The Spanish residents were allowed to establish a private cholera hospital in a large and well-ventilated _convento_ on Calle Herran. As the number of sick Spaniards was nothing like sufficient to fill this building, they were asked to turn over the unoccupied s.p.a.ce in it to the board of health, which they most generously did.

In response to popular clamour a hospital under strictly Filipino management was opened in a nipa building in Tondo. Interest in it soon flagged, and the government found itself with this inst.i.tution on its hands.

The epidemic came soon after the close of a long-continued war, and there were at that time in Manila not a few evil-intentioned persons, both foreign and native, who welcomed every opportunity to make trouble. The difficulties arising from the claim advanced by a number of reputable but ignorant medical men that the disease was not cholera at all were sufficiently great. They were enormously increased by false and malicious stories to the effect that "contacts"

were killed at the detention camp; that patients on arrival at the cholera hospital were given a drink of poisoned _vino_ [500] and instantly dropped dead; that the distilled water distributed free of charge was poisoned, and that the Americans were poisoning the wells.

The necessary use of strychnine as a heart stimulant at the cholera hospital was made the basis for a story that the sick were being poisoned with this drug.

These silly tales were widely circulated and quite generally believed, and as a result of the fear thus engendered, and of the desire on the part of relatives and neighbours of stricken persons to escape disinfection and quarantine, strong efforts were often made to conceal the sick and the dead, and when this was not possible the "contacts"

usually ran away. There were not wanting instances of the driving of cholera victims into the streets.

In spite of the generally hostile att.i.tude of the public and some grave mistakes in policy, the measures adopted sufficed at the outset to hold the disease in check to an extent which surprised even the health officers themselves.

On May 15 there began a rapid and quite steady decline in the number of cases.

In June, however, it increased. During July it grew steadily larger, and on the 25th of that month there were ninety-one cases, the largest number which has ever occurred in Manila on any day since the American occupation.

Throughout the early months of the epidemic Major Maus had laboured unceasingly to check it, displaying an energy and an indifference to fatigue and personal discomfort which were highly commendable. The long-continued strain ultimately began to tell on him severely. On May 17 orders were received from the Adjutant-General's Office providing for his relief on or about July 30, and stating that Major E. C. Carter, of the United States Army Medical Corps, would be available for detail as commissioner of public health on that date, if his services were desired. Arrangements were accordingly made to have Major Carter proceed to the Philippines. Major Maus's resignation was accepted, effective July 31. Dr. Frank S. Bourns was urged to take temporary charge of the situation, and consented to do so.

On the 8th of August Major Carter arrived and announced his readiness to a.s.sume his duties, but it was suggested to him that he ought first to have some time to familiarize himself with them, and Dr. Bourns was left free to carry out the special work for which he had been appointed.

This he did with promptness and despatch, the number of cases for August being but seven hundred twenty as against thirteen hundred sixty-eight for the previous month. On the 8th of September, having brought the disease under control at Manila, he insisted on resigning in order to attend to his private affairs, which were suffering from neglect, and his resignation was reluctantly accepted.

Dr. Bourns's remarkable success in dealing with a very difficult situation was largely due to his ability to devise measures which, while thoroughly effective, were less irritating to the public than were those which had been previously employed.

The policy which he had inaugurated was followed by his successor with the result that the cases fell to two hundred seventy-five in September and eighty-eight in October. In November there was a slight recrudescence, but the disease did not again threaten to escape control and in February practically disappeared, there being but two cases during the entire month.

The return of hot, damp weather again produced a slight recrudescence, and scattering cases continued to occur until March, when the epidemic of 1902-1904 ended in Manila.

In view of the conditions which then prevailed and of the extreme risk of a general infection of the city water supply, which, had it occurred, would doubtless have resulted in the death of a third of the population, this is a record of which the Bureau of Health may well be proud.

The effort to prevent the spread of infection by maintaining a land quarantine around Manila proved entirely ineffective. The disease promptly appeared in the provinces where the campaign against it was from the outset in charge of newly appointed Filipino presidents of provincial boards of health, aided, when practicable, by medical inspectors from Manila.

Before it was finally checked in Manila there were 5581 cases with 4386 deaths; while in the provinces, in many of which it necessarily long ran its course practically unhindered, there were 160,671 cases, with 105,075 deaths.

On the 27th of April, 1904, the Board of Health pa.s.sed the following resolutions:--

"Whereas cases of Asiatic cholera have occurred in but three provincial towns of the Philippine Islands since February 8, 1904; and

"Whereas only one case of Asiatic cholera has been reported as occurring any place in the Philippine Islands since March 8, 1904; and

"Whereas the city of Manila was declared on March 23 to be free from the infection of Asiatic cholera; On motion

"_Resolved_, That the islands composing the Philippine Archipelago are, and are hereby declared to be, free from the infection of Asiatic cholera; and

"_Be it further resolved_, That the Commissioner of Public Health be directed to send a copy of these resolutions to the honourable the Secretary of the Interior, the Munic.i.p.al Board, the United States Marine-Hospital Service, and the Collector of Customs."

As a matter of fact, however, it later proved that cholera was endemic in certain swampy regions near Manila, and in 1905 we found ourselves with a new epidemic on our hands.

At the end of the second week, beginning August 23, there had been one hundred thirty-seven cases, as compared with one hundred twenty-five for the same period during the epidemic of 1902-1904.

However, the conditions for combating cholera were now far more favourable than in 1902. Major E. C. Carter had at his own request been relieved from duty as commissioner of public health, and Dr. Victor G. Heiser, pa.s.sed a.s.sistant surgeon of the United States public health and marine hospital service, had been appointed to succeed him on April 5, 1905. Dr. Heiser was a highly trained officer of one of the most efficient services which has ever been organized for the combating of contagious and infectious diseases.

He had under him in the city of Manila a small but thoroughly trained body of twenty-four medical inspectors, of whom nineteen were Americans and five Filipinos. Profiting by his previous experience and that of his predecessors in the Philippine service, he inaugurated a campaign which practically terminated the epidemic in Manila on February 21, 1906, [501] with a total of two hundred eighty-three cases and two hundred forty-three deaths.

This brief and decisive campaign reflects the greatest credit on all concerned with it.

The board of health had one great advantage in the fact that the San Lazaro contagious disease hospital had been completed. This building, with its cool wards and attractive surroundings, made it possible to give cholera victims the best of care.

There was at the outset little or no fear of this hospital, but apparently this condition of things was not satisfactory to that small but dangerous element of the Manila public which from the time of the American occupation has never let pa.s.s any opportunity to make trouble. As usual, the medium of attack was the local press. _Soberania Nacional_ published a most extraordinary article painting in vivid colours the alleged horrors of the San Lazaro Hospital, and stating among other things that the naked bodies of the dead, tagged and with their feet tied together, lay about the entrance of that inst.i.tution. A more false statement was never published.

Within twenty-four hours after its appearance terror reigned among the lower cla.s.ses, and living and dead cholera victims were being smuggled out of the city to neighbouring towns.

Feeling that the vicious att.i.tude of a certain section of the press had cost lives enough, I sent the editor of this paper a courteous invitation to call at my office. He made no response. I then wrote him, demanding a retraction, and sending him a correct statement to publish. [502]

He was at first disposed to argue the matter, but finding that I meant business published the article which I sent to him and made the following retraction:--

"We are exceedingly glad to affirm in the honour of truth and justice, that the news given by us on the seventh instant under the t.i.tle 'Painful Scenes,' and 'Naked Dead,' is absolutely absurd, false and unreasonable.

"We have investigated the truth of the said notice, and can affirm to our readers that it is entirely inaccurate, as in the courtyard of the said hospital the naked dead that we have spoken of are not now exposed, nor have they ever been so exposed.

"The truth is above all things, and to rectify a baseless piece of news should not be a doubtful action on the part of the person who gave the news, but rather something in his favour that the public should appreciate it at its full value.

"To conclude, we must record our grat.i.tude to the Secretary of the Interior, the Hon. Dean C. Worcester, for the investigations made in the premises with the purpose of ascertaining the truth of the alleged facts, and for the courteous way in which he received us this morning when interviewed by one of our reporters."

In the provinces the results of the campaign against cholera were far less satisfactory than in Manila as was to be antic.i.p.ated, owing to lack of adequate personnel, but the cases, which numbered 34,238 and deaths which numbered 22,938, were far fewer than during the previous epidemic.

I shall not attempt here to trace the course of the subsequent epidemics which have occurred from time to time, but shall content myself with giving the deaths by years. In 1908, they numbered 18,811; in 1909, 7306; in 1910, 6940; in 1911, 203. In 1912, there were none, and thus far in 1913 there have been none. [503]

The superst.i.tious practices which were formerly employed by the Filipinos to combat this scourge have given way to simple and inexpensive hygienic measures, and we can safely count on sufficient cooperation from the people to make an effective campaign possible when it next appears.

Never shall I forget the strain of the early days of the first epidemic. Two of my best men, Dr. Meacham and Mr. Mudge, literally worked themselves to death, remaining on duty when they knew that they were in imminent danger, and in the end laying down their lives willingly for an alien and hostile people. Such things make one proud of being an American.

At times the situation was not devoid of amusing features. I had occasion to visit one of the northern provinces, where the epidemic was especially severe, in an effort to calm the panic-stricken populace. I stayed with the governor, a very intelligent Filipino. For obvious reasons I investigated his domestic arrangements, finding that he was boiling drinking water, thoroughly cooking all food, and taking all usual and necessary precautions to prevent infection.

On returning to his house the first evening, after a short absence, I found the grounds decorated with lighted j.a.panese lanterns. Supposing that the proverbial Filipino hospitality had risen above even such untoward circ.u.mstances as those which then existed, I asked the governor what the entertainment was to be. In evident perplexity he replied that he had not planned to have any entertainment, and on my inquiring what the lanterns were for, said he had heard that they were good to keep away cholera germs!

I have referred to the fact that the civil government inherited a fairly well developed epidemic of bubonic plague. In 1901 this disease caused four hundred twenty-seven deaths, in 1902 it caused ten only, but the demands made on the sanitary force by the cholera epidemic which began in that year rendered it impossible to give to plague the attention which it otherwise would have had, with the result that in 1903 we had one hundred seventy-four deaths. In 1904 there were seventy-eight; in 1905, forty-three; in 1906, seven; in 1907, none; and from 1907 until 1912, none. In the latter year the disease was reintroduced.

Rats become infected with it, and fleas transmit it from them to human beings. It was probably brought in by pestiferous rodents hidden inside packages of vegetables, as it appeared in a district where crates of vegetables are opened in large numbers, and did not appear in the vicinity of the piers, although sh.o.r.e rats are abundant there, and if diseased rodents had landed from shipping, would promptly have become infected,--a thing which did not occur.

At about the same time plague also appeared at Iloilo, where it was eradicated with a total of nine deaths. At Manila there have been up to the present time [504] fifty-nine deaths, and scattering cases continue to occur at considerable intervals.

Had plague not been promptly and effectively combated, it would unquestionably have spread rapidly, causing untold misery and heavy property losses.

As I have previously stated, at the time of the American occupation smallpox was by many people regarded as an almost inevitable ailment of childhood. It proved necessary to secure the pa.s.sage of legislation forbidding the inoculation of human beings with it to prevent misguided Filipinos from deliberately communicating it to their children, not because they did not dearly love them, but because they regarded infection with it as a calamity sure to come sooner or later, and desired to have it over with once for all.

We have performed more than ten million vaccinations, with the result that the annual deaths from this disease have decreased from forty thousand at the outset to seven hundred for the year just ended. There is now less smallpox in Manila than in Washington.