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By Root 335 0

the eight million inhabitants lived on the big northern island of Luzon, home of Manila, a city of a quarter million. The Filipinos had never known Edenic isolation. But prior to the mid-nineteenth century, geographic obstacles and dispersed settlement patterns had reinforced local communities’ separateness from one another and from the outside world. Even on a single island, villages were separated by the characteristic landscape of rugged, mountainous terrain rising up from broken coastal plains. Roads were few and travel arduous, particularly during the long rainy season. Local epidemics tended to remain local, running their course among the nonimmune inhabitants. The late nineteenth century brought population growth and an increasing connectedness: a proliferation of towns (pueblos), a stronger market economy, new steamship connections, and a rise in immigration to the coastal cities, mainly from China. As the long isolation of Filipino communities diminished, domestic and imported microbes circulated. By the 1890s, exposure to and mortality from infectious diseases had risen sharply, especially from malaria, dysentery, cholera, tuberculosis, and smallpox.42

The arrival of six years of war—first during the Filipino independence struggle against Spain of 1896–98, followed by the Spanish-American War of 1898 and the Philippine-American War of 1899–1902—caused the breakdown of the Spanish health system. Twenty-five thousand Spanish soldiers arrived in 1896. Between 1898 and 1902, roughly 122,000 U.S. troops would come, carrying microbial pathogens from North America and, more important, toting local disease agents from place to place in the islands. The U.S. Army reported nearly one-half million cases of illness in its ranks during the wars, roughly four sick reports per soldier. U.S. soldiers not only engaged the enemy; they fraternized with the civilians, drinking, gambling, having sex, and, all the while, spreading disease.43

As the four-month war with Spain gave way, in August 1898, to longer occupations in Cuba, Puerto Rico, and the Philippines, the responsibilities of the Army medical staff did not diminish. In the surgeons’ eyes, threats to the good health of the soldiers in the garrisons abounded. Heat exhaustion and sunstroke were perennial fears, leading some in the Philippines medical staff to shed their U.S. military blues and campaign hats for khaki clothes and the white cork helmets favored by the British in India. Army surgeons advised that Filipino or Chinese laborers, presumably accustomed to the oppressive heat, be used for the heaviest manual labor, lest white soldiers succumb to heat exhaustion. Most surgeons and soldiers took it as axiomatic that under tropical conditions a white man’s resistance to disease quickly deteriorated, making him especially susceptible to exotic microbes. Even diseases well known to North America seemed more threatening under such conditions. “[I]n this latitude and longitude,” reported Dr. Henry Hoyt from the Philippines, smallpox was “very fatal, especially to the white man.”44

The first American health interventions in Cuba, Puerto Rico, and the Philippines followed the territorial logic of the cordon sanitaire. As the British had done in India, the Americans aimed to create a kind of moving quarantine line, a zone of sanitary and immunological protection around the bodies of their soldiers. In the garrisons, this entailed frequent vaccinations of the troops, strict sanitation, and training the men in hygiene. But since the soldiers necessarily moved across spaces populated by indigenous (and thus “foreign”) people, eliminating filth and disease among the most proximate of “the natives” became a military imperative. Those natives with whom the Americans were likely to come into contact, such as the citizens of occupied Santiago, San Juan, or Manila, were the first local communities targeted for sanitary intervention. In the early phase of the occupations, the medical officers expressed no loftier purpose for their work. “From the day of the invasion,” said Lieutenant