'Feminine outbreak' from the periphery to the Presidio

Introduction

Describing the mass incarceration of over 800 women in Puerto Rico during the latter six months of 1918 under policies of the so-called America Plan, Red Cross director Gavin Payne “excitedly”[i] claimed that “the confinement of so many women at one time was unparalleled elsewhere … in the federal domain, if indeed the world.”[ii]^,[iii] How were such public health policies—which encouraged the quarantine of “venereal disease suspects”—circulated between the US metropole and the US-occupied tropics?

In what ways were practices of compulsory disease testing and the policing of women in San Diego and San Francisco—between 1908 and 1918—influenced by discourses and practices of professional networks of health officials in US-occupied tropical territories? Responding to this inquiry, I trace the evolution of US practices of quarantining allegedly diseased women in San Diego, San Francisco, and US-occupied Panama, 1908-1918, to integrate California’s cases into a wider history of US health policies entangled with practices in the tropical periphery of the Caribbean. I give specific attention to the ways in which racialized and migrant women were described in the discourse of these policies. I find that: (1) In each case, perceived threats to the health of US military personnel were cited as rationale for the detention of women; racialized and migrant women were described as vectors of contagion. (2) The coalescing of professional networks in San Diego and San Francisco suggests that the period 1908-1918 was a critical moment which influenced health practices beyond California. (3) Health practices in Panama and California were deeply entangled; such discourses and practices of quarantining women provided a template which prefigured the later systematization of US national policies. Like those “vagrant” women subjected to increasingly stringent regulations, networks of US professionals working from the Caribbean to California—who promoted and enforced those policies—were themselves also quite mobile in global circuits.

Describing intellectual and institutional “capillaries of empire,” historian Alfred McCoy proposes that the surveillance of dissidents and related information-collection techniques which developed in the US-occupied Philippines in the first decade of the twentieth century circulated back to the metropole and influenced practice within the US; anthropologist Jolen Martinez describes a similar process in reverse, in which the practices of data collection, records-keeping, and “racial apprehension” of Chicago institutions in the 1890s flowed outward to influence US administrative practices in the Philippines. What other imaginaries of empire, (racial and medical) contagion, and environmental space were circulated in these imperial networks—and did these imaginaries have very material consequences for many people subject to institutions of medicine and incarceration in both metropole and periphery?

“We hea’ a callin’ from Colon, We hea’ a callin’ from Limon,”^[iv] wrote Harlem Renaissance icon and Jamaica-born poet Claude McKay in his “Peasants’ Way O’ Thinkin’” (1912), referencing the migration of his fellow Jamaicans to those Panamanian cities where work could be found in the US-occupied Panama Canal Zone, the destination of over 40,000 West Indian laborers between 1904 and 1914. Transnational migration—of West Indian laborers, US personnel, medical discourse, and administrative practices—enabled the fixing of US authority, yet alarmed US officials. Arriving in January 1904, Dr. Claude C. Pierce was the first US sanitary officer in Panama; writing that year to his superiors, Pierce argued for the immediate establishment of quarantine stations, since “Panama is the gateway from the whole world to the west coast of America.”[v] Colon was the site of one of Panama’s primary venereal disease hospitals, where Pierce was superintendent in 1913 and where women—mostly Afro-Caribbean—suspected of participating in sex work were detained and subjected to weekly inspections. In 1919, Dr. E.M. Blatchford reported that “ninety per cent of the patrons of the prostitutes of Panama and Colon have been American soldiers, sailors, and civilians.”^[vi] The journal in which Blatchford relayed these statistics—Social Hygiene—hints at the scale of the influence of the social hygiene movement, whose advocacy for national policies prohibiting sex work culminated in the America Plan, the Chamberlain-Kahn Act’s legal authorization of the mass arrest, compulsory testing, and detention—in the US domestic mainland and during the First World War alone—of thousands of women suspected of disease infection. The act was passed partially in response to a 1917 report of US military personnel patronage of sex workers at the edges of training camps at the US-Mexico border, a report drafted by Raymond Fosdick—appointed by John D. Rockefeller as leader of the Bureau of Social Hygiene.

Matters of tropical periphery and urban metropole thus coalesced, an entanglement facilitated by professional networks. After his stint in Colon, Pierce would later lead hygiene campaigns in San Francisco and oversee quarantines as a top US Public Health Service official whose practices in El Paso represented a systematization of border control policies. Migrant women in El Paso, however, resisted this treatment on the very first day of Pierce’s “iron-clad” new policies; reporting on the “feminine outbreak” which launched the Bath Riots of March 1917, the El Paso Times narrated how two hundred “[w]omen ringleaders … hurled stones” in protest of their compulsory treatment.^[vii]

But how’d we get here? Let’s follow the trans-border routes of circulation which brought Pierce—a US doctor stationed in Panama—to the world’ fairs of California and the border stations of El Paso.

1: Prelude in the Tropics

Anxieties about the US military and the maintinence of borders are implicated early and often in discourses of disease policy and sex work. In the Philippines at the turn of the twentieth century, US soldiers diagnosed with sexually-transmitted diseases were given the crude nickname “Rough Riders” by their compatriots.[viii] The name was widely known at that time, having been ascribed to Teddy Roosevelt’s pseudo-paramilitary cavalry which in 1898 had participated in the invasion of Cuba. Thus, despite spatial distance, US operations in the Philippines and the Caribbean were acknowledged as discursively—indeed, explicitly—linked. “If the civilization of the white race is to survive,” pronounced Charles Eliot, president of Harvard University and honorary president of the American Social Hygiene Association (ASHA), in 1916, “it must be saved through the diffusion and adoption of sound policies in regard to social hygiene, carried enthusiastically and persistently into action.”^[ix] Following the initial US occupation of Manila in August 1898 and the US Army’s founding of the Bureau of Municipal Inspection in November 1898, anxieties about transnational mobility and the maintenance of racial boundaries were evident in disease discourse. In Theory and Practice of Military Hygiene (1901), a textbook circulated among US military personnel, author Capt. Edward Munson of the Army Medical Department proclaimed that “altered conditions” and “changed moral environment” instigated by “the recent acquisition of foreign territory and contact with alien races” had made sexually-transmitted disease inspection of paramount importance.^[x],[xi] In May 1901, General MacArthur’s General Orders No. 101 mandated that US soldiers in the Philippines submit to regular venereal disease inspection, while “all women found infected” were to be “placed under surveillance.”^[xii] To that end, in 1903, Dr. M.A. De Laney provided the names and locations of sex workers to the local municipal presidente and was “assured” that municipal authorities “would order the police to drive all infected women from the town.”^[xiii] Regular inspections were formalized more widely by the War Department’s General Orders No. 17 of May 1912, which extended rules governing troops in the Philippines to the US Army in its entirety, heralding a turn toward stringent policing which would eventually be enshrined in US municipal and federal law.

2: “Sanitizing” San Diego

Authorities in San Diego were initially ambivalent about brothels in Stingaree, the city’s twelve-block red-light district; the city’s increased policing of sex workers occurred in tandem with urban development accommodating a celebration of the Panama Canal’s completion, eventually hosted between January 1915 and January 1917. Linking concern with vice directly to the planning of the event in a 1908 statement, Dr. Francis Mead, a chief health officer of San Diego, instructed plumbing inspectors to condemn buildings in the red-light district: “[T]he town folks are talking about a World’s Fair to be held here, and want to make the town attractive … The Board of Health wants the Stingaree district cleaned up.”^[xiv] Evidencing perceived threats from migrants, “[a]s San Diego prepared to host the Panama-California Exposition,” social hygiene groups “urged … the safeguarding of ‘feminine virtue’” to “confront the interconnected problems of … immigration, and the sex trade.”[xv] On the single day of November 10, 1912, San Diego police arrested 138 women for prostitution, with a city prosecutor recalling women “lined up in rows of five or ten” before a judge.[xvi] San Diego jail rosters indicated 92 prostitution-related arrets in 1913, while “[t]hat number more than doubled in 1914,” with a “high mark of 420 arrests” in 1918—a number not including those detained by US military police under the America Plan.[xvii]

Municipal administrators saw the issue of regulating sex work as essential to the US military. In 1917, Bascom Johnson, a director of the Army Sanitary Corps and prominent contributor to the Journal of Social Hygiene, wrote that San Diego was bound to “fulfill its obligations to the boys in khaki”^[xviii] by curtailing sex work. Johnson had cut his teeth as a law officer for the Federal Indian Bureau before becoming a leader of the social hygiene movement in 1913, after which he would help administer disease inspection at a national scale. The language of local print media suggests that the quelling of disease by policing “negro”[xix] women was entangled with anxieties about the mobility of racialized peoples; many Black women had recently moved to San Diego from the American South. A “disturbing” statistic made it “quite clear that black women were more likely to be arrested”; in 1920, despite comprising 1.3% of women aged 15-44 years, Black women made up 17% of prostitution arrests and 24% of vagrancy arrests.[xx] With invocations of vagrancy further reflecting a concern with mobility, a superintendent of public health in San Diego, Dr. A.E. Banks, penned in Social Hygiene an open letter to the California State Board of Health in 1917, detailing steps that California cities should take to curtail vice, including first reporting venereal disease among military personnel; targeting the “worse element” of sex workers with “prompt arrest under vagrancy charges … anything but lenient”; guidelines for “detection of diseased women”; and the forced quarantine of those women.^[xxi],[xxii] In 1913, partially in response to intense social hygiene lobbying, the California legislature passed the Red Light Abatement Act, which allowed for statewide police evictions of “disorderly house[s]” which harbored women of “ill repute,” employing public nuisance laws against alleged sex workers.^[xxiii]

3: “Progress” at the Presidio

As in San Diego, authorities in San Francisco advanced an overhaul of urban hygiene in anticipation of a major Panama-themed fair. In 1915, at the same time that San Diego was hosting its exhibition, San Francisco hosted the largest of the official celebrations of the Canal’s completion—the Panama-Pacific International Exposition (PPIE), attended by 18 million visitors. The event, hosting over 900 conferences, earned the city the moniker “University of the World,” while the PPIE’s “official history” guidebook heralded the event as “the greatest period of medical conventions in the world’s history.”^[xxiv],[xxv] Curators of the PPIE awarded a bronze medal to the Race Betterment exhibit on “race degeneration,”[xxvi] and a gold medal to an exhibit produced by the American Social Hygiene Association. Surviving photography of the latter exhibit held at California State Library depicts a panel labeled “PROGRESS,” with text encouraging moves to “suppress prostitution”; the subsequent panel in the exhibit, labeled “VENEREAL DISEASE,” described the importance of protecting “fathers and mothers of the race” from disease.^[xxvii]

Discourses and practices articulated in California from 1908 to 1918 would have implications beyond the California coast. Historian Alexandra Minna Stern emphasizes that the “colonial circuits that linked public health and sanitation in Cuba, the Philippines, and the Canal Zone to the PPIE [in San Francisco] were busy highways” well-traveled “perhaps by no one more than Claude C. Pierce.”^[xxviii] After serving as superintendent of the Colon Hospital in Panama, Pierce was appointed as chief sanitary officer of San Francisco’s PPIE event grounds in 1915; immediately afterward (December 1915), he was ordered to investigate typhus at the US-Mexico border, where he would become “instrumental in shaping the racial and sexual order of the American West.”^[xxix] Arriving in El Paso in March 1916, Pierce was “at the apex of the [US Public Health Service] hierarchy” and “entrusted with overseeing the modernization and enlargement of the disinfection plant” at the border crossing, where he “announced that the time had come for an ‘iron-clad quarantine’ against every body entering the United States,” an impulse which Stern locates partially in the fact that “the El Paso-Juarez region was a focal point of … popular mobilization” at the time of the Mexican Revolution.^[xxx],[xxxi] Also in spring 1917, General Pershing was operating out of El Paso, where he was hunting Pancho Villa. On the morning of the implementation of Pierce’s strict new protocols in March 1917, local press described the Bath Riots as a demonstration originally prompted by an “auburn-haired Amazon” and two hundred other “Juarez women, incensed at the American quarantine regulations,” when“[w]omen ringleaders … hurled stones” during a “feminine outbreak” at Santa Fe Street Bridge;^[xxxii] Stern narrates how the “women were irate at the prospect of being forced into kerosene showers and had heard rumors that American soldiers were ‘photographing the women while bathing.’”^[xxxiii] Professional networks—through key figures like Pierce—carried practices and beliefs from venereal disease hospitals in Panama, to San Francisco’s conventions, and ultimately to US-Mexico border control stations. Stern proposes that such quarantine policies in El Paso “became the status quo on the border,” corroborating the reach of Pierce’s professional network. Border outposts in Texas—in this case, military training camps—were also the sites where Bureau of Social Hygiene leader Fosdick penned the 1917 report which popularized support for the Chamberlain-Kahn Act. In fact, Fosdick, after his appointment to lead the Bureau of Social Hygiene by Rockefeller, took a leave to work for the War Department to lead the anti-prostitution campaign and was appointed as a civilian aide to General Pershing in 1918. The institutionalization of quarantine stations at El Paso was followed the 1924 founding of the US Border Patrol and the 1924 passage of the federal Immigration Act.

4: Prophylaxis in Panama and Beyond

In 1915, while both San Diego and San Francisco hosted Panama-themed exhibitions, Dr. Woods Hutchinson, president-elect of the American Academy of Medicine, spoke in San Francisco. Woods delivered a keynote address titled “The Physician as Pioneer,” in which he “told his audience that for progress to proceed apace in the current ‘age of the insect,’ the stringent sanitary regime” of prophylactic stations and home inspections “imposed and perfected” by US Army officials “in the Canal Zone was the sine qua non.”^[xxxiv] The Panamanian sanitary regime so celebrated by doctors in California had been the brainchild of Pierce’s former superior officer, US Army surgeon William C. Gorgas, who first honed his practices as the leading sanitary officer in US-occupied Cuba (1898-1902) before acting as Chief Sanitary Officer in Panama (1904-1914), a tenure he celebrated at the annual session of the American Medical Association in 1909 in his dramatically titled president’s address, “The conquest of the tropics for the white race.”^[xxxv] The house-to-house inspection of Panamanian dwellings for compliance with these anti-mosquito regulations paralleled the inspection of people themselves in the US-Panama cooperative health administration’s detention of women. In Neel Ahuja’s analysis, “[t]he spatial imaginary established” in these campaigns “influenced cartographies of racial risk attributed to sex in Panama” and was “also common to wartime representation of transborder contagion.”^[xxxvi] US administrators’ awareness of “growing contact” between its personnel “and a transnational population of Panamanians, then, led to fears over miscegenation and vice,” as “Army health campaigns of the time stressed the international and multiracial character of sex workers in Panama.”^[xxxvii]
In 1918, “during the mandatory weekly inspections of prostitutes”[xxxviii] at the Colon hospital where Pierce had been superintendent five years prior, physicians “opened the abdominal cavities of sixty women”[xxxix] and “wherever practicable hysterectomy was performed”[xl]; in Panama, “US-operated hospitals detained 1,057 women for treatment in 1919 alone.”[xli] Media produced by the US Navy—whose purview united Panama with the ports of California—reinforced perceived connections between diseased women and threats to the nation. In a US Government Publishing Office (GPO) poster from 1944, a seductively lounging semi-anthropomorphic mosquito with lipstick and blushing cheeks leers invitingly at the viewer, adjacent to the text: “DON’T GO TO BED WITH A MALARIA MOSQUITO – SLEEP UNDER A NET!”^[xlii] The US GPO’s name for the dangerous and highly-gendered character represented here—Annie O. Pheles—is wordplay in reference to the notorious malaria-carrying Anopheles mosquito.

This anxiety extended to other US territories, metropolitan and otherwise. Beginning in July 1918, US Attorney General Kern launched a campaign to “exterminate prostitution”[xliii] on the US-occupied island of Puerto Rico, “based on plans from Bascom Jonhson”;[xliv] within six months, “courts convicted 824 women of practicing prostitution,” averaging eight-month jail sentences. This was the same mass incarceration which prompted Red Cross director Payne to suggest that such “confinement of so many women at one time” was perhaps “unparalleled.”[xlv] Concern with military stability was directly cited by Payne, who claimed that “Porto Rico [sic] was cleaned up to protect a camp of … soldiers … For every fifteen soldiers one woman was sent to jail for a long period.”[xlvi]^.[xlvii] Corroborating connections between California and the Caribbean via professional networks, Johnson was the same official who had worked as a law officer for the Federal Indian Bureau before joining the social hygiene movement; he was the one, you’ll recall, who used that colorful language, encouraging San Diego to move against sex workers in 1917 on behalf of the khaki-clad US military. In 1918, Johnson was the Commission on Training Camp Activities (CTCA) Director of Law Enforcement, the same government body which would arrest and detain US women under the Chamberlain-Kahn Act, which policed women in “moral zones” within a five-mile radius of military bases. In a 1918 article, Lieut. George Anderson, director of the CTCA’s Section on Vice and Liquor Control, celebrated both Raymond Fosdick’s work at the US-Mexico border and Johnson’s role in California: “[A] small group of men specially trained in the social hygiene movement were operating … under the direct supervision of Mr. Raymond B Fosdick … Thus was evolved the organization of the Law Enforcement Division. The appointment as its director of Bascom Johnson … who scored notable successes … particularly in the wiping out of the notorious ‘Barbary Coast’ of San … a particularly happy and efficient one.”[xlviii] The “Barbary Coast” here, which Johnson cleansed, is the colloquial name for San Francisco’s red-light district.

This nugget of information hints at a lot, and bolsters our framing of the geographical scope of these professional networks.

Fosdick led anti-“vice” campaigns in New York City, befriended John D. Rockefeller as leader of the Bureau of Social Hygiene, raised the alarm about US-Mexico border camps, and worked for General Pershing.

Johnson’s reach extended even further. Johnson influenced policy for “the boys in khaki” in San Diego, “the Barbary Coast” of San Francisco, law enforcement at the US-Mexico border, and quarantine policies in the tropical Caribbean alike; policy in the tropics and the metropole were directly, intimately linked.

Conclusion

Part of the impetus for the migration of thousands of Afro-Caribbean laborers to Panama—wbo had heard that call to Colon as celebrated in McKay’s poetry—was the devastation of the 6.2-magnitude Kingston earthquake of 1907, which shocked the Jamaican capital with what the US Geological Survey has described as one of the most destructive earthquakes in recorded history. Coincidentally, a motivating factor in San Francisco’s sanitation campaigns in anticipation of the Panama-Pacific International Exposition was a felt imperative to remake the city in the aftermath of the devastating 1906 earthquake; San Francisco, like San Diego, used these urban renewal campaigns in anticipation of a Panama-themed exhibition to enforce new regulations curtailing sex work, inspired by social hygienist discourse. The US military’s turn away from tolerance in the Philippines between 1899 and 1910 and the remaking of California’s legal and urban environments leading up to the 1915 Panama-themed exhibitions—each influenced by social hygienist advocates—are both cases which predate the US federal legislature’s 1918 act. If US soldiers in the Philippines described themselves in terms originally referring to Cuba—“Rough Riders”—then the discursive linking of Pacific and Caribbean archipelagos is reinforced by other connections. Cuba, after all, was where Gorgas originally refined disease control routines before transplanting them to Panama. These metropole-to-periphery-and-back routes and circulations reflect the fin de siecle’s significances as a culminating moment of global empire-building, and also suggest the utility of both transnational scales and geographical perspectives in contemplating seemingly “local” histories.

Public health officials in the US seemed to perceive the caricatured visage of the subversive Annie O. Pheles in the faces of those racialized, poor, and migrant women relegated to detention and compulsory testing across the US. Discourses and practices of quarantining women in San Diego and San Francisco from 1908 to 1918 were harbingers of national policy. Such detention of women was entangled with concerns of US military stability, the maintenance of US borders, and anxieties about race and the transnational mobility of migrants. The America Plan of the Chamberlain-Kahn Act was nominally implemented “for the protection of the military”; predating its 1918 passage, San Diego’s arrests of “vagrant” sex workers and the clearing of its red-light districts were pursued in part to account for California’s “obligations to the boys in khaki.” Policies of quarantine in Panama—where the majority of those quarantined were Black women—provided an aspirational template for officials in California; Pierce’s tenure as sanitary officer in Panama was followed by his oversight of similar projects in San Francisco and El Paso, the latter of which contributed to the systematization of US border control policies. US administrative officials were themselves also highly mobile in global circuits. Dr. Goodman, “architect of the anti-venereal efforts for the military in Puerto Rico,” had “described the America Plan as a ‘test-tube experiment’” for health administration of the tropics.[xlix]^,[l]

Beliefs regarding women as vectors of contagion were shared by US health officials at tropical frontiers, border stations, and US urban hubs alike; these sites were linked materially and imaginatively by the circulation of US personnel and administrative practices. These consistencies suggest that California’s local cases, 1908-1918, can be understood as part of a broader history of US public health as developed in the tropical periphery. Future scholarship may further clarify the potency of professional networks in systematizing intellectual frameworks and material practice at the peripheries of global power.

[i] Eva Payne, Empire of Purity: The History of Americans’ Global War on Prostitution (Princeton University Press, 2024), 154.

[ii] Gavin Payne, “The Vice Problem in Puerto Rico,” Journal of Social Hygiene 5, no. 2 (April 1919): 240.

[iii] Payne, Empire of Purity, 154.

[iv] Claude McKay, “Peasants’ Way O’ Thinkin’,” in Complete Poems, ed. William J. Maxwell, (University of Illinois Press), 11.

[v] James C. Perry, “Colon,” in Public Health Reports (US Government Publishing Office, 1904): 351-6.

[vi] E.M. Blatchford, “Venereal Disease in the Canal Zone,” Social Hygiene 5 (1919).

[vii] “Auburn-Haired Amazon at Santa Fe Bridge Leads Feminine Outbreak,” El Paso Times, January 29, 1917.

[viii] Paul Kramer, “The Military-Sexual Complex: Prostitution, Disease and the Boundaries of Empire during the Philippine-American War,” The Asia-Pacific Journal 9, no. 30 (2011).

[ix] Charles E. Eliot and William F. Snow, “1900-1915 Progress,” Social Hygiene 2 (1916): 37-48.

[x] Kramer, 2011.

[xi] Edward Lyman Munson, The Theory and Practice of Military Hygiene (William Wood and Co., 1901), 835-7.

[xii] General Orders No. 101, May 21, 1901, RG350/2039/26 (Box 246), NARA CP.

[xiii] M. A. De Laney to Chief Surgeon, February 18, 1903, RG 112/26/88939/B (Box 614), NARA DC.

[xiv] Elizabeth C. MacPhail, “Shady Ladies in the ‘Stingaree District’ When the Red Lights Went Out in San Diego,” Journal of San Diego History 20, no. 2 I1974): 2-28.

[xv] Eric C. Cimino, “Safeguarding the Innocent: Travelers’ Aid at the Panama-California Exposition, 1915,” The Journal of San Diego History 61, no. 3-4 (2015): 456.

[xvi] Clare V. McKanna, Jr. “Prostitutes, Progressives, and Police,” The Journal of San Diego History 35, no. 1 (1989).

[xvii] McKanna, Jr., “Prostitutes, Progressives, and Police.”

[xviii] Bascom Johnson, “What Some Communities of the West and Southwest Have Done for the Protection of the Morals and Health of Soldiers and Sailors,” Social Hygiene 3 (1916-17): 487-503.

[xix] Christina Carney, “”The Worse Element”: Black Sex Workers, White Slavery, and Sexual Policing in San Diego,” Radical History Review 149 (2024): 133-151.

[xx] McKanna, Jr., “Prostitutes, Progressives, and Police.”

[xxi] “A State Health Department and a City Department Prepare for Action,” Social Hygiene 3, no. 4 (1917), 447-48.

[xxii] Carney, “”The Worse Element.””

[xxiii] California Penal Code §§ 11225–11235.

[xxiv] Frank Morton Todd, The Story of the Exposition: Being the Official History of the International Celebration Held at San Francisco in 1915 to Commemorate the Discovery of the Pacific Ocean and the Construction of the Panama Canal 5 (G.P. Putnam’s Sons, 1921):16.

[xxv] Alexandra Minna Stern, Eugenic Nation: Faults and Frontiers of Better Breeding in America (University of California Press, 2015), 61.

[xxvi] Stern, Eugenic Nation, 67.

[xxvii] Carinell-Vincent Co., 1915.

[xxviii] Stern, Eugenic Nation, 61.

[xxix] Stern, Eugenic Nation, 73.

[xxx] Claude C. Pierce, “Mexican Border Quarantine,” January 23, 1917, File 1248, Central File 1897-1923, El Paso, USPHS, RG90, NARA.

[xxxi] Stern, Eugenic Nation, 78.

[xxxii] “Auburn-Haired Amazon at Santa Fe Bridge Leads Feminine Outbreak,” 1917.

[xxxiii] Stern, Eugenic Nation, 79.

[xxxiv] Stern, Eugenic Nation, 60.

[xxxv] William C. Gorgas, “The conquest of the tropics for the white race: president’s address at the sixtieth annual session of the American Medical Association, at Atlantic City, June 9, 1909,” Journal of the American Medical Association 52, no. 25 (1909): 1967-1969.

[xxxvi] Ahuja, Bioinsecurities: Disease Interventions, Empire, and the Government of Species (Duke University Press, 2016), 76.

[xxxvii] Ahuja, Bioinsecurities, 85.

[xxxviii] Payne, Empire of Purity, 165.

[xxxix] Payne, Empire of Purity, 165.

[xl] McCormack, Report of the Health Department of the Panama Canal for the Calendar Year 1918 (Panama Canal Press, 1919), 35.

[xli] Payne, Empire of Purity, 167.

[xlii] Don’t go to bed with a malaria mosquito, 1944, United States Government Printing Office, multicolor poster, Images from the History of Medicine (IHM), National Library of Medicine Digital Collections. https://collections.nlm.nih.gov/catalog/nlm:nlmuid-101454783-img

[xliii] Kern, “Special Report,” 51.

[xliv] Payne, Empire of Purity, 154.

[xlv] Payne, “The Vice Problem in Puerto Rico,” 240.

[xlvi] Payne, “The Vice Problem in Puerto Rico,” 240.

[xlvii] Payne, Empire of Purity, 155.

[xlviii] George J. Anderson, “Making the Camps Safe for the Army,” Annals of the American Academy of Political and Social Science 79 (1918): 143-151.

[xlix] Payne, Empire of Purity, 155.

[l] Herman Goodman, “Prostitution and Community Syphilis,” American Journal of Public Health 9, no. 7 (July 1, 1919): 519.

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