In this connection the following extracts from a letter of August 7, 1913, from the director of medical services in India to the department surgeon of the Philippines are of interest:--
"In reply to your letter of June 31st I attach a statement showing the number and location of the hill stations in India with the approximate capacity of each, and their height above sea-level.
"With regard to your inquiry regarding the number of cases treated in these sanitaria we use these hill stations not only for the treatment of convalescents, but also for giving healthy men an opportunity of spending the Indian hot weather under the best climatic conditions procurable. To this end, so far as is practicable, all units are sent to the hills for the first hot weather after their arrival in India, and they are thus able to settle down to their new conditions of life without being immediately exposed to the trying and enervating environment of a plains station in the summer months. We also send as many soldiers as we can of the older residents from hot stations to summer in the hills.
"Practically all soldiers" wives and families are given an opportunity of a change from the more unhealthy stations to the hills during the hot weather.
"Our experience shows that the following cases are most benefited by a change to the hills:--
"1. All cases of malarial fever and malarial cachexia.
"2. Patients recovering from acute diseases.
"3. Convalescents after surgical operations.
"4. Cases of anaemia and debility.
"5. Cases of chronic venereal diseases.
"6. Neurasthenics."
Not only are all such cases greatly benefited at Baguio, but patients suffering from dysentery and chronic diarrhoea are also greatly benefited and often cured by a sufficiently long sojourn there. This is the experience of the civil government at its hospital and of the military authorities at the Camp John Hay hospital, according to General Bell.
Continuing the quotations from the letter of the director of medical services in India:--
"We have found that by the judicious use of hill stations for convalescents both the invaliding and death rate of the British troops in Indian have been enormously reduced and the efficiency of the Army has been increased with a considerable financial saving to the Government.
"It is advisable that all troops and families should be accommodated in huts, especially during the rainy season in the hills, but there is no doubt that they are benefited by the change even if they have to live in tents and are thereby exposed to considerable discomfort."
The importance attached by the British to hill stations is shown by the fact that there are no less than 29 in India, their height above sea-level varying from 2000 to 7936 feet. Of these eleven have no permanent accommodations and are used for men only.
I add the following extracts from a letter of Major P. M. Ashburn, Medical Corps, U.S.A., president of the army board for the study of tropical diseases:--
"A man can remain in the tropics indefinitely without being actually sick, if infectious diseases are avoided. This is fast leading to the fallacy that we can advantageously remain many years in these lat.i.tudes. The fact that while a man may never be sick, he yet may have his physical and mental vigour greatly impaired by prolonged exposure to heat is thus lost sight of. No man can do his best work, either physical or mental, if he is hot and uncomfortable. The same feeling of la.s.situde and indisposition to exertion is experienced at home during the hot summer, which after a few years here becomes chronic."
"It is a matter of official recognition that government employees need to get away from the heat of Manila each year, hence the removal to Baguio.
"It is likewise commonly recognized that many women and children become so run down and debilitated as to need to go to j.a.pan, Baguio or the United States.
"It is often true that monotony and discomfort are the cause of nervous and mental breakdown, witness the often-mentioned insanity among farmers" wives and the nervous breakdowns attributable to pain and strain, even though it be, as in many cases of eyestrain, so slight as not to be recognized by the patient."
In short, it is the monotony of a tropical lowland climate which makes an occasional change so imperatively necessary. Shall residents of the Philippines be forced to seek that change, at great expense of time and money, in j.a.pan, the United States or Europe, or shall we make and keep available for them a region which admirably answers the purpose, distant only half a day"s travel from Manila?
I give extracts from a memorandum of Col. William H. Arthur, Department Surgeon of the Philippines, which are important in this connection:--
"3. Experience has shown that long residence in the Philippines has a marked effect on the mental and physical vigour of people not born and raised in the tropics. This is manifested in many ways, and men, women and children who are not actually ill, seem to lose their energy, become listless, irritable, and forgetful, and find the least exertion burdensome. This is much aggravated in the hot season, and very few individuals manage, without permanent mental and physical deterioration, to live through many hot seasons in the plains.
"4. There are in the Philippine Islands two places where relief from these conditions can be found:--(1) Camp John Hay, near Baguio, in the mountain province of Benguet, Island of Luzon; and (2) Camp Keithley, in the Lake Lanao District of the Island of Mindanao. Camp John Hay, in the province of Benguet, is in the mountains at an elevation of approximately 5000 feet and is 175 miles from Manila, most of which distance is covered by railroad. Within 18 months it is expected that the railroad all the way to Baguio will be completed.
"5. Experience has shown that a large number of cases of disease or injury, or patients convalescing from surgical operations, recover much more rapidly in the cool mountain climate of Baguio than in the depressing heat and humidity of the plains. Before the establishment of this mountain refuge from the heat of the plains, many cases of this cla.s.s were transferred to the United States that are now brought back to health at Camp John Hay and Camp Keithley. The beneficial effect of the change in climate is particularly noticeable in people who have become run down after one or more hot seasons spent at the lower levels.
"6. The great value of a refuge in the mountains from the effect of prolonged heat is shown in enclosed reports, which indicate the cla.s.ses of cases especially benefited, but there are a great many others not reported and not actually sick but whose vitality and resistance are more or less diminished and who find great benefit from an occasional sojourn in the mountains of Benguet or the highlands of Mindanao, especially during the hottest part of the year."
I have quoted thus at length from communications of a distinguished British medical officer, of a well-known and able special student of tropical diseases, and of the ranking United States army surgeon in the islands to show the consensus of opinion among experienced experts as to the necessity of hill stations in the tropics. I might give numerous additional similar opinions of equally competent men but will only add two more statements of Major Ashburn, the latter of which seems to me admirably to sum up the situation:--
So firm is my belief in the efficacy of the place that I have at considerable expense kept my two sons in school there, instead of keeping them at home in Manila at no expense for schooling, and so satisfactory has been the result in normal, vigorous growth and robust health for both boys, that I consider the money so spent about the best investment I have ever made.
I state all this to show the faith that is in me. To experience Baguio and to see the rapid improvement of visitors there is to be convinced that it is a delightful and beneficial climate. To appreciate the full degree of its delights it is only necessary to compare in one"s own experience (not in weather reports) a hot season in Manila and one there. To appreciate its benefits it is necessary to compare in one"s own experience (not in statistics) the appearance of health of the people seen at the two times and places. As recent work on beri-beri has clearly shown the vast importance in diet of substances formerly not known to have any importance, so, I think, are the factors in climate not to be recorded by wind gauges, thermometers or other meteorological instruments, and factors in health and efficiency not recorded in books on physiology, bacteriology, pathology or health statistics."
Let no one think that the summer capital of the Philippines has been built solely for the benefit of Americans. The Filipinos need it almost as much as we do, and many of them profit by the change with extraordinary promptness.
It is really almost incredible that such a place should exist within eight hours" travel of Manila, and every possible victim of tuberculosis in the islands, which means every inhabitant of the lowlands, has a right to demand that it should be made, and kept, readily accessible. Existing accommodations are nothing like adequate for the crowds which desire to take advantage of them during the season. Hotels are filled to overflowing. There are always several different applicants for each government cottage. Many persons who would be glad to spend the hot months in the Benguet mountains find it impossible to do so, because they cannot obtain accommodation, and at present many more are obliged to shorten their stay in order to give others a chance.
In the early days, when we were facing unforeseen difficulties and discouragements, I was for a time the one member of the Philippine Commission who was really enthusiastically in favour of carrying out the original plans for the summer capital. It was then the fashion to charge me with responsibility for the policy of opening up communication with the place and for the mistakes made in the construction of the Benguet Road, although I had never had any control over the road work and had been one of five at first, and later one of nine, to vote for every appropriation found necessary in order to complete it.
It was the enthusiasm of Mr. Forbes which at a critical time finally saved the situation, and now that Baguio has arrived, and the wisdom of the policy so long pursued in the face of manifold discouragements has been demonstrated, my one fear is that he will get all the glory and that I shall be denied credit for the part which I actually did play in bringing about the determination to establish quick communication with one of the most wonderful mountain health resorts to be found in any tropical country, and in giving that determination effect. But I have had a more than abundant reward of another sort. My wife, my son and I myself, when seriously ill, have been restored to vigorous health by brief sojourns at this one of the world"s great health resorts.
It has been very much the fashion for Filipino politicians to rail at Baguio, and now that the dangerous experiment of giving them control of both houses of the legislature is being made, they may refuse to appropriate the sums necessary to make possible the annual transfer of the insular government to that place. The result of such a bit of politics would be a marked increase in the present extraordinarily low death rate among government officers and employees, American and Filipino, [515] beginning in about two years, when the c.u.mulative effect of long residence in the lowlands makes itself felt.
Meanwhile, Baguio can stand on its own feet, and if, as the politicians suggest, the government buildings there be sold at auction, purchasers for all dwelling houses should readily be found. Too many Filipinos have learned by happy experience the delights of this wonderful region, to let such an opportunity pa.s.s. Baguio has come to stay.
CHAPTER XVIII
The Coordination of Scientific Work
When Americans landed at Manila, they found no government inst.i.tutions for the training of physicians and surgeons and no hospital in any sense modern or indeed worthy of the name.
There did exist the equipment of what had been called a munic.i.p.al laboratory, outfitted for a limited amount of chemical work only.
When the Philippine Commission arrived on the scene, it fell to my lot to draft the necessary legislation for placing scientific work on a firm foundation, and, later, as secretary of the interior, to exercise ultimate executive control over practically all such work carried on under the insular government.
The complete initial lack of adequate hospital facilities and of means for making chemical and bacteriological investigations had been promptly remedied by the establishment of army hospitals and an army laboratory. Although these could not be placed fully at the service of the public, they nevertheless bridged the gap for the time being, and in formulating laws and making plans for the future I was inclined to say, "Blessed be nothing," as we were not hampered by useless employees or archaic equipment, but were left free to make a clean start.
I had thoroughly learned one lesson at the University of Michigan while a member of its zoological staff. We had a zoological laboratory in which were conducted the zoological half of a course in general biology and numerous other courses in animal morphology, mammalian anatomy, comparative anatomy and embryology. There was also a botanical laboratory in which all of the botanical work of the inst.i.tution was carried on. This did not involve any overlapping, but there was overlapping of the work of the zoological laboratory and that of the medical department, which had an anatomical laboratory, a histological laboratory, a pathological laboratory and a so-called hygienic laboratory. The professor of anatomy thought that his students would understand human anatomy better if they knew something of comparative anatomy, and instead of sending them to us wished to start his own courses. The histologist dabbled in embryology and was soon duplicating our course in the embryology of the chick. He was constantly at war with the pathologist over the question of where histology left off and pathology began, and both of them were inclined to differ with the man in charge of the hygienic laboratory over similar questions of jurisdiction. Furthermore, we had a chemical laboratory split up into various more or less independent subdivisions, and a psychological laboratory. In these several inst.i.tutions for scientific research there was much duplication of instruction and of books, apparatus and laboratory equipment. Great economies might have been effected by the establishment of a central purchasing agency, which could have obtained wholesale rates on supplies ordered in large quant.i.ty. Nothing of the sort existed. One laboratory chief would order from the corner drug store, while another bought in Germany.
There was danger that a similar condition of things might arise in the Philippines. The Bureau of Health would want its chemical and its biological laboratories; the Bureau of Agriculture would need to do chemical work covering a wide range of subjects, and botanical and entomological work as well. The Bureau of Forestry would of course require a large amount of botanical work, and would also need to have chemical work done on gums, resins and other forest products, to say nothing of investigating insects injurious to trees and more especially to timber after cutting. The latter cla.s.s of destroyers do enormous damage in the Philippines. Much chemical work would be required by the Bureau of Customs, which as a matter of fact later insisted upon the necessity of a "microscopical laboratory"