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 subst.i.tuted 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-cla.s.s 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 inst.i.tution 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 inst.i.tution 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 inst.i.tutions or by government organizations.
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 Cebu 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 Luzon. Think of the advantage of being absolutely certain of curing such an ailment in every case, and think of the grat.i.tude 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 a.s.sembled 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 pa.s.s 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 inst.i.tutions 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 inst.i.tution, 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 inst.i.tutions doing admirable work should be mentioned the University Hospital, an Episcopal inst.i.tution; the Mary J. Johnston Hospital, a Methodist inst.i.tution; and St. Paul"s Hospital, a Catholic inst.i.tution. 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 inst.i.tution, 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 inst.i.tutions 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 inst.i.tutional care.
The several inst.i.tutions 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 a.s.sist 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 inst.i.tution there is now conducted an admirable school where more than two hundred young men and women are being trained. Three cla.s.ses 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 a.s.sistants 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 inst.i.tution, 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 Cebu a thoroughly up-to-date sixty-bed inst.i.tution 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.