Pox_ An American History - Michael Willrich [75]
A strong desire to clear the good name of their institution only begins to describe the range of aspirations and interests U.S. military surgeons carried with them or discovered within themselves in the cities, garrisons, and villages of Cuba, Puerto Rico, and the Philippines. Military surgeons went to extraordinary lengths to protect the troops in those tropical places. Over time the surgeons would turn their medical gaze outward, from a narrow professional concern for the health of the troops—the maintenance of a continually shifting cordon sanitaire—to a broader interest in governing the health of the civilian populations of the newly subordinated territories. These agents of the American nation seized upon the vast and (to their eyes) exotic field of medicine, administration, and humanitarian intervention opened up by the Navy’s gunboats and the Army’s rifles. The worlds they entered would never be the same.
The lingering shame of the national encampments did not diminish the air of sanitary superiority with which American military men and civilians took in the sights, sounds, and smells of their new tropical surroundings. Disembarking from Army transports and commercial steamships, the Americans first encountered the old Spanish port cities. Judging the coastal population centers of Cuba, Puerto Rico, and the Philippines by standards of cleanliness only recently (and all too incompletely) achieved in American cities, the occupiers attributed the unsanitary state of affairs in equal parts to the incompetence of their Spanish predecessors and the indifference of “the natives.” “Nauseating odors” assaulted the nostrils of one American visitor to Havana: “dead animals abounded, garbage was encountered everywhere, and open mouths of sewers running in to the ocean and harbor were reeking.” Captain L. P. Davison of the Fifth Infantry, newly installed as president of the San Juan Board of Health, described the Puerto Ricans as “a poverty-stricken and extremely dirty and mixed population, living in absolute violation of all civilized rules.” In Manila, where residents reportedly thought nothing of relieving themselves at the side of the road or dumping chamber pots from windows, one American official advised his countrymen to walk in the center of the street and always carry an umbrella. To these Americans abroad, filth signified disease. And filth was everywhere.36
Wherever they went in these disorienting, humid cities, with their old Spanish churches and crude palm shacks, the Americans noted the traces of a disease they still associated with filth: smallpox. Army surgeons and U.S. health officials likened the epidemiological life of smallpox in these erstwhile Spanish colonies to eighteenth-century Europe, before the invention of vaccination. “[A]s was the case in Europe, so in the Philippines, it seems to be almost a disease of childhood,” said one report. “The explanation of this is that all natives who have reached adult age were exposed in their childhood to smallpox, and those who did not contract it may be considered immune.” If, as Captain Davison insisted, “Good sanitation is the visible sign of civilization,” the unmistakable sign of barbarism and misrule was the pockmarked face of a dark-skinned native.37
Like most first impressions, the Americans’ commentaries captured only the surface of things. To be sure, the Spanish colonial health systems had been halfhearted during the best of times; as The Boston Globe’s Philippine correspondent J. N. Taylor noted with contempt, they paled in comparison to the British sanitary measures in India. But the American occupiers failed to consider that the conditions they encountered might be anything out of the ordinary for these places. In fact, all three areas had suffered through mounting health crises during the late nineteenth century.38
Cuba, an island about the size of Pennsylvania that lay less than a hundred miles south of the U.S. mainland, had long been viewed by American health officials as a massive pesthole whose most notable export was yellow fever.