Pox_ An American History - Michael Willrich [83]
General Order No. 7 called for compulsory public health on a scale never before seen in Puerto Rico or, for that matter, any territory under the direct jurisdiction of the U.S. government. As the Army carried vaccination to the people, the Marine-Hospital Service ran a quarantine at the island’s ports, requiring all arriving passengers to show proof of vaccination and all travelers bound for the mainland to undergo the procedure. The vaccination campaign was all the more ambitious given the serious technological, geographical, and political obstacles that stood in the way. Dozens of centers of contagion existed, including barrios high in the mountainous interior whose people had little experience with sanitary authority. Most Puerto Ricans lived under crowded conditions, moving constantly between the countryside and the towns for trade and work. Like other Western physicians in colonial settings, the military doctors complained of the “indifference” of the “natives.” Ames noted the difficulty of delivering modern health to “hundreds of thousands of unregistered people, mostly ignorant and scattered, speaking foreign tongues, and unused to sanitary controls.” Unbeknownst to him, his complaint echoed those sounded by Kentucky health officials as they struggled to enforce vaccination in Appalachia.64
The most pressing challenge at the start of the Puerto Rico campaign was to secure a reliable vaccine supply. Vaccine did not survive long in heat (a problem that would bedevil tropical vaccination programs until the invention of a heat-stable, freeze-dried vaccine in the 1950s). Vaccine tubes shipped from the mainland usually lost their potency by the time they reached Puerto Rico. The British imperial experience in India (as well as the Spanish record in Puerto Rico and the Philippines, assuming the Americans actually consulted it) taught that ineffective vaccines engendered popular resistance to vaccination in general. The solution the Army settled upon—to produce vaccine on the island itself—was, in keeping with colonial administrative imperatives, the cheapest. It was also the most ambitious. Governor General Henry put Major Ames in charge of the operation.65
Azel Ames was one of the hundreds of civilian physicians recruited, as he said, in “hot haste” for the war with Spain. Born in Chelsea, Massachusetts, in 1845, Ames had served in the Union Army and graduated from Harvard Medical School. The unifying theme of his career to date was the way it had blended seamlessly—and, on at least one occasion, scandalously—public service and private interest. As a physician in Wakefield, Massachusetts, he founded the town’s board of health. His résumé also included stints as a temperance crusader, state factory inspector, and administrator of U.S. government pensions. Ames had gotten himself embroiled in a national scandal in the 1880s, when he was indicted for abusing his position with the Boston board of medical examiners in the U.S. pension office by extorting bribes from claimants. The jury was hung, and Ames was never convicted. In none of his writings about his Puerto Rican experience did Ames mention any previous experience with vaccine production. But vaccine manufacture in the late nineteenth century remained a largely pastoral pursuit. And in Ames’s Wakefield it was not unknown for a physician to keep a calf on hand to meet his patients’ needs for lymph.66
The Puerto Rican vaccine farm was the capstone of Ames’s career, pulled off, if he said so himself, on a “grand scale . . . practically in the open air, in a new country, by unskilled hands.” Ames based his operations on rented fields at Coamo Baths, an area of “fine cattle country” on the dry coastal highlands near the island’s south shore. He supervised the construction of stables, corrals, and a camp large enough to sleep over a hundred men—Army surgeons, a pathologist, cattlemen, guards, cooks, couriers, and teamsters. Fresh meat, ice, and medical supplies from the United States were hauled almost daily up twenty-three miles of rough roads to