The naval medical service builds eleven hospitals in fourteen years

When the Americans landed, Haiti carried hookworm, tuberculosis, filariasis, leprosy, malignant malaria, yaws, syphilis, smallpox, typhoid and a range of intestinal diseases. Captain Kent Melhorn, the naval officer put in charge of public health, described a country full of filth and sickness in which the few buildings called hospitals were shacks where the sick were brought to die. The Service de Santé Publique built and ran eleven modern hospitals employing 2,222 people, all but two percent of them Haitian, along with 147 rural and travelling clinics. Four further hospitals included the United States naval hospital in the capital, a building that later became the Hotel Oloffson and the setting of Graham Greene's novel The Comedians. In 1929 the service recorded 1,341,596 consultations and treatments, and nearly half of Haiti's 159 physicians worked for it. From 1926 a Rockefeller Foundation grant allowed the occupation to reorganise the national medical school, which with a new dispensers' school let Haiti train doctors and technicians to current standards. The British minister, who praised little else, called the medical work a credit to the profession.

Seabrook's travel narrative The Magic Island, built around the marine sergeant Faustin Wirkus and Seabrook's own fanciful account of Haitian religion, was chosen by the Literary Guild as its featured book for January 1929 and became a national bestseller. Renda uses its reception to show how empire was absorbed at home. Seabrook printed Wirkus's address, and schoolboys in Pennsylvania wrote to the man they understood to be a king, identifying with him as a Pennsylvanian, a working class boy and a Boy Scout, and asking about wild animals and chief exports. The Guild editor Carl Van Doren praised the book as a work in the literature of American empire and told readers they were citizens of an empire reaching far beyond their own continent. Renda notes that in 1929 empire was no longer debated in the United States, it was a point of pride.

The Caco rising began in earnest in 1918, and its cause was the corvée. Peasants were being taken by gendarmes and set to work without pay on roads the occupation wanted for moving troops. Charlemagne Péralte gave the resistance a command and a political programme. Nicholls calls it the most serious armed opposition the American occupation ever faced. Peasant irregulars turned out in thousands across the Central Plateau and the North, and the Gendarmerie, created two years earlier so that marine garrisons would be unnecessary, proved unable to hold the country without marine reinforcement. That failure is the point of the entry. The occupation had built a Haitian force to do its policing, and the first serious test showed the force could not police Haitians who had decided to fight. What followed was a campaign of nearly two years, fought by United States Marines with aircraft, machine guns and paid informers, against people armed mostly with what they could take from the posts they overran.

On the morning of 26 August 1915, a month after the Marines came ashore, Caroline Dagille sent Ludowick Jeudi, aged seventeen or nineteen, out on errands. Her instructions took him toward the corner of Rue du Pont and Rue Oswald Durand in Cap-Haïtien. On that same morning a man named Louie Joseph was being held at the American regional headquarters in the railway station on Rue du Pont, accused of stealing a cow. When the woman who had accused him arrived to make her statement, Joseph saw her and ran. Corporal Fred Parsons drew his pistol and fired twice down a busy street. People scattered after the first shot, apart from a few children crouching at the west end of the bridge. Joseph stopped and gave himself up. Ludowick had just turned the corner. He was hit, ran along Rue Oswald Durand and dropped. Dagille found him sitting in a chair against a wall some two hundred yards off, his body cooling to the temperature of the stone behind him. His parents lived in the country and had trusted her with him.