Professional Documents
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Colonial Philippines
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vaccination against smallpox during the late nineteenth century
a “remarkable demonstration of the interventionist ambitions
and capabilities of western medicine in India.” And yet, despite the
obvious efficacy and cheapness of vaccination, a general feeling
emerged that “vaccination was a distinctive form of medical activity
that did not provide a suitable base or blueprint for the wider devel-
opment of state medicine and public health.” In the 1870s, efforts in
British India to merge vaccination departments with the newly
established sanitary departments failed, in part because vaccinators were
deemed ignorant of sanitation. Arnold thus points to a paradox: vac-
cination, whether as symbol or act, epitomized the interventionist
[ 1 ]
2 Journal of the History of Medicine : Vol. 62, January 2007
ambitions of the colonial state, even as that same state increasingly
displayed an “ambivalent or hesitant attitude” toward it.1 In this article I
intend to explore some of the tensions that can develop between inter-
vention and government, ambiguities that are also expressed in the dif-
ferences between vaccination and hygiene, or safeguard and discipline.
1. David Arnold, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-
Century India (Berkeley: University of California Press, 1993), 121, 148, 157.
2. Warwick Anderson, “Excremental Colonialism: Public Health and the Poetics of
Pollution,” Critical Inquiry, 1995, 21, 640–69. On the difference between hygienists and
“vaccinologistes,” see Anne-Marie Moulin, Le dernier langage de la médecine: histoire de
l’immunologie de Pasteur au Sida (Paris: P.U.F., 1991), 129.
3. H. J. Parish, A History of Immunization (Edinburgh and London: E. & S. Livingstone
Ltd, 1965), 63–68. See also Anne-Marie Moulin, “Introduction: hasard et rationalité dans
l’approche vaccinale,” History & Philosophy of the Life Sciences, 1995, 17, 5–30. Frederick
F. Russell confirmed the effectiveness of the typhoid vaccine in a large-scale study of American
Anderson : Immunization and Hygiene in the Colonial Philippines 3
under the “progressive” and interventionist American regime thus
serves as another example of state reticence to vaccinate civilians,
but not for the reasons commonly adduced in histories of colonial
public health.
The emerging pattern of typhoid vaccination in the early years of
troops: The Results of Anti-Typhoid Vaccination in the Army in 1911, and its Suitability for Use in
Civil Communities (Chicago: American Medical Association, 1912). See also Frederick
F. Russell, “Anti-typhoid Vaccination,” Am. J. Med. Sci., 1913, 146, 803–33.
4. Anne Hardy, “‘Straight Back to Barbarism’: Antityphoid Inoculation and the Great
War, 1914,” Bull. Hist. Med., 2000, 74, 265–90. See also Derek S. Linton, “Was Typhoid
Inoculation Safe and Effective during World War I? Debates within German Military Medi-
cine,” J. Hist. Med. Allied Sci., 2000, 55, 101–33.
4 Journal of the History of Medicine : Vol. 62, January 2007
sought to detect children with communicable diseases.5 So there are
plausible phenomenological and historical reasons to view vaccination
as an especially egregious state intervention. But in focusing on vac-
cination, we may miss other medical agitations of social life that are
more productive and lasting, though less obvious.
13. George Foy, “The Introduction of Vaccination to the Southern Continent of America
and to the Philippene [sic] Islands,” Janus, 1897–98, 2, 216–20; Reglamento de vacunacion para
las Islas Filipinas; aprobado por Superior decreto de 6 de febero de 1895 (Manila: Ramirez, 1895).
See Ken de Bevoise, Agents of Apocalypse: Epidemic Disease in the Colonial Philippines
(Princeton, N.J.: Princeton University Press, 1995).
14. The best source for the history of public health under the Spanish is J. P. Bantug, A
Short History of Medicine in the Philippines under the Spanish Régime, 1565–1898 (Manila: Colegio
Médico-Farmaceútico de Filipinas, 1953). See also Teodora Tiglao and W. L. Cruz, Seven
Decades of Public Health in the Philippines, 1898–1972 (Tokyo: South-East Asian Medical
Information Center, 1975); Enrico Azicate, “Medicine in the Philippines: An Historical
Perspective” (M.A. thesis, University of the Philippines, 1989); and Marcelo C. Angeles,
“History of the Public Health System in the Philippines,” typescript c. 1967, Department of
Health Archives, Manila, Republic of the Philippines.
15. Leoncio Lopez-Rizal, Annual Report of the National Research Council of the Philippines
(Manila: Bureau of Printing, 1934–35), 159.
Anderson : Immunization and Hygiene in the Colonial Philippines 7
based directly on a military model.16 The interim military board of
health for Manila, organized in September 1898, developed the fun-
damental arrangements for sanitation and health care delivery in the
city. It divided the city into ten districts and appointed a municipal
physician to each. During this period, separate hospitals for small-
18. “General order no. 16,” Headquarters Provost Marshal General, 6 April 1901, RG
350/2394–3, United States National Archives and Records Administration (NARA), College
Park, Maryland.
19. Ibid. The board of health, through its vaccinators, would “inspect all persons” (section 8).
20. John E. Snodgrass, Smallpox and Vaccination in the Philippine Islands, 1898–1914
(Manila: Bureau of Printing, 1915), 15. Snodgrass was assistant to the director of health. For
accounts of similar methods of smallpox control, see Azel Ames, “The Vaccination of Porto
[sic] Rico—A Lesson to the World,” Pacific Med. J., 1902, 45, 513–32; and José G. Rigau-Pérez,
“Strategies that led to the Eradication of Smallpox in Puerto Rico, 1882–1921,” Bull. Hist.
Med., 1985, 50, 75–88, and “The Introduction of Smallpox Vaccine in 1803 and the
Adoption of Immunization as a Government Function in Puerto Rico,” Hispanic Am. Hist.
Rev., 1989, 69, 393–423. Soon after the American occupation of Puerto Rico, Governor
Guy V. Henry ordered a mass vaccination and barred anyone without a vaccination certificate
from school, employment, and public transportation. For Indochina during this period, see
Annick Guénel, “Lutte contre la variole en Indochine: variolisation contre vaccination?”
Hist. Philos. Life Sci., 1995, 17, 55–80.
21. Fernando Calderón, “Some Data Concerning the Medical Geography of the Philippines,”
Philippine J. Sci., 1914, 9B, 199–214, 204.
Anderson : Immunization and Hygiene in the Colonial Philippines 9
103,931 vaccinations in 1899 alone, and almost 18 million by 1914.22
Even so, the coverage of these campaigns was generally more limited
than their promoters admitted, with the exception, perhaps, of an
unusually thorough general vaccination in 1905. Probably not more
than half the vaccinations were successful. Smallpox remained endemic
28. Victor G. Heiser, “Unsolved Health Problems Peculiar to the Philippines,” Philippine
J. Sci., 1910, 5, 171–78, 174–75.
Anderson : Immunization and Hygiene in the Colonial Philippines 11
abolished, and then a gigantic anti-spitting crusade begun, and, last
of all, comes the Herculean task of rousing them out of their iner-
tia.”29 Health authorities reached out to those who had not yet con-
tracted disease, to emphasize that “they live in constant danger of
infection,” and to point out that “the path of safety lies in the main-
34. Hubert Lyautey, “Du rôle colonial de l’Armée,” Revue des deux mondes, 15 February
1900, 157, 308–28. Lyautey, the major theorist of colonial warfare, was of course describing
French operations, but even Charles Callwell, in his influential contemporary publication
Small Wars: Their Principles and Practice, 3rd ed. (London: HMSO, 1906), makes a similar
argument for combining military action with political action. And from late 1899 in the
Philippines, the United States army provided a perfect example of the “new” principle of
strategy.
35. Gottman, “Bugeaud, Galliéni, Lyautey,” 246.
36. Parish, History of Immunization.
14 Journal of the History of Medicine : Vol. 62, January 2007
By the end of the nineteenth century, it was evident that the
injection of germs in an attenuated state, or when dead, could con-
fer a resistance to many communicable diseases. The list of candidate
vaccines might be expanded indefinitely. In 1896, Wilhelm Kolle
had prepared a heat-killed cholera vaccine that gained some epide-
37. Ibid.; Rosen, History of Public Health; Paul Weindling, “The Immunological Tradition,”
in Companion Encyclopaedia of the History of Medicine, ed. W. F. Bynum and Roy Porter,
2 vols. (London and New York: Routledge, 1993), I, 192–204.
38. Paul C. Freer, Third Annual Report of the Superintendent of Government Laboratories,
1903–04 (Manila: Bureau of Printing, 1905), 12–14.
39. Paul C. Freer, Eighth Annual Report of the Director of the Bureau of Science, 1909 (Manila:
Bureau of Printing, 1910), 18.
40. Paul C. Freer, Tenth Annual Report of the Director of the Bureau of Science, 1911 (Manila:
Bureau of Printing, 1912), 16. See A. F. Coca and P. K. Gilman, “The Specific Treatment
of Carcinoma,” Philippine J. Sci., 1909, 4B, 391–403.
Anderson : Immunization and Hygiene in the Colonial Philippines 15
indicates more an enthusiasm for the potential of the new serology
than any confidence in its current efficacy. But all the same, a few
products were clearly effective. By 1918, the serum laboratory was pro-
ducing annually enough vaccine virus to effectively vaccinate two
million people against smallpox.41
41. Alvin J. Cox, “Philippine Bureau of Science,” Bureau of Science Press Bulletin No. 87
(Manila: Bureau of Printing, 1918), RG 350/3466–38, NARA College Park, Maryland, 5.
See also Elmer D. Merrill, “Bureau of Science,” 11 October 1921, RG 350/3465–97,
NARA College Park, Maryland.
42. Freer, Third Annual Report, 1903–04, 14.
43. Paul C. Freer, Fifth Annual Report of the Director of the Bureau of Science, year ending
August 1, 1906 (Manila: Bureau of Printing, 1907), 19.
44. Paul C. Freer, Ninth Annual Report of the Bureau of Science, 1910 (Manila: Bureau of
Printing, 1911), 17. See E. H. Rüdiger, “Filtration Experiments on the Virus of Cattle
Plague with Chamberland Filters ‘F’,” Philippine J. Sci., 1909, 4B, 37–42.
45. See for example E. R. Whitmore, “The Inoculation of Bacterial Vaccines as a
Practical Method for the Treatment of Bacterial Diseases,” Philippine J. Sci., 1908, 3B, 421–30;
A. W. Sellards, “Immunity Reactions with Amoebae,” Philippine J. Sci., 1911, 6B, 281–98;
H. D. Bloombergh, “The Wasserman Reaction in Syphilis, Leprosy, and Yaws,” Philippine
J. Sci., 1911, 6B, 335–42; Rüdiger, “The Duration of Passive Immunity against Tetanus
Toxin,” Philippine J. Sci., 1913, 8B, 139–42; and idem., “The Preparation of Tetanus Anti-
toxin,” Philippine J. Sci., 1915, 10B, 31–64.
46. See Richard P. Strong, “The Investigations Carried on by the Biological Laboratory
in Relation to the Suppression of the Recent Cholera Outbreak in Manila,” Philippine J. Sci.,
1907, 2B, 413–41. Strong was later the first professor of tropical medicine at Harvard. See
also Paul C. Freer, Fourth Annual Report of the Superintendent of Government Laboratories, 1905
(Manila: Bureau of Printing, 1906), 17.
16 Journal of the History of Medicine : Vol. 62, January 2007
Photographs on display there showed the serum stables, bleeding
house, and the process of obtaining blood from horses to make sera
and vaccines. (Many physicians later visited the Bureau itself, where
they were entertained by J. A. Johnston’s demonstration of the motility
of cholera vibrios, “showing the scintillating, darting movements” of
47. Alvin J. Cox, 17th Annual Report of the Director of the Bureau of Science, for the year ending
December 31, 1918 (Manila: Bureau of Prining, 1919), 20.
48. Freer, Fifth Annual Report, 1906, 11.
49. See Eli Chernin, “Richard Pearson Strong and the Iatrogenic Plague Disaster in
Bilibid Prison, Manila, 1906,” Rev. Infect. Dis., 1989, 11, 996–1004.
50. “Report of the General Committee,” 1 March 1907, RG 4341/21, NARA, 11.
51. Ibid., 18. A. C. Ivy (“History and Ethics of the Use of Human Subjects in Medical
Experiments,” Science, 1948, 108, 1–5) claims that Strong was the first American to use pris-
oners for medical research. Chernin (1001) points out that Strong’s earlier study of plague
immunization, also conducted without consent, has been presented as a case study in
human experimentation in J. Katz, Experimentation with Human Beings (New York: Russell
Sage Foundation, 1972), 1014–15.
Anderson : Immunization and Hygiene in the Colonial Philippines 17
reform. But the new candidate vaccines were used primarily in the
military in the Philippines; even the expatriate American community
was allowed no automatic biological protection from local diseases.52
No one proposed any additional mass vaccination campaign; the
response to outbreaks of plague, typhoid, and cholera did not include
52. The first attempt to vaccinate U.S. troops against typhoid took place in 1904, with
disastrous consequences. See W. D. Tigertt, “The Initial Effort to Immunize American
Soldiers with Typhoid Vaccine,” Mil. Med., 1959, 124, 342–49. By 1911, though, the U.S.
Army had made typhoid vaccination compulsory; see Russell, “Anti-typhoid Vaccination.”
53. Paul C. Freer, “A Consideration of Some of the Modern Theories of Immunity,”
Philippine J. Sci., 1907, 2B, 71–81, 75. For a typically confident account of the field’s potential,
see W. M. Haffkine, “On Preventive Inoculation,” J. Trop. Med., 1899, 2, 322–27.
54. Judith W. Leavitt, “Politics and Public Health: Smallpox in Milwaukee, 1894–95,”
Bull. Hist. Med., 1976, 50, 553–68, 553.
18 Journal of the History of Medicine : Vol. 62, January 2007
politicians or the public, used compulsory vaccination to construct a
“medical department of state.”55 Although mass vaccination became
the symbol of an interventionist and repressive state, it more accu-
rately indicated the state’s sensitivity to pressure from the medical
profession or public health bureaucrats. But in the early twentieth
58. Julia A. Walsh and Kenneth S. Warren, “Selective Primary Health Care: An Interim
Strategy for Disease Control in Developing Countries,” N. Engl. J. Med., 1979, 301,
967–74. See also William Muraskin, The War Against Hepatitis B: A History of the Interna-
tional Task Force on Hepatitis B Immunization (Philadelphia: University of Pennsylvania Press,
1995).
59. Debabar Banerji, “Hidden Menace in the Universal Child Immunization Program,”
Int. J. Health Serv., 1988, 18, 293–99, 293. See also Banerji, “Crash of the Immunization
Program: Consequences of a Totalitarian Approach,” Int. J. Health Serv., 1990, 20, 501–10.
See also the useful distinction between routinized vaccination and the vaccination cam-
paign in Pieter Streefland, A. M. R. Chowdhury, and Pilar Ramos-Jimenez, “Patterns of
Vaccination Acceptance,” Soc. Sci. Med., 1999, 49, 1705–16.
60. Peter F. Wright, “Global Immunization—A Medical Perspective,” Soc. Sci. Med.,
1995, 41, 609–16, 615. Vicente Navarro criticizes both vertical and horizontal programs,
with their common emphasis on access to medical care, for ignoring the need for structural
economic and political changes, in “A Critique of the Ideological and Political Position of
the Brandt Report and the Alma Ata Declaration,” Int. J. Health Serv., 1984, 14, 159–72.
20 Journal of the History of Medicine : Vol. 62, January 2007
intercourse.”61 A vaccine, to some extent, would make such social
reform unnecessary, but would its use, however “coercive,” promote
the interests of a modern state dedicated to the colonization of the
bodies of its citizens? Probably not so effectively as current stipulations
of sexual and social hygiene, delivered at the level of primary health
61. Wright, “Global Immunization,” 615. See also Max Essex, “Strategies of Research
for a Vaccine Against AIDS,” Hist. Philos. Life Sci., 1995, 17, 141–49.
62. Paul Greenough, “Global Immunization and Culture: Compliance and Resistance in
Large-Scale Public Health Campaigns: Introduction,” Soc. Sci. Med., 1995, 41, 605–7, 606.