Pox_ An American History - Michael Willrich [80]
Hoff stepped ashore in San Juan, a city of 32,000 people, to find a big job waiting for him and no organization in place. “Nothing was and everything had to be,” he recalled, “not a record, nor a book in which to keep it.” In the coming months, Hoff and his medical staff would evolve into a de facto public health service for Puerto Rico. Under his command, the surgeons pursued health campaigns on a scale the U.S. government had never before attempted on the mainland. They enacted new sanitary codes based upon the police regulations of the American states. They studied diseases and taught modern hygiene to an impoverished rural people. By far the most ambitious of these efforts—“the first big sanitary undertaking of our Government in the tropics,” Hoff proclaimed—was the quixotic campaign to vaccinate the entire population of the island. It was “an immense task,” another Army surgeon agreed, “and possible only through military agency.”52
To Hoff and his staff, Puerto Rico was terra incognita. The smallest and easternmost island of the Greater Antilles, with a landmass three quarters the size of Connecticut, Puerto Rico lay roughly a thousand miles southeast of the recently incorporated U.S. city of Miami. A range of rugged mountains called the Cordillera Central divided the island’s wet Atlantic-facing northern half from its dryer Caribbean southern half. The climate was unmistakably tropical, with a rainy season that stretched from August to December. Getting around was hard. The island possessed few good harbors, most notably at San Juan on the north and Ponce on the South. But for the old Spanish military road that ran between those cities, there was, as one frustrated Army surgeon noted, “not a good road on the island.” In the wet season, the bridle paths and streams that connected the villages and barrios along the Cordillera Central flooded and became impassable for weeks.53
The Puerto Ricans confounded the Americans. “The laws, language, customs, institutions, and aspirations of the people were all strange, and in many respects, very difficult of comprehension,” said one military government report. American eyes puzzled over the island’s peculiar settlement patterns. Puerto Rico seemed to them a contradiction in terms: an overpopulated rural country. Fewer than one tenth of the people lived in cities, the rest in barrios, villages, and small farms. The chief industries centered on the land, especially sugar cultivation (along the coast), coffee growing (in the mountains), and cattle raising (along the southern plateaus). To the occupiers, the islanders’ problems resembled those the Americans associated with the tenement districts of their own industrial cities. The crowded palm-thatched huts were “entirely without any arrangements for the disposal of excreta.” Three quarters of the population lived in “miserable hovels,” subsisting upon “the merest apology for food.” Although the island had a small professional elite, including well-trained physicians, few Puerto Ricans could read. And the people suffered prodigiously from intestinal diseases as well as endemic tuberculosis, smallpox, and a deadly disease called anaemia.54
The multiracial population of the island defied the familiar American racial taxonomies. Major Ames described Puerto Rico uneasily as “the only ‘white’ island of the Antilles.” American racial norms had consolidated in recent years, with the Supreme Court recognizing the southern states’ peculiar “one drop” rule (which made a person with even a small amount of African “blood” black in the eyes of the law). Slavery had survived in Puerto Rico until 1873, and black laborers predominated on the sugar plantations. But Americans were uncertain how to classify the rest of the people. Assistant Surgeon General C. H. Alden reckoned that three fifths of the population was “pure white and