Pox (20 page)

A
s Wertenbaker's faith in the southern people grew, his opinion of their local institutions continued to diminish. In February 1900, after more than two years of smallpox work, Wertenbaker sent Surgeon General Wyman a memorandum. Not only did epidemic smallpox continue to plague many of the southern states, but now reports of new outbreaks of mild type smallpox (and, occasionally, its more terrifying ancestor) were reaching Washington from locales in the Middle West, the urban North, and the far West. The epidemics had become a national problem, making a coordinated federal response imperative.

“As matters now stand,” Wertenbaker wrote, “the suppression of the disease is left to individual communities, where action is but rarely taken until after smallpox has made its appearance.” Not only were the present methods expensive, but they allowed smallpox to spread endlessly from one community to another. “It is only by a general concerted action, embracing all the infected territory that we can hope to arrest the spread of the disease, and [guarantee] its ultimate suppression,” Wertenbaker told Wyman. “The Marine-Hospital Service, being the guardian of the Public Health, seems to be the proper source for the inauguration of such measures.” Wertenbaker had always believed that a successful smallpox eradication effort on any scale necessitated having a single “officer in charge.” And he let Wyman know that if his proposal for nationalizing smallpox control met with the surgeon general's approval, he, C. P. Wertenbaker, would be willing to be that man.
⁸⁴

Wertenbaker surely knew better than to expect any such sudden sweeping change in existing institutions. If the smallpox epidemics of the end of the century had shown anything, it was that democratic institutions and the political communities they governed often moved slowly, especially when official claims to expertise and visions of social control collided with the interests, beliefs, and values of the people. Walter Wyman did not put Wertenbaker's plan in place on the national level, nor did he make Wertenbaker “officer in charge.” Seven months later, he transferred Wertenbaker to take command of the Service's station in the huge southern port of New Orleans—a promotion, to be sure, but not the one Wertenbaker had once asked for.

In 1907, Wertenbaker happily returned with his family to his native Virginia to run the Service station at Norfolk. In the final years of his career, he would become well known to African American educators, ministers, physicians, and nurses for his efforts to organize rural black farmers and church groups into state and local “anti-tuberculosis societies.” In classic Wertenbaker fashion, he wrote up a detailed “Plan of Organization” for creating these societies. But the essence of the plan was to mobilize African Americans at the grassroots to fight a deadly infectious disease. By the time of Wertenbaker's death, of kidney disease, in 1916, southern blacks had founded five state leagues and numerous local societies.
⁸⁵

C. P. Wertenbaker's grave lies in a well-shaded area of the University of Virginia cemetery, not far from the resting places of the eleven hundred Confederate soldiers buried there during the Civil War. The remains of C. C. Wertenbaker, who outlived Charlie by two years, lie nearby. The words on Charles Poindexter Wertenbaker's tombstone remember a son of the Confederacy who, along with hundreds of other traveling medical men of the United States Marine-Hospital Service, carried the influence of the national government across the South. The inscription reads: “As Soldier, Doctor, and Officer for Twenty Eight Years of the National Health Service His Good Works are Imperishable.”
⁸⁶

In the years after Wertenbaker left Wilmington, he saw many of the reforms he had advocated come to pass. Local, state, and federal health authorities placed a greater reliance on public education in their work. A new federal system, established in 1902 and run by the U.S. Public Health and Marine-Hospital Service's National Hygienic Laboratory, regulated the manufacture of smallpox vaccine and the proliferating array of new vaccines, sera, and antitoxins on the market. And Congress gave the Service greater authority to standardize and coordinate the control of infectious disease at the local and state levels. No revolution had taken place. But reform surely had come.

At the turn of the century, there existed as yet only a few areas of the American domain where the authority of the nation reigned supreme in the field of public health. Foremost among them were the new colonial possessions acquired by the United States in the Spanish-American War of 1898. In those distant spaces, medical officers of the United States Army exercised powers of a scale and scope that C. P. Wertenbaker could scarcely have imagined.

Windswept and weather-beaten, the city of Iloilo stood upon unpromising marshland near the southeastern tip of Panay, in the vast Pacific waterworld of the Philippine archipelago. The center of the islands' sugar trade, for decades the old Spanish port had sent forth from its deep harbor steamships bearing that prized commodity, as well as hemp, sapanwood, coffee, mangoes, and mother of pearl. The people of Iloilo were known for their habit of resistance to outside authority, be it the Kingdom of Spain, the Catholic Church, or, now, the United States. In December 1898, Emilio Aguinaldo's Filipino independence movement set up a military stronghold there. By October 1899, when the Twenty-sixth U.S. Volunteers stepped ashore, Aguinaldo's
insurrectos
had already been driven out, but they remained entrenched not far from the city.
¹

The Twenty-sixth was a regiment of New England militiamen. They had recently undergone a crash course in the geography of American expansion. Their journey began two months earlier in Boston. They traveled by train across the continental United States to San Francisco. Encamped in the late summer fog of the Presidio, they learned that smallpox had broken out in a neighboring regiment, which was swiftly quarantined on Angel Island. After a fresh round of vaccinations, the Twenty-sixth crowded aboard the
Grant
, a 454-foot transport ship that carried them across more than seven thousand miles of Pacific Ocean to Manila Bay, with a stopover for coal in Honolulu, the premier port of newly annexed Hawaii. Last, they steamed thirty-six hours from Manila to arrive here, in Iloilo. Their mission was to man the U.S. garrison and establish order.
²

A
Boston Globe
reporter named J. N. Taylor had traveled with the Twenty-sixth all the way from Massachusetts. “The city was very dirty—oozy with it,” he recalled. Of pressing concern to the U.S. command, small-pox raged in the city, killing more residents every day. Prior to the arrival of the Twenty-sixth, smallpox, known by its local name,
buti
, seemed to be accepted as a fact of life. Few of the inhabitants had ever been vaccinated, and they made no effort to isolate the sick.
³

On the advice of the U.S. health officer on the scene, the soldiers set about enforcing a “progressive policy” of sanitation, “giving Iloilo a bath and a scrubbing.” They set up a smallpox hospital outside the city and removed the sick from their families. Soldiers inspected homes, cleaned out decrepit privy vaults, and introduced a new system of dry earth closets. The troops moved with particular force upon an expanse of shacks that stretched a quarter mile from the old Spanish palace to the Jaro bridge. The district housed one thousand of Iloilo's poorest residents, among whom, Taylor noted, “fully 700 were pock-marked.” The soldiers leveled the district.
⁴

Risking fines or imprisonment, many Ilonggos resisted the American sanitary campaign, which, as Taylor had to admit, did require “a radical change in the sanitary conduct of their homes.” The Army's effort to enforce vaccination proved so unpopular that the soldiers found it “necessary to round up the inhabitants with guns to inoculate them.”
⁵

Within three months of the Twenty-sixth Regiment's arrival, Iloilo seemed to Taylor a city transformed. The offensive odors had abated. Small-pox was disappearing. Even the attitude of the Ilonggos appeared to be softening. Many now called upon the health inspector's office, children in hand, and asked to be vaccinated. Taylor could imagine a time when, with a little more sanitary work (draining the city's swamps was the obvious next project), Iloilo might make a perfectly salubrious home for white men.

“There seems to be no good reason why Iloilo should not be as healthy as Boston,” he said.
⁶

W
here soldiers go, plagues follow. Since the age of Alexander, the annals of war had known no truer axiom. Mobilizing armies uprooted young men from great cities and remote villages, previously distinct epidemiological environments, and threw them together in crowded camps where the air reeked of waste and the water teemed with the unseen agents of cholera and typhoid. Across the millennia, seasoned generals had fairly expected diseases to take more lives than spears, swords, or guns. Rarely did those expectations go unmet. Beneath the staggering death toll of the American Civil War, in which some 620,000 Union and Confederate soldiers perished, lay the familiar but little understood handiwork of microbial pathogens: nearly twice as many soldiers had died from disease as from combat.
⁷

When army camps grew up near centers of population, microbes circulated indiscriminately between soldiers and civilians. Soldiers on the march carried smallpox across continents, as the Spanish
conquistadores
had done in the Americas. The Franco-Prussian War of 1870–71 unleashed a European pandemic of pox that killed more than 500,000 people. Wars disrupted entire societies, causing famine and poverty, displacing populations, and destroying fragile systems of sanitation—all of which increased people's vulnerability to disease. As catastrophic events, wars and the epidemics they made sometimes became indistinguishable from one another, making it hard for the soldiers and civilians caught in their crossfire to reckon which invasion was the defining one. After witnessing the plagues and carnage of the devastating Crimean War (1853–56), the Russian surgeon Nikolai Ivanovich Pirogoff concluded, “War is a traumatic epidemic.”
⁸

And so it took some gall for Rudyard Kipling, well known to Americans as “the unofficial poet-laureate of the British Empire,” to imagine that a modern imperial army could be a force for public health, rather than an instrument of apocalypse. In his most famous poem, Kipling wrote:

Published simultaneously in the London
Times
and the American
McClure's Magazine
in February 1899, “The White Man's Burden” was reprinted in newspapers across the United States. Even Kipling's friend, New York governor Theodore Roosevelt, judged it “poor poetry” in a letter to Senator Henry Cabot Lodge of Massachusetts, though the “Rough Rider” added that Kipling's lines “made good sense from the expansionist viewpoint.”
⁹

At the moment of the poem's publication, Lodge was exhorting his colleagues in the Senate to ratify the Treaty of Paris, a document that would officially end the Spanish-American War of 1898 and bring the former Spanish colonies of Puerto Rico, Guam, and the Philippines under U.S. rule. (In keeping with the Teller Amendment, enacted on the eve of war, Congress forswore annexation of Cuba; U.S. control of the island would end, officially, in 1902.) But even as the senators made their speeches, a new American war with Emilio Aguinaldo's Philippine Republic was beginning in the suburbs of Manila, a city that, as American anti-imperialists pointed out, lay halfway around the world—five weeks' voyage by steamship—from the U.S. mainland. Kipling appealed to a divided American people, urging them to “take up” their destiny as white colonial rulers in the Philippines. The purpose, he assured them, was noble: to deliver the blessings of Anglo-Saxon civilization, including freedom from want and disease, to that far-off archipelago and its “new-caught sullen peoples, Half-devil and half-child.”
¹⁰

A native of British India, Kipling seemed at peace with the glaring ironies of colonial public health, with its frank uniting of idealism and violence. Some of his contemporaries were less untroubled. “It is a bad pedagogy to teach people at the point of a bayonet,” objected G. Stanley Hall, the eminent American psychologist and educator. But according to the expansionist viewpoint—informed by the long record of British colonialism and America's own experience with westward expansion—sometimes bayonets were exactly what the situation required.
¹¹

In a previous story, “The Tomb of His Ancestors,” Kipling paid sardonic tribute to the British compulsory vaccination campaigns in nineteenth-century India. An industrious young British military officer, John Chinn, the latest in his family line to serve the Raj in central India, tricks the Bhil people—who “seemed to be almost as open to civilization as the tigers of [their] own jungles”—to bare their arms to “the vaccine and lancets of a paternal Government.” But it was hard work. The Bhils had kidnapped and beaten the first government vaccinator (an Indian) sent to do the job. The clever Englishman succeeded only by playing on the group's superstitions. In “The White Man's Burden,” Kipling cautioned the Americans to expect only heartache for their selfless efforts in the Orient: