Recent literature has shown that western tropical medicine has a 400-year-old history in Asia, Africa and the Americas. Scholars have explored the role of tropical medicine in the European search for medicinal plants and spices, in the exchange and acquisition of medicinal and botanical knowledge, in shaping western perceptions of distant lands, in controlling the indigenous populations of those lands, and, not least, in ensuring the physical survival of Europeans in alien environments. Since the very earliest European voyages, medicine occupied a central place in Europe's exploration and conquest of the world. In this long history, American tropical medicine does not appear significantly until the early twentieth century, a relative late-comer. But its practitioners—their attitudes, ideas and methods—would establish models of health care that would have a far-reaching influence around the globe and well into the future. Yet, strikingly, there is little in the way of critical scholarship on the colonial experience of American public health care regimes in the tropics, most especially in the Philippines, America's largest colony. In focusing on militarized medicine, health care and hygiene in the US colonization of these islands, Warwick Anderson's Colonial pathologies addresses this gap and, importantly, interweaves the perspectives of race and gender in the relationship between tropical medicine and US imperial policy.
The Philippine wars of resistance against Spain (1896–1898) and then the United States (1899–1902) left the local population decimated. During the American conquest, one historian has conservatively indicated a total mortality of 1.7 million people from warfare and disease in less than five years. Despite this appalling figure, the US colonization was predicated on what was termed “benevolent assimilation”, which was imagined and argued as being quite distinct from the crime of invasion and conquest. Rather, colonization was explained as an act of benevolence, a noble and moral imperative that sought to raise a purportedly barbarous, infantile race from a state of savagery and immaturity, and imbue it with a love of civilization. A number of scholars have closely examined the rhetorics of benevolent assimilation in the Philippines, but few have looked at its paternalistic logic through the lens of public health care. For Anderson, the institution of American colonial health care and hygiene regimes in these islands was both an intrinsic part of the civilizing procedure and a process of Americanization. He tells a compelling story of how US military physicians and civil health officers strove to transform Filipino bodies and their everyday bodily habits and customs into sanitized “germ-free” subjects and “probationary” citizens, that is “hygienic” subjects who might one day be judged as capable of governing themselves. Under heavily militarized conditions that subjected Filipinos to intense surveillance and disciplinary measures, US sanitation officials focused on rendering cities, villages and native bodies clean and wholesome. Chapter Two, for instance, does an impressive job of showing the suturing of medicine and occupation. The establishment of a Board of Health in 1902, the very same year civil government was proclaimed, ushered in a host of sanitary laws and regulations, as well as programmes to re-train American physicians as sanitary inspectors, who dispersed throughout the archipelago to scrutinize the habitations and bodies of the natives—“men, manners, mind, diet, dress and discipline all fall legitimately within the province of the sanitary inspector” as one military hygienist is quoted as saying (p. 50).
While predictably pestilential environments and intractable natives are discovered, there is an interesting twist in Anderson's story. American bourgeois white culture in the colonies underwent its own radical transformations. The tropical conditions proved to be very difficult and trying for American manhood. American scientists and physicians, already fretting over bodily and mental degeneration, believed to be caused by the debilitating environment, had their fears compounded by the risk of contagion from contact with germ-carrying natives. Moist heat, filthy Filipinos and their unhygienic social customs appeared to attack and erode the integrity, the wholeness of white male bodies and minds. Unmarried and frequently socially isolated, American white men, as Anderson describes, found themselves mentally breaking down, losing their nerve, becoming literally “unmanned”, their “whiteness and manliness” proving “disappointingly fragile or corruptible”. In Chapter 5 Anderson examines what he terms the “White man's psychic burden” or the heavy toll exacted by overwork and the hot moist climate. Even the most productive of American imperialists, as Anderson shows, were laid low by “tropical neurasthenia” and the disease called “philippinitis”.
This experience strikes a familiar note in relation to the British and Dutch susceptibilities in India, Africa and the Dutch East Indies, and Anderson's Colonial pathologies draws productively from the insights of much of this excellent post-colonial literature. Anderson's Philippine case study uncovers a new dimension of the colonial process by re-considering colonial medicine as a web of interconnecting practices, people, technologies and ideas that dynamically link metropole with colony. This movement of ideas and people has profitably allowed for a balanced appreciation of the “experience of empire” in a far too neglected part of the world.
Perhaps it might have been useful to provide a brief account of late-nineteenth-century Spanish sanitation measures and how these, and Spanish science more generally, were effectively denigrated and denied by American secular and Protestant colonialists. Moreover, some mention might have been made of efforts by European-trained Filipino physicians to reform their own people's sense of hygiene, which began well before the arrival of the Americans. Overall however, this is a fantastic book which is richly nuanced, meticulously researched and wittily written.