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"It's difficult to overstate the significance of this book. Its account of hygiene as the means for establishing 'biomedical citizenship' in the Philippines under U.S. rule is carefully crafted and powerfully argued. Sympathetically deconstructing the assertiveness and delusions of white colonial medical practitioners beset by the specters of native bodily excess, Warwick Anderson shows how race and biology defined civic identities in the colony and the metropole alike. A path-breaking work on imperial medicine, it is certain to attract a wide readership."--Vicente L. Rafael, author of "The Promise of the Foreign: Nationalism and the Technics of Translation in the Spanish Philippines"

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COLONIAL PATHOLOGIES

DUKE UNIVERSITY PRESS

Contents

ACKNOWLEDGMENTS...........................................................viiINTRODUCTION..............................................................11. American Military Medicine Faces West..................................132. The Military Basis of Colonial Public Health...........................453. "Only Man Is Vile".....................................................744. Excremental Colonialism................................................1045. The White Man's Psychic Burden.........................................1306. Disease and Citizenship................................................1587. Late-Colonial Public Health and Filipino "Mimicry".....................1808. Malaria Between Race and Ecology.......................................207CONCLUSION................................................................227ABBREVIATIONS.............................................................235NOTES.....................................................................237BIBLIOGRAPHY..............................................................299INDEX.....................................................................343

Chapter One

On June 13, 1900, Captain S. Chase de Krafft, M.D., a volunteer assistant surgeon with the American forces in the Philippines, reported from his post at Balayan the death from "hemoglobinuric fever" of Private Glenn V. Parke of the 28th Regiment. In January, Parke had fallen out of a march "from physical exhaustion" and was sent to the hospital in Manila. When he rejoined his company a few months later he appeared to be well but soon succumbed to "malarial fever intermittent." On the long, hot march to Balayan, Parke had fallen out again and was admitted to the post hospital with an acute attack of diarrhea. After daily doses of quinine and thrice-daily strychnine, the soldier soon returned to duty. But his malarial fever recurred: back in hospital he was "seized with a severe attack of bilious vomiting," and later his urine was red and scanty. The bilious vomiting, diarrhea, and fever persisted, along with pain over the liver; his entire body was soon "saffron-colored." His urine became darker and more concentrated. Within a few hours, the patient sank into delirium and then coma, dying early in the morning. Parke had told the surgeon he was twenty-three years old, though most suspected he was no more than twenty-one; in any case, his body was quickly buried in the north side of the cemetery at Balayan. De Krafft then turned his attention to ensuring the well-being of the remaining troops.

Tropical disease would take the lives of many U.S. soldiers during the Philippine-American War. From General Wesley Merritt's assault on Manila on July 31, 1898, until the war gradually eased in 1900, more than six hundred soldiers were killed or died from wounds received in battle, and another seven hundred died of disease. The record of Parke's clinical course presents in unusual detail an example of diagnosis and treatment in the medical corps of the U.S. Army during the first year of the campaign. The army surgeon in the field was still likely to attribute illness to exhaustion or reckless behavior and to favor explanations that implied a mismatch between bodily constitution and circumstance. In his extensive case notes, de Krafft nowhere mentions germs, even though the microbial causes of diarrhea and malaria had been established for many years. Parke's feces were not cultured for bacteria; his blood was not examined for the malaria parasite. Instead, the surgeon carefully described the vitality and appearance of the patient, the strength of his pulse, the qualities of his dejecta, and the hourly variations in body temperature. The diagnosis was expressed not in terms of any causative organism but as a type of fever, a bodily response not identified with any inciting agent. In a tropical environment, in conditions that supposedly depleted white constitutions, the surgeon turned naturally to stimulants-strychnine, quinine, mustard plasters, and eggnog-to rally Parke's resisting powers. There was no suggestion that a medication might attack directly a microbe or other specific cause. The surgeon hoped to restore his patient's balance and vitality and thus combat the nonspecific challenges of overwork or feckless behavior in trying foreign circumstances.

The surgeon's meticulous attention to this individual case reveals more than just the expediency and deftness required in clinical engagement under such grueling conditions. It also indicates medical priorities in the U.S. military at the outset of the war. In an elaborate epidemiological reconstruction of the effects of the Philippine-American War on the local population, Ken de Bevoise has estimated that the annual death rate in the archipelago, previously a high thirty per thousand, soared to more than sixty per thousand between 1898 and 1902, and that more than seven hundred thousand Filipinos died in the fighting or in concomitant epidemics of cholera, typhoid, smallpox, tuberculosis, beriberi, and plague. Displaced and destitute, sometimes crowded into reconcentration camps, ordinary Filipinos were especially vulnerable to disease. Endemic infection, previously contained, flared into epidemics; new diseases, some perhaps carried by invading troops, soon became rife. But the spread of disease among local communities was not, in the early stages of war at least, the main concern of the medical corps of an attacking army.

The job of a military surgeon, recently codified in the U.S. Army, was clearly delimited. During battle, the care and evacuation of sick and wounded soldiers would inevitably preoccupy the military surgeon; at other times, in the respite from the demands of surgical treatment of acute cases, the surgeon worked to ensure the sanitation of camps and the hygiene of troops. "A military surgeon who believes he is appointed for the sole purpose of extracting bullets and prescribing pills," according to Captain Charles E. Woodruff, M.D., was "a hundred years behind the times." The medical officer was also a sanitary inspector, responsible for the scrutiny of food, provision of adequate clothing, ventilation of tents, disposal of wastes, and the general layout and "salubrity" of camps. In the past, according to Woodruff, the military surgeon might have restricted himself to preventing and eradicating "hospital contagion"-gangrene among the wounded and fever (usually typhus) among long-term inmates-but now, in the "modern era," he had a duty to provide for the well-being of troops. Thus de Krafft, after hastening the disposal of Parke's body, had gone about trying to prevent other cases. "The army medical officer," noted a contemporary observer, "ceased to be primarily a general practitioner in becoming the administrative officer of a sanitary bureau, with certain clinical duties when accident or the failure of prevention placed the individual soldier for special care in a hospital ward."

In seeking to protect white soldiers, the military surgeon in the Philippine-American War repeatedly assayed the nature of the territory and climate and the character and behavior of troops and local inhabitants. Like medicine more generally, army sanitary science was heedful of environment, social life, and morality; always conservative, it tried to guard against...