The idea of infant mortality as a “class mortality” was further demonstrated in the descriptions of the laboring population’s living and housing situation. According to the committee, overcrowding was an important factor regarding infant mortality, which was mostly practiced in “large districts mostly occupied by laborers, especially in Tondo.”583 One reason for overcrowding were both poverty and the
high cost of rent.584 Especially in the laboring districts of Manila, as the researchers
stated, there were large areas with “tumble-down nipa shacks” with “about as unsightly and insanitary conditions as are possible”:
At present time, even in Manila, there are large areas with about as unsightly and insanitary conditions as are possible. There are thickly congested districts closely built up with tumble-down nipa shacks propped up on high bamboo poles in order to get the floor above green, foul-smelling, sewage-charged ponds of water, which stand for months on the sunken lands. It is impossible to get into some of these barrios without wading through the muck surrounding the houses.585
580 Reynolds, Infant Mortality and Working-Class Child Care, 1850-1899, 35. 581 Bureau of Science Manila, Infant Mortality in the Philippine Islands, 446. 582 Bureau of Science Manila, 445.
583 Bureau of Science Manila, 401–2. 584 Bureau of Science Manila, 402. 585 Bureau of Science Manila, 406.
Producing Citizens: Infant Health Programs in the Philippines, 1900-1930
136 The “nipa houses” were built closely together and each one “was divided as a rule into many rooms.” The rooms were small and poorly ventilated. They were occupied “by many persons, the number of which exceeds the average number of persons that the room should contain.”586 “It is not at all an uncommon thing,” the
report stated, “to see from 8 to 12 or more persons, including sick and well, children and adults, sleeping in a single room not more than 5 by 6 meters, with tightly closed windows and doors.”587 They were especially concerned that these
conditions facilitated the spread of infectious disease such as tuberculosis.
The physicians were especially worried about the consequences of the insanitary conditions for children in terms of disease. “Flies, mosquitoes, and vermin are found in large numbers”, they explained, so that “the only wonder is that any children escape death.”588 In course of their research, the committee inspected
Manila’s barrios in order to assess the living conditions of the working class. The report gave a detailed account of one of these visits during which the committee inspected a so-called “dump” around which the houses were built and in which the garbage from the surrounding houses was left. The committee reported “strong and offensive odors”, “dogs were extracting morsels of decomposing food from the garbage; and children were using it as a playground.”589 In addition, “myriads of
flies” fed on the garbage, sewage and “inundated sewage-charged land,” and which in turn infected the food supply and which crawled “upon the faces and bodies of the sleeping infants.”590
The physicians stated that it “was not surprising to learn from the poor people living in the near-by huts that there was a great deal of sickness in that neighborhood.”591 This was true not only for this respective barrio, but for “a large
586 Bureau of Science Manila, 402. 587 Bureau of Science Manila, 414. 588 Bureau of Science Manila, 406. 589 Bureau of Science Manila, 406. 590 Bureau of Science Manila, 24. 591 Bureau of Science Manila, 406.
Producing Citizens: Infant Health Programs in the Philippines, 1900-1930
137 percentage of the poorer classes of people even in Manila,” whose sanitary environment was “unbelievably bad.”592 Many of these places were “not fit for
human habitation” at all.593 Further, they stated that the living conditions were much
closer to those of animals than to living conditions of human beings.594 Besides the
waste dumps, the absence of sewer systems or water supply added to the health hazards these places.595
Even though the construction of new barrios for workers had been discussed from time to time, these propositions had been dismissed on the grounds that people would not be willing to make use of new quarters and “would continue to live under the present undesirable circumstances”, as the committee criticized.596 The
physicians Musgrave and Sison, however, had studied the subject and found that out of 1,000 people, 900 were “willing and anxious to move into more suitable surroundings.”597 As the committee concluded, “with these facts before us, it seems
that the solution of the problem of the bad sanitary conditions, particularly of Tondo and some other congested districts and barrios of Manila, would be one of financial consideration only.”598
Interestingly, even though sanitation had been a major focus of the U.S. administration from the beginning, in 1914 the researchers still found the living conditions of large parts of the population to be highly insufficient.599 As historian
Reynaldo Ileto has suggested, the sanitation campaigns Americans organized during the early years of the occupation were pre-eminently “practices of discipline
592 Bureau of Science Manila, 406. 593 Bureau of Science Manila, 406. 594 Bureau of Science Manila, 24. 595 Bureau of Science Manila, 406–7. 596 Bureau of Science Manila, 407. 597 Bureau of Science Manila, 407. 598 Bureau of Science Manila, 407.
599 Anderson, Colonial Pathologies; Anderson, “‘Where Every Prospect Pleases and Only
Man Is Vile’: Laboratory Medicine as Colonial Discourse”; Anderson, “Excremental Colonialism: Public Health and the Politics of Pollution.”
Producing Citizens: Infant Health Programs in the Philippines, 1900-1930
138 and containment.”600 Communities were “targeted for medical intervention;
populations had to be moved around, then confined; lines had to be drawn around social spaces; and local medical practices deemed superstitious and backward by American officials had to be marginalized or uprooted altogether.”601 Even though
sanitary and quarantine measures had been the poster child of American imperialism in the Philippines, this focus had not caused massive changes for the population at large. Especially discussions about waste and disease had been part of colonial discourse from the American occupation onwards. In the works of American physicians, containing waste became a means of organizing the threatening and chaotic population.602
This connection between order and chaos became especially visible in the educational material furnished by the Bureau of Health. During a 1911 carnival exhibition, for instance, the Bureau of Health presented an exhibit of nipa houses that underlined the binary of dirt and disease versus health and sanitation:
The first exhibit after passing through the entrance was a miniature model nipa house having sleeping porches, perfectly ventilated rooms, cement drain for yard, sanitary kitchen, and sanitary appointments. If nipa houses are properly constructed they are the most sanitary houses that can be built. The next exhibit in the isle was a model of Santa Monica barrio, Tondo, showing the haphazard arrangement of the houses with reference to alignment and street lines; their crowding together life dwarfed trees in a jungle, and the insanitary, imperfectly drained ground-space that can never be kept clean. The third exhibit showed Santa Monica barrio as it will appear when it is made a sanitary barrio. The difference between ordinary barrio and a sanitary barrio is the difference between order and chaos.603
600 Go and Foster, The American Colonial State in the Philippines, 15; See also Ileto,
“Cholera and the Origins of the American Sanitary Order in the Philippines”; Willie T. Ong, “Public Health and the Clash of Cultures: The Philippine Cholera Epidemics,” in Public
Health in Asia and the Pacific: Historical and Comparative Perspectives, ed. Milton J.
Lewis MacPherson Kerrie L. (New York: Routledge, 2008); Aaron Rom O. Moralina, “State, Society, and Sickness: Tuberculosis Control in the American Philippines, 1910- 1918,” Philippine Studies 57, no. 2 (June 2009): 179–218.
601 Go and Foster, The American Colonial State in the Philippines, 15. 602 Anderson, Colonial Pathologies, 106.
603 Fox, Annual Report of the Bureau of Health for the Philippine Islands for the Fiscal
Producing Citizens: Infant Health Programs in the Philippines, 1900-1930
139 In the new sanitary barrio, as the report stated, “all hidden places are uncovered so that the interspaces are accessible to the health-giving rays of the sun and to unobstructed uncontaminated currents of air. With model houses erected in sanitary barrios, former pest holes of Manila will become veritable health resorts.”604 Living
conditions and habits of the population were directly connected with infants deaths: Side by side with the cholera pictures was a series of three pictures with the following significations:
1. A father with consumption coughing and spitting on the floor; only child crawling on the sputum-soiled floor.
2. The sickness and death of the child from tuberculosis.
3. The burial of the little one and the sadness of the heart-broken mother and the death-doomed father in their childless home from which the last ray of hope had departed.605
Bodily control in terms of hygiene and health and the absence of “healthy habits” legitimated colonial rule. At the same time, the alleged insanitary habits and bodies of Filipinos signified their much lower position on the civilizational stratum.606
Warwick Anderson argued that through “somatic control and moral training, the colonial state attempted to shape the bodies and conduct of Filipinos and Americans.”607 This was closely connected to the idea of the “civilizing mission”
which was to legitimate American military intervention and colonial rule in the Philippines.
In the report on infant mortality, however, the connections between dirt, disease and power were examined from a different angle. The researchers highlighted that the major reasons for those conditions, besides the governmental reluctance to start a more thorough sanitation campaign, were poverty and the high cost of living in the Philippines. Even though they were “fully aware of the good sanitary work that has been performed and now is being carried out in this country”,
604 Fox, 21. 605 Fox, 23.
606 Anderson, Colonial Pathologies, 106. 607 Anderson, 106.
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140 everyone was “resting too much on the glory of accomplishment” which had been “the keynote of reports since the American occupation, and are neglecting and have neglected to bring out all the facts and show conditions as they exist in our ‘back yard.’”608
Especially in the Provinces, sanitary conditions had not improved during previous decades. Since measures for sanitary improvement had mostly been limited to Manila and the surrounding areas, many of the provincial regions had not profited from the activities at all. Thus, as the committee explained, this narrow focus on Manila had omitted the deficiencies in other parts of the country. The sanitary conditions in “vast areas of the provinces and even in certain places in the cities” were “inefficient and insufficient” and were only a little better than the conditions that existed fifty years prior.609 Thus, even though people knew better
than to surround themselves and others “with the vilest elements of human waste,” they allowed it “to remain near the homes of the poor, turning living places into nothing more or less than disease factories.”610 In some provinces, Philippine
physicians such as Dr. Fajardo and Dr. De Jesus had managed to establish new systems of sewage disposal, but “in the rest of the Archipelago, excepting Manila, ancient and unhygienic systems” still prevailed.611
Within this context, Filipino physicians themselves also became investigators of the conditions at hand. Due to class differences, Filipino physicians were able to position themselves not only as subjects of reform, but rather as reformers of “the masses.”612 They attributed the living conditions they found to
poverty and economic conditions rather than to racist ideas about Filipino bodies and habits. Thereby, their focus shifted from inherent racial characteristics towards an assessment of social factors.
608 Bureau of Science Manila, Infant Mortality in the Philippine Islands, 36–37. 609 Bureau of Science Manila, 36–37.
610 Bureau of Science Manila, 24. 611 Bureau of Science Manila, 403.
612 See also the chapter on the reform of midwifery and the opposition of biomedicine and
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141