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 (c) Copyright by Matthew Davidson 2014 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. ii 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 iv 1 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