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worked. Vaccination had not proven itself worthy of their confidence. In 1897, more than ninety years after Balmis first brought vaccine to the archipelago, the Spanish regime maintained a central vaccination establishment in Manila and employed 120 public vaccinators (vacunadores) in the various provinces. But many Filipinos spurned them. Traditional beliefs about the seasonal cycles of smallpox made vaccination seem unnecessary. Filipinos had all too often seen that even after the vacunadores did their work, smallpox returned. As Americans discovered, the tropical heat often rendered vaccine inert and thus ineffective. Filipinos had observed that vaccination sometimes spread skin diseases. In fact, the Spanish health authorities’ use of the arm-to-arm method for propagating vaccine carried the real risk that syphilis and other infectious diseases might be transmitted from person to person. Reports coming in to the Spanish authorities from the provinces during the 1890s indicated that vaccination had been “completely discredited.”82

From the outset of the U.S. occupation of Manila, on August 13, 1898, the Army’s top brass and medical officers were preoccupied with preserving the health of the troops. That in itself was a tall order. From 1898 to 1902, the Army reported a half-million cases of illness, more than four sick reports for every soldier who served. Every regiment suffered from dysentery, malaria, and venereal diseases. Typhoid fever and smallpox were continuing threats. While the Army’s sickness data documented the suffering of white American soldiers, they also showed the power of soldiers to carry infection across the archipelago, transmitting pathogens between local disease environments that had previously been isolated from one another.83

As the bustling base of operations for the U.S. command—not to mention for American business interests—Manila topped the Americans’ sanitary agenda. The first measures, as Colonel Greenleaf said, were “designed mainly with a view to the preservation of the health of the troops.” But the Army approached the cleanup of Manila with the determination of people planning to stay awhile. The commanding general established a board of health for the city, under the leadership of Major Frank S. Bourns, a surgeon with the U.S. Volunteers. The Atlanta physician possessed an exceptional knowledge of the Philippines, having spent four years there on two previous zoological and ornithological expeditions.84

By October 1898, Bourns’s health board had nearly eighty employees, including a number of European-educated Filipino physicians. A few of the physicians, such as Dr. Trinidad H. Pardo de Tavera, had been members of Aguinaldo’s government at Malalos. The board divided Manila into ten sanitary districts, appointing a local physician for each; hired eight municipal midwives; and established special hospitals for smallpox, leprosy, and venereal diseases. Working with the new American department of sanitation, the board cleaned streets, staged house-to-house inspections, and seized and burned the corpses of inhabitants who had died from contagious diseases. Bourns’s activities extended beyond purely sanitary matters.85

As relations with Aguinaldo’s independence movement deteriorated, late in 1898, Bourns began relying on the local physicians and his growing network of personal contacts to acquire, as he modestly put it, “a good deal of information not otherwise obtainable.” Bourns’s talents were not lost on the Army generals, who assigned him to investigate reports of insurgent activities in the city and suburbs. By the time the first shots were fired in the Philippine-American War in February 1899, Major Bourns had established within the health board what he called a “little spy system, by which we were enabled to keep track, especially in the city, of everything that was going on on the insurgent line.” Information-starved U.S. military governments in both Puerto Rico and the Philippines exploited the wealth of local knowledge produced by sanitary campaigns. But Bourns pursued that