Pox_ An American History - Michael Willrich [89]
The first scattered cases of smallpox had appeared among the U.S. troops in Manila in September. Surgeon General Sternberg reported that the men had been “visiting the huts of the natives, in many of which smallpox of a very malignant character was prevailing.” In November, as U.S. forces in the vicinity grew to 21,000 men, more cases appeared among them and also among the 2,000 Spanish prisoners in Manila. The Army’s first response was to “protect the command by vaccination.” All the Spanish prisoners were vaccinated, and Major General Elwell S. Otis ordered the revaccination of all enlisted men in the islands. After much of the vaccine sent from San Francisco to meet this demand proved inert, Major Bourns reestablished the old Spanish vaccine farm in the city and started harvesting fresh lymph by inoculating local carabao (water buffalo). The situation worsened in December when smallpox infected the Twentieth Kansas Volunteers, killing ten. An investigation traced the origins of the outbreak to a cluster of native inhabitants who lived across the street. By this time, as one U.S. soldier recalled, the rising incidence of smallpox “caused the Army Medical Corps to view the general health and living conditions of the civil population as being pertinent to the well-being of the American command.”87
Bourns established a corps of city vaccinators, starting with six men, then doubling their number, then increasing them further after the new year as smallpox became epidemic in Manila. On the eve of war, Major General Otis sent Secretary of War Alger a dispatch on the health of the troops: “Smallpox causes apprehension. Entire command vaccinated several times. Twelve physicians engaged several weeks vaccinating natives.” Soon the suburbs of Manila were in flames, and terrified residents poured into the congested central city. In the Tondo district, seventy-five Filipinos died of smallpox in March. Bourns’s corps aggressively enforced vaccination, meeting “considerable opposition” at first, applying force when necessary. In all, the corps vaccinated eighty thousand residents of Manila that winter. By the end of March, the danger appeared to be over. And by June, Bourns reported, “there were but 4 cases of smallpox in the entire city of Manila.”88
The Manila epidemic had demonstrated, to the satisfaction of the Army Medical Department, the importance of vaccinating not just the soldiers but the local inhabitants among whom they lived. It had been a costly lesson: from September 1898 through March 1899, the troops in Manila had suffered 236 cases of smallpox. Eighty-five of these were mild cases, reported as varioloid (smallpox modified by previous vaccination). But among the other 151 cases, more than half of the patients (77) had died, seeming to confirm that smallpox in this tropical zone was especially deadly to white men. The presence of any smallpox among the U.S. troops in Manila created a public relations problem for a War Department still reeling from the typhoid revelations. American newspapers reported the tragic deaths of young soldiers from the disease and advised parents to disinfect letters received from their boys in the islands. To Surgeon General Sternberg’s chagrin, English antivaccinationists seized on the news that smallpox had broken out among the U.S. troops to cast doubt upon the efficacy of compulsory vaccination.89
But to Army officials, a strategy of wholesale compulsory vaccination—of the troops and the most proximate natives—had proven its merits. For the people of Manila, the U.S. vaccination campaign far exceeded anything they had experienced under their previous rulers. The Spanish regime’s chief vaccinator had reported just 9,136 vaccinations performed in the city during the four years prior to October 1898. During the next five months, the U.S. military government vaccinated 80,000 inhabitants.90
The U.S. Army took the war beyond Manila to the provinces, across the central