Dean C. Worcester.

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was high, and paid the penalty for their ignorance with their lives.

The average Spaniard was a firm believer in the noxiousness of night
air, which he said produced _paludismo_. [499] Most Filipinos were
afraid of an imaginary spirit, devil or mythical creature known as
_asuáng_, and closed their windows and doors after dark as a protection
against it. Thus it came about that in a country where fresh air is
especially necessary at night no one got it.

Tuberculosis was dreadfully common, and its victims were conveying
it to others without let or hindrance.

A distressingly large percentage of native-born infants died before
reaching one year of age on account of infection at birth, insufficient
clothing, or improper food. I have many times seen a native mother
thrust boiled rice into the mouth of a child only a few days old,
and I have seen babies taught to smoke tobacco before they could walk.

Before our party left the islands in 1888, cholera had broken out
at a remote and isolated place. A little later it spread over a
considerable part of the archipelago. On my return in 1890 I heard
the most shocking stories of what had occurred. Victims of this
disease were regarded with such fear and horror by their friends
that they were not infrequently carried out while in a state of
coma, and buried alive. It became necessary to issue orders to have
shelters prepared in cemeteries under which bodies were required to
be deposited and left for a certain number of hours before burial,
in order to prevent this result.

In Siquijor an unfortunate, carried to the cemetery after he had
lost consciousness, came to himself, crawled out from under a mass
of corpses which had been piled on top of him, got up and walked
home. When he entered his house, his assembled friends and relatives
vacated it through the windows, believing him to be his own ghost. They
did not return until morning, when they found him dead on the floor.

I heard a well-authenticated story of a case in which all the members
of a family died except a creeping infant who subsisted for some time
by sucking a breeding sow which was being kept in the kitchen.

During the great cholera epidemic in 1882 it is said that the
approaches to the Manila cemeteries were blocked with vehicles of
every description loaded with corpses, and that the stench from
unburied bodies in the San Lazaro district was so dreadful that one
could hardly go through it.

Beri-beri was common among the occupants of jails, lighthouses and
other government institutions, as well as in certain garrisoned towns
like Balabac.

In 1892 I found the wife of a very dear Spanish friend dying from
an ailment which in the United States could have been promptly and
certainly remedied by a surgical operation. I begged him to take her
to Manila, telling him of the ease with which any fairly good surgeon
would relieve her, and promising to interest myself in her case on
my arrival there. To my utter amazement I found that there was not a
surgeon in the Philippine Islands who would venture to open the human
abdomen. The one man who had sometimes done this in Spain stated that
it would be impossible for him to undertake it in Manila, on account
of the lack of a suitable operating room, of instruments and of the
necessary anaesthetist and other professional assistants. In fact, at
the time of the American occupation there was not a modern operating
room, much less a modern hospital, in the Philippines. Thousands upon
thousands of people were perishing needlessly every year for the lack
of surgical intervention. A common procedure in dealing with wounds
was to cover them with poultices of chewed tobacco, ashes, and leaves.

In many provinces the people were without medical assistance of
any sort, and fell into the hands of native quacks who were little,
if at all, better than witch doctors.

The most fantastic views were entertained relative to the causation
of disease. In some towns it was vigorously asserted that after a
peculiar looking black dog ran down the street cholera appeared. In
other places cholera was generally ascribed to the poisoning of wells
by Spaniards or foreigners.

Cemeteries were not infrequently situated in the very midst of towns,
or near the local supplies of drinking water. Conditions within
their walls were often shocking from an aesthetic view point. As the
area available for burials was limited, and the graves were usually
unmarked, parts of decomposed bodies were constantly being dug up. It
was the custom to throw such remains about the foot of the cross at
the centre of the cemetery.

Military sanitation was also very bad. I was at Zamboanga when
the wreck of General Weyler's expedition to Lake Lanoa began to
return. There had been no adequate provision for the medical care of
the force in the field, and the condition of many of the soldiers was
pitiable in the extreme. Disabled men were brought in by the shipload,
and the hospitals at Zamboanga, Isabela de Basilan and Joló were soon
filled to overflowing.

The lack of adequate sanitary measures was equally in evidence in
dealing with cattle disease. Rinderpest, a highly contagious and
very destructive disease of horned cattle, was introduced in 1888 and
spread like fire in prairie grass. No real effort was made to check
it prior to the American occupation, and it caused enormous losses,
both directly by killing large numbers of beef cattle and indirectly
by depriving farmers of draft animals.

When I first visited the islands every member of our party fell
ill within a few weeks. All of us suffered intensely from tropical
ulcers. Two had malaria; one had dysentery; one, acute inflammation
of the liver, possibly of amoebic origin; and so on to the end of
the chapter. I myself got so loaded up with malaria in Mindoro that
it took me fifteen years to get rid of it.

Fortunately the American army of occupation brought with it numerous
competent physicians and surgeons, and abundant hospital equipment
and supplies, for the soldiers promptly contracted about all the
different ailments to be acquired in the islands.

When I arrived in Manila on the 5th of March, 1899, I found that a
great army hospital, called the "First Reserve," had been established
in the old rice market. There was another sizable one on the Bagumbayan
drive. A third occupied a large building belonging to French sisters
of charity which was ordinarily used for school purposes.

In immediate connection with the First Reserve Hospital was a tent
hospital where sick and wounded Insurgents were being given the best
of care.

Field hospitals were promptly established as the troops moved out
from Manila, and in connection with many of these Filipinos were given
much needed medical and surgical help. The recipients of such kindly
treatment were, however, prohibited by Insurgent officers from telling
others of their experiences lest the hatred of Americans diminish as
a result.

Smallpox had broken out among the Spanish soldiers in the walled
city and was spreading badly when my friend, Major Frank S. Bourns
of the army medical corps, was given the task of eradicating it,
which he promptly accomplished. A little later the use of the Santa
Ana church as a smallpox hospital was authorized, and sick Filipinos
were carefully tended there.

The army promptly set about cleaning up Manila and waging war
upon the more serious ailments which threatened the health of the
soldiers and that of the public. The work was at the outset put under
the direction of Major Edie, a very capable and efficient medical
officer. Subsequently it was turned over to Major Bourns, who, on
account of his intimate knowledge of Spanish, and his wide acquaintance
with the Filipinos, was able to carry out many much-needed reforms,
and in doing so aroused a minimum of public antagonism.

Upon the establishment of civil government Governor Taft was very
desirous of retaining Major Bourns's services, but this did not prove
practicable, as he desired to give up government work and engage in
private business.

There was promptly created an efficient board of health made up of men
of recognized ability and large practical experience. Its chairman was
Major Louis M. Maus, commissioner of public health. The other members
were Mr. H. D. Osgood, sanitary engineer; Dr. Franklin H. Meacham,
chief sanitary inspector; Dr. Paul C. Freer, superintendent of
government laboratories; and Dr. Manuel Gomez, secretary.

This board was promptly put upon its mettle. It had inherited from
the army an incipient epidemic of bubonic plague in Manila, and
the disease soon spread to Cavite and also to Cebú, then the second
port of the Philippines in commercial importance. It also appeared in
several provincial towns near Cavite. An effective campaign against it,
inaugurated at this time, was never abandoned until it was completely
eradicated in 1906, - a noteworthy result to achieve in a country like
the Philippines.

On March 21, 1902, I was advised that two patients at San Juan de
Dios hospital were developing symptoms of Asiatic cholera, and on the
following day a positive laboratory diagnosis was made. Other cases
followed in quick succession, and we soon found ourselves facing a
virulent epidemic of this highly dangerous disease. At the outset
the mortality was practically 100 per cent. Unfortunately, there was
no one connected with the medical service of the islands who had had
practical experience in dealing with cholera, and we had to get this
as we went along.

At the time of the outbreak, Governor Taft was in the United States,
Acting Governor Wright was in Leyte, the secretary of finance and
justice was in Japan, and there were present in Manila only the
secretary of public instruction and the secretary of the interior. As
the executive head of the government was absent, and there was no
quorum of the legislative body, I of necessity arrogated to myself
powers which I did not lawfully possess, appointing employees and
incurring expenses without the usual formalities.

On the morning of March 22 I informed General Chaffee that four cases
of cholera had occurred in Manila, and requested that an adequate
military force be despatched to the valley of the Mariquina River to
protect the city water supply from possible contamination.

This request was promptly acceded to, and the guard thereafter
maintained proved adequate to prevent infection of the city water,
although there are three towns on the river above the intake, and it
was the custom of their people to bathe and wash their clothing in
this stream. Many of the filthy surface wells of the city were filled
as rapidly as possible, and those that could not be filled were closed.

The people, entirely unaccustomed as they were to any sanitary
restrictions, believing that the disease was not cholera, and firm in
their conviction that they had a right to do whatever they liked so
long as they kept on their own premises, bitterly resented the burning
or disinfection of their houses and effects, and the restriction of
their liberty to go and come as they pleased, and in spite of the
fact that the number of cases was kept down in a manner never before
dreamed of at Manila, there arose an increasingly bitter feeling of
hostility toward the work of the board of health. In fact, the very
success of the campaign proved an obstacle, and we were assured that
the disease could not be cholera, as, if it were, there would be a
thousand deaths a day!

An educational campaign was immediately begun, and simple
directions for avoiding infection were published and scattered
broadcast. Distilled water was furnished gratis to all who would drink
it, stations for its distribution being established through the city
and supplemented by large water wagons driven through the streets. The
sale of foods likely to convey the disease was prohibited. Large
numbers of emergency sanitary inspectors were immediately appointed,
and every effort was made to detect all cases as soon as possible. A
land quarantine was established around the city, to protect the
provinces.

In anticipation of a possible extensive outbreak of contagious disease
a detention camp capable of accommodating some twenty-five hundred
people had been established previously on the San Lazaro grounds, and
to this place were taken the cholera "contacts." A cholera hospital
was opened near this camp, and the stricken were removed to it from
their homes as speedily as possible, the buildings which they had
occupied being thoroughly disinfected, or burned if disinfection
was impracticable.

The bodies of the dead were at the outset either buried in hermetically
sealed coffins or cremated. When the detention camp and hospital at
San Lazaro threatened to become crowded, a second camp and hospital
were established at Santa Mesa. At this latter place both "contacts"
and the sick were obliged to live in tents.

The Spanish residents were allowed to establish a private cholera
hospital in a large and well-ventilated _convento_ on Calle Herran. As
the number of sick Spaniards was nothing like sufficient to fill this
building, they were asked to turn over the unoccupied space in it to
the board of health, which they most generously did.

In response to popular clamour a hospital under strictly Filipino
management was opened in a nipa building in Tondo. Interest in it
soon flagged, and the government found itself with this institution
on its hands.

The epidemic came soon after the close of a long-continued war,
and there were at that time in Manila not a few evil-intentioned
persons, both foreign and native, who welcomed every opportunity
to make trouble. The difficulties arising from the claim advanced
by a number of reputable but ignorant medical men that the disease
was not cholera at all were sufficiently great. They were enormously
increased by false and malicious stories to the effect that "contacts"
were killed at the detention camp; that patients on arrival at the
cholera hospital were given a drink of poisoned _vino_ [500] and
instantly dropped dead; that the distilled water distributed free of
charge was poisoned, and that the Americans were poisoning the wells.

The necessary use of strychnine as a heart stimulant at the cholera
hospital was made the basis for a story that the sick were being
poisoned with this drug.

These silly tales were widely circulated and quite generally believed,
and as a result of the fear thus engendered, and of the desire on
the part of relatives and neighbours of stricken persons to escape
disinfection and quarantine, strong efforts were often made to conceal
the sick and the dead, and when this was not possible the "contacts"
usually ran away. There were not wanting instances of the driving of
cholera victims into the streets.

In spite of the generally hostile attitude of the public and some
grave mistakes in policy, the measures adopted sufficed at the outset
to hold the disease in check to an extent which surprised even the
health officers themselves.

On May 15 there began a rapid and quite steady decline in the number
of cases.

In June, however, it increased. During July it grew steadily larger,
and on the 25th of that month there were ninety-one cases, the
largest number which has ever occurred in Manila on any day since
the American occupation.

Throughout the early months of the epidemic Major Maus had laboured
unceasingly to check it, displaying an energy and an indifference to
fatigue and personal discomfort which were highly commendable. The
long-continued strain ultimately began to tell on him severely. On
May 17 orders were received from the Adjutant-General's Office
providing for his relief on or about July 30, and stating that Major
E. C. Carter, of the United States Army Medical Corps, would be
available for detail as commissioner of public health on that date,
if his services were desired. Arrangements were accordingly made to
have Major Carter proceed to the Philippines. Major Maus's resignation
was accepted, effective July 31. Dr. Frank S. Bourns was urged to
take temporary charge of the situation, and consented to do so.

On the 8th of August Major Carter arrived and announced his readiness
to assume his duties, but it was suggested to him that he ought first
to have some time to familiarize himself with them, and Dr. Bourns
was left free to carry out the special work for which he had been
appointed.

This he did with promptness and despatch, the number of cases for
August being but seven hundred twenty as against thirteen hundred
sixty-eight for the previous month. On the 8th of September, having
brought the disease under control at Manila, he insisted on resigning
in order to attend to his private affairs, which were suffering from
neglect, and his resignation was reluctantly accepted.

Dr. Bourns's remarkable success in dealing with a very difficult
situation was largely due to his ability to devise measures which,
while thoroughly effective, were less irritating to the public than
were those which had been previously employed.

The policy which he had inaugurated was followed by his successor
with the result that the cases fell to two hundred seventy-five
in September and eighty-eight in October. In November there was
a slight recrudescence, but the disease did not again threaten to
escape control and in February practically disappeared, there being
but two cases during the entire month.

The return of hot, damp weather again produced a slight recrudescence,
and scattering cases continued to occur until March, when the epidemic
of 1902-1904 ended in Manila.

In view of the conditions which then prevailed and of the extreme
risk of a general infection of the city water supply, which, had it
occurred, would doubtless have resulted in the death of a third of
the population, this is a record of which the Bureau of Health may
well be proud.

The effort to prevent the spread of infection by maintaining a land
quarantine around Manila proved entirely ineffective. The disease
promptly appeared in the provinces where the campaign against it
was from the outset in charge of newly appointed Filipino presidents
of provincial boards of health, aided, when practicable, by medical
inspectors from Manila.

Before it was finally checked in Manila there were 5581 cases with
4386 deaths; while in the provinces, in many of which it necessarily
long ran its course practically unhindered, there were 160,671 cases,
with 105,075 deaths.

On the 27th of April, 1904, the Board of Health passed the following
resolutions: -

"Whereas cases of Asiatic cholera have occurred in but three
provincial towns of the Philippine Islands since February 8,
1904; and

"Whereas only one case of Asiatic cholera has been reported as
occurring any place in the Philippine Islands since March 8,
1904; and

"Whereas the city of Manila was declared on March 23 to be
free from the infection of Asiatic cholera; On motion

"_Resolved_, That the islands composing the Philippine
Archipelago are, and are hereby declared to be, free from
the infection of Asiatic cholera; and

"_Be it further resolved_, That the Commissioner of Public
Health be directed to send a copy of these resolutions to the
honourable the Secretary of the Interior, the Municipal Board,
the United States Marine-Hospital Service, and the Collector
of Customs."

As a matter of fact, however, it later proved that cholera was endemic
in certain swampy regions near Manila, and in 1905 we found ourselves
with a new epidemic on our hands.

At the end of the second week, beginning August 23, there had been one
hundred thirty-seven cases, as compared with one hundred twenty-five
for the same period during the epidemic of 1902-1904.

However, the conditions for combating cholera were now far more
favourable than in 1902. Major E. C. Carter had at his own request been
relieved from duty as commissioner of public health, and Dr. Victor
G. Heiser, passed assistant surgeon of the United States public
health and marine hospital service, had been appointed to succeed
him on April 5, 1905. Dr. Heiser was a highly trained officer of one
of the most efficient services which has ever been organized for the
combating of contagious and infectious diseases.

He had under him in the city of Manila a small but thoroughly trained
body of twenty-four medical inspectors, of whom nineteen were Americans
and five Filipinos. Profiting by his previous experience and that of
his predecessors in the Philippine service, he inaugurated a campaign
which practically terminated the epidemic in Manila on February 21,
1906, [501] with a total of two hundred eighty-three cases and two
hundred forty-three deaths.

This brief and decisive campaign reflects the greatest credit on all
concerned with it.

The board of health had one great advantage in the fact that the San
Lazaro contagious disease hospital had been completed. This building,
with its cool wards and attractive surroundings, made it possible to
give cholera victims the best of care.

There was at the outset little or no fear of this hospital, but
apparently this condition of things was not satisfactory to that
small but dangerous element of the Manila public which from the time
of the American occupation has never let pass any opportunity to make
trouble. As usual, the medium of attack was the local press. _Soberanía
Nacional_ published a most extraordinary article painting in vivid
colours the alleged horrors of the San Lazaro Hospital, and stating
among other things that the naked bodies of the dead, tagged and with
their feet tied together, lay about the entrance of that institution. A
more false statement was never published.

Within twenty-four hours after its appearance terror reigned among
the lower classes, and living and dead cholera victims were being
smuggled out of the city to neighbouring towns.

Feeling that the vicious attitude of a certain section of the press
had cost lives enough, I sent the editor of this paper a courteous
invitation to call at my office. He made no response. I then wrote
him, demanding a retraction, and sending him a correct statement to
publish. [502]

He was at first disposed to argue the matter, but finding that I
meant business published the article which I sent to him and made
the following retraction: -

"We are exceedingly glad to affirm in the honour of truth and
justice, that the news given by us on the seventh instant under
the title 'Painful Scenes,' and 'Naked Dead,' is absolutely
absurd, false and unreasonable.

"We have investigated the truth of the said notice, and can
affirm to our readers that it is entirely inaccurate, as in
the courtyard of the said hospital the naked dead that we
have spoken of are not now exposed, nor have they ever been
so exposed.

"The truth is above all things, and to rectify a baseless
piece of news should not be a doubtful action on the part
of the person who gave the news, but rather something in his
favour that the public should appreciate it at its full value.

"To conclude, we must record our gratitude to the Secretary
of the Interior, the Hon. Dean C. Worcester, for the
investigations made in the premises with the purpose of
ascertaining the truth of the alleged facts, and for the
courteous way in which he received us this morning when
interviewed by one of our reporters."

In the provinces the results of the campaign against cholera were
far less satisfactory than in Manila as was to be anticipated, owing
to lack of adequate personnel, but the cases, which numbered 34,238
and deaths which numbered 22,938, were far fewer than during the
previous epidemic.

I shall not attempt here to trace the course of the subsequent
epidemics which have occurred from time to time, but shall content
myself with giving the deaths by years. In 1908, they numbered 18,811;
in 1909, 7306; in 1910, 6940; in 1911, 203. In 1912, there were none,
and thus far in 1913 there have been none. [503]

The superstitious practices which were formerly employed by the
Filipinos to combat this scourge have given way to simple and
inexpensive hygienic measures, and we can safely count on sufficient
coöperation from the people to make an effective campaign possible
when it next appears.

Never shall I forget the strain of the early days of the first
epidemic. Two of my best men, Dr. Meacham and Mr. Mudge, literally



Online LibraryDean C. WorcesterThe Philippines: Past and Present (Volume 1 of 2) → online text (page 32 of 43)