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worked themselves to death, remaining on duty when they knew that
they were in imminent danger, and in the end laying down their lives
willingly for an alien and hostile people. Such things make one proud
of being an American.

At times the situation was not devoid of amusing features. I had
occasion to visit one of the northern provinces, where the epidemic was
especially severe, in an effort to calm the panic-stricken populace. I
stayed with the governor, a very intelligent Filipino. For obvious
reasons I investigated his domestic arrangements, finding that he
was boiling drinking water, thoroughly cooking all food, and taking
all usual and necessary precautions to prevent infection.

On returning to his house the first evening, after a short absence, I
found the grounds decorated with lighted Japanese lanterns. Supposing
that the proverbial Filipino hospitality had risen above even such
untoward circumstances as those which then existed, I asked the
governor what the entertainment was to be. In evident perplexity he
replied that he had not planned to have any entertainment, and on
my inquiring what the lanterns were for, said he had heard that they
were good to keep away cholera germs!

I have referred to the fact that the civil government inherited a
fairly well developed epidemic of bubonic plague. In 1901 this disease
caused four hundred twenty-seven deaths, in 1902 it caused ten only,
but the demands made on the sanitary force by the cholera epidemic
which began in that year rendered it impossible to give to plague
the attention which it otherwise would have had, with the result
that in 1903 we had one hundred seventy-four deaths. In 1904 there
were seventy-eight; in 1905, forty-three; in 1906, seven; in 1907,
none; and from 1907 until 1912, none. In the latter year the disease
was reintroduced.

Rats become infected with it, and fleas transmit it from them to human
beings. It was probably brought in by pestiferous rodents hidden
inside packages of vegetables, as it appeared in a district where
crates of vegetables are opened in large numbers, and did not appear
in the vicinity of the piers, although shore rats are abundant there,
and if diseased rodents had landed from shipping, would promptly have
become infected, - a thing which did not occur.

At about the same time plague also appeared at Iloilo, where it was
eradicated with a total of nine deaths. At Manila there have been
up to the present time [504] fifty-nine deaths, and scattering cases
continue to occur at considerable intervals.

Had plague not been promptly and effectively combated, it would
unquestionably have spread rapidly, causing untold misery and heavy
property losses.

As I have previously stated, at the time of the American occupation
smallpox was by many people regarded as an almost inevitable ailment
of childhood. It proved necessary to secure the passage of legislation
forbidding the inoculation of human beings with it to prevent misguided
Filipinos from deliberately communicating it to their children, not
because they did not dearly love them, but because they regarded
infection with it as a calamity sure to come sooner or later, and
desired to have it over with once for all.

We have performed more than ten million vaccinations, with the result
that the annual deaths from this disease have decreased from forty
thousand at the outset to seven hundred for the year just ended. There
is now less smallpox in Manila than in Washington.

In the six provinces nearest Manila it was killing, on the average,
six thousand persons annually. For a year after we finished vaccinating
the inhabitants of these provinces it did not cause a death among them;
nor has it since caused such a death except among new-born children
or newly arrived unvaccinated persons.

These extraordinary results have been achieved without the loss of
a life or a limb so far as we know. The vaccine used was prepared by
our own Bureau of Science with extraordinary care, and has proved to
be remarkably pure and active.

We at first endeavoured to have vaccinations performed by local
Filipino health officers, but, after spending large sums without
obtaining satisfactory results, gave up this plan and substituted
therefor a method of procedure by which the work was carried on under
the very immediate supervision of the director of health. We then made
substantial progress. However, under the law as it at present stands,
succeeding annual vaccination, intended to insure the immunization
of children soon after they are born and of unvaccinated persons who
may come into a given territory, are intrusted to the local Filipino
authorities, with the result that in very many cases they are not
attended to. We get elaborate returns showing the number of persons
vaccinated. Then comes an outbreak of smallpox, and on investigation
we learn that the vaccinations so fully reported were made on paper
only! In other words, the continuance of this work, of such vital
importance to the Filipino people, is still directly dependent upon
continued control by American health officers.

Another great problem now in a fair way to final solution is the
eradication of leprosy. At the outset we were told by the church
authorities that there were thirty thousand lepers in the islands. In
1905 we began to isolate and care for all supposed victims of this
disease, only to find that many outcasts believed to be suffering
from it were really afflicted with curable ailments. We were able to
restore a very large number of them to society, to their great joy
and that of their friends.

A few hundreds of true lepers were being humanely cared for in
Manila and elsewhere. Many others had been driven out of the towns
into forests or waste places on the larger islands, where they were
perishing miserably from fever and other diseases. Still others had
been isolated on sand quays, where they were in danger of dying from
thirst during the dry season. Not a few wandered through the towns
at will, spreading the disease broadcast.

All known lepers are now cared for at Culion, a healthful, sanitary
town with good streets, excellent water and sewer systems, many modern
concrete buildings and a first-class hospital.

They are not confined to the limits of the town, but wander at will,
except that they are excluded from the immediate vicinity of the
houses of the officers and employees of the colony.

They may have their little farms, and raise pigs, chickens, vegetables,
etc., if they wish. They may, and do, float about over the waters of
the neighbouring bay in boats or on rafts, and fish to their hearts'
content. They are well fed and well cared for, and their physical
condition improves to a marked degree promptly after their arrival at
the colony. The only hardship which they suffer is that necessarily
involved in separation from their relatives and friends, and this is
mitigated by occasional visits which the latter may make them.

Since we began to isolate lepers, their number has decreased to
approximately three thousand, and with a continuance of the present
policy the disease should soon disappear from the Philippines.

During the period immediately subsequent to the American occupation,
amoebic dysentery wrought sad havoc both among our soldiers and among
civil government officers and employees. Four of my own family of five
had it, and one had it twice, in spite of the fact that we took all
known precautions; and the experience of my family was by no means
exceptional. This disease then annually cost the lives of a large
number of American men and women, and a considerable additional
number went home invalids for life as a result of infection with
it. We seemed to hear almost daily of some new case.

Careful scientific investigation carried on at the bureau of science
taught us the best methods of combating this type of dysentery,
and the proper disposal of human feces, the regulation of methods
used in fertilizing vegetables, improvement in supplies of drinking
water, and other simple, hygienic measures have reduced the deaths
from it among Americans to an almost negligible minimum. Such cases
as occur are almost without exception detected early, and readily
yield to treatment.

The belief that Filipinos do not suffer from this disease has proved
to be without foundation. It kills thousands of them every year. Those
who are willing to adopt the simple precautions which experience has
shown to be necessary may enjoy the large degree of immunity from it
which Americans now have.

The chief cause of amoebic dysentery in the Philippines has undoubtedly
been infected drinking water. From time immemorial the people have
been obtaining their water for drinking purposes from flowing streams,
open springs or shallow surface wells.

The wells were especially dangerous, as it was the common custom
to wash clothing around them so that water containing disease germs
frequently seeped into wells used by whole villages. The results of
such conditions during a cholera epidemic can readily be imagined.

The drinking supplies of many provincial towns have now been radically
improved by the sinking of 853 successful artesian wells.

In many places there has been a resulting reduction of more than
fifty per cent in the annual death rate. Large sums are spent yearly
by the government in drilling additional wells, - a policy which is
warmly approved by the common people. The recent appropriations for
this purpose have been $255,000 for the fiscal year 1912, $60,000
for 1913 and $200,000 for 1914.

When we came to the islands, malaria was killing as many persons
as was smallpox. The mortality caused by it is now being greatly
reduced by giving away annually millions of doses of quinine, and by
draining or spraying with petroleum places where mosquitoes breed,
as well as by teaching the people the importance of sleeping under
mosquito nets and the necessity of keeping patients suffering from
active attacks of malaria where mosquitoes cannot get at them. Only
quinine of established quality is allowed in the market.

The results obtained in combating malaria are often very
striking. Calapan, the capital of Mindoro, was in Spanish days known as
"the white man's grave" on account of the prevalence of "pernicious
fever" there. To-day it is an exceptionally healthy provincial town.

At Iwahig, in Palawan, the Spaniards attempted to conduct a
penal colony. They were compelled to abandon it on account of
pernicious malaria, which caused continued serious mortality when
the American government attempted to establish a similar institution
there. Application of the usual sanitary measures has made it a
healthful place.

Old jails throughout the islands have been rendered sanitary,
or replaced by new ones. The loathsome skin diseases from which
prisoners formerly suffered have in consequence disappeared. The
practical results obtained in Bilibid, the insular penitentiary, are
worthy of special note. The annual death rate at this institution was
78.25 per thousand for the calendar year 1904. It increased steadily
each month from January, 1904, to September, 1905, when it reached
its maximum, deaths occurring at the rate of 241.15 per thousand per
year. At this time the director of health was given charge of the
sanitation of this prison.

By remedying overcrowding, improving drainage, installing sewers and
regulating diet along scientific lines, the rate was reduced in six
months to 70 per 1000, and there it stuck.

A systematic examination of the stools of prisoners was then
made. Eighty-four per cent were found to be afflicted with at least
one intestinal parasite. Fifty per cent had two or more, and twenty
per cent had three or more. Fifty-two per cent of the total had
hookworm. Active treatment for the elimination of these parasites was
begun in one barrack, and after the work was completed it was noted
that there was much less disease there than in the remainder. All
of the thirty-five hundred prisoners were ultimately examined,
and intestinal parasites eradicated if present. The death rate then
dropped to thirteen to the thousand, and has remained at or near this
figure up to the present time.

I have already referred to the discovery of the cause of beri-beri,
and to the effect of the governor-general's order forbidding the
use of polished rice in government institutions or by government

I subsequently made a strong effort to secure legislation imposing
a heavy internal revenue tax on polished rice, thus penalizing its
use. I failed, but such effort will be renewed by some one, let us
hope with ultimate success.

In Spanish days cholera, leprosy, smallpox and other dangerous
communicable diseases were constantly reintroduced from without. This
is no longer the case. The United States public health and marine
hospital service has stretched an effective defensive line around the
archipelago and has sent its outposts to Hongkong, Shanghai and Amoy,
to prevent, so far as possible, the embarkation for Manila of persons
suffering from such ailments. We now have the most effective quarantine
system in the tropics, and one of the best in the world. At Mariveles
there is a very large and complete disinfecting plant, and vessels
may also be satisfactorily disinfected at Cebú and Iloilo.

This quarantine service kept the Philippines free from bubonic plague
for seven years, and has repeatedly prevented the entry of pneumonic
plague, that most deadly of all known diseases.

A peculiar and shockingly disfiguring disease known as yaws occurs
somewhat infrequently in the Philippine lowlands and is very prevalent
in a number of places in the highlands. In many ways it resembles
syphilis, and indeed at one time was considered to be syphilitic
in its origin. Doctor Richard P. Strong, of the Bureau of Science,
made the very important discovery that salvarsan is an absolute
specific for it. The effect of an injection of this remedy closely
approaches a miracle in medicine. In five or six days the condition
of the patient begins to improve rapidly. By the end of the second
week his horrible sores have healed.

It was with this remedy that we began our health work among some of
the wilder head-hunters of northern Luzón. Think of the advantage of
being absolutely certain of curing such an ailment in every case, and
think of the gratitude of poor wretches, undergoing untold suffering,
when they were almost immediately relieved!

Soon after this use for salvarsan was discovered, I caused a liberal
supply of it to be sent to the Bontoc Hospital. For some time we
were unable to persuade any victims of yaws to undergo treatment,
but finally we found one at Barlig who was guilty of a minor criminal
offence, arrested him, and took him to Bontoc. Instead of putting
him in jail there, we sent him to the hospital for treatment.

At first he complained bitterly that we were putting no medicine
on his sores. Then the remedy began to work and he decided it was
"strong medicine." By the tenth day he was running around town
joyfully exhibiting his rapidly healing body to every one who would
look at it. On the fourteenth day he suddenly disappeared, to the
deep regret of the medical men, who had hoped that they might keep
him as an example of what could be done, and thus persuade others
to undergo treatment. A few days later, however, he reappeared with
thirteen victims of yaws from his home town, having meanwhile twice
covered on foot the great distance which separates Barlig from Bontoc,
and assembled and brought in his fellow-sufferers.

As we have seen, the people of Manila were formerly supplied with
impure drinking water from the Mariquina River, and were therefore in
constant danger of infection with cholera and other deadly diseases. At
a cost of some $1,500,000 we have given the city a modern water system,
the intake of which is far up in the hills above the last village. The
annual deaths from ordinary water-borne diseases exclusive of cholera
have fallen from 3558 - the average number at the time the new system
was introduced - to 1195. Recently a leak in the dam, which necessitated
temporary resumption of the use of the Mariquina River water, was
immediately followed by a marked increase in the number of deaths
from such diseases, thus conclusively demonstrating the fact that we
were right in ascribing the previous reduction in deaths to a better
water supply.

This annual saving of lives is an important result, but more important
yet is the fact that when Asiatic cholera reappears in the Mariquina
valley, as it inevitably will sooner or later, we shall not live in
constant fear of a general infection of the Manila water supply,
which, judging from the experience of other cities where modern
sanitary methods have been introduced, might result in the death of
a third of the population. In every country a very considerable part
of the population always fails to boil its drinking water, no matter
how great the resulting danger may be.

Manila lacked any facilities for the proper disposal of human waste,
and the conditions which resulted were unspeakable, especially in
the little _barrios_, or groups of houses, placed close together,
helter-skelter, on wet, swampy ground and reached by means of runways
not worthy even of the name of alleys, as one often had to crouch to
pass along them.

A modern sewer system costing $2,000,000, supplemented by a pail
system, has very effectively solved this problem, while thousands of
homes closely crowded on disease-infected, mosquito-breeding ground
have been removed to high, dry, sanitary sites. The regions thus
vacated have in many instances been drained, filled, provided with
city water and good streets, and made fit for human occupancy.

The old moat around the city walls was a veritable incubator of
disease. It has been converted into an athletic field where crowds
of people take healthful exercise. The _esteros_, or tidal creeks,
reeked with filth. More than twenty miles of such creeks have been
cleaned out, although much still remains to be done to put them in
really satisfactory condition.

There were no regulations covering the construction of buildings, and
it was not unusual to find six or eight persons sleeping in a closed
and unventilated room 10 × 8 × 8 feet. Manila now has an excellent
sanitary code, and such conditions have been made unlawful.

The previous woeful lack of hospital facilities has been effectively
remedied. At a cost of approximately a million and quarter pesos we
have built and equipped the great Philippine General Hospital, one of
the most modern institutions of its kind in the world, and by far the
best in the Far East. In it we have very satisfactorily solved the
question of getting sufficient light and air in the tropics without
getting excessive heat. Its buildings are certainly among the very
coolest in the city of Manila, and "the hospital smell" is everywhere
conspicuously absent.

It is called a three-hundred-bed institution, but as a matter of fact
the ventilation is so admirable that nearly two hundred additional
beds can safely be put in as an emergency measure.

Two hundred and twenty of its beds are free. In them a very large
number of persons are annually given the best of medical and surgical
care. At its free clinic some eighty thousand patients find relief
in the course of a year.

The increase in private hospital facilities has also been
noteworthy. Among the new institutions doing admirable work should be
mentioned the University Hospital, an Episcopal institution; the Mary
J. Johnston Hospital, a Methodist institution; and St. Paul's Hospital,
a Catholic institution. Patients are admitted to all of them without
regard to their religious belief, a policy the liberality of which
must commend itself to all broadminded persons.

In enumerating the hospitals of Manila, the old Spanish institution,
San Juan de Dios, should not be forgotten, for it has been improved
and modernized until it offers good facilities for the treatment of
the sick and the injured.

All of the above mentioned institutions are in effect acute-case
hospitals designed for the treatment of curable ailments. Cases
of dangerous communicable disease are excluded from them, but are
adequately provided for at San Lazaro where the insular government
has established modern and adequate hospitals for plague, smallpox,
cholera, diphtheria, scarlet fever, measles, etc., as well as a
detention hospital for lepers, pending their departure for Culion.

An insane hospital capable of comfortably accommodating 300 inmates
has also been provided. A few years since the insane were commonly
chained to floors, or tied to stakes under houses or in yards,
and were not infrequently burned alive during conflagrations. Such
conditions no longer exist, but the government is not yet able to
provide for nearly all of the insane who need institutional care.

The several institutions above mentioned have a very important
function apart from the relief of human suffering, in that they afford
unexcelled opportunities for giving practical instruction in nursing
and in the practice of medicine and surgery.

A few years ago there was not such a thing as a Filipina trained
nurse in the islands. I was firmly convinced that the Filipinas of
this country could learn to be good nurses, and made earnest efforts
to have included among the first students sent at government expense
to the United States several young women of good family who should
attend nurses' training schools and then return to assist in our
hospital work.

I failed to secure the adoption of this plan, but later the training
of nurses was inaugurated in connection with hospital work at the
old Civil Hospital, St. Paul's, the University Hospital, the Mary
J. Johnston Hospital and the Philippine General Hospital. At the latter
institution there is now conducted an admirable school where more than
two hundred young men and women are being trained. Three classes have
already graduated from it, and Filipina nurses have long since proved
themselves to be exceptionally efficient, capable and faithful. It
will be some time before we can educate as many as are needed in the
government hospitals, and after that has been accomplished a vast
field opens before others in the provincial towns, where the need of
trained assistants in caring for the sick is very great.

We found exceedingly few competent Filipino physicians or surgeons
in the islands. This condition was due not to natural incompetence
on the part of the Filipinos but to the previous lack of adequate
educational facilities. The government has established a thoroughly
modern college of medicine and surgery, well housed, and provided
with all necessary laboratory facilities. It furnishes the best of
theoretical instruction, while its students have every opportunity
for practical work at the bedsides of patients in the government
hospitals, all patients in free beds being admitted subject to the
condition that they will allow their cases to be studied.

While there is still an evident tendency on the part of graduates of
this school to feel that they know enough, and to desire to get to
making money without delay, we are nevertheless managing to attract an
increasingly large number of the more competent to the intern service
of the Philippine General Hospital, where as the result of additional
years of practical experience they become exceptionally proficient.

This institution, with its great free clinic, offers very exceptional
facilities for practical instruction, and we have already trained
some extremely competent Filipino physicians and surgeons.

As funds permit, hospital work is being extended to the provinces. At
Cebú a thoroughly up-to-date sixty-bed institution is now open. A
smaller one was established years ago at Baguio, where surgical work
may be performed with great advantage on account of the rapidity with
which convalescence occurs in the cool, pure mountain air, which also
expedites the recovery of persons recuperating from wasting diseases.

A little more than a year ago a hospital was opened at Bontoc, the
demand for accommodations being so great from the start that we did
not even await the arrival of beds. Sick Igorots were only too glad
to lie on the floor if their needs could be ministered to.

It had previously been the custom of the wild men to kill chickens,
pigs or carabaos in case of illness, in order to propitiate evil
spirits, the kind and number of animals killed being of course

Online LibraryDean C. WorcesterThe Philippines: Past and Present (Volume 1 of 2) → online text (page 33 of 43)