Chapter XVI: Health Conditions (2)

Six months later he again appeared at Baguio to ask the governor about a _fiesta_ which he had just heard it was customary to celebrate on the 25th of December. He had been told that Americans were in the habit of giving presents to each other at this time, and asked if this was the ease. Governor Pack said yes. Palasi then inquired if the feast was a _good_ feast, and the custom a _good_ custom, and was assured that both of these things were true. He next asked if it would be a good feast for Igorots as well as for Americans, and receiving an affirmative reply from the unsuspecting governor, triumphantly declared that he was going to give Baron his best horse. Under the circumstances the governor allowed him to do so.

In connection with the Bontoc Hospital we use two men, one of whom travels from settlement to settlement, relieving minor ailments on the spot and sending to the hospital only those patients who need to go there, while the other stays at home and receives them. From time to time these two doctors "change works." Pages from their daily journals, written in the field, often read like romance.

Were I a young man, and possessed of adequate knowledge of medicine and surgery, I would ask nothing better than to minister to the wants of these people. One might not, and indeed would not, acquire great wealth, but he would be rich in friends. Here lies a great field for practical missionary work.

In connection with the health work there have been many occurrences which were both amusing and sad. At one time there was great excitement over a sacred spring which had appeared in Manila Bay off the district of Tondo. It was duly blessed by Aglipay, the head of the so-called Aglipayano church. Coincidently with its discovery there was a sharp little outbreak of Asiatic cholera. Investigation revealed the fact that the "spring" had its origin in a broken sewer pipe. We were obliged to prevent the faithful from further partaking of its waters, and thus insuring themselves a speedy trip to the better world.

At one time cases of cholera appeared scattered generally throughout the Mariquina valley and without apparent connection. For some days we were unable to make a guess as to their origin. Then we heard that a "Queen" had arisen at the town of Taytay near the Laguna de Bay. An investigation of the Queen and her activities resulted in rather astonishing revelations. She was a very ordinary looking Tagálog girl who had secured the body of an old bull-cart, stopped the cracks with clay, partially filled it with water and decaying vegetable matter, and at rather frequent intervals had bathed in the fermenting mass thus concocted. In due time she announced herself a healer of all the ills to which flesh is heir, and the sick flocked to her. Cholera was then prevalent in some of the towns near Taytay, and there were persons suffering from it among those seeking relief. Some of them were directed to wash their hands in the extemporized tank, while others bathed their bodies in it. As a result it soon contained a cholera culture of unprecedented richness. This was given to patients applying for treatment, and was bottled and sent to those who were too ill to come in person. Hence numerous scattering cases of cholera which did not bear any relationship to other known cases.

It proved quite an undertaking to put the Queen of Taytay out of business. We first asked the local authorities to have her sent to Manila, but the presidente and the police declined to act. We then applied for a warrant to the Filipino judge of the court of first instance having jurisdiction over Taytay, but that worthy official found it convenient to be suddenly called out of the province. At last we prevailed upon soldiers of the Philippine constabulary to arrest the queen and bring her to Manila.

We had anticipated that she might prove insane, but she showed herself to be a very keen-witted young woman. We employed her at the San Lazaro Hospital to look after cholera patients. The people of Taytay were not satisfied, and a few days later a large delegation of them came to Manila and demanded the Queen. I was at my wits' end to know what to do, but old Spanish law can usually be relied upon in emergencies, and the attorney-general discovered a provision couched in very general terms, which provided against disobedience to the authorities. It was only necessary for an "authority" to have read to an ordinary person a statement setting forth what that person must not do; then if the order was violated, such person could be made to suffer pains and penalties.

I accordingly prepared a most impressive order prohibiting the Queen of Taytay from further engaging in the practice of medicine, had her followers drawn up in battalion formation, placed myself at the front and centre, caused the Queen to be brought before me, and read her my communication, at the same time charging the good people of Taytay not to tempt her again to try her hand at healing, for the reason that if they did she would surely get into serious trouble. They marched away with the Queen and I have not heard of her since.

Hardly a year goes by that some similar miraculous healer does not set up in business, and the supply of dupes seems to be unending.

While it is comparatively easy to combat disease in a place like Manila, what of the provinces, where in many cases there is not one physician to two hundred thousand inhabitants?

To meet this difficulty we have an organization of district and municipal health officers. A district may include a single province or several provinces. A district health officer is invariably a physician who has had reasonably thorough practical training in the work of public sanitation, usually at Manila.

He is supposed to spend his time in sanitary work rather than in treating sick individuals, but it is, of course, impossible for him always to refuse to treat such persons, and we encourage gratuitous work for the poor when it can be carried on without interfering too seriously with more important duties.

Presidents of municipal boards of health may exercise jurisdiction over a single municipality or over several. They are supposed to maintain good sanitary conditions in their respective towns, under the general supervision of district health officers, and to instruct their people in sanitary methods and their results, as well as to devote a certain amount of their time to the relief of the suffering poor.

On the whole it must be admitted that while this system has accomplished much, it has fallen far short of accomplishing what it should.

Men like Dr. Arlington Pond of Cebú have wrought marvels, and have conclusively demonstrated the fact that it is not the system that is at fault. Of our thirteen district health officers, ten are Filipinos. They are, with few exceptions, letter-perfect. They know what they ought to do, but as a rule lack the initiative and the courage to do it.

Recently after discovering exceptionally bad sanitary conditions in several towns of the province of Misamis, I demanded an explanation of the district health officer, an exceptionally well-educated and intelligent Filipino physician. I found, as I had anticipated, that the sanitary regulations of his towns left little to be desired, but that they were absolutely ignored.

I asked him what sense there was in paying his salary if he failed to remedy such conditions as I had discovered. He replied that if he were really going to compel people to clean up, it would be necessary to begin with the provincial governor, whose premises were in a bad state. When I suggested that in my opinion the provincial governor would be the best possible man to begin with, the doctor evidently thought me crazy!

It is as yet impossible for the average intelligent Filipino to understand that the rich and the poor, the powerful and the weak, should be treated alike.

It often happens that a province asks for an American health officer, or a Filipino demands the services of an American physician. My invariable procedure in such cases has been to request that the application be made in writing. For some mysterious reason the petitioners are seldom willing to go on record.

A short time since we had a strong demand from Iloilo for an American district health officer. I made the usual suggestion and got a written request that there be sent to Iloilo a district health officer "after the style of the district health officer of Cebú." If Dr. Pond's nationality may be considered a part of his style, then this was a request for an American, otherwise not!

With rather shocking frequency, Filipinos who must be examined for leprosy or some other dangerous communicable disease strongly insist that the examination be made by an American bacteriologist rather than by one of their own countrymen.

In connection with recent election troubles two men were wrongfully denounced as lepers. In several instances perfectly sound people have been thrust among lepers who were being taken on board steamer for transfer to Culion. This grievous wrong was committed by their enemies under cover of darkness, and in the confusion which attends the embarking of a number of people in a heavy sea. The reason why the services of Americans are often specially requested for diagnostic work is not far to seek!

It is a significant fact that our greatest success in establishing satisfactory provincial sanitary conditions has been achieved in certain of the "special government provinces," where the people are under the very direct control of American officials.

There is not a regularly organized province in the Philippines in which the towns are as clean as are those of Mindoro, where, until recently, we have never had a resident district health officer.

I believe that nowhere in the tropics can there be found native towns which are cleaner or more healthful than are those of Bukidnon, inhabited in some instances by people who have literally been brought down out of the tree-tops within the last two or three years. We have never had a resident health officer in this subprovince.

I mention these facts not as an argument against health officers, but as a proof of what can be done without them by intelligent Americans vested with proper authority.

It has given me especial pleasure to see the fundamental change which has come about in public sentiment relative to medical, surgical and sanitary work. At the outset sanitary inspectors and vaccinators carried on their work at serious risk of personal violence. Indeed, several of them were killed. Incredible tales were believed by the populace, with the result that cholera victims sometimes had to be taken to the hospital by force. In later years it has been by no means unusual for them to come in voluntarily and request treatment.

General hospitals were in the old days regarded as places where people so unfortunate as to have no homes to die in might go to end their days. It was almost impossible to get any other class of persons into them.

Now we constantly turn away deserving patients from the Philippine General Hospital because of lack of room. The common people are flocking to it in rapidly increasing numbers. We even have "repeaters," and persons who drop in just to get a comfortable bed and a bath while waiting for an examination which will inevitably show that there is nothing wrong with them.

Our difficulties were increased at the outset by the fact that many foreign medical men working in the Far East good-naturedly ridiculed our efforts to better conditions, claiming that in tropical colonies it was customary to take only such steps as would safeguard the health of European residents, and that it was really best to let the masses live as they would, since orientals were incapable of sanitary reform, and the attempt to bring it about involved a waste of effort that might be more profitably directed elsewhere. Furthermore these men were, in their several countries, practising what they preached.

It has been very interesting to note the reaction of American methods upon those previously in vogue in neighbouring colonies. At first our efforts to make Asiatics clean up, and to eliminate diseases like leprosy, cholera and plague, were viewed with mild amusement, not unmixed with contempt; but the results which we obtained soon aroused lively interest.

Foreign governments began to send representatives to the annual meetings of the "Philippine Island Medical Association," [505] in order to learn more of our methods. From these small beginnings sprang "The Far Eastern Association of Tropical Medicine," the biennial meetings of which bring together the most experienced, skilful and widely known physicians and sanitarians in the East for an interchange of views and experiences which is invaluable, and greatly facilitates concerted action between the various governments concerned in dealing with what may be termed "international health problems."

The first meeting of this Association was held at Manila, the second at Hongkong. The third will take place at Saigon.

The results of a rigid enforcement of the "Pure Food and Drugs Act" are worthy of more than passing notice. Such enforcement has been comparatively easy as the officials concerned are not hampered by politics. The Philippines were at one time a dumping-ground for products that could not be sold elsewhere, but it is now possible for Filipinos to obtain wholesome preserved foods and unadulterated drugs, except in very remote places where none of any sort are available.

The cost of our medical and sanitary work has been comparatively small. The per capita rate of taxation here is lower than in any other civilized country. What we have done has been accomplished without spending vast sums of money or resorting to military measures.

The results obtained are very largely due to the faithfulness and efficiency of Dr. Victor G. Heiser, who was chief quarantine officer of the Philippines when he succeeded Major E. C. Carter as commissioner of public health on April 5, 1905, and was later made director of health when the original board of health was abolished as an administrative entity. He has continued to hold the office of chief quarantine officer, and thus has been in complete executive control of the health situation for eight years.

Through good report and ill, mostly ill, he has given unsparingly of his time, his skill and his wisdom, always treating the government money as if it were his own.

His tenure of office has been long enough to enable him to inaugurate and carry out policies, and thus get results.

Seldom, if ever, have health officials been more viciously and persistently attacked than have Dr. Heiser and myself. The assaults on us have been the direct result of a firm stand for a new sanitary order of things, established in the interest of the whole body of inhabitants of these islands, civilized and uncivilized. We both welcome the profound change in public sentiment, which has slowly but surely come about as a result of practical accomplishment.

Many very grave health problems still confront the insular administration. Of these the most serious are the eradication of tuberculosis and the reduction of the very high infant mortality rate.

It is believed that about one Filipino in five suffers from tuberculosis in some form during his life and the work we have thus far accomplished in many fields must be considered as in a way a clearing of the decks for action against this, the greatest enemy of all. However, the Philippines do not differ essentially from other civilized countries, in all of which tuberculosis is a very serious factor in the death rate.

As regards infant mortality the situation is different. More than fifty per cent of the babes die before completing their first year of life. The causes which lead to this appalling result have been made the subject of careful investigation which still continues. Popular interest has been aroused, but it is undoubtedly true that many years of patient work will be necessary before anything approaching satisfactory results can be brought about.

The physical condition of the average Filipino is undoubtedly bad. Of one hundred seventy-eight university students recently examined sixty-nine were found to be suffering from serious organic troubles. Unquestionably the great mass of the people are underfed. This is largely due to the poor quality of the rice which they consume, and to the fact that rice forms too large a part of their diet. I am firmly convinced that much of the so-called laziness of the Filipinos is the direct result of physical weakness due to improper and insufficient food.

Since the American occupation a large amount of time has been successfully devoted to the working out of a good all-around diet made up of local products the cost of which comes within the means of the poor. The next thing will be to get them to adopt it, and there comes the rub. Incalculable good would result, if we could only persuade the people of these islands to sleep with their windows open. Thousands upon thousands of infant lives would be saved annually, if mothers could be persuaded not to give solid food to their little ones during the early months of their existence.

In the educational campaign which we have thus far conducted with some considerable degree of success, two agencies have proved invaluable, namely the Catholic Church and the public schools. Again and again I have begged Apostolic Delegate Monsignor Agius and Archbishop Harty to bring to bear the influence of the Church in favour of simple sanitary regulations, the general adoption of which was imperatively necessary in combating some epidemic of disease. They have invariably given me invaluable assistance.

Through the public schools we reach more than half a million children, and they take the information which we convey to them home to their parents. Simple rules for the prevention of cholera have been universally taught in the schools. When the use of English has become generalized the difficulty now encountered in reaching the common people will largely disappear. The truth is that they are singularly tractable and docile when their reason can be effectively appealed to. The readiness with which they have submitted to the rigorous measures necessary for the elimination of leprosy is a lasting honour to them.

Would the sanitary campaign so vitally important to the people of the Philippines be effectively continued if American authority were withdrawn at this time? With regret I must answer this question emphatically in the negative. We have succeeded in training a few good physicians and surgeons. We have thus far failed to train really efficient sanitary officers. What is lacking is not so much knowledge as to what should be done as initiative and courage to do it. Until this condition changes radically for the better, Filipinos cannot safely be intrusted with the sanitary regeneration of their country. Under American control the population of the islands is steadily and rapidly increasing. It is my firm conviction that if Filipinos were at this time placed in control of the health work, the population would steadily and rapidly decrease.

The present attitude of the Filipino press toward sanitary work is both interesting and important. I quote the following editorial from the March 27, 1913, issue of _El Ideal_, a paper generally believed to be controlled by Speaker Osmeña:--

"Some persons, who, because of being ignorant of many
things, do not sympathize with the Filipino people, who are
in the habit of frequently throwing up to them the violent
opposition of our masses to strict sanitary measures in cases
of epidemics, and the lively protests which are provoked
here on some occasions by other provisions tending to end
some public calamity, thinking they see in this disposition
of mind an indication of our incapacity to govern ourselves....

"To be more expressive, we shall say that the sanitary agents
and veterinarians of the government, swollen with power and
overly zealous of their prestige, quickly become, when an
occasion like those cited by us presents itself, cunning czars,
whose sphere of influence is in direct ratio to the peaceful
character and ignorance of the people intrusted to their
care, and whose excesses and abuses recognize no limits but
the natural ones established by the greater or lesser honour
of those public servants, their greater or lesser cynicism,
and their greater or lesser degree of temerity.

"This, and nothing else, is the logical and natural explanation
of the hostility of our people toward those measures of good
government which are sincerely esteemed for what they are
worth, but for which they have veritable terror because of
the nameless abuses to which they give rise.

"These comments are of palpitating current interest at this
moment, when reports are made almost daily to the press and
the proper authorities of misbehaviour and excesses befitting
soulless people who live without the law committed by persons
who should be examples of prudence, honesty and good manners,
for it is in this concept that the people are compelled to
furnish them their daily bread."

It is deeply to be regretted that the public press of the islands has not yet become sufficiently enlightened to join in the great sanitary campaign which has already relieved an enormous amount of human suffering and has greatly increased the expectancy of life of the people of the Philippines.

The Philippine Assembly has repeatedly passed acts providing for the creation of a sort of sanitary council of numerous members authorized to pass on public health measures proposed by the director of health and instructed to disapprove them if not in accordance with the beliefs and customs of the Filipinos.

In protecting the public health in the Philippine Islands emergencies constantly arise which must be instantly and effectively met. It would be as logical to place a commanding general directing a battle under the control of an advisory board as it would thus to tie the hands of the director of health, and it is difficult to see how any competent and self-respecting sanitarian could be willing to continue to hold this position if so hampered.

The Philippine Commission has heretofore invariably tabled the acts designed to accomplish this end, but that body has now been "Filipinized" and its future attitude on this very important question is therefore in doubt. Hardly had the legislative session opened in October, 1913, when the assembly again passed the same old bill. Should it become a law, there will be occasion to watch, with especial interest, the death rate of Manila and that of the archipelago as a whole.