Immunities of Empire

Immunities of Empire: Race, Disease, and the New Tropical Medicine, 1900–1920
Author(s): WARWICK ANDERSON

Source: Bulletin of the History of Medicine , Spring 1996, Vol. 70, No. 1 (Spring 1996),
pp. 94-118
Published by: The Johns Hopkins University Press
Stable URL: https://www.jstor.org/stable/44444595
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RACE AND ACCLIMATIZATION
IN COLONIAL MEDICINE
Immunities of Empire: Race, Dis

and the New Tropical Medicine,
1900-1920
WARWICK ANDERSON
In 1900, Nathaniel Southgate Shaler, the dean of Harvard's L

Scientific School, proposed that the "troops which are req
Federal service in tropical lands might well be recruited from the
with their families, these soldiers would soon "become perman
contentedly established in Luzon and elsewhere in the colonie
was convinced that such "children of the tropics" would "mak
soldiers - at least as infantry men" - because the African-Ame
stitution was preadapted to the tropical disease environment.2
I would like to thank Charles Rosenberg, Barbara Gutmann Rosenkran

Rafael, and Caroline Hannaway for their comments on earlier drafts of this pa
grateful for the suggestions I received when I presented versions of this work a
of Physicians of Philadelphia and the Johns Hopkins University.
1. Nathaniel S. Shaler, "The Future of the Negro in the Southern States
Monthly, June 1900, 57: 151. On Shaler, the "forefather of American geograph
N. Livingstone, "Science and Society: Nathaniel S. Shaler and Racial Ideology,"
Brit. Geog, 1984, 9: 181-210. On racial classification in American medicine, se
Fredrickson, The Black Image in the White Mind: The Debate on Afro-American
Destiny, 181 7-1944 (New York: Harper and Row, 1971); andjohn S. Haller, Jr., O
Evolution: Scientific Altitudes of Racial Inferiority, 1859-1900 (Urbana: Universi
Press, 1971).
2. Nathaniel S. Shaler, "The Transplantation of a Race," Pop. Sci. Monthly , March 1900,
56: 521. Shaler was surprised at how well Africans - those "tropical exotics" - had acclima-
tized to temperate North America. They had withstood their "trials of deportation in a
marvellous way," with no particular liability to disease, or impairment of fecundity (p. 514) .
He supposed this was because slave-owners had carefully managed their health and breed-
ing (p. 518).
94 Bull. Hist. Med., 1996, 70: 94-118

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Race, Disease, and Tropical Medicine 95
Philippines, Shaler's distinguished advice was already redundant: during

the previous two years, the United States had been using African-Ameri-
can and Filipino scouts to suppress the resistance to its occupation of the
archipelago. To Capt. R. L. Bullard, one of the "white men of good
standing" who commanded the "30th Alabama Volunteer Infantry (Ne-
groes)," it had long been plain that "negro volunteers" were less liable to
succumb to the regional ailments than white soldiers; indeed, the differ-
ences in health and labor power between the two groups were "so great
that they almost require the naturalist and do require the military com-
mander to treat the negro as a different species."3 But while black troops
"could accomplish the most amazing amount of work" in such trying
circumstances, they unfortunately showed a tendency to "go in parties,
they herd," and "in the lonely duty of the sentinel this herding peculiarity
becomes a positive fault."4 Filipino scouts proved more abundant and
somewhat more independent, though similarly resistant to the tropical
diseases and climate of their ancestral realm. Capt. Charles D. Rhodes
observed that local troops were "able to drink all kinds of water with
impunity, and the common intestinal disorders are unknown"; they were
susceptible perhaps only to "calentura or break-bone fever."5 As the
Filipino soldier "stands in the rice-fields, knee-deep in mud and water,
during the working hours of day after day, one almost believes that years
of exposure have made him amphibious. The factor of sickness among
soldiers made of such material will not cause the surgeons much uneasi-
ness."6 And indeed, for the first few years of the American occupation, it
did not.
Assumptions of racial immunity to disease pervade nineteenth-cen-

tury medical and social theory. For colonial physicians in particular,
racial endowment provided a potent, if somewhat inchoate, means of
understanding observed differences in disease susceptibility. It was a
truism, in the tropics as elsewhere, that contact with the exciting cause of
3. R. L. Bullard, "Some Characteristics of the Negro Volunteer," J. Milit. Service Inst.

United States (henceforth /MS/), 1901, 29 : 29-39, quotation on p. 29.
4. Ibid., pp. 30-31. Bullard had ensured that "men with a larger proportion of white
blood [were] rejected" (p. 30). See also Willard B. Gatewood, Jr., Black Americans and the
White Man's Burden, 1898-1903 (Urbana: University of Illinois Press, 1975), esp. pp. 297-
309.
5. Charles D. Rhodes, "The Utilization of Foreign Troops in Our Foreign Possessions,"

JMS1 , 1902, 30: 1-26, quotations on pp. 7 and 6.
6. Ibid., p. 7. To "eliminate one of the greatest problems besetting an army on a foreign
shore, that of acclimatization," Maj. Louis L. Seaman suggested raising friendly "native
regiments," just as Britain had for many years ("Native Troops for Our Colonial Posses-
sions,"/ Assoc. Milit. Surgeons [henceforth JAMS], 1901-2, 10: 240).

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96 WARWICK ANDERSON
disease - whatever its nature - did not always produce the same pattern
of illness among individuals. Disease manifestation seemed to depend on
the condition of the body at the time, which was the sum total o
hereditary endowment, life history, and environmental influence. Whether
this aggregate was called constitution, immunity, or "vital machine,"7 the
importance of predisposition seemed, for most of the century, beyond
doubt. And in colonial circumstances, racial difference was undoubtedl
the most prominent of all the possible influences on a population'
immunity or liability to disease. The principle that a race was best fitte
to resist the diseases of its ancestral realm - and, as a corollary, was
especially susceptible to ailments encountered in a foreign land - was a
remarkably resilient element in the general understanding of disease
susceptibility. Such assumptions form a large part of the texture of
contemporary hereditarian thought.8 An enormous amount of colonial
epidemiological research and diverse clinical experience could be built
into this framework of meaning.
The supposition that manifold racial difference would somehow shape
disease expression was itself relatively immune to etiological and thera
peutic change. To an extent, it did not matter much whether the cause of
the ailment was miasma or microbe. Even during a period when such
speculation about the seed of disease regularly obscured the old, surer,
pieties of the soil, the standard assumptions of predisposition were never
entirely displaced.9 But if this interest in patterns of natural immunity
was surprisingly long-lasting, the form it assumed was never immutable.
Although "race" remained an organizing principle, the precise meaning
7. The last is a common formulation in the Philippines in the early nineteenth century:
see C. R. Greenleaf to G. M. Sternberg, 30 January 1900, File 57592/76, p. 14, Record
Group 112-E26, United States National Archives, Washington, D.C. (henceforth USNA).
8. On ideas of predisposition during the nineteenth century, see Christopher Hamlin,
"Predisposing Causes and Public Health in Early Nineteenth-Century Medical Thought,"
Soc. Hist. Med., 1992, 5: 43-70; and Charles E. Rosenberg, "The Therapeutic Revolution:
Medicine, Meaning, and Social Change in Nineteenth-Century America," in The Therapeutic
Revolution: Essays in the Social History of American Medicine, ed. Morris J. Vogel and Charles E
Rosenberg (Philadelphia: University of Pennsylvania Press, 1979), pp. 3-25. On hereditar
ian thought, see Charles E. Rosenberg, "The Bitter Fruit: Heredity, Disease, and Social
Thought," in No Other Gods: On Science and American Social Thought (Baltimore: Johns
Hopkins University Press, 1976), pp. 25-53.
9. The seed and soil analogy - from the parable of St. Matthew - was a popular one well
into the early twentieth century. See, for instance, Stephen MacKenzie, "The Powers of
Natural Resistance, or the Personal Factor in Disease of Microbic. Origin," Lancet, 31 Ma
1902, 1: 1513-17. MacKenzie lamented that "the tendency of the medical mind at th
present time seems to be to attach too great importance to the germ or seed and too little t
that of the body or soil in diseases of microbic origin" (p. 1513).

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of hereditary predisposition - as of race - altered significantly during the

late nineteenth and early twentieth centuries. It is the politics of this shift
in the colonial understandings of racial immunity that I shall trace here.
Physiological Immunities of Race

At the turn of the century in the Philippines, as the United States was
strengthening its hold on the archipelago, very few, if any, of the anxious
colonial emissaries doubted that race was a major influence on indi-
vidual immunity. For some it seemed the chief determinant of disease
expression; for others, it was merely one among many factors - along
with diet, character, energy, and exposure to pathogenic material -
contributing to a person's predisposition to illness. Dr. W. S. Washburn,
the head of the civil service, thought it undeniable that "natives of the
Philippines eat and drink with comparative impunity articles of food and
water, the use of which by white men is disastrous."10 Dr. Paul Freer
explained this apparent natural immunity of Filipinos to local ailments as
"a process of heredity [in which] the substances that confer certain types
of immunity on individuals of a race have been produced by a course of
development concomitant with the other manifestations of evolution. "n
Over many generations, the indigenous Malay race thus had acquired a
heritable resistance to the diseases that surrounded it.12
But any alien race in this environment would be doubly challenged.

Not only did the foreigner's "vital powers" of resistance have to adjust
rapidly to novel tropical pathogens, but this process was occurring at a
10. W. S. Washburn, "Health Conditions in the Philippines," Philippine J. Sci., 1908, 3B:
273.
11. Paul C. Freer, "A Consideration of Some of the Modern Theories of Immunity,"
Philippine J. Sci., 1907, 2tì: 74. Freer was the director of the Bureau of Science.
12. James A. LeRoy suggests that, although "the anthropologist is puzzled in his
endeavor to untangle the racial knots of the Pacific and to classify people even on broad,
general lines," the fact that the "native stock of the Philippine Islands is Malayan is one of
those things that have been recognized 'always, everywhere, and by all'" {Philippine Life in
Town and Country [New York: G. P. Putnam's Sons, 1906], pp 20, 14). But dûs racial
typology was perhaps not so obvious to Filipinos themselves. William B. Freer gives this
example of the "stupidity" - or perhaps resistance - of his Filipino students: "After attempt-
ing to teach the class of beginners for several days respecting the five races of mankind, the
color and name of each. ... I requested a middle-aged man, in English, to tell me to what
race he belonged. He appeared not to understand, even after several repetitions of the
question in both English and Spanish. I then had a fellow student put the question in his
own dialect, the Gaddan. . . . The poor fellow stood up, scratched his head, and averred he
was an African" ( The Philippine Experiences of an American Teacher: A Narrative of Work and
Travel in the Philippine Islands [New York: Charles Scribner's Sons, 1906], p. 105).

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98 WARWICK ANDERSON
time of great systemic vulnerability.13 The constitution of the alien race,

from the moment of arrival, seemed out of gear with the local climate.
One can almost hear the white race's "vital machine" sputtering to a stop.
All the activities that Americans thought essential to the maintenance of
immunity to disease became disordered in the tropics: their diet seemed
inappropriate; they weakened physically and became forgetful; day and
night they perspired excessively; their passions were awakened. The
balance between the racially constituted body - with its broad, unspeci-
fied powers of resistance - and the foreign environment was horribly
awry. In these conditions the newcomers feared even the onslaught of
familiar temperate diseases; no wonder, then, that the new tropical
varieties were anathema.
Americans resident in the Islands fixed on these theories of racial
dislocation, and the attendant predictions of vulnerability. Thus Lt.
Joseph J. Curry expected that malaria would become prevalent among
white troops because "die depressing influence of the tropical climate
lessens the individual's normal resisting powers and thereby prepares a
favorable soil for the invasion of parasites."14 Smallpox "in this latitude
and longitude," according to Surgeon Henry F. Hoyt, was "very fatal,
especially to the white man."15 William B. Freer, a teacher and occasional
doctor to his charges, also observed that smallpox
is never entirely absent from the Philippines, but so many generations of

Filipinos have experienced it that it does not, as a rule, go badly with them.
But woe to the American who contracts the disease. He invariably suffers
severely, and the malady usually takes the most malignant form, that known as
"black smallpox." Such cases are nearly always fatal.10
Dr. Charles Mason's experiences in the Philippines treating American

soldiers who came down with typhoid convinced him that "the disease is
more severe than in the temperate zone, and more fatal in its results."17
13. See Mark Harrison, "'The Tender Frame of Man': Disease, Climate, and Racial
Difference in India and the West Indies, 1760-1860," Bull. Hist. Med., this issue. For surveys
of the debate on human acclimatization, see David N. Livingstone, "Human Acclimatiza-
tion: Perspectives on a Contested Field of Inquiry in Science, Medicine and Geography,"
Hist. Sci., 1987, 25: 359-94; and Dane Kennedy, "The Perils of the Midday Sun: Climatic
Anxieties in the Colonial Tropics," in Imperialism and the Natural World, ed. John D.
MacKenzie (Manchester: Manchester University Press, 1990), pp. 118-40.
14. J. J. Curry, "Notes on the Diseases of the Philippine Islands," Report to the Surgeon-
General (c. 1900), File 68075/G, p. 31, Record Group 112-E26, USNA.
15. Henry F. Hoyt, "Appendix," in Report of the Philippines Commission to the President, 3
vols. (Washington, D.C.: Government Printing Office, 1900), 1: 262.
16. W. B. Freer, Philippine Experiences (n. 12), p. 188.
17. Charles F. Mason, "Notes from the Experiences of a Medical Officer in the Tropics,"
JAMS, 1903, 13: 309.

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The sense of imminent danger never left Emily Bronson Conger, an

otherwise self-possessed osteopath, known appropriately as "Señora
Blanca." On first encountering the heat of the tropics, she felt that it
"seemed beyond physical endurance. . . . exhaustion without relief. The
only time that one could get a breath was about five o'clock in the
morning; in the middle of the day the sun's rays are white-hot needles . . .
and even if one carries an umbrella the heat pierces directly through";
the pores of her pale skin had thus become "weakened by excessive
exudation," leaving her especially exposed to all the evils of the tropics.18
By 1900, the literature on racial liability and immunity to disease was
vast and widely scattered. Although the general sense of European vul-
nerability was often bolstered by increasingly reliable (if partial) statistics
of mortality and morbidity, the actual attribution of specific racial immu-
nities in colonial medical theory was still based largely on the repetition
of anecdote.19 Thus, in 1856, E.J. Waring of the Madras Medical Service
was simply giving wider circulation to a commonplace when he noted
that European soldiers, far more than sepoys, were "particularly liable" to
dysentery in India.20 Joseph Ewart, of the Bengal Medical College, en-
dorsed, with some qualification, the common belief that "the natives of
India, and of the hot climates generally, enjoyed an immunity from
18. Emily Bronson Conger, An Ohio Woman in the Philippines (Cleveland, Ohio: Arthur
H. Clark, 1904), pp. 133-34.
19. For an analysis of the general patterns of mortality and morbidity in colonial military
forces, see Philip D. Curtin, Death by Migration: Europe's Encounter with the Tropical World in the
Nineteenth Century (Cambridge: Cambridge University Press, 1989). Although the British in
India - and the French and the Dutch elsewhere - had been compiling morbidity and
mortality statistics for their colonial armies since the 1860s, these statistics were never
regarded as complete enough or representative enough to formulate a detailed account of
the natural immunities to specific diseases of nonmilitary populations. (I emphasize here the
colonial literature on racial immunity because the racial migrations implied by imperialism
exaggerated race as an organizing principle for immunity. Race was a less important factor
in more stable and homogeneous societies, but it was never irrelevant. See, for instance, the
debate on the immunity of Jews: E. M. Epstein, "Have the Jews Any Immunity from Certain
Diseases?" Med. Surg. Reporter, 9 May 1874, 30: 440-42; Madison Marsh, "Have the Jews Any
Immunity from Certain Diseases?" ibid., 15 August 1874, 31: 132-34. Of course there was
also much speculation on the character of African racial immunity in the United States: see,
for example, Frederick Hoffman, "Vital Statistics of the Negro," Med. News, 22 September
1894, p. 322; and Daniel D. Quillian, "Racial Peculiarities as a Cause of the Prevalence of
Syphilis in Negroes," Amer. J. Dermat. Genito-Urin. Dis., 1906, 10: 277-79. It comes as no
surprise to find Nathaniel S. Shaler at the end of the century still urging a scientific
investigation to determine finally if the Negro was "relatively less liable to certain forms of
disease than whites, and . . . more open to invasions of other maladies than European races"
["Our Negro Types," Current Literature, Arthritis and Related Diseases, July 1900, 29: 47].)
20. Edward John Waring, "Statistical Notes on Some of the Diseases of India," Indian
Ann. Med. Sci., 1856, 6: 508.

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100 WARWICK ANDERSON
[tuberculosis], a disease which thins the ranks of the rising generation

of cold and temperate regions."21 August Hirsch pointed out the racia
and geographical constraints on the distribution of malaria, yellow fever,
typhoid, scarlet fever, and dengue.22 Even Armand Quatrefages de Bréa
had noted that what he called "negritoid-polynesian" races were not
susceptible to scarlet fever.23 As late as 1900, in the British Medical Journal
Colonel Kenneth MacLeod declared that "the constitution of the Negr
is more tolerant of [malaria] than that of the Caucasian race."24
But just as Europeans were especially vulnerable to diseases deemed
tropical, equatorial races appeared particularly susceptible to any disea
to which their ancestors had not become inured. Jousset, Arthur Bordier,
and other authorities agreed that Africans were especially subject to
consumption, more so than Europeans.25 (And yet the Chinese - and
many other Asian races - seemed relatively exempt from the disease: i
was assumed they had been exposed to it and resisted it long ago.) Som
other diseases and presumed resistances presented much greater chal
lenges to such evolutionary explanations. Why, for instance, were Afri
cans more liable, as Quatrefages claimed, to elephantiasis?26 Or, as Hirsc
reported, to sleeping sickness?27 Or, according to R. Clarke, to skin
21. Joseph Ewart, "Phthisis in India," Indian Ann. Med. Sci. , 1868, 24: 157.
22. August Hirsch, Handbuch der historisch-geographischen Pathologie, 3 vols. (Stuttgart
F Enke, 1881-86; London: New Sydenham Society, 1883).
23. Armand de Quatrefages, The Human Species (New York: D. Appleton, 1883), p. 426
Quatrefages points out that while most diseases are common to all races, "one race may be
either more liable to or more susceptible to certain afflictions than another" (p. 423). H
calls this "an ethnological immunity" (p. 427).
24. Kenneth MacLeod, "The Scope and Aim of the Section s work, Brit. Med. J.,
August 1900, 2: 295; Col. MacLeod, of the Indian Medical Service, was delivering h
presidential address to the British Medical Association's section on tropical diseases. O
course the extent of racial susceptibility depended both on the sum total of all predisposin
factors operating within each individual and on what Charles Rosenberg has called th
"individuality of the disease entity" ("Cholera in Nineteenth-Century Europe: A Tool f
Social and Economic Analysis," Comp. Stud. Soc. Hist., 1966, 8: 453). Thus the stronges
racial immunities were to endemic, rather than epidemic, diseases. And in the case of
disease like cholera it was often thought that insanitary living conditions could overwhelm
any racial resistance. But in assessing racial immunities, it was always necessary to conside
case mortality as well as prevalence.
25. A. Bordier, La géographie médicale: La colonisation scientifique (Paris: C. Reinwald
1884) , p. 472; A. Jousset, Traité de l'acclimatement et de l'acclimatation (Paris: O. Doin, 1884) , p
211. Jousset attributes this to the less developed chests of black races (p. 85) and their poo
respiratory power (p. 88).
26. Quatrefages, Human Species (n. 23), p. 426.
27. Hirsch, Handbuch (n. 22), 3: 595.

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diseases?28 Why were Asians the predominant victims of beriberi? How

could evolutionary history explain racial proclivities for leprosy? It was
difficult, if not impossible, to render coherent the masses of anecdotal
observations on the racial distribution of disease. Clearly racial endow-
ment - although important - was not the sole arbiter of predisposition
and immunity. Nevertheless, most explanations (and speculations) con-
tinued to presume some racial essence, or constitution, that was more or
less resistant to some diseases, and liable to others. The process was not
perfect, though - and certainly not unalloyed - so no one was surprised
that some mismatches remained to puzzle the experts.
What explains this search for racial explanations of disease liability?
Physicians have always been responsible for devising compelling narra-
tives that account for human difference at the same time that they frame
the knowledge of disease.29 And in a colonial context, race was the
obvious explanatory salient. Racial typologies of resistance and suscepti-
bility appealed especially to foreigners who felt themselves wilting in the
tropical humidity (and often more than wilting, as the medical records
indicated time and time again).30 Medical theory made sense of the lay
experience of illness in the tropics: it was a cognitive framework that all
colonizers could share. But these occasions of mutual affirmation de-
pended also on a vast ignorance of the actual distribution of disease in

colonial populations. Ewart, writing about tuberculosis in India, was not
alone when he admitted that he had very little information about disease
patterns in the local community. He rarely was permitted to perform
postmortems on Indians; and he suspected that few of his colleagues,
even in the 1850s, could use a stethoscope competently - and if they
could, they applied it preferentially to European chests. No wonder,
then, that Indians appeared relatively exempt from consumption.31 As
Western epidemiological research developed and clinical experience
accumulated, the edifice of racial immunity would become increasingly
shaky.
Expectations of racial vulnerability animated the colonial obsession
28. R. Clarke, quoted in W. Z. Ripley, "Acclimatization," Pop. Sci. Monthly , 1895, 48 : 671.
(Ripley was then a professor of sociology and economics at MIT.)
29. Rosenberg makes this point in "Bitter Fruit" (n. 8).
30. See Curtin, Death f/y Migration (n. 19). Curtin points out that the death rates for
whites in many tropical colonies had been falling since the 1850s, long before any major
revision of theories of racial immunity.
31. Ewart, "Phthisis in India" (n. 21), p. 157. Of course, many commentators extrapo-
lated from the resistance of many West African populations to malaria, a result of the
prevalence of the sickle cell trait (though not then recognized as such).

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with the health status of depleted whites, and legitimated the neglect of
local populations. Some physicans had proposed drastic solutions to the
mismatch of European immunities and tropical disease environments. A
few had even suggested marriage with local races in order to breed a new,
preadapted "type." Bordier, in his treatise on scientific colonization,
concluded that any hope for French settlement in Indochina depended
on intermarriage.32 Paul Topinard agreed that mixed races resisted the
ill-effects of regional dislocation better than pure Europeans.33 But En-
glish and American authorities generally were less than enthusiastic
about these French theories. W. Z. Ripley in 1895 pointed out that "a
cross between races is too often apt to be a weakling, sharing in the
pathological predispositions of each of its parent stocks, while enjoying
but imperfectly each of their several immunities."34 Others claimed,
more generally, that mixed races lacked "vitality" and might, indeed,
become infertile after several generations. But reproduction was not the
only way to gain access to an adapted race's constitutional strengths.
Thus S. P. Desmartis, in 1859, had advocated inoculating British troops in
India with what he called "Hindoo blood"; James Hunt, at the meeting of
the British Association for the Advancement of Science in 1861, thought
Desmartis's plan was worth trying - but nothing practical was done about
it.35 And yet the idea kept circulating. In 1891, Bordier - still doggedly
seeking a physiological solution - wanted to transfuse the blood of Afri-
cans into "non-acclimated whites" before they left for tropical countries,
to protect them against yellow fever.36 And in the same decade Albert
Ashmead proposed inoculating a "Caucasian" with the blood of a Japa-
nese apparently racially exempt from scarlet fever.37
In the Philippines, such racial mixing was never recommended by the
surgeon-general. If American immunity was disordered and inappropri-
ate in the Islands, then it should be bolstered through regimen, not
32. Bordier, Géographie médicale (n. 25), p. 39.

33. Paul Topinard, Eléments d'anthropologie générale (Paris: A. Delahaye et E. Lecrosnier,
1885), p. 204.
34. Ripley, "Acclimatization" (n. 28), p. 671.
35. S. P. Desmartis, Quelques mots sur le prophylaxis (Paris, 1859), quoted in James Hunt,
"On Ethnoclimatology or the Acclimatization of Man," Proceedings of the British Association for
the Advancement of Science, 1861 (London: James Murray, 1862), p. 143.
36. Bordier, cited in "Injections of the Blood of Negroes in Yellow Fever," Med. Rec., 14
November 1891, 40: 615.
37. Albert S. Ashmead, "A Claim of Priority: Attempt to Communicate Artificial Immu-
nity, "/AMA, 1892, 18: 381. Ashmead collated many accounts of racial immunities in "Racial
Immunity and Inoculation, and Secular Restriction of Certain Diseases to Particular Locali-
ties before Commerce Disseminated Them," Med. Rec., 16 April 1892, 41: 430-34.

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blood. A hereditary predisposition to tropical disease could be mitigated

if the foreigner obeyed the rules of personal hygiene that had prolifer-
ated over the past century. Colonial physicians routinely dispensed ad-
vice on diet, exercise, clothing, and personal conduct. Clearly, if an
American soldier was to withstand the tropics, his "habits, his work, his
food, his clothing, must be rationally adapted to his habitat."38 The basic
precepts of tropical hygiene were simple enough: avoid the sun; stay
cool; eat lightly; drink alcohol in moderation, or not at all. In Major
Mason's experience, for instance, "errors of diet, abuse of alcoholics,
chilling after overheating, especially at night, excessive fatigue, and the
use of the heavy cartridge belt" had all been "powerful predisposing
factors" to invaliding and death in the tropics.39 Although the precise
stipulations varied considerably, they had in common the goal of sup-
porting a manifestly inadequate white immunity, and the effect of regu-
lating the social life of subordinate colonizers.
But if this ceaseless struggle against tropical nature should begin to
fail, one could always flee to the hills. Americans in the Philippines
counted themselves fortunate in having access to Baguio, a town in the
mountains of Luzon, "a rolling country filled with groves of pine trees
and grass, in which the temperature rarely goes below 40 degrees and
never goes above 80 degrees in the shade."40 W. Cameron Forbes, a
governor-general of the Islands, regarded Baguio as "a place to which
people exhausted or debilitated by their sojourn in the heat below may
come and renew their strength and vigor and increase the number of
38. Hamilton Stone, "Our Troops in the Tropics - From the Surgeon's Standpoint,"
[MSI, 1900, 26: 361.
39. Mason, "Notes" (n. 17), p. 309. Hamilton Stone declared: "Given an enlisted man of
average strength and intelligence who lives in clean government quarters, eating the
ration, drinking boiled water, who is particular as to his personal cleanliness, who wears and
frequently changes his underwear, who keeps good hours, who has neither alcoholic,
venereal nor tobacco excesses, who uses his best judgement and the surgeon's advice in
satisfying his passions, who avoids the filthy places in the cities, and who is blessed with a
detachment commander who conscientiously looks after the interests of his men, and I
guarantee to him in the tropics a health record equal to my own" ("Our Troops in the
Tropics" [n. 38], p. 365).
40. Report of the Secretary of War on the Philippines, in Rupori of the Philippine
Commission Lo lhe President, 1907 (Washington, D.C.: Government Printing Office, 1908), 3:
287. See also Dean C. Worcester, The Philippines Past and Present (New York: Macmillan,
1930), pp. 358-87. Recourse to hill stations had long been popular in most tropical
colonies. See, for instance, Norman Chevers, "A Brief Review of the Means of Preserving
the Health of European Soldiers in India," Indian Ann. Med. Sci., 1859, 12: 577-812; and J.
Collins, "Effects of the Climate of the Darjeeling Hills on the Constitution of Europeans,"
ibid., 1860, 13: 1-8. Dane Kennedy has described this medical prescription in "Perils of the
Midday Sun" (n. 13).

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their red corpuscles."41 He helped establish a country club there, which

boasted a golf course and a polo field. Fred Atkinson praised this "sum
mer resort for the recuperation of those government officials who from
the effects of the climate become run down."42 When Edith Moses, th
wife of the secretary of public instruction, was sent to Baguio during the
1902 cholera epidemic, she immediately felt healthier, and more secure.
She realized she was "forgetting all about microbes, dust, servants and
dinner parties. I have not thought of a cholera germ since yesterday.
Even the doctor's wife has forgotten to ask if the plates are clean mor
than twice during a meal."43 Dean Worcester, the secretary of the interior,
also was convinced that the "delightful coolness and bracing air afford
heavenly relief to jangling nerves and exhausted bodies, worn out by
overwork and by a too prolonged sojourn in tropical lowlands."44
Yet even as the vulnerability of the white race was repeatedly asserted,
the exemption of Filipinos from local diseases began to be questioned.
With the consolidation of the United States' hold on the archipelago,
and with the interest in developing the "labor power" of the local inhab
itants, it was becoming clear that Filipinos succumbed to disease at least
as often as Americans. A few commentators continued to dismiss con-
cerns about Filipinos' health. Ralph Buckland, for instance, asserted that
they "are attacked by light illnesses of short duration, all of which worry
the sufferers almost to distraction."45 But Mary H. Fee could not help but
notice that her students suffered "from boils and impure blood and
many skin diseases. Consumption is rife, and rheumatism attacks old and
young alike."46 Malaria was common, and when plague and cholera swept
through the Islands, Filipinos were principally affected. The extent of
Filipino illness came as a revelation to Cameron Forbes. When he visited
the new medical school in 1907, Paul Freer showed him a "rather grue-
some dissection," and then "pointed out that as a result of the first one
hundred autopsies they could state positively that the physically diseased
condition of the Filipino was such that he absolutely couldn't do the
41. W. Cameron Forbes, quoted in V. G. Heiser, Annual Report of the Bureau of Health for
the Philippine Islands, July 1912-June 1913 (Manila: Bureau of Printing, 1913), File 3465/59,
p. 63, RG 350, USNA.
42. Fred W. Atkinson, The Philippine Islands (Boston: Ginn, 1905), p. 153.
43. Edith Moses, Unofficial Letters of an Official's Wife (New York: D. Appleton, 1908), pp.
239-40.
44. Worcester, Philippines (n. 40), p. 379.

45. Ralph Kent Buckland, In the Land of the Filipino (New York: Everywhere Publishing,
1912), p. 231.
46. Mary H. Fee, A Woman's Impressions of the Philippines (Chicago: A. C. McClurg, 1910),
p. 236.

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work that a well man could."47 Forbes found this information disconcert-
ing.
Clearly, racial resistance was less absolute than anyone had thought.
William Freer gave a social explanation for the peculiar Filipino suscepti-
bility to local disease: with the decline in agriculture during the war, most
people were poorly fed, "and when attacked by disease they succumb
quickly because, already weakened by hunger, their power of resistance is
not sufficient to withstand the ravages of fever."48 Others were quick to
attribute this newly recognized liability to personal failings. For if the
locals were acquiring diseases that their race presumably had hitherto
resisted, then they must surely have become very depraved indeed. After
all, Filipinos should have had a long process of adaptation on their side,
unlike any whites who succumbed; Americans, in contrast, were more
likely the innocent victims of immigration. To "Señora Blanca" (and
others), finding tropical disease amongst the Filipinos meant that their
charges must truly be wallowing in filth, enough to overcome their
natural resistance. "And I looked at them," she recalled, "saying to
myself, as I often did, 'You poor miserable creatures, utterly neglected,
utterly ignorant and degraded'. . . . No wonder that the diseased, the
deformed, the blind, the one-toed, the twelve-toed, and monstrous parts
and organs are the rule rather than the exception"; she wanted to "dip
them into some cleansing caldron," but resisted the impulse, for "charity
begins at home."49 The combination of somatic anxiety, cultural self-
satisfaction, and moral insensibility is typical. But such quiescence could
be maintained only so long as the increasingly evident disease burden of
Filipinos was solely their burden - so long as it did not appear to threaten
the health of whites. Thus neglect was soon transformed into medical
activism.
Through the Lens of a Microscope

Toward the end of the nineteenth century, immunity came to be viewed
less as some innate, indeterminate force and more as a specific, acquired
faculty of the individual organism. This rising interest in the mechanism
of resistance to specific diseases paralleled a growing obsession with
tracking down and isolating the microbial cause of each condition. Both
trends point to the emergence of the laboratory as the premier location
47. W. Cameron Forbes, "Journals," 19 October 1907, 2: 324-25, File fMS Am 1365,
Forbes Papers, Houghton Library, Harvard University, Cambridge, Mass.
48. W. B. Freer, Philippine, Experiences (n. 12), p. 144.
49. Conger, Ohio Woman (n. 18), pp. 159, 51, 148.

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for the production and ordering of medical knowledge. During this

period, epidemiological inquiry and clinical observation came to exert a
decreasing influence on the shape of etiological reasoning and immuno-
logical thought. To understand disease one needed a laboratory - or at
least a microscope.50
Louis Pasteur was not particularly interested in documenting the
inherited natural immunities of individuals or races; for him, it was the
more dynamic character of acquired immunity that mattered. He pro-
posed that individuals acquired a resistance to a specific type of pathogen
when the germ had consumed all its necessary substrate within the body.
According to this depletion theory, humans were just another "milieu de
culture," and germs might die of inanition.51 Other investigators claimed
that resistance was acquired when the products of bacterial metabolism
became concentrated enough to poison the pathogen. This retention
theory, popular through the 1880s, suggested that bacteria would eventu-
ally die from autointoxication. The bacterial poisons would presumably
protect the individual from subsequent attack.52
Although both depletionist and retentionist theories appealed to
physicians trained to understand physiological processes in terms of the
regulation of intake and excretion, a more active and mechanistic under-
standing of immunity had edged these conventional schemata aside by
the end of the century. As early as 1881, George M. Sternberg, later the
surgeon-general of the United States during the Spanish-American War,
had suggested that "the vital resisting power of the protoplasm" could be
educated - and that this acquired transformation was inherited by the
cells of the individual (if not the race); thus he argued that "the protec-
tion from yellow fever resulting from acclimation - if indeed there is
50. On the history of immunology, see Anne Marie Moulin, Le dernier langage de la
medicine: Histoire de l'immunologie de Pasteur au Sida (Paris: P.U.F., 1991), esp. pp. 24-36; and
Arthur M. Silverstein, A History oj Immunology (San Diego: Academic Press, 1989). (Warwick
Anderson, Myles Jackson, and Barbara Gutmann Rosenkrantz have recently argued that
the history of immunology should include now-discredited research interests such as the
study of racial immunity: "Toward an Unnatural History of Immunology," J. Hist. Biol. ,
1994, 27: 575-94). On the expansion of the laboratory during this period, see Bruno
Latour, Th* Pasteurization of France, trans. Alan Sheridan and John Law (Cambridge, Mass.:
Harvard University Press, 1988).
51. Louis Pasteur, Oeuvres (le Pasteur, ed. Pasteur Valéry-Radot, 7 vols. (Paris: Masson,
1922-39), 6: 315. For a criticism of Pasteur that anticipates Metchnikoff, see G. M. Sternberg,
"What Is the Explanation of the Protection from Subsequent Attacks, Resulting from an
Attack of Certain Diseases, and of the Protective Influence of Vaccination against Small-
pox," Amer. J. Med. Sci., 1881, 18: 373-78.
52. M. von Nencki, "Uber die Lebensfähigkeit der Spaltpilze bei fehlendem SauenstofF,"
/. Prakl. Chem., May 1879, 9: 337-58; cited in Silverstein, History of Immunology (n. 50), p. 19.

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such a thing as acclimation independent of an attack of the disease -

seems to be a tolerance acquired by repeated exposure to the poison in
quantities not sufficient to produce an attack."58 Accordingly, Sternberg
placed adaptation to an alien environment, inoculation by an attenuated
virus, and an attack of a specific disease all in the same category. The
power of resistance to the newly discovered pathological organisms seemed
to depend more and more on previous, often asymptomatic, attacks of
the disease in an individual, and ever less on some racial endowment.
In 1884, Elie Metchnikoff described phagocytosis: he showed wander-
ing white cells taking up, and digesting, foreign microorganisms.54 Many
took this to imply that immunity could be reduced to the activity of white
cells. About the same time, Hans Buchner suggested that "reactive
changes" in an individual's "integral cells" provided protection from
subsequent incursions of the offending microbe.55 In 1890, Emil von
Behring and Shibasaburo Kitasato used a serum to render animals im-
mune to tetanus, and so set off a search for the specific antibodies to
disease organisms.56 That same year, E. H. Hankin isolated a reactive,
defensive "proteid," a globulin, from the spleen and lymph nodes: Hankin
distinguished a "chemical immunity" (from products of the life of
microbes) from a "vaccinal immunity" (from the injection of attenuated
virus) .57 Studies of immunity had become more reductionist and precisely
interventionist, and there was a general expectation that something
53. Sternberg, "Explanation of Protection" (n. 51), p. 377.

54. Elie Metchnikoff, "Ueber eine Sprosspilzkrankeit des Daphnien . . . ," Virchows Arch.,
1884, 96.š 177-95; translated as "A Disease of Daphnia Caused by a Yeast: A Contribution to
the Theory of Phagocytes as Agents for Attack on Disease-Causing Organisms," in Milestones
in Microbiology , ed. Thomas D. Brock (Englewood Cliffs, N.J.: Prentice Hall, 1961), pp. 132-
38. See also E. Metchnikoff, Lectures on the Comparative Pathology of Inflammation (London:
Kegan Paul, Trench, Trubner, 1893) . For a discussion of the intellectual context, see Alfred
I. Tauber and Leon Chernyak, Metchnikoff and the Ońgins of Immunology: From Metaphor to
Theory (New York: Oxford University Press, 1991).
55. H. Büchner, Eine neue Theorie über Erzielung von Immunitätgegen Infectionskrankheiten
(Munich: Oldenbourg, 1883).
56. E. von Behring and S. Kitasato, "Ueber das Zustandekommen der Diphtherie-
Immunitat und der Tetanus-Immunität bei Thieren," Deutsche med. Wochenschr., 1890, 16:
1113-14; translated as "The Mechanism of Immunity in Animals to Diphtheria and Teta-
nus," in Brock, Milestones in Microbiology (n. 54), pp. 138-40.
57. E. H. Hankin, "Report on the Conflict between the Organism and the Microbe,"
Bńt. Med. J., 12July 1890, 2: 65-68; idem, "Cures for Infectious Diseases," ibid., 28 February
1891, 1: 456-57. For the American reception of this research, see A. C. Abbot, "A Review of
Some of the More Important Contributions to Our Knowledge upon Immunity and
Infection," Med. News , 1891, 59: 534-40; and G. W. Finley, "Thoughts on Vital Resistance to
Disease - Immunity, Natural and Acquired," fAMA, 1896, 26: 211-13.

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might be done to supplement an individual's inadequate immune re-

sponse to disease.
As immunity appeared more a specific reaction to an exciting cause -
and a reaction modulated within the individual's lifetime - so it seemed
less a fixed racial characteristic. A limited role was nevertheless reserved
for inheritance. Thus F. G. Clemow, in his Geography of Disease, expressed

the common opinion that a physiological immunity acquired to certain
germs or poisons might become "not merely an individual immunity, but
a racial immunity, transmissible from generation to generation, and truly
permanent so long as man shall continue to live in an atmosphere of
these particular organisms."58 Kenneth MacLeod argued that "the native
immunity in India, though not absolute, is undoubted; its cause has not
been satisfactorily ascertained. It has been attributed to minute dosage of
the contagium, to protection conferred by attack during infancy and
childhood, and to racial resistance acquired in the course of generations
through both these influences."59 Sternberg, too, in the first edition of
Infection and Immunity, published in 1903, still conceded that "the negro
race is less susceptible to yellow fever and the malarial fevers than the
white race; on the other hand, smallpox is exceptionally fatal among
negroes and dark-skinned races"; but he felt that even if this was a true
racial immunity, it had only a relative value, since starvation and other
"devitalizing agencies" could reduce the "quantity of defensive proteids,"
or the defenses might yet be overwhelmed by vast quantities of germs.60
During this transitional period, evidence of native disease carriage was
crucial in reshaping the medical understanding of racial immunity. From
the moment they arrived in the Philippines, American public health
officers dedicated themselves to the identification and isolation of the
region's portable microbial pathogens. The transmission of these germs
could be traced ever more efficiently and persuasively through the region's
insect and human populations. As a result, just when it became common
knowledge that a great many Filipinos were manifestly unwell, physicians
in the archipelago were able to reveal a more widespread, and hitherto
disguised, disease carriage among even the apparently "healthy natives":
58. F. G. Clemow, The Geography of Disease (Cambridge: Cambridge University Press,

1903), p. 5. For the most complete compendium of supposed racial immunities, see Ripley,
"Acclimatization" (n. 28).
59. MacLeod, "Scope and Aim" (n. 24), p. 295.
60. George M. Sternberg, Infection and Immunity, with Special Reference to the Prevention of
Infectious Diseases (New York: G. P. Putnam's Sons, 1903), p. 24. Reference to racial
immunity is very rare by the 1920s, but see Ralph W. Mendelson, "Natural Immunity to
Infection and Resistance to Disease, as Exhibited by the Oriental, with Special Reference to
Siamese," Philippine J. Sci., 1923, 22: 115-23.

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malarial organisms could now be found "commonly" in the blood of

lowland Filipinos, especially children.61 Weston Chamberlain reported
that 92.5 percent of Igorots showed enteric parasites in their stools,62
while 95.9 percent of 1,000 Filipinos were infected, though usually
asymptomatic. R E. Garrison claimed he had discovered "one of the most
striking instances in the history of medicine of a population almost
universally infested with animal parasites."63 In the 1915 cholera out-
break, Edward Lyman Munson, using "laboratory facilities in the making
of bacteriological diagnoses on a large scale," found that vibrio carriers
"would seem to be not only the most numerous but the most insidious
and dangerous sources of infection."64
It was during this period that Patrick Manson, too, changed his mind
about liability to typhoid: in 1914 he observed that "natives" no longer
seemed to enjoy an immunity, and the disease was "by no means uncom-
mon among all classes."65 In 1915, Victor C. Vaughan, in his book Infec-
tion and Immunity , reported that "variations in susceptibility among the
races is not so great as was once believed": more thorough research had
revealed that malaria was "highly prevalent" among Africans; and if there
was any immunity to yellöw fever, it was acquired through light exposure
in infancy.66 In 1920, Aldo Castellani and Albert Chalmers concluded
that native races at best were "partially immune hosts [who] act as
61. P. E. Garrison et al., "Medical Survey of Taytay," PhilipfńneJ. Sci., 1909, 4B: 257-68.
On the development of the idea of carrier status in the 1890s by Robert Koch and William
H. Park, see Charles-Edward A. Winslow, The Conquest of Epidemic Disease: A Chapter in the
History of Ideas (Madison: University of Wisconsin Press, 1980), chap. 16, pp. 337-46.
62. Weston P. Chamberlain et al., "Examinations of Stools and Blood among the Igorots
at Baguio, Philippine Islands," Philippine J. Sci., 1910, 521:505-14.
63. P. E. Garrison, "The Prevalence and Distribution of the Animal Parasites of Man in
the Philippine Islands, with a Consideration of Their Possible Influence upon Public
Health," Philippine J. Sci., 1908, 3B: 205.
64. E. L. Munson, "Cholera Carriers in Relation to Cholera Control," Philippine J. Sci.,
1915, 10B: 5, 9. See also Otto Shöbl, "Observations Concerning Cholera Carriers," ibid., pp.
11-17.
65. Patrick Manson, Tropical Diseases: A Manual of the Diseases of Warm Climates, 5th ed.
(London: Cassell, 1914), p. 368.
66. V. C. Vaughan, Infection and Immunity (Chicago: AMA, 1915), p. 179. See also idem,
"The Principles of Immunity and Cure in the Infectious Diseases," Transactions of the Pan-
American Medical Congress, Washington, 1893, 2 vols. (Washington, D.C.: Government Print-
ing Office, 1895), 1: 152-65. Hans Zinsser discusses the limitations of the immunities of
race in Infection and Resistance: An Exposition of the Biological Phenomena Underlying the
Occurrence of Infection and the Recovery of the Animal Body from Infectious Disease, 2nd ed. (New
York: Macmillan, 1922), chap. 3; he concludes, rather equivocally, that "it is by no means
certain that there may not be a very slight, but through generations gradually accumulat-
ing, inheritance of immunity" (p. 58).

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reservoirs or carriers," enabling "the parasite to complete its life-cycle

without producing marked pathological changes in the host."67 A local
population, then, possessed at best only a limited clinical resistance to
local disease: just enough to render a large number of them carriers -
not victims- of the biological pathogens to which alien white colonists
were still uniquely vulnerable.
In identifying Filipinos as physical reservoirs for tropical disease or-
ganisms, and insects as their typical vectors, medical authorities in the
islands were recognizing that protection for susceptible Americans woul
require a more rigorous surveillance and regulation of contact with
human and insect populations. Filipinos were armed - only to be dis-
armed - with a weapon more insidious than any rifle. "The Filipinos ar
never free from contagious diseases of one form or another," warned Lt
Col. Henry Lippincott, "and we can never be sure that they are no
bringing infection into our midst."68 Being of a tropical race no longer
necessarily conferred a complete immunity to tropical disease: more
often, it was taken to imply a complicity in the transmission of loca
pathogens. No matter how clean the Filipinos might look or smell, the
were still to be distrusted. "The natives do not keep their hands clean,
although it is said their bodies are washed daily," wrote Surgeon Joseph
A. Guthrie; "at all events, they are not microscopically clean."69 Just as the
alien environment itself appeared less of a general threat to Americans
than ever before, the foreigners faced sickness and death from contac
with a panoply of tropical fauna, much of it invisible to them, but all of it
now readily signified by the presence of insects and Filipinos.
Cultural Liabilities of Race
If previous subclinical exposure of individuals - or the adaptation of the

race's ancestors - had fashioned Filipinos as potential reservoirs of tropi-
cal pathogens, to the Americans it seemed that unhygienic racial custom
and habit would ensure that this potential was realized. An appreciation
of supposedly insidious cultural practices, especially those concerning
defecation and eating, began to supplement the emerging biological
understanding of tropical disease acquisition and transmission. While
67. Aldo Castellani and Albert Chalmers, Manual of Tropical Medicine (New York:
Balliere, Tindall and Cox, 1920), p. 115.
68. H. Lippincott to G. M. Sternberg, 31 March 1899, File 57592/A, p. 7, RG 112-E26,
USNA.
69. Joseph A. Guthrie, "Some Observations while in the Philippines," JAMS , 1903, 13:
148.

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the sanitary practices of Filipinos had long been regarded as primitive

and foolish, these racial customs took on a new and frightening signifi-
cance. Before, these patterns of behavior had simply explained the
unexpectedly vitiated physiological immunity of the race; now, they
suggested a source of danger for the utterly unprepared white immune
system. Once merely causes for American self-congratulation, Filipino
customs and habits increasingly prompted thoughts of impurity and
danger. That Filipinos appeared to flout the rules of hygienic behavior
was becoming more than a formalistic cultural distinction, or an excuse
for administrative scorn and neglect; it now appeared that they were
failing to take precautions against acquiring or distributing the disease
organisms that were most virulent for whites.70
To James A. LeRoy, the Filipino's "shocking ignorance of sanitary
principles as regards his house and community" was still chiefly a prob-
lem for the Filipino - it accounted for the evident impairment of the
race's expected immunity to local pathogens.71 Although these unhealthy
habits explained, perhaps, the deficit in Filipino labor power, and at-
tested to a racial immaturity, they caused LeRoy no anxiety. But other
Americans were beginning to feel rather more physically threatened by
the proximity of diseased Filipino bodies and "disease-dealing" Filipino
behavior. Edith Moses found that rendering her house "sanitary" re-
quired "continuous oversight" of "twelve ignorant, superstitious Orien-
tals"; to prevent the spread of germs, she "hosed off the 'China' boys and
Filipinos with disinfectants. I made their eyes stick out with fright by
describing a cholera germ. . . . They go about with their mouths shut
tight, scarcely daring to open them lest a microbe pops into them."72 Few
accounts of domestic colonial life during this period fail to discuss the
insidious behavior and embodiment of servants.
Ideally, the new research on the individual immune response to spe-

cific disease would soon be harnessed to confer on everyone an appropri-
ate stock of antibodies and white cells. Paul Freer extolled experiments
based on the theory that "a natural immunity may be increased or one
which is scarcely existent may be rendered apparent and protective by
the introduction of cells, or the products of these cells."73 In pursuit of
70. See Warwick Anderson, "Excremental Colonialism: Public Health and the Poetics of
Pollution," Cńl. Inquiry , 1995, 21: 640-69.
71. LeRoy, Philippine Life (n. 12), p. 54.
72. Moses, Unofficial Letters (n. 43), p. 222.
73. P. Freer, "Modern Theories of Immunity" (n. 11), p. 75. For a typically confident
account of the field's potential, see W. M. Haffkine, "On Preventive Inoculation,"/ Trop.
Med., 1899, 2: 322-27.

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this goal, the serum laboratories of the Bureau of Science produced an

enormous variety of trial vaccines - but their use remained limited.
Whether for technical, financial, or administrative reasons, the health
authorities continued to rely on stipulations of personal hygiene to
control the transmission of pathogens, rather than attempting to deliver
an automatic immunological protection that might render such rules of
proper conduct medically unnecessary. Until 1915, smallpox vaccination
was the only large-scale program of biological protection in the archi-
pelago.
In the absence of an immunity conferred by biological products,
health officials expressed repeatedly, and bluntly, the need for rigorous
social control in the Philippines. "As long as the Oriental was allowed to
remain disease-ridden," recalled Dr. Victor G. Heiser, "he was a constant
threat to the Occidental who clung to the idea that he could keep himself
healthy in a small, disease-ringed circle"; furthermore, the director of the
Bureau of Health continued, since "any successful commercial develop-
ment" of the islands would require fit Filipino labor, it should be "evident
to employers of colonial labor that human life had a direct monetary
value."74 If "the weak puny bodies" were to be "transformed into a
healthy, vigorous race,"75 the Oriental would have to be "sanitated" -
regardless of the obstacles. Thus medical regulation of the personal
conduct and social life of Filipinos would have multiple benefits. While
"former custom had been to 'civilize' native populations with the aid of a
whiskey bottle, the Bible, and the Krag," medical authorities in the
Islands would try modern techniques of sanitary education and supervi-
sion.76
While the Americans in the Philippines liked to imagine themselves as
far more scientific and progressive than other imperialists, they were not
alone in giving new emphasis to the control of personal conduct. Ken-
neth MacLeod of the Indian Medical Service recently had observed that
while in India natives appear to be readily susceptible to the infection of

plague, Europeans, though not absolutely insusceptible, exhibit a compara-
74. Victor G. Heiser, An American Doctor's Odyssey: Adventures in Forty-Five Countries (New
York: W. W. Norton, 1936), p. 37. In view of such marked similarities between tropical
hygiene and occupational medicine, Heiser's subsequent career with the National Associa-
tion of Manufacturers has a certain logic. See Warwick Anderson, "Victor G. Heiser,"
American National Biography (forthcoming).
75. H. L. Kneedler to Woodrow Wilson, 13 March 1913, File 2394-35, RG 350, USNA.
Kneedler was a physician who had practiced in the Philippines since the American occupa-
tion.
76. Heiser, American Doctor's Odyssey (n. 74), p. 47.

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tive immunity. . . . This immunity is doubtless a sanitary immunity, due to a

purer personal, domestic and social life, and perhaps to circumstances and
habits rendering admission of infection less easy.77
Examples of the increasing weight of culture in explanations of an

individual's disease susceptibility can readily be multiplied. C. W. Daniels
noted in British Guiana that
It is not to be contended that race perse protects from these parasites [filariae] ,
as it is well known that no race is immune, and that East Indians can be, under
favourable conditions, frequently attacked. We have therefore to inquire what
difference in the racial habits is responsible for the different proportions of
persons who are attacked living under the same climatic conditions.78
Martin Hahn, like many others, thought he had the answer: any apparent
racial difference in disease susceptibility was simply because "one race
lives more hygienically and more intelligently than the other."79 Accord-
ingly, the control of personal conduct and social interaction, whether
internalized or imposed, seemed everywhere to offer a new prospect of
limiting disease transmission.
Starting in the early 1900s, and gaining pace after 1910, health offi-
cials in the Philippines urged all races to acquire this "sanitary immu-
nity" - Filipinos in order to supplement the partial physiological immu-
nity that permitted disease carriage, Americans in order to build up their
profoundly lacking clinical resistance. If the supposedly unsanitary "cus-
toms and habits" of Filipinos could be suppressed or modified, then the
race might reduce its acquisition and transmission of disease - be forc-
ibly rendered, in effect, more immune; this would presumably lead to
improvements in health status and labor productivity, as well as eliminat-
ing a biological threat to foreigners. Americans, in contrast, still required
the old-fashioned supportive regimens that would build up - in some
vague way - their powers of resistance.80 Thus the road up to the rolling
hills of Baguio would stay busy for some years.
77. MacLeod, "Scope and Aim" (n. 24), p. 296.

78. C. W. Daniels, "Filariae and Filarial Disease in British Guiana,"/ Trop. Med., 1898, 1:
15.
79. Martin Hahn in Kolle und Wassermann 's Handbuch , vol. 1; quoted in Vaughan,
Infection and Immunity (n. 66), p. 179.
80. The persistence of older preventive measures - especially those which had some
experiential validation for patients and physicians alike - is similar to the therapeutic
conservatism described in John Harley Warner, The Therapeutic Perspective: Medical Practice,
Knowledge, and Identity in America, 1820-1885 (Cambridge, Mass.: Harvard University Press,
1986).

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In developing programs to modify Filipino customs and habits (whether

through education or regulation), the Bureau of Health attempted to
inculcate a distrust of the body and its products, a dread of personal
contact, and a respect for American sanitary authority.81 Colonial au
thorities targeted toilet practices, food handling, dietary customs, hou
ing design; they rebuilt the markets, using the more hygienic concret
and suppressed the unsanitary fiestas; they assumed the power to exam
ine Filipinos at random, and to disinfect, fumigate, and medicate at wil
The new methods of disease prevention sanctioned, as never before i
the archipelago, the reformation of everyday life and personal knowl
edge. The crusade for "cleanliness" sharpened social divisions (and
legitimated racial categories) in the Philippines, further separating colo
nized from colonizers, the sick from the healthy, native disease carrier
from nonimmune foreigners. To have engaged in this enterprise durin
the first years of American occupation would have been futile: the ne
colonial authority was not yet organized for persuasion, and its emissaries
were too few to develop a rigorous apparatus of inspection. The exten-
sion of control over the archipelago soon permitted such intervention
which in itself would further ramify colonial authority. And clearly th
policy of education and supervision had other advantages. Its goal of
nurturing self-control among Filipinos offered both to absolve the au
thorities from major environmental and social reform (so promising th
great financial savings that were never far from a colonial administrator's
thoughts) and to accord in the most progressive style with the new
science of disease causation, transmission, and acquisition.
Most Americans in the Philippines believed that it would take many
generations to replace the traditional customs and habits - apparentl
almost as characteristic of the race as its pigmentation - with a mor
hygienically ordered American way of life. In general, colonial physicians
held to an implicit Lamarckian dynamic, arguing that if Filipinos coul
eventually acquire the sanitary habits characteristic of more advance
races, then these might, over generations, be heritable.82 But even th
relatively optimistic supposition allowed for considerable variation in th
time-frame of any change. Observing the general failure to inculcat
81. These methods are described in detail in Warwick Anderson, "Colonial Pathologies
American Medicine in the Philippines, 1898-1920" (Ph.D. dissertation, University of Pen
sylvania, 1992), chap. 3. See also Nicholas Thomas, "Sanitation and Seeing: The Creation
State Power in Early Colonial Fiji," Comp. Stud. Soc. Hist., 1990, 32: 149-70.
82. On neo-Lamarckism during this period, see Peter J. Bowler, Evolution: The History o
an Idea (Berkeley: University of California Press, 1984), pp. 243-53; and George W
Stocking, Jr., "Lamarckianism in American Social Science, 1890-1915," in Race, Culture, an
Evolution: Essays in the History of Anthropology (New York: Free Press, 1968), pp. 234-69. Afte

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American excretory habits in Filipinos, Allan McLaughlin lamented that

"it requires a long time completely to change the habits of a people and it
will probably require another generation to complete the work."83 When
the "native custom" of eating with one's fingers was not easily suppressed,
Heiser saw "years of discouraging struggle ahead of us before they can be
broken of so fixed a habit, the menace of which as yet is entirely beyond
their comprehension."84 Dr. Thomas W.Jackson, having lived "surrounded
by Filipino neighbors" in a provincial town, where it had been "impos-
sible to avoid an intimate knowledge of their manner of life," endorsed
the general pessimism.85 The first seven years of American control had
seen few improvements in the condition of the market, the disposal of
garbage, and in "such personal habits as defecation, urination, expecto-
ration, and eating with the fingers"; Jackson concluded that the teach-
ings of sanitary principles might be the "necessary and preliminary
foundation" for disease prevention, but the introduction of such sanitary
teachings "into the home by schoolchildren must be a slow and tedious
process, unlikely to produce results within a generation."86 Clearly an
American medical administration would be required for many more
decades, until the Filipino way of life was properly reformed. And until
educational programs elevated the local sanitary culture, the colonial
authorities would ensure that Filipinos were repeatedly inspected, iso-
lated, and doused with disinfectant.
Perhaps most revealing of the new tropical hygiene was the concern
with identifying apparently "healthy natives" as a source of disease. Fili-
pinos once were thought to be completely immune from typhoid; now
their race was prima facie evidence of germ carriage. When the disease
broke out at Camp Eldridge between July and October 1909, the post
surgeon attempted to determine the source of the infection. The first
1910, Franz Boas challenged the physical anthropologists' argument that cultural achieve-
ments were the result of racial composition, but his influence clearly did not extend to the
Philippines during this period. See Franz Boas, Mind of Primitive Man, rev. ed. (New York:
Macmillan, 1938 [1911]). His work reflects the growing appreciation of the historical
shaping of culture among populations. See also George W. Stocking, Jr., "Franz Boas and
the Culture Concept in Historical Perspective," in Race, Culture, and Evolution (n. 82), pp.
195-233; and Stephen Horigan, Nature and Culture in Western Discourses (New York: Routledge,
1988).
83. Allan J. MacLaughlan, "The Suppression of a Cholera Epidemic in Manila," Philip-
pine J. Sci., 1909, 4B: 55.
84. Victor G. Heiser, "Unsolved Health Problems Peculiar to the Philippines," Philippine
/. Sci, 1910, 5: 176.
85. Thomas W.Jackson, "Sanitary Conditions and Needs in Provincial Towns," Philippine
J. Sci, 1908, 3tì: 432.
86. Ibid., pp. 435-36.

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suspects were nearby "natives," but the president of the local Board of
Health, "an American resident of the town since 1902 and a physician,"
knew of no recent cases of typhoid in Los Baños.87 Attention then turned
to the detection of "one or more typhoid bacillus excretors in the
command" - but all faecal specimens were negative. The post surgeon,
nevertheless, thought it wise to ensure that additional measures "were
taken to prevent the contamination of food from the excreta." Guards
placed at the latrines checked that "all deposits were promptly covered
with a liberal amount of dry earth and that each man washed his hands
after defaecation in a one per cent solution of tricresol." All dishes and
food were screened from flies; drinking water was thoroughly boiled; the
use of raw native vegetables was strictly forbidden; and "two natives
employed in the company as dishwashers were dismissed" - although
producing negative specimens.88 In practice, the term "healthy native"
referred to a deceptive appearance, not to any exemption from disease
carriage. It usually implied a prefix: "apparently."
Physicians continued to magnify the threatening microbial pathology
that lurked within native bodies. Malaria, the most typical of tropical
diseases, provides us with the best example. Wherever microscopy was
undertaken, it revealed that many Filipinos harbored "so-called latent
malaria."89 Charles F. Craig, an industrious surgeon at Fort William
McKinley, sought out the cause of the high incidence of malaria among
enlisted men at the post. His suspicions led him first to examine blood
specimens, taken "somewhat at random," from a number of "natives" in
the nearby town; these indicated "that the same general latent infection
of Filipinos, both children and adults, which has been observed else-
where in the Islands exists in this community": 28 of 45 adult Filipinos,
and 87 of 180 children, had latent infections.90 Craig concluded that "in
view of the well-known proclivity of the native soldiers for sleeping out of
quarters and the convenient location of the native houses which shelter
their wives and children, who take no precautions against mosquitoes, it
is not surprising that latent malaria exists."91 The results had confirmed
87. Chief Surgeon, Philippines Division, to Surgeon General, Washington, D.C., 31

December 1909, File 24508/120, p. 12, RG 112-E26, USNA. See also the "Report on
Typhoid Fever," 30 September 1909, File 68075/73, RG 112-E26.
88. Chief Surgeon to Surgeon General (n. 87), p. 13.
89. Charles F. Craig, "Observations upon Malaria: Latent Infection in Natives of the
Philippine Islands," Philippine J. Sei., 1906, 1: 525.
90. Ibid.
91. Charles F. Craig, "Report," quoted in Chief Surgeon, Philippines Division, to

Surgeon General, Washington, D.C., 7 March 1908, File 24508/38, p. 10, RG 112-E26,
USNA. Similar strictures against the habits of the enlisted men are not made.

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the impression, now common, that "the greatest source of danger to the
white man in a malarial locality lies in the native population, especially in
the native children"; consequently, it would be "futile" to attempt to "rid
any locality of malaria so long as the native element in the question is
neglected."92
Conclusion
No wonder the enthusiasm of Shaler and others for "Negro colonization"

in the Philippines was so evanescent. Gen. G. W. Davis was one of those
who had contemplated "transferring large numbers of this race to the
congenial soil of the Philippines, where they may aid in the development
of the country."93 In the Voice of the Negro , T. Thomas Fortune had argued
that black Americans could best hold up the flag in the new Island
possessions, for, "all in all, the Afro-Americans in the Philippines stand
the climate better and are on terms of better and more helpful under-
standing with the Filipinos than are white Americans."94 But the belief
that black Americans and Filipinos were naturally fitted for the Philip-
pines climate and its disease environment was now more a cause for
concern than an excuse for complacency. Increasingly the old confi-
dence in racial immunities gave way to fears that these races lacked the
proper sanitary character. Indeed, doubts soon surfaced about the African-
Americans' "moral stamina," and their perceived tendency to "fraternize"
92. Craig, "Observations upon Malaria" (n. 89), p. 525. This does not mean that
previously recommended environmental intervention was abandoned. Indeed, mosquito
eradication was still attempted, and buildings and sleeping quarters were screened as never
before. Furthermore, prophylactic quinine was dispensed to Americans in areas where
malaria prevailed. Disease prevention remained pragmatic, but the public health officer's
repertoire was expanded.
93. George W. Davis's April 1902 report is quoted at length in Joseph O. Baylen and
John H. Moore, "Senator John Tyler Morgan and Negro Colonization in the Philippines,
1901-1902," PhyUm , Spring 1968, 24: 65-67. (Davis, responding to the Alabama senator's
colonization scheme, concluded that the plan was inexpedient.)
94. T. Thomas Fortune, "The Filipino," Voice of the Negro, 1904, 1: 93-99, 199-203, 240-
46; quotation on pp. 202-3. (Fortune had been appointed by Roosevelt in November 1902
to investigate labor and race relations in the insular possessions; see E. L. Thornborough,
T. Thomas Fortune: Militant Journalist [Chicago: University of Chicago Press, 1972].) Despite
Fortune's enthusiasm, the U.S. administration seems to have lost interest in the idea by late
1903: see Gatewood, Black Americans (n. 4), p. 317. In favor of voluntary emigration was
W. S. Scarborough, "The Negro and Our New Possessions," Forum , 1901, 34: 341-49; in
opposition, Rienzi B. Lemus, "The Negro and the Philippines," Colored Amer. Mag., 1903, 6:
314-18.

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with "native women."95 Medical officers now pointed out that any natural
affinity for Filipino customs and habits, combined with any minor re
sidual advantage in disease resistance, was likely to produce only mor
carriers of the diseases prevalent in the tropics.
The enthusiasm of tropical physicians for the hunting of microbes,
their preoccupation with tracing the distribution of the "exciting cause
of each disease, can obscure the resilience of hereditarian thought in
medicine. But one finds, on closer inspection, that theories of racial
predisposition continued to suggest the contours for the new disease
maps, even if the lines so described by race have moved. Immunity t
local disease appeared more often to have been acquired by exposure i
childhood. It was more likely to be partial than absolute; and rarely, if
ever, was it inherited through racial descent. Furthermore, the physi-
ological adaptation of local inhabitants to local disease had become, to
aliens at least, a mixed blessing - for it had apparently fashioned
reservoir for the region's population of microbes (many of which were
entirely new to foreigners) . At the same time, the tendency of "primitive
races to acquire, to retain, and to distribute the portable pathogen
seemed far more important than ever before. Although cultural in char
acter, this was regarded - in good pre-Boasian fashion - as a behavioral
predisposition organized fundamentally by racial descent. It was the
essentialized race culture, more than the old notions of distinct racial
physiologies, that in the early twentieth century become a major salien
in the war against tropical disease.
By 1910, American ideals of hygienic behavior, if not actual American
bodies, had been naturalized in the tropics. A confidence in science and
sanitation helped to displace, if not entirely assuage, the alien race's
somatic anxieties. More and more it seemed that the white race, if it
followed universalized stipulations of hygiene, could survive in the trop-
ics without degenerating, and without necessarily contracting the local
diseases. But this consoling order was also a political order, for the new
optimism implied the power to intervene in the most intimate aspects of
private life. If the great modern experiment in racial mobility was to
succeed, Filipinos - even more than the American intruders - would
have to submit to the complete reformation of their personal conduct
and social relations. In magnifying microbes as social actors, American
physicians made Filipino bodies and Filipino behavior, both framed by
adapted racial typologies, the objects of ceaseless medical inspection and
regulation. It was the beginning of modern tropical medicine.
95. Congressional Record, 57th Cong., lstsess., 7 May 1902, p. 5103.

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Immunities of Empire

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Immunities of Empire

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Immunities of Empire: Race, Disease, and the New Tropical Medicine, 1900–1920

Author(s): WARWICK ANDERSON

Stable URL: https://www.jstor.org/stable/44444595

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