HEALING A NATION
The sanitary conditions which existed in the Islands twenty odd years
ago would seem to us appalling, but perhaps they were no worse than
those of some other tropical countries at that time. Even the most
progressive colonizers, like the English, had given up trying radical
reforms, contenting themselves with making passably healthful
conditions, especially for the European part of the towns. The
combination of climate and native inertia seemed to them one which it
was difficult and almost hopeless to combat. So it remained for us to
prove that the thing could be done--that a tropical country could be
made sanitary and hygienic for all its inhabitants, whether they were
white or brown or yellow, and whether they wanted it made so or not. If
we had done nothing else for our restless dependency, that achievement
would be a sufficient crown of glory.
Manila was then, as it still is, the most highly civilized spot in the
Islands. As I have said, much of the walled city was built of stone
and plaster, but many of the natives in the suburbs lived in one-room
houses made of wood and raised on stilts. No provision whatever was made
for drainage or for the removal of garbage. Each house was a law unto
itself and very often an offense unto its neighbours.
[Illustration: _A Carabao_]
A large part of the city drained, directly or indirectly, into the Pasig
River. Here, also, the carabao, which is not a fastidious animal, went
for his mud baths, and the women washed their clothes. This river
furnished drinking water for all who lived near enough to share the
privilege. It was said to have a flavour like the Ganges, which they
sorely missed later on when a purer supply was substituted.
The medieval wall, which allowed for many damp, unhealthy corners,
interfered with municipal ventilation. No cleansing winds can sweep
through a city whose every street ends in a high wall. Outside was a
stagnant moat which made a convenient breeding place for the industrious
mosquito.
The local market used to be a community dwelling for all the vendors,
who lived there, reveling in their filth. Their children were born
there, also their dogs, pigs, cats, and chickens. It was so vile
smelling that no American dared go into it. Never being cleaned, it was
the center from which disease was spread to the city.
These markets were the first places to be cleaned by the Americans. The
first step was always to burn up the entire shed, and then build an iron
and concrete structure, which could be washed down every night with a
hose. Only the night watchman was allowed to live there.
This is only typical of changes made in every department, from market to
school, from custom house to palace. To tell a long story very shortly,
gaps have been opened in the city walls to let in the air, the moat has
been filled in with soil dredged from the bay to make a field for
sports, nearby marshes have been reclaimed and old wells filled up,
while a sewerage system and a method of collecting refuse have of course
been established. The new water system has cut the death rate from
water-borne diseases in half. To stop an epidemic whole districts of
huts which could not be fumigated were burned and others were sprayed
with strong disinfectants by fire engines. Slowly the people are being
taught the rules of hygiene. The new and up-to-date medical school is
turning out very good doctors, and the school of nursing, most excellent
nurses, who are gentle, cheerful and dainty.
The modern hospitals were at first regarded with suspicion by the
natives, who went with the greatest reluctance for treatment. But to-day
the difficulty is to keep them out. A toothache is excuse enough for a
week's sojourn with free board. The native doctor often is a skilful
grafter, and has to be watched, otherwise he may pass in all his poor
relations, more to give them food and rest than for illness. A friend
was much annoyed while sick in a Manila hospital by some Filipina girls
in pink and lilac hospital gowns who were romping through the corridors.
Her nurse explained that they were passed in by the native doctor. One
of these physicians had every bed in his ward filled with patients who
were not ill but just enjoying themselves. Some of these doctors abuse
their authority in other ways. One of them, it was discovered, used to
go to San Lazaro, the hospital for contagious diseases, and take friends
who were detained there with leprosy to ride in public vehicles.
But aside from occasional abuses by natives, the work which has been
done for the public health in Manila is an example of what has been
accomplished elsewhere. In many of the provincial towns the introduction
of artesian wells has brought the death rate tumbling down to half its
former size. The work was carried on under disadvantages at first, for
it was the butt of much ridicule and abuse--the former from abroad, the
latter from the native press. Medical authorities in other parts of the
Far East laughed at our efforts to create better conditions for the
Filipinos, and told us that Orientals were incapable of sanitary
reforms. Before long, these same men were seeking to learn by what magic
we had accomplished what they had hardly dared even attempt, and were
sending delegates to Manila to study our methods.[17]
When Americans went there they found the Filipinos a race of
semi-invalids. Those who had managed to survive the various scourges
which were constantly sweeping the Islands were often infected with
hookworm or similar parasites which sapped their vitality. Many of them
were tubercular, and most of them were under-fed. The laziness which
made several Filipino workmen equal to one American was much of it due
to actual physical weakness. As a people, they are showing a marked
improvement in energy and activity. It was from changes of this sort
that the would-be benevolent anti-imperialists laboured to save them.
Of course, a great deal remains for us to do. Half the babies still die
before they are a year old. Only a beginning has been made in stamping
out tuberculosis. The people have not yet been educated out of that
fatalism which makes them prefer acceptance of evil to fighting it. But
as fast as they learn English they come under our educative influence
more and more.
Dr. Richard P. Strong, whom we knew when we were in the Islands and who
is now at the Harvard Medical School lecturing on tropical diseases, has
done many notable things in various parts of the world. We all know
about his wonderful work in the northern part of China, when the
pneumonic plague[18] was raging there a few years ago, and still later
his heroism among the typhus-stricken soldiers of Serbia. But we do not
all know that, among other things, he has discovered a cure for a
dreadful skin disease called yaws, which has been prevalent in the
Philippines. A doctor in Bontoc cured a case with a single injection of
salvarsan. The "case" was so delighted that he escaped from the
hospital before a second injection could be given him, rushed home to
his native village, and returned a day or so later with a dozen or more
of his neighbours who were suffering from the same trouble.
We were fortunate in traveling through the Islands with Dr. Heiser, who
had entire control of the health conditions there for many years--in
fact, until the Democratic administration. To him is largely due the
practical disappearance of smallpox from the Philippines. When the
Americans took over the country there were sometimes over fifty thousand
deaths a year from this one disease. The change is the direct result of
the ten million vaccinations which were performed by American officials.
An effort was made to entrust the vaccinating to Filipino officials, but
epidemics kept breaking out, and it was discovered that their work was
being done chiefly on paper.
In a recent letter a friend writes, "The other day one of our servants,
Crispin, was ill. I tried to get him to go to the hospital, but he
insisted he was not sick. I did not enjoy having him wait on the table,
for I thought he had measles. So I took him to the hospital myself and
told him to do what the doctor said. When I returned home a telephone
call summoned us to the hospital to be vaccinated at once, for Crispin
had the smallpox! They sent him to San Lazaro, where he had a good time,
and came home smiling, while we spent a miserable ten days waiting to
see what was going to happen to us. The native _saindados_ came promptly
to disinfect, but all they did was to put a bucket of something in the
center of the room. I soon saw that they were not going to be thorough,
so after ten minutes, just as they were going away, I called them back
and telephoned to the board of health, asking if no American sanitary
officer was coming. They said no, that Filipinos had been put in all the
white men's places. So I went to work myself, burning bedding, clothes
and hangings, and opening every trunk and closet. It was a revelation to
those two little natives, who thought they had done enough before."
Apparently the natives had the same aversion to the preventive method of
vaccination that some of our own countryfolk have, for Dr. Heiser writes
of the early work in the field: "Formerly ... the lives of the
vaccinators were seriously threatened by persons who refused to be
vaccinated. However, after much persuasion, a considerable number of the
inhabitants were vaccinated. Shortly afterwards smallpox was introduced
and the death rate among the unvaccinated became alarming; the people
themselves then noted that in spite of the fact that the vaccinated
persons frequently came in constant contact with the disease they did
not contract it, while the unvaccinated died in large numbers. This led
to urgent request being made for vaccination and the vaccinators who
previously found their lives in constant danger were welcomed."
But perhaps Dr. Heiser's greatest work has been done in freeing the
Islands of the worst-feared disease of all times and nations--leprosy. I
was walking along the street with him one day when he noticed the
swollen ear lobes of a man near by. It was one of the first symptoms of
leprosy. He stopped and spoke to the man and walked with him to the
hospital. The disease is not really so much to be feared as people
think, for it is seldom inherited and is not easily contagious.
We had planned to go to Culion, the beautiful island where thousands of
lepers have been taken to live or to die, and where they have every care
and comfort that science and unselfish devotion can give them.
Unfortunately for us, the Secretary of War was obliged to cut the trip
short, owing to official business in Manila, so we did not go there. We
heard so much about the place that this was a real disappointment.
The island is a day's sail from Manila. It is well forested, and has
hills and fertile valleys and a fine harbour. The more important
buildings of the town which the authorities knew would be needed by the
thousands of lepers then at large, were built from the foundations
entirely of concrete, for sanitary reasons and economy. Besides hundreds
of houses, one finds there to-day a theater, a town hall, a school,
dining halls, hospitals, stores, docks and warehouses. Water, lighting
and sewerage systems were also constructed, and a separate settlement
was built for the non-leprous employees.
Culion is really a leper's heaven. The people have perfect freedom, and
live normal lives, farming or fishing when they are able, carrying on
their own government, having their own police force, playing in the band
if they are musical, giving theatrical performances. They have social
distinctions, too--those better born take the place denied them in the
outer world because of their affliction. Here they are again Somebody.
When Americans took possession of the Islands there were six thousand
lepers at large. Two things evidently had to be done--first, prevent a
further spread of the disease; and second, cure those who already had
it, if this were possible.
Segregation of all known cases, as fast as accommodations could be
provided for them, was the immediate necessity. The colony at Culion was
opened in 1906 with five hundred patients. These went reluctantly to
their new abode, but once settled there, found it so much to their
liking that they wrote home enthusiastically, and after that the
authorities had no difficulty in persuading others to go. Indeed, the
plight of these poor outcasts had been pitiful enough. They were so
neglected that in one of the larger cities they had been known to go
into the markets and handle the produce, as a protest against their
treatment.
More than eight thousand have been transferred to Culion in all, and
to-day every known leper in the Philippines is there. New cases are
still occasionally found, but even the worst provinces are now
practically free from the historic scourge. It was that remarkable man,
Dr. Heiser, who not only organized and carried out this great
undertaking, but who himself saw to the smallest details. Many times he
is known to have carried the loathsome patients in his own arms.
The second problem, that of finding a cure, was not so easily solved.
But it has been found, and our nation had the credit of finding it--"the
first definite cure ever established," Dr. Heiser says. Two methods were
tried out very carefully, both with some success. The first was the
x-ray, which brought a marked improvement in most of the cases where it
was used, and an apparent cure in one case. The other method was the use
of chaulmoogra oil. This remedy had been known and used in the Far East
for some time, but it could rarely be given long enough to produce much
effect, because it was so unpleasant to swallow. Our doctors, however,
devised ways of injecting it, after mixing it with resorcin and
camphorated oil, so that there were no ill effects. Already several
cures have resulted.
Ten years ago there were forty thousand users of opium in the Islands.
In five years that number was reduced ninety-five per cent, and most of
those still addicted to the drug are Chinese. In the last few years,
moreover, cholera and bubonic plague have been practically wiped out,
but, of course, a few other tropical diseases still exist.
The Philippine Assembly recently conceived the brilliant idea of cutting
down expenses by halving the health appropriation. Dr. Heiser got
permission to speak before them, but instead of talking a few minutes,
as they expected, he spoke for three days. He told them that if they did
not give him the money he needed for the work, he would be forced to
economize by setting free the criminally insane, who, he promised,
should be given tags stating that they had been set free by order of the
Assembly. Also, he said, he would have to send back many of the lepers
to their friends. It proved to be the way to deal with the child-like
legislators, who in the end gave him what he wanted. Since that,
however, he has resigned, and his loss will be sadly felt. Indeed, there
has already been an outbreak of cholera since he left.
Regenerative work among the Filipinos has by no means been confined to
their bodies, however, for besides the educational advance that has been
made in their schools, which I have mentioned elsewhere, their prisons
have become sources of light instead of darkness. It is true that
penology in the Philippines has gone ahead with great strides.
In Bontoc, for instance, there is a prison which the commissioner in
charge of the province proudly called his "university." Its inmates are
men of the mountains. In the old days they would have been sent to
Bilibid prison in Manila, where few of them lived over two years. A
longer term meant practically a death sentence. This provincial jail is
situated in the high and healthy capital of the province, and is kept
clean and sanitary by the prisoners themselves. The men are well fed and
cared for, and they are taught trades, and made to work at them, too, so
that they learn industry along with technical skill.
Bilibid prison is a huge institution. It occupies several acres of land
in the heart of the city of Manila, its buildings radiating from a
common center, so that the guard in the high tower at the hub can
overlook anything that occurs. High walls surround the whole, patrolled
by watchful guards and mounted with gatling guns. It is an extraordinary
institution, inherited from Spanish rule, but, like everything else,
completely changed since then. The wives of men committed there were
considered widowed in those days, since so few survived a long term, and
were free to marry again. There has been some confusion of late years,
because most of the prisoners not only come out alive, but healthier
than when they went in. So prison "widows" who remarried found that
they had not counted on American methods. Bilibid, though in many ways
still rather experimental, is a great success.
There are extensive shops, and the prisoners are kept at work all the
time. Some make silverware, carriages, and furniture, while others do
the cooking and washing for the prison, make their clothes, and run a
laundry, not only for their own use, but for outside custom. Many are
employed in road building and on fortifications. Each man learns a trade
during his term of imprisonment, and so is better able to earn an honest
livelihood than when he entered. I have been told that Bilibid
"graduates" are in demand because of their honesty and industry. No
better recommendation for a prison could be desired.
Besides the shops, there is a school in which they are taught English.
The day we visited the prison we saw a teacher there who had been a
guest at the Governor's table, but as he had forged a check he was
paying the penalty. Most of the attendants in the up-to-date prison
hospital were Spaniards who were in for life sentences and who made very
good nurses. Part of this institution is devoted to consumptives, of
whom there are so many in the Islands, and they receive treatment
according to the best and latest methods.
[Illustration: PENAL COLONY ON THE ISLAND OF PALAWAN.]
We were much interested in the kitchens, and the manner in which food
was issued to several thousands in only six minutes. It was all
wonderfully systematized.
Late in the afternoon we went up into the central tower to watch the
"retreat." The prisoners' band, which had played for us as we entered
the prison gates, now took its place in the courtyard below and began to
play. Out of the workrooms trooped hundreds of convicts, who were
searched for hidden implements and then released to take their position
in military formation. The different groups marched to their quarters
and, standing outside, went through a series of exercises to the music
of the band. They seemed to enjoy this very much, and later, still to
the music, marched gaily off to get their rations.
A long-term prisoner with two years of good conduct to his credit is
given the privilege of going to the penal colony on the island of
Palawan. This island is one of the more southern ones, and is the place
where the Spanish sent their convicts in the old days. But the present
colony, which was established by Governor Forbes, is very different from
the former one. It was once a malarial jungle, but now is a healthy,
thoroughly up-to-date and successful reform institution.
Our visit to this place was one of the most interesting features of our
whole trip. Palawan itself is a curiosity, for it has an underground
river which has been explored for two miles beneath a mountain. But the
penal settlement is unique.
Leaving the steamer at Puerto Princessa, a quaint little town with
charming old Spanish gardens, we were met by a launch which took us up
the Iwahig River to the colony. This launch, which was gaily decked with
flags, was manned by convicts, the engineer himself being under a
sentence of nineteen years for murder. After an hour's sail up the
tropical river, we reached our destination. At the wharf we were greeted
by Mr. Lamb, superintendent of the colony, a Dominican priest, and a
crowd of prisoners who were enjoying a holiday.
We were driven to headquarters, near a pretty plaza with hedges and
flowers, surrounded by several two-story barracks built of bamboo and
nipa, where the prisoners live. As we walked about the plaza we visited
the hospital and the chapel, as well as the main office and the
superintendent's house.
The penal settlement is located on a reservation of two hundred and
seventy square miles. At the time of our visit there were in all eleven
hundred convicts--Filipinos for the most part, with a few Moros--and
only three white men to keep them in order. The prisoners had all come
from Bilibid prison.
In its management, the colony is somewhat like the George Junior
Republic for boys in America. The prisoners elect their own judges and
make some of their own laws, subject to the approval of the
superintendent. A majority verdict will convict, but the superintendent
has the right to veto any measures. Men who break the laws are locked
up, but can be released on bail.
The police force is composed of convicts, of course. The chief of police
when we were there was a murderer who had earned his pardon but
preferred to remain in the settlement. If a prisoner tries to escape he
is followed, and occasionally one is shot. The attempt is seldom made,
for it is difficult to get away, and the men are, moreover, quite
content to live there. Once thirty-five convicts did make a break for
liberty, but beyond the confines of the settlement they found themselves
in the midst of the savage Mangyans, by whom some were killed. Of the
rest, those who were not captured alive returned of their own free will
and were consigned again to Bilibid, which is considered a great
punishment.
For good behaviour, convicts may earn the right to have a house of their
own, with their family, one bull or carabao, and a little farm to
cultivate. There were then a hundred and eighty of these farmers, who
raised their crops on shares, the government receiving half. They had to
report to headquarters by telephone every other day and undergo a weekly
inspection as well. Every year they were obliged to plant cocoanuts,
which in a few years were expected to bring in large returns. Already
great quantities of yams were being shipped to Bilibid, and in a short
time enough cattle would be delivered there to supply, in part at least,
the meat demand of that prison. The colony suggests the possible
solution of the meat question for the American army in the Philippines,
as they were successfully raising calves from native cows by Indian
bulls.
Although the majority of the prisoners were engaged in farming, they
were often given the privilege of selecting the kind of work that they
preferred, and were divided accordingly, their hats and the signs on the
sleeves of their prison clothes showing what grade of convict they
belonged to and what work they did. They were paid in the money of the
colony, which was good nowhere else.
There were about forty women on the reservation. The men might marry if
they earned the privilege, or if already married, they might have their
wives and children come to live with them. There were six marriages the
year we were there. After receiving their pardons, they could remain on
the island if they wished, their work being credited toward the purchase
of their farms, but they had to continue under the laws of the colony.
At the main office we saw four prisoners who were about to be pardoned.
Governor Forbes very kindly asked me to hand them their pardons and ask
any questions I wished. One, a _bandolero_, or brigand, was small and
wizened. Another, who looked much like him, when asked what crime he had
committed, laughed and answered, "Bigamy!" A third, a stolid, thickset
fellow, had the best face of them all, but showed no emotion whatever
when I gave him his pardon. He also had been a brigand.
The convicts gave an exhibition fire drill for us at the barracks. The
natives are born climbers, and scramble down the poles with the agility
of monkeys. They also play baseball, of course. They are remarkably
musical and have a good band.
We had luncheon with Mr. and Mrs. Lamb in their pretty bamboo and nipa
cottage. Mrs. Lamb was a frail little woman, but strong in spirit, for
she did not seem at all afraid to live in this land of evil men. She
told us that the three murderers whom she had as servants were very
efficient, and were devoted to her little four-year-old son.
When our visit ended we were driven in a wagon to the river, accompanied
by a troop of prisoners who ran alongside shouting good-bys. At the
wharf they lined up while Mr. Lamb and the priest bowed us politely
aboard the launch.
These intrepid countrymen of ours, who are healing and uplifting a whole
people, seem to me to be true missionaries. The time may come when the
work which they are doing will set a standard for us stay-at-homes to
follow, that is, if we send the right kind of men out there. As the song
says,
"Ah, those were the days when the best men won,
The survival of those that were fit--
When the work to be done counted everything,
And politics nary a bit."