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Times, a stalwart supporter of American expansion abroad and compulsory vaccination of the urban masses at home, applauded Wheaton’s speech. “The anti-imperialist, with his tender regard for the inclinations and preferences of all races except his own, will doubtless object that it is no favor to save the lives of people by forcing them to follow customs and endure Governments distasteful to them,” the Times noted. “[B]ut with the world as small as it is nowadays, this argument is decidedly weak. . . . The unsanitary have become public enemies, and modern war, with its enormous evils, does spread habits of clean living among ‘natives’ and the ‘unprogressives’ whom it leaves alive.” As American officials, commentators, and scholars praised the new levels of sanitation, hygiene, and health that the American efforts had brought to the peoples of Cuba, Puerto Rico, and the Philippines—from the old Spanish ports to the rural interiors—a new rhetoric of justification for military action crystallized. U.S. military medicine had preserved the health of the soldiers, protected American commercial interests, and saved the lives of countless natives.107

Health administration would remain an integral part of U.S. colonial rule in the Philippine archipelago—and also a principal means of justifying that rule. Americanized Manila stood as a model of the healthful city. In the 1904 fiscal year, the board of health had vaccinated 213,000 people in Manila and an additional 1,007,204 people in the provinces—well over one eighth of the entire population of the archipelago. American-made vaccine, packed for shipment in special boxes of ice, was reaching the people of the interior on horse-drawn carromatas, in water-borne bancas, and on the backs of Igorot runners. Local officials placed orders for vaccine over the telegraph wires the Americans had installed. Marine-Hospital Service surgeons vaccinated thousands of sailors each year in the harbors and pressed shipping firms to employ only persons holding the Service’s blue vaccination cards.108

By 1906, the Philippine Commission was boasting of the real possibility of eradication: “The day should not be far distant when smallpox will disappear from the Philippines.” The following year, Dr. Victor Heiser, the U.S. director of health, stated the argument in its baldest form. “During the year there has been unquestionably less smallpox in the Philippines than has been the case for a great many years previous.... In fact, if any justification were needed for American occupation of these islands, these figures alone would be sufficient, if nothing further had been accomplished for the benefit of the Filipinos.” Between the arrival of the U.S. troops in the summer of 1898 and 1915, some 18 million vaccinations were performed in the Philippines under American rule. The Filipinos, according to U.S. officials, had come to accept vaccination as an effective and necessary measure, suggesting, if true, a dramatic transformation of medical beliefs in a very short time.109

With the end of the war, the question of force became the greatest political liability of U.S. colonial health policy. Significantly, in 1904 the Philippine Commission ordered that public vaccinators would henceforth be “prohibited from using force in accomplishing vaccinations.” Individuals who refused to submit to vaccination would be tried in the courts. All of these ongoing efforts did not succeed in completely wiping out smallpox on the islands. The tropical climate continued to render much of the American-produced vaccine useless. But the efforts did dramatically reduce the incidence of smallpox there and laid the groundwork for the Philippines to become, in 1931, the first Asian country in which the disease was eradicated.110

At a time of pervasive opposition to compulsory vaccination at home and abroad, U.S. health officials presented the vaccination campaigns in Puerto Rico and the Philippines as evidence of the efficiency of compulsion. Azel Ames touted the Puerto Rico campaign as “A Lesson for the World.” Surgeon General Walter