Colonial Pathologies: American Tropical Medicine, Race, and Hygiene in the Philippines (review)

This innovative collection of essays succeeds (to paraphrase the author's stated aspiration) in connecting the privy to the empire, offering an exciting, new cultural political history of Philippine-American colonialism in the early twentieth century. Its loosely connected essays can be read as a history of how concepts of the integral body—and the diverse threats posed to it—mediated between the colonial situation in the Philippines under U.S. rule, on the one hand, and frameworks of whiteness and masculinity on the other. Specifically, Anderson argues for the mutual encoding of medical and civic discourses in the American colonial Philippines, identifying his subject as the history of the development and deferral of what he calls "biomedical citizenship." Exploring these themes across a wide range of imperial-medical projects, Anderson delivers a rich and vital contribution to the cultural history of U.S. colonialism in the Philippines, to the imperial history of medicine, and to cultural studies of whiteness and masculinity.

The book begins with the Philippine-American War, at the brutal outset of U.S. colonial rule, when U.S. Army medical officers grappled with the myriad organizational and conceptual dilemmas posed by colonial warfare. Anderson describes their application of models of "geographical pathology" (p. 24), which attributed disease to tropical conditions of heat and humidity. When combined with theories of racial geography—Nature's unforgiving desire to fix races in their proper places—these theories gave rise to fears of white degeneration in the tropics as well as efforts to mitigate it through individual bodily controls. Here Anderson argues for "a military genealogy of modern tropical hygiene" (p. 46), asserting that the army's medical efforts in the Philippines were "as much a manifestation of military administrative logic as an expression of the rising enthusiasm for germ theories" (p. 45). He identifies a shift in attention among his doctors from hostile physical environments to bacteria, the struggle against which, he argues, framed and was framed by the surrounding combat. Anderson witnesses a shift in tropical-medical theory and practice by war's end from a geographic to a racial-bacteriological basis: what he calls an "exoneration of the tropical milieu," accompanied by the "racializing of pathogen distribution" (p. 75), the assumption of a one-to-one correspondence between bacterial disease and the "native" body. Guaranteeing the health of white people—and the stability of their "whiteness"—became a matter of policing racio-medical contact between white Americans and Filipinos.

The core of U.S. medical interventionism, Anderson demonstrates, involved sanitary engineering and the mass inculcation of personal and communal hygiene. Anderson pays special attention to what he calls "excremental colonialism," the training of Filipinos in the hygienic disposal of feces that simultaneously coded Filipinos as irresponsible, incontinent, and, metonymically, as the lower body itself. U.S. colonial sanitary engineers would contrast the purity of disciplined, ordered spaces like the laboratory with the danger of Filipino realms such as the marketplace and fiesta. In a relatively freestanding chapter, Anderson discusses the trajectory of the tropical neurasthenia or "Philippinitis" that struck many white American elites in the islands, which were manifested in torpor, irritability, and forgetfulness and sometimes resulting—if not addressed by regular visits to the cool, detached hill station at Baguio—in colonial breakdown. A chapter on the Culion leper colony presents the most striking instance of U.S. public health officers attempting to put "biomedical citizenship" into microcosmic practice. At Culion, he shows, physical isolation from family networks, treatment regimes, and "rituals of citizenship" aimed to fasten individualized patient-subjects to the therapeutic state.

A final two chapters deal with later campaigns against hookworm and malaria in the 1920s and 1930s, campaigns that took place in light of the "Filipinization" of the...