THE Island of Porto Rico is more free from disease than the average
tropical or semi-tropical country, due to the active efforts of the
medical profession and of the special commissions and departments
created for the elimination of disease within the last few years.
Nevertheless, a great deal of sickness which might be avoided, part of
which is responsible for death, and part of which merely incapacitates
the sufferers or renders them less useful citizens, is to be found. The
elimination of such diseases as smallpox and yellow fever, which
formerly were responsible for a great number of deaths and which
descended upon the Island as epidemics with considerable regularity, has
been accomplished, and if similar care were taken in the case of less
dreaded diseases, there is reason to believe that they could also be
wiped out of existence in the Island.
For the year 1915-16 there was a total of 26,572 deaths in Porto Rico.
Most of these deaths were from diseases classified as transmissible,
and, consequently, from diseases which could be prevented by complete
quarantine. Following is a list of the number of deaths from the
diseases which took the heaviest toll in the Island:
Rickets 1,271
Tuberculosis (lungs) 2,125
Malaria 1,290
Typhoid fever 94
Whooping cough 167
Tetanus 109
Cancer 365
Meningitis 344
Epilepsy 57
Acute bronchitis 1,015
Chronic bronchitis 309
Bronco-pneumonia 822
Pneumonia 569
Diarrhea and enteritis under two years 3,485
Diarrhea and enteritis two years and over 870
Infantile tetanus 729
Lack of care in infancy 117
Congenital debility in children 1,145
Uncinariasis 479
Smallpox 9
Diphtheria 26
The two diseases which are of most vital importance to the people of
Porto Rico at present are undoubtedly tuberculosis and anemia. The
ravages of tuberculosis are more noticeable in the cities, and it has
been stated that in 1912, on one street in San Juan, 12 out of every 100
residents died of this disease. Anemia is prevalent throughout the
Island, but is more noticeable in the country districts than in the
cities, and while the death rate for anemia is not so high as the death
rate of some other diseases, yet by reason of weakening the vitality of
the sufferers it tends to offer a fertile spot for the incubation of
germs of other diseases, and the working and producing power of the
individual is lessened with the acuteness of the disease.
It has been claimed that anemia was introduced into Porto Rico by the
negroes who were brought here as slaves in the sixteenth and seventeenth
centuries, and the identity of the disease with the anemia existing in
about 20 per cent of all the negroes of the Gold Coast has been
determined. The disease was for a long time limited to the coast land
and was propagated on the sugar plantations, but after the introduction
of coffee, which has come to be the chief product of the mountain
regions, the disease was propagated throughout the entire Island.
This disease has left its trace among the country people and they have
been accused of laziness and idleness when it is probable that the cause
of the apparent disinclination for work is due to the weakened physical
condition which is a result of the anemia. In this connection, Drs.
Gutierrez and Ashford in their work on _Uncinariasis in Porto Rico_
quote Col. George D. Flinter, an Englishman in the service of Spain, who
published in 1834 "An account of Porto Rico," as follows:
"The common white people, or lowest class (called _jíbaros_), swing in
their hammocks all day long, smoking cigars and scraping their native
guitars.... Most of these colonists are inconceivably lazy and
indifferent. Lying back in their hammocks, the entire day is passed
praying or smoking. Their children, isolated from the cities, without
education, live in social equality with the young negroes of both sexes,
acquiring perverted customs, only to later become cruel with their
slaves."
Commenting on this statement, Drs. Gutierrez and Ashford speak as
follows:
"What if these people were merely innocent victims of a disease, modern
only in name? What if the brand placed by the Spaniard, the Englishman,
and the Frenchman in olden times upon the _jíbaro_ of Porto Rico were a
bitter injustice? The early reports savor strongly of those touristic
impressions of the Island which from time to time crop out in the press
of modern America, in which 'laziness and worthlessness' of the
'natives' are to be inferred, if, indeed, these very words are not
employed to describe a sick workingman, with only half of the blood he
should have in his body."
"True, Col. Flinter, Field Marshall Count O'Reilly, and the rest of the
long list of early 'observers' did not know what uncinariasis was. But
is it necessary that we have a record of microscopic examinations of the
feces of the people they describe to realize what can be read between
the lines? Convicts, adventurers, and gypsies may have formed part of
the element that colonized Porto Rico, but we cannot believe that these
were all, nor that their descendants were 'lazy' and 'worthless.'
"We cannot believe that vicious idleness comes natural to the Spanish
colonist, even in the Tropics, for the very reason that we have seen
these descendants at their very worst, after the neglect of four
centuries by their mother country, and after the laborious increase of
an anemic population in the face of a deadly disease, whose nature was
neither known nor studied, work from sunrise to sunset and seek medical
attention, not because they felt sick, but because they could no longer
work.
"We strongly feel that these writers have unconsciously described
uncinariasis. Are the Spanish people considered 'lazy' by those who know
them? Were those Spaniards who conquered Mexico, Peru, and all South
America, who formed so formidable a power in the Middle Ages, a lazy
people?
"Is it 'laziness' or disease that is this very day attracting the
attention of the United States to the descendant of the pure-blooded
English stock in the Southern Appalachian Range, in the mountains of
Carolina and Tennessee, the section of our country where the greatest
predominance of 'pure American blood' occurs, despised by the negro who
calls him 'poor white trash'?"
During the year 1914-15 there were 6,644 deaths of children under two
years of age, which constituted 28.8 per cent of the total mortality of
the Island. Approximately 14 out of every 100 children born, died in
infancy, and the death rate for the total population was 5.55 per cent
for children under one year of age, and 7.71 per cent for children under
two years of age. Diarrhea and enteritis were responsible for 33.8 per
cent of infant mortality; congenital debility for 13.14 per cent;
infantile tetanus for 10.32; while disease of the respiratory organs
caused 16.17 per cent of the infant mortality.
It has never been definitely determined just what losses, from the point
of view of days of labor, or from the point of view of vitality of the
laborer, have been caused by malaria. Mr. D. L. Van Dine, in an article
in the _Southern Medical Journal_ for March, 1915, gives the result of
some of his investigations among the laboring class in Louisiana. In
this study, which was made on one of the large plantations and which
covered 74 tenant families with a total of 299 individuals, he shows the
losses which occurred from May to October 15, 1914. There were 970 days
of actual illness of such a nature that the illness was reported to the
physician. Forty-eight out of the seventy-four families were reported to
the doctor for malaria. According to Mr. Van Dine, this does not take
into consideration mild attacks of malaria which were not reported to
the physician, especially in the cases of children. He has estimated
that there were at least 487 days lost in cases which were not reported
to the doctor. He also estimates that there was a loss of 385 days on
the part of the adults who assisted in caring for the malaria patients.
It is estimated that there was a loss in days of labor equal to nearly
six days and a half for each case of malaria. It will easily be seen
that this may be a serious loss of time as far as the production of
crops is concerned, and even thus it does not fairly represent the loss,
as it does not take into consideration the weakened energy of the man
just before or just after the malarial attack.
Undoubtedly, there is as great a loss in Porto Rico from malaria as is
indicated in the statements just made. It has been reported that in some
sections of the Island, 85 per cent of the people were found to have
malaria germs in their blood. Between the two diseases of malaria and
anemia, there is no doubt that the physical condition of the Porto Rican
countrymen is gradually debilitated.
Since the American occupation, stress has been laid upon the attempts to
eliminate anemia, and this work has received special attention since
1906. During the year 1914-15 there were 32,278 new cases of anemia
treated in different parts of the Island, and 15,497 cases were
discharged as cured.
Undoubtedly a great deal of the illness in Porto Rico is the result of
improper food, or food prepared in an improper manner. Malnutrition
among children is frequent and leads to such diseases as rickets, which
we find has an exceptionally high death rate. In the recent measurements
given at the University among university students, it has been found
that there was an average depth of chest of nearly half an inch more
than is found in the American boy or girl of the same age, and this has
been considered as an indication of malnutrition and general softening
of the bones in early childhood.
A hemoglobin test which was given to the students of the University this
year showed that the average among the men was 80.04 per cent, and only
77.6 per cent among the women. The average for Porto Rico should not
fall below 85 per cent, and the anemic conditions indicated by the low
average is an indication that the disease is to be found not only among
the country people, but also among people of the best conditions of
life.
It will be impossible to settle the economic and social problems of
Porto Rico until the question of personal health has been more nearly
solved than it is to-day. With a large proportion of the country people
sick from anemia and malaria, and with tuberculosis as prevalent as it
is at the present time, the weakened vitality will not permit strenuous
or continued work sufficient to improve economic conditions to any great
extent. Social conditions, depending as they do upon the economic
situation, must also be slow of improvement, and the most important work
facing the Government of Porto Rico at present is the elimination of
such diseases as impair the physical condition of the people and thus
interfere with economic and social progress.