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By Root 364 0

came unparalleled opportunities for the exercise of American health authority. While keeping infectious diseases at bay—including the virulent smallpox that broke out in all three areas after the landing of U.S. troops—the Americans acquired a new mastery of what the brigade surgeon Azel Ames called “the science and art of colonial government.” Like the mobile surgeons of the U.S. Marine-Hospital Service, who at that moment were fighting smallpox in the American South, the doctors of the Army Medical Department aspired to use the latest medical knowledge to fight disease. But unlike C. P. Wertenbaker and his colleagues, U.S. military surgeons in the new overseas domain possessed broad national authority and the resources of an army. For the occupying Americans, the vaccination campaigns in particular became a means to gather vital data on the local topography, political institutions, and indigenous peoples—making those exotic tropical places legible to their new rulers.17

In the American system of government, guarding the public health was the most elemental action a state could take under its police powers; the almost unlimited legal authority to ward off epidemics had often been compared by the courts to the right of any government to protect its own people from invasion. In the tropical possessions, that old analogy quickly became superfluous. Absent the institutions of popular sovereignty and due process (which the Americans planned to withhold until the indigenous peoples proved themselves fit for a measure of self-government), police power was military power. The Army’s sanitary campaigns far exceeded the normal bounds of the police power, which by a long American constitutional tradition had always been assumed to originate in sovereign communities of free people. In America’s overseas sanitary campaigns, the scale and scope of governmental power were greater, the colonial space was different, and the fact that an institution of the national government, the Army, was undertaking these measures was altogether revolutionary.18

By any honest measure, the achievements of U.S. military medicine in the overseas possessions were extraordinary, even when they did not meet the Americans’ own ever-rising expectations. Within just a few short years, the Army Medical Department could fairly boast that its surgeons had cleaned up the old Spanish colonial cities and made major discoveries in the etiology and prevention of yellow fever, beriberi, and other terrible diseases. These discoveries took place in Army camps, native villages, and colonial laboratories, using the full intellectual arsenal of the bacteriological revolution. But in the eyes of many Army medical men, it was the fight against smallpox—using the older technology of compulsory vaccination on a hitherto unimaginable scale—that showcased the full humanitarian promise of U.S. military medicine. For the Medical Department’s original mission, to protect the troops from disease, unexpectedly gave rise to the first glimmerings of a grander vision. Uninhibited American power might one day eradicate the ancient scourge of smallpox from entire regions of the globe.19

As the first major U.S. military action since the germ theory of disease gained broad acceptance in the medical profession, the war with Spain should have been a milestone in military medicine. And, in important respects, it was. The decades since the Civil War had witnessed the creation of modern health departments in the major U.S. cities, a greater recognition of the importance of aseptic practices in the treatment of wounds, and, in 1895, the discovery of X-rays. During the Civil War, Army surgeons had still probed bullet wounds with unsterilized instruments and unwashed fingers. By 1898, most Army doctors and volunteer nurses knew better. On the battlefield, they wrapped soldiers’ wounds in antiseptic dressings. In the field hospital, they used X-rays to locate bullets and assess damage to bones. At the operating table, they followed aseptic techniques. The results (aided by the introduction of