara.
82. J. F. Smith to Chief, Bureau of Insular Affairs, March 5, 1908, rg 350-5434-5, nara.
83. ‘‘Manila Carnival’’ 1909, n.p., rg 350-5453-13, nara.

270 notes to chapter 4

 84. W. Cameron Forbes to Edwards, Bureau of Insular Affairs, June 17, 1909, rg
350-5453-14, nara.
85. W. Cameron Forbes to Major Frank MacIntyre, Bureau of Insular Affairs, Decem-
ber 6, 1910, rg 350-5453-24, nara.
86. W. Cameron Forbes to Jacob M. Dickinson, February 19, 1910, rg 350-5453-30,
nara. Still, these institutional carnivals played on a few extraordinary symbolic
inversions. In The Carnival Spirit, a gossip sheet published daily during the 1911
carnival, ‘‘Hemlock Jones,’’ the carnival detective, reported that he found Dr. Victor
Heiser ‘‘on the Main Street carrying a hypodermic syringe and injecting cholera
germs into the arms of luckless persons who came within his grasp’’ (rg
350-5453-38, nara). Perhaps memories of R. P. Strong’s use of contaminated vac-
cine at Bilibid were still fresh.
87. H. S. Howland to Secretary, Philippine Carnival Association, April 30, 1908, p. 4,
rg 350-5453-12, nara.
88. Editorial, La Vanguardia (January 19, 1911).
89. Editorial, La Democracia (February 8, 1911).
90. See Vaughan, ‘‘Ogling Igorots.’’
91. Editorial, El Ideal (January 23, 1912).
92. Editorial, La Vanguardia (January 27, 1912).
93. See, for example, La Vanguardia (January 30, 1912), El Ideal (February 1, 1912),
and La Vanguardia (February 1, 1912).
94. Anon., ‘‘Highly Artistic Red Cross Carnival,’’ 95.
95. Anon., ‘‘The 1918 Philippine Red Cross Carnival,’’ 196, 197.
96. Anon. ‘‘The 1918 Philippine Red Cross Carnival,’’ 198.
97. Anon., ‘‘Commercial Exhibits,’’ 3.
98. Anon., ‘‘The Carnival and the Student,’’ 6. For a report emphasizing sanitation in
the 1922 Carnival (and describing the first ‘‘Health Parade’’), see Anon., ‘‘Manila
Carnival and Commercial-Industrial Fair.’’
99. ‘‘Clean-Up Week.’’ Provincial Circular (Unnumbered), Oct. 21, 1914 rg 350-
3465- 80, nara. Clean-Up Week was also observed in many U.S. towns. Frank
Crone instructed teachers in the Philippines to explain to their students the meaning
of Clean-Up Week. ‘‘If ‘Clean-Up Week’ is carried out successfully the Philippines
will be cleaner than ever before in their history,’’ he declared. ‘‘Public health will be
improved accordingly’’ (‘‘Clean-Up Week.’’ Board of Education Circular No. 142,
Nov. 3, 1914, rg 350-3465-80, nara).
100. ‘‘Clean-Up Week.’’ Provincial Circular (Unnumbered), Nov. 2, 1915, rg 350-3465-
80, nara.
101. Clean-Up Week: A Patriotic Message to all Patriotic Citizens (Manila: Bureau of
Printing, 1922), rg 350-3465-80, nara. This pamphlet also suggests that ‘‘unsani-
tary condition is not compatible with our national pride and aspiration.’’
102. ‘‘Clean-Up Week.’’ Public Welfare Board Circular, Oct. 30, 1920, rg 350-3465-80,
nara.
103. Ibid.
104. Clean-Up Week: A Patriotic Message, 8. Clean-up Week was still popular in the

notes to chapter 4 271

 1930s: see Davis, ‘‘Significance of Clean-Up Week.’’ Davis, the governor-general of
the islands, pointed out that ‘‘the formation of health habits is an important factor
in the prevention of diseases. Health habits include sanitation, personal cleanliness,
plenty of fresh air, good nourishing food, sleep, sunshine, and exercise’’ (7). See also
the delightfully specific Organization and Activities of Clean-Up Week for 1924
(Manila: Bureau of Printing, 1924), rg 350-3465-80, nara. This is prefaced with a
‘‘proclamation’’ from Leonard Wood, then governor-general: he insists that ‘‘unat-
tractive unsanitary surroundings are inconsistent with the best traditions and ideals
of a progressive people’’ (5).
105. These are not, however, commonly regarded as sites where the nation may be
imagined. See Benedict Anderson, Imagined Communities; and Chatterjee, The
Nation and Its Fragments. Of course both Benedict Anderson and Chatterjee are
arguing about the sources of nationalism, which should be distinguished from what
I describe here: the creation of a certain sort of civic mentality, that is, the colonial
project of making proper, though never quite authentic, national subjects.
106. Joaquin, ‘‘Sa loob ng Manila,’’ 455.
107. Walker and Sellards, ‘‘Experimental Entamoebic Dysentery.’’ William H. Welch
had recommended Sellards, a Hopkins graduate, as a man with ‘‘a good training in
laboratory work in bacteriology and pathology . . . a gentleman of high character’’
(rg 350-19335-7, nara). Sellards was later a physician at Hopkins and Harvard.
See Sellards, ‘‘Bonds of Union between Tropical Medicine and General Medicine.’’
108. Douglas, Purity and Danger, 165. ‘‘Epistemological clarity’’ is from Stallybrass and
White, Transgression, 108.

5. the white man’s psychic burden

1. ‘‘Journal,’’ n.d [c. March 1912], vol. 5, p. 121, fMS Am 1365, W. C. Forbes papers,
Houghton Library, Harvard University. On Forbes, see Stanley, ‘‘William Cameron
Forbes.’’
2. Forbes to A. L. Lowell, Oct. 24, 1912, Dean’s File (T. M.) 1908–23, Code 11: 597,
Rare Book Room, Countway Medical Library, Harvard Medical School.
3. Adjutant general, Philippines Division, to P. M. Ashburn, March 15, 1912, rg
112-e26-68075-123, nara. P. M. Ashburn to adjutant general, March 18, 1912,
rg 112-e26-68075-123, nara.
4. Roosevelt, The Philippines, 245.
5. Beard, A Practical Treatise on Nervous Exhaustion (Neurasthenia). Rosenberg
has suggested that Beard’s work illustrates ‘‘the utility of scientific metaphor
and authority in helping rationalize a rapidly changing and stress-filled world’’
(‘‘George M. Beard and American Nervousness,’’ 98). On the rise of the diagnosis
of neurasthenia in America, see also Sicherman, ‘‘The Uses of a Diagnosis’’; Gos-
ling, Before Freud; and Lutz, American Nervousness 1903. See also Showalter, The
Female Malady, esp. chapter 5; Oppenheim, ‘‘Shattered Nerves’’; and Gijswijt-
Hofstra and Porter, eds., Cultures of Neurasthenia from Beard to the First World
War. On the related ‘‘discovery of fatigue’’ by European scientists after 1890, see
Rabinbach, The Human Motor.

272 notes to chapter 5

 6. On tropical neurasthenia in other imperial contexts, see Kennedy, ‘‘The Perils of the
Midday Sun.’’
7. See Vaughan, Curing Their Ills; Ernst, Mad Tales from the Raj, and ‘‘European
Madness and Gender in Nineteenth-century British India’’; McCulloch, Colonial
Psychiatry and ‘‘the African Mind’’; Sadowsky, Imperial Bedlam; and Mills, Mad-
ness, Cannabis, and Colonialism. For a perceptive review essay, see Keller, ‘‘Madness
and Colonization.’’
8. Hartnack, ‘‘Vishnu on Freud’s Desk’’; Nandy, ‘‘The Savage Freud’’; and Sudhir Ka-
kar, ‘‘Encounters of the Psychological Kind.’’
9. In American studies they are rarely recognized as such: both Bederman and Rotundo
emphasize the importance of the idea of empire in reshaping masculinity but do
not study the experience of empire. See Bederman, Manliness and Civilization; and
Rotundo, American Manhood. Yet Rafael has remarked on the Philippines as a
‘‘terrain for the testing and validation of white masculinity’’ (‘‘Colonial Domes-
ticity’’). See also Mrozek, ‘‘The Habit of Victory’’; and Kaplan, ‘‘Romancing the
Empire.’’
10. See Bederman’s helpful remarks on the redefining of manhood in terms of racial
dominance in the United States, in Manliness and Civilization.
11. Nandy, The Intimate Enemy; Hyam, Empire and Sexuality, 72; and Sinha, Colonial
Masculinities. On the mutually reinforcing categories of gender and empire, see also
Callaway, Gender, Culture and Empire; Sangari and Vaid, Recasting Women; Han-
sen, ed., African Encounters with Domesticity; Chaudhuri and Strobel, eds, Western
Women and Imperialism; and Nussbaum, Torrid Zones. All of these studies refer to
the British Empire.
12. Stoler, Race and the Education of Desire, 62, 99, 32. See especially Stoler, ‘‘Rethink-
ing Colonial Categories,’’ ‘‘Carnal Knowledge and Imperial Power,’’ and ‘‘Sexual
Affronts and Racial Frontiers.’’
13. Rosenberg, ‘‘Sexuality, Class and Role in Nineteenth-century America’’; Lears, ‘‘The
Destructive Element’’; Kimmel, ‘‘The Contemporary ‘Crisis’ in Masculinity in His-
torical Perspective’’; and Griffen, ‘‘Reconstructing Masculinity from the Evangelical
Revival to the Waning of Progressivism.’’
14. Bederman, Manliness and Civilization; and Rotundo, American Manhood. On the
flexibility of gender categories, see Scott, ‘‘Gender: A Useful Category of Historical
Analysis.’’
15. James, ‘‘The Moral Equivalent of War,’’ 323. On James’s own breakdown, see Fein-
stein, ‘‘The Use and Abuse of Illness in the James Family Circle.’’ For similar prescrip-
tions, see Roosevelt, The Strenuous Life.
16. The phrase is of course from Kipling’s poem ‘‘The White Man’s Burden.’’
17. Rafael, ‘‘White Love,’’ 200. See also Rafael, White Love, and Other Events in Fili-
pino History.
18. Much recent postcolonial criticism has valorized heterogeneity and hybridity: see,
for example, Bhabha, The Location of Culture; McClintock, Imperial Leather; and
Young, Colonial Desire.
19. The quotation is from Williams, Empire as a Way of Life. See also Kaplan, ‘‘ ‘Left
Alone with America,’ ’’ 14.

notes to chapter 5 273

20. See Kagan, Life and Letters of Fielding H. Garrison; the Fielding H. Garrison Memo-
rial Number of the Bulletin of the History of Medicine 5 (1937): 299–403; and
Brieger, ‘‘Fielding H. Garrison: The Man and His Book.’’ Garrison was a leading
figure in the study of medical history in the United States; the Fielding H. Garrison
lecture is delivered each year at the annual meeting of the American Association of
the History of Medicine. The Army Medical Library was the forerunner of the
National Library of Medicine.
21. Garrison-Mencken correspondence, box 5, F. H. Garrison papers, Ms c 166, History
of Medicine Division, National Library of Medicine, Bethesda, Md. I am grateful to
Elizabeth Toon for suggesting I look at the Garrison-Mencken correspondence.
22. Garrison frequently boasts about his alcohol consumption. He liked ‘‘above all the
local beer, which is well-brewed and of which I usually absorb two bottles a day in
the ‘wet’ (typhoon) season. There are also Burgundies, Spanish (Rioja) clarets, and
even some Rhine wines, also chartreuses, benedictines, and other cordials galore.’’
The Scotch ‘‘flows in rivers’’ (July 29, 1923).
23. ‘‘Review of the Year 1906,’’ 51; ‘‘Review of the Year 1907,’’ 241; ‘‘Review of the Year
1908,’’ 105; in cartons 2 and 3, David Prescott Barrows papers, mss c-b 1005,
Bancroft Library, University of California at Berkeley. Barrows had studied anthro-
pology at the University of Chicago. During his stay in the Philippines, Barrows was
losing a political battle over the direction of the school system. He returned to the
United States as a professor of education at Berkeley; and in 1919–23 he was presi-
dent of the University of California.
24. Herbert I. Priestley to mother, October 5, 1902; October 19, 1902; December 21,
1902; January 2, 1903; March 9, 1903, Priestley papers, mss 94/13 cz, Bancroft
Library, University of California at Berkeley.
25. Havard, ‘‘Is Mortality Necessarily Higher in Tropical than in Temperate Climates?’’
17, 20. Havard was an assistant surgeon general of the army. This is probably the
earliest article on tropical neurasthenia in the Philippines. But see Tucker, ‘‘Neuras-
thenia in Anglo-Indians.’’ Tucker suggested that in India too there is ‘‘a continual
strain upon the machinery of [British] bodies from the influence of a tropical climate’’
(44). Beard had doubted that neurasthenia was present in the tropics because of the
absence of any civilization in the region (Nervous Exhaustion, 189).
26. Temkin, ‘‘The Scientific Approach to Disease: Specific Entity and Individual Sick-
ness.’’
27. Woodruff, ‘‘The Neurasthenic States Caused by Excessive Light,’’ and The Effects of
Tropical Sunlight Upon the White Man. I discuss Woodruff’s theories in more detail
in chapter 3. For a similar explanation of the ‘‘lack of self-control,’’ ‘‘profound
nervous depression,’’ and ‘‘irritability of temper’’ that prevailed in sunny parts of the
United States, see Watkins, ‘‘Neurasthenia among Blondes in the Southwest,’’ 1374.
(Watkins was stationed with Woodruff at Plattsburgh Barracks, New York.) Wood-
ruff was probably responding to the theories of Sterne, ‘‘Neurasthenia and Its Treat-
ment by Actinic Rays.’’
28. See Pick, Faces of Degeneration.
29. Woodruff, Expansion of Races, 257, 274.

274 notes to chapter 5

30. ‘‘Charles E. Woodruff,’’ rg 94-1946apc87, nara. This file contains Woodruff’s med-
ical records, including the ‘‘Report’’ of March 31, 1910.
31. Fales, ‘‘Tropical Neurasthenia,’’586, 583. Fales also thought that attacks of dengue
fever and alcoholism frequently ‘‘predisposed to nerve exhaustion’’ (585). Fales had
spent three years as a medical inspector in the islands and become dissatisfied both
with the opportunities for private practice there and with ‘‘favoritism’’ in the Bureau
of Health. See his ‘‘The American Physician in the Philippine Civil Service.’’ Cas-
tellani and Chalmers in their Manual of Tropical Medicine rely heavily on Fales for
their description of tropical neurasthenia (1065). For another evocative account of
the ‘‘mental and physical stagnation and retrogression’’ of whites in the tropics, see
Edwin P. Wolfe, ‘‘Report on Research Work on the Effects of Tropical Climate on the
White Race’’ [c. 1906], rg 112-e26-72605-75, nara.
32. Fales, ‘‘Tropical Neurasthenia,’’ 591. Warnings of the damage to the mental appara-
tus of white children are commonplace and persistent: ‘‘In the case of European
children living in the tropics the whole nervous system seems to be in a condition of
unstable equilibrium so that, apart from illness, fretfulness and peevishness are com-
mon, and a condition often approaching hysteria may even be encountered’’ (Bal-
four, ‘‘Personal Hygiene,’’ 5).
33. Huntington, Civilization and Climate, 8, 42, 44. The lack of will power was often the
reason for fits of anger: ‘‘their power of self-control is enfeebled’’ (44).
34. Collini, ‘‘The Idea of ‘Character’ in Victorian Political Thought.’’ Oppenheim ex-
plains the importance of ‘‘will or ‘‘managerial force’’ as an organizing principle for
the nervous system in ‘‘Shattered Nerves’’ (42–43).
35. Fales, ‘‘American Physician,’’ 514. See also Fales ‘‘Tropical Neurasthenia,’’ 584.
Fales estimated that 50 percent of women and 30 percent of men in the American
community in Manila became neurasthenic.
36. Francis B. Harrison to secretary of war, September 30, 1914, letters, box 43, Francis
Burton Harrison papers, Library of Congress.
37. King, ‘‘Tropical Neurasthenia,’’ 1519. King was an assistant surgeon with the U.S.
Public Health and Marine Hospital Service. For an analysis of similar explanations
of female neurasthenia in the United States and Britain, see Showalter, Female Mal-
ady, esp. chapter 5; and Oppenheim, ‘‘Shattered Nerves.’’ On tropical menstrual
irregularities, see Mackinnon, ‘‘Diseases of Women in the Tropics.’’
38. For example, Moses, Unofficial Letters of an Official’s Wife; Dauncey, An English-
woman in the Philippines; and Mrs. W. H. Taft, Recollections of Full Years.
39. See Rafael, White Love.
40. Bernard Moses thought it was because the men of the army showed a ‘‘lack of wide
intellectual range’’—though ‘‘formally polite . . . to the best of knowledge and mem-
ory they never say anything’’ (February 8, 1901, Diary, vol. 2. Moses papers, mss
308x m911 di, Bancroft Library, University of California-Berkeley).
41. Eli L. Huggins to sisters, January 18, 1901, Huggins papers, mss 81/51 p, Bancroft
Library, University of California-Berkeley. Huggins retired in 1903 as brigadier gen-
eral. See Huggins, ‘‘Custer and Rain-in-the-Face’’; and Foreman, ‘‘General Eli Lundy
Huggins.’’ Dean C. Worcester, in his struggle with Col. L. M. Maus, claimed that the

notes to chapter 5 275

 director of health had suffered in the effort to control a cholera epidemic, and ‘‘he
had become excessively nervous and had at times been very depressed. On two
occasions he had shed tears in my office when discussing difficulties of minor impor-
tance’’ (D. C. Worcester to adjutant-general, March 2, 1909, p. 8, rg 94-67091-
a220, nara). Not surprisingly, Colonel Maus denied this accusation.
42. William P. Banta, ‘‘Medical History of als, Oct. 2, 1901,’’ and Richard McDonald,
‘‘Personal Report, Feb. 5, 1902,’’ ago file, rg 94-403201, nara.
43. William P. Banta, ‘‘Medical History of wb, Oct. 2, 1901’’ ago file, rg 94-403202,
nara.
44. Gimlette, ‘‘Notes on a Case of ‘Amok.’ ’’ For other local ‘‘culture-bound’’ syndromes,
all regarded as evidence of ‘‘mental degeneracy,’’ see Musgrave and Sison, ‘‘Mali-
mali, a Mimic Psychosis in the Philippine Islands.’’ See also Winzeler, ‘‘Amok: His-
torical, Psychological, and Cultural Perspectives’’; Ee, ‘‘Amok in Nineteenth-century
British Malaya History’’; and Ugarte, ‘‘ ‘Like a Mad Dog’: The Perceived Savageness
of ‘the Malay.’ ’’
45. Foreman, The Philippine Islands, 140. See also Ugarte, ‘‘Muslims and Madness in
the Southern Philippines.’’ Ugarte distinguishes premeditated juramentado or jihad
from amok.
46. Osler, ‘‘The Nation and the Tropics,’’ 1401, 1405. Osler, one of the leading physi-
cians of the late nineteenth century, had recently left the United States to take up the
Regius Chair of Medicine at Oxford.
47. ‘‘Report of the Secretary of War on the Philippines,’’ in Report of the Philippine
Commission to the President, 1907 (Washington, D.C.: Government Printing Office,
1908), 3:287. See also Worcester, The Philippines, Past and Present, 358–87; and
Reed, City of Pines. The Spanish had built a small sanitarium nearby at La Trinidad,
but a commission led by Worcester and Luke E. Wright, with Frank Bourns and L.
M. Maus as medical advisors, in 1900 decided to develop Baguio. Although a civil
sanitarium operated there from 1902, the road was opened only in 1905. On other
hill stations, see Kennedy, The Magic Mountains.
48. ‘‘Report of the Secretary of War,’’ 288.
49. W. Cameron Forbes, quoted in V. G. Heiser, Annual Report of the Bureau of Health
for the Philippine Islands, July 1912–June 1913 (Manila: Bureau of Printing, 1913),
63. Interestingly, this report extols the advantages of Baguio while condemning
Filipino recourse to Sibul Springs. Heiser refers to the ‘‘unsanitary conditions and
undesirable features which prevail at the Sibul baths’’ (31). He conceded that the
sulfurous water may have a specific effect on ‘‘chronic gastritis of a catarrhal nature’’
(32), but Filipinos, in their ignorance, took it also for ‘‘moist skin diseases, low-grade
ulcers, herpes, dyspepsia, . . . chronic dysentery, liver diseases, and menstrual disor-
ders’’ (64).
50. Atkinson, The Philippine Islands, 153.
51. John F. Minier to Harriet C. Huggins, August 15, 1912, mss 76/157p, Bancroft
Library, University of California-Berkeley.
52. Carpenter, Through the Philippines and Hawaii, 86.
53. Worcester to Miss C. E. Worcester, February 5, 1908, box 1, Worcester papers,
Bentley Historical Library, University of Michigan.

276 notes to chapter 5

54. Worcester, Philippines, 379, 387n.
55. H. R. Hoff to Surgeon General, Washington, D.C., Mar. 7, 1908, p. 31, rg 112-
e26-24508-100, nara.
56. Ibid., 32.
57. Ibid., 33.
58. Victor G. Heiser to Walter Wyman, Surgeon General U.S. Public Health Service, Jan.
14, 1908, Letterbook, 1901–13, vol. 15, Heiser papers, b:h357.p, American Philo-
sophical Society.
59. Heiser, An American Doctor’s Odyssey, 74.
60. But see Brooke, ‘‘Baguio as a Health Resort.’’
61. Charles Burke Elliott, Diary, June 10, 1912, Library of Congress. Elliott was secre-
tary of commerce and police between 1910 and 1912. When he left the Philippines
later in 1912 he took ‘‘the cure’’ at Carlsbad, where his physician detected evidence
of tropical residence. Forbes made perfunctory efforts to welcome elite Filipinos to
Baguio, but in general they found it too cold.
62. Editorial, El Ideal (April 22, 1911).
63. Editorial, El Ideal (June 6, 1911) . McDonnell was editor of the Cablenews; Hath-
away was Forbes’s secretary. See also the criticism in the June 21 issue; and the
concern about the cost of American self-indulgence in La Vanguardia (October 6,
1911). Randy David has recently defended the investment in Baguio, arguing that
‘‘the American governors knew that leisure was a complement to the work ethic’’
(Philippine Daily Inquirer [December 30, 2001]).
64. Memorandum Book No. 1 (Army and Navy Club, Philippines), Garrison papers, Ms
c 166, History of Medicine Division, National Library of Medicine. Garrison’s later
memoranda books consist mostly of literary quotations and clinical descriptions,
without passages of self-analysis.
65. Garrison returned to Baltimore, his nervousness apparently under control once he
was back in the United States.
66. On the selective appropriation of Freud in America, see Hale, Freud and the Americans.
Interestingly, Garrison (who had read Freud in German) seems far more receptive than
most early American psychoanalysts to Freud’s theories of infantile sexuality.
67. Stone, ‘‘Shellshock and the Psychologists.’’ See also Hale, The Rise and Crisis of
Psychoanalysis in the United States, esp. chapter 1.
68. Thompson, ‘‘ ‘Tropical Neurasthenia’: A Deprivation Psychoneurosis,’’ 319.
69. Ibid., 325. See also Beard’s later emphasis on ‘‘sexual neurasthenia.’’
70. V. B. Green-Armytage, ‘‘Discussion,’’ in Acton, ‘‘Neurasthenia in the Tropics,’’ 7.
Acton was professor of bacteriology at the Calcutta School of Tropical Medicine and
Hygiene; Green-Armytage was a gynecologist.
71. Hill, ‘‘Neurasthenia in the Tropics,’’ 234. Berkeley Hill was superintendent of the
European Mental Hospital at Ranchi, Bihar, between 1919 and 1934. In 1922, he
was one of fifteen psychiatrists brought together by Girindrasekhar Bose to form the
Indian Psychoanalytic Society. See Hartnack, ‘‘British Psychoanalysts in Colonial
India,’’ and ‘‘Vishnu on Freud’s Desk.’’ Nandy refers to Berkeley Hill as the ‘‘first
Westerner to attempt a psychoanalytic study of the Hindu modal personality and the
first Westerner to use psychoanalysis as a form of cultural critique in India’’ (‘‘Savage

notes to chapter 5 277

 Freud,’’ 96). But if critique at all, it was a strangely complicit one: see Hill, ‘‘The
‘Colour-question’ from a Psychoanalytic Standpoint.’’
72. C. J. Singapore ‘‘Mental Irritability and Breakdown in the Tropics,’’ bmj i (March
13, 1926): 503–04. The bishop observed, ‘‘Countries such as British Malaya are now
distinctly healthy, but ‘nerves’ are as frequent a cause of breakdown as ever,’’ 503.
See later contributions, under the same title, by A. F. MacCallan, bmj i (March 20,
1926): 545–46; Andrew S. McNeil and R. van Someren, bmj i (March 27, 1926):
595–96; R. Murray Barrow and J. W. Thomson, bmj i (April 3, 1926): 634–35; H.
M. Hanschell, M. Iles, and E. Rivaz Hunt, bmj i (April 10, 1926): 676–77; George
Mahomed and K. Vaughan, bmj i (April 24, 1926): 760–61; Andrew S. McNeil, bmj
i (May 8 and 15, 1926): 846–47; Q. B. de Freitas, M. Jackson, and L. D. Parsons,
bmj i (May 22, 1926): 884; and J. W. Lindsay, bmj i (May 29, 1926): 920. An
editorial (‘‘The White Man in the Tropics,’’ bmj i [May 29, 1926]: 909–10) was
optimistic about the prospects for settling a working white race in the tropics but
pointed out that ‘‘shibboleths die hard’’ (910).
73. Hill, ‘‘Mental Hygiene of Europeans in the Tropics,’’ 392. Hill had married an Indian
in order to escape his neuroses.
74. Joseph R. Darnell, ‘‘Sojourn in Zamboanga’’ [typescript, c. 1949], U.S. Army Mili-
tary History Institute, Carlisle Barracks, Penn, 190, 195. Fugate had arrived in the
Philippines in 1903 and remained there until 1938, when he was murdered.
75. Historians are prone to structure such breakdowns of male identity as feminization,
but I would argue that male neurasthenia connoted disorder and fragmentation so
profound as to subvert the sort of coherence that feminization implies. To be called
unmanned is not always to be named woman. On the coding of aporias in grand nar-
ratives as feminine, see Jardine, Gynesis: Configurations of Women and Modernity.
76. For an ethnographic project to retrieve embodied memory, see Kleinman and Klein-
man, ‘‘How Bodies Remember.’’
77. For example, there is still the folk diagnosis of ‘‘going troppo’’ in northern Australia
and perhaps similar popular residuals in other tropical settler societies (see Ander-
son, The Cultivation of Whiteness, chapter 6). Recently there has been renewed
critical attention to white male ambivalence in colonial settings: Nandy has de-
scribed Kipling’s ‘‘pathetic self-hatred and ego construction which went with colo-
nialism’’ (‘‘The Psychology of Colonialism,’’ 209); and Bhabha observes that ‘‘the
colonizer is himself caught in the ambivalence of paranoic identification’’ (Location
of Culture, 61). Bhabha argues that by avoiding the earlier emphases on personal
responsibility and on the recovery of masterful identity, it may be possible ‘‘to redeem
the pathos of cultural confusion into a strategy of political subversion’’ (61).
78. Musgrave, ‘‘Tropical Neurasthenia, Tropical Hysteria and Some Special Tropical
Hysteria-like Neuropsychoses,’’ 399, 400, 401.
79. Musgrave clung to a mechanistic theory of Filipino neurasthenia which emphasized
simple racial incompetence, but a later generation of colonial psychiatrists would
render the male native conflicted, or hybrid, and therefore psychoanalyzable. Just as
Freud had discovered the tropics within the European mind, colonial psychoanalysts
like Berkeley Hill began to argue that the elite native might yet develop a superego.
For later developments in ‘‘socioanalysis,’’ see Fanon, Black Skin, White Masks; and

278 notes to chapter 5

 Memmi, The Colonizer and the Colonized. For more on critical colonial psycho-
analysis, see Gates, ‘‘Critical Fanonism.’’ Gates notes that in Fanon’s work, ‘‘the
Freudian mechanisms of psychic repression are set in relation to those of colonial
repression’’ (466). Similarly, Bhabha has referred to ‘‘Fanon’s sociodiagnostic psychi-
atry’’ (‘‘Remembering Fanon,’’ xx). For an interesting account of Fanon’s ‘‘socio-
therapy,’’ see Vergès, ‘‘Chains of Madness, Chains of Colonialism.’’

6. disease and citizenship

1. On the history of the Culion leper colony, see Thomas, A Study of Leprosy Colony
Policies, chapter 7; [Wade, ed.], Culion: A Record of Fifty Years Work with the
Victims of Leprosy at the Culion Sanitarium; Chapman, Leonard Wood and Leprosy
in the Philippines; and Anderson, ‘‘Leprosy and Citizenship.’’
2. Mr. V. to Rev. Frederick Jansen, May 8, 1927, Culion Museum. On the transfer of
Estela, see Casimiro B. Lara, m.d., to Director of Health, Manila, February 25, 1927,
Culion Museum.
3. See Elias, The Civilizing Process. See also Bauman, Modernity and Ambivalence; and
Burkitt, ‘‘Civilization and Ambivalence.’’ On similar reformism at the Iwahig Prison
Colony, see Michael Salman, ‘‘The United States and the End of Slavery in the
Philippines, 1898–1914: A Study of Imperialism, Ideology, and Nationalism’’ (ph.d.
dissertation, Stanford University, 1993), esp. chapter 23. Zinoman has criticized the
efforts of Salman and others to ‘‘locate in colonial environments a system of power
relations marked by the pervasive circulation of disciplinary practices throughout
the social body’’ (The Colonial Bastille, 7). Yet he later concedes that Vietnamese
‘‘incarceration promoted certain characteristically modern attitudes toward society
and human nature’’ (131).
4. On nationalism’s tendency to forget, see Renan, Qu’est-ce qu’une nation?
5. Chakrabarty, ‘‘Of Garbage, Modernity and the Citizen’s Gaze.’’
6. Victor G. Heiser, ‘‘The Culion Leper Colony: One of the Outgrowths of Our Oc-
cupation of the Philippine Islands,’’ December 14, 1914, p. 6, Heiser collection,
b:h357.p, American Philosophical Society.
7. Heiser Diaries, July 13, 1914, Heiser collection, b:h357.p, American Philosophical
Society.
8. Stoler, ‘‘Tense and Tender Ties,’’ 832.
9. Ibid.
10. Foucault, Discipline and Punish, 144.
11. Foucault, Abnormal, 46.
12. Foucault, Discipline and Punish, 199. For a complication of this argument, see Pegg,
‘‘Le corps et l’authorité: la lèpre de Badouin IV.’’
13. Vaughan, ‘‘Without the Camp: Institutions and Identities in the Colonial History of
Leprosy,’’ in Curing Their Ills, 79.
14. Kipp, ‘‘The Evangelical Uses of Leprosy,’’ 176. For another account of leper evan-
gelizing, see Kakar, ‘‘Leprosy in British India, 1860–1940.’’ See also Harriet Jane
Deacon, ‘‘A History of the Medical Institutions on Robben Island, Cape Colony,
1846–1910’’ (ph.d., University of Cambridge, 1994), esp. chapter 6; Buckingham,

notes to chapter 6 279

 Leprosy in Colonial South India; and Obregón, Batallas contra la lepra, and ‘‘The
Anti-leprosy Campaign in Colombia.’’
15. Heiser later claimed that the attitude of Filipinos ‘‘fluctuated between a great horror
of [leprosy] amounting almost to a panic, and the greatest callousness’’ (An Ameri-
can Doctor’s Odyssey, 220). On the developing bacteriological understanding of
leprosy in the Philippines at the end of the Spanish period, see M. Rogel, ‘‘Lepra en
Visayas,’’ El Boletín de Cebú (Dec. 15, 1895), (Dec. 22, 1895), and (Dec. 29, 1895).
16. MacNamara, ‘‘Leprosy,’’ 426, 448, 448–49.
17. Gatewood, ‘‘Report on the International Conference on Leprosy,’’ 155, 158. He had
attended the First International Leprosy Conference in Berlin, which recommended
the segregation of lepers. See also Pandya, ‘‘The First International Leprosy Con-
ference, Berlin, 1897’’; and Robertson, ‘‘Leprosy and the Elusive M. leprae.’’
18. Manson, Tropical Diseases (1898), 412, 417. Difficulties in transmitting the disease
through inoculation led to disputes over the degree of contagiousness, but few au-
thorities doubted that infection would eventually take place. Heiser concurred that
‘‘prolonged intimate contact’’ was necessary for infection, but he was understand-
ably far more optimistic about the feasibility of segregation (‘‘Tropical Diseases,’’
195, 204).
19. Manson, Tropical Diseases (1914), 627. On the supposed susceptibility of ‘‘dressed
natives’’ to tuberculosis (caused by another mycobacterium), see Packard, White
Plague, Black Labor.
20. Dean C. Worcester, ‘‘Report of the Committee Appointed to Select a Site for a Leper
Colony,’’ Jan. 1, 1902, pp. 447, 449, rg 350-1972-2, nara. Worcester, the secretary
of the interior, was chairman of the search committee.
21. D. C. Worcester to J. E. Reighard, April 23, 1903, box 4, Reighard papers, Bentley
Library, University of Michigan Historical Collections, Ann Arbor.
22. Heiser, ‘‘The Culion Leper Colony,’’ 1–2. See also, Victor G. Heiser to Secretary of
the Interior, Memorandum, 1911, rg 350-1972-31, nara.
23. H. B. Wilkinson to Commissioner of Public Health, September 1, 1903, Wilkinson
folder, U.S. Medical Corps box, Spanish-American War survey, U.S. Army Military
History Institute, Carlisle Barracks, Penn.
24. Case report, rg 350-1972-16, nara. Heiser, An American Doctor’s Odyssey, 235.
25. Heiser, ‘‘Culion Leper Colony,’’ 5.
26. Heiser, An American Doctor’s Odyssey, 220.
27. Victor G. Heiser, Diary, Sept 1, 1908, Heiser collection, b:h357.p, American Philo-
sophical Society. On accusations of insidious harm as a technique of exclusion and
control, see Douglas, ‘‘Witchcraft and Leprosy: Two Strategies of Exclusion.’’
28. C. E. MacDonald to Isadore Dyer, m.d., August 15, 1908, Charles Everett Mac-
Donald papers, U.S. Army Military History Institute, Carlisle Barracks, Penn.
29. Richard Johnson, ‘‘My Life in the Army, 1899–1922’’ (typescript, 1952), 107, 108,
Johnson papers, U.S. Army Military History Institute, Carlisle Barracks, Penn.
30. See Victor G. Heiser, ‘‘Memorandum of Leper Collecting Trip,’’ June–July 1913,
Heiser collection, b:h357.p, American Philosophical Society. See also, Teofilo Cor-
pus, ‘‘Experiences in Collecting Lepers,’’ Philippine Health Service Monthly Bulletin
4 (October 1924): 450. The accusation of leprosy became a potent weapon in local

280 notes to chapter 6

 disputes. Thus when Teodulfo Ylaya wrote a scathing play about Vicente Sotto, a
Cebuano politician, he was denounced as a leper. Sotto ensured that Ylaya was
consigned to Culion in 1907, where he remained for the rest of his life. (I am grateful
to Mike Cullinane for this information.)
31. Heiser, ‘‘Culion Leper Colony,’’ 7. Between 1912 and 1924, a few dozen Chamorro
lepers from Guam were transferred to Culion: see Hattori, Colonial Dis-Ease, chap-
ter 3. Heiser estimated that there were over fifty thousand lepers in Japan, few of
whom had been isolated; in China, the problem was still the responsibility of mis-
sionaries; in Java, too, the government had done little. In India the number of lepers
was so great that the financial burden would far surpass the resources of the Indian
treasury. Only in the Federated Malay States had the government tried systematically
to isolate lepers: a colony was planned at Pulau Jerajak. See Victor G. Heiser, ‘‘Lep-
rosy in the East: Its Treatment and Prevention,’’ Nov. 3, 1915, pp. 10–11, Heiser
collection, b:h357.p, American Philosophical Society.
32. Saturday Evening Post (Feb. 2, 1918).
33. Mayo, The Isles of Fear, 154.
34. Victor G. Heiser, ‘‘Hospital No. 66’’ [c. 1938], p. 14, Heiser collection, b:h357.p,
American Philosophical Society.
35. Goffman, Asylums.
36. Wade and Avellana Basa, ‘‘The Culion Leper Colony,’’ 402. Avellana Basa was the
director of the colony in 1919–25; Wade, a pathologist from Tulane, was the resident
physician in 1922–31—he stayed on and died there in 1968.
37. Ibid., 399. See also Ernest R. Gentry, ‘‘Report of a Leper-Collecting Trip in the
Philippine Islands,’’ 1912, rg 112-e26-68075-123, nara.
38. Long, ‘‘Health in the Philippine Islands,’’ 50.
39. MacNamara, ‘‘Leprosy,’’ 451.
40. Manson, Tropical Diseases (1898), 419.
41. Ibid., 420–21, 419. The reference to specific therapy for syphilis was dropped in later
editions. On the search for a ‘‘specific therapeutics,’’ see Warner, The Therapeutic
Perspective.
42. Heiser, ‘‘Fighting Leprosy in the Philippines,’’ 311, 312. Eliodoro Mercado, of San
Lazaro Hospital, had prepared the first injectable form of chaulmoogra in 1910, but
Heiser took most of the credit for his invention. Snodgrass describes unsuccessful
early attempts made in the Philippines to treat the disease with x-rays (Leprosy in the
Philippine Islands, 27). For an overly optimistic discussion of x-ray treatment, see
Heiser, ‘‘The Progress of Medicine in the Philippine Islands.’’ See also Lara, Leprosy
Research in the Philippines. Lara was a physician at Culion in 1922–62 and director
in 1947–55.
43. Snodgrass, Leprosy, 27. Unusually, Snodgrass had trained in homeopathy and bac-
teriology.
44. Ibid., 28.
45. Manson, Tropical Diseases (1914), 634.
46. Ibid., 637. For more on the results of nastin treatment and of immunological thera-
pies, see Strong, ‘‘Leprosy.’’
47. Heiser, ‘‘Tropical Diseases,’’ 203.

notes to chapter 6 281

48. Ibid.
49. Victor G. Heiser, ‘‘Leprosy in the East: Its Treatment and Prevention,’’ Nov. 3, 1915,
pp. 10–11, 16, Heiser collection, b:h357.p, American Philosophical Society. The
first female suffrage in the rest of the macrocolony occurred in 1916.
50. Heiser, ‘‘Hospital No. 66,’’ p. 5, Heiser collection, b:h357.p, American Philosophi-
cal Society.
51. Heiser, ‘‘Fighting Leprosy,’’ 316–17.
52. Heiser, An American Doctor’s Odyssey, 236. See Snodgrass, Leprosy in the Philip-
pine Islands.
53. Heiser, An American Doctor’s Odyssey, 236.
54. Wade and Avellana Basa, ‘‘Culion Leper Colony,’’ 406.
55. A. J. McLaughlin to Mrs. G. H. Burwell, April 5, 1909, rg 350-1972-10, nara.
56. Snodgrass, Leprosy in the Philippine Islands, 25.
57. Goffman describes the institutional theatrical in Asylums, 99; Stewart describes the
theatricality of the miniature in On Longing; and Bhabha refers to the performativity
of ‘‘people’’ in the narrative address of the nation in ‘‘DissemiNation: Time, Narra-
tive and the Margins of the Modern Nation,’’ in The Location of Culture, esp. 145–
46. On the ‘‘exhibitionary order,’’ see Mitchell, Colonising Egypt.
58. Heiser, ‘‘Fighting Leprosy,’’ 318.
59. Heiser, ‘‘Leprosy in the East,’’ 17–18. See also Wilson, ‘‘Industrial Therapy in
Leprosy.’’
60. Heiser, ‘‘Leprosy in the East,’’ 17–18.
61. Heiser, ‘‘Hospital No. 66,’’ p. 4, Heiser collection, B:H357.p, American Philosophi-
cal Society. When Dr. T. C. Wu visited from China in 1930 he found a ‘‘happy colony
of people whose principal idea in life is to get cured. . . . The bright light of hope has
permeated the horizon of consciousness and changed the whole aspect of the people’’
(‘‘Fighting Leprosy in the Philippines,’’ 7). I am grateful to Angela Leung for this
reference.
62. Heiser, ‘‘Fighting Leprosy,’’ 318, 320.
63. Heiser, ‘‘Memorandum of Leper Collecting Trip,’’ 1. Yet when the evangelist Rev.
James B. Rodgers visited Culion, he admired the same gardens (‘‘Culion, the Leper
Colony of the Philippines,’’ Silliman Truth [Negros Oriental], [May 1, 1911], pp. 2,
4, rg 350-1972-19, nara).
64. ‘‘Culion and Its Inhabitants,’’ La Vanguardia (August 27, 1912).
65. ‘‘What Is Happening in Culion?’’ El Ideal (September 16, 1912).
66. ‘‘The Culion Lepers,’’ La Vanguardia (October 2, 1912).
67. Burgess, Who Walk Alone, 92, 94, 101. Burgess won the National Book Award for
this work.
68. Ibid., 142, 180.
69. Ibid., 220, 221, 245.
70. Ibid., 266.
71. Frederick Hoffman to Forrest F. Dryden, March 10, 11, 1915, Special Reports on
Leper Colonies, Hoffman papers, ms/b/247, National Library of Medicine, Be-
thesda, Md. Hoffman, well known as a race theorist in North America, was selecting

282 notes to chapter 6

 a site for the federal leprosarium. Edmond claims ‘‘Molokai was less a model colony
than a monstrous reflection of the real thing’’ (‘‘Abject Bodies/Abject Sites,’’ 139).
72. Gussow, Leprosy, Racism, and Public Health: Social Policy in Chronic Disease, 147.
Carville began with ninety inmates, and the most it ever contained was four hundred.
For an account of Carville in the 1930s, see Stein, with Blochman, Alone No Longer.
See also Gussow and Tracy, ‘‘Stigma and the Leprosy Phenomenon: The Social His-
tory of a Disease in the Nineteenth and Twentieth Centuries.’’ Culion also served as a
model for the leper colony at Trujillo Alto, Puerto Rico, which opened in 1926,
replacing the deplorable old colony at Isla de Cabras. The scale of the new Puerto
Rico colony limited its activities: there were only forty-three inmates in 1926. See
Levinson, ‘‘Beyond Quarantine: A History of Leprosy in Puerto Rico, 1898–1930s.’’
73. A protestant missionary, Rev. Paul F. Jansen, was stationed at Culion permanently
through the 1920s, successfully evangelizing the Catholic lepers, with the tacit ap-
proval of the medical authorities. Previously, Dr. George ‘‘Skypilot’’ Wright had
visited the colony regularly from the Presbyterian Mission in Manila.
74. Sergio Osmeña, a leading nationalist politician, was a Cebuano like so many of the
lepers. He became vice president of the Philippine Commonwealth in 1935–44 and
then president in 1944–46. Manuel Roxas defeated him in 1946 in the first elections
for the presidency of the independent Philippines.
75. Chapman, Leonard Wood and Leprosy in the Philippines, esp. 83–84. See Wood,
‘‘Progress Fighting Leprosy at Culion.’’ In 1921, Wood inaugurated a more intensive
treatment program at Culion. Over 4,000 lepers were injected weekly with the ethyl
esters of chaulmoogra oil. It was claimed that by 1925 a total of 196 cases were sent
away as cured and 499 were bacteriologically negative and undergoing the required
two years’ observation period for release. See Callender, ‘‘The Leprosy Problem in
the Philippine Islands’’; and Annual Report of the Philippine Health Service, Fiscal
Year 1922 (Manila: Bureau of Printing, 1923), 15. By the early 1920s, Bayer had
developed ‘‘antileprol,’’ a derivative of chaulmoogra oil, which was better tolerated
orally, and it soon displaced the parenteral oil. See Stitt, Diagnostics and Treatment
of Tropical Diseases, 266. After Wood’s death, American supporters established in
1927 the Leonard Wood Memorial for the Eradication of Leprosy. In 1931, H. W.
Wade organized a conference in Manila that led to the establishment of the Inter-
national Leprosy Association and the International Journal of Leprosy, which he
edited. See Anon., ‘‘Leprologists form International Leprosy Association,’’ Manila
Daily Bulletin (January 22, 1931), 1.
76. Anon., ‘‘Quezon Tells Medicos Culion Costs Too Much,’’ Manila Times (December
17, 1923), 1. Dr. José Albert, a liberal pediatrician and former revolutionary, also
condemned Culion as ‘‘anachronistic, unjustified, and ultrascientific’’ (The Experi-
ment of Leper Segregation in the Philippines, 2).
77. Anon., ‘‘Quezon Pays His Respects to Major Hitchens,’’ Manila Times (Decem-
ber 19, 1926), 1. The voluntary efforts were organized through the Philippine Islands
Anti-Tuberculosis Society; I discuss tuberculosis further in chapter 8. The annual
appropriation for Culion did not fall below one million pesos until 1931, and it was
sharply reduced in later years.

notes to chapter 6 283

78. See Quezon, The Good Fight. Quezon was president of the new Philippine Common-
wealth from 1935 until his death in exile.
79. Diary of Dr. Heiser’s Trip Around the World, October 1930-May 1931, January 18–
20, 1931, pp. 111–12, 5.27, unit 63, room 104, rg 12.1, rfa, rac.
80. Diary of Dr. Heiser’s Trip Around the World, 1932–33, Dec. 21, 1932, p. 62, 5.27,
unit 63, room 104, rg 12.1, rfa, rac.
81. ‘‘Will Continue Segregation in Leprosy Work,’’ Manila Bulletin (October 7, 1936).
The activists pointed out that after thirty years of strict segregation, there had been
no decrease in the admission of new cases to Culion.
82. ‘‘Police Force Helpless as Mob Rushes,’’ Manila Bulletin (April 1, 1932). Marriage
had been restricted in 1929, when the number of births increased; the sanctions were
lifted in 1934.
83. ‘‘Hearing in the Colony Hall,’’ July 26, 1935, pp. 1–4, Joseph R. Hayden papers,
Bentley Library, University of Michigan Historical Collections. For another account
linking medicalization with unrest, see Kakar, ‘‘Medical Developments and Patient
Unrest in the Leprosy Asylum, 1860–1940.’’
84. Chakrabarty, Provincializing Europe: Postcolonial Thought and Historical Dif-
ference.
85. Brownell, ‘‘American Ideas of Citizenship,’’ 975. Brownell claimed U.S. policy was
‘‘the subject of scoff by every other colonizing nation’’ because it ‘‘considers each of
the subject people to be a human being, entitled to certain unalienable rights, which
we not only freely grant, but teach to him’’ (975, emphasis added). See also Brownell,
‘‘Turning Savages into Citizens.’’
86. Jenks, ‘‘Assimilation in the Philippines, as Interpreted in Terms of Assimilation in
America,’’ 789. Jenks, formerly the chief of the Bureau of Ethnology, thought that in
the archipelago more generally, ‘‘to accomplish all this against their natural inertia of
race, and the inertia of social and physical environment is not a task that can be
completed by the year 1921’’ (789). Culion was designed to disturb this ‘‘inertia.’’
87. Brownell, ‘‘American Ideas of Citizenship,’’ 975.
88. During the war, the Japanese effectively quarantined Culion, and more than a quar-
ter of the inhabitants starved to death. In 1947, sulfone drugs were introduced; and
in 1948, Culion was declared a municipality. There were, however, still over two
hundred lepers in Culion in 2001.
89. Foucault, Discipline and Punish, 298.

7. late-colonial public health and filipino ‘‘mimicry’’

1. V. G. Heiser, ‘‘Notes of 1916 Trip,’’ July 19, 1916, vol. 2, p. 537, 58.5, room 102,
Hei 2, rfa, rac.
2. Heiser lamented that Harrison had ‘‘the same peculiar and intangible view of things
as of yore’’ (‘‘Notes of 1916 Trip,’’ August 10, 1916, vol. 2, pp. 573–74). Harrison
later described Heiser as ‘‘a shrewd intriguer’’ (Journal, 27 February 1936, in Ono-
rato, ed., Origins of the Philippine Republic: Extracts from the Diaries of Francis
Burton Harrison, 58).
3. Heiser, ‘‘Notes of 1916 Trip,’’ July 28, 1916, vol. 2, p. 553.

284 notes to chapter 7

 4. Heiser, ‘‘Notes of 1916 Trip,’’ August 7, 1916, vol. 2, p. 570.
5. V. G. Heiser, Diary of Dr. Heiser’s World Trip, October 1927-May 1928, March 27,
1928, p. 166, 5.27, unit 63, room 104, rg 12.1, rfa, rac.
6. Heiser, ‘‘Notes of 1916 Trip,’’ August 31, 1916, vol. 2, p. 621.
7. V. G. Heiser, Diary of Dr. Heiser’s World Trip 1925–26, November 22, 1925, p. 130,
5.27, unit 63, room 104, rg 12.1, rfa, rac.
8. V. G. Heiser, Diary of Dr. Heiser’s Trip Around the World, October 1930-May 1931,
Jan. 6, 1931, p. 91, 5.27, unit 63, room 104, rg 12.1, rfa, rac.
9. V. G. Heiser, Diary of Dr. Heiser’s Trip Around the World, October 1930-May 1931,
Jan. 8, 1931, p. 96.
10. C. H. Yaeger to V. G. Heiser, June 10, 1933, folder 94, box 7, series 242, rg 1.1, rfa,
rac.
11. Douglas, Purity and Danger. See also James, ‘‘Lectures Six and Seven: The Sick
Soul,’’ 113.
12. Wilson, Constitutional Government in the United States, 52–53. Rafael has sum-
marized this American colonial principle: ‘‘The self that rules itself can only emerge
by way of an intimate relationship with a colonial master who sets the standards and
practices of discipline to mold the conduct of the colonial subject’’ (White Love and
Other Events in Filipino History, 22). See also Miller, ‘‘Benevolent Assimilation’’:
The American Conquest of the Philippines 1899–1903.
13. Bhabha makes the more general point in ‘‘Of Mimicry and Man.’’
14. Elias, The Civilizing Process.
15. Benjamin, ‘‘On the Mimetic Faculty’’; Taussig, Mimesis and Alterity; and Rafael,
‘‘Mimetic Subjects.’’ On Rockefeller activities in the tropics, see Farley, Bilharzia,
chapter 5; Cueto, ed., Missionaries of Science; Palmer, ‘‘Central American En-
counters with Rockefeller Public Health, 1914–21’’; Birn, ‘‘A Revolution in Rural
health?’’ and ‘‘Revolution, the Scatological Way’’; and Birn and Solorzano, ‘‘Public
Health Policy Paradoxes.’’
16. For examples of the historical and anthropological study of development practition-
ers after World War II, see Ferguson, The Anti-Politics Machine; Escobar, Encounter-
ing Development; Cooper and Packard, eds., International Development and the
Social Sciences; and Gupta, Postcolonial Developments. All of these studies treat
development as though it emerged only in the 1940s and pay little attention to
colonial antecedents. As Escobar notes, ‘‘The period between 1920 and 1950 is still
ill understood from the vantage point of the overlap of colonial and developmentalist
regimes of representation’’ (27). The lack of attention to U.S. colonial policy is
especially surprising given the prominence of American development institutions
and agencies after World War II.
17. Harrison to Gen. Frank McIntyre, chief, Bureau of Insular Affairs, November 15,
1915, rg 350-4981-123a, nara.
18. Leslie A. I. Chapman to Guy N. Rohrer, October 4, 1915, rg 350-4981-123a, nara.
19. Hards to G. N. Rohrer, 10 August 1915, rg 350-4981-123a, nara.
20. Harrison to Gen. Frank McIntyre, November 15, 1915, rg 350-4981-123a, nara.
21. Victor G. Heiser, Annual Report of the Bureau of Health for the Philippine Islands,
July 1, 1912, to June 30, 1913 (Manila: Bureau of Printing, 1913), 3–6.

notes to chapter 7 285

22. Sullivan, Exemplar of Americanism; and Worcester, The Philippines, Past and Present.
23. Heiser, ‘‘Sanitation in the Philippines,’’ 124.
24. Heiser, An American Doctor’s Odyssey, 192, 194.
25. Heiser, An American Doctor’s Odyssey, 195, 198.
26. Kafka, ‘‘A Report to an Academy,’’ in The Metamorphosis, In the Penal Colony and
Other Stories.
27. Pardo de Tavera, ‘‘Filipino Views of American rule,’’ 74. Pardo de Tavera, who came
from a wealthy mestizo family, had trained in medicine in Paris. See Paredes, ‘‘The
Ilustrado Legacy: The Pardo de Taveras of Manila’’; Santiago, ‘‘The First Filipino
Doctors of Medicine and Surgery (1878–97)’’; and Gaerlan, ‘‘The Pursuit of Moder-
nity: Trinidad H. Pardo de Tavera and the Educational Legacy of the Philippine
Revolution.’’
28. Pardo de Tavera, El Legado del ignorantismo, 33, 36, 4, 5, 41. This is the text of an
address to the annual teachers’ assembly at Baguio.
29. T. H. Pardo de Tavera, ‘‘The Conservation of the National Type,’’ 11th Annual
Commencement Address, University of the Philippines, April 4, 1921, pp. 19–20,
13, 22, Pardo de Tavera Collection, b2 e16, Rizal Library, Ateneo de Manila. On the
various understandings of self-government among Filipino elites, see Go, ‘‘Colonial
Reception and Cultural Reproduction.’’
30. Forbes to James, January 30, 1905, Forbes papers, bMS Am 1092 (262–68), Hough-
ton Library, Harvard University.
31. Forbes to James, June 15, 1905, Forbes papers, bMS Am 1092 (262–68), Houghton
Library, Harvard University.
32. Stanley refers to a ‘‘collaborative compromise’’ emerging in the first decade of Ameri-
can colonial government and institutionalized in the second, in his edited collection,
Reappraising an Empire, 2. See also Robinson, ‘‘Non-European Foundations of
European Imperialism.’’ Etherington also suggests the importance of peripheral po-
litical negotiations when he calls for ‘‘an historical sociology of colonial bureau-
cracies’’ (Theories of Imperialism, 270). On the role of local elites in ‘‘moderniza-
tion,’’ see Johnson, ‘‘Imperialism and the Professions.’’
33. Wilson, Constitutional Government, 52.
34. Harrison, Inaugural Address, 4–5.
35. Harrison, The Corner-Stone of Philippine Independence, 81, 44.
36. Zaide, Philippine Political and Cultural History, 2:248. The total population was
approximately eight million plus. Agoncillo and Alfonso point out that in 1913
Filipinos were already occupying 71 percent of civil service positions, but usually at
the lower levels (Short History of the Philippine People).
37. Heiser, An American Doctor’s Odyssey, 56.
38. Worcester, Philippines, 685, 693, 695. Worcester complained that ‘‘seldom, if
ever, have health officials been more viciously and persistently attacked than have
Dr. Heiser and myself. The assaults on us have been the direct result of a firm stand
for a new sanitary order of things’’ (444).
39. H. L. Kneedler to Woodrow Wilson, March 25, 1913, rg 350-2394-35, nara. See
also Alatas, The Myth of the Lazy Native.

286 notes to chapter 7

40. Charles H. Yeater to Daniel R. Williams, August 28, 1917, David P. Barrows papers,
mss c-b 1005, Bancroft Library, University of California at Berkeley. Williams later
wrote to Barrows, ‘‘You know, and I know, that the masses of Filipinos have neither
the numbers, capacity nor industry to compete against or protect themselves from
their more virile neighbors to the North’’ (October 4, 1924). Williams was referring
to the Japanese occupying Taiwan.
41. New York Herald (September 17, 1916).
42. Vicente de Jesús to Gen. Frank McIntyre, March 3, 1920, rg 350-3465-105, nara.
See also Eschscholtzia and Haymond, An Analysis of Certain Causes of Mortality in
the Philippine Islands.
43. Vicente de Jesús to Gen. Frank McIntyre, March 3, 1920, rg 350-3465-105, nara.
44. Ibid. The death rate in 1921 did go down to 21.14 per 1,000 of population.
45. On Heiser’s involvement in the hospital disputes of 1912, see D. C. Worcester to
Governor-General, January 31, 1912, rg 350-21274-15, nara; and Dean C.
Worcester’s Private Annotated Copy of the Attempt to Transfer Jurisdiction over the
Philippine General Hospital from the Bureau of Health . . . , box 1, Worcester papers,
Bentley Historical Library, University of Michigan Historical Collections.
46. F. McIntyre, Memorandum, November 1915, rg 350-59-81, nara.
47. Winfred T. Denison to David P. Barrows, November 28, 1914, Barrows papers, mss
c-b 1005, Bancroft Library, University of California at Berkeley.
48. Winfred T. Denison to T. Roosevelt, November 27, 1914, Barrows papers, mss c-b
1005, Bancroft Library, University of California at Berkeley.
49. Winfred T. Denison to David P. Barrows, March 27, 1915, Barrows papers, mss c-b
1005, Bancroft Library, University of California at Berkeley.
50. United States Special Mission of Investigation to the Philippine Islands, Report on
the Special Mission on Investigation to the Philippine Islands to the Secretary of War
(Washington, D.C.: Government Printing Office, 1922), 21.
51. Heiser, An American Doctor’s Odyssey, 417, 419.
52. Wood, Report of the Governor-General of the Philippines, 1925, 5. In 1919 Ameri-
cans comprised 6 percent of all government personnel, including teachers; in 1925,
3.1 percent. Wood did, however, make some efforts to ‘‘stem the slowly-moving
landslip which our friend Harrison left for us’’ (Wood to Forbes, 9 March 1924,
Forbes papers, bMS Am 1364, Houghton Library, Harvard University). See also
Hagedorn, Leonard Wood: A Biography.
53. For science and Philippine nationalism, see Ileto, ‘‘Outlines of a Non-linear Emplot-
ment of Philippines History.’’ Lo observes a similar generational disposition in colo-
nial Taiwan in Doctors Within Borders.
54. Vicente de Jesús to F. McIntyre, March 5, 1920, rg 350-3465-105, nara.
55. Hernando, ‘‘The Environment in Relation to Infectious Diseases,’’ in his Manage-
ment of Communicable Diseases, 5–7.
56. V. de Jesús, ‘‘Narrative Summary of the Cholera Situation in the Provinces and
Manila,’’ Sept. 19, 1914, rg 350-4981-114, nara.
57. Calderón, ‘‘Faulty Maternity Practices and Their Influence upon Infant Mortality.’’
58. De Jesús, Proposed Sanitary Code, 7.

notes to chapter 7 287

59. De Jesús, ‘‘Narrative Summary of the Cholera Situation.’’
60. Philippine Health Service, Memorandum, July 1929, rg 350-3465-165, nara.
61. Paul C. Freer, Eighth Annual Report of the Director of the Bureau of Science for the
Year ending August 1, 1909 (Manila: Bureau of Printing, 1910), 16.
62. Cole, ‘‘Necator americanus in the Natives of the Philippine Islands’’; P. E. Garrison,
‘‘The Prevalence and Distribution of the Animal Parasites of Man in the Philippine
Islands’’; Phalen and Nichols, ‘‘Notes on the Distribution of Filaria nocturna in the
Philippine Islands’’; R. E. Hoyt, ‘‘Results of Three Hundred Examinations of Feces
with Reference to the Presence of Amoebae’’; P. E. Garrison and Llamas, ‘‘The
Intestinal Worms of 385 Filipino Women and Children in Manila’’; Stitt, ‘‘A Study of
the Intestinal Parasites Found in Cavite Province.’’ Stitt later wrote the major Ameri-
can text in tropical medicine, The Diagnostics and Treatment of Tropical Diseases.
63. Willets, ‘‘A Statistical Study of Intestinal Parasites in Tobacco Haciendas of the
Cagayan Valley.’’
64. Ettling, The Germ of Laziness. See also Cassedy, ‘‘The ‘Germ of Laziness’ in the
South, 1901–1915.’’ Ashford disclaimed Stiles’s influence: see his letter to Major
Lynch, November 16, 1909, rg 112-e26-106177-21, nara.
65. Bailey K. Ashford, ‘‘Porto Rico Sanitary Commission,’’ July 24, 1905, p. 3, rg 112-
e26-106177-s, nara.
66. Ettling, The Germ of Laziness.
67. Ibid. See also Ashford, A Soldier in Science; and Trigo, ‘‘Anemia and Vampires:
Figures to Govern the Colony, Puerto Rico, 1880–1904.’’
68. Charles T. Nesbitt, ‘‘The Health Menace of Alien Races,’’ The World’s Work 28
(November 1913): 74–75, quoted in Ettling, The Germ of Laziness, 173.
69. C. W. Stiles, Hookworm Disease and the Negroes (Hampton, Va.: Hampton Normal
and Agricultural Institute, 1909), 4, quoted in Ettling, The Germ of Laziness, 172.
The term ‘‘ecological détente’’ is Ettling’s (172).
70. Anon. [Wickliffe Rose], ‘‘Visit to Manila’’ (June 1–7, 1914), p. 2, folder 121, series
242, rg 5, rfa, rac.
71. J. D. Long, Report of the Philippine Health Service for the Fiscal Year from January 1
to December 31, 1915 (Manila: Bureau of Printing, 1916), 56. Long was director of
health in the Philippines from 1915 until 1918 and was succeeded by Vicente de
Jesús.
72. Long, Report of the Philippine Health Service, 57. For more on toilet design, see
chapter 4.
73. Heiser, Diary of Dr. Heiser’s World Trip 1925–26, November 25, 1925, p. 132.
74. Heiser to Jerome D. Greene, secretary Rockefeller Foundation, February 20, 1915,
folder 61, subseries 2, series 1, rg 5, rfa, rac.
75. See chapter 8.
76. Heiser to Leonard Wood, May 26, 1922, folder 122, series 242, rg 5, rfa, rac.
77. Charles N. Leach to V. de Jesús, May 10, 1923, folder 122, series 242, rg 5, rfa,
rac. Leach at the time was director of Rockefeller Foundation activities in the Philip-
pines.
78. [C. N. Leach], ‘‘Methods Suggested for Carrying Out a Hookworm Campaign in the
Philippine Islands’’ [1922], folder 122, series 242, rg 5, rfa, rac.

288 notes to chapter 7

 79. E. L. Munson to Leonard Wood, October 7, 1922, folder 126, series 242, rg 5, rfa,
rac.
80. Heiser to Leonard Wood, October 22, 1921, folder 127, series 242, rg 5, rfa, rac.
81. W. S. Carter to G. E. Vincent, pres. Rockefeller Foundation, January 28, 1923,
folder 34, box 4, series 242, rg 1.1, rfa, rac.
82. W. S. Carter to Alan Gregg, January 29, 1923, folder 34, box 4, series 242, rg 1.1,
rfa, rac
83. E. B. McKinlay, ‘‘Report concerning the Bureau of Science,’’ Manila, 1927, folder 1,
box 1, series 242, rg 1.1, rfa, rac.
84. C. F. Moriarty to Heiser, April 11, 1928, p. 31, folder 94, box 7, series 242, rg 1.1,
rfa, rac. The Rockefeller Foundation set up similar rural health centers in India
after 1934.
85. Heiser to C. H. Yaeger, July 11, 1929, folder 95, box 7, series 242, rg 1.1, rfa, rac.
86. Heiser, Diary of Dr. Heiser’s Trip Around the World, October 1930-May 1931,
January 11, 1931, p. 103.
87. C. H. Yaeger to Heiser, December 31, 1929, folder 95, box 7, series 242, rg 1.1,
rfa, rac.
88. C. H. Yaeger to Heiser, July 2, 1929, folder 4, box 1, series 242, rg 1.1, rfa, rac.
The unit in Laguna was closed in 1932, when funds became scarce as a result of the
depression.
89. C. H. Yaeger to Heiser, March 4, 1932, folder 96, box 7, series 242, rg 1.1, rfa,
rac.
90. V. G. Heiser, Diary of Dr. Heiser’s Trip Around the World, 1932–33, December 11,
1932, p. 52, 5.27, unit 63, room 104, rg 12.1, rfa, rac.
91. Paul F. Russell to Heiser, September 5, 1933, folder 96, box 7, series 242, rg 1.1,
rfa, rac.
92. Limjuco, ‘‘Hygiene in the Community,’’ 23, 21.
93. Yaeger to Heiser, May 26, 1933, folder 96, box 7, series 242, rg 1.1, rfa, rac.
94. Yaeger to Heiser, May 28, 1932, folder 96, box 7, series 242, rg 1.1, rfa, rac.
95. Yaeger to Heiser, February 11, 1930, folder 100, box 7, series 242, rg 1.1, rfa,
rac.
96. Yaeger to Heiser, June 17, 1932, folder 101, box 8, series 242, rg 1.1, rfa, rac.
97. Yaeger to Heiser, April 12, 1934, folder 96, box 7, series 242, rg 1.1, rfa, rac.
98. Heiser, Memorandum on Conference with Dr. Jacobo Fajardo, January 9, 1930,
folder 8, box 1, series 242, rg 1.1, rfa, rac. As far as I know, this is the only time Hei-
ser refers to ‘‘the masses,’’ rather than the Filipino: it may be an aberration or it may
indicate a shift in his attitudes—an embrace of social medicine—during the 1930s.
99. Sison, ‘‘Educating Our Educators,’’ 123, 124.
100. Fajardo, ‘‘Commencement Address,’’ 174, 175. For an account of earlier hygiene
education in the schools, see chapter 4. Fajardo was a great favorite of Heiser’s,
who was disappointed when the director of health was forced to resign in 1936
after allegedly taking a bribe from a leper.
101. Yaeger to Heiser, May 23, 1933, folder 9, box 1, series 242, rg 1.1, rfa, rac. Pigg
quotes an aid advisor in Nepal during the 1990s: ‘‘Our own staff don’t even boil
their drinking water. How are we going to educate villagers?’’ (‘‘ ‘Found in Most

notes to chapter 7 289

 Traditional Societies’: Traditional Medical Practitioners between Culture and De-
velopment,’’ 259).
102. Yaeger to F. F. Russell, May 2, 1933, folder 9, box 1, series 242, rg 1.1, rfa, rac.
103. Yaeger to F. F. Russell, February 8, 1935, folder 11, box 1, series 242, rg 1.1, rfa,
rac.
104. Heiser, Diary of Dr. Heiser’s Trip Around the World, 1932–33, January 4, 1933, p.
74.
105. Heiser to F. F. Russell, January 31, 1931, folder 100, box 7, series 242, rg 1.1, rfa,
rac. Russell, the director of the International Health Division from 1923 to 1935,
preferred laboratory research to demonstration units: see Farley, To Cast Out Dis-
ease.
106. Heiser, Diary of Dr. Heiser’s Trip Around the World, October 1930-May 1931,
February 4, 1931, p. 143.
107. Heiser, Diary of Dr. Heiser’s Trip Around the World, October 1930-May 1931,
January 11, 1931, p. 103.
108. Paul F. Russell to Heiser, April 4, 1932, folder 67, box 6, subseries 1, series 242, rg
1.1, rfa, rac.
109. Heiser to Paul F. Russell, August 10, 1933, folder 67, box 6, subseries 1, series 242,
rg 1.1, rfa, rac.
110. Heiser, Diary of Dr. Heiser’s World Trip, October 1927-May 1928, March 27,
1928, p. 164.
111. Heiser, Diary of Dr. Heiser’s World Trip, October 1927-May 1928, March 28,
1918, p. 167.
112. Administration, Programs and Policy—ihb, box 3, series 908, rg 3, rfa, rac.
113. Tomes, Gospel of Germs, 19.
114. As Bhabha reminds us, ‘‘Colonial mimicry is the desire for a reformed, recognizable
Other, as a subject of a difference that is almost the same but not quite’’ (‘‘Of
Mimicry and Man,’’ 126). For a complication of this argument, see McClintock,
Imperial Leather, 61–71. According to Glenn, women comics dominated Ameri-
can stage mimicry during this period. It is therefore tempting to relate the figure of
the mimic to the notion of the feminine, but there is far more evidence that Filipinos
were cast as children, not as women. See Glenn, ‘‘ ‘Give Me an Imitation of Me’:
Vaudeville Mimics and the Play of the Self.’’
115. Recto, ‘‘Most Ignominious Surrender,’’ 18–19.
116. Recto, ‘‘Our Mendicant Foreign Policy,’’ 82.
117. Recto, ‘‘Our Lingering Colonial Complex,’’ 90, 91.
118. Freud, ‘‘The Uncanny.’’

8. malaria between race and ecology

1. Victor G. Heiser, Memorandum re. Conference with Dr. Jacobo Fajardo, January
9, 1930, folder 8, box 1, series 242, rg 1.1, rfa, rac. In 1928, after talks with the
governor’s health advisors, Heiser writes in his diary, ‘‘If these amateurs could only
understand something of the lack of economic resources, and that at this stage
building them up would do more to improve health than direct hygienic measures’’

290 notes to chapter 8

 (Diary of Dr. Heiser’s Trip Around the World, October 1927–May 1928, March 18,
1928, p. 154, 5.27, Unit 63, Room 104, rg 12.1, rfa, rac).
2. Victor G. Heiser, Memorandum, February 2, 1932, p. 1, folder 9, box 1, series 242,
rg 1.1, rfa, rac.
3. Diary of Dr. Heiser’s Trip Around the World, October 1930–May 1931, January 7,
1931, p. 94, 5.27, Unit 63, Room 104, rg 12.1, rfa, rac. Edward L. Munson,
however, remained convinced that while ‘‘tuberculosis is rife . . . improvement de-
pends chiefly on changes in the basic habits of life of the people’’ (Memorandum to
Leonard Wood, governor-general, October 7, 1922, folder 126, series 242, rg 5,
rfa, rac). He was referring principally to expectoration.
4. Headquarters, Third Brigade, Department of Luzon, Circular No. 7, March 2, 1903,
rg 112-e26-77872-33, nara. See chapter 3.
5. Craig, ‘‘Observations upon Malaria,’’ 525.
6. Ross, Memoirs, with a Full Account of the Great Malaria Problem and its Solution;
Harrison, Mosquitoes, Malaria and Man; and Haynes, Imperial Medicine: Patrick
Manson and the Conquest of Tropical Disease. Ross believed in the drinking-water
theory of transmission as late as 1897: see his letter to Manson, May 3, 1897, in
Bynum and Overy, eds., The Beast in the Mosquito: The Correspondence of Ronald
Ross and Patrick Manson, 163–66. Ross had wondered if ‘‘the disease is communi-
cated by the bite of the mosquito’’ (May 27, 1896, 116); but Manson advised him
that ‘‘it may be that the mosquito conveys the parasite in biting but I do not think so’’
(October 12, 1896, 124).
7. Ross, Memoirs; and Worboys, ‘‘Manson, Ross and Colonial Medical Policy.’’ For a
debate on the medical uses of segregation during this period, see Curtin, ‘‘Medical
Knowledge and Urban Planning in Tropical Africa,’’ and Cell, ‘‘Anglo-Indian Medi-
cal Theory and the Origins of Segregation in West Africa.’’
8. De Bevoise provides an excellent account of the epidemiology and underlying causes
of malaria in the colonial Philippines in Agents of Apocalypse.
9. Page, ‘‘Malaria and Mosquitoes at Lucena Barracks, Philippine Islands.’’
10. Chamberlain, ‘‘Analysis of One Hundred and Twenty Cases of Malaria Occurring at
Camp Gregg, Philippine Islands.’’
11. W. D. Crosby, ‘‘Record of the Medical History of Camp Stotsenberg’’ (1904), 104,
quoted in Russell, Malaria and Culicidae in the Philippine Islands, 15. Stotsenberg,
later Clark Air Base, was in Pampanga, Luzon. It included the foothills of the Zam-
bales mountains.
12. Chief Surgeon, Philippines Division, to Surgeon General, Washington, D.C., March
14, 1907, pp. 9–10, rg 112-e26-24508-38, nara.
13. Chief Surgeon, Philippines Division, to Surgeon General, Washington, D.C., March
14, 1907, pp. 10, 13, rg 112-e26-24508-38, nara.
14. Craig, ‘‘Observations on Latent and Masked Malarial Infections,’’ ‘‘Observations
upon Malaria,’’ and ‘‘A Study of Latent Malarial Infection.’’ See chapter 3. We now
know that some clinical immunity to malaria is achieved after one or two infections;
antiparasitic immunity is rarer and requires many infections. The high rate of thalas-
semia and frequency of HbE in the Philippines would also have provided some

notes to chapter 8 291

 Filipinos with protection from the disease. See Carter and Mendis, ‘‘Evolutionary
and Historical Aspects of the Burden of Malaria.’’
15. Craig, ‘‘The Importance to the Army of Diseases Transmitted by Mosquitoes and
Methods for their Prevention.’’
16. Bureau of Health, Annual Report for the Year Ending August 31, 1905 (Manila:
Bureau of Printing, 1906).
17. Dunbar, ‘‘Antimalarial Prophylactic Measures and Their Results.’’
18. Bureau of Health, Annual Report for the Year Ending June 30, 1911 (Manila: Bu-
reau of Printing, 1911), 48–49.
19. Joint Commission of Representatives, ‘‘Sanitary Survey of San José Estates and Adja-
cent Properties on Mindoro Island,’’ 187, 188.
20. Bureau of Health, Insects and Disease, 12–14.
21. Seale, ‘‘The Mosquito Fish, Gambusia affinus in the Philippine Islands.’’ Of course,
this introduction proved completely useless.
22. Bureau of Health, Annual Report for the Year Ending December 31, 1914 (Manila:
Bureau of Printing, 1915), 170.
23. Walker and Barber, ‘‘Malaria in the Philippine Islands I.’’
24. Barber, Raquel, Guzman, and Rosa, ‘‘Malaria in the Philippine Islands II,’’ 243.
25. Russell, Man’s Mastery of Malaria; and Harrison, Mosquitoes, Malaria and Man.
26. J. W. W. Stephens, in ‘‘Discussion of the Prophylaxis of Malaria,’’ British Medical J. ii
(1904): 629–31, at 629, 631. See also Christophers and Stephens, ‘‘The Native as the
Prime Agent in the Malarial Infection of Europeans.’’ For more on the racializing of
malaria transmission in India, see Arnold, ‘‘ ‘An Ancient Race Outworn’: Malaria
and Race in Colonial India, 1860–1930’’; and Bynum, ‘‘Malaria in Inter-war British
India.’’ On malaria and segregation policies in Africa, see Dumett, ‘‘The Campaign
against Malaria and the Expansion of Scientific Medical and Sanitary Services’’; and
MacKinnon, ‘‘Of Oxford Bags and Twirling Canes: The State, Popular Responses
and Zulu Antimalaria Assistants.’’
27. Ronald Ross, in ‘‘Discussion of the Prophylaxis of Malaria,’’ 635. See also Ross, The
Prevention of Malaria.
28. Ross, Studies on Malaria, 137, 78. As late as 1936, Paul F. Russell noted that: ‘‘Mian
Mir proved nothing, but it weighed heavily with officialdom’’ (‘‘Malaria in India:
Impressions from a Tour,’’ 653).
29. Watson, The Prevention of Malaria in the Federated Malay States, 10, 360. This
technique of mosquito reduction would have been ineffective in decreasing malaria
in the Philippines.
30. Ronald Ross, ‘‘Preface,’’ to Watson, Prevention of Malaria, lx.
31. But see the report to the Army Board for the Study of Tropical Diseases from the
1909 Bombay Medical Congress, at which Christophers and Stephens had com-
plained that the ‘‘human factor’’ in malaria had been neglected in favor of larval
destruction, and Ross ‘‘replied with vigor’’ (Anon., ‘‘The Bombay Medical Con-
gress,’’ p. 2, rg 112-e26-68075-68, nara). The delegate from the Philippines recom-
mended an emphasis on mosquito control, ‘‘done with American thoroughness and
attention to detail’’ (3).

292 notes to chapter 8

32. Delaporte, The History of Yellow Fever.
33. Ross, Studies on Malaria, 127. See Gorgas, Sanitation in Panama; and Gorgas and
Hendrick, William Crawford Gorgas, His Life and Work. Gorgas became surgeon
general of the army and later advised the Rockefeller Foundation on yellow fever
control programs in South America.
34. Russell, Man’s Mastery of Malaria, 145. The term ecological was not part of the
vocabulary of tropical medicine before the 1920s, but it is hard to describe this
understanding of malaria in any other way.
35. Hackett, Malaria in Europe: An Ecological Study.
36. Farley, To Cast Out Disease: A History of the International Health Division of the
Rockefeller Foundation, 1913–1951; and Schneider, ed., Rockefeller Philanthropy
and Modern Biomedicine: International Initiatives from World War I to the Cold
War.
37. Rose, ‘‘Field Experiments in Malaria Control,’’ 1414. Rose directed the International
Health Board from 1913 to 1923. In 1914, Rose had sought advice from Ross and
Watson: see Russell, ‘‘The United States and Malaria: Debits and Credits.’’
38. Rose, ‘‘Field Experiments in Malaria Control,’’ 1416, 1417.
39. Ibid., 1417–18. The scope of southern vector control programs widened in the
1920s, as local communities took them over. By 1922, the Rockefeller Foundation
was aiding malaria control in 163 counties in 10 states. See Humphreys, Malaria:
Poverty, Race and Public Health in the United States.
40. Bass, ‘‘A Discussion of Malaria Carriers and the Important Role They Play in the
Persistence and Spread of Malaria’’; and Graves, ‘‘The Negro as a Menace to the
Health of the White Race.’’
41. Rose, ‘‘Field Experiments in Malaria Control,’’ 1418–20.
42. Stapleton, ‘‘Internationalism and Nationalism: The Rockefeller Foundation, Public
Health, and Malaria in India, 1923–51,’’ 134. See also Stapleton, ‘‘Dawn of ddt’’;
Farley, To Cast Out Disease; and Pauline A. Mead, ‘‘The Rockefeller Foundation:
Operations and Research in the Control and Eradication of Malaria’’ (New York:
Rockefeller Foundation, 1955 [typescript at rac]). Stapleton points out that the
Sardinian experiment was the culmination of the foundation’s antimalaria program.
The International Health Division closed in 1951.
43. Farley makes another, related distinction, arguing that hookworm was a means to an
end and malaria an end in itself (‘‘The International Health Division of the Rocke-
feller Foundation: The Russell Years, 1920–1934’’).
44. Barber and Hayne, ‘‘Arsenic as a Larvicide for Anopheline Larvae.’’ On the develop-
ment of Paris Green—copper aceto-arsenite—in the 1920s, see Whorton, ‘‘Insec-
ticide Spray Residues and Public Health, 1865–1938.’’ The first large-scale use of
Paris Green was in the Philippines in 1924.
45. Tiedemann, ‘‘Malaria in the Philippines.’’ See also Paul F. Russell, ‘‘Final Report on
the Malaria Investigations of the International Health Division of the Rockefeller
Foundation in the Philippine Islands, 1921–1934,’’ p. 7, box 72, 3, series 242I, rg 5,
rfa, rac. A few years later it was established that A. minimus was probably the sole
effective vector.

notes to chapter 8 293

46. ‘‘Annual Report 1930,’’ box 71, 3, series 242I, rg 5, rfa, rac; and Russell, ‘‘Final
Report on the Malaria Investigations.’’
47. J. J. Mieldazis to W. A. Sawyer, May 26, 1928, box 70, 3, series 242, rg 5, rfa, rac.
It was in this period that Vedder claimed that Philippine experience showed that
quinine prophylaxis was a ‘‘complete washout,’’ and selective mosquito control was
the only answer to malaria (‘‘Report on the Seventh Congress of the Far Eastern
Association of Tropical Medicine,’’ 280).
48. Diary of Dr. Heiser’s World Trip, 1925–26, November 30, 1925, p. 151, 5.27, unit
63, room 104, rg 12.1, rfa, rac.
49. Diary of Dr. Heiser’s World Trip, October 1927–May 1928, March 27, 1928, p.
162, 5.27, unit 63, room 104, rg 12.1, rfa, rac.
50. C. H. Yaeger to V. G. Heiser, July 29, 1929, folder 63, box 6, series 242i, rg 1.1, rfa,
rac.
51. Persis Putnam to W. A. Sawyer, January 18, 1928, folder 63, box 6, series 242I, rg
1.1, rfa, rac.
52. Heiser to F. F. Russell, May 8, 1928, folder 63, box 6, series 242I, rg 1.1, rfa, rac.
53. C. H. Yaeger to V. G. Heiser, July 29, 1929, folder 63, box 6, series 242I, rg 1.1, rfa,
rac.
54. C. H. Yaeger, ‘‘Annual Report of the Rockefeller Foundation for the Philippine
Islands, 1929,’’ pp. 17, 11, box 70, 3, series 242, rg 5, rfa, rac.
55. Diary of Dr. Heiser’s World Trip, October 1927–May 1928, March 27, 1928, p.
162, 5.27, unit 63, room 104, rg 12.1, rfa, rac.
56. Diary of Dr. Heiser’s Trip Around the World, October 1930–May 1931, January 2,
1930, p. 80, 5.27, unit 63, room 104, rg 12.1, rfa, rac.
57. Heiser to Jacobo Fajardo, September 6, 1927, folder 63, box 6, series 242I, rg 1.1,
rfa, rac.
58. C. Manalang, ‘‘Brief Report on the Results of Paris Green Control in the Philip-
pines,’’ 1928, folder 80, box 7, series 242I, rg 1.1, rfa, rac.
59. Diary of Dr. Heiser’s Trip Around the World, 1932–33, December 29, 1932, p. 67,
5.27, unit 63, room 104, rg 12.1, rfa, rac. See Lovewell, ‘‘Malaria at Camp Stot-
senberg, P.I.’’; Parsons, ‘‘Malaria Control at Camp Stotsenberg, P.I.’’; and Simmons,
St John, and Reynolds, ‘‘Malaria Survey at Camp Stotsenberg, P.I.’’
60. Paul F. Russell to V. G. Heiser, October 11, 1933, folder 2, box 1, series 242, rg 1.1,
rfa, rac.
61. Selskar M. Gunn, ‘‘Report on Visit to the Philippines,’’ August 26, 1933, folder 4,
box 1, series 242, rg 1.1, rfa, rac.
62. Heiser to F. F. Russell, January 31, 1931, folder 66, box 6, series 242I, rg 1.1, rfa,
rac. W. V. King was also active at the bureau during this period as an entomologist,
working on mosquitoes.
63. Paul F. Russell to V. G. Heiser, January 21, 1930, folder 65, box 6, series 242I, rg
1.1, rfa, rac.
64. Paul F. Russell to V. G. Heiser, March 23, 1932, folder 67, box 6, series 242I, rg 1.1,
rfa, rac. Ironically, Russell complained that the malaria control section of the
Philippine Health Service was ‘‘more concerned with research than with practical
control measures’’ (Russell, ‘‘Final Report on the Malaria Investigations,’’ 18).

294 notes to chapter 8

65. Paul F. Russell to V. G. Heiser, April 4, 1932, folder 67, box 6, series 242i, rg 1.1,
rfa, rac.
66. Michael Salman, ‘‘The United States and the End of Slavery in the Philippines, 1898–
1914: A Study of Imperialism, Ideology and Nationalism’’ (ph.d. dissertation, Stan-
ford University, 1993).
67. Heiser to Paul F. Russell, August 22, 1934, folder 69, box 6, series 242i, rg 1.1, rfa,
rac.
68. Paul F. Russell to V. G. Heiser, February 15, 1934, and C. H. Yaeger to F. F. Russell,
February 7, 1935, folder 71, box 6, series 242i, rg 1.1, rfa, rac. See also C. H.
Yaeger, ‘‘Final Report—Malaria Control at Iwahig, Palawan, Philippine Islands,
1933–34,’’ folder 72, , box 6, series 242i, rg 1.1, rfa, rac. The hospital admission
rate for malaria in August 1933 was 246; in August 1934 it was 62. On Atebrin use
among U.S. troops from 1933, see Simmons et al., Malaria in Panama.
69. Russell, Malaria and Culicidae in the Philippine Islands, 55.
70. Paul F. Russell, ‘‘Malaria in the Philippine Islands,’’ 174. Frederick F. Russell, the di-
rector of the International Health Division, had previously complained about work-
ing with ‘‘backward peoples’’ (‘‘War on Disease, Particularly Yellow Fever and Ma-
laria,’’ 11). He stressed that for quinine treatment to succeed, the population must be
‘‘small, very intelligent and under perfect control’’ (31).
71. Manalang, ‘‘Malaria Transmission in the Philippines II.’’ Manalang was concerned
that the mosquitoes could fly farther than 1.5 km., which was the usual coverage of
Paris Green spraying.
72. Russell, Malaria and Culicidae in the Philippine Islands, 55, 56, 60.
73. Russell, ‘‘Malaria in the Philippine Islands,’’ 176.
74. Russell, ‘‘Malaria in India: Impressions from a Tour,’’ 662, 658, 664.
75. Russell and Knipe, ‘‘Malaria Control by Spray-killing Adult Mosquitoes.’’ See also
Paul F. Russell, ‘‘Malaria Investigations—Madras: A Résumé of Activities, 1936–
1940,’’ folder 88, box 11, series 464, rg 1.1, rfa, rac. Pyrethrum sprays were
introduced in the 1930s and used from 1938 in Rockefeller projects in India.
76. Russell, ‘‘Malaria in the Philippine Islands,’’ 176.
77. On the ‘‘central role of technical expertise in malaria control from 1930 to 1960,’’ see
Stapleton, ‘‘Technology and Malaria Control, 1930–1960: The Career of Rocke-
feller Foundation Engineer Frederick W. Knipe,’’ 59. Similarly, Najera, a former
director of the Malaria Action Program of the World Health Organization, has noted
that ‘‘the overwhelming emphasis was on the creation of an efficient operational
mechanism for the spraying of insecticides and the collection of blood slides’’ (‘‘Ma-
laria Control: Present Situation and Need for Historical Research,’’ 220). On the
development of international health services between the wars, see Allen, ‘‘World
Health and World Politics’’; Howard-Jones, International Health Between the Two
Worlds; and Weindling, ed. International Health Organizations.
78. Najera observes that the antimalaria campaign ‘‘reveals in its own terminology its
origin from the military, in concepts such as campaign, attack, logistics, armamen-
tarium, brigades, squads, strategy and tactics’’ (‘‘Malaria Control,’’ 225).
79. On military metaphor, see Edmund Russell, War and Nature: Fighting Humans and
Insects with Chemicals from World War I to Silent Spring. These different ‘‘military’’

notes to chapter 8 295

 strategies map roughly onto the debate between advocates of vertical (or specific)
and horizontal (or primary health care) approaches to disease control in the develop-
ing world: see, for example, Bradley, ‘‘The Particular and the General: Issues of
Specificity and Verticality in the History of Malaria Control.’’ Predictably, some
British and European malariologists displayed a lingering commitment to working
with the human factor in malaria. They felt that specific vector control projects might
deprive native peoples of their acquired immunity to malaria, thus making fresh out-
breaks of the disease more devastating. See Corbellini, ‘‘Acquired Immunity against
Malaria as a Tool for the Control of the Disease’’; and Dobson, Malowany, and
Snow, ‘‘Malaria Control in East Africa: The Kampala Conference and the Pare-
Taveta Scheme.’’ Most historians, though, date the interest in primary health care to
the 1970s: Cueto, ‘‘The Origins of Primary Health Care and Selective Primary Health
Care’’; and Litsios, ‘‘The Christian Medical Commission and the Development of the
World Health Organization’s Primary Health Care Approach.’’
80. Hackett, ‘‘Malaria Control through Anti-mosquito Measures in Italy,’’ 478, 482,
493. Hackett had worked with the International Health Board since 1914, mostly on
hookworm in Guatemala and health policy in Brazil. On the continuing conflict in
Europe between malariologists favoring antimosquito measures and those wanting
quininization and social improvement, see Evans, ‘‘European Malaria Policy in the
1920s and 1930s: The Epidemiology of Minutiae.’’
81. Hackett, ‘‘Biological Factors in Malaria Control,’’ 343, 350. Hackett and Russell
later wrote together on the principle of ‘‘species sanitation’’ and the use of ‘‘naturalis-
tic methods’’ (Hackett, Russell, Scharf, and White, ‘‘The Present Use of Naturalistic
Measures in the Control of Malaria’’).
82. Farley, To Cast Out Disease. See also Soper and Wilson, Anopheles gambiae in
Brazil, 1930–1940; and Packard and Gadelha, ‘‘A Land Filled with Mosquitoes:
Fred L. Soper, the Rockefeller Foundation, and the Anopheles gambiae Invasion of
Brazil.’’ Interestingly, Packard and Gadelha criticize the ‘‘inattention to the human
dimension of malaria’’ and point out that the ‘‘landscape portrayed in these docu-
ments [on mosquito eradication] is almost devoid of humans’’ (205).
83. Litsios, ‘‘René Dubos and Fred L. Soper: Their Contrasting Views on Vector and
Disease Eradication’’; and Packard, ‘‘ ‘No Other Logical Choice’: Global Malaria
Eradication and the Politics of International Health in the Post-war Era.’’
84. Russell, Man’s Mastery of Malaria, 257.
85. Russell, West, Manwell, Practical Malariology.
86. Hackett, Malaria in Europe, 266.
87. Strong, ‘‘The Importance of Ecology in Relation to Disease,’’ 308.
88. Burnet, Biological Aspects of Infectious Disease, 159, 284. On Burnet, one of the
leaders of the new disease ecology, see Anderson, ‘‘Natural Histories of Infectious
Disease: Ecological Vision in Twentieth-century Biomedical Science.’’

conclusion
1. On social medicine in the twentieth century, see Rosen, From Medical Police to Social
Medicine; Porter, Health, Civilization and the State.

296 notes to conclusion

 2. Anderson, The Cultivation of Whiteness. For a comparison of Australian and Philip-
pines racial and national hygiene projects, see Anderson, ‘‘States of Hygiene: Race
‘Improvement’ and Biomedical Citizenship in Australia and the Colonial Philip-
pines.’’
3. Deutschman, ‘‘Public Health and Medical Services in the Philippines’’; de la Cruz,
History of Philippine Medicine and the pma; and Dayrit, Santos Ocampo, and de la
Cruz, History of Philippine Medicine, 1899–1999.
4. Cohen, ‘‘Public Health in the Philippines’’; and Dayrit, Santos Ocampo, and de la
Cruz, History of Philippine Medicine.
5. As Michel Foucault argues, ‘‘A whole series of colonial models was brought back to
the West, and the result was that the West could produce something resembling
colonization . . . on itself’’ (‘‘Society Must be Defended,’’ 103).
6. First Annual Report of the Department of Public Health [Illinois], July 1, 1917, to
June 30, 1918 (Springfield, Ill.: State Printers, 1919), 19. The phrase ‘‘public health is
purchasable’’ was a commonplace of the New York City and State Health Depart-
ments when Hermann M. Biggs directed them in the early twentieth century. See
Winslow, The Life of Hermann M. Biggs. Stern traces the direct medical influences of
Panama and the Panama-Pacific Exhibition in Eugenic Nation.
7. Heiser, An American Doctor’s Odyssey; and Duffy, A History of Public Health in
New York City, 271. Reform and reorganization of the New York City Health
Department had begun earlier under Dr. Sigismund S. Goldwater, but Emerson
greatly increased the momentum.
8. William Everett Musgrave papers, ucsf, mss 27–5.
9. Gonzalez Flores, Historia de la influencia extranjera en el desenvolvimiento educa-
cional y científico de Costa Rica, 160; Palmer, From Popular Medicine to Medical
Populism, 155–81. I am grateful to Steve Palmer for drawing this to my attention.
On Milwaukee public health, see Leavitt, The Healthiest City.
10. The San Francisco Department of Public Health even established a Bureau of Tropi-
cal Medicine in 1911 because ‘‘numbers of Asians immigrating to this country are
afflicted with or carry with them germs of diseases which are endemic to Oriental
countries’’ (Annual Report of the Department of Public Health, San Francisco, Cali-
fornia, July 1, 1910–June 30, 1911 [San Francisco: Neal Publishing, n.d.], 7). To get
an idea of the range of public health activities in the United States during this period,
see Chapin, A Report on State Health Work. Even in 1913, American sanitary
science was ‘‘still largely in the experimental stage’’ (3), with great variation in public
health activities, from the extensive work of authorities in New York, Massachu-
setts, and Pennsylvania to almost nothing in states like New Mexico, Wyoming,
Arkansas, and Florida.
11. Rosenkrantz, Public Health and the State, 142.
12. Forty-Sixth Annual Report of the State Board of Health of Massachusetts (1914) (Bos-
ton: Wright and Potter, 1915), 2. There had been part-time district officers since 1907.
13. First Annual Report of the State Department of Health of Massachusetts (1915)
(Boston: Wright and Potter, 1916), 8, 22–23. The phrase ‘‘public health is purchas-
able’’ (10) again betrays another great influence on the reform of U.S. public health
departments during this period: the New York City Health Department.

notes to conclusion 297

14. McLaughlin, assisted by Tobey, Personal Hygiene: The Rules of Right Living, 63.
15. Many of the American scientists at the Manila Bureau of Science did, however, go
on to distinguished careers in pathology and microbiology: W. B. Wherry became
professor of bacteriology at the University of Ohio; Paul G. Woolley, professor of
pathology at the same institution; Maximilian Herzog, professor of pathology at
Northwestern University; and H. T. Marshall, professor of pathology at the Univer-
sity of Virginia.
16. Some of Heiser’s former colleagues expressed disappointment with these curiously
depopulated reminiscences. S. M. ‘‘Sam’’ Lambert wondered why it was not entitled
‘‘Alone in the Orient’’ (A Yankee Doctor in Paradise, 4).
17. Victor G. Heiser, ‘‘Conquering Industrial Diseases’’ (c. 1940), p. 11, Heiser papers,
American Philosophical Society b: h357.p. Heiser argued that an ‘‘industrial health
program . . . bids fair to take such issues [of labor conditions] out of the grievance
picture and place management in an improved bargaining position’’ (‘‘Industrial
Health Programs are Good Business,’’ 1947, p. 6, Heiser papers, American Philo-
sophical Society b: h357.p).
18. ‘‘It is high time,’’ he wrote, ‘‘for Americans to get some of the brawn of their pioneer
forbears and quit being dainty, steam-heated, rubber-tired, beauty-rested, effemi-
nized, pampered sissies’’ (Toughen Up America, 21).
19. See, for example, his comments on the habitual carelessness of ‘‘Negro workers’’ in a
radio talk: ‘‘Conquering Industrial Diseases’’ (c. 1940), p. 1, Heiser papers, Ameri-
can Philosophical Society b: h357.p.
20. James D. Sobredo, ‘‘From American ‘Nationals’ to the ‘Third Asiatic Invasion’:
Racial Transformation and Filipino Exclusion (1898–1934)’’ (ph.d. dissertation,
University of California-Berkeley, 1998); Deverell, ‘‘Plague in Los Angeles, 1924:
Ethnicity and Typicality’’; and Abel, ‘‘ ‘Only the Best Class of Immigration’: Public
Health Policy toward Mexicans and Filipinos in Los Angeles, 1910–1940.’’
21. Choy, Empire of Care: Nursing and Migration in Filipino-American History.
22. See Hewa, Colonialism, Tropical Disease and Imperial Medicine: Rockefeller Phi-
lanthropy in Sri Lanka; and Farley, To Cast Out Disease.
23. Long was on epidemic duty in San Francisco in 1914 and 1921. See Williams, The
United States Public Health Service, 1798–1950. Richard Strong was another major
figure in international health development. In 1920, he established the medical de-
partment of the League of Red Cross Societies and later became a leading promoter
of the League of Nations Health Organization.

298 notes to conclusion

Bibliography

manuscript and photograph collections

Philippines
Archives Section, Department of Health, Republic of the Philippines, Manila
Angeles, Marcelo C. ‘‘History of the Public Health System in the Philippines.’’
Unpublished ms., c. 1967
Culion Museum, Palawan
Patient Records
Philippine National Archives, Manila
Memorias Medicas
Sanidad
Rizal Library, Ateneo de Manila
American Historical Collection
T. H. Pardo de Tavera Papers

California
Bancroft Library, University of California, Berkeley
David Prescott Barrows Papers
Louis D. Baun Papers
Eli L. Huggins Papers
John F. Minier Papers
Bernard Moses Papers
Herbert I. Priestley Papers
Special Collections, University of California, San Francisco
Alice Burrell Papers
William E. Musgrave Papers

Delaware
Hagley Museum and Library, Wilmington
National Association of Manufacturers Papers

Maryland
Alan Mason Chesney Archives, The Johns Hopkins Medical School, Baltimore
The Johns Hopkins University Commission for the Study of the Prevalent Diseases
of the Philippine Archipelago
William C. Welch Papers
History of Medicine Division, National Library of Medicine, Bethesda
Fielding H. Garrison Papers
Charles R. Greenleaf Papers
Frederick Hoffman Papers
United States National Archives and Records Administration, College Park
rg 94: Records of the Adjutant General’s Office, 1780s–1917
rg 111-fg: Photographs of Scenes in the Philippines, c. 1899–c. 1903
rg 112-e25: Records of the Office of the Surgeon General, Army
rg 165-pw: Prints of the Philippine Insurrection, 1899–1903
sws: Spanish-American War Photographs, 1898–99
rg 200-pi: Allan N. Webster Photographic Collection Relating to the Philippine
Islands, 1898–99
rg 350: War Department, Bureau of Insular Affairs
rg 350-bs: Photographs of the Philippines Islands, c. 1907–c. 1918
rg 350-p: Photographs of the Philippines Islands, 1898–1935
rg 350-pc: Photographs of the Philippine Islands, c. 1902–1928

Massachusetts
Countway Medical Library, Harvard Medical School, Boston
Richard P. Strong Papers
Houghton Library, Harvard University, Cambridge
William Cameron Forbes Papers
Massachusetts Archives, Boston
Health and Human Services Records

Michigan
Michigan Historical Collections, Bentley Library, University of Michigan, Ann Arbor
Joseph R. Hayden Papers.
J. E. Reighard Papers
Dean C. Worcester Papers

New York
Rockefeller Foundation Archives, Rockefeller Archive Center, Sleepy Hollow
rg 1: Projects, 1912–89
rg 2: General Correspondence, 1927–89
rg 5: International Health Board/Division
rg 12: Officers’ Diaries

Pennsylvania
American Philosophical Society, Philadelphia
Victor G. Heiser Papers
United States Army Military History Institute, Carlisle Barracks
Darnell, Joseph R. ‘‘Sojourn in Zamboanga.’’ Unpublished ms., c. 1947
George De Shon Papers

300 bibliography
 Johnson, Richard. ‘‘My Life in the Army, 1899–1922.’’ Unpublished ms., c. 1952
Halstead-Maus Family Papers
Charles Everett MacDonald Papers
Snyder, Arthur Augustine. ‘‘Experiences of a Contract Surgeon.’’ Unpublished ms.
Spanish-American War Survey: U.S. Medical Corps Box

Washington, D.C.
United States Library of Congress
Charles Burke Elliott Papers
Francis Burton Harrison Papers

published primary sources

Acton, Hugh W. ‘‘Neurasthenia in the Tropics.’’ Indian Medical Gazette 62 (1927): 1–7.
Albert, José. The Experiment of Leper Segregation in the Philippines. Manila: n.p., n.d.
[1920].
Alden, Charles H. ‘‘The Special Training of the Medical Officer, with Brief Notes on
Army Medical Schools Abroad and at Home.’’ tams 4 (1894): 675–89.
Anon. ‘‘Highly Artistic Red Cross Carnival.’’ Philippine Review (January 1918): 95.
———. ‘‘Commercial Exhibits.’’ Philippines National Weekly (February 9, 1918): 3.
———. ‘‘The Carnival and the Student.’’ Philippines National Weekly (February 9,
1918): 6.
———. ‘‘The 1918 Philippine Red Cross Carnival.’’ Philippine Review (March 1918):
196–200.
———. ‘‘Manila Carnival and Commercial-Industrial Fair.’’ American Chamber of
Commerce J. 2 (1922): 9–12.
———. ‘‘Quezon Tells Medicos Culion Costs Too Much.’’ Manila Times (December 17,
1923).
———. ‘‘Quezon Pays His Respects to Major Hitchens.’’ Manila Times (December 19,
1926).
———. ‘‘Leprologists Form International Leprosy Association.’’ Manila Daily Bulletin
(January 22, 1931).
Aron, Hans. ‘‘Investigations of the Action of the Tropical Sun on Men and Animals.’’
pjs 6 (1911): 101–23.
Ashburn, Percy M. The Elements of Military Hygiene, Especially Arranged for Officers
and Men of the Line. Boston: Houghton Mifflin, 1909.
Ashburn, Percy M., and Charles F. Craig. ‘‘The Work of the Army Board for the Study of
Tropical Diseases in the Philippine Islands.’’ Military Surgeon 21 (1907): 38–49.
Ashford, Bailey K. A Soldier in Science. New York: William Morrow, 1934.
Atkinson, Fred W. The Philippine Islands. Boston: Ginn, 1905.
Bache, Dallas. ‘‘The Location of Sites for, and the Construction of, Military Posts in
Relation to Proper Sanitation.’’ jams 5 (1895): 413–30.
Balfour, Andrew. ‘‘Tropical Problems in the New World.’’ Trans. Society of Tropical
Medicine and Hygiene 8 (1915): 75–108.
———. ‘‘The Problem of Acclimatisation.’’ Lancet 205 (1923): 84–87.

bibliography 301
Balfour, Andrew. ‘‘Personal Hygiene.’’ In The Practice of Medicine in the Tropics, edited
by W. Byam and R. G. Archibald, 3 vols., 1:1–26. London: Henry Frowde and
Hodder and Stoughton, 1923.
Bancroft, Hubert Howe. The New Pacific. New York: Bancroft, 1899.
Bantug, J. P., P. Gabriel, and M. Arguelles. A Simple Manual for Sanitary Inspectors.
Manila: Bureau of Printing, 1923.
Barber, M. A., A. Raquel, A. Guzman, and A. P. Rosa. ‘‘Malaria in the Philippine Islands
II.’’ pjs 10 (1915): 177–245.
Barber, M. A., and T. B. Hayne. ‘‘Arsenic as a Larvicide for Anopheline Larvae.’’ U.S.
Public Health Reports 36 (1921): 3027.
Barker, Lewellys F. Time and the Physician: The Autobiography of Lewellys F. Barker.
New York: G. P. Putnam’s Sons, 1942.
———. ‘‘Medical Commission to the Philippines.’’ Bulletin of the Johns Hopkins
Hospital 11 (1900): 26–30.
Bass, C. C. ‘‘A Discussion of Malaria Carriers and the Important Role They Play in the
Persistence and Spread of Malaria.’’ Southern Medical J. 8 (1915): 182–84.
Bean, Robert Bennett. The Racial Anatomy of the Philippine Islanders. Philadelphia:
J. B. Lippincott, 1910.
Beard, George M. A Practical Treatise on Nervous Exhaustion (Neurasthenia) and its
Symptoms, Nature, Sequences, Treatment. 2nd ed. New York: William Wood, 1880.
Berkeley Hill, Owen. ‘‘The ‘Colour-question’ from a Psychoanalytic Standpoint.’’ In
Collected Papers, 139–48. Calcutta: Book Co., 1933 [1923].
———. ‘‘Neurasthenia in the Tropics.’’ Indian Medical Gazette 62 (1927): 228–37.
———. ‘‘Mental Hygiene of Europeans in the Tropics.’’ In Trans. of the 7th Congress of
the Far Eastern Association of Tropical Medicine, December 1927, edited by
J. Cunningham, 1:389–99. Calcutta: Thacker’s Press and Directories, 1928.
Beveridge, Albert J. ‘‘March of the Flag.’’ In The Meaning of the Times and Other
Speeches, 47–57. N.p.: Bobbs-Merrill, 1908 [1900].
———. ‘‘Our Philippine Policy.’’ In The Meaning of the Times and Other Speeches, 58–
88. N.p.: Bobbs-Merrill, 1908 [1900].
Billings, John Shaw. ‘‘The Military Medical Officer at the Opening of the Twentieth
Century.’’ jams 12 (1903): 349–57.
Birch, E. A. ‘‘Influences of Warm Climates on the Constitution.’’ In Hygiene and
Diseases of Warm Climates, edited by Andrew Davidson. Edinburgh: Pentland,
1893.
Birmingham, Henry P. ‘‘Some Practical Suggestions of Tropical Hygiene.’’ jams 12
(1903): 45–54.
Board of Health. Manual of the Board of Health for the Philippine Islands. Manila:
Bureau of Printing, 1911.
Boekmann, Edouard. ‘‘Some Remarks about Asepsis in Military Service.’’ tams 5
(1895): 143–62.
Brooke, A. Y. ‘‘Baguio as a Health Resort.’’ Mid-Pacific Magazine 23 (1922): 457–58.
Brown, Orlando J. ‘‘The Effects and Treatment of Heat and Sunstroke at Camps of
Instruction.’’ jams 5 (1895): 431–35.

302 bibliography
Brownell, Atherton. ‘‘What American Ideas of Citizenship May Do for Oriental
Peoples.’’ The Outlook (Dec. 23, 1904): 975–85.
———. ‘‘Turning Savages into Citizens.’’ The Outlook (Dec. 24, 1910): 921–31.
Bryan, William Jennings. Bryan on Imperialism. New York: Arno Press and New York
Times, 1970 [1900].
Buckland, Ralph Kent. In the Land of the Filipino. New York: Every-Where, 1912.
Bullard, Robert L. ‘‘Some Characteristics of the Negro Volunteer.’’ jmsi 29 (1901):
29–39.
———. ‘‘Small Maneuvers,’’ jmsi 39 (1906): 57–67.
Bureau of Education and Philippine Health Service. Health: A Manual for Teachers.
Manila: Bureau of Printing, 1928.
Bureau of Health. Infectious Diseases: Period of Incubation, Quarantine and Infection;
Sources of Infection. Health Bulletin No. 1. Manila: Bureau of Printing, 1903.
———. Cholera Measures. Health Bulletin No. 7. Manila: Bureau of Printing, 1909.
———. Insects and Disease. Health Bulletin No. 11. Manila: Bureau of Printing, 1913.
———. The Disposal of Human Wastes in the Provinces. Health Bulletin No. 13. Manila:
Bureau of Printing, n.d. [c. 1914].
———. Sanitary Measures in Connection with Local Fiestas. Provincial Circular No. 124
(Oct. 6, 1915).
———. Proposed Sanitary Code. Health Bulletin No. 22. Manila: Bureau of Printing,
1920.
Burgess, Perry. Who Walk Alone. New York: Henry Holt, 1940.
Burrill, Herbert L. ‘‘Is It Expedient to Have a Physical Examination of Men before
Enlisting Them as State Troops?’’ tams 2 (1892): 133–37.
Calderón, Fernando. ‘‘Faulty Maternity Practices and Their Influence upon Infant
Mortality.’’ In Proceedings of the First National Conference on Infant Mortality and
Public Welfare, December 6–10, 1921, 33–43. Manila: Bureau of Printing, 1922.
Callender, George R. ‘‘The Leprosy Problem in the Philippine Islands.’’ American J.
Tropical Medicine 5 (1925): 351–58.
Callwell, Charles C. E. Small Wars: Their Principles and Practice. 3rd ed. London: His
Majesty’s Stationery Office, 1906 [1896].
Capelo y Juan, Francisco. Manila, la Higiene y el Cólera. Manila: Colegio de Santo
Tomás, 1883.
Carpenter, Frank G. Through the Philippines and Hawaii. Garden City, N.Y.:
Doubleday, Page, 1925.
Carter, E. C. ‘‘Sanitary Conditions as Affecting Contracts for Works in the Philippine
Islands.’’ Engineering News 54 (1905): 544–47.
Castellani, Aldo, and Albert J. Chalmers. Manual of Tropical Medicine. London:
Baillière, Tindall and Cox, 1910.
Chamberlain, Weston P. ‘‘Analysis of One Hundred and Twenty Cases of Malaria
Occurring at Camp Gregg, Philippine Islands.’’ Boston Medical and Surgical J. 154
(1906): 29–40.
———. ‘‘Observations of the Influence of the Philippine Climate on White Men of the
Blond and Brunet Type.’’ PJS 6 (1911): 427–63.

bibliography 303
Chamberlain, Weston P. ‘‘A Study of the Systolic Blood Pressure and the Pulse Rate of
Healthy Adult Males in the Philippines.’’ pjs 6 (1911): 467–81.
———. ‘‘The Red Blood Corpuscles and the Hemoglobin of Healthy Adult American
Males Residing in the Philippines.’’ pjs 7 (1912): 483–88.
———. ‘‘Some Features of the Physiological Activity of White Races in the Philippine
Islands.’’ American J. of Tropical Disease and Preventive Medicine 1 (1913): 12–32.
Chamberlain, Weston P., et al. ‘‘Examination of Stools and Blood among the Igorots at
Baguio, Philippine Islands.’’ pjs 5b (1910): 505–14.
Chamberlain, Weston P., and Edward B. Vedder. ‘‘A Study of Arneth’s Nuclear
Classification of Neutrophils in Healthy Adult Males and the Influence thereon of
Race, Complexion and Tropical Residence.’’ pjs 6 (1911): 405–19.
Chamberlin, Frederick. The Philippine Problem. Boston: Little, Brown, 1913.
Chapin, Charles V. Sources and Modes of Infection. New York: John Wiley and Sons,
1910.
———. A Report on State Public Health Work, Based on a Survey of State Boards of
Health. Chicago: ama, n.d. [1915].
———. ‘‘Dirt, Disease and the Health Officer.’’ In The Papers of Charles V. Chapin, m.d.:
A Review of Public Health Realities, edited by Frederic P. Gorham and Clarence L.
Scamman, 20–26. New York: Commonwealth Fund, 1934 [1902].
———. ‘‘The Fetich of Disinfection’’ In The Papers of Charles V. Chapin, m.d.: A Review
of Public Health Realities, edited by Frederic P. Gorham and Clarence L. Scamman,
65–75. New York: Commonwealth Fund, 1934 [1905].
Christophers, S. R., and J. W. W. Stephens. ‘‘The Native as the Prime Agent in the
Malarial Infection of Europeans.’’ Reports of the Malaria Committee of the Royal
Society, 3:3–19. London: Royal Society, 1900.
Clausewitz, Carl von. On War. Translated by Michael Howard and Peter Paret.
Princeton: Princeton University Press, 1976 [1832].
Clemow, F. G. The Geography of Disease. Cambridge: Cambridge University Press,
1903.
Codorniu y Nieto, Antonio. Topografía médica de las Islas Filipinas. Madrid: Alejandro
Gomez Fuentenebro, 1857.
Cole, C. L. ‘‘Necator americanus in the Natives of the Philippine Islands.’’ pjs 2b (1907):
333–42.
Comisión Central de Manila. Memoria complementaria de la sección 2 del programa:
Pobladores aborígenes, razas existentes y sus variedad de religiones, usos y
costumbres de los habitantes de Filipinas. Manila: Imprenta del Colegio de Santo
Tomás, 1887.
Conger, Emily Bronson. An Ohio Woman in the Philippines. Cleveland: Arthur H.
Clark, 1904.
Corpus, Teofilo. ‘‘Experiences in Collecting Lepers.’’ Philippine Health Service Monthly
Bulletin 4 (October 1924): 450.
Craig, Charles F. ‘‘Observations on Latent and Masked Malarial Infections with an
Analysis of 395 Cases.’’ American Medicine 8 (1904): 757–61.
———. ‘‘Observations upon Malaria: Latent Infection in Natives of the Philippine
Islands.’’ pjs 1 (1906): 523–31.

304 bibliography
———. ‘‘A Study of Latent Malarial Infection.’’ Yale Medical J. 13 (1906–7): 349–63.
———. ‘‘The Importance to the Army of Diseases Transmitted by Mosquitoes and
Methods for Their Prevention.’’ Military Surgeon 26 (1910): 292–308.
Crane, C. J. ‘‘The Fighting Tactics of Filipinos.’’ jmsi 31 (1902): 496–507.
Daniels, Charles W., and E. Wilkinson. Tropical Medicine and Hygiene. 2nd ed., 2 vols.
New York: Wood, 1913–14.
Dauncey, Campbell. An Englishwoman in the Philippines. New York: E. P. Dutton,
1906.
Davidson, Andrew, ed. Hygiene and Diseases of Warm Climates. Edinburgh: Pentland,
1893.
Davis, Dwight D. ‘‘Significance of Clean-Up Week.’’ Monthly Bulletin Philippines
Health Service, January 1930. Manila: Bureau of Printing, 1930.
Davy, John. Researches, Physiological and Anatomical. 2 vols. London: Smith, Elder,
1839.
De Jesús, V. Proposed Sanitary Code. Health Bulletin No. 22. Manila: Bureau of
Printing, 1920.
De Witt, Wallace. ‘‘A Few Remarks Concerning the Health Conditions of Americans in
the Philippines.’’ Yale Medical J. 11 (1904–05): 56–63.
Del Rosario, S. V., and L. Lopez Rizal. Some Epidemiological Features of Cholera in the
Philippines. Philippine Health Service Bulletin No. 25. Manila: Bureau of Printing,
1922.
Dunbar, A. W. ‘‘Antimalarial Prophylactic Measures and Their Results at the Naval
Station, Olongapo, P.I.’’ pjs 5 (1910): 285–89.
Edger, J. M. The Present Pandemic of Plague. Washington, D.C.: Government Printing
Office, 1908.
Fajardo, J. ‘‘Commencement Address.’’ Bulletin of the San Juan de Dios Hospital 5
(1931): 173–75.
Fales, Louis H. ‘‘The American Physician in the Philippine Civil Service.’’ American
Medicine 9 (1905): 513–17.
———. ‘‘Tropical Neurasthenia and Its Relation to Tropical Acclimation.’’ American J.
Medical Science 133 (1907): 582–93.
Fee, Mary H. A Woman’s Impressions of the Philippines. Chicago: A. C. McClurg,
1910.
Felkin, Robert W. On the Geographical Distribution of Tropical Diseases in Africa.
Edinburgh: Clay, 1895.
Flexner, Simon, and Lewellys Barker. ‘‘Report of a Special Commission Sent to the
Philippines by the Johns Hopkins University to Investigate the Prevalent Conditions
of the Islands.’’ jmsi 26 (1900): 421–33.
———. ‘‘The Prevalent Diseases in the Philippines.’’ Science 11ns (April 6, 1900): 521–
28.
Forbes, William Cameron. The Philippine Islands. 2 vols. Boston: Houghton Mifflin,
1928.
Foreman, J. The Philippine Islands. Singapore: Kelly and Walsh, 1906.
Fortune, T. Thomas. ‘‘The Filipino.’’ Voice of the Negro 1 (1904): 93–99, 199–203,
240–46.

bibliography 305
Foster, Charles C. ‘‘Notes by a Medical Officer in the East.’’ tams 6 (1896): 365–69.
Fox, Carroll. Handbook for Sanitary Inspectors. Manila: Bureau of Printing, 1914.
Freer, Paul C. Description of the New Buildings of the Bureau of Government
Laboratories. Manila: Bureau of Printing, 1904.
———. ‘‘A Consideration of Some of the Modern Theories of Immunity.’’ pjs 2b (1907):
71–82.
Freer, William B. The Philippine Experiences of an American Teacher: A Narrative of
Work and Travel in the Philippine Islands. New York: Charles Scribner’s Sons, 1906.
Galliéni, Joseph S. La Pacification de Madagascar: opérations d’octobre 1896 à mars
1899. Edited by F. Hellot. Paris: Chapelot, 1900.
Garrison, P. E. ‘‘The Prevalence and Distribution of the Animal Parasites of Man in the
Philippine Islands, with a Consideration of Their Possible Influence upon the Public
Health.’’ pjs 3b (1908): 191–210.
Garrison, P. E., and R. Llamas. ‘‘The Intestinal Worms of 385 Filipino Women and
Children in Manila.’’ pjs 4b (1909): 185–87.
Garrison, P. E., et al. ‘‘Medical Survey of Taytay.’’ pjs 4b (1909): 257–68.
Gatewood, James D. ‘‘Report on the International Conference on Leprosy.’’ In Report of
the Surgeon-General, U.S. Navy, to the Secretary of the Navy, 1898, 138–58.
Washington, D.C.: Government Printing Office, 1898.
Gibbs, H. D. ‘‘A Study of the Effect of Tropical Sunlight upon Men, Monkeys, and
Rabbits, and a Discussion of the Proper Clothing for the Tropics.’’ pjs 7b (1912): 91–
114.
Gimlette, John D. ‘‘Notes on a Case of ‘Amok.’ ’’ J. Tropical Medicine 4 (1901): 195–96.
Gonzalez, R. Filipinas y sus inhabitantes. N.p.: n.pub., 1896.
Gorgas, William Crawford. Sanitation in Panama. London: Appleton, 1915.
Graves, Marvin L. ‘‘The Negro as a Menace to the Health of the White Race.’’ Southern
Medical J. 9 (1916): 407–13.
Greenleaf, Charles R. An Epitome of Tripler’s Manual and Other Publications on the
Examination of Recruits. 4th ed. Washington D.C.: Judd and Detweiler, 1898
[1884].
———. ‘‘The Practical Duties of an Army Surgeon in the Field, in Time of War.’’ tams 2
(1892): 9–14.
———. ‘‘A Brief Statement of the Sanitary Work Accomplished So Far in the Philippine
Islands, and of the Present Shape of the Sanitary Administration.’’ Public Health
Papers and Reports: American Public Health Association 27 (1901): 159.
Griffis, William Elliot. America in the East: A Glance at Our History, Prospects,
Problems and Duties in the Pacific Ocean. New York: A. S. Barnes, 1899.
Griffith, Jefferson D. ‘‘Hospital Experience in the War with Spain.’’ jams 8 (1899):
161–67.
Guthrie, Joseph A. ‘‘Some Observations While in the Philippines.’’ jams 13 (1903):
141–49.
Hackett, L. W. Malaria in Europe: An Ecological Study. Oxford: Oxford University
Press, 1937.
———. ‘‘Malaria Control through Anti-mosquito Measures in Italy.’’ Trans. of the Royal
Society of Tropical Medicine and Hygiene 22 (1929): 477–506.

306 bibliography
———. ‘‘Biological Factors in Malaria Control.’’ American J. Tropical Medicine 16
(1936): 341–52.
Hackett, L. W., P. F. Russell, J. W. Scharf, and R. Senior White. ‘‘The Present Use of
Naturalistic Measures in the Control of Malaria.’’ Bulletin of the Health
Organization of the League of Nations 7 (1938): 1016–64.
Halley, George. ‘‘First-aid to the Wounded.’’ tams 2 (1892): 129–32.
Hamilton, Louis M. ‘‘Jungle Tactics,’’ jmsi 37 (1905): 23–28.
Hammond, William Alexander. A Treatise on Hygiene, with Special Reference to the
Military Service. San Francisco: Norman, 1991 [1863].
Harris, Seale. ‘‘Tuberculosis in the Negro.’’ jama 41 (1903): 834–38.
Harrison, Francis B. Inaugural Address. Manila: Bureau of Printing, 1913.
———. The Corner-Stone of Philippine Independence: A Narrative of Seven Years. New
York: Century, 1922.
Havard, Valery. Manual of Military Hygiene for the Military Services of the United
States. 3rd ed. New York: William Wood, 1917.
———. ‘‘Is Mortality Necessarily Higher in Tropical than in Temperate Climates?’’
American Medicine 9 (1905): 16–20.
Heiser, Victor G. An American Doctor’s Odyssey: Adventures in Forty-Five Countries.
New York: W. W. Norton, 1936.
———. Toughen Up America. New York: McGraw-Hill, 1941.
———. ‘‘The Progress of Medicine in the Philippine Islands.’’ jama 47 (1906): 245–47.
———. ‘‘Unsolved Health Problems Peculiar to the Philippines.’’ pjs 5 (1910): 171–78.
———. ‘‘Typhoid Fever in the Philippine Islands from the Sanitary Standpoint.’’ pjs 7b
(1912): 115–18.
———. ‘‘Sanitation in the Philippines.’’ J. Race Development 3 (1912): 121–34.
———. ‘‘Fighting Leprosy in the Philippines.’’ World’s Work 31 (1916): 310–20.
———. ‘‘Tropical Diseases.’’ In Handbook of Medical Treatment, edited by J. C.
DaCosta, 1:189–399. Philadelphia: F. A. Davis, 1918.
Henderson, Thomas. Hints on the Medical Examination of Recruits for the Army.
Philadelphia: Haswell, Barrington and Haswell, 1840.
Hernando, E. Management of Communicable Diseases. Health Bulletin No. 21. Manila:
Bureau of Printing, 1919.
Herzog, Maximilian. The Plague: Bacteriology, Morbid Anatomy, and Histopathology.
Manila: Bureau of Printing, 1904.
———. ‘‘The Brain-weight of Filipinos.’’ American Anthropologist 10 (1908): 41–47.
Herzog, Maximilian, and Charles B. Hare. Does Latent or Dormant Plague Exist Where
the Disease Is Endemic? Bureau of Government Laboratories Publication No. 20.
Manila: Bureau of Printing, 1904.
Hill, Hibbert Winslow. The New Public Health. Minneapolis: Press of the Journal
Lancet, 1913.
Hirsch, August. Handbuch der Historisch-Geographischen Pathologie. 2nd ed., 3 vols.
London: New Sydenham Society, 1883.
Hoff, John van R. ‘‘Sanitary Organization in the United States Army.’’ tams 6 (1896):
207–30.
———. ‘‘Scheme of Military Sanitary Organization.’’ jams 7 (1897): 437–47.

bibliography 307
Hoff, John van R. ‘‘Some Steps in the Organization and Instruction of the Medical
Department of the Third Corps, U.S.V.’’ Proceedings 8th Annual Meeting of the
Association of Military Surgeons of the U.S., Kansas City, 1899, 106–38. Columbus,
Ohio: Berlin Printing, 1900.
Howard, R. ‘‘Emotional Psychoses among Dark-skinned Races.’’ Trans. of the Society of
Tropical Medicine and Hygiene 3 (1910): 323–41.
Howard, William Lee. ‘‘The Negro as a Distinct Ethnic Factor in Civilization.’’ Medicine
60 (1903): 418–28.
Hoyt, Henry F. A Frontier Doctor, edited by Doyce B. Nunis. Chicago: R. R. Donnelly
and Sons, 1979 [1929].
———. ‘‘Observations upon and Reasons for a More Complete Physical Examination of
Railway Employees.’’ Railway Surgeon 4 (1895): 51–54.
———. ‘‘Appendix.’’ In Report of the Philippine Commission to the President, 1:262–64.
Washington D.C.: Government Printing Office, 1900.
Hoyt, R. E. ‘‘Results of Three Hundred Examinations of Feces with Reference to the
Presence of Amoebae.’’ pjs 3b (1908): 417–20.
Huggins, Eli L. ‘‘Custer and Rain-in-the-Face.’’ The American Mercury 9 (1926):
338–43.
Huntington, Ellsworth. Civilization and Climate. New Haven: Yale University Press,
1915.
Jackson, Thomas W. ‘‘Sanitary Conditions and Needs in Provincial Towns.’’ pjs 3b
(1908): 431–38.
Jagor, Fedor. Travels in the Philippines. Manila: Filipiniana Books, 1965 [1873].
James, William. The Varieties of Religious Experience. Cambridge: Harvard University
Press, 1985 [1901–02].
———. ‘‘Lectures Six and Seven: The Sick Soul.’’ In The Varieties of Religious
Experience, vol. 15 of The Works of William James, edited by Frederick H.
Burkhardt, Fredson Bowers, and Ignas K. Skrupskelsis, 103–31. Cambridge:
Harvard University Press, 1985 [1901–2].
———. ‘‘The Moral Equivalent of War.’’ In Essays on Faith and Morals, 311–28. New
York, 1943.
Jenks, Albert E. ‘‘Assimilation in the Philippines, as Interpreted in Terms of Assimilation
in America.’’ American J. Sociology 19 (1912): 773–91.
Joaquin, Nick. ‘‘Sa loob ng Manila.’’ In The Likhaan Anthology of Literature in English
from 1900 to the Present, edited by Gemino H. Abad, 445–60. Quezon City:
University of the Philippines Press, 1998 [1988].
Joint Commission of Representatives from the College of Medicine and Surgery,
University of the Philippines, the Bureau of Science, and the Bureau of Health.
‘‘Sanitary Survey of San José Estates and Adjacent Properties on Mindoro Island, P.I.,
with Special Reference to the Epidemiology of Malaria.’’ pjs 9B (1914): 137–95.
Jordan, David Starr. Imperial Democracy: A Study of the Relation of Government by
the People, Equality Before the Law, and Other Tenets of Democracy, to the
Demands of a Vigorous Foreign Policy and Other Demands of Imperial Dominion.
New York: D. Appleton, 1899.

308 bibliography
Kafka, Franz. The Metamorphosis, In the Penal Colony and Other Stories. New York:
Simon and Schuster, 1995.
Kemp, Franklin M. ‘‘Field Work in the Philippines.’’ jams 9 (1900): 73–85.
Kidd, Benjamin. The Control of the Tropics. New York: Macmillan, 1898.
King, W. W. ‘‘Tropical Neurasthenia.’’ jama 46 (1906): 1518–19.
Kipling, Rudyard. ‘‘The White Man’s Burden.’’ McClure’s Magazine 12 (February
1899): 290–91.
Kulp, John S. ‘‘A Manila Military Hospital.’’ jams 10 (1901–02): 225–38.
Lara, Casimiro B. Leprosy Research in the Philippines: A Historical-Critical Review.
Manila: National Research Council, 1936.
Lemus, Rienzi B. ‘‘The Negro and the Philippines.’’ Colored American Magazine 6
(1903): 314–18.
LeRoy, James A. Philippine Life in Town and Country. New York: G. P. Putnam’s Sons,
1906.
———. The Americans in the Philippines: A History of the Conquest and First Years of
Occupation, with an Introductory Account of the Spanish Rule. 2 vols. New York:
ams Press, 1970 [1914].
———. ‘‘The Philippines, 1860–1898—Some Comment and Bibliographical Notes.’’ In
The Philippines Islands 1493–1898, edited by E. H. Blair and J. A. Robertson,
52:112–207. Cleveland: Arthur H. Clark, 1907.
Lévi-Strauss, Claude. Tristes tropiques. New York: Athenaeum, 1975 [1955].
Limjuco, Ignacia. ‘‘Hygiene in the Community.’’ Bulletin of the San Juan de Dios
Hospital 6 (1932): 21–25.
Lippincott, Henry. ‘‘Report of Lt.-Col. Henry Lippincott, Deputy Surgeon-general, U.S.
Army, on the Condition of Medical Affairs in the Philippine Expeditionary
Commands, Manila, August 31, 1898.’’ In George M. Sternberg, Report of the
Surgeon-General of the Army to the Secretary of War, 262–65. Washington, D.C.:
Government Printing Office, 1898.
———. ‘‘Reminiscences of the Expedition to the Philippine Islands.’’ jams 8 (1899): 168–
74.
Long, J. D. ‘‘Health in the Philippine Islands.’’ Philippine Review (January 1916): 49–51.
Lopes-Rizal, Leoncio. Annual Report of the National Research Council of the
Philippines. Manila: Bureau of Printing, 1934–35.
Lovewell, C. H. ‘‘Malaria at Camp Stotsenberg, P.I.’’ Military Surgeon 60 (1927): 688–
700.
Lyautey, Hubert. ‘‘Du rôle social de l’officier.’’ Revue des deux mondes 104 (March 11,
1891): 443–59.
———. ‘‘Du rôle coloniale de l’armée,’’ Revue des deux mondes 157 (Feb. 15, 1900):
308–28.
Mackinnon, Grace. ‘‘Diseases of Women in the Tropics.’’ In The Practice of Medicine in
the Tropics, edited by W. Byam and R. G. Archibald, 3:2472–76. London: Henry
Frowde and Hodder and Stoughton, 1923.
MacNamara, N. C. ‘‘Leprosy.’’ In Hygiene and Diseases of Warm Climates, edited by
Andrew Davidson, 426–52. Edinburgh: Pentland, 1893.

bibliography 309
Manalang, C. ‘‘Malaria Transmission in the Philippines II.’’ pjs 45 (1931): 367–81.
Manson, Patrick. Tropical Diseases: A Manual of the Diseases of Warm Climates.
London: Cassell, 1898.
———. Tropical Diseases: A Manual of the Diseases of Warm Climates. 5th ed. London:
Cassell, 1914.
Marshall, Thomas R. Asiatic Cholera in the Philippines Islands. Manila: Bureau of
Public Printing, 1904.
Mason, Charles F. ‘‘Notes from the Experiences of a Medical Officer in the Tropics.’’
jams 13 (1903): 306–14.
Maus, L. Mervin. ‘‘Report of Major L. M. Maus, Surgeon, U.S. Army, Chief Surgeon
Second Division, Eighth Army Corps, to Chief Surgeon, Division of the Philippines,
June 15, 1900.’’ In George M. Sternberg, Report of the Surgeon-General of the Army
to the Secretary of War, 116–29. Washington, D.C.: Government Printing Office,
1900.
———. ‘‘Venereal Diseases in the United States Army—Their Prevention and
Treatment.’’ Military Surgeon 27 (1910): 130–48.
———. ‘‘The Ethics, Scope, and Prerogative of the Army Medical Officer.’’ Military
Surgeon 28 (1911): 295–309.
Mayo, Katherine. The Isles of Fear: The Truth about the Philippines. New York:
Harcourt Brace, 1924.
McLaughlin, Allan J. ‘‘The Suppression of a Cholera Epidemic in Manila.’’ pjs 4b
(1909): 43–58.
McLaughlin, Allan J., assisted by James A. Tobey. Personal Hygiene: The Rules of Right
Living. New York: Funk and Wagnalls, 1924.
Meacham, Franklin A. ‘‘Report of Major Franklin A. Meacham, Chief Surgeon 3rd
Military District of the Department of Northern Luzon, to Chief Surgeon
Department of Northern Luzon, May 31, 1900.’’ In George M. Sternberg, Report of
the Surgeon-General of the Army to the Secretary of War, 137–42. Washington,
D.C.: Government Printing Office, 1900.
Mearns, Lilian Hathaway. A Philippine Romance. New York: Aberdeen, 1910.
Miller, George Amos. Interesting Manila. Manila: E. C. McCullough, 1912.
Morris, Charles. Our Island Empire: A Handbook of Cuba, Porto Rico, Hawaii and the
Philippine Islands. Philadelphia: Lippincott, 1899.
Moses, Bernard. ‘‘Control of Dependencies Inhabited by Less Developed Races.’’
University of California Chronicle 7 (1905): 83–99.
Moses, Edith. Unofficial Letters of an Official’s Wife. New York: D. Appleton, 1908.
Munson, Edward L. The Theory and Practice of Military Hygiene. London: Ballière,
Tindall and Cox, 1902.
———. The Principles of Sanitary Tactics: A Handbook on the Use of Medical
Department Detachments and Organizations in Campaign. Menasha, Wis.: Banta
Publishing, 1911.
———. The Management of Men: A Handbook on the Systematic Development of
Morale and the Control of Human Behavior. New York: Henry Holt, 1921.
———. ‘‘The Ideal Ration for an Army in the Tropics,’’ jams 9 (1900): 298–333.

310 bibliography
———. ‘‘The Civil Sanitary Function of the Army Medical Department in Territory under
Military Control.’’ Military Surgeon 25 (1909): 273–304.
———. ‘‘Cholera Carriers in Relation to Cholera Control.’’ pjs 10b (1915): 1–9.
Musgrave, W. E. ‘‘Progress of Medicine in the Philippines.’’ Bulletin of the Manila
Medical Society 8 (1911): 122–26, 138–44.
———. ‘‘Tropical Neurasthenia, Tropical Hysteria and Some Special Tropical Hysteria-
like Neuropsychoses.’’ Archives of Neurology and Psychiatry 5 (1921): 398–407.
Musgrave, W. E., and A. G. Sison. ‘‘Blood Pressure in the Tropics: A Preliminary
Report.’’ pjs 5 (1910): 325–29.
———. ‘‘Mali-mali, a Mimic Psychosis in the Philippine Islands: A Preliminary Report.’’
pjs 5 (1910): 335–39.
Notter, J. Lane. ‘‘On the Sanitary Methods of Dealing with Epidemics.’’ jmsi 35 (1899):
111–24.
O’Reilly, G. A. ‘‘Manila’s Grand Annual Carnival: The Great Unexpected Success of
1908 and the Splendid Spectacle Assured for 1909.’’ Colonial and Philippines
Monthly Review 2 (1908): 55–59.
Osler, William. ‘‘The Nation and the Tropics.’’ The Lancet ii (Nov. 13, 1909): 1401–06.
Page, Henry. ‘‘Malaria and Mosquitoes at Lucena Barracks, Philippine Islands.’’ jmsi 19
(1906): 65–76.
Palmer, G. G. ‘‘Notes on Luzon.’’ jmsi 33 (1903): 223–30.
Pardo de Tavera, T. H. El Legado del ignorantismo. Manila: Bureau of Printing, 1921.
———. ‘‘Filipino Views of American rule.’’ North American Review 174 (January 1902):
73–84.
Parker, James. ‘‘Some Random Notes on the Fighting in the Philippines.’’ jmsi 27
(1900): 317–40.
Parsons, A. L. ‘‘Malaria Control at Camp Stotsenberg, P.I.’’ Military Surgeon 63 (1928):
816–29.
Phalen, James M. ‘‘An Experiment with Orange-red Underwear.’’ pjs 5 (1910): 525–46.
Phalen, James M., and H. J. Nichols. ‘‘Notes on the Distribution of Filaria nocturna in
the Philippine Islands.’’ pjs 3B (1908): 305–10.
Phelan, Henry du Rest. ‘‘Sanitary Service in Surigao, a Filipino Town on the Island of
Mindanao.’’ jams 14 (1904): 1–18.
Quezon, Manuel L. The Good Fight. New York: D. Appleton-Century, 1946.
Rattray, Alexander. ‘‘On Some of the More Important Physiological Changes Induced in
the Human Economy by Change of Climate, as from Temperate to Tropical, and the
Reverse.’’ Proceedings of the Royal Society of London 18 (1869–70): 513–29; 19
(1870–71): 295–316.
Recto, Claro M. ‘‘Most Ignominious Surrender.’’ In Vintage Recto: Memorable Speeches
and Writing, edited by Renato Constantino, 13–24. Quezon City: Nationalist
Studies, 1986 [1933].
———. ‘‘Our Mendicant Foreign Policy.’’ In Vintage Recto: Memorable Speeches and
Writing, edited by Renato Constantino, 63–83. Quezon City: Nationalist Studies,
1986 [1951].
———. ‘‘Our Lingering Colonial Complex.’’ In Vintage Recto: Memorable Speeches and

bibliography 311
 Writing, edited by Renato Constantino, 84–94. Quezon City: Nationalist Studies,
1986 [1951].
Reed, Walter, Victor C. Vaughan, and E. O. Shakespeare. Abstract of the Report of the
Origin and Spread of Typhoid Fever in United States’ Military Camps During the
Spanish War of 1898. Washington D.C.: War Department, 1900.
Rhodes, Charles D. ‘‘The Utilization of Foreign Troops in Our Foreign Possessions.’’
jmsi 30 (1902): 1–26.
Rizal, José. Noli Me Tangere. Translated by Priscilla G. Valencia. Manila: National
Book Store, 1967 [1887].
———. El Filibusterismo. Translated by Jovita Ventura Cruz. Manila: Asean Committee
on Culture and Information, 1991 [1891].
Roosevelt, Nicholas. The Philippines: A Treasure and a Problem. New York: J. H. Sears,
1926.
Roosevelt, Theodore. The Strenuous Life. New York: Century, 1901.
———. A Book Lover’s Holidays in the Open. New York: Scribner’s, 1919.
———. ‘‘At Arlington, Memorial Day, May 30, 1902.’’ In Presidential Addresses and
State Papers, 1:56–67. New York: Review of Reviews, 1904 .
———. ‘‘At the Banquet Tendered for Gen. Luke E. Wright, at Memphis, Tennessee, Nov.
19, 1902.’’ In Presidential Addresses and State Papers, 1:202–08. New York: Review
of Reviews, 1904 .
———. ‘‘Message of the President of the U.S., Communicated to the Two Houses of
Congress at the Beginning of the First Session of the 57th Congress.’’ In Presidential
Addresses and State Papers, 1:529–606. New York: Review of Reviews, 1904 [1901].
———. ‘‘At the Coliseum, Hartford, Conn., Aug. 22, 1902.’’ In Presidential Addresses
and State Papers, 2:85–98. New York: Review of Reviews, 1904.
———. ‘‘Message of the President of the US, Communicated to the Two Houses of
Congress at the Beginning of the Second Session of the 57th Congress.’’ In
Presidential Addresses and State Papers, 2:606–45. New York: Review of Reviews,
1904 [1902].
Root, Elihu. ‘‘Report for 1902.’’ In Annual Reports of the Secretary of War to the
President of the United States, 1898–1903, 245–323. Washington, D.C.:
Government Printing Office, 1904.
Rose, Wickliffe. ‘‘Field Experiments in Malaria Control.’’ jama 73 (1919): 1414–20.
Ross, Ronald. The Prevention of Malaria. New York: Dutton, 1910.
———. Memoirs, with a Full Account of the Great Malaria Problem and Its Solution.
London: John Murray, 1923.
———. Studies on Malaria. London: John Murray, 1928.
Russell, Frederick F. The Results of Anti-Typhoid Vaccination in the Army in 1911,
and Its Suitability for Use in Civil Communities. Chicago: American Medical
Association, 1912.
———. ‘‘War on Disease, Particularly Yellow Fever and Malaria.’’ Sigma Xi Quarterly
13 (1925): 11–32.
Russell, Paul F. Malaria and Culicidae in the Philippine Islands: History and Critical
Bibliography. Manila: Bureau of Printing, 1934.

312 bibliography
———. Man’s Mastery of Malaria. London: Oxford University Press, 1955.
———. ‘‘Malaria in the Philippine Islands.’’ American J. Tropical Medicine 12 (1933):
167–78.
———. ‘‘Malaria in India: Impressions from a Tour.’’ American J. Tropical Medicine 16
(1936): 653–64.
Russell, Paul F., and Fred W Knipe. ‘‘Malaria Control by Spray-killing Adult
Mosquitoes.’’ J. of the Malaria Institute of India 2 (1939): 229–37.
Russell, Paul F., L. S. West, and R. D. Manwell. Practical Malariology. Philadelphia:
W. B. Saunders, 1946.
Sambon, Luigi W. ‘‘Remarks on Acclimatisation in Tropical Regions.’’ British Medical J.
1 (1897): 61–66.
Scarborough, W. S. ‘‘The Negro and Our New Possessions.’’ Forum 34 (1901): 341–49.
Schöbl, Otto. ‘‘Observations Concerning Cholera Carriers.’’ pjs 10b (1915): 11–17.
Schurz, Carl. For American Principles and American Honor. New York: Anti-
Imperialist League, 1900.
Seale, A. ‘‘The Mosquito Fish, Gambusia affinus in the Philippine Islands.’’ pjs 12
(1917): 177–89.
Seaman, Louis L. ‘‘Observations in China and the Tropics’’ jams 10 (1901–02):
149–50.
———. ‘‘Native Troops for Our Colonial Possessions.’’ jams 10 (1901–02): 240.
Sellards, Andrew Watson. ‘‘Bonds of Union between Tropical Medicine and General
Medicine.’’ Science 66ns (1927): 93–100.
Shaklee, Alfred O. ‘‘Experimental Acclimatization to the Tropical Sun.’’ pjs 12 (1917):
1–22.
Shaler, Nathaniel S. ‘‘The Transplantation of a Race.’’ Popular Science Monthly 56
(March 1900): 513–24.
———. ‘‘The Future of the Negro in the Southern States.’’ Popular Science Monthly 57
(June 1900): 145–54.
Simmons, J. S., J. H. St. John, and F. H. K Reynolds. ‘‘Malaria Survey at Camp
Stotsenberg, P.I.’’ Military Surgeon 67 (1930): 1–13.
Sison, Agerico B. M. ‘‘Educating Our Educators.’’ Bulletin of the San Juan de Dios
Hospital 1 (1927): 123–24.
Smart, Charles. ‘‘Medical Department of the Army.’’ tams 3 (1893): 193–203.
———. ‘‘Transport of the Wounded in War.’’ tams 4 (1894): 22–45.
Smith, Goldwin. Commonwealth or Empire: A Bystander’s View of the Question.
London: Macmillan, 1902.
Snodgrass, John E. Leprosy in the Philippine Islands. Manila: Bureau of Printing, 1915.
Soper, Fred L., and D. B. Wilson. Anopheles gambiae in Brazil, 1930–1940. New York:
Rockefeller Foundation, 1943.
Stein, Stanley, with Lawrence Blochman. Alone No Longer. New York: Funk and
Wagnalls, 1963.
Stelle, Matthew F. ‘‘Some Notes on the Clothing and Equipment of the Soldier for
Service in the Tropics.’’ jmsi 29 (1901): 14–23.
Sternberg, George M. Report of the Surgeon-General of the Army to the Secretary of

bibliography 313
 War, For the Fiscal Year Ended June 30, 1898. Washington D.C.: Government
Printing Office, 1898.
Sternberg, George M. Report of the Surgeon-General of the Army to the Secretary of
War, For the Fiscal Year Ended June 30, 1900. Washington D.C.: Government
Printing Office, 1900.
———. Infection and Immunity, with Special Reference to the Prevention of Infectious
Disease. New York: G. P. Putnam’s Sons, 1903.
———. ‘‘A Fatal Form of Septacemia in the Rabbit Produced by Subcutaneous Injection
of Human Saliva.’’ National Board of Health Bulletin 2 (1881): 781–83.
———. ‘‘Presidential Address.’’ tams 5 (1895): 8–22.
Sterne, Albert E. ‘‘Neurasthenia and Its Treatment by Actinic Rays.’’ jama 42 (1904):
500–507.
Stillman, James W. Republic or Empire? An Argument in Opposition to the
Establishment of an American Colonial System. Boston: George H. Ellis, 1900.
Stitt, E. R. The Diagnostics and Treatment of Tropical Diseases. Philadelphia:
Blakiston, 1914.
———. The Diagnostics and Treatment of Tropical Diseases. 5th ed. Philadelphia:
Blakiston, 1922.
———. ‘‘A Study of the Intestinal Parasites Found in Cavite Province.’’ pjs 6b (1911):
211–14.
Stone, Hamilton. ‘‘Our Troops in the Tropics—From the Surgeon’s Standpoint.’’ jmsi
26 (1900): 358–69.
Strong, Richard P. ‘‘Leprosy.’’ In Forchheimer’s Therapeusis of Internal Diseases,
edited by Frank Billings and Ernest E. Irons, 387–400. New York and London:
D. Appleton, 1914.
———. ‘‘The Importance of Ecology in Relation to Disease.’’ Science 82ns (1935):
307–17.
Strong, Richard P., et al. ‘‘Medical Survey of the Town of Taytay.’’ pjs 4b (1909):
247–52.
Suarez Caopalleja, Victor. Le salud del europeo en América y Filipinas y del repatriado
y criollo en Europa. Madrid: Gabriel Pedraza, 1897.
Taft, Helen. Recollections of Full Years. New York: Dodd, Mead, 1914.
Taft, William H. Special Report of W. H. Taft to the President on the Philippine Islands.
Washington, D.C.: Government Publications Office, 1908.
———. ‘‘The Work of the United States in the Philippines.’’ In William Howard Taft, the
Man of the Hour: His Biography and His Views on the Great Questions of the Day,
edited by Oscar King Davis, 229–65. Philadelphia: P. W. Ziegler, 1908 [1907].
———. ‘‘Progress of the Negro.’’ In William Howard Taft, the Man of the Hour: His
Biography and His Views on the Great Questions of the Day, edited by Oscar King
Davis, 319–28. Philadelphia: P. W. Ziegler, 1908.
———. ‘‘Address of President Taft at the 15th International Congress on Hygiene and
Demography.’’ Science 36ns (October 18, 1912): 504–08.
Taylor, Frederick Winslow. Principles of Scientific Management. New York: Harper,
1911.

314 bibliography
Terry, C. E. ‘‘The Negro, a Public Health Problem.’’ Southern Medical J. 7 (1915):
458–67.
Thompson, Joseph C. ‘‘ ‘Tropical Neurasthenia’: A Deprivation Psychoneurosis.’’
Military Surgeon 54 (1924): 319–24.
Tianco, Mamero, under direction of J. D. Long. Philippine Health Service Sanitary
Almanac for 1919 and Calendars for 1920 and 1921. Health Bulletin No. 19.
Manila: Bureau of Printing, 1918.
Tiedemann, W. D. ‘‘Malaria in the Philippines.’’ J. Preventive Medicine 1 (1927):
205–54.
Traub, P. E. ‘‘Military Hygiene: How Best to Enforce Its Study.’’ jmsi 36 (1905):
1–38.
Tucker, E. F. Gordon. ‘‘Neurasthenia in Anglo-Indians.’’ Indian Medical Gazette 38
(1903): 43–49.
Turner, Frederick Jackson. ‘‘The Significance of the Frontier in American History.’’ In
The Frontier in American History, 1–38. Huntington N.Y.: Robert E. Krieger, 1976
[1893]).
Twain, Mark [Samuel Clemens]. ‘‘To the Person Sitting in Darkness.’’ North American
Review 172 (February 1901): 161–76.
Vaughan, Victor C. Infection and Immunity. Chicago: ama, 1915.
———. ‘‘Typhoid Fever among the American Soldiers in the Recent War with Spain.’’
jmsi 35 (1899): 85–88.
Vedder, Edward B. Beriberi. New York: W. Wood, 1913.
———. ‘‘Report on the Seventh Congress of the Far Eastern Association of Tropical
Medicine.’’ Military Surgeon 62 (1928): 275–82.
Wade, H. W., and José Avellana Basa. ‘‘The Culion Leper Colony.’’ American J. of
Tropical Medicine 3 (1923): 395–417.
Walker, E. L., and A. W. Sellards. ‘‘Experimental Entamoebic Dysentery.’’ pjs 8b (1913):
253–329.
Walker E. L., and M. A. Barber ‘‘Malaria in the Philippine Islands I.’’ pjs 9 (1914):
381–439.
Washburn, W. S. ‘‘The Relation between Climate and Health, with Special Reference to
American Occupation of the Philippine Islands.’’ American J. of the Medical
Sciences 130 (1905): 497–517.
———. ‘‘Health Conditions in the Philippines.’’ pjs 3b (1908): 269–84.
Watkins, V. E. ‘‘Neurasthenia among Blondes in the Southwest.’’ New York Medical J.
82 (1905): 1373–74.
Watson, Malcolm. The Prevention of Malaria in the Federated Malay States. 2nd ed.
London: John Murray, 1921.
Willets, D. G. ‘‘A Statistical Study of Intestinal Parasites in Tobacco Haciendas of the
Cagayan Valley.’’ pjs 6b (1911): 77–92.
Williams, Daniel R. The United States and the Philippines. New York: Doubleday,
1924.
Wilson, R. M. ‘‘Industrial Therapy in Leprosy.’’ Southern Medical J. 23 (March 1930):
218–22.

bibliography 315
Wilson, Woodrow. Constitutional Government in the United States. New York:
Columbia University Press, 1921.
Winslow, Charles-Edward Amory. ‘‘Man and the Microbe.’’ Popular Science Monthly
85 (1914): 5–20.
Wood, Leonard. Report of the Governor-General of the Philippines, 1925. Washington
D.C.: Government Printing Office, 1926.
———. ‘‘Progress Fighting Leprosy at Culion: Better Facilities Might Open the Way to
Complete Victory.’’ The World’s Work (Dec. 1925): 144–47.
Woodhull, Alfred A. Notes on Military Hygiene for Officers of the Line: A Syllabus of
Lectures at the United States Infantry and Cavalry School. New York: Wiley, 1904
[1890].
Woodruff, Charles E. The Effects of Tropical Sunlight Upon the White Man. New York:
Rebman, 1905.
———. Expansion of Races. New York: Rebman, 1909.
———. ‘‘Military Medical Problems.’’ tams 3 (1893): 220–38.
———. ‘‘The Military Uses of Bacteriology.’’ jmsi 35 (1899): 178–202.
———. ‘‘Hygiene in the Tropics.’’ jmsi 35 (1899): 296–99.
———. ‘‘The Neurasthenic States Caused by Excessive Light.’’ Medical Record 68
(Dec. 23, 1905): 1005–09.
Woodward, C. M. ‘‘The Sanitation of Camps.’’ tams 2 (1892): 138–46.
Woodward, Joseph Janvier. Outlines of the Chief Camp Diseases of the United
States’ Armies as Observed During the Present War. Philadelphia: J. B. Lippincott,
1863.
Worcester, Dean C. History of Asiatic Cholera in the Philippine Islands. Manila: Bureau
of Printing, 1908.
———. The Philippines, Past and Present. 2 vols. New York: Macmillan, 1930 [1914].
Wu, T. C. ‘‘Fighting Leprosy in the Philippines.’’ Leper Quarterly 4 (1930): 3–14.
Zinsser, Hans. Infection and Resistance: An Exposition of the Biological Phenomena
Underlying the Occurrence of Infection and the Recovery of the Animal Body from
Infectious Disease. 2nd ed. New York: Macmillan, 1922.

secondary sources
Abel, Emily K. ‘‘ ‘Only the Best Class of Immigration’: Public Health Policy toward
Mexicans and Filipinos in Los Angeles, 1910–1940.’’ American J. Public Health. 94
(2004): 932–39.
———. ‘‘From Exclusion to Expulsion: Mexicans and Tuberculosis Control in Los
Angeles, 1914–1940.’’ Bulletin of the History of Medicine 77 (2003): 823–49.
Ackerknecht, Erwin. History and Geography of the Most Important Diseases. New
York: Hafner, 1965.
Adas, Michael. Machines as the Measure of Men: Science, Technology, and Ideologies
of Western Dominance. Ithaca: Cornell University Press, 1989.
———. ‘‘Improving on the Civilizing Mission? Assumptions of U.S. Exceptionalism in
the Colonization of the Philippines.’’ Itinerario 22 (1998): 44–66.

316 bibliography
Adelman, Jeremy, and Stephen Aron. ‘‘From Borderlands to Borders: Empires, Nation-
states and Peoples in between in North American History.’’ American Historical
Review 104 (1999): 814–41.
Agamben, Giorgio. Homo Sacer: Sovereign Power and Bare Life. Translated by Daniel
Heller-Roazen. Stanford: Stanford University Press, 1998.
Agoncillo, Teodoro A. The Revolt of the Masses: The Story of Bonifacio and the
Katipunan. Manila: University of the Philippines Press, 1956.
Agoncillo, Teodoro A., and O. M. Alfonso. Short History of the Philippine People.
Manila: University of the Philippines Press, 1963.
Alatas, Syed Hussein. The Myth of the Lazy Native: A Study of the Image of Malays,
Filipinos and Javanese from the 16th to the 20th Century and Its Function in the
Ideology of Colonial Capitalism. London: F. Cass, 1977.
Alfonso, Oscar M. Theodore Roosevelt and the Philippines, 1897–1909. Quezon City:
University of the Philippines Press, 1970.
Allen, Charles E. ‘‘World Health and World Politics.’’ International Organization 4
(1950): 27–43.
Anderson, Benedict. Imagined Communities: Reflections on the Origins and Spread of
Nationalism. Revised ed. London: Verso, 1991.
———. The Spectre of Comparisons: Nationalism, Southeast Asia and the World.
London: Verso, 1998.
Anderson, Warwick. ‘‘Colonial Pathologies: American Medicine in the Philippines,
1898–1921.’’ ph.d. diss., University of Pennsylvania, 1992.
———. ‘‘Excremental Colonialism: Public Health and the Poetics of Pollution.’’ Critical
Inquiry 21 (1995): 640–69.
———. ‘‘Immunities of Empire: Race, Disease, and the New Tropical Medicine.’’
Bulletin of the History of Medicine 70 (1996): 94–118.
———. ‘‘The Trespass Speaks: White Masculinity and Colonial Breakdown.’’ American
Historical Review 102 (1997): 1343–70.
———. ‘‘Leprosy and Citizenship.’’ Positions: East Asia Cultures Critique 6 (1998):
707–30.
———. ‘‘Victor G. Heiser.’’ In American National Biography, edited by John A. Garraty
and Mark C. Carnes, 10:522–24. New York: Oxford University Press, 1999.
———. ‘‘Richard Pearson Strong.’’ In American National Biography, edited by John A.
Garraty and Mark C. Carnes, 21:46–48. New York: Oxford University Press, 1999.
———. ‘‘The ‘Third-World’ Body.’’ In Medicine in the Twentieth Century, edited by
Roger Cooter and John Pickstone, 235–46. Amsterdam: Harwood Academic, 2000.
———. ‘‘Going through the Motions: American Hygiene and Colonial ‘Mimicry.’ ’’
American Literary History 14 (2002): 686–719.
———. The Cultivation of Whiteness: Science, Health and Racial Destiny in Australia.
New York: Basic Books, 2003.
———. ‘‘The Natures of Culture: Environment and Race in the Colonial Tropics.’’ In
Nature in the Global South: Environmental Projects in South and Southeast Asia,
edited by Paul Greenough and Anna L. Tsing, 29–46. Durham, N.C.: Duke
University Press, 2003.

bibliography 317
Anderson, Warwick. ‘‘Natural Histories of Infectious Disease: Ecological Vision in
Twentieth-century Biomedical Science.’’ Osiris 19 (2004): 39–61.
———. ‘‘Postcolonial Histories of Medicine.’’ In Locating Medical History: The Stories
and Their Meanings, edited by Frank Huisman and John Harley Warner, 285–307.
Baltimore: Johns Hopkins University Press, 2004.
———. ‘‘States of Hygiene: Race ‘Improvement’ and Biomedical Citizenship in Australia
and the Colonial Philippines.’’ In Haunted by Empire: Geographies of Intimacy in
North American History, edited by Ann Laura Stoler. Durham, N.C.: Duke
University Press, 2006.
———. ‘‘Science in the Philippines.’’ In Cambridge History of Science, edited by
Ronald L. Numbers and David Lindberg, vol. 8: National Sciences, edited by
Ronald Numbers and David Livingstone. Cambridge: Cambridge University Press,
forthcoming.
Appleby, Joyce. Liberalism and Republicanism in the Historical Imagination.
Cambridge: Harvard University Press, 1992.
Aretxaga, Begoña. ‘‘Dirty Protest: Symbolic Overdetermination and Gender in
Northern Ireland Ethnic Violence.’’ Ethnos 23 (1995): 123–48.
Arnold, David. Colonizing the Body: State Medicine and Epidemic Disease in
Nineteenth-Century India. Berkeley: University of California Press, 1993.
———. ‘‘Introduction: Disease, Medicine and Empire.’’ In Imperial Medicine and
Indigenous Society, edited by David Arnold, 1–26. Manchester: Manchester
University Press, 1989.
———. ‘‘ ‘An Ancient Race Outworn’: Malaria and Race in Colonial India, 1860–
1930.’’ In Race, Science and Medicine, 1700–1960, edited by Waltraud Ernst and
Bernard Harris, 123–43. London: Routledge, 1999.
Ashburn, Percy M. A History of the Medical Department of the United States Army.
Boston: Houghton Mifflin, 1929.
[Ashburn, Percy M.] ‘‘A Synopsis of the Work of the Army Medical Research Boards in
the Philippines.’’ Army Medical Bulletin (1929): 2–179.
Azicate, Enrico. ‘‘Medicine in the Philippines: An Historical Perspective.’’ m.a. thesis,
University of the Philippines, 1989.
Bakhtin, Mikhail M. Rabelais and His World. Translated by Helène Iswolsky.
Bloomington: Indiana University Press, 1984 [1964].
Bankoff, Greg. ‘‘A Question of Breeding: Zootechny and Colonial Attitudes toward the
Tropical Environment in the Late Nineteenth-century Philippines.’’ J. of Asian
Studies 60 (2001): 413–37.
Bantug, J. P. A Short History of Medicine in the Philippines under the Spanish Regime,
1565–1898. Manila: Colegio Médico-farmaceútico de Filipinas, 1953.
———. ‘‘Rizal and the Progress of the Natural Sciences.’’ Philippine Studies 9 (1961):
3–16.
Barrett, Frank A. Disease and Geography: The History of an Idea. Toronto: Geography
Department, York University, 2000.
Bauman, Zygmunt. Modernity and Ambivalence. Cambridge: Polity Press, 1991.
Bederman, Gail. Manliness and Civilization: A Cultural History of Gender and Race in
the United States, 1880–1917. Chicago: University of Chicago Press, 1995.

318 bibliography
Beisner, Robert L. Twelve Against Empire: The Anti-Imperialists, 1898–1900. New
York: McGraw Hill, 1968.
Benjamin, Walter. ‘‘On the Mimetic Faculty.’’ In Reflections, edited by Peter Demetz,
translated by E. Jephcott, 333–36. New York: Harcourt Brace Jovanovich, 1979.
Berkhofer, Robert F., Jr. The White Man’s Indian: Images of the American Indian from
Columbus to the Present. New York: Alfred A. Knopf, 1978.
Bhabha, Homi. The Location of Culture. London: Routledge, 1994.
———. ‘‘Of Mimicry and Man: The Ambivalence of Colonial Discourse.’’ October 28
(1984): 125–33.
———. ‘‘Remembering Fanon.’’ Foreword to Frantz Fanon, Black Skin, White Masks,
vii–xxvi. London: Pluto Press, 1986.
Bickel, Keith B. Mars Learning: The Marine Corps Development of Small Wars
Doctrine, 1915–1940. New York: Westview Press, 2001.
Biehl, João. ‘‘Other Life: aids, Brazil, and Subjectivity in Brazil’s Zones of Social
Abandonment.’’ ph.d. diss., University of California-Berkeley, 1999.
Birn, Anne-Emanuelle. ‘‘A Revolution in Rural Health? The Struggle over Local Health
Units in Mexico, 1928–1940.’’ J. of History of Medicine and Allied Sciences 53
(1998): 43–76.
———. ‘‘Revolution, the Scatological Way: The Rockefeller Foundation’s Hookworm
Campaign in 1920s Mexico.’’ In Disease in the History of Modern Latin America:
From Malaria to aids, edited by Diego Armus, 158–82. Durham, N.C.: Duke
University Press, 2003.
Birn, Anne-Emanuelle, and Armando Solorzano. ‘‘Public Health Policy Paradoxes:
Science and Politics in the Rockefeller Foundation’s Hookworm Campaign in
Mexico in the 1920s.’’ Social Science and Medicine 49 (1999): 1197–1213.
Birtle, Andrew J. ‘‘The U.S. Army’s Pacification of Marinduque, Philippine Islands,
April 1900–April 1901.’’ J. of Military History 61 (1997): 255–82.
Bourdieu, Pierre. Outline of a Theory of Practice. Translated by Richard Nice.
Cambridge: Cambridge University Press, 1977.
Bradley, D. J. ‘‘The Particular and the General: Issues of Specificity and Verticality in the
History of Malaria Control.’’ Parassitologia 40 (1998): 5–10.
Braeman, John. Albert J. Beveridge, American Nationalist. Chicago: University of
Chicago Press, 1971.
Brieger, Gert H. ‘‘Fielding H. Garrison: The Man and His Book.’’ Trans. and Studies of
the College of Physicians of Philadelphia 3 (1981): 1–21.
Briggs, Charles L., and Clara Mantini-Briggs. Stories in a Time of Cholera: Racial
Profiling During a Medical Nightmare. Berkeley: University of California Press,
2003.
Briggs, Laura. Reproducing Empire: Race, Sex, Science, and U.S. Imperialism in Puerto
Rico. Berkeley: University of California Press, 2002.
Brown, Jo Anne. ‘‘Purity and Danger in Color: Notes on Germ Theory, and the
Semantics of Segregation.’’ In Heredity and Infection: The History of Disease
Transmission, edited by J. P. Gaudillière and Ilana Löwy, 101–31. London:
Routledge, 2001.
Brown, Norman O. ‘‘The Excremental Vision.’’ In Life Against Death: The

bibliography 319
 Psychoanalytic Meaning of History. 2nd ed., 179–201. Middletown, Conn.:
Wesleyan University Press, 1985 [1959].
Brugger, Bill. Republican Theory in Political Thought: Virtuous or Virtual? New York:
St. Martin’s Press, 1999.
Buckingham, Jane. Leprosy in Colonial South India. Basingstoke: Palgrave, 2002.
Burkitt, Ian. ‘‘Civilization and Ambivalence.’’ British J. of Sociology 47 (1996): 135–50.
Burnet, F. Macfarlane. Biological Aspects of Infectious Disease. Cambridge: Cambridge
University Press, 1940.
Bynum, W. F. ‘‘An Experiment that Failed: Malaria Control at Mian Mir.’’
Parassitologia 36 (1994): 107–20.
———. ‘‘Malaria in Inter-war British India.’’ Parassitologia 42 (2000): 25–31.
Bynum, W. F., and Caroline Overy, eds. The Beast in the Mosquito: The
Correspondence of Ronald Ross and Patrick Manson. Amsterdam: Rodopi, 1998.
Callaway, Helen. Gender, Culture and Empire: European Women in Colonial Nigeria.
Urbana: University of Illinois Press, 1987.
Cannell, Fenella. Power and Intimacy in the Christian Philippines. Cambridge:
Cambridge University Press, 1999.
Carter, Richard, and Kamini N. Mendis. ‘‘Evolutionary and Historical Aspects of the
Burden of Malaria.’’ Clinical Microbiology Reviews 15 (2002): 564–94.
Cassedy, James H. Charles V. Chapin and the Public Health Movement. Cambridge:
Harvard University Press, 1962.
———. ‘‘The ‘Germ of Laziness’ in the South, 1901–1915: Charles Wardell Stiles and the
Progressive Paradox.’’ Bulletin of the History of Medicine 45 (1971): 161.
Cell, John W. ‘‘Anglo-Indian Medical Theory and the Origins of Segregation in West
Africa.’’ American Historical Review 91 (1986): 307–35.
Chakrabarty, Dipesh. Provincializing Europe: Postcolonial Thought and Historical
Difference. Princeton: Princeton University Press, 2000.
———. ‘‘Of Garbage, Modernity and the Citizen’s Gaze.’’ Economic and Political
Weekly (March 7–14, 1992): 541–47.
Chapman, Carleton B. Order Out of Chaos: John Shaw Billings and America’s Coming
of Age. Boston: Boston Medical Library, 1994.
Chapman, Ronald Fettes. Leonard Wood and Leprosy in the Philippines: The Culion
Leper Colony 1921–27. N.p.: University Press of America, 1982.
Chatterjee, Partha. The Nation and Its Fragments: Colonial and Postcolonial Histories.
Princeton: Princeton University Press, 1993.
Chaudhuri, Nupur, and Margaret Strobel, eds. Western Women and Imperialism:
Complicity and Resistance. Bloomington: Indiana University Press, 1992.
Chernin, Eli. ‘‘Richard Pearson Strong and the Iatrogenic Plague Disaster in Bilibid
Prison, Manila, 1906.’’ Reviews of Infectious Diseases 11 (1989): 996–1004.
———. ‘‘Richard Pearson Strong and Manchurian Epidemic of Bubonic Plague,
1910–11.’’ J. of History of Medicine and Allied Sciences 44 (1989): 296–319.
Choy, Catherine Ceniza. Empire of Care: Nursing and Migration in Filipino-American
History. Durham, N.C.: Duke University Press, 2003.
Cirillo, Vincent J. Bullets and Bacilli: The Spanish-American War and Military
Medicine. New Brunswick, N.J.: Rutgers University Press, 2004.

320 bibliography
Cohen, Nancy. The Reconstruction of American Liberalism, 1865–1914. Chapel Hill:
University of North Carolina Press, 2002.
Cohen, Nathaniel A. ‘‘Public Health in the Philippines.’’ Far Eastern Survey 15 (1946):
87–90.
Coleman, William. ‘‘Science and Symbol in the Turner Frontier Hypothesis.’’ American
Historical Review 72 (1966): 22–49.
Collini, Stefan. ‘‘The Idea of ‘Character’ in Victorian Political Thought.’’ Trans. of the
Royal Historical Society 35 (1985): 29–50.
Comaroff, John, and Jean Comaroff. Ethnography and the Historical Imagination.
Boulder: Westview, 1992.
Conklin, Alice L. A Mission to Civilize: The Republican Idea of Empire in France and
West Africa, 1895–1930. Stanford: Stanford University Press, 1997.
Cooper, Frederick. ‘‘Modernizing Bureaucrats, Backward Africans, and the
Development Concept.’’ In International Development and the Social Sciences:
Essays on the History and Politics of Knowledge, edited by Frederick Cooper and
Randall Packard, 64–92. Berkeley: University of California Press, 1997.
———. ‘‘Modernizing Colonialism and the Limits of Empire.’’ Items 4 (2003): 1–9.
Cooper, Frederick, and Randall Packard, ed. International Development and the Social
Sciences: Essays on the History and Politics of Knowledge. Berkeley: University of
California Press, 1997.
Cooter, Roger. Surgery and Society in Peace and War: Orthopaedics and the
Organization of Modern Medicine, 1880–1948. Manchester: Manchester
University Press, 1993.
Corbellini, G. ‘‘Acquired Immunity against Malaria as a Tool for the Control of the
Disease: The Strategy Proposed by the Malaria Commission of the League of
Nations Health Organization in 1933.’’ Parassitologia 40 (1998): 109–16.
Corbin, Alain. The Foul and the Fragrant: Odor and the French Social Imagination.
Translated by Miriam L. Kochan, Roy Porter, and Christopher Prendergast.
Cambridge: Harvard University Press, 1986.
Cosmas, Graham A. An Army for Empire: The United States Army in the Spanish-
American War. St. Louis: University of Missouri Press, 1971.
Craddock, Susan. City of Plagues: Disease, Poverty and Deviance in San Francisco.
Minneapolis: University of Minnesota Press, 2000.
Craig, Charles F. ‘‘The Army Medical Service.’’ Yale Medical J. 16 (1910): 415–27.
Cruz, Romeo Victorino. America’s Colonial Desk and the Philippines 1898–1934.
Quezon City: University of the Philippines Press, 1974.
Cueto, Marcos, ed. Missionaries of Science: The Rockefeller Foundation and Latin
America. Bloomington: Indiana University Press, 1994.
———. ‘‘Tropical Medicine and Bacteriology in Boston and Peru: Studies of Carrión’s
Disease in the Early Twentieth Century.’’ Medical History 40 (1996): 344–64.
———. ‘‘The Origins of Primary Health Care and Selective Primary Health Care.’’
American J. Public Health 94 (2004): 1864–74.
Cullinane, Michael. ‘‘Ilustrado Politics: The Response of the Filipino Educated Elite
to American Colonial Rule, 1898–1907.’’ ph.d. diss., University of Michigan,
1989.

bibliography 321
Cunningham, Andrew, and Perry Williams, eds. The Laboratory Revolution in
Medicine. Cambridge: Cambridge University Press, 1992.
Curtin, Philip D. Death by Migration: Europe’s Encounter with the Tropical World in
the Nineteenth Century. Cambridge: Cambridge University Press, 1989.
———. ‘‘Medical Knowledge and Urban Planning in Tropical Africa.’’ American
Historical Review 90 (1985): 594–613.
Cushner, Nicolas. Spain in the Philippines. Quezon City: Ateneo de Manila University
Press, 1974.
Darwin, John. ‘‘What Was the Late-Colonial State?’’ Itinerario 23 (1999): 73–82.
Dayrit, Conrado S., Perla Dizon Santos Ocampo, and Eduardo R. de la Cruz. History of
Philippine Medicine, 1899–1999. Pasig City: Anvil, 2002.
Deacon, Harriet Jane. ‘‘A History of the Medical Institutions on Robben Island, Cape
Colony, 1846–1910.’’ ph.d. diss., University of Cambridge, 1994.
Dean, Mitchell, Governmentality: Power and Rule in Modern Society. London: Sage,
1999.
De Bevoise, Ken. ‘‘The Compromised Host: The Epidemiological Context of the
Philippine-American War.’’ ph.d. diss., University of Oregon, 1986.
———. Agents of Apocalypse: Epidemic Disease in the Colonial Philippines. Princeton:
Princeton University Press, 1995.
De Certeau, Michel. Heterologies: Discourse on the Other. Translated by Brian
Massumi. Minneapolis: University of Minnesota Press, 1986.
De la Cruz, Eduardo R. History of Philippine Medicine and the pma. Manila: pma, 1983.
Delaporte, François. The History of Yellow Fever: An Essay on the Birth of Tropical
Medicine. Cambridge: mit Press, 1991.
Dery, Luis. ‘‘Prostitution in Colonial Manila.’’ Philippine Studies 39 (1991): 475–89.
Desmond, Jane C., and Virginia R. Domínguez. ‘‘Resituating American Studies in a
Critical Internationalism.’’ American Quarterly 48 (1996): 475–90.
Deutschman, Zygmunt. ‘‘Public Health and Medical Services in the Philippines.’’ Far
Eastern Q. 4 (1945): 148–57.
Deverell, William. ‘‘Plague in Los Angeles, 1924: Ethnicity and Typicality.’’ In Over the
Edge: Remapping the American West, edited by Valerie J. Matsumoto and Blake
Allmendinger, 172–200. Berkeley: University of California Press, 1999.
Dirks, Nicholas B., ed., Colonialism and Culture. Ann Arbor: University of Michigan
Press, 1992.
Dobson, M. J., M. Malowany, and R. W. Snow. ‘‘Malaria Control in East Africa: The
Kampala Conference and the Pare-Taveta Scheme: A Meeting of Common and High
Ground.’’ Parassitologia 42 (2000): 149–66.
Doeppers, Daniel F. Manila, 1900–1941: Social Change in a Late-Colonial Metropolis.
New Haven: Yale University Southeast Asian Studies, 1984.
Douglas, Mary. Purity and Danger: An Analysis of the Concepts of Pollution and
Taboo. London: Routledge and K. Paul, 1966.
———. ‘‘Witchcraft and Leprosy: Two Strategies of Exclusion.’’ Man 264 (1991):
723–36.
Drinnan, Richard. Facing West: The Metaphysics of Indian-Hating and Empire-
Building. Minneapolis: University of Minnesota Press, 1980.

322 bibliography
Duffy, John. A History of Public Health in New York City. 2 vols. New York: Russell
Sage, Foundation, 1968.
———. The Sanitarians: A History of American Public Health. Urbana: University of
Illinois Press, 1990.
Dumett, Raymond E. ‘‘The Campaign against Malaria and the Expansion of Scientific
Medical and Sanitary Services in British West Africa, 1898–1910.’’ African
Historical Studies 1 (1968): 153–97.
Dyer, Thomas. Theodore Roosevelt and the Idea of Race. Baton Rouge: Louisiana State
University Press, 1980.
Edmond, Rod. ‘‘Abject Bodies/Abject Sites: Leper Islands in the High Imperial Era.’’ In
Islands in History and Representation, edited by Rod Edmond and Vanessa Smith,
133–45. London: Routledge, 2003.
Ee, Heok Kua. ‘‘Amok in Nineteenth-century British Malaya History.’’ History of
Psychiatry 3 (1991): 429–36.
Elias, Norbert. The Civilizing Process. Translated by E. Jephcott. New York: Pantheon,
1978 [1939].
Ernst, Waltraud. Mad Tales from the Raj: The European Insane in British India, 1800–
1858. London: Routledge, 1991.
———. ‘‘European Madness and Gender in Nineteenth-century British India.’’ Social
History of Medicine 9 (1996): 357–82.
Eschscholtzia, L. Lucia, and Laura S. Haymond. An Analysis of Certain Causes of
Mortality in the Philippine Islands with Reference to Changes in Administrative
Policy. University of California Publications in Public Health No. 1. Glendale,
Calif.: Arthur H. Clark, 1928.
Escobar, Arturo. Encountering Development: The Making and Unmaking of the Third
World. Princeton: Princeton University Press, 1995.
Esty, Joshua D. ‘‘Excremental Postcolonialism.’’ Contemporary Literature 40 (1999):
22–59.
Etherington, Norman. Theories of Imperialism: War, Conquest and Capital. London:
Croom Helm, 1984.
Ettling, John. The Germ of Laziness: Rockefeller Philanthropy and Public Health in the
New South. Cambridge: Harvard University Press, 1981.
Evans, Hughes. ‘‘European Malaria Policy in the 1920s and 1930s: The Epidemiology
of Minutiae.’’ Isis 80 (1989): 40–59.
Fairchild, Amy L. Science at the Borders: Immigrant Medical Inspection and the
Shaping of the Modern Industrial Labor Force. Baltimore: Johns Hopkins University
Press, 2003.
Fanon, Frantz. Black Skin, White Masks. Translated by Charles Lam Markmann. New
York: Grove Press, 1967.
Farley, John. Bilharzia: A History of Imperial Tropical Medicine. Cambridge:
Cambridge University Press, 1991.
———. To Cast Out Disease: A History of the International Health Division of the
Rockefeller Foundation, 1913–1951. Oxford: Oxford University Press, 2004.
———. ‘‘The International Health Division of the Rockefeller Foundation: The Russell
Years, 1920–1934.’’ In International Health Organizations and Movements, 1918–

bibliography 323
 1939, edited by Paul Weindling, 203–21. Cambridge: Cambridge University Press,
1995.
Feierman, Steven. ‘‘Struggles for Control: The Social Roots of Health and Healing in
Modern Africa.’’ African Studies Review 28 (1985): 73–128.
Feinstein, Howard. ‘‘The Use and Abuse of Illness in the James Family Circle.’’ In
Our Selves/Our Past: Psychological Approaches to American History, edited by
Robert J. Brugger, 228–43. Baltimore: Johns Hopkins University Press, 1981.
Feldman, Allen. Formations of Violence: The Narrative of the Body and Political Terror
in Northern Ireland. Chicago: University of Chicago Press, 1991.
Ferguson, James. The Anti-Politics Machine: Development, Depoliticization, and
Bureaucratic Power in Lesotho. Cambridge: Cambridge University Press, 1990.
Fieldhouse, D. K. The Colonial Empires: A Comparative Survey from the Eighteenth
Century. London: Weidenfeld and Nicolson, 1966.
Filiberti, Edward J. ‘‘The Roots of U.S. Counterinsurgency Doctrine.’’ Military Review
58 (1988): 50–61.
Foreman, Carolyn T. ‘‘General Eli Lundy Huggins.’’ Chronicles of Oklahoma 13
(1935): 255–65.
Fosdick, Raymond B. The Story of the Rockefeller Foundation. New Brunswick, N. J.:
Transaction Publishers, 1989 [1952].
Foucault, Michel. Discipline and Punish: The Birth of the Prison. Translated by Alan
Sheridan. New York: Pantheon Books, 1977.
———. Power/Knowledge: Selected Interviews and Other Writings, 1972–77. Edited by
Colin Gordon, translated by Colin Gordon, Leo Marshall, John Mephan, Kate
Soper. Brighton: Harvester Press, 1980.
———. The History of Sexuality. Volume 1: An Introduction. Translated by Robert
Hurley. New York: Vintage, 1980.
———. Technologies of the Self: A Seminar with Michel Foucault. Edited by Luther H.
Martin, Huck Gutman, and Patrick H. Hutton. Amherst: University of Massachu-
setts Press, 1988.
———. Abnormal: Lectures at the Collège de France, 1974–75. Translated by Graham
Burchell. New York: Picador, 2003.
———. ‘‘Society Must be Defended’’: Lectures at the Collège de France, 1975–76.
Translated by David Macey. New York: Picador, 2003.
———. ‘‘Governmentality.’’ In The Foucault Effect: Studies in Governmentality, edited
by Graham Burchell et al., 87–104. Chicago: University of Chicago Press, 1991.
Fredrickson, George M. The Black Image in the White Mind: The Debate on Afro-
American Character and Destiny, 1817–1914. Hanover N.H.: Wesleyan University
Press, 1987 [1971].
Freud, Sigmund. Civilization and Its Discontents. Translated by Joan Riviere. London:
Hogarth Press, 1973 [1929].
———. ‘‘The Uncanny.’’ In The Standard Edition of the Complete Psychological Works
of Sigmund Freud, translated by James Strachey, vol. 17 (1917–19), 219–52.
London: Hogarth Press, 1955 [1919].
Friend, Theodore. Between Two Empires: Philippine Ordeal and Development from the

324 bibliography
 Great Depression through the Pacific War, 1929–46. New Haven: Yale University
Press, 1965.
Furner, Mary O. ‘‘The Republican Tradition and the New Liberalism: Social
Investigation, State Building, and Social Learning in the Gilded Age.’’ In The State
and Social Investigation in Britain and the United States, edited by Michael J. Lacey
and Mary O. Furner, 171–241. Cambridge: Woodrow Wilson Center Press and
Cambridge University Press, 1993.
Gaerlan, Barbara S. ‘‘The Pursuit of Modernity: Trinidad H. Pardo de Tavera and the
Educational Legacy of the Philippine Revolution,’’ amerasia j. 24 (1998): 87–108.
Galambos, Louis. ‘‘The Emerging Organizational Synthesis in American History.’’
Business History Review 44 (1970): 279–90.
———. ‘‘Technology, Political Economy and Professionalization: Central Themes of the
Organizational Synthesis.’’ Business History Review 57 (1983): 471–93.
Galishoff, Stuart. ‘‘Germs Know No Color Line: Black Health and Public Policy in
Atlanta, 1900–1918.’’ J. of History of Medicine and Allied Sciences 40 (1985):
22–41.
Gamble, Vanessa Northington, ed. Germs Have No Color Line: Blacks and American
Medicine, 1900–1940. New York: Garland, 1989.
Garrison, Fielding H. John Shaw Billings: A Memoir. New York: G. P. Putman’s Sons,
1915.
Gates, Henry Louis, Jr., ‘‘Critical Fanonism.’’ Critical Inquiry 17 (1991): 457–70.
Gates, John Morgan. Schoolbooks and Krags: The United States Army in the
Philippines, 1898–1902. Westport, Conn.: Greenwood Press, 1973.
Gatewood, Willard B. Jr. Black Americans and the White Man’s Burden, 1898–1903.
Urbana: University of Illinois Press, 1975.
Gerstle, Gary. American Crucible: Race and Nation in the Twentieth Century.
Princeton: Princeton University Press, 2001.
Gibson, John. Soldier in White: The Life of General George Miller Sternberg. Durham,
N.C.: Duke University Press, 1958.
Gijswijt-Hofstra, Marijke, and Roy Porter, ed. Cultures of Neurasthenia from Beard to
the First World War. Amsterdam: Rodopi, 2001.
Gillett, Mary. The Army Medical Department, 1865–1917. Washington, D.C.: Center
of Medical History, 1995.
———. ‘‘Medical Care and Evacuation during the Philippine Insurrection, 1899–1901.’’
J. of History of Medicine and Allied Sciences 42 (1987): 169–85.
———. ‘‘U.S. Army Medical Officers and Public Health in the Philippines in the Wake of
the Spanish-American War, 1898–1905.’’ Bulletin of the History of Medicine 64
(1990): 567–87.
Gilman, Sander L. Difference and Pathology: Stereotypes of Sexuality, Race and
Madness. Ithaca: Cornell University Press, 1985.
Glenn, Susan A. ‘‘ ‘Give Me an Imitation of Me’: Vaudeville Mimics and the Play of the
Self.’’ American Quarterly 50 (1998): 47–76.
Go, Julian. ‘‘Colonial Reception and Cultural Reproduction: Filipino Elites and United
States Tutelary Rule.’’ J. of Historical Sociology 12 (1999): 337–68.

bibliography 325
Go, Julian. ‘‘Introduction: Global Perspectives on the U.S. Colonial State in the Philip-
pines.’’ In The American Colonial State in the Philippines: Global Perspectives,
edited by Julian Go and Anne L. Foster, 1–42. Durham, N.C.: Duke University Press,
2003.
Goffman, Erving. Asylums: Essays on the Social Situation of Mental Patients and Other
Inmates. New York: Anchor Books, 1961.
Gonzalez Flores, Luis Felipe. Historia de la influencia extranjera en el desenvolvimiento
educacional y científico de Costa Rica. San José: Editorial Costa Rica, 1976.
Gorgas, William C., and Burton J. Hendrick. William Crawford Gorgas, His Life and
Work. London: Heinemann, 1924.
Gosling, F. G. Before Freud: Neurasthenia and the American Medical Community,
1867–1910. Urbana: University of Illinois Press, 1987.
Gottman, Jean. ‘‘Bugeaud, Galliéni, Lyautey: The Development of French Colonial War-
fare.’’ In Makers of Modern Strategy: Military Thought from Machiavelli to Hitler,
edited by Edward Mead Earle, 234–59. Princeton: Princeton University Press, 1952.
Goubert, Jean-Peirre. The Conquest of Water: The Advent of Health in the Industrial
Age. Translated by Andrew Wilson. Cambridge: Polity Press, 1989.
Gouda, Frances. Dutch Culture Overseas: Colonial Practice in the Netherlands Indies,
1900–1942. Amsterdam: Amsterdam University Press, 1995.
Griffen, Clyde. ‘‘Reconstructing Masculinity from the Evangelical Revival to the
Waning of Progressivism: A Speculative Synthesis.’’ In Meanings for Manhood:
Constructions of Masculinity in Victorian America, edited by Mark C. Carnes and
Griffen, 183–204. Chicago: University of Chicago Press, 1990.
Grmek, Mirko. ‘‘Géographie médicale et histoire des civilisations.’’ Annales:
Economies, Sociétés, Civilisations 18 (1963): 1071–87.
Guerra, Francisco. El Médico político: Estudios biográficos sobre la influencia del
médico en la historia política de Hispanoamérica y Filipinas. Madrid: Afrodisio
Aguado, 1975.
Gupta, Akhil. Postcolonial Developments: Agriculture in the Making of Modern India.
Durham, N.C.: Duke University Press, 1998.
Gussow, Zachary. Leprosy, Racism, and Public Health: Social Policy in Chronic
Disease. Boulder, Colo.: Westview Press, 1989.
Gussow, Zachary, and George S. Tracy. ‘‘Stigma and the Leprosy Phenomenon: The
Social History of a Disease in the Nineteenth and Twentieth Centuries.’’ Bulletin of
the History of Medicine 44 (1970): 425–49.
Haber, Samuel. Efficiency and Uplift: Scientific Management in the Progressive Era,
1890–1920. Chicago: University of Chicago Press, 1964.
Hagedorn, Hermann. Leonard Wood: A Biography. 2 vols. New York: Harper and
Bros., 1931.
Hale, Nathan G., Jr. Freud and the Americans: The Beginnings of Psychoanalysis in the
United States, 1876–1917. New York: Oxford University Press, 1987.
———. The Rise and Crisis of Psychoanalysis in the United States: Freud and the
Americans, 1917–85. New York: Oxford University Press, 1995.
Hansen, Karen Tranberg, ed. African Encounters with Domesticity. New Brunswick,
N.J.: Rutgers University Press, 1992.

326 bibliography
Haraway, Donna. Primate Visions: Gender, Race and Nature in the World of Modern
Science. New York: Routledge, 1989.
Harrison, Gordon. Mosquitoes, Malaria and Man: A History of the Hostilities Since
1880. New York: E. P. Dutton, 1978.
Harrison, Mark. Climates and Constitutions: Health, Race Environment and British
Imperialism in India, 1600–1850. New Delhi: Oxford University Press, 1999.
———. ‘‘The Medicalization of War—The Militarization of Medicine.’’ Social History
of Medicine 9 (1996): 267–76.
Hartnack, Christiane. ‘‘British Psychoanalysts in Colonial India.’’ In Psychology in
Twentieth-Century Thought and Society, edited by Mitchell G. Ash and William R.
Woodward, 233–52. New York: Cambridge University Press, 1987.
———. ‘‘Vishnu on Freud’s Desk: Psychoanalysis in Colonial India.’’ Social Research 57
(1990): 921–49.
Hattori, Anne Perez. Colonial Dis-Ease: U.S. Navy Health Policies and the Chamorros
of Guam, 1898–1941. Honolulu: University of Hawaii Press, 2004.
Hayden, Joseph R. The Philippines: A Study in National Development. New York:
Macmillan, 1942.
Haynes, Douglas M. Imperial Medicine: Patrick Manson and the Conquest of Tropical
Disease. Philadelphia: University of Pennsylvania Press, 2001.
Heidegger, Martin. The Question Concerning Technology, and Other Essays.
Translated by William Lovitt. New York: Harper Torchbooks, 1977.
Hewa, Soma. Colonialism, Tropical Disease and Imperial Medicine: Rockefeller
Philanthropy in Sri Lanka. Lanham, Md.: University Press of America, 1995.
Higham, John. Strangers in the Land: Patterns of American Nativism, 1860–1925.
New Brunswick, N.J.: Rutgers University Press, 1955.
Hobsbawm, Eric. The Age of Empire 1875–1914. New York: Vintage, 1989.
Hofstadter, Douglas. ‘‘Manifest Destiny and the Philippines.’’ In American Imperialism
in 1898: Problems in American Civilization, edited by Theodore P. Greene, 54–70.
Boston: D. C. Heath, 1955.
———. ‘‘Cuba, the Philippines and Manifest Destiny.’’ In The Paranoid Style in
American Politics and Other Essays, 145–87. New York: Knopf, 1965.
Hoganson, Kristin. Fighting for American Manhood: How Gender Politics Provoked
the Spanish-American and the Philippine-American Wars. New Haven: Yale
University Press, 1998.
Holborn, Hojo. ‘‘Moltke and Schlieffen: The Prussian-German School.’’ In Makers of
Modern Strategy: Military Thought from Machiavelli to Hitler, edited by Edward
Mead Earle, 172–205. Princeton: Princeton University Press, 1952.
Horsman, Reginald. Race and Manifest Destiny: The Origins of American Anglo-
Saxonism. Cambridge: Harvard University Press, 1989.
Howard-Jones, Norman. International Health Between the Two World Wars—The
Organizational Problems. Geneva: W.H.O., 1978.
Hoxie, Frederick E. A Final Promise: The Campaign to Assimilate the Indians, 1880–
1920. Lincoln, Neb.: University of Nebraska Press, 1984.
Hoy, Suellen M. Chasing Dirt: The American Pursuit of Cleanliness. New York: Oxford
University Press, 1995.

bibliography 327
Humphreys, Margaret. Malaria: Poverty, Race and Public Health in the United States.
Baltimore: Johns Hopkins University Press, 2001.
Hutchcroft, Paul D. ‘‘Colonial Masters, National Politicos, and Provincial Lords:
Central Authority and Local Autonomy in the American Philippines, 1900–1913.’’
J. of Asian Studies 59 (2000): 277–306.
Hyam, Ronald. Empire and Sexuality: The British Experience. Manchester: Manchester
University Press, 1990.
Ileto, Reynaldo C. Pasyon and Revolution: Popular Movements in the Philippines,
1840–1910. Quezon City: Ateneo de Manila University Press, 1979.
———. ‘‘Cholera and the Origins of the American Sanitary Order in the Philippines.’’
In Imperial Medicine and Indigenous Society, edited by David Arnold, 125–48.
Manchester: Manchester University Press, 1989.
———. ‘‘Outlines of a Non-linear Emplotment of Philippines History.’’ In The Politics of
Culture in the Shadow of Capital, edited by Lisa Lowe and David Lloyd, 98–131.
Durham, N.C.: Duke University Press, 1997.
Jacobson, Matthew Frye. Whiteness of a Different Color: European Immigrants and the
Alchemy of Race. Cambridge: Harvard University Press, 1998.
Jamison, Perry D. Crossing the Deadly Ground: United States Army Tactics, 1865–
1899. Tuscaloosa: University of Alabama Press, 1994.
Jardine, Alice. Gynesis: Configurations of Women and Modernity. Ithaca: Cornell
University Press, 1985.
Johnson, Terence. ‘‘Imperialism and the Professions.’’ In Professionalisation and
Social Change, edited by Paul Halmos, 281–309. Keele: University of Keele Press,
1973.
Jones, David Shumway. ‘‘Rationalizing Epidemics: Meanings and Uses of American
Indian Mortality since 1600.’’ ph.d. diss., Harvard University, 2001.
———. Rationalizing Epidemics: Meanings and Uses of American Indian Mortality since
1600. Cambridge: Harvard University Press, 2004.
Kagan, Solomon R. Life and Letters of Fielding H. Garrison. Boston: Medico-Historical
Press, 1938.
Kakar, Sanjiv ‘‘Leprosy in British India, 1860–1940: Colonial Politics and Missionary
Medicine.’’ Medical History 40 (1996): 215–30.
———. ‘‘Medical Developments and Patient Unrest in the Leprosy Asylum, 1860–
1940.’’ Social Scientist 24 (1996): 62–81.
Kakar, Sudhir. ‘‘Encounters of a Psychological Kind: Freud, Jung, and India.’’ In Culture
and Psyche: Selected Essays, 20–32. Delhi: Oxford University Press, 1997.
Kaplan, Amy. ‘‘Romancing the Empire: The Embodiment of American Masculinity in
the Popular Historical Novel of the 1890s.’’ American Literary History 2 (1990):
659–70.
———. ‘‘ ‘Left Alone with America’: The Absence of Empire in the Study of American
Culture.’’ In Cultures of United States Imperialism, edited by Amy Kaplan and
Donald E. Pease, 3–21. Durham, N.C.: Duke University Press, 1993.
Katz, J. Experimentation with Human Beings. New York: Russell Sage Foundation,
1972.

328 bibliography
Keller, Richard. ‘‘Madness and Colonization: Psychiatry in the British and French
Empire, 1800–1962.’’ J. of Social History 35 (2001): 295–326.
Kennedy, Dane. The Magic Mountains: Hill Stations and the British Raj. Berkeley:
University of California Press, 1996.
———. ‘‘The Perils of the Midday Sun: Climatic Anxieties in the Colonial Tropics.’’ In
Imperialism and the Natural World, edited by John M. McKenzie, 118–40.
Manchester: Manchester University Press, 1990.
Kimmel, Michael S. ‘‘The Contemporary ‘Crisis’ in Masculinity in Historical
Perspective.’’ In The Making of Masculinities: The New Men’s Studies, edited by
Harry Brod, 121–54. Boston: Allen and Unwin, 1987.
Kipp, Rita Smith. ‘‘The Evangelical Uses of Leprosy.’’ Social Science and Medicine 39
(1994): 165–78.
Kleinman, Arthur, and Joan Kleinman. ‘‘How Bodies Remember: Social Memory and
the Bodily Experience of Criticism, Resistance, and Delegitimation Following
China’s Cultural Revolution.’’ New Literary History 25 (1994): 707–23.
Kramer, Paul A. ‘‘The Pragmatic Empire: U.S. Anthropology and Colonial Politics in the
Occupied Philippines, 1898–1916.’’ ph.d. diss., Princeton University, 1998.
———. ‘‘Making Concessions: Race and Empire Revisited at the Philippine Exposition,
St. Louis, 1901–05.’’ Radical History Review 73 (1999): 74–114.
———. ‘‘Empires, Exceptions, and Anglo-Saxons: Race and Rule between the British
and United States Empires, 1880–1910.’’ J. American History 88 (2002):
1315–53.
Kraut, Alan M. Silent Travelers: Germs, Genes, and the ‘‘Immigrant Menace.’’
Baltimore: Johns Hopkins University Press, 1994.
Kristeva, Julia. Powers of Horror: An Essay in Abjection, Translated by Leon S.
Roudiez. New York: Columbia University Press, 1982.
Kunitz, Stephen J. ‘‘Efficiency and Reform in the Financing and Organization of
American Medicine in the Progressive Era.’’ Bulletin of the History of Medicine 55
(1981): 497–515.
———. ‘‘The History and Politics of U.S. Health Care Policy for American Indians and
Alaskan Natives.’’ American J. Public Health 86 (1996): 1464–73.
Lacey, Michael J. ‘‘The World of the Bureaus: Government and the Positivist Project in
the Late Nineteenth Century.’’ In The State and Social Investigation in Britain and
the United States, edited by Lacey and Furner, 127–70. Washington, D.C.,
Woodrow Wilson Center Press; Cambridge: Cambridge University Press, 1993.
Laporte, Dominique. Histoire de la Merde. Paris: Christian Bourgois Editeur, 1979.
Lasch, Christopher. ‘‘The Anti-imperialists, the Philippines and the Rights of Man.’’
J. of Southern History 24 (1958): 319–31.
Latour, Bruno. Pandora’s Hope: Essays on the Reality of Science Studies. Cambridge:
Harvard University Press, 1999.
———. ‘‘Give Me a Laboratory and I Will Raise the World.’’ In Science Observed:
Perspectives on the Social Study of Science, edited by Karin Knorr-Cetina and
Michael Mulkay, 141–70. London: Sage, 1983.
Lawrence, Christopher. ‘‘Disciplining Disease: Scurvy, the Navy and Imperial

bibliography 329
 Expansion.’’ In Visions of Empire, edited by D. Miller and P. Reill, 80–106.
Cambridge: Cambridge University Press, 1994.
Lears, T. J. Jackson. ‘‘The Destructive Element: Modern Commercial Society and the
Martial Ideal.’’ In No Place of Grace: Antimodernism and the Transformation of
American Culture 1880–1920, 97–140. New York: Pantheon, 1981.
Leavitt, Judith Walzer. Healthiest City: Milwaukee and the Politics of Health Reform.
Princeton: Princeton University Press, 1982.
———. Typhoid Mary: Captive to the Public’s Health. Boston: Beacon Press, 1996.
Lee, Chistopher. ‘‘Toilet Training the Settler Subject: An Exercise in Civic Regulation.’’
Southern Review 29 (1996): 50–63.
Lefebvre, Henri. The Production of Space. Translated by Donald Nicholson-Smith.
Oxford: Blackwell, 1991 [1971].
Levine, Philippa. ‘‘Venereal Disease, Prostitution and the Politics of Empire: The Case of
British India.’’ J. History of Sexuality 4 (1994): 579–602.
Levinson, Julie. ‘‘Beyond Quarantine: A History of Leprosy in Puerto Rico, 1898–
1930s.’’ História, Ciéncias, Saúde—Manguinhos 10, Suppl. 1 (2003): 225–45.
Linn, Brian McA. The United States Army and Counter-Insurgency in the Philippine
War, 1899–1902. Chapel Hill: University of North Carolina Press, 1989.
———. Guardians of Empire: The U.S. Army and the Pacific, 1902–1940. Chapel Hill:
University of North Carolina Press, 1997.
———. The Philippines War, 1899–1902. Lawrence: University of Kansas Press, 2000.
Litsios, Socrates. ‘‘René Dubos and Fred L. Soper: Their Contrasting Views on Vector
and Disease Eradication.’’ Perspectives in Biology and Medicine 41 (1997):
138–49.
———. ‘‘The Christian Medical Commission and the Development of the World Health
Organization’s Primary Health Care Approach.’’ American J. Public Health 94
(2004): 1884–93.
Liu, Shiyung. ‘‘Building a Strong and Healthy Empire: The Critical Period of Building
Colonial Medicine in Taiwan.’’ Japanese Studies 24 (2004): 301–14.
Livingstone, David N. ‘‘Science and Society: Nathaniel S. Shaler and Racial Ideology.’’
Trans. Institute of British Geography 9 (1984): 181–210 .
———. ‘‘Human Acclimatisation: Perspectives on a Contested Field of Inquiry in
Science, Medicine and Geography.’’ History of Science 25 (1987): 359–94.
———. ‘‘Climate’s Moral Economy: Science, Race and Place in Post-Darwinian British
and American Geography.’’ In Geography and Empire, edited by Anna Godlewska
and Neil Smith, 132–54. Oxford: Blackwell, 1994.
———. ‘‘Tropical Climate and Moral Hygiene: The Anatomy of a Victorian Debate.’’
British J. of the History of Science 32 (1999): 93–110.
Lo, Ming-Cheng M. Doctors Within Borders: Profession, Ethnicity, and Modernity in
Colonial Taiwan. Berkeley: University of California Press, 2002.
Lull, G. ‘‘The Days Gone By: A Brief History of the Army Medical School, 1893–1933.’’
Military Surgeon 74 (1934): 78–86.
Lutz, Tom. American Nervousness 1903: An Anecdotal History. Ithaca: Cornell
University Press, 1991.

330 bibliography
MacKinnon, Aran S. ‘‘Of Oxford Bags and Twirling Canes: The State, Popular
Responses and Zulu Antimalaria Assistants in the Early-twentieth-century Zululand
Malaria Campaigns.’’ Radical History Review 80 (2001): 76–100.
Madison, Donald L. ‘‘Preserving Individualism in the Organizational Society:
‘Cooperation’ and American Medical Practice, 1900–1920.’’ Bulletin of the History
of Medicine 70 (1996): 442–83.
Manderson, Lenore. Sickness and the State: Health and Illness in Colonial Malaya,
1870–1940. Cambridge: Cambridge University Press, 1996.
Markel, Howard. Quarantine! East European Jewish Immigrants and the New York
City Epidemics of 1892. Baltimore: Johns Hopkins University Press, 1997.
Martellone, Anna Maria. ‘‘In the Name of Anglo-Saxondom, for Empire and
Democracy: The Anglo-American Discourse, 1880–1920.’’ In Reflections on
American Exceptionalism, edited by David K. Adams and Cornelis A. van Minnen,
83–96. Keele: Keele University Press, 1994.
Mauss, Marcel. ‘‘Techniques of the Body.’’ Economy and Society 2 (1973): 70–88.
May, Glenn A. Social Engineering in the Philippines: The Aims, Execution, and Impact
of American Social Policy, 1900–13. Westport, Conn.: Greenwood Press, 1980.
———. Battle for Batangas: A Philippine Province at War. New Haven: Yale University
Press, 1991.
———. ‘‘Filipino Resistance to American Occupation: Batangas, 1899–1902.’’ Pacific
Historical Review 4 (1979): 531–56.
Mbembe, Achille. ‘‘The Banality of Power and the Aesthetics of Vulgarity in the
Postcolony.’’ Translated by Janet Roitman. Public Culture 4 (1992): 1–30.
McClain, Charles. ‘‘Of Medicine, Race and American Law: The Bubonic Plague
Outbreak of 1900.’’ Law and Social Inquiry 13 (1988): 447–513.
McClintock, Anne. Imperial Leather: Race, Gender and Sexuality in the Colonial
Contest. London: Routledge, 1995.
McCoy, Alfred W. ‘‘The Colonial Origins of Philippine Military Traditions.’’ In The
Philippine Revolution of 1896: Ordinary Lives in Extraordinary Times, edited by
Florentino Rodao and Felice Noelle Rodriguez, 83–124. Quezon City: Ateneo de
Manila University Press, 2001.
McCoy, Alfred, and Ed J. de Jesus, eds. Philippine Social History: Global Trade and
Local Transformations. Quezon City: Ateneo de Manila University Press, 1982.
McCulloch, Jock. Colonial Psychiatry and ‘‘the African Mind.’’ Cambridge: Cambridge
University Press, 1995.
McFerson, Hazel M., ed. Mixed Blessing: The Impact of the American Colonial
Experience on Politics and Society in the Philippines. Westport, Conn.: Greenwood
Press, 2002.
Mehta, Uday S. ‘‘Liberal Strategies of Exclusion.’’ In Tensions of Empire: Colonial
Cultures in a Bourgeois World, edited by Frederick Cooper and Ann L. Stoler,
59–86. Berkeley: University of California Press, 1997.
Memmi, Albert. The Colonizer and the Colonized. Translated by Howard Greenfeld.
New York: Orion Press, 1965.
Mendelsohn, J. Andrew. ‘‘Medicine and the Making of Bodily Inequality in Twentieth-

bibliography 331
 century Europe.’’ In Heredity and Infection: The History of Disease Transmission,
edited by J. P. Gaudillière and Ilana Löwy, 21–79. London: Routledge, 2001.
Miller, Stuart C. ‘‘Benevolent Assimilation’’: The American Conquest of the Philippines,
1899–1903. New Haven: Yale University Press, 1982.
Mills, James H. Madness, Cannabis, and Colonialism: The ‘‘Native Only’’ Lunatic
Asylums of British India, 1857–1900. New York: St. Martin’s Press, 2000.
Mitchell, Timothy. Colonizing Egypt. Berkeley: University of California Press, 1991.
Mohanty, Chandra Talpade. ‘‘Under Western Eyes: Feminist Scholarship and Colonial
Discourse.’’ boundary 2 12 (1984): 333–58.
Monnais-Rousselot, Laurence. Médecine et Colonisation: L’Aventure Indochinoise,
1860–1939. Paris: CNRS Editions, 1999.
Moore, John H. ‘‘Senator John Tyler Morgan and Negro Colonization in the
Philippines, 1901–2.’’ Phylon 24 (1968): 65–67.
Mrozek, Donal D. J. ‘‘The Habit of Victory: The American Military and the Cult of
Manliness.’’ In Manliness and Morality: Middle-Class Masculinity in Britain and
America, 1800–1940, edited by J. A. Mangan and James Walvin, 220–41.
Manchester: Manchester University Press, 1987.
Mullan, Fitzhugh. Plagues and Politics: The Story of the U.S. Public Health Service.
New York: Basic Books, 1989.
Najera, J. A. ‘‘Malaria Control: Present Situation and Need for Historical Research.’’
Parassitologia 32 (1990): 215–29.
Nandy, Ashis. The Intimate Enemy: Loss and Recovery of Self under Colonialism.
Delhi: Oxford University Press, 1983.
———. ‘‘The Psychology of Colonialism.’’ Psychiatry 45 (1982): 197–218.
———. ‘‘The Savage Freud: The First Non-Western Psychoanalyst and the Politics of
Secret Selves in Colonial India.’’ In The Savage Freud, and Other Essays on Possible
and Retrievable Selves, 81–144. Princeton: Princeton University Press, 1995.
Nichols, H. ‘‘Notes on the History of the Laboratories of the Army Medical School.’’
Military Surgeon 60 (1927): 52–58.
Nussbaum, Felicity A. Torrid Zones: Maternity, Sexuality and Empire in Eighteenth-
Century English Narratives. Baltimore: Johns Hopkins University Press, 1995.
Obregón, Diana. Batallas contra la lepra: Estado, medicina y ciencia en Colombia.
Bogotá: Banco de la República, 2002.
———. ‘‘The Anti-leprosy Campaign in Colombia: The Rhetoric of Hygiene and Science,
1920–1940.’’ História, Ciéncias, Saúde—Manguinhos 10, Suppl. 1 (2003): 179–
207.
O’Connor, Erin. Raw Material: Producing Pathology in Victorian Culture. Durham,
N.C.: Duke University Press, 2000.
Olch, Peter D. ‘‘Medicine in the Indian-fighting Army, 1866–1890.’’ J. of the West 21
(1982): 32–41.
Ong, Aihwa. ‘‘Making the Biopolitical Subject: Cambodian Immigrants, Refugee
Medicine, and Cultural Citizenship in California.’’ Social Science and Medicine 40
(1995): 1243–57.
Oppenheim, Janet. ‘‘Shattered Nerves’’: Doctors, Patients and Depression in Victorian
England. Oxford: Oxford University Press, 1991.

332 bibliography
Owen, Norman G., ed. Compadre Colonialism: Studies on the Philippines under
American Rule. Ann Arbor: University of Michigan Papers on South and Southeast
Asia No. 3, 1971.
———, ed. Death and Disease in Southeast Asia: Explorations in Social, Medical and
Demographic History. Singapore: Oxford University Press, 1987.
Packard, Randall M. White Plague, Black Labor: Tuberculosis and the Political
Economy of Health and Disease in South Africa. Berkeley: University of California
Press, 1989.
———. ‘‘Malaria Dreams: Visions of Health and Development in the Third World.’’
Medical Anthropology 17 (1997): 279–96.
———. ‘‘Visions of Postwar Health and Development and Their Impact on Public Health
Interventions in the Developing World.’’ In International Development and the
Social Sciences: Essays on the History and Politics of Knowledge, edited by
Frederick Cooper and Randall M. Packard, 93–115. Berkeley: University of
California Press, 1997.
———. ‘‘ ‘No Other Logical Choice’: Global Malaria Eradication and the Politics of
International Health in the Post-war Era.’’ Parassitologia 40 (1998): 217–29.
Packard, Randall M., and P. Gadelha. ‘‘A Land Filled with Mosquitoes: Fred L. Soper,
the Rockefeller Foundation, and the Anopheles gambiae Invasion of Brazil.’’
Parassitologia 36 (1994): 197–213.
Palmer, Steven. ‘‘Central American Encounters with Rockefeller Public Health, 1914–
21.’’ In Close Encounters of Empire: Writing the Cultural History of U.S.-Latin
American Relations, edited by Gilbert Joseph, Catherine C. LeGrand, Ricardo
Salvator, 311–32. Durham, N.C.: Duke University Press, 1998.
Pandya, S. S. ‘‘The First International Leprosy Conference, Berlin, 1897: The Politics of
Segregation.’’ História, Ciéncias, Saúde—Manguinhos 10, Suppl. 1 (2003): 161–77.
Paredes, Ruby R. ‘‘The Ilustrado Legacy: The Pardo de Taveras of Manila.’’ In An
Anarchy of Families: State and Family in the Philippines, edited by Alfred W.
McCoy. Quezon City: Ateneo de Manila University Press, 1994.
Parekh, Bhiku. ‘‘Liberalism and Colonialism: A Critique of Locke and Mill.’’ In The
Decolonization of Imagination, edited by Jan Nederveen Pieterse and Bhiku Parekh,
81–98. London: Zed Books, 1995.
Parreñas, Rhacel Salazar. ‘‘Transgressing the Nation State: The Partial Citizenship and
‘Imagined Community’ of Migrant Filipina Domestic Workers.’’ Signs 26 (2001):
1129–54.
Pateman, Carole. The Sexual Contract. Cambridge: Polity Press, 1988.
Pegg, M. G. ‘‘Le corps et l’authorité: La lèpre de Badouin IV.’’ Annales: Economies,
Sociétés, Civilisations 45 (1990): 265–87.
Petryna, Adriana. Life Exposed: Biological Citizens After Chernobyl. Princeton:
Princeton University Press, 2002.
Pick, Daniel. Faces of Degeneration: A European Disorder, c. 1848–c. 1918.
Cambridge: Cambridge University Press, 1989.
Pickens, Donald K. ‘‘The Turner Thesis and Republicanism: A Historiographic
Commentary.’’ Pacific Historical Review 61 (1992): 319–40.
Pigg, Stacy Leigh. ‘‘ ‘Found in Most Traditional Societies’: Traditional Medical

bibliography 333
 Practitioners between Culture and Development.’’ In International Development
and the Social Sciences: Essays on the History and Politics of Knowledge, edited by
Frederick Cooper and Randall Packard, 259–90. Berkeley: University of California
Press, 1997.
Poovey, Mary. Making a Social Body: British Cultural Formation, 1830–1864.
Chicago: University of Chicago Press, 1995.
Porter, Dorothy. Health, Civilization and the State: A History of Public Health from
Ancient to Modern Times. New York: Routledge, 1999.
Prakash, Gyan. Another Reason: Science and the Imagination of Modern India.
Princeton: Princeton University Press, 1999.
Pringle, Henry F. The Life and Times of William H. Taft. 2 vols. New York: Farrer and
Rinehart, 1939.
Quisumbing, Eduardo. ‘‘Development of Science in the Philippines.’’ J. of East Asiatic
Studies 6 (1957): 127–53.
Rabinbach, Anson. The Human Motor: Energy, Fatigue and the Origins of Modernity.
New York: Basic Books, 1990.
Rabinow, Paul. French Modern: Norms and Forms of the Social Environment.
Cambridge: MIT Press, 1989.
Rafael, Vicente L. White Love, and Other Events in Filipino History. Durham, N.C.:
Duke University Press, 2000.
———. ‘‘White Love: Surveillance and Nationalist Resistance in the United States’
Colonization of the Philippines.’’ In Cultures of United States Imperialism, edited by
Amy Kaplan and Donald E. Pease, 185–218. Durham, N.C.: Duke University Press,
1993.
———. ‘‘Colonial Domesticity: White Women and United States Rule in the
Philippines,’’ American Literature 67 (1995): 639–65.
———. ‘‘Mimetic Subjects: Engendering Race at the Edge of Empire.’’ differences: A
Journal of Feminist Cultural Studies 7 (1995): 127–49.
———, ed. Discrepant Histories: Translocal Essays on Filipino Cultures. Philadelphia:
Temple University Press, 1995.
Ramos, Paz G. ‘‘Historical Background of Health Education in the Philippines.’’
Education Quarterly 14 (1966): 4–13.
Reed, Robert R. City of Pines: The Origins of Baguio as a Colonial Hill Station and
Regional Capital. 2nd ed. Baguio City: A-Seven Publishing, 1999 [1976].
Renan, Ernest. Qu’est-ce qu’une nation? Et autres essais politiques. Paris: Presses-
Pochet, 1992.
Renbourn, E. T. ‘‘The Spine Pad: A Discarded Item of Tropical Clothing.’’ J. of the
Royal Army Medical Corps 102 (1956): 217–33.
———. ‘‘Life and Death of the Solar Topi.’’ J. of Tropical Medicine and Hygiene 65
(1962): 203–18.
Robertson, Jo. ‘‘Leprosy and the Elusive M. leprae: Colonial and Imperial Medical
Exchanges in the Nineteenth Century.’’ História, Ciéncias, Saúde—Manguinhos 10,
Suppl. 1 (2003): 13–40.
Robinson, Ronald. ‘‘Non-European Foundations of European Imperialism: Sketch for a

334 bibliography
 Theory of Collaboration.’’ In Studies in the Theory of Imperialism, edited by Roger
Owen and Bob Sutcliffe, 117–42. London: Longman, 1972.
Rodgers, Daniel T. ‘‘In Search of Progressivism.’’ Reviews in American History 10
(1982): 113–32.
Rogaski, Ruth. Hygienic Modernity: The Meanings of Health in Treaty-Port China.
Berkeley: University of California Press, 2004.
Rogers, Naomi. ‘‘Germs with Legs: Flies, Disease and the New Public Health.’’ Bulletin
of the History of Medicine 63 (1989): 599–617.
Rose, Nikolas. Powers of Freedom: Reframing Political Thought. Cambridge:
Cambridge University Press, 1999.
Rosen, George. A History of Public Health. New York: md Publications, 1958.
———. From Medical Police to Social Medicine: Essays on the History of Health Care.
New York: Science History Publications, 1974.
———. Preventive Medicine in the United States, 1900–75: Trends and Interpretations.
New York: Prodist, 1977.
———. ‘‘Nostalgia: A ‘Forgotten’ Psychological Disorder.’’ Psychological Medicine 5
(1975): 340–54.
———. ‘‘The Efficiency Criterion in Medical Care, 1900–1920: An Early Approach to
the Evaluation of Health Service.’’ Bulletin of the History of Medicine 50 (1976):
28–44.
Rosenberg, Charles E. ‘‘George M. Beard and American Nervousness.’’ In No Other
Gods: On Science and American Social Thought, 98–108. Baltimore: Johns
Hopkins University Press, 1976.
———. ‘‘Sexuality, Class and Role in Nineteenth-century America.’’ In The American
Man, edited by Elizabeth H. Pleck and Joseph H. Pleck, 219–54. Englewood Cliffs,
N.J.: Prentice-Hall, 1980.
———. ‘‘Framing Disease: Illness, Society and History.’’ In Framing Disease: Studies in
Cultural History, edited by Charles E. Rosenberg and Janet Golden, xii–xxvi. New
Brunswick, N.J.: Rutgers University Press, 1992.
Rosenkrantz, Barbara Gutmann. Public Health and the State: Changing Views in
Massachusetts, 1842–1936. Cambridge: Harvard University Press, 1972.
Rotundo, E. Anthony. American Manhood: Transformations in Masculinity from the
Revolution to the Modern Era. New York: Basic Books, 1993.
Russell, Edmund. War and Nature: Fighting Humans and Insects with Chemicals from
World War I to Silent Spring. Cambridge: Cambridge University Press, 2001.
Russell, Paul F. ‘‘The United States and Malaria: Debits and Credits.’’ Bulletin of the
New York Academy of Medicine 44 (1968): 623–53.
Sadowsky, Jonathan. Imperial Bedlam: Institutions of Madness in Colonial Southwest
Nigeria. Berkeley: University of California Press, 1999.
Said, Edward W. Orientalism. London: Routledge and Kegan Paul, 1978.
Saldivar, José David. ‘‘Looking Awry at 1898: Roosevelt, Montejo, Paredes, and
Mariscal.’’ American Literary History 12 (2000): 386–406.
Salman, Michael. ‘‘The United States and the End of Slavery in the Philippines, 1898–

bibliography 335
 1914: A Study of Imperialism, Ideology and Nationalism.’’ ph.d. diss., Stanford
University, 1993.
Sangari, Kumkum, and Sudesh Vaid. Recasting Women: Essays in Colonial History.
New Delhi: Kali for Women, 1989.
Santiago, Luciano P. R. ‘‘The First Filipino Doctors of Medicine and Surgery (1878–
97).’’ Philippine Quarterly of Culture and Society 22 (1997): 103–40.
Scheper-Hughes, Nancy. ‘‘Rotten Trade.’’ J. of Human Rights 2 (2003): 197–226.
Schneider, William H., ed. Rockefeller Philanthropy and Modern Biomedicine:
International Initiatives from World War I to the Cold War. Bloomington: Indiana
University Press, 2002.
Schumacher, John N. The Propaganda Movement 1880–1895. Manila: Solidaridad,
1973.
———. ‘‘Rizal and Blumentritt.’’ Philippine Studies 2 (1954): 85–101.
———. ‘‘Philippine Higher Education and the Origins of Nationalism.’’ Philippine
Studies 23 (1975): 53–65.
Scott, David. ‘‘Colonial Governmentality.’’ Social Text 43 (1995): 191–220.
Scott, Joan W. Only Paradoxes to Offer: French Feminists and the Rights of Man.
Cambridge: Harvard University Press, 1996.
———. ‘‘Gender: A Useful Category of Historical Analysis.’’ American Historical
Review 91 (1986): 1053–75.
Shah, Nayan. Contagious Divides: Epidemics and Race in San Francisco’s Chinatown.
Berkeley: University of California Press, 2001.
Shirmer, Daniel B. Republic or Empire: American Resistance to the Philippine War.
Cambridge: Schenkman, 1972.
Showalter, Elaine. The Female Malady: Woman, Madness and English Culture 1830–
1980. Harmondsworth: Penguin, 1985.
Sicherman, Barbara. ‘‘The Uses of a Diagnosis: Doctors, Patients and Neurasthenia.’’
J. of the History of Medicine and Allied Sciences 32 (1977): 33–54.
Sinha, Mrinalini. Colonial Masculinities: The ‘‘Manly Englishman’’ and the ‘‘Effeminate
Bengali’’ in the Late Nineteenth Century. Manchester: Manchester University Press,
1995.
Skowronek, Stephen. Building a New American State: The Expansion of National
Administrative Capacities, 1877–1920. Cambridge: Cambridge University Press,
1982.
Smallman-Raynor, Matthew, and Andrew D. Cliff. ‘‘The Epidemiological Legacy of
War: The Philippine-American War and the Diffusion of Cholera in Batangas and La
Laguna, South-West Luzón, 1902–4.’’ War in History 7 (2000): 29–64.
Smith, Dale. ‘‘Edward L. Munson, m.d.: A Biographical Study in Military Medicine.’’
Military Medicine 164 (1999): 1–5.
Smith-Rosenberg, Carroll, and Charles E. Rosenberg. ‘‘The Female Animal: Medical
and Biological Views of Woman and Her Role in Nineteenth-century America.’’ J. of
American History 60 (1973): 332–56.
Sobredo, James D. ‘‘From American ‘Nationals’ to the ‘Third Asiatic Invasion’: Racial

336 bibliography
 Transformation and Filipino Exclusion (1898–1934).’’ ph.d. dissertation, University
of California-Berkeley, 1998.
Spivak, Gayatri Chakravorty. In Other Worlds: Essays in Cultural Politics. New York:
Methuen, 1987.
Stallybrass, Peter, and Allon White. The Politics and Poetics of Transgression. Ithaca:
Cornell University Press, 1986.
Stanley, Peter W. A Nation in the Making: The Philippines and the United States 1899–
1921. Cambridge: Harvard University Press, 1974.
———. ‘‘William Cameron Forbes: Proconsul in the Philippines.’’ Pacific Historical
Review 35 (1966): 285–301.
———. ‘‘ ‘The Voice of Worcester Is the Voice of God’: How One American Found
Fulfillment in the Philippines.’’ In Reappraising an Empire: New Perspectives on
Philippine-American History, edited by Peter W. Stanley, 117–42. Cambridge:
Committee on American–East Asian Relations, Harvard University, 1984.
Stapleton, Darwin H. ‘‘Technology and Malaria Control, 1930–1960: The Career of
Rockefeller Foundation Engineer Frederick W. Knipe.’’ Parassitologia 42 (2000):
59–68.
———. ‘‘Internationalism and Nationalism: The Rockefeller Foundation, Public Health,
and Malaria in India, 1923–51.’’ Parassitologia 42 (2000): 127–34.
Stauffer, Robert B. The Development of an Interest Group: The Philippine Medical
Association. Quezon City: University of the Philippines Press, 1966.
Stepan, Nancy Leys. ‘‘Race, Gender, Science and Citizenship.’’ In Cultures of Empire:
Colonizers in Britain and the Empire in the Nineteenth and Twentieth Centuries,
edited by Catherine Hall, 61–86. New York: Routledge, 2000.
Stern, Alexandra Minna. Eugenic Nation: Faults and Frontiers of Better Breeding in
America. Berkeley: University of California Press, 2005.
Sternberg, Martha L. George Miller Sternberg: A Biography. Chicago: ama, 1920.
Stewart, Susan. On Longing: Narratives of the Miniature, the Gigantic, the Souvenir,
the Collection. Durham, N.C.: Duke University Press, 1993.
Stoler, Ann Laura. Race and the Education of Desire: Foucault’s History of Sexuality
and the Colonial Order of Things. Durham, N.C.: Duke University Press, 1995.
———. ‘‘Rethinking Colonial Categories: European Communities and the Boundaries of
Rule.’’ Comparative Studies in Society and History 31 (1989): 134–61.
———. ‘‘Carnal Knowledge and Imperial Power: Gender, Race, and Morality in
Colonial Asia.’’ In Gender at the Crossroads of Knowledge: Feminist Anthropology
in the Postmodern Era, edited by Micaela di Leonardo, 51–101. Berkeley:
University of California Press, 1991.
———. ‘‘Sexual Affronts and Racial Frontiers: European Identities and the Cultural
Politics of Exclusion in Colonial Southeast Asia.’’ Comparative Studies in Society
and History 34 (1992): 514–51.
———. ‘‘Tense and Tender Ties: The Politics of Comparison in North American History
and (Post) Colonial Studies.’’ J. of American History 88 (2001): 829–96.
———. Carnal Knowledge and Imperial Power: Race and the Intimate in Colonial Rule.
Berkeley: University of California Press, 2002.

bibliography 337
Stoler, Ann Laura, and Frederick Cooper. ‘‘Tensions of Empire: Rethinking a Research
Agenda.’’ In Tensions of Empire: Colonial Cultures in a Bourgeois World, edited by
Frederick Cooper and Ann L. Stoler, 1–56. Berkeley: University of California Press,
1997.
Stone, Martin. ‘‘Shellshock and the Psychologists.’’ In The Anatomy of Madness: Essays
in the History of Psychiatry. Vol. 2: Institutions and Society, edited W. F. Bynum,
Roy Porter, and M. Shepherd, 242–71. New York: Tavistock, 1985.
Sturdy, Steve. ‘‘From the Trenches to the Hospitals at Home: Physiologists, Clinicians
and Oxygen Therapy, 1914–30.’’ In Medical Innovations in Historical Perspective,
edited by J. V. Pickstone, 104–23. New York: St. Martin’s Press, 1992.
Sturdy, Steve, and Roger Cooter. ‘‘Science, Scientific Management, and the
Transformation of Medicine in Britain, c. 1870–1950.’’ History of Science 36
(1998): 421–66.
Sullivan, Rodney J. ‘‘ ‘Exemplar of Americanism’: The Philippine Career of Dean C.
Worcester.’’ ph.d. diss., James Cook University of North Queensland, 1986.
———. Exemplar of Americanism: The Philippines Career of Dean C. Worcester. Ann
Arbor, Mich.: Center for South and Southeast Asian Studies, University of
Michigan, 1991.
———. ‘‘Cholera and Colonialism in the Philippines.’’ In Disease, Medicine and Empire:
Perspectives on Western Medicine and the Experience of European Expansion,
edited by Roy MacLeod and Milton Lewis, 284–300. London: Routledge, 1988.
Tadiar, Neferti X. ‘‘Filipina Domestic Bodies.’’ Sojourn: A Journal of Social Issues in
Southeast Asia 12 (1997): 153–91.
Taussig, Michael. Mimesis and Alterity: A Particular History of the Senses. London:
Routledge, 1993.
Temkin, Owsei. ‘‘The Scientific Approach to Disease: Specific Entity and Individual
Sickness.’’ In The Double Face of Janus and Other Essays in the History of
Medicine, 441–55. Baltimore: Johns Hopkins University Press, 1977.
Thomas, Howard Elsworth. A Study of Leprosy Colony Policies. N.p.: American
Mission to Lepers, 1947.
Thomas, Nicholas. Colonialism’s Culture: Anthropology, Travel and Government.
Princeton: Princeton University Press, 1994.
Tomes, Nancy. The Gospel of Germs: Men, Women and the Microbe in American Life.
Cambridge: Harvard University Press, 1998.
Trask, David F. The War with Spain in 1898. New York: Macmillan, 1981.
Trauner, Joan B. ‘‘The Chinese as Medical Scapegoats in San Francisco, 1870–1905.’’
California History 57 (1978): 70–87.
Trennert, Robert A. White Man’s Medicine: Government Doctors and the Navajo,
1863–1955. Albuquerque: University of New Mexico Press, 1998.
Trigo, Benigno. ‘‘Anemia and Vampires: Figures to Govern the Colony, Puerto Rico,
1880–1904.’’ Comparative Studies in Society and History 41 (1999): 104–23.
Ugarte, Eduardo F. ‘‘Muslims and Madness in the Southern Philippines,’’ Pilipinas 19
(1992): 1–24.
———. ‘‘ ‘Like a Mad Dog’: The Perceived Savageness of ‘the Malay’ in Euro-British and
Euro-American Colonial Writing,’’ Pilipinas 29 (1999): 97–118.

338 bibliography
Utley, Robert M. Frontier Regulars: The United States Army and the Indian, 1866–
1891. New York: Macmillan, 1973.
Valenčius, Conevery Bolton. ‘‘Histories of Medical Geography.’’ In Medical Geography
in Historical Perspective, edited by Nicolaas Rupke, 3–29. London: Wellcome Trust
Centre for the History of Medicine, 2000.
Van Hise, Joseph B. ‘‘American Contributions to Philippine Science and Technology,
1898–1916.’’ ph.d. diss., University of Wisconsin-Madison, 1957.
Vaughan, Christopher A. ‘‘Ogling Igorots: The Politics and Commerce of Exhibiting
Otherness, 1898–1913,’’ In Freakery: The Cultural Spectacle of the Extraordinary
Body, edited by Rosemary Garland Thompson, 219–33. New York: New York
University Press, 1996.
Vaughan, Megan. Curing Their Ills: Colonial Power and African Illness. Stanford:
Stanford University Press, 1991.
Velasco, José R., and Luz Baens-Arcega. The National Institute of Science and
Technology, 1901–1982: A Facet of Science Development in the Philippines.
Manila: Philippine Association for the Advancement of Science, 1984.
Vergara, Benito M., Jr. Displaying Filipinos: Photography and Colonialism in Early-
Twentieth-Century Philippines. Quezon City: University of the Philippines Press,
1995.
Vergès, Françoise. ‘‘Chains of Madness, Chains of Colonialism: Fanon and Freedom.’’
In The Fact of Blackness: Frantz Fanon and Visual Representation, edited by Alan
Read, 47–75. Seattle: Bay Press, 1996.
Vigarello, Georges. Concepts of Cleanliness: Changing Attitudes in France since the
Middle Ages. Translated by Jean Birrell. Cambridge and Paris: Cambridge
University Press and Editions de la maison des sciences de l’homme, 1988.
Visvanathan, Shiv. ‘‘On the Annals of the Laboratory State.’’ In Science, Hegemony and
Violence: A Requiem for Modernity, edited by Ashis Nandy, 257–88. New Delhi:
Oxford University Press, 1988.
Vogel, Morris J. ‘‘Managing Medicine: Creating a Profession of Hospital Administra-
tion in the United States, 1895–1915.’’ In The Hospital in History, edited by
Lindsay Granshaw and Roy Porter, 243–60. New York: Routledge, 1989.
[Wade, H. W., ed.]. Culion: A Record of Fifty Years Work with the Victims of Leprosy at
the Culion Sanitarium. Manila: Bureau of Printing, 1956.
Walker, David. A Selected Bibliography of Malaria in the Philippines. Manila: Bureau
of Printing, 1953.
Warner, John Harley. The Therapeutic Perspective: Medical Practice, Knowledge and
Identity in America, 1820–1885. Cambridge: Harvard University Press, 1986.
———. ‘‘The Idea of Southern Medical Distinctiveness: Medical Knowledge and Practice
in the Old South.’’ In Sickness and Health in America: Readings in the History of
Medicine and Public Health. 2nd ed. Edited by Judith Walzer Leavitt and Ronald L.
Numbers, 53–70. Madison: University of Wisconsin Press, 1985.
Weigley, Russell F. History of the United States Army. Bloomington: Indiana University
Press, 1984.
Weindling, Paul, ed. International Health Organizations and Movements, 1918–1939.
Cambridge: Cambridge University Press, 1995.

bibliography 339
Welch, Richard E., Jr. Response to Imperialism: The United States and the Philippine-
American War, 1899–1902. Chapel Hill: University of North Carolina Press, 1979.
Whorton, James C. ‘‘Insecticide Spray Residues and Public Health, 1865–1938.’’
Bulletin of the History of Medicine 45 (1971): 219–41.
Wiebe, Robert H. The Search for Order, 1877–1920. New York: Hill and Wang, 1967.
Williams, Ralph Chester. The United States Public Health Service, 1798–1950.
Washington, D.C.: Commissioned Officers Association of the usphs, 1951.
Williams, Walter L. ‘‘United States Indian Policy and the Debate over Philippine
Annexation: Implications for the Origins of American Imperialism.’’ J. of American
History 66 (1980): 810–31.
Williams, William Appleman. Empire as a Way of Life: An Essay on the Causes and
Consequences of America’s Present Predicament. New York: Oxford University
Press, 1980.
———. ‘‘The Frontier Thesis and American Foreign Policy.’’ Pacific Historical Review 24
(1955): 379–95.
Wilson, Rob. American Sublime: The Genealogy of a Poetic Genre. Madison:
University of Wisconsin Press, 1991.
———. ‘‘Techno-euphoria and the Discourse of the American Sublime.’’ boundary 2 19
(1992): 205–29.
Winichakul, Thongchai. Siam Mapped: A History of the Geo-Body of the Nation.
Honolulu: University of Hawaii Press, 1993.
Winslow, Charles-Edward Amory. The Life of Hermann M. Biggs, Physician and
Statesman of Public Health. Philadelphia: Lea and Febiger, 1929.
———. The Conquest of Epidemic Disease: A Chapter in the History of Ideas. Madison:
University of Wisconsin Press, 1980 [1943].
Winzeler, R. ‘‘Amok: Historical, Psychological, and Cultural Perspectives.’’ In Emotions
of Culture: A Malay Perspective, edited by Wazir Jahan Karim, 96–122. Singapore:
Oxford University Press, 1990.
Worboys, Michael. Spreading Germs: Disease Theories and Medical Practice in Britain,
1865–1900. Cambridge: Cambridge University Press, 2000.
———. ‘‘Manson, Ross and Colonial Medical Policy: Tropical Medicine in London and
Liverpool, 1899–1914.’’ In Disease, Medicine and Empire: Perspectives on Western
Medicine and the Experience of European Expansion, edited by Roy MacLeod and
Milton Lewis, 21–33. London: Routledge, 1988.
Wright, Gwendolyn. The Politics of Design in French Colonial Urbanism. Chicago:
Chicago University Press, 1991.
Wright, Lawrence. Clean and Decent: The Fascinating History of the Bathroom and the
Water Closet. London: Routledge Kegan Paul, 1960.
Young, Iris Marion. ‘‘Polity and Group Difference: A Critique of the Ideal of Universal
Citizenship.’’ Ethics 99 (1989): 250–74.
Young, Kenneth Ray. The General’s General: The Life and Times of Arthur MacArthur.
Boulder: Westview Press, 1994.
Young, Robert J. C. Colonial Desire: Hybridity in Theory, Culture and Race. London:
Routledge, 1995.

340 bibliography
Zaide, Gregorio F. Philippine Political and Cultural History. 2 vols. Manila: Philippine
Educational Co., 1957.
———. The Philippine Revolution. Manila: Modern Book Co., 1968.
Zinoman, Peter. The Colonial Bastille: A History of Imprisonment in Vietnam, 1862–
1940. Berkeley: University of California Press, 2001.

bibliography 341
Index

abdominal bandages, 42–43 Atebrin, 222, 295n.75

abjection, 106, 129, 266n.11 Atkinson, Fred W., 80, 142, 146
acquired immunity, 87–95 Australia, 227, 297n.2
actinic agency theory of neurasthenia, 80–
83, 137–38 Bache, Dallas, 26
Acton, Hugh W., 152, 277n.70 Bacillus dysenteriae, 61
African Americans: as disease vectors, 98, Bacillus pestis, 62
264n.96; Filipinos vs., 57–58; hook- bacteriology: epidemic disease control
worm eradication and, 195–96; ma- and, 61–69; human waste habits and,
laria control program and, 216–17, 104–5; leprosy research and, 163,
239n.39; as soldiers in Philippines, 280nn.17–18; military medical
101–3, 265nn.111–13 research in, 24–30, 37–38, 244n.59;
Agramonte, Aristides, 215 Philippine research programs in, 194–
Aguilar, Eusebio D., 228 205; Philippine sanitation policies and,
Aguinaldo, Emilio, 17, 20, 31–32, 47–48, 58–61; sanitary immunity concept and,
57 97–101; tropical medicine legacy in,
Albert, José, 283n.76 298n.15
Alden, Charles H., 29, 244n.59 Baguio sanitarium, 142–47, 276nn.47, 49
American Anthropologist, 100 Bakhtin, Mikhail, 267n.28, 268n.47
American Doctor’s Odyssey, An, 232, Balfour, Andrew, 74, 76, 259nn.1, 4
298n.16 Bancroft, Hubert Howe, 78–79
American Indians, 57–58, 254nn.58–59 Barber, M. A., 213
‘‘American sublime,’’ 111, 268n.30 Barker, Lewellys, 32, 79, 255n.74, 260n.19
Anchylostoma duodenale, 195 Barrows, David P., 136–37, 190, 274n.23
Anderson, Benedict, 18, 272n.105 Bass, C. C., 216–17
Anopheles mosquito, 209–26 Baun, Louis D., 68–69
‘‘Antipolo’’ toilet, 120, 198, 270n.72 Bean, Robert Bennett, 88–89
Army Board for the Study of Tropical Dis- Beard, George M., 131, 272n.5
eases, 8, 75, 82, 261n.33; bacteriologi- Bederman, Gail, 133, 273nn.9–10
cal research by, 108 benzozone, 66, 257n.93
Army Medical Board, 22 Berkeley Hill, Owen, 152–54, 277n.71,
Army Medical Department, 22–30 278nn.73, 79
Arnold, David, 4, 249n.2 Beveridge, Albert, 32, 56, 253n.51
Aron, Hans, 83 Biggs, Hermann M., 229, 297n.6
asepsis, 23–30 Billings, John Shaw, 22, 29, 242n.24
Ashburn, Percy M., 131, 138, 252n.37 biomedical citizenship, 3–11, 238n.10
Ashford, Bailey K., 194–95 Birch, E. A., 41
blood pressure, 84–85 Cablenews-American, 101, 277n.63
Blue, Rupert, 229 Calderón, Fernando, 184–86, 191
Blumentritt, Ferdinand, 21 Calvert, W. J., 61
Board of Health and Charity (Philippines), Camp John Hay, 142–45
18, 50–51, 251n.24 Camp Stotsenberg, malaria control at,
body: human waste disposal policies and 209–20, 291n.11
racialization of, 106–11, 267n.14; carbon tetrachloride, for hookworm erad-
laboratory as ritual frame for, 128– ication, 199
29; racialized concepts of, 4, 182– Carlisle Indian Industrial School, 56
84 carnival, 121–28, 271n.86
Boletín de medicine de Manila, 18 Carnival Spirit, 271n.86
Bonifacio, Andrés, 20 Carpenter, Frank, 116, 143, 253n.47
Bourdieu, Pierre, 266n.13 carrier mechanisms: disease immunity and,
Bourns, Frank, 49–50, 52, 250n.20, 91–95, 262n.65; in malaria, 211,
276n.47 291n.14; racialized theories of, 181–
British Medical Journal, 153–54 82; for typhoid, 97–101, 264n.92
British medical research: malaria control Carroll, James, 215
and, 213–15; sanitary immunity con- Carter, E. C., 52, 68, 70, 252n.30,
cept and, 98–99; in tropics, 245n.63 258n.113
Brownell, Atherton, 284n.85 Carter, Henry R., 215
Bryan, William Jennings, 54, 237n.7 Carter, William S., 198–99
bubonic plague: epidemic of 1899, 61–69, Carville Leprosarium, 174–75, 283n.72
260n.19; Filipinization of health service Casteel, Delphey T. E., 59, 255n.65
and incidence of, 189–90, 287n.44; Castellani, Aldo, 92
immunization against, 263n.84; in San Cavite rebellion, 20
Francisco, 98 Cebú Leprosarium, 162–63, 165, 179
Buccaneers Club, 147 Chalmers, Albert, 92
Buckland, Ralph, 89 Chamberlain, Weston, 74–76, 84–87, 91,
Bullard, R. L., 102, 265n.113 231, 262nn.46–47
bureaucratic institutions: colonial health Chapin, Charles V., 97, 105, 264n.89
politics of, 7, 239n.29; Filipinization of Chapman, L. A. I., 184
government and, 143–47, 180–93; Chatterjee, Partha, 272n.105
independence and decline of, 228–33; chaulmoogra oil, for leprosy, 164–77,
‘‘tropical neurasthenia’’ concept and, 281n.42, 283n.75
131–34 China, 281n.31
Bureau of Government Laboratories, 111– Chinese Americans, 98
12, 268n.32 Chinese Filipinos: bubonic plague outbreak
Bureau of Indian Affairs, 57, 254n.57 among, 62–63; human waste habits of,
Burgess, Perry, 173–74 104, 110; as stretcher bearers, 31–33,
Burnet, F. Macfarlane, 226 39, 245n.71
burning of dwellings to control cholera, cholera epidemics: Filipinization of
64–66, 256n.87 response to, 184, 189–93; human
Burrell, Alice, 248n.110 waste analysis during, 108; sanitation
Burrill, Herbert, 26 measures during, 63–68, 93, 119–20,
business models, and Philippine public 249n.2, 256n.83
health policy, 72–73, 259n.117 citizenship: biomedical concepts and, 177–

344 index
 79; hygiene programs and, 202–6; in Cooper, Frederick, 4, 238n.17
leper colony, 171–75 cordon sanitaire, 46–47
civic bacteriology, 3–4 corporate liberalism, 2–3, 237n.2
civic virtue: in colonial Philippines, 2–11, Corregidor Hospital, 34–35, 246n.83
237n.2; in Culion leper colony, 159– Craig, Charles, 94–95, 208–9, 231
61, 169–75, 177–79; military rhetoric Crane, C. J., 59
of, 52–58, 252n.33; racialization of criollos, 19–20, 241n.16, 259nn.10–11
human waste policies and, 106–7, 116– Crone, Frank, 271n.99
20; sanitary immunity concept and, Crónicas de ciencias médicas, 18
98–101 Crosby, W. D., 210
civilization: ‘‘climatic hypothesis’’ of, 139– Cuba, 97, 215, 247n.95
40, 275n.33; as colonial ideology, 2–3, Culion leper colony, 9–10; biomedical cit-
183, 237n.7; in development discourse, izenship and, 177–79; as colonial
183–84; masculine dominance and, obsession, 175–77, 283nn.75–77;
132–34; tropical neurasthenia and, founding of, 164–68; hygiene programs
154–57 at, 158–61, 168–75; institutional the-
civil service, in Philippines, 186–93 atricals at, 171–72, 282n.57; Japanese
class structure: biomedical citizenship and, quarantine of, 284n.88; nationalist pol-
4; colonial public health policies and, itics and, 175–77, 283n.74
51–52, 230–33; Filipinization of pub- Curry, Joseph J., 61
lic health and, 227–33; impact of
cholera epidemic and, 66–68; in mili- Darnell, Joseph R., 156, 278n.74
tary medical policies, 27. See also elite Dauncey, Mrs. Campbell, 110, 121,
Filipinos 276n.27
Clausewitz, Carl von, 45, 249n.1 David, Randy, 277n.63
Clean-Up Week, 127–28, 271nn.99, 101, Davidson, Andrew, 41
104 Davis, Dwight D., 272n.105
Clemow, F. G., 243n.36 Davy, John, 84
climate conditions: burden of whiteness DeBevoise, Ken, 14, 240n.4, 256n.85,
and, 76–81, 154–57; exoneration of, in 291n.8
tropical disease, 81–87; impact of, on Debnam, Harry, 123
American military, 17–18; military deferral ideology: racializing of hygiene
medical research on, 24–30, 38–43; policies and, 3–11, 238n.14; resistance
military medicine’s reaction to, 30–37; to Filipinization and, 184–93
tropical neurasthenia research and, degeneration theory of neurasthenia, 137–
132–47 42
Codorniu y Nieto, Antonio, 76–77 De Jesús, Vicente, 189–93, 288n.71
Cole, C. L., 194 De Krafft, S. Chase, 13–17
colonial warfare, 46–48, 249n.3, 250n.6; De Mey, C. F., 66
Philippine public health policy affected Democracia, La, 124, 186, 258n.101
by, 72–73. See also guerrilla warfare dengue fever, 80, 225
Colonizing the Body, 4 Denison, Winfred T., 190
colored underwear, 83–84 Denny, Oswald E., 175
communication systems, 19–20 De Shon, George D., 66
Conger, Emily Bronson, 80, 90, 110, development, 183–84, 285n.16
260n.21 Dewey, George, 17

index 345
de Witt, Wallace, 81, 104, 261n.28 homogenization and, 3, 238n.8,
dichloro-diphenyl-trichloroethane (DDT), 239n.24; carnival and, 124–28;
224–25 nationalism movement and, 20–22;
dietary needs, 43 Spanish classification, 19–22, 241n.16.
discipline: in leper colonies, 162, 171, 177– See also racial typologies
79; in military medicine, 26–30; in evangelism, 162–63
tropical neurasthenia prevention, 144– excrement: as colonial racial obsession, 8–
47 11, 104–29; military medical policies
disease control: American military pro- on, 27–30; parasite research and, 194–
grams for, 15–17; in colonial Philip- 205. See also toilets
pines, 2–3; Filipinization of, 181–82,
189–93; scientific approach to, 137–42 Fabella, José, 227
Dutch East Indies, 4, 99 Fajardo, Jacobo, 202, 227, 289n.100
dysentery, 61, 129, 143–44, 272n.107 Fales, Louis, 138–40, 275nn.31–32
Fanon, Franz, 278n.79
ecological intervention, 208–26 Fauntleroy, P. C., 37, 231
economic conditions, 207–8 Federal Party, 186, 258n.101
Edger, Benjamin J., 108–9 Federated Malay states, 281n.31
educational programs: changes in focus of, Fee, Mary H., 89
208; for hookworm eradication, 199, feminist theory, 3
202; for malaria control, 211–12, 221; fiesta, 120–28
on sanitation and hygiene, 116–20, Filaria nocturna, 194
202–3, 289nn.100–101. See also medi- Filipino culture: carnival and, 123–28,
cal education 271n.86; civic virtue rhetoric and, 54–
Egan, Eleanor Franklin, 167–68 58; Filipinization campaign and racial-
Eighth Army Corps, 241n.10 ization of, 186–93; human waste habits
El Ideal, 125, 147 in, 104–29; immunity mechanisms
elite Filipinos: Americans viewed by, 204; assumed in, 92–95; leprosy policy in,
at Baguio, 145–47, 277n.61; colonial 175–77; ‘‘mimicry’’ aspects of, 180–
collaborative compromise with, 187, 205; psychoanalysis in, 132; racializa-
286n.32; Filipinization resisted by, 183, tion of, 3–11, 59–61, 69–73, 128–29,
286n.29; public health policies and, 238n.8; response to cholera epidemic
51–52; response to cholera epidemic in, 66–68; sanitary immunity and sup-
among, 67–68 posed resistance, 95–101; tropical dis-
Elliot, Charles Burke, 146, 277n.61 ease concepts rejected in, 147
Emerson, Haven, 229, 297n.7 Filipino physiology: immunity and, 88–95,
environmental conditions: malarial control 102–3; leprosy research and, 166–68;
programs and, 208–26; military medi- tropical medicine research and, 74–76,
cal research on, 24–30; racial economy 85–87; tropical neurasthenia and, 141–
in tropics and, 37–43 42, 157, 278n.79
epidemic disease: colonial politics and, 61– Finlay, Carlos, 215
69; military medical control procedures Fleming, Kenneth, 35, 246n.84
for, 28–30, 244n.55. See also specific Flexner, Simon, 32, 79, 255n.74, 260n.19
epidemics Forbes, W. Cameron, 1, 89, 123–25, 130–
Escobar, Arturo, 285n.16 31, 253n.45, 266n.8; Baguio sani-
ethnic identity of Filipinos: American tarium and, 142, 146–47, 276n.49,

346 index
 277n.61; Filipinization resisted by, Gussow, Zachary, 175
186–87, 190–91 Guthrie, Joseph A., 40, 47–48, 59–61
forcible disinfection, 119–20
Forster, E. M., 149 Hackett, Lewis, 215, 225–26, 296n.80
Fortune, T. Thomas, 102–3, 265n.116 Hansen, G. A., 163
Foster, Charles C., 245n.63 Harding, Warren G., 190–91
Foucault, Michel, 161–62, 249n.1, 297n.5 Hards, Ivan B., 184
Freer, Paul C., 52, 88–89, 95, 111–14 Harrison, Francis Burton, 81, 140, 180,
Freer, William B., 88–89 184, 187–90, 284n.2
Freud, Sigmund, 135, 147–48, 150–55, Hathaway, Conrad, 147, 277n.63
206, 277n.66, 278n.79 Havard, Valery, 137, 274n.25
Fugate, James, 156, 278n.74 Hayden, Joseph R., 113, 176
Heiser, Victor G., 1, 265n.102, 271n.86;
Gallardo, Marcelino, 184 breakdown of, 145; Filipinization resis-
Garrison, Fielding H., 132, 134–36, 145, ted by, 180–86, 189–93, 200–205, 221,
147–51, 156–57, 274nn.20–24, 227, 289n.98; hookworm eradication
277nn.64–66 program and, 180, 184, 194, 196–201,
Garrison, P. E., 91, 108, 194, 231 284n.2; on human waste management,
Gates, Frederick T., 195–97 115, 118, 259nn.53–54; hygiene pro-
Gatewood, James D., 163–64 grams under, 69–73, 232–33, 285n.113;
Gautier, Théophile, 141 on immunity, 95, 101; industrial hy-
gender: citizenship and, 3; in Filipinization giene research by, 231–32, 298n.17;
of health care, 201–5; male dominance leprosy research by, 160, 164–68, 170–
of colonial public health and, 6–11; 77, 280n.18, 281nn.31, 42, 282n.61;
masculine dominance in colonial ideol- malaria control programs and, 211,
ogy and, 132–34 ‘‘mimicry’’ and, 217–22, 224; New York City Public
290n.114; in tropical neurasthenia re- Health Department and, 229; racial pre-
search, 132–34, 146–47, 155–57, judices of, 208, 232, 290n.1; tropical
278n.75 medicine research and, 87, 156,
Gibbs, H. D., 83 276n.49
Gilchrist, Harry, 50 Herzog, Maximilian, 62, 100, 298n.15
Gimlette, John D., 141 Hirsch, August, 243nn.35–36
Goldwater, Sigismund, S., 297n.7 Hobsbawm, Eric, 241n.9
Gomez, Manuel, 122, 184, 251n.25, Hoff, H. R., 143–44
270n.79 Hoff, John van Rensselaer, 30, 243n.48
Gorgas, William, 214–15, 229, 293n.33 Hoffman, Frederick, 175, 282n.71
Goto Shinpei, 99 homesickness: as colonial concept, 77; mil-
Gottman, Jean, 46, 249n.3 itary medical observations on, 40,
Green-Armytage, V. B., 152, 277n.70 248n.109
Greenleaf, Charles R., 27, 39, 43, 50, Hookworm Commission of Puerto Rico,
243n.48, 245n.77, 246n.87, 247n.102 195
Griffis, William Elliot, 79 hookworm control: economic conditions
Griffiths, Jefferson D., 30–31 and, 207; malaria control program and,
guerrilla warfare, 46–48, 57–61, 255n.68. 217, 293n.43; pathophysiology of,
See also colonial warfare 194–95, 262n.49; racialized approach
Gunn, Selskar M., 221 to, 10, 180–81, 183, 191, 196–204

index 347
Hospital de San José, 18 ilustrados, 191–93
Hospital de San Juan de Dios, 18 immigration: by Filipinos to United States,
hospitals in Philippines: American mili- 232–33; by white Americans to Philip-
tary construction of, 33–35, 245n.77, pines, 79–81, 260n.22
246n.83; Filipinization of, 184–93; for immunity: Filipinization of programs and,
lepers, 162–63; military oversight of, 189–93; imperialist concepts of, 87–
50; Spanish construction of, 18 95; to malaria, 211, 213, 291n.14; san-
Hoyt, Henry F., 31–33, 35, 194, 245nn.64, itary immunity concept, 95–101
68 imperialism: civic virtue rhetoric and, 52–
Huggins, Eli, 141, 275n.41 58; immunity concepts and, 87–95;
humidity hypothesis of neurasthenia, 152 masculinity and, 132–34; race and, 2
Hunt, William H., 195 India: British health policies in, 99; leprosy
Huntington, Ellsworth, 139–40, 275n.33 in, 169, 281n.31; malaria control in,
Hyam, Ronald, 132–33 214, 223–24, 292n.28, 295n.75
hygiene policies: among American Indians, Indian Psychoanalytic Society, 152,
58, 254n.59; in bubonic plague out- 277n.71
break, 62–69; cholera epidemic and Fil- indios, 19–20, 241n.16
ipino practices of, 63–64; at Culion industrial hygiene, 231–32, 298n.17
leper colony, 158–61, 168–75; eco- Instituto di Sanità Pubblica (Italy), 217
nomic factors in, 207–9; Filipinization international health and development pro-
and, 3, 181–93; in hookworm eradica- grams, 10–11, 232–33
tion programs, 195–205; human waste International Health Commission (Board),
disposal policies and, 105–29; immu- 196–99, 203–4, 215–16, 223, 232–33,
nity and, 89–95, 101–3; leprosy and, 293n.42
162–68; in military medical infrastruc- International Journal of Leprosy, 283n.75
ture, 1–11, 23–30, 45–73, 237n.1, International Leprosy Association, 283n.75
244n.59, 249n.5; in postwar Philip- interracial sex, 5, 239n.20
pines, 69–73; racialization of, 3–4, 8– intimacy: in colonial hygiene policies, 4–5,
11, 37–43; sanitary immunity concept 239n.19; in leper colonies, 160–61
and, 96–101; state-run Filipino health Iwahig Prison Colony, 221–22, 295n.68
program and, 227–33; as surveillance
apparatus, 128–29; in tropical condi- Jackson, Thomas W., 101
tions, 30–37, 42–43; in tropical neuras- Jagor, Fedor, 77
thenia prevention, 144–47; in United James, William, 187, 266n.8
States, 229–33; white male dominance Jansen, Paul F., 283n.73
of, 6; white physiology in tropics and, Japan: Culion quarantined by, 284n.88;
82–87 leprosy, 281n.31; Philippines invaded
by, 228; public health programs, 99
Ide, Henry C., 253n.45 Jenks, Albert E., 284n.86
identity formation, 4–11 Joaquin, Nick, 127–28
Igorots: classification of, 242n.16; in Johnson, Richard, 65, 166, 257n.90
Philippine-American war, 33; phys- Jones Act, 188
iological studies of, 86–87, 92; racial- Jordan, David Starr, 260n.25
ized exhibitions of, 124–25
Ileto, Reynaldo C., 2–3, 5, 249n.2, Katipunan, 20
251n.23 Kemp, Franklin M., 32–33

348 index
Kidd, Benjamin, 41 Ludlow, C. S., 212
King, W. W., 140, 195, 275n.37, 294n.62 Lyautey, Hubert, 46–48
Kipling, Rudyard, 1, 4, 273n.16, 278n.77
Kneedler, H. L., 188–89 MacArthur, Arthur, 47–48
Koch, Robert, 213, 243n.36 MacArthur, Douglas, 228
Kramer, Paul, 5 MacDonald, Charles Everett, 166
Kristeva, Julia, 266n.11 MacNamara, N. C., 163–64, 169
malaria: carriers of, 91; colonial ideology
Laboratorio Municipal de Manila, 19 and, 10; community involvement in con-
laboratory science: during cholera epi- trol of, 221–22; control of, 198–205;
demic, 68; colonial public health pol- cost issues and, 219–20; early research
icies and, 5–11, 45–46, 239n.27; at on, 243n.36; among Filipinos, 89;
Culion leper colony, 169–75; evolu- human factors in control of, 225–26,
tion in military medicine of, 23–30, 295n.79; during Philippine-American
242n.25; Filipinization of, 194–205; war, 13–17, 38–43; race and ecology in
as locus of modernity, 110–16; post- control of, 208–26; racialized immunity
war Philippine hygiene and, 70–73; studies of, 94–95; treatment of, 144
racialization of human waste analysis Malaysia, 214, 292n.29
and, 108–11; as ritual frame, 128– Manalang, C., 220, 223
29; tropical disease research and, 74– Manila Board of Health, 49–50, 251n.25;
76; white physiology in tropics and, bubonic plague outbreak and, 62; chol-
82–87 era epidemic and, 64–69
Langhorne, George T., 122 Manila Bureau of Health, 98, 251n.24;
Lanza, Conrad, 35 fiesta management policies of, 121–28;
Latour, Bruno, 87 Filipinization of, 184–93; human waste
Laveran, Alphonse, 209, 243n.36 policies of, 104; leprosy programs of,
Lawton, H. W., 35 166–68; malaria control initiatives of,
Lazear, Jesse, 215 211–26; toilet installation program of,
Leach, Charles N., 198–99, 288n.77 117–20; water purification policies
Leonard Wood Memorial for the Eradica- of, 115–16
tion of Leprosy, 283n.75 Manila Bureau of Science, 8, 75, 82–87,
leprosy: in China, 281n.31; research in 95, 112, 268nn.32, 36; bacteriological
colonial Philippines, 161–75, 207 studies of, 108, 194, 298n.15; Filipini-
LeRoy, James A., 93, 113–14 zation of, 185, 189–93, 220–21; lep-
liberalism, 3–4, 238n.14 rosy research by, 167
Liga Filipina, 20 Manson, Patrick, 62, 91–92, 164, 169–70,
Limjuco, Ignacia, 201 209, 243n.36
Lippincott, Henry, 33–34, 38, 59–60, marketplace: as laboratory, 110–16,
245nn.74, 77 268n.47, 269n.59; reterritorialization
Livingstone, David, 76 through sanitation of, 128–29
Llamas, R., 194 Marshall, H. T., 298n.15
Lombroso, Cesare, 138 Marshall, Thomas R., 104
London Society of Tropical Medicine and masculinity: in American colonial health
Hygiene, 74 policies, 7–11; in American military
Long, J. D., 169, 197–98, 233, 288n.71, culture, 8, 43–44; as model of cleanli-
298n.23 ness, 111; in sanitariums, 146–47;

index 349
masculinity (continued) theories of, 150–54; tropical neuras-
sexual identity and, 148–50, 152–54; thenia concept and, 132–42, 147–50
tropical disease among white males and, Mercado, Eliodoro, 281n.42
74–76; tropical neurasthenia as threat Merritt, Wesley, 14
to, 132–34, 154–57, 182, 273n.9, Mestizos, 19–20, 241n.16; racial stereo-
278n.75. See also gender; women typing of, 56, 259n.11
Mason, Charles F., 39–40, 42, 248n.109 microbiological research: on leprosy, 163,
Maus, Anna Page Russell, 66, 257n.98 280nn.17–18; military medical policies
Maus, L. Mervin, 251n.25, 275n.41; and, 24–25, 28–30; Philippine sanita-
Baguio sanitarium and, 276n.47; chol- tion policies and, 58–61; in postwar
era epidemic and, 66–68; on colonial Philippines, 71–73; racial concepts of
sanitation, 48, 51–52; Heiser and, 70; immunity and, 90–95, 102–3; wartime
on immunity, 88; leprosy research and, limitations on, 47
164; on prostitution and venereal dis- Mieldazis, J. J., 198, 218–19
ease, 251n.27; racialization of hygiene military medicine: Army Medical Depart-
and, 59; Worcester and, 252n.29, ment transformations of, 22–30; ascen-
256n.84 dancy of, 29–30, 245n.61; characteris-
Mayo, Katherine, 115, 167–68, 269n.49 tics of, in Philippines, 17–22; codifica-
McDill, John, 82, 231 tion of, during Philippine-American
McDonnell, P. G., 147, 277n.63 war, 15; colonial public health in Phil-
McIntyre, Frank, 190 ippines and, 45–73; history of, in Phil-
McKinley, E. B., 199, 220 ippines, 8–11; limitations of, in tropics,
McKinley, William, 17 30–37; malaria control models of,
McLaughlin, Allan J., 101, 119, 171, 230– 210–11, 224–25, 295n.79; race-based
31 health policies of, in Philippines, 2;
Meacham, Franklin A., 48–49, 251n.25 racial economy of tropics and, 37–43;
Mearns, Lilian Hathaway, 110 research legacy of, 231; tropical neuras-
medical education: of Filipino physicians, thenia research and, 141–42, 275n.40
184–87, 198; hygiene principles in, 29– mimesis: in Filipinization of bureaucracy,
30; international developments in, 183–84, 205–6, 290n.114; in hook-
244n.59; lack of training in tropical worm eradication programs, 199–205
medicine in, 30–37; military training Minier, John F., 142–43
programs for, 29–30, 244n.59; missionaries, 162
nationalist politics and, 191–93; racial- Molokai, Hawaii, 175, 282n.71
ization in Philippines of, 20–21 Monnais-Rousselot, Laurence, 98
Medical Field Service School, 49, 231 morality: human waste disposal policies
medical geography: military medical pol- and, 106–7; racialized colonial con-
icies and, 24–25, 243nn.35–36; racial cepts of, 9, 47, 89–90; in military medi-
and ethnic characteristics and, 41–42 cal policies, 26–30, 40; tropical neuras-
Mencken, H. L., 134–36, 149–51 thenia and, 139–42, 154–57
mental deterioration: climate and, 87; colo- morbidity and mortality statistics: in chol-
nial concepts of, 9; in leper colonies, era epidemic, 65–66, 68, 257n.89; Fil-
172–73; military medical research on, ipinization of health service and, 189–
40–43, 248nn.109–10; as moral 90, 287n.44; on malaria, 210–12; dur-
failure, 154–57; psychic burden of ing Philippine-American war, 14–17,
whiteness and, 130–57; psychoanalytic 38, 240n.4, 247n.95; tropical climate

350 index
 and, 79–81; white physiology in tropics New York City Public Health Department,
and, 81–87; for whites in Philippines, 229–30, 297n.13
74–76 New York Herald, 189
Morel, Bénédict Augustin, 138 Nichols, H. J., 85, 194
Moriarty, C. F., 199–200, 204–5, 219 Nietzsche, Friedrich, 135
Moros: American colonial policies and, 5, non-Christian Filipinos, 3, 238n.8
58, 239n.24; classification of, 242n.16; Notes on Military Hygiene, 49
racialized stereotypes of, 142 Notter, J. Lane, 24–25, 39
Morris, Charles, 79, 260n.16 nursing, 201–5, 233
Moses, Bernard, 56, 253nn.45, 49,
275n.40 O’Reilly, G. A., 123
Moses, Edith, 93, 110, 121 Osgood, H. D., 251n.25
mosquito control programs, 211–26 Osler, William, 142, 276n.46
mosquito netting, 209–11, 221–22 Osmeña, Sergio, 283n.73
Munson, Edward L., 243n.33; 250n.16;
cholera epidemic and, 65–66, 68, 108, Panama Canal Zone, 214–15, 229,
190; on diet in tropics, 43; Heiser and, 292n.31, 297n.6
70; hookworm eradication program Pan-American Sanitary Bureau, 233
and, 199; on human waste disposal, parasitology research, in Philippines, 194–
105; hygiene policies and, 27–28, 49, 205
231; on medical geography, 24–25; on Pardo de Tavera, T. H., 67–68, 186–87,
mental and moral health, 40–41; on 258n.101, 286n.27
sanitation, 58; on tuberculosis preva- Paris Green, 218–19, 221–24, 293n.44,
lence, 291n.3; on venereal disease, 295n.71
243n.44 Parke, Glenn V., 13–15
Musgrave, W. E., 85, 100, 157, 229, Pasteur, Louis, 87
261n.43, 278n.79 pathology, 8–11, 25
Muslim Filipinos, 141–42 peninsulares, 19–20, 241n.16
Musset, Alfred de, 141 Phalen, James M., 84–85, 194
Mycobacterium leprae, 163, 167 Phelan, Henry du Rest, 107
Philippine-American War: American mili-
Najera, J. A., 295nn.77–78 tary medicine and, 8, 13–17, 30–37;
Nandy, Ashis, 132–33, 271n.71, 278n.77 civil morbidity and mortality during,
nastin, 170, 281n.46 14–15, 21–22, 240n.4; military strat-
National Association of Manufacturers, egy in, 46–47
231–32 Philippine Civil Affairs Unit, 228
National Guard, 30 Philippine Commission, 43, 54–56, 67–68,
nationalism: Filipino ethnic identity and, 111, 186
20–21; leprosy management policies Philippine Expeditionary Force, 241n.10
and, 160–62, 175–77, 283n.74; in Philippine General Hospital, 190
medicine and science, 191–93, 206; Philippine Health Service, 197, 220–21,
opposition to carnival and, 124–28, 227–33, 251n.24, 294n.64
272n.105 Philippine Islands Medical Association, 82,
National Library of Medicine, 242n.24 176, 231
Necator americanus, 194–95 Philippine Journal of Science, 185
Nesbitt, Charles T., 195–96 Philippine Republic, 20

index 351
physical examinations, 26–27, 243 Quezon, Manuel L., 176, 228, 283nn.76–
politics: Filipinization of colonial bureau- 77, 284n.78
cracy and, 191–93; in leprosy manage- quinine, 14, 209–26, 240n.3, 294n.47,
ment, 167–68, 175–77, 280n.30, 295n.70
283n.74; malaria control in American
South and, 216–17 Rabinow, Paul, 249n.3
population management: in American Phil- race: changing notions of, 207–8; tropical
ippines policies, 4, 8; colonial warfare climate and, 39–43
and, 48; in leper colonies, 162, 171; racial typologies: blood studies and, 85–
malaria control and, 224–25 87; homogeneity of Filipino groups
Priestley, Herbert Ingram, 79–80, 137, and, 88–95; in Spanish colonial regime,
260n.20 19–20, 241n.16
progressive ideology: in American colonial racism: civic virtue and, 52–58, 252n.33;
health policies, 6–7, 239n.29; at Culion in colonial hygiene policies, 2–11, 47–
leper colony, 160–61; in Filipino 52, 69–73, 258n.108; Filipinization of
nationalism, 20–22; masculinity and, colonial bureaucracy and, 181–93;
133–34; Philippine public health policy toward Filipino immigrants to U.S.,
and, 72–73 232–33; in Filipino ‘‘mimicry’’ charac-
Propaganda movement, 20 terization, 180–205; in hookworm
prostitution: colonial public health policies eradication programs, 195–205;
on, 52, 251n.27; military medical pol- human waste disposal policies and,
icies on, 26, 243n.44; transmission 104–29; in immunity research, 26n.71,
models for venereal disease and, 91 87–95, 262n.54; in leprosy research,
psychoanalysis, in colonial Philippines, 170–75; in malaria research, 208–26;
132–57, 278n.79 Manila Carnival and, 123–28; of mili-
public health programs: colonial warfare tary medical infrastructure, 15–17, 37–
tactics and, 46–47, 249n.5; Culion 43; psychoanalytic theory and, 151–
leper colony and, 159–61; Filipiniza- 54, 156–57, 278n.79; sanitary immu-
tion of, 10, 180–93, 227–33; hook- nity and, 96–101; tropical disease
worm eradication program, 198–205; among whites and, 74–76; in tropical
human waste disposal and, 105–29; neurasthenia, 131–34, 137–42, 272n.5
independence and, 228–33; Japanese Rafael, Vicente L., 5, 134, 273n.9, 285n.12
invasion and, 228; in late colonial era, Rattray, Alexander, 84
180–205; leprosy research and, 162– Recto, Claro M., 206, 228
68; military basis for, 45–73; paranoia Red Cross Carnival, 125–26
and racism in, 4–11; sanitary immunity Reed, Walter, 28–29, 215, 244nn.55, 57
and, 96–101; in United States, 229–33 republicanism, 2–3, 237n.2
publicity programs, 116–20 Revista farmacéutica de Filipinas, 18
public schools, 117–20 Rhodes, Charles D., 102
Puerto Rico, 194–95, 283n.72 Rizal, José, 18, 20–21, 120–21, 126, 177,
Putnam, Persis, 219 191–92
pyrethrum, 295n.75 Rockefeller Foundation: hookworm pro-
grams of, 180, 183, 191, 195–205,
quarantine regulations: during cholera 229, 233; Malaria Experiment Station
epidemic, 65–68; malaria control and, and, 225; malaria programs of, 10,
211–26 180, 209–10, 215–26, 293n.42;

352 index
 regional health programs in Asia of, of, 8–11, 107–29; Rockefeller Founda-
175, 265n.102, 289n.84 tion programs for, 199–200; in tropical
Rodgers, James B., 282n.63 conditions, 30–37; in United States,
Rogaski, Ruth, 10 241n.13
Roosevelt, Nicholas, 114, 131 San Lazaro Hospital, 18, 64, 162–63, 165,
Roosevelt, Theodore: immigration policies 190, 256n.86
of, 254n.57; imperialism and, 52–55, Sardinia, 217–18, 225, 293n.42
57, 190, 237n.2 Schapiro, Louis , 229
Roosevelt, Theodore, Jr., 208, 221 School of Sanitation and Public Health
Root, Elihu, 52–53 (Manila), 217
Rose, Wickliffe, 195–97, 216, 293n.37 self-government: at Culion leper colony,
Ross, Ronald, 76, 209–10, 214–15, 175–77, 179; education linked to, 207;
243n.36, 291n.6 Filipinization and, 186–93, 286n.29;
Roxas, Manuel, 283n.74 racialized colonial policy and, 4–11,
rural health programs, in Philippines, 199– 54–58, 182–84, 203–5, 285n.12
205 Sellards, Andrew W., 129, 231, 272n.107
Russell, F. F., 203, 205, 290n.105, sexuality, 149–54. See also gender;
295n.70 masculinity
Russell, Paul F., 198, 201, 204, 215, 217, Shakespeare, E. O., 244n.55
220–27, 233, 294n.64, 296n.81 Shaklee, Alfred O., 83
Shaler, Nathaniel Southgate, 101–2,
St. Louis Exhibition, 125 265n.111
Saldivar, José David, 8 Sibul Springs, 276n.47
Salman, Michael, 5, 279n.3 Sinha, Mrinalini, 132–33
San Francisco, 230, 297n.10 Sison, Agerico B. G., 85, 202
San Francisco Corporation, 18 Sloper, Mary E., 35
Sanitary Commission for the Eradication smallpox: Filipinization of vaccination pro-
of Hookworm Disease, 195, 197–98 gram, 189–90; immunity to, 88; in San
sanitary commissions, 116–20 Francisco, 98; vaccination programs
sanitary engineering, 108, 267n.18 for, 38–39
sanitary immunity, 87–88, 95–101 Smart, Charles, 29
Sanitary Model House exhibit, 126–27 Smith, James F., 115, 253n.45, 269n.50
sanitation infrastructure: bubonic plague Snodgrass, John, 170–71, 233, 281n.42
outbreak and, 62–69; at Carnival cele- social gospel, 2–3, 237n.2
brations, 121–28; cholera epidemic Soper, Fred L., 225
and, 65–68, 249n.2; Clean-Up Week Southall, E. A., 256n.86
campaign for, 127–28; colonial poli- Spanish occupation of Philippines, 17–
cies on, 1–3, 18–19, 69–73, 237n.1, 22; leper colonies during, 162–63;
241n.13; at Culion leper colony, 169– medical geographies and, 76–78,
75; Filipinization of, 181, 189–93, 259nn.10–11; response to cholera
200–205; in Filipino culture, 92–95; and, 64, 256n.85
hookworm eradication programs and, Stanley, Peter, 253n.45, 286n.32
195–205; in marketplace, 114–16, Stapleton, Darwin H., 217, 293n.42
259nn.53–54; military medical poli- Stelle, Matthew F., 42
cies on, 15–17, 23–30, 48–53, 58–60, Stepan, Nancy, 3
244n.59, 245n.74; racialized concepts Stephens, J. W. W., 213–14

index 353
Sternberg, George M., 23, 28–29, 35–36, War, 13–17, 240n.2; psychoanalytic
39, 48, 242n.25, 244n.57 theory and, 150–54; white immunity
Stiles, Charles Wardell, 29, 194–96, and vulnerability research and, 88–95;
288n.64 white physiology and, 81–87
Stitt, E. R., 194 tropical neurasthenia: in colonial Philip-
Stoler, Ann Laura, 4, 133, 160–61 pines, 131–42, 144–47, 272n.5; mili-
Stone, Hamilton, 43 tary medical research on, 80–81, 83,
Strong, Richard P.: bacteriology research 87, 260nn.23–25; as pathology of will,
by, 61, 109; cholera epidemic and, 63, 154–57; psychoanalytic theory and,
68; Filipinization resisted by, 190; at 150–54
Harvard, 231, 255n.72; international tuberculosis, 176, 283n.77, 291n.3
health activities of, 298n.23; malaria Turner, Frederick Jackson, 44
control programs and, 226; tropical Twain, Mark, 81
neurasthenia research by, 129–31, 147; Tyddings McDuffie Act, 232
vaccination programs and, 263n.84 typhoid: among American military in Phil-
Suarez Caopalleja, Victor , 77–78, ippines, 38–43; immunity studies of,
259nn.108–11 91–93; military medical policies on,
sunstroke: in military medical research, 28–29, 244n.55; vaccination against,
83–84, 247n.102; in tropical neuras- 96
thenia research, 137–38 ‘‘Typhoid Mary,’’ 97

Taft, William H., 54–58, 67, 78–79, 97, United States: Filipino immigration and,
253n.45, 254n.59, 258n.108 232–33; hookworm eradication pro-
Tagalogs, 5, 58, 239n.24 grams in, 195–96; public health pro-
Taussig, Michael, 5 grams in, 229–33, 297n.6
Thailand, 99 U. S. Coast Guard, 258n.112
Theory and Practice of Military Hygiene, U. S. Public Health Service: malaria pro-
The, 24 grams of, 215–16, 293n.39; medical
Thompson, Joseph C., 151–52 training in, 6–7; origins of, 258n.112;
thymol, 195 Philippine hygiene policies and, 70–73;
Tiedeman, W. D., 198, 217–18 in Philippines, 228–29
toilets: Filipinization and, 181–84; in University of Santo Tomás, 18
hookworm eradication program, 197– University of the Philippines, 198
99; installation of, in Philippines, 117–
20; as political weapon, 207. See also vaccination programs: Filipinization and,
excrement 189–90; on Filipino prisoners, 95,
Tomes, Nancy, 205, 264n.92 263n.84; in postwar Philippines, 69–
Torney, George H., 251n.25 70, 96–101
Treaty of Paris, 17 Vanguardia, La, 124–25, 173, 277n.63
Tripler’s Manual, 27 Vaughan, Megan, 162
tropical medicine: British research on, 74; Vaughan, Victor C., 91–92, 244n.55
colonial public health policies and, Vedder, Edward, 85–86, 262n.47, 294n.47
45–73; decline in prestige of, 231–33; venereal disease: colonial public health pol-
exoneration of climate in, 8, 81–87; icies on, 52, 251n.27; military medical
legacy of, 231–32; military experiences policies on, 26, 243n.44; transmission
with, 30–43; in Philippine-American models of, 91

354 index
vertical disease control techniques, 225– 282n.49; tropical neurasthenia re-
26, 295n.79 search and, 140, 275n.37. See also
Von Ezdorf, R. H., 215–16 gender
Wood, Leonard, 82, 122, 175–77, 191,
Wade, H. W., 283n.75 217, 272n.104, 283n.75, 287n.52
Walker, E. L., 129, 213, 272n.107 Wood, W. T., 83–84
Washburn, William S., 81–82, 261n.29 Woodhull, Alfred A., 34–37, 49, 245n.77
Watson, Malcolm, 214 Woodruff, Charles E., 15, 43, 249n.124;
Welch, William, 246n.77 malaria advice of, 91, 208; military
Welfareville Institution, 159 medical authority and, 245n.61,
Wherry, W. B., 298n.15 248n.120; tropical neurasthenia
‘‘White Man’s Burden,’’ 4, 132–34, research by, 80–81, 83, 87, 137–40,
273n.16 156, 260nn.23–25, 274n.27
whiteness: American military concepts of, Woodward, C. M., 25
15–17, 43–44, 241n.8; climatic burden Worcester, Dean C., 124–25, 250n.20,
of, 76–81; fragility and ambivalence of, 253n.45, 275n.41; Baguio sanitarium
134, 273n.18; immunity and, 87–95; and, 143, 146, 276n.47; on cholera epi-
physiology in tropics and, 81–87, demic, 63, 257n.97; colonial hygiene
262n.51; psychic burden of, 130–57; in policies and, 52, 72–73; Filipinization
public health programs, 6–11, 239n.28; resisted by, 185–86, 188, 284n.38; on
racialization of human waste disposal leper colonies, 164, 176–77; Maus and,
and, 106–7; sexuality and, 152–54; 68, 252n.29, 256n.84; Philippine hos-
tropical disease morbidity and mortality pital construction and, 50
analysis and, 74–76; tropical neuras- World Health Organization, 295n.77
thenia and, 38–43, 137–42, 156– Wright, George ‘‘Skypilot,’’ 283n.73
57, 278n.77 Wright, Luke, 66, 253n.45, 258n.113,
Who Walk Alone, 173–74 276n.47
Wickline, W. A., 262n.57 Wu, T. C., 282n.61
Widal typhoid test, 28, 94 Wyman, Walter, 70
Wilkinson, H. B., 165
Willets, David, 119, 270n.70 x-ray treatment, for leprosy, 281n.42
Williams, Daniel R., 114–15, 189,
287n.40 Yaeger, C. H., 181, 200–204, 219
Wilson, Woodrow, 182–84, 187 Yeater, Charles H., 189
Winslow, Charles-Edward Amory, 97 yellow fever, 215, 225
Wolley, Paul G., 298n.15 Yellow Fever Commission, 244n.55
women: tropical climate effects on, 79; Yersin, Alexandre, 61
in Filipino hygiene programs, 6; as
health-care workers, 200, 233; in Zinoman, Peter, 279n.3
leper colonies, 160, 171–75,

index 355
Warwick Anderson is Robert Turell Professor of Medical History and Population Health and
professor of the history of science, as well as a faculty associate of the Center for Southeast Asian
Studies, at the University of Wisconsin, Madison. He is the author of The Cultivation of White-
ness: Science, Health, and Racial Destiny in Australia (Melbourne University Press, 2002; Basic
Books, 2003; paperback, Duke, 2006).

Library of Congress Cataloging-in-Publication Data

Anderson, Warwick
Colonial pathologies : American tropical medicine, race, and hygiene in the Philippines /
Warwick Anderson.
p. cm.
Includes bibliographical references and index.
isbn-13: 978-0-8223-3804-8 (cloth : alk. paper)
isbn-10: 0-8223-3804-1 (cloth : alk. paper)
isbn-13: 978-0-8223-3843-7 (pbk. : alk. paper)
isbn-10: 0-8223-3843-2 (pbk. : alk. paper)
1. Tropical medicine—Philippines—History. 2. Military hygiene—Philippines—History.
3. Philippines—Colonization—History. I. Title.
rc962.p6a53 2006
616.9%883009599—dc22 2006004594