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Plain of Luzon and to other islands. By 1900, Aguinaldo’s forces adopted guerrilla warfare, which the Americans derided as uncivilized. The Army countered with increasingly violent tactics, including interrogation of suspected insurgents and spies using a form of torture known, in an especially perverse marriage of medical metaphor and military technique, as the “water cure.” The Medical Department had its hands full, establishing military hospitals, caring for the wounded, and moving with the line. Controlling infectious diseases remained a high priority. During 1899, the most deadly year of the campaign for the Army, 475 soldiers and officers died from wounds of battle, another 139 died from “other forms of violence,” and 709 succumbed to disease, “principally diarrhea and dysentery, small-pox and typhoid.” During the same year, nearly two thousand soldiers were sent home due to sickness. Throughout the war, smallpox weighed heavily on the minds of the military surgeons. They vaccinated the troops with great regularity.91

Preserving the health of the troops called for measures to sanitize their environment and the peoples who inhabited it. Many of the soldiers were stationed in one of five hundred garrison towns, which soon grew overcrowded with migrants fleeing the war-torn countryside. Stationed indefinitely in garrison towns, the troops mixed promiscuously with the inhabitants, consuming palm wine, gambling, and fraternizing. “The most crying need in the early days of our occupancy of the Provinces was to check the ravages of smallpox,” Greenleaf recalled. He advised the U.S. military governor, General Arthur MacArthur, that each garrison should have an army surgeon designated as “health officer,” “special orders being given for the vaccination of the population of the towns and neighboring barrios as far as the people could be reached.” As one U.S. colonial official reported, the garrison surgeons “had great latitude, and under their direction compulsory vaccination was usually enforced.” The surgeons also used “arbitrary military compulsion” to enforce “simple regulations as to cleaning streets, putting dirty premises in order, [and] tying up pigs.”92

A comprehensive plan for vaccination in the provinces emerged. The idea appears to have originated with a military surgeon named Major Louis M. Maus. Major Maus knew how infection could rip through an army. He began the Spanish War as chief surgeon with the VII Corps in Miami and Jacksonville, bearing witness as more than 5,000 of the soldiers in his care were hospitalized with typhoid fever. Reporting from Bautista, Pangasia, in February 1900, he warned that smallpox prevailed among the people of the towns and was “not rare among our troops as a consequence.” It would be impossible, he said, to “stamp out this disease among our soldiers, in spite of the frequent and careful vaccinations among them, until the natives are themselves protected.” Not long after this report, the Army issued orders to vaccinate all people within the reach of the division of the Philippines, which at that time included seven provinces north of Manila. Within five months, more than 600,000 Filipinos certified by the medical department as protected from smallpox by vaccination or previous infection.93

For the remainder of the war, the Army enforced vaccination wherever it went. Sometimes that meant rounding up the inhabitants with bayonets in order to inoculate them. By 1901, the American vaccine farm in Manila was turning out a million points a year, and more farms were being established in the provinces. The U.S. Marine-Hospital Service established a quarantine station at the entrance to Manila Bay, vaccinating crews and passengers aboard ships approaching the principal harbor of the colonial government. On December 2, 1901, the Philippine legislature put its seal on this emerging American regime, mandating the compulsory vaccination of the entire population of the Philippines. The law ensured that the Army’s wartime policy would continue under the colonial regime long after the war’s end.94