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‘To Awaken the Medical and Hygienic Conscience of the People’: Cultivating Enlightened Citizenship through Free Public Healthcare in Haiti from 1915–34

  • Elliott M. Reichardt (a1)

Abstract

This paper addresses the relative scholarly oversight of the history of public health in Haiti through a close examination of the colonial public health system constructed and operated by the United States (US) during its occupation of Haiti from 1915 to 1934. More than simply documenting a neglected aspect of Caribbean history, the paper offers the US occupation of Haiti as a remarkably clear example of a failed attempt to use a free public health service to cultivate a health conscientiousness among the Haitian citizenry through the aggressive treatment of highly visible ailments such as cataracts and yaws. I argue that the US occupation viewed the success of the Haitian Public Health Service as critical to the generation of a taxable, compliant and trusting citizenry that the colonial state could enter into a contract with. This idealistic programme envisioned by the US occupation was marred by financial mismanagement, racism, delusions of grandeur and contempt for Haitian physicians that resulted in the production of a far more precarious public health service and administrative state than the US occupation had hoped. By the time the Great Depression arrived in 1930 the Haitian Public Health Service was gutted and privatised, having successfully provided the majority of Haitians with free healthcare, yet failed to have persuaded them of the value of being governed by a centralised administrative state.

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*Email address for correspondence: erei@stanford.edu

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I would like to thank the anonymous reviewers for their thoughtful and detailed feedback that improved the clarity, structure and precision of the article. I would also like to acknowledge the generous mentorship of Mary Brazelton during my early development as a scholar and for her extensive advice during the early drafting of the paper. I am grateful to Henderikus Stam for reading a draft of the paper and for supplying comments on its organisation. I am also grateful to the Rockefeller Archive Center for financially supporting this research.

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References

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1. Street, Alice, Biomedicine in an Unstable Place: Infrastructure and Personhood in a Papua New Guinean Hospital (Durham, NC: Duke University Press, 2014), 22; Michel Foucault, ‘Society Must Be Defended’: Lectures at the Collège de France, 19751976 (New York: Picador, 2003); Joseph-Achille Mbembé, ‘Necropolitics’, trans. Libby Meintjes, Public Culture, 15, 1 (2003), 11–40.

2. Pamphile, Leon D., Contrary Destinies: A Century of America’s Occupation, Deoccupation, and Reoccupation of Haiti (Gainesville, FL: University Press of Florida, 2015), xvi; Mary A. Renda, Taking Haiti: Military Occupation and the Culture of US Imperialism, 19151940 (Chapel Hill, NC: University of North Carolina Press, 2001), 10.

3. This protectionism was designed to prevent the ownership of land by whites, following the Haitian’s successful revolution in 1804. Renda, op. cit., (note 2), 10.

4. Marvin, George, ‘Healthy Haiti: Whitewashing the Black Republic: The Changes Accomplished During a Year and a Half of American Administration’, World’s Work, 34, May–October (1917), 33–51: 45, 47.

5. Davidson, Matthew, ‘Empire and Its Practitioners: Health, Development and the US Occupation of Haiti, 1915–1934’ (unpublished Master’s Thesis: Trent University, 2014); Paul H. Douglas, ‘The American Occupation of Haiti II’, Political Science Quarterly, 42, 3 (1927), 368–96.

6. Millspaugh, Arthur C., Haiti Under American Control 19151930, student edition (Boston, MA: World Peace Foundation, 1931), 1–64.

7. Anderson, Warwick, Colonial Pathologies: American Tropical Medicine, Race, and Hygiene in the Philippines (Durham, NC: Duke University Press, 2006), 1; Mariola Espinosa, Epidemic Invasions: Yellow Fever and the Limits of Cuban Independence, 18781930 (Chicago, IL: University of Chicago Press, 2009), 16.

8. McBride, David, Missions for Science: US Technology and Medicine in America’s African World (New Brunswick, NJ: Rutgers University Press, 2002), 88.

9. Moll, Arístides A., ‘The Pan American Sanitary Bureau: Its Origin, Development and Achievements I’, PAHO/WHO Institutional Repository (1940), 1219–34; Aristides A. Moll, ‘The Pan American Sanitary Bureau: Its Origin, Developments and Achievements I/II’, PAHO/WHO Institutional Repository (1941), 41–6.

10. Dr H.A. May, Dr P.E. Garrison, ‘Preliminary Report Upon the Sanitary Conditions in Port au Prince, Haiti, and its Environs. October 18, 1915’, folder 1684, box 142, FA115, RG 5, Rockefeller Foundation Archives, RAC.

11. Ibid.; Charles St John Butler and E. Peterson, ‘The Public Health Service of Haiti. It’s Origin, Organization and Present System of Administration’, 1926?, folder 1, box 1, FA386b, RG 1.1, Rockefeller Foundation Archives, RAC.

12. Ibid.

13. Millspaugh, op. cit. (note 6), 88–91; Renda, op. cit. (note 2), 182. Resistance to what was reminiscent of slavery was put down through militarised strategies of repression. The tactics applied could be extremely violent, and included the rape of women or young girls, killing ‘bandit leaders’ and then parading their bodies tied to doors, or the lynching or torturing of Haitians who dissented; this promoted an atmosphere of casual and quotidian violence against Haitians.

14. See Renda, op. cit. (note 2), 182. for a discussion of rape and sexual violence; Shearon Roberts, ‘Then and Now: Haitian Journalism as Resistance to US Occupation and US-Led Reconstruction’, Journal of Haitian Studies, 21, 2 (2015), 241–68.

15. United States and W. Cameron Forbes, Report of the President’s Commission for the Study and Review of Conditions in the Republic of Haiti: March 26, 1930 (Washington: United States Government Printing Office, 1930).

16. Trouillot, Michel-Rolph, Silencing the Past: Power and the Production of History (Boston, MA: Beacon Press, 2015), 145.

17. Butler, Charles S., ‘Coordination of Medical Problems; Medical Education: Public Health and Hospitals in the Republic of Haiti’, Academic Medicine, 3, 1 (1928), 46–58. During the early twentieth century, the term ‘backwards’, in contrast with ‘mental defective’, implied that the environmental and social conditions in which someone operated was responsible for their apparent savagery or lack of education rather than implying an inherent and unchangeable defect.

18. Ibid., 48.

19. Holcomb, R.C., ‘REAR ADMIRAL CHARLES ST JOHN BUTLER, Medical Corps, United States Navy: An American Pioneer in Tropical Medicine’, Bulletin of the History of Medicine, 18, 2 (1945), 185–94.

20. Anderson, Warwick, ‘Excremental Colonialism: Public Health and the Poetics of Pollution’, Critical Inquiry, 21, 3 (1995), 640–69.

21. Butler, C.S. and Choisser, R.M., ‘Rural and Municipal Water Supplies in Haiti’, The American Journal of Tropical Medicine and Hygiene, s1–8, 1 (1928), 9–15.

22. Ibid., 11.

23. Marvin, op. cit. (note 4), 39.

24. Nb Rohan Deb Roy, Malarial Subjects: Empire, Medicine and Nonhumans in British India, 1820–1909 (Cambridge: Cambridge University Press, 2017), 1–70, for an outstanding and sophisticated discussion of non-humans and their role in shaping a colonial imaginary.

25. Robert Percival Parsons, History of Haitian Medicine (New York: Paul B. Hoeber Inc., 1929), 137.

26. Ibid., 137.

27. Ibid., 176.

28. Ibid., 179.

29. Ibid., 180–1.

30. Ibid., 189.

31. Allen, A.H., ‘The Problem of Malaria in Marines in Haiti’, United States Naval Medical Bulletin, 18, 1 (1923), 25–31: 25.

32. Connor, M.E., ‘Final Report on the Control of Yellow Fever in Merida, Yucatan, Mexico’, The American Journal of Tropical Medicine and Hygiene, s1–2, 6 (1922), 487–96; W.H. Michael, ‘Satisfactory Treatment of Malaria’, United States Naval Medical Bulletin, 14, 3 (1920), 367–70: 367; Randall M. Packard, A History of Global Health: Interventions into the Lives of Other Peoples (Baltimore, MD: Johns Hopkins University Press, 2016), 20–3; R.B. Williams, ‘A Brief Report of the Activities of the Field Hospital, First Brigade, United States Marine Corps, Port-Au-Prince, Haiti, September 4, 1915–September 20, 1916’, United States Naval Medical Bulletin, 11, 1 (1917), 107–13.

33. Allen, op. cit., (note 31).

34. ‘Abstracts from the Annual Sanitary Report of the First Brigade, United States Marine Corps, Republic of Haiti, for the Year 1922’, United States Naval Medical Bulletin, 18, 4 (1923), 526–7: 526.

35. Enlarged spleens were believed to indicate the presence of a malaria infection.

36. Allen, op. cit. (note 31); C.S. Butler and E. Peterson, ‘Malaria in Haiti’, United States Naval Medical Bulletin, 25, 2 (1927), 278–88.

37. Allen, op. cit. (note 31); Butler and Peterson, op. cit., (note 36).

38. Allen, op. cit. (note 31).

39. Bass, C.C., ‘Studies on Malaria Control. III: Observations on the Prevalence of Malaria, and its Control by treating Malaria Carriers, in a Locality of great Prevalence in the Mississippi Delta’, Southern Medical Journal, 12, 4 (1919).

40. Allen, A.H., ‘Report of an Antimalarial Campaign Conducted by the Medical Officers of the First Brigade, United States Marines, in Haiti’, United States Naval Medical Bulletin, 19, 4 (1923), 402–7.

41. Ibid.

42. Allen, op. cit. (note 31).

43. Allen, op. cit. (note 40), 404.

44. E. Vermeire et al., ‘Patient Adherence to Treatment: Three Decades of Research. A Comprehensive Review’, Journal of Clinical Pharmacy and Therapeutics, 26, 5 (2001), 331–42. Nancy Houston Miller, ‘Compliance with Treatment Regimens in Chronic Asymptomatic Diseases’, The American Journal of Medicine, 102, 2, Supplement 1 (1997), 43–9.

45. Storch, R.B., ‘Personal Experiences with Malaria Among Natives of the Republic of Haiti’, United States Naval Medical Bulletin, 19, 3 (1923), 422.

46. Allen, op. cit. (note 40), 406.

47. Storch, op. cit. (note 45), 420–1.

48. Ibid., 422.

49. McLean, N.T., ‘Public Health Problems of the Southern Countries’, The American Journal of Tropical Medicine and Hygiene, s1–2, 1 (1922), 25–39.

50. Ibid., 26.

51. Ibid.; United States and Atlee Pomerene, Treaty with Haiti. Treaty between the United States and Haiti. Finances, Economic Development and Tranquility [Sic] of Haiti. Signed at Port-Au-Prince, September 16, 1915. (1915).

52. Parsons, op. cit. (note 25), 176–89.

53. Ibid.

54. Ibid., 101.

55. See Paul Brodwin, Medicine and Morality in Haiti: The Contest for Healing Power (Cambridge: Cambridge University Press, 1996), 50, for a discussion of the rejection of collaboration in the design of public health during the initial stages of the occupation. Aristides A. Moll, ‘Half a Century of Medical and Public Health Progress’, Bulletin of the Pan American Union, 74 (1940), 341.

56. Lopez, Patricia J., ‘Clumsy Beginnings: From “Modernizing Mission” to Humanitarianism in the US Occupation of Haiti (1915–34)’, Environment and Planning A: Economy and Space, 47, 11 (2015), 2240–56.

57. McLean, op. cit. (note 49), 28.

58. The American Red Cross was a substantial supporter of public health works during the US occupation. It provided initial funding for the first set of ‘free rural dispensaries’, funded a nursing school and the re-fabrication of a surgical ward, and notably oversaw reconstruction efforts following the 1927 and 1928 hurricanes. John H. Russell, Second Annual Report of the American High Commissioner at Port Au Prince, Haiti, to the Secretary of State: 1922, 2 (1923), 14; John H. Russell, Sixth Annual Report of the American High Commissioner at Port Au Prince, Haiti, to the Secretary of State: 1927, 6 (1928), 18; John H. Russell, Seventh Annual Report of the American High Commissioner at Port Au Prince, Haiti, to the Secretary of State: 1928, 7 (1929), 34.

59. Ibid., 31. The occupation also advocated vaccination campaigns in response to crisis. For example, in 1920–21 it was estimated that approximately one million Haitians were vaccinated against smallpox following an outbreak in 1920, and following that success vaccination was imagined as a means of demonstrating the value of a public health service to the Haitian people. Parsons, op. cit. (note 25), 114.

60. Lopez, op. cit. (note 56).

61. Ibid.

62. Millspaugh, op. cit., (note 6), 88, notes that some Haitians were convinced that the US occupation’s ‘real purpose was to destroy Haitian independence and exploit Haitian resources for their own benefit’.

63. Parsons, op. cit., (note 25), 90.

64. Ibid.93.

65. Russell, John H., First Annual Report of the American High Commissioner at Port Au Prince, Haiti, to the Secretary of State: 1921, 1 (1922), 15.

66. Butler, op. cit. (note 17); United States and W. Cameron Forbes op. cit. (note 15), 12.

67. Russell, Second Annual Report 1922, op. cit. (note 58), 25.

68. Russell, Sixth Annual Report 1927, op. cit. (note 58), 47–8.

69. Butler and Peterson, op. cit. (note 11).

70. Mink, O.J., ‘Toxic Effects of Arsenical Compounds Employed in the Treatment of Syphilis in the United States Navy’, United States Naval Medical Bulletin, 32, 2 (1933), 177.

71. Russell, Sixth Annual Report 1927, op. cit. (note 58), 26.

72. Parsons, op. cit. (note 25), 89.

73. Butler, op. cit. (note 17), 48.

74. John Henry Russell, Eighth Annual Report of the American High Commissioner at Port Au Prince, Haiti, to the Secretary of State. 1929 (Washington: US Government Printing Office, 1930), 33.

75. See Vinh-Kim Nguyen et al., ‘Adherence as Therapeutic Citizenship: Impact of the History of Access to Antiretroviral Drugs on Adherence to Treatment’, AIDS, 21 (2007), S31, for a contemporary analysis of the use of pharmaceuticals to gain compliance. It is unclear to what extent one can consider the Haitians’ compliance with American treatments to have been freely made in contrast to the claims made by the US occupation; indeed, faced with the decision between death from disease or chemical ‘civilisation’ it appears that many chose the latter, sometimes under extremely violent conditions.

76. Butler and Peterson, op. cit. (note 11).

77. Ibid.

78. Russell, op. cit. (note 74), iv.

79. Ibid., 32.

80. Ibid., 33.

81. S. De La Rue et al., Haiti: Annual Report of the Financial Adviser-General Receiver for the Fiscal Year October 1929September 1930 (Port-au-Prince [etc.], 1930).

82. Schmidt, Hans, The United States Occupation of Haiti, 19151934 (New Brunswick, NJ: Rutgers University Press, 1995), 130–2.

83. S. De La Rue et al., op. cit. (note 81); S. De La Rue et al., Haiti: Annual Report of the Financial Adviser-General Receiver for the Fiscal Year October 1933September 1934 (Port-au-Prince [etc.], 1934), online: http://ufdc.ufl.edu/AA00001157/00001/2j, accessed 4 May 2019.

84. The ‘independence debt’ is one of the most controversial of the debts leveraged on Haiti. This debt originated in 1824 as part of a negotiated deal between France and Haiti. France requested the sum of 150 million francs to compensate French colonists for the property that they ‘lost’ following the slave revolt that resulted in the founding of Haiti. In return, the French government would recognise ‘Saint Domingue’ as sovereign and would no longer enforce a naval blockade of Haiti. Schmidt op. cit. (note 82), 25–26.

85. Emily Greene Balch, OCCUPIED HAITI: Being the Report of a Committee of Six Disinterested Americans Representing Organizations Exclusively American, Who, Having Personally Studied Conditions in Haiti in 1926, Favor the Restoration of the Independence of the Negro Republic (New York, NY: The Writers Publishing Company Inc., 1927).

86. Ibid., 89.

87. Russell, op. cit. (note 74), 33.

88. Melhorn, Kent C., ‘Haiti’s Greatest Public Health Problem’, United States Naval Medical Bulletin, 28, 2 (1930), 310–2.

89. Russell, op. cit. (note 74), 19.

90. Ibid., 20.

91. Ibid., 20.

92. United States and Pomerene, op. cit. (note 51).

93. Pamphile, op. cit. (note 2), 42–3.

94. Ibid., 43.

95. S. De La Rue et al., Haiti: Annual Report of the Financial Adviser-General Receiver for the Fiscal Year October 1930September 1931 (Port-au-Prince [etc.], 1931), 2.

96. Rulx Léon, ‘Le Service d’higiène et d’ássistence Publique En Haiti’, PAHO/WHO Institutional Repository (1933), online: http://iris.paho.org/xmlui/handle/123456789/10238.

97. Lopez, op. cit. (note 56), 2249.

98. Ibid., 36.

99. Léon, op. cit. (note 96); Parsons, op. cit. (note 25), 157.

100. Rulx Léon, ‘La Santé Publique En Haiti’, PAHO/WHO Institutional Repository (1937), online: http://iris.paho.org/xmlui/handle/123456789/15677; Rulx Léon, ‘La Santé Publique En Haiti’, PAHO/WHO Institutional Repository (1941), online: http://iris.paho.org/xmlui/handle/123456789/13610, accessed 25 January 2018.

101. Camille Lhérisson, ‘Diseases of the Peasants of Haiti’, American Journal of Public Health and the Nations Health, 25, 8 (1935), 924–9.

102. Bordes, Ary, Haïti, la santé de la république 19341957 (Port-au-Prince: Imprimerie Deschamps, 1997); Ary Bordes, Évolution des sciences de la santé et de l’hygiène publique en Haïti ([Port-au-Prince?]: Centre d’hygiène familiale, 1980); Laura Briggs, Reproducing Empire: Race, Sex, Science, and US Imperialism in Puerto Rico, vol. 11 (Berkeley and Los Angeles, CA: University of California Press, 2003); Brodwin, op. cit. (note 55); Davidson, op. cit. (note 5); Espinosa, op. cit. (note 7); James E. McClellan III, Colonialism and Science: Saint Domingue and the Old Regime (Chicago, IL: University of Chicago Press, 2010); Packard, op. cit. (note 32); Steven Paul Palmer, Launching Global Health: The Caribbean Odyssey of the Rockefeller Foundation (Ann Arbor, MI: University of Michigan Press, 2010); Antony Dalziel McNeil Stewart, ‘An Imperial Laboratory: The Investigation and Treatment of Treponematoses in Occupied Haiti, 1915–1934’, História, Ciências, Saúde-Manguinhos, 24, 4 (2017), 1089–106.

103. McClellan III, ibid.; Pamphile, op. cit. (note 2); Trouillot, op. cit. (note 16); Michel-Rolph Trouillot, Haiti: State against Nation (New York: Monthly Review Press, 1990); Chantalle F. Verna, Haiti and the Uses of America: Post-US Occupation Promises (New Brunswick, NJ: Rutgers University Press, 2017).

104. Parsons, op. cit., (note 25), 185.

I would like to thank the anonymous reviewers for their thoughtful and detailed feedback that improved the clarity, structure and precision of the article. I would also like to acknowledge the generous mentorship of Mary Brazelton during my early development as a scholar and for her extensive advice during the early drafting of the paper. I am grateful to Henderikus Stam for reading a draft of the paper and for supplying comments on its organisation. I am also grateful to the Rockefeller Archive Center for financially supporting this research.

Keywords

‘To Awaken the Medical and Hygienic Conscience of the People’: Cultivating Enlightened Citizenship through Free Public Healthcare in Haiti from 1915–34

  • Elliott M. Reichardt (a1)

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