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.