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 pa.s.s 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 pa.s.sed 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 b.u.t.t 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.

In a recent letter a friend writes, "The other day one of our servants, Crispin, was ill. I tried to get him to go to the hospital, but he insisted he was not sick. I did not enjoy having him wait on the table, for I thought he had measles. So I took him to the hospital myself and told him to do what the doctor said. When I returned home a telephone call summoned us to the hospital to be vaccinated at once, for Crispin had the smallpox! They sent him to San Lazaro, where he had a good time, and came home smiling, while we spent a miserable ten days waiting to see what was going to happen to us. The native _saindados_ came promptly to disinfect, but all they did was to put a bucket of something in the center of the room. I soon saw that they were not going to be thorough, so after ten minutes, just as they were going away, I called them back and telephoned to the board of health, asking if no American sanitary officer was coming. They said no, that Filipinos had been put in all the white men's places. So I went to work myself, burning bedding, clothes and hangings, and opening every trunk and closet. It was a revelation to those two little natives, who thought they had done enough before."

Apparently the natives had the same aversion to the preventive method of vaccination that some of our own countryfolk have, for Dr. Heiser writes of the early work in the field: "Formerly ... the lives of the vaccinators were seriously threatened by persons who refused to be vaccinated. However, after much persuasion, a considerable number of the inhabitants were vaccinated. Shortly afterwards smallpox was introduced and the death rate among the unvaccinated became alarming; the people themselves then noted that in spite of the fact that the vaccinated persons frequently came in constant contact with the disease they did not contract it, while the unvaccinated died in large numbers. This led to urgent request being made for vaccination and the vaccinators who previously found their lives in constant danger were welcomed."

But perhaps Dr. Heiser's greatest work has been done in freeing the Islands of the worst-feared disease of all times and nations--leprosy. I was walking along the street with him one day when he noticed the swollen ear lobes of a man near by. It was one of the first symptoms of leprosy. He stopped and spoke to the man and walked with him to the hospital. The disease is not really so much to be feared as people think, for it is seldom inherited and is not easily contagious.

We had planned to go to Culion, the beautiful island where thousands of lepers have been taken to live or to die, and where they have every care and comfort that science and unselfish devotion can give them.

Unfortunately for us, the Secretary of War was obliged to cut the trip short, owing to official business in Manila, so we did not go there. We heard so much about the place that this was a real disappointment.

The island is a day's sail from Manila. It is well forested, and has hills and fertile valleys and a fine harbour. The more important buildings of the town which the authorities knew would be needed by the thousands of lepers then at large, were built from the foundations entirely of concrete, for sanitary reasons and economy. Besides hundreds of houses, one finds there to-day a theater, a town hall, a school, dining halls, hospitals, stores, docks and warehouses. Water, lighting and sewerage systems were also constructed, and a separate settlement was built for the non-leprous employees.

Culion is really a leper's heaven. The people have perfect freedom, and live normal lives, farming or fishing when they are able, carrying on their own government, having their own police force, playing in the band if they are musical, giving theatrical performances. They have social distinctions, too--those better born take the place denied them in the outer world because of their affliction. Here they are again Somebody.

When Americans took possession of the Islands there were six thousand lepers at large. Two things evidently had to be done--first, prevent a further spread of the disease; and second, cure those who already had it, if this were possible.

Segregation of all known cases, as fast as accommodations could be provided for them, was the immediate necessity. The colony at Culion was opened in 1906 with five hundred patients. These went reluctantly to their new abode, but once settled there, found it so much to their liking that they wrote home enthusiastically, and after that the authorities had no difficulty in persuading others to go. Indeed, the plight of these poor outcasts had been pitiful enough. They were so neglected that in one of the larger cities they had been known to go into the markets and handle the produce, as a protest against their treatment.

More than eight thousand have been transferred to Culion in all, and to-day every known leper in the Philippines is there. New cases are still occasionally found, but even the worst provinces are now practically free from the historic scourge. It was that remarkable man, Dr. Heiser, who not only organized and carried out this great undertaking, but who himself saw to the smallest details. Many times he is known to have carried the loathsome patients in his own arms.

The second problem, that of finding a cure, was not so easily solved.

But it has been found, and our nation had the credit of finding it--"the first definite cure ever established," Dr. Heiser says. Two methods were tried out very carefully, both with some success. The first was the x-ray, which brought a marked improvement in most of the cases where it was used, and an apparent cure in one case. The other method was the use of chaulmoogra oil. This remedy had been known and used in the Far East for some time, but it could rarely be given long enough to produce much effect, because it was so unpleasant to swallow. Our doctors, however, devised ways of injecting it, after mixing it with resorcin and camphorated oil, so that there were no ill effects. Already several cures have resulted.

Ten years ago there were forty thousand users of opium in the Islands.

In five years that number was reduced ninety-five per cent, and most of those still addicted to the drug are Chinese. In the last few years, moreover, cholera and bubonic plague have been practically wiped out, but, of course, a few other tropical diseases still exist.

The Philippine a.s.sembly recently conceived the brilliant idea of cutting down expenses by halving the health appropriation. Dr. Heiser got permission to speak before them, but instead of talking a few minutes, as they expected, he spoke for three days. He told them that if they did not give him the money he needed for the work, he would be forced to economize by setting free the criminally insane, who, he promised, should be given tags stating that they had been set free by order of the a.s.sembly. Also, he said, he would have to send back many of the lepers to their friends. It proved to be the way to deal with the child-like legislators, who in the end gave him what he wanted. Since that, however, he has resigned, and his loss will be sadly felt. Indeed, there has already been an outbreak of cholera since he left.

Regenerative work among the Filipinos has by no means been confined to their bodies, however, for besides the educational advance that has been made in their schools, which I have mentioned elsewhere, their prisons have become sources of light instead of darkness. It is true that penology in the Philippines has gone ahead with great strides.

In Bontoc, for instance, there is a prison which the commissioner in charge of the province proudly called his "university." Its inmates are men of the mountains. In the old days they would have been sent to Bilibid prison in Manila, where few of them lived over two years. A longer term meant practically a death sentence. This provincial jail is situated in the high and healthy capital of the province, and is kept clean and sanitary by the prisoners themselves. The men are well fed and cared for, and they are taught trades, and made to work at them, too, so that they learn industry along with technical skill.

Bilibid prison is a huge inst.i.tution. It occupies several acres of land in the heart of the city of Manila, its buildings radiating from a common center, so that the guard in the high tower at the hub can overlook anything that occurs. High walls surround the whole, patrolled by watchful guards and mounted with gatling guns. It is an extraordinary inst.i.tution, inherited from Spanish rule, but, like everything else, completely changed since then. The wives of men committed there were considered widowed in those days, since so few survived a long term, and were free to marry again. There has been some confusion of late years, because most of the prisoners not only come out alive, but healthier than when they went in. So prison "widows" who remarried found that they had not counted on American methods. Bilibid, though in many ways still rather experimental, is a great success.

There are extensive shops, and the prisoners are kept at work all the time. Some make silverware, carriages, and furniture, while others do the cooking and washing for the prison, make their clothes, and run a laundry, not only for their own use, but for outside custom. Many are employed in road building and on fortifications. Each man learns a trade during his term of imprisonment, and so is better able to earn an honest livelihood than when he entered. I have been told that Bilibid "graduates" are in demand because of their honesty and industry. No better recommendation for a prison could be desired.

Besides the shops, there is a school in which they are taught English.

The day we visited the prison we saw a teacher there who had been a guest at the Governor's table, but as he had forged a check he was paying the penalty. Most of the attendants in the up-to-date prison hospital were Spaniards who were in for life sentences and who made very good nurses. Part of this inst.i.tution is devoted to consumptives, of whom there are so many in the Islands, and they receive treatment according to the best and latest methods.

[Ill.u.s.tration: PENAL COLONY ON THE ISLAND OF PALAWAN.]

We were much interested in the kitchens, and the manner in which food was issued to several thousands in only six minutes. It was all wonderfully systematized.

Late in the afternoon we went up into the central tower to watch the "retreat." The prisoners' band, which had played for us as we entered the prison gates, now took its place in the courtyard below and began to play. Out of the workrooms trooped hundreds of convicts, who were searched for hidden implements and then released to take their position in military formation. The different groups marched to their quarters and, standing outside, went through a series of exercises to the music of the band. They seemed to enjoy this very much, and later, still to the music, marched gaily off to get their rations.

A long-term prisoner with two years of good conduct to his credit is given the privilege of going to the penal colony on the island of Palawan. This island is one of the more southern ones, and is the place where the Spanish sent their convicts in the old days. But the present colony, which was established by Governor Forbes, is very different from the former one. It was once a malarial jungle, but now is a healthy, thoroughly up-to-date and successful reform inst.i.tution.

Our visit to this place was one of the most interesting features of our whole trip. Palawan itself is a curiosity, for it has an underground river which has been explored for two miles beneath a mountain. But the penal settlement is unique.

Leaving the steamer at Puerto Princessa, a quaint little town with charming old Spanish gardens, we were met by a launch which took us up the Iwahig River to the colony. This launch, which was gaily decked with flags, was manned by convicts, the engineer himself being under a sentence of nineteen years for murder. After an hour's sail up the tropical river, we reached our destination. At the wharf we were greeted by Mr. Lamb, superintendent of the colony, a Dominican priest, and a crowd of prisoners who were enjoying a holiday.

We were driven to headquarters, near a pretty plaza with hedges and flowers, surrounded by several two-story barracks built of bamboo and nipa, where the prisoners live. As we walked about the plaza we visited the hospital and the chapel, as well as the main office and the superintendent's house.

The penal settlement is located on a reservation of two hundred and seventy square miles. At the time of our visit there were in all eleven hundred convicts--Filipinos for the most part, with a few Moros--and only three white men to keep them in order. The prisoners had all come from Bilibid prison.

In its management, the colony is somewhat like the George Junior Republic for boys in America. The prisoners elect their own judges and make some of their own laws, subject to the approval of the superintendent. A majority verdict will convict, but the superintendent has the right to veto any measures. Men who break the laws are locked up, but can be released on bail.

The police force is composed of convicts, of course. The chief of police when we were there was a murderer who had earned his pardon but preferred to remain in the settlement. If a prisoner tries to escape he is followed, and occasionally one is shot. The attempt is seldom made, for it is difficult to get away, and the men are, moreover, quite content to live there. Once thirty-five convicts did make a break for liberty, but beyond the confines of the settlement they found themselves in the midst of the savage Mangyans, by whom some were killed. Of the rest, those who were not captured alive returned of their own free will and were consigned again to Bilibid, which is considered a great punishment.

For good behaviour, convicts may earn the right to have a house of their own, with their family, one bull or carabao, and a little farm to cultivate. There were then a hundred and eighty of these farmers, who raised their crops on shares, the government receiving half. They had to report to headquarters by telephone every other day and undergo a weekly inspection as well. Every year they were obliged to plant cocoanuts, which in a few years were expected to bring in large returns. Already great quant.i.ties of yams were being shipped to Bilibid, and in a short time enough cattle would be delivered there to supply, in part at least, the meat demand of that prison. The colony suggests the possible solution of the meat question for the American army in the Philippines, as they were successfully raising calves from native cows by Indian bulls.

Although the majority of the prisoners were engaged in farming, they were often given the privilege of selecting the kind of work that they preferred, and were divided accordingly, their hats and the signs on the sleeves of their prison clothes showing what grade of convict they belonged to and what work they did. They were paid in the money of the colony, which was good nowhere else.

There were about forty women on the reservation. The men might marry if they earned the privilege, or if already married, they might have their wives and children come to live with them. There were six marriages the year we were there. After receiving their pardons, they could remain on the island if they wished, their work being credited toward the purchase of their farms, but they had to continue under the laws of the colony.

At the main office we saw four prisoners who were about to be pardoned.

Governor Forbes very kindly asked me to hand them their pardons and ask any questions I wished. One, a _bandolero_, or brigand, was small and wizened. Another, who looked much like him, when asked what crime he had committed, laughed and answered, "Bigamy!" A third, a stolid, thickset fellow, had the best face of them all, but showed no emotion whatever when I gave him his pardon. He also had been a brigand.

The convicts gave an exhibition fire drill for us at the barracks. The natives are born climbers, and scramble down the poles with the agility of monkeys. They also play baseball, of course. They are remarkably musical and have a good band.

We had luncheon with Mr. and Mrs. Lamb in their pretty bamboo and nipa cottage. Mrs. Lamb was a frail little woman, but strong in spirit, for she did not seem at all afraid to live in this land of evil men. She told us that the three murderers whom she had as servants were very efficient, and were devoted to her little four-year-old son.

When our visit ended we were driven in a wagon to the river, accompanied by a troop of prisoners who ran alongside shouting good-bys. At the wharf they lined up while Mr. Lamb and the priest bowed us politely aboard the launch.

These intrepid countrymen of ours, who are healing and uplifting a whole people, seem to me to be true missionaries. The time may come when the work which they are doing will set a standard for us stay-at-homes to follow, that is, if we send the right kind of men out there. As the song says,

"Ah, those were the days when the best men won, The survival of those that were fit-- When the work to be done counted everything, And politics nary a bit."