cholera – Jennifer Hallock

My Favorite Medical History Podcasts

In addition to an extensive list of memoirs, biographies, and research texts on medical history that I have read for background research on Sugar Communion, I have also spent a lot of time walking the dog and listening to podcasts. Here’s a photo of Wile E. and me on the way to the trail, just because:

Wile-E-Dog-and-Jen-COVID-masked — Heading out to the trail and hoping we’re the only ones on it. Listening to medical podcasts during COVID is on-point.

My heroine, Dr. Elizabeth “Liddy” Shepherd, M.D., is one of many young women who became physicians or surgeons at the turn of the twentieth century. Many? Yeah! I mean, not a flood but enough to say that it was a viable career path for quite a few. In romance novels, the introduction of a female doctor character is often presented as something truly exceptional: “the only female physician in England,” one says, which is sorta lousy history. (Is it good marketing? I suppose so.) The aforementioned heroine was loosely based on the first female physician licensed in England, Elizabeth Garrett Anderson—not counting James Barry, who was assigned female at birth. By 1876, the year this other novel takes place, Dr. Anderson was already training female doctors by the class-full in the medical school she had opened—women who could have applied for licensure just like hers. Also, Scotland not England was really the “scene of the first major attempt by British women to break into the exclusively male world of medicine.”

Sugar-Sun-series-Pinterest — Check out my Pinterest pages for all my inspirations and visual research. Liddy will grow up in a medical family: her father and two brothers are both physicians of the eclectic school and operate a hydrotherapy sanitarium (think Kellogg‘s Battle Creek sanitarium for more frugal customers). She will go against her family’s wishes—not in becoming a doctor but in studying the new microbiological, laboratory-based field, which they regarded as a threat.

Women in the US probably had an easier road, with several coeducational and women’s medical schools existing in the Gilded Age, especially in the midwest. At the University of Michigan, for example, women made up a quarter of the class. The school turned out country doctors—a difficult, smelly career that these Gibson girls were welcome to try. Michigan was a better school than most, but in general medical education was not really stellar for either men or women. For example, there were no written examinations at Harvard Medical School at the beginning of the Gilded Age. None. In fact, that would have been impossible, one professor complained, because half of his students “could barely write.”

Ohio-Medical-University-Protestant-Hospital-Goodale-Ohio-State — Ohio Medical University was one of the predecessor institutions of the eventual Ohio State University Medical School, and the affiliated Protestant Hospital would eventually become Riverside Methodist Hospital. This original campus was at Goodale Park. Postcard courtesy of Historical Reflections, the Ohio State Medical Heritage Center Blog.

During the Gilded Age, doctors went from being considered “butchers” and “bleeders” to people who could actually diagnose what was wrong with you. Obviously, this is a great advance—though, before antibiotics and safe anesthesia, odds on treatment, care, and recovery were still not great.

It was the improvement in the status of doctors that led conservative elements of American society to decide that medicine was not an appropriate career for women, often because a woman doctor would be taking a “good job” from a man. The publication of the Flexner Report in 1910 is credited with creating the modern scientific medical school system in the US, but it also directly or indirectly caused the closure of many medical schools for women and African Americans. Those that had been coeducational reduced their admission of women, partly because they had a rise in male applicants. One study calls an unintended consequence of Flexner’s report “the near elimination of women in the physician workforce between 1910 and 1970.” It is the post-Gilded Age lack of women in medicine that makes us think that women have always been uniformly shut out of the field.

1896-fashion-plate — Sugar Communion’s heroine, Dr. Elizabeth “Liddy” Shepherd, as inspired by an 1896 fashion plate at the Met. (She will borrow the dress.)

(Side note: Johns Hopkins, the model of a modern medical school for Mr. Flexner, only managed to operate because of the patronage of four women: Martha Carey Thomas, Mary Elizabeth Garrett, Elizabeth King, and Mary Gwinn. According to Johns Hopkins: “They would raise the $500,000 needed to open the school and pay for a medical school building, but only if the school would open its doors to qualified women. Reluctantly, the men agreed.” Unfortunately, the legendary founder of internal medicine at Hopkins, Dr. William Osler, was less enthusiastic about the role of women in the field, and the numbers of female students would dwindle before growing again decades later.)

My character Liddy needs to be a good doctor, yet one appropriate to her time period. I had to understand the world of medicine she was a part of. Better than studying it, I had to immerse myself in it. For that task, I did use some good books, but mostly I listened to podcasts. Let’s talk about a few of those:

Bedside Rounds

I happened upon Bedside Rounds first and have since listened to every single episode. Dr. Adam Rodman is engaging and informative—so informative, in fact, that members of the American College of Physicians can earn Continuing Medical Education (CME) and Maintenance of Certification (MOC) credit for just listening to these episodes and taking a quick quiz! But, trust me, we general listeners need not worry about the test, nor are we left behind. Dr. Rodman’s intention was to model his podcast on Radio Lab, and his delivery is just as compelling and digestible (health-related pun?) as that popular program. There were times when I did backtrack 15 seconds or so just to let some point wash over me a second time, but keep in mind that I was taking mental notes for my book. A casual listener can easily stay on pace, though Rodman doesn’t shy away from the tough stuff. His presentations do have lighter moments but never get silly. Listening changes the way you view medicine, mostly by making you realize how young the field really is. (Note: The COVID-related episodes, including an in-depth treatment of previous coronaviruses and the 1918 flu, are very good.)

This podcast will kill you

Two immediate advantages of This Podcast Will Kill You are (1) the incredibly impressive epidemiologist-and-disease-ecologist-presenter-duo, Erin Welsh, Ph.D. and Erin Allmann Updyk, Ph.D.; and (2) the structure of each episode into separate segments on biology, history, and modern epidemiological issues related to each chosen disease. (They also have a Quarantini—or, if you prefer, a non-alcoholic Placeborita—for each episode, and this was before we were all quarantining.) “The Erins” (their label, though I prefer “Dr. Erins”) have just begun their fourth season, and that is a lot of episodes to catch up on, but you will be glad you did. Until I listened to TPWKY, I did not truly understand sickle cell disease, for example, or dengue—not even while I lived in the Philippines, which is embarrassing.

The Dr. Erins deal with diseases that other podcasts do not cover, like rinderpest, the bovine form of measles, which will have to be another glossary post on this blog because it comes up a few times in my books. (The Philippines lost 90% of their carabao population during the Philippine-American War period, which added greatly to the suffering of the people.) TPWKY also has episodes on cholera, malaria, and other diseases that have made an appearance in Under the Sugar Sun and, in particular, Tempting Hymn. Upcoming in Sugar Communion, TPWKY has been instrumental in my understanding of syphilis (don’t worry, I will stick to the chronotope), as well as smallpox and the history behind vaccines, aspirin, and caffeine. Relevant to the whole nineteenth and early twentieth century periods, there are episodes on typhoid fever and yellow fever and so much more! The more I listen, the more I love this podcast. I think they are having lots of (appropriate) fun too.

(Note: TPWKY also put out a series of excellent COVID episodes, as you might expect. They are broken down by different facets of the pandemic, along with a December 2020 update.)

the history of medicine

I have only listened to the first half of the first season of The History of Medicine podcast, but what I like about it is the deep dive into a narrative history of one big medical invention at a time. The first season is all about antibiotics—yay, penicillin! The show on plague (Yersinia pestis) is an excellent short backgrounder for all history teachers. A final advantage is that each episode here is very short. A possible disadvantage is that host and producer Kirby Gong is not a practicing physician—he only (ha!) has a master’s degree in biomedical engineering—but, actually, I call his perspective an advantage. He investigates medical inventions in a more procedural way. This podcast is the lens of an engineer, and I find that fascinating.

this won’t hurt a bit

This Won’t Hurt a Bit was a lot of fun, but sadly you will quickly run out of episodes. The two ER physicians who are the main hosts here, Dr. Mel Herbert and Dr. Jess Mason, are so busy with saving lives and producing other educational modules for ER docs that they are not actively creating many new releases. (Note: They do have a few COVID episodes that I have not gotten to yet. I am more interested in everything non-COVID right now. Go figure.) Though these doctors are not exclusively focused on history, usually each episode touches upon the historical approach to a disease or treatment in some way. They also teach you a lot about being a good patient, including when you might want to go to a hospital yourself! Dave Mason, Jess’s non-MD husband, is also one of the hosts, and he provides banter and asks the questions you really wanted to know. What I appreciate about Dave, though, is that he is not entirely silly, and he does not derail Mel and Jess when they are delivering information. This podcast is very well produced and engineered, with additional asides and definitions that you appreciate not dread.

sawbones

Sawbones is probably the most popular podcast of all the above, at least by the size of the live audiences that they have performed in front of (pre-quarantine days). This podcast is billed as “A Marital Tour of Misguided Medicine,” and that is because the show is based around the relationship of the medical host, Dr. Sydnee McElroy, and the comic relief, her husband Justin McElroy. (And they published a book too!) Most of the background medical history research is done by Sydnee—or maybe I’m underestimating Justin?—and fortunately she brings her A-game. Her episode on hydrotherapy was quite useful for my research. Dr. McElroy is also living and practicing in Huntington, W.V., which is where my grandparents and aunt lived (and therefore I spent a lot of time growing up)—and I feel connected to the McElroys that way too. (Surprise, surprise, they have several COVID episodes that I have not listened to yet, and they have also done an important set of podcasts on the history of medical racism inspired by recent protests.)

[Edited to add: The most recent episode on “Physician Burnout” is essential listening for all of us, physicians and patients alike. If you work in another “helper” profession, there are many parallels you will relate to.]

[just added!] maintenance phase

Maintenance Phase, a podcast that bills itself as “Wellness & weight loss, debunked & decoded,” started as a friend’s recommendation. She suggested the “Olestra” episode because I have family members who were involved in that indigestible chapter of history. This show has quickly become one of my favorites for general listening, though. I am one of those people who have been constantly in one diet cult or another my whole life, and counterprogramming is a challenge. The hosts of this podcast are not just scientifically informed, they are so much fun to listen to. In terms of medical history, their “Snake Oil” episode is one of my absolute favorites.

[just added!] the curious clinicians

The Curious Clinicians is sometimes too much for me, the writer who had not taken biology since freshman year in high school. This podcast is hosted by doctors and lab researchers for a similar audience, and so they do not explain every term or concept for the non-biologists in the room, and I recommend that we humanities folk out here choose our episodes wisely—but not shy away altogether. One episode that is amazing for everyone, especially if you are a foodie, is: “Episode 9: Why is umami so delicious?” A runner-up is “Episode 4: Why did Van Gogh paint with so much yellow?” Currently, I am learning about how fevers are actually useful, which is why almost all animals and even plants use them to fight infections!

stuff you missed in history class

For a history podcast, Stuff You Missed in History Class touches on medical topics a lot. There is even a good episode on the Flexner report, mentioned above. I think this is because the hosts, Holly Frey and Tracy Wilson, show a real concern for the daily lives of past people. One of their other stand-out episodes for me was on the “Orphan Trains,” which is a footnote of history you might also see in Sugar Communion. [Update: I don’t know anymore. I have to do a lot of cutting.] There is a deep backlog that I plan to dive into once I’m finished with some of my medical questions.

the others you see on my player

There are more podcasts that I have not yet gotten around to, like the History Chicks, the Revisionist History podcast, and This Land. Other titles are related to my professional interests. I highly, highly recommend the first season of Blowback about the Iraq War. I do not think that I can say that enough times. There are other podcasts in my favorites that I have listened only to a few episodes of, like Casenotes. (Nope, not the true-crime podcast, but the medical history one. It is a fortnightly podcast from the Physicians’ Gallery at the Royal College of Physicians of Edinburgh. Essentially it is just the audio of lectures given by doctors and epidemiologists for other highly-degreed people. It can be very good, depending on the speaker, but it is like listening to a conference, not a highly-produced podcast.)

You may have also noticed Book Thingo on my Stitcher account because it’s the best romance podcast out there, and I’m not just saying that because they were willing to talk to me. Kat Mayo is also the originator of the #UndressAndres hashtag, so I owe her a lot. [Edited to add: Did you know I was interviewed for a podcast on Balangiga too? Check it out!]

If you know of more stuff I should be listening to—especially anything relevant to Sugar Communion—please let me know. My dog always needs walking.

The Pulahan War, Part I

[This is the first in a series of three posts on the Pulahan War. Find links to parts two and three here.]

If the Philippine-American War (1899-1902) gets little attention in history classrooms, the subsequent Pulahan War (1903-1907) in Samar and Leyte gets none. But it is the Pulahan War that may have the most parallels to later fights against the Khmer Rouge of Cambodia; the Islamic State in Syria and Iraq; the Abu Sayyaf/Maute group in Marawi, Philippines; Boko Haram in Nigeria; and even the Aum Shinrikyo terrorists, who released sarin gas on a Tokyo subway train in 1995.

The Pulahan War erupted after the Americans captured Samareño guerrilla leader Vicente Lukban in April 1902, and after the Americans declared the Philippine “insurrection” over on July 4, 1902. In other words, it happened after the islands had supposedly been pacified. In reality, the islands were still at war. (The Pulahan War was the largest of its particular type, but it was not the only indigenous, messianic movement in the islands.)

Maybe the Pulahan War is not studied because it was squashed in only four years—a short insurgency compared to the ones the United States has fought more recently. But shouldn’t that be a reason to study it? To find out how American soldiers (and American-trained Filipino soldiers) succeeded so quickly in Samar and Leyte, but cannot outmaneuver the Taliban after nearly two decades in Afghanistan? What really happened out there in the boondocks?

Sugar-Sun-series-Philippines-Visayas-map — Most of the Sugar Sun series takes place in the Visayan Islands in the central and southern Philippines.

The Pulahans

Who are the Pulahans? The name given to them is thought to mean “red pants,” but few of these men actually had enough pants to set aside a pair as a uniform, let alone dye them a specific color. Sometimes they were known to wear red bandanas or other items, but not always. The name could also come from the pulajan, or red, variety of abaca grown by these farmers. The origin of the name “reds” is not what is important about them. What is critical is how they arose: from a specific cauldron of local grievances, traditional values, and foreign interference that so often gives rise to millennial movements.

It began with the previous war. In April 1902, the captured revolutionary, Vicente Lukban, negotiated the surrender of the rest of his men: 65 officers, 236 riflemen, and 443 bolomen (wielders of a bolo, or machete-style, knife). These guerrillas brought in 240 guns and 7500 rounds of ammunition, much of which had been pilfered from Company C, Ninth Infantry, at Balangiga (Dumindin). Instead of punishing those who had participated in this attack, the Americans welcomed them in from the jungle. The colonial government even provided cloth, tailors, and sewing machines to outfit the men so they could parade through the capital city Catbalogan in front of the Army brass (Borrinaga, R.O., 20).

This colorful celebration papered over the fact that Samar was a smoking ruin. In his implementation of General Orders No. 100, General Jacob H. “Hell-Roaring Jake” Smith ordered the burning over 79,000 pounds of stored rice and countless rice fields (War Department 1902, 434-51). One American soldier estimated that, by 1902, the island was subsisting on only 25% of a normal yield (Hurley, 55-56). Smith had ordered the destruction of entire villages, and he got his wish: by 1902, 27 of 45 municipalities were in ashes, and of those that remained only 10 had a standing town hall (Borrinaga, G.E.R., “Pulahan Movement in Samar,” 245).

Worst of all, Smith ordered that all captured abaca harvests be destroyed (“Massacre Averted“). Known as “Manila hemp,” abaca is actually a banana plant whose strong fibers can be used as naval cordage, which was in short supply at the time. It was so badly needed by the U.S. Navy and merchant fleets that Congress had made a singular tariff exception for it before the rest of the free trade laws came into effect in 1913. Abaca and coconut products could have been the keystones of Samar and Leyte’s economic recovery, but in 1902 the harvest was, again, only 25% of pre-war levels. To make matters worse, a terrible drought hit Samar immediately after the war ended, from October 1902 to June 1903, so what abaca had not been burned by Smith’s forces was torched by the sun (Borrinaga, G.E.R., “Samar,” 245-49).

abaca rope making manila for Jennifer Hallock Sugar Sun series — Making abaca (Manila hemp) rope in the street in Tondo, Manila. Photo courtesy of the Philippine Photographs Digital Archive.

Even had abaca thrived, the Pulahans would not have gotten rich off the sales. Samar was structured like an island plantation: the growers in the highlands were beholden to the coastal elites. Lowlanders, as they were known, were the ones with ties to foreign merchant houses like Britain’s Smith, Bell, and Company. These elites paid the actual abaca growers less than half the crop was worth, and then they turned around and sold the peasants imported rice at a premium (Borrinaga, G.E.R., “Samar,” 257).

Now that the island was “pacified,” the Americans demanded new taxes to pay for their civil government, including a twenty-peso tax on all adult Filipinos (Talde, “The Pulahan Milieu of Samar,” 229-30). The growers did not have twenty pesos—which was US$10 then, or $280 now—so they had to borrow it from the same merchants who had already fleeced them. All they had to stake as collateral was their thousand-peso plots of land. When they could not repay their debts—and the merchants made sure of that—the wealthy townsmen seized title to all they had in the world. To save their families from starvation, or from contracting malnutrition-based diseases like beri-beri, some parents sold off a child at a time to procurers from the big cities (Borrinaga, G.E.R., “Samar,” 258-59). These children would become servants, laborers, and prostitutes to pay off their parents’ debts.

The grower had no one to complain to because the elites who had stolen from them were the mayors, police officials, and municipal authorities of Samar and Leyte. In fact, the twenty-peso poll tax that cost the grower his land had been used to pay the mayor’s salary, and you can be sure he was paid before any of the other tax funds were allocated (Borrinaga, G.E.R., “Pulahan Movement in Leyte,” 255). If the growers complained, they found themselves held on trumped-up charges until they sold the abaca at the desired rate—or for less. “[American] garrison commanders were both appalled and outraged at the mistreatment they witnessed. The civil officials in particular seemed completely irresponsible, robbing their constituents in the most brazen manner” (Linn, 69).

If that was not enough, the 1902 cholera epidemic killed 3175 people in Samar and 4625 in Leyte (War Department 1904, 232). (For Samar, that was about as many as died during General Smith’s “howling wilderness.”) Livestock had also fallen victim to war and disease (specifically, rinderpest). Carabao, or local water buffalo, fell to 10% of their pre-war numbers, according to one contemporary source. The price to replace them went up by a factor of ten (Hurley, 55-56). Because carabaos were essential to plowing and harvesting all crops, their absence meant the starvation that had driven the guerrillas to surrender would continue.

Carabao photograph from the Philippine Photographs Digital Archive at the University of Michigan Special Collections Library

The governor of Samar province, George Curry of New Mexico, knew the peasants were “industrious and hardy people” (Executive Secretary for the Philippine Islands 1906, 584). The problem was that the Americans needed the lowland elites on their side—many of the revolutionaries who had surrendered in April 1902 were these elites, and they were already worming their way into Insular Government positions. The peasants could fall in line with a regime that robbed them blind, or they could look elsewhere. They looked elsewhere.

Specifically, they looked at an old movement for answers to new problems. There had been a messianic group under the Spanish in the late nineteenth century, the “Dios-Dios,” which arose in similar economic conditions as those described above, including both smallpox and cholera epidemics.

Gilded-Age-Medicine-banner-Heroin-Bayer — Read more about the birth of scientific medicine at the turn of the century.

At the time, the highlanders thought their illness would be healed by a mass pilgrimage to Catholic shrines to pray for their loved ones’ souls. But the Spanish, thinking this exodus from the mountains was a revolt in the making, attacked the peasants, thus igniting a several-year-long struggle (Couttie). In 1902 this movement resurfaced—or maybe it had never left. Several of the key figures in Lukban’s guerrilla war—the ones who had not surrendered—had been tied to Dios Dios. While under Lukban, the war had not taken on a distinctly religious character, his most die-hard supporters now made fighting Americans a mission from God.

Ablen Faustino Pulahan pope for Jennifer Hallock Sugar Moon — Pope Ablen Faustino, leader of the Pulahans in Samar.

The Pulahans appropriated a specific Dios Dios-brand of Catholic syncretism, similar to the folk tradition of the babaylans (faith healers). The Pulahans called their leaders popes (“Papa Pablo” or “Papa Ablen,” for example), displayed crosses on their clothing or ornaments, and mentioned Jesus and Mary occasionally. They also prayed to living saints, like the “goddess” Benedicta, who, decades before, had led a crowd of 4000 followers up into the mountains to prepare for the coming apocalypse. Benedicta described the coming end of times as a flood that would wipe out the thieving lowlanders while keeping the mountains safe (Borrinaga, G.E.R., “Leyte,” 211).

The Pulahans kept this blend of Visayan animist and Roman Catholic practices—all without the hated Spanish friars and priests. In fact, like Benedicta, Pulahan women were often priestesses, especially in the highland farming communes hidden within the jungle. To the Pulahans, this location made perfect sense. These were sacred mountains that symbolized light, redemption, and paradise (Talde, “Pulahan Milieu,” 215). This would be where Independencia, when finally freed from its once-Spanish-now-American box, would fashion a world with “no labor, no jails, and no taxes” (Hurley, 59). Even better, “once they destroyed their enemies, [Papa Ablen] would lead them to a mountain top on which they would find seven churches of gold, all their dead relatives who would be well and happy, and their lost carabao” (Roth, Muddy Glory, 99). In retrospect, it seems impossible for the highland people of Samar and Leyte not to join the Pulahan revolt.

The Pulahan soldiers were a special kind of fierce: they did not cut their hair, did not cut down vegetation while trekking through the jungle, and did not need food or water on their multi-day operations (Talde, “Bruna ‘Bunang’ Fabrigar,” 180-81). They wore special charms, known as anting-antings, made out of anything: cloth, paper, or even carabao horn. Special prayers—composed of pseudo-Latin, local languages, and numerology—offered protection against bullets and bolos. “Should they be shot, which could only happen if they turned their backs, their spirits would return in another person’s body in three days, or if hacked by a bolo, in seven days” (Borrinaga, G.E.R., “Leyte,” 230-31). Even better, this reincarnation would deliver the soul to another island. It was a decent way out, given the conditions on Samar and Leyte at the time.

Anting Pulahan amulets for Jennifer Hallock Sugar Moon — From the Aswang Project description of anting-anting.

These spells may be quite familiar to China scholars. They sound like the Boxers’ charms—especially the imperviousness to bullets—and there is a good reason for that. Both movements were millennial:

. . . a religious or ideological movement based on the belief in a millennium marking or foreshadowing an era of radical change or an end to the existing world order; especially (a) believing in the imminence or inevitability of a golden age or social or spiritual renewal; utopian; (b) believing in the imminence or inevitability of the end of the world; apocalyptic.

Millennial movements are often caused by rapid economic and cultural change, an increased foreign presence, and natural disasters or war. Samar, Leyte, and China had all these things. Afghanistan did, too. So did Iraq, Syria, Nigeria, Cambodia, and more. Like all these countries, the Pulahans believed salvation would be theirs eventually, even if they would have to help God along a bit. When the righteous flood finally came, the Pulahans would be on their Monte de Pobres (Mountain of the Poor), the “surest and safest place” in the islands (Borrinaga, G.E.R., “Leyte,” 211). From there they could establish a perfect Samareño kingdom on earth, free from Spanish, American, Chinese, and mercantile interests.

Only it did not go quite like that. Read more on the Pulahan War in part two.

[Featured image was taken by and of members of the 39th Philippine Scouts dressed in captured Pulahan uniforms and carrying captured bolos. Multiply these men by several dozen, at least, to get the full effect of a Pulahan charge. Photo scanned by Scott Slaten.]

Guide to the history behind Sugar Sun

Note: If you are looking for only the history that relates to my newest release, Sugar Moon, you may find a pared down list of posts on this page, “Essential History for Sugar Moon.” Enjoy!

At the start of Under the Sugar Sun, Georgina Potter travels to the Philippines to search for her brother, Ben—a soldier missing since the Philippine-American War. The night she arrives, she walks into a fire set by the cholera police to “cleanse” a neighborhood. Right away we are rooted in the history of the American occupation, a period too few in the United States understand.

But why were Americans in the Philippines in the first place? How did war with Spain in the Caribbean turn into an empire in Asia?

Here on my blog, I have written a lot of history—no surprise since it is my day job. Here are links to the most relevant posts, complete with illustrations.

1896 election history for Sugar Sun history — The bid for empire started with an election about making America great (again?), with jobs, industrialism, and trade. Sounds familiar. Find out more.

Spanish American War Part 1 — American imperialism was a cause and effect of the Spanish-American War. Why fight at all? It’s the economy, stupid!? Find out more.

Spanish-American War Part 2 — The Spanish-American War made Teddy Roosevelt a national political hero, but how much of his call to war was fake news? Find out more.

African-American-heroes-save-Roosevelt-in-Cuba — How much of Roosevelt’s reputation was fake news? And who had really saved his hide in Cuba? Read more about African American heroes of the Spanish-American War.

Spanish-American War Part 3 — Mission creep was a thing before we had the phrase. How the war in the Caribbean turned into an empire in Asia. Also, imperial euphemisms. Find out more.

New imperialism in the Philippines — What was so “new” about American imperialism in the Philippines? Also, how Mark Twain is still relevant today. Find out more.

Why the Philippine-American War matters now. — The good, bad, and ugly of your great-great-great grandparents’ Vietnam War: the Philippine-American War. Also, why it matters to you now more than ever. Find out more.

Calloway-Challenges-Empire-Richmond-Planet-front-page — Sergeant Major John W. Calloway, experienced soldier and reporter for the *Richmond Planet*, called out the incongruency between empire and democracy—in his *private* correspondence—and he was punished for it. Find out more.

african-american-officers-philippines-walter-loving-constabulary-band — The history of systemic racism in the US Armed Forces extended to America’s empire. Read more about the talented officers who have been left out of popular history, including Walter Loving who was posthumously awarded the Philippine Presidential Medal of Merit and the Distinguished Conduct Star, the second-highest military honor in the Philippines.

The Pulahan War parts 1, 2, and 3. — The Pulahan War was a millennialist insurrection, like ISIS. Why don’t we study it more? Find out more in Part 1, Part 2, and Part 3.

Insular euphemisms for imperialism. — Euphemisms for imperialism but not immigration reform. They called that what it was: Chinese exclusion. Find out more.

Baseball history in the Philippines — Baseball was a perfect metaphor for American colonial rule. Find out more.

Cholera epidemic in 1902 Philippines — Cholera has long been a sideshow of war. For the Americans in Manila, it was a challenge to modernity and “benevolent assimilation.” Also, silly naval surgeons. Find out more.

Gilded-Age-medicine-history — Read more about why cocaine for surgery and heroin from the Sears Catalog was actually a step up for the history of medicine.

Army life in the Gilded Age — Soldiers in…negligées? My research rabbit hole on daily life in the U.S. Army in 1901. Find out more.

Benguet road to Baguio — For the Americans sweating it out in Manila, all roads led to Baguio—once they built them, that is. Find out more.

Missionaries in the Philippines — Learn about the real missionaries of Dumaguete, the backdrop for Tempting Hymn, and their best legacy: Silliman University. Find out more.

Balangiga occupation and attack — A case study in occupation, and a town that every American should know. Essential reading for the upcoming Sugar Moon. Find out more.

return-Balangiga-bells-photo-company-C-survivors — The US returned war booty known as the bells of Balangiga in December 2018, over 117 years too late. Why now? Find out more.

Ninth Infantry in Boxer War and Philippines — Talk about mission creep: a war against Spain fought in Cuba blossomed into a new war in the Philippines that lent soldiers to fight yet another campaign in China. Find out more.

Fil-Am-Friendship-Day-July-Fourth — Happy Fourth of July, Republic Day, Philippine-American Friendship Day, and 21st Hallock wedding anniversary! (Yes, Mr. H and I married on American Independence Day because we enjoy irony.) Find out more.

Thanksgiving with the 30th Volunteers in Pasay — Spend the holidays with the 30th U.S. Volunteers in Pasay. Find out more.

Deaf education in the Gilded Age — Take a peek inside deaf education in the Gilded Age with heroine Della Berget, modeled on real-life adventuress, Annabelle Kent. Find out more.

Marijuana in the Gilded Age — Who won the 2016 election? Marijuana, of course. But beware! Gilded Age America preferred cocaine tooth drops. Find out more.

Gibson girls tackle international travel — Three intrepid Gilded Age women take on illiteracy, disease, and the perils of international travel. Find out more.

Gilded Age in Newport and Manila — The wealth of the Gilded Age reached both sides of the Pacific, but nowhere was it gaudier than at Newport. Find out more.

Sex Education in the Gilded Age — What did Gilded Age authorities teach about sex, virginity, and pleasure? The results may surprise you. Find out more.

New Year's 1900 and 2017 — War, natural disaster, terrorism, technology, and health care: all concerns of New Years Day 1900. Find out more.

I hope you have enjoyed my snarky view of history, and I hope it enriches your reading of the Sugar Sun series.

Raise the Red Flag: Cholera in Colonial Manila

My novella Tempting Hymn is the second in my series to mention the 1902 cholera epidemic in the Philippines. The book’s hero, Jonas Vanderburg, volunteered his family for mission work in the Philippines, only to lose his wife and daughters in the same outbreak that Georgina Potter dodged when she arrived in Manila in Under the Sugar Sun. Both books give a glimpse into what people feared most in the Edwardian era. Before the mechanical death of the Great War, disease was the worst of the bogeymen. [Edited to add in March 2020: It still is a bogeyman, obviously, even though cholera is a very different type of disease than #COVID19. For starters, cholera is caused by a bacterium not a virus. Nevertheless, it matters how society approaches containment and treatment of both diseases.]

Character board for Tempting Hymn part Sugar Sun steamy historical romance series — Cholera is important backstory for Jonas, the hero of my new novella, Tempting Hymn.

My books may be historical romance, but this post will not romanticize the history. Census figures put the total death toll from Asiatic cholera in the Philippines (1902-1904) between 100,000 and 200,000 people. Even that number might be low. This strain of the disease was particularly virulent, killing 80 to 90 percent in the hospitals. The disease progressed rapidly and painfully:

Often the disease appears to start suddenly in the night with a violent diarrhea, the matter discharged being whey-like, ‘rice-water’ stools…Copious vomiting follows, accompanied by severe pain in the pit of the stomach, and agonizing cramps of the feet, legs, and abdominal muscles. The loss of liquid is so great that the blood thickens, the body becomes cold and blue or purple in color…Death often occurs in less than a day, and the disease may prove fatal in less than two hours. (A.V.H. Hartendorp, editor of Philippine Magazine)

The Yanks saw cholera as a personal challenge to their colonial ideology. They had come to the Philippines to “Fill full the mouth of famine and bid the sickness cease,” in the words of Rudyard Kipling. What was the point of bringing the “blessings of good and stable government upon the people of the Philippine Islands” if they could not prove the value of their civilization with some modern medicine?

Cholera was not a new killer in the islands, nor did the Americans bring the disease with them. Though the Eighth and Ninth Infantries were initially blamed, the epidemic probably had its roots in China in this case. As Ken de Bevoise said in his outstanding work, Agents of Apocalypse: “The volume of traffic…between Hong Kong and Manila in 1902 was so high that it is pointless to try to pinpoint the exact source.” However, just because Americans did not bring cholera does not mean that we will let them off the hook. American policies, both military and civil, may have made the course of the disease worse.

Cholera virus Edwardian medicine — Amoeba with cholera vibrio and leprosy bacillus, as pictured in the *Twelfth Annual Report of the Bureau of Science* in Manila, courtesy of the Internet Archive.

War weakens and disperses a population, leaving it more vulnerable to disease. In 1901-1902 General J. Frederick Bell set up “protection zones” in Batangas, south of Manila, where all civilians were forced to live in close quarters without access to their homes, farms, and wells. Once cholera hit these zones, there was no escape: 11,000 people died. Even worse, mass starvation forced the general public to ignore the food quarantine, meant to keep tainted vegetables from being sold on the market. The Americans blamed Chinese cabbages for bringing cholera spirilla to the Philippines, but the war gave the people no other choice but to eat (possibly contaminated) contraband to survive.

Inside Manila people were also quarantined—a good idea, actually. The traditional Filipino home quarantine had worked well in the past: infected homes were marked with a red flag to signal people to stay away while loved ones were cared for. [Edited to add in March 2020: This may be the equivalent of social distancing and self-isolation of those sick. In the current #coronavirus crisis, health professionals like the CDC and WHO ask that only those who need advanced care—those with a fever or difficulty breathing—go to a hospital.]

But the Americans thought bigger. They collected the infected and brought them all to centralized hospitals outside of the city—buildings that also housed a morgue and crematorium, the public noticed. According to De Bevoise, eighty percent of the time, this was the last time the family saw the patient. Despite the Manila Times portraying the Santiago Cholera Hospital as a “little haven of rest, rather than a place to be shunned,” and bragging that it was staffed by the “gentle…indefatigable, ever cheerful” Sisters of Mercy, readers were not convinced. They would do anything to keep their family members from being taken there. They fled. They hid their sick. Because cremation was forbidden for Catholics at this time, the Filipinos hid their dead.

And the disease spread.

Cholera fire Tondo Manila during American colonial regime Philippines Edwardian Gilded Age era — Burning of the cholera-stricken lighthouse neighborhood of the Tondo district, Manila, 1902, by the health authorities. Photo courtesy of Arnaldo Dumindin.

My book Under the Sugar Sun began with a dramatic house burning scene, where public health officials destroyed an entire neighborhood in the name of sanitation. The road to hell was not just paved with good intentions. It was also littered with the corpses of industrious, exuberant, and dogmatic government officials. Any houses found to be infected were burned, “because the nipa hut cannot be properly disinfected,” in the words of one American commissioner’s wife. People were forced to find refuge elsewhere in the city, carrying the disease with them. Because it was such a counterproductive policy, Filipinos thought the American officials must have an ulterior motive in the burnings: to drive the poor out of their homes, clear the land, and build their own palaces. The commissioner’s wife, Edith Moses, herself said: “Sometimes, when I think of our rough ways of doing things, I feel an intense pity for these poor people, who are being what we call ‘civilized’ by main force….it seems an act of tyranny worse than that of the Spaniards.”

American instructions to the sick were also confusing—and sometimes bizarre. Clean water was a necessity, but this was not something the poor had access to. Commissioner Dean C. Worcester claimed: “Distilled water was furnished gratis to all who would drink it, stations for its distribution being established through the city, supplemented by large water wagons driven through the streets.” But no other source mentions such bounty. In fact, as author Gilda Cordero-Fernando pointed out in her article, “The War on Germs,” in Filipino Heritage, most people treated distilled water like a magic tonic, it was so rare: “Asked whether a certain family was drinking boiled water, as prescribed, one’s reply was ‘Yes, regularly—one teaspoon, three times a day.’” Even worse, though, was this advice by Major Charles Lynch, Surgeon, U.S. Volunteers, which was reprinted in the Manila Times:

Chlorodyne, or chlorodyne and brandy, have been found especially useful; lead and opium pills, chalk, catechu, dilute sulphuric acid, etc., have all been used. With marked abdominal pain and little diarrhea, morphine should be given…Ice and brandy, or hot coffee, may be given in small quantities, and water, in small sips, may be drunk when they do not appear to increase the vomiting…cocaine and calomel in minute doses—one-third grains—every two hours, having been used with benefit in some cases.

Lead pills. Opium. Chalk. Cocaine. And “calomel”? Mercurous chloride. If the cholera doesn’t kill you, Dr. Lynch’s treatment will! Though the coffee and brandy sounds nice…

Opium children teething powder cure cholera dysentery Edwardian medicine — Dr. Moffett’s Teethina Powder, with a secret ingredient of powdered opium, claims to cure “cholera-infantum,” which is a form of severe diarrhea and vomiting. This ad is from Abilene Weekly Reflector, courtesy of the Library of Congress.

When the Americans could not control the spread of the disease, they reverted to racism and blamed the epidemic on the victims. As public health historians Roy M. MacLeod and Milton James Lewis wrote:

American cleanliness was being undermined by Philippine filth. The Manila Times lamented the cholera deaths of “clean-lived Americans.” It identified the “native boy” as “the probable means of infection” since in hotels and houses he prepared and served food and drinks to unwitting Americans. The newspaper reminded its American readers that “cholera germs exude with the sweat through the pores of the [Filipino servant’s] skin”and that “his hands may be teeming with the germs.”

Racism advertising Edwardian Gilded Age Pears Soap — Racist Pears’ soap ads of the Edwardian era. Notice that the ad on the left borrows from Kipling’s poem, “The White Man’s Burden,” and equates virtue with cleanliness. The one on the right is even more offensive, equating cleanliness (and virtue) with fair skin.

According to the Manila Times, the Americans organized their cholera hospitals by race: the tent line marked street A was “Chinatown,” street B was for the Spanish, street C for white Americans, street D for African Americans, and E through G for Filipinos. Though trade with China had been the cholera vector, Chinese-Filipinos actually had the lowest death rate of any group, including Americans. A Yankee health official ascribed this to the fact that they “eat only long-cooked and very hot food, in individual bowls and with individual chopsticks, and that they drink only hot tea.”

The epidemic reached its peak in Manila in July 1902, and in the provinces in September 1902, before running its course. Its decline was probably due to the heavy rains cleansing the city, increased immunity among the remaining population, and a strategic call by the Archbishop of Manila to encourage Filipinos to bury their dead quickly—but Americans still congratulated themselves on their efforts. And they had worked hard, it is true: Dr. Franklin A. Meacham, the chief health inspector, and J. L. Judge, superintendent of sanitation in Manila, died from exhaustion. The Commissioner of Public Health, Lt. Col. L. M. Maus, suffered a nervous breakdown. Even the American teachers on summer vacation were encouraged to moonlight as health inspectors—for free, in the end. The wages paid to them by the Police Department were deducted from their vacation salaries because no civil employee was allowed to receive two salaries at once. (The relevant Manila Times article explaining this policy is not online, but its title, “Teachers are Losers” is worth mentioning.)

Cholera epidemic in American colonial Philippines in Gilded Age — The hope of a quick end to the cholera outbreak was dashed by July and August 1902, as shown in these three articles from the San Francisco Call, the Akron (Ohio) Daily Democrat, and the Butte (Mont.) Inter Mountain.

All their hard work might have been for nought, though. Filipino policies of individual house-by-house quarantine would have probably been more effective, had they been given the chance to work. Whipping up the population into a panic was exactly what the Americans should not have done. In the name of containing the disease, they caused the real carriers—people—to disperse wider and faster throughout the country. We all need to be on guard against such hubris. [Edited to add in March 2020: Please practice social distancing and self-isolation to #flattenthecurve. If you are not in a high-risk group by age or pre-existing conditions, please take these precautionary measures in order to protect those in your family or community who are most at risk. And stop hoarding the toilet paper. What are you going to do, eat it? Also, check out my full history of Gilded Age medicine and my favorite medical history podcasts for more information.]

I write my love stories in the middle of challenging settings like cholera fires and wars because I believe that love will find a way to grow even during the darkest of times. In the Sugar Sun series, American and Filipino characters untangle international and interpersonal conflicts to create their happily-ever-afters, even if they cannot change the larger course of history that envelops them. Along the way, they show that today’s debates over global economic integration, nation-building, military force, religious extremism—and epidemic disease—echo the scrutiny over American policy that started in the Philippines.

Featured image is of the cholera squad hired by the Americans in the Philippine outbreak of 1902. Photo courtesy of the Library of Congress.