How to Hide an Empire

by Daniel Immerwahr

  Three years later, Arellano applied to another fair, the Jamestown Exposition.66 This time he succeeded—not as an artist, but as one of the native “living exhibits” these fairs fed on. For seven months he wore a pineapple-fiber shirt and allowed himself to be ogled. Fairgoers were taken aback, though, when he answered their questions in fluent English.

  But Arellano had come to the mainland to study, not to be studied. Once he made enough money working at Jamestown, he moved to Philadelphia to enroll at the Pennsylvania Academy of Fine Arts. He won the academy’s annual award for best painting, a prize that automatically placed him in the next year’s competition for the Prix de Rome. He was disqualified at the last minute,67 though, when someone noted that as a Filipino, he wasn’t a U.S. citizen.

  Arellano then turned to architecture, winning more prizes, securing a diploma from the Drexel Institute and studying the Beaux Arts style in New York. He got a job in New York and eventually found work with Frederick Law Olmsted Jr.,68 one of Daniel Burnham’s close collaborators. Olmsted sparked Arellano’s interest in city planning.

  Arellano was, in other words, a Renaissance man: painter, builder, and planner. His first major architectural commission upon returning to Manila was the Legislative Building, part of the civic core Burnham had planned around the Luneta. The foundation had been laid by Ralph Harrington Doane, the final mainland consulting architect, in his last year in the Philippines. It was Arellano who expanded the building, gave it a classical façade, and raised it into one of the largest edifices in the colony.

  This was a massive undertaking, costing as much as the road to Baguio. Yet here the symbolism was reversed. The Legislative Building was in Manila, not up some mountain, and it was designed to house the Philippine Legislature, the only elected part of the colonial government. More to the point, it had been built by a Filipino.

  The press loved it. It was “the most magnificent and impressive structure ever erected in the Philippines,”69 a Manila magazine raved. “Here is a stronger and more enduring argument as to the capacities of the Filipino race than any that the most enthusiastic of the American friends of the Filipinos can formulate,”70 a newspaper wrote. “The pessimists who said that Filipinos were not capable of doing anything have not a leg to stand on.”

  The Legislative Building was indeed a rebuke to imperialists like Forbes, who doubted Filipinos’ abilities. Yet in beating imperialists at their own game, Arellano was also playing their game. Though he later regretted this,71 he conspicuously built the Legislative Building in the style of the White City rather than the Spanish style that Burnham and even Parsons had gamely accommodated. One of Manila’s best-known historians, Nick Joaquin, has identified the Legislative Building as “architecturally,72 the landmark dividing the American from the Spanish era.” That is, it was Arellano’s building, not one of Parsons’s creations, that marked the full shift to the neoclassical style that, Joaquin writes, “has ever since dominated our public works.”

  Arellano kept going. He became the architect in the colonial Philippines, eventually taking Parsons’s former position, consulting architect. He designed the massive post office in Manila. He designed capitol buildings for three provinces. The office of the high commissioner in Manila was another Arellano project—today it serves as the U.S. embassy. In the 1930s the government contemplated moving the capital north from Manila to Quezon City, a planned metropolis of Burnham-style plazas and radial boulevards. Arellano served on the planning commission.

  Juan Arellano’s Legislative Building, completed 1926

  *

  Had Daniel Burnham lived through the 1930s and returned to the Philippines, he would have been thrilled by what he saw. In Chicago, he’d struggled mightily for years to realize his vision (and his allies had worked for decades to do so after his death). In the Philippines, however, just half a year’s hasty work, only six weeks of it in-country, sufficed to remake one city and build another from the ground up.

  Such were the joys of empire. The colonies were, for men like Burnham, playgrounds, places to carry out ideas without worrying about the counterforces that encumbered action at home. Mainlanders could confiscate land, redirect taxes, and waste workers’ lives to build paradises in the mountains.

  Filipinos, for their part, were relegated to the sidelines. The segregated spaces at the center of Burnham’s plans were not for them, though their taxes paid the cost. The best they could hope for was to win some measure of respect by showing themselves worthy in their colonizers’ eyes. In the realm of architecture, that looked like Juan Arellano carrying out Burnham’s plans with even greater devotion than William Parsons had.

  And so, from Burnham to Parsons to Arellano, the torch passed. Looking back on it all, Burnham’s biographer concluded that Burnham’s vision achieved its “greatest architectural success” not on the mainland,73 but in the Philippines.

  9

  DOCTORS WITHOUT BORDERS

  The U.S. conquest of Puerto Rico was relatively painless—“a picnic,”1 as one journalist put it. But if Puerto Ricans had avoided the horrors of war, they met something similar the following year, when a category-4 hurricane slammed into the island. Whole coffee plantations washed down the mountains. Thousands of people were killed, more left homeless.

  From the perspective of Assistant Surgeon Bailey K. Ashford, it was Dantesque. Ashford was stationed in Ponce, the hometown of Pedro Albizu Campos. He saw the hurricane wreck the city, demolishing houses, denuding trees, flinging metal roofs through the air. He watched as “hordes of pallid refugees” fled the mountains seeking food,2 shelter, and medical treatment.

  They could have done much worse for a doctor than Ashford. He was a gifted physician whose talents had drawn him to Leonard Wood’s attention.3 Wood had befriended Ashford and encouraged him, which is how Ashford ended up in Puerto Rico in the first place. But unlike Wood, Ashford didn’t hold himself aloof from the colonized. He learned Spanish, fell in love with a Puerto Rican woman, María, and had three children with her: Mahlon, Margarita, and Gloria María. He collaborated closely with local physicians, particularly his colleague Dr. Pedro Gutiérrez Igaravídez. Indeed, as Ashford would live on the island for most of his life, he came to see himself as Puerto Rican,4 not as a mainlander.

  But that would come later. Now Ashford had a more immediate concern: the refugees. He eyed their “flabby flesh and ghastly pallor” with alarm. His wife,5 María, explained that what he was seeing was not just the work of the hurricane, but the work of centuries. This was just what peasants looked like, she explained. They are weak and anemic. They die.

  Thinking the problem was their poor diets, Ashford fed them meat, beans, and fish. Yet their complexions stayed pale, and they kept dying. He examined their blood and confirmed María’s diagnosis: they were severely anemic. But this made no sense. An epidemic of anemia afflicting an entire class? “It was unthinkable.”6

  He inspected one of his patients’ feces under a microscope. There he saw something interesting: an “oval thing with four fluffy gray balls inside.”7 An egg. Probably a worm egg. He checked his manual of tropical diseases. It looked like hookworm.

  Hookworm—the force of the revelation struck him. It was, he felt, “like a veil had been lifted.”8 Peasants didn’t just look like that. They weren’t simply malnourished because they were oppressed. Nearly all—Ashford would later estimate nine in ten rural Puerto Ricans—were suffering badly from an intestinal parasite.9

  *

  Like most parasites, hookworms are both fascinating and deeply gross. The larvae grow in shaded, moist, warm soil and seek human feet. They bore through the skin, usually the skin between the toes, and worm their way into the bloodstream, then to the lungs, and then, after a cough and a swallow, into the upper part of the small intestine. There, they take up residence and live out their six- or seven-year lives, subsisting on blood. People with enough worms in them—it can be more than two thousand—grow listless, become pale, and lose muscle. They al
so, through their feces, pass out hundreds of thousands of worm eggs, which, if deposited in the right environment, will hatch, find more human feet, and complete the revolting cycle.

  Hookworms have stowed away in humanity’s small intestines for some twelve thousand years, a side effect of domesticating dogs. But since the parasites typically weaken rather than kill, and since the African populations most likely to carry them have some immunity, hookworms went unnoticed until the nineteenth century. Western doctors first realized how dangerous they could be in 1880, when a professor at the University of Turin found a lethal form of hookworm disease among workers digging a long tunnel under the Alps between Italy and Switzerland. The tunnel was hot,10 wet, crowded, and full of feces—hookworm heaven. Rather than carrying just a few worms, the men were overloaded, expelling eggs and reinfecting themselves daily.

  It’s hard to imagine a habitat as congenial to hookworms as a trans-Alp tunnel, but Puerto Rico came surprisingly close. Not only was the island densely populated, but nearly two-thirds of Puerto Ricans lived in the highlands,11 where coffee was king. The coffee plantations lacked privies, the workers toiled barefoot, and the harvest was during the rainy season—providing a pretty good approximation of the hot, moist, shaded, and well-trafficked soil of the tunnel.

  Hookworms flourished so abundantly on the island’s coffee estates that they didn’t only enfeeble workers, they killed them. By the turn of the century, anemia was the leading cause of death in the colony,12 accounting for some 20 to 30 percent of mortality.

  But the worms in Puerto Rico were unusual, as Ashford discovered. Unlike the ones in his book, they had no teeth. He returned to Washington “carrying a bottle of my precious worms with me” and presented them to his former professor at Georgetown,13 Charles Wardell Stiles. Stiles concluded that this was a previously unknown species. He gave it a dramatic name: Necator americanus. American murderer.

  Luckily for Ashford, Necator americanus was easily dealt with. A cheap (though nausea-inducing) pill was all it took to dislodge the worms, and visible recovery took just days. Ashford returned to Puerto Rico and, with his colleague Pedro Gutiérrez Igaravídez, established a clinic at Utuado. Patients came slowly at first, then quickly, until Ashford, Gutiérrez, and their colleagues were treating hundreds a day. The physicians supplied medicine and spoke to their patients about hygiene, explaining the importance of shoes and latrines.

  In 1905 the Puerto Rican legislature funded a national program, again under the supervision of Ashford and Gutiérrez. By 1910, they estimated that nearly 30 percent of the population had been treated,14 for less than a dollar per patient.

  As Bailey Ashford fought hookworm in Puerto Rico, his professor, Charles Wardell Stiles, continued to contemplate the disease. In 1908 Stiles took a train through North Carolina with Walter Hines Page, the great Southern journalist, and Henry C. Wallace, the Iowa agricultural expert (and father of the future vice president Henry A. Wallace). Wallace pointed to a pale and hunched man by the station. “What on earth is that?” he asked—he hadn’t seen anyone like that in Iowa.15 Page explained that this was a poor white, an all-too-familiar type in the South. Such men were called “dirt eaters.”

  Stiles piped up. No, that man was suffering from a severe hookworm infestation. His pallor and posture were the result of anemia. Severely anemic people eat dirt or clay; they are hungry for iron. And the man could be cured “at a cost of about fifty cents.”

  “Good God! Stiles, are you in earnest?” Page exclaimed.

  Again, the veil lifted. Is that where the “lazy white Southerner” stereotype came from? Is that why Southern whites looked funny—lanky, pale, and slack? Page introduced Stiles to John D. Rockefeller’s aide, who arranged for the oil baron to give a million dollars to deworm the South.16 This was an early venture by Rockefeller into philanthropy, which would culminate in the establishment of the Rockefeller Foundation.

  The head of the Rockefeller campaign traveled to Puerto Rico to consult with Ashford. The idea was to start something similar in the South, with Stiles as part of it. Thus, while Ashford battled hookworms on the island, his former teacher would fight them on the mainland.

  Even with cheap deworming pills, though, a hookworm campaign was not an easy sell. Stiles, born in New York, found white Southerners prickly to the point of violence when he brought up the delicate subject of their toilet habits. After one address to a school, the local sheriff insisted on guarding Stiles until he made it safely out of town.17 The editor of a Tampa newspaper threatened to lynch him. The Civil War was over,18 but it wasn’t so far past that Southerners would stand for a Northern doctor diagnosing their entire region as pathologically lazy and unhygienic.

  Mark Twain, watching from the sidelines, hooted with delight at the indignity of it all. He wrote a lilting satire in which he imagined biblical figures suffering from the timeless scourge (“Six thousand years ago Shem was full of hookworms”).19

  Few, however, shared Twain’s sense of humor. And it seems that elite Puerto Ricans were as prideful about this matter as Southern whites were.20 Some mocked the doctors, questioned the diagnosis, and put up active opposition. Yet the manner in which the two campaigns were carried out was a study in contrast, one that says much about how things worked in the colonies.

  In the Southern campaign, the Rockefeller men took great care to avoid offending public sensibilities. Instead of sending their own doctors, they worked with state boards of health and employed local doctors—all white. They courted newspaper editors. And they adopted a familiar cultural form for their campaign: the Southern tent revival.21 Like itinerant preachers, hookworm fighters quietly approached local power holders, secured their blessing, and then brought the show to town with great fanfare. There were picnic lunches, gospel songs, and dramatic conversion testimonies (once I was blind, now I can see; once I was wormy …). The dispensaries doled out the medicine—to more than 440,000 patients in five years—and down-played the stern lectures.

  Ashford and Gutiérrez would have loved to run a campaign that way. They envisioned a network of clinics and an army of local Puerto Ricans, men who enjoyed the confidence of the peasants, to “preach the gospel.”22

  But that required funding, which meant squeezing resources from the colonial government. Whereas the Southern campaign began with a million-dollar grant from John D. Rockefeller, the Puerto Rican one started with $5,000 from the colonial treasury. After Ashford and Gutiérrez demonstrated that deworming worked, they begged for funds to permanently eradicate hookworm disease. But the money that arrived was, in their judgment, “utterly inadequate”: half what was needed in the best year,23 then down to a third. In 1908 the government didn’t appropriate any funds, so all dispensaries were officially closed (though some persisted, using stockpiles and volunteered labor) for more than three months.

  Unable to afford persuasion, Ashford and Gutiérrez tried compulsion. They implored plantation owners to force workers to wear shoes. They advocated a “sanitary ordinance” to be “energetically enforced” throughout the colony.24 In order to work, peasants should have to carry papers certifying that they were hookworm-free. Such measures would infringe on the “liberty of the citizen,” Gutiérrez admitted, but the cause was worth it.

  Yet these laws never passed, and it’s unclear how well the colonial government would have enforced them. In the end, it didn’t matter. Oversight was taken from Gutiérrez (Ashford had already resigned) and placed under a single authority, the Washington-appointed commissioner of health. The campaign fizzled.25

  The result? Hookworm disease in the South was reduced substantially, with enduring economic effects,26 mainly due to children staying in school longer. So encouraging were the results that the Rockefeller Foundation took on a more ambitious project: combating hookworm throughout the tropics—history’s first global health campaign.27

  Meanwhile, in Puerto Rico, Ashford, Gutiérrez, and their colleagues treated hundreds of thousands and headed off the direst c
ases,28 of which there were many. Hookworm treatment, plus parallel campaigns that the military ran against yellow fever and smallpox, brought the Puerto Rican death rate down dramatically. Yet Ashford and Gutiérrez watched in frustration as their patients succumbed to reinfection again and again. Treatment could forestall death, but all the worm pills in all the dispensaries couldn’t change the larger facts: most Puerto Ricans were poor, they worked outdoors without shoes or privies, and their government lacked the resources, and possibly the will, to do much about that.

  Medicine reduced hookworm disease’s morbidity in Puerto Rico, but not its spread. In 1930 it stood pretty close to where it had been when Ashford first arrived more than thirty years earlier. It was now chronic rather than acute, but it still afflicted eight or nine in ten rural Puerto Ricans.29

  *

  By 1930, hookworm was just one of Puerto Rico’s many problems. Two years before, another hurricane—the worst the region had seen in modern times—had sliced across the island. It killed hundreds,30 inflicted tens of millions of dollars of damage, and nearly destroyed the coffee industry. The next year, 1929, brought the Great Depression, which sent sugar prices and wages tumbling.31 Incomes in Puerto Rico fell by nearly 30 percent between 1930 and 1933.32 Meanwhile, prices rose, trade plummeted, unemployment engulfed more than half the workforce, and strikes lit up the ports, needlework factories, tobacco fields, and cane fields.

  The causes of Puerto Rico’s woes were multiple and complex. Many involved arcane aspects of sugar tariffs and the lax enforcement of land-holding laws. Mainlanders, however, tended to focus on a different explanation: overpopulation. It was the very thing that had troubled them about Puerto Rico back in 1898, when they worried that Spain’s colonies had too many nonwhites to be safely annexed.