Health, Development, and the U.S

EMPIRE AND ITS PRACTITIONERS: HEALTH, DEVELOPMENT, AND THE U.S. OCCUPATION OF HAITI, 1915-1934

A Thesis Submitted to the Committee on Graduate Studies in Partial Fulfillment of the Requirements for the Degree of Master of Arts in the Faculty of Arts and Science

TRENT UNIVERSITY

Peterborough, Ontario, Canada

History M.A. Graduate Program

May 2014

ABSTRACT

Empire and its Practitioners: Health, Development, and the U.S. Occupation of Haiti, 1915-1934

Matthew Davidson

In 1915 U.S. Marines invaded Haiti. Driven first by the epidemiological dangers in Haiti, health and medicine was made a central tenet in administering the occupation. Useful for protecting the American Marines from disease, the Service d'Hygiene (the occupation-era

Public Health Service) also served a hegemonic purpose. By bringing American biomedicine to sick Haitians, the Service d'Hygiene built support for the occupation and helped foster long-term connections between Haiti and the United States. This hegemonic drive was made possible by the incorporation of non-state actors into the colonial project.

To achieve this, the American authorities forged a development strategy for Haiti that was premised upon a relationship between the state and private institutions such as the

Rockefeller Foundation. This strategy also encouraged Haiti to look to the United States for support, a goal successfully realized when Haitian politicians continued to do so even after the Marines left Haiti in 1934.

Keywords: Biomedicine, Education, Environment, Hegemony, Imperialism,

International Development, Marines, Medicine, Public Health, Rockefeller Foundation,

Sanitation, Service d'Hygiene, Student Strike, Tropical Disease.

ACKNOWLEDGEMENTS

It was while I was in the midst of applying for graduate school that the earth shook for 35 long seconds in Haiti, collapsing buildings and killing thousands of people. Among the dead were 125 students of the l'Hôpital Université d'Etat d'Haïti. The entire second year class of the affiliated State University School of Nursing were also killed, along with a number of professors, when the lecture hall they were in collapsed. At a moment when they would be needed the most, the National Medical School had no graduates for the first time in nearly a century. This thesis is dedicated to them.

It is thanks to the tremendous support of my supervisors, colleagues, and family that this work has come to completion. My supervisor, David Sheinin, consistently pushed me to do better. His incredible guidance helped me grow as a scholar, and I am grateful for it.

Finis Dunaway and Robert Wright, my committee members, both provided valuable commentary on my work as well. Many other people at Trent provided support and assistance at different times too, all of which has been much appreciated. The same goes for Margaret Hogan from the Rockefeller Archive Center. It was with her assistance that I was able to access the bulk of the primary sources that I rely on for this thesis. Of course if it weren't for the support of my parents, researching history would never have been an option for me at all. Finally, thank you Megan for putting up with me through this whole process.

iii

TABLE OF CONTENTS

Abstract ii

Acknowledgements iii

Contents iv

A Surgical Intervention 1

The State of Health: Entrenching the Occupation through Curative Institutions 21

The Landscape of Disease: Place, Space, and Preventative Medicine 47

Aiding the Occupation: The Rockefeller Foundation and the National School of Medicine 68

In Triage: American Hegemony in Question 101

Imperialism and the Appearance of Philanthropy: The Occupation and the Origins of International Development 128

Notes 148

Bibliography 169

A SURGICAL INTERVENTION

When the U.S.S. Washington sailed into the Port-au-Prince harbour on July 28, 1915,

Admiral William Caperton must have recalled a similar voyage from a year earlier.

Across the water lay the same dense city, the green hills and mountains rising off behind.

From the port Caperton had trekked to the United States legation, passing balconied houses and the many "open" and "closed" markets in their respective dusty squares or enclosed pavilions. Just as the year prior, there would have been a "pungent stench" from the open gutters and garbage heaps, a smell only made worse by the intense tropical sun.1

Certainly other Marines felt this way.2 Unlike the previous visit, though, the three hundred and thirty white U.S. Marines aboard the Washington disembarked alongside

Caperton, launching a nearly two decade long occupation of the country.3 The occupation broke from the prevailing pattern of intercession in Haiti; no longer a brief sojourn lasting just long enough to protect American persons and capital from violence, the 1915 intervention initiated a period of semi-permanent control over the republic. As the

Americans sought to establish hegemony in the country during the ensuing period of colonial domination, they slowly formulated a strategy that ultimately recreated Haiti both materially and in the American imperial imagination. To have a successful imperial endeavor, the Americans needed to develop Haiti.

Driven first by the epidemiological dangers in Haiti, health and medicine was made a central tenet in administering the occupation. Applying American medical knowledge, much effort was spent on making Haiti clean and healthy. The technical approach used

2 allowed the occupiers, without confronting white supremacist notions about Haiti, to reconceptualise "The Black Republic" as being developable under paternal American guidance. The U.S.-controlled Public Health Service was instrumental in this process, popularizing American biomedicine through both curative and preventative means. The former entailed bringing modern medicine to the Haitian populace, while the latter meant

"sanitizing" the country, acting on Haiti's geography to make the island free of disease.

Both processes also made knowledge of American health practices intrinsic to administering the Haitian state. Throughout the occupation the American authorities deliberately acted to circumvent the power of the Haitian elites.4 As a result the state, which had previously been the private preserve of that elite class, was reoriented so as to be accessible to all of Haiti's citizens. It was predominantly through the activities of the

Public Health Service, which aimed to spread "the Gospel of Health" that this happened.5

By sending medical practitioners into the interior of the country, by building hospitals and clinics, by instituting measures to rid the island of malaria, and by enforcing public health regulations, the Haitian state was transformed into a body that was both functional and desirable. But the successful implementation and continuation of these projects was dependent upon American medical ideas, establishing for the Americans the possibility of continued influence after the end of the occupation. In turn, public health provided the means by which the United States could establish a long-lasting hegemonic presence in

Haiti.

Hegemony, in this case, refers not simply to the idea of domination, the usage which

William Robinson claims is most commonplace when studying foreign relations.6 Rather,

3 and in a more Gramscian sense, the term is denoting an application of subject consent to that relation of dominance.7 The Americans essentially sought to make Haiti willingly reliant on the United States, indirectly dominating the country through a process that the

Haitians would actively encourage. This hegemonic drive was made possible by the incorporation of non-state actors into the colonial project. To achieve this, the American authorities forged a development strategy for Haiti that was premised upon a relationship between the state and private institutions. Working with private partners allowed the colonial authorities to yield certain activities to other American agents. In the process the locus of interaction between Haitians and Americans shifted, facilitating Haitian contact with non-military actors. But even though the intentions of the U.S. civilian representatives sometimes differed from immediate military aims, both American parties were ultimately interested in facilitating capitalist notions of stability, development and progress in Haiti. In the realm of health, the redevelopment of the National School of

Medicine was the pinnacle of this relationship. Not only was the entire cost of the project hosted upon the private, philanthropic Rockefeller Foundation, but the end product was an institution that served to strengthen American hegemony as it necessitated continued linkages between Haitian and American health professionals. The inclusion of the

Rockefeller Foundation essentially also made Haiti the site of a pioneer project testing the privatized, NGO-dependent model of development in vogue today.

That healthcare could be a useful tool of imperialism had to be learned. Out of legal obligation and self-interested need, what had originally been intended only for the occupying Americans was expanded in scope. As the national Public Health Service

4 began treating Haitian patients, the Americans observed how medical practitioners were enthusiastically received by them, which was a stark contrast to the common Haitian attitude demonstrated towards U.S. soldiers. U.S. authority in Haiti between 1915 and

1934 was ultimately predicated on military control, something which the Haitians never fully consented to, but the use of public health tempered the climate of violence.

Americans could exercise their rule without relying upon force for most of the 1920's. A major student strike in 1929, which led to a nation-wide revolt, made it clear that

American control over Haiti was limited, however. Public health could not bandage over the national wound that was foreign occupation. It had given the Americans room to maneuver, though, and it ultimately recreated Haiti in a dramatic way. After 1934, without the Americans present to maintain the system they imposed, many of the occupation's health developments deteriorated. Nevertheless, just as had been demonstrated during the 1929 student strike, the power of health gave the Americans an influence in Haiti that was neither obvious nor easy to subdue.

The nineteen year occupation of Haiti had begun in 1915 after a series of chaotic events led the Americans to intervene in the affairs of the tropical nation. Facing a rebellion in the north the Haitian President of the time, Vilbrun Guillaume Sam, had imprisoned 167 family members of his political rivals. As the threat increased he ordered on July 26 that all of these prisoners be executed in cold blood. When word of the massacre spread

President Sam and the executioner, General Oscar Etienne, fled to the French and

Dominican legations respectively seeking refuge. Having buried their dead, on the morning of July 28 a mob gathered, thirsting for vengeance. Taking no notice of

5 diplomatic protocol, the enraged family members stormed into each embassy, seizing the targeted individual. Neither lived much past that point. Shocking all foreign observers in its barbarity, the former President was dismembered by the mob, his body then dragged through the streets where it was simply left to rot.8 Reacting to the chaos the United

States, the "self-appointed trustee of civilization in the Caribbean," subsequently sought to protect American lives and property and to maintain stability in the region as a whole.9

Initiating a plan that had actually been drafted a year prior with only the dates left to be decided, the Americans launched what would become their second-longest military occupation, and Haiti was made to join the ranks of Cuba, Puerto Rico, and Panama as a regional American colonial outpost.10 In each of those places the United States had experimented with how best to establish empire. One such procedure, according to military historian Hans Schmidt, was to use Marines instead of regular infantry so as to

"evade the stigma of outright invasion and conquest."11 But while the forces associated with the tactic of gunboat diplomacy were "establishing their pre-eminence as colonial infantry for surgical intervention," in Haiti the United States applied another kind of surgical intervention as well, one where the surgery was not just metaphorical. In seizing

Haiti, the American imperialists were presented with a problem that doctors and other medical practitioners ultimately helped to solve.

Establishing direct military domination over Haiti was a relatively simple task for the

United States Marine Corps (USMC). However, in the previous thirteen years the U.S.

Navy had already sent gunboats to Haiti twelve different times. Intransigent, Haiti remained uncivilized and unstable in the American mind. Despite the insistence by

6 individuals such as Frederick Douglass that such arguments "are hard to sustain,"

Americans had long considered Haiti to be "on the down grade to barbarism."12 The island, as described by Marine Commander Charles S. Butler and Lieutenant Edwin

Peterson, was inhabited by a "rather primitive people," and the invaders considered the country they now controlled to be politically hopeless.13 Short of employing continuous military coercion - and annexation or the establishment of a protectorate à la Puerto Rico was not an option that the American leaders in Washington were willing to consider - there seemed to be no hope that this irremediably 'backward' country could ever be a civilized nation. Haiti did not have to be civilized though: it merely needed to be a non- threatening entity that was satisfactorily pliant with U.S. foreign policy. Primarily this meant being politically and financially stable, conditions which the Americans looked to foster via their expertise and command over the next ten years (the original duration envisioned for the occupation). And so, shortly after sequestering Haiti's customhouses and treasury the Americans seized control of Haiti's governance machinery, placing themselves in charge of nearly the entire state bureaucracy.14 But Haiti was not only a place of political chaos. Like all tropical locations, it was considered by the Americans to be an epidemiologically dangerous place. Naval medical authorities were called upon in response, and they subsequently applied the public health knowledge that they had gained in other American colonial possessions to make Haiti safe for the troops stationed there.

This alone made the medical practitioners an integral part of the occupation apparatus, but the interactions that these health professionals ultimately had with the Haitian population proved to be quite valuable as well.

Public health operations were at first confined primarily to sanitation work in the areas where U.S. forces were stationed. But since the invaders initially endeavored to occupy

Haiti under a guise of legality, in order to carry out the desired sanitary improvements the

Americans had taken responsibility for such matters via a treaty signed with Haiti at the start of the occupation. Doing so placed the Americans in charge of the Haitian Public

Health Service, known as the Service d'Hygiene. This initially made sanitary and other public health duties the purview of the Navy, but in 1917 such responsibilities were returned to supposedly civilian - though ultimately still American - control. The shift in command also entailed a shift in focus. With the Naval Medical Corps still serving

American health needs, the Service d'Hygiene was repurposed to work with the Haitian population. The extent of that work was relatively limited until 1920 when, in an emergency response to a smallpox outbreak, a massive vaccination campaign was initiated, bringing protection against the disease to a vast majority of Haitians. Over the course of this campaign some American officials began to realize the potential support medicine could offer to the occupation. The vaccination drive happened to coincide with a major revolt against American control of Haiti; while the Marines were busy combating

'Caco' rebels other Haitians were willingly welcoming American healers. The success of these and other medical initiatives suggested to the occupation authorities a unique strategy for colonial control. By employing a strategy of medical intervention and regulation, what Michel Foucault would call an exercise of disciplinary power through

"the biopolitics of population," the Americans could manage the Haitian population.15

But though some American officials explicitly identified healthcare as having political

8 intent, health and medicine were not envisioned as being independent operators. Rather, they served as just one part in the larger process of state formation.

Once the Caco revolt was finally put down in 1920, the occupation authorities sought to consolidate their renewed military control of Haiti by expanding and strengthening the

Haitian state. The Americans hoped to structure the state in such a way that the Haitians would identify with it while still having the state serve American interests. Public Health had a vital role in this process. Under 'civilian' command the Public Health Service joined other sectors of the occupation state in initiating "projects of productive development."16

What followed was a massive investment into Haiti's public health system, starting with the construction of a series of hospitals and clinics across the country, a project that continued to expand as the occupation continued. The Americans hoped to undermine

Haitian hostility and to create a benevolent image for the occupation by emphasizing these productive and beneficial aspects. By 1926, the Marines were taking pride in and touting the fact that "one great feature stands out [...] which has brought enormous benefit, comfort, satisfaction to the inhabitants of [Haiti]. This," Dr. E.R. Stitt, the

Surgeon-General of the United States Navy, explained, "has been the improvement in sanitation, the public health advancement that we have brought."17 In providing modern medicine to the Haitian population, the American-controlled Public Health Service rapidly became the only aspect of the occupation that was well-received by the Haitian population. Occupation authorities regularly reported, as Maurice Dunlap of the U.S.

Consular Service did, that "thousands of people swarm down from the mountains" to places where clinics were hosted, where "energetic American doctors" would treat

9 hundreds of people in a day.18 But as Dunlop also indicated, the doctors were often accompanied by constabulary personnel. Writing about a trip to Fond-Verrettes with a company of U.S. doctors, Dunlop noted that the medical brigade was joined by a captain of the gendarmerie, who was seeking to expand the police presence in that valley.19 The same occurred across the island. The medical practitioners were also often members of the U.S. Navy or the Haitian gendarmerie. In their eagerness to engage with the Service d'Hygiene, the Haitian peasantry was unwittingly inviting a hidden expansion of military personnel into the otherwise hostile countryside. By virtue of being one of the most expansive sectors of the colonial state, by the end of the twenties the majority of Haiti's population was regularly and positively interacting with the occupation via the Public

Health Service. As chapter one shows, clinics and other curative institutions provided a veil behind which the occupation was entrenched.

As popular and as successful as these clinical programs were, they were not all that the

Public Health Service did, even if they received the most attention. The imperial health mission had not been launched with clinics but with sanitation projects, and throughout the occupation the American-led Service d'Hygiene devoted as much if not more attention to that original task of purifying Haiti's natural environment as they did to establishing clinics. In their view, "The whole country teemed with filth and disease," and

"had reached the stage of hopeless chaos."20 To American eyes, the Haitians lived "under the most primitive conditions[,] not duplicated possibly except in the remote districts of

China and British India."21 Partly this was because their "Latin mind," as American

Chargé Stuart Grummon claimed, led the Haitians to "scorn [...] and neglect activities

10 looking to the health [...] of the masses."22 The Gospel of Health had an educational component for this reason, and the Americans hoped that the Haitian population would learn the importance on sanitation. But "to create conditions which would make healthful and orderly living possible," which one U.S. government official claimed was the aim towards which the occupation worked, the Americans did not believe that they could rely upon Haitian action.23 However, by altering Haiti's physical environment the Americans could avoid this impasse.

Public health endeavors during the occupation were environmental projects as well as medical. Operating from the premise that the natural environment influenced whether the local population would be healthy or diseased, the Service d'Hygiene prioritized sanitation as a means of promoting health. But this did not simply mean promoting the use of toilets. Despite the Navy having deemed this approach insufficient in 1917, throughout the occupation the Public Health Service made land and geography a prime target for health interventions. Both in urban and rural areas the sanitarians modified the natural environment in such a way as to make Haiti less disease prone. Efforts were made to eliminate the mosquito population in the country by filling in low-lying breeding areas and, where that was not possible, alter the environment through other means such as by introducing foreign fish species. Other projects worked to cleanse major rivers and water supplies of both sediments and pathogens. Any other aspect of the physical environment that could even remotely be linked to disease occurrence was targeted as well, resulting in a range of activities that included everything from street sweeping campaigns to rebuilding marketplaces according to new "sanitary" designs. These physical

11 interventions were supported by other, more abstract geographical activities. Attempts were made to strengthen Haiti's borders through medical means, such as by establishing a cordon sanitaire. In order to prevent pathogens from crossing over Haiti's territorial boundaries from abroad, suspected conduits of disease - particularly foreign ships and prostitutes - were policed and made subject to state authority at Haiti's borders. These combined geographical, sanitation-based approach to disease preventions had two related consequences, both of which are discussed in chapter two. One consequence was that the state was strengthened, allowing it to express itself in a more robust way. By engaging in medical projects, the Haitian state was transformed. Prior to the occupation, the state essentially belonged to a small number of Haitian elites. The occupation-era medical projects changed this as the Service d'Hygiene was fundamentally concerned not just with a privileged segment of the Haitian population, but rather with the entire national body.

In turn the Haitian population's main interaction with the state was through the clinical or sanitary divisions of the Public Health Service (as opposed to interacting only with coercive elements of the state, such as the army, which had previously been the case for most Haitians). The other consequence of the sanitation-based approach to health was the promotion of American biomedicine in Haiti.

When acting on Haitian geography the Public Health Service was simultaneously operating from and popularizing an American biomedical conception of health.

Biomedicine, as defined by Adele Clark, et al, refers to the incorporation of basic life sciences - biology - into applied clinical medicine.24 Though in many ways this was still an emerging category in the early twentieth century, in Haiti this constituted a scientific,

12 laboratory-based approach to understanding health and illness. Health problems in Haiti were interpreted by American medical practitioners in relation to their knowledge of biology. Though racial assumptions still factored into their thinking about health and disease, American medical men did not emphasize race as a medical determinant. Rather, they studied the disease environment in Haiti and came to the conclusion that the physical landscape was a decisive factor influencing the health of those who lived on it. Unlike some previous medical theories that also prioritized place, which emphasized proximity to bogs, smells, or miasmas as the reason for poor health, American biomedicine was concerned with the ways that a place hosted various pathogens or disease vectors. It was this knowledge that informed the above-mentioned land alterations. But if this is what informed and motivated the public health projects, which in turn reoriented the entire way that the Haitian state functioned, it would follow that the continued functioning of the

Haitian state would be dependent upon maintaining a state understanding of biomedical knowledge. This was indeed the case. However, even though Haitian physicians employed western medicine long before the occupation began, the biomedical shift of the state required a new domestic source of biomedical knowledge, lest the changes instituted by the Americans be for naught. As a result, the Americans were forced to further expand their development project in Haiti.

In a 1926 report, an unknown American official wrote that "If we consider the general condition of the hospitals in Haiti at the time the United States took them over as a criterion of the efficiency of the native medical profession we must consider it quite low."

But he noted that "The Haitian medical profession is not alone to blame for this

13 condition," as "medical education was part and parcel of the general situation found in

Haiti in 1915." Since the Port-au-Prince based National School of Medicine, Dentistry, and Pharmacy was "practically the only source of native physicians," the occupation official felt that the medical school could not "retain the same organization as it now has without retrograding to a state of more absolute uselessness." Yet because the Haitian state had by that time so thoroughly incorporated American biomedicine into its operations, meaning that physicians' knowledge was necessary for the continued functioning of the state, the American astutely observed that the school needed to be improved for the sake of "the future development of Haiti."25 The occupation authorities subsequently transferred management of the medical school to the American-held Office of the Sanitary Engineer of Haiti, who in 1927 oversaw a complete overhaul of the educational facility. In the process the Americans, as chapter three will show, intentionally structured the school so as to secure a biomedical, and thus American, hegemony in Haiti.

While the promotion of biomedicine concerned the Americans because of their conception of progress, labelled as "techno-nationalism" by David McBride in his study of medicine during the occupation, the American interest in biomedicine went beyond simply using it to "impart miraculous progress in the 'backward' society that was Haiti."26

As integral a belief as the-U.S.-as-harbinger-of-progress was, biomedicine was also viewed as a vehicle to ensure stronger ties between Haiti and the United States, especially when thinking forward to when the occupation would eventually end. When re- establishing the National School of Medicine, the American plan rested upon training

14 new school instructors and administrators according to American methods. Those instructors were given fellowships to study in the United States where their American benefactors hoped they would learn about modern biomedicine, while also establishing lasting commitments to that country. The funders hoped that upon returning the Haitian doctors would successfully educate the next generation of medical professionals in such a way as to maintain the Public Health Service's reliance on the United States. Not only was this intended to create new ties of dependence between Haiti and the U.S., but it was also intended to supplant the ties that Haiti had with its former colonial ruler, France.

Although the Americans maintained an effective monopoly on biomedical knowledge in contrast to the Haitians, such was not the case with other world powers. Haitians were most apt to seek medical training in the country that they were once colonial citizens of, and so initially it was France that was best-positioned to have an educational sway upon

Haiti's physicians. The American overhaul of the medical school displaced the French influence though, and after the occupation ended it was towards the U.S. that Haiti turned to for support in the field of medicine.

That Haitian nationalists later sought further support and guidance from the United

States, the very nation that had for nineteen years occupied their country against their will, is a clear example of Haitians giving their "active and direct consent," to quote

Antonio Gramsci, to American leadership.27 But revamping the school resulted in more than a willing Haitian reliance on the U.S. Re-establishing the National Medical School was a pinnacle event in the occupation, as it represented the invention of a modern development strategy in Haiti. Mary A. Renda has shown how the Marines used

15 paternalism to conscript American civilians into supporting the occupation; such a strategy was likewise used to incorporate private, non-state, not-for-profit organizations into the American imperial project. Since the colonial authorities were constrained by the financial situation they had imposed upon the country - one aim of the occupation was to eschew debt and place the finances of the republic "upon a sound basis" - they formulated a strategy that sought external assistance to realize the occupation's development objectives.28 Subsequently the occupation health authorities approached organizations such as the Rockefeller Foundation for assistance, invoking their motto of "promoting the well-being of mankind throughout the world," hoping to utilize both their financial resources and their various in-house expertise on subjects such as public health.29

Alongside showing how the Americans used the medical school to build a hegemonic influence in Haiti, chapter three will also demonstrate how the U.S. Navy successfully negotiated with and then incorporated private philanthropy into their imperial strategy.

The Rockefeller Foundation's engagement in Haiti was the culmination of the development project initiated by the American occupation authorities. Over the course of the occupation the Americans had modified their thinking about Haiti. The country had become developable, not forever condemned to be a backward, primitive place in the

American imagination. The words of one State Department official, written in 1921, are representative of what the American mindset was at the onset of the occupation. "The

Haitians are negro for the most part," he wrote, "and, barring a very few highly educated politicians, are almost in a state of savagery and complete ignorance." It thus followed that "it is necessary to have as complete a rule within a rule by Americans as possible."30

But as the Americans saw successes in their attempts to transform Haiti into a healthy place with a stable government, they began to reconsider their harsh evaluations of Haiti and Haitians. Whereas it was deemed that prior to the occupation "rural development would have been impossible if not unthinkable," by 1923 American military representatives instead were emphasizing that "conditions favourable for the development of the resources of this rich country exist."31 "It was fortunate," another U.S. government official wrote three years later, that the Americans sent to Haiti "saw how far Haiti had to go to be capable of self-government and [that] they undertook the task of leading the mass of people along that road, with both sympathy and farsighted vision."32 This paternalist attitude, which held that the Haitians could only progress by the guidance of the United States, emerged in concert with the various public health measures and other economic development projects instituted by the colonial authorities. By 1924, not only had the Service d'Hygiene established widespread sanitation projects and an extensive network of clinics, but the occupation authorities had also launched massive projects meant to strengthen the infrastructure needed to facilitate international investment in

Haiti. Roads, bridges and lighthouses were constructed, harbours were improved, the

Artibonite river was dredged opening it another 15 miles to develop a trade in logwood, and electrical and telegraph lines were strung.33 By the mid-twenties the Americans had proved to themselves that through state action they could facilitate the "efficient development of [Haiti's] agricultural, mineral, and commercial resources" while placing

"the finances of Haiti on a firm and solid basis," which according to the treaty that formalized U.S. control over Haiti was the utmost priority for the occupation.34 The

Rockefeller Foundation's redevelopment of the medical school was merely a privatized

17 extension of this development program, allowing the U.S. Marines to avoid the costs of empire building whilst also hiding colonial intent behind the facade of charity.

All seemed to be going well for the Americans as the occupation neared the fifteen-year mark. Having “exerted every effort to build up the organizations which are increasing the productive wealth” of Haiti, the occupation authorities had already reported in 1926 that

"the public debt was diminished by about $2,500,000 [...], Government income increased

$2,500,000, exports increased nearly half a million dollars and imports diminished by about $200,000."35 Stability seemed to reign in the once volatile country, and even the

Cacos that had once plagued Marine patrols had not been an issue in years. U.S. rule seemed secure, and the Americans even believed that the Haitians desired their presence.36 But the illusion came crashing down in 1929, as chapter four will demonstrate, when the Haitian desire for sovereignty led to a direct challenge to

American control. A dispute in one of the Service Technique agricultural training schools over a change in policy precipitated a student strike which rapidly expanded into an all- out challenge against the occupying Marines. Though initially a local incident, the strike was framed by the students as being fundamentally about sovereignty, creating an opportunity for Haitians to collectively rise against colonial control. Students across the country, including those enrolled in the National School of Medicine, joined their compatriots in the strike, as did many workers. The Haitian employees of the Service d'Hygiene did not, however. The Americans interpreted the Service d'Hygiene's loyalty to be the product of a successful drive for hegemony; "It was gratifying indeed," one official observed, that the Public Health Service was "standing like a rock in its loyalty to the

18 government" during the "trying period in the life of this little country."37 The American interpretation was much too simplistic though, for while the Haitian health officials may have demonstrated support for the Americans during the strike - and the extent to which this was the case is not entirely clear - it is just as likely that the health officials were navigating how best to serve their country within the framework of foreign occupation.

The medical students similarly grappled with that dilemma, ending their strike early as it became clear to them that the U.S. was hesitant to vacate the island without having a trained cadre of Haitians to take the reins of power (and rule according to American methods).

The student strike was relatively short in duration, but it proved effective. One significant outcome from the 1929 student strike was the establishment of an investigative mission by President Herbert Hoover. Two commissions subsequently travelled to Haiti, tasked with evaluating all aspects of the occupation. The reports they delivered upon their return were extremely critical of the occupation, and both recommended withdrawal. Though authored to inform policy considerations, the reports also illustrated what the 1929 strike demonstrated; the Americans had failed to establish a clear and unmistakable hegemony in Haiti. An evaluation of public health featured prominently in the first commission's report, in which this dynamic was particularly evident. Though largely happy with the medical activities, the report of the Forbes Commission raised concerns over the durability of the Public Health Service. The report suggested that American medical norms had not taken hold as strongly as the occupation authorities hoped, which was likely to undermine the long-term medical connections that the Americans hoped Haiti

19 would have with their country. Less evident in the report but equally significant, members of the Forbes Commission found during their time in Haiti that many Haitians had strong critiques of the Public Health Service. Little is made of this by the Americans, but it indicated that public health had become an apparent site of contestation for the

Haitians in stark contrast to its earlier status as the only universally supported aspect of the occupation. Consequently, when the Marines withdrew from Haiti in 1934, a year earlier than originally intended, they left unsure about the platform that further relations were to be premised upon.

The Americans had little to be worried about. Shortly after the occupation ended some

U.S. officials returned to Haiti as invited guests. Welcomed because of their medical knowledge, the occupation had successfully made Haiti beholden to the United States.

The occupation-era development program taught the Americans, years before comparable programs were implemented elsewhere, that non-military international aid complimented

U.S. military dominance. The Marines, Hans Schmidt writes, had believed that the most effective means of ensuring that Haiti stayed a client state vis-a-vis the United States was through maintaining strong military ties. As such, as early as 1915 the Marines had moved to train and professionalize the Garde d'Haiti, hoping that the Haitian Army would maintain peace and stability, and thus a business-friendly climate, in the republic.38 Or, in the words of the twice-deposed Haitian President Jean-Bertrand Aristide, "[The U.S.] set up the Haitian Army, they trained it to work against the people."39 Much has already been written about the role of this army that has never since fought an outside force, instead having only ever targeted Haitian citizens.40 But while this violent and coercive apparatus

20 has been extremely important in protecting American interests in Haiti, it was not solely through naked violence that Haiti remained subordinate to the United States. Just as the medical programming had proven beneficial to the Americans during the years of the occupation, legitimizing colonial rule, the early development projects fostered a relationship of dependency in the years after, pioneering a defining aspect of the

American empire.

THE STATE OF HEALTH: ENTRENCHING THE

OCCUPATION THROUGH CURATIVE INSTITUTIONS

Soon after the Marines landed, the former U.S. Secretary of State, William Jennings

Bryan, held a meeting with the Haitian representative in Washington, Solon Ménos.

Speaking to the man whose country had just been invaded, it was posited that “The intelligent Haitians should feel gratified that it was the United States” that had taken over their country, “rather than some other power whose motives might not be as unselfish as ours.”1 Completely dismissive of the idea of Haitian sovereignty but representing popular opinion, Bryan suggested that benefits would accrue to the Caribbean nation by virtue of the American presence. Though it was assumed, as the New York Times calculated, that the U.S. Marines would stay in Haiti just long enough to enforce stability on the republic before withdrawing again, regardless of their position on the endeavor all who paid attention believed that the Haitian population would inevitably benefit from the occupation.2 Their confidence in the matter was not buoyed by any official government plan, however. Despite the missionary tone, the Americans had no real plan to aid Haiti in 1915. Yet when the Americans finally withdrew nineteen years later, they left behind a fully refurbished health apparatus. Their need to protect themselves - first from disease but later also from Haitian discontent - had precipitated changes in how the Marines administered the occupation, and gradually the Americans fostered a formidable development project oriented towards the health of the Haitian nation.

When the U.S. troops first arrived in Haiti, the Americans had quickly become concerned about the health of the country. Focused narrowly on the potential impact of disease on

American soldiers, the occupation forces sought to replicate the achievements they had made in the realm of public health in their other colonial locations. When the U.S. and the militarily-imposed Haitian government signed a treaty in September of 1915, the

Americans were granted the power to direct and oversee matters of sanitation and health.

But with control came obligation, and the Americans were required to establish a national public health service, the Service d'Hygiene. Dutifully established in 1917, the Public

Health Service led to a change of approach in how the Americans administered the occupation. Meant to serve the general population of the country, the Service d'Hygiene brought the Americans in contact with the Haitians in a seemingly non-military way. This aspect of the service became indispensible to the colonizers, especially after a massive revolt challenged Yankee control in 1918. In the midst of the anti-American rebellion, the

Public Health Service became a vehicle to expand state control. Recognizing that medical practitioners' interventions were welcomed and even sought after by the Haitians,

American treaty officials up to the High Commissioner heavily promoted their medical expertise and established curative institutions throughout the country. Through this process the Haitians were encouraged to see the state as being beneficial to them, while the occupiers hoped that a seemingly benevolent approach to ruling Haiti would make opposition to the occupation disappear. By the mid-1920s the Public Health Service had become the only aspect of the occupation viewed favorably by the Haitians. Mediated by medical practitioners, the majority of the Haitian population interacted positively with the colonial state, which permitted an entrenchment of the occupation throughout the

23 country, and the U.S. quest for hegemony ultimately came to rely upon the opportunities created by such. The American commitment to health and development thus emerged from an imperial self-interest, and was fostered to advance the same.

Soon after the Americans 'took' Haiti they had moved to 'legalize' the occupation by signing a treaty with the Haitian government, making the occupation one of the few

American cases of 'legitimate' colonial rule. The treaty also established the framework that governed the occupation.3 Indicating the main priorities, the bulk of the September

16 treaty was concerned with establishing American control over Haitian finances. Even health was framed according to economic concerns. Article XIII, the first non-economic clause of the occupation, declared that sanitation was the next-most important priority of the occupation as it was "desirous to further the development of [Haiti's] natural resources."4 This was a product of the underlying economic rationale of the occupation which permeated all that the Americans did, and was consistent with the way that at least one military commander understood his role: "I was a racketeer for capitalism," Smedley

Butler wrote in 1935. Saying that he suspected it at the time, Butler confessed that he

"helped make Haiti [...] a decent place for the National City Bank to collect revenues in."5

But even as the Americans articulated a relationship between economic exploitation and health, unnecessarily revealing the real purpose behind their being in the Caribbean country, they were also driven by concerns about their own health in that place. After all the "Black Republic," as Haiti is sometimes known, ruled as it was by a population that was "Nearly all black, very ignorant, primitive, with simple wants and utterly without initiative," was but an "unspeakable hotbed of diseases" in the American imagination.6

During the first summer months of 1915, when the occupation was still in its infancy, the

Marines Corps had initiated a "crude and superficial" study of disease in the country so as to be informed of the epidemiological dangers they faced.7 Their decision to include sanitation and health in the September treaty was partially a product of what they had found during this survey. Because "the whole country teemed with filth and disease," wrote the Commander of the U.S. Medical Corps, K.C. Melhorn, "from sheer necessity" one of the first major tasks of the Marines was to take over the health system and "the few so-called hospitals which were nothing but miserable shacks to which more miserable human wrecks were brought to die."8 In order to protect their own men the

Medical Department of the Brigade Forces quickly initiated measures of sanitation in areas where troops were amassed and seized control of government hospitals as well.9

It was a wise move on the part of the United States Marine Corps to immediately concern itself with the spread of parasitic infections and contagious diseases. As Commander

Charles S. Butler would later note, "The most picturesque example that the world affords of a disease defeating the will and purpose of a great general and determining the destiny of a people is exhibited [in this] Republic."10 Knowing that the French General Charles

Leclerc's attempts to retake the island from black control in 1801 failed largely on account of the inhospitable disease environment, the Americans paid close attention to the health of all the troops under their command, quickly finding that the disease threat was not just a thing of the past.11 Amongst the Haitians recruited to serve under American commanders, widespread medical afflictions led to an overall lack of physical stamina, necessitating a lowering of military discipline standards.12 When three thousand adult

25 male recruits to the Haitian Gendarmerie, which was commanded by Marine Smedley D.

Butler (no known relation to C.S. Butler), were examined by Navy Surgeon Koltes at some point before 1917 it was found that the hookworm prevalence rate was around 20%, and "practically 100%" were infected with common animal parasites. Tuberculosis, malnutrition, syphilis, and leprosy were all identified as problems as well.13 However, it was malaria that concerned the Americans the most though, as it was the one disease that also posed a threat to the occupiers. Incidence rates were meticulously tracked, and extensive efforts were undertaken in the regions where Rangers were stationed to combat

Anopheles Albimanus, “the malaria transmitter par excellence.”14 Within two years the occupation authorities were claiming that improvements in sanitary conditions had been made, meaning that by 1926 the Sanitary Engineer could say that "the [malarial] disease has practically ceased to be a problem."15

The control the Americans exhibited over the disease environment was certainly impressive. Of the sixteen casualties suffered by the Marines over the nineteen years they spent in Haiti, not a single case has been mentioned as being due to disease.16 However this was not unprecedented. While the military authorities were undoubtedly reacting to the Haitian pathogenic reality, the early preoccupation with health was not unique to this imperial endeavor. Rather, it was a direct product of the American experience with administering empire. The intervention in Haiti had been precipitated not only by a series of other incursions into Haitian territory but also by a program of American expansion into other tropical regions, during which time a tremendous amount of knowledge about combating tropical diseases was gained. It was over this period that the so-called

"sanitation revolution" occurred, which J.R. McNeill labels as a golden age of health occurring between the years of 1885 and 1920.17 Disease, according to McNeill, has always played a geopolitical role in the Caribbean due to "differential immunity and differential resistance," which has traditionally favoured those who have resided in the region the longest. But the sanitation revolution changed this, allowing the United States to better weather the disease environment, resulting in far fewer microbe-related casualties.18 Looking to tap into this experience the Sanitary Engineer of Haiti, who was responsible for establishing a Public Health Service, explicitly planned "along broad lines" to base the institution off of the model established by Americans in their other colonial possessions of Panama, Cuba, and the Philippines.19

Starting with the invasion of Cuba in 1898 the Americans, Gillian MacGillivray argues, began portraying their actions as being motivated by humanitarian generosity.20 But with that intervention the United States also began to tie health and sanitation projects to their imperial program via the field of tropical medicine.21 Concerned about the spread of yellow fever, a major and widespread health and sanitation campaign was initiated after the Americans seized control from Spain. This established a new precedent of what

American imperialism could look like. Not only did the Cuban case show that the United

States was capable of totally altering the disease environment of a small country, having instituted major sanitation initiatives and eradicating yellow fever by 1901, but it also provided a blueprint for future action.22 Having successfully sanitized their nearest neighbour, Ludwell Montague writes that the Americans desired also to "Cuba-ize" Haiti if ever given the chance.23 Other strategies were formulated in the Philippines which, like

Cuba, had been seized during the 1898 Spanish-American War. Warwick Anderson documents how the Marines there attempted to reshape and control the country through sanitation. The aim was to make the country replicate a laboratory, uninfected, clean, and controllable.24 Concerned with diseases and parasites such as cholera, typhoid, and hookworm, public health workers there sought to spread "the gospel of hygiene," driven by what Anderson calls a racialized germ theory, targeting the disease vector that was the

Filipino body.25 This experience in the Philippines, with its emphasis on surveillance and control, is arguably the genesis of the "new public health" that developed in the continental U.S. after 1910.26 Not coincidentally, these methods quickly became prevalent in Haiti as well, as did the rhetoric, which was echoed in the so-called "gospel of health." The Panama Canal Zone likewise joined the territories seized during the war against Spain as an experimental location for an American brand of colonial medicine.

Having learned from the abysmal French effort in that place, after having gained control of the Canal Zone in 1903 the Americans instituted what has been described as an

"environmental management state."27 Facing the momentous task of safeguarding the new construction workforce from the malaria and yellow fever that wrought havoc during the French attempt to cut a seaway into the isthmus, the American health officials attempted to control the mosquito vector population rather than coercively control the infected and infectable individuals as the French had tried. The Americans tactics were often as intrusive as the French strategy had been - inspection teams intruded into homes, and residents who violated the health code risked imprisonment - but the emphasis was on ruling and managing nature, not people. Consequently the disease rates were

28 diminished, and the United States was able to complete a truly impressive engineering feat.28

While the Sanitary Engineer of Haiti planned to base Haiti's health program upon

American successes in these other colonial possessions, he was not presented with a clear model. The highly bodily-based approach favored in the Philippines, a coercive medical strategy that "fashioned [Filipino bodies] as natural resevoirs of disease organisms, containers that racial customs and habits kept filled to the brim," contrasted greatly with the environmental management state applied to Panama, which was preoccupied with the non-human sources of disease.29 But if the "transformative processes" of empire

"percolated homeward through the invisible 'capillaries of empire'," as argued by Alfred

McCoy, Francisco Scarano, and Courtney Johnson, resulting amongst other things in "the formation of an agile, transnational imperial state," then it should be of no surprise that these different models could be articulated together in a complimentary manner in a later colony.30 Aided by the fact that the Americans did not become embroiled with any one specific set of pathogens in Haiti in the way that they did elsewhere, such as with malaria and yellow fever in Panama, the Haitian Public Health Service took no one specific case as a model. Instead, the repertoire of Public Health included the full variety of techniques developed and finessed by the Americans in their other colonial possessions, establishing the basis for a technical approach to health in Haiti. Aspects of each model would find expression in the Haitian Public Health Service at various moments throughout the occupation, but their application was dependent upon the particularities of America's engagement in Haiti.

Because of the terms of a treaty that the Americans had signed with Haiti shortly after the invasion, the colonial officials were forced to gradually shift their 'medical gaze' away from the troops and onto the Haitians. The need to protect the foreign troops from tropical pathogens meant that health work was initially controlled by the Medical

Department of the Brigade Forces, as administering the public health system was not a task that could be entrusted to the Haitians. But Article XIII of the 1915 treaty prescribed that "The Republic of Haiti [...] agrees to undertake and execute such measures as in the opinion of the high contracting parties may be necessary [...], under the supervision and direction of an engineer or engineers, to be appointed [...] upon nomination by the

President of the United States."31 The Americans were required to hand control of public health work to the Sanitary Engineer of Haiti, a nominally independent agent of the

Haitian government. By February, 1917, Dr. S.T. McLean had taken control of the department in that capacity. McLean was a U.S. Naval Officer, and like all positions detailed in the treaty was actually suggested by the Office of U.S. President Woodrow

Wilson and then duly appointed by the Haitians.32 The Marines had been reluctant to relinquish direct control of the health services, so the choice of a Naval Officer eased that transition.33 But while an American remained in charge, the shift of medical control from the Marines to the Sanitary Engineer entailed a substantial enlargement in the population with whom the health officials were concerned. An administrative framework was created that would allow the relatively small Public Health Service to have both national scope and authority. Consisting only of nine people, which included Dr. McLean, three other medical officers, two pharmacists, and three chief pharmacist's mates, the health

30 service established three administrative zones, with the northern section headquartered in

Cape Haitian, the south controlled by Aux Cayes, and everything else centralized in Port- au-Prince.34 Solely responsible for sanitation, quarantines, hospitals, and anything else health-related in the country, the Service d'Hygiene was one of the few national institutions concerned with meeting the needs of the Haitian people. Unlike the now

American-controlled national treasury, the Service d'Hygiene was not just concerned with realizing imperial goals, though it supported those too.

As the health service expanded its sanitation work and began constructing hospitals in some of the larger cities the following year, the Americans also began reimagining their purpose in Haiti.35 Despite being initially driven only by concern for their own well- being, as the Americans found themselves overseeing a national healthcare program they suddenly, at least when read retroactively, became concerned with aiding the poor

Haitians. As Eric Love has shown in Race Over Empire, U.S. imperialists had learned to not fix nonwhites to the core of their objectives through projects of "benevolent assimilation" or the "white man's burden" until the territory in question had been definitively seized.36 Just as had been done during the debate over whether to annex

Hawaii, the Wilson Administration initially rationalized the need to occupy Haiti by emphasizing the need to protect American lives and property.37 It was not until the

Americans had unquestionably established their dominance over Haiti that the black residents were constructed as requiring the paternal guidance that only white America could offer. But once that point had been reached the occupation authorities began to claim, as they did in a later press release from 1926, that the Americans "saw how far

Haiti had to go to be capable of self-government" and so they benevolently "undertook the task of leading the mass of people along that road, with both sympathy and farsighted vision."38

With the occupation conceptualized differently, and in stark contrast to the initial unwillingness to place Haitians at the centre of the imperial project, paternalism became the reigning discourse of the occupation. Paternalism, as Mary Renda has written,

"culturally conscripted" Americans into not only supporting the occupation, but outright identifying with American imperialism by encouraging them to see themselves as benefactors of a needy child.39 Whereas in 1916 the U.S. Treaty Officials simply rebuffed a group of Haitian physicians who approached them looking for support in restructuring and re-establishing the health system, choosing to assert absolute control instead, after

1917 the Americans built a system that would spread "the gospel of health" and provide support and guidance to all Haitians.40 The exclusion of Haitians from the most important administrative positions remained an integral part of this system and would be one of the biggest complaints amongst Haitians, but by supposedly compassionately guiding the development of the public health system the occupation authorities fashioned themselves as being benevolent, helpful, and necessary for Haiti.41 In this way the whites became the most important actors in the country. With the exclusion of whites being as central to the founding of Black Republic as white domination was to the birth of the United States, plus there being an incompatible system of racial definition in Haiti that privileged

Mulattoes in a way that did not occur in the United States , the establishment of white supremacy necessarily became of central importance to the occupation's hegemonic

32 project. Paternalism, understood as a raced and gendered assertion of authority and domination, “masked as benevolent by its reference to paternal care and guidance, but structured equally by norms of paternal authority and discipline," was an important tool for achieving this.42 Even though the discourse of paternalism was in many ways initially meant only for American consumption, both domestic and in Haiti, it provided the

Marines the political space necessary to carry out projects that Haitians would benefit from. Similarly, when colonial control floundered with the re-establishment of slavery and it became apparent that the violence that hitherto underpinned the occupation was unable to maintain an optimal environment for American hegemony, the paternalist structures and institutions founded by the treaty authorities made possible the response and allowed the Marines to establish a deeper level of control.

Of course the Americans never actually reintroduced slavery, though rumours on the subject abounded. They did, however, reinstate the corvée system of labour, still technically on the books from President Fabre-Nicholas Geffrard’s 1863 Rural Code.43

Driven by the necessity of needing an adequate system of roads into the interior of the country for both military and economic purposes, and connected to the national project of expanding public works (which included the sanitation initiatives), the corvée provided a means by which free labour could be instituted.44 Local residents were instructed by the local gendarmes to either pay an extra tax or report for three days of labour, after which point they were to be exempted from further duty for the next year.45 For most Haitians barring the elite this meant having to do the labour, which was supposedly even enthusiastically welcomed by the jobless populace as food and a meagre pay were

33 supposed to be provided.46 The scheme proceeded relatively smoothly at first, and 470 miles of road were successfully built before the corvée was abolished, compared to the just three miles of road traversable by automobiles prior to the occupation. However, the situation degenerated when Smedley Butler, who had been in charge of the corvée, left the Caribbean nation in late 1918.47 Abuses mounted under a system liable to abuse; food and pay was often denied, peasants were roped together and marched far from their homes to continue construction in more remote areas, and violence became common.

Though some scholars see these abuses as being solely because of the Haitian gendarmes involved in the administration of the corvée, the American commanders were at least aware of the abuse, and the Marines may have even been directly responsible for violent deaths amongst the workers.48 Yet in many ways, just who did what doesn’t even matter; the optics were bad and in the Haitian imagination the forced work and roped labour- gangs spoke to the collective memory of slavery.

Colonel John Russell finally abandoned the corvée on the first of October, 1918, recognizing how unpopular it was with the Haitian peasants. Officially it had actually already been abolished in August by another commander, but Russell determined that certain strategic roads needed to be completed first.49 Before the second proclamation could be made however, and precipitated by the corvée, a major revolt broke out against the occupation. On September 3 an imprisoned opponent of President Dartigenave,

Charlemagne Péralte, escaped from his cell in Cap Haitien with the complicity of his guard and fled to the hills to rally the Caco fighters who had been largely quiet since the end of 1915. Over one thousand Haitians from both urban and rural areas joined Péralte,

34 launching attacks on gendarmerie outposts, and assassinating or taking hostage prominent figures.50 The rebellion, which may have involved a full fifth of the population of Haiti, quickly secured a number of decisive victories, especially as the Haitian gendarmerie was largely untrained since “you could never trust a nigger with a gun,” as Colonel Waller had so ineloquently put it.51 The revolt only came to an end in 1920 after the Marine counterinsurgency killed more than three thousand Haitians, but the rebellion made it clear that relying solely on coercive power left the American project insecure.52

Moreover, the Cacos had initiated a process that even threatened to erode white consent to the occupation back on the continent, and because of these events there was a moment where the United States considered pulling out of the Caribbean country in 1921 before the treaty expired.53 Rifles would not be enough if the Americans wished to retain their hold over the island.

In reaction to the Caco revolt, and using the Service d'Hygiene as their platform, the occupation authorities expanded the role of the state, hoping that public health would be non-threatening and thus would normalize relations between the subject population and the colonial power.54 This process began, likely by mere coincidence, over the course of

1919 when three laws were enacted that, while useful from a health perspective, also substantially enlarged the state's presence. Sanitary Rules and Regulations, very similar in nature to the sanitary code in the United States, were published on April 18, and quarantine regulations were put into effect as of December 7. These two laws will be discussed further in chapter two; more significant for pacifying the vast rural population through non-military means was their predecessor, which on February 26, 1919, actually

35 legally integrated the Public Health Services of Haiti as a Haitian government service after a few years of de facto operation.55 With the passage of that law came increased funding, permitting the construction of a more robust administrative framework through a further subdivision of the country into nine health districts. The headquarters for each were found in the main ports of the district and were organized under the authority of pharmacists or chief pharmacist’s mates of the U.S. Navy in Saint Marc, Gonaives, Port- de-Paix, Petit Goave, and Jeremié. Naval Medical Officers controlled the other four regions from their postings in Port-au-Prince, Cap-Haitian, Aux Cayes, and Jacmel. This followed an earlier policy, used successfully during the initial 1915-16 phase of military action, of redrawing internal boundaries. "Military cartographers literally remapped the country," Mary Renda writes, "dividing it into departments, districts, and subdistricts, which could be policed and managed more readily than the nation's traditional configuration."56 The 1919 changes expanded on this, though with one subtle but important change. Of the regions controlled by the higher ranking medical officers, three were department (region) headquarters. The seat of power for the fourth department,

Hinche, also happened to be where the 1918 Caco rebellion began.57 Instead of continuing to prioritize that city, the fourth Naval Medical Officer was sent to Jacmel instead. In a seemingly punitive move, no health services appear to have been based in

Hinche in 1919.

The law of February 26 provided a framework for the Americans to venture further afield within Haiti in a non-aggressive manner. In doing so the colonial authorities found themselves interacting with indigenous power and culture in a different way than they

36 previously had. To the Americans this was represented by Vodou. Mostly misunderstood by the occupiers, Vodou was considered to be threatening and a symbol of resistance to white control. Supposedly Vodou acts, such as banging drums and blowing conch shells, were unnerving to the U.S. Marines, and Vodou ceremonies were quickly banned and soldiers were given orders to shoot Vodou practitioners on sight.58 Given the importance assigned to Vodou, whether correctly or not, the cultural leaders were singled out as people to be directly challenged through the field of medicine. The ‘Papa Loi’ and

‘Mama Loi’ Vodou priests were recognized as holding a great deal of power in their communities because of their status as healthcare providers, power that could only be challenged by creating the demand for a modern public health organization.59 Confident that western biomedicine would be more effective than tying “a string with a bunch of asafoetida” around someone’s neck, the Public Health Service hoped to challenge the

Papa Loi on his own turf in the interior of the country, and by being more effective the

Americans were hoping to gain support and influence. "The Public Health Service has staked its future on the successful carrying out of this scheme of taking modern medicine out to the bushes and up to the mountain sides," one document indicated. The authors asked "What will be the influence of the 'Papa Loi' amongst these people after he has treated his patients for months and months without results and the patient finally wanders into the clinic and after a couple of weeks of treatment improves with all prospects of getting well?" Answering themselves, Charles Butler and Edwin Peterson say that

"Naturally the influence of the 'Papa Lois' will wane and staunch supporters of the Public

Health Service will increase."60 In the climate of popular revolt against the U.S., medicine's political function did not go unnoticed. Labelling it politics, public health

37 officials lamented that many Haitian leaders would attempt to "influence his compatriots" into rejecting the medical men, their opposition to the health projects being due to their

"years of distrust" of the government.61 But despite the early hesitancy around welcoming the imperialists, the Americans were granted the opportunity they were looking for in

1920 when a smallpox epidemic ravaged the country.

The outbreak of smallpox caught the Public Health Sevice completely unprepared and the disease spread rapidly, with an estimated sixty percent of the country becoming infected.

Though a country-wide casualty rate does not appear to have been determined, in Port- au-Prince approximately ten percent of the 3000 patients who were treated succumbed to the disease.62 Supposedly the only people who had not fallen victim to the sickness were those who had been inoculated in a vaccination drive initiated in the midst of the epidemic, an estimated 850,000 – 900,000 people.63 For Charles Butler the outbreak was occasion to establish an expansive vaccination program, something which he claims the occupation had always intended to do, "but it was not until the epidemic appeared that proper response was given."64 This was contested by a local medical journal, which noted that "The health department had ample warning and did not take the simplest measures necessary to ward off the danger while there was still time."65 However, regardless of whether there had been previous intent, a mandatory vaccination law was subsequently passed in 1920 (though there had already been such a law in place from before the occupation).66 Two years later Dr. Francois Dalencour, the Haitian author of the Journ.

Méd. Haitien, charged that "the new law on vaccination has never been properly applied by the health department," though it had been used to support one other immunization

38 campaign combating yaws.67 These were the exact sort of programs that the occupation authorities had hoped for. Haitian healers were incapable of doing anything to alleviate the condition of their sufferers; smallpox victims either died or survived as luck would have it, and individuals affected with external yaws lesions found themselves segregated and barred from entering villages and towns.68 U.S. doctors, on the other hand, easily demonstrated that the pharmaceuticals they distributed were useful and, by some accounts, Haitians eagerly welcomed the American presence.

Likely having recognized that “dispensaries and physicians have of late been peacefully penetrating areas of the Philippine Islands and demonstrating the fact that for purposes of placating primitive and suspicious peoples medicine has some advantage over machine guns," as George Vincent, President of the Rockefeller Foundation, had pointed out in

1917, the US strategy in Haiti came to be characterized in the same way.69 With a central office coordinating activities in Port-au-Prince, the "farthest corners of the Republic" were reached by the health services, and public health became the main site of interaction between the Haitian population and the American-controlled Haitian state.70 The Public

Health Service first established travelling clinics to ensure reach into all regions of the country. Pack-trains with tents, medical and – tellingly - commissary supplies spread "the message of public health" into the mountainous regions, all the while led by American authorities.71 Members of the Gendarmerie, which was "Haitianized" after the 1920 pacification campaign, were employed in public health work in lieu of proper health professionals as well.72 Thus when Haitians welcomed public health officials into their communities, they were at the same time also welcoming military authority. In 1924 one

39 of the administrative regions was further subdivided, making ten. At this point command was also assigned to Naval Medical Officers, each district no longer reliant on naval pharmacists as had originally been the case, who oversaw the 102 rural clinics and 18 dispensaries in operation throughout the country. These institutions facilitated close contact with 146,579 patients, numbers that rapidly grew over the course of the next five years.73 Another forty clinics were added in 1926, and 673,369 patients passed through these clinics over the course of 1927, a number that increased to 856,679 the following year. This meant that in 1928 alone, nearly half of the population was estimated to have positively interacted with the state through the Public Health Service’s rural clinics, on top of all the other services provided.74 In 1929 this increased again, with 1,341,596 visits to 153 clinics.75

As the Americans gained a greater presence within Haitian communities, the health programs that came with them were increasingly structured to support the priorities of the occupation. A case study of the work undertaken by the rural clinics in the Port-au-Prince district in 1926 demonstrates how the American Treaty Officials viewed their public health work. The region is described as extending “from Ganthier and Thomazeau near the lakes, to Arcahaie and Grand Goave along the Gulf of Gonave and up to Trouin,

Petion-Ville and Fonds Varrettes along the top of the mountain range of South Haiti.”

Within the region there were twelve locations where regular clinics were held.76 At those clinics the American doctors prioritized treponematosis as the most pressing affliction to be cured. During the month of July, 1926, 5102 individual diagnoses were made in the district, 3274 of which were for treponematosis (incorrectly lumping together both yaws

40 and syphilis). The disease was exactly what a doctor would have ordered for an ailing occupation. The Americans easily constructed a racial understanding of the disease, reinforcing the paternal relationship imagined and enforced by the occupation.

Treponematosis became what Sheldon Watts calls a construct disease, whereby "the elite would claim that the disease targeted one particular set of people while leaving others alone," and when establishing official responses, "this Construct determined what - if anything - should be done in an attempt to limit disease transmission."77 Not just the result of a bacterial infection, treponematosis was described as a disease that "operates among primitive peoples" and was associated with a "stone age" conditions of hygiene.

Referencing a document from 226 years earlier that made mention of the disease, the

Sanitary Engineer complained in a report co-authored with Lieutenant Peterson that the inhabitants of Haiti have had this disease since "generations before" then. “It requires no stretch of imagination to picture what will happen to a race with no treatment for a hundred years or more,” they wrote.78 Moreover, syphilis / yaws was an "exanthemata of childhood"; it was supposedly hereditarily passed from mother to child, and though 70% of the Haitian population was claimed (likely incorrectly) to have the disease, it also marked the sufferer (regardless of age) as being essentially child-like, further rationalizing the view that Haitians were childish "wards of the United States."79 Working from this position, the public health workers took to heart the words of President Hoover, who posited that “The greatness of a nation, its freedom from poverty and crimes, its aspirations and ideals are the direct quotient of the care of its children. Racial progress marches upon the feet of healthy and instructed children."80 Yaws was also identified as having a tremendous impact on Haitian earning capacity, and was considered to be an

41 obstacle to the economic progress of the country.81 This was a "most damaging disease," damaging mostly because it lowered the sufferer’s capacity for work and because of the

"terrific" expenses the government was forced to spend to lower the incidence rate to a

"civilized figure."82 But most importantly, the Americans were aware that benefits could be gained through an "awakening of a medical consciousness."83 Luckily for the occupiers (if not necessarily for those suffering from it) yaws, with its cauliflower-like eruptions and raspberry-coloured lesions, is a very visible disease, and a marked improvement could be seen after a few doses of sulpharsphenamine.84 Subsequently, since all Haitians were assumed to be suffering from the disease, every patient who entered a clinic of the Public Health Service was simply administered the treatment for syphilis.85 Even "the most ignorant peasant" was deemed able to appreciate the improvement, and attendance at the clinics grew by "leaps and bounds" once word spread amongst the peasants. Riding on this popularity, the clinic in Leogane recorded as many as 950 clients in one day, which included men, women, and – excitingly for the

Americans - children.86

This model of healthcare was replicated in all of the rural medical districts. Treatment was generally only offered for the most common ailments. Quinine was made available for treating malaria, chenopodium was given to children with worms, digitalis for patients with heart disease, and hospital space opened for individuals with inflamed thyroids.

Electrocardiograms, basol metabolism determinations, or other specialized equipment and procedures were simply not available.87 It was only in the urban centres where

"medicine of the highest order" was practiced; simpler and cheaper methods of treatment

42 were used in rural areas.88 These healthcare practices were critiqued as inadequate by contemporaries, but at the risk of making what Paul Farmer labels "immodest claims of causality" regarding quality of care and the resources available, the health authorities were severely constrained financially due to the requirement imposed that Haiti acquire no new debt.89 Unless external grants could be acquired (such as from the Rockefeller

Foundation) all expenses had to be covered by Haiti’s own revenues, meaning that funding for all of health, education, public works, and justice was only about $2 per capita.90 Of course, just as Farmer has so damningly demonstrated in his work on the provision of healthcare in a more recent Haiti, the occupation-era healthcare providers could have operated a more effective and equitable public health service had that been a priority. Their failure to do so was not simply caused by choices about cost effectiveness, though. Rather, the services provided by the clinics tended to be oriented towards supporting the occupation in the same way that the smallpox and treponematosis programs did. The ailments targeted were both widespread and easy to quickly cure, meaning increased support for the state. As Butler and Peterson noted about one such program, cataract operations; “It is a pleasure to note the gratitude of these poor sufferers who have been blind for years and suddenly have regained their sight. These are worth- while apostles to send back to the hills."91

While the colonial authorities celebrated "apostles" returning to the hills and clinic attendance growing by "leaps and bounds," the theatre that was public health sought to normalize relations between Haitians and Americans through other means as well.

Beyond being just a non-threatening element of the state, the Service d'Hygiene desired a

43 permanent presence in the Haitian communities. With this in mind, the real pride of the health services was the permanent clinics. Even if the clinic was only held on a bi-weekly basis the government, in order to increase its prestige, built permanent dispensary buildings consisting of a consultation room, treatment room, and large gallery. By 1926 eighteen of these buildings had been constructed, with twenty more in progress.92 It was hoped that these dispensaries would help disseminate new, American-produced pharmaceuticals to the Haitian population.93 As Paul Brodwin notes, as roads were built

"which integrated the national space and hastened the emergence of new circuits of exchange, Western pharmaceutics travelled these circuits to enter isolated villages."94

Perhaps more importantly though, the clinics and dispensaries also proved to be good propaganda for the occupation. Lieutenant-Commander Robert Parsons (MC, USN) notes that the Haitians appreciated the dispensaries so much that when Dr. Paul W. Wilson, the

Navy Officer who had initiated the program of dispensaries, left Haiti in 1925, a peasant from Jacmel remarked that "He could have started another revolution!"95 Continuing along the same vein, in March of 1928 a "prettily parked and attractive two-story building" was opened in downtown Port-au-Prince beside the National Cathedral which hosted the first Health Center. Alongside a photographic laboratory, infant welfare, prenatal, and dental clinics, the Offices of Public Health and the Offices of the District of

Port-au-Prince, the building also included a Museum of Hygiene that aimed to spread

American conceptions of health.96 But if these buildings served to increase the prestige of the state, then the much more expansive system of hospitals that were established during the occupation would have created even more goodwill. Over the course of the occupation eleven hospitals were built, ranging in size from 50-300 beds.97 Modern in

44 design, the hospitals often consisted of a number of concrete buildings allowing for quarantine of patients with infectious diseases. All had laboratory facilities, a supply of sanitary running water as well as "satisfactory" sewage and toilet systems, and in definite contrast to the health facilities the U.S. had constructed in the Panama Canal Zone, all buildings were well screened to keep out mosquitoes.98 The Americans were proud to compare these institutions to the “so-called hospitals" that had existed before.99

These monuments to the occupation were completely operated by the Americans. The hegemonic project would have been severely undermined if credit was given to another party, so the U.S. Navy had consciously brought all healthcare under government control.

By 1930, "private hospitals and volunteer aid [was] almost entirely lacking."100 Only a few Catholic hospitals remained independent of the government.101 Even within the state,

Haitians were deliberately isolated via political manoeuvring. The 1919 medical reforms, for example, abolished the local Jury Médical boards of health that were in existence prior to the occupation and had hitherto managed to remain under Haitian control. The physicians who had previously run these were brought into to the Health Services and thus began working directly under American authority.102 Initially the occupation forces had some difficulty in working with these pre-existing Haitian medical authorities, who held unfavourable attitudes towards the Americans and simply refused to collaborate.103

"The attitude of the Haitian medical profession was what probably could be expected,"

Butler and Peterson wrote.104 But while this law undercut any ability the Haitians had to resist through simple non-cooperation, thus ensuring full control over all areas of the country, it also helped foster the appearance of American benevolence, a benefit reaped

45 by the naval authorities in charge. As one contemporary observer, Charlotte Atwood, a member of the Women’s International League for Freedom’s (WILF) mission to Haiti, ultimately noted; “There is more good feelings, and less hard feelings among Haitians towards the Service d’Hygiene, than toward any other branch of the American occupation.”105 Dr. Pearce of the Rockefeller Foundation took notice of this as well during a road trip with Dr. Butler and his wife through Hinche - the very place where the

Caco rebellion began - in 1926. Pearce noted that the region which was "formerly infested by bandits" was now peaceful. "Rarely penetrated by officials" prior to the

American period, the area now hosted a hospital as well as eight clinics in the outlying districts.106

After a decade of occupation an American official, Elwood Mead, noted that "when 250 ill and maimed people wait by the roadside in the mountain districts for the doctors which

American occupation has employed, to bring them relief from pain and cure the two diseases that have long been a curse to the people of this country, there is no need to discuss compulsion. It does not exist. Even the voodoo doctors are abandoning their superstitions to enjoy this blessing."107 Public health was evidently working in the

Americans' favor. But despite this, and while Americans could feel comfortable travelling through Hinche and other areas of Haiti by 1926, indicating success in pacifying both the diseases and bandits that had previously plagued the foreigners, it would be premature to suggest that hegemony had been established in the country. Certainly, in the eyes of the

Americans, Haiti had progressed under their tutelage. After years of occupying the country the Marine Corps had not lost 80-85% of their troops to disease the way previous

46 occupying forces had.108 White dominance had also been clearly established, and there was no sustained violence initiated by the Haitians since 1920. Americans were even working in administrative posts throughout the country with reach into every community.

But hegemony required much more of the Haitians than just acceptance of and consent towards American control. Hegemony also required that the Haitians adopt American ideas, accepting the primacy of the United States while rejecting the hold of ideas that did not position the Yankees at the centre. However, once the Haitians accepted the presence of the Americans, health again acted as an instrument to further American hegemony via the dissemination of knowledge and ideas.

THE LANDSCAPE OF DISEASE: PLACE, SPACE, AND

PREVENTATIVE MEDICINE

"Prior to the occupation," Robert Parsons wrote in 1930, "no one [in Haiti] seemed to know what the principle problems [of health] were." Nor did anyone, he claimed, "have any conception of their magnitude."1 This was as true for the Americans as it was for the

Haitians. Until Navy Surgeon Koltes examined the Gendarmerie recruits in 1917 the

Americans had little idea about what afflicted Haiti, and even then their scientific understanding was limited. It was not until the early Twenties that the occupation health service actually made any country-wide attempt to determine what pathogens plagued the

Haitian population. This had not been a major concern during the early years of the occupation as the U.S. forces had simply replicated the public health programs developed in other colonial locales, most of which were focussed on protecting U.S. troops. Yet once the scope of public health was expanded to include the entirety of the Haitian population and not just the occupying forces, it was no longer sufficient to simply enact mosquito control measures in the areas frequented by the foreigners. As the Americans learned to use public health as a support for the occupation, they found it necessary to determine what the main causes of disease were as well as how best to mitigate them.

However, by placing Haiti under a microscope, both literal and figurative, the Americans also gave themselves the power to define the connection between health and that location.2 Having diagnosed the situation, they also gave themselves the power to prescribe the cure.

The Public Health Service, as established by the Americans, was strongly rooted in the tradition of tropical medicine, a tradition that posited that Haiti's very geography fostered disease. Consequently, as the health authorities sought to determine what afflicted the country and what needed to be done as a result, they determined that the Service d'Hygiene could make best use of its resources by making Haiti's landmass the object to be cured, as opposed to curing each individual Haitian directly. Driven by this medical mission, American sanitarians sought to reshape the landscape and physically alter local environments. Where possible the Haitian countryside was altered so that the natural environment could be made sanitary, sterile, and an unlikely host for disease. The urban environment was also made one to be shaped at will, with the physical infrastructure becoming the decisive factor in the presence or absence of disease. In doing so, the state gained a stronger presence in Haitian life via public health, normalizing the existence of an active and engaged state. It was also given the tools to help attract international capital to Haiti. However, while the state gained strength and purpose through public health, it also came to rely upon it. Ultimately this meant that over the course of the decade biomedical knowledge became integral to the proper functioning of the Haitian state.

The Naval Medical Officers who were stationed in Haiti knew immediately that the

"mass of three million people" who lived there were "sick, suffering beyond all power of words to describe, crippled and weakened from the ravages of a host of diseases, [...] pitifully helpless and hopelessly resigned to their lot."3 What they did not know was why.

Initially the U.S. perception of the Black Republic's collective health was shaped by the legacy of how antebellum America received revolutionary Haiti. As Robert McRuer

49 notes, long before the Marines landed in Haiti the country had been viewed and understood by Americans through the raced metaphors of disability, disease, and contagion. The success of the slave revolution in 1804 had marked the country as

"dysfunctional." By no longer allowing the blan (whites) to profit from the exploitation of slaves, the revolution had "crippled" the island’s position in the capitalist economy, and it was assumed that the disease of revolution was contagious. According to McRuer, this discourse also disallowed other ways of imagining Haiti.4 So while the Americans came to Haiti 'knowing' that the country was ill, they did not actually understand why.

Their scientific approach did not help them much either. Most of the medical men understood the reality through the lens of tropical medicine, which accordingly held that the Haitians had both "racial susceptibilities and immunities to various diseases."5 This,

Warwick Anderson declares, was a "remarkably resilient element in the general understanding of disease susceptibility," and it was premised on the idea that a race best resisted the diseases of its "ancestral realm."6 The recent emergence of biomedical sciences had forced a modification of this understanding, leading northern scientists to posit that "equatorial races" were as susceptible to tropical diseases as their European brethren were, unless their ancestors had somehow become accustomed to withstanding a certain disease.7 This helped explain why the Haitians were as sick as they were; most

Haitians were descendants of slaves forcibly transported from Africa to the then-colony of St. Domingue. Though they remained in the tropics, they were living outside their

"ancestral realm" in a new disease environment. But while this gave the Americans a framework to make sense of why Haiti was so diseased, it did not actually help them understand what afflicted the country.

Fortunately for the Americans, the occupation occurred at a time when medical ideas were rapidly changing. As Linda Nash notes, twentieth century medicine largely turned away from using local knowledge of the land, prioritizing laboratory sciences instead.8

Basic life sciences were starting to be incorporated into applied clinical medicine, forming the field of biomedicine. This laboratory-based approach subsequently allowed the Americans to develop new understandings of health in Haiti. Numerous academic studies of disease and illness were undertaken during the years of American domination, mostly during the mid-1920s, and all informed by the emerging field of biomedicine.

These studies gave public health officials a greater understanding of what ailed the republic and also suggested a future course of action. Largely these surveys fixated on

Haiti's land and geography. As one study which offered comment on the diseases of

Haitian peasants noted just after the occupation came to a close, "the environment and geographical location [...] constitute a factor exerting considerable influence on the sanitary status of the rural people."9 In doing so, the studies remained located in the tenets of tropical medicine, even as they were informed by new medical knowledge. As Laura

Briggs notes, the field of tropical medicine was essentially "a racial theory that posited a metonymic relationship among race, place and disease: the tropics were inhabited by a dark people whose bodies were a wellspring of disease."10 But since the exact constellation of tropical medicine's three components was not constant, the significance of each shifted as biomedical science mediated health officials' understanding. Race became almost coincidental. Blackness as a category continued to be marked in the

American imagination by ill-health, but only because blacks were largely found in

51 unhealthy parts of the world (this was in contrast with eugenics, a rivalling understanding of health, which "designat[ed] pathology as a transmissible characteristic of human biology" and thus deemed only whites as reformable and curable).11 The supposed racial origins of diseases were sometimes still referenced, such as when Robert Parsons posited that disease had arrived in Haiti with the slaves, but the medical professionals usually instead emphasized how efficiently Haiti's landscape promoted disease.12

The first occupation-era health studies were all authored by the colonial authorities.

Undated, though seemingly written between 1924 and 1926, the studies placed a heavy emphasis on the factor of location and geography, emphasizing the belief that Haiti was inherently diseased. In a report on treponematosis, Butler and Peterson claim to discover that yaws, or the more elegant framboesia in French, is actually the same condition as syphilis, which was the main venereal disease. Arguing that public health officials had

"in general failed to grasp the important fact that there is an epidemic type of syphilis as well as a venereal type," the authors note that "we physicians have allowed the sexual form of transfer of the virus to monopolize our ideas of the prevention and the proper mode of attack."13 Their inaccurate conflation of the yaws spirochete, Treponema pertenue, with the structurally indistinguishable syphilis-causing T. pallidum - two diseases so similar as to still provide false-positives in certain syphilis tests - was noted to have a distinctive spatial prevalence.14 In the towns the disease "assumes its usual complexion, that of a venereal disease," while in the vast rural districts that made up most of the country the non-sexual, endemic syphilis was said to be predominant.15

In determining that one strain of treponematosis was endemic to Haiti, a strain that predominated in the assumed-to-be unaltered and natural environment of the countryside, not only did the regional distinction made by Butler and Peterson provide some of the rationale for the previously discussed Public Health Service excursions into the countryside but it also coincided nicely with the author's conclusion that the disease originated from that unhealthy place. Contesting European knowledge with their

"discovery" by using a seemingly anti-colonial narrative often present in their medical discourse, the Americans juxtaposed and set themselves apart from and different than the

European colonial tradition. Quoting a Pere Labat, who had visited the country 266 years prior and whose story served as the basis for the entire report, Butler and Peterson demonstrate how France, Italy, and Spain all attempted to disavow any responsibility for having transported syphilis back to Europe, blaming the other countries instead. The

Americans on the other hand, without upsetting the supposition that the Caribes were the source of the disease, did not partake in blaming other nations but rather were portrayed as being engaged in objectively producing knowledge about the malady in order to effect a cure.16 That knowledge, however, firmly linked the disease to the place where it originated. If the various European nations were not to be blamed for having transported the disease of treponematosis back to their home continent it was because, as Pere Labat put it: "This disease is peculiar to America, it is a normal thing there. Every child that is born there has it almost at birth [...] it should be called the American disease" (emphasis original).17 Though there is now doubt about whether syphilis actually has New World origins the occupation-era study, taking Pere Labat at his word, did nothing to challenge the idea that Haiti, like most of the tropics, was a naturally diseased place.18

While the report on treponematosis emphatically located Haiti as the original source of the disease and thus the reason why the resident black bodies were so infected, a complementary study by the same authors found it "immaterial" whether malaria was indigenous to that same place.19 Instead, urging the reader to glance at an accompanying relief map to see "what a crumpled mass of land it is," with its vast coast and many wetlands the island was construed as fostering the disease.20 Unlike Europe, Haiti hosted in these conditions "the only efficient mosquito host of malaria," the Anopheles

Albimanus.21 So regardless of whether malaria originated from Haiti, it was still the geography and thus the place that made the disease so potent. Moreover, in the American medical imagination such disease-fostering conditions represented the entirety of Haiti's topography. Invoking the Creole epithet “Dèyè mòn gê mòn," to the Americans “Haiti

(the old Carib Indian term for mountain) is all the name implies.”22 Not only did this discursively construct Haiti's interior as being inaccessible (at least until the corvée roads were built), but the entire land was made medically suspect. Areas that were not considered to foster disease - such as the Cul-de-Sac plain, hookworm free because of its salty soil - were rare exceptions.23

Through the latter half of the twenties and into the thirties health officials repeatedly linked their incipient knowledge of life sciences with their environmental observations as well. Even diseases and conditions that had more to do with poverty and poor living conditions than with the land were spatially defined and linked to Haiti's natural environment. Tuberculosis, the most important cause of death in the hospitals, was

54 described as being "rather common in [the] country districts," the implicit contrast being that the urban areas were largely TB-free even though records of the gendarmerie showed a high rate of TB prevalence.24 Though some Americans did recognize that increased standards of living were required before TB could be eradicated, others simply blamed tuberculosis on a rural deficiency rather than recognize its status as a disease of poverty

(unlike the diseases that were "rare and uncommon," such as diabetes and heart disease).25 The sociologist James Leyburn, writing only a few years after the occupation ended and relying heavily on occupation-era documents for his sources, blamed, albeit incorrectly, the frequently polluted spring water in the country districts for tuberculosis' rapid spread. The cases were also "practically always complicated by malaria," that other environmental disease with which the Americans were so concerned.26

The occupational health hazards of labour, too, were deemed to be exacerbated by Haiti's geography and environment. According to Dr. Camille Lherisson, who was at one time the President of the Medical Society of Haiti as well as a Professor of Biology at the

American-established National Medical School, "While farm work is not the cause of the prevailing industrial diseases," environmental factors such as the region in which the work was being done or the hot summer sun meant that such labour is "almost invariably accompanied by an acute morbid condition." The peasants were also "quite liable to traumatic injuries," a fact linked to their working in a mountainous place. The "flattening of cranial bones, the exaggerated bending of the spine, the injuries or prolapse of internal organs, muscular tremors, [and] headaches" were all linked not just to overwork, but specifically overwork in the mountain regions. So too was the case for the "undue

55 pressure on the posterior portion of the chest" caused by carrying heavy weights for long distances over that same terrain, which "makes inspiratory [sic] dilation more difficult, increases the tendency to pulmonary and heart infections, decreases blood oxygenation, and paves the way to a resistent [sic] anemia."27

Near the end of the occupation Lieutenant-Commander Parsons observed that “Haiti has served as a laboratory of applied medicine and state medicine."28 Imagined as a laboratory, the country was conceived as a contained space that could be controlled and manipulated by seemingly dispassionate scientists. Not only did the public health officials try to objectively study how Haiti's landscape shaped the medical climate, but they also sought to experiment with various remedies. Parsons argued such himself, noting that in Haiti "problems can be studied and solutions tried as nowhere else in the world."29 With the landscape as the focus, the Americans could believe that Haiti was medically redeemable. Through reinforcing the construct that Haiti was diseased by virtue of its place, or more correctly that Haiti's location and geography was well-suited to host specific pathogens, American biomedical understanding could then be invoked to cure and heal, or at least to lessen the disease prevalence. Biomedically-inspired tropical medicine allowed "the white man," as Parsons wrote, to show "the Negro" the road to health.30 Understanding from their experience in the Philippines that the prevalence of certain diseases could be lessened by controlling its vector, the Americans knew that they could acquire a "sanitary immunity" by disinfecting and keeping clean the villages and towns.31 There they had encouraged all races to do so and, reinforced by the medical studies, in Haiti they did the same. Typically, this entailed physically altering the

56 landscape to make it a less-ideal host environment for various disease vectors. Not only did this strategy address the public health concerns, but it also gave the Americans an opportunity to model the Haiti they desired. Changing Haiti's landscape precipitated changes in the ways that Haitian interacted with their environment and state. The state likewise underwent a transformation in the process. It became more active and engaged in Haitians' daily lives, and was able to cater more directly to the needs of international capital. However, this also created a state dependency upon American biomedical knowledge. Without it the state would have been unable to function in the same manner, and so the transformation established favourable conditions for the Americans to achieve a long-term hegemonic influence in Haiti.

The Americans did not focus on Haiti's landscape just because the medical studies encouraged them to do so. The environmental focus predominated because it served the occupation authorities well. The alternate approach was to focus public health's attention upon the Haitian population, treating those suffering from infection while also promoting healthy habits. However, optimism for success was lacking when the American health officials discussed targeting the human population. Though they were “simple and kind, because… his contact with the stress of modern civilization has not yet been sufficiently severe to blunt his native generosity and curiosity,” American doctors like Butler and

Peterson understood the Haitians as being “to a large extent disease ridden, poverty stricken, superstitious, ignorant, and wholly illiterate.”32 Because of this the Haitians could not be trusted to comprehend the benefits of taking preventative measures against sickness. The eradication of malaria "to the extent that it will be no longer a serious

57 menace to economic development," for example, was ultimately deemed dependant on widely implementing two factors: mosquito control and the use of quinine as both a preventative and curative measure. While the former could occur "as rapidly" as irrigation and swamp drainage could occur, the latter approach would unfortunately proceed "no faster than people themselves can be enlightened in regards to prophylactic measures and possess the means and ability to live accordingly."33 And so, while the occupation health programs still brought biomedical care to the Haitian populations, offering immunizations and other curative technologies, Public Health placed an emphasis on a land-based strategy for counteracting pathogens.

Not only was altering the land considered a quicker method, but it also largely relied only upon the national health authorities, meaning its application would occur in precisely the way expected. Much in the same way as how curative medicine and medical institutions were used to raise the prestige of the occupation forces, in the process the Americans hoped to leave an imprint on Haiti that would ultimately be of benefit to their imperialism. Specifically, the Americans hoped that if the land changes could predominantly seem to be both successful and useful, the Haitians would freely mimic and replicate the "improvements." As Dr. Butler noted in 1926: "In the division of sanitation, our aim is to incorporate a system that by natural growth will become part and parcel of the necessary government activities that the people actually will demand."34

However, anticipating Mats Lundahl's observation that for peasants "the state has always been a very distant entity - something that had better be avoided," the Sanitary Engineer of Haiti was aware that the "[peasants'] experience during the last 100 years with the

58 governing body of his country has not been a happy one," making them suspicious and not wanting anything to do with the government.35 And so, "[f]or the purpose of demonstration," state sanitarians initiated work that would appear beneficial to the

Haitian people. In two areas just north of Port-au-Prince, in Cazeau and Bon Repos, for example, they filled low-lying areas, straightened drainage ditches, built small canals, and drained swamps, which "took care of the situation nicely," not only lowering the mosquito count but also reclaiming land for local farmers.36

The land strategy was not perfect. Though land could be easily reshaped without it offering any resistance in the way that a peasant might, and while changes became permanent and not subject to a reversion to old habits, the sanitarians' chosen medium was not necessarily as malleable as they had hoped. The existing land tenure pattern and the related conceptions about land rights was a product of the Haitian Revolution, at which point the former slaves abandoned the plantations in favour of individual subsistence plots and the autonomy that came with it. Given this legacy, the practice of land belonging to those who toil it was carefully guarded, and any initiative by the

Americans that threatened to undermine this status quo provoked definite opposition. In

1926, for example, the building housing the negatives from an aerial photographic survey was mysteriously burned down, and it was suspected that this was a Haitian attempt to secure and protect the many freeholds in the country.37 However, the American medical men hoped that land - and with it the wider Haitian environment - could be made neutral territory for state intervention. While the Haitians weren't necessarily enthusiastic about the sanitation projects, the silence of the archival record seems to indicate that most

Haitians were largely compliant. As the Sanitary Engineer put it, "The response from landowners is as good as can be expected," indicating that the Haitians generally, even if grudgingly, allowed the sanitarians to proceed unimpeded.38 The Haitians may not have flocked to support the sanitation measures in the way that it was claimed they did for the clinics, but the public health officials were still afforded the space necessary to operate and realize their sanitary objectives.

The Public Health Service deployed teams of sanitary inspectors into both rural and urban areas - twenty-two working in Port-au-Prince alone - to support the sanitation initiatives.

Employed to identify and rectify problem areas, their duties were identified as identical to the sanitary inspectors of any other tropical place.39 Likely operating as intrusively and coercively as their colleagues in other colonial situations, the duties of inspectors in Haiti included the same variety of property inspections, vegetation clearing, and oiling of collected pools of water.40 In the process, and supported by aerial dusting with Paris

Green and other poisons, these officials eradicated numerous potential mosquito - and thus disease - breeding grounds.41 More substantially though, the activities of the sanitary inspectors also worked to popularize the tenets of biomedicine. Since projects such as the razing of rice paddies and potato patches in the area around Port-au-Prince - plots that provided the food upon which Port-au-Prince depended - were nonsensical unless understood in relation to the biologists' perception of those same plots being prime breeding grounds for mosquitoes, the Americans were forced to popularize a rudimentary understanding of the basic life sciences upon which biomedicine relied.42 Public health workers thus articulated their findings in such a way as to clearly communicate the

60 importance of their land-based interventions. Inspectors were charged with determining where mosquitoes bred, allowing the Public Health Service to locate and thus articulate with precision the connection between the land and disease prevalence. For example, they determined that 2% of properties (317 total) in Port-au-Prince were sites of mosquito breeding in October, 1926, as opposed to only 1.66% the month before. Likewise, in Cap

Haitian anophelines were found breeding in crab holes "about one fourth mile outside of the South Gate of the town in the low area along the river."43 The exactness of such reporting seems slightly comical, especially since there were only two individuals known to be infected by malaria that month (both Marine Officers), but the Public Health

Service needed to make known the perceived link between land and health.

Gazing upon Haiti's terrain, the sanitarians easily identified features that caused or facilitated disease. Upon making such a determination, a swift correction followed. When certain rivers and other water supplies were found to be contaminated and the source of typhoid fever and dysentery, for example, a quick technocratic intervention - chlorination

- ensured that the diseases which once had high incidence rates were by 1930 no longer a problem, at least in cities such as Port-au-Prince.44 Those and other rivers were also dredged or lined with stone to facilitate better flow, reducing optimal mosquito breeding grounds in the process.45 Though not biomedical interventions in the narrowest sense, these measures must be considered as part of that broader project as the sanitarians marshalled their understanding of life sciences in order to enhance Haiti's landscape to prevent disease. Similarly, state-led projects in other sectors sought parallel achievements. Within Port-au-Prince, for example, three hundred individuals were

61 employed in 1926 as street sweepers, collecting with the help of thirteen Dodge trucks all the waste and refuse in the city. But this was more than just an effort at cleanliness.

Rather, the Sanitary Engineer emphasized that such activities were "closely associated with the antimalarial [sic] work," as the rubbish collected was used to fill swampy lands where Anopheles Albimanus bred.46

For the urban-oriented health projects attention was mostly applied to the human-created environment. Exemplifying this were the new "sanitary" markets constructed in 1926, built using modern materials such as concrete.47 These places were kept clean by three market inspectors (presumably one assigned to each of the three major markets) and their gangs of laborers who scrutinized all the produce sold and worked to keep the points of exchange clean. A veterinary surgeon was also employed to inspect all meat prior to sale as well.48 The visibility of these measures was important. By keeping the various inspectors present and by making sanitary initiatives routine, not only could there be tangible improvements in health, but there would also be a constant reminder to the

Haitians that the Americans were the purveyors of a health not present in Haiti prior to the occupation. Laws were passed that encouraged Haitians to reconceptualise common elements of their environment as potential epidemiological risks. For example, worried about how they might spread disease, as of September 1, 1926, a law was implemented requiring all dogs to be registered and licensed. Any unlicensed canines were to be captured, and if not claimed within forty-eight hours, destroyed.49 Over a one month period in Port-au-Prince alone, 150 dogs were killed in compliance with that law via a

"painless" gas chamber.50 Similarly, two Rat Catchers were employed in Port-au-Prince

62 to prevent the circulation of disease, though ironically it was an incident of plague in

New Orleans that spurred their employment even though that disease was unknown in

Haiti.51 Perhaps the most 'routine' sanitary intervention, however, was the construction of privies in a number of towns, and the employment of sanitary inspectors specifically entreated to enforce proper nightsoil disposal.52

When focussing on Haitians' excrement, the Public Health officials were replicating a colonial practice established in the Philippines where, according to Warwick Anderson,

American colonial health officers explicitly regulated "matter out of place" to mark racial and social boundaries and support the U.S. forces who happened to be out of place themselves.53 But if the emphasis in the Philippines on controlling the ways that the colonial subject defecated was meant to mark racial and social boundaries, in Haiti this

"excremental colonialism" was intended instead to impart a biomedical ethic into daily living. Privies weren't the only medium communicating this though. While perhaps being an unlikely combination, radio was used for the same purposes. During the spring of

1926 a one-kilowatt radio station, powerful enough to reach all the other important towns in the country, was established in Port-au-Prince. Receivers and loudspeakers were installed in all the major open markets within range of station. This was partly intended to be a means of control, since the system “afford[ed] the possibility of diverting the people with music.”54 However it also had a didactic quality to it. Since ninety-five percent of the Haitian population was illiterate and only a quarter of the school-aged population was enrolled, radio afforded widespread general education opportunities.55 Short educational lectures were broadcast in the Creole language on each market day to "instruct" the

63 peasants. Topics ranged from Haitian law, to sanitation and health methods, to the cultivation of both cash crops like coffee and cotton but also native crops.56 Based on the accounts offered by John Russell, the American High Commissioner, these radio programmes clearly indicate American priorities of order and capitalist export production, as well as demonstrate their feelings of superiority over, and disdain for, the

Haitian peasant (as if a peasant cultivator needed instruction on how to tend local crop varieties). Nonetheless, while encouraging Haitians to alter their environment and living habits in ways that were consistent with American colonial ambitions, the message coming over the airwaves was one that further emphasized and entrenched biomedical ideas.

For Haitians, by the late-1920's biomedicine mediated their interaction with the state. Or more succinctly, other than via the armed divisions, it was through the Public Health

Service that the state actively engaged with the Haitian population. This changed the very nature of the state though. Regulating and promoting health actually gave the Haitian state new purpose and structure. Previously, Alex Dupuy has argued, because of the country's underdevelopment and its lack of a domestic economic dynamic, the Haitian bourgeoisie "considered the state and its prebends as its private reserve."57 The eminent

Haitian anthropologist, Michel-Rolph Trouillot, likewise concurs. Juxtaposing the state against the nation, he wrote that "Peasants were the economic backbone of the nation; yet peasants had no claim whatsoever on the state."58 Access to the state was instead reserved for the urban elite. Yet during the occupation, both note, there was a fundamental change.

While the Haitian elite still laid claim to control of the state - ultimately the cause of elite

64 opposition to the occupation, according to Heinl and Heinl - under U.S. control a

"modern bureaucratic administration" was created, and the Haitian state began to provide the basic services necessary to facilitate capital investment.59 The Service d'Hygiene was integral to this process, allowing the state to express itself in a more robust way.

Public Health endeavors, fully motivated by the desire to make Haiti a healthy place, had a tendency to directly support capitalist projects. Convinced, for example, that they could improve upon nature, at some point before 1926 public health officials had introduced into the country foreign species of fish and plants. The fish, introduced to lakes and streams around Port-de-Paix and other areas, were of a variety that fed upon mosquito- larvae. Alongside planting vegetation that had already been known to grow well in Haiti, non-native varieties of plants were imported as well.60 These initiatives were intended to create microclimates hostile to mosquito reproduction. However, the introduction of foreign species was actually part of a larger, non-health related project of land formation and insect control. Enacted by both businesses and treaty officials, capitalist activity in

Haiti - much of it agriculture-based and predominantly driven by profit-seeking motives - was already concerned with altering the landscape, importing a variety of foreign cash crops - tomatoes, corn, pineapples, and trees. Brought to Haiti under the auspices of the

(American-run) Agricultural Department, the state hoped to introduce new crops to the country in order to foster a favorable climate to invest in. Likewise, the department's

Agricultural Experiment Station, seeking to support American sisal and cotton producers as well as a number of other agricultural enterprises, was already experimenting with controlling insects using a variety of chemical applications. Though the Agricultural

Experiment Station was mostly concerned with the cotton caterpillar, a common crop pest, the sanitation measures supported their work.61 In the agricultural areas of the country sanitation techniques tended to improve irrigation as well, leading to increased crop production.62 Because of this agricultural companies tended, Butler and Peterson suggest, to replicate the improvements once enlightened on the matter.63 Not only was that a convenient booster for the state sanitarians, but it also provided legitimacy to foreign capital in Haiti. Public health officials pointed to the comparative lack of

"excessive" mosquito breeding in the sugar region of the Cul-de-Sac Plains, at the same time highlighting the health benefits that apparently came from engaging in export- oriented sugar cultivation (the economic development plan that other occupation authorities deemed would be Haiti's saviour).64

That public health had a role to play in relation to Haiti's economic development was certainly not a new observation. A letter circulated to the press in 1926 from Dr. Elwood

Mead, the Commissioner of Reclamation, certainly demonstrates that one American bank had already made that connection. Largely propagandizing, Mead details a story of how

Port-au-Prince was once a "pest hole," with the "smells from the filth in the streets" apparently drifting far out to sea. Supposedly when the National City Bank first attempted to set up a branch there, the bank employees were forced to wrap brown paper around their feet and ankles to protect them from the mosquitoes and filth. The manager purportedly was able to change the conditions in the vicinity around his bank, leading

Mead to humorously note that "Home authorities wrote to [the bank manager, saying] that he had mistaken his calling and ought to be a sanitary engineer."65 But the banker

66 was not a sanitary engineer; he was a representative of a private corporation, someone who shouldn't, Mead implies, have needed to do that work. The occupation-era Service d'Hygiene was, in many ways, a response to such a concern, transferring responsibility for sanitation and health to the state, allowing business to focus solely on its profit- maximizing function.

The public health measures created a favorable investment climate in other ways as well.

The anti-malarial campaign provides an excellent example of this. Not showing much concern for the local Haitian population on the merits of simple human dignity, the occupation authorities worried instead about the extent to which malaria might impact the exploitation of the country, lamenting that in "considerable areas of the Republic the rich soil [...] is rendered almost valueless by reason of this disease."66 The campaign against yaws, as was previously mentioned, was considered in much the same way. By addressing the medical impediments to cultivating export-oriented crops, public health was working to support capital investment. An occupation-era medical journal published in Haiti had for this reason argued in 1922 that health and labour formed a "psychological unity," advocating for the government department that oversaw the labour force to also concern itself with health in the Republic.67 That did not happen, but the Service d'Hygiene still became a vehicle for facilitating economic development in Haiti.

The cumulative effect of these various disparate measures was that during the occupation, the Haitian state became reliant on public health knowledge. Not only did its application help protect Americans in their tropical colony, but it also fundamentally altered the way

67 the Haitian state operated. The application of biomedicine in public health gave the

Haitian state both the rationale and the ability to be more assertive and active. It also provided the means for the state to interact with the general population of the country as the Service d'Hygiene worked to fulfill its mandate. While filling swamps, ensuring sanitary conditions in the markets, and enforcing quarantine measures at the border, the

Haitian state became a productive, as opposed to repressive, actor in its interactions with the Haitian populace. But once that logic was ingrained within the state, the proper functioning of the state was made dependant on there being personnel familiar with the application of biomedicine in public health. With less than 150 doctors working in Haiti at the time of the occupation though, there was little hope that the state would be able to continue functioning in the same way unless some drastic changes occurred.68

AIDING THE OCCUPATION: THE ROCKEFELLER

FOUNDATION AND THE NATIONAL SCHOOL OF

MEDICINE

The New Republic magazine, in its October 6, 1926 issue, asked whether "[it is] right for the people of the United States to impose their standards of sanitation, order, and education by force of arms on people who do not want them, as there is reason to believe is the case with the Haitians?" The query continued, as the editors wondered if "these people [are] being prepared to travel alone or for continued and increasing dependence on the United States?"1 Though misunderstanding the Haitian attitude towards health and education and assuming incorrectly that Haitians had no interest in modern medicine, the question that the magazine posed was astute and timely as the public health projects imposed upon the Caribbean nation begged the same question: how would public health influence Haitian-American relations over the long term? What the question did not conceive, however, was that the answer could be both. The American strategy did not entail binary options, but rather prepared Haiti to travel alone while still being dependent.

As Alan Knight observes, imperialism tends to seek to fulfill two functions. The first is defensive, aiming to secure the benefits for the metropolis through the preclusion of other foreign powers. The second intent is an "engineering" function, which seeks to "mold" the subject peoples and territory in a way that serves the "imperial-metropolitan" interests.2 However in the case of Haiti the Americans only really had to worry about fulfilling the latter requirement as there was no real threat of a rival imperial power

69 challenging U.S. dominance. The supposed German menace had always been exaggerated, and once the Marines had landed any remaining threat they posed to Haiti evaporated.3 Likewise, there was no real risk of any European power contesting the

American position once it had been established. The only real threat to Yankee control of

Haiti was from the Haitians themselves, and even this possibility had been effectively neutralized through the potent combination of military force and public health initiatives.

The engineering function would prove more of a challenge to implement, however. As

Knight notes: "successful 'engineering' requires a long-standing and often costly commitment to direct rule (or, failing that, some efficacious and congenial collaborators)."4 Yet the United States was committed to withdrawing from Haiti by 1936 and hoped to develop in that country a "sound financial condition," which meant that all costs were to be covered by domestic Haitian revenues.5 Nor could members of the

Haitian elite be counted on to do America's dirty work when even the client government was obstinately refusing to follow the precise dictates of the American High

Commissioner.6 The prospects of succeeding in any initiative not buttressed by military force seemed unlikely, even after replacing the increasingly recalcitrant President

Dartiguenave in 1922, seven years into the occupation.

Presented with this dilemma, the Americans committed to building a modern medical school in Port-au-Prince. After having so fundamentally altered the terrain on which the

Haitian state operated, both literally and discursively, biomedical knowledge became a necessary prerequisite for administering the country. Yet all these changes risked being for naught, as there was no domestic source producing such medical knowledge. The

70 planned instructional institution was a response to this, and the school was intended to provide the next generation of state administrators, aiming to have Haitians rather than foreigners filling the government posts. In doing so, the Americans could also ensure that they, rather than any other nation (notably France) would have the most influence in

Haiti. The curriculum taught in the new medical school was explicitly designed to promote American ideas, fostering those very ties. To ensure that the education offered in that school was to be consistent with the hegemonic desires, the educational institution was to emphasize laboratory work, which happened to be an area in which American science excelled. The Haitian instructors were also to be sent to the United States for training, ensuring that American scholarly traditions prevailed instead of those of France.

Establishing the National School of Medicine, Dentistry, and Pharmacy was an ambitious program though, and it was not something that the occupation health authorities could do on their own. As a result, the Public Health Service turned to third-party, non-state actors for assistance.

In many ways, and across a variety of sectors, the American occupation of Haiti had become reliant on support from charitable and philanthropic organizations. Nominally independent, and not-for-profit in design, these outfits were essentially early manifestations of what is now labelled a Non-Governmental Organization (NGO). While the occupation authorities worked with a number of these groups, in the medical sector the closest relationship was with the Rockefeller Foundation. Instrumental in making the medical school a success, the philanthropic organization provided the funding and expertise needed to make the National School of Medicine the institution the Americans

71 hoped it would be. The Foundation had previously also been enlisted to carry out various other tasks that the Public Health Service lacked the resources to do. It was in order to conduct a medical survey of the country that the Naval forces first invited the philanthropic organization to Haiti, and it was because of that engagement that the

Foundation turned its sights on the medical school. However, though a close relationship developed between the Rockefeller Foundation and the Marines by the end of the occupation, the two institutions were driven by different interests and goals. As such the

Rockefeller Foundation was initially reluctant to work with the Marines in Haiti, but through the process of navigating those differences the Americans were ultimately able to fully incorporate the Foundation into the imperial project in Haiti. Perhaps for the first time (extra-continentally, at least), the American military establishment employed a policy of broadly co-opting third-party aid to support colonial objectives.

The relationship between the colonial Haitian state and the Rockefeller Foundation began in earnest during the 1920s following the defeat of the Cacos. Unable to effectively rely on Haitian collaborators, and facing Washington's unwillingness to commit resources essential to manufacture the country into the state desired, the American High

Commissioner to Haiti, John. H. Russell, enthusiastically attempted to incorporate third- party non-state actors into the colonial project. Accordingly with this strategy, Russell wrote to the Rockefeller Foundation's International Health Board (IHB) in April of 1922, requesting assistance in determining the prevalence of various diseases. "The masses are ignorant, superstitious, disease ridden, and under-nourished" he wrote, "living in the worst possible hygienic surroundings. Their customs and habits with regard to living,

72 housing, and disposal of waste [and] excrement [...] are the most unsanitary imaginable."7

Since Haiti's afflictions were at this time still unknown beyond the existence of smallpox

(made apparent by the devastating 1920 outbreak) and the findings of the initial 1915 survey, Russell hoped that assistance from the Rockefeller Foundation would help determine the health conditions in the country, something that the Public Health Service had no capacity to do. That Russell would turn to the Rockefeller Foundation for support of the Public Health Service was a fairly unremarkable decision. Mandated "to promote the well-being of mankind throughout the world," the organization bearing John D.

Rockefeller's name had supported various medical initiatives since 1913, and the organization's namesake had funded various health projects since 1889, such as the

Rockefeller Institute for Medical Research, which was established in 1901 and which later became the Rockefeller University.8 The Foundation had conveniently become accustomed to working in the other locations around the globe where the Marines had inserted themselves as well, such as in Panama or Nicaragua.9 Nor was it surprising that the High Commissioner would seek to engage with private medical-sector organizations.

Public health had already provided the pretext for doing so, as some charitable assistance and aid organizations (what might get referred to today as development organizations) had already shown a willingness to work with the Marines.

The American Red Cross was one such group already working with the occupying forces in Haiti when the Rockefeller Foundation received its invitation. The Red Cross had committed in January of 1916 a fund of $1,500 earmarked for the "large population of sick and practically starving people" that lived in and around Port-au-Prince.10 However,

73 if this initial Red Cross assistance is any indication, the Marines wished to engage U.S. organizations for more reasons than just administering health programs or writing cheques. These incipient NGOs were politically significant to the occupation, and the

Marines hoped that their aid would benefit the Haitian people and the imperial project equally. When the Americans landed on Haitian shores in 1915 there was some, albeit limited, resistance encountered, but the towns remained relatively quiet as those who were determined to fight the invaders had left to gather in the hills. Though two Marines were killed in the first few days, these casualties turned out to be cases of friendly-fire by nervous and inexperienced sailors. More significantly, the native resistance had erected roadblocks to besiege the occupied cities. Though this and all armed resistance was routed in short time by the Marines, these blockades quickly caused serious food shortages in the urban areas. The Americans swiftly used the situation to their advantage, as Secretary of State Lancing urged President Wilson to use the "famine situation" as a premise to undertake the "humane duty" of seizing control of the local political machinery.11 Beginning in August, while the Marines were dodging tossed rocks and patrolling from the centre of streets at night to avoid chamber pot greetings, food aid was provided by naval medical personnel, aiming to establish some Haitian goodwill towards the American medical men and, by proxy, the rest of the occupation.12 The humanitarian emergency was thus actually manufactured, the Red Cross used by the Marines as part of the drama.

Soon after having satisfactorily incorporated the historic relief organization into colonial service, the Marines looked to do the same with other aid companies. The Rockefeller

Foundation was actually one of the first considered. In November of 1915 Dr. P.E.

Garrison, a Navy P.A. Surgeon, wrote to Dr. John A. Ferrell of the Rockefeller

Foundation. Indicating that the Foundation's International Health Commission (which had actually been renamed that year the International Health Board) relied upon assistance from state functionaries to build its library of medical knowledge, Garrison's letter included "with the permission of Admiral Caperton" a copy of a report on the sanitary and public health conditions in Port-au-Prince.13 But Garrison had "in mind not only the interest I know you personally will have in learning something of conditions here but also the possibility of the International Health Commission taking up its work here." Though he noted that there was much to be done and that the means of the American forces to do so were "almost nil," he made care to note that for the Rockefeller Foundation, "the time appears to be particularly favourable."14 There was no direct request made, but slightly over a year later in February 1917 the New York-based organization received another letter from occupied Haiti, in which the Sanitary Engineer, Dr. McLean, appealed for their aid. Describing the "The Republic of Haiti [as] now being a ward of the United

States" - invoking the same paternalist language which Mary Renda claims was used to

"culturally conscript" Americans into supporting the occupation - McLean made a

"request of the members of the Rockefeller Foundation such assistance as may be available."15

To the occupation authorities' dismay, their requests were initially rejected by the

Rockefeller Foundation. Wickliffe Rose, Director of the IHB, responded to McLean indicating that while the International Health Board was "interested in the improvement

75 of sanitation in all countries," the Foundation considered the request to lay outside the bounds of the relatively-new IHB.16 Yet the American request had been quite vague, as

McLean asked simply "for help in any way that you may decide."17 That the Foundation was unable to find a project that fit within the scope of its activities seems highly unlikely. Moreover, Rose even noted in his reply that "We had a letter some time ago from Dr. Garrison [...] which show the prevalence of intestinal parasites in Haiti."18 In that letter Garrison had written that "Hook worm [sic] infections prevail here."19 But as

Rose was informing McLean that his request was not possible, he was also noting that

"The Board is co-operating with government in a number of countries in the relief and control of uncinariasis," which is the scientific term for hookworm disease.20 Hookworm eradication was actually one of the Rockefeller Foundation's priority focuses during its early years of operations though. It was the very disease that the International Health

Commissions was founded to address.21 Clearly, despite Rose's claim, McLean's request was not actually "outside the present field of operations of the board."22

What, if not a mandated inability to act, explains why the IHB rebuffed the occupation authorities? While there were likely a variety of considerations that factored into the decision, it is probable that the Rockefeller men did not want to be seen as explicitly aiding an imperial project, even if they were. Established "in the heyday of capitalism accumulation," the Foundation, as Edward Berman argues, shared with the other major

American philanthropic funds (Carnegie and Ford) the objective of supporting the class interests of their respective founders. These corporate philanthropic organizations thus served to stabilize and legitimize the new atmosphere of politics and exchange,

76 institutionalize a project of limited reform, and foster the development of a worldwide network of elites that Americans could do business with.23 However, as Steven Palmer has noted, the directors of the Rockefeller Foundation tended to order their representatives not to employ assistance from diplomatic or corporate sources, desiring that the foundation's work avoid the charge of being a tool of imperialism.24 Likewise, he also notes that the Foundation preferred working in states that were more autonomous, and was actually hesitant to work in places like Nicaragua that were only nominally independent.25 It was only, he notes, because the local political elite had initiated the process and not the occupying Americans that the Foundation came to work in that place.

The Foundation still operated, as Palmer puts it, in a "dispersed web of connections, conditions, financing, epistemology, and influence operating, ultimately, in the interests of empire," but the individuals who made up the organization were conscious to not act as conduits of imperialism.26

Employee intentions ultimately meant little. Their agency was constrained by institutional purpose, which was codified into policy and operating procedure. One prerequisite requirement demanded by the Rockefeller Foundation before providing assistance in a country was the expectation of long-term stability. Starting with the hookworm campaigns in Central America, International Health's general modus operandi was to not to wield direct control of the medical sector, but rather it was to establish a health regime that would subsequently be adopted by the local government.27 It was thanks to this institutional approach that the Foundation came to operate in the interests of empire in

Haiti, despite the Board's initial reluctance. Starting in 1921, Rockefeller representatives

77 began to have regular communication with occupation officials again. The Republican

Whip, Harold Knutson, wrote to the philanthropic body in November of that year, asking for help in establishing medical clinics and hygiene centers in Port-au-Prince and Cap

Haitian. Perhaps recognizing that the Foundation required an invitation from the country's government before they could agree to act, the Republican sent a second letter five days later indicating that he would present the matter to Haiti's government when he next visited the country. Rockefeller officials actually had to intervene in order to prevent

Knutson from encouraging the Haitians in requesting aid from the foundation, on the grounds that "IHB representatives report governments of Santo Domingo and Haiti as being unstable and the outlook uncertain and advises against cooperation in public health work."28 Of course, though no documented request from Haitian representatives is evident, after having received such letters from Knuston the veracity of any such request being Haitian-initiated likely would have been in question. Knuston complied with the

Foundation's wishes, but he also informed the Foundation that upon his return to

Washington he held conference with President Warren Harding and Secretary Hughes on the matter. Noting that they "assured him that Americans were in Haiti to stay and that a definite policy on part of [the] American government would soon be made public,"

Knuston asked permission to raise the issue again in the future.29

The following May the matter was raised again, as the Undersecretary for the Department of State, William Phillips, transmitted a letter to the IHB from John H. Russell, the

American High Commissioner to Haiti. Both Phillips and Russell explicitly asked for

IHB cooperation with, and aid to, the Haitian public health service and gendarmerie. For

78 the first time, the occupation authorities received a receptive response from New York, indicating that although previous commitments prevented the Foundation from being of assistance at that time, future partnership was possible provided that "the American government continued in Haiti."30 In a follow-up conversation with Phillips the next month, Wickliffe Rose was even more explicit about what the Foundation required: "The

Foundation is dependent on governmental stability and Haiti and the Dominican Republic might lapse into a state of instability if American control were withdrawn under which circumstance the Rockefeller Foundation would have no justification in commencing hygienic reform."31 Contrary to how the Rockefeller Foundation has been said to operate elsewhere, and differing from the IHB's 1915 and 1917 response, the philanthropic organization was growing receptive to working with the Marines in Haiti.

Communications continued into the following year, at which time the Rockefeller

Foundation was informed of a recent resolution passed by the American Chamber of

Commerce of Haiti. On October 15, 1923, it was declared by the representatives of

American capital that the Chamber of Commerce would "support and give active assistance" to the Rockefeller Foundation, should it choose to undertake a Haitian program.32 Having been given the extra push, the Rockefeller Foundation finally decided that work in Haiti would be appropriate. Only two weeks after the Chamber of Commerce drafted their letter informing the Rockefeller Directors of the resolution of support, on

November 3, 1923, the RF Director of the West Indies, H.H. Howard, responded to Mr.

Davis of the American Chamber of Commerce, informing him that the International

Health Board was looking with favor upon conducting a sanitary survey in Haiti.33

Though the decision was not implemented until June of 1924, within the remaining two months of 1923 the American High Commissioner, General John H. Russell, the Sanitary

Engineer of Haiti, Dr. J.P. Haynes, and Dr. Howard of the IHB decided in conference that the Rockefeller Foundation should "provide personnel and funds for making a survey to determine the chief causes of disability among the rural population of the Republic of

Haiti."34 It was later also approved by the President of the Republic, Louis Borno (elected in 1922 after Phillippe Dartiguenave's term expired), and Dr. E.R. Stitt, the Surgeon-

General of the United States Navy.

Having decided to undertake a survey, the International Health Board sent Dr. George C.

Payne to Haiti. Responsible for the field operations throughout 1924 and 1925, Payne also worked closely with Dr. William A. Hoffman, an entomologist, and Dr. Edwin

Peterson, a Lieutenant in the U.S. Navy Medical Corps, while conducting the survey. The final study, which was published in 1926, was a typical Rockefeller report. Marcos Cueto has noted that the Foundation's comprehensive surveys, which is what Payne was engaged in producing, usually followed a specific format:

"First, they provided information on the country`s location, natural resources, form of government, and history. Second, they analyzed public health agencies and medical practice, presenting data on prevalent diseases, the ratio of doctors to population, the conditions of medical licensing, and special regulations concerning foreign physicians. Third, the report described primary, secondary, and higher education in the country, including a brief history of medical schools and universities."35

However, though following the specific format that the Rockefeller Foundation required for the comprehensive surveys, Payne intriguingly did not include any substantial observations or data on prevalent diseases and health conditions, a seemingly crucial

80 oversight in a report meant to determine the health of a country.36 Indeed, despite the stated goal of "determin[ing] the chief causes of disability," the final Rockefeller report was concerned little with the actual epidemiological state of Haiti. Highlighting various historical epidemics, "information in regards to [which...] is not lacking," the report emphasized the prevalence of smallpox and yellow fever. Of course Haiti had recently been struck by smallpox, so the report thus implied a continuous and unchanging pathological nature of the tropical island (the inclusion of the latter disease is also significant as it happened to be a primary focus area of the RF, though this was ultimately inconsequential in the Black Republic).37 Somewhat more informatively, the report also listed the various epidemics recorded since the change of the century, indicating bouts of enteric and other undiagnosed fevers, influenza, smallpox, and dysentery. However, though the latter water-borne disease was still an issue in 1923, no more recent observations were to be found in the entire document beyond a vague mention in an attached document commenting on the "appalling" extent of malaria infection.38

Given that the report was commissioned by an organization which scholarly consensus holds as having sought to establish a "totally biomedical view" of public health necessities, fostering in the process a specific biomedical hegemony, this omission of detailed health statistics is peculiar.39 As Ilana Löwy and Patrick Zylberman write, "The

[Rockefeller Foundation's] new science of public health was primarily oriented towards the physician and scientist, rather than towards the engineer or city planner. Its principal element was the training of physicians in appropriate scientific methods of studying pathogens and their vectors, and their parallel training in specific methods for collecting

81 and classifying epidemiological data.40 The contents (or lack thereof) within Payne's report do not seem to support this mission. Haiti, however, was a unique site of engagement for the Rockefeller Foundation. The presence and active collaboration with the U.S. treaty officials fundamentally altered the political terrain on which the IHB was engaged, offering a possible explanation for the curious exemption. With the United

States Marines sharing a consensus with the Rockefeller Foundation regarding the medical methods that were to be practiced in the occupied territory, the need was not actually to determine the diseases prevalent (information that would be vital to convincing a government elsewhere of the need to establish certain medical programs).

Rather, such data was guaranteed to be produced under an American-administered health regime. The Foundation men thus worked to support existing initiatives. It actually seems that Hoffman's contribution, an entomological report, found its place not in the document that Payne prepared, but rather in Butler and Peterson's malaria report. Though not receiving any official recognition, Hoffman is mentioned as a contributor to the report in the body of the text.41 Hoffman's unrecognized contribution to this reports raises the question of whether he also silently contributed to other reports by Butler and Peterson, especially since the timing of the reports seem to coincide with the time Hoffman and

Payne spent in Haiti. With the medical information going directly into the military reports, rather than replicating what was already being produced, Payne instead gathered data useful for other occupation ventures.

Responding to an early and common lament by Navy officials that vital statistics including even basic population figures were not in existence, the Rockefeller survey

82 attempted to establish a preliminary census, arriving at an estimate of two million people.42 Though noting that other estimates ranged from 1,500,000 persons on the low end of the spectrum and 3,000,000 on the other, the Rockefeller estimate would come to be the number most commonly used by the occupation authorities. The report also makes note of the spatial distribution of the Haitian population, indicating only seven cities with a population of over 7,500, and a combined population of only 207,000, indicating that

(even when using the lowest population estimate) over eighty percent of the population was rural. Yet at the same time the report invoked the familiar colonialist trope of empty land, a misleading discourse often found during times of colonial land theft , indicating that "large areas [of Haiti] are sparsely populated."43 Though not a narrative that became common parlance, it nonetheless entered the official record at the same time that

American companies were purchasing vast swaths of Haitian land from the Haitian state, a process which according to Alex Dupuy "proletarianized" and made landless tens of thousands of small peasants who used the land, but whose title was unsecure.44

Coincidentally HASCO (The Haitian-American Sugar Company), one of the companies purchasing land, also happened to be an important source of information for the

Rockefeller Foundation. Not having any in-house expertise on the country, the

Rockefeller medical men relied on corporate representatives for information about Haiti, such as from H.P. Davis of the Chamber of Commerce, or C. Edgar Elliot, head of the

U.S. conglomerate controlling HASCO, the electric light, the street railway, and the national railway systems of Haiti. These were also individuals who felt that Haitians had

"limitations" but could be "developed to do fairly satisfactory public services" provided they be kept from positions of power and control, inserting and reinforcing a racism that

83 would later be replicated within the public health service.45 The observations regarding

Haiti's population (and its uneven dispersion) is consequently also positioned next to commentary about agricultural; a sector "almost exclusively an industry of farms of less than 10 acres and of hard labor."46 Emphasizing that "food crops are produced by the expenditure of extraordinary amount of energy," the report offered rhetorical support for the technologically-based and thus (foreign) capital-intensive development strategy articulated by the treaty officials.47

The rest of the report reads largely as a hagiography, venerating the American officials for the "marked progress" they brought to the country.48 Not insignificantly, the

Rockefeller report legitimized the initiatives introduced by the American treaty officials, strongly endorsing the transformations brought about by the Service d’Hygiene. It certainly was not the first report to sanction the occupation activities, though unlike the report authored by the 1921 McCormick Committee as part of a full-scale Senate Inquiry, the Payne report was a non-governmental affair.49 But amongst the revering of the school inspections, hospitals for lepers, and many of the other developments discussed in the first chapter, Payne's report also detailed statistics on the existent industries (tobacco manufacture, rum, mahogany furniture, basket and mat weaving, brick-making, logwood extract, raw sugar, and canning of pineapples), the "considerable" but "completely undeveloped" mineral resources, statistics on labour, military, and crime, and customs revenue data.50 In short, the survey that Payne wrote was not actually one of health.

Rather, it is analogous to the seventeenth-century travel narratives that Michel Foucault discusses during his conversation on geography and power.51 Just as those stories of

84 various marvels and monsters were actually "coded reports" about the military, economic, and diplomatic states of the lands and countries travelled, the Rockefeller survey of Haiti

(though couched in the language of health and somewhat more transparent about the data being reported) was also a coded report about many of the same categories. So despite being largely irrelevant to the actual health work in Haiti, the knowledge produced by

Payne's report was still relevant and useful in other spheres, specifically for private

American capital. Not only did the report discursively support American capital, as discussed above, but it also made the IHB an institutional support for American businesses. Shortly after the report was released, for example, the Rockefeller delegates found themselves joined in their travels by corporate representatives sent to Haiti to investigate business opportunities there. In November of 1926, the United Fruit Company sent Dr. Herbert C. Clark and two members of the United States Public Health Service to

Haiti with RF's Dr. Pearce in order to do a malaria survey of 10,000 laborers that were later to be sent to work in the company's sugar fields in Cuba.52 In doing so the

Rockefeller Foundation helped ensure that Haiti would continue being what Brenda

Gayle Plummer has labelled "an agrarian reserve," having since 1902 been the source of some 20,000 migrants workers per annum, allowing U.S. sugar companies to profit off of

"cheap, demoralised labour."53

Payne's medical survey had two other minor but significant consequences. Both meant that further and more fruitful collaboration could occur between the Marines and the IHB.

The first was the contribution that Payne's report made to the growing Rockefeller annals of medical knowledge. Driven by the influential secretary, Jerome Greene, since 1916 the

85 foundation had committed itself to deriving a library concerned with global health. By the end of 1926, twenty-one reports had been produced on the states of health of thirteen

Latin American countries. But whereas some countries such as Brazil were comparatively well-studied (and continue to be by scholars concerned with the IHB), there was as of yet no in-house knowledge of Haiti.54 Payne's report thus established the foundation from which further interest in the country could be produced. The other consequence was that in the process of producing the initial report, the Rockefeller Foundation was brought into further contact and conversation with the American military authorities in Haiti. Dr.

Payne, for example, was actually incorporated into the Service d’Hygiene as an employee.55 As the official representative of the Rockefeller Foundation in Haiti, this by default also converted the philanthropic body into an agency of the colonial state. While this by no means meant that the IHB was subservient to the treaty officials, it did change the relationship between the two bodies. As long as the Rockefeller Foundation continued to operate in Haiti its goals would be compatible with, if not indistinguishable from, those of the occupation government. It also gave the Foundation somewhat more clout within

Haiti, able to influence occupation policies on public health and inducing changes in the administrative structure.

This mutually-influencing relationship became visible through an ongoing conversation that occurred in the midst of the International Health Board's commitment to Haiti. In

July, 1925, while Payne was in the midst of working on his report, C.S. Butler began making overtures to the Rockefeller Foundation to continue their involvement in Haiti by aiding the National School of Medicine. As administering that institution was "the only

86 prerogative left to the Haitian medical profession," an institution General Russell derogatorily only "by courtesy" called the Medical University of Haiti, the Rockefeller

Foundation wanted nothing to do with it.56 Not interested in working with the Haitians, an officer of the foundation, Dr. Richard Pearce, emphasized to Admiral Stitt that the

International Health Board would only work directly with the Haitian government, by which he really meant the bodies under the authority of the American treaty officials.57 In response, the Sanitary Engineer of Haiti, C.S. Butler, arranged to have legislation passed that transferred responsibility for medical education to his office, thus having it fall under the Minister of the Interior as opposed to the Minister of Education (under the September

19 treaty, education and justice were the only two areas which Haitians were permitted to retain responsibility).58 Just as the Foundation had been initially reluctant to work in Haiti until assured of American control, having inclined the occupation authorities to expand their authority over Haitian institutions, the IHB decided that it would be appropriate to engage in an effort to improve medical education in Haiti.

Swayed by the Sanitation Engineer's machinations, the IHB's Dr. O'Connor met with Dr.

Butler at the beginning of September to discuss support for the National School of

Medicine. Butler argued that it was "imperative" to start a medical training program, otherwise "the people would be no better off than when [the Americans] came down there." But this was not simply a paternalistic desire to provide enlightenment and guidance, as he frankly admitted to O'Connor that despite having a treaty valid for another ten years, "the Americans may be thrown out at any time."59 Rather, Butler hoped to find cover for the occupation behind a development project. Heeding this call, the

"burlesque of a medical school" became the object of Rockefeller assistance. It was realized, however, that assisting the National Medical School solely to strengthen the position of the Marines was fraught with pitfalls. Having been in existence since 1808, and thus one of the first national institutions created in postcolonial Haiti, it was noted that unless channelled through the Haitian government, aid to the National School of

Medicine would probably "arouse the antagonism of the people," obviously not the desired outcome when aiming to support a military occupation.60 Moreover, the school had already proven to be a site of conflict between the occupation authorities and Haitian nationalists. Six of the school's best professors had been forced to resign in 1918 after they voted against ratifying the U.S.-drafted constitution in a national plebiscite that year.

Thanks to Minister Dantès Bellegarde, who convinced President Dartinguenave that education and politics should remain separate, all of the professors were soon reinstated.

Nevertheless, following that incident the Americans moved to have the school closed down, though it was ostensibly because both C.S. Butler and Dr. McLean felt that the school was inefficient and outdated in its teaching methods. Subsequently the Marines blocked the medical students from entering the grounds of the General Hospital in Port- au-Prince, where the school was based, and all of the teaching equipment and material was dumped outside in the yard. The teaching facilities were ultimately turned over to the

Navy Nurse Corps to create a nursing school. It was only because some Haitian doctors had volunteered their time, services, and equipment that the medical school continued to exist at all when Butler contacted the Rockefeller Foundation in 1925.61 So when the

Foundation consented to rebuilding the National School of Medicine, the philanthropic body was self-consciously entering into the political realm of colonial control. As Doctor

H.H. Howard told Richard Pearce, "Control of the school by anyone connected with the

U.S. Navy now administering the country would probably defeat the object of aid." The

Rockefeller Foundation could step into that role without being associated with the occupation though, because as Howard observed, there was "No IHB representative now in Haiti."62

Occupying a different conjecture in the imperial project than the Marines, the Rockefeller

Foundation was uniquely positioned to address via the medical school the longer-term but still urgent issue of constructing a reality that would support a continued American influence in Haiti past 1936. While the USMC was largely concerned with shorter-tem objectives premised on the use or threat of force, such as seizing territory or ensuring regional security and stability (a more long-term objective, but still ultimately premised on the ability to immediately respond with force when needed), the Rockefeller

Foundation could instead be concerned with the long-term "engineering" function of empire. Engaging less in the direct elaboration of control than the Marines were, the

Rockefeller men facilitated imperialism through broader networks of power and influence instead. So when the IHB became perceptive of the occupation state's medical dependence, the men from International Health realized they had a means of consolidating that position. The IHB, in turn, adopted the position that "Nothing can be done by a public health program until the [medical] school is in some sort of shape."63 If the public health programs in Haiti had inscribed into the land, the state, and the national consciousness a certain American conception of health, the maintenance of that specific biomedical view and the privilege conferred to the U.S. through it would be maintained

89 only through a means of continuously and freely reproducing that knowledge in Haiti beyond the end date of the occupation. The National School of Medicine became the perfect vehicle to realize this hegemonic ambition.

The culture of white supremacy fostered by the Marines meant that their preference normally would have been to retain direct control of the school. "Intensive supervision" was deemed necessary to make anything of the Haitians, since "90% of them are black and mentally they are like children."64 But since it was also anticipated that the Haitians would object to the U.S. Navy administering the school, which would "probably defeat the object of aid," the Rockefeller Foundation considered it necessary to cloak the project as being a Haitian initiative.65 That December, Richard Pearce travelled to Haiti on behalf of the foundation's Division of Medical Education (DME), spending sixteen days there to develop such a program. Evidently accorded a great deal of status by the U.S. officials in

Haiti due to his position and the purpose of his visit, after having in the afternoon attended a general reception hosted by President Borno, Pearce was honoured with a cocktail party upon his arrival that was "attended by practically all the American residents of Port-au-Prince."66 Facilitated by high-ranking Marines, Pearce was also granted unparalleled access to various functionaries of the Haitian government, including meeting with President Borno twice to discuss the assistance that the Rockefeller

Foundation could provide. The actual plans, however, were not developed with Haitian input. Rather, it was in conjunction with American officials of the Sanitary Service that a plan was drafted to refurbish the National School of Medicine. Having composed the scheme in full, including requiring an annual appropriation of funds from the Haitian

90 government starting at $15,000 and reaching $30,000 within five years, on his last full day on the island Pearce then pitched the plan to President Borno for approval. In order to maintain the facade of desiring only to work with the Haitian government and not the

Marines, Pearce made a show of asking General Russell to leave the meeting when the plan was pitched. President Borno deemed the plan satisfactory even though he did not seem to actually comprehend the details of the arrangement. Pearce indicates in his diary that "It was obvious, however, that [Borno] expected a different arrangement. [...] He was highly delighted when I again went over the details and explained that we are not sending

Americans [to teach at the school] at all but are only interested in training Haitians." The following day Pearce embarked for New York, having secured a major undertaking for the foundation.67

The essence of the agreed upon plan was to "bring about a reorganization of the school and hospital on such a basis [...] to train personnel to take care of the Sanitary Service of the country."68 Unconcerned with private practice, the idea was to ensure the continuance of the public health programs introduced by the military authorities. Effectively given a carte blanche and a promise to pay by the Haitian government, the plan was premised on a relatively simple progression of events. First the school was to go through a series of material upgrades, prioritizing laboratory upgrades, making it a place where American biomedical practice could occur. At the same time, the entire future teaching and administrative staff were to travel to the United States to undergo medical training there.

Upon returning to Haiti they were to solely concentrate on training new Haitian healthcare professionals in the techniques that the professors had learned in the U.S.

Those students would then automatically be incorporated into the Haitian public health service, hopefully giving the institution an Americentric orientation (and forestalling any

French, or worse, any indigenous influence). Importantly, the school plan also entailed

"[forgetting] the ideal of producing serious thinkers," imparting instead an ethic that simply emulated the Americans.69

Of the sixty thousand dollars spent on upgrading the National School of Medicine, half of that was allocated for badly needed improvements to infrastructure. The building that the school had previously been housed in was built in 1881 as an exhibition building, in which there were four lecture halls and a library. Construction on the second story of the building had never been finished, and white ants had proven to be a scourge to the rest of the building.70 Rather than attempting repairs, a new two-story building was constructed on the grounds of the Haitian General Hospital.71 The new school boasted lecture halls, a full library, and most importantly in the eyes of the Rockefeller men, a number of fully equipped laboratories. The Foundation decided that, even more than having practical clinical experience, Haitian physicians needed to know how to use a microscope and do other laboratory work:

"[T]he physician should know that the microscope is a useful instrument. He should know that bacteriology really is a science that is able to help the practicing physician. He should know that gross pathology has been developed in other countries to a marked degree and is of tremendous importance to the practice of medicine. He should know what information can be gained from examining a histological slide and that pathological sections often reveal conditions that otherwise would have been unsolved secrets."72

To facilitate this, over two thirds of the funds allocated for equipment and facilities went towards constructing various laboratories.73 Warwick Anderson has written on the

92 importance assigned by Americans to the laboratory in the Philippines, describing it as

"the exemplary locus of colonial modernity."74 For Anderson, the laboratory was also a site of control, a space to be replicated across the rest of the country. Similarly, to the school reformers in Haiti the laboratory took on an analogous significance. It was in the laboratory where Haitians could "occupy all the chairs, but there [be] Americans in the background who guide their work."75 While marking the hierarchy of authority and control, the labs were simultaneously also where the Americans could mark the progress they had brought to the Black Republic. The biggest scandal about the old medical school was that "the laboratory, the backbone of any medical institution, does not exist in the usually accepted use of the term."76 By properly incorporating those facilities into the institution however, the Division of Medical Education would be responsible for constructing an establishment that Haitians could point to "with real pride."77 Most importantly though, laboratories materially entrenched into the medical school the mission carried out by public health officials in the rest of Haiti. A school with only one microscope and pedagogically based upon the "natural method" of teaching preferred in

France would inevitably be the weak link in the sanitation programs instituted throughout

Haiti. That, of course, had been the condition of the old school. Nevertheless, resources were only one part of the equation. Though laboratories and microscopes made it possible to practice American biomedicine, their very existence and accessibility did not in itself guarantee that such an approach would be employed. Needed also was the knowledge of how and why, which was a knowledge not considered to yet exist within the entire country.

At the time of the occupation, there were an estimated 143 doctors practicing in Haiti. Of these, all but sixteen had been trained within the country, which in the minds of the

Americans meant that most of the doctors could not be considered to have received an adequate education. Even those who worked in laboratories had "no more training than a good technician."78 The solution to this was to be found in the United States proper, where a number of Haitians were sent to learn their craft with the expectation that they be able to teach a number of subjects upon their return.79 Establishing fellowships to train

Haitians, four in laboratory work (anatomy and embryology; pathology and histology; bacteriology, clinical pathology, and serology; and physiology, physiological chemistry, and pharmacology), three clinical-based (obstetrics, medicine, and surgery), one in public health (hygiene and sanitation), and one to develop administrative skills, the remaining

$34,000 allocated by the Rockefeller Foundation was to be spent covering tuition and living expenses within the United States.80

The first person to enjoy a Rockefeller fellowship was Dr. J. Dominique, the Director of the National School of Medicine. Throughout October and November of 1927 he was afforded the possibility of travelling across the United States and Canada, visiting seventeen medical schools to learn their style of administration and teaching methods.81

Upon returning to his country having experienced "a new birth [...] into the medical world, [...] elevated to a plane never before attained in Haiti," Dr. Dominique gave an address to the Haitian Medical Society extolling the virtues of the "superior quality" of the study of scientific medicine found in the United States.82 But while speaking the school director made clear what, beyond simple training, was intended to happen with the

Rockefeller fellowships. Dominique came back knowing what "real universities" (which presumably the Haitian school of medicine was not) emphasize. These schools were exclusive, accepting only "well-cultivated" men without "congenital weakness."83

Unsurprisingly, and consistent with Rockefeller projects elsewhere, despite the lack of tuition being a defining feature of the Haitian school, emulating this elitist approach in

Haiti meant that the training of physicians would remain restricted only to the already privileged members of Haitian society, reproducing existing class dynamics.84 The "real" schools also made laboratory study a "capital part" in the formation of the students.85 Of course the laboratory was assigned a different significance in the Ivy League schools of the United States than it was assigned in a colonial location, becoming a place of scientific advancement and a driver of progress, thus also marking the standard that Haiti must adhere to. This "new conception" necessitated that Haiti choose to look to the

United States (and Canada) for guidance in all things scientific, rather than turning to

France, the country with which Haiti shared historical ties.

It had only been as recently as 1910 that the United States had become the principal economic actor in Haiti in lieu of France.86 Haitians, especially the elite, still predominantly looked to France for both education and culture as well. This prompted the occupation authorities to undertake extraordinary initiatives to supplant this influence and strengthen their own.87 The assistance given to the medical school naturally became part of this process, as naval authorities lamented that Haitians still would travel to France to become physicians.88 The Americans in turn emphasized that while in France an aspiring physician would attain an education premised upon the outdated French "natural

95 method," the Americans were developing a modern school of medicine within Haiti.

Invoking the supposedly anti-imperial nature of the U.S., the modernity of the laboratory- based school was also contrasted with the "colonial graduate" certificate that would be received in France, which was granted only on the condition that they not practice there.

The narrative of laboratory-based study as being a marker of modernity and progress thus became infused with the hegemonic project of displacing French cultural influences in favor of American. The success of this initiative was recognized years later when, in

1947, the Rockefeller Foundation received a letter from the then Dean of the Faculty of

Medicine, wishing to honour John Rockefeller for his philanthropy that not only made possible the National School of Medicine, but that also "created a teaching technique based upon American pedagogic methods in a country where French culture becomes more intensified each day." His altruism "stengthen[ed] the American cultural influence" on the faculties of the school, developing as a result "bonds of Inter-American cultural solidarity."89

Ironically, while the Rockefeller Foundation was attempting to construct a medical system in Haiti modelled off of that of the United States, the foundation directors found themselves somewhat stymied by structures of racism at home. Language barriers did not help either. It was "rather difficult" for Pearce to find schools that would accept the

Haitian fellows, the choice of places to work being limited "on account of color."90 Even when touring Dr. Dominique throughout the country, it became necessary for the

Foundation to announce (in brackets beside their names) in communications with the various schools that the Dean was "colored" but that he would be travelling with the

96 white Lieutenant Commander E. Peterson of the U.S. Navy.91 Likewise, while seeking placements for the other Haitians granted fellowships, it became necessary to send photographs of the candidates so that the prospective school may have "a better idea of the type of person [they] are being asked to receive."92 The combination of skin color, not being fluent in the English language, and having graduated from an "inferior" school meant that placement often could not be found in the United States. Where the Haitians could get accepted, such as the segregated hospitals, it was deemed that they would receive "inadequate instruction." Forced to admit failure to Captain Butler in his attempt to find places for the fellows in surgery and obstetrics, and finding it "inadvisable" to subject the Haitian doctors to conditions that would "make them unhappy or dissatisfied,"

Pearce determined that the best course of action would be to send some of the fellows to

France instead.93 One other, the fellow in medicine, needed to be sent to France as well, meaning that one third of the fellowships could not be found spots in the United States.94

American structures of racism, class, and social status actually complicated the attempts to extend U.S. cultural influence and power.

Pearce and the other Rockefeller directors could hardly lament the difficulties that social hierarchies posed, being guilty of expecting such privileges themselves. A few months prior to the fellowship dilemma, the Rockefeller Foundation found itself squabbling with the American in charge of Haiti's finances. Pearce had written to Mr. W.W. Cumberland, the Financial Advisor of the Republic of Haiti, inquiring whether the goods imported by the Foundation would be subject to customs duties.95 The response was in the affirmative, indicating an estimated twenty percent excise. With Haitian law permitting exemptions

97 only for diplomatic and consular offices, U.S. armed forces, and certain religious items imported by the Catholic Church, Cumberland communicated clearly that no authority of law existed to permit the Rockefeller goods to enter the country un-levied.96 Though

Pearce indicated that the foundation desired no change in regulations, by virtue of being a benevolent source of aid it was clear that the philanthropic organization, like many NGOs today, expected to receive privileged treatment. It was "rather amusing" to Pearce that the aid the Rockefeller Foundation was providing would be reduced by twenty percent, effectively causing the foundation to make a contribution of five or six thousand dollars to the Haitian government instead. Betraying a major arrogance regarding how subservient the Haitian government should be to a development agency, Pearce requested that the income levied from the Rockefeller Foundation be specially earmarked for the medical school in Haiti's 1928 budget.97 Despite the Financial Advisor also being

American (or perhaps it was possible only because he was American), the donor was rebuked. Writing to Pearce, Cumberland noted:

"It would be so unusual for foreigners to contribute to educational or charitable enterprises in the United States in the way that the Rockefeller Foundation is doing for the medical school in Haiti that it has perhaps escaped your attention that the United States government assesses duties on all materials and supplies imported for its account. In short, Haitian law follows the United States practice in this regard."98

Recognizing a logic often ignored by the neoliberal development industry today, a sector that regularly circumvents the state, Cumberland continued his rebuff stating that it was precisely because of the tariffs levied that the Haitian government could ensure increased appropriations from the treasury to support the National School of Medicine. He estimated that ultimately the allocations would actually exceed the amount to be collected

98 in customs from the Rockefeller Foundation. Ultimately, though reluctantly, Pearce consented.99

Despite the various impediments, re-establishing the medical school proceeded. When

Captain C.S. Butler's tour of duty came to an end in June of 1927, construction of the school was nearly complete. Slated to be equipped in July, with classes commencing on

October 1, Butler was confident that the "matter which has been very close to [him] for nearly three years" would succeed in supporting "a backward people, to the end that they might, in the future, become self supporting."100 Such fond paternalism knew that thanks to the combined forces of the Rockefeller Foundation and the United States Marines,

Haiti would soon boast a full School of Medicine, Dentistry, and Pharmacy, which would stand alongside a Nurses Training School founded in 1918 by the Navy Nurse Corps.101

Such rhetoric likewise flowed when Butler's successor, Commander Kent C. Melhorn, presided over the opening of the new school on October 3, 1927. During the dedication ceremony, which was attended by President Borno, Melhorn gave great praise to the

"untiring efforts" of the USMC and the "magnificent gift" of the Rockefeller

Foundation.102 This was to be expected. Significantly however, though the Americans received plenty of credit, Melhorn returned to the narrative of the school being a Haitian initiative. It was because of President Borno's "vision and unfailing zeal" that such an accomplishment was possible.103 Yet since Borno could rightfully be labelled a collaborator with the Marines, to ensure the school's permanence it became important to locate the institution as being an outgrowth of Haitian design that predated the

99 occupation. According to Melhorn, the National School of Medicine was not simply a colonial project, but rather the fulfillment of the vision of the "brilliant" Doctor Audain:

"In the annals of the Haitian Medical profession what more brilliant pages are found than those recording the name and work of Doctor Lêon Audain, who in collaboration with Doctors Mathon, Ricot, Dalencourt, and Salomon wrote that monumental work on Tropical Medicine. Surely the incentive of that splendid book is also playing a role at this hour."104

Though officials from the Rockefeller Foundation lamented in an unattributed report that there were not more than just a few medical men in Haiti's past to whom the country

"could point with pride to," a common discourse amongst the colonial officials, references would often be made to the doctors Audain and Dehoux.105 Both had attempted to instill new visions of health in Haiti, the former in 1905 and the latter before him in 1879, but both fell victim to political machinations and their projects never took hold. For his introducing microscopy to Haiti, Dr. Audain represented an early Haitian disciple of the American biomedical approach. Likewise, the Americans could take

"pleasure to follow the reasoning of Dr. Dehoux" when it came to the medical school, and they took pride in working towards the "fulfillment of his dreams."106 Having been partially borne out of the discursive environment inscribed into the Haitian landscape, the school that would naturalize such discourse was itself rhetorically normalized as being

Haitian. In doing so, one aspect of hegemonic engineering became beyond reproach.

In the following years the National School of Medicine would continue to be a site of contestation between the occupation authorities and Haitian nationalists. In 1929, when popular discontent with the occupation once again resulted in outright confrontation between the general Haitian population and the Marines, the students of the medical

100 school joined their fellow citizens in revolt. However, even when other elements of the

Public Health Service were singled out for criticism by the nationalists, the medical school remained unscathed. Thanks to the assistance of the Rockefeller Foundation, the

Americans had created an institution that would survive the occupation, fostering an allegiance to American medical ideas in the process. Coming on the heels of other

Rockefeller projects in the country, this hegemonic achievement was the product of a

Marine strategy that sought to incorporate non-governmental actors into administering the occupation. These partnerships produced some of the most durable outcomes of the occupation, though this only became clear after projects such as the medical school weathered the disturbances of 1929. The Rockefeller-built medical school consolidated occupation public health achievements, ensuring that the programme developed and implemented by the U.S.-controlled Service d'Hygiene would continue even once the

Americans relinquished direct control over Haiti. Young Haitian doctors would, being dependant on the technologies and knowledge produced in the metropole, look to

American medical science for direction. The disturbances of 1929 tested the strength of the institution, but the school proved to be one of the few aspects of the occupation that would endure.

101

IN TRIAGE: AMERICAN HEGEMONY IN QUESTION

As the Americans began looking forward to the occupation's end date in 1936, the question of maintaining influence in Haiti loomed larger and more important. The

National School of Medicine was to be an important institution in this regard, solidifying through biomedicine ties between Haiti and the United States. Deemed to be the

"crowning success" of the Public Health Service, the school created an "enviable liaison" that the Americans had with few other countries. The strength of its example even seemed to stretch beyond the bounds of Haiti and into the wider Caribbean region though,

"its importance to tropical medicine" being such that the school received "numerous requests for data [...] from foreign lands."1 Public Health as a whole seemed to be placing the Americans in a favourable position, and even critics of the occupation tended to support the medical programme. Despite this positive prognosis however, the Public

Health Service, and especially the National School of Medicine, became embroiled in a

Haitian challenge to American authority. Though fourteen years had been spent painstakingly establishing a health system that served both the ill of Haiti and American interests, the Haitian desire for sovereignty brought into question the very ability of public health to serve hegemonic purposes. After 1929, the Americans were forced to contemplate whether their public health measures were nearly as effective as they had earlier believed.

Since the Caco rebellion of a decade earlier, Haitian animosity to the occupation had laid latent. A student conflict within one of the agricultural schools reignited the possibility for open revolt though, and in 1929 a student strike was launched, setting in motion a

102 process that ultimately brought the occupation to an early end. Though the conflict was initially over a matter wholly unrelated to public health, the medical students eventually joined in the strike, as did a large proportion of Haiti's population. In doing so the medical students directly challenged and impeded the ability of the Americans to fully implement visions of governance, and ultimately forced a change in policy. While the employees of the Service d'Hygiene chose to remain on the job, something the Americans interpreted as an expression of loyalty and proof of the efficacy of the health services instituted by the occupation, even they were engaged in the struggle to regain Haiti's sovereignty. The 1929 strike marked a challenge to American hegemony in Haiti, and even the widely popular public health projects could not forestall the Haitians from forcibly demonstrating that they did not consent to the American domination of their country.

Reacting to the challenge, the American leadership hoped that by making the right political moves they could retain a long-term hegemonic influence in Haiti. In response to the opposition movement, but also motivated by domestic political concerns, the

President of the United States ordered a commission of enquiry be sent to Haiti. The

Forbes Commission, as it came to be known, determined that many improvements had been made in the health of the country, a finding heralded by the final report. But the commission, which had also been advised to determine the best strategy for withdrawal, privately also raised concerns over the state of the Public Health Service. Problems were found that suggested that once the Americans left the Service d'Hygiene would falter, ultimately meaning that the American influence represented by the medical services

103 would also wane. The strike, then, elucidated to the Americans the limits of their hegemonic project. Not only did it serve as a reminder that Haitians would not passively consent to foreign occupation, but it also forced a re-thinking of the effectiveness of such development projects. Sure enough, the early withdrawal of the Marines in 1934 marked a deterioration of the Public Health Service. However, in 1929 Public Health was one of the few areas in which the Americans could express confidence.

During the latter years of the Twenties, the Public Health Service was experiencing success in the collaborative project of re-establishing the National School of Medicine.

The Haitian medical professionals that had been trained abroad in partnership with the

Rockefeller Foundation had returned to their Caribbean home, and three cohorts of students had begun their studies by the autumn of 1929. The country as a whole was in the midst of a substantially different experience, however. The coffee crop of 1928 had been poor, a hardship exacerbated by the collapse of that market with all the others in

1929. Concurrently, while also strengthening the restrictions on labor migration, taxes within Haiti were increased.2 Though some of these taxes may have been beneficial to the majority of the population, such as the excise on tobacco that Ludwell Montague argues would have forced the elites to share in the country's tax burden, the timing was bad.

These measures were also coupled with others such as the coffee standardization law, an edict desiring to regulate peasant habits by subjecting them to penalty for "indolence" while rewarding "industry."3 Discontent was steeping, even without considering the

(actually inseparable) popular posture on the political situation or the foreign military

104 presence. It was against this background that passions were inflamed at another of Haiti's national schools, and the dispute rapidly spread to encompass the medical school.

Though it had emerged out of the need to maintain in Haiti an expertise in public health, the National School of Medicine was not the sole educational endeavor made by the occupation authorities. In 1922, despite lacking in legality according to the treaty of

1915, General Russell initiated what has been called "one of the largest educational reform efforts in Haitian history."4 Alongside the re-establishment of the medical school, which in some ways was actually one facet of this broader initiative, Russell also sought to create a network of national agricultural and industrial schools. Much like how the

National School of Medicine was moved under the authority of the Sanitary Engineer so that it would fall outside the jurisdiction of the Haitian-controlled Ministry of Education, a "Bureau of Technical Service of Agriculture and Vocational Education" was newly- created within the Agricultural Department. Hired to head up this project was George F.

Freeman. The position had Freeman overseeing the agricultural experimental stations and also automatically placed him as Principal of the École Central de l'Agriculture, which he founded in 1924. By the end of 1929, there were sixty-nine other agricultural and vocational institutions scattered across the country, all funded and controlled by the

Agricultural Department. This funding was vastly disproportionate to what the regular public schools received, with General Russell allocating 4.5 million gourdes to Freeman's schools, more than twice the funding allotted for the 208 elementary, secondary, and post-secondary schools controlled by the Ministry of Education. The aim, A.J. Angulo notes, was to supplant the regular school system with an education scheme that would

105 develop a pliant workforce instead of encouraging intellectual pursuits.5 In the

Rockefeller Foundation documents, this was articulated as developing schools "along practical lines," forgetting "the ideal of producing serious thinkers."6

The disparity in funding between the two education systems was not well-received by most Haitians, and even client-President Borno pleaded for the Americans to reconsider their program.7 The problem was not in regards to the amount of funds allocated for education, but rather that a two-tiered system of education was being established. The

American-controlled upper tier, Laurent Dubois observes, operated on a premise antithetical to the academic lyceum tradition that prevailed in Haiti, prioritizing technical education over teachings more academic in nature. This was correctly viewed as being racist as it was based on an implied inability for Haitians to acquire classical education.

According to the African American historian Rayford Logan, who visited Haiti in the late

1920s, the U.S. authorities seemed convinced that "vocational training is the only kind to which Haitians are suited." The American-run schools also tended to have a budget six- fold larger than their Haitian-run counterparts.8 Meanwhile the lower tier subsisted with poor supplies in rented buildings. Russell's "inflammatory" decision to send what he labelled "surplus" budget funds to Wall Street to make additional loan repayments instead of propping up the existing school system certainly did not help alleviate the negative popular feelings either.9 But while the Agricultural Department's educational system was already being seen as a microcosm of all that was wrong with the occupation, certain actions by Freeman only made matters worse.

106

Much like in the National School of Medicine, the Americans sought to remunerate the instructors better than had previously been the case for educators. In the case of the medical school the Americans desired that the instructors would forego private practice so that they could devote all of their time towards teaching, and consequently

Commander Melhorn was proud to show the increase afforded in salaries.10 Whereas clinic professors had previously earned between thirty and sixty dollars a month, after

August, 1926, the salaries ranged between one- and two-hundred dollars per month. And it was not just the professors who saw an enlargement in their salaries; everyone from the janitor (from $4 to $15) to the Dean (from $80 to $250), and everyone in between

(secretary, librarian, technicians, "etc."), received an increase in pay.11 In comparison to the average monthly salary of four to six dollars found in the public system, Freeman's schools also paid generously with most monthly salaries falling in the forty to ninety dollar range, though some were extremely high, reaching four or five thousand dollars per year ($333-$416 per month).12 The difference, however, was that while all the employees of the medical school were native Haitians, Freeman's employees were nearly all white

Americans who could not even speak French, let alone Kreyol. Though apparently quite generous with Haitian funds to his fellow Americans, his 'generosity' did not extend to the Haitian students. Unexpectedly, this became nearly fatal for the occupation.

Despite the obvious disparity in funding between the two educational system, the École

Central de l'Agriculture struggled to attract students. A.J. Angulo has noted that "while denied the formal democratic process, students could vote with their feet," and only ten percent of the Haitian student population enrolled in the American system.13 In response

107 to this Freeman had established a $10,000 scholarship program to entice students to fill his desks.14 However, in the midst of the 1929 fall semester, Freeman slashed the scholarships by twenty percent.15 The rationale, at least as described by the American

Special Envoy to Haiti, Dana Munro, was that many of the scholarship recipients were members of the Haitian bourgeoisie who felt that manual farm labour was below their status. Thus rather than performing the farm tasks expected of them these students would use a portion of their scholarship to hire rural Haitians to perform such duties for them, while the students of elite status focussed on more academic matters. The scholarship cuts were meant to discourage this practice.16 Suddenly seeking fiscal responsibility,

Freeman reallocated the scholarship cash to the Service Technique's agricultural experimental station.17 Located like the École Central in the city of Damien, the experimental station was known to cater towards the interests of American investors. So even if Munro's version of events is correct and not just a diplomatic whitewashing for the sake of the American Senate, like so many of the other events that preceded crises in

Haiti the optics were bad.18

Freeman was in his office in Damien when the agricultural students confronted him in late October. Dismissing their concerns between puffs on his pipe, through a translator

(after seven years in Haiti, he hadn't bothered to even learn French) Freeman indicated that he could change the policies as he saw fit.19 If the students did not like that, they were free to leave the school. Leave the school they did, though not in the manner that

Freeman envisioned. The student committee decided to march the five miles to Port-au-

Prince to appeal to the Haitian Minister of Public Instruction, Charles Bouchereau.20 In a

108 show of unity every classroom emptied as the student body collectively went on strike against Freeman's decision. Ever the paternalist, Freeman claims the student actions caused anguish to his tender feelings. "There was one young man especially in whom I had great trust, in fact, it hurt me so badly at the time I almost cried," Freeman maintained, "he swore he would go down and restrain the boys in their action and then became a leader!"21 Laurent Dubois details just how out-of-touch the school director was with the Haitian students was, though. Clearly still acting out a dismissive paternalism,

Freeman attempted conciliation when he learned of the student plan to march on Port-au-

Prince, offering use of the institution's bus instead. Mystifying the Principal with their response, the students refused.22

In the eyes of the students Minister Bouchereau, though a fellow Haitian, proved to be no more than an elite collaborator. He indicated that the students needed to return to their seats the next day otherwise they would be withdrawn from the school and the rest of their aid would be withheld as well. But this response, rather than discourage the students, actually transformed the strike. Though Freeman and the system of agricultural education still served a representative purpose, the student strike was no longer just about scholarships and other classroom issues. In his response, the Minister of Public

Instruction had managed to direct the strike against the more fundamental question of

American control. Control over education, control over Haitian government officials, and ultimately control over the entire country and thus the occupation as a whole was brought into question.23 Although the student strike was somewhat of an elite-driven protest in response to an issue that only immediately impacted the portion of the population that

109

Montague refers to as the "white-collar class," the student strike received popular support.24 As the disturbance grew, the Americans declared that the strike was "Seized upon by disgruntled politicians as a means of wrecking the administration of President

Borno."25 The occupation faced "tirades of abuse" from a hostile press that demanded an investigation into Freeman's tenure at the head of the École Central de l'Agriculture.26

Momentum grew as the law students of the École Nationale de Droit struck on November

6 "till satisfaction is given to the students of the École Central de l'Agriculture."27 "I was fearful," Kent Melhorn would later write, "that sooner or later our medical students would enter in [to the strike]."28 He had reason to worry. Following the lead of the law students, pupils at the École Normale d'Institutrices and the School of Applied Science joined the strike the next day.29 "In spite of the earnest pleas of the Dean to refrain from strike activities," the sixty eight medical school students joined the strike that day as well.30 For the next five weeks the strike movement continued to grow, even supported by the brothers and sisters of the Catholic schools. The inmates of the École des Arts et Métiers

(Boys Reform Trade School) launched a hunger strike in solidarity as well.31 During this time coordinated rallies were seen in Jacmel, Cap Haitien, and St. Marc.32

The protest movement escalated on November 8, as Freeman's house in Port-au-Prince was stoned by an angry mob while an effigy of his likeness burned outside. Showing the changing nature of the strike movement, alongside the chants of "A bas Freeman!"

(Down with Freeman!) chants of "A bas Borno!" could be heard as well.33 President

Borno had earned the ire of his fellow countrymen and women for much the same reason that Freeman had. Though he had at times shown some independence, such as in

110 opposing Russell's education plans, for the most part Borno was considered to be a willing collaborator with the Americans. Elected with American blessing to the presidency in 1922, Borno took charge of the country the same year that General Russell was appointed to the position of American High Commissioner. Together they ruled Haiti in what has been called a "joint dictatorship."34 Patrick Bellegarde-Smith, grandson of the

Haitian historian and occupation-era diplomat Dantès Bellegarde, has even gone as far as to label this period as the "inception of 'Haitian fascism," though in truth this should be read as more allegorical than actually descriptive.35 Still, martial law continued to remain in effect throughout Borno's term in office, and members of the press and judiciary were regularly harassed and jailed, consented always by Russell.36 Borno's unpopularity mounted in 1929 as he signalled his intent to seek another term in office. Having been re- elected again in 1926, Borno had since managed to convince the Council of State to alter the length of the presidential term from four to six years. This compounded all of the other reasons for opposing Borno, both petty and substantive, for if Borno was successful in his 1930 bid it would mean that he would still be President in 1936 when the United

States was scheduled to withdraw. Since Borno relied on the joint dictatorship for the maintenance of his power, it was speculated that he would renegotiate an extension of the

American occupation for upwards of another thirty years.37 As the nature of the grievance had naturally already infused the student strike with an anti-imperial element, these concerns of sovereignty and self-determination meshed well. The mood was so restive as to inspire comparison to the times "not seen [...] since the Caco Raid on Port-au-Prince in

January 1920."38

111

Forced by the strike, by mid-November Borno announced that he would not seek a third term, but the opposition's momentum had grown such that even this was inadequate.39

For a protest movement that began with what Léon Pamphile labels the first ever

[recorded] militant action in Haitian educational history, the militancy and demands had escalated rapidly.40 Perhaps a revolutionary legacy motivated the Haitian populace: certainly allusions to the 1804 victory against colonialism were made by some Haitian students during the 1929 strike.41 Either way, even those who originally supported

American control had largely joined in allegiance with the opposition, swept along by the anti-imperial mood of the moment.42 What started as a student walk-out grew into a general strike on the last day of November, as government employees refused to work.

By the third of December, no students were attending class in the entire country, politicians and business owners were seeking to align themselves with the strikers, and the loyalty of the Garde was in question. Sensing what was to come, General Russell requested that Washington send five hundred more Marines to Haiti.43 The following day

Haitian custom employees joined the strike, deepening the crisis.44

As popular as the strike movement was, there were still some Haitians who chose not to publicly express opposition to the occupation. Despite the strike, the personnel of the

Public Health Service had continued attending to their work. On December 4, when the custom employees walked off their jobs, the Public Health employers were in the midst of a Sanitation Congress with Commander Melhorn. Rioting broke out though, and the customs house was raided by a crowd that Melhorn described as "several hundred political agitators, striking students and vagabonds."45 Some of the other major symbols

112 of American colonial control were attacked as well. The office of the Financial Advisor, right next to Melhorn's, was stormed, while the Marines were stoned by the crowds in the streets.46 Though numbers are not available for Port-au-Prince where these incidents occurred, in Cap Haitian the assembly was more than one thousand in number. Melhorn correctly predicted that another declaration of martial law was "only a matter of minutes," adjourning his congress while pleading his personnel "to stand fast no matter what the provocation."47 "In striking contrast to the section of the Medical Students," the Public

Health Service employees would prove loyal to Melhorn's pleas.48 Even after the events of December 6, "to a man they refused to participate in the 'strike' movement."49 On that day a group of fifteen hundred Haitian "peasants" marched on Cayes armed with stones and clubs seeking, amongst other grievances, the release of prisoners detained in the previous day's protests. The Marines responded by sending a detachment of twenty soldiers to halt the crowd, while also dropping bombs into the harbour from airplanes to pressure the Haitians into submission. With this show of force failing, a skirmish followed in which the Marines opened fire on the crowd.50 Commander Melhorn would later shrug off this event, noting in communication with Admiral Riggs that though "we have been almost submerged in work," it was "not so much in handling casualties, for they were relatively few." Thanks to the press the events, Melhorn claimed, "had all the appearance of rapidly developing into something more serious than [what was] actually taking place."51 Still, even according to his (disputed) numbers, five Haitians were killed and another twenty injured at Cayes.52 But despite these events, in what Melhorn labelled

"a beautiful example of loyalty to government," the Public Health Service employees stayed at their posts. "Never has espirit de corps been more effective," Melhorn would

113 later write. "To have been a member of such an organization is a matter of intense pride and satisfaction to us all." The paternalist memory that 'his' Haitians stayed loyal to the government would always be one of Melhorn's "treasured memories."53

Why, when nearly all of the other sectors of the Haitian workforce walked out, did the health workers continue toiling? Though Melhorn's self-congratulatory report makes absolutely no hint of this possibility, and though this must remain nothing more than speculation, it is possible that the rapid culmination of events simply had not left sufficient time for the public health employees to further consider joining the strike.

Within three days of the massacre the country returned to a relative quiet. The imposition of martial law and the willingness of the Marines to use force had succeeded in calming by December 10 the disturbances and the outright revolt, even if it was now a restless peace.54 It is also quite possible that at no point did these healthcare workers desire to join their colleagues of the medical school in the strike. However, Melhorn's simple proclamations of the Public Health Service's loyalty to the government do come across as slightly naive. When approached and asked to enroll in the strike, Melhorn reports that the Haitians of the Public Health Service responded by indicating that "no cause existed which was greater than that of the care of the sick and the health of the nation."55

Reminiscent of the reasons why it become such an effective method of control in the first place, the Public Health Service was one of the few national institutions actually concerned with the Haitian people and not just with establishing imperial goals. Whereas a strike in the U.S.-founded schools interrupted the creation of the workforce desired by

American capital, and while a strike of the custom house employees handicapped the

114 ability of the colonial authorities to control Haiti's finances, a strike of the medical practitioners would predominantly hurt the Haitian populace and not the occupation.

Either way, it is doubtful that the members of the Public Health Service avoided the strike out of pure loyalty to the government.

That the Public Health Service's continued operation is not to be solely understood as an expression of loyalty to the government is, ironically, supported by the actions of the striking medical students. Both actions actually represent an overlapping expression of sovereignty-desired. The strike movement is explicit in this, but while being a cognisant demonstration of collective rage and a direct challenge to the authority and rule of the

Americans, in some sectors the strike also became somewhat of an obstacle to the repossession of sovereign control. When on the seventh of November the students of the

National School of Medicine informed Commander Melhorn via letter of their intent to strike in "sympathy with their comrades in the school of agriculture," they also used the opportunity to state, in a salient contrast to the original strikers, that they "bore nothing but good will toward the Public Health Service and that they had no fault to find with the

Medical School."56 This seemingly contradictory message was actually consistent with the general Haitian attitude towards all aspects of public health, but despite this approving attitude Melhorn was ultimately unsuccessful in his repeated attempts to persuade the students to return to their desks. When it became "evident" in Melhorn's eyes that the students "were more in sympathy with strike movements than with the health interests of 2,000,000 of their countrymen," he moved to have the school closed.57

On December 19, Melhorn recommended to President Borno and the Minister of Interior

115 that the medical school be closed until October 1, 1930.58 This was officially rationalized by noting that a professional school could not ensure a satisfactory education with seven weeks lost from the semester.59 However, when in communication with Dr. W.S. Carter, an Associate Director of the funding Rockefeller Foundation, Melhorn stated that he hoped the "decision will not soon be forgotten; [and] that it will prove a lesson to students contemplating strikes in the future."60 However, by cancelling the academic year the

Marines' long-term plans were placed in jeopardy. It had been planned that by 1936 all

Naval personnel would be replaced by Haitian doctors graduating from the medical school, but the loss of the year meant that there would not be enough native doctors to do so.61 It is in this dilemma that the commonality between the striking students and the non- striking medical practitioners is made evident. The striking students became presented with a predicament over how their sovereignty-desired could best be achieved. Breaking with the open confrontation of the strike, on January 13, 1930, the medical students returned with full attendance to their classes. The strike committee, having learned of the decision to close the school for the rest of the academic year, met with Melhorn and communicated their desire to return to classes as soon as possible and to make up lost time.62 But this was not because "those who were responsible for precipitating the students' strike [...] learned enough from the experience" to repent in their actions, as the

Rockefeller Foundations' Dr. Carter had hoped.63 Rather, the medical students "did not wish to interfere longer with the plan [...] to effect the replacement of U.S. Naval personnel with Haitians as rapidly as possible."64 Saving the school year, the students committed to staying in class until September 15.65

116

The whole debacle had "demonstrated both to Haiti and to the United States," Melhorn wrote in December of 1929, "that this country is still far from being able to function on its own."66 In this the Director General of the Public Health Service was merely repeating a wisdom regularly extolled by the occupation authorities. One official had previously even gone as far as to argue that Haiti would need to stay under the tutelage of the United

States for another fifty years before the hospitals and other institutions were firmly established enough for Haiti to "travel alone."67 But, following the strike, these officials could do little but lament that Haiti was not ready to go alone without the U.S. The strike had changed the political climate in the United States, and as a result the American

Executive was mulling over bringing the occupation to an end. The relatively newly- elected President Herbert Hoover, having taken over from Calvin Coolidge in March

1929, was already somewhat ill-at-ease over the United States' continued presence in

Haiti. As Donald Cooper notes, the original rationale for occupying the country was no longer apparent and it was no longer necessary to maintain American troops on that island.68 More importantly for Hoover though, the 1929 disturbances posed a serious political challenge for Hoover. Not only had the strike called into question American control over the western third of Hispaniola, but it also roused the struggle against white supremacy and imperialism within continental North America.

While the students agitated against colonial rule by refusing to take their seats, other

Haitians had organized trans-nationally in support of the same objective. Since the early days of the occupation, under the guise of the Union Patriotique, Haitian elites had been agitating and writing against American control of their country. Though they were

117 dismissed by the Treaty Officials as being "Cacos de la Plume" (Cacos of the Pen), in the early twenties they were joined by American critics of imperialism, notably by the

NAACP and The Nation magazine.69 The small expatriate community of approximately five hundred Haitians who were living in the United States had established relationships with the major black associations and small African-American communities across the country as well. And so, when the student strike broke out in 1929, the African-American presses were already in the midst of a series of exposés on American foreign policy in

Haiti.70 Blacks in the United States had by this time already been organizing extensively in support of their brethren in the occupied Caribbean country, and this media campaign was just the latest of the initiatives that had spanned the previous decade. The NAACP, despite existing antagonisms with the Universal Negro Improvement Association

(UNIA), had even reached out to Marcus Garvey in an effort to broaden the opposition against the continued occupation of Haiti, and broad coalitions between black organizations, unions, and other social movements were formed to deal with "the Haitian question."71 The American intervention, as Brenda Gayle Plummer notes, was seen as being an attack on the progress of all blacks, and opposing the occupation was envisaged as being a necessary part of combating black oppression in the U.S.72 By striking in their classrooms, Haitian students managed to galvanize the struggle against white supremacy in the United States as well as in the protectorate. As violent protests against the occupation and "Yankee Imperialism" in general struck New York in December, the political ramifications of the continued occupation, mostly ignored previously, began to threaten President Hoover's popularity.73 The 1929 disturbances had resulted in negative headlines internationally about American actions in Haiti, too. The occupation was made

118 the subject of criticism around the world, something that greatly concerned the

Americans, especially in relation to their broader affairs in Latin America.74 In response to all these pressures, all the product of the Haitian students' actions, Hoover was forced to chart a new course on Haiti.

Needing to act even though most students in Haiti had by this time already returned to their classes, in December of 1929 President Hoover requested that the American

Congress establish a commission of enquiry to be sent to Haiti. Dutifully established on

February 7, 1930, a former Governor-General of the Philippines and supposed expert on colonial problems, William Cameron Forbes, was named by Hoover as the head of the commission.75 The Forbes Commission was tasked by Hoover with investigating "when and how we are to withdraw from Haiti," as well as "what we shall do in the meantime."76

Unlike the various commissions that had previously been sent to Haiti, this commission was earnestly composed; each member understood the French language and an attempt was made to include individuals who were knowledgeable about Haitian national and religious traditions.77 Despite this however, even though so much of the occupation was imbued with racial overtones, not a single member of the commission was black thanks to a request by President Borno. As the New York Times explained, the Haitians noted the antipathy that many Americans had towards blacks, and thus the Haitians did not believe that the commission's findings would be properly received if blacks were involved.78 Yet

Borno was also likely driven by self-interest when he requested the exclusion of blacks, as he felt that a black man would naturally be biased against the United States government and such partiality would inevitably be expressed in the final report.79

119

Though it did not insulate Hoover's administration from charges of racism, in the end a second commission was sent to investigate the state of education in Haiti. Headed by

Robert Moton, President of the Tuskegee Institute, all members of this second commission except one were Afro-Americans.80 The racial make-up of these two commissions ultimately influenced the reception their reports received in Washington, with the Moton report described as sounding like "Nigger to Nigger" and ultimately hidden away and condemned by the State Department.81 In spite of this, the full content of both reports as well as the events that occurred while the respective commissions were in Haiti (such as Forbes arranging for the dissolution of the Council of State and the end of the Borno dictatorship) ultimately did have a major impact on American and Haitian relations.

The picture that the commission presented was nuanced and likely concerning to policymakers in Washington. A careful reading of the final report elucidated the weaknesses of the occupation's hegemonic project and questioned the extent to which the

United States could expect to influence Haiti through projects such as public health over the long term. Unlike the various bodies that had previously been sent to investigate events in Haiti, such as the 1921 Harding Commission, the Forbes Commission did not just 'whitewash' what was occurring there. On top of having been instructed by Hoover to look for the means to withdraw, this may have had something to do with the fact that it would have been hard to ignore Haitians' dissatisfaction with the occupation. The commissions' February 28 introduction to the country consisted of a large demonstration of some six thousand Haitians protesting against the occupation, something that became a

120 common daily sight until the commission returned to the United States on March 16.82

The commission rapidly found that all aspects of the occupation were unpopular. Even the Public Health Service was subject to criticism, despite being the one aspect of the occupation that held any rapport with Haitians. On the very first day of the public hearings held by the Forbes Commission, Max Hudicourt spoke on behalf of the Union

Patriotique. Amongst other observations, many condemning the Americans for their condescension towards Haitians, Hudicourt noted that "there had been good Haitian doctors even before the American intervention, but the Americans were unwilling apparently to admit it."83 In doing so Hudicourt was highlighting the realm of health as a site of contestation, while also anticipating the words of the opposition member Georges

Léger who would later say to a Marine officer; "We know that [the U.S.] has helped us in many ways and we appreciate that. But after all, this is our country and we would rather run it ourselves."84 The hegemonic role that the Americans were hoping Public Health would play clearly did not go unrecognized. Articulate Haitian commentators such as

Dantès Bellegarde had long been saying similar things, observing that American civil servants "were more to be feared than Marines," but the Forbes Commission finally provided a means to directly challenge the non-military hegemonic structures of the occupation.85 Perhaps more articulate on such matters than the average Haitian by virtue of their social status and education, individuals such as Hudicourt, Léger, and Bellegarde certainly weren't the only people who raised issues of health before the commission.

Any Haitian was permitted to make an oral statement or submit a written deposition to

Forbes' investigative body. In spite of this official openness however, it "distressed" the

121 committee that they only heard from elites such as Hudicourt.86 Fortunately though, besides the visible protests, the commission had established a means of cultivating information from regular Haitians without relying on their attendance at public hearings.

The commission, though officially numbering five, was actually joined by at least one other: acting as medical advisor was the Rockefeller Foundation's Victor Heiser. The doctor's presence has been described as integral to the work of the commission by Robert

Spector.87 Not only did Heiser attend a number of the public hearings and take part in all of the commission's internal discussions and deliberations, but he also travelled the country far more widely than any other member did.88 The first and last days in the country were spent in Port-au-Prince, but from the third to the thirteenth Heiser managed to visit Pont Beudet, Dufort, Petit-Goave, Miragone, Cayes, St. Louis de Sud, Hinche,

Mirebelais, Las Cahobas, Thomaside, Cap-Haitien, Gonaives, St. Marc, and Archaie.89

In contrast the rest of the commission, despite their initial intentions, were mostly confined to Port-au-Prince. Also, because of Heiser's interest in medicine, which included him undertaking a health survey of his own, he was also placed in far more intimate contact with the Haitian populace than any of the official members of the commission ever were. Heiser's interactions with regular Haitians allowed him to take note of the popular opinion regarding the occupation, something he later fully articulated to Forbes and the rest of the commission. While the information passed along by the doctor tend to emphasize areas of greater concern to the commission, such as in highlighting the risk of another popular uprising, Heiser could not overlook the negative feelings that were specifically directed at the health services, even if his overall evaluation was positive.90

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Certainly some of Heiser's observations indicated improvements. At the Pont Beudet

Isolation Camp for the Insane, for example, Heiser noted that though being "primitive" compared to similar institutions in the United States, and though food spending was only fifteen cents per day for each charge, all housed there received meat on a daily basis.

Meat in Haiti, Heiser was told, was normally only consumed once-weekly.91 Medical training in Haiti impressed Heiser as well. He considered the nurses' training as being

"good" and described aspects of the National School of Medicine as being "striking."92

Likewise, many of the American-built hospitals and medical facilities were evaluated favorably; Heiser even described the hospital in Cap-Haitien as being "a monument to the occupation."93 But despite all of the positive aspects of Public Health in Haiti, Heiser was also struck by Haitian attitudes towards and within some of these institutions. Within the

Nurse Training School, amongst some problems that predated the occupation such as the color-conflict between the blacks and mulattoes, Heiser found overt dissatisfaction with

Dr. Butler's administration of the school, as well as some less-overt signs of trouble such as extremely high staff turn-over.94 Heiser also reported to the commission that of the peasants he came in contact with - despite always occurring within the context of an

American-established clinic - all were "intensely opposed" to the occupation.95 While in the end the Forbes Commission could affirm that the Haitian medical services had indeed elicited progress in the realm of health, it was also evident that many citizens harbored dissatisfaction about the Public Health Service as well. Heiser, too, would prove to be intensely critical of the occupation health programs. The clinic in Dufort, located thirty miles from Port-au-Prince, was "crude" in Heiser's opinion, offering "sloppy" diagnoses while taking more time to collect the four cent fee than was spent on the actual

123 examination. The patients tended to leave unconfident in the prognosis, often seeking additional remedies from local healers.96 The fees collected by the various clinics were identified as sometimes being barriers to service as well. In Port-au-Prince, even though access to the health services was supposed to be free, the fees charged by the Haitian

General Hospital were actually higher than those charged by Haitian practitioners.97 This meant that the hospital essentially only served the American and Syrian communities.98

Forbes too offered criticisms, such as noting that after fifteen years of occupation the

Public Health Service had failed to adequately deal with the yaws endemic.99 However, the criticisms offered by commission members must be differentiated from those offered by the Haitians. Heiser challenged the efficacy of the Public Health Service on a technical level, while the Haitians tended to react to the reality of American control.

It would seem that for the purposes of maintaining a hegemonic American influence the

Public Health Service was well positioned. Despite the criticisms, Heiser could report that "There is abundant evidence that great improvement has taken place in the health of the people since the occupation." And even though there was some opposition to direct

American control of the medical sector, Heiser maintained the popular belief that the

Public Health Service "enjoys the confidence and approval of the public."100 Given the painstaking work that had been done to implant American biomedical knowledge, supplant French medical ties with American ones, and generally change the terrain upon which the Haitian medical practitioners could operate, a switch from American administration to Haitian promised to be relatively simple. Following this, the first of the eight recommendations made in the final Forbes report included, amongst a number of

124 other sectors, effecting "a rapid Haitianization" of the medical services.101 Public Health would indeed be one of the first posts of the state to be transferred to Haitian control, as the new Director General, Rulx Léon, took control on October 1, 1931, following an early agreement between Dana Munro and Abel Nicolas Léger, the Haitian Foreign

Minister.102 This was an easy transition to make as it was already largely Haitians who made up the workforce of the Public Health Service. In 1924 there were 1433 Haitians employed, which increased to 2184 in 1928. The number of Americans increased by two over this time.103 However, after the transfer Léon demonstrated why so few Americans were needed to administer the Haitians, as he indicated that he would "employ the method of [his] American predecessors."104 On the surface it appeared as if the American hegemonic project was coming to fruition, at least in the realm of health.

Yet even as the Forbes Commission was recommending the Haitianization of the Public

Health Service, doubt was expressed over the wisdom of removing the American officials. The only recommendation that Heiser actually made in his report was that the

American medical men should maintain their positions for longer. While noting that steps had been taken to train the Haitians in the proper administration of the health services, in the interest of the "disease-weakened Haitian people" Heiser recommended:

"that it be made possible for the Government of Haiti to avail itself of the Services of the United States naval medical officers as advisors after the present treaty expires. It might also be desirable to employ a few other American medical men to insure longer tenure and continuity of service. In the meantime the assignments of the medical officers and hospital corps men should be lengthened."105

The report concluded with a warning that, unless those steps were taken, the entire apparatus risked deteriorating and much ground would consequently be lost.106 The

125 disconnect between this set of recommendations and the final set of recommendations offered by Forbes is striking. While Forbes was obviously constricted by political considerations in a way that Heiser was not, perhaps explaining the disparity, the doctor's observations also suggest that he recognized that the Public Health Service was actually in a precarious position, especially given the hopes assigned to it. His above-mentioned observation that most Haitians tended to still seek alternatives from local Vodou healers certainly did not suggest that the supremacy of American ideas was yet fully accepted. He was also less-than-impressed with the facilities already supervised by Haitians, observing that they did not follow American methods satisfactorily. The "coal black" in charge of the hospital in Petit-Goave, for example, did not maintain "that cleanliness found where whites were in charge."107 In St. Marc, Heiser noted that he caught Dr. Louis Jourdan, the

Haitian in charge, offering false replies to routine questions. This "tendency to falsify"

Heiser found to be "a characteristic trait among Haitian medical personnel."108 Even the more prestigious Haitian doctors Heiser found wanting, including the President of the

Haitian Medical Society.109 Likewise the American Dr. Brinkley, stationed at Hinche, told Heiser that the Haitian nurses were not satisfactory.110 There were very few areas in which Heiser could approvingly report of Haitian activities. If this was actually the state of the medical services that the Americans had installed in the hopes of having it continued by the Haitians, how reliable would the Public Health Service be in maintaining American hegemony? None of this mattered in the moment, however.

When politics made it necessary to initiate a withdrawal from Haiti, concerns regarding the strength of the hegemonic project did not necessarily factor too heavily on the mind

126 of President Hoover, especially when disturbances continued to challenge American control of the country even after the Forbes Commission had given its recommendations on how to withdraw. Despite their refusal to abandon their posts during the student strike, even Service d'Hygiene employees in Cap Haitien joined a strike against the occupation in December of 1930.111 Escalating events eventually made it desirable for the United

States to withdraw early. On August 15, 1934, two years prior to the date when the treaty was set to terminate, the Marines departed Haiti. Though the Americans were to retain control of Haitian finances until 1947, in all other areas control was returned to the

Haitians. Renamed the Département de la Santé Publique (Department of Public Health) after the Americans left, Haitians had of course already been fully in charge of the medical sector since 1931.112 But with the withdrawal of the American forces also came the withdrawal of American funds, bringing extra challenges for a department that even before the Marines had left the country was already having problems with corruption.113

The departure of the Marines meant that 10% of the national budget - $700,000 that had financed the payroll of the Garde and other positions - was no longer available to the government.114 While little of those funds had actually been directed towards the Public

Health Service, this reduction in the national budget still had a tremendous impact on the

Santé Publique's operations. The budget for public health was slashed in half so that the

National Police could be paid, leaving only 500,000 Gds ($100,000) to pay for the salaries of doctors, nurses, health officers and sanitary inspectors, as well as maintaining all the facilities in the republic. In Port-au-Prince this meant that new supplies could not be purchased, and a third of the workforce responsible for sanitary activities saw their jobs disappear.115 Without direct American control and supervision, it appeared as if the

127 hegemonic potential of the Public Health Service was rapidly disappearing. But the 1929 strike had also made it clear that the prospect and possibility of exerting control through public health was tenuous at best.

When students in the Agricultural Training School at Damien walked out of their classes in 1929, their actions sparked a national movement against the American occupation.

Despite the investment in Haiti's medical sector, a venture intended to win support for the colonizers, the Haitian population still lashed out in an effort to regain their sovereignty after fourteen years of U.S. military rule. The movement, aided by allies abroad, was successful in challenging the occupation and the Americans moved forward their withdrawal date by two years. The Americans were also forced to re-evaluate their occupation strategies. The presence of U.S. Marines on the island clearly negated any goodwill established by the Public Health Service, as only those who directly received their paycheques from the Service d'Hygiene stayed loyal during the strike. Certainly the health strategy was more long-term, with the Americans hoping that the National School of Medicine would act as a liaison between Haiti and the U.S. long after the occupation ended, but the post-strike investigation indicated that the likelihood of this happening was slim. The 1929 student strike called into question the hegemonic potential of public health in Haiti, and the Americans left the Caribbean country with few hopes that their long-term project would succeed.

128

IMPERIALISM AND THE APPEARANCE OF

PHILANTHROPY: THE OCCUPATION AND THE

ORIGINS OF INTERNATIONAL DEVELOPMENT

The Marine withdrawal from Haiti inaugurated the period of the as-of-yet unannounced

Good Neighbour Policy. The objective of the policy, as Mark Berger notes, was to

"substitute the punishment of Latin Americans for 'uncivilized behaviour' with a Pan

American policy that emphasized political and economic integration, development, and stabilization under U.S. leadership."1 While forsaking their assumed right to intervene in the affairs of their hemispheric neighbours, in a military manner at least, the Good

Neighbour Policy allowed the Americans to further develop a relationship that had been established with Haiti during their occupation there. The relinquishment of formal colonial control had allowed for Haitian leaders to make independent policy decisions, untarnished by the dictates of American overseers. However, though the Haitians were happy to see the Marines go, celebrating what they called their "second independence," and even though the nationalist, anti-American Sténio Vincent had succeeded Borno as president in 1930, in a testimony to the success of the hegemonic project of the occupation, Haiti still appealed to American agencies for guidance and assistance after

1934.2 With the end of the occupation came not just the era of the Good Neighbour, but for Haiti it also ushered in "the era of development." During the occupation the colonial leaders had devised strategies for control that entailed relying upon "projects of productive development," and when the Americans relinquished control in 1934 they subsequently encouraged Haiti to continue pursuing the same path towards social and

129 economic development.3 The Haitian government obediently complied, and so by request

American agencies continued to offer support to Haiti throughout the rest of the 1930's.

Thus, in what is perhaps the most substantial legacy of the nineteen years of colonial control, and predating the same phenomena elsewhere, the practice of international development in Haiti was borne of the American occupation.

Like the rest of Latin America, a region that Greg Grandin labels as being an "Empire's

Workshop," Haiti has been aptly described as a "laboratory for foreign policy."4

Examples abound, especially in regards to concepts typically associated with the field of international development. During the 1791 slave revolution the Americans offered for the first time ever foreign aid to what was then known as St. Domingue. The move is telling about the nature of international assistance, as Washington provided $40,000 to the French colonists in a bid to help crush the slave insurgency.5 The indemnity that

France demanded from Haiti in exchange for the slaveholders' "loss of property" has likewise been described as the first ever instance of structural adjustment. In order to pay the massive sum, which French recognition of Haiti's independence was conditional upon, Haiti was forced to close nearly all of the country's schools.6 But it was not just these early precursors to what are now common development instruments that were first seen in Haiti. Rather, the very idea of development made an early appearance there. The concept of International Development is commonly understood to be a post-WWII phenomena, springing from the Marshall Plan. Arturo Escobar, to use just one example, argues that the idea of development was "invented" in 1949 with the International Bank for Reconstruction and Development's (IBRD) economic mission to Columbia, which

130 was "one of the first concrete manifestations of an entirely new strategy for dealing with the perceived problems of a large number of countries that, after the war, came to be known as 'underdeveloped.'"7 Consistent with this analysis, though somewhat pre- empting Escobar, Mark Schuller holds that for Haiti the "official development era" was inaugurated by the UN's 1948 Mission to Haiti.8 International Development, however, began in Haiti much earlier. The istwa (Kreyòl for story / history) of public health during the U.S. occupation is essentially a story of development.9 Under the direction of an

American Sanitary Engineer, a medicalized strategy of development was embarked upon once the Americans became conscious of the power of health. Hospitals were built and clinics were established; immunization campaigns were initiated and pharmaceuticals were distributed; sanitation projects altered the environment and pathogenic hosts were destroyed. Along with other sectors of the Haitian state, which were targeted for similar treatment by other occupation agencies, Haiti's entire health apparatus was fundamentally restructured as the Americans sought to capitalize on the medical knowledge that they possessed. In short, the entirety of the Haitian state, society, and economy was altered by international actors that claimed to know best.

This development strategy was not pursued for altruistic reasons, but rather because it served a hegemonic purpose for the Americans. The apparatus of health was originally envisioned by the Marines as being a means of safeguarding themselves from the dangers of tropical pathogens. However it was noticed by the colonial authorities that, in stark contrast with the reception afforded to those Marines, the Haitian population was generally receptive towards the American healers. While white Marines were plagued by

131 the Caco resistance, the population from which those "bandits" came flocked to white doctors to have their medical needs looked after. Medical practitioners were welcomed into the hostile Haitian territory, and the American colonial strategy changed as a result.

The Americans sought to make their development projects as visible as possible, eager to show how much they were helping Haiti. Whether by building hospitals and clinics or by making "sanitary" changes to the environment, the Americans hoped to normalize their intrusion within Haiti. They also hoped that their work would have a lasting legacy. And it did. The American developmental strategy was concerned not only with maintaining the occupation, but also with establishing a long-term Haitian dependence on the United

States. Through the institutions they developed, such as the National School of Medicine, the Americans created reliant ties between Haiti and the U.S. This encouraged the Haitians to look for support and guidance from within the same nation that had just occupied their country.

And so, as Haiti emerged from the occupation, American privilege was not lost. It was instead independently maintained by the Haitian government. Within a year of the occupation coming to an end the Americans were back, this time as invited guests.

Haiti was visited in March of 1935 by a representative of the Rockefeller Foundation, Dr.

B.E. Washburn, who was asked to evaluate the state of the health services. What

Washburn found was encouraging for him. Despite slashing the budget, Haiti's hospitals were still operating, and much work was being done in the areas of sanitation, school hygiene, baby clinics, and syphilis detection and treatment. Washburn found that every home in Port-au-Prince was provided with pit latrines or water flush toilets, and that the

132 water supply, unfiltered but chlorinated, was abundant. He found slum clearance projects in progress, noting that two blocks of "the worst type" of shacks had been demolished.

Twenty new homes, three rooms each with water and toilets, had been constructed in their place. However at a cost of $600 each, a price subsidized by use of prison labor,

Washburn made no mention of whether the old inhabitants were able to return to these new abodes. But these programs, along with a continuation of drainage improvements and other anti-mosquito measures, all indicated to Washburn that the Haitian government was committed to maintaining the health programs that had been initiated under to occupation. While in Haiti, Washburn was presented with a request for continued

Rockefeller Foundation assistance. The Haitian government asked for aid in improving sanitation in a number of small towns, places where no educational work had previously been done. The government was also interested in malaria survey and control campaigns, in enlarging the yaws treatment program and the infant welfare work, as well as in training more health workers. Washburn's evaluation of the post-occupation health sector was positive, and since "the situation in Cuba does not seem very promising for cooperative health work at the present time," he even recommended that the Rockefeller

Foundation abandon their commitment to Cuba and focus their energies on Haiti instead.10

No decision to transfer the Rockefeller Foundation's attention away from Cuba and on to

Haiti ever occurred, though the philanthropic body did briefly appear to consider expanding their Haitian program. The Foundation man, F.F. Russell, pitched the idea of transferring Dr. Payne back to Haiti. After his previous stint in the Black Republic Payne

133 had been posted in Puerto Rico, but he still maintained an interest in Haiti. Russell was also under the impression that it would be possible to release Payne from Puerto Rico at some point over the course of the next year.11 This, too, was not to be. While Haiti was actively expressing an interest in maintaining the existing health programs, the

Rockefeller Foundation was growing concerned that the Puerto Rican medical programs were under threat. A presidential election was approaching there, and it was deemed important that Payne remain in Puerto Rico to "assist in the reorganization" should the government change. Another factor under consideration was the "danger of the present health organization being upset when Federal Relief is withdrawn."12 While no

Americans seemed overly concerned about the Haitians' diminished budget when the

Marines left that country, Puerto Rico continued to be a direct colony of the American empire and thus was deemed a higher priority. The Foundation thus considered it necessary that Payne stay in Puerto Rico for two more years, ultimately meaning that the

Haitian requests for assistance remained unanswered.13 Beyond the quick survey of conditions undertaken by Washburn, the Haitian government was unsuccessful in their seeking assistance in 1935. Their disappointment, however, did not lessen Haiti's willingness to look to the United States for continued guidance. Haiti remained firmly committed to following and expanding the program that the Americans had established during the occupation. In that vein, by 1937 the country's health statistics had been made much more reliable; the reporting of deaths was considered by the Haitian Director of

Health to be fairly complete, for example.14 In 1938 a mandatory pre-medical year was added to the curriculum of the National School of Medicine.15

134

The year 1939 saw yet another request to the Rockefeller Foundation by the Haitians, expressing a continued reliance on American expertise five years after the end of the occupation. On that occasion Dr. Porter J. Crawford accompanied Dr. Washburn to Haiti.

Though they obviously took note of the many health problems that still faced Haiti, the

Rockefeller men determined that the Public Health Service was operating efficiently.16

They even mounted a defence of the Haitian hospitals to the representative of the Unites

States in Haiti, Fred Mayer, who was urging the Foundation to build more hospitals in the country. The contrary opinion of Washburn and Crawford was that the hospitals "were well equipped and administered in an efficient manner and were meeting the needs of the country in an excellent way." The need, they declared, was to "work to prevent disease so that the large sums already being spent in the hospitals and sick relief could be decreased."17 Dr. Rulx Léon, the Haitian Director of Health, had stated the same thing, evidently frustrated that Mayer was criticizing the hospitals; in spite of numerous invitations extended by Léon to tour the facilities, Mayer had never set foot in one himself.18 Overall, medical programs seemed to be doing relatively well in 1939. But while content with aspects of their Public Health Service such as the hospitals, Léon and

President Vincent did still take the opportunity of the Americans' visit to ask for further assistance. Unfortunately for them, even as the Rockefeller men were offering an unprecedented strong defence of the hospitals to the American government official, they too had criticisms and these again threatened the possibility for further cooperation. The

Rockefeller Foundation required that the host government would commit resources to the area of focus, yet the Haitian officials continually repeated the same line: "There is no money for further health work and it is impossible to secure funds with which to

135 cooperate with the Foundation."19 This was partly thanks to American machinations, as

U.S. officials had discouraged foreign banks from loaning funds to Haiti, limiting the country's scope of options.20 Writing to John Foster Dulles, who served as a Trustee of the Rockefeller Foundation from 1935 until becoming the American Secretary of State in

1953, Wilbur Sawyer had in April expressed a similar opinion. "The trouble in Haiti," he wrote, "is that they have not yet organized and supported a health department in such a way that the Foundation can help the country gradually to face its own health programs."

Though Sawyer had hope for the future, he felt the Foundation's dealings with Haiti had been "long and discouraging," and he questioned whether anything could actually be done in the country at that time.21

Because of the Haitian inability to contribute to any project nothing came of their 1939 request. Mayer's daftness and his not understanding what would have been a useful contribution to Haitian medicine was likely a factor as well. But however inadequate he was as an ambassador, he is exemplary for further highlighting the desires that the

American government had for aid. Just as events in the wake of Haiti's 2010 earthquake provided for anthropologist Mark Schuller a "teachable moment" about the international aid system, the discussions that surrounded Haiti's failed request for aid in 1939 do the same.22 For months Fred Mayer had been encouraging the Rockefeller Foundation to continue their partnership with Haiti. Seeking to allay any of the Foundation's concerns

Mayer noted in March that of the Haitians he had spoken to, no one believed any antagonism was ever directed towards the Rockefeller Foundation. He found instead that the 1929 student strike and subsequent disturbances were more a product of the general

136 attitude towards the occupation, something that "local personalities" influenced.

"Fortunately," Mayer noted, "the anti-Americanism of those days has now changed to a universal pro-Americanism, which we hope will continue." Not willing to leave it up to chance though, and indicating the purpose he assigned to aid, Mayer appealed to the

Rockefeller Foundation for assistance in maintaining a political climate fortuitous for the

U.S.: "the establishment of a hospital and laboratory would do so much to maintain [that pro-Americanism]," he wrote.23 The Rockefeller man with whom Mayer was corresponding was likewise candid about the power of aid. Sawyer concurred that no anti-Americanism was ever directed towards his own organization. Instead, highlighting the Foundation's potential to act as an intermediary for American imperialism, Sawyer noted that the Haitians had for many years actually been trying to get the Rockefeller

Foundation to serve as a civil organization in their country, hoping that they would run the medical services instead of having them administered by the U.S. Navy.24 Since public health is, as postulated by Dorothy Porter, "an expression of the way different societies [address] questions of social order and nationhood," there would have been little difference between IHB or Navy control of Haitian health services.25 Moreover, both entailed Haiti lacking sovereign control over public health. There is one significant difference however, and it is one that clearly reveals the hegemonic potential of the

American development project: while the Haitians decried the violation of sovereignty that Navy control represented, they invited foreign domination when it came under the guise of foreign assistance.

137

Though in 1939 the Haitians did not get the support that they had hoped from the

Rockefeller Foundation, in the post-occupation years development assistance was also coming from other American sources. While Washburn and Crawford were in Haiti they noted that Haiti had applied for and received a $5-million loan from the American semi- governmental Export-Import Bank of Washington. In what may be an early example of tied aid, the funds were subsequently expended through an American business. The J.G.

White Construction Company was contracted to complete a number of projects, amongst which were included various health-related initiatives such as improvements to the country's water supply.26 The Rockefeller men also found that William Boaz, the Chief

Sanitary Engineer of the Pan American Sanitary Bureau, was engaged in a large study of

Haiti`s public health system. Invited by Dr. Léon while both were in Bogota, Columbia at the Pan American Sanitary Conference in September 1938, Boaz began his visit to Haiti on November 19, 1939. Until February 27, 1940, with a brief interlude where he accompanied President Vincent on a trip to New York and Washington, Boaz undertook the task of drafting a list of suggestions on how to improve all aspects of public health in

Haiti. The final report consisted of twenty-nine pages of recommendations, all appropriate according to the level of capacity demonstrated by the health service.27 As the decade changed the development project continued apace. In March of 1940 Dr. Mark F.

Boyd of the International Health Board visited Haiti to examine the malarial conditions there.28 This was followed by a new commitment by the Foundation to work in Haiti, granting $1750 to the Département de la Santé Publique for the purposes of establishing a malaria division and studying the local anophelines.29 The next year another ten thousand

138 dollars were committed by the Foundation to Haiti in order to further expand the malaria control process.30

Unfortunately, by the 1940's Haiti was already forced to contend with the failures of development. Though it may have been, as François Duvalier later quipped, that

"foreigners don't know how to build roads in Haiti," the infrastructural improvements made during the occupation were falling into decay.31 The devastating floods of 1935, possibly exacerbated by the practice of reclaiming land for sanitary purposes during the occupation years, certainly did not help this situation as roads, bridges, and houses were swept away by the eight feet of water that deluged the area around Jacmel and killed at least 2000 people across the country.32 Other ambitious development projects such as the

Société Haitienne-Américaine de Développement Agricole (SHADA), a corporate partnership between the governments of Haiti and the United States, ultimately also failed. In the case of SHADA, which began operations in 1941, the corporation did little to support Haiti's economy. Rather, in Brenda Gayle Plummer's analysis, SHADA actually "accentuated the chronic problems of poverty and underdevelopment" in Haiti.33

Even projects that were previously considered unmitigated successes, such as the

National School of Medicine, Dentistry, and Pharmacy, were having their value questioned. Though the war in Europe "brought the worth of the local Medical School to the attention of local statesmen," in 1944 Crawford noted that since re-establishing the school in the late twenties "there have been practically no changes in faculty or equipment." Other than the pre-medical year that was added in 1938, the only other change that Crawford could note was that in 1942 a law was passed that required

139 graduates of the school to teach in the interior of the country for two years before they were licensed to practice in the capital. The school still only graduated ten to twelve doctors each year, even though it needed to produce at least thirty each annum in order to meet the country's health needs.34 In light of that evaluation Rockefeller officials questioned whether they should continue providing fellowships for Haitians to come to the United States for training, wondering if it it would be best to instead send Americans to Haiti to teach. There was even the question of whether the National School of

Medicine should even remain open.35 By 1946 the Foundation held the opinion that "the matrix of medicine in Haiti isn't a good enough setting for any investment at all." Dr.

Robert A. Lambert noted:

"That we gambled and lost in a previous effort to put the Port-au-Prince Medical School on its feet, is no reason for our betting again, particularly as we know now better than in 1926 how great are the odds against success."36

So even before the country joined the International Monetary Fund (IMF) and the IBRD in 1951, development projects were failing in Haiti.37

The continued failure of development in Haiti is well known. That Haiti is today "the poorest country in the hemisphere" has almost become cliché for reporters to note.38 The environmental degradation - only 1% of the country remains forested, in stark contrast to the Dominican Republic's 28% - has been oft commented upon too.39 This is in spite of the growth of the development project in Haiti. The wave of development endeavors that began with the U.S. occupation continued unabated in the decades past the 1940s, and the development industry has since become one of the most defining features about contemporary Haiti. In 2009 it was estimated that there were 10,000 NGOs working in

140 the country, which per-capita is the highest in the world. Only India can boast a higher absolute number. With 80% of schools and 90% of clinics amongst other important national infrastructure controlled by various development agencies, Haiti has been described as "the Republic of NGOs," or alternately as having a "non-governmental government."40 Despite this attention, development efforts are categorically considered to have been a failure. In the mid-2000s, for example, some 70% of Haitians lacked adequate access to clean water. Likewise, there were only 2.5 doctors for every 10,000 people.41 And this was before the earthquake. As the celebrated Haitian author Edwidge

Danticat has noted, "From now on, there will always be the Haiti of before the earthquake and the Haiti of after the earthquake."42

On January 12, 2010, the earth shook in Haiti for a devastating 35 seconds. As buildings collapsed around them, one in seven Haitians were rendered homeless. Up to another

316,000 perished as homes, businesses, schools and government offices "pancaked" atop them.43 Amongst the dead were 125 students of the l'Hôpital Université d'Etat d'Haïti

(the Haitian State University Hospital), otherwise known as the Lopital Jeneral. The entire second year class of the affiliated State University School of Nursing were killed along with a number of professors when the lecture hall they were in collapsed.44 At a moment when they would be needed the most, the National Medical School had no graduates for the first time in nearly a century.45 The tranbleman té ("earthquake"), more commonly called bagay la ("that thing") or goudou goudou (an onomatopoeia which mimics the sound of the earth's rumbling), was an unmitigated disaster. But it also resulted in a massive outpouring of response from around the globe. Showing just a

141 portion of what was donated by private citizens around the world, in the first week alone

U.S. households donated $275 million dollars for relief. By the end of year $1.4 billion had been committed by individual Americans. An amazing sixty percent of all American households and more than eighty percent of all African-American households had donated funds.46 Yet alongside the genuine concern shown for the people of Haiti, the colonial origins of aid became more apparent than ever.

Against the backdrop of a humanitarian crisis, the political uses of aid were illuminated after the earthquake. Partners in Health, an internationally respected medical aid organization, estimates that in the first few days after the earthquake as many as 20,000 people may have died each day as they succumbed to injuries sustained due to bagay la.

Many of these deaths may have been avoidable had the disaster response been formulated differently. As Beverly Mullings, Marion Werner, and Linda Peake have shown, countries such as Canada, U.S. and France prioritized a military rather than medical response to the disaster, emphasizing that there was political instability and lack of security in the country.47 22,000 troops were sent to Haiti by Washington and the soldiers quickly seized control of the L'Ouverture airport in Port-au-Prince. The U.S. Navy meanwhile established a naval blockade around the island to prevent any refugees from fleeing to the U.S. Only later did much needed medical supplies arrive. However, as the

Nation magazine would later report, leaked diplomatic cables disclosed by Wikileaks indicate that no serious security threats ever existed.48 Instead, the earthquake relief became an opportunity for the Americans to shore up their pre-existing military control over the country. Ever since the Canadian-, French-, and American-backed coup d'état

142 against President Aristide in 2004, there has been a United Nations "peacekeeping" force deployed in Haiti.49 This force, the UN Stabilization Mission in Haiti (known by its

French acronym MINUSTAH), is considered by many Haitians to be occupying their country, preventing the popular democratic will from being realized. But for the countries that backed the coup, MINUSTAH has been an important asset. As another leaked

American cable stated: "The UN Stabilization Mission in Haiti is an indispensable tool in realizing core USG [United States Government] policy interests in Haiti." Since the U.S. was set to "reap benefits from this hemispheric security cooperation for years to come," the cable, written in 2008, noted that the United States "must work to preserve

MINUSTAH." But most ominously, the cable observed that:

"The current post-hurricane relief effort, however disordered, is proving an opportunity for U.S., Canadian, and other bilateral donors to partner with MINUSTAH in disaster assistance and reconstruction. We sense that the humanitarian focus of these crisis-response efforts -- in contrast to riot-control efforts in April -- is helping the case in Latin countries for continuing their peacekeeping contributions in Haiti."50

Just as President Wilson had used a "famine situation" as a premise to undertake the

"humane duty" of seizing military control in 1915, slightly less than a hundred years later the Americans were invoking the same strategy.

The politic of foreign aid in Haiti is a politic of control, and it goes beyond MINUSTAH and direct military control. As Justin Podur argues, borrowing a notion from Erica James, there is a "humanitarian market" that exists in Haiti. This market, Podur writes, "is a specific way for international aid agencies and foreign governments to relate to Haiti."

More specifically, it is a relationship that entails a denial of Haitian sovereignty.51 That less than one percent of all earthquake relief funds were directed to the Haitian

143 government - 0.3% , which is even less than what was directed towards the unaffected

Dominican Republic- is a particularly telling example of how aid has tended to undermine sovereignty in Haiti.52 Subsequently the NGO recipients of those aid dollars, according to Nikolas Barry-Shaw and Dru Oja Jay, "now play the role of handmaidens to empire."53 Or as Schuller puts it, NGOs in Haiti act as the glue for globalization through a process of "trickle-down imperialism."54 Recognizing that such processes run contrary to the common narrative of development work , Barry-Shaw and Jay suggest that development work has become "a graveyard for good intentions."55 However, that supposedly benevolent activities would be used for such self-serving purposes by countries like Canada and the U.S. would not come as a shock to Haitians who lived through the American occupation. Similar actions had driven the Haitian intellectual Jean

Price-Mars to decry in his seminal 1928 book Ainsi Parla l'Oncle, "the moment when imperialism of every order disguises its lusts under the appearance of philanthropy."56

Price-Mars was a man who understood the political power that both charitable aid and medicine held. He had studied under Dr. Audain at the National School of Medicine in

1895, and would later use his medical knowledge to contest American power, administering free healthcare to Haitian peasants during the occupation.57 Medicine had become an import site of political engagement in those years, and in order to maintain their benevolent image the Americans tried to monopolize medical goodwill. They could not permit challengers to leverage health as a nationalist tool. Those who did, such as Dr.

Rosalvo Bobo, the man who led the revolt that first threatened President Guillaume Sam's government, were quickly dismissed and discredited. Bobo, recognized by the Americans

144 as being "greatly beloved in Haiti because the poor and needy sick always had the first call on his services, and none of these ever received a bill from him," was dismissed as being, in the words of the British Consul, "A great charlatan in medicine [who] deceives his patients with high-sounding names and other quack remedies."58 Traditional Vodou healers were likewise rejected by the occupation authorities as well, even though

Americans such as William Seabrook recognized that these healers held legitimate remedial knowledge.59 The Americans weren't interested in anyone's healing powers though, unless those skills were used to support the occupation.

It had been somewhat by chance that the Americans learned the power of health in Haiti, as they had originally taken over and set up medical institutions solely out of concern for self-preservation, worried about the impact that tropical diseases might have on the troops who had invaded Haiti. But due to the language of the treaty that legitimized the occupation, the Americans were forced to offer healthcare to the Haitian population. In the midst of the 1918 Caco revolt, however, the Americans realized that the white men who offered medical aid were welcomed into territories that were hostile to the white men who carried guns. Learning from this, the occupation authorities sought to consolidate their military control via the use of medicine, establishing a system of clinics, hospitals, and other public health initiatives. Interaction with the occupation state was made palatable to the Haitian populace by making public health their primary site of contact. By all means, the strategy seemed to be effective. Overt opposition to the occupation was weakened through most of the twenties, and when popular discontent did boil over, no animosity was ever directed towards the health services.

145

American medicine managed to maintain a hegemonic position in the Haitian imagination after the Marines' withdrawal in 1934. As Alan McPherson indicates, the few good

American characters in post-occupation Haitian literature tended to be portrayed as having a connection to the medical profession.60 But through the application of biomedical knowledge during the occupation, a form of hegemony was realized in more concrete ways as well. In some cases the Americans managed to maintain direct control over Haitian medical institutions. At least one American stayed in his position after the

U.S. forces formally relinquished control: a certain Dr. Resser continued to be in charge of Haiti's asylums - a task that had actually remained the charge of the Gendarmerie up until 1929 - in the years following the withdrawal, for example.61 More significant still was the privilege and power that a few Haitians gained via the American-run medical services. One student of the National Medical School in particular would prove to be an important ally of the United States in the following decades. After receiving training at the Port-au-Prince school, François Duvalier was offered a fellowship to the United

States for further study. In the 1940s he was hired to take part in a U.S.-sponsored anti- yaws campaign, and subsequently spent time traversing the country providing medical care to the Haitian populace, earning his nickname "Papa Doc" in the process. It was in part on the merits and prestige of his medical work that Duvalier was able to successfully seek the presidency in 1957.62 For the next thirty years, between Papa Doc and his son

"Baby Doc" Jean-Claude, the Americans were assured that Haiti would remain a staunch anti-communist ally. But even if the Americans had not lucked out in that way, the occupation had fostered a system of dependency between Haiti and the U.S., especially in

146 the field of medicine. The Americans had realized that the various public health projects they had initiated could only continue as long as the occupation continued, as Haiti did not have the capacity to reproduce the necessary biomedical knowledge. Though a medical school had existed since 1823, medical education relied largely on French techniques, while the new public health measured were based upon American biomedicine.63 As such the Americans, with the help of the Rockefeller Foundation, re- established the National School of Medicine, Dentistry, and Pharmacy. But while the school became an important domestic source of medical knowledge, it structuralized a dependence on American expertise.

When they revolted in 1929, Haitian students and then eventually Haitians in general challenged the structures of dependence and control that had been established during the years of occupation. They challenged American power and called into question the hegemony which the occupation authorities had been seeking. Though different sectors of

Haitians acted in different ways, all expressed a desire for sovereignty. The tactical decisions of those in the medical sector reflected this, as the students joined the strike while public health workers continued to work, both decisions seemingly calculated to best serve their country. As the nineteen year occupation came to a close, the Americans, as pleased as they were with some aspects of their colonial experiment, could not be assured that they had established the hegemony that they desired. Though the retrospective view from several decades later would suggest that the Americans had indeed been successful in their hegemonic project, in the immediate years after 1934 the medical improvements brought by the Americans all seemed ready to collapse. And

147 collapse they did in many cases, but by then the necessary ties between Haiti and the U.S. had been established. For the Americans, this was good enough. After all, the primary goals of the medical development projects in Haiti were never actually about helping the

Haitians.

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NOTES

Introduction - A Surgical Intervention

1 David Healy, Gunboat Diplomacy in the Wilson Era: The US Navy in Haiti, 1915-1916 (London: University of Wisconsin Press, 1976), 26. 2 Of his first encounter with Haiti, Faustin Wirkus would write that "It hurt, It stunk, Fairyland had turned into a pigsty. More than that, we were not welcome. W could feel it as distinctly as we could smell the rot along the gutters. ... In the streets were piles of evil-smelling offal. The stench hung over everything. Piles of mango seeds were heaped in the middle of the highway, sour-smelling. It was not merely that these, mingled with banana peels and other garbage, were rotting - the whole prospect was filthy." (Faustin Wirkus and Taney Dudley, The White King of La Gonave, quoted in Hans Schmidt, The United States Occupation of Haiti, 1915-1934 (New Brunswick, NJ: Rutgers University Press, 1995), 68). 3 “Notes from H.H. Howard’s Diary – Haiti – August 1923," folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Schmidt, The United States Occupation of Haiti, 67. 4 Alex Dupuy, Haiti in the World Economy: Class, Race, and Underdevelopment Since 1700 (Boulder, Colorado: Westview Press, 1989), 139. 5 Maurice Dunlap, "Carrying the Gospel of Health to Haiti," 1924(?), http://ufdc.ufl.edu/UF00028492/00001, Digital Library of the Caribbean. 6 William I. Robinson, Promoting Polyarchy: Globalization, US Intervention, and Hegemony (Cambridge: Cambride University Press, 1996), 21. 7 Steve Jones, Antonio Gramsci (New York: Routledge, 2006), passim. 8 Philippe Girard, Haiti: The Tumultuous History - From Pearl of the Caribbean to Broken Nation (New York: Palgrave Macmillan, 2010), 81-2; Schmidt, The United States Occupation of Haiti, 65-6. 9 Schmidt, The United States Occupation of Haiti, 66. 10 Robert Debs Heinl and Nancy Gordon Heinl, Written in Blood: The Story of the Haitian People, 1492- 1995 (Toronto: University Press of America, 2005), 358; Patrick Bellegarde-Smith, Haiti: The Breached Citadel (Toronto: Canadian Scholars' Press, 2004), 99; Of course 'the second-longest military occupation' refers only to the non-permanent occupations of territory, not taking into account the continued occupation of indigenous land upon which the USA is based. Nor does it take into account permanent colonies like Puerto Rico or long-held segments of territory such as Guantanamo Bay, both of which could be construed as occupied territory. 11 Hans Schmidt, Maverick Marine: General Smedley D. Butler and the Contradictions of American Military History (Lexington, Kentucky: TheUniversity Press of Kentucky, 1987), 44-5. 12Frederick Douglass. "Lecture on Haiti at The Haitian Pavilion (1893)," in Haiti, A Slave Revolution: 200 Years After 1804, ed. Pat Chin et al (New York: International Action Center, 2010), 79, 86. 13 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 14 Schmidt, The United States Occupation of Haiti, 70. 15 Denise Gostaldo, "Is health education good for you? Re-thinking health education through the concept of bio-power," in Foucault, Health, and Medicine, ed. Alan Petersen and Robin Bunton (New York and London: Routledge, 1997), 115. 16 Arthur Chester Millspaugh, Haiti under American Control, 1915-1930 (Westport, Conn.: Negro University Press, 1970 (1931)), 136. 17 E.R. Stitt, "Forward," to History of Haitian Medicine, by Robert P. Parsons (New York: Paul B. Hoeber, Inc., 1930), xv. 18 Dunlap, "Gospel of Health," 1, 5. 19 Dunlap, "Gospel of Health," 2. 20 K.C. Melhorn, “Public Health in Haiti- A Resume of Ten Years’ Work," 1929, p. 1, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 21 “Notes from H.H. Howard’s Diary – Haiti – August 1923," folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 22 Schmidt, The United States Occupation of Haiti, 145.

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23 “Department of the Interior - Memorandum for the Press," September 13, 1926, p. 4, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 24 Adele E. Clark, "Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedecine," American Sociological Review, 62, no.2 (2003): 162. 25 “National School of Medicine," p. 7, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 26 David McBride, "Curing the Caribbean: Haiti Through the Occupation," in Missions for Science: US Technology and Medicine in America's African World (New Brunswick, NJ: Rutgers University Press, 2002), 81. 27 Antonio Gramsci, "The Art and Science of Politics" in David Forgacs, ed., The Gramsci Reader: Selected Writings, 1916-1935 (New York: New York University Press, 2000), 244. 28 C.S. Butler, “A Brief Sketch of the Republic of Haiti," Aug 25, 1925, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 29 Dr. S.T. McLean to The Rockefeller Foundation, February 19, 1917, folder 709, box 47, series 1.2, RG 5, Rockefeller Foundation Archives, RAC; “National School of Medicine," p. 8, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 30 Robinson, Promoting Polyarchy, 265. 31 “Department of the Interior - Memorandum for the Press," September 13, 1926, p. 2, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; “Notes from H.H. Howard’s Diary – Haiti – August 1923," folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 32 “Department of the Interior - Memorandum for the Press," September 13, 1926, p. 2, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 33 Heraux, Imp. Aug. A., “Data on the physical features and political, financial, and economic conditions of the Republic of Haiti," 1924, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 34 "Treaty With Haiti: Treaty Between the United States and Haiti. Finances, Economic Development, and Tranquility of Haiti," September 16, 1915. Open Library, Internet Archive, http://www.archive.org/stream/treatywithhaiti00pomegoog#page/n12/mode/2up ; Alex Dupuy has made the same observation in Haiti in the World Economy (p. 130). 35Russell, John. H, “Fourth Annual Report of the American High Commissioner at Port-au-Prince, Haiti," 1925, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; “Department of the Interior - Memorandum for the Press," September 13, 1926, p. 5, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 36 “Department of the Interior - Memorandum for the Press," September 13, 1926, p. 6, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 37 K.C. Melhorn to Dr. W.S. Carter, June 15, 1930, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 38 Schmidt, The United States Occupation of Haiti, 86. 39 Jean-Bertrand Aristide, In the Parish of the Poor: Writings from Haiti (Maryknoll, NY: 1990), 59. 40 Michel-Rolph Trouillot, Haiti: State Against Nation - The Origins and Legacy of Duvalierism (New York: Monthly Review Press, 1990), 106.

Chapter One - The State of Health: Entrenching the Occupation through Curative Institutions

1 Brenda Gayle Plummer, Haiti and the United States: The Psychological Moment (London: The University of Georgia Press, 1992), 107. 2 Ludwell Lee Montague, Haiti and the United States, 1714-1938 (New York: Russell and Russell, 1966), 210; John W. Blassingame, "The Press and the American Intervention in Haiti and the Dominican Republic, 1904-1920," Caribbean Studies 9, no.2 (1969): passim. 3 Alan Knight, "US Imperialism / Hegemony and Latin American Resistance," in Empire and Dissent: The United States and Latin America, ed. Fred Rosen (Durham and London: Duke University Press, 2008), 26; Montague, Haiti and the United States, 209-11. 4 "Treaty With Haiti."

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5 Smedley D. Butler, War is a Racket (Las Angeles: Feral House, 2003 (1935)), 9-10. 6 “Notes from H.H. Howard’s Diary – Haiti – August 1923," folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Parsons, History of Haitian Medicine, 14. 7 Dr. P.E. Garrison, P.A. Surgeon, USN, to Dr. John A Ferrell, Asst. Director-General, International Health Commission, November 20, 1915, folder 709, box 47, series 1.2, RG 5, Rockefeller Foundation Archives, RAC; This would determine that hookworm infection was the same as in Manila, approximately 8-12%. 8 K.C. Melhorn, “Public Health in Haiti- A Resume of Ten Years’ Work," 1929, p. 1, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 9 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 10 C.S. Butler, “A Brief Sketch of the Republic of Haiti," Aug 25, 1925, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 11 C.L.R. James, The Black Jacobins: Toussaint L'Ouverture and the San Domingo Revolution (London: Allison and Busby, 1980), passim. 12 Schmidt, The United States Occupation of Haiti, 86. 13 Dr. S.T. McLean to The Rockefeller Foundation, February 19, 1917, folder 709, box 47, series 1.2, RG 5, Rockefeller Foundation Archives, RAC. 14 C.S. Butler and E. Peterson, “Malaria in Haiti," 1926, p. 9, 11-15, folder 3, box 1, series 320, subseries A, RG 1.1. Rockefeller Foundation Archives, RAC. 15 C.S. Butler and E. Peterson, “Malaria in Haiti," 1926, p. 9, 11-15, folder 3, box 1, series 320, subseries A, RG 1.1. Rockefeller Foundation Archives, RAC. 16 Schmidt, The United States Occupation of Haiti, 103. 17 J.R. McNeill, Mosquito Empires: Ecology and War in the Greater Caribbean, 1620-1914 (Cambridge: Cambridge University Press, 2010), 313. 18 McNeill, Mosquito Empires, 4-6; McNeill argues that differential immunity favouring the Spanish served as an important part of the defence against rival European powers during the eighteenth century, but switched against the Spanish to favour the local forces (as opposed to imperial troops from Europe) during the various revolutions in the region after 1775. In both cases, yellow fever and malaria would reduce the invading troop force by as much as 90%. 19 Dr. S.T. McLean to The Rockefeller Foundation, February 19, 1917, folder 709, box 47, series 1.2, RG 5, Rockefeller Foundation Archives, RAC. 20 Gillian McGillivray, Blazing Cane: Sugar Communities, Class, and State Formation in Cuba, 1868-1959 (Durham and London: Duke University Press, 2009), 67. 21 Mariola Espinosa, "The Threat from Havana: Southern Public Health, Yellow Fever, and the U.S. Intervention in the Cuban Struggle for Independence," The Journal of Southern History 72, no.3 (2006): 541- 2; Espinosa even argues that the United States invaded Cuba, launching the Spanish-American war in the process, in order to combat the yellow fever microbe and to stomp out the incessant yellow fever threat that Cuba was perceived to pose after a number of outbreak occurred in the US over the previous 30 years. 22 Sheldon Watts, Epidemics and History: Disease, Power, and Imperialism (London: Yale University Press, 1997), 255. 23 Montague, Haiti and the United States, 184-5; When the Americans withdrew from Cuba they ensured that the Platt Amendment contained a treaty guaranteeing that Cuba would be kept sanitary and free of disease. The inclusion of sanitation in the Haitian treaty indicates that the Americans did indeed seek to replicate the Cuban experience. 24 Warwick Anderson, “Excremental Colonialism: Public Health and the Politics of Pollution," in Contagion: Historical and Cultural Studies, eds. Alison Bashford and Claire Hooker (New York: Routledge, 2001), passim. 25 Warwick Anderson, "Pacific Crossings: Imperial Logic in United States' Public Health Programs," in Colonial Crucible: Empire in the Making of the Modern American State, eds. Alfred McCoy and Francisco Scarano (Madison: University of Wisconsin Press, 2009), 281. 26 Nancy Tomes, "Introduction (Imperial Medicine and Public Health)," in Colonial Crucible: Empire in the Making of the Modern American State, eds. Alfred McCoy and Francisco Scarano (Madison: University of Wisconsin Press, 2009), 275.

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27 Paul S. Sutter, "Tropical Conquest and the Rise of the Environmental Management State," in Colonial Crucible: Empire in the Making of the Modern American State, eds. Alfred McCoy and Francisco Scarano (Madison: University of Wisconsin Press, 2009), 317-326. 28 Alexandra Minna Stern, “Yellow Fever Crusade: US Colonialism, Tropical medicine, and the International Politics of Mosquito Control, 1900-1920," in Medicine at the Border: Disease, Globalization, and Security, 1850 to the Present, ed. Alison Bashford (New York: Palgrave Macmillan, 2007), 46-52. 29 Warwick Anderson, "Going Through the Motions: American Public Health and Colonial 'Mimicry'," American Literary History 14, no.4 (2002): 687. 30 Alfred McCoy, Francisco Scarano, and Courtney Johnson, "On the Tropic of Cancer: Transitions and Transformations in the U.S. Imperial State," in Colonial Crucible: Empire in the Making of the Modern American State, eds. Alfred McCoy and Francisco Scarano (Madison: University of Wisconsin Press, 2009), 3-4. 31 "Treaty with Haiti." 32 Montague, Haiti and the United States, 224. 33 Millspaugh, Haiti under American Control, 69. 34 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 35 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 36 Eric Love, Race Over Empire: Racism and U.S. Imperialism, 1865-1900 (Chapel Hill and London: The University of North Carolina Press, 2004), passim. 37 "Annexation was [made] an absolute necessity," writes Love, "not for the sake of uplifting Hawaii's native population but for the sake of the [resident] whites" (Love, Race Over Empire, 106). 38 “Department of the Interior - Memorandum for the Press," September 13, 1926, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 39 Mary A. Renda, Taking Haiti: Military Occupation and the Culture of U.S. Imperialism, 1915-1940 (Chapel Hill and London: The University of North Carolina Press, 1996), 13-22. 40 Paul Brodwin, Medecine and Morality in Haiti: The Contest for Healing Power (New York: Cambridge University Press, 1996), 49-50. 41 A number of scholars do actually argue that the occupation was a benevolent project. Heinl and Heinl (2005) recognize that the USA was not in Haiti for any altruistic reason, but argue that the "overriding impact of American occupation was modernization" (pp. 458). Harold Palmer Davis (1936) offers that the USA operated from a "Sincere, if perhaps sometimes misguided, effort to carry out the expressed objects of the Haitian-American treaty for the benefit of the Haitian people as a whole" (pp. 200). For Philippe Girard, entitling his chapter on the occupation "Benevolent Imperialism," the outcome of American control was "nothing short of spectacular," though he does state it was "damning" in the eyes of Haitians because the entire cost for public improvements was borne by the Caribbean country itself, and not by foreign aid. (pp. 69-70). 42 Renda, Taking Haiti, 15. 43 Heinl and Heinl, Written in Blood, 415; “Public highways and communications will be maintained and repaired by the inhabitants, in rotation, in each section though which roads pass and each time repairs are needed.” 44 Schmidt, Maverick Marine, 92. 45 Heinl and Heinl, Written in Blood, 415. 46 Girard, Haiti, 86. 47 Butler’s replacement, Major A.S. Williams, ended up taking much of the blame for the abuses, though the corvée was abolished during his command. 48 Girard, (Haiti, 86) and Heinl and Heinl (Written in Blood, 416) place the blame on the Haitians, whereas Schmidt (Maverick Marine, 93) and Renda (Taking Haiti, 148-150) argue that the occupation forces condoned, if not took part, in the abuses. 49 Schmidt, The United States Occupation of Haiti, 101. 50 Plummer, Haiti and the United States, 103.

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51 Heinl and Heinl, Written in Blood, 424; Péralte would even claim to have 30,000-40,000 followers, though Russell put the estimated number of ‘bandits’ at 2000 (Schmidt, The United States Occupation of Haiti, 102). 52 Both Schmidt (1995, p.103) and Heinl and Heinl (p. 424) offer discussions on the exact number of Haitians killed, with the numbers 2250, 3071, 3250, and 15,000 all appearing. These contrast starkly to the no more than 16 Marines killed in action that Schmidt cites, or the combined number of 98 Marine and gendarmerie casualties noted by Heinl and Heinl. 53 Montague, Haiti and the United States, 236. 54 The idea that people would react differently to a ‘medical dominance’ than to other expressions of power is not a new observation, and it is something that Foucault’s theory of power helps to explain. As he noted; “What makes power hold good, what makes it accepted, is simply the fact that it doesn’t only weigh on us as a force that says no, but that it traverses and produces things, it induces pleasures, forms knowledge, produces discourse. It needs to be considered as a productive network which runs through the whole social body, much more than a negative instance whose function is repression” (Michel Foucault, “Truth and Power," in The Foucault Reader, ed. Paul Rabinow (New York: Pantheon Books, 1984), 61). 55 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, p. 4, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; K.C. Melhorn, “Public Health in Haiti- A Resume of Ten Years’ Work," 1929, p. 2, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; A slight disparity exists between the two reports in regards to the Health Services Law, with Butler and Peterson stating that it was passed on February 26 and that it created nine health districts, while Melhorn states it was passed February 24 and divided the country into ten sections. 56 Renda, Taking Haiti, 139; This is a topic that will be discussed further in chapter two. 57 Plummer, Haiti and the United States, 103. 58 Renda, Taking Haiti, 41-45. 59 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 60 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 61 Payne, George C. “Education," 1926, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 62 Parsons, History of Haitian Medicine, 117. 63 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 64 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 65 Delancour, Francois. “Abstracted notes - Pour la Création des ministères de l’hygiene et de travail," Journ. Méd. Haitien, 3:26-7, Port-au-Prince, 1922, folder 707, box 47, series 1.2, RG 5, Rockefeller Foundation Archives, RAC. 66 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 67 Delancour, Francois. “Abstracted notes - Pour la Création des ministères de l’hygiene et de travail," Journ. Méd. Haitien, 3:26-7, Port-au-Prince, 1922, folder 707, box 47, series 1.2, RG 5, Rockefeller Foundation Archives, RAC; Brodwin, Medicine and Morality in Haiti, 52n26. 68 Parsons, History of Haitian Medicine, 85-86. 69 Edward H. Berman, The Influence of the Carnegie, Ford, and Rockefeller Foundations on American Foreign Policy: the Idea of Philanthropy (Albany, New York: State University of New York Press, 1983), 26.

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70 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 71 K.C. Melhorn, “Public Health in Haiti- A Resume of Ten Years’ Work," 1929, p. 4, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 72 Plummer, Haiti and the United States, 104; McBride, "Curing the Caribbean," 85. 73 “Doctor Pearce’s Diary, Oct. 21, 1926: Commander C.S. Butler," folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 74 K.C. Melhorn, “Public Health in Haiti- A Resume of Ten Years’ Work," 1929, p. 2, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; The exact percentage would have been 42% of an estimated two million inhabitants, however there had been no census undertaken to confirm this number. 75 Heiser, Victor G, “Haiti: Health and Medical Relief," 1930, p. 1, folder 3735, box 555, series 320, RG 2, Rockefeller Foundation Archives, RAC. 76 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, p. 8, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Clinics were held on a weekly basis in the villages of Leogane, Arcahaie, Cabaret, Dumay, Croix de Bouquets, and Petion-Ville, and bi-weekly in Carrefour, Gressier, Grand Goave, Trouin, Ganthier, and Thomazeau. 77 Watts, Epidemics and History, xv. 78 C.S. Butler and E. Peterson, “Treponematosis as a Public Health Factor," p. 4, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 79 Victor G. Heiser, “Haiti: Health and Medical Relief," Report to the President’s Commission for the Study and Review of Conditions in the Republic of Haiti, March 19, 1930, folder 3735, box 555, series 320, RG 2, Rockefeller Foundation Collection, RAC. 80 K.C. Melhorn, “Public Health in Haiti- A Resume of Ten Years’ Work," 1929, p. 8, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 81 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, p. 9, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 82 C.S. Butler and E. Peterson, “Treponematosis as a Public Health Factor," p. 2-4, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 83 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, p. 9, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 84 Kara Rogers, “Bacterial Diseases: Anthrax to Yaws," in Infectious Diseases, ed. Kara Rogers (New York: Britannica Educational Publishing, 2011), 94. 85 C.S. Butler and E. Peterson, “Treponematosis as a Public Health Factor," p. 5, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 86 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, p. 9, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 87 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, p. 10, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 88 C.S. Butler and E. Peterson, “Treponematosis as a Public Health Factor," p. 6, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, p. 10, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 89 Who levied this criticism is unclear, though Butler and Peterson evidently felt compelled to mount a defence of the Public health Service in their report (C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Paul Farmer, Infections and Inequalities: The Modern Plagues (Berkeley and Los Angeles, California: University of California Press, 1999), 4.

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90 “Correspondence with Haiti; Abstracts," 1926, p. 10, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Yearly income of the Haitian state was approximately $8 million, a quarter of which was spent on public debt, and $1 million was allocated for the forces of arms. This left $5 million for all other expenditures. 91 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 92 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, p. 10, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 93 McBride, "Curing the Caribbean," 85. 94 Brodwin, Medicine and Morality in Haiti, 59. 95 Parsons, History of Haitian Medicine, 93. 96 K.C. Melhorn, “Public Health in Haiti- A Resume of Ten Years’ Work," 1929, p. 7-8, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 97 K.C. Melhorn, “Public Health in Haiti- A Resume of Ten Years’ Work," 1929, p. 2, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; “Excerpts of RMP’s diary of his trip to Haiti (Tues. Dec. 7, 1926 – Sun. Dec. 12, 1926)," folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; 300 beds at the Haitian General Hospital in Port-au-Prince, 150 beds in Hinche, 75 beds in Gonave, and 50 in St. Marc. No numbers were available for the hospital in Cape Haitian, and the locations of the other six hospitals are unknown. These numbers appear to represent a much more expansive program than was instituted in the Dominican Republic during the US occupation of 1916-1924. For example, though two hospitals had been constructed in San Domingo, there was only a combined capacity of 350 beds. 98 Alexandra Minna Stern (“Yellow Fever Crusade," 50) notes how black canal workers suffered from higher disease mortality rates than whites did partly because of the practice of having proper screening in white residences while West Indian workers were not afforded the same protection in order to draw the mosquitoes away from the whites. Though Stern argues that the inevitable disparity in health helped construct the black as diseased, the more equal prevention initiatives in Haiti did nothing to undermine this perception. If anything, it simply reinforced the notion that black Haitians needed the guidance and knowledge of the white Americans in order to become healthy. 99 K.C. Melhorn, “Public Health in Haiti- A Resume of Ten Years’ Work," 1929, p. 1, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 100 Victor G. Heiser, “Haiti: Health and Medical Relief," Report to the President’s Commission for the Study and Review of Conditions in the Republic of Haiti, March 19, 1930, folder 3735, box 555, series 320, RG 2, Rockefeller Foundation Collection, RAC. 101 Brodwin, Medicine and Morality in Haiti, 50. 102 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, p. 4, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; K.C. Melhorn, “Public Health in Haiti- A Resume of Ten Years’ Work," 1929, p. 2, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; While both the archival record and most of the existing literature do suggest that the Americans had almost entirely brought healthcare under their control, Hans Schmidt states that of the 159 physicians practicing in Haiti, only 42% were employed by the Public Health Service (Schmidt, The United States Occupation of Haiti, 187). 103 “National School of Medicine," 1926, p. 5, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 104 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, p. 3, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 105 Charlotte Atwood, “Health and Sanitation," in Occupied Haiti, ed. Emily Balch (New York: The Writers Publishing Company, Inc., 1927), 91. 106 “Diary of Dr. Pearce’s Trip to Haiti (Tues. Nov. 30, 1926 – Wed. Dec. 15, 1926)," folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC.

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107 Mead, Elwood. "Correspondence - What We Have Done in Haiti," folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 108 During the Haitian Revolution, the French casualty rate was around 85%, with an estimated 35-45 thousand soldiers succumbing to nasty yellow fever deaths. No country had made a serious attempt to occupy Haiti since that point (McNeill, Mosquito Empires, 258-9).

Chapter Two - The Landscape of Disease: Place, Space, and Preventative Medicine

1 Parsons, History of Haitian Medicine, 82. 2 Using similar imagery for an observation about Aotearoa / New Zealand, Merata Mita notes that; "We have a history of putting Maori under a microscope in the same way a scientist looks at an insect. The ones doing the looking are giving themselves the power to define" (Quoted in Linda Tuhiwai Smith, "Colonizing Knowledges," in The Indigenous Experience, eds. Roger C.A. Maaka and Chris Andersen (Toronto: Canadian Scholars' Press, 2006), 91). 3 Parsons, History of Haitian Medicine, 4-5. 4 Robert McRuer, “Reflections on Disability in Haiti," Journal of Literary and Cultural Disability Studies 4, no.3 (2010): 328-30. 5 Parsons, History of Haitian Medicine, 1. 6 Warwick Anderson, "Immunities of Empire: Race, Disease, and the New Tropical Medicine, 1900-1920," Bulletin of the History of Medicine 70, no.1 (1996): 96. 7 Anderson, "Immunities of Empire," 100-6. 8 Linda Nash, Inescapable Ecologies: A History of Environment, Disease, and Knowledge, (Berkeley and Los Angeles: University of California Press, 2006), 7-9. 9 Camille Lherisson, "Diseases of the Peasants of Haiti," American Journal of Public Health 25, no.8 (1935): 924. 10 Laura Briggs, Reproducing Empire: Race, Sex, Science, and U.S. Imperialism in Puerto Rico (Berkeley and Los Angeles: University of California Press, 2002), 100. 11 Briggs, Reproducing Empire, 100. 12 Parsons, History of Haitian Medicine, 13-15. 13 C.S. Butler and E. Peterson, “Treponematosis as a Public Health Factor," p. 2, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 14 Rogers, ed., “Bacterial Diseases: Anthrax to Yaws," in Infectious Diseases, 94. 15 C.S. Butler and E. Peterson, “Treponematosis as a Public Health Factor," p. 2, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 16 C.S. Butler and E. Peterson, “Treponematosis as a Public Health Factor," p. 2-4, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 17 C.S. Butler and E. Peterson, “Treponematosis as a Public Health Factor," p. 3, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 18 Anton Luger, "The Origin of Syphilis: Clinical and Epidemiological Considerations on the Columbian Theory," Sexually Transmitted Diseases 20, no.2 (1993): 112; Beyond providing one argument as to why syphilis must have existed in Europe prior to Columbus' 1492 contact with the Americas, Luger includes a list of the main contributions to the scholarly debate on the origins of the disease. 19 C.S. Butler and E. Peterson, “Malaria in Haiti," p. 1, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 20 C.S. Butler and E. Peterson, “Malaria in Haiti," p. 2, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 21 C.S. Butler and E. Peterson, “Malaria in Haiti," p. 1, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 22 "Beyond the mountains there are more mountains"; Robert A. Hall, Haitian Creole: Grammar, Texts, Vocabulary, (American Anthropological Association, 1953), 197; K.C. Melhorn, “Public Health in Haiti- A Resume of Ten Years’ Work," 1929, p. 1, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 23 Lherisson, "Diseases of the Peasants of Haiti," 926.

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24 Lherisson, "Diseases of the Peasants of Haiti," 927; Victor G. Heiser, “Haiti: Health and Medical Relief," Report to the President’s Commission for the Study and Review of Conditions in the Republic of Haiti, March 19, 1930, folder 3735, box 555, series 320, RG 2, Rockefeller Foundation Collection, RAC. 25 Baber and Balch, "Problems of Education," in Occupied Haiti, ed. Emily Balch (New York: The Writers Publishing Company, Inc., 1927), 91; Dubos, R., and J. Dubos, The White Plague: Tuberculosis, Man, and Society, (New Brunswick, NJ: Rutgers University Press, 1992), 207. Quoted in Farmer, Infections and Inequalities, 210; Farmer, Infections and Inequalities, 13-14; Victor G. Heiser, “Haiti: Health and Medical Relief," Report to the President’s Commission for the Study and Review of Conditions in the Republic of Haiti, March 19, 1930, folder 3735, box 555, series 320, RG 2, Rockefeller Foundation Collection, RAC. 26 James G. Leyburn, The Haitian People (New Haven and London: Yale University Press, 1966), 275-6. 27 Lherisson, "Diseases of the Peasants of Haiti," 924. 28 Parsons, History of Haitian Medicine, 5. 29 Parsons, History of Haitian Medicine, 5. 30 Parsons, History of Haitian Medicine, 5. 31 Anderson, "Immunities of Empire," 113. 32 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, p. 5-6, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 33 K.C. Melhorn, “Public Health in Haiti- A Resume of Ten Years’ Work," 1929, p. 4, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 34 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, p. 13, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 35 Mats Lundahl, "Underdevelopment in Haiti: Some Recent Contributions," Journal of Latin American Studies 23, no.2 (1991): 417; C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, p. 6, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 36 C.S. Butler and E. Peterson, “Malaria in Haiti," p. 10-11, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 37 Heinl and Heinl, Written in Blood, 439. 38 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, p. 12, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 39 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, p. 10-11, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 40 McNeill, Mosquito Empires, 311; Marcos Cueto, "The Cycles of Eradication: The Rockefeller Foundation and Latin American Public Health, 1918-1940," in International Health Organisations and Movements, 1918-1939, ed. Paul Weindling (Cambridge: Cambridge University Press, 1995), 236; Stern, “Yellow Fever Crusade," 48; “Republic of Haiti – Monthly Bulletin, Volume III, Number 11, Office of Financial Adviser-General Receiver," November 1926, p. 12, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 41 McBride, "Curing the Caribbean," 98. 42 C.S. Butler and E. Peterson, “Malaria in Haiti," p. 10, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; The impact of actions such as this on the city's food security would be an intriguing area for further research, as well as the extent to which such initiatives may have contributed towards the creation and differentiation of an urban and rural workforce. 43 “Republic of Haiti – Monthly Bulletin, Volume III, Number 11, Office of Financial Adviser-General Receiver," November 1926, p. 11-12, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC 44 Victor G. Heiser, “Haiti: Health and Medical Relief," Report to the President’s Commission for the Study and Review of Conditions in the Republic of Haiti, March 19, 1930, folder 3735, box 555, series 320, RG 2, Rockefeller Foundation Collection, RAC. 45 C.S. Butler and E. Peterson, “Malaria in Haiti," p. 11, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC.

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46 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, p. 11, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; The Office of the Financial Adviser - General Receiver kept very precise statistics on these sorts of operation, indicating that in October of 1926, 2936 truckloads of refuse were hauled from Port-au-Prince an used to fill low-lying areas in Eau Caraco, Maison Contralo, Rue Joseph Janvier, Fort St. Clair, the St. Louis Market, and Croix-de-Bossalos. Similar statistics were also kept for the other major cities and town in the country (“Republic of Haiti – Monthly Bulletin, Volume III, Number 11, Office of Financial Adviser-General Receiver," November 1926, p. 11, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC). 47 “Republic of Haiti – Monthly Bulletin, Volume III, Number 11, Office of Financial Adviser-General Receiver," November 1926, p. 12, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Anderson, “Excremental Colonialism," 86. 48 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, p. 11-12, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 49 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, p. 12-13, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 50 “Republic of Haiti – Monthly Bulletin, Volume III, Number 11, Office of Financial Adviser-General Receiver," November 1926, p. 12, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, p. 12, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Parsons, History of Haitian Medicine, 143. 51 Leon D. Pamphile, Clash of Cultures: American Educational Strategies in Occupied Haiti, 1915-1934 (Lanham, Maryland: University Press of America, Inc., 2008), 45. 52 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, p. 11, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 53 Anderson, “Excremental Colonialism," 77. 54 Russell, John. H, “Fourth Annual Report of the American High Commissioner at Port-au-Prince, Haiti," 1926, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 55 A.J. Angulo, "Education during the American Occupation of Haiti,1915-1934," Historical Studies in Education (2011): 4. 56 Russell, John. H, “Fourth Annual Report of the American High Commissioner at Port-au-Prince, Haiti," 1926, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 57 Dupuy, Haiti in the World Economy," 139. 58 Trouillot, State Against Nation, 16. 59 Heinl and Heinl, Written in Blood, 397; Dupuy, Haiti in the World Economy," 134-5. 60 “Republic of Haiti – Monthly Bulletin, Volume III, Number 11, Office of Financial Adviser-General Receiver," November 1926, p. 18-21, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 61 “Republic of Haiti – Monthly Bulletin, Volume III, Number 11, Office of Financial Adviser-General Receiver," November 1926, p. 18-21, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 62 Mead, Elwood. "What we have done in Haiti," January 18, 1927, p. 5, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 63 C.S. Butler and E. Peterson, “Malaria in Haiti," p. 11, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 64 C.S. Butler and E. Peterson, “Malaria in Haiti," p. 9, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 65 “Department of the Interior - Memorandum for the Press," September 13, 1926, p. 4, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 66 C.S. Butler and E. Peterson, “Malaria in Haiti," p. 1-2, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC.

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67 Delancour, Francois. “Abstracted notes - Pour la Création des ministères de l’hygiene et de travail," Journ. Méd. Haitien, 3:26-7, Port-au-Prince, 1922, folder 707, box 47, series 1.2, RG 5, Rockefeller Foundation Archives, RAC 68 Pearce, Richard M. "Medical Education in Haiti:, 1926, p. 22-23, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC.

Chapter Three - Aiding the Occupation: The Rockefeller Foundation and the National School of Medicine

1 Quoted in: Mead, Elwood. "Correspondence - What We Have Done in Haiti," folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 2 Knight, "US Imperialism / Hegemony and Latin American Resistance," 27. 3 Walter H. Posner, "American Marines in Haiti, 1915-1922," The Americas 20, no.3 (1964): 239. 4 Knight, "US Imperialism / Hegemony and Latin American Resistance," 27. 5 Russell, John. H, “Fourth Annual Report of the American High Commissioner at Port-au-Prince, Haiti," 1925, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 6 Schmidt, The United States Occupation of Haiti, 98, 113, 127. 7 John H. Russell, American High Commissioner, to the International Health Board, RF, April 14, 1922, folder 709, box 47, series 1.2, RG 5, Rockefeller Foundation Archives, RAC. 8 The Rockefeller Foundation, "Our History - A Powerful Legacy," The Rockefeller Foundation, http://www.rockefellerfoundation.org/about-us/our-history . 9 Steven Palmer, Launching Global Health: The Caribbean Odyssey of the Rockefeller Foundation (Ann Arbor: The University of Michigan Press, 2000), 79. 10 Schmidt, The United States Occupation of Haiti, 69. 11 Schmidt, The United States Occupation of Haiti, 67. 12 Schmidt, The United States Occupation of Haiti, 69. 13 Dr. P.E. Garrison, P.A. Surgeon, USN, to Dr. John A Ferrell, Asst. Director-General, International Health Commission, November 20, 1915, folder 118, box 8, series 1.2, RG 5, Rockefeller Foundation Archives, RAC; It was not just the Marines that the IHB relied upon for local health information. Steven Palmer has noted how in Costa Rica the Rockefeller Foundation looked to the United Fruit Company for intelligence on the local health situation (Steven Palmer, "Central American Encounters with Rockefeller Public Health, 1914-1921," in Close Encounters of Empire: Writing the Cultural History of U.S.-Latin American Relations, eds. Gilbert M. Joseph, Catherine C. Legrand, and Ricardo D. Salvatore (Durham and London: Duke University Press, 1998), 316). 14 Dr. P.E. Garrison, P.A. Surgeon, USN, to Dr. John A Ferrell, Asst. Director-General, International Health Commission, November 20, 1915, folder 118, box 8, series 1.2, RG 5, Rockefeller Foundation Archives, RAC. 15 Dr. S.T. McLean, Office of the Sanitary Engineer, Port-au-Prince, Haiti, to the Rockefeller Foundation, February 19, 1917, folder 709, box 47, series 1.2, RG 5, Rockefeller Foundation Archives, RAC; Renda, Taking Haiti, 18 16 Wickliffe Rose to Dr. S.T. McLean, March 15, 1917, folder 709, box 47, series 1.2, RG 5, Rockefeller Foundation Archives, RAC. 17 Dr. S.T. McLean, Office of the Sanitary Engineer, Port-au-Prince, Haiti, to the Rockefeller Foundation, February 19, 1917, folder 709, box 47, series 1.2, RG 5, Rockefeller Foundation Archives, RAC. 18 Wickliffe Rose to Dr. S.T. McLean, March 15, 1917, folder 709, box 47, series 1.2, RG 5, Rockefeller Foundation Archives, RAC. 19 Dr. P.E. Garrison, P.A. Surgeon, USN, to Dr. John A Ferrell, Asst. Director-General, International Health Commission, November 20, 1915, folder 118, box 8, series 1.2, RG 5, Rockefeller Foundation Archives, RAC. 20 Wickliffe Rose to Dr. S.T. McLean, March 15, 1917, folder 709, box 47, series 1.2, RG 5, Rockefeller Foundation Archives, RAC. 21 Palmer, Launching Global Health, 1.

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22 Dr. P.E. Garrison, P.A. Surgeon, USN, to Dr. John A Ferrell, Asst. Director-General, International Health Commission, November 20, 1915, folder 118, box 8, series 1.2, RG 5, Rockefeller Foundation Archives, RAC. 23 Berman, The Influence of the Carnegie, Ford, and Rockefeller Foundations on American Foreign Policy, 15. 24 Palmer, Launching Global Health, 58. 25 Palmer, Launching Global Health, 79. 26 Palmer, Launching Global Health, 216. 27 Palmer, Launching Global Health, 216. 28 “Correspondence with Haiti; Abstracts," 1926, p. 1, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 29 “Correspondence with Haiti; Abstracts," 1926, p. 1, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 30 “Correspondence with Haiti; Abstracts," 1926, p. 2-3, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 31 “Correspondence with Haiti; Abstracts," 1926, p. 3, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 32 “Correspondence with Haiti; Abstracts," 1926, p. 6, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 33 “Correspondence with Haiti; Abstracts," 1926, p. 6, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 34 “Correspondence with Haiti; Abstracts," 1926, p. 6, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Payne, George C. “Survey of Haiti:1924-25," 1926, p. 1, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 35 Marcos Cueto, "Visions of Science and Development: The Rockefeller Foundation's Latin American Surveys of the 1920s," in Missionaries of Science: The Rockefeller Foundation and Latin America, ed. Marcos Cueto (Bloomberg and Indianapolis: Indiana University Press, 1994), 7. 36 Payne, George C. “Survey of Haiti:1924-25," 1926, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 37 Payne, George C. “Survey of Haiti:1924-25," 1926, p. 7, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Cueto, Missionaries of Science, ix. 38 Payne, George C. “Survey of Haiti:1924-25," 1926, p. 8, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; C.S. Butler, `1924-1925 Annual Report of the National Public Health Service, Republic of Haiti`, 1926, p. 2, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 39 Palmer, Launching Global Health, 2, 13. 40 Ilana Löwy and Patrick Zylberman, "Medicine as a Social Instrument: Rockefeller Foundation, 1913-45," Studies in History and Philosophy of Science 31, no.3 (2000): 371. 41 C.S. Butler and E. Peterson, “Malaria in Haiti," p. 3, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 42 Dr. S.T. McLean, Office of the Sanitary Engineer, Port-au-Prince, Haiti, to the Rockefeller Foundation, February 19, 1917, folder 709, box 47, series 1.2, RG 5, Rockefeller Foundation Archives, RAC; "Notes from H.H. Howard's Diary - Haiti - August, 1923," folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Butler and Peterson note that a census had not ever been taken since Haiti became an independent nation, finding fault also with the system of charging 40 cents gold to register a birth or a death. As flawed as this registration system was though, it also represents an incipient but competing structure of biopolitics, as the question of 'vital statistics' was a function of the Bureau of Internal Revenue, while the Naval Officers would have it a function of the Public Health Service. 43 Payne, George C. “Survey of Haiti:1924-25," 1926, p. 2, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC.

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44 Dupuy, Haiti in the World Economy, 136-7; Dupuy records that 43,000 acres of land were purchased by American companies in 1922, increasing to 70,000 in 1930. Recognizing that this only represents 2% of Haiti's cultivated lands, he notes that the significance lays less in the final amount in foreign hands than the impact it had on the Haitians who depended on that land, some of which Dupuy documents. 45 “Diary of Dr. Pearce’s Trip to Haiti (Tues. Nov. 30, 1926 – Wed. Dec. 15, 1926)," folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 46 Payne, George C. “Survey of Haiti:1924-25," 1926, p. 2, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 47 Payne, George C. “Survey of Haiti:1924-25," 1926, p. 2, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Dupuy, Haiti in the World Economy, 135. 48 Payne, George C. “Survey of Haiti:1924-25," 1926, p. 8, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 49 Schmidt, The United States Occupation of Haiti, 121. 50 Payne, George C. “Survey of Haiti:1924-25," 1926, p. 11-14, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 51 Michel Foucault, "Questions on Geography," in Power / Knowledge: Selected Interviews and Other Writings, 1972-1977 (New York: Pantheon Books, 1980), 75. 52 “Diary of Dr. Pearce’s Trip to Haiti (Tues. Nov. 30, 1926 – Wed. Dec. 15, 1926)," folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 53 Brenda Gayle Plummer, "Haitian Migrants and Backyard Imperialism," Race & Class 26, no.35 (1985): 35-9. 54 Cueto, "Visions of Science and Development," 4-5; The countries surveyed were: Brazil (1916); Argentina and Uruguay (1917); Brazil, Chile, and Paraguay (1919); Guatemala, Nicaragua, and El Salvador (1922); Colombia, Brazil, Mexico, and Paraguay (1923); Brazil (1924); Argentina, Brazil, and Paraguay (1925); and Bolivia, Peru, Uruguay, and Haiti (1926). 55 “Correspondence with Haiti; Abstracts," 1926, p. 7, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 56 "Notes from H.H. Howard's Diary - Haiti - August, 1923," folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 57 “Correspondence with Haiti; Abstracts," 1926, p. 8-9, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 58 “Correspondence with Haiti; Abstracts," 1926, p. 10, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Pearce, Richard M. "Medical Education in Haiti:, 1926, p. 17, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 59 Interview between Dr. C.S. Butler and Dr. O'Connor, Friday September 4, 1926, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 60 “National School of Medicine," folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; "From RMP's Diary, Sept, 20, 1926," folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 61 McBride, "Curing the Caribbean," 88-89; Pamphile, Clash of Cultures, 36; Parsons, History of Haitian Medicine, 105. 62 “National School of Medicine," folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; "From RMP's Diary, Sept, 20, 1926," folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 63 "From RMP's Diary, Sept, 20, 1926," folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 64 Interview between Dr. C.S. Butler and Dr. O'Connor, Friday September 4, 1926, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 65 "From RMP's Diary, Sept, 20, 1926," folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 66“Diary of Dr. Pearce’s Trip to Haiti (Tues. Nov. 30, 1926 – Wed. Dec. 15, 1926)," p. 1, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 67 “Diary of Dr. Pearce’s Trip to Haiti (Tues. Nov. 30, 1926 – Wed. Dec. 15, 1926)," p. 7-9, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC.

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68 Pearce, Richard M. "Medical Education in Haiti:, 1926, p. 22, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 69 “National School of Medicine," p. 8, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 70 “National School of Medicine," p. 5, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 71 Pearce, Richard M. "Medical Education in Haiti:, 1926, p. 18, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 72 “National School of Medicine," p. 8, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 73 Pearce, Richard M. "Medical Education in Haiti:, 1926, p. 29, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Of the thirty thousand dollars allocated for equipment, $27,010.70 was actually spent. $18,510.70 of that (68%) went towards the various laboratories. 74 Anderson, "Excremental Colonialism," 83. 75 "Dr. Pearce's Diary, October 21, 1926: Commander C.S. Butler," folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 76 “National School of Medicine," p. 5, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 77 “National School of Medicine," p. 7, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 78 Pearce, Richard M. "Medical Education in Haiti:, 1926, p. 22-23, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; "Dr. Pearce's Diary, October 21, 1926: Commander C.S. Butler," folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 79 “National School of Medicine," p. 8, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 80 Pearce, Richard M. "Medical Education in Haiti:, 1926, p. 26, 29, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 81 The schools visited were Harvard, Pennsylvania, Ann Arbor, Yale, Chicago, Illinois, Northwestern, Montreal, McGill, Toronto, Columbia, Cornell, Washington, Rochester Western Reserve, Cleveland, Baltimore, and Johns Hopkins ("Untitled" (Dr. Dominique speech to medical society), January, 1928, p. 2, folder , box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC). 82 K.C. Melhorn to Richard M. Pearce, January 19, 1928, folder , box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; "Untitled" (Dr. Dominique speech to medical society), January, 1928, p. 2, folder , box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 83 "Untitled" (Dr. Dominique speech to medical society), January, 1928, p. 3, folder , box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 84K.C. Melhorn to Richard M. Pearce, October 10, 1927, p. 2, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Berman, The Influence of the Carnegie, Ford, and Rockefeller Foundations on American Foreign Policy, 15. 85 "Untitled" (Dr. Dominique speech to medical society), January, 1928, p. 4, folder , box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 86 Manigat, Leslie. "La substitution de la prépondérance américaine à la prépondérance français en Haiti au debut de XX siècle: La conjoncture de 1910-1911," 321-55, quoted in Renda, Taking Haiti, 52. 87 Renda, Taking Haiti, 52, 99, 195. 88 Interview between Dr. C.S. Butler and Dr. O'Connor, Friday September 4, 1926, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 89 Dr. Rene Salomon to Mr. Raymond B. Fosdick, July 7, 1947, folder 2, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 90 Richard M. Pearce to Prof. Benjamin P. Watson, April 18, 1927, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 91 F.W. O'Connor to Dr. M.C. Winternitz, October 6, 1927, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 92 Richard M. Pearce to Prof. Benjamin P. Watson, April 18, 1927, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC.

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93 Richard M. Pearce to C.S. Butler, April 22, 1927, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 94 Richard M. Pearce to Alan Gregg, April 22, 1927, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 95 Richard M. Pearce to W.W. Cumberland, January 3, 1927, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 96 W.W. Cumberland to Richard M. Pearce, January 12, 1927, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 97 Richard M. Pearce to W.W. Cumberland, January 19, 1927, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 98 W.W. Cumberland to Richard M. Pearce, January 13, 1927, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 99 Richard M. Pearce to W.W. Cumberland, February 25, 1927, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 100 C.S. Butler to Richard M. Pearce, March 14, 1927, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 101 C.S. Butler and E. Peterson, “The Public Health Service of Haiti – It’s Origin, Organization and Present System of Administration," 1926, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Though there is only cursory information about the nursing school within the RF documents, it appears that this institution followed a similar trajectory as the National School of Medicine. Opened on October 15, 1918, the school was the product of a collaboration between the US Marines and another international aid organization, this time the American Red Cross. The nursing school likewise relied on fellowships in the United States, making it likely that the school similarly contributed to the spread of American biomedical ideas. Though "social caste" in Haiti had made it difficult to find "native girls" willing to be trained as nurses, by 1929 the school had graduated 81 Haitian nurses. Only 70% of these nurses were employed though. (K.C. Melhorn, “Public Health in Haiti- A Resume of Ten Years’ Work," 1929, p. 7, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Parsons, History of Haitian Medicine, 102). 102 K.C. Melhorn to Richard M. Pearce, October 10, 1927, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 103 K.C. Melhorn to Richard M. Pearce, October 10, 1927, p. 1, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 104 K.C. Melhorn to Richard M. Pearce, October 10, 1927, p. 2, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 105 Reflecting in 1930 on the American medical intervention, for example, Lieutenant-Commander Robert Parsons (MC, USN) wrote in his History of Haitian Medicine that "hardly a name is recorded of anyone making even a serious pretense to practicing according to the European or American [medical] methods" during the nineteenth century. This discourse served to erase Haiti's long record of state-directed medical care that dated back to 1808, when only four years after the revolution Haiti established several hospitals to serve "the sick of the country's indigent population,"; “National School of Medicine," folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Payne, George C. “Survey of Haiti:1924-25," 1926, p. 3, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Parsons, History of Haitian Medicine, 53. 106 “National School of Medicine," folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Payne, George C. “Survey of Haiti:1924-25," 1926, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Pearce, Richard M. "Medical Education in Haiti:, 1926, p. 29, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC.

Chapter Four - In Triage: American Hegemony in Question

1 K.C. Melhorn, “Public Health in Haiti- A Resume of Ten Years’ Work," 1929, p. 5, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 2 Schmidt, The United States Occupation of Haiti, 196. 3 Montague, Haiti and the United States, 269n20.

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4 "Treaty With Haiti"; Angulo, "Education during the American Occupation of Haiti," 5. 5 Angulo, "Education during the American Occupation of Haiti," 5-6. 6 “National School of Medicine," p. 8, folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 7 Angulo, "Education during the American Occupation of Haiti," 7. 8 Laurent Dubois, Haiti: The Aftershocks of History (New York: Metropolitan Books, 2012), 279-284; McBride, "Curing the Caribbean," 91. 9 Angulo, "Education during the American Occupation of Haiti," 8. 10 “National School of Medicine," folder 3, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 11 K.C. Melhorn, “Public Health in Haiti- A Resume of Ten Years’ Work," 1929, p. 7, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 12 Angulo, "Education during the American Occupation of Haiti," 8. 13 Angulo, "Education during the American Occupation of Haiti," 6. 14 Plummer, Haiti and the United States, 118. 15 Angulo, "Education during the American Occupation of Haiti," 8. 16 Plummer, Haiti and the United States, 118. 17 Schmidt, The United States Occupation of Haiti, 196; Angulo, "Education during the American Occupation of Haiti," 5-9. 18 Plummer's account of the change in scholarship policy is based off of a letter from Dana Munro to Senator Tasker Oddie, sent on December 9, 1929 (Plummer, Haiti and the United States, 118n53).. This would have been in the midst of the student crisis, just three days after the massacre at Cayes. It is likely that Munro was responding to queries about the sequence of events from American politicians hostile to the continued occupation. Senator Oddie, to whom Munro was addressing, certainly was one such politician who took interest in the affairs of the United States in Haiti (Spector, W. Cameron Forbes and the Hoover Commissions to Haiti, (New York: University Press of Americam, 1985), 45). 19 Dubois, Haiti: The Aftershocks of History, 283-4. 20 Angulo, "Education during the American Occupation of Haiti," 9. 21 Schmidt, The United States Occupation of Haiti, 197. 22 Dubois, Haiti: The Aftershocks of History, 284. 23 Angulo, "Education during the American Occupation of Haiti," 9. 24 Montague, Haiti and the United States, 269. 25 K.C. Melhorn to Admiral Riggs, December 1929, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 26 K.C. Melhorn to Admiral Riggs, December 1929, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Pamphile, Clash of Cultures, 127. 27 Pamphile, Clash of Cultures, 128. 28 K.C. Melhorn to Admiral Riggs, December 1929, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 29 Pamphile, Clash of Cultures, 128. 30 K.C. Melhorn to Admiral Riggs, December 1929, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 31 Schmidt, The United States Occupation of Haiti, 197; Pamphile, Clash of Cultures, 128. 32 Angulo, "Education during the American Occupation of Haiti," 9. 33 Schmidt, The United States Occupation of Haiti, 197-8; Interestingly, "A bas les Experts!" (Down with the experts!) was another common rallying cry heard as well, demonstrating the anger that Haitians held towards intrusiveness of the Public Works department, as well as the general desire to not have Americans operating all aspect of the country (Pamphile, Clash of Cultures, 128). It is unclear whether these ill- feelings were also directed towards the sanitation experts as well, given their similar and also intrusive methods. 34 Spector, W. Cameron Forbes and the Hoover Commissions to Haiti, 29. 35 Bellegarde-Smith, Haiti: The Breached Citadel, 95. 36 Schmidt, The United States Occupation of Haiti, 189-196. 37 Spector, W. Cameron Forbes and the Hoover Commissions to Haiti, 29.

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38 K.C. Melhorn to Admiral Riggs, December 1929, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 39 Schmidt, The United States Occupation of Haiti, 197. 40 Pamphile, Clash of Cultures, 127. 41 Pamphile has reproduced the text of a letter printed in an opposition newspaper from the students of Sainte-Rose de Lima, in which reference was made to 'our great Dessalines', the 'hero of 1804'. While urging the striking students to 'Hold fast' in their 'action against injustice', the students of Sainte-Rose also expressed their solidarity (Pamphile, Clash of Cultures, 138-9). Alan McPherson has also noted that the "unofficial anthem of Haitian resistance and political autonomy" during the strike was entitled "1804" (Alan McPherson, "Artful Resistances: Song, Literature, and Representations of U.S. Occupations in Nicaragua and Hispaniola" The Latin Americanist, (June 2012): 102). 42 David Nicholls, From Dessalines to Duvalier: Race, Colour, and National Independence in Haiti (New Brunswick, NJ: Rutgers University Press, 1996), 150. 43 Donald B. Cooper, "The Withdrawal of the United States from Haiti, 1928-1934," Journal of Inter- American Studies 5, no.1 (1963): 91. 44 Pamphile, Clash of Cultures, 132; Schmidt, The United States Occupation of Haiti, 197. 45 K.C. Melhorn to Admiral Riggs, December 1929, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 46 K.C. Melhorn to Admiral Riggs, December 1929, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Schmidt, The United States Occupation of Haiti, 198. 47 K.C. Melhorn to Admiral Riggs, December 1929, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 48 K.C. Melhorn to Admiral Riggs, December 1929, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 49 K.C. Melhorn to Admiral Riggs, December 1929, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 50 Schmidt, The United States Occupation of Haiti, 199-200. 51 K.C. Melhorn to Admiral Riggs, December 1929, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 52 Russell would later update the number to list 12 dead and 23 wounded, but the Haitian press printed a casualty list in January, 1930, that had the names of 24 dead and 51 wounded (Schmidt, The United States Occupation of Haiti, 200). 53 K.C. Melhorn to Admiral Riggs, December 1929, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 54 Cooper, "The Withdrawal of the United States from Haiti, 1928-1934," 92. 55 K.C. Melhorn to Admiral Riggs, December 1929, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 56 K.C. Melhorn to Admiral Riggs, December 1929, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 57 K.C. Melhorn to Admiral Riggs, December 1929, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 58 K.C. Melhorn to Dr. W.S. Carter, January 6, 1930, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 59 K.C. Melhorn to Admiral Riggs, December 1929, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 60 K.C. Melhorn to Dr. W.S. Carter, January 6, 1930, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 61 K.C. Melhorn to Dr. W.S. Carter, January 6, 1930, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 62 K.C. Melhorn to Admiral Riggs, January 13, 1930, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 63 Dr. W.S. Carter to K.C. Melhorn, January 23, 1930, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 64 K.C. Melhorn to Admiral Riggs, January 13, 1930, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC.

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65 K.C. Melhorn to Admiral Riggs, January 13, 1930, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; The regular end date would have been July 15. 66 K.C. Melhorn to Admiral Riggs, December 1929, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 67 Mead, Elwood. "What we have done in Haiti," January 18, 1927, p. 4, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 68 Cooper argues that the defence of the Panama Canal, one apparent consideration that led to the occupation, was no longer an issue as no European threat had re-emerged after the Great War, while new technology allowed the U.S. to defend the canal from bases that were legitimately theirs. Other important objectives of the occupation had been , such as the reorganization of the country's finances and military, while those areas in which the Americans had been unable to affect a difference would likely be impossible to resolve to their satisfaction. More generally, Cooper argues that the occupation was also just generally considered "out of tune with the times" (Cooper, "The Withdrawal of the United States from Haiti, 1928- 1934," 99). 69 Heinl and Heinl, Written in Blood, 428-9. 70 Henry Lewis Suggs, "The Response of the African-American Press to the United States Occupation of Haiti, 1915-1934," The Journal of African-American History 87 (2002): 74. 71 Brenda Gayle Plummer, "The Afro-American Response to the Occupation of Haiti, 1915-1934," Phylon 43, no.2 (1982): passim; Plummer's article examines in great detail the full extent of how Afro-American communities agitated against the American occupation while also seeking to support Haitians in other ways as well. These actions were envisaged as being a necessary part of combating black oppression in the U.S. As Plummer writes; "The American intervention was thus an attack on the progress of all blacks" (pp. 139). 72 Plummer, "The Afro-American Response to the Occupation of Haiti, 1915-1934," 139; Plummer's article examines in great detail the full extent of how Afro-American communities agitated against the American occupation while also seeking to support Haitians in other ways as well. 73 Margaret Stevens, "Hands Off Haiti! Self-Determination, Anti-Imperialism, and the Communist Movement in the United States, 1925-1929," The Black Scholar 37, no.4 (2007): 61. 74 Schmidt, The United States Occupation of Haiti, 205. 75 Cooper, "The Withdrawal of the United States from Haiti, 1928-1934," 92. 76 Schmidt, The United States Occupation of Haiti, 205-6. 77 Cooper, "The Withdrawal of the United States from Haiti, 1928-1934," 92; Pamphile, Clash of Cultures, 136. 78 Spector, W. Cameron Forbes and the Hoover Commissions to Haiti, 46. 79 Cooper, "The Withdrawal of the United States from Haiti, 1928-1934," 92; Plummer actually notes that Borno requested a black American to be named to the commission so that there could be no charges made against the process, however her account is contrary to what most scholars posit (Plummer, "The Afro- American Response to the Occupation of Haiti, 1915-1934," 141). 80 Angulo, "Education during the American Occupation of Haiti," 11. 81 Angulo, "Education during the American Occupation of Haiti," 12. 82 Schmidt, The United States Occupation of Haiti, 208. 83 Spector, W. Cameron Forbes and the Hoover Commissions to Haiti, 81. 84 Heinl and Heinl, Written in Blood, 459. 85 Montague, Haiti and the United States, 261. 86 Magdeline W. Shannon, Jean Price-Mars, the Haitian Elite, and the American Occupation, 1915-1935 (New York: St. Martins Press, Inc., 1996), 90. 87 Spector's lengthy account of Heiser's time in Haiti must suffice for the next session. Unfortunately, while the doctor's final report was available to me, his notes, which Spector cites, were not. Moreover, Heiser's time in Haiti is not included in his 1936 best-selling An American Doctor's Odyssey. In an interview from which Spector would draw even more information, Heiser noted that his book, which was written in two- volumes, originally included his Haitian experience, but the second volume was never published and the manuscript had since been lost (Spector, W. Cameron Forbes and the Hoover Commissions to Haiti, 146). 88 Spector, W. Cameron Forbes and the Hoover Commissions to Haiti, 119. 89 Spector, W. Cameron Forbes and the Hoover Commissions to Haiti, 118-30. 90 Shannon, Jean Price-Mars, the Haitian Elite, and the American Occupation, 90. 91 Spector, W. Cameron Forbes and the Hoover Commissions to Haiti, 121.

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92 Spector, W. Cameron Forbes and the Hoover Commissions to Haiti, 122-3. 93 Spector, W. Cameron Forbes and the Hoover Commissions to Haiti, 126. 94 Spector, W. Cameron Forbes and the Hoover Commissions to Haiti, 123. 95 Shannon, Jean Price-Mars, the Haitian Elite, and the American Occupation, 90. 96 Spector, W. Cameron Forbes and the Hoover Commissions to Haiti, 121. 97 "Interview between Dr. C.S. Butler and Dr. O'Connor, Friday, September 4, 1926," folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Spector, W. Cameron Forbes and the Hoover Commissions to Haiti, 122. 98 Despite the way that race would be constructed within the United States, the Syrians were deemed to be the only other foreign white group living in Haiti at the time and as such they, like the Americans, refused to utilize the services of Haitian doctors. 99 Spector, W. Cameron Forbes and the Hoover Commissions to Haiti, 126. 100 Victor G. Heiser, “Haiti: Health and Medical Relief," Report to the President’s Commission for the Study and Review of Conditions in the Republic of Haiti, March 19, 1930, p. 5, folder 3735, box 555, series 320, RG 2, Rockefeller Foundation Collection, RAC. 101 Spector, W. Cameron Forbes and the Hoover Commissions to Haiti, 144. 102 Rulx Léon, to Dr. Allen Gregg, October 10, 1931, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC; Pamphile, Clash of Cultures, 158. 103 Millspaugh, Haiti under American Control, 173. 104 Rulx Léon, to Dr. Allen Gregg, October 10, 1931, folder 1, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 105 Victor G. Heiser, “Haiti: Health and Medical Relief," Report to the President’s Commission for the Study and Review of Conditions in the Republic of Haiti, March 19, 1930, p. 5-6, folder 3735, box 555, series 320, RG 2, Rockefeller Foundation Collection, RAC. 106 Victor G. Heiser, “Haiti: Health and Medical Relief," Report to the President’s Commission for the Study and Review of Conditions in the Republic of Haiti, March 19, 1930, p. 5, folder 3735, box 555, series 320, RG 2, Rockefeller Foundation Collection, RAC. 107 Spector, W. Cameron Forbes and the Hoover Commissions to Haiti, 124. 108 Spector, W. Cameron Forbes and the Hoover Commissions to Haiti, 128. 109 Spector, W. Cameron Forbes and the Hoover Commissions to Haiti, 123. 110 Spector, W. Cameron Forbes and the Hoover Commissions to Haiti, 126. 111 Schmidt, The United States Occupation of Haiti, 218-9. 112 Brodwin, Medecine and Morality in Haiti, 52. 113 Blaming the Americans for failing to implant any truly democratic institutions, Heinl and Heinl argue that the Service d"Hygiene was vulnerable to corruption. Illustrating the point, they note that by the end of 1932 doctors were diverting pharmaceuticals and other medical supplies away from government programs and towards their own private practices, threatening in the process the ability of public health institutions to operate (Heinl and Heinl, Written in Blood, 459, 513). 114 Heinl and Heinl, Written in Blood, 473. 115 Dr. Washburn to Dr. F.F. Russell, March 16, 1935, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC.

Conclusion - Imperialism and the Appearance of Philanthropy: The Occupation and the Origins of International Development

1 Mark T. Berger, "A Greater America? Pan Americanism and the Professional Study of Latin America, 1890-1990," in Beyond the Ideal: Pan Americanism in Inter-American Affairs, ed. David Sheinin (Westport and London: Praeger, 2000). 48. 2 Schmidt, The United States Occupation of Haiti, 230; Plummer, Haiti and the United States, 141. 3 Millspaugh, Haiti under American Control, 136. 4 Greg Grandin, Empire`s Workshop: Latin America, the United States, and the Rise of the New Imperialism (New York: Metropolitan Books, 2006), passim; Mark Schuller and Pablo Morales, Tectonic Shifts: Haiti Since the Earthquake (Sterling, Virginia: Kumarian Press, 2012), 57.

167

5 Greg Dunkel, "Haiti's Impact on the United States: What 'Voodoo Economics' and High School Textbooks Reveal," in Haiti, A Slave Revolution: 200 Years After 1804, eds. Pat Chin et al (New York: International Action Center, 2010), 48. 6 Jean-Bertrand Aristide, Eyes of the Heart: Seeking a Path for the Poor in the Age of Globalization (Monroe, ME: Common Courage Press, 2000), 30. 7 Arturo Escobar, "Power and Visibility: Development and the Invention and Management of the Third World," Cultural Anthropology 3, no.4 (1988): 428. 8 Mark Schuller, Killing with Kindness: Haiti, International Aid, and NGOs (New Brunswick, NJ and London: Rutgers University Press, 2012), 20. 9 Schuller, Killing with Kindness, 16; Hall, Haitian Creole, 302. 10 Dr. Washburn to Dr. F.F. Russell, March 16, 1935, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 11 F.F. Russell to Dr. Washburn, March 26, 1935, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 12 Dr. Washburn to Dr. F.F. Russell, April 4, 1935, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 13 Dr. Washburn to Dr. F.F. Russell, April 4, 1935, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 14 Dr. Washburn to W.A. Sawyer, October 13, 1939, p. 1, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 15 "From P.J. Crawford's Diary, September 8, 1944," folder 2, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 16 Dr. Washburn to W.A. Sawyer, October 13, 1939, p. 1, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 17 Dr. Washburn to W.A. Sawyer, October 13, 1939, p. 2, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 18 Dr. Washburn to W.A. Sawyer, October 13, 1939, p. 2-3, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 19 Dr. Washburn to W.A. Sawyer, October 13, 1939, p. 2, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 20 Plummer, Haiti and the United States, 139. 21 W.A. Sawyer to John Foster Dulles, April 4, 1939, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 22 Schuller points to occasions such as U.S. President Bill Clinton's admission that U.S. aid policies destroyed Haiti's capacity to cultivate rice, for example. (Schuller, Killing with Kindness, 173). 23 Fred Mayer to John Foster Dulles, March 30, 1939, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 24 W.A. Sawyer to John Foster Dulles, April 4, 1939, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 25 Porter, Health, Civilization, and the State, 16, quoted in April J. Mayes, "Tolerating Sex: Prostitution, Gender, and Governance in the Dominican Republic, 1800's - 1924 ," in Health and Medicine in the Circum-Caribbean, 1800-1968, eds. Juanita De Barros, Steven Palmer, and David Wright (New York: Routledge, 2009), 122. 26 Montague, Haiti and the United States, 288; Dr. Washburn to W.A. Sawyer, October 13, 1939, p. 2, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 27 Boaz, William, "Sanitation - Haiti," February 27, 1940, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 28 P.J. Crawford to Dr. Rulx Léon, January 31, 1940, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 29 "Haiti - Malaria Survey - Designation and Budget," June 7, 1940, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 3030 "Haiti - Malaria Survey - Designation and Budget," September 12, 1941, folder 4, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 31 Girard, Haiti, 95; Schmidt, The United States Occupation of Haiti, 233. 32 Heinl and Heinl, Written in Blood, 475.

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33 Plummer, Haiti and the United States, 145-6. 34 "From P.J. Crawford's Diary, September 8, 1944," folder 2, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 35 "RAL Interviews - Dr. Ronald Augustine, April 9, 1945," folder 2, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 36 "Inter-Office Correspondence, From: RAL," November 15, 1946, folder 2, box 1, series 320, subseries A, RG 1.1, Rockefeller Foundation Archives, RAC. 37 Plummer, Haiti and the United States, 167. 38 Ansel Herz, "How To Write About Haiti," Mediahacker, http://www.mediahacker.org/2010/07/23/how- to-write-about-haiti/ . 39 Diamond, Jared, Collapse: How Societies Choose to Fail or Succeed (New York: Viking, 2005), 340, quoted in Paul Farmer, Haiti: After the Earthquake (New York: Public Affairs, 2011), 390. 40 Schuller and Morales, Tectonic Shifts, 57. 41 Schuller and Morales, Tectonic Shifts, 172. 42 Edwidge Danticat, Create Dangerously: The Immigrant Artist at Work (New York: Vintage Books, 2011), 162. 43 The actual body count is up for dispute. The 316,000 figure was offered by Haitian Prime Minister Jean- Max Bellerive, while a leaked USAID report suggests that the figure is as low as 66,000. Most press reports offer a vague estimate of at least 200,000 (Schuller and Morales, Tectonic Shifts, 11-2). 44 Evan Lyon, Evan. "Lopital Jeneral Struggles to Survive," in Haiti: After the Earthquake, ed. Paul Farmer (New York: Public Affairs, 2011), 308. 45 Farmer, Haiti: After the Earthquake, 161. 46 Schuller and Morales, Tectonic Shifts, 2. 47 Beverley Mullings, Marion Werner, and Linda Peake, "Fear and Loathing in Haiti: Race and Politics of Humanitarian Dispossession," ACME: An International E-Journal for Critical Geographies 9, no.3 (2010): passim. 48 Ansel Herz, "Wikileaks Haiti: The Earthquake Cables," The Nation, June 15, 2011, http://www.thenation.com/article/161459/wikileaks-haiti-earthquake-cables . 49 Yves Engler and Anthony Fenton, Canada in Haiti: Waging War on the Poor Majority (Winnipeg: Fernwood Publishing, 2005), passim; Peter Hallward, Damning the Flood: Haiti and the Politics of Containment (London and New York: Verso, 2007), passim. 50 Janet A. Sanderson, "08PORTAUPRINCE1381, WHY WE NEED CONTINUING MINUSTAH PRESENCE IN HAITI," Wikileaks, November 1, 2008, http://wikileaks.org/cable/2008/10/08PORTAUPRINCE1381.html . 51 Justin Podur, Haiti's New Dictatorship: The Coup, the Earthquake, and the UN Occupation, (Toronto: Between the Lines, 2012), 6. 52 Farmer, Haiti: After the Earthquake, 102. 53 Nikolas Barry-Shaw and Dru Oja Jay, Paved with Good Intentions: Canada's Development NGOs, From Idealism to Imperialism, (Halifax and Winnipeg: Fernwood Publishing, 2012), 243. 54 Schuller, Killing with Kindness, 7, 11. 55 Barry-Shaw and Jay, Paved with Good Intentions, 247. 56 Jean Price-Mars, So Spoke the Uncle, trans. Magdaline W. Shannon (Washington: Three Continents Press, 1983), 10. 57 Shannon, Jean Price-Mars, the Haitian Elite, and the American Occupation, 17; Magdaline W. Shannon, "Introduction" to So Spoke the Uncle, by Jean Price Mars (Washington: Three Continents Press, 1983), xiii. 58 Schmidt, The United States Occupation of Haiti, 71; Heinl and Heinl, Written in Blood, 336. 59 William B. Seabrook, The Magic Island (New York: Harcourt, Brace, and Company, 1929), 302-6. 60 McPherson, "Artful Resistances," 109. 61 Adam McGee, "Hurston's Vodou: A Re-evaluation" (Conference presentation, Haiti Beyond Borders: Challenges and Progress Across the Diaspora - 24th Annual Conference of the Haitian Studies Association, York College, City University of New York, November 9, 2012). ; McBride, "Curing the Caribbean," 85. 62 Dubois, Haiti: The Aftershocks of History, 280, 320. 63 Dubois, Haiti: The Aftershocks of History, 280.

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BIBLIOGRAPHY

Archival Sources

University of Florida Digital Collections, Digital Library of the Caribbean: http://dloc.com/ . Gainesville, Florida. Rockefeller Foundation Archives, Rockefeller Archive Centre, Sleepy Hollow, New York.

Primary Sources and Works Published Prior to 1940

Balch, Emily, ed. Occupied Haiti. New York: The Writers Publishing Company, Inc., 1927. Butler, Smedley D. War is a Racket. Los Angeles: Feral House, 2003 (1935). Davis, Harold Palmer. Black Democracy: The Story of Haiti, New York: Dodge, 1936. Heiser, Victor. An American Doctor's Odyssey: Adventures in Forty-five Countries. New York: W.W. Norton and Company, Inc., 1936. Lherisson, Camille. "Diseases of the Peasant of Haiti." American Journal of Public Health. 25, no.8 (1935): 924-29. Millspaugh, Arthur Chester. Haiti Under American Control, 1915-1930. Westport, Connecticut: Negro University Press, 1970 (1931). Parsons, Robert. History of Haitian Medicine. New York: Paul B. Hoeber, Inc., 1930. Price Mars, Jean. So Spoke the Uncle. Introduction and Translation by Magdaline W. Shannon. Washington: Three Continents Press, 1983 (1928). Sanderson, Janet A. "08PORTAUPRINCE1381, WHY WE NEED CONTINUING MINUSTAH PRESENCE IN HAITI." Wikileaks, November 1, 2008. http://wikileaks.org/cable/2008/10/08PORTAUPRINCE1381.html . Seabrook, William B. The Magic Island. New York: Harcourt, Brace and Company, 1929. "Treaty With Haiti: Treaty Between the United States and Haiti. Finances, Economic Development, and Tranquility of Haiti, September 16, 1915." Open Library. Internet Archive. http://www.archive.org/stream/treatywithhaiti00pomegoog#page/n12/mode/2up

Secondary Sources

Anderson, Warwick. "Excremental Colonialism: Public Health and the Poetics of Pollution." Contagion: Historical and Cultural Studies, edited by Alison Bashford and Claire Hooker, 76-105. New York: Routledge, 2001. Anderson, Warwick. "Going Through the Motions: American Public Health and Colonial Mimicry." American Literary History, 14, no.4 (2002): 686-719.

170

Anderson, Warwick. "Immunities of Empire: Race, Disease, and the New Tropical Medicine, 1900-1920." Bulletin of the History of Medicine. 70, no.1 (1996): 94- 118. Angulo, A.J. "Education During the American Occupation of Haiti, 1915-1934." Historical Studies in Education, (January 2011): 1-17. Aristide, Jean-Bertrand. In the Parish of the Poor: Writings from Haiti. Maryknoll, NY: 1990. Aristide, Jean-Bertrand. Eyes of the Heart: Seeking a Path for the Poor in the Age of Globalization. Monroe, ME: Common Courage Press, 2000. Barry-Shaw, Nikolas, and Dru Oja Jay. Paved with Good Intentions: Canada's Development NGOs, From Idealism to Imperialism. Halifax and Winnipeg: Fernwood Publishing, 2012. Bellegarde-Smith, Patrick. Haiti: The Breached Citadel. Toronto: Canadian Scholars' Press, 2004. Berger, Mark T. "A Greater America? Pan Americanism and the Professional Study of Latin America, 1890-1990." In Beyond the Ideal: Pan Americanism in Inter- American Affairs, edited by David Sheinin, 45-56. Westport and London: Praeger, 2000. Berman, Edward H. The Influence of the Carnegie, Ford, and Rockefeller Foundations on American Foreign Policy: The Ideology of Philanthropy. Albany, New York: State University of New York Press, 1983. Briggs, Laura. Reproducing Empire: Race, Sex, Science, and U.S. Imperialism in Puerto Rico. Berkeley and Los Angeles: University of California Press, 2002. Blassingame, John W. "The Press and the American Intervention in Haiti and the Dominican Republic, 1904-1920." Caribbean Studies, 9, no.2 (1969): 27-43. Brodwin, Paul. Medicine and Morality in Haiti: The Contest for Healing Power. New York: Cambridge University Press, 1996. Pat Chin et al, eds., Haiti, A Slave Revolution: 200 Years After 1804. New York: International Action Center, 2010. Clark, Adele E., et al. "Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedecine," American Sociological Review, 62, no.2 (2003): 161-194. Cooper, Donald B. "The Withdrawal of the United States from Haiti, 1928-1924." Journal of Inter-American Studies, 5, no.1 (1963): 83-101. Cueto, Marcos. "The Cycles of Eradication: the Rockefeller Foundation and Latin American Public Health, 1918-1940." In International Health Organisations and Movements, 1918-1939, edited by Paul Weindling, 222-243. Cambridge: Cambridge University Press, 1995. Cueto, Marcos. "Visions of Science and Development: The Rockefeller Foundation's Latin American Surveys of the 1920s." In Missionaries of Science: The Rockefeller Foundation and Latin America, edited by Marcos Cueto, 1-22. Bloomington and Indianapolis: Indiana University Press, 1994. Danticat, Edwidge, Create Dangerously: The Immigrant Artist at Work. New York: Vintage Books, 2011.

171

Dubois, Laurent. Haiti: The Aftershocks of History. New York: Metropolitan Books, 2012. Dupuy, Alex. Haiti in the World Economy: Class, Race, and Underdevelopment Since 1700. Boulder, Colorado: Westview Press, 1989. Engler, Yves, and Anthony Fenton. Canada in Haiti: Waging War on the Poor Majority. Winnipeg: Fernwood Publishing, 2005. Escobar, Arturo. "Power and Visibility: Development and the Invention and Management of the Third World." Cultural Anthropology. 3, no.4 (1988): 428-443. Espinosa, Mariola. “The Threat from Havana: Southern Public Health, Yellow Fever, and the U.S. Intervention in the Cuban Struggle for Independence, 1878-1898.” The Journal of Southern History. 72, no.3 (August 2006): 541-568. Farmer, Paul. Haiti: After the Earthquake. New York: Public Affairs, 2011. Farmer, Paul. Infections and Inequalities: The Modern Plagues. Berkeley and Los Angeles, California: University of California Press, 1999. Foucault, Michel. "Questions on Geography." In Power / Knowledge: Selected Interviews and Other Writings, 1972-1977, 63-77. New York: Pantheon Books, 1980. Foucault, Michel. “Truth and Power.” The Foucault Reader. Edited by Paul Rabinow, 51- 75. New York: Pantheon Books, 1984. Girard, Philippe. Haiti: The Tumultuous History - From Pearl of the Caribbean to Broken Nation. New York: Palgrave Macmillan, 2010. Gostaldo, Denise. "Is health education good for you? Re-thinking health education through the concept of bio-power." In Foucault, Health, and Medicine, edited by Alan Petersen and Robin Bunton. New York and London: Routledge, 1997. Gramsci, Antonio. "The Art and Science of Politics." In The Gramsci Reader: Selected Writings, 1916-1935, edited by David Forgacs. New York: New York University Press, 2000. Grandin, Greg. Empire`s Workshop: Latin America, the United States, and the Rise of the New Imperialism. New York: Metropolitan Books, 2006. Hall, Robert A. Haitian Creole: Grammar, Texts, Vocabulary. The American Anthropological Association, 1953. Hallward, Peter. Damming the Flood: Haiti and the Politics of Containment. London and New York: Verso, 2007. Healy, David. Gunboat Diplomacy in the Wilson Era: The US Navy in Haiti, 1915-1916. London: University of Wisconsin Press, 1976. Heinl, Robert Debs, and Nancy Gordon Heinl. Written in Blood: The Story of the Haitian People, 1492-1995. Toronto: University Press of America, 2005. Herz, Ansel. "How To Write About Haiti." Mediahacker. http://www.mediahacker.org/2010/07/23/how-to-write-about-haiti/ . Herz, Ansel. "Wikileaks Haiti: The Earthquake Cables." The Nation, June 15, 2011. http://www.thenation.com/article/161459/wikileaks-haiti-earthquake-cables . James, C.L.R. The Black Jacobins: Toussaint L'Ouverture and the San Domingo Revolution. London: Allison and Busby, 1980. Jones, Steve. Antonio Gramsci. New York: Routledge, 2006.

172

Knight, Alan. "US Imperialism / Hegemony and Latin American Resistance." In Empire and Dissent, The United States and Latin America, edited by Fred Rosen, 23-52. Durham and London: Duke University Press, 2008. Leyburn, James G. The Haitian People. New Haven and London: Yale University Press, 1966. Love, Eric T. Race Over Empire: Racism and U.S. Imperialism, 1865-1900. Chapel Hill and London: The University of North Carolina Press, 2004. Löwy, Ilana and Patrick Zylberman. "Medicine as a Social Instrument: Rockefeller Foundation, 1913-45." Studies in History and Philosophy of Science. 31, no.3 (2000): 365-379. Luger, Anton. "The Origin of Syphilis: Clinical and Epidemiologic Considerations on the Columbian Theory." Sexually Transmitted Diseases. 20, no.2 (1993): 110-117. Lundahl, Mats. "Underdevelopment in Haiti: Some Recent Contributions." Journal of Latin American Studies. 23, no.2 (1991): 411-429. Mayes, April J. "Tolerating Sex: Prostitution, Gender, and Governance in the Dominican Republic, 1800s - 1924." In Health and Medicine in the Circum-Caribbean, 1800- 1968, edited by Juanita De Barros, Steven Palmer, and David Wright, 121-141. New York: Routledge, 2009. McBride, David. "Curing the Caribbean: Haiti Through the Occupation." In Missions for Science: US Technology and Medicine in America's African World. New Brunswick, NJ: Rutgers University Press, 2002. McCoy, Alfred, Francisco Scarano, and Courtney Johnson. "On the Tropic of Cancer: Transitions and Transformations in the U.S. Imperial State." In Colonial Crucible: Empire in the Making of the Modern American State, edited by Alfred McCoy and Francisco Scarano, 3-33. Madison: University of Wisconsin Press, 2009. McGee, Adam. "Hurston's Vodou: A Re-evaluation." Conference presentation, Haiti Beyond Borders: Challenges and Progress Across the Diaspora - 24th Annual Conference of the Haitian Studies Association, York College, City University of New York, November 9, 2012. McGillivray, Gillian. Blazing Cane: Sugar Communities, Class, and State Formation in Cuba, 1868-1959. Durham and London: Duke University Press, 2009. McNeill, J.R. Mosquito Empires: Ecology and War in the Greater Caribbean, 1620- 1914. Cambridge: Cambridge University Press, 2010. McPherson, Alan. "Artful Resistances: Song, Literature, and Representations of U.S. Occupations in Nicaragua and Hispaniola." The Latin Americanist. (June 2012): 93-117. McRuer, Robert. “Reflections on Disability in Haiti.” Journal of Literary & Cultural Disability Studies. 4, no.3 (2010): 327–332. Montague, Ludwell Lee. Haiti and the United States,1714-1938. New York: Russell and Russell, 1966. Mullings, Beverley, Marion Werner, and Linda Peake. "Fear and Loathing in Haiti: Race and Politics of Humanitarian Dispossession." ACME: An International E-Journal for Critical Geographies. 9, no.3 (2010): 282-300.

173

Nash, Linda. Inescapable Ecologies: A History of Environment, Disease, and Knowledge. Berkeley and Los Angeles: University of California Press, 2006. Nicholls, David. From Dessalines to Duvalier: Race, Colour and National Independence in Haiti. New Brunswick, NJ: Rutgers University Press, 1996. Palmer, Steven. "Central American Encounters with Rockefeller Public Health, 1914- 1921." In Close Encounters of Empire: Writing the Cultural History of U.S.-Latin American Relations, edited by Gilbert M. Joseph, Catherine C. Legrand, and Ricardo D. Salvatore, 311-332. Durham and London, Duke University Press, 1998. Palmer, Steven. Launching Global Health: The Caribbean Odyssey of the Rockefeller Foundation. Ann Arbor: The University of Michigan Press, 2000. Pamphile, Leon D. Clash of Cultures: American Educational Strategies in Occupied Haiti, 1915-1934. Lanham, Maryland: University Press of America, Inc., 2008. Plummer, Brenda Gayle. Haiti and the United States: The Psychological Moment. London: The University of Georgia Press, 1992. Plummer, Brenda Gayle. "Haitian Migrants and Backyard Imperialism." Race & Class. 26, no.35 (1985): 35-43. Plummer, Brenda Gayle. "The Afro-American Response to the Occupation of Haiti, 1915-1934." Phylon. 43, no.2 (1982): 125-143. Podur, Justin. Haiti's New Dictatorship: The Coup, the Earthquake, and the UN Occupation. Toronto: Between the Lines, 2012. Posner, Walter H. "American Marines in Haiti, 1915-1922." The Americas. 20, no.3 (1964): 231-266. Renda, Mary A. Taking Haiti: Military Occupation and the Culture of U.S. Imperialism, 1915-1940. Chapel Hill and London: The University of North Carolina Press, 2001. Robinson, William I., Promoting Polyarchy: Globalization, US Intervention, and Hegemony. Cambridge: Cambride University Press, 1996. Rockefeller Foundation, The. "Our History - A Powerful Legacy." The Rockefeller Foundation. http://www.rockefellerfoundation.org/about-us/our-history . Rogers, Kara. “Bacterial Diseases: Anthrax to Yaws.” In Infectious Diseases, edited by Kara Rogers, 76-95. New York: Britannica Educational Publishing, 2011. Schmidt, Hans. Maverick Marine: General Smedley D. Butler and the Contradictions of American Military History. Lexington, Kentucky: The University Press of Kentucky, 1987. Schmidt, Hans. The United States Occupation of Haiti, 1915-1934. New Brunswick, NJ: Rutgers University Press, 1995. Schuller, Mark. Killing with Kindness: Haiti, International Aid, and NGOs. New Brunswick, NJ and London: Rutgers University Press, 2012. Schuller, Mark and Pablo Morales, eds. Tectonic Shifts: Haiti Since the Earthquake. Sterling, Virginia: Kumarian Press, 2012. Shannon, Magdaline W. Jean Price-Mars, the Haitian Elite and the American Occupation, 1915-1935. New York: St. Martins Press, Inc., 1996.

174

Smith, Linda Tuhiwai. "Colonizing Knowledges." In The Indigenous Experience: Global Perspectives, edited by Roger Maaka and Chris Anderson, 91-108. Toronto: The Canadian Scholars' Press Inc., 2006. Spector, Robert M. W. Cameron Forbes and the Hoover Commissions to Haiti (1930). New York: University Press of America, 1985. Stern, Alexandra Minna. "Yellow Fever Crusade: US Colonialism, Tropical Medicine, and the International Politics of Mosquito Control, 1900-1920." In Medicine at the Border: Disease, Globalization, and Security, 1850 to the Present, edited by Alison Bashford, 41-59. New York: Palgrave Macmillan, 2007. Stevens, Margaret. "'Hands Off Haiti!' Self-determination, Anti-imperialism, and the Communist Movement in the United States, 1925-1929." The Black Scholar. 37, no.4 (2007): 61-70. Suggs, Henry Lewis. "The Response of the African American Press to the United States Occupation of Haiti, 1915-1934." The Journal of African-American History. 87, (2002): 70-82. Trouillot, Michel-Rolph. Haiti: State Against Nation - The Origins and Legacy of Duvalierism. New York: Monthly Review Press, 1990. Watts, Sheldon. Epidemics and History: Disease, Power, and Imperialism. London: Yale University Press, 1997.