Page 1


.\


AN AMlItRICAN DOCTOR 'S

ODYSSEY


DOC70R VICTOR HEISER


An

American Doctor's

Odyssey Adventures in Forty-Jive Countries

by VICTOR HEISER,

M.D.

NEW YORK

W·W·NORTONC#COMPANY·lnc prrBLISHERS


.... -

CopY!'ight, 1936, by

iIDR. WC'F@R 'I'I'1'lISER F"it Ed't;"m

PJUN'r.ED AND nOUND IN THE UNI:rED STATES OF AMERICA

POll. THE P-U.BLISBEltS BY THE BADDON CllAFTSUEN. INC., CAlla!DE'N, NEW }E:RSE .Y


ACKNOWLEDGMENT

When I hlegan to write this book I f0und there were lit¡ eFa!l1y huge boxes of memoranda, notes, diaries, and other manuscripts to be sifted and read. Mrs. Rackham Holt, ably assisted by Mr. Walter Hayward, has been of invaluable help in organizing this vast amount of material and in preparing it for publicati0n. I am deeply grateful to them both. I am also most grateful to Miss Grace Carpenter who as my secretary f0r twenty years worked so indefatigably over tihis long EJeriod to prepare the daily notes which made this volume possible.


CONTENTS

I. Jlust Short of Btemity II. The Lame and the Halt

Ill. The Promised Land IV. And Bid the Sickness Cease V. Little Brown Brother VI.

Washing Up the Orient

VB. The Black Death VIII.

Eat, Drink, and Be Merry

IX. Water, Water, Everywhere X. XI.

Not with Beat of Drum For Their Own Goed

XII. The Heavenly Flower Xu!. Alas and a Lack XIV. The House of Pain XV. Prisoners of Hope XVI. XVII.

Dividends from Philanthropy A Drummer of Ideas

XVIII. Much Have I Traveled XIX.

Snakes in Eden

XX. The White Man's Last Refuge XXi. Parasites Lost and Parasites Regained vii

3 8

20 36 40 59

79 100 121 133 151 17 6 19 2 211 235 26 5 29 1 30 8 327 344 35 8


CON'FENWS

xxn. XXI[[. XX]V. XXV. XXVI. XXV!I!L XXVUI.

~ish

Stevies

A Great Little P eel?le . Pic~ing

Up BFell:en 'il"nreaes

An Ounce ef :Bl'evention And Make Persuasion De the Work of Fear Wustling the

~ast

386 395 417 437 461 ,j:8®

Pearl ef Great PriGe

50 3

XXIX.

Pilgrim's Progress

519

XXX.

@rant IDut MemeFf

53 2

]n<ilex

5'],7

viii


AN AMERICAN DOCTOR'S

ODYSSEY


~UST

CHAPTER. ].

SHORT OF ETERNITY

ALL during the latter part of May, 1889, a chill rain had been fidescending in tOFrents upon the (C(memaugh Valley. The small eity ef lfehnste:wn, wa:lll ed in by precipitous Pennsylvania hills, was invaded by high water whioh stood knee deep in ÂŁront of my father's house on Washington Street. Nobody seemed particularly concemed at the time over the dam which rich Bittsburghers had maintained high up on the South Fork to pFevide water for their fishing streams. When the earthen dam had fiFst been censtructed, there had been some apprehension. TheFe was a ninety foot head of water behind the embankment, and only a small spillway had been provided. But the dam had never burst and, with the passage ef time, the townspeople, like those who live in the shadow of Vesuvius, grew calloused to the possibility of danger. "Some time," they thought, "that dam will give way, but it won't ever happen te us." IDurillg tne afterno<'ln of the thirty-first the overflew from the river crept steadi1y nigher, inch by inch, through the streets of the tewn. A[though it had not yet reached the stable, which stood on higher ground than the house, my father became concerned over the safety of his fine pair of horses which were tied in their stalls, and suggested that I make a dash for the stable and unfasten them. The rain was fal!ling se hard that I was allmest wenched as I plowed my laborious way through the twe feet ef water. ;(had leosed the horses and was about to leave the shelter of the deorway when my ears were stunned by the most terrifying noise I

3


AN AMERiCAN

~e.>eFOR'S

ODYSSEY

had ever hflaFd in my sixtflfln years of !life. ~he dreadfu'l. rear was punctuateed with a SUGcessien ot tremendous cFashes. I steoed for a mement, liJewiMeFflG ana hesitant. J! eewfed see my mefheF and my fatheF staneding at an upper w:ind0w in tihe house. My fatheF, fFant;i€ with anxiety 0ver my safety, was m0tiening me urgently t0wand the teW of the builtiling. Fortunately, I had made a passageway only a few edays Defore to thfl Feed tin r00f, so that some necessary repairs GOuld be made. T 'h us it was eniy a matter ef swmeds bef<\lFe 1 was up on the Fiedgfl. !I.)1nom m:y peFeh ]] ceuJl!! see a huge W3!ll aavanGing with in€[;(~a%ifl r.apiclity dewn the diagenai SWflet. lt was net Fflcegnizable as wateF; it was a dark mass in whi€'h seetihed houses, fFeight cars, trees, and animals. As this wall struGk Washington StFeet breadside, my beyhood home was crushed like an eggshell befoFfl my eyes, and '[ saw it disappear. I :w:anteGl te kn0w hew leng it w0u'ld take me to get te the ethflr W0Flcd, ana in the spiit se€end full·fol'e ~he stafule was fUt, iii ieokecl: at my watch. Tt was Ilxa€tly four-trWflnty. But, instllaed 0f being shattllFed, the big barn was rip peed fFom its f0undations aned began to !tel'!, like a ba~rel, eve. and over. Stumbling, crawJing, anm ra€ing, I semeh0w managed to kllep on t0p. [n the JDa~h ef the revolv,iBg stable loemed sl!ltileden!ly the 'heusll ef eur neighb0F, MFs. iJiilel'll'l. ']'0 avoid being hudllaeff by the mflV1ita!1Ji1l co:\ilision\ ill ~eaplld into the air at the JDI'e0ise mement et impa0t. But just as I mira€u'leusly Janded (m the r00f ef hllr house, its wal!1 fullgan te cave in. I plunged aownwarcl with the roef, but saved mysdf by clamber-ing m0nkey-likll up the slope, and befor.e the house gavll way compietely, anether b0iled up bllSide me. iI cal!lght heicd ef the eaves aBed sWl!lng iilangiling tiheFe, ~hi~1l thll weight 0F my fuedy dFain@d the stFength f,r0m my hands. For years t;hereafter ]] was visited fuy fecurl1ing dFllams in which I lived OVflr and ever again that fllar£ul e~perience 0f hanging with my £nger~aills dug deep into thll water s0£tened sliingllls, knowing that in the ena I must let g0. When my. gl'\P finaJJly r.eI3.*ee, [ aF0ppllcd siGhningJ\)' iBt0 spaGe. But 0nce again I was saveed. Wi1ih aJ gFeat thud iL hit a pieGIl 0f tihe 0iG! bmiiiaF baFn F00f, aBed [ clutGheed wibh a~r my Femaining power. at the half inch tin l'icilges. Lying 0n my De~Jy, [ Dumpecd along on the SUF£aGe 4


IUST SHORT OF ETERNITY ef the :f\eoa, which was orushing, GI'umMing, a,nd splintering everything hlefore it. The screams of the in jured were harl'lly to be distinguished above the awful clamor; people were being killed all about me. In tihat mement ef terI'iMe clanger r saw the Ita,lian f.ruit cleailer Mussante, with his wife and two children, racing along on what seemed to be their old barn floor. A Saratoga trunk was open beside them, and nhe whole bmily was frantically packing a pile of possessiens into it. Sul'lclen~y the whole mass ef wreckage heaved up and Grushed them out ef existence. '[ was borne heal'lIong toward a jam where the wreckage was already piling up between a stone church and a three story brick building. i[.nto this hurly burly I was cataFwted. The pressure was terI1ific. A tree weuld shoot out ef the water; a huge girder weuld come thundeuing down. As these trees and girders drove booming into the jam, I jumpecl them desperately, ene after another. Then suddenly a ÂŁr.eight car reared up ever my head; I ceuld net leap that. But just as it plunged toward me, the brick building gave way, and my raft shot out from beneath the freight car like a bullet born a gun. In a moment more I was in comparatively open water. Although ne lanclmank was visible, I could identify the space as the park which had been there only a shert while hlefore. '[ was still being swept along, but the danger had lessened. I had opportunity to observe other human beings in equally perileus situations. I saw the stoutish Mrs. Fenn astride an unstable tar barrel which had covered her with its centents. !Rohling fa,r over to one side, then swaying back to the ether, she was making a l'lesperate but gretesque struggle to keep her head abeve water. There was nothing I could do for anybody. 'mr. ;Lee's negre hestler, al!l ailone anl'l stark nakied, was shivering en tne reoi' ef his master's house. In the penetrating rain his supplicating hanl'ls were raised toward the heavens. As I tore by I heard him shouting, "l,awl'l ha' mercy en l'lis pore cold nigger." !L was aar~ied on rteward the narrows below the oity where the tracks ef tlle Pennsylvania Railroad crossed both valley and river on a high embankment anl'l bridge. When the twisted, interlaced timbers ahead of me snnuck the stene arohes, they plugged them tight, and in the 5


JUST SHORT 0F ETERNITY Everyone I met was 0n the same sad e17rand-Iooking for parents, children, relatives, or friends. B0dies were already being taken out of the ruins. As I appr0ached the railway embankment, I saw that it had given way in the night and al10wed the water to rush unimpeded toward Pittsburgh and the Mississippi. The consequent subsidence of the flood hacilleft in front of the stone bridge several acres of wreckage in which m3iny pe0pie were stil!.l imprisoned. This inflammable material had Gaught fire. ] can stiilll hear the maddened shrieks of the men, women and children, as the flames appF0ached. I joined the rescue squads and we stFuggled for hours trying to release them from this funeral pyre, but our eff0rts weFe tragically hampered by the lack of axes and other tools. We c0uld not save them all. It was horrible to watch helplessly while people, many of whom I actually knew, were being dev0ured in the holocaust. At last I met one of my friends who lived outside the city and whose house had not been harmed. Mis family took me in, and gave me food and shelter. The people of the United States were unbelievably generous to the stricken cmnmunity. The relief trains which soon were pouring in brought me doilies and money. Day after day I seaFched among the ruins and viewed with a tense anxiety the nundFeds of C0rpSes c0nstantly being carried to the m0ligues. 1i'W0 weeks weFe dev0ted to this gruesome task, a most ag0nizing experience f0r a b0Y. EventuaHy the body of my mother was found; my father neve!' was identified with certainty. Most of the victims were buried in the "plot of the unknown dead," but I laid my mother in our own cemetery 10t. I was alone in the world.

7


1i!iMlffi

T

LA.M~

AND THE MALT

HE Jehnstown Boed cmcded the pFesGribecd course of my life,

which until then had been carefully planned fOF me by my parents. My ecducation had been forced beyend my yeaFS. All winter long [ used to sit with the otheF GhiJdren at my cdesk in the puhli£ scho0I, and, in summer, when all my friends were playing baseball ancd fishing, ~ was stil!l sitting at a desk, but rl'his time in a private SGh0el. Mo/ ellenings weF/: spent under a stutliy lamp leaFning Frenoh and (Jerman with a tuter by. my siGle. 'if~e seie eeneession ,to JeisuFe aiJewea me out ef the yeaF was 0ne ID0nth en a brm. Aitnough ]i was pavticular1y fend 0£ SP0FtS ancil hat(;lcd the steaciLy grincil, ~ rebel!le~ eh1y enGe. Learning te Jlllay the vi0lin was 'teo much. When the eatastrophe came, I was ready f0F GOllege, );,ut ill~quipwecil for life. By a freak e£ chance, a chest whiGh had stoed in the upper haN e£ 0UF house was feuncd practically intact on one 0f the piles of wreckage. In it were my father's Civi[ WaF unj,f0I1ffi with a laFge eld penny in ene pocket, a misce~laneous C0~leetien 0f Bat silver, ancd my mother-'s RiMe. The sele value ef these siendeF p0ssessiens lay in their asse€iations. $inee eveFything else fudonging to m¥ father hacd been sweJllt away in the fl00cd, ~ nacd to nnd imme€liatdy some W3>Y of eaming a EII,ing. ill hiFetd 0ut as a p~umfuer's assist-ant, and FaJllicd!!.y ieaFnecii te cut an<d ,ftt pipe, anm even te "wipe" a [eam ac:>int, which is geneFaiUy regaFaed as ene ef the most diffiGult! a€Gomwlishments in the plumbing tr.ade. 'But 8


"For. nine hOllFS and a half he talked te the ceok, And si><ty-fi·ve aollaFs was charged on the book."

Mi);'I nellit j0b was with ~ carpenter. ~Fa,ming a h0use was m0re diflku'lt tha,n wiping a 10int but, to my 0Wn satistaction at least, I S00n €onsidet.ed 'Ii haiiI' masteFeGl €arpentFy.. I aspireiiI arls0 to cabinet malfing but, fas0inating as t·his was" it 't00 failed to 0lfer sufficient indu~ement as a ~ife w0rlt. !Ii then Gle~ideGl to l5e~0me a me~hanical engineeF. By tthis time S0me 0£ my EatFteF's Fea~ estate had been sold, aniiI with the m0ney thus sa!lvageci! I went to an engineer-ing sch00] in Chi~ago. :A!ltli0ugh iii GliiiI fairly well in my studies, met many pe0ple, am! gained! mu~h w0r-lcd[y elliJilel'ienee, I c0aliiI not be entirely happy. For a ¥0uth of sevcmteen, panticulaFl;y 0ne who had leGl so welil-oriiIened a me, to be cast 01lt int0 the C0l<i1 world was not an easy experience. @tiher b0¥s weFe able to tHFn to their paFents, Felatives, or f,riends, :w;h0 ilY.eFe genuineLy intenested in them. ~ haiiI n0 experienced person with /iV,h om to disouss my peFwlelliities, and haiiI to make my own decisi0ns. iJiil0F many yeaFs 'Ii suffeFeiiI beoause [ C0UlGi not avail mysd£ of a<!lult G0unsei amI aGl¥iGe. M Iy, first lesson in the reallities 0f life was tFtat n0ID0<!1y wanted to be b0theFeiiI with the I?F0blems of 0theFs; I Fta~ to [earn to Kee,p my tF0ubles to myseU. r d0 Il0t Irnow Gltlfinitely what turneGl me t0ward meiiIicine, but, a,f,iltlF m¥ fiFst ¥ear at engineering sch00l, I ~0ncluded that I wanted ta me ~ d0Gt0F. Never.thdess, I ha'Ve never. considereGl the time wasted w.hi@h iii spent in ~eaming 1;0 iiI0 things with my hands. The practical Kn0wJeiiIge thus aCCijuiFed has been 0f incakulable serVlice to me all aver tae waFM in the career whi@h I ultimately ~hose. !I! <!lid n0t ha.ve the ne~essary a€ademic credits faF aiiImiuance to a meiiIi€a~ s~h00t 011 t0P Fating, but ~ GleteFmineiiI to aCCijuiFe them, and set to wor-I!: at my b001l!s 0nce mOFe. lin ad!ditia n I haunted the, pulYlic nbFaroes and ennol[ed in €0UFSeS 0lfered in such subjeots as mechanical &,awing and engineering design. To test my pr,agFess, [ r-egularIy took tihe examinatians af the UniveFsity, of the State of New York, until I

9


Iâ&#x201A;¬I


immediately for Jetters of introduction and oredentials to be sent spe~ial edelivery, and these arriveed in time for me to be aedmitted to the examination at nine the neJOt morning. [ was somewhat startled to find I was one of forty-two candidates for only three vacancies, and not encourageci by the remark of one of my classmates who greeted me lII'ith\ "Wlh y in God's name ave you going into this examination? Y@u haven't had any special preparation." "['l~ stay as long as I can," I assured him with an appearance of ~onfidence ] edid not feel. '['he pveliminary physicaI examination was so rigid that twelve aspirants were promptly ruled out. Thirty began the week's ordeal of wFiting. iEaGh eday's paper ~ontaineed onIy four quc:;stions, and, since eighty was the minimum passing mark, whoever failed in a sing,l e @ne was automatically eliminated. The Board read the papers at night, and just bef@Fe 'nine o'd@Gk of the second day the announcement was made, "l1he following gentllemen willi be eXGUseci," aned five disappointed young men filed out. ] deoiedeed theFe was at least a Ghance for me to get through. I rememBereed my classmate's taunt, aned my resolve to stick it out stiffened. I wwed for my Practice of Medicine, Surgery, Therapeutics, and other text bo@ks and, as soon as they arrived, I organized each twentyfour h@uFs. ~he examinations lasteed from nine to twelve and two to five; evenings I devoted to study. It was July in Washington. I wouled sit in my room with no clothes on, and, even though the windows aned trans@m were open, the per¡ spiration would run off me in streams. At three o'clock I would tumble int@ Bed and reluctantly out at eight in time for Bath and breakfast BefoFe the t@FtuFe began again. ' r grew more and m@reexcited as our numbers dwindled. However, I still edid not see how I could face the humiliation of walking out. I oIDserved eaGh mOlrning the pFecauti@n of piacing my hat within easy reaGhing edistance, so that, at the sound of my name, I could make my exit as speedily and inconspicu@usly as possible. iHappiJ,y r was sparea, and found myself among the ten who fin¡ isheed the written part of the examination. But the pFe-medicals were still t@ c@me. We were to be orally examined in history, philoso~hy, eG@nomiGS, literatme, and kinedreed SUBjects whkh I haed not studied II


AN AMERICAN DOC1FOR'S @DYSSEY for foul' years. I knew I caul<;! nevt:r get through these on tht: basis of exact infoFmation. I should ha,vt: to devise some method. One by one we went UI1' before a Boand of three. As soon as a candi= date would emerge, aamPJ ana persPJiFing, the Fest of us weuld rush to cFess-exa,mine him. Wt: wt:re thus able to get a general idea of ~he fielcrl. ef inquiry, even though tht: aetual 'lues~ions might never: be duplieatea. M¥ bUFn finaNy €a,me. Ea0h t:*a,miner [nterrogated fOF a, haH heur; obviously the mor:e aela,ys I Gould intFoGil!lCe, the fewer woU!led bt: the qlie;:stioJils. !If iJ! knew the;: a,nsweF w~l!l. [ woule make fa,lse staFts a,nill hesitate untilene of the liIoarcfr woule t:xclaim in ir!1itatien, "Coml:) now, we must get on. '[)o you know this or: eon't you?" Just before his patienee was exhausted, I wouM givl:) my answer oleariy and briefly. On the other hana, i,f I w€.re unable to answer con~isely, I woulci! ramhlle on and on, and tFy to involve the whole Board in a disGussion. After the PJre-mediGals, eaGh ef the survivors was taken to a hospital anci! requestecl to examine anG! cliagnest: six patients. Although they haG! been told to misle~.e us if 11'0ssible, tile clinica~ signs were theorC!tiGwHy so obvious tllat we shoulci! be aJ)lt: to makt: €OFrect diagnoses. Thl:) sa,rne tedmi'lue was £ol!l:ewee in the laboratory, where we wert: Fe<jjuiFee to aJila'I¥,ze sPJecirnens anci! ici!C!nbify DaetC!ria anci! I!'aFasites Meer thl:) mi0Foseope; ma,ny e£ tf.:tt:se sE<des fuad 1'iee1'l sPJeciail!ly PJFepaFeG! te con' fuse us. A.t the ene of a grueling two weeks, eig'ht were left worn whom tht: ~ucky three weFe to be Ghose;:n. 'I l'esumecl m¥ interl'upted vacation, dismissed the examinatioJil tram my mine, ane starteG off with my bicycle, Jeaving my care;:s in the wiJcl1'lC!nnsylvania hiNs. 1"e;:daiing vigorously on level stret~hes, coasting down the long slopes, wande!1ing aroune the little towns, i[ seon regainee my spirits and was rapidly Fecovering the twenty pounes ] haed lost. "Dhe morning of my aFFi;vai in J?itMburgh, I saw an announGemC!nt in t he Post rhat l'Ficks, White, ana Weisel' haG! passed the exarninaliic,)Il fOF tile Marine Hospita~ Sewice. Naturai[IJ:y, [ was jufuaant OVI:)F tihis tFiumpf.:t, fuut G!oubtfu~ over lihe wisGom of aecepbin.g lihe commission, , be;:~ause ill was onl¥ haH throl!lgili my interneship at Lwnkenau. !l'n tlb.e belief tfuat another ¥e;:af's intensive;: work anci! stuey woula make me faF better equippea !Ii WFOte;: tihe;: Swgeen-General a [ong explanato!o/ 12


'FHuE LAME AND THE HALT le~ter, h0ping he would agree with my conclusi0ns and, further-more,

appreciate the sacrifice ![ was willing to make in giving up a year's salary f0F the sake of further training. '['he only reply was a peremptory telegram that I should report at 0nGe to Boston. ] was now in the Service. SinGe I c0uld n0t question 0reders, I necessarily cIDmplied. The Feason for official disFegard of my pr0posals was eviedent. The ;yeaF was 1898, aned many s0lGliers, edesperatel;y ill, were retuming fFom Cufua and iBuex;t0 !RiGID. 'fhe facilities 0f the Boston hospitals we·re 0v.eFtaxed fur this unpFecedcmteed influx, and an appeal had been made to the MaFine N0spital SeFvice for help. I was assigneed tID this task. Any 'Federa!l 0fficer, regaFc!iless of his deserts, has muoh prestige. 'Fheref0re, in spite of m;y inexperience, I was able to advise several hospitals how to deal with the situation. But when this organizing work was over, hospital routine seemed uninteresting. I explained this to my aommanding officer,' who said, "Very well, I'll assign you to the medical examination of immigrants. You'll find enough there to keep you busy." For yeaFs the flooed 0f imported oheap labor had poured unchecked thii0ugh the wide.IDpen gateways 0f Boston, New York, Philadelphia, San iFi'ranciS€0, aned othen large ports, bringing with it the lame, halt, ami! b'lind. [Even 1unatiGS aned ic!ii0ts had not been barred until 1882. Nine more years passed before pubEc sentiment, sl0wly rising against bne foneign [abor invasion, fonceed Congressional acti0n. At that time, not only were the Ghin~e excluded, but the Marine Hospital Service was charged with the edut;y of recommending for rejection immigrants affiicted with loathsome or contagious diseases, or th0se who were likely, for any physical reasons, to become public charges. The invaders were .a rriving in such numbers that individual physical examination with our meagne staff was out of the question. A snap ediagn0sis which stood a reasonable chance of proving correct had to be made in the space of a few seGonds. I read everything on the subje€t that I G0uld fined, supplementing my own ideas with the experiences 0f others, aned, atter muoh triaol and error, developed a system. ~n iBost0n the meeica:l examinati0ns were always held ey edaylight 0n the pieF where the ship eookeed. The stage had to be carefully set so that the immigrants w0uled n0t be awaFe that the;y were being ob-

13


AN AMERICAN DOCTOR'S ODYSSEY seFVea. I haa it so arranged that they would walk aown a lane, in single diie, tcm feet apa'r t, unencumberea by baggage, ana then make a right ~urn in f,r ont of an examining officer. ~r.om his apF'ad'enuy atSual station at fihe angle, he €oula oetain a £ront, siae, and rear view of eacl'i passer-by. T1he path had to be [eve1, so that the immigrant would not have to watch his feet, ana also lead away {irom the water, so that there would be no glare to €ause squinting. Some affiiGtions were easily F'ieked out. A aeaf man in almost eveFy case hela his hea~ sl~ghdy to one siae. V,ail¥U'l.ar aiseases of the heaIlt were often aete~table by tne riagecl! nails and peculiar paMor of faee and neck, sugg@5ting faulty nutrition. Less simple were cases of favus, a contagious filth disease of the scalp or nails. We would have to be on the alert for the fine, wire-like hair and the betraying bala pateh@5 symptomati~ of the disease, beeause a ship's physician would often dissolve off the scal@5 to make fhe · head r.easonably clean f01' our insJDection. I founa tnat a man's walk was often charaGteFistk of his physical and mental state. Hernia, for example, caused a distinctive though indescribable gait, and faulW vision was betraytla by hesitation on reaohing the ~or.neF. Tra~homa, a Gontagious inflammation of the eyelias, haed a1:ways to be watchecif for with speeia1 €are. itt was @5timated fi.£teen percent of the miinaness in United States instituti0ns at that time was due to this disease. Olinics in our large cities were over,run with cases whioh proved stuoborn to treat ana often impossible to cure. The typi€al thickening of the lids or roughenea conaition of the copnea Gould be eaught as the immigrant turned, because the light then struck: his eyes at dtanging angJes of inoidenee. 1i1hough the w0ldl: was eXGiting anci interesting, it Iiaa many tilistressing aspects. Meal'tbreaKing incidents weFe constantly oGGUl'ring when rtlje~tions haa to be made. A Scandinavian farmer might spencl years in Minnesota earning enough money to pay the passage for his wife and their: fi:ve chilclren. When they woulcl £inal\1y arri:ve, ana the Jong seF'aratea famlll\y would ee reunited, ours w0ulci be the painFul auty 0~ sing~ing out one of tFte ~hiMren, an61 ot sa;ying, "She has traehoma. She ~annot enter." 11he m0ther and the Fest 0f the ehildren woula often have to retU!1n to Europe willh the diseasea one, ana, until the boat saiie61, the father, wretchecl and unhappy, woula haunt the

14


TWIil LAME AND THE HALT aetentien <qua~ters, while his famhly keFlt uFl a oenstant waiiing and orying. !But the law was on tile statute boeks and we haa to enforee it, regarding the child as a potential focus of infection rather than as a ngur.e ef tragedy. ]n eFaeF to FeaUGe the haFdships as mUGh as pessible, government hosFlitals were estalllishea in which curalJIe cases might be treated. But inevitably many hard decisions had to be made. Young women with illegitimate pFegnancies, whose family or frienas frequently had sent them te this ceuntry in the hope ef covering up their disgrace, weFe warticuiarly FlathetiG. The regulatiens forbade the entrance of these unfortunates, because of the likelihood that they and theiF children would become public charges. A, aetailea examination was impossible, but I haa observea that on tihe left siae ef any immigFant woman's head was a strand of hair w:hieh, uneer normal cenditiens, was more or less lustrous. If it hung aulf ana lifeless ever her ear, it marked her at once as possibly pregnant. Other meaical men may ridicule the ebservation, and I cannot eJâ&#x201A;ŹFl'lain it myself scientifieal'ly, but time ~and again suspicien turned out te be fact. The distinguishing clifferences between a healthy and a diseased Flersen wer-e often subtle, but pra~tice maae us reasonably proficient. 'Fhe system ef aiagnesis werkea se weN in Boston that I was promotea to the Ghief Genter of immigration at New York, where a new system was te be developea fer the inspection of first and second class passengers. Up to this time no examination had been required for these Glasses, ana many immigrants whe haa been rejected when they haa come steerage, were adepting tile dedge of traveling cabin. Other defectives, forewarned, were doing likewise. Over the loud protests of the steamship officials, who were fearful of offending their best paying dientele, the regulations had been extendea to first and second Glass passenger-so l1he government realized it was treading on delicate ground and that such inspections would have to be handled with great finesse. A heahh officer needed more than technical training to sueceed at such a task. ~n faGt, it apFlearea that diplomacy shoula constitute a major part of his equipment. It was vital, first ef all, to make sure that no American citizen should 15


.AN AMER]CAN 'DOCTOR'S OIDYSSEY be mistaken~y inelueded in the e!Caminabon. Before we haed rea:lly f0rmula ted an efficient working methoed, 0ne of my subordinates maede a serious error. One eday he tm:lh:ed erutantly, "I've a fine case of aene r0sacea." "Let's have a J00k at him." To my horror [ reeognizeed the elder Bitwpont Morgan. Myassistant had been led by his J'lF0fessionai enthusiasm to forget the routine "Iuesti0n as to citizenshiw. :r l\;we mFely seen SUGh an angry man. At first he w0l!l!ld aeGewt n0 aJ'l010gy, but Jj e~wla.jneed to him tnat my assistant was ;very Y0ung, and we reald.y 0ught to fue easy 0n him beeause everybody makes mistakes. PerhaJ'ls Mr. Morgan, 0Bserving my own youth, was amused at these solemn platitudes; he finahly began to laugh and said he would forget the inciedent. My task was comJ'llicated by the intense rivalry which at that time existed between State aned Feederal authorities over the administration of a quarantine law designed to proteGt the c0untry against such ediseases as plague, cholera, smallp0!C, l()prosy, typhus, aned yeNow fever. Alth0ugh Federal laws and regu'lations applied to quarantine, the 10ml J'lort authorities interJ'lreteed them as ~hey saw fit. A ship might d0ck at B0ston uneder one set of ~eguJat;i0ns, but, if Bahimore were to be its first jil0rt 0£ caDi, preJ'l:lirati0lls w0ud<il have to IDe made £01' ~ cdt~fferent set. Because of the resultant €Onfusion, ~he Business interests 0f d ie Gountry had aeddecil their mite 0f pressure t0wared unifieati0n, :lined the Feederal government was n0W trying to arr:linge f0r taking over aU "Iuarantine sewices stiM being administered by State officials. F OF reasons not always ereeditable, the laUer, pleading their c0nstituti0nal right to exercise "J'l0lice J'l0wers," resented what they GOnsideneed Feederal interfe17ence with their affairs. The Marine HosJ'lital Service in New Y0rk was concerned only wit;h the diseases :lind physical handicaJils 0f the immigrant, aned haed nothing to do with the State administration of <j)uarantine laws. '['he [ mmigration launoh usecil to go ed0wn the Bay at aB0ut five-thirty in the morning to meet any ineoming vessd, ahhough we weFe n0t a]loweti! to b0ard h()r until she haed Been rodeasetil fF0m "Iuarantine oy the State 0f1'icers. me would then emJ'lloy fne h0ur's wassage uJ'l the Bay in examining the cabin passengers S0 that American Giti.zens and f0FeigneFs with clean

115


'fWiE LAME AND THE HAL'[' bills elf heallth ceuld! be bee te leave tile mement the ship decked. One dreary, dFizzly March dawn, so thick with fog that visibility was almest zere, OUF launch approached a French boat which we believed had cleared quarantine. [ damber.ed up the high side and jumped to the cdeck. 1'0 my sUFpFise, Dr. Jenlliins, the State quarantine efficer, was still there. The sight ef my Federal uniform was as a red rag te a bull. He brist1ecd. "Doetor, you're under arrest. This ship's in quarantine for smaHpox." 'Ii sa;w, ]j was in fer it. I shoutecd waFlninglo/ ever the FaiJ te my cempanions who were already starting up the ladder after me. "Don't come up. SmaNpox en boarcd." The ~aunch pushecd eff again. As I turned back to Dr. Jenkins, he said w:itih satisfactien, "You'n have to stay in qua,rantine fourteen cda,)"s, Deetor." For a Fecderal officer to be arrestecd by a State officer because of assumecd ignorance of the law would have made a wonderful newspaper stery. rnn my mind's eye I could alFeady see the headlines. I sat dewn en one ef the cdamp hatches and, with my heacd in my hands, gazed up into space, and cerebrated hard. When Dr. Jenkins had finished his work, he strolled over to me. ''We'Fe Feady to ge. Yeu'hl have to spend the next two weeks on Hoffman's Island, Doctor," he rubbecd it in. "Pm not going with you," I said. "I hope you won't compel me to use force." "Oh, ne, that wen't be necessary," I retorted. "But still I'm not geing with you." ''Why not!" he demanded. ''Because there's a law in this State that every ship must fly the yellew flag at her masthead while she's in qua,Fantine. 1£ youlll show me any such flag on this boat," I answered, peering up through the fog, "~'ll ge with you. Otherwise, I'm afraid I must say goodby." The little man could do no more than stamp his foot helplessly and utter a fervent damn. I hailecd a nearby government launch and was taken ashere. • I found the office in a turmoil. When my cdetention had been dolefuM¥ repertecd, there had been uemencdous excitement over the in17


A:N AMi1l'R!I©J.W ID©Cl1elR.'S @ill)¥$SiEY

ev"itab1e r.i<d:icu1e. 'Fhe wines to W.ashington hai!l been set humming, ana anLy my aIi1pear-an€e halil fonestaillleiil the issue €If a w,l'it €If hahJeas


THE !LAME AND THE HALT an'angements had been maae fer me to take a primary course in diplemacy at the State Department. AÂŁter a month of learning the things I must do and the things I must not do in ambassado~ial halls, and a post-graduate drill in the Immignation Laws, I was ready for Europe.


CMAIIPTlillR 3.

'fHE Pltâ&#x201A;ŹHvUSiIillD LAND

F]RST ocean el10ssing holds mare glamour than a hundred suceeeding @nes. This v@yage, oM t@ the seasonea w,w:eler, is @ne ef expl@Fati@n to the neop>hyte. I had watchea thousan~s of passengel'S stream down the g3ingplanks of the giant @eean liners. I knew the interior @f the one on which I was sailing almost blindfold, but never IDe.f@re had I felt the tl1F@b of the engines @n a ship outw3iFa b@una bey@ncil Ambrase Light. To IDecome familiar with the pl10blems I sh@wd have to solve in my new assignment, I journeyed from @ne c;apitall @f Europe te another. ']ihe mel1low grime @f Londen, the fever-ish ID@mev3irds @f Par~s, the g@ase-stepping al1c!lerliness of Berlin, ana the grey ruins of R@me, each in turn captUFea my imaginati@n, eaGh was new ana strange, n@ matter how familiar its exteFnal characteristies from baoks and pietUFes. At ~ast [arrivea at lNap>les, melodi@us with souna ana glowing with caior, where I secuFed reluGt,mt consent tFem Italian @fficiruld@m to act as temporary medical officer. LilVing at a hotel brandea me at ance as a fOFestiel1o. ana rum foreigneFs weFe fair game far caIDmen. W hen [ ;wouJl.c!l hancl aut the p>r@peF fare the eochieF@ wauM invariably break out in violent remonstr-anee, and my Ellis Island Italian was in no w;ay adequate to eop>e with him. Wo pratect mÂĽself, I evalved a EttIe strategem, whieh 1 usea with gFeat S\!lecess. After. ai nurnIDer @f e@chiere haa insistea they were unaeFpaia, I tried the experiment @f hailing a weN~essea ] talian wallcing along the street, taM him I ;was a stranger, and showea him the fare

A

20


THE iPRGlMiESE1) LAND anid tip iL haa offered to pay. "Will you please explain this to the cab !driver?" '[ asked. 'f,he tw0 immeaiatc:d,y fold int0 a vi0ient aitercati0n. I left them on the sidewalk, went into the hotel, took a hot bath, dressed for dinner, and came aown to fina them in the same place, still indefatigably arguing a1)0ut the inadequacy 0f my fare. The dis~overy that any stranger to whom I appealed would support my c0ntentic'ln I put to good advantage frequently. I once boarded a tI:am Iilouna for the center 0f Naples. I gave the c0nductor my destination, paid him the specifiea sum, and received in return a pink slip in the true Mark Twain tradition. When we reached the end of the Z0ne, the c0nduct0r tapped me on the shoulder and askea, "AFe you g0ing iiurtl\.erl" 1100Ked up from my paper in surprise. "Certainly," I said. "'Tihen you'H have to pay m0re fare." "But ] t01d you where I was going," I protested. "It's your faudt if Y0U didn't charge me enough." I then turned to the man next me. "Didn't I teH himl" I demanded. " ''ifes, yes, 0f C0Ul'Se Y0U did," he chimea in eagerly. Somebody else stood up and cried loudly, "No, he didn't! " In n0 time aliI the passengers had taken sides and, with sh0uts and gesticulati0ns, had risen to their feet. The motorman stopped the car and himself joined in. The tumult grew fiercer and fiercer. Sin~e the matter was now out of my hands, I settled back in my seat anc!l Fesumed my reading. T ime passed. Presently an inspector appeared. ''What's going on herel" he called to the conductor. "You're tying up the whole line!" 1 leeked ba~k; there were ditera!lly aozens of trams behind us. 1"he same psychology could be invoked against the arm of the law. A ship was waiting for its clearance papers one day, and I had only a few moments in w.hich te reaâ&#x201A;Źh it. I directed the cochiero, therefore, to "dz,ive as fast as I\.e Gould te the pier. The street along the waterkent was fenced off into two parts, one for heavy traffic, al)d one for Garviages. The latter was blecked solid; the former was deserted. I signaled to the cochieFo to take the free lane, but no sooner had we started than a policeman waved and shouted, "Get back! You're on the wreng side of the stI:eet!" 21


22


1i1WE PROMiESEiJD LANE> was at the end af the lang line which passed before him as he stood an a dais, speaking a few fOFmal words af greeting to each in turn. [n tFanslating my reply, the interpreter. hesitated for the correct word and, befare I realizea what r was doing, I had suppliea it in Italian. I was overcame with confusion, but the King's aflicial attitude at an~e rela'Xed. He smiled. "Oh, you know Italian," he said, and, waving the interpFeter asiae, put his arm through mine, and led me to a winaaw seat. My knees liteFalUy shOOK. I haa been stuCiliying Itrulian anly a few weeks, and I knew the IGng sp>ake no English. "[lve meen wanting to taJk: directly to an American for a long time, ana get some fu:st hana infor,mation," Humbert continuea. l1he King's pronunciatian was so clear that I could follow his ques. tian about the Spanish-Arnerkan War. Thinking to myself, "This wi1l end in one second," I replied stumblingly. The situation was saved by the ap>pearance of Queen Margharita, to whose beautiful German I could make answer with a fair aegree of fluency. The Crown Prince ana Princess also joined us, and they were all so pleasantly friendly that 1 was soan at my ease. lLt was an excessively hat evening. The Crown Princess, fatigued at ha'Ving sta0a so lang in the Feception line, fainted ana was carried inta an ante-Foom. BeGause I happ>ened to be talking with the royal fam~}" at that mament, I was asked ta attend her. Du~ing the hour or sa in whioh she was recovel'ing, I continuea my discussian with the {;rown Prince, naw King V:ictor Emmanuel III, but somewhat more valubly because of his excellent command of English. Unaerstanding King Humbert's classic Italian was quite another matter from comprehending the multifarious Italian dialects. But these also I had to learn if I were to dispense with interpreters in ae:cling with emigrants. The dialects were vastly different. The - Genoese w0uld have no iciiea what the Neapalitans, with their in,. numenable slang expFessions ana Glipp>ea waFds, were talking amout. Tlhe saft Slciiian sp>eeoh aifferea from the Calabrese. lt was sUrp>rising, nev:e~heless, how CiJuielhly the essential waras of each coula be p>iekeâ&#x201A;Źi up>. Cansiaerable or.ganiza60n was r.equirea to examine expeditiously

23


AN AMERKAN DOCTOR'S ODYSSEY ana properly the thFee thousand emigrants who weuld s0metimes sail fr.em Naples in 0ne day. Sinee they were unfamiliar with any f01l!:eustoms sa",e ~neir 0wn, they e0uJ.cd n0t uncderstand, fer example, why they hatil to pr.0auce their bel0ngings a few <days in advance 0f sallrng. iL0Ud compiaints usuaHy r0se as olothing and bedding disappeared int0 the disinfeGting plant. N 0t only the pr0eedure but the neeessio/ lier it bewildered them. Practically all the emigrants were inveteFate smugglers, with a paFtieuiar pre&ilecti0n f0F eheese, on whieh they theught there was a high duty in the 'United States. 'This they w0illd hide in the m0st impossible fllaces, even sewing it in the lining of their clothes. I1hey would protest ",i0lently that they had n0 cheese, although we explained to them again and again we were not eust0ms oHiceFs an<d had no interest in their cheese beY0nd preventing damage to their possessions. When bhe aooFs e£ the ten-foet €¥~inaeF weFe l0Gkea and the steam was tU11lled en,tine effect 0f tne heat was etten disastFous. Oa ene occasi0n when we epenea the chamber, a gFeat stream of het, sizzling, liquia cheese came running out. Shoes also were faverite objects of coneealment. The owner's eyes would staFt with amazement when a pair which he had tucked away in his mattress Fell W0u!ld emerge from the eylindeF shrunk to the size ef hwo watol! eh\l,rms. On.1y tne metal eyeiets and the nails w0Uillil keep llheir shape, and in the fiiny shoes these appeared enorm0US. In line with the attitude ef c00perati0n w,hich ] was trying to bl1ing about, ] had, f·rom the very beginning, asked the Italian doctoFs te help me in making' inspeotions. But as time went on and nothing untoward happenea, they left me to do the werk atter my, 0wn fashi0n. My m0st serious trouble came £1'0m an entiFely ai,fferent quarter. [ had been in Naples a little more than a month whIm l! em,0untered the Camorra, at that time a powerful secret 0r~ization whiGh, like the modern raGket, levied a tol!l on many eivic activities. It was said even the maY0r c0uld n0t act without its sanction. 'Dhe p0weF 0f t he Cam0rra :was st11iking,ly iMustFatecd in the <disputes whiGh arose between the society an~ the agent 0f 0ne 0f the 'large German steamship companies. This agent 0nce had the temerity to inquire why the ships of his line sh0uld not d0e~ at the government

24


THE PROMISED LAND pier, ami thus avoid the annayance and the exorbitant charges of the beatmen :wJ1a cenveyeed passengers and baggage ÂŁrom steamship ta wha,rf a,na <v,iGe versa. A re~resentative of tne CamorFa informea him, "[t willI be better for your business if your ships anchor in the harbor. We can't control the boatmen; they are disagreeable people when aroused. If you land passengers on the pier, something unpleasant may happen." The agent, hewever, relying on the close relationship between his ceuntIo/ ami ~ta.}y, considereed his compa,ny w.as in a peculia,rly strong pesition., a,ml began ha,ving the liners brought to the pier. Nething happened at first. The society waited until a day when the single pier was already occupied and three ships of this one lil)e were in p(])rt. The ubiquitous Camorra had in its ranks people who spoke all languages, and had attired a number of them in Company unif(])rms. 1n ahe conrusion attendant upon sailing, nobody noticed the ma,ny unfamiliar faces. As a passenger came down the wharf, he w(])uled be asked, "Where are yeu geing?" "America." The baatman woulcd reply, "I'll look after your baggage." "Fhe passenger would be put on the right tender and the right ship, but his fuaggage wouled be placeed (])n a vessel going to South Africa, aned that (])f a passenger embaFlcing for South Africa would be sent to China. Almost immediately the offices of the line everywhere were bombarded with the protests of the righteously indignant, and the officials, becoming seriously alarmed over the bad name they were acquit:ing, threw up their hanas and sa,id, "We surrender." Thus simply edied the Cam(])rra edeai with such situations. My own run-in with the s(])ciety came over the inspection of bag. gage. One day I was waited upon by a courtly gentleman who re- marked that it must be an arduous and difficult task to examine the belongings of so many peaple. I agreed that it was not easy. "Y(])U might be ha,ving a g(])od time out in the country," he suggested. "Not far ÂŁrem Naples are same delightful amusement places, scenic outdo(])r restaurants, and pleasant feminine companionship. I'd like to relieve you of your burden. I'll give you a thousand lire for

25


p,eset!l ef sever.all et us, the Wnitec;l States wouie;! take aetien, ana the ellimer weuM be weFJd-wiae. '[lhe, f.\:meFican public aheaay has a grievanee against yeur ceuntry e~er the payments we had to make aLter the [New: @r'Jeans Mafia fliet. tr:he Roman government may be weak in iNaJ!lies, but my gevemment is strong, ana weuld bring such p,ressqlte te bear that the Camerra might be wiJ!led out. You go back te yeUF p,eeJille and tela the·m that ["m geing to eontinue running th~ ge inspeGtien myself." is was my first ana last difficulty with the C:amerra. They hela ne 1'3.I1GOF eveF tne fact they had failed, and eventualdy many became mr &.ienas ana mere than ence renaered me vwluable aied. ilin fine GOUFSe ef the day's werK: my assistant, Dr. Norman Barnesby, was en€e ooiigeed te aavise against a Neapolitan named Giuseppi. A stef,m ef abuse in whioh fihe weFa "killl" fFequentlr recurr.ed follewed tihe aa:veFSe veFdiet. We paid ne attention; such oecurren~es were Gemmen. A few nights later, just after BaFnesby had left my heuse, ne was attaekea. iBeeause he was a geod boxer aned extremely agile, lie :was aThie te deage se that the manls knife went through his sleeve, weunding him enJr slightl~. Bar,nesby believed his assailant was Giuseppi, although it had been tee dar,k te make al'>seiutely sure. He reperted the inoident to the peiice wRe; with chaFaoteFistic .Ii,atin shrugs, Feplied, "1£ we question die man, ne iwilll enly <rl:eny it. You have no witness. We can do netliing." Barnesby's bria.e was frantie with anxiety. I, too, was eoncerned and went fer ait!l to one OL fihe steamship companies. These were my d'iie£ SupJ!loFteFs. Because it eost se mueh money te bring back rejected immignants, mr werd was invaFiablr aeeepted as to physical conaitiofl; tihe¥ weula Fefuse to selJ tickets to anyone named on my list. After exJ!llaining tlie eiFcumstanees te a sympathetic efficial, I suggested, "[IE ¥eu',ne wiillLing te take a Ghance en this fellow, he could sail." "SupJ!lose we try," he FeJ!llied. But when Giuseppi was rejeeteed at New Yerk, he was so anxious te Femain in tne Uinitea States that he eseaped from Ellis Island and swam te the mainlana. be.feFe he was r.ecaptured and shipped baek to iNaJ!lies. 'iJ!1ne meF,ning afteF his Feturn I found' him sitting on the eutb aC!l'ess fihe street trom m¥ house. As I walked toward the tram

27


AN AMER.ICAN !DOC'ID'OR'$ ODYSSEY !Ii c0ul~ hear his stear~hy £ootiaJlils blehind me. ] haM truwea my hea<d so that he couM not come upon me unobseFVe<d. On the tram I Pl'U<dently stood on the Fear platform; ha<d [ taken a seat a knife might have lodged between roibls. A;11 day Jong Giusewwi sat on a ben~h in a small p>ar.K opp>osite tne office, waiting p>atiently anG! wat0hing the door Eke a ~t at a mousehole. When I went out to luneh, his pursuing steps followed me. TheFe was no mistaking his intentions; he had transfeFred his animus to me, €onvincec[ 1 was to lHame fOF his Fejection. 1l1heroeafteF this aark snadow never reEt me. Each morning when [ arose he was a!lready on guard. The first few days of this I endurea with a £air degree of patien~e. But alter a while my neFVes were so on edge that ] complained to tile authorities. 1I1her said thfl,y could @o nObhing unbii Giusepp>i commillted some overt a~t; tnFeats and even attaeks were not actionable in Naples. I must wait untiJ. I was lcilledI, or at least wounded, before steps could be taken. This eswionage went on for so many m0nths that finally I took it lor granted. (';)ne evening alter. tihe opera :[ forgot my p>ursueF completely and, without thinking, took a shoFt €at home through a narrow dimJy-lighted viculo winding between tal'l, dark houses. Just as '[ tUFne~ a corner, Qiuseppi jump>ed out at me with a kni,fe in his upraised hand. Wis SHortness o£ sta1iuFe gave me the ad'l'antage. I mocked him down with an uppeFcut to the jaw. ]j didI not hurry t·he rest of the way home; but neither did I dawdle. The next morning intensfl, disgust, the fol!lowing day Giuseppi was not . here blut, to he was lbaek again. A week ~ater I had iunch OB bloard one of tl\.e steamships whfl,re 1 ha<d been making an examination, and toM the assemblage about my disagr.eeaMe eJqDeriences. il!t [ouM be assumed that w!:\gFeveF one went in 'Nap[es tne CalIDol'Fa .:voul@ bleroepresented. One 0f the guests said immediately, ''Why didn't you mention this befoFe? The matter Gould easily have bleen arranged. But I assure you that theFe wiJhl be no further. tFouble." I never saw Gitlseppi again.

mr

mr

I had worked almost a year in Naples an~ was bleginning to make pFogress in winning the confidenGe of ItaJian goveFnment officials

28


THE PROMISED LAND when I FeG/lived an urgent message fr0m Washington saying one hundFea th0usana Dales of rags had entered the United States un· aeeounted £0r. Many 0£ ~hem w.eri Feadily iaentifialiJIe as Egyptian T0mes, S0me 0f which might h:we come from tHe bodies of bubonic p'lague victims. [ was oraered to Egypt to solve the mystery. The Amer-iean public was becoming alarmed over ~he steady march 0f plague around the world. Crawling insidiously hom Hongkong into the Red Sea ports, it had fastened upon Egypt. Coming slowly West, reaehing out to ~ndia, it haa fiJtered into Spain and subsequently ]jtally, iEnglana, and f'1rance. Its progFess could be followed on the map aIlso ~s it e;ept around the other way. In 1899 it leaped to Hawaii, ana in relatively few months bridged the final gap to our own Pacific Coast. In 1900 the method by which plague was transmitted, in spite of untemitting Fesearch, still remained a riddle. But it was suspected that these aiEty, filthr, Gotton Fags of Egypt, most of which ultimately f0und thew way to the paper mills of the United States, might be s0urces of infection. I was to determine how these rags were getting into the country, when every port was blocked against them, and alS0 to apply myself to research on the disease. In Alexanada the plague was enaemic; sometimes epidemic. A Gase w0ulld bFeak 0ut in 0ne seGti0n 0f t0wn. It would be iS0lated at once by the English and German doctors in the employ of the Egyptian g0vernment. We would set to work to investigate all the Gircumstances. Just then another case would be reported from an en· tirely different section. Since we were certain contact between the two must have taken place, we w0uld f0110w every clue in the effort to establish some F,l0ssible c0nnecti0n. Discouragingly seld0m were we able to fina any. The difficulty ~f the work was increased because we Goula not make these Orientals realize the importance of giving stFaight answer-so The fleas must have been laughing at our ineffectual efforts. After considerable detective work I traced the Egyptian cotton Fags to Liverp001, ana f0und they were thence being reexported to Canada. A final manifest made them appear as Canadian rags, in whiGh guise they couM enter the United States freely. I suggested simple legislation requiring shippers to declare the place of origin

29


'liRE PROMISED LAND where the gevemment this time welcomec;\ them, and later to the other ceuntr-ies which were senciing us their excess pepulatien. I hacd sGaFce[ij' neturnecd, l\.eweven., befeFe the Surgeon-General. delegatec;\ me to stefl anether leak in the health dam. Back acress the water ~ came . . lmmigr-ation laws had been growing more and more effective in our own ports. But their success was largely nullified because the Fejected aEens soon leamed a method ef circumventing them. No matteF hew inGaflacitating or €ontagious the disease might be for which they had been barred, they were finding fFee entry from Canada. Canadian steamship agencies in Europe were advertising how easy it was to avoitil inspection by traveling to the States through Canada. {)ne €ircular was printed and distributed which announced: "For sicl<ly or de·fective passengers who want to avoid to land in the I1:lnited States ports, I recommend my new Canadian line to St. John, where passengers are £reely landed, without any examination. From St. John passengens can get within a few hours ride by rail to any place in the United States."

iLt was impraaticable to guarc;\ three thousand miles of border, but our government hac;\ ebtained flermission to open stations at Quebec in the SUmmel' and, at Ha1ifalC ancd St. John in the winter, where a ummissien eould examine ever.y immigrant who applied for entry into the Unitecd States. This measure, however, was of only slight assistance, because proportionately few of the defectives announced their intentions beforehand. iLn Canac;\a, as in Egypt, I hac;\ a dual assignment. Although I was teehnieaH¥ medical eflicer fer- this Cemmission, my real function was te per.suade r.eluctant Canada to pass an immigration law similar to ours. Because of their widesflreac;\ nesentment over the high protective miff of the United States which interfered with their trade, Canadians were not likely te lenc;\ a willing ear. They might go as far as to like an inc;\ividual American here and there, but if the United States wantea any €ertain thing, they c;\efinitely did not want it. During the yeaI' I spent in Canada, I became familiar with the entir.e borc;\er, anc;\ knew almost every stream and town along it. WiheFever I went, I talked about immigration laws. Ultimately I

31


AN AMERJiCAN !DO€:TOR'S ODYSSEY aeoitdg<'l to cl0 thg 01wi0us taing a,na erulist bhe aid ef nhe FailFoaGls, which were then a power in Canadian Fl0litics. The Canadian Paeific RailF0acl had allways been on the side of fhe government, whethgr Liberall or C0nservative, ana any govevnmgnt was embarrassed wit:h0Ut its sUFlJilort. lmite .0ad was wi'l~ing to G00jlleFate with us beeausg it did net wa,nt its passengers further in€0nveniencgd by the gver more stringent r,ggulati0ns Wg found it ngGessary to impose. '['he FFemier of Canada, Sir Wilfred LaurieF, on whom final' action dejllenclgd, was rel.u@tant to takg any steps t0waF~ keeJDlng immigrants out 0f the c0untry, which w.as faFge and nee@ecl fihling. Mg had fttst to be jllersuade@ that his p0licy of settling would be hdped anm n0t hindered by ba~ring the same Wes 0f a·ligns we had found undesirable. iBut, 0n€e €0nv.inced, ne a€ttl@ imme<'liat~ly. An @FcleF in C0Un€i! was JDF0muigated which emb0eie@ the important JDF0visions ef our immigration laws, an@ later a bill was enacttld by the Canamian Parliament which turne<'l the Order in CounGil into law, ane thus largdy Flfuggem the immigration leak. A cel'tain a,m0unt of running ef aliens acress the !D0reer still G0ntinuem. Once when I was staying at Lake Memphremagog, Vermonf, somtl 0f my frienms in the ]mmigFation $er.vice hacl rtlceived wOFd to btl at the b0rGler the ~0fl10wing mi@night and, thinking [ might be inttlresfe@, they in'lited me te g0 with tfltlm. We ha€f not 10ng to wait bef0re a covere@ undertaktlr's wagon l00me@ out of the daDk. "l'Ia,lt! Everyb0dy 0Ut!" GaUecl one of tlk officers. 'J1htl dlliveF, in a snacked tentl, exclaimecl, "¥0U can't inteFfertl winh us. Pm taking thestl sisters 0f charit;y to a, £untlral." "L.et's see 'em," 0F<ilered thtl 0fficer peremptorily. From the wagon clesGendtlm first ontl sister, them another, and an0tner, their whittl _0i,fs glea:rning in tne faint ~ight. But whtln thtl lantern was ~i~e<'l to t;he eight faees, paFGhrnent ye1ll0w sItins a,nd flat eyes were revealtld. The 0ffiGelF sar@onica,llly requeste@ the JDseum0sisters te disFobe, ami undernc:ath the volumin0us trailing black garment-s apJDearea Chinese Gott0n Dmusers a,n@ jackets. The men were all dejll0Ftecl under the Chinese Excillsi0n A'ct. Often applicants for ennry ,ham to be barreGl because of some irr.egulaFity. U-sual'.ly these p00F people, ami@ strange surroundings,

32


THE

PR(,!)M~$ED

LAND

wer.e almost overwhelmed by their misfortunes. In response to a call to act as interpreter, I arrivecd late one evening at another Vermont border town, and found in detention an unmarried Swedish couple. Even before I saw the woman, I could hear her loud sobs; the man stood aside resent£ully. It seem~d hard to send her back just because she was pregnant. I explained to them in my none·too·good Swedish that she would be al!lowed to enter if they would first get married. Tlhey caula nat comprehend why the American government should €anGer.n itseLf with their private relationship. They were going to get Joes, bhey said. l1he man impassively expiained that he intended to marry her as soan as he had enough money. I reiterated that, under to~ law, she cauld not enter un1= they were first married. After [ had talked with them most of the night, the man reluctantly Gansented. In the early morning I found a minister who was willing to marry them and accept my services as interpreter, though I had many quaJms myself as to whether I should be able to translate questions and respanses correctly. The service was a sketchy one, but the minister said it was legal, and the bride and groom, not looking partieularly happy, departed into the promised land. Afiter Canada had passed her immigration law, the main reason far my I\a,ving been sent there was concluded. Four years of study of toe immigration pl'o!Dlem at Boston, New Yark, and Naples, as well as Canada, had convinced me that mOfe constructive legislation was needed. During the long winteF evenings in Canada I had studied law, which helped me to gather together in legal form the data I Gonsidered vital for this purpose. I submitted these to Washington, ancd they formed the nucleus of the Immigration Act of 1907. This bill was passed with the active support of labor. During its pfeparation I frequently met Terence V. Powderly, the former head ot the powerful Knignts of La!Dar, who had been appointed to the Bmeau of Labor as a conGession to\those who claimed that the hordes af Eurape were !Deing !Draught in for the use of American capital. Fawderly gave me a valuable piece of advice which has often stood me in good stead. "Yau probably wi~l have to dea,l with newspapers a good deal, young man. Here~s a little rule for you. If you've 33


AN AMERICAN IDOCTe>R'S O:IDYSSEY anything yeu don't want published, just give ~he repel1ters the whole story aned then telJl them how much or it is off the l'eeol'a. They'll never go baek en yeuI" I have always fohlowea ~his proecept ana have never. in an,y country had a reperter abuse my confidence in a peFsonal interview. But leng before the Immigl'ation Law had been passed., my activities haed been cemp1etdy shi,ftea. [ reeeivea the appeintment ef Chief Quarantine Officer for the Philippine islands on the other side of the wC;lFId. ;\\':t the en~ et the $panish-.t~meroican War tihe United States was confronted with large responsibilities in the field ef tropical sanitatic'lfl. Sudden'l y we found on eur hands an unseught dut!}'. In the Philippines the Army Beard ef Wealth was pr-esentedi ;with a medilial! situatien of unparalleled gravity; an entire natien haed to be r-ehabifitatea. 'Fhe British, the Freneh, aned the DutGh had had yeal's of deaiiPg with a4ministratien and heaRth in the Orient and the tropiGS, but, bFeadly speaking, American medic3J! officers were inexpeAenced. Almest the en!y exceptien-and that a recent ene-was t.he edramatic ana successful fight wagedi in ŠI:lba against yel[ew revel', ;w,hich Ilaa caused such a high mertaHty tnere, am! often invaeded our ewn shores. 'Fo prevent this edanger was one et the prineip3J! reasons fel' our geing te war willa $pain. Bubtic attentien haa been feeuseed up en ~his ydlftew fever battle conducteed by M'ilitary Gevernor Leonard Weod, the Walter Reed Commissien, ana Majol' WilJliam e. Gorgas of the United States Army Meediea!] Cer,ps. Diseussien and argument ever our making another trepieal venrul'e had simmered for years and was now coming to a boiL ':Ehe French efFert to buiM a camd at !Panama! ha~ br-oken edewn beeause ef their failure te cenquer yelJlew fever and malaria, ana we were about to mali!e our attempt to GUt the ilsthmus. SUCGess in this endeaver must nest upon sanitatien, and Gepgas was ~he legiGaI pe. sen te super:vise it. The government eenc!uded ~hat, before taking up 0ur pests, beth Gergas am! I shoulcd be f0rtified with information as te what was being dene in ~he Orient in the field et trepiGa~ meaicine, and, theFeferoe, sent us in ['902 to the !Enternational CongRess on Meedicine at Cairo. Medica! officers frem most ef the tFepiC3JI ceuntries were present. 34


THE PROMISED LAND As is true of ai~~ sud\. asso~iation gather.ings, iii [earnee far mOFe in on the famous veranda of Shepheard's Hotel than I did £rom hearing papers read at the meetings. I was particularly impressee with the Germans who, at that time, stood at the top of the worM in s0ientifie l'esear0h, ana were attacking the pnoblems of tropicrul medicine with their usua;l thoroughness. We spent several weeks in the Egyptian capital, and I found Gorgas a most delightful calleague. We were both reluctant to make public aa&esses IDut, sinee he was my senior, it became his duty ta serve as spoKesman, and he acceptea this obligation manfully. He, wha had so reluctantly adopted the mosquito theory of yellow fever, with all the zeail af the convert was anxious to have this Congress formally recognize his yel!low fever wark in Cuba, ana have it on record that the mec!!iGall profession was canvineea the stegomyia mosquito was the sole canveyor of the disease. I argued with him privately as to the desirability of making such an all-inclusive statement, but the Congress, sway,ee by his magnetic personality, passed the resolution in the form he hac!! wl'itten it. /It recent expedition into Bpazil sent by the RockefeLler iFoundation once more raises the question and throws a cloud of eoubt over the theory. After the Congress was eon€l.uded, Gorgas returnee to await dev:elopments on the Isthmus, an~ I went on my Eastward passage thFaugh the hot eountries-India, Ceylon, Malaya-alluring names for earefl'ee travelers, but each a tocsin for the health officer from the New World, anxious to redress the balance in the Old. A:l1 aJong the way [ heard the same arguments: the Oriental could not be sanitated; he always haalived in filth and squalor; to persuade him to live in any other way was hopeless; he was happy in his present mode a£ existence ane it would be a shame to disturb him; all efforts, ther.efore, shoule IDe concentFated on making living conditions safe for the EUFopean who was obliged to sojourn in his midst. I listened patiently, but I knew the American people would never sanction such an attitude towara our "little brown brother." ~onversation

35


ANID lUI) THE S[CKNESS CEASE , '"11,W]CH

'V'V'

et you, intending to \;J1!1iM a tewer, sitteth net mewn fust anm GOuntetih the Gest, whetiher he have suffioient to

finish it." FFom the time the slew Rohilla Maru lett the Feadstead at HengK:eng tihere was ne [ileaee ,t l'em the fFething, ehUFning tur.li>u'1enee ef the China Sea unthl, some s~ heUFs [ater, she steamem tihrough the Boca Chico, betwflfln Mariveks and the lslanm ef Cor.regidor, inte the Galm of Manila Bay. 'Fherfl, in panerama, was spread out the tfltlming ;wattlF i~,£e en the Oriflnt's iJ.aFgflst narbot. !Little in~er-islanGl steamtlFS ehuggeti! busi~y up an~ mown. ]lFaes with latflen sails anGl crews balanced on eutFiggers sailem in £rem remote plaees. Fishflrmews bancas bobbeG! up and dewn in the shallows. SeorflS of bambeo fences jl!ltting frem the 1II'ateF en0lesfl<ii thfl fi.sh weirs, VIIhic;h ~ee&flti! iike fields ef rippling grain, manll:e~ eut in eFderJ.y apFay. At inttlrvals a~eng the twenty-five milflS te Manila tile embraGing arms VIIClFe dottfled w.it;h clusters ef little nipa huts, spFouting tFom the water's eclge like teuF-leggflm mushmems. Among them Cavite" the AmflFiean naval li>asfl, gieamflGl with tFesh Ameriean paint, anti! the whitfl ships of the White FJeflt Fede at anc;hor. Toward the cmid of the day- the hot sun, beating en tihe wateF, pi'le~ UIi' a huge $fla1;heF bed ef flufFy clou(as. A faint steam arose, aned threugh tHe hwze gJeVllecd sunsets unequalecd the wei>lcll aFound. [ had seen the sun sink behinti! Capri in gaumy gJery, the vi,,,idi racdiance of the Golden Gate, the terFicl Maze of the AEriean desert, and tihe

36


AND Bl'Jii> l'Hiffi SICKNESS CiEJli.ÂŁE eelicate pastel pinks of New York, but nowhere else, before or 3ifterwares, die I ever see sunsets of such grandeur or so varied in their swift changing colors, ranging over the spectrum even to delicate green. From far out in the Bay Manila appeared in the distance, with its Fed roofs gleaming amid the dense green of the cocoanut fronds. Abl0ve the roya,l patms along the Malecon Elrive stood out the crosses of uhe chur0h buildings. Water once lapped about the foundations of tnese stFu~tures, But now the Americans, to make way for new and impo~tant commerce, 'have eFedged the harbor, jUled in the fOFeshore, anci! pushea the tidal flats away from their doors. Great ships, w.hich fo~merly hae ancnared per forGe in the roadstead, are now escorted to fhe new piers, ane the smoke from their funnels drifts like incense through the naves of the ancient stone churches. AN the long way out ta the Philippines I had considered the nature of the task before me. As Chief Quarantine Officer, I was to work with the Health Board so that when the time came to release the Army officers who largely controlled it, I should be ready to add to my duties thase of Cammissioner of Health. My future was in my awn hands. ] nae alFeaey formu~ated m;v answer to the constant reiteration af the !British, the FFencl\, and the 1">utch that it was waste of time ana mane;v to sanitate Orientals, who wanted ta be left to their ancient unsavory habits. M;V answeF was, "You cannot let people suffer if you have the means to relieve them." ]p. addition, I had not averlooked the fact, repeatedly impressed upan me in my immigration training, that disease never stays at home in its natural breeding places of filth, but is ever and again breaking into the precincts of its more cleanly neighbors. As long as the Oriental was allawed ta remain disease-ridden, he was a constant threat to the Oecidentai who dung to the idea that he could keep himself healthy in a smahl disease-ringed ciFcle. Lt shauld also have been evieent to employers of colanial labor tnat human life ha<d a direct monetary value, even though it might me cil:iffieult ta estimate and mi~ht vary gr.eatly with age and race; the @..ienta,ls had too long held a position near the bottom of the sGflle. I believed that health should be regarded ÂŁ.rom the economic. as 37


ANID BID 1:WE SKKNESS CEASE taminatetd. Only a few huneFee were caFee for by the Church. The insane weFe enainee [ike eogs uneeFneath tne houses. Imitation quinine pills were sole:! at fabulous priGes to the wan and shaking sufferers £Fom mallaria. Mec:licail relief had never been extem!led to the three huneree thousane wild peoples of the mountains. Even as simple a thing as a £rncrure caused severe suffering, lifelong deformity and haneicap which eouId so easily have been avoided by proper setting o£ the broken bones. SeGtions o£ Manila were so closely crowded that no Foom for streets or even aiJleys was left, anc:l the wretched people who lived there nae to cFeep through human excrement under one another's houses to reach their own. Six to eight human beings packed themselves to sleep into a room hardly large enough for one. With the exeeption of an antiquated and polluted Spanish water system in tlhe Capitall, theFe was not a reservoir, not a pipe line, and not an artesian weN in the [slands. Without let or hindrance the vill'est Glass of food pFOc:luctS was shipped into the eountry. Perishable provisions were soM from the ground, so that eust and dirt were soon intimately mixed with them. No proper inspection of animals was made before slaughter, and diseased cattle were constantly marketed to the public. In generaJ 1ihe people of the Fhilip1p1ines were strongly imbued with superstitions and traditions. ~hey were apparently contented in their ignorance anc:l poverty, and resigned to their many ailments. i set myself the goal of trying to save fifty thousand lives a year.

39


( .t) ic( ~

0: u

Ii

LITILE BROWN BROTHER traflk stneam antiL exduaea ~ight ana a,iâ&#x20AC;˘. ln aisregara ef the hurt feelings ef antiquarians ana historians, we aamitted Twentieth Cen¡ tury vehicles, and ventilated the quarter by punching holes through the wahls. In our holy zeal fer sanitation, we might have ra,zed them wffiplete1y. 'But fer.tunately tfie anguishea larnentatiens of Ameri~an histo.dcal societies were potent enough te stay the execution. Before this happened, however, the river wall was entirely removed, and the IilUilrter maae thoroughly accessible. !F'he eIed Spanish neuses whioh linea fhe narrew streets of the [,nwamures leaned lovingly teward each other. These heavy masses ef stone, weathered and grey, for centuries had withstood the triple threat of fire, earthquake, ana invasion. Their cautious owners had ~eGkeiil lihe doors seGurely against thieves, but had locked within the aamp, insanitary interiers the aeadly germs of tuberculesis, dysentery, and cliolera, and had invitea plague rats to dine with them. By far the majority of Manila's population of twe hundred ana fi,f,1ly thousa,na li,vea outsiae the walled city in more moaern houses. 'lIhe first stery eften was ef sandstone, soft when sawed trom the quaFries, but hardening when exposed to the air. Above was a projecting wooden superstructure around which was a paSsage way, ferming a' aouble wall ana proviaing air space to keep the interior Geet. . !Dhe first thing a Filipino did when he rese in the social scale was to buila one of these ha,rd material houses with a decorative hardwood fleer maae of the pelished yellow molave, more beautiful than mahogany. ]f mere est;heticahly-minded, he might alternate fhe molave with lihe colorful reddish ipil. The airy baskets en stilts in which the fishermen and the toilers en lana lived were fashionea a,fteF the old Malay villages built always en tida~ flats or atl eng river banks. !Reefs and sides of these huts were of nipa palm, trames ana fleors of ant-proof bamboo, the whole bouna together with withes of vegetable fibres-there was not a nail in the peasant Filipino house. The poles for the floor were split and placed flat siae aewnwana, thus making a smooth and resilient surface en wliidi were spread their petates, or sleeping mats. Other furniture they haa none except, perhaps, the ever-present Singer Sewing Machine. 'Fo GatGh vagrant Gurrents of air, door and window flaps were propped 41


AN AMER]CAN DOCTOR'S ODYSSEY 0pen with stioks. U nGlernea~h the h0uses were the fow puGldles formed by refuse GlroipJiling through the fi00rs. 1Jl\.e niJila Jil3Jim, F00ted in salt water, gF0WS luoouFiantly in the iF'l\.iJippines, blut Gloes n0t 0€GUI' again unti[ fal' away Sumatra. 1f1he Filipino takes it f0r gFanteci!., out with0ut it his life w0ulGl be vastly m0re difficult. It proviGles him with the roof f0F his home and with internal warmth. Because it has no insect enemies the crop is unfaiJing, and untm the ocean dries uJil it ean suffer n0 dF0ug'ht. With 11ttie effOl't, the b0ats 0£ tae hanresteFs wind their way thr.ough nal1r0W water . ways, Gutting the proteoting bns, tapping the slender sta!lks, and emptying the Ettie cups of their sweet sap. Out 0f this are distillecl alcoholic imitations of beverages ranging from Ghartreuse to G0gnatrimitations so closely resembling the 0riginals that 0nly the most cldicate palate Gan distinguish the differenee. 'il"fte niJila hut, frail as it is, GaIlJ withstanGl 0ne enemy to whiGh w00d Fap id~y SUGGuffibs. One 0ppressive iN'0vemoer Glay 'Ii went to a'li'hanksgiving party in Manila, anGl when, aliter the h0ffie fashion, a huge turkey was bF0ught to the table, instead of beal'ing the weight Gheel'£uUy, the festive board literaBy groaneGl and c0:tJ.apse<ill at our feet. EverJlbody, was startleGl, but nob0Gly was su~pI1iseGl. Termites haGl b0rel1i uJil thF0ugh the ~egs, leaviNg 0n[0/ 3J shel!! 0£ varonish. 'Fhese white ants were the great Glestr0yers in uhe tFopics. At the Mariveies Quarantine Station where, dm-ing the first years, [ sJiltmt mUGh of my time, f0ul' carpenters were kept busy as the busy ants themselves, replaGing their GlepFedations. If the queen ant could be 10cattlGl anGl destr0ye<1l, the Golony w0ulGl Glie off, but she was usuaHy hiGl<1len so carefuUy that it was weMI nigh imp0ssible to lind her. EaGh ant €0i0ny was lJuiit unGlergr0un<1l, tier 0n tier J:ill'e a !iJ.uge upside-<1l0wn skysGraper. Somewhere in the midci!ll e 0f ~e structure was the bouGloir, bed chamber, anGllying in Foom of the fat and bulbous queen, wh0 passed her life there in purci!ah, be€ause her jeal0us subjects had designed the exit and entranGe tunnels far t00 small for her passagtl. [ remember sJilending alm0st an entiFe Sun<1lay ruftern00n wat0hing these 1i>linGl w.011k:ers s0tve 3J G0ffiJil'lex engineering JilF0blem, appaFent~y requiring a high Glegree 0f Feas0ning p0wer. iCffp the siGle 0f the oathr00m wall they had c0nstr;utrted their tunnel 0f mud and sand, Gemented with a glue-like seGFetion whiGh, when dry, was hard and 42


UTILE BitOWN lBRQ;:J;'HER f~lrJ,y

wateFproof. apposite the wooeden flush tank, their objective, S0me sioc indles fr0m the wal!l, they stoppeed to c0nsideF the question. First they vainly endeavored to bridge the gap with their ordinary tunnel swucture by pr0jecting it int0 the intervening space. When this edied n0t work, they carried out one of the most ingenious operati0ns I have ever witnessed. Against the side of the wall 0pposite the tank they extendeed the tunnel h0rizontally., forming an L, and then waited for it to dry. While a few of them wet it at the joint, bhe majority took holed of the vertic~l section and slowly turned it until the horizontal section bridged the gap. Without instruments and without sight they had constructed the connection the exact six inches necessary. 'f.W0 ants cautiously ran across aned fastened it; in a few moments it was ready for use. $lcilileed artisans though they were, the habits of these ants were notoriously bad. In the vaults of the Treasury the great silver cartwheel pesos were st0red in canvas sacks. The rude and pushing insects entereed the cracks of the vault and devoured the sacks. When, for all. their nibbling, the silver remained intact, their low and revengeful natutes came to the fore. They covered the coins with a thick and horrible edeposit which no soap, no water, and no solvents could remove. Sm!lll boys earned large sums scrubbing away with stiff wire Thrushes at the pesos, trying to get them clean. Many of the hot dusty streets of old Manila presented a grey mon0tone until the Americans, with tremendous enthusiasm, began planting trees. Growth in the tropics is so rapid that much of the city was soon sheltered. In April and November, when the leaves 0f &he fiFe tree edliOpped and the bl0ssoms emerged, the town was aglow with incandescent flame. ~Favel on the thoroughfares of Manila was not without its hazards. Šrc!linary asphalt paving was tried but the continuous heat melted it; similarly, the tar filling around wooden blocks ran away. Until reGentily there remaineed 0niy the large G0bblestones, heritage of Spanish rule, over which vehicles rattled with careless abandon and deafening n0ise. [l,n Ithe Escolta aned Calle Rosario, ambulances, even when carrying emergency cases, had to proceed at a walk; the violent jolting might easily have caused further injury. No street seene in Manib wouled have been complete without ,he 43


UTILB BROWN BROTHER £r.@nt @f the independence movement since the old days @f the Katipunan, the rev@lutionary secret society led by Jose Rizal and Emiuo Aguinaldo. To the N@rthwest are the hard-working Ilocanos, l!t1ue sons @f Martha, who, in their thatched-roof carts, foll@w the harvests around Luzon. 'In the central hills are the five wild tribes, animistic in their religion; ana here and there in Luzon, tucked away in the recesses of the Mari~eles hilils ana the East Coast, are the Negritos. Far to the South in tne [slanGis @t the Sulu Sea-M,inaanao, J@le, Tawi-tawi-aFe the fie:Fee Mores, last of the Malay invaders and the only Mohammedans in ~he Arohipelago. F orotunately, the race question has never proved a stumbling block be:tween whites and Filipinos. Perhaps three hundred years of Christian influence have given the latter an attitude toward Western races not shal'ed by other Orientals. Of mestizos there are many, mostly a mixture of Filipino with Spanish or Chinese, and from these are ge:nerahl}' drawn the leaders of the people, including Manuel Quezon, a Sp,anish-TagaJ.og, ana Sergio Osmena, a Chinese-Visayan, both ex€c;:pti@naily able men. 'ifne FilipillC!ls, with the eXGeption of the wild tribes and the Moros, wC;:l'e devout Catholics. But tli:c;:ir grievances against the Church were so hitte:!' that the iRev,@lutien haa been directed as much against it as against Spain. Many @£ the Imlepe:ndistas wanted religious as well as poiiti€ai fFeed@m, so that a F-ilipin@ might become a priest or a ~ilipina a sister. In Father Aglipay, who had been Aguinaldo's chaplain and one @f the brains of the Revolution, they found a leader. 'Fhe schismatics took possession of the Catholic churches in the distroicts where they were stFongest. The question of ownership was taken to the Supreme Court of the United States where the adherents of Aglip,ay contended that the churches had been built by the people _ af the community, and therefore belonged to them; the Roman eatnel~cs, @n the othe:r hand, daimed that a church once built bel@ngea t@ the Holy See foreveF. The Supreme Court decided for the: orth@d@x Feligion, and the Aglipaists had to' gi;ve up the churohes. 'illihe:y, hewever, wel'e n@tto be Ghecked s@ easily. They el'ectea ohur€hes @f fneir awn, first of bamboo and wood to serve until, as ~heir nurn45


AN AMERICAN DOCTOR'S ODYSSEY mers s~emea to ~ miil!l;ion ana a halff a,n~ runes inel'easee, they GeuhdJ affora better ones. ~he bulk of the population of the Philippine Islands was agricultural. ,])he tao, or peasant JiaFmer, was a Fr,ienaly cFeature, simple and unc0IFJ,p>iaining. Jin the 0iGi aa,ys, haU the v,hl!lage might me aead 0f ch01era, but the surv,ivors wou1d be cheerful. Or if his house burned edown the tao, with no caviling at fate, wouled set to W0FK the next clay to muild it up aga,in. Al!l 1;he Amerieans fe1t s}"mwa~h\y ana affection fer the tao anid wantea to p>Fotect him. But ~his was ed,iflkult mecause 0~ the cacique system, so strongly entrenched that neither Spaniards ner Amerieans had been able to r00t it out. The cacique was the rich man of the t0wn, who owneed alm tne WF0p>eFty ami reeeivea aJ peF~entage 0n aa the prociluee. 1fihrougn fiis system 0f usury he kept the ta0 in a state 0f serfd0m. In the health service we had to recegnilZe the powel; of the cacique; usuaUy an intel!Iigent weFson, his 0p>positi0n e0uld ha,ve nul!lifiee 0UF eff0lts. But as S0en as ne reaIilZed fie C0UlGi get fl0 gr:ak £r0m us, aned that, 0n the contrary, we might bFing him added in~0me by making his subject taos more p>r0duGliive, he rangee himself 0n 0UF siee. '['he ta0, who was as unp>!1ogFessive as he was gentle, 0tten offeFea p>assive rClsistanee to Westernizing, blUt at a thiieatening w0re from his cacique hCl wouM p>FOVCl amenable. lit is always easy to condemn a whole weople by caUing them this OF that when, as a matteF 0£ fact, the ad~e€tivCl may 0niy be tFue in p>al't. mne Fi~ip>ines have been termCla lazy, IDut the ta0, the submCl~geE! nine-tenths, is anything but lazy. With his earabao he wo~ks his plet of gwund da,y in and day out. The class aDevCl the tao, on the other hand, is frequen.dy disinclinCla to Who/siGal exeFcise==€aEpentClFing, gan!iClning, "0r even wa,lkin.g. But even they coulld n0t be ea!1lJ;ed mCln.taUy lazy. All Filipinos have the siesta habit, although it was amruptly br0kem into by bustling American 0f!i~e routine. Americans f0und it diflkult to app>FCl0iate 1;1\.e lClisllrdin.ess 0f the Ri~iwin0s, w1\.0, i60r examp>iCl, measmed !distance by the time it t00k to sm0ke twe ciga,rettes, 0r five, or whatever the number might be. The Filipinos, on ~he other hand, failed utterly to c0mprehen!d the imp,>ortanee of time as viewem

4'6


LI'iITiL'E iBRCWN BR01'HER by Westerners. 1'0 an American, an appointment at ten o'clock meant ten o'dock, but to the Filipin0 it meant the time at which he left his housej he might arrive at the meeting place at eleven. Whe net r.esult of centuries of subjection was a tendency to evasion, a characteristic 0f people who have long lived in a state of dependency. This inediFection was carrieed over into daily conversation. I soon learned that I must never say "no" to an Oriental, because nothing gave greater. offense than the ediFect negative. If a Filipino asked me for the ioan 0f an umbnella, ] must not say, "I'm s0rry, but I have no urnbr.el!la," but Father, "I edon't think it's going to rain." He would unaer.stane and not be affronted. 1fhough the Filipino seldom smiled, he was by no means dour. Kindliness was one of his most charming traits. Family life was invariably amicable and friendly. Marsh or scolding voices were seldom heared. Even the little children were polite to each other. No child was rude to strangers or failed to obey. He seldom whined or cried. Equally endearing was the generosity which welled spontaneously £nom Filipino hearts. I was once accompanying Jacob M. Dickinson, $e€l'etary of War, on a tour of the provinces when, due to a motor mishap, we had to stop at a v,illage which had not been expecting us. OUF party was composed 0f at least twenty-five, but within an hour an exce:JJent bJan<i[uet was pr,odu£ed, complete even to such oFations as would have made a United States Senator envious. Mr. Dickinson was much impressed with the spirit of hospitality he found everywheFe, and at the conclusion of his five weeks' stay among the Filipinos quoted as his valeedictory the words of Charles Sumner, "Let us know each other better and we will love each other more." Former oustom had been to "civilize" native populations with the aid of a whiskey bottle, the Bible, and the Krag. The United States was determined that different methods would be employed in the Philippines. Kipling's advice to the American people was noble but - unneci!Ssaryj in our hearts we had already assumed the white man's oUFmen. P,resident McKiniley had sincerely believed, as he said, "There was notiliing left for us to do but to take them all, and to educate the F-ilipinos, aned upiift and eivilize and ChFistianize them, and Thy God's gr.ace to do the very best we could by them." 'Ln harmony with this sentiment he selected men who would also

47


LITTLE BROWN BROTHER pines was to train the Filipinos to self-government as quickly as possible_ T 0 attain this end, as well as to ,increase gooawill, three Filipino members were added to the Commission_ They were participants, and thew wishes were carefully considered, but the five Americans retainea the aeciding vote by reason of their numbers, although it is inter-esting to note that the vote seldom split along racial lines. Until the advent of the Democratic Administration in I9I3, it was a c0nsistcmt American pollcy never to delegate authority to Filipinos untj,l they haa been trainea to responsibility, gust as it was the poliGY to tl'ain them to this resplOnsibility as quickly as possible. Another immediate pFoblem was due to the inevitable friction eausea by a military occupation; the soldiers with whom the Filipinos haa been at war were natur-ally still regarded by them as their enemies. 'Faft had to make himself popular as a necessary incident to initiating a civil government. He was so successful in this endeavor that w.hen there was talk of Pnesident Theodore Roosevelt offering him a Supreme C0urt justiceship, thousands of Filipinos serenaded him with the stirring sentiment, "We want Taft!" His winning smile ana his jovial good nature w@re maintained in the face of every obstacle. The Filipino t00k life seriously. The Americans were so bUFaenea with the resp0nsi bility 0ÂŁ their mission that they had little incllnati0n fOF humor. But "Taft, amia the encircling gloom, woula tel!! his stories with such gusto as to command appreciation and delight. Taft came down shomly with amoebic dysentery, the inevitable result of his constant attendance at banquets_ He believed it his duty to partake freely of the soft drinks and the strange food until, as he himself expressed it, his "intestines harbored a first class zoological garden." In spite of his size, and aJthough the perspiration poured from him, he was a glutton for wOFk. He haa a most extraordinary talent for _ preFaFing laws. I have seen him dictate ex tempore to a stenographer a legal document running into several pages in which scarcely a word w0ula have to be alterea_ Taft â&#x201A;Źreated hunareds of ~aws, but the man who saw to their administrati0n was Luke E. Wright, a former general of the Confedemcy, a typical. S0uthern 0flicer with upright bearing and clear, G001 eye. His wisaom had much to do with the success of Taft's ad-

49


AN AMERICAN DOCTOR'S ODYSSEY ministration, and when he sUGGCle<!led as goveFneF, he ably calTie<!l out ~he [aws whieh Taf.t ha<!l <!!Fawn up. W!1ight was feill ewee oy Hen!o/ C. il!c!le whe hcd<!l offiGe only :v short time. 'fhen in [9@6 came the piGtures<!!ue James F. Smith, Colene! ef Califernia Veiunteers, who hae seFVed as Customs CoNectoF, ffiustiGe of the Supreme Ceurt, and Vice Gevernor-Gener:vl. He was likeable, sincere, honest, ane, abcwe all, human. It was <!luring his term of effice that the F3iilFeadls ef the [ slands weFe buj,lt anc!l the goveFnment fin3inces stalliiJj;jze<!l. Me €euM seOUl'e li'id.ipine suppeI1t fel' his meaS\!llles, a gift wllich, as time went on, meGame inGFeasingly essentiaL Eaoh ac!lministratien Feiterate<!l Taft's eriginad pFomise ef in<!lependence when the Filipines were prepared for it. One step teware its fulfilment Game in 1907 when the first Philippine Assembly was epenee by 1faEt, then Seoretary of War in PFesident 11heoe@re Roosevelt's eabinet., w,he hae maee the l@ng joul'ney aGEeSS the Paeifk fCDr this el!ipFeSS Wlu'pese. The CCDmmissi@n, seCDn inoFeasee by the adrution of a feurth FilipinCD member, then became the upper house CDf the legislature. I have km@wn aM the goveFnoF-generals of the Philippines and, in my opinion, the one mest gifted in administrative ability was w. C3imeFOn iIIel'llies. We la·i d a liFm feundation for seund gevernment whioh might tetteF in poiitieaJl eaFth<!!uaK:es but weulc!l not falhl. M!is nine real'S CDf service began in 1!,)@4 when he oec;ame a member of the Commission. As Secretary of <remmeF€e ami PeliGe he controHe<!l many @f the basic government entities upon whieh the material prespeFity of the Islan<!ls depen<!le<!l- Public WOFks, <roast and Ge@detic $UFVey, ~ests andl TeiegFaph, [JjnteF-ls1an<!l Navigatien, and a <:enstabulary ef ten theusanc!l men. We d,i d much to oreate the feFces whiGh woul<!l eventuaillly make the Islands ful!ly roundled and self-sustaining ecenomicaidr. Impr@vernent of harboF facilities aniil reduction @F ab@lition ef harbCDr <!lues did much tCD stimulate €Qmrnerce. His brilliant aehievements in aid these lieles Fanke<!l with those ef Lord Creme); in Egypt. 1i1his gFan<!ls@n e£ Rallpl\. WaddCD iErneFsen, the ttaiDScencdental tihe@Fist, usee his brains to build up the most eflkient gevernment the WCDFtcd has ever KnCDwn. For a p@pulation ef ten mihlien he cilid aH the things a gCDvernment ha<!l to <!lC>---"€OUFtS, censtabulary, harbers, eduGation,

S0


:LI1TLE BROWN BiROiTHER civil servke-on thirty million aollars a year. He ran the Philippines as a business; (Doiitics were allowed to play no part. Every item of expense, no matter how minute, was carefully scru· ninizea by his loyal lieutenant, auditor Lawshee, who would lop off heFe and whittle there, waging a successful war against the common human £ailing to pad expense accounts. I remember one occasion when lLawshee's eagJe eye was skimming the expense account of one of my su0orainates. When it [it upon an item charging two dinners in one aay, his inexoraliile blue pen~il l',uled it out. My man explained defensi~ej,y that he haa been on shipboard one rough nig.h t and haa [ost his ainnel'. But shortJy the sea had grown calm, and he had been aMe to return to the aining room and consume a second dinner. His contention was that the first haa been lost in the line of duty. But tile Rhaaamanthine Lawshee brushed this explanation asiae, saying one dinner was all that could be allowed. Philippine revenues wer.e small, and much money was needed to awn into reality the American dream of rehabilitating the Islands. Fonbes started in to develop their material resources. But before this €oulcl ne done, roaas had to be constructed. The military eaminos whioh the Spanish haa built for conquest had long since fallen into aeeay and disrepair. Forbes built new ones, also for conquest, but this time intemded to seize the tr.easures of Mother Earth. According to the Fornes plan, after a road had been built, a caminero was hiFed to patrol each kilometer on the s(;lUnd theory that a stitch in time saves nine. He would plod up and down with his little cart, his eyes scanning the surface, and then, with simple tools, a bushel of stone, and a bucket of tar, he would mend immediately each rift or hole. Though Forbes was doing this work for the good of the Filipinos rofher. than for their exploitation, he, like every departmental head, _ had always to battle with the ghosts of past abuses; the Filipinos had "IIivia memories of the €OIWee system under which they had been conS€F.ipted for Foad w0rk. Nevertheless, S0 persistently did F0rbes bend his energies in this dil'ection that, haH jokingly, haH affectionately, he :was duliibecl Caminer0 i'0rbes. Weahh began to flow along the Foads which he had opened. His eif0rts resulted in raising sugar production from fifty thousand tons 51


AN AMERICAN }i)OClfOR'S OIDYSSEY ~o a mi1!1ion ami aJ haiU a year ana in clev~loping the C0lilra indust:ry to allJ extent hitherto undFeamea of. Wherever we went in Southern Luzon we useGi to see the silvery white hemlil fibre hanging out to clry Eke washing. Tlhe smple, ten ~e fiFteen feet leng, strengeF under water lihan aJny ether fioFe grown, loJ.as maGie ManiJa virtuaill y synonymous witih geed rope throughout the werld. ForIDes encouraged goM mining anGi the Philippines are rapiaJy becoming ene of the world's leaGiing pFoGiUGers. [!\1eElhes c;l:ia mueh to advan€e tile PIli!Lipliline rtelhaeco [ndlistFy against tile nitter antagenism of AmeFi€an corporations already intereste<il in the CUIDan produGt. As soon as Fhilippine tobacco, which has a smaller nicotine content than the best Havana an!!! is unsurpasseGi in quaE~, IDegan to win pop1:l!!aFilly on its ewn merit, FepoFts weFe ciF0u1late~ that BhiiliJi1pine oigars weFe made by 'lepers an<il syphilitiGS. SUGh is the sugges~ibility ef Iluman natiUre that even the reGi sentinels at cigar store entwies seemel!ll to hold their Fight hancls MoM with, "Thou shMt not enter." '[1he B\!lFeau ef Meaitll, trying to cernbat this unfounded pFejudiee, ceFtifiea lihat eaGh box exported was manufactured uncler absolutely sanitary cenditions. But a IDad name, ence given, clings as tenaciclUs1y as a ian~ lleunGi te fhe trail. '['he eM ster.ies wol!ild ke"F 0l'Opping ulil. Whenever ]; weulld try rte purchase a Philiwpine cigar in the ilniteGi States, tile cigar store clerk would reply, "We don't carry 'em. 1Dhey'd ruin the Fest ef our steck." Then he woul<il Gie:liver a it'mgthy hemily on the dangers iniler-ent in e:ven Ilaving them in the stereo He woula shew me il"hi[~F1pine @igaFs wi1il\ runy Ile'les in tllem, ami! instruGt me in the habits of werms, with many Gietails as to how they wouM infect the geoa clean Mavanas. My explanation liLiftered From his. Occasionallliy, as is Gommon te any tobacco, eggs hacilloJeen latia on a few of nhe Jea:ves. After tiney ~al!! been roNee in~o the €igars, the eggs haa hatchecii anGi the WO!1ms boreGi their way out. But the worms haGi Jong since gene their way anGi tllerefore Gould not possibJ1y have "infe€~ed" any o~lier €igars. [FoerIDes' inteFests iWeFe not alene materiaL We ha<il a stiI;ong so€ielogical bent, parti0ularty directeGi towar<il peneiogy. Tlhe great €entral pFison of iBilibid was beGOming much overcrewded. Instead of

52


aacling to its gFeat stone walls, or to its wings, radiating from the cen~Fai tower where the guards unceasingly watched, Forbes established tille FaFbial.dy seLf-governing community of lwahig, consisting of twelve hunarea adUlt criminals, on the far distant island of Palawan. As in the Gearge Junior Republics in this country, there were no walls at aid; ]wahig was designed to Feform rather than to punish. Privileges were won by merit. After two years of good behavior a prisoner coUld sena for his fami[y, set up housekeeping, and develop a plot of land indepenaentlÂĽ as thaugh he were at home in his own village. Half af what he pFoduced was his. If he did not care fOF agricUlture, he GauM learn a trade. iIIew esGaFes were attem,ptea; mast of the murderers, highway robbers, am!! burglars layally observed the conditions of their parole. Ailter release they were in gFeat demand for servants because of the excellent training they had received, and the reliability they had Jl>roved. Paradoxically, released conv,icts found it easier to get jobs than those who had not served an apprenticeship at Iwahig. $uch was the pawer of Forbes' personality that it pervaded every aeFartment. The esprit de corFs was raised to so high a pitch that all labared joyfu1Jy and without regard for their own interests; even the aHke boy was heart and soUl a part of the movement and firmly convincea that iÂŁ he were not there at eight o'clock in the marning the wheels would stop. Mthaugh he worked sa hard, Forbes seemed to be able ,to stretch fue twenty-four hours farther than most people. He attended official funcrtions faithfully, and did more than his share in furthering good fellowship between FiEpina and American. He was at the height of his suecess and had attained world renown when in 1'913 the administration changed. President Woodrow Wilson subjected him to one at the extreme cruelties so often perpetrated under a democratic _ faFID af gavernment. Withaut warning he received the following curt cable from Washington, "Washington, August 23, 1913. Harrison confirmed August 21. ~he Pr.esident desires him to sail September 10. Will it be convenient to have your resignation accepted September I. Harrison to accept and take office September 2. The President desires to meet your convenience. Should

53


AN AMERJCJ.,N ]DOCTOR'S ODYSSEY RatTison take linen, silver, glass, china, and automobiles? What also would you suggest? Wife and children will accompany him. Please engage far him servants you leave."

Two aays later, President Willson, apparenrly realizing that something more was due, wFete as fellows: "Washington, August 2'5 , 1913. My Dear Gavemor Forbes, ]' ha,ve appreoiated ¥our willingness to remain as @ovemar General of the Pl\ilippines until [ might with deliberation select ¥OUF successor. [ "ealize the amaunt af excellent worlC which you have dane in the Jslan<ls as Seoretary of Cammerce and Police, and as GovernoF GeneF"I, and J desire to thank you for your faithful and careful service. iJit is my desiee that your successor should, if possible, reach the Philippines before October 16, and I therefoFe accept your resignation to take effect September 1 ~rom the se>rvice.' , Fo~bes had perfoFmea a gr;~t weFle for the American g(wemment in a position which, in administrative importance, ranked next te that of the Presidency itself. Wilson's abrupt actien was a poor return fer ene who haa swent his persenall fortune treely antd haa worbd so haFa, otten against the ep>pesitien ot the Assembly, that his hearth haa gi'll'en way a numbe! of times. Under Osmefia and (QueZien tihe mevement fer indeweniilence naG! been steadido/ grewing, although, in their aesire fo! persona[ p>eweI', the leaders o£ten talkeG! in g(meua1lities, either without knew leage of the facts er disregarding them. Forbes had no intention of denying inaep>endence [0 the Fitlipines but only of withho:lding it untid he considered these novices in sdf-government haa beceme exper.ienced enough to manage their ewn affairs without tariff concessions am;! military p>rotection from the United States. The arrival ef Francis Burton Marrison, former Cengressman antru the aveweG! champ>ion of Filip>ino inaepenaence, was awaiteG! with much speculatien and curiesity. Whe Imew what hapwy hunting grounds in the ¥aFious government aewartments might be op>eneG! te the potitices? As a gesture ef ceuFtesy, an envey was sent to meet Gov~rneF WarFisen's shiW at NagasaKi to answer any questions he might wish to ask about the country he was to aaminister. When he proDeunded bhe 54


UTfLE BROWN BROTHER l'het0rical questi0n, "I suppose I should wear a silk hat and morning coat when I enter Manila!" the envoy, anxious to please, replied politely, "Of cOUFse." 'But the moment the emissary was out of the presence he sent off waFning cables to Manila that the new Governor General intended landing in silk hat and frock coat. The Filipinos were always immaculately and neatly clad l;mt always in white, and even formal occasions call1:e~ 0nly for mess jackets. There were no more than a half dozen top hats in Mani,la and no time in which to pf0CUFe more. They were not to be f0umd lacking in eticquette, h0wever. They organized the official 1lâ&#x201A;ŹCepti0n in relays. Several hundred people are supposed to have tdefiletd before Governor Harrison, exchanging the six silk hats rapidly behind a screen. Meanwhile emergency telegrams by the hundred were being despatched to Singapore, Hongkong, and Calcutta calling for hats, but to fill this unprecedented demand the emporiums of the East were able to send hardly two of the same shape or vintage. Governor Harrison was both amused and embarrassed at the furore lie hacl unwittingly created. After his first appearance he had discontinued toppers, but for many months they were faithfully worn by the iPi~ipin0s to the tdelight of Phi1istine beholders. When we went on insJllecdon tours it was the custom for the officials of each town to line up in the main stFeet. ] usetd to pull out my binoculars as we applloached. G0vernor Harrison w0uld ask anxiously, "How are they <1lressetd!" I would take a gleeful look and reply, "They're all out in their silk hats." Governor Harrison would sigh and say, "I suppose I'll never be able to !i.ve that down." In spite of Governor Harrison's personal charm, he was to create much havoc throughout the Islands. Because he said to the Filipinos, "'What Y0U want you may have," his popularity with them was immense. But he had not been in Manila twenty-four hours before he began td,ismissing American 0fficials 0f the Philippine government whe, as Ci:vil Service incumbents, had c0nsidered their tenure permanent. They were informed, 0ften with only a few hours' notice, that theilj0bs were terminated, and they weve left str:anded ten thousand miles 55


AN

AM~RrCAN

DOCTOR'S OID¥SSE¥

trom heme. "The biade rose ancd fel!l, ami ene head a;ftel' anether Fe1leGi into the basket. Many FiliJ1lines were lifte<il inte posi~ions whieh they were not quaJifie<il te tiM. Twe scheels of thought abeut the Philippines existed among Arnel'" icans. One was te al!low the Filipinos to <ilirect the lesser units of government an<il, as they sfiewed fil!ness, to tum oveF te them 1ihe higheF units. The e~heF, to wfiieh Ge~ernel' HaFrisen belengecd, believecd ~he enlr way fOF peeJ1lte te learn hew to gove~n was te let ~fiem de tae geveFning as bhey wishecd. SinGe [9(JJ7 theFe haa been we main J!lat~ies in bhe iPhiliJ!lpine :AssemD1y- the Natienal JjneeJ1len€lent, which wanted nreedem at enGe, an<il bhe Demoeraliic, whicfi was atlways in bhe mineFity an<il favowi geing slewly. A<il<ililiionall par~ies kept CFopJ!ling up, enly te be J1l1ewe<il under again. One e£ them, t~ EleGtrie Indepen<ilenee party, wante<il independence as fast as electriGi~ €Quld travel. The twe leaders ef the Natien3il Independent party weFe SeL"gio Dsmeiia and Manuel Quezon. U m;ieubteilly the latter was even t'hen the chief figure in the ]slands. Although our elDjects weFe eften antitheticatl, he had such charm that it was impesslbie to dislike him., and Ou); Felatiens w.ere always £Fiend!1y. Osmeiia, long SpeakeI' ef tlie Meuse., an~ then .l?nesicdenti e£ the Senate, was secen<il en~o/' te Ql!lezen in J!lremjneNee . .Af,ter Rizal, Jlmi~ie Aguina:l dh:J il'l:as tae mest eutstaneing figl!ll'e in 'Phi'lippine histery. He was a ful:l-bleeded TagaJ!eg f-rem Cavite, in whose name the li1ilipino insuFreGcien ha<il been con<iluete<il. !fhis scheel teacher, exile<il by Spain fel' pelitica[ activity, in sJ1lite ef his original1y peaceful eccupatien, lia<il shewn a eertain talent for military tactics. After Funsten had capture<il him by a daring ruse, he gave his parole, and from that moment became a loyal citiQ:en, whe did his utmost te help buil<il u,p the i[slan<ils. He retired from active 1ife a;n<il cencentrated on his farm in Cavite. ]n an<il out ef the ceUFse ef <ilutr [ saw .AguinaMo etten. We stil!l ha<il aJ gFeat name. IDUFing J!ltesiclentiaJ! eampaigns, J!leiibicians weu!M ceme 31]] bfie wa:y PFeil'! bae T!JniteGi States to wrililg iiFem bim his ewinien en th.e WFeg.Fess rt!ne Filliipines weFe makJing tewaFe inciepenclence. Ammunition was alilva,),s nee<ile<il £01' j!11·eo€en;ventien speeches. Senator Wil~iam j. Stene, a Deme0mt tFem Misseuri, ap>peal'ee en

S6


LITTLE BROWN BROTHER one @f these missi@ns. Americans in the Islands kept telling him that .Aguinalcd@ ha<d n@ influence whatsoeyer politirnUy, but Stone natural!l.y G@nsiedeneed that these ar.tf.ul RepubLicans wene trying t@ leaed him astray, ana p>nevel'lt him from tracking dawn the truth. Stone was a guest ot the GovernoF General at Malacafian, the former residence of ~he Spanish governors, and Aguinaldo was produced for him. Since no interpreter was present, I was asked to fulfill that function. "Now, General," Stone began. "Don't you think the Filipinos iWouM haiVe been much better off if we hadn't occupied the Islands?" "I reilly don't know," replied Aguinaldo, "but I'm trying to raise some corn in Cavite. Now I understand you come from a great cornFaising state, and I wish you'd tell me something about the essentials of seed selection." "I haven't ever thought about it. I don't know anything about cOFn. But you, General, know that the Democratic party in the United States has aiways st@@ed for release @f the Islands. Don't you think you sh@uled have independence right away?" "1'hat's a debatable question, Senator, but now about fertilizers. What fertilizer edo you use on your corn?" "I edon't know anything about fertilizer," asserted the Senator fumly aned with signs of irritation. "But I'd like to get your opinion @n what Ameriâ&#x201A;Źa shouled edo right now, and whether it wouldn't be the correct fJ@licy to turn these Islands over t@ you. What do you think?" "Oh, there are many people who know much more about governmental matters than I. But in Missouri-" "To hell with Missouri," shouted the Senator, and stamped out of the F@@rn. But if Aguinaldo were lukewarm to independence some years ago, he was in the minority, because independence was the burning issue. A sch@ol superintendent in Cebu reported that he had received from a - small potential voter the following answer to his request for a description of a cow. "A caw is an anima:! which has a leg at each corner, it has horns aned gives milk, but, as for me, give me Independence." By the fJassage of the Jones Act in 1'9 I 6 an elective Senate replaced the Commission, leaving the legislature in financial control. Thereafter Filipino bills were subJect only to the veto of the Governor 57


AN AMiERlle AN iDOe1POR'S ODYSSEY General. With c0ml"iact;:nt Harris0n falling to asse~t his pFer0g!ltllvt;:, the Filipin0s haed a¡/fairs in tht;:ir own hands. Unfortunately, the novitiate had not lasted long en0ugh; the V0WS of g0vernment haed bet;:n taken too S00n. l'ht;: peoJ'lle had not "haed time to absorb ana th0Foughly master the poweFs afn:aedy in their haneds."


WASHING UP THE ORIENT

CHAPTER 6.

Asia for more than a thousand miles; a fast OGean liner can T pass by in no less than two full days. The only quarantine station in M~

Philippine Archipelage stretohes aleng the coast ef Southern

this vast and scattered collection of Islands was at Mariveles. Ships w.hiG/\. came inte any pert of entry with communicable diseases sometimes had to be remanded enormous distan~es. In order to ease the burdens on commerce one of my first duties was to build a quarantine station at the populous port of Cebu, and later others at Iloilo, Zambeanga, and Jelo. iln Spanish days the quarantine department had been run on a simple system. Whenever a ship sailed into Manila with dangerous communicable disease aboard, its captain would take up a "collection," as it was caNed. If it were sufficient, the ship would be promptly re[easeed witheut being delayed in quarantine. If not ample, another GolleGtien, and perhaps even a third, woulcd have to be tendered. The result was that an outbreak of plague, cholera, or smallpox in China or 1apan wouled usually be followed by an outbreak in the Philippines. We applied water, soap, and disinfectant rigorously. Whenever ships came in from Hongkong, or Amoy, the crews, many of whom had loathsome skin diseases due to filth, were scrubbed, sometimes forcibly;. After a few rounds of bathing most of these skin troubles d'isawpeaFed. Later we haed an arFangement with Hongkong so that the crews of , ships abeut to sail for Manila would be bathed there. The Chinese,

59


W.ASH[NG UP THE OmEll'l'F metihod of ereeping int0 the hearts of my superiors was to save them the annual! expenditure of three hundred clollars for a launch awning. The FOt in this humid climate was so gFeat that the canvas would quickly mold away. I adoFlted the simple expedient of having it washecl once a weeK with bichloride of mercury, theFeby killing the mold germ ami extending the life of ~he canvas considerably. "Ii'he financiall stFingency uncle. whiGh I worked as quarantine officer Flel'meated all government departments, and was an ever¡present and Fluessing pFoblem in the BUFeau of Health. We weFe at ali times nanaiGapFled by bhe shortness of the Treasury purse. Whatever we aGGOmFliished had to be done within the revenues of the Islands, and, m0Fe0ver, appropriations had to be secured from a reluctant and unG0mprehending legislature. We had approximately fifteen cents per Gapita compared with the $3.65 which Gorgas could spend yearly in 'Panama. Moreover our territory covered a hundred thousand square miles ancl three hundred inhabited islands instead of the narrow strip of Canal Zone. Contrary to general belief, the Philippines never received any financial assistanâ&#x201A;Źe except a million dollars from the United States to repair the losses of the frightful rinderpest epidemic. An0theF handieap with which I struggled for a year was the limited Flower grantecl to the head of the heathh department. For example, unmer the Heabh .AGt as origina1!li)' clFafted, I had to secure the permissi0n 0f tile @oveunor Generai and of the Commission before making any imFloFtant move. When r had to have an assistant the list of eligible appointees limited me to five ex-presidents of provincial boards of health. One had an aortic aneurism which made him a hopeless invalid, one weighed two hundred pounds and could not speak after ilimbing a flight of stairs, and the others had no technical training. Governor General Ide, at my' request, cabled to the United States for an assistant. When Dr. Burdette arrived, the members of the Commission, angered at what they considered derogation of their auiliority, rdused to confirm"the appointment, and offered to pay ElF. !Burdette's passage back if he w0uld take the first boat. Within a few hours, however, they hacl reconsiclered and informed me they wou!lcd c0nfirm Dr. iBurclette's apFlointment, but only because of the expense alreacly incurrecl in bringing him out. iI! eamestly wished to clo my duty, but it was impossible to work 61


WASHING UP THE ORIENT OlildJy emlUgh, hewever, telegFams weFe being Feceived at the same time f.Fem his previeus statiol1' I summoned him to an interview a,nd ;w~wea the telegFams in fx:ent eÂŁ him, demanding, "Hew eould yeu have Been in beth Cavite and Laguna at the same time?" "011, that's very simple," he replied disingenuously, "I knew how werFied you were about the cholera epidemic, and I told my subeFdinate to keep en sending reports after I had left. He simply made a mistake and signed my name to them. He shouldn't have done that." ] e~ten useÂŤd te piay the faseinating game ef eatching an Oriental squaFe1y in a lie. The caretaker ef the Manila morgue had the strictest instructions to see that Fats were kept out. One day when I made my inspeatien, it was all too evident that, in spite of my injunctions, Fats had been there. "~heFe aFe Fats here," [ said sternly to the caretaker. " iLt's imposslbJle," he replied steutly. "Oh, yes, theFe are," I corrected him. "Ne, sir, there are no rats," he stubbornly maintained. "What's that Fight under the roof?" I asked, pointing te a dark ebjeGt on top of the wall. "That's just some old rags I Fut up there." Rather than take the tFeuble te' r.emeve the doths with wl1ich he had wiped off the tables, l1e haa tossed them up on tl1e rafters. But I knew that cloths could not move ef themselves. "You go get them." "I haven't any ladder." I had one bFought in and he gingerly climbed up the rungs. The animatea Bundle 0f cloths qui,veFed as he approached. The aaretakeF hesitated. "Bring them down," I ordered sternly. He reached over, and the rat, who could retreat no further, bit him savagely. Me uttered a bloodcurdling yell. "~e theFe any rats in here?" I demanded inexorably. 1!1his was the enly time I ever won the game. My sUBordinates did not lie with malice but rather as children do. A\t fust ~hey had little cemprehension of the essential purposes be,

63


AN AMiERJiCAN D()CfOR'S ODYSSEY

innumeFamle instml!letft@ns wnioh tili~y haG! t@ <larry out. 'fhey their duties mainly by If@te. But th~y, being uncl~r my immediat~ control, could be traine@ t@ see; t€l move th~ vast ineFtia @f the populace was tar mOJ;e difficmlt. Nev~D~hdess, fih@ sanita,ry Feg@neration @f the Fnil~Jilpines had t@ The br@ught about, n@t in spite of the FiliJilrno, but with his assista:nG~. It was natural at first that a p~@ple shoulGi resist measures which, in their inmost hearts, they believecl weFe being enforced by the govel'lling POW@f t@F the €-llPFess pU1jJilose ou malbing them mis~Fa1Dle, 'IlIlhaJilPY, anGl UIlGomfortabie. President McKin!ley had onee promis~td that th~ United States woulcd d0 nothing to interfere with Filipin€l habits anG! customs. But tHe Bmeal!! ef Health was GOflstaFltly cl@ing this veF¥ ~hiFlg, ancl any measure JilF@p0secl which the Fi!liJilinos Glicd net 1ike was ipse faGt@ not one of their customs. I cOUilcd sympathize with them; it was cloubtless unpleasant to be ordeFed abeut my sanitary ef6cers ancl nurses. iPeJ1>war h@stillity, was natUFalilo/ reflected in tHe pFesS, anGl even the cd@CtOFS 00inea in tHe hue and cry when iJi summittecil a sanitary GeGle for Manib. I was invading th~ Jilrivacy of the home. After they had delayeGl its passag~ for a yeaF, I caUeG! th~m int@ eenf~renc~ and as\{eGl, "Gefltlemen, what G0I'!e€tiens wouM y@u like t@ make?" 'ifhey suomitte@ tn@iF JilreJil@sah '[ agreed they weFe excel!lent, Thut n€~Gl~G! on!ly a few slight Ghanges here and there of a pur~ly teGhnicM natur~. ]j then rewrete the code,. essentialJy as it haGl been bdeFe, and everybeGly was haJilJilY. '[ us~Gl this sam~ syst~m @1t~n in tHe l~gislature, Where hostilirycou1d IDe converted into ac~iv~ cooperation by th~ simJille expedi@nt of ·saying to th~ mest vi@lent @ojeceoF, ''Will y@u GlFa·ft this bill for me?" Mis oJilpesitien weuld eyaJ1>@.llate instantly, anGl h~ would ~gerly a€oeJilt the commission. 'Wl1en !i~ bWI!Ignt [t bao\{, rn w0U!ld agree tihat his versien was exe~U@nt, and th~n recast the entire bi1!l. As tli~ bil!l thereafter bore his name, the theoreti€al author anGl iI w@ul@ Femain faithuul alilies £oFev~r. We ru1ways hacil t@bea·r in mind t-fuat we hacl to fia,ve pl!!b1i€ eJilinien on OUF sicle. PubliG eJilinion Gonceives ef sanitation in terms ef c@l!leoting garbage' anGl Gleaning @irty streets, removing deaGi animals, GUtting hiFlcil

th~

fuHill~Gl

04


WASHING UP THE ORIENT weems an@ gFass en ~aGant lets, kee('ling geats eut of back a'l'leys, sweeping si@ewaiks, penning up pigs, and @ee@orizing foul smeNs. We had to de all the things which the public regarded as of most importance, even to seeing that their whiskey was fr-ee of impurities. 'fiNe eit;izens weFe being bitten continuailly my m0s<quitoes, and hence mosquitoes became, in their eyes, the paramount health ('lroblem. In reality the mosquitoes of Manila, though enormous in numbers, were negligible ÂŁFom a health poi~t of view because they did not transmit any impoFtant @isease ther-e. Even te free the aity of flies was not of ÂĽita!! ,importance but ham to be done. Every householder and stablekee('lel'in Manila was required to have a garbage and refuse receptacle, w.hi(lh was emptied daily under the eyes of the Bureau of Health employees. !Epidemics ef flies, however, sometimes served a goo@ puvpose. People never C0unt their. blessings until they suffer a little annoyance. If the inspeetors became careless, flies would promptly breed. The pr.ess woul@ C0me out with lou@ aenunciations ef the Health Bureau. I woul@ <dutifully promise, "We'll get rid of them in two weeks." When this miracle was achieved, the people were alive to the fact that they ham a sanitary department. I would not have been able to carry them with me in greater things if they had not been able to say, "Mani[a"is the deanest city in the Orient." But fhe public never realized that the real health work went far deeper. ~han this. Water ana soil pollution are the root causes of mortality in the tropics. We wouM have save@ more lives in the end if we e0uM haNe wor.ked on ~hese a!lone and disregarded the things w.hich were merely irritations and not major health hazards. A diFeet corFelation is not always traceable between the amount spent for health and the death rate. People talk glibly about the \i>1'ieelessness ef human li,fe, mut they reaJ!ly @o not believe tihis. If the (lost of saving lives is too great, the money must be spent where it wiN ae the most g00d. Though we could not install a permanent water system when thousan@s of people were dying of cholel'a, plague, an@ smreliJ:l0Jf, I dia what I ceulGi. A(lcording to a consistent gevernmentat p0liey, anything I could save from my appropriation might, with the approval of the Governor General, be used where neces-

6S


AN AMERICAN DOCTOR'S; ODYSSEY sity tdemamiet4. [ljt was my €ustem te take ea€h pC!Se tl1at became allaJilalhie and use it te £ree a G~rtain numb~r of indi~iclua.js of intestinal p>arasites, er ~mp>loy it te help drill an artesian well, or va€Ginate forty p>~ople. ~n later. iY~afS my great satisf.actien cam~ £rem wa:lking aieng ~he streets of Manila and seeing that uneder a G~l1tain age nebeedy was pockmarked. But the public in generad was boreed by the €easeless detail whi€h had gone into achieving this Fesult; aJlthough after a dise'lSe had been Feeducem, they would b~ p>Fomp>t to applaud anG! @heeF to tihe e€ho. It is hard for the white man in the Bhilippines to wor.k for the joy of it. He is oppressed by the humid heat and has to drive himself €enstantIy. Persp>irati0n b~gins to r,oil from him tl1e moment he JeaNes the shelter of the €ool interior, even to walk across the street. Only after sundown is it p>ossible to be comfortabl~, and then only by establishing sleeping quanters on the windwartW sied<l. One guest at a hotel wiN €emp>lain at &reakfast, "['ve haed a fI'ig;ntfu.J night," while nhe canny old-timer will report, "I've rarely had such a. pleasant sleep>." It aId edep>ended where their rooms had been locateed, wh~theF on the windward or lee siede. 'Tl1e dimate of Luzen nas its vagaries, tihough they are weld r<lgulatem. When the Northeast monsoon comC!S over the Ji!acific, it strikes the mountain range which diVliedC!S the island in the middle, and drops its load of rain on the sparsdy inhabited East C0ast. In Manila, whiGh is on ~he West Coast, the seasons are exaotly tl1e F~veFse. THe b~­ "Iuent r.a:ins begin in June with the advent of the £euthwest monsoon, and last until October; for heUFs each day it may paul' in torrents. 'Fhe winds at Ma:niia blow tl1l'e mont'ns antW change, al}m fiv<l ment'Ns and change aga:in. November a:ned May ar~ uncomfoFtable becaus(l of the calm that comes when the winds are gr-aedually shiEting. Through :December until the middle of January is the seas0n to which eV~FiY­ b0edy ieoks feFWard, when the nights ane €oeier than th<l edaytime, ana when there is aJlways a refreshing Northeast breez<l. 'liheFea£ter, however, th~ country takes on a brown aned deaed app>earanee. Vegetation is burned up. Only the beautiful round mange trees, with their. tre-

66


WASHING UP THE ORIEN!!' rnemlGlUS 101lg tap ~00tS seeking water at unbel:ie'lable eistances in ~he ear-th, show spots of green. In the early summer, the dreaded typhoon season begins. Father Jese lUgue, S.]., in charge of the Manila observatory, first won fame when he made steFm warnings puMic while Dewey's fleet was blockading Manila in the typhoon season, losing his Spanish citizenship thereby. He later invented a baro-qclometer which invariably indicates the center of the storm. Much of our present knowledge of these eisturbances is attributable to his scientific observations. iFl10m the time the typhoons ferm in the Ladrones until they hit the China coast, or are lost in the China Sea, they are carefully watched ane repertee, so that every place in the Islands with telegraphic communication is seasonabIy informea. The typhoons move along certain oefts, accoFding te the time of year. The early ones go South and, as the season aavances, they gradually move North until they miss the fslands entirely. _ IDeath ane destruction aFe left in the path of a typhoon. I have seen wans-iJi'acific lineFs come limping into Manila Bay after passing through such a storm, not only with their boats gone, but with the sturey iron railings torn away by the forae of wind and wave. In one wild blew at Leyte a Jarge steamer was carried half a mile inland, ana a huge ohannel, cesting a!lmest as much as the vessel was worth, had to be dug before it could regain the sea. Since the track of the typhoon is never over fifty miles wide, and its speea is only six to ten miles an hour, any modern boat can run away, EFem it, but most vessels Femain prudently in POFt until the steFm is over. I remember once being caught by a typhoon in the treacherous waters eff the East Coast of Luzon, when I was carrying a load of [ellleFs in tlhe gO'ler.nment steamer, the Basilan. The trembling vessel would climb up and up a huge forty-foot wall of water, and then ÂŁrem the dizzy peak she would toboggan aown the other side with terrific speed, ana plunge her nose so deep into the trough that she seemea heaaed for the bettom of the sea. The whole ecean was staneing in pinnaoles which moment by moment broke, smothering the ooat in foam. We had not darea approach the treacherous shore. 'feward midnight the captain said the ship could not last more than

67


AN AMlERl'CAN IDC>CT(J)R'$ OEl¥SSEY a few h0UFS; he must t-ake a @eswerate chan€e, a,nd maKe f01' the narFOW, unlignted, F0€k-boumd entrance to the harbor of the little islltncl of FeliN0. It was <!lark as ink. The b0at Wiungecl, pitohed, tosse@, and r01le@, and then su<ilaen!l:y steadiecl anG! gFew sti!l!l. 1iDne €afltain let the a,neh0r g0, ama we waited fOF wha,t might happen next. I'n the rum gFey light 0f @a,wn we saw the rocky shore 100ming Ufl all around us only a terrifiyingLy short distance away. T:his m0st remarkable seaman haG! ma,naged to gui<!le his €Fa,f,t, my what c0u1aIJ 0nJ.'y ha,ve meen sheer luek 011 instinct, thF0ugh the naFr0W flassage and int0 the very centeF of the tiny harmor. Gn lan<!l also the tylflh00n was a fearful thing. No 0ne who has n0t eeen thF0ugn it can awpFeeiate it. 1E1he imflFessi(Ve thing is the war nhe wind increases, incFeases, an<!l inGFeases until it seems impossible tnat it can blow harder-and then it does. One flarticular tyr>hoon I was able to watch tr0m the Feasonably safe @00FWay of a str0ng stone h0use. was as tn0ugh I weFe 10elciflg at the stage 0f a tneafule. r Mene was m0ti0n~ess. Huge tFees w0u1d me li f,te~ up, F00ts and ali, ancl 150 saiEng 0ff into the atmosphere. Small houses dashed after them. In the harID01' steameFS 0f ten th0usand t0ns, with noses fl0inte@ frantiGaUr at the 0J!>en sel!, w.ith the anchers 0Ut a,mi steamiflg £u!ll sfleeci! ahea<!l, weFe Wilecl stern fOFem®st on tep of nile bl1ea~ater. Street cars left the tracR:s; down went the wires. Sheets of c0ITugated won roefing s0ared through the air, sometimes cutting off the al'ms OF legs 0f @esweFately liiul'rying fleclesti1lia,ns seeking shelter. 1i'nen in the mi<!lst 0f the wil@est confusi0n came the 0miJilous <ilea@ ca!'m, which marl!:em the so-cahleG! €enteF 0f the typhoon. But the quiet was only momentary. The other Cldge arrivCl@, the win@ Fever:sed, anG! everything m®veaMe went 1"0a'Fing back aga,in. 'NatUFe in lihe tF®flics tcm@s t® excesses and tOFces hl!lman lDeiN~ to set ufl a wall. of aflathy to prote€t the neFVOUS system trom C0nstant shocks. '['he things that hapflen near the iE'iJ.uat0r are <ilramatic anm awpear witIit eyclonic su<!ldenness. Earth'iJ.uaKes 0CCUF meFe tre'iJ.uen1ily than tywh®0ns anm the inhamita,nts must eec0me accust0meGi to these terrifyiNg experiences 01' eaeh time they W01rltd be 0vel1whelmed, During a quake; when I used to 100k 0Ut the win@ow of my office 0n tlle

,h

68


W A!$WTNCi liliF lfiW!E OiUENT naF..0:1>l Ci:ail!le ilPa[aci0, ancil 0fusewe nne houses swayiNg towa.a 0ne aQ0tili.eF, ~ W0utl:<d bve tine iJ!lusi0!1 ~hat they were a€~ually fuumJiling neacils. iBe.f0rll tne €lays 0f Fein-forcea c0NcFete, sections 0f Manila would be Jiler.i0cil'iealily cileme1ishea. I have seen a fu0ttemless crack streak Eke a flasn 0£ 11ghtning aer0SS the gFGuncii and split a fuig church in tW0. '¥Ilavs age it was 0bseFved tHat these seismic waves came in kn0wn ciliFecti0ns., ancil a Cath0lic priest, wise fueyond fiis gemerati0n, insteaa G£ IilUi1lding fiis GhUFch 0n rocks, mountecl it undergrouna 0n nockers, tUFnecii in the &reeti0n of the waves. [t has stood several hundrea ¥eaFs, c0mplacen1lly F0cking whi1le its contemp0raries crumfulea to Jilieees besiae it. ©n the night 0f January 3@, 1<1)1~, the ears 0f :lilll Manila were shatteFIl6 by tihe 10u@est noise in the world, audibie for two hun@ned ancil [i.,f ty miles. lin a few m0ments the streets were filled with (Deople, ga:z,ing with awe and C0nstepnati0n at a titanic !Foul1th ef J.uly celefuratl0n. Whll wn01e sky was fiUed with stars, shooting t0ward infinity. !Phil Taa~ v0icano, thiFt}"'five miies south, standing silent in the midcd'Ie e£ a lake since 17:54, had presumedly sprung a leak, generatecii steam, ana b10wn up. !1t was celefurating its release with a gigantic eruptllen 0t lava, mua, fine, Sm0Ke, an~ gas. I1fi0usanciis GI ~he in'hafuitants Gt Batangas li'r.ovince lived in the vicinity. Allthoagh t he hcl'l enormity of tne catastrophe could net be determind unti1 rep0rts fuegan te come in £r0m the stricken towns an@ lbal'1'i0s, I Silt the machinery in m0tion to organize a relief expedition as '!Iuiilly, as Jil0ssible. W Il Gould not travel by motor car fuecause tne 0M lbreken-aGwn Spanish FGacls [eacliNg there were impassaMe. But t he ne:xit may, w.itih ample hospita!l supplies, a aetachment ot the sanitary C0l'JilS, ana a fuQ(ay of constaou[ary under Col0nel William Rivers, we emfuarke<lt em a geveFnment steamer an@ anchored in Ba!layan Bay. 'i]1nenee we maae aJl JilossiMe spee@ the seven miles inland to the scene 0£ tlile <ilisaster. 1Pfie sight was lil0rribJle. Not Gn!!y ham all life been wiped out on V:0ieano rnslana itse1E, but aols0 tor miles away from the shore of the ialCe. 'lli1he €lead G0ulhl wait ; 0Ul' first care was f0r the w0unded ama the neID(;jless stFays whe were witnout food, drink, ami shelter.. i'emporary

69


AN AMERICAN l)(i)CTOR'$ ODYSSEY n0spitaJls were set up; acres 0£ gauze :wer.e us!:1!! to I!!ress the fFigntf,ul burns, bFuises, an(1! £FactuFes. Many W0m!:n anI!! animals were foun<il to have aborted, doubtless from the te~rific concussion. The number 0f woundel!! was in remarkab1y small f,lr,0p0rtion to toat 0£ tne <ileal!!, ana the evi<ilence sn0w!:cl that ~he mag0rity of lih!: fatalities hal!! been eausecl by the explosi0n 0f gases. When naliUre runs am0k, she oft!:n becomes pranksom!: in a ghastly way. The Fiiipin0s are norma1ly so mol!!est that they are never caught with their cl0thes 0ffi. Even in bathing they are weN ~overel!!. But among tne Fuins we f0una F1i1lipin0s staFk nake<il, stancling upl'ight ancl embedcl!:cl in ashes to their knees, still h0lcl.ing protecting umbrellas ov!:r their heacls. They had appaFently been attempting to g!:t away when the asnes Fainecl 0ver them an<il tne vaeuum ~ause~ by th!: explocling gases haa torn off their c10thes. Only about seven hunclrecl ana fifty boG!ies were Fe£Ov!:recl out of an estimated two thousand k;illecl. Many hacl either been buriea by tn!: mucl 0r ashes 0r washecl baGk int0 the lak!: by th!: immense wave wnich nad inundatecl several barri0s ancl, in Fececiing, earriecl pFa€tical!ly every m0veable thing with it. Our worK: was interrupted by constantly recurring <quakes whiGh c0ntinu!:cl for sev!:Frul weeks. C0lonei RiveFs an~ iL sl!:pt in the sa!li\!: tent ana for the time Iileing aG!optecl the Filipino indifferenc!:. Our nervous systems beeame S0 adjustecl to the sn0cks that we woulld sl!:!:p soundly at night, but kept a Jantem burning in case we should b!: neeaeG!, 01' shoulcl haN!: to maKe a <quick e~t. One night €arne a <quak!: "i0!ent en0uga even to waken me. [[ l1etum!:cl to €0nsGi0usness gust in time to h!:ar C010nel iRivers utter a startleG! "Wh00-00~00" as lie sat up in bed and rubbed his eyes. A crack haG! clug diag0nally acr0SS the gnouncl coverea by the tent, and tne earth was sinkilllg fast 0n his sicle. He macle a f!:ap t0war61 me. I Iileat a hasty retreat under the si<il!: 0f the tent ana he eame tumlliling after. In the course of a aay or S0 the quakes settlecl to their busin!:ss with dock-like Fegularity. Every twelve minutes the gr0uncl SA00k, ana tA!: ea~t'h 0p!:necl. Wh!:n w!: amusecl 0uFsetves stFa61cdll,ing ta!: clefts ancil riding the quakes we would reG!:ive an exaggeI<atea sense of up and clown m0tion. It was much like trying to stand with tli!: Fight foot in one Fowboat aned the left foot in another when a light ,,/0


WA:SiWING tTlF 'ifHE OR[ENT sea was running. These er.acks might fall together at the next shock or remain gaping for months before they were filled with edebris. FFem the dressing stations we hauled the wounded to the coast on high, two-wheeled, canopied, pony carts, using the board seats as stretchers. I 'was taking a full load on one of these carretelas down a leng hilll when suddenly a tremendous quake came and a crack appeaFed in the road directly ahead of us. The cochero could not pull 1:lp the peny in time. The animal fell into a Cl'evasse, but the sha£ts ~FiGgeed the gap, and the harness held him. Wie knew we had twelve minutes in which to work. Saplings weFe hastiiy pFocuFed, the pony was pFieed out, aned the hoard seats were laid aeFOSS the crack. We continued to the coast unharmed. The hardening precess we had gone through made this only an incident in the day's work. Newspaper reporters came frem all over the East to cover this catastrophe. Among them were two Frenchmen who arrived after most of the rescue work had been aacomplished, and who remarked superciliously that it had hardly been worth their while to come. In the enedeaver to make it worth their while, fifty stalwart constabulary were selecteed, who eagerly entered into the plan. The next night we ~iteed until the 'F'renohmen were asleep,' and then cast a rope over the Foe£ ef the nipa s.hack in which they were heused. The soldiers took heM ef either end, aned stoeed peised. When the customary tremblement de terre came, they began to sway, pulling back and forth on the repe in accelerating tempo. The bamboo creaked and groaned under the stress as the hut lurched dangerously on its stilts from side to side. The soldiers gathered momentum, and it swung faster and far.ther, until the terrified Fren~hmen catapulted out the window, hit the gFeund, like Antaeus gained new strength, and sped away into the darkness. Vile learned later that they had not stopped until they had reached the nearest town, many miles distant, and we read with great interest and amusement their aceount of the frightful earthquake at the scene ef the 'Faa! volcane. '®he ~ilipinos who surviveed continued phlegmatically with their Fegular rouned of duties. I Fememher watching an old peasant plowing a nea~hy fieled with his ancient and resigned carabao. When he reached

7I


AN AMERICAN DOCTOR'S ODYSSEY the lowe. end, sua'd enly th(m: came a tlFem(mGieus quake, anGi ~hat side ef the field sank about thFlle feet. 'Fhe €aFabaCD ntlVeF stepped, but kept metnediea!lll'y en and a'Feun<!i un1ii~ ne Game up against thtl row emlDankment wnicfu ma~kea tfue scissien. I saw him cock an eye tquiz21icrol!!y as thoug,h te say, "W'fueFtl tilid this come fuCDml 1 neveF hacl to climb anything like tbis befortl." Ami then he wearily hoisted himself over the acdivity and monotoneusly centinued on his way.

Wlienever the heat beGrome tee gFeat at Manilla Americans wou!lti! make the thFee day jeurney to the hitlIs, sometimes by steamer anti! pony, sometimes by train and feur-mule team. The heavy oPFlFessiveness of the capital changed tCD the sparkling wine-tang of the Fare£i.ea mountain air. At night the soughing of the wincl in the pines was I'eminiscent ef home. ~t imviteGl the AmeriGans, exfuaustea oy their label'S in a heat sbFange anti! €liffi01dt fior them to GOptl witn; the sick wtlrtl made wetl ana the tired were FdresheGl. The clevelepment of picturescque Baguio, a ciry- planned in every Qtltail by D. :&I. Burnham of Chicage, was, for yeaFs, the object of more cFitioism on thtl FlaFt of the Filipinos than aU ethel' Ameriean ventures. Nev.ertfueless it €l'eate<d mUGh attention througfueut the !East, anGi tfue FFenGIi govemment enoe sent a ti!elegate te obseF¥e ana FeFloEt en tihe possibility eli building a similaF Flaradise feF i1n~iG-China. 'I'he Governor Gentlral asked me to seFve as a guide te this reFlresentative. 1Dhe Frenchman showed great inteFest, asked pertinent questions, ancl was tlnthusiastic about what had IDeen acccilmplisheGl. We Game back en the same tr-ain as the JaFlanestl Consul, anGi iii intreduceti! bioIe two. wv'e ifuaplPeneCii at the FFlement be be passing a su€cessien ef pits a~eng the I'aillreaa Ene, ana tne J aFlanese, with thtl [nsatiable curiesity typical of his race, asked, ''What are 1ihose?" "I can't talli: about them," I assured him. "Why can't yeu tdl me?" he persevereGl. ,,~ can't tel!! yeu why. ]j simJilly cannet sa,y anything about thtlm." Sinee it was beeeming mOFtl an~ mer.e difliel!lllt te ,weiGl nrs iFFlFlertlmities gFa€efuJlly, I retiree;! te t'fue smoking cemFlar;tment, When ![ finisheGl m:y cigar and was FetUFning clown the cef11iGier, I could hear seunGis of violent upheaval. On oFlening the doeF, I was clumbfeunaea

72


WA'S'H!J:NG UJ? "FHE ClRIiENT to find the Japanese Consul on the floor and my French friend on top pounding his head up and down. With one hand I grabbed the Frenchman by the collar, and with the other pulled the Japanese Consul to his feet. ''What in the world is the matter?" l'hey glared at each other. Then the Frenchman, in lofty dignity, saia, "] won't talk about it here." !l.i:he Japanese, who was almost inarticulate, managed to stutter, "1Dllis is perfe~tly outrageous!" With my pf,otege, who was boiling with indignation, I repaired once more to the smoking compartment. ''IDo you know what that.J apanese proposed to me?" he sputtered. "He wanted to have me ask you what those holes were along the railFoad. Does that scoundrel think a guest of the government would beway a secret? I wouldn't stand for such a thing. It reflected upon the honoF of a Frenchman." FOF a few moments it seemed probable that an international incident would follow, but with soothing words I managed to calm them down, wa finilly persuaded them to shake hands. This re~uife(il all my diplomacy. What L had intended as a mild joke ha~ got out of hand. Had I explained about the pits it would have been very embarrassing to all conGerned and I would have been the object of their joint wrath. The simple explanation was that the Filipinos did not like day labor and henee, when they needed filling material, the rai'lFoad engineers had found it much simpler to stake out places for 'the workers, and say, "When you've dug those out, you'll be paid for so many cubic yards," and the system had left borrow pits along the right of way. Many of the attacks leveled by the Filipinos against Baguio were not so much on its own account, but because of the unexpected and appalling cost of building the Benguet Road, which was to connect it witll the lowlands. Seventy thousand doNars was appropriated fOF its construction. It appeaFea that this was haFdly a start. The two hundred thousand :which ilVas confidently asserted would be ample also gave out. Half a million more had to be pFovided and still the road was not Gom¡ pleted. ':Dhere seemed to be a hoodoo upon it. The typhoons hit it, "13


WASHING UP THE ORIENT the maily temperature is usual1ly ninety degrees. Since that ef the body is 98.6, fewer heat units are needed than in the temperate zone. I never. knew any(me te get Phi1ipp>initis whe teek the proper amount of brolanced foed, er consumed his excess, heat units in regular exercise, and lived a reasonably hygienic life. Like many of the diseases of the Islands, it was self-induced. The rays ef the sun are not a danger in the Phi1lippines. But I never sueceeded in GOnvincing the conservative British that tennis may be p>iayed the yeal. around at Manila. They always abstained during the net season, and oensequently became so out of practice that the Amerieans whe fol~owed my example could usually excel them. It was, however, necessary to guard against heat. In the course of experimentation, the army developed a felt campaign hat with a ventiiated sweat band so that a current of air could pass over the head. This was much more agreeable te wear than the awkwardly shaped sela tepee. T he BFitish were herrified when I appeared in India equipped with one ef these innovations. What was good enough for the Britisher's grandfather was good enough fer him. My friends said, "If you persist in going eut with that on your head, we won't go with you. You'll get sunstroke ,alnd we'll have al'l tlie bether of bring,ing you back." Hewever, I eontinued te wear this nat te my own satisfactien and comfert. At one time it was believed all the heat troubles of the white man in the tropics could be ascribed to the ultra-violet ray and that this could be exduded by wearing orange-red underwear. The American Al~mÂĽ w.as interested but skeptical.. They decided to equip one thousand men wi~h the erange-red and use another w.hite clad thousand fer Qentreis. Five thousand suits were erdered which were intended to last a year_ From the beginning the exp>eriment met difficulties. Less than a quarter of the upderwear was furnished in the 36 and 38 sizes worn by the majerity of the soldiers. Therefore, the unfortunate subjects had te be Ghosen largely from among the smaller men. When it was discovered five suits a year were not sufficient, the number of vietims had te be eut in haiJf. T he exp~rimentees to a man became univt;rsally color conscious and pretested vielently against the indignity. They continued to protest

7S


WASHJNG UP THE OR]IllNT an0thtr requires the agency of a thin;! 0r entit<e1y different animal. If this anima1 is foumd 0n'ly in the tropics, the disease' will, of course, be €Onfined to the trop>iGs, a'nd may be accurately called a tr0pical disease. M0st of the m0Fe serious e;!iseases in the tropics can be avoided 1i>y tl\.e 01i>seFvanGe 0£ a few simple little rules. Any0ne who foll0WS these bith£ully will be practicaHy sure to remain well. Among these, the first and foremost is never to drink any water that has not been b0i.\'ea 0F otherwise sterilized. It may be pure, but the chances are against it. Am0ther, is never to eat raw, any low-growing garden truck, such as lettuce or cabbage, because they may, in spite of laws against it, be fertilized with human excreta. I am certain that at least a third of tihe pcwple who violate these two laws sooner or later have amoebic ayscmtery 0r S0mt 0ther form of intestinal parasite. 'iPhe Philippines were a huge laboratory in which my collaborators and I could work out an ideal program. Often in emergencies this would have to be !1lFop>ped, and months might elapse before we could i'etUFn to it, 1i>ut in the end, in my opinion, we had the most comp>lete set 0f sanitary laws and as good enforcement as any country ever had. In the course of these years we met the chief enemies of man in the tropics, and fought and conquered many of them by simple prophy,la,l@s. Th~ g0al of saving fifty thousand lives a year was so soon attained that I l1ealize(;i it sh0uld have been set at one hundred thouWhen I returned to New York the medical profession gave me a e;!inner. 1rhe chairman, Dr. Abraham Jacoby, made many pleasant remarKs, most of them dealing with my bravery in facing the pestilential diseases of the tropics, ane;! congratulating me on being safely back in New York. As he portrayed the p>erils I had faced, I could see on the C0untenances of those present evidence of sincere sympathy for 0ne who they believee;! had been exiled by official duty to a service _of afHiGti0n and danger in a foreign, God-forsaken land. I thanked Dr. Jacoby for his kindly words. ''But in reality," I said, "I C0me bad!: to the United States in fear and trembling. The ~liseases of the tFopics which s0uncl so terrifying here we know how to prevent. But even among you I see joints gnarled by rheumatism. I read every day of deaths from pneumonia, scarlet fever, and other diseases which p>FaGtidlJ.J.y never Gast their shadows over the happy homes of the

77


AN AMERICAN DOCTOR'S OD¥SSfl:Y iJi1hil~PFines. We Kmnv, ~ne pnlFh¥ta.xis £el' dwleF~ and <dysentery" the mecle ef wansmitting malama, the €auses of Flague and typhus, and the neasons fer beriberi. We run practical!ly ne dangelT ef contFaeting them. But there is ne pro,phylaxis against pneumenia er rheumafusm. lIDe net, trheFef0Fe, Gondeie witll. me. I aSSUFe \yeu r ~ensicler you, whe live amc;>ng dangers that yeu Knew net hew to eentFel, trhe real herees."


CMAPTER 7.

THE ELACK DEATH

"The houses were filled with dead bodies and the streets with funerals; neither age nor sex was exempt; slaves and plebeians were suddenly taken "ff amidst the lamentations of their wives and children, who, while they assisted the sick and mourned the dead, were seized with the disease and, pemshing, were burned on the same funeral pyre. To the knights and senators the disease was less mortal though these also suffered in the common €alamity."

liJCM is the account of the FlestilenGe which struck Imperial Rome antd w,hion, during the ensuing €enturies, was repeated again ami again. 1n the ·Secomi Century A. D., accovding to Herodian, the Empe~~r retired to Laurentium because it was considered the fragrance of the laurels acted as an antidote against the contagion. The Fleople in the city also, by the advice of physicians, filled their noses and ears with sweet ointments and perfumes. Nevertheless, nothing which they could do for themselves saved them from the deadly attack of the limbonic plague. In the Fourteenth Century the scourge appeared in the East, spread raJj>id1y to Asia Minor, thence to Northern Africa, and followed the tiiade routes into Europe. By the sFlring of 1348 it had entered Italy by way of Genoa, and soon had gripped the entire peninsula. Threel!IuaFteFs aD the FloFlulation of Siena c;lied; seven-tenths that of Pisa. l'etFaF€h, who saw with his own eyes the Black Death at work in Fierence, said, 'cw.e ge eut of cloors., waik through street after street, ana find them £ulJl. ef clead and dring, and when we get home again

S

79


AN AMER,KAN DOCTOR'S ODYSSEY we find nm live thing within the house, all having perished in the bFief intel'Val mE our absence." iFerhaJils best IDF aM €mntemFJmFaF¥ ciescriFJtiIDns mf rthe Black Death is that by iPletFaFch's friend Jil.mGcacoio, whioh fIDrms the intFoci!uctimn to his D ecameron. "There appeared certain tumors in the groin, or under the armpits, S0me as big as a small apple, otheFS as an egg; and afterwaFds purple 8p0ts in m0st paFts of the bod)'; in some cases large and but few in numbeF, in 0thers less and more numerous, b0th SOFts the usual messenge.s of death . . • . And the disease, by being communicated £Fom Ule sick to the well, seemed daily to get ahead, and to rage the more, as fire will do by lying on fresh combustibles. Nor was it given by conversing with only, or coming near the sick, but even by touching their clothes, or anything that they had before touched. . .. These accidents . . . occasioned various fears and devices amongst th0se people that sUFvived, all tending to the same uncharitable ani! cFuel end; which was to avoid the sid" and eveFy,t hing 1ihat had been near them; expecting by that means to save themselves. . . . What numbeFs of both sexes in the prime and vigor 0f youth, whom in the morning neither Galen, MippocFates, nor Aesculapius himself, but would have deolared in perfect health, after dining heartily with their £riends heFe, have supped with their departed friends in the o~her world!"

'Fhe Riacli: IDeatn tmmK tilie ChanMl in its stFide and wreabd SUdl havoc in England that the @€aa weFe heaped into rtrenches, Parliament was suspencled, lmed those who couM Hee the Grmwded cities did sm. 'Fhe SC0tS in deFision clubbed it I1he "f0ul death" of the English, be'£0re it leapecl their bOFcleFs and wiFJed mut 0ne-third ot tnem. '[)ming this mfle year between a quarteF and a naif mt the FJmFJwatimn mt iIlmmFJe died. ~n ewnomic an~ smGial l"eY0iutimn w,hich proved one of the great tuming points in the histmry mf tfue worM fmMIDwed in the wake mF the FJlague. The nature mf mankind under extFeme terror leads him tm excesses. T1he cmnvenient Jews weFe aG@ usedi of FJoisoning the ail" and the weUs. Smme inciiviGhlails cmnsicieFed that, since 11£e was so uncertain, ~hey weFe entitrlei!l tm efliIDY ail~ ti€ense. gthers beliiev<ed tnat theiF mn!l:y hmFJe [ay in FJ1acating an angry Gaff. '['he sect of the Flage:lQants revivecl. ln their despair tne pemple regarded aU effo~ts tID St0P the FJrmgress IDf the disease as sacrilege. '['he Duke IDf Reggim wisely ordered tilie iso80


'FHE BLACK DEATH ~atien o£ the stricken, but "acll weFe meFe grieved and terrified by this eai€t nhan my the fear of the p>estilcmce whioh, wheFII God perrBits [t, erumet ID~ a~Festee." During the next thFee huneree yeaFs the p>lague retwnetil p>eriedical1y. I,t reached its climax in England in r665 when, after carFying off seventy thousand in London alone, approximately sixteen peFcent of the population, it spread South and East. !Pepys faithfulily recorded its onset in his diary for June 7th. "~ did in Drury Lane see two OF three houses marked with a red cross upon 1ihe doors, and 'Lord have Mercy upon Us' writ there, which was a sad sight to me, Deing the first of the kind that, to my remembrance, I ever saw. It put me into an ill conception of myself and my smell, so that I was fOFced to buy some roll tobacco to smell and to chaw, which took away the appr.ehensionY

1i1he fel,l ewing year €arne the Great Fire of London, after which the p>lague clisap>peared fnom Englancl, and shoFtly from Europe. But it remainecl ~ndemic in the East. Toward the end of the Nineteenth Century there was a recrucleseence of plague. Hongkong, which had bel:ome the second largest port in the world, was the chief exporting point. The British, who wepe traders mst ancl foremost, hatil shut their eyes to the need for sanitary eentp@l; eense<ijuent1y in the early days, few precautions were emserved. iFrom Hongkong the plague girdled the Pacific and, on its way, swept into the Philippines. 'iFhe human mind for centuries had been so handicapped by its ignerance ef bacteriology that any hope of successful warfare against ~he plague was vain. But in the eighties some knowledge of microscep>ie Me began te me aequiFed by the soientific world. J1he spreacl of the plague fecused attention on Hongkong and there, in r 894, the baeiUus p>estis was isolated my Alexandre Yersin, the pupil of Pasteur, ancd Shibasaburo Kitasato, the pupil of Koch, working independently. This cliscovery marked the first great advance in the history of the cenquest ef the cdisease. 1iihe asse0iatien o£ rats with plague is so ebv.ious that it was noted [eng lile£ene it GeulGl be provecl. After the discovery of the bacillus it w.as a simp>le matter to identify the epi200tic among rats as identical with the epidemic among men, and the close relation of the two was

8r


AN AMERICAN DOC'FOR'S ODYSSEY shown to be almost invariable. 'Fhe pr0blem was how to link them together. 'i]i\her.e was a h¥Jil0thesis, €0neei;vea IDy P. iL. Simena eu SJDain, that plague was €enveyed by fleas. He nad no sup-potting proof fer his theory; he mer-ely imagined this was the way it hapJDened. Ris claim was tested by the First Indian .Flague Commission which, after investigation, ann0unced that no e0nneeti0n couM be f0und between the flea and the p:lague. In the C0urse 0t my W0!1K in Egypt, iii ha<d fOFmulatea certain theoFies ef my own about plague, ami wuM not t:eGoneile them to the fimiings 0f the Commissi0n. 'fhe subject had been extensively discussed at the Cairo MediGal Congress in 1902. On my way thence to the PhiliJDpines I met Captain W. Glen Liston ot the Indian MediGal Service, ana mame the tt:iJD to i1india in comJDany winh him. He also was a,issatisfled with bhe c0n€,lusi0ns of the Plague <Commission. As we swelte·Fed in the iRed Sea heat, we would lie on ae@!( unti~ late h0uFs, and as we erossed the Indian Ocean pace up and down, discussing the pros and GOns of JDlague thclOries. When we reached ]ndia, Ikiston enthusiastical[y t00k me to inspeet the flood 0f plague cases wming int0 the hospita1ls. One ef the m0st interesting de;velopments in i1inGiilO at fihe time was the JDlague vacrIDine devel0ped by ~FOfessoF W. M. Halrkiine at B0mbay. The Feligious tenet of the Hindus that the e0W was saGFed had interfered with his use of the beef furoth, essentirul for culturing plague bacilli. He had surmountea this GiiffiGulty and haed produce<d a vaGGine which areused the immunity forces of the indiviedua~ into wh0m it was injeetecl, ~h0ugh the immunity e0nveyeed was relati'Vely shol.1t. [It was proving partioulady useful ,f0r th0se €0mJDdieed to work in plague stFidl:en areas. But while [ was there, Professer Haffkine was in nhe midst of a gFeat battle fer his Feputation. Fart ef his pr0Gess haed been te treat his cultuFe w,ith carbolie acia, which kiHed the baciNi but left the annitexin. ]n tne effeFt to fiU a quantity demand kom the Bunjafu, the a€iGi was emitted. By an unf0vtunate aceident teta,nus germs weFe somehow incLuded in a JDarticular botcle and lOU in0cul'ated fFem it died. However, after pr0longed investigation by a sJDeeial Commis-

Sa.


THE BLACK DEATH sion, ~he Haffkine Laboratory was exonerated of aU blame and he was r.eempleyeed by ~he indian government. Before ilListc;)fi aned I separateed, we agFeed to centinue plague reo search, he in Bembay, aned I in Manila. I established a laboratory at Mariveles where one of my assistants, Dr. H. S. Stansfield, began reo search on the flea transmission theory. Every year came new evidence that fleas and rats were closely conneeteed wifh tne plague in human beings. Liston was sucprised to find an eutoFeak ef plague ameng guinea pigs at Bembay, aned an examination showecil fhey were infested with rat fleas. Guinea pigs do not usuilly harbor fleas, but dead rats were found in the vicinity. By keeping up a constant agitation Liston finally secured the appointment of a second ]ndian Plague Commission of which he became a member. ~n 19ÂŽ7 the Commission was able to announce that fleas definitely i\Vene tihe cenveyers ef plague, and preved its case to an increedulous weded with a simple eocperiment. Cages containing rats were hung at cdifferent heights with plague fleas hopping about below. The rats which dangleed enticingly above the fleas' four inch high jump record did net catch plague; the unfortunate ones which hung lower sickeneed aned died. In ill my study ef the Fat I never was able to solve the enigma of his me's ending. ]t woU'!d seem he transported himself bodily to his heavenly granary. The statistic:s are incontrovertible. It is conservatively estimated that in every city of the world there is one rat for each two persons. I once made :Ii determined effort to locate the tomb or the Fat in Manila, which, at the time, had a population of three hunedred theusaned. Estimating the average life of a rat even at five yeaFs, bneFe should have been a mortality from natural causes of twenty-five hunedred rats a month. The rat catcher gangs of over three hundred men seldom found a edead rat that had not died of poison placed for it, or from some other -reaedily explainable cause. My curiosity was aroused; I stationed inspeetors at the puolic cremateries in which was incinerated the daily Gel1eetion of aU ganbage, refuse, aned stFeet sweepings. They personally examined the eentents of eaeh container. Only one dead rat was ediscovered in the course of a month.

83


AN AMEIUCAl'J DOCTOR'S ODYSSEY

1f <ileaa rats had been fDuna by hDusehDldIers they wDuld autematically have been placecl in the re£use cans DF left lying Dn the streets. They wDuld nDt have b~en burned, because St0Ves wep~ unk:n0wn, and the smwll pFimit;ive fires Df bamIDDD sticks w0uld n0t hav~ IDeen likely to. have cDnsumed the caFC!aSSes entiFely. 1t was p0ssible, 0f ~0UFse, tFiat a eeFtain pereentage 0f the rats ham aiea in inaC€essible places. But 0wing·to. the rapia de€o.mp0siti0n in a troo.pical dimate, the 0a0Ps whidi! w.o.uM hav~ aF>isen w01i!la S00n have attraaw;l atitentio.N; c0mpar.ativdr. few nuisances 0f this lcina w(j)r~ Fep'<iJl;t~d . ~he rats wer~ bar-rea by fin~ g..atings fro.m a€cess to. th~ s~w(j)rs. 'fl\.e generalUy swampy nature 0f th~ gr0und prevented burr0wrng, ana the few SPo.ts where ho.les c0ula no.t be flo.Da~a, w~ had seal~d with CDnerete. lit was suggested that tt;h~ aead rats were eaten by their bret1:wcm, but €aFcasses 0r even skd~t0ns Dt partly eaten Fats were n0t encDunter~d. The Fiaale 0f the Fat's last resting plaee still awaits its Oeaip'us. With the links 0f plague transmissi0n jo.ifl€d, research mad~ rap,i~ p'F0gress. Any rat may haFID0r th~ p'lague flea, fuut the Ghie£ aaNgel' ~0mes £ro0ID tlile 10ng-tai[~<d, ThiaGk;ish mus rattus, w1il0, an unbimm~n gu~st, makes man's h0me anm f0DclI his o.Wl'l. !Ii1he reeaish-gr.ay sh0rttailecl mus nDrw.egiws is a fiereer fighter and seeks his shelter away fr0m man. The plague-stricken rat, liK~ tli~ human, has fever ana s~pti€~mia. H~ mo.ves very slDwly. H~ sho.WS no. f~ar Df human beings, IDut lc;)()KS up at them witho.ut shying 0r running away. He may so.metimes F~ C0veF, and, after lo.ng years 0f elCPQsur~ to. plague, may even a~Vd0p a eertain immunity. In india this is gl'~atest in places which in tli~ past haVe;! sufferecd m0st severeiy. Art: iB0mbay, f0r ~xampie, l0cru rats Ganno.t IDe ased f0r e*jlerimenta60n, but must be 0IDtainea fF0m MadFaS, where ~he aisease has neveF strueK. Oat o.f the mu~tit;udin0us v.a.ri~ties 0f fleas the p'~il'l0\p'a~ ehllp'rit was p'FQVea to fue the P~ex che0p'is. ]Later Research sh0w~c!l that 0n Far~ 0€easio.ns 0tners, sueh as th~ astia, nlight e0nv~y plagu~. But unless the rat aets as ho.st to m0re than f0ur fleas, there is 1itt:.1~ c!lang~r. 84


THE BLACK DEATH :Fhe flea has a hoHow tulle, cal1ed the epipharynx. With this it pierces ~he skin, and then with its jaws enlarges and lacerates the hole. It pump!s saliva down its epipharynx into the wound, which mpidly becomes congested. The blood that collects is sucked up thFeugh the ho/Pepharynx, er prolongation of the lip. The oesephagus of many types ef flea has a valve which retains 1ihe bioed once it is swal!1ewed, but in the cheopis and astia the appaFatus is lacking, and an IweFdose fFequently causes Fegurgitation. If the flea is infected, lihe fluid will contain p!lague bacilli. As many as /l.;ve theusand may be ledged in the body of one flea. When the rat siokens and dies his boarders leave him and hide in a Grack or a pinch of dust. They may survive for two months, growing ever mere hungry, and, if ne rat appears, rather than starve, they will content themselves with a meal from a human or any other animal. The laboFing class in tropiGal countries customarily goes barefeoted and baFelegged to the knee. This gives the flea the advantage. When man is bitten, he scratches, inflames the wound, and makes a way for the plague bacilli to enter more easily. These multiply with awpaNing rapidity. Although the incubation period may last as long as seven mays, plague novmally app!ears within forty-eight hours. The <t!e:x;in a;ffeets first the lymphatic system. One of the functions of the lymp!h grands is te r.epeI invading poisons, but because they are unable te eep!e with the plague baciLli, the buboes, or glandular swellings, lihe sight of which had areused such terror in the ancients, are fermeci!, usually in the groin, more r.arely in the armpit. After this system of defense has broken down, the whole body is invaded. Delirium shortly sets in, vital organs are poisoned, and the patient ordinarily rues between the third and fifth day. In the septicemic type of plague, so much and so powerful a toxin is liberated that lihe body defenses are overwhelmed before nature's normal protections can become effective. These are brushed aside, and 'lil\.eFefere ne bube app!eaFs. In most ep!idemics the mortality is over ninety p!eFâ&#x201A;Źent, and no tFeatment has been feund of much avavl. @nly in p!neumenic plague is the disease transmitted directly from man to man. The bacil!l.i reach the lungs, and the fine spray ÂŁrom the eoughing is chargem with the deadly microbes so that those whe 8S


AN AMERICAN DOCTOR'S ODYSSEY Dreathe fhem are infected. The serum exucdate in the lungs is so great tnat the v;ictim is Iiterally cdrowned. iOeath comes with shocking sucdaenness. N0ne s1ll1v,i:ves. The Pni[iJ!1lilines were aiways threatene<il with plague. Once when the steamer Za-firo arrived in ManiJa from Hongkong the routine mecdical inspection was made, ancd no illness cdetected. But twentyfour hours later a Chinese member of the crew who had apparently been in excellent health the night De'fore was f0uncd dea<il in his bunk of pneamcmic wiague. 'iFwo cdars later ~ne Loonsang arrivecd in nhe harb0r, a[so £t0m Hongkong, with a deacd Chinese 0n board. While hawing spiriteMy on a rope, he had t0ppled over in an apparent faint, and hacd <ilie<il in the course 0f a few hours. Me also had had pneumonic plague. Chinese nepoFts claim that ptal'migans and manR0ts, as well as rats., are subljeet to plague in septi@mi€ form. But when fiheir fleas blite man, he c0ntrac~s pnClamoni~ piague. E:very year Chinese laThorers migrate to Manchuria in vast numblers. T1heFe they live hudcdled in mirty sheds. If 0nly 0ne lablorer is infected with the pneumonic type, he may, by coughing, tt:ansmit the disease to a crowcdecd trainload returning at the enid of the harvest, and, as the coolies seaHer to their h0mCls, plague wiJ.ll! sp"Clad ~ike wild'fl.re, s0mel'imes wiping 0ut whole cdiswiGts. 1'ine €001~es St0,p> o:vernight, sleeping in €110Wcdecd little sha,nties a10Ng the way, where they become infectecd, ancd tt:a:vel on the ne)l;t cday, starting new f0Gi of infection all along the route. Whenever they are segregated, or even made to wear gauze masks, the disease cdeelines rapiclly. The plague had made its apwearance in Mani~a: in DecembleF, ~8~'9. 10he measures adoptecd against it nhen were veFf strict ana in f,a!lJJ a€G0ra wita tae status of current mecdic~ knowlecdge. ~he sick weFe sent to the nospital, and the cdeacd taken in charge bly the fumy iEloard of Health. 'The houses ancd their contents were c0mpletely reflfDvatecd and disinfectecd. Partitions ancd cublieles were t0Fn mown, court yarcds 0penecd up, ancd oblstFuctions to surulight removecd. CiFwlar letters were issued, gi'l.'ing the sai,ient points of p>lague diagn0sis, ~hCl0Fies of transmission, and ~ne course to be ~uFsuem when a suspectecd or genuine case hae 0ccurIteci in a ~ocadity. All vessels aFl'iiVing cduring the t;;pidemic were disinfected. Although it was not Known at that time that 86


THE BLACK DEATH the mt flea was the communicating agent for the plague, many of the meaSUFes taken hald resulted in the destruction 0ÂŁ the rats which Ca:Fflea the fleas. !Later, anti-rat measures were invoked and the Board of Health had spent $350,000 in the effort to wipe out all the rats of the city. !But rats are difficult to exterminate because they breed so rapidly. l'hl'ee to five times a year, after a gestation period of only twenty0ne days, the female brings forth from six to sixteen young, and these in tUl'n pl'oduee offspring when they are less than three months old. llhus a single pair in one year might be responsible for hundreds of descenldants. At the end of five years when I took charge the rat popu1ation of Manila was apparently as plentiful as ever, and plague was still present. At one time a bounty of five centavos was paid for each rodent ~h0se tail was 0ffer.ed in evildence of Ideath. But diffieulties soon arose. Cer.tain enterprising inhabitants of Manila began breeding rats. The 0utlay was negligible and the profits high; a tail was a tail, whether from a baby or a grandfather. The bounty system had to be stopped. Experimentation showed that spring traps were seven times as efficacious as the cage type. We also spent much time and thought on the subjeet of pois0ns. Our greatest suecess came from mixing cheap ana tasteless ~hite ar.senic with rice, which was the natural diet of rats in the Philippines. Every riee grain was impregnated with enough poison to kill 0ne rat. But the rat was appaFently able, in some myster.ious fashi0n, to warn his brethren of danger. After only a short time the rats would refuse the poisoned tidbits, although their savor was unaffected by any detectible taint. We had to provide meals varied with suoh f00ldstuffs as fish and t0mat0es. 'Fo catch the mts was easy en0ugh, 'but other factors complicated the campaign. It was always possible that a child might unsuspectingly swaNowa porti0n of the poisoned bait. For the greater good we had to take this risk, iJut we useld to provide for the contingency. When an epidemic broke Qut and intensive methods had to be used, antidote stations were i0â&#x201A;Źateld every few blocks S0 that, in case 0f a casualty, sesll(ui0Jcilde 0f ir0n e0uM be aldministered immediately. As we had feareld, a few ehiMren did succumb to the temptation of the rice, but due to our precautions no fatalities resulted. 87


THE BLACK IlEA'FM heurs, anGi then expese everything te f,resh air.. But some d~unken sailor weuld aisregard instruotions, find his bunk, and turn in; enough gas weuld still remain in the mattress to kill him. To avoid such casuaJties, ships aFe now completely ventilated with air jets before anÂĽene is a[[ewea en beara. Our primary concern in the Philippines was to keep rats from landing. Under exceptional circumstances rats will swim. I have seen them scuttle aown the anchor chain of ene ship and paddle fUFieusly, ever te that ef another. Vessels w.eFe made te Femain at least six feet from the pier, speGiaJ. iron ratguards were placed on all ~ines leading to shore, and the gangplanks lifted at night. As a final pFecaution, we built in Manila the first ratproof wharves. 'if1hey weFe eÂŁ GenGr:ete throughout so that no rat could gnaw his way thFough, ana so flashed with steel sheathing underneath that the rat ceuld not find a foothold. Clever as he is, he has never yet contrived a methea of walking upside down on smooth metal: Rats are noted travelers though their names never appear on the passenger list. For centuries their presence on ships was taken for granted. No one even inquired into the reasons therefor. When it finally became apparent that these rats were a menace to every port where dHwpis fleas elllistea, all efforts were directed at clearing them eut ef ships "ana preventing etheFs from entering. Over thirty counwies joined in an internationa[ agreement to this end. As I learned in my Philippines experience, the most effective way te aeal with any pest is to intedere with its natural breeding places. A rat has te have a protected heme and an adequate food supply. If he is not afforded harborage near man, his fleas are less likely to reach man. Thus the danger from plague can best be reduced by \;lUilding him eut. 'Fhe rat is expensive te get ria en, but even more expensive to maintain. The rats of New York cost the resiaents more than ten million - dellars annually for meals. Crop destruction is also enormous, so that beth urban and rural dwellers suffer loss. The world rat bill 3lffieunts te staggel1ing sums. At ~east a cent a day must be expended to feed a Fat' en shore, and twice that on ships where the garbage is dumpea everboard and where he must live on clean feod. On

89


AN AME'IHCAN ID80FGJR'S @iD¥SSE¥ shipbeard also, tnere is the atdtditional expense of fumigating uwiGe a year. Almest fitly thousancl clelilaFs used to be spent on the McuwetrJ11,ia to keep her £F~e of rats fer tweliVe months. [n 1924 the United Stat~ Publi€ Health Service plac~d a t~h­ ni€al. assistant on the Leviathan, ancl cluring a y~ar's stucly et the rat pFeblem he fe\!lncl fi,nty-tihre~ sbruoturam GtefectS ;which were respensible for rat harborag~. The ship was bh~n ratproefed; tnereaJit~r ne rats hauntea the store rooms or lurl{ec;! areuna th~ pipes. The British, ~1l~ Germans, ant!! th~ IDuteh ~eme;woo the Am~l'iean Jea<d. Onlly thfl [French, reluotant to spent!! meney en new schflmes, hdd out. But even they were convineed when the Lafayette hac;! to b~ £umigatecl afteJ; h~r maic;!en :v:oyage b~eaus~ ef 1l1l~ mano/ rats ;whi€n haed bearc;!~t!! her while she was on the ways. The N ormandie was Fatp.roofec;!. BuiJding the Fat eut ef Mani~a was a tar mere diffiel:l!lt uncl~F­ taking, requiring th~ Feconstruction ef the eity, and eovieusly was a matt~r of y~ars. W~ began by having a munic;iJDal orilinance passed that all new houses er maj or FeW airs ha<d te be Gonstru€t~td acconiling te plans which would make it impossible for rats to find shelter. Ne hollow walls, partitions, fleors, er structural JDarts were allowed. The neundation hacll to be of ceneF~te, oFiek, sten~, eF meFtaF, extenaing three feet abeve the gFouncil and several below it. The house JDlan of the wiled mountain tribe of the lJiugaos serv~cil in wart as medels feF eivili!Zea Manila. 'the ~fugaes IUs~ nh~ir nemes as granaries, and an ecoRomic rather than a sanitary motive mam pret!!uced an efficient methocl of protection. Th~iF thatchecl houses stooa on JDQsts, each of which was fashionea with a Sfle1!1Jaer ~aFge eneugh to pF~vent the .rat fr.om creeJDing areund it. It €ost only a smaH sum to proteot the nipa huts of Mani~a similarly by plaGing flashing along the sit!!es ef th~ building. iRats are 'Very tena ef mUFrowing fite tine Relilew eJilds ef l'iambee pel~s, out ef which the floors of nipa huts are almost universall.y maae. They did Jilet gnaw thl10ugh the sme0th, hard, Fesistant SUFfaee, but €eull'td anm dim enter th~ epen enms, biting ufteiF w:j,y thrQugh the joints until they found saf~ shelter. Suefl floQrs we ratproofetd by Gementing the ends e£ the bamboe poles. If th~ Fat haJDpenet!! te be 91il


THE BLACK DEATH insitde at tne time, it waS so much the worse for him. The bamboo fences weFe weatea in the same way. Mest ef bhe eIDjectiens te ratproofing in Mani1a ~ame from the elhinese, wh@ controUed the mercantile trade ami ownea most of the rat-infestecl bodegas. The adobe walls of these warehouses were often severai feet thick and containea rat burrows. Under the board floors tl\.e earbl\. was heneycombed with runs. However, oppesition began te [essen as soon as the €aretakers of premises began to .eport unwented tteeclem from rats and it became appaFent that absence of rats not OMY meant immunity from plague but was als0 of great e€@nomic value. Our problems in the Philippines were simple compared with the situation in lnclia, where over a million persons were dying annually 0f plague. 'I'he Hindus would take no life. No rat could be killed in iJ)ndia; any live thing might GOntain the s0ul of an ancestor. Consequent[y, bhey stubborn~y opposed the killing of rats. One method of clriving eut rats and at the same time compromising with religious sentiment was to lift off the roefs of the houses and let the sun in, S0 that the rats, who abhor light and crave privacy, would retire to S0me clarker reEuge. In other cases, a self-curing method was used. Wl\.en plague apl"eared in a native village, the inhabitants were all meved out into the fields under temp0rary canvas shelters. At the ene of six months the rats had moved @ut, and the townspeople moved in again. Ratproofing was a preventive measure. An epidemic called for instant and concertecl action. Plague slipped by the defenses in Manila, in 1905, ancl again in 1912. On the latter occasion we were prel"arecl. One morlling reports Game in that plague had broken out in several widely separated districts of the city. But the flying squads 0f tat catchers, clad in flea-proof €lothing, and with powdered naph_thalene or kerosene @n neck, wrists, and ankles, at once started as th0ugh to a fin:. Any bloGk in which the clisease occurred was regarded as infected. Radiating lines, usual1ly five in number, were prolonged l'ike the spokes of a wheel to the outskirts of the city. Plague rats were seld0m f0und more than a few blocks away, but rats all along the lilles

91


AN AMERICAN DOCTOR'$ ODYSSEY :wer,e mmght an~ e;:xaJminea. 'Fhe £wthel'm0st points at which infeote;:cl ani mails were clete;:01ied wel'e then aonnectea with lines FunniNg fr0m spoke to spoke, ancl the;: space enol0sed was regarded as ~he area of infection. Instead 0f thmwing a f0Fce;: of rat catohers int0 the h0use where tae case ot piagl!le hacl 0~GUFrea, Wlhiea wOUJla have scabtere;:a the scum:ying menace in all]! ruFections, the e;:ntire f01:ee;: 0i a hunclred ana fifty men was wncentrate€l along the border af the infeete;:a section. As the rat catehers closed in, the !;,leeks were ~hF0:1'1\n 0ut 0£ oommission. iEvery house was· g0ne thr0ugh in systematic fasai0n, starting at the t0P and m0ving a0wn. iEvery box, barrel, or Feceptade which might harbor a rat was 0pe;:nea. All dirt, filth, ana straw in the yar,~ was m0V@Q ana burne;:a. WoodpiJes, which W@Fe favarite;: harb®l1ing piaces t0r Fats, were iThvarialJiy taken e®wn and re-pi'l ed well ab0ve the gr0una and away from any wahl, so that cl0gS ana cats might keep the r0dents out of them in the future;:. Rat nests, when found, were sprayee with insectiGide. Whe;:n !;j,ve rats we;:re encountered, these were ki!l1ea at 0nee. Some of the rat catching gang had fox terriers, imported especia,llly £rom Austnvlia f0r their lightning-like swittness. Others haa traineed fel1rets which w0u!§l c®me to theiF masters' caN like dogs, and were e;:ven m0Fe effecti¥e. 1Fhe rat st00€1 n0 sh0w. ¥ ou caulcd hear the Grad~ as the ferret's sha,rp teeth severed the spinal c01umn. We never shook the Fat as the terriers did, and ntlver attempted to eat him. He was a killer, pure aned simp'le. 1f1he ~i!l!i pinos a,~S0 gFew unbelieva1i>iy slbilileed in cateRing Fats wi1ih their ha,nds. As the animal w0i1'ld start to l1un from its hiding place, , a ma,n would grab it, ancl, before it c0uled bite, :wouled stun it against the WaiN and finish it 0ff with a, club. oAI:w.a ys as the . a,t eatchers ®l0sed in, the ratpr.0®ters di®'l~owed in their tracks, making it eertain 6hat !the area wouM nat be reinfeGteed. One secti(;lI1 after anothel' was treated in this way. Once weekly thereafter, Fats were caught in previously infested sections, anC'i at ®t;her. F'laces whieh weFe Ib1il0vlm to be;: insanita,FY. By the practicaJl applicati0n ot ~his system plague was twice wiF'eed 0ut of Manila, tae anly large eity until FeGent years where an imported infection has been thus Gompletely eradicatecl.

92


'fME BLACK lilEAI'FH ]n the Phiiippines, as elsewhefe in the lEast, Europeans and Ameriâ&#x201A;Źans whe livec!l in more cleanly surroundings were rarely attacked by wlag;ue. But ~heFe was ene eutstanding exception. One day Wihliam Crezier, eclitor of the Manila Daily Bulletin, was taken violently ill, and forty-eight hours later died at the San Lazaro Hospital. While the sanitary s!ijuacl was carrying out the insecticiclall and other anti-Jillague measures in his office, an inspecter pulled the upper dfawer of his desk out to the end. Live fleas were seen hopping avound, and in the very back lay the body of a mummified rat. A hole in the rear ef the c!lrawer showed the manner of its entrance. After the rat had died its fleas had deserted it. Crozier, who was presurnaIDIy working in his shirt sleeves because of the heat, must have reaohed into the clrawer and been bitten by one of these fleas. We found a wound on his arm later. Plague bacilli were recovered from the fleas and the rat in the clFawer. il"lague Femainecl ef vitali il1tefest to me long after I had left the Philippines. The Rockefeller Foundation, generously recognizing this, was always glad to make my services available to any govCl'nment whiGh requested aid in dealling with the disease. One of my visits to Ceylon happened to coincide with a bad outbreak at Kandy. People in CCl>ylen were generally accustomed to ha"ing natives clie horr,ibly ef plagUe, but when members of the nice clean English club also began to die horribly, consternation reigned. Some had already died, many more would die, and the instant the news became public, the teurists, en whom the material pFesperity of Kandy largely depencled, would seek a safer playground. Immediately upon my arriva.l at Colombo, I was called in as a GOnsU'ltant. I repaired to Kancly and went over the grouncl with the plagl!le expert of the Mealth Department. We spent hours poking about in native houses and difty narrow alleys. I could point to nothing which had net been dene. Semetimes, hewever, the obvious - is everloeked. A large English store en the main street backed upon the plague area. At the end of a long day, I asked, "Have you investigated that?" "No," my wMeague explainecl. "That is a European store which is kept perfectly clean. If there had been any sick rats around, they weulcl have been noticecl."

93


A.N AMERlCAN ];lOCTOR'S OIDYSSEY "I'd Eke: tEl gEl over it just the: same," [ sai(!i. ACC<im;ling1y, he intreaucea me to bhe manage:F. ] examinea tiie: first :lined se€Ell'l& steFies without tfinail'lg any susp>i€ieus imdi€atiens. When [ asked., "What else de you sell])l" "We nave a feecd edepartment in the basement," he answeFea. Ne furthe:r information was ne:e:clea. As soen as he had taken me aownsta.iFs, I singleed out the: pilc:s ef balecl hay ancl straw. «We eught to take those clown," I suggested. i,nsi&e were: eeael! and aying rats by the aElzen. Semetraveler Fat er flea, plagwe.striGken, had entez;e:@j with aJ gFain shipment ane infectecd tj1e leml I'edents. 'Fhe English dub hacl mee:n we'ill witfiin the radius of the infe:€tion. Stamping eut the focus steppea the piague in iKandy. I reallly enjeyed the aete:eti;ve work often inveived in €emFletirtg the deaed1y tFi:lingle ef the rat, the flea, rt;he man. iLt was extFaerainary bu~ tFue that in€li'eclLU1ity as to tihe r.elatiensliliF,l stiilll F,lersisteGl. Only aJ few years :,.ge, Sir Heli'belit S:limuel, goveyneF of the Pale:stine: Mandate, sent werd te me that plague had blieKen out and that he: desired aavice. On my arrival, he presented his partiGular preblem. "QUii' headth se:rvice says it wil!l take a half mil!lien dellars te get the: piague unaer €<!lnliFel. T:hat's an e:neFmeus sum reF :li smal~ gevemment te spen<!l. iBefoFe emIDa,ro~ng <!lIT th,is F,lf0gram, we'i!f ~ike an ootsiae: eFinien, :li!though, ef ~OUFse, we'M spene the mone:y if it's ne€essa,ry." "l'lJ talk it over with your Herul:th OHicer," I saia. 11his eHiGial shewed ne rese:ntment at what mig:ht have been Fe:g:liredeG! as inteFference w,i th his euties en my pafftj insteaa, he gan me aJ he:aFty wd€Gme. :Hewe"l'e:n, he: saia he d·i e net agre:e with my Ful:ilishea FeFElDt that €lead Fats we:Fe alw:liYs asse€iate:a with plague. No rats haed been founa auping nhe: pFc:sent outbFeak, and) theFefGlie, he was fOF€e:d te £Onclude that my de:cduGtions must be wrong. ''Where is the p>lague ce:nteF!" ill aske:a. "Jaffa." "Ceu[@ we: ge ~litelie?" "Geli't:Mnio/," he: ag.eecil. A.ccordingly, he eonaucted my young North €:aFelinian assistant, Dr. W. F. Ja€e€ks, ana myself te ene: house in Jaffa where: seve:nte:en

94


'iFHE BLA:CK DEA'FH people haed just died of plague, but whet:e nobady had seen a dead rat. "Where did the first person die?" I asked. I was shown a bed against a wall in a downstairs room. "I'ed like to have a hammer," I said. f b€gan to tap the wal'ls, listening carefully to the sound. As I was working my way towards the large cr-ack which I had noted above tn€ beed, the Health Officer interrupted me. "Y:ou't:e evidently not familiar with house construGtion methods her-e. 'iFneFe are no hol!low wails." " iJ!'m pr,obab1y a damn fool," ] replied, "but, if you don't mind, iE'cllik€ to satisfy my own curiosity." Me made no further objection, and I continued tapping until I reached the crack, where the wall gave forth an unmistakably hollow sound. '''Will you have a man dig into the wall just here?" I asked. In a few moments the workmen had uncovered an open shaft, and in the shaft was a small shelf on which lay a dead rat. "The flea came ~hFoug,h the crack," I explained. . "You seem to be right," the Health Officer admitted, "but how wauled you account for this one?" and he led me upstairs to a bed S€t squarely in the midtille of a Foom. ]j glanceld' at the cei[ing and located another crack. "If you'll sened a man to the attic, you'H find a dead Fat just about there," I said, pointing to a particub1.r spot above the bed. 'fhe corpus delicti was there. [ glanced at Dr. Jacocks, but instead of the expression of satisfaction I expecteed, I saw that his face was as white as his linen suit. !L was startled. ''What's the matter with you ? Are you ill?" "Look at me!" he shouted. "What is the matter?" "Look!" To my utter horror he was literally covered with fleas. They were crawling aU over him, black spots against his white clothes. Everybody Fushed to pluck them off, aned we soon had them in bottles which were hurrieed to the hospita.llaboratory. After an hour of great anxiety, we received word that they had been identified as merely aog fleas.

9S


AN AMERICAN DOCTOR'S ODYSSEY When we had FeGOvered £Fam @ur fFight, we returnem to the search for the focus of plague infeetion. Twa dead rats did not explain the origin of the epiGiemie. The house we had just examined was one removeGi fwm the COllner, arounGi which was a blaeksmith shoJi'. We repaired thither. r engaged the owner in comrersation and Gasuahly inquired, "Do you ever see any Fats aFouna heFe?''' "Oh, yes," he repiieed. ":JLo.t 's of 'em. iElut thq're the funniest Fats J] ev;er saw. 1I'1hey eome out @li tha.t hole ove. t,heFe and ~l!Ist staned. Whey edon't seem t@ lJe a£r.a.ia @1' Fun a.wa.y, a.ned aM we n:jlve to do is hit 'em with a hammer anGi thp@w 'em in the fire." "That's Viery interesting," e@mmenteGi. "Where does that d@or lead?" . "Int@ a vacant Jot." I promptly f@llowed it through aned behinGi the high waH fmelosure 'found from three to four feet @f d6bris remaining fFem the wreckage @f a. h@use. [ prowred s@me bab laborers at onee. llJ ndeFneath the rubbish they Game up@n a wooeden flooF, ripped it up, aned unc@vered h undreas of dead Fats. Bl!lt my waPK was net yet Glone; ~hese mute boGlies @flieFed na eocplanatien ef tne tnagecilo/ Wini€fl fuaa ' eveFtaken ~hem . ~ s€autea f.u~theF, aneJ €a.me upeIIJ a gFain steFe a€FeSS the street. Sueh an estalHishment is aJways suspect, beGal!lse the mus rattus is an elPiouFe, a.nd ~oves fuest the fooed which humans eat. I learned that this store had been importing ri€e from Rangoon, one ef the plague Genters of the werla. Sin€e vessels there wer.e loaaed trom lighters ceming direct from the heavily rat-infested gedewns, 0r warehouses, it was safe to assume that plague rats, or fleas, haa IDeen unwittingly imported, and had b1'@ught the infection to Ja,ffa. The final step was to have speeimen rats collected £ram towns ana villages in iI'alestine. 'Fhe 0rdeFs were sent out for this to IDe done. ~ was suademLy awakenea tW0 nig,hts laterIDY the ja.ngJing ef the te1epl\ene IDelt "D~. ]aG0Gl{s is "ery iJ[," I was teled. While rn was lwrriecilll:Y pl!llnling 0n my <!letaes" ~ I{ept thinking, "The-ne must I\a.v.e been seme eheoJi'is fleas that weFe misseed." 'Ln the fuill rea[izati@n that it was iii whe hacil IDeen nesp0nsiIDle f0r taKing him te the

r

96


THE BLACK DEATH p>lague n0use, ~ spent s0me h~r.asseld moments oetore a~~i'ling at his bedsilde. To my intense relief, the dread triangle was inc0mplete, and he was in no mortal ldanger. His iUness was malaria with chills and Dever ~0n~r.acteld in his 0wn S0utnla¡nd. Mean;white the fleas of Palestine were coming to the laboratory. Out of them all only the rats of Jaffa and Haifa proved to be infested with the cheopis variety, and the plague was cleared out of jpMestine D0r a Dew thousand ldol!ars . .A far greater amount has been expended in the effort to eradicate the p>lague menace in this country, gradually spreading eastward from Calif0rnia, where it had landed in I900. It is reasonable to believe that, if pr0p>er measures had been taken, the disease could ha,ve been wipeld 0ut at that time. The Federal government, which had been steadily assuming more and more responsibility for the entrance of dangerous communicable diseases into this country, sent Dr. J. J. Kinyoun there to take charge. But the people of Cali!Fomia so bitterly resented the suggesti0n that bubonic plague might be present in their midst that he was publicly assaulted and even sPlat upon in the theatre. At first the disease was confined to Chinatown, where Dr. Kinyoun asselilteld plague-infe~ted pers0ns were ac~uaUy found. When the Calif0rnia authorities deriield this, a plague commission was appointed to go to California, headed by Dr. Simon Flexner, then Professor of Pathology at the Uni'lersity of Pennsylvania. The Commission found unmistakaole e'lidence 0f the baGil!lus pestis among the Chinese, but California was still unconvinwi, and the press was almost unanimous in denying it. Then the Federal government. delivered an ultimatum to Calif0mia: "You ~Fe a s0veFeign state. You may do as you p>lease within your borders, but if you do not take steps to control this vital danger, _ we will establish a quarantine entirely around you, and every person and every piece of goods crossing your state line will have to go tnFough this quarantine." Only under this duress did California finally surrender. But the capitulation came too late. The rats had infected the

97


AN AMERICAN J00 crOR'S OiD¥SSEY gFoun€f s<!lui~Fers . i~ s,p>ite 0f tne eJqllendituFe 0f mi1!l:i0ns of cd0tlars, these infeoted gr0um.a s<!luiFrels have not I!;c:len eraaic:atea. They do no~ live neaF human habitati0ns as ao rats. Canbon biswp>hide, p>oisoned fruit and grain, a,aa sharpsh00teFs ha'Ve n0t sufficed for theiF extinetion. AI1ways S0me get awa,y. to infect o~heFs. i1in tne fu;lJli of 19f9 f0urteen cases of p>neumonic plague 0eOUFFc:lcil in Oaldand., a,na ill but one of these died. [n the epidemic at Los Angeles of October, 1924, thirty ciliea out 0f thirty-two cases. Even now there is an 0€€asi0nal ease of Jlliague in CaLi,fol'nia. 'F:ne gFouna s<!luirrd infeGtion has extenae~ ove!' ~he Coast Range, whi€h bJarFea the way for a i0ng time, ana has Fecently Grossed the Roclcies. in 1935, plague-infected s<quil',!'els were founa in Neb!'aska. FlagIJe wm JllrolDaDly neveF flouFish in this counw,y, but its Jll!'evention may meeome exaeeaingly cost;l:y. "i]'lhe great haozaFa lies in the p>ossibJi!lity of the squirrel, whi€h avoicils the pFesen€e 0t man, transmitting his fleas to the rat, which li'Ves with man. 11his danger might have bJeen a,voiaea had the peoJllie 0J! Califol1<llia been Feasonable in 1'90®. iL't is n0W oegiam.im.g to ap>p>ear that if piague has been enaemic lio!' thirty yeal's in a C0mml:lnity, it tends to vanish by irsdf. I noted this first in Basra, analatel' in Cant<2lll, Hongkong, and BomlDay. In Cant0n the disapJlleaFance was certa,inlli'y n0t due to direct JllFop>hylactic measunes, oe€ause n0ne was takea. At WoagK0m.g, 0n the othel' ha,m.<lI, by 19 [Q a nousewifely saaitary fOfce haa o.!eanea and cilusted the wh0le town twice a year; every p>iece of furniture had been set 0n the street while the tumigati0n, dea,nsing, and a,iring was pl'o€eeaing. But the w1agl:le m0~ta/lity in s10ven!lr Cant0n was [10 higher tnan in ti®y Hongk!0ng. BubJ0nic plague, a name syn0nymous with disaStel' to the Ancient ana Meaiae.va,l W orld, need not eJcist in the Modern. ''[',llis is aJ gFeat hl:lman a€hie:vemem.t. ~he s€ounge ha~ seemec;l; to attaGk biim.clIJ.y ancil without Feason; neith.e!' t ieh nol' p>o0r, high nor i0W, 01cd nor young, knew who might be the next victim. Peowle n0 longe!' neea wring their hanas in futile tenror ana deswa,ir at t;he ap>weaFance ot wlague. 'Fhe mrsteF¥ of its Gause has n0W bJeem. solvea my nhe laborat0ry wo~R:er; the JIM in the ehain of tnansmission has I10W \ken broken by the p>rophylaJcis 0f the watohful and !'esolute sanitarian. ]f jDlague d0es €FeIlW bJy the 0utel' cdefenses, 98


THE BLACK DEATH it can sti~l b<t dealt with swiftly and with cettainty. Finally, the health 0ffiâ&#x201A;Źer, who stands sentuy at the port, knows when it is safe from a:ny attack. !JI1lea surveys a:re now made to sh0w what species are Jj)Fesent am0ng the denizens 6f tile rat underworld. A port may be considered non-infectible when the flea population of the average rat GOntains no m0re than one cheopis. New York is a safe port. The New Yorker may seek his Sabine Far.m as a pleasant refuge; he need never be driven there by the blind panic wl\i~h p0ssessed th<t citizens of FloteMe wh<tn the Black iIDeath had st0rmed theiF walls and taken their city in "a sad and w0nderÂŁul manner." But the citizens of San Francisco, Mobile, and New Orleans must still exercise vigilance if they wish to sleep in peace.

(

99


imA'lli', IDIlUNK, AND JB:Jffi M iIUtR.Y


EAT, DRINK, AND BE MERRY 5. Beds Nos. 15, 7, and 8 were still occupied when I entered the F00m. FouDly expe€ting ~hat he would be the neXit to go, the N egro in Mo. 15 ha<1i p>utIl1eCii the sheet over his head to shield himsetf from the sight of the gruesome succession of corpses being taken from the room. I drew it aside. His eyes were at first tight shut. As he gradually opened them, I could see the whites shining in the semi-darkness of the r00m. "Boss, is I <1iaid?" he inquired anxiously. He was birl'}' €10se to it. IDeath, however, ha<1i paused by his bedsi<1ie. He and his two companions left the hospital on their own feet, none the WOFse for their harrowing experience, but wi th no assurance tha.t they might not find themselves in beds Nos. I, 2, and 3 the next time. In all my experience in the Philippines not one medicine ever J?F0ved of any great value in the treatment of cholera. Many so€a[lle<1i specifics wer;e recommended. An old doctor in far away Ohio cilogmatica!lly proclaimed that it was unnecessary for anyone to die 0f eholera; that our wanton disregard of his quinine cure was unjustifiable. Because we had ourselves been vainly searching for a remedy, we na<1i airea<1iy .given his treatment a trial, hoping that by some miracle it w0uld pf0ve IDeneficiai. Convince<1i it was worthless, we had discontinue<1i its use. When the old doctor received no satisfaction from us, he wrote President Theodore Roosevelt to the effect that the bureaucratic physicians in the Philippines were prejudiced against him. He knew his remedy woul<1i €ure and we weFe sacrificing thousands of lives my failing to use it. [p,Fesiment Roosevelt, in his forthright manner, cabled us suggesting that the treatment be given a trial at once. The epidemic of 1905 was in its most virulent stage, and patients were dying in large _ numbers. In any event, quinine could do no harm, and the suggestion had G0me from the President of thel United States. The mediGine was given in strict compliance with the inventor's p>FClscr;iption. But it failed to save the life 0f the first man upon whom it was tFied. The second man died also. A few days later we cabled the President saying we had tried the quinine remedy on six patients, anm that alii of them had died. "Do you wish it continued?" 101


AN AMERICAN DOCT@R'S ODYSSEY "No!" came the quick FeWly. bon baFs ana thick stene walls had sel"'Ved for eentul'ies to pro ted: the ci@istered nuns of Santa Clara hom the prying eyes OF the @utside world, but eould not guar@ against the entrance of the pcmetrant Gholera. One nun after another was strieken, until the boclies of half a dozen had been placed outside the great weeden doors. Then terrgr became so great that the M@ther Superior appealea f@r he1W te Ar.chbishoJil Harty. He adiVised that tne rules be abrogated ana that ~ be asll:ecll te atteaa. On my way te and from bhe Ayuntamient@ r haa @ften passed these lotty wa!llls, IDut it was with a sense gf cdreaa tnat il st(;lOped to enter. the ~itde cleoF set within the la,rger one, ana pla€ed my feet up en the stones ever whiGh no man had walked fer a ~un@red years OF m@re. 'Ehe Mother SupeFi@r, of commanding presenCI!, conducted me down the long hall, grim in its austerity, where through years ef poverty the once w.hite WallIs had grown darkly stained. The €orridors seemed alive with restless, swishing, gFey-robed figures; eyes which had long forgetten hew a man appearem stared GUriously lirem white faces. I Jilassed the ehapel, gleaming with many fliGkering eand!les, w,heFe nuns kaelt si~ent in perJiletuai ad@ration. At ~ast 1 eateFem the deFmitouy anm fhcm~, w,i1:n what meagre fa~i~ities sGien€e nad te @lfeF, minister-em t@ the @eslllerate:ly siek Inms. ]lut s@met"hiag c@u:ld IDe done f@F those as yet unteuchelii. r rurne@ t@ the (wershamowing JilFoMem @f seeking the way by which the misease hacl crept into these forbiclden precincts. In the iong baFe inner court I found the nunnery we~l trom which aLl ham drunk. As s@ often before, in s@ many ceuntfies, cholera had sprung fr@m this unguarded SOUFce. 1 steridizea this death-deaJling menace,_explained the simple Fules f@r aveicd.ing cholera, and to@k my al\partuFe, leaving the nuns onee m@re t@ their d@istered sedusion. TheFe weFe no mere cases. 'iJi'h e first s1:lggesti@n @E the cenneeti@n ef eholera with G@ntaminated water haa ceme ia [8)5 k@m Dr. Jehn Snew @r London. The WFe;vi01:ls yeaF he ham tFaGem 3!a ejl>imemie te 31 jl>ump @1iI B~eam $tFeet. He !fiound tHat on,],y tn@se whe liiaa aFunk @f ~his water weFe attaekem hiy t"he misease. We asceFtainea tnat a eessjl>@@1 ml'ainea int@ this we1I, ana tHat 'there had eeen a ease of GhgleFa in the h01:lse served ey the 1m!).


~~sJ:l001. He F.JFovea that the intestina1 discharges of the si€k haa p0~I\!lteGi

fhe water sUPFdy. Mis dassle re\'ll,y to the query, "How can we St0\'l hhis oh01era e\'lililemic?" was, I'Niemove the \'lum\'l han<dle." ~F. $new iWF0te an aec0i:1nt of his <dis€overy that seemed of sueh litt,l e inteF~t to the \'lumi-is!iers 0t his day that he was foreea to \'lrint it at his 0wn expense. Nevertheless, though Feeognition was late, the English \'lee\'lle, geade<d by fear, began to install unc0ntaminated :wateF sUF.J\'llies. ]n [88* Roli>ent Koch, oM;en referrea to as the f0under 0f bactel'i0i0gf, a,EteF having alreaay isolated the baoiHus of anthrax an<d o£ tUIDeFculosis, discover-ed the cholera vibrio. Although it creates suoh great <damage, it is subject to many inimical forces; like the rare ord'iia it must be nuptured in exact1y the right environment. In 0ne h0UF the sun ean destroy it, aeid ki~ls it, drying sterilizes it, almost anJy 0tner li>aeteria €an eh0ke it 0Ut. Ilf it is to flourish, it must somenow or other get 6r-0m 0ne human intestine to another. In s\'lite of these serious handica\'ls, the v,ibrio manages to fina tr-anspertation, and has circumnavigate<d the w0rlcl more than once, and alway~ :witn0ut a tieket. @h01er,a has been 0ne of the great S€0urges of medern times. At f0UF liIiffere,nt per-ieds in the Nin(lteenth Century it was pandemic. ] n the siocties it was tal!;ing t011 thFough large parts of the United $tat~. 'FeFrifiea Englam! was twiee swe\'lt by the disease. Seven great e\'lidemies since 1820 ravagea the population of the :E1hiJjppin~. When the <deaths in Manila Feached a thousand a clay, net enough peeple could be founcl to bury the dead. Nightly the sweets to the cemeteries wen~ bl0Gked. ~he priests, leading the reiJig,ious \'lr-o€~sions of atonement, Gould with difficulty find ~ path, thr0ugh the calesins, C3Fromatas, 'a nd slow carabao-drawn cads, all beat:ing the dead fOF burial. Mecliaev3Il theel0gians had taught that aliI il!lness and defoFmity were manife.stations et divine wrath; plague, pestilence, and famine weFe visited up0n the pe0ple £0r their tFansgressions. Where this IiIQGtI'ine had meceme powerful en0ugh to regulate the life 0f the Cnr-istian w0rld, the progr-ess ef medicine had come to an alm0st G0rnpIete standstilil. The Fi1ipinos were still living in this mediaeval atm0sJilheFe; they wc:te r-esigned to their angry God, Were used to 103 ,

\


AN AMER1Cl'tN IDOCTOR'$ ODYSSEY his punishments, ana pre£errem their- own ways to those ef strangitrs. Beyon@ establlishing free meliiioine statiens, the Spanish authol1itr~ had bleen powerless. Instead of taking these simple measur~ ef health ana sanitation which wouM have prevente@ these destroying epidemies they had bowed their heaes ana praye@ whi~e the @eath rate meunte@ te its inevitable peak:. When the Amerieans Game, they were net disposed te telerate such l1esignati<m. Because ~hey ham to Il'Fote@t ~heir troops, ~hey iileoi@e@ tnat semething mHst De ~ene ameut oheleFaJ. MaJrem. 3, 19@rl., the at;tentien ef ~he <Chief Quanantiine @ffieeF at Manila was ealill ee to the existence e£ P.l.siatie choleFa in Canten. li1iYe mays bter eame news of it at Hongkong, from whieh large qU<llntities of fresh vegetallil~ were constantly being shippea te Manila. In the e/fel1t te wand elF infection, the port authoFities at Manill a immediately pla,em an embargo on low-grewing vegetalDles. This step was necessary Thecause the Chinese were aceustomeQ to sPJrinkle human eXGreta in liquia form en growing eabbages, not enly for fertilizer, but alse fer protection against inseGt pests. [f ehelera were PJresent in tlle :vieini1j,y, it was always posslblle that each £resh, GFisp, tender ieaJf wouM enfola a myriaa choler-a germs. Uinaer the teFms ef the embl<llrge, a farge shill'ment ef cabbages ~rom Canten was Felluse<il, <line tine angry sniPJmaster theFeuPJon dumPJea tne caFge into Mani1aJ Ea.y <lIl'Id sailea eft, reaving ~he stiFfaGe ef the water literahly eeveFea witl1 the fuoBfuing heads. f'1rom the nill'a huts ef Famla, Tenao, and Meisie, the FiJiPJinos swarmed te the wateF £rent, launched their PJraes and blaneas, ami went fishing fer cabbages. They welcomea the succulent vegetablles as manna. In the light of subsequent knowle@ge it is @oubtful whether eholera enterea the Philippines in t;his way. There is no aoublt, however, that one ef the mest terEible epidemics of moaern times had blegun. A few days later two cases of GholeFa were admitted eaFly in the <lIfternoon te San ~uaJn ae Dios M'ospital, ~hrough whese <lIncient POt\tMS se maJny theus<llNas nam pFe€eae~ them. Before .he daJy was ever, twe mo.Fe al!rivea. Within fel1ty-eignt neUFS mecters anld mIFS~ weFe Fushing afuout aistl1aetea[r tuying te fine;! bleds in whieh te put the sH/ferers. ResPJonsioility aevel:vem upon Seeretary ef the InteFier W;OrGesteF. 1@4


!EAT, lORINK, AND BE MERRY He was a m~n ef magnificent physique, respected by the Filipinos fer his size anti! courage, but teared f nlli disliked for his personality. We :was !;,rusque, anlli Iliilli net ask for GeepeFatien; he Iliemanllied complianGe with his ordeFs. He always insisted that the e~tablished sanitary fact of the morning must be the rule to be observed for the evening. In following out what he considered right, he paid no heed te Filipino public opinion. Worcester was taking vigorous steJ'ls, and cholera was not claiming se many vietims as in Spanish days. 1:1he more ignorant of the J'l0J'lulace, therdere, said this Iliisease could not be cholera because not enough people were dying. Many Spanish and Filipino physicians, who, unllier the old regime, had been the most influential class J'l0litically and socially, jealous of the authority of the Board of Health, criticized it~ measures and fanned the antagonism of the people. A ~and quarantine was established aFound Manila in the effort to keep the aisease f.rom the J'lrovinces. In the state of resentment over what seemed the dictation and ruthlessness of a military occupation, the Filipinos cauld not comprehend the theory of paternalism which said, "We ave doing this for your own good." Eluding the futile cardan at night, or slipping across the fields by day, people akealliy sickening ot the disease eSGapelli to start new fooi of infection. Within a few weeks seven thousana temporary employees of the Board of Health were in the field. But the force was new and untrained, and undoubtedly in exercising its duties it was guilty of discourtesy and even abuse of power. The F aFola dist~ict, a na~row neck of land along the Pasig River running eut into the Bay, GoveFed with wareheuses, coal piles, and a crowded m~ss of small filthy nipa huts, was the apparent focus ef the disease. Worcester ordeFed it evacuated and burned. Under a blazing sky the terrified and resentful owners watched the shooting sparks as shaGk after shack crackled and collapsed. The report spread abaut that tihe homes of the poor were being burned to make room fer future dwellings ana waFehouses of rich Americans. 'Further I1UmaFS that the fareign docters had poisoned the wells were also williely credited; it was even said the American aim was to annihilate the Filipino race. IDS


AN AMERICAN IDOC]!1(9R'$ ODYSSEY ~t

was r,I'ue llhat, in the (}ifeli't te step' ~ne sp"r.eam ef infCl@~ien, tae Amevieans s0metimes may have 0vervimm®n the private vights 0f individuals. Uniformed men datterem uF with amJiJullances and wiili0Ut aeFem0ny liEred the sick from their mats and caFted them away f,F0m ~neiF wailing families. The husJiJaneds, wives, aned Ghiolcdren €eulcl not un~eFstanc;l why they were ff0Fbiedclen to f0U0w,. Fou. times eut of five this was the last they ever saw 0f their ~ovea 0nes until sh0rtrLy they FeGeivecd a eur.t n0tice to eome to the hoslllital ancd €laim their e<lad. 1J1lh<l se,veFity oli fihis tFeatment gave . ,is<l to even m0Fe eJ<tFavagant rumOFS. It was saied that in ~h<l eetention €amps where contacts wer<l segregated all s0rts 0f h0rriihl<l abuses WeF<l being Ferpetuatea, ana at the emergency fl0sFitais nhe sick weFe bJeing aeliber-ate'ly mUFdered. mnt: state on W0Fuhr aFF>r.e'ht:nsi0n am0l!lntem to lilysteFia. ~iVh<ln­ ever p0ssible, the sick were G0noea!1ed by their; families ana the dead thrown into the esteros er the Pasig River or the ~a,y, thus aaeding fUFth€lr !»0ison te th<l alrea4y p0ison0us wat€lfS. M€lasures WeF€l tak<ln te G@nwe] S€la tEaffic. Al~ vessels leaiVing Maniia were quarantined five days at Mar.iveles, and f0r a longer periocl if cholera broke out. IX water patr.el was established on the Bay, but heFe aJs0 many smaN b0ats evaa<ld the wateh. At the tim<l ef m,y aF,FjvIDI ~h<l emergeney was S0 gFtmt tllat Un<l quarantine sew,i€e was ellitencded to cover the Manila waterways. Tlhe FeoFle WeF<l often, in their pitifUl ignorance, hastening their 0wn destrueti0n. One mor.ning I Game down to my 0ffice. My first g.lanGe, as ad~vays, was tew,aFeds tne big maF 0n the waH. [ was staEt~ecl to see fhat, aecored'i ng to the arrangement ef the e0ferClc;l flags which mark<ld the lecatic)J1 of every Gase, ch0lera haed suddenly burst forth in little iselated gFOUpS aU 0ver Manila. An in;vestiga~i0J1 was begun at enee. 'iJj1his S0en Fevealed ~1\at UW0 days eaJilier a! ,fisherman haed G0me in fF0m the Bay with a marveleus st0ry 0f h0w he haed seen bublDles rising in the sa!lt water which, as they rose, fOFmed t'ne vague 0utline of a great Gr0SS. He had tasted the water anCilJ f0und it sweet. (;F0ssing himsel,f, with weneder in his nearot ~nat he Iilaed lDeen ohosen te 4isGe;ver Flilis WOEtent, he pacddleGi furiously te la,nd. ObheFs, at first ineFedulous, tasteli! ana theA believecd. ']fhe fisheFman es€orte4 to the spet a pFiest, who blessed 106


EAT, DRINK, AN'Ji) BiE MERRY the water and declared it a miracle. The Filipinos were such ardent seekers aÂŁter wonderworking that they would CLY out "I believe" when any prophet pFoclaimed, "Lo! A Miracle!" Dwellers along the shore poured themselves out on the Bay in anything that would float ana eager,l y scooped up the holy water in bottles, jugs, pans, and pails. Together with the Manila health officials, I was soon on a launch, which nosed its way ~hFough the conglomeration of native craft. A glance was enough ta show us that this was no miracle but a dire ~la:mity. The seweF Ene, which emptied far out in ~he Bay, had I!lFaken. ]f aGcess to the miracle were shut off immediately, we knew that, in the prevailing state of incipient rebellion against health measures, the believers would feel deeply outraged and would be rclady for' any violence; the health service would be attacked fOl interfering with divine providence itself. On the other hand, action was imperative if cholera were not to run riot in the town. We went to the Governor General and asked for constabulary to patrol the area and keep the people from Eommitting mass suicide. Instead of acceding immediately to aur request, he hesitated. "It's quite possible there'Ll be a minor insurrection if I do this," he argued. "h's cquite certain theFe'll IDe a major catastrophe if you don't," I FetoFted. ''WeN, r don't know," he drawled. I was well enough acquainted with the Governor's legal turn of mind to realilZe that he was wdghing all contingencies before making a decision. To me there Gould be no question as to the necessity, and, moreover, speed was of the essence. ''We are advising you in the strongest terms that the constabulary be called out. The situation is serious, and if you want to assume the Fesponsibility, we can't do anything further about it. But we want to have it plainly in writing that it is you who are responsible." We could state our position no more plainly. The Governor did realize the danger, the police and the constabulary prevented the collection of the water until the sewer was reIDairea, and, (!)n this occasi(!)n at ieast, the disturbances whioh ensued were af only a minor eharaGter. When i t(!)ok charge of the Bureau of Health in 1905, cholera liad broken (!)ut again. If a me is to be kept under control, it is imperati,ve 107


AN AMiERKAN DOC'T1G>R'$ ODYSSEY to prevent a! stalte 0f p,almie. My el<iperienee in tae pFevi0"ls e!!,idemi€ haa taugllt me ~hat quiet, effective measUJ1@5 and Jilersevering kinaness were far more p,otent than martial law ana armed for€@5. BeY0nd placing guaFds on the Benguet Road and trai,ls leaGling to the M0untain tiD,F0vinee .f.r0m bac±1y infeoteGl t0wns, no attempt was macrle at a lancrl qtlaFantine. f.M efEeient Iillookade W0Ule;! ha.v e requiFed an army of fifty thousand an<il the expenditure of vast sums of money. ~f we Gould keep the p0pulac€ f.Fom becoming a~armea, they 1IV0uJa perha!!,s stay in M:j!nila. Simuitaneously with 0UF efF0FM to keep the infeet;i0n 10Ga'l~ze€l, we were isolating the sick in h0spitals as quiekly as possifule. M0st 0f them weFe taken to the newly eompleted San !Lazaro buildings which, ] beLieve, llarb0Fed m0I'e pests than weFe eveF blef0Fe wncentrated at anyone spot in tlie w0rTcrl. lEut instealli of maFring ~l:l.e fFiencrls and Felativ@5, we muilt glass partitions S0 that tlley coud<il see and realize the patients were bleing properly cared for. However, memories of old wr0ngs <ilie har<il. [1)/1 spite of 0UF eif01'ts to eMm the pani., the ver·naGUla'. pr@5s accl!lsecrl us 0f exereising the same ruthless m€asur;es as haa been enf0Fcea in the !!,revi0us epi<ilemie, ami! OF bleing laeking in pity and humanity. ()ne article desGribeGL h0w the naked b0dies of the dea<il, tagged ana wir.a Feet tiecrl together, lay ab0ut the entrance. Wi<!i@5ll'reacrl teF,F0r am0mg the [0wer dasses was prev.ented emIy by WOFGesteF's IJDr0mpt a€ti0IT in c0mpeliting the paper to !!,rint a publi. Fetracti0n. Jis0iati0n was the m0st imp0rtant weap0n against Gholem, but 0UF inabil!lit y al,ways to IOGate Gases in ~heiF eal'ly stages ll'FoiongeG! the ep>iGlemi€. I3ven with house to house insp>eetion by police and constabulary, £rom two to twenty-foUF hours often would elapse befoFe the iBureau of :&halth was informecrl. A C!\uarantine guaF<iI was at once F1aGe~ tl!!,on an infeete® house a:nGl its inmalt€s, ama FFom ~hat m0ment the paFtieulaF FOCUS was acrlequately carelli fOF; yet in the 1l0UFS !DefoFe these measures coule;! be taken, 0ther ' incrlivicrlua1s alm0st inevitably had been infectecrl. [l)n 0FcrleF to r.ecrltlce t'h e J)iSK; as mueh as !!,osslble, we maJ!>!!,ecil 0Ut ~J;je city 0f Manila in districts., and crlisinfeating carts were maintainecrl Eke fire ap!!'aFatus. At the souncrl of an a;l arm, the <illsinfeetoFs would set out 0n a mad galN0P, an<il in m0st cases wotlld be at work in a few ~08


EA'F, DRINK, AN[]) BE MERRY maments. NCilthing but prepareed fooed was destroyed or damaged. Clonhes, blankets, mats, crockery, aM , went into a tub fiMed with carbCillie a~icl sCiliution. TheFe was rarely a secCilnd ease in a house whieh had been thus treated. The spFead of infection was often edue to the kindly Filipino nabit af visiting any neighbor whCil fel1 ill. FFiends aned relatives litevaldy oFawded to cammiserate with him. But upon discovery of the nature of the disease, or upon notice from the doctor that he had to rep>Cilrt the case, they prCilmptly scattered and went to their meals win1lout washing their infected hands. Many times they carried from the house mats, clothing, food, and drink, to save them from the disinfectors. We tried to trace the homes to which these articles had been carried, but it was always edifficult and often impossible to locate them all. ln giving foremen their instructions, we laid great stress upon the necessity for edisplaying cCilurtesy at aN times. They were told to take part in no argument with householders or anybody else, and to do their work with consideration, but none the less thoroughly. I'n ane epiedemi~ we had six hundreed men working. The daily consumption of disinfectants was enormous. About seven hundred gallons of carbolic acid and seventy-five tCilns of lime were used. The en~i r.e stock of the for.mer was cCilnsumed in one month and emergency shipments haed to be secured from Hongkong and J apan. In this crisis Dr. Paul Freer, the Director of the Bureau of Science and a bril1iant chemist, suggested that sea water could be electrolyzed, forming a disinfecting fluid which, according to laboratory tests, would kill cholera vibrios promptly. This provided us with a, cheap and inexhaustible supply of disinfectant. To sanitate people with fixed abodes was comparatively simple when compared to the p>roblem presented by the harvesters of rice, sugar, aned tobacco. These semi-nomads moveed rapidly from place - to place seeking employment. 'Fney stubbornly persisted in stating that the disease was not cholera, but poison introduced by los Americanos under the guise of disinfectants. ~n aeddition to aotive apposition, we had passive obstruction to deal with. At times when the immediate isolation of a case of cholera wauled have saveed a town, factional disputes might either p>revent 1'09


:AlN AMiIilR!l'CAN !!DOCTOR'S O])JYSSEY tlie Municipal Council's convening f0r iaek of a quorum, or, if it mid m@€t, it might cleoid€ that gq.ava wat€r was a more d€Sirable rusint@ota,nt than ca,vIDe'l1G aeie. !lif dIe town heaitli oflkeu hall'Pl@ned to IDe persona non grata thF0ugh religious., politica,l, or persona'! cdifferenc@s, his salary might be FeduGee to the lowest pessible limit. Doetors W€Fe stilW! r.duetaht te setti€ in the pr0vinGes, se that tli@Fe W€F€ many secti0ns without skiJIlea m@miCail ai@. Even whet'€ th€y wer€ stationed, I haa occasional difficulti€S with them. Th@ foNowing exohang€ of teillgrams is se1f-llxplanateFY: "Dr. - - , San Fernando, Union: Governor, Zambail€s, Feperts chelera San Narciso. Proceea immediatdy take charge situation. Answt:lr." HEISER.

The Feply came, "W€ailth, Manila, am sick. ] mpessibl€ for m€ to

m-aN€i." "When wiN you b€ ready?" "'Wave itch: am making house my office. Shall aavise when cUFea." 'i)!,h e telegrams Wel'e som€tim.es even more ~cenic. A yeung Filipine graduate of Rush Medical School in Chicago ha@ returned sartouiailly garbed in the height of Am€riGan fashien with the lat€St thing in ned!!ties and toothPlieK s'hees. Miis first assignm0nt was to a ch0i0ra 0utbreak in an isolaeea town t@n miles b@yond th@ €nm e£ a railroad line. He founa not even a carr0mata taxi at the terminus. "No Gonveyanee. ";What sha!l!l [Ij ae?" h€ td€graphea me at 0nc@. ''Walk!'' it wired. But i am remina@d of an @arlier ocmsion on whieh th@ zeai 0f a sub®Fainate haa createa une~€ote€l <!lifficuhies. "[1he fitst indication that !Ii had of anything wrong came in the form of a summons to an int€rvitlw with Goyernor TaM. Trying to C0mp0se his ~ovial f@atures int0 an €~prtlssi®n' ef s€verity, n@ began ~he c®n(\7~Fsati®n. "Leek RtlFe, Doot0r, I want to help you al!l [ can, but Y0ur department is going much toe far." , ''What's the m.attll.?" !Ii asRee. "T:hey've 'IDeen stoPPling tlill ringing 0f ohurdh bells in iBatangas. Why ?" " !E'm Sillle ![ don't ~n0w,>J it answer-ea, "out l'tI!I fin€t 0ut at once." 1I0


ElA.'f, DR[NK, AlN!D iBE M:JE.RiRY ill summoned the insp&ter and askea for an explanation. He admitted Feaaily ~hat he had stopped the Bells. "But that's not a sanitary measure," I pointed out. "Oh, yes, it is," he insisted. "When the church bell rings, it lets everybody know another person has died ef eholera. This news casts a ,gloom over the whole eommunity. You know, yourself, Doctor, that any depressing news interfeFes with the secretion of the gastric juices, and that one of the best pFotections anybody can have against cil.etem is stFong gastric juice. Now, when the ehuroh belQ rings, the gastrie juice of aU these who hear it is reduced in strength, and they aFe much meFe likely to get chelera." Stil!l inexperienced with Oriental sophistry, I was taken aback by his roeasoning. It is true that a deranged digestive system and a weakened hydFechloric acid offers a happy hunting ground for cholera germs. But even so, I was well aware that the inspector was moved by anti-Church feeling rather than true scientific spirit. I accepted his explanation, however, merely admonishing him that he was not in the future to interfere with religious observances. I relayed his explanation to Taft who roared with laughter, and admitted the logic was incontrovertible. The basis en which I wor-ked in attempting to control cholera was that it could only be eontFacteGi By the introduction into the mouth ef â&#x201A;Źentaminated foed' or drink. "Y:eu can eat cholera, and you can drink oholera, but you cannot catch it." Almost absolute safety against infection couid be secured by the simple precaution of using safe, potable water and cooked food. My greatest task was to convince the Filipinos that this assumption was correct. Large portions of the population were ignorant and inaccessible. Mueh superstition existed, one of the most popular beliefs being the supposedly injurious eharacter of boiled water. The time-honored custom had been to keep water in lar.ge earthen jars into which any-one who was thirsty dipped his ha1f cocoanut shell and, incidentally, IUs fingers. The eating habits were equally simple and primitive. Food was â&#x201A;Ź(;lfiveyed to the mouth w.ith the fingers from a general bowl used Dy al'll the householcl. The stevilization ef water and the preparation of hot food was difficult and eJqlensive, because al'l heating and ceoking had to be done over infinitesimal fires of bamboo sticks. III


AN AMERiliCAN IDOC!FOR'S ODYSSEY The question ef the perishaIDle foe~ sUliljiliy of 6he inhabitants ef Manila was almost as impeJ'toant as water. It had to be inspeGtea se that nothing diseasecl, unseuna, OF unfit woultd be sold or €ensumetd. We ereoted large airy builtdings ef €enGrete, which were te serve as oentr<lll markets. This system ef tdistributien prov~d to be one of our few innovanions which pleasea everybotdy. 'rhe city likietd it because of the inc0me, the tdea!lers because of the Gheap rents, the housewives lDeGause en the wide €heiGe ef feetds anc;li tne convenience of being ai'lie to bu¥ 31111 their sUlilpi:ies in 0ne jillaee. ~ina.l!l'y, it setiVe€l the liluIjJDeses ef the Bureau e£ iW'ea!ltli IDecause it gave us an eppeJ',t;unity te €entrel trhe sale 0f £eetdstuffs. Mani~a has the distinQti0n ef being the eaiy city in tne worM where perisnable foetd may IDe sold OfiIly in a public market. We alse toe~ advantage of these gathering plaees to teach the Filipines hab>its of sanitatien oy instruoting them in the use of public latrines. 'The lew-grewing vegetables, as usual, were baFred, but the sale Gf fruits that grew high 0n trees, SUGh as bananas, coc0anuts, anill manges, was not dangereus and net inter:feretd with. Ftorks were previcletd in the meat stams, but mueh eauGatien an<d patience was necessar,y befoue tne eld eustom Gf nandQing one pie€e ef meat after another €eu1cl IDe steppem. 'E;ver}l mar-Il:et had a large nUlRlDer e£ stanas which GateJ'ea solely te the diteweJ's e£ b>etel. Tne Ke~nd ef this nat, truit ot the Are<ta palm, is taken Frem its thi€k nusk, muon like that ef a walnut el' Dutternut, and is then GUt into tdisks. The pieces are ceveretd with iime, wrapped in m0ist green DUra: leaves ab0ut the size ef these of a mOFning glory, an<d plaGetd in an earthen pet. They are thoroughly spJ'inkled every few hours, out the 0Ia water at the bottom Gf the vessel is seldom replaced. The Filip>ine purGhaseF is very particular as to the ten<;le~ness e£ the Iea'V'es. He puts his hantd inte the aar and feels them a!N care fuMy benere makiing his seiecti0n. N aturany, j.f his fingers are infeotea, he spFeatds the oentagien thF0ughl0ut the lilet. !Fhe haIDit el mete] nat eFtewing' was se ingFainea ameng ~ne ilslancders thlat any atteml"t te Eel1lDi€l it wel!l~a have ,!been us~less. '!its mi1tdl1y stimulating eifeet was apparently ne <detriment te health, a:hnough it was inciaentaility injurieas. !Fhe Fi1.ip>ine wouid push the 1[2


'&lAT, ElR[NK, AND HE MERRY Gud between his teeth ana cheek, ana the pungent essence of the nut weula iHitate the mueous membrane, otten causing buccal cancer. Since we â&#x201A;ŹeuiM net steJil ~his habit, which was mer:e com men than gum che,wing in the United States, we prohieitea the sale of the nut eutside the markets. In an epiaemic we used to rope off the market so as to leave enly one possible entrance. There we stationed a uniformed guard, and Jillaeed by his side a earrel filled with a weak solution of bichloride eÂŁ mercury, mild enough to be haFmless to human beings. The guard saw te it that ellcn person entering the market rinsed his fingers in dIe barrel. Since no towel was provided, the disinfectant perforce dried on his hands. The Filipinos regarded this procedure as a rather childish American practice which hurt nobody. They dipped in their hands and then, with shouts of laughter, splashea one ' another with the disinfecting seiutien. Nothing could have served our purposes better. Even more important than bullfighting to the SJilaniard is cockfighting to the Filipino, because every man, no matter how poor, can participate in the sport. In many homes the cock is the most valued Jilossession. In case of fire the Filipino is popularly said to rescue fiFst his cock, then his wife, and lastly his children. A cock costs meney, a wife nothing, ami chiJaren ane easily come by. One of the commonest tableaux in the Islands is that of twe men holding their cocks by the tails and letting them scratch and pull towards each other to strengthen their muscles. Around the eockpits, whieh are in every village, amphitheatres are Duilt ef bamb@o ami nipa, and each Sunday the seats are filled from mawn to dark. Usuahly a white cock is matched with a colored one, s@ that eacn may be readily distinguished. Before a contest begins, the owner brings in his cock and, holding it firmly by the tail, allows it to struggle and strain in order to display its fierceness and strength. The audience of inveterate gamblers makes its appraisal promptly and the betting begins. Cries of, "Five on the red," or, "Ten on the white," a¡lterenate with the clink of money thFown into the pit. The attenaant shouts, "Any mone bets?" and when none is forthcoming, he sweeps uJil the silver and paper with a broom. Each cock has fastened on one leg a steel gaff of razor-like sharp;

113


AN AMlER'liCAN IDOeTOR'S ODYSSEY ness, and one of the c0mbatants [s disemboweled quickly 01' runs away. '['he slain her-oes, although t0ugh, eventuaclly fincl theiF way into the family soup pot. The pRy-oBi, which takes place withGut any appaFent system of aCG0uncing, is a most amazing perf0l7manGe. A man C0mes up to a little wind0w ani<! meFelo/ says, "I bet five 0n fhe Fed," and Feceives his m0ney. i[ Mvel' saw a single dispute ab0ut the am01!1nt 0£ the wager. ilin times of eJlliclemics any ~the~ing 0f people was clangeF0us. We G0U!lcru n0t Fiee r0ughsh0~ OYer the oust0ms ant!! ~ll.e FeLig.i(j!R Iii£ tlite p>eoJll~e; @Eten we hacill tG €@mpF@mise. 1The fiesta is a time-h0n@FeC!! instituti@n in the Philippines, ant!! the prinGipai event in the featly history @f each t@wn. Save !E0r its religi0us asp>eot, it Fesemfules ene @f our c@unty fairs, bringing together thousands of people of ali ages and c@ncliti@ns, wh@, f0r the time being, lose themselves in resti,vity. The gl'eatest single hazard to health cluring the year came from the annual celebration of the feast 0f Nuestra Senora de Paz y Btten Viaje at Antipolo. For sevel'al weeks ten t;housand pers0ns 0r evc;m m@re would congregate in the smail town containing the shr-ine. Feasting was @ne 0£ the essentiial. featuFes. Food was bF01!1ght £r0ID ch0iera-infeGtet!! clistriets aned evellJ k,0m invacileGt h0mes, ancl, with that sinGe~e h@sJllita,l ity s@ ehaFa0tevistic 0£ the Fitlpin0s, was &StFibuteGi t@ al!1 who W01!1[t!i pantaKe. 1F.ll.eFe was a naMaL teneden"J' to excess in eating, aned the indigestion thus incluced might have aif@Fedea just the oppGrtunity feF the cilevdopment 0f a Gase 0f ~h0iera OF typh@id or dysentery. il"atients in the inculDation state 0f cholera often mingled freely with the wel'l, and, sinc:e the means fer the disp0sal 0f the eXGFeta 0f so many pe@ple weFe uSl!1aNy inacle"luate, it was quite obvious how the clisease might spreacil. After visiting the ¥irgin, the pilgrims usecl! to bathe in the MaFiquina River, which was neavby, ana the clrinking water was sGoojj>ecl up farther m@wn: the stream. A~m0st immecliat~Iy a,EtIlF AntiJll0t0, eh@leFa w01!1!1cl 0~@p u]ll sim1rl.ta:neel!1siy her-e aN~ theFe ab0ut il'.;Uz,0n. '[1he viJll agers €0U'1cil finEt n0 other ell!pl.<lJnati0N tlilan r1;hat s@me mysteri@l!1s ~eFmentati@n was wOFkiing in the s@it But t@ the memlDers of the Bureau @f Weaith who were stuclying the route maps 0f the FetuFning pilgrims, it was

H4-


lEAT, DRINK, AND BE MERRY apparent that the ~ines of infection tadiated in all directions like the spekes frem a hub. The devout travelers might h:we escaped con¡ tagien at Antipolo itself, but too often it was obvious they had stopped at Pasig, where they must have purchased low-growing vegetables fer6lized with human excreta alive with cholera organisms. Quarantine as an emergency measure and, as more permanent preventives, the dispesal of excreta and the provision for pure water, were eUF on[y pIlophylaxis against chelera in the early epidemics. But it was ebvieus t;hat other mcters, as yet unknewn, entered the equat;ien. Chelera had always broken out at crowded Bilibid Prisen in every epidemic. When I was first calJed upon to cope with this disease, the prisen medical service was under the complete contrel of an official called the Director of Prisons. As the death rate was mounting to over two hundred per iliousand, Governor Wright asked whether I weuld find out wherein lay the trouble. "I'll try," I said, "but I Gan do this only if I have the necessary authority. Will you instruct the Director of Prisons to carry out any reasonable requests ]j may make?" "But that weuld be infringing on his domain. I don't see hew I am do t'h at," said the Gevernor. Rea1i2ling that my werk weuld be useless witheut complete control, '[ said [ was sorry, but t;hat I sheuld have to decline. Governor Wright censidered fer a moment, and then decided that the emergency required the cutting of red tape. "This outbreak must be stopped. I'll de as you say." I went to the prison and, after searching all morning, had disGevered nothing. The sick had been promptly isolated, the food was ceoked, and the water was pure; there seemed to be no reason for the constant recurrence of cases. '['hen the dinner gong rang. The prisoners trouped into the dining reem, amd ] neticed the flies Brom the toilets went with them. In these mays little was known about the possibilities of carriers anm inseet transmission. iFlies, however, were a manger in any epidemic, because they might ca\1ry on their feet any intestinal disease. They fu-eliJ.uented misease breeding spots and purpesely hunted for filth. If there were no filth, there would be no flies. I ordered the toilets to be

lIS


AN AMERICA.N ;QOCTOR'S ODYSSEY soreeneGi an<iU the entrance to me pF0viGlecl with a vestibule anc;! spring cl00Fs. Wir,ain f0I1ty·eight h0UTs tne eh0ieFa eFieemic in, Bi~ibie iJi'l'iSCi)fi st0FIDecl with dramatic suGleenness. 1'1he t'ris0n mea,ica!] servi(e was sh0n1lly thetea·£ter t'la(ed unGier the Bur.eau 0£ Wea!lth, and Bilibil!! became a [aID0ratory wheFe we €oull!! stutdy I!!isease unl!!eF Con~l;(!)l1ed c0nl!!iti0ns. llhe Gleath Filte there dr0t'IDel!! to the level of the most fam0us health resoFts. Flies mignt explain an 0utiIDr.eak [n an insti~libi0n, but c0u11!! n0t make deaF wlity, in sJilite 0£ :lI][ 0UF sanitary, measuFes, ea01eF:lI kept GF0Jilping ut' in wiae:l ¥ seatteree GiistIricts 0f I!;;U'll0n. An eJiliGiemic wouitd start in Hagent'>y, anGi a few Giays lateF break out in PamFanga. J3y rigor0us meth0ds we wou[1!! me able to declaFe Hagenoy dean, out while we were eoncentrating 0n PamFanga, Hagenoy would somehow me r.einfeGteGi. Alnc;! n0 S00ner w0uld FamIDanga be deareclJ uF and we w0u1a FF0@eec;l to an0tliter c;llstF·iet tnam. it woilld IDe FeinfeeteGl w0m iBillacan. €)ften cases weFe few anc;t aiSS0Giatec:l, mut ~he endlless chain went 0n. Am infecti0n disFersed so broad.1y, S0 elusive, ana S0 slight as to me scarcely n0ticeable, could w.ith gr.eat c;lif!icu[ty be C0mbated. Nevertheless we knew that any rela;xati0n in vigillanee w0ulc;l SUFe1y me fo1[0wed by a maj0F 0utmreak. i1in stul!!ying the causes 0f t'h e tragic WammUFg d:isasteF 0f [8c;la, when eig:n:t th0usand FeoFie had d'iecl in taFee m0n~hs, the Gi0ct0rs of the perioa hac;! offeree as a the0FY the F0ssimility of choleFa carlliers -people who, th0\:lgh themselves not il[, were yet able to l!!istFimute miHi0ns 0£ germs anI!! infect many 0thers. The eXIDlanati0n hal!! n0t been proved and was 10st sight 0f unti] Elr. Al'lan J. M€1.aughlin, 0ne 0f the 0utstand,ing memIDeFs 0f my deFantment, w0rking 0n tine German N¥iF'0t.hesis, l!!eteFl1iunel!! tine exlsten@e 0£ c:a~r.ieus in ~he FhiIipFines. TheFeaf.ter, in 0UT measUl1es f0r c0ntll0:m.rng €h01era, we t00k eognizanee 0£ the p0tential dangeF £rom this S0UF€e. If the mactellia car,l1ier washeGi his hands 0ften enough anGi at tne pr0per times, he woull!! not tr.ansfer infection £r0m his I!!irty fingers to the f00G1 0F eFink 0f 0taeFS. O the'Fwise, he was a! gFeat menace to tne pum1i@. We l!:eFt iV:ery 0i0se track 0f aruI eam,ieFs anI!! iS0latecli them w.neneveF they gave F0siti",e nesu[ts. iE",en waen illey weue negati",e, it was t'0ssiMe that they mignt become p0siti",e at any time.

u6


EAT, ]DRINK, AND BE MERRY Censequently, 1;,efere the season for cholera came around, we used to have them examinea. On~e in possession of the faGt that cholera carriers existed we were able to guard the Philippines against the entrance of cholera from other countFies. We required bact€riological examination of all passen· g€rs at quarantine, a system which has now become an essential part et safeguaFding any pert from cholera carriers or those slightly ill with the aisease. ~n I~Il I happenea te 1;,e in New ¥ ork on my vacation wh€n eheleFa lllroke out at Breeklyn. Three thousand immigrants were coming in almest daily, and it was assumed €holera carriers among them must have brought in this infection. Wholesale bacteriological examinations were obviously necessary, and, because of my previous expel'ience with cholera, I was asked to help. An emergency appropriation was secured, a laboratory was set up at Rosebank, New Jersey, ana thirty women technicians were employed to find the carriers. Insteaa of sweeping the country as had so often happened, oholera was stopped in its tracks. The system we instilled at Rosebank has now become the recognized one thFeughout the world. Although it is most useful in prev:€nting cholera, it does not give absolute assurance. All threatened towns OF sections must always be prepared to fight the disease. Com1;,ating epidemics was temporarily stopping the leak in th€ aam, and cleaning and r€novating were essential, but all would be of no ~asting value unless the coming generation were educated in the necessity for and knowledge of prophylaxis through inculcating cleanly habits in eating and the disposal of feces. The childFen made the handiest tools to work with. The little Filipinos were exceedingly studious; such a thing as a child not preparing its lessons was unknown. There were never enough sohools to go reund, and it was pathetic to see them standing outside the -;'Ghoo~heuse leoking lengingJy in, heping that some boy or girl would not appear ana one of them might enter in his er her place. t:eadiiing by pFecept ana example and literature did a great dea.I. W€ organized Knife and Perk Secieties among them. In some cases they earried this lessen in taOle manners home, but the older peopl~,

117


AN AMER'lCAN IDOCTOR'S ODYSSEY were selcdern affected; their ~ating habits were fixecl., ancl the clanger "Il!Iite beY0ncl their €OmpFehensi0n. Neve~bheless; we e(meinl!le€l .to eFlC0l!1tage the chiMren to I'epeat w,h at ~hey ~ear.necl to th!lir p>areFlts who, adthough they themselves G0uM neither Fea€l ne! wr.ite, were also eager. for leaming. Simple rules of hygiene w~r.e pla€ed in the newspapers and on handbills in English, S!!,anish, Tagalog, nocano, Visayan, and vameus other native dia,leets. With the ceop>eratien of the Bureau 0! iIileduGani0n, these 0iFoub r.s wene sent to evel'Y SGh00~ teacher. in the Manes. They. were to IDe tal!lght to the chilcdren so that they €oulcl rep>eat th.em verwatim to their !!,ar.ents. We also hacl the r.ules pr-int~d on large fla,ring red posters whNh weFe placaFd~d en muniGipal ancl other p>ublic buildings. We sp>ent muoh time in the prepaFat.i0n 0f a E>Fimer ef sanitation, edestineed tOF ~he benGiing e:l1 tfiese young twigs whose nemes p>ossesseed ne Funning water, ne steves, aned no IDathiie0ms. When it was p>ut in w0rGls of one syllaIDle, it b&ame the stanclaFd for sch00ls throughout the tropics. 'F0 get the west results in 0UT campaign 0f eGlucation we coneelb tratee 0n 0nll subject at a timll-beribeF>i, Ghoillra, tuberoul0sis, OF whateVlev m""as mest imp>oFtant at the memento Walks., 'p>a,m,p>h1ets, newsp>a!!'er ar.,tides, ancl eemonstr-ati0ns were a~l USIl€l. We wol:lid gather. the p>~0ple together whllFever we GOulGi ane iJ!lustrate eur points with lanttlrn slides. We s~Gureed a ear fFom the railway, and macle it into a traveling exhibit with a Filip>in0 ~eGturer to aGGompan'}' it. iILater a Heahhmobii~ ane g00cl r0aeds enaIDlee us to r~Gh many m0Fe. 'F0 th0se wh0 WIlFIl stil~ ina€€llssibi~ we sllnt miniatuFe eocfuiIDits on E>erteFs' baoks, ancl a le0turer went :6t:0m 1'i01!1Se to 'h0use e~ouncllng.

A p>rime Fllquisite in th~ campaign was thll 600peratllon of th~ churches, wecause of the great resp~ct which the Filipin0s gllner-aliy paied to the w01'cls of their Feligi0us inStFUGtOFS. T first went to Archbishop Ha~ty, a very intel~igent man without wh.os~ help> 1i eouM na,\(1l aGG0mp>tishecl tittte. iii e~ia,j.Fle<il to him tfue higMy infeeti0l!1s natuFe 0f oh0lera, ancl pointed out that it Glid net make any differehce whethllt a Catholie or a il"Fotestant swa!ll1.owecl the germs-th~y both died. Our aims wllre identiGaJ. His priests were intelligent men,

II8


EAT, iJDRiNiK, ANI> BE MERRY rout as ~eng as bhey taught their fleck,s that ehelena was a punishment for transgressien and merely commiserated with them, they. helped Father than hindered the spread ef the rusease. Every death was furthering destruction by bringing together large groups of people, and dur.ing an epidemie it was vitail to stop these wakes. "[ do not want to ban them arbitrarily," I explained to the Archmishep, "because I should gain nothing in that way. The people would prebably hold their wakes in secret. But you can instruct your priests and they will faithfully ebey." He agreed to help me. I then bl'Oached an even more important subject. I wanted him to cil:istroimute simple rules for cholera prevention. He promised that they would be preached from every Catholic church in the Islands. Armed with Archbishop Harty's assurance, I approached Monsigner Aglipay, the head of the Independent Catholic faction. "Your Grace," I megan, "the Roman Catholics are semling out cholera circulars. Den't you want to save the lives of your people also? If you de, here are the handbills which will teach your parishioners how to avoid this disease." In his eagerness, Father Aglipay almost snatched the circulars from my hands. [ then mame' the rounds of the Protestant denominations and said to Episcopalian, Methodist, and Presbyterian in turn that the Cathelics weFe sending out circulars, and suggested they might wish to do the same. They also promptly agreed. In this manner r mrought into my camp the mest educational and Feligious forces of the country. Menth after month and year after year we labored by every possible means to persuade the Filipinos to boil their water, but with no great success. One of my American doctors, valuable because of his knowledge of the Tagalog tongue, was especially good at coping w.ith oholera eutbreaks. I knew that wherever he went he would stress the necessity for sterilized water. When the cholera rate remained high in his province of Pampanga, I went in person to investigate. I Jli@gan making the rounds of the houses and in each one I asked, "Do yeu use boiled water?" and in each received an affirmative reply. By tne nime i{ nad reached the fifth house, I decided I had better go

II9


AN AMi[iIH(:AN !ID@Cl'OR'$ ODYSSEY int0 the question s0mewhat moroe th0F!;lUghly. "'M ow ed0 yeu use this b0ileed water?" I inquiretil. "We take a teasF'o0nfui thFee times a eday." The wise Chinese are the 0nly Oriental (ile0ple wh0 apparently cio n0t suffer fr0m cholera. They Kn0w the use of boiled water aned e00ked f00ed. 1i1hey dl'ink teal aned eat h0t l1ice. [l>erhaps far baGK in the S:ha,ng, 0r the Obeu\ 0r the Tsin, ex 1ihe Han tilynasties, Gel"ta,in Cbinese F're.fer'Fed fFagFant tea to insipied water when they weFe th,iFsty. ()h0ier.a passed them lDy. iJ3ut these w'th0 @iGli n0t pFlIiCti€e tne @eI;iGate al1t of bFew,i ng ana tilrinlcing tea, in the e0tlFSe 0£ time peFished, iea;ving a nation 0£ tea d'FinkeFs. iJ)n fhe Philippines it was .jj(;lUn61 that the Chinese who were stl"iGken ha<il betrayed their ancestors by ad0pting the I<ilipino m0de of Eving. lin Manila there was one Gase 0f Gholera out of a thousand Chinese, 0ne out ef seven hunedred AmeriGans, an@ one out of two hundretil aned fifty Filipin0s. The Chinese ail,ways edr-ink beileed water, the Americans generalily edFink b0iJeed water, and the I"ilipin0s seledom drink boj,[eed water.


WATER, WATER, EVERYWHERE

CHAPTER 9.

OR many years the indifference of the Filipinos toward the question of better water seemed almost impossible to overGeme. If a bridge fell cdewn ana ten jlleojllie were killed, the public would be wrought up to fever pitch, and an investigating committee would at once be appointed to fix ~he responsibility, but the deaths of flumireds ef jlleople who died of peer water went totally unregarded. Whether water was safe and potable seldom seemed to have been inquirea into from . a scientific standpoint, nor was the enermous amount of labor to be saved and the convenience which would result by having it delivered through pipes seriously considered. !f1he Sjllaniards had put in a pumping station for Manila which eievated water from the Mariquina River to a reservoir and then distributed it by pipes. But this system did not reach all the people in Manila. As a result, the poorer classes, among whom the danger tmm cholera was greatest, were accustomed to take water from shallow. wells, ponds, esteros, or other questionable sources, not only fer washing clothes and kitchen utensils, but in many instances fer - cdrinKing purpeses. We tried to forbid this practice, but more often than not our orders were ignored because some barrios were located so far frem the nearest hydrants that the people had to carry water a leng distanGe in bamboo tubes or the emptied Standard Oil tins which litter the East. One of the first steps in a cholera epidemic was to guard the water

F

121


AN AMJERICAN IDOCTOR'S ODYSSJEY sUJilWiy ÂŁr0m poNuti0n. We closed aN tll.e wel!ls, except a few in the more distant barrios. These we treated with permanganate 0f J?0tasa; n0bl.0ri1y wouJ@ tthen @li\idk tae M00a Fed water. Wherever Jil0ssible, a~~ stagnant Jillaces were drained oy c!ligging ditehes, and certain small infected esteros were jilauolled by the constabulary. Unti,l simJille disinfecti0n wita "M0rine bleÂŤ:ame a.va,i[a!Dh~., the UniteiilJ Sutes Army was als0 GaHed uJil0n in emergenGY to guard the ba,nks 0f the Mariquina and Jilrevent S0a jil0Nuti0n. C0mmunities aggregating ten th0usand were i0cate<li afong the blanks 0f the river, and fF0m time immemori3!l had !Deen aGGustome@ to blathe and to wash there. In the 1<;j@5 eJilidemic, a few .days aEter the first cases of Gholera a,ppeareli! in Maniia, reW0rts of an outlbFeak ca,me in hom San Maee0~ 0ne of the t0wns in the MaFiquina Vai1ey. A Gertain young F~J?ina, living nearby an@ ca,hled by her aclmilJers the Queen of Taytay, was perfonming mitaGJes. She was bathing in a gailvanize@ i.0n ga,rblage diswosail tanK: whieh hali! bleen ablancd0ne61 by the fumy. VilQageFs tr0ID near and far were standing in line all <itay long waiting to drink the water after her ablutions. They believe@ that she was en@0wecl with such miFaGulous cumtive p0wers tha,t the hund.e@s 0f ta0se wh0 @rank would be healed. No d0ubt some wh0 came to m.ink had cholera germs upon their ha,nms an@, as they GHwperii in tineir Gontainet:s, tfie water had bec0me infeGted. Cholera organisms Femained in the residue, which was not removed, so that each fresh tankful was Feinfecte@. Faith aea,ling aas always hali! a troemen@0US 1l.0M ove. aJN pe0w1e of all times. 'Ehis is J?articularly true 0f a c0untry whiGIl. has been disease-ri@@en f0F centuries. To tamJiler with the Queen's mirade waen R,iza~ il"F0vince was in s1:10h a state OF emobi0naJ e-xcitement would, as in the case 0f the Droken sewer in Maniia Bay, have been a hazar-d0us undertaking. But it was even mote danger0us to let her G0nbilme. Although the Queen 0f Ta~tay was inva@ing my preoincts, ] couM think of no legal way in which she couliilJ be st0pped. The Bureau of Hea[6a <lilwa,ys trie@ to proeee~ aiong tae ~ines 0li law and onder, li>ut every avenue in tais case seeme@ to be bloeite@. '!Fhe Attorney Genel'ai went through the PhiliJ?pine statute books, and he also was unable to offieF any soiuti0n. 122


'WATER, WATER, EVERYWHERE :Ii haed te resert to guile. I repaireed to Taytay aned went into €onfenen~e with the father aned mother of the Queen. I conceded that sne might me elioing good, but il pointed out that in the cap>ital she weu:ltd ha·ve wieder scepe fer her activities. Where hundreeds c@uld edrink in Taytay, thousands could drink in Manila. I promised here aned ~a,joled there, and in the end I persuaded them. Even the Queen, atter a eday of earnest argument, consented to come to Manila. In additi@n, I made solemn affidavit to the whole village that she w@uled me gi;ven a,mple opp>011tunity to bathe as much as she pleased, ami that we would take g00d care 0f her. A pr0cession was formed. The Queen and I led the van during the twelve mile walk to Manila, and many of the inhabitants of Rizal accompanied us to make sure no harm should befall her. Before she disappeared within the hospital, I aderessed the multitude, which, atter the manner 0f crowds, had increased enormously in numbers. "¥0ur Queen," I saied, "must go inside to d0 her bathing ane perf@rm her miFacle, but once an hour she will come out on the bal~@ny, so that you may see that she is safe." Though the assemblage edie not seem to be altogether convinced, 110 open protest was made. Curiously enough, we haed n0 eifficulty with the Queen herself. ~t mst she t@@k her baths regulanly, aned Fegularly we let the water run away a,tter she lett and drew a new @ne for her. She seemed to have no C0nGern over the disposition of the water. As time went on, she bathed less often. Since she was being fed well a~d having a p>leasant time, her interest in miracles rapidly waned. F@r the fiFst few days the Queen's malcony appearances had been auti£uhly maede. At night we hae even turned a H@od light on her s@ that her faithful watehers wouled have hourly reassurance. But graduaUy they grew tiFed of their long vigil and went home. She walked en less and less frequently as the numbers of her followers dimin_ ished. By the end of a week she had played her final performance. After tW0 weeks we told her she might go home, but that she should bathe in the tank n@ mone. If she were overpowered by the need for p>erf@vming mirades, she sh@u1cd come back to us aned perform them at the hOl>Jlital. 'J1he Buneau @f Heahh did not subscribe to miracles. We put our 12 3


AN AMERrCAN DOC!FOR'$ OD;YSSEY bith in a new wattlF system. We went thin;y miles fanthtlr up the Mari<!luinaJ tG a sparseLy inhaoitea watershed, and across the \\lure white marble gGrge of Montalban we buhlt a. edam. Necessariiy, the few inhabitants haa tG be mGvea elsewhere; nGt al1 wanted to go. I caa stiJllJ see 'W Ol'CesteF in his (lustGmarily fOFceliu1 language taiking to Gne Fecalcitrant wnGse stabres and sty stOGd besiede a sman stream which emptied into the Mari<quina above the dam. He said this little river bdonged to him, and Fefused! absolutely to budgll. "All Fight," sailil WGFCester. "We can't ))lut you Gut Gf YGur nome. 'Bat we can forbi<w you tG [en Gne aro))l G£ YGur pGllutea water gGW over on our aFea." The farmllr CGulcd nGt very well k/lilp his riveF at home, and surrendered. tiMer the new water sup))lly was tUFnecd intG the pipes, eight hundFed fewer aeaths aanuaillly GGcurrecd in tllil city Gf Manila than Ilv;er befone. We were to be given (wen further pFoof of the vitally imJilontant rGle played by water in the tropics. The Filipinos were always dynamiting the stFeams to get fish, and bly ohance they once set Gff a "harge !!IiFeGtly aoove the water main 'Wi1ieFe it 0FGSSea the riveF bed. We hacd to send al'l the way tG GlasgGw for new fengths of piJile. This accident, combined with a severe dreught, compelled us to go black to the €lId Spanish system. Mthougn we tuied bly every mllans tG indace the peGp.~e to IDGil1 their water oefGre cdr-inking, yet tihFee hanaFllcd and! ten mGre died than in any similar periocd since the new system had bleen €Ompleted. As SOGn as the pure water was in use again, the cdeath rate came cdown, not Gn~y from water-blorne, but £rom a:.t:l GtheF aiseases. 'Fhis was dine@tiy in line with Hazen's statement that when d~inking water was mame sa~e, each death aVGided trom typ.h®id fever caused the aVGidance of two or even three other- deaths from ruseases nGt negaFcde~ as intestia:l!l-blol'ne. !lit would neveF have IDeen pGssible to guaFIil aU the streams anlll shallGw wel'ls Gf the 'PhilipJilines against pollution. Furthermore, if pure water CGuld be provided, we sh0\iJ.d be sJilal'ea the neverendiag task Gf in0mcating the IDoi[ed wate. habit. We askem the Legislature for twenty·£'ve hundred aGi'lar-s with whioh tG hGr.e a few ex" perimental artesian wells. Wibh the gr.eatest reluotaMe this money was a\\lJilf0priatecd. 'llhe members, almost to a man, regaFaed this as 12d-


WAtiIi'iffiR, WitTiER, lEVlERYWMlEiRE a new-fung[@ed nmbimn mf the Ameri€ans whidh €muld not possibly be mb ani)' utHity tm their cmnstituents. l1he iiFst weI!! was dFil[ed in 1906 iII the ~rmvin€e mf Pam~anga. iJit Ciame in sl:l€€essfully and megan flowing large quantities of pure, ~mtal)le water. But the pem~le would not come near it. They said, "If eimd haed intended us tm drink water out of a hmle edrilled in the crust of the earth he wmuled have put it there." AccoFding to their ancient custmm, they continuea drinking out of ~he stFeams in which carabao waJilmwed, aned the wel'ls into which filth dFained. We sent a [Il'ili~inm doctor to ex~lain to the Pampangans in their mWJ!1 Cilialect the vrntues of this new water. In the effort to give them 3J ~Fa€ti(1lll1 exam~le of its bene.fits, he almost water-logged himself, mut to no gooed. 'the Fleople remained indifferent. Other doctors were edes~atched; hmstility grew. One mf them had to flee for his life, ~ur­ sueGJI fuy molos. Rumors began to cirwlate. "If you drink this water," the ;v.ilrrageFS sai<ll, "y.our hair wiN faMI out. If you don?t believe it, 1mok at the 'IDiFector mf Hea1lth at Manila. He drinks this water. Look at him!" [ cmu'ltil maRie no valied defense to this· eonclusion. It posed a neal wroblem, beeal:lse the Filipinos are so proud 0f their hair that they wilLI gm tmalmmst any lengths to eonseFVe it. F or several months the weH bubbled invitingly, but none ~artook. We had rreed the FiJipinos to the water but they would not drink. "illihen we were ourselves vouchsafed a lay miracle which brought to Plass instantaneously aned simply the results we haed so long struggled fol'. This well was located a shmrt distance from a town. A weary and sick stranger was passing ai0ng the Foad, and in his great thirst dranK: mf the water. Almmst frmm the first si~ he began to feel his siekness [Clave him. Me sat edown beside the well and drank more. 'i]l1l\.e more he edFank the metter he felt, until finaJll y he was entirely FClGOVere<d. Whe tra;yei@r hastened to tdl the villagers what had happened to him, and of thCl great medicinal value possessed by this water. Nothing cmuM hav:e oeen better ada~ted to Filipino psychology. The villagers strClamCled to thCl well. The parish priest blessed it. The news spread to thCl surFmuntiling distriets by grapev,ine telegraph. Inside of a week ~CloI!!le were €mming £wm points as 4istant as one huncdred aned fifFy 12:)


WATiER, WATER, EVERYWHERE operation thFoughout the worlcl, and even today are practised by those who ~ive a ~amp life. The pit system used in the armies of the worlcl is but a slight deviation from that enforced among the Ancient Jews. Moses had no knowledge of disease germs, but he had learned from experience that if he died not keep his camp grounds clean, his people eecame sick. Cholera, typhoid fever, aned dysentery are due to soil pollution. No one would think of throwing a suestance known to be poisonous into the yared, OF leaving it uncovered in the house; yet human wastes aFe mOFe edangeFous than arsenic or strychnine, and a thousand times more likely to be carried to the supply of drinking water, or to be erought in contact with the food, than are vegetable and mineral poisons. The public generally is not interested in the subject of soil pollution. The excreta of a great city can be safely disposed of with a modern sewer system, but in the Philippines there were no sewers. 'In the nipa hut districts of Manila, houses had been built promiscuously allover an interior plot of ground without regard to street or alJey lines. Access to many was only by means of a narrow path, not even wide enough for a cart. OtheFs had to be reached by going under the neighboring houses. [n these closeed barrios, made up of coJilections of miserable shacks, without pFopeF kitchen facilitlies or even surface drainage, and with overcrowding worse than the old "lung" blocks of New York or Chicago, the difficulty of ÂŁneding an"ed combating epidemic disease was very great. Kitchen refuse, and even human excreta, were dropped nhrough the interstices in the bamboo floors; the waiting pigs were the only sanitarians. Pigs are omnipresent and offensive in the Philippines, but as scavengers they are invaluable. These starvelings ran loose in Manila until the olfactorily-sensitive Americans passed a law whereby they haed to be locked up. Thereafter most Filipino homes had bamboo - runways uneder the houses. The gastric juices of a pig are so powerful t;hat they destroy practically any bacteria he eats. Cholera vibrios whieh would have kil!l:ed a human being in a few hours, were as nObhing to the pig. We concluded he was a help rather than a hindrance. 12 7


~lf.tlIrHliR,

'\IV:A!FEiR, 'E\\;TlItR:¥W'NiElRiE

am;! melle ~ime ~os~ from ga;intu[ oGcup>ations than all[ otAer ~ropiEal clIiseases Gemoinecil. .Annual11y dysentery assllmed an epidemic form in a numfuer ef leGalities, shprtlo/I afteF the Beginning of the rainy seasen. ell1'ieusly eneugh' it usualLy did not swread By €J<itension as did eheieFa, but kept within certain bounds. Sometimes it appeared simultaBeously over a widesp>read terFitory. It might break out on an islana which had had ne cemmunicatien for weeks with the main[ana at ~he same time as in the thickly inhabited Dagupan Vailley. iDysentery is ef two kincls. It may be caused either by a baciUus er an amoeba, ahhough the symp>toms are much the same. 11he am0eoa is a slightly greenish, microswp>ic, unicellular parasite, which is able to m0ve arounlli with €onsiderable freedom. In the early days we theught all am0ebae could convey dysentery, and, since all water in the Fhilippines centained amoebae, we would have to sterilize it a!1l. 'Phis weulGi have been so costly as to be practically p>rohibitive. "tne prebiem was turned over to the Bureau of Science, and its exjiler.1:s pFoved that amoebae were of p>athegenic and non-pathogenic mroes. $ince the ordinary amoebae did not hurt anybody, this made it pessible te ex€lude trem treatmcmt a great many water installations. ])t was long kn0wn that the drug ip>eGacuanha was useful in treating ci!.ysenteFY. In 1658 it had !been bFought to Europe frem Brazil and seld as a· secret remedy to the F,ren€h government. But the use 0f ~his drug caused d'lsagFeeaMe and exhausting nausea as well as actual vemiting, BeGaUSe ef the large doses essential to obtain fulll curative effeGts. Many 'Vain efEefts were made to coat the pills with salol or keratin, so that they would wass tilireugh the stomaoh undigested, or te eheGk the vemiting wi~h op>ium, dhJorai hydrate, or tannic acid. t,J1ltimateiy, Captain Edward Vedder of the United Stat~ Army MedimI Corp>s, in the iE'hilippines, discevered that emetine, the principa~ atR;aleid er ipecacuanha, had the p0wer, even in high dilutions, 0f desttoying ameebae in test tubes. He Giid not, however, experiment with tl'iis drug 0n human beings. Ji.eonarGi Rogers of the lndian Medical Service, later knighted £01' this distinguished €ontrilDutien te science, hap>pened to read en shiFlBearQ the pamphiet in which Vedder described his experiments. We c0uld hardly wait to FeaGh India and try emetine on dysentery watients. By administering it hypodermically, he obtained r~ults 129 I

\


WATER, WATER, EVERYWHERE obeyea the inst:I;ucticm to partake only of boilea water invariably became sick. One by cme the foolhardy ones woula sucoumb to temptation. We w0u:.td arrive at a m0untain stFeam which rippled invitingly across the trail. They would be so hot, and the water would look so clean and cool, that they would lie down and put their dry thirsty mouths int0 it and drink. For the moment they would be refreshed, but they would soon find to tlieir cost that they had been imbibing contamination from the villages above. I remember one particular expedition when 0Ut 0f twenty men Forbes, Worcester, and myself weFe ~he only ones who dia fl0t have to be carried in litters to the ~oast and shipped back to the Manila hospital. Among the wild tribes, who had the best opportunity to disseminate infection, there existed dense ignorance in regard to the nature of bacteriologica1 cleanliness. To them a germ was a bug, something that Goula be seen ana dealt with by means of a bolo. The difficulty of eJqllaining to a pFimitive race the nature of microbes and their wicked doings was excellently illustrated by the endeavor of Winfred T. Dennison, Secretary of the Interior under Harrison, to teach the Igorots about the amoeba. Mr. Dennison was a little man, and therefore not so much admired in the Mountain Pr0vince as his predecessor, the gigantic Worcester. 'He was convinGed .that he coula rurn the Ig0rots' belief in evil spirits to good aCC0unt, and asked that a motile amoeba be mounted for him 0n a microscopic slide. A lusty specimen was accordingly provided. We went on the annual tour of the Mountain Province, and, at one of the chief towns of the Igorots, Mr. Dennison decided to give his dem0nstration. He haa one of the chiefs brought over and said to him, ee] wa,nt to show you an evil spirit that causes diseases. The white man ean c0ntrol him. If you look thr0ugh this you will see him." The Apo looked as directed, and grunted. ee'ÂĽhat do you see?" N0 repl.y could be elicited. Mr. Dennison then hancded the Apo a pencil and paper, and said, "IDraw what Y0U see." The Apo produced a very good likeness of an amoeba jlll1,lping about. 13 1


AN AMEIUCAiN

iD()C;:~()R'S

(,)DY'SS'EY

Mr. IDennis0n then triumphant"ly ex<!ilaimed, "That's what Gauses d~seases that kill you, but we can Kil!l it." "You say that little thing €an kill a man?" queried tihe A-po incFeaul0usly. "Yes," came Mr. Dennis(m's G0nfiaent Feply. "WeN, it might kil~ a little white man like you, but it w0ulciln't hurt a great big Arpo like me." ~ have £0l1l0wecil 0w.n ~~es o£ exeFcise., €00kecil f00e, ancil b0hlflm water faitMuHr f0r years in line tt:0pi€s, ancil on~y 0nGe haw,e ]j Ilaa any s0'€allle~ ~r0pica] cl~sflase. 'itl'iis was in tne nature 0£ an eXjlleFiment. r was attempting to test th~is hIFther. ] began to aFink watflF €asuaD1y 0n ships and in hotels witn0ut making pFecise inquiries int0 its S0UFce. A£ter two m0nths 0f fihis n0n€ha~an£e, [ came cilown with am0ebic cilysentery at CalGutta.

mr

mr


CHAPTER

I

10.

NOT WITH BEAT OF DRUM

HAVE always found that, no matter what the color of a person's skin, if you can relieve him of pain, he becomes your fFiend. This is especial1y true among primitive races, who are more laNish in their gratitucle than many civilized people I know. In the mountainous interior of Northern Luzon lived three hundred thousand wild tribesmen, untamed wards of the government who, for lack of a better name, were commonly called non-Christians. But they were not savages and, because they had so recently abandoned the FlFactice, they were sensitive to the opprobrium conveyed by the term head-hunter. The principal reason for their long isolation was geographical. The narrow passes which led into the mountains could be easily defencled against a considerable military force. Furthermore, the lancl was poor and the ptlOple fierce and warlike. It had never been worth the Spaniards' time or money to conquer them. For centuries also a feud had smolclâ&#x201A;Źred between Christian lowlander and animistic mountain dwel'Ier, and for a long time it was questionable whether friendly relations between the two could be established. In general, the mountain people were exceptionally healthy and sturdy, and the normal death rate from disease was not so high as in the lowlands, although many children died of malnutrition or improper feecling. The mothers used to chew up rice, camotes, and meat, an<!l teem infants of a few days directly from their own mouths, as a squabl is fed. All fi,ve tribes suffered appallingly from a disease called yaws, which is communicated under conditions of filth and poverty, and 133


AN AMER]CAN IDOC'TOR'S ODYSSEY roy aetual wntact. Albhough not venereal, it had many of the patholegiGail eharaeteristi€S eD syphilIs, among fihem a Jilositive reaetien to the Wasscmmann test. [t :usuall!l\y began wi~h a ~aFge caaiirf!ewer-1ike exeFeseenee ID10Wn as the meuher yaw, and tilierealfter the lesions sJilread over the entir.e bOGY, In later iife it etten caused parallysis and deformities. Children were particularly susGeptible to this disease, whioh fre~uently and tragiGrully rc;Jroroed them of their ehildhood. Our Mst step in p>eaeeful pcmetrntion was te previde medieaJ sel'vi.e fer these mountain clwelJers whem Givililzatie1'l ha<il oveuloeked. Tn the iJigOr!ilt c.o untfy, whieh lay gust beyend 011F @eol's, we roeg?ll tne attempt to relieve some of the suffering caused by yaws. We were making slow progress with the old potassium ioillide treatment for syphilis, when luck unexpectedly came our way. Dr. Paul Ehrlich sent some ef his newly, develoJilea salvarsan ~15(6) to DF. RiGhaFd P. $treng, who e~erimente€l with it, ama fC;lUn@ it marveleus1y effeGtive in y.aws, werking miraeuleas cures. Armel!! anew with this discovery, we op>cmed a smail! aisJilensary on the edge ef the lIgoFet territory. 'I1he healthy IgoFot wore nothing but a roFee<lh dout, rout when he feN iill he immediately took his Manket an@ wFapped himself into k, no sun-d:iai, ne nourglass in the his misel'}'. where Was ne d0@ M011lltain Ji!Fovinee, but the sall 110se every c;lay. il[vepY me@·icine man, IDFewn, Mad!;, yel!low, OF white, 0Eten p>Factises aocus-po€Us. 'if0 an Igerot w,hose sufferings haG overeeme his susJili<rions, we handeill a stick with fifteen loops ef string tie@ around it. "Be up at €lawn eaeh merning," he was adm.0nished selemnly. "Have yoUI' 0010 ready. W:j.teh carefully. must as you see the fiFst yei[ow tip ef tae sun, lOut off ene fool'" !Iiil0 net ta&e off \}loaF bf:l!nket. IDe not [eo&: at your skin. At every sunrise cut one more ~oop. When the last ene is gene, throw asi@e yeur blanket. 1'"ou wiil be well." Having pronouneec;l thesd words, we in1eoteG the 6®6, and sent the Igor0t 0n his way. One oD eUF @octeFs was mest :l!nxious to @'es€Fibe the magie treatment for a meciLica[ jeurna~. We b.a@ seleeted sill!: Jil:l!FtioulaFly intevesting eases, an~ sent for a pfletogFap>heF llrem the Bureau of SGienee, asking the sil< rgoFets to be present on a certain mOFning. 'lIhe morning eame, and so ilIid the phet0grapher, rout no l!gO!0tS:

I34


NOW WITH BEAT OF DRUM "That's just the way with these ungrateful people," the doctor irritaMy exclaimed. "You cure them with great trouble and CQst, lliut when ÂĽQU ask SQme little faveF, that's the last yeu see ef them." Two weeks late!' the doctor heard a gneat hullabaloo. He went te the door of the dispensary, and there were his six "ungrateful" patients, triumphantly leading several hundred of their afflicted brethren, all coming for theiF sticks with the fifteen loops. By healing the people we gradually extended our dispensaries, untii we had JDenetrated into the heart of the non-Christian country. 1Fhe trilDesmen lDegan floclcing to them, carrying their sick in litters and welcoming physicians and nurses into their homes. Eventually at Bontoc, the capital of the Mountain Province, we built a modern hospital, made of brick baked in the hills. It teok much time to teach the people our new and strange ways. Just after the hespital was oJDened I remember malcing an inspection visit one ni~ht and finding al!l the beals empty. I had seen the ward full only a few heurs lDefore. As I was loolcing around for some explanation of the JDhenomenon, I noticed a pair of bare brown feet sticlcing out from under a bed, and stooping down, I found all the patients in similar positions. We had to permit them to sleep on the floor until we ceuld wnvince them a bed reilly had its advantages. J1he non-Christians were mUGh a:vense in the beginning to staying in an enClosed sJDace for any length of time, ignored the advantages of quiet in pFoducing a cure, and abhorred all treatment which limited the usual quantity of their daily food. They much preferred to remain in their homes and enjoy the canao, er feasting, which, according to them, was the best cure for theiF infirmities. But in the end they turned eut to be excellent publicity agents. A man who had been eperated on for a large benign tumor would say to a friend in the same sad case, "You go down to those American doctors. You go to sleep in a room. When you wake up, it is gone." When we first went into the meuntain country, tribe warred against tribe, all hunting each others' heads. The mutual ferocity and hatred was unlDelievaMe. The people were compelled to huddle into v.illages fen JDroteGti0n direm their head-hunting neighbors, and spent hours traveling ÂŁnom their distant fields to their homes. Men from Village A would not even carry our baggage as far as Village B. They would

I35


AN AMERICAN DClCFOR'S ODYSSEY go haH way, lay clown th~irr l(i)acls and retire, whereupon th(i)se fFom ViHage iE W(i)"l'ld €(i)me f(i)rwand ana pi& fhem up. Alm(i)st every h(i)use had its neam rMk, wml th~ number (i)ff sK:u1!ls, which might Fange fr(i)m tW(i) t(i) s~veral cl(i)zen, incii€ateGi the s(i)€ia'l standing anGi pFestige (i)f the (i)wner. HeaGi-hunting was a S(i)rt (i)f game; if (i)ne village took three htlads, the enemy village had to pF(i)Ve its manh(i)(i)Gi by securing four in return. There w(we great GeFemonitlS, with speeGhtlS and songs, whtln tne heaGis were ca~rieGi h(i)me in trium ph. Amy waF>Fi(i)r GieGapitateGi in one (i)£ t;htlse tlR£olmteFs was £(i)nsiclereGi t(i) have ~ast sucrh discFeait (i)n his GOmmunity that he was buritla uncler a trai!l where his resting plaGe w(i)uld be trampled up(i)n. The Igqr(i)ts had a funmameflfal sporting instinct; they would send timely warning to the villilage to be attaeked, and sometimes met by mutual appointment. hi lat~F ¥ears the wan,i(i)Fs wou[€! stage snam nead-huntomg battdtlS f(i)r IUS with s(ilt:ar, ht:aGi axe, ana sAielGi of st(i)ut W(i)(i)t!I ~ashed wi~1't rattan. It was a beauti,ful sight to see with what accuracy they Gould hurJ the wiGkeGily barbed, long steel-tippeGi spear, but gruesome to watch them manipulate, even in playacting, the terrible head aoxe, pointed at one end to puncture t;he enemy's sktJl!l, anGi tashioneGli and sharpened at the (i)ther t(i) wt (i)ffi his head. Heam-hURting was fOl,bidGien b¥ law, but ~he enEor€ement of SUGh iaws is n(i)t easy. in most ba&war€! countries, the white man's usuaf m(lth(i)d is to shoot the offenders; we did it chiefly by changing the nature of the rivalry. We substituted athletics, rt:Giuced to their simplest teFms. ]nstead of roll(i)w.ing the vimagers to cut each (i)theFS' heads (i)ff, we weu'!€! say t(i) those et Vil'l age A, "Ch(i)ose eight ef ¥(i)ur stFengest men. v':i!l[age 'B is g(i)ing te Gie the same. 1J!1l\.en yell wm m(!et in a tug of waF and whichever team can pu'~l the (i)th~r (i)ver the [ine has proved that he be'longs to the better village." These contests becamt: life and Gieath matters; in this way the tribtlSmen sublimateGi tnt: violent em(i)tions which fOFmeFly had found outlet in bl(i)odsheGi. ] maGie many so11tary t;rips iRt(i) the ]g(i)r(i)t c(i)untry, uS],la'lly f(i)rewal'nee fuy W!]OXi(i)llS tri(lnds that ill weudGi @t:l'taini¥ i1De kiilled, fut:tlause [ ceu~d not tel!l' when the savagtlS would turn upon me. I was geing along (i)ne day in a remott: part (i)f the count;ry when my ears weFe

I3 6


NOT' WITH BEAT OF DRUM sta11t1ed IDy the mest stu\,>endeus u\,>roar of yelJing and shouting. It seundeed omineus, IDut ~her.e was no help for it. I had to go on. These agite /;unneFs â&#x201A;Źeu!lcil h:we eutrustanGeed me and cut ofF any possible esc.tpe had ~hey IDeen so minded. The only thing to edo was to keep Cijuietly on as unconcernedly as possible. The din increased as I proceeded. Suddenly I emerged into a clearing, IDut, instead of spears and bolos, my eyes were startled with the sight ef bats aned bails, and the fantastic piature of a savage, naked save f.eF a stF,ing around his middle and a great wire cataher's mask befoFe his face. An inter-village baseball game was in progress. Nobody paid any attention te me; nobody knew or cared whether I had arrived. The teams were fairly matched, and I was soon raised to almost the same pitch of excitement. With one man on first base, a young IgQrot came to bat and, with a resounding crack, hit the ball into left field. The man on first started for second, but it seemed almost certa:in he wouled IDe put out. With one acwrd the cry arose f.rom the throats of the will d men, "Slide, you son of a bitch, slide!Âť The Igorots had watched the games of the American soldiers at the hill station, and were letter perfect in their lines. The meuntain tribes had seme characteristics and habits sharply clis6nguishing them ffom one anotner. The Igorots, largest in numlJers and highest in the scale ef mevelopment, were still not far removed frorri barbarism. Their b0dies were strong and lithe, but around their tattooed limbs they often wore coiled brass rings or bands, which in time became so tight that they impeded the circulation and made the veins stand out in snakelike ridges. Their teeth were filed to shal1P peint.s as a mark of beauty. Their hair was banged on the fereheaed amd long behind, confined in a little basket-woven cap ef scarlet, yellow, aned brown. When matches were introduced, they were kept with the tobacco in this tiny hat on the back of the head. On their chests hung necklaces of dogs' teeth, saved from their feasts. On the Benguet Road I often used to see Filipinos, bound for the - Saturday edog market at Baguio, each dragging along on a leash six te ten yel.llewish-IDFown curs. It was hard to imagine why these lean and hungry beasts, which had never been fed anything beyond the SGFapS ef garbage and Fefuse they haed picked up, were so prized as 137


AN AME!JUCAN DOC"f{)R'S ©];}¥SS'E¥ articles 0f diet. iBut the meat hunger in this country which had little game 0F fish, ha~ givcm the 'Iig0FOtS a keen apwetite T0r prot@ins. lPhe fav0J1ite method of pl'epaFation was to feea ~he starving animal with rice till his belly bulged full ami F0umd. When he c(mld swa110w il0t 0ne gFain 1TI0re,.he was pFOIT\Wtly, kil1eGi anGi, thus neatly setf-stuffed, was FoasteGi anGi eaten. The undigested rice was esteemed the greatest GieIicac;y Gf aU. GeneFM W 00Gi Fem0nstratei!l witlh t'fle 1!g0r0ts, and, partly due to their fondness f0F him, anGi paptly to the tinned salLm0n with whiClh they weFe then being supWlieGi, they agreed to give up the praetice. Since meat CGulGl not be preserved, whene¥er a family hac;! an animall to k;iJJl, it was the 0ccasion f@r a eM/ClO, to which all £~iends Wc;lFe invited. T1here was no wastage; visGera and heaa clisappeared with the flesh as everyboGiy g0rgeGi. When the heacl of a tamiJy died, acc0l'Gi,ing tG the ligorot "Share-tihe-wealth" plan, al!r his Wl'@perty was given away OF c0nsumed. If he wel'e rich, if he had plenty of carabao, pigs, and camotes, the native 1moers, there W0UIM be a spiemGiid festiva:l which woula continue untiJ. the fortune was entircdy eaten up. The feasting m@urners womGl st:juat in the house on the deceased, and cust0m aemanaed ~hat the c0rwse be there w.ith them, jilFoppecl ujil in a rudll chair with a smoke fire g0ing under fum t@ keep him. I havc;l kn0wn ~Rllse a£Fa.irs to ~ast six m0nths, ana in: that ;waJ1m el:imatll thll corpse, even in its smokeGi GonGiiti0n, was likely to beCGmll rather high. !fhe nc;ligho0ring UugaGs haed an unattr,actdvll practice:: of eating thc;lir Garabao alive. 'iJ'1he beast was turned 100se ami hamstrung with rll.e fiFst bl0w S0 that lite @Gulcff nGt escaWIl, ancdl .hem evel'}'m0dy attaGklla him with b@ios, cutting bhe raw flesh from thll living animal. In a fllw moments, the carabao was ehopjillld to pillces. ]i havll often: seen the orowd SG £Fantic with mllat ~ust that the flai!ling 0010s inflietea sc;lri0us w0wlds, Ilven cutting 0ff fingers. It was a j0b fGr sllvc;lral doctors to sew up the i-nuuF,ies a£tc;lF one 0f tll.ese a,fI!airs. 'Later the praetice was f0rbidden anGi, instead, the meat was pFOWerly slaughtered. Igor0t a,nGi iM'ugao wer.e 0bJliged to Gi@pend f0F thc;liF cffaid¥ fooGi on camotes and, mGrll particuJa'Fiy, 0n rice. !Both weFe haFGi-w@rkling agrieulturists and cultivateGi ~he land to the limit of maximum producti:vity. Ea0R ¥ea'F chming .he i!lry seaS0n th@li1sanGis 0f aClFes 0f .icll padcdies 13 8


NO']' WiTH BiEAW OF DRUM were planted in the dry river beas, the stones were cleared out, dikes were eFected, and earth was carried in by hanci, and each year dW'ing the rainy season they were destroyed by the floods and all had to be dene over again the following year. The lans in the Fiver beds was only a fraction of that required for sustenance. There was little level ground elsewhere, only hill after hili, the seiJ ef which had ne acihesion or cohesien, and slipped incessantly. 'With marvelous engineering ability the tribesmen had terraceS the sides of the high, steep slopes, and had leci water to them ÂŁe1' iFJligatien, buiilding stene and clay wails from four to ten feet high to keep the rice paddies from being washed away. From the very top of the mountains they stretched, "Down, down, and away over the mighty hills like stairways of the hosts of heaven." The Hugaes displayed the grc:ater skill in all building operations. 'Tihe Igerot house was merely a depression in the ground with logs and stenes heaped around and covered with a high grass roof. But the Ifugao dwelling, built on stilts with board floor, wooden sides, anS thatched roof, was a remarkable structure. The door posts had interesting designs carved upon them, and invariably the supports had the projecting shoulders te keep the nats and vermin from getting into tilie granary and store room. Chickens were hung at night in cages, like pard7ots, from the Beams undernc:ath the hut. Below these prewled the s<;avengihg pigs, the dirtiest, !leanest, and hungriest specimens I have met with on my travels. ]n the IgoFet country the girls and unmarried women lived in one large house, where young men of the village sought companions for the oolug, or trial marriage. Most of these were successful from the Beginning; the partners in the experiment really wanted to see whether they could live happily together, and childlessness was usu3illy the only cause of dissolution of unions made in this way. As far as I could observe, the Igerots possessed a natural sense of merality. If pregnancy occurreci, the mother and father married. - ABortion was net popular; these who were compelled to practise it l'egaFded themsdves as prostitutes. The Igorots claimeci knowledge 0I a certain vegetable extract which would help te cause abortion ciul'ing the first two months of pregnancy. But under controlled conditions this clrug was testeS and proved ineffective. 139


AN AMERiCAN DOCTOR'S ODYSSEY ~h~

animistic r.digi0n 0f tht:se wises was as uncomFiiGatea as nheir s~xua[ cust0ms. 'ifnt: spwit 0ÂŁ %,fe ane! aeatn was tne beme/kent iILumawig wh0, they belit:vt:d, appeaFea to tht:m in ghostlike form. But fht:y had always to FT0pitiate the anitas, or spirits, which wert: emb0diea in eveFyt;bting aiLive ane inanimatt:-biFd, beast, snake, grass, w00e., 0r stone. Tnt: folkloFe of the mountains was exttemely limited. The m0st common story was that of an old woman wh0 haa two b0Ys. She was never satisfiea with anything tney aid. 'Fbey brought in :liM kinds 0f w00d, mut sne ailways saia it was eifner t00 gFeen 0r t00 oM, and fOF punishment began aepFiv,ing tIlem 0f fOIDe!. 11he bIDYs grew thinneF and thinner until one day one of them climbed a tFt:e ana Gillea to his companion. "PH get SIDmt: w00a to satisfy the old woman." ~irst he taFew aIDwn 0ne leg, tbten an0ther leg, tnen 0ne aFm, then the 0ther arm, tnen his trunK, and 1astlo/ his healii. "'ifake th0se to tne 0ici1 woman," he said. He had given uF his wh0le b0dy ana was now an anita . ]n the f01'm 0f a bwa he aireated the other SIDY sy the sh0rtest Fatn maek to ~he h0use. . 'F0 the Westem mind this story, in its ine0mplet~nt:ss, aaorons n0 tale and Foints no moral}. :But it is typieal of the simFlicity of tilie FFimiti;ve mind which demancls n0 explanati0ns. Fa!' m0Fe JiJa@ k,waFa ana m0re diflicu'lt to make c0ntaet with than 19on)t 0F ]fugao were the 110ngIDts, wh0 suffenea ag0nies fwm thei1' sUJ!lers~itions, and propitiatt:d the evil anitos with shrintlS. 'They weFe f0rest dwehlers, smahl in size and numbers, who !Livea by hunting game with .bteiF [lliFge b0w,s ane al',FOWS, ana wagelii e0nsta:nt Wa:F against the m0re Givillzed peoFles. Lying G0ncealleci rulong mveled trails, hiding behina tneir light wooden shielas 0f aull biriek red, tliey attacha trom amsush, rushing uFon the enemy and decapitating t'hem. W01:eesteF eallled them "a g00d deal more than Na~f devi~, with the b>alanee btaM Gliild, but pecuiia:dy treaener0us, viGious, ana savage man."

Penetrating n0Ffih, further and fuuther fr0m the settled territory, was like pushing baek the eurtains of time. Eaeh sueâ&#x201A;Ź(lssi;ve tribe was IDne steF oackwa:rd in FF0gFesS, ana feroeity ineFeasetit wi~h eaen 01lward step. 11he small tribe 0f the iKalingas, Mong0lian in appeal'ance, livecd 0n I40


NOT WUH BEAT OF DRUM the open sp>aees amI the bane hil!lsides. Their houses were, however, o£ten neste<d in tFees, and even when on stilts wefe cleaner and more of<derly than th@se of ]g@r@t OF Hugao, s@ otten grim€d with s@ot and aslles. Their G@stume was especially colorful; they ornamented their hair with tufts of scarlet feathers, tipped with yellow. Their fighting regalia was as gay as their dress. They had black shields, quite diffeFent in shape from those of their neighbors, and brilliantly ornamented with scarlet and yellow, or black and white. ;Ln making the first o:vel'tures among them, one of the white Constabu1ary officers formed a l)unCHe of the lances thrown at him, and sent tliem back to the KaJingas, suggesting this was not the prop€r way to treat a would-be friend. Ultimately these tattooed devils, whose name means "enemy," were turned into effective agents for the maintenance of law and order. . Once the Kalingas had accClpted the proffered amity, they showed a chi'ld!like €uriosity in the devices of modernity. One of the officers displayed a ph@nograph to a Kalinga chief whG could not believe that the sound whiGh delighted him came from the machine, but ascribed it to some supernatural origin. When the phonograph was taken away, he dug deep into the ground with his bolo, attempting to locate the pipe which had conducted f@rth the sub-terrestrial harmonies. FieFcest of all the mountain tribes, and the last to be persuaded of our peaceful intentions, were the Apayaos. They were supposed to be the remnant of a band of Moro raiders whose wild natures had been attraGted by the wildness of the country, and who found as good hunting there as in Mindanao, a thousand miles away. The result had been a strange people, warlike, but fond of fiestas and gaudy clothing. FOl'bes took a paternal interest in the welfare and happiness of the five tribes, and each year went on a tour of inspection, accompanied by his aide, Secretary Worcester, in whose department lay the care of - the non-Christians, Governor Pack of the Province, the five subg@vernors of Benguet, lfugao, Bontoc, Kalinga, and Apayao, and a few flwored visitors. I went along to keep everybody healthy, as well as to inspect medical progress. The trip, which had to be made on horseback, required about a month. The baggage train would consist of carriers from the local 141


AN AMERICAN DOCTOR'S ODYSSEY provin~e. ~ gorots, nOF

exacmpl€, wouM FIl€et >us act tfu€ edge of tfueiF territory. 'Fhey woulc!l ill pick up their fifty-pound loa@s ane:! dash off over the hills, rarely following the regular trails, but taking a sfuilrt route of their own. We nev€r gave a thought to our unlocked baggage tli.eFeaJtet:. ~ t was invariably sa,f€ wfuen w€ ar,J)ive@ in €aill'\P for nhe night; in my experience] hav€ £ounq! t;hat primitive peoples seldom lie 01' sterol. Not m€rely was €verything in its plac€, but the cal1ri€rs with huge banana leaf umbr,ehlas ha<il kept everything e:!ry in a <!ountry wfuere rain fel!l aimost dai~¥. lBe£@Fe G@vermor !I:'<'@noes was to make his first inspection trip, he suggested that we ride his tli.@roughbre<il polo ponies. I ham been over tile r@ugh, precipitous trai.Is on @ther occasions, and was practically certain tihat I woule:! have dlffi<!ulty in hanliLLing the high-bred ner;vous animal assignee:! to me. Two weeks before we starte<il, therefore, f@1lowing a presentiment, I be~ to pr,aotise mounting and dismounting on the wrong side. By the time we set out [ was "l.uite adept at getting on or @f!i either side of the horse. On such tJ'iIDs iii was fr,equentli)' st@ppeQi br urgent Fequests to visit the sick. Medica,l attention was still rare; we had not yet hae:! time to establish enough @ispensa,r;ies in these almost ina~cessible m0unta,ins. ill happened to be aela,yecl one .ii!ay by One @£ these professional cal!ls, a,ncii the main party went on ahea<il. While J] was hUl'rying to catc'fu up with them my skittish hors€ shiea at a fluttering leaf, slipped, a,nd left thll trail. I leaFed from the off side to safety. As he fell, he rolled over and over, down the mountainside, loose nock datt€r,ing and banging after l1.im. I peened over the edge, never eJqJDllcting to see him, but by some miracle his f@rdoot had ~aught on a vine just at the eege of a sheer drop OF hundreds of feet. I was stanaing helplessly Fitring the dumb anima,l, whel'l the baggage tt:ain <!ame tl'@tting aFoun<d tihe bentiI:. HeFe was a p@ssible s@'Lutiml. The sUlle-fo@ted Igor-ots clambered down goat~ike t@ the eage of the pre8pice ana, while five or six heM the p@or beast, one cut the vine with his bolo, and @thers hauled _he p@ny b¥ the bria'le. He came scra,mbling up the steep hi,l!lsiGie, baalr s0ratdkd but ;witfu no l;)@nes br@ken. The most f@r1@rn mountain village at news of our approach w@u1d be transformea into a bower @f bacmbQ@ acnd greenery. The receptiQn l42


NOT WITH BEAT OF DRUM pM"ties would come to meet us and escort us in under the triumphal areh with a gFlllld hurrah. Always a canao would be held and native edances to the rhythm of an Umpah, Umpah, Umpah, beaten on an instrument that looked like a copper skillet, sometimes assisted by a nose flute or a stringed instrument of bamboo. Although the warriors would seem mirthful aned gay at such a reception, we always had them stack their spears, over which two of our party were told off to keep a close eye, because in case of trouble their first movement was to:wartlr their weapons. One of the essentials in the welcoming ceremonies in any Ifugao "il1age was the passing of the bubud. '['0 the foreigner this fermented riGe cdrink was a vile tasting mixture, but to refuse the proffered loving GUp as it made the rounds was an unforgivable offense. It had to circulate until it was emptied. Furthermore, if anyone entered the company before the ceremony was completed, he had himself to down an entire bumper. I had observed that Dr. Strong always happened to be absent while we were undergoing the ordeal by bubud. This made it necessary for everyone else to imbibe just that much more oE the fearful stuff. I calleed Forbes' attention to Strong's defection; he noddeed meaningJy. We neachecl Banaue, the next vil!lage, in a driving rain storm, and weve Feeeived in a fr.agile lean-to. Dirty muddy water was rushing threugh a Glitch past our feet. Just as the inevitable btebud made its appea-rance the prudent Strong, as was his custom, melted away. Manfully the rest of us kept at the container until finally we saw the bottom. At this point Strong returned unobtrusively and sat down debonair and smiling. The moment Forbes caught sight of him, he turned to the Apo and said, "Dr. Strong has not yet had his bubud." With his dirty toes, the chief immediately retrieved the cannikin from the ditch, poured bubud into it, and offered it to Strong with a fine gesture of courtesy. Strong was now in for it. He would take a swallow of the nauseating stuff, but it weuld not stay down. It would have been a bitter insult to ha-ve spit it out. We gloated fiendishly over his predicamelilt. Largtt tears appeaFed in his eyes, and he haGi many chances to taste it beth going down and coming up before it finally stayed down. Strong was never again late for his bubud. 143


AN AMERICAN IDOC'fOR'S ODYSSEY Pl'esents haed aIways to be given at a canao. Since there were ~h(!)u­ sands wa(!) aali! t(!) r.eGeiv~ them. <dUFing a tJ;ip, this might hav~ s~em~a a diflkult J(!)1b ~0F any(!)ne bJut $anta ([)laus, bJut fiaes~ gF(!)Wncaj!l dhifdF~n weFe j!lerfeGt1y satisfie<d with strips of w.hite paper, which they ti~m gle~ful'lf aroand their black hair. A big s~rong man might (!)btain tw(!), or perhaps thFee, in the grabJ. Such shouts (!)f j0Y were never hear<d even (!)n Christmas morning. Needles ana skeins of G(!)loFea ram spread! equal <delight am(!)ng the w(!)men. A~ (!)ne time ilN.on,estef ;wh(!), bJeGaus~ 0f his Fegail mannel1, was r~gaFd~d with special deference, to(!)K: all(!)ng suitcases of suoh yarn f(!)r the wom~n . 'fo handle th~ ~xj!le0ted rush, he useli! a large GabJin into which they were admitted one by one, and J'lassed out by another aoor. But after Ju,If a dozen had secur~d their yarn, the women, unalble t(!) restFain their. exeit~ment, st(!)J;med tih~ guard, thFew thtlmselves int(!) t;Rtl F00m and DUFitld thtl w.orste<d, ana W(!)FCester as Wtli'l!, in a t~emenlil(!)as sorimmage. A numlber (!)f us I'ushe<d to thtl Fescue. Onlr waving arms ana ~tlgs could be setln; it seemed quittl likely that thtl S~cretary of the [nterior w(!)uld be suif(!)cated. Wtl seiz~d the IgoF(!)t ladies bodily and tossed them through the win<d(!)w unti<L we haa aug d(!)wn t(!) whtlFtl W (!)rGesteF [31Y helplesstr tang~~e in the skeins. !By sU0h m~ans as ~he gi'ling (!)f simp~e pres(;lnts and entewing int(!) theiF testiviti~s, we workee towar-d winning the iirienaship of tihe nonChristians, ana bringing them law and order. But enly little by tttle coule tribal hatFeds be br(!)K:tln down. Once whtln Wtl aFri;ved at lfuga(!) we t(!)und that an Ig(!)rot, in an attempt to escaptl fF(!)m the jail, had bJeen Gaag,h t by the ~£ugalD guard, wh(!) ha~ l1ev~r.tee te their anGitlnt tribJal] hatiFee a,na out him aj!l Ib,uall\y, e:v:en Ibreal!;ing s(!)me (!)~ his bJ0nes. Talcing no ellances, they haa then put irons on Ilim. Dr. Str(!)ng, af.ter working (!)ver the prisontlr f(!)f s(!)me time, was of the epini(!)n he w(!)uld pr(!)bably die within tlight hours, ana wuld almost cel'taiilliy live no more than ten. Since dltlre was n0 possibJility of his eSGape, Dr. Strong ask:ed! to have the inms r.em(!)vtle, ami [aid him on tlk v(;lFamia (!)f the guare aease t(!) <die in ~eaGe. !But mecaase the feeLing against ~gOFOtS was so stl1(!)ng, Captain €ia~man gav.e striot orders t(!) the Huga(!) sentry that tihtl pris(!)ntlr was n(!)t to be harmed

144


NOT W[TH BEAT OF DRUM in any way. Ii£ an ]fugao were given a direct order by his commanding officer, he woui<d never clisobey. Fer a ~irne ruI!l was <quiet. The sentry pacea up and down outside ~e guared house and Governor Pack sat inside edeing his accounts. Then suddenly warned by a slight sound, Pack looked up to see the delirious prisoner, given up for deag, coming at him with leveled bayo· net. With a cenvulsive and almost instinctive leap, he was through . the windCDw, Galling to the sentry, "Shoot! Shoot!" The sentry Waicl ne attentien, but centinued placidlly walking his beat. GovernCDr Pack dodged in through the door, the "sick man" a£ter him, and in a second leaped through the window again, closely fCDllowed by the small dark figure. The foot race continued. Round and round they went-from the garden into the guard house and out again threugh the w,indow. Governor Pack was a big man and easily winded, se that he ceuled never gain a safe lead over the prisoner who, wounded though he was, kept at his heels. The Governor was staggering when Captain Galman arrived on the run to see what all the noise was about. "For God's sake, tell the sentry to shoot!" panted Governor Pack. Captain Galman gave the order. '['he sentry came to attention, raised his rifle deliberately, ana shot the prisener through the head. Then he p.ut the gun back en his shoulder, and resumed his beat as though nothing at all had happened. The behavior of these Ifugaos was an exception. In general, the men of that tribe formed the best Constabulary companies, and practically always won the annual rifle competition. When the Americans came, the undress uniform was "back ana siede go bare, go bare." The government had to consider this prejudice in forming the constabulary. The ]fugaos liked the nice blouses with shiny buttons, but drew the line absolutely at trousers and shoes. As they strode along, it seemed like the march of civilization-strong splay toes gripping the ground _ firmly, brown legs twinkling in the sun, buttons on their blouses shined according to regulations, uniformed hats jauntily perched on their heaeds, aned Springfields ever their shoulders instead of boles in their hands. As soon as !!he health service was well entrenched in the hearts of 145


AN AMER!JiCAN DOCT@R'S ODYSSEY the people, the educators followted 1ihrough this opening wedge. The young 19orots learned English rapiddy, the school idea spFeaed quickly, and the mountain people often ereeted their own buildings 'With fret labol'. The most promising pupils were sent to Normal School, and art now teaching their own ptople. A,f ier the schools were establisheli! the Ohurch bFought up the IieaF, both Catholic and ]\rotestant, aned b~gan to capture pagan souls. ;r on€e met a most edisc0nsoiate ~00Jcing oied iLgorot sitting by nhe r>oadsime. He G00keGi so aosotut~lf. wFetC!heli! that 1 stoppea and askel!l, ''Wnat's the matter!" "1 feet so bad," he answereli!. ''\;Vhy? TeM me ab0ut it." "Oh, Bishop Bl'ent is coming here tomorrow." "He's a nice man," I said reassuringly. "He W0n't hurt you." "Oh, yes, I like him too;" agreed the Igorot. "Then what's wrong?" "When he WaS heFe last hll gave me a hat and I became an Episcopalian." . " iFhat's fine. It's a good Fdigion." "WeN, aJ Ettle later a CatnoliG priest Game al10ng and gave mil a wail' 0f pants, aned ] beeame a «:ath01iG." "CathollGism is aho aJ VIlFy g00cill Fllllgion," it assureed him. "'B ut what is iEish0,j'> iErllnt g0ing to say? ]j monlt want to make him unnappy." 'Fhe ]gorot meeditated until finaNy I asked, "Weld, which aFIl y@u going to choostl?" "I think I'll give the bishop back his hat and the priflSt his pants, and just be an 19orot again." Far more primitive than any of the wiled trioes were the Negl1itos. Only in August, eduring the dry season, was it possible to cross the East Coast barrier Tllef 0f LUZ0n to the country where m0st 0f them 1i;ved. ,[,hey naed once spl'eacl: tlir0ugn the A:r:chiwelago, but thllY WIlFIl a vanishing r.aCIl, onlty SGatteFe€l Femnants of 1ihem Femaining. 'Xhey wer-e edwarfish, with tnicK: l'iws., killock k;nees, and Maek kinky hair. Many of them haed curly IDeaFQs. 1i'neir arms, Hke those 0£ the AbiGan pygmies, were edispFowortionatdy long. What they weFe lirue NegF0flS was shown oy the 0ne wieee GaFtilagll in theiF spFeaGting noslls; ill

]46


atiher raGes h:l>Ve a split ca~tiJ.age. [Even 1ihe oetataans shaw this negroid GnaFa0teFisti€, whiGh is lteganilecd as a r.eliaMe' test far. Negra mlaaed. Ais far as hea~th work was c0ncerneed we G0uled 40 n0thing for the shy" mi~a, Ettile people any more than we c0uled far the deer in the f0Fest. 1rlhey spoKe neither Spanish nar Elnglish-onl'Y a gabMe of their own. They haal n0 h01!1ses; f0r shelter they ripped the bark 0ff a tree and st00a it against ano~her, tree. 'Dhey useal m0WS and arFOWS smeaFeli! with a€aally p@isan, the merest scratch hom which was Sl!lPJil@se<i1 to me fatal. Like the natives of Yap, fhey made scar patterns by Gutting theiF sklins with sha~pened pieees 0f mamboo anal rubbing alirt int0 the 0pen wounals. 'Tlh ey were w0naler tul w00dsmen but good f01' tittle else. 1Ii1he [E<1iJipin0s haal trieed to use them as h0use servants, but they, were hand to al0mestieate. 1i:h0ugh they d id not slave-raid themselwes, these impr0vialent pe0ple, when they suffered hom hunger, useal ba seN their ehiicdFen into slavery. £@metimes they came into the cultllvateel €@untry dUF,i ng the harvest season ana worked in return far l'i€e ; @therwise they [i¥ed 0n game, fruit, and r00ts. A smrulll calony at them had settled back af the· quarantine station 011 the slopes @f Mount M ariveles, where on Sunday afterno@ns I useG! 0ften ti@ go for a straN in the hilts, ®n one occasion I had proeeeedea out a mile ar tiw0 aIlong a tFaii when I met a little naked Negrito girl ab0ut ten yeaFs old. "HIiN0," !Ii saicil without thinking. "MeNa," she responded with an ./MneFican aceent. Talial not melieve I €ollied have heaFd aFight. To test my ears I said, ''What would you J.ike to have?" "'Ai. d'loe@late iee CFeam s0ala," she answereed without the slightest hesitati0n. ~ wou[(;Ill.ave gFanted this simple wish had it been possible. Instead, I in!'J.uiFec;i fur-ther anal f01!1na she haa been one of the exhibits in the $t. :!Louis :ffixpositi0n 0f 19@3, anal fueFe had reamed English so that - she e0uid speak It as weli as any Ainer,ican child. One amusing 0lcd feJ.r.low in her tribe used to ca~l himself a ehid, but Il.is s01e distinguisli:ing claim t@ such rank was an ancient si,fk hat, his 0i1'ly aFticle 0ii d0thing, given to him by a Spanish official. It :1;1ways Femainecil a m¥stery h0w he kept it alry and prevented it fram ffi@laiing in a country where edampness and heat were so incessant. But

147

\


AN AMERICAN ]DOCTOR'S Qf)¥SSEY in the €Durs€ ef yeaFs it became tattered and t orn. Wercester was se deiighteed by the Ghief's unusuaL Gestume aned ahaiell that it weuld net [ast inedefinitely, that he lbveugfit a n€W silk nat k.em tae States an<d pFesenteed it te the Negrite. 'Fhe hat must long since have passed to the elcll ohief's descenclants, but to this <day [ h3ive no deubt that its lucky ewner is aGcordeed a position of honer and edignity ameng the shy Negrit0 survivors ef the Ma~iveles Ril!ls. During m¥- nFst years in the Philippines ~ hadllittle te ao :with the Southern ls1an<ds eu Mimlanae an~ Jole ana the ether Mohamme&n lands. They, weFe aclministeFem by the hmy, ana their health serviee was also under military contrel. It was always fhe enaeaver ot the Givil regime te extemd its sway to these [slands as soon as they coulell be. pacified. 'This was difficult, lbemuse the SJ;>aniaros hacl been sh00ting them £eF several hundFeed yeaFs, 3inmeur Mmy ana iNa,v y was similarly engag€ed fer. eyer ten. PeFsll,i ng haa "SUOaU€ed" them, aned Weed had led a great attack te the ctlnter ef Minedanae. i1t'llGh time the Yakan Moros, more savage, more eruel, and more agg¥essive than the Ilongots, had reta[iateed in kind. 'Dhe chief pet€ntate to whom all the d-attos were subject was rlliie Sultan 0f $u~u, wh0 liW'eed en tfie island et ]010, but was aJse Suhan eu Borm:e uneder 'BFitish jurisdietllon. IDhe Femnants of his fOrm€F p0wer G0u'1'ell only be exeFciseed ever petty ell'enses and religien. ]n spite of being subsiclizecl both £rem Philippine ancl British sourGes, he was ,always notoriously hared up. On one ot my visits I was aGcempanied by BT0fessor John Mulholland eu C@lumbia University iWae, in his lighter. moments, practisecl magic ancl was ellipert at this art beyened m0st Jl>r.etessienails, wllwa;ys maintaining that it Gonsisteed selely ef triekeFY. Tegether Wtl paim a call on the petentate and, in er<!ler to entertain him, I asked tfie Fre: fesser te wer-k some of his magie. He agre€d ana went through the usual rigmaFole of making things dis3iPFlear anell reaFlpear, ancl th€n turned to the Sultan with the F€maFk, "I can't pessibly undel'Staned who/ mene¥- sheuM lbe se S€3iFG€ in Jele when tlvel~ llfltl aiF is £u~l of i~." He theFeupen te0k elF !lis €Gat, Fohleed up his slee;\<es, aned Jl>u1Il€td silver clollars out 0f the air until the floor was litteF€o with them. The Sultan's eyes Jl>opped so far eut of his !lead that they couM h3ive been

14-8


NG>T WITH BEAT OF DRUM 1rn0ckcld 0:ff :w.it'll. a stick. To think that the air was so full 0f meney ami he who neecdecd it S0 much had not been able to discover it! He was inartieulate with amazement, and I do not know to this day what he Fea,lly thought of the performance. It was n0t until we changeld our p0licy to one of peace that any rea:! pregress was made among the Moros. In 1914 the change from military to civil government was finally brought about, and Frank W. Carpenter was put in charge. As Governor he showed the same sagacity as he had displayed when councillor to the successive Govem0r <r;enerals of the Philippines. Tremendous pr0gress was made toward pacifying this race ¡of warriors under his administration; the b010 and lihe rifle were replaced by the hoe and the plow. Much time was a!lse spent trying to organize schools to which the Moro women eeuM go, but the men always reterted, "We don't want our women educated." The Mero health service was brought under the central office in Mllinila and Fe0rganized by Colonel E. L. Munsen, who had done so much to help formu1ate the sanitary laws of Manila. Hospitals and dispensaries were established, and produced the same calming and civilizing effect as among the wild tribes. Colonel Munson was succeeded by Dr. Jacobo Faja,rdo, who carried the work yet further and accomplished it so well that ne eventualily became Director of Health of thel Philippines. With three hundred islands to inspect, scattered in a huge thousand mile cFescent from the tip 0f Luzon in the North to the Celebes Sea in the South, much ef my time was inevitably spent upon the water. Some of the Islands-Cebu, Mindoro, Negros, Samar, Leyte, and Panay-were large and easily ll!Ccessible. Others seemed lost in the immensity of endless sea and sky. Once a year only the mail boat went to the rocky Batanes, tiny Christian outposts anchored firmly in the wincdswept Bashi Channel. The tidal maelstrom which separated them from Formosa rushed by with. such fury that no swimmer and no boat propelled by oars could make headway against it. Clne ef this iS0lated group, only ten miles in diameter, was the â&#x201A;Źurious and remote c0ral islet of Ibayat. It formed almost a perfect circle, cupped around a lake in the center which furnished the few thousancd inhabitants with water. Ibayat rOSel sheer from the sea; ~n 149


AN AMERICAN DOCTOR'S ODYSSEY eGea,n ~ine~ €eu1ilL stea,m clese te its edg~ a,nd stiil find! ne a,n€llerag~. Fier€e as was th~ time oe1ew, the wind en top was ev~n fierceF. 'The houses had to be tuGkem half inte the ground, and the lioefs fasten~d on ,sewrely. lin seme areas, ea€h stalk of suga,r cane ham te be pegg~m 'to the gFound. 1"h~r~ was ne iDreaK: in th~ GirGwar Fim; not ev,en a goat ceuld clamiDer up. The island provided unexGeIJ~m gra~ing land, anm the herdsmen ham mevisem a m~thod of exporting Gatt1e which, a<ltheugh it seemed Gruel te W ~ster.n eyes, serveCil its p,ur.jilese. 1Dhe a,nimMs were ar.i;ven te the emg~ ef ~he J;lreciJDitous cli,flj anCil then ~\:I~hiIessly JDroaded into spaGe. I have watched th~m drop with helpless Jegs asprawl, aN the while bawling in mortal} terror. TheF~ woulm be a, sp1ash ana a thum, anm a splash a,nd a thuc!l; then oeIDbing heads w.eulm emerg~ and the peor frighteneiil €reatUFes w.ouM swim maml1y in a,l!J: Gfirections. RowiDoats £Fom tfi~ steamer would close in te piek up the shert ropes previeusly tiem areund their flems, and when five OF six hatd been tewem within rea€l~ et the steamer's WiMfi, <'Jne by €me they weu<llil iDe hal:Ilem aboarcil iDy the hems. As ma,ny as thr~~ eF four hunaFe@ woulm IDe taken away en a tFip . .At rare intervMs I paim a "isit to insJDtl€t the work of the resiment medi€al efficer. 'ill'<'J admit th~ visiter, tfl~ !lJbayat hermits, lik~ the mon1fs e£ A'thes, <l~t oewn a lDaskoet dangilng at ~he en~ et a leng v,ine. We maneuvered und~rneath ancl, what with the reGking et the beat and th~ swaying ef the basket, alm<'Jst simian agility was Fetquiretd to sCFamMe in. I clutGhem its sides firmly as it swung JDeri1eusly back and f,el'th; the v.ine stem seemed! a, iiragikhe1Cil te lik rn watohea the tep ef the cliff slowly appF<'Ja€h and €OU!ld not pFevent a sigh of relief when the basket bumped on selid ground.


CIilAPTER

[I.

FOR THEIR OWN GOO D

HE Bureau of Health was like the tree of life, Yggdrasill. Wor¡ cester, Forbes, and I were the three Noms who assiduously watered its roots, which pushed their way around stones and through clay into the not too clean earth of Filipino existence, so that it might reach from the Hell that was to the Heaven that might be. Necessarily we had to invade the rights of homes, commerce, and paFliaments. We had to guard against the entrance of dangerous communicaMe diseases by strict measunes, even when they conflicted with c@lwenience"or personal necessity, and segregate the cases of leprosy :w>hich might endanger the health of the greater numbers. Hospitals for the sick had to be built, and doctoFS and nurses trained. The physica:l welfare of the morally ill had to be cared for. The helpless insane and orphans had to be provided with homes. Births had to be rewrded and resting places found for the dead. What the people ate, what they drank, where they went, and how they traveled had to be safeguarded. Finally, the great majority had to be taught how to arm themselves against disease and death. . But always we tried to tangle the threads of Filipino lives as little - as p@ssible. When we arrived the hospitals were of the most primitive type. 'EheFe was not a g~@d operating F@om in the Islands and no laborat@ry faeilities. Modern medicine had not penetrated faJ:. To remedy this comiition Worcester, in I'l)OO, had formulated a plan on a noble scaQe to built;! a hospital, a medical school, and a laboratory of science

T

l SI


AN AMERIOAN DOC1Ii'lDR'S OD1':SSEY aN in one integra'l group-the meediGaiI center iedea aedopted III the Uniteed States so muoh later. &fteF the !BuFeau ef ScienGe was starteGi in ](;)01, the neJ<t step was to train do~tors. The ancient Santo ']j'omas l!J niversity aJready had a medi.~l seheol attacheed to it, but it was inade,!)uate. ln 1905 we semrem an all'pFepriatien feF aJ g0vernment ins~itution w,ith Arnel'ican curricular requirements, whiGh later was to become part 0f the g0vernment-owned University of ~he Fhilippines. When the Chureh scheol saw the meFe modeFn ene in ell'er.atien, it Faised its stanGiaFeds so that, in addition to turning out eur ewn graduates, we were, by our example, assuring a further suppty of well-trained young men. The Filipines made exee[t[ent phrsieians, ence their m,is[.ike ef m,iIftying their ham;ls was overcome_ But the project was not yet completed. Session after session aned year after y€tar Worcester ll'Fesented te the !egislati;ve 000Y a retquest fer money with which to build a modern hospital in. ManiJa. As often as he came away clisappointem, he returned te the ~harge. After eight . y€tars of steaGiy pounming he was r.ewal'edeGi with swecess. The il"hi~p­ pine General Hospita'l was authorized in 1-908 an€! cempletem in 19T@. Wospitals are too often bare and bleak. We tl1ied to make eurs, bwilt on the paviJ.ien system., open on al'l sides, cooi, pleasant, and cheerful as weill as praoticaL By polishem mela¥e aned media aguas we endeavored to soften its white austerity. For the first time hespital beds were etquippeed with wheels; tney couled be Fohlecil on te the spaeieus veranclas s® that tne eyes 0f Genvaiescents CGulcl be made g1acl fuy the sight of royal palms and the gorgeous acacias, which twice yearly made the grouneds a sheet of flame. What the patients ate at heme was not goecl for them, and we had n® wish te maKe them amopt eur .f®0d, which they did not like; we handed ever the problem of modifying their diet to importeed dieticians. But a fine hospital was net enolJgh. The imp®~tem American nlU'ses would so®n go home and it was.essential to have iIIi'lipinas te take their places. In the effort to train them, we came up at once against the stFengly r0eteGi s0ciail eust®m which deereed that women sh®u~cl €!o no manual work. My constant endeavor was to interest the FiJ.ipinas in health work; through them we could reach the men also. Rarely dis a !I11i[ipin0 take any aetien with®ut fiFst e0nsu[bing his wife. She hefGi 15 2


FOR THEm OWN GOOD the keys to whatever there was of value in the house. She was the fuusiness manager and, as a rule, she was the m0re intelligent. The ma,n c00kem, washed the dishes, rna'de beds, a,ncl also labored in the fields. W0spitall nursing was foreign to the Filipina of the upper S0ciai strata. This prejudice had to be overcome. I first persuaded five girls at the Normal School to include a course 0f nursing which in the beginning was to be entirely theoretical. They seemed to enjoy learning out of a book how much of this or that drug sh0uld be given for this 0r that ailment, but luring them into practising their kn0wledge was anether matter. Only after much cajolery on my Jllart did they consent to wander around the wards of the hospital for a few hours each day. But then they struck. It took candy and Hewers to bring them back, and no sooner had I shepherded them into the hospital than they walked out again. After this had happened three times, r effected a compromise by installing a small sick bay ill the iNeFmal Sch00l, where a few students weuld pretend to be the patients. Hal'f-heartedly for a fe'Y days the girls practised bed making, giving baths, and dish washing, and then declared, "This is servants' work. We'll have no more to do with it." At this turn of affairs, I threw up my hands. Not even Miss Mary C0leman, who was in charge, Gould, by any form of persuasion, get the y0ung .ladies back. Finall,y, in a moment of inspiration, she ann0unced, "We'll have to write a play." "But I don't know anything about playwrighting." In the end, however, we composed a remarkable drama. I supplied the technical details and Miss Coleman the plot. We engaged pro£essi0nal actresses to play the Toles of the nurses, who were all costarred. The perfermance was attended solely by invitation and sparkled witih secial t0ne. The wives of the highest ¡ ranking officials were all patronesses, and the tickets were distributed to a specially selected _ group, including our former pupils. The play, which was produced before a capacity audience, provecl an unbelievable success. Crisis fol10wem crisis. Almost every instant a situation arose where a nurse saved ~he mar. Whenever one ef the numerous heroines would rush in and snat"h half a dozen lives from the jaws of death, loud and enthusiastic applause would shake the hall. \ 153


AN AMERICAN DOCTOR'S ODYSSEY The next met:ning the five girls were back again, this time to finish their preliminary GOUFse. Als seon as it seemea safe, [ ventunea te sen~ them te the hosp>itall, with the intention of having them practise two heUFs a, .a a,y in the waFas. The morning a£ter their first el!perience, I was sitting at my t'lffice aesk when the attendant bnought in a shea,f ef cards. The briefest glance infopmea me that I was in fer a mass attack trom the parents of the girls. As they ste!ilmea through the <rl:oel', the leaaer saia, '\@ur aaugll.tel'S have Deen humiliatea anG disgl1aeea. We al'e taking them heme at once." "Why?" r inquirea innocently. "My Rosita was asked to go into a room wheFe a man was in bed. She never Gan heia up her head in society again." I tr,ied neasening, but w.ith ne suceess. Nebhing I eoulcl say weula eause · these eften~ed patients to change their minas. ]; then plao/e~ my last cara. "I've been very patient with you," [ said. "New I'm tired ef aliI ihis nonsense. Our American women are just as fine as yours, and they take up nursing Gareers w.itheut ~ess of dignity or self-resp>eet. If yeu'ne so fa,[ &ehind in the sGaile et ei"il1izatien that yeu can't ~eaJize this, tali!e your dal:lghteFs out ef the sehcmi at onee. ] den' t want them 1?here any lenger. I've given them the eFpe~tun ity to learn an henerable pFl!r fession. But you're just exactly what your critics........" «Wait a moment," they intenrupted in concert, "let's consider. this further." "Ne.! !Net for a sllcena," ]1 assll~ted fil1ml1y. "~ake the gitlls a,way." 1i1hey Ibllgan te ~lea<d with me. '[1heiF aq;~uments tUFnea te entrea~ . "Ne!" ] sail!! haughtily. "1!herll's nothing mere yeu need say." But they said much more. Only after an hour's ardent efteFt were they able to Jilersuade me not to Gismiss their aaughters. The next year the class increased te thirty. iFinailily we haa te make pFevislon fer two hunared. w'e aistrilbutea app>i~ Gation blanks ameng thll seheols, which were te select the mest aesiralb1e giIils. :IN'et only the chesen enes put in an awpearance, but an aaGitienail one hunarea accompanied them. I was pleasea with their enthusiasm, and told them r genuinely regretted we haa no reom fer the extra enes. IS4


FOR THEm. OWN GOOiD All Filipinos, men, women, and children, petition the Legislature when anything displeases them. T~e hundred rejected girls appealed to the Philippine Congress. They said I was refusing them an eduQltion, and-ellmanded entrance to the school. The Legislature subpoenaed me, read charges against me, and intimated that my resignatian was in order. When this ceremony was over, I asked, "Will you hand me that digest of laws over there?" ~n the ÂŁourse of my professional duties I had been abliged to familiarize myself thoroughly with the volume in question, because such contingencies were apt to occur at any moment. I flipped the pages to the paragraph I wanted and read it aloud. It was to the eHect that any public officer who incurred an expenditure not specifically authorized by the Legislature would be subject to fine and imprisonment. I dosed the book with a bang, laid it down, and stru~k: an attitude. "I am acting in accordance with your own law," I told them. "If I ad'mit these girls, I shall have to feee and house them. You have giVllll me no money for this purpose, and I refuse to disobey the law!". ''We see that, we see that," they chorused eagerly. And immediately a law was passed appropriating the money necessary to include thll extra hundred students. ill a way the question raised by the l.egislature was most gratifying. lit shawee that nurses were making a place for themselves in the life of the community and that there was a desire on the part of the lawmaking body to give them protectian. The long struggle to establish nUFsing in the Philippines an a sound basis with standards that would compare with the world's best now began to look: as though it could be won. In this I was not only thinking of the Philippines but other ~auntries in the OFient. There was hope that the sick of China, Japan, Siam, Java, and other Eastern nations could have much more adequate carll. A career was in prospect for the women of the Orient through wliich they might have an important part in aileviating unnecessary suffering. If nursing on a proper basis could be established in the Philippines there was much reason to believe that it could be done in otaer Asiatic eountries. 155


FI@R TWnlil!JjiR @WIN @@@!IQ)

Man¥ of m¥, e'oGtors i"ter attainea eminen~e in the mec;j.i~ai :W01ild, ibut one of tliie greatest ,geniuses "mong ~hem aG!'tievei!l no SUGh Feputa~i c;)fi. iIDI:. @iilDert ]. eui[en coula 'ao more things weIll than anyone [ /it"ve e,VIlF kmoWin. Whenever any plaGe was mentioned, he haa been uheFIl; whenever an¥ibody was in a tight spot, GuUen ""as able to ex1!FiGate him. H is feats of. iegeri!lemain s0unaed so improbable that mmr JjleoJjlle €onsii!leFei!l his el!iperiences fabriGatea. But I saw him often in a~tion" ani!ll am sune the things I aid n0t see must also have Been true. ehlien hai!l come out in 1899 :with the PhiIippinll V0iunteers, and !'taG{ se~Med in WeI[ Roa~ing Jake Smith's contingent at Samar, where Ill'te insUFr.eGtion was nging most violently. All the sign"l men had Been kilQeill in t!'te initia.>l fight, ana there was n0 way of communicating witll. ManiJa. S0mebody familiar with Cullen's' versatility suggesteill he might Ire able to use a telegraph key. "Oh, yes, !Ii Gan telegraph," Cuhlen admitted readily. For a month he a.>lternatei!l GliGking out messages in M orse with dressing wouni!ls ana tending the sick. Tihe Army was so grateful that a line was ilIiveFtei!l to Il.is tent trom the main Gable, through which all the news oE the w0rla Game to him. Lt was aiways possible that Cullen, in t!'te G0UrSe 0f satisfying his Guri0sity, might stumble up0n information 0£ va.>lue. ' CuNen sewea the AFmy weld not only by his varied knowledge but also by !'tis physiGaI cOUFage. W,'hen it was aJmost certain death for <!Iny. A!meFi~an to set foot in the P ula jan country of Samar, the C0nst-abuiary askeG! him, bemuse he haa alreai!ly familiarizec:l himself with the nati;ve aia,l eGts, to unaertake a mission into the interior. He went a:l'one, ami by methoas 0f his 0wn arr."nged for the surrender of the ree~ls. ', When CUllen came una er my gUFisaiGtion I appointei!l him Health <DffiGtw 0f Samar, where his I:eall¥ thor0ugh kn0wledge of medicine G0uJjllei!l :with his unri;vaied knowleage of the ]island made him invaduaMe. iW!is intimate accquaintanGe with Army affairs 0ften stood us in g00i!1 stead. One day he walkei!l unanneuncea into my office at Manilla. " What "re you i!loing here!" ~ asked. "I didn't give you any 0Fae17S to leave Samat:. You're supposei!l to be there attending to y,our

aob ." 157


AN AMERICAN i[)OCTOR'S ODYSSEY Government approplliations were meagre, as Cullen was wdl awa~e. «[ knew hew impeliltant bargains are to yeu," he reJi>iieEl. «11hete's geing to De a big ~lear.ing out sale of Army meedicaJl sUPFlies. I wanted to tell you ahead of time." "How do you know?" I asked. All Cullen would vouehsafe was, "I've ways of fineding out." That same noon I met the Quartermaster in €harge of Army suI" plies ana remarked, "I hear you'Fe having a big sale of meeIiGllll ar,tieles." "Oh, no, we're not having any sale," he assurea me. 1 sent for Cullen. "I've just seen the Quaite~master ana he says there isn't going to be any sale. I assume you haa some private neason for coming uJi> here. l1he best thing you can do is to get back as fast as possible." "Y01:l!1~ get not·iee pFetty soon," Culien repliea eonfiedentily. 'fwo €lays later the Quartermaster approaGliea me. "Do you remember you asked me abeut a merucal supplies sale? Weli, I don' t know how you found out, but we've just had a cable this morning teliing us to clear them out." l1hel'eat ter I believed in the aGcuracy of 0 iiHen's information, though 1 never diEl fine out hew he obtaine® it. Cuilen hacl a:lso haEl training as a iawyer. He was able to piead eloquently in Gourt, and otten a efended the poor without thought of a fee, usually winning his Gase. But whatever his extra-medical ac;; tivities might be, he never al10wed them to interfere with his work. He was one ef those rare individua:ls who requil'e only a few hours of sleep; he dia his reaaing ana e:x;perimenting at night. F'\lI1tlieFmere, he was se proficient meohaniC!llI[y that he was ab'le to start a stul'lbolln fire engine wllen noilo was burning up, ancl even lDuild himseH a raaio set out of odas and ends when he was confinea to a hospital bed. After Cullen had served at Slamar for some time, [ had him transferred to the [aIDeratory of the Bureau of Sl€ience with the iaea of having him aGquaint himsel.E with the more reeent cleve10pments in soience. He had meen there no mere than a WeClK: when the heaa at the aepartment askea me, '''Why did you sened Cullen here? H e knows more laboratory proGeedure than we de."

158


FOR THEIR OWN GOOD At another time a plan for the Ceast and Geodetic Survey of the mslands was being developed oy Geol'ge Rockwell Putnam, who iWanted te aeter-mine the exact spet in the PhiJ.ipp'ines on which to base his suwey. '['his problem in triangulation was extremely difficult, and an expert in geodesy was breught from the United States. Dr. Cullen happened to drift into the Survey office at Manila and asked inq)lisi~vely, ''What al'e you fellows doing?" ''We're trying to plot a base position," he was told. "Let me see what I â&#x201A;Źan do," said Cullen. With seme merriment the data were handed over to him, put he sllrJllris~d the experts by rolling up his shirt sleeves and setting effiGiently to work. Their amazement grew as he completed step after step and arFived at the correct solution. Cullen was p'ast master of practically all branches of higher mathematics. A eeast guard cutter was once about to leave Samar when the effieeFs decided they needed a purgativ.e. Somehow they confused a bettIe of bichloriae of mercury with Epsom salts; several died and tne others were completely incapacitated. Nobody was left on the DFidge. When Cullen volunteered the information that he had officer's p'apers, he was thankfully told te take command, and he navigated the ship' safely back to Manila. CuMen .was allways immaeulate:ly dressed. When everybody else iWas het ana untidy, he was clean and coel. Dr. George Shat~ck of B~ston went with me on one of my leper collecting trips. When we were off the East Coast of Samar, he said, "I'm terribly embarrassed, but I've left my teothbrush behind. I don't suppose there's any possible way of getting one here." 1ihe plac~ was remote and the near.est shop many miles away. But !l' autematically said, "Cullen will be able to take care of you." Cullen did not let me down. T6 my question he replied, "Certainly, I have a new prophylactiG brush right here," and reached into his dWllebag. "How about some chocolates? Got some of those too?" I asked jocularly. 'cw.oulli yeu like a box?" he asked, and, like a magician producing rabbits hom a hat, he handed out a pound carton.

159


AN AMERICAN DOCTOR'S ODYSSEY One ali the inevitahlle G!aties of <liny cleFlartment ot he<lilth is r(;he Gompilation of ¥itai statistiGS, whieh are an indispensa!ble measuEing rod of sanitary progress. BefoFe we took charge in Manila not over forty percent of the births theFe were Feconded, and the percentage was far lower in the pFovin~es. By persistent efforts we gralliuali1y . 01[ected the neeessaFY Iliata. Sanitary inspeGtors on their rouncls woUld make inquiries as to whether there hacl bllen any new biI1ths, ancl hlaptismal infoFmation was obtained from Ghurches. The eemeteFies proved to be one of the most vexatious of aiil 0ur admini.s trative pz:oblems. ~n Spanish times tne pFaGtiGe hacl !been to deposit boG!ies in tented graves or in leaselli niches, the lease period being usually five years. When the time expirelli, the well-to-do would renew their leases 0F FemOVIl the bodies to theiF final resting p1a~es in the crypt. iEut un~ess <linother Gash payment were maMe the hlones were thrown out. When the AmeriGans Game to the IslanMs their first messages to the homelami tolcl of the ossuaries, or human bone PflIlS, hlack of eVllry epUFch, anG! many a femur aRM tihlia fouRcl its W<liy to the U nited States as a relic twm this far away and very ollid Gountry. In [ess than fWo years alil the bones in the ossuary of Paco cemetery disappeared. Sometimes a section ot a skeleton would turn up under queer £ircumstanGes, ancil we weFe never "luite saFe whether a muraer haG! taken pla€e. No reGorllis seem to nave belln Kept as to the exact 10eati0n of boG!ies in the majority of €emeteries, which were scattered helter skelter over Manila, and mourners not in£requently halli to witness the uncovering o£ remains in the same gFaves in whiGh theiF own deaG! were aDout to De laid. Five or more bolliies haG! sometimes been interFed in one grave. Governor T<li£t was amazed and distresslld at the eondition of the cemeteries., anG! haG! a Jaw passeG! which compelled eaGh one to seGure a license. Being ahlIe to tnink of no other ageney, he put the enfor.ement of the ordinance into the hands of the Health Department, even though the problem was one of esthetics and not of disease. We haG! to elliamine each GemCltery anG! listen to £omplaints whiGh, in some cases, red us into [egaJi Gompie;x;ities., <lind m<liny times into £onflict with the peopie, a situation we were most anxious to avoid. As the schism in the ChuFc!h proceeded, the fol!lowers of Father I60


!FOR 'fWE[R (i)WiN GOO])

Aglipay wer-e not aillowed to bury their dead in the Roman Catholic cemeteries. Constant fights and reprisals took place. An Aglipay health officer would declare a Catholic cemetery insanitary and close it. A Catholic of the old faith would complain to me there was grease on the top of his well, which must have come from some grave in the A:glipay cemetery near his house. Whenever we had to close a filled cemetery, the Church had to fin!li new ground. Formerly the government had supported the ChuFGh; now, fees h~.d to be collected directly, so much each for bapbism., maFDiage, and buriaL 'fhe FiJipinos were not used to paying fees, and pa:id them seldom if eve.; the priests had very little to get along on. An Aglipay cleric one morning came to my office, and begged for a permit to bury a rich parishioner whose family ardently desired to have him placed in a cemetery I had ordered closed. "I'm sorry I can't open this cemetery for you," I said. "It's far too crowded already." "Oh, I should so like to eat some meat," he moaned. "I've had nothing but rice and dried fish fer so long a time. You could make it pessible fer me to get some meat. All I need is a temporary permit for ~his one burial, an!li I GOulcl get some meat again." Jj Gould not make an exception fer him, but compromised by buying him a mell!l w,ith meat indu!lied. [ not only had to watch over the cemeteries, but also concern myserf with allied activities. There was an undertaker in Manila named Dell who had erected a new and first-class establishment for which he had to get a license from the Municipal Board. But all was not plain sailing, and he sought aid. "You've helped me with the plans for my mortuary, and you know I've fulfilled all the health requir-ements. But the Board is going to vote me down. I don't knew what I'm going to do. All my money is invested in this, and I'll lose it ali." "Hew do you know you're going to be turned down!" I asked. "1Ehey've got a petition signed by a thousand people saying my estaD1ishment would be inimical to business and bad for tracie." "Mew much time have you before the hearing!" "Only three days." 161


J&N AMER!l!CAN

DOC~OR'S

O:0¥SSE¥

"'I1hatls time enough. Write yourseH a flowery F'etition. Tell how your establishment would enhance valu@5 and b~ an ass~t t(;) the (lity. Show h(;)w desiralDle it wotill.1il be. Make it elegant." '~ut all the pe0F'le in the ne!ighb0rhood have signed the other petition." "Get ~neir signatures first of aN and linen go liiuntiher a:fi.ellil." Here was an oppoNunity to tC!St the truth of the current belief that anybody in the Philippines wull!! get any petition signed f(;)r anything pr(;) OF cen. There was a story ef how, far back in Spanish times, "harges had once been filed with the Governor Generall against a iPr.ovinGial G(;)vernor. When shown the scr(;)ll with thousands (;)f signatures affiocee, nhe latter had askee, "May 1 have a w~ek to answer!" .Nt the time specified he had return~d with a long petiti(;)n signee by twiGe as many people, whieh read, "To OUF personal. knowlCldge the Governer General is a son of a jackass." IDelJl aGceptecl my adviGe ami had his 'lawyer diraw up a beautiful petition which he circulated. Every shopkeeper and h0useh(;)lder :l?hese signature was en th~ oth~r jPaper was eC!jua~l¥ G(;)mpiacent when asked to affuc his name to the new one. At the hearing Dell's opponent~ reae a petition signed by a thousand citil.Z ens against granting him a license. Mis lawyer thereupon r.ose aned rClalil a peti~ion in fall(;)r of granting him a !licens~, signed not eniy by the thousand who had endorsed the other, but by many othel's as w~ll. Del[ 0futained his ikense. As a person wielding much authol1ity over many aetivities, I was ceNstantly being imjPortuned for favoFs (;)f one! tyF'~ eF another. A gravestone manufacturer onGe Gam~ to find out whewner I wolillle let him print his advertisements on the back: of th~ official death certificates; in re~urn he F'Fomised till Gut and eFect me the lln@5t tombst(;)nCl in tille cemetery. I also had tile usuaJ difficulties in wareing off ambitieus saJesmen fr(;)m the States. A shrewd Irish Amel'iean named Kel!ly, realiczing it was a F'rlllblem fer our smalill staff till be in a!l'l neGessary F''laGes at on€~, was constantly after me to buy s(;)me of tilie new-fangled motor bicycles for our sanitary inspectors. His argument was that they woullil be afuie t(;) coveF m(;)re gF(;)l!Ulcd with these G(;)l1tFaJ!>ti(;)ns. He had tne F'r(;)-

r62


FOR THEIR OWN GOOD verbial pertinacity -of his kina, ana it was not easy to avoid him. On my way to lunch at the Army and Navy Club I used to pass lily Ilhe oiGll1.uneta, whieh auring the late a£ternoon and early evening was filled ;with cal'riages and promenaders. One noon as I eame across the park, practically deserted during the siesta hour, Kelly hailed me from his motorcycle. "Please give me a minute. I want to show you how well it r.uns." ]j had Gone some amateur bicycle racing, and was naturally interestea. He inveigled me 011 to the seat. I was aamiring the gadgets ami fiddling with them when, without meaning to, I pressed something, and the thing started off like a shot. I had never been on one before, knew nothing about it, and had not the faintest idea how to stop it. All I could do was to guide it around and around the Luneta. KeLLy shouted directions at me, but the machine ·was making such a FaeKet that I could hear nothing as I tore past. He rushed across the oval to intersect me, cupped his hands and yelled at the top of his lungs, but still to 110 avail. I sped along wondering how much gas theFe was in the tank and praying that nothing would get in my way before it was gone. I lapped the Luneta at least ten times, while Kelly shuttled back ana forth, his face getting redder and redder, still screaming futile (;iirections. Suecler!!ly a carFomata loomed ahead. I swung sharply to one side to avoid it, and in so doing I happened to twist the handlegrip. To my amazement the machine increased its dizzy speed. This astounded me. In my bicycling days it had been essential to have the grips firmly cemented, and it would never have occurred to me that a grip could serve as a control on a motorcycle. But such was obviously the case. Feeling safe in the knowleclge that I haa mastered the infernal machine, I thought I woula have a· little fun. I turned the rubber gl'ip until I was going sixty or seventy miles an hour. Kelly was nearly Grazy. There was no use now in his racing back and forth; he merely jumped fFantically up and down. After thFee Of four turns, I took pity and pulled up to a nellrt stop l'iglh beside him. "'li'lhese things are very nice," I said as I dismounted nonchalantly and strolled on toward my lunch_ 163


AN AMERICAN DOCTOR'S OID;YSSEY The Bmcmu of Health dep,(maea ta a great extent an the Bureau of ScienGe far aid af all Sovts. WaFcester's greatest a0hievement haa eeen ta assemThie unlde! ane a€tlninistr.abian, as £a.t as pFactiGaMe, all:! ~he scientifiG wa~k af the gavemment, buiJt'!ing up in ane unit the mast modern arganization in the laborataFY fieled that any country hat'! ever e"olved. Uneder the able edirectian ot ]Dr. Paul Freer, aiscoveries weFe made whieh are even now just beginning to be utilizeed elsewlkFe in the warled. ~Iile BUFeau of Seienee Bia'lagi€a!l lLamaFataty werfaFmed aJ!J! 1;ne mi0FOSGapy fCllF the general haspita!ls, ana tdiagnoset'! specimens at alll kines. Four hundFet'! thausaned Fats were examined for piague bacilli. A routine examination was maae far all oholera earFiers. When a cure for any disease was annClluncea the laboratory would test its value. Qua€k nati;ve Femeaies were often at'!;vertiset'! as being cUFe-all!s, anGl the pea pie weFe apt ta have ffiar.e faith in them t han in faFeign impavtatians. i!'1or any t}jpe at ex!,?el'imentatian !,?F,isoners kCllln ilMiI'>it'! would always vClllunteer, beGause they wouM reGeive !,?erquisites ant'! even ha,v e their sentenees Gommuted if they weFe ta incm sevious risks. AU vaGGines ar serums develaped in any part at the world against t'!isease weFe manufaGtured at t·he laboratary. IDiphtheria antitaxll llInd the Pasteur treatment £aF Iilydraphoeilll wer.e kept ~n r.eaainess. (lver two miJ!1ion units af va€Gine against smal!lpax wer.e made annuaUy. In additian ta the rautine at least hllllf the laliCllr.atory was wCllrking on indepenedent research. Extensi;ve studies were maede for er.aediGating the iCllGUStS whioh causet'! hunt'!ret'!s of thousanas of dol[ars t'!amage to agriculture annuall1lr" llInld ~elllrs w,eFe spent in t'!evelCllping a 'rinael" west serum. iDF. MaFshaU !Bar-ber investigatefil the fCllle piayem by cCllcklr CllaGhes and other insects as Gafl'iers Cllf chClllera, macillary dysentllry, and typhoit'!. lOr. E. L. Walker wCllrked mare than a year on amoebiG dysentery, ant'! succeedet'! in t'!ifferentiating pathogenic trom nCllnp>athog~niG tW?es. Over three thCllusant'! eXlllminations were maede Cllf iFhilippine water supp.J.\es tCll aflter.ffi,ine t heir. biClllCllgiGa~ €0ntent. ~he eClltlllnists caffimet'! the ~slaneds, ant'! fCllr the first time qassified the flowers ant'! plants ant'! stuaied the inseGt pests and the fung,i, the forest proGlucts, fibres, seeds, d yes, and tans. The entamoit;>gists

104


FOR TMEIR OWN GO@D stucd'ied meth0ds 0f exterminating mosquitoes, flies, and termites. They als0 e0ncduetecd extensive reseaFch on the possibility 0f introducing silk eu'ltuFe, though the industFY never gained a foothold because 0£ t00 Keen c0mpetiti0n from China and §aJ'la:n. The ornithologists c0lilectecd the common f0rest birds, and showed which ones were injUI1ious and which helpful. Worcester himself discovered the nesting place of the frigate bird, an enormous creature like the albatross. The [sland 0f Bancanan was thiGkly covered with these strange birds, whieh ref.usecd to give the human tresJ'lasser the ~ight of way, biting when any attemJ'lt at force was maee. The Philippine Journal of Science became rapidly one of the leading publications of the world in its field. The central scientific library, the largest East of Suez, was accessible to anybody. In the museum weFe assembled the tools, weapons, agricultural implements, costumes, an~ basketFY of the various pe0ples. One of the most valuable wlleeti0ns 0f pietULes in the w0rlcd was gathered by the photographic depa:lltment. A proof 0f each was filed so that the negative could be procured f0r use at a moment's notice. The wild peoples were photographed at regular intervals, showing the stage of civilization to which they had arrived year by year. 1i:he chemicallab0ratory aJso had a vital function to perform. Ten tih0usan~ sa:mples of aement were testecd to see which would best stand the tr0pi<:a1 quakes and d0wnJ'lours. Paints were tried out against PhiliJ'lpine sun and rain. ~he first steps were taken in developing industries. Soils were analyzed, copra production improved, gums, perfumes, and essential oils tested and experiments made in the extFacti0n 0f sugar from the nipa palm. '['he F00a ancd DFUgS Act in the Philippines could not be enforced untiJ definite knowledge became available; first, of the effects of certain substances upon the human organism, and, second, until laboratory methocls for examining foods had been still further perfected. But it was obvious that lime juice adulterated with five percent sulphuric acid, jellies with formaldehyde, peas with copper, cheap flavoring extraets w.ith wood a'lcohol, and coloring matter with arsenic or mercury were highiy deleterious to health. Moreover, the pe0ple ~vere n0t being fairly treated when they bought butter with rennet added to inGFease the weight, or balcing powder with starch added up to 165 \


AN

AMBlRl~AN

DG>C']10R'S ODYSSEY

fifty pereent, or lared with water added up to twenty-four percent, an@ mixed flerhaps with starch, lime, alum, and salt. Sausage etten €ontained nitric acie. Many shipments (!)f milks contained formalin and other preservatives which might Feadily have been responsible fer mUGh of the indigesti(!)n ameng chiler-en. [Ge OFeam maee in Manila ha1il Mm(!)st everything in it eXGeflt what the name inaicatee. When bFOUgll.t te booK the dealers claimecl it was imp(!)ssible to make flrofler ice c;ream in a tF(!)pica,1 dlimate. SUGh elaims were pr(!)mptly eispr(!)vee Dy the ehemists, w,ho dem(!)nstratee beyen@ questi(!)n that g(!)oe iGe €ream €(!)uli!! be maee as weN in Manila as an;),where else 'in the w(!)Fle. The cnemists ef the Bureau of SeienGe were exhaustive in their sear0h for these aeulterated fo(!)ms. One of them determinee, f(!)r example, that certain impoFtee lar.@ centainee C(!)Goanut oil. Alth(!)ugl! Armeur & Company deniee cat~gorically that it had been adulteFat~@ by them, our ohemist stuok to his guns. It finally devel(!)ped that the latd in C!(uestion had been rcmdere@ frem Oregon hogs fee on Gepra, a/1m ~hat the eoc(!)anut oi1 gl(!)bules had been clep(!)sited by natUF~ in the tissues of l'ive h(!)gs. When an(!)ther (!)f the chemists statee he had dis€overeed salicyEc aGim in Hites toot beer, tnat €(!)mpanr almost burst with indignatic'>n. "ifhe;), saicil tFteir chemists weFe as Gompetent as any in Amel'ica, anm tfu~y coule eertif;y on tll.eir honor that their extract Gontainecl no Sa!1iCWJ.lG aGid. !However, it turnee out oil of wintergreen had been includem among the flavorings, ane w,h en the extra€t haed been shippecl tl!r(!)ugh tll.e het tropics the wintergreen had been chemically transfor-mem into srulicylie acid. l1hen formaldehyee was founed in Swiss strawberry jam. The Swiss saie this was impossible, but it eventuatee that certain sugar-s in the strawbetries of Switzerlane had the peculiar quality (!)f turning into formaildeho/de uneer the influcmee of heat. '['he Chinese wene naturally the gr:eat f(!)(!)d importers, ancl Gontnol!l'ecd ninety fleFGent (!)f the Iliusiness in Manik Whey knew that a hunenea Genta¥os macile a fleso ami! paie mOFe attention to the one whiGh they eie n(!)t haove tll.an t(!) the ninety and nlne wFtiGh they !lam safely hicdeen. When we founcil aauiJ.terated artiGies on their sll.elves, we had t(!) seize ane destFoy them. They meant to be law abieing, but

I66


FOR THEiR OWN GOOID they; could net undeFStand wha~ we weFe trying te get at. In his bewilaerment, one of them approached me and 'exclaimed plaintively, "']jIhe g~eellJ the peas, lilie green the peas, the gFeen ~he peas," ove. and ewer again. It was hopeless to try to explain to him that the peas contained Gopper. We maae life fairly miserable for the poor Chinese. On one occasion i stopped a shopkeeper on the street. Divining from my uniform that I was an official of some sort, without a word he brought out from under his shirt the Jeather bag in which he carriecl his valuables. First he pFesented me wibh his ceFtificate of residence. I shook my head. T hen out came his immigration certificate. I assured him I did not want to see it. He kept hauling out more papers-the cedula which pFoved he had paid his head tax. I shook my head again. He produced hi's merchants' tax receipt, looking up hopefully at me. Again he was wreng. ] hacl given up trying to stop him by this time. His plague inocUilatien ee~tificate aid nat satisfy me, nor did the license which showecl he owned a stall in the market. Finally, he pulled out his vaccination caFcl, which happened to be what interested me at the moment. I had never realized before what a bale of papers the poor Chinese had t@ â&#x201A;Źarry about with him in the Philippines to prove his right to exist. At the ~ime the civil regime was instltuted in Manila, there were twa hunclFed or mliire places wheFe the Chinese could buy a pipe and table space for twenty cents. Their contention was that opium, as they used it, was no more detrimental te their health than whiskey and soda to a foreigner. But while they were satisfied with the drowsiness and visions they obtained fFom their tiny pipes, the Americans and Europeans, when they took up the drug, wanted the full effect. In the fear that the Filipinos might become aadicts to the opium habit unless some means eould be found of preventing its spread, a commission was appointed. After studying the @pium question throughout the East, it recommended that the drug be excluded entirely from the Islal1l'is two years from that date. The first <!lay of March, 1908, was "Black Sunday" for opium halhitues. The tFubh and seri@usness @f the situation finally dawned @n these who haa sinned away their two years of grace between the passage @f the law and its going into effect. The behavior of the vic167


AN AMERICAN IDOCll0R'$ ODYSSEY" tims in the faGe et 1fue geve~nment's deter.mina,tien te sa:ve them by lega:i .feFce weuM truly chara~terize them a:s fiends. 'The term fiend is useci! liberahly by 6he laity, but becemes appropriate When a vi€tim is edepFived 0f the drug. ~n sheer edesper.ation the suffereFs s0ught the hespitai ~Featment pFeviedeed Thy the g0vernment. '['he rush wa:s S0 gFeat a,ned t'he tasl!: so hared fhat the San Juan de Dios Hospital, whieh haed previ0usly C<~Feed f0r edfUg adedicts, asked to be Felea:seed en the ground that it l~ke~ pr.oper faoillities for the accemmoedatie!l aned Festraint ef so la:rge a numbeF of ken'liieci! patients. ~~Gordingly, to meet the emeFgeney, tihe government made reaedy seveI'M wards ef the new insane department of the San Lazaro Mespital. Where the aci!edicts fought, screameci!, thlieateneed, a,nd su'lkeed unt·iiIJ they realizeed that the gevemment meant business, when they quietly su!Dmitteci!. ExpeFience ci!emonstrateed that the opium habit wa:s net paliticu1aFly . difficult to treat, ~ll'eGially among the smekers. "IDhose who took fhe drug !Dy m0uth e~peFienced meFe incomveni:en~e, ana th0se who weFe in I\;ne halDjt ef taking it h'}lll'eci!el'miGal!ly sNflleFed e(;msici!eFaMy. We us'eed the Towne treatment as Fecemmendeci! by JUl'. Alexander Lambert. Severe as it wa:s, it wa:s justifieed by the results. Its seem a:s the ~raving f0r epium w.a:s gene, we Il'Fo~eedeed ~o bui~ed up the patients. Wew. rna,ny ne[apse€f af.ter iDeing <iI~scha,r.geci! £Fem the nespita~ !l\':as, e£ ceUFse, unkmewn, but many habitues Il'Fefesseed pFef0uned relief at being cured. Alceh0:lism couled also be simi'larly treateed. [t gave me great satisfa~tien te pick up beaGhcembers aned by the same mefhmi! turn them enee meFe inte sdf-nespe~ting eitizens. Up0n the exdusien of opium and the clesUFe ef the Il'ublic r.esoFtS, the pFiee ef epium promptly went up, whieh made it prohibitive for Filipino purses. Mereover, the Chinese were not ll'artiGularly anxieus to £eFee the l\.albit 0n the iECi~ ill'in0s, 0nee they hacil to dell'ened 0n iiJ.egal SOUFGeS f0r their 0wn supll'l1.es. The Chinese are, with0ut ed0uiDt, the w0ded's m0st adell't smugglers, al'l..ed they soon edev,iseci! ways aned means of satisfying their simple needs. We weFe always finci!ing 0Fium in the most un.heared-of jDla~es. Glne day, in my routine exa,minati0n 0f imF0fteci! f00ds, ·'I: madle a:n unannounceed inspeeti0n at the Customs H0use. A huge shiFment 0f jam haed Just arJ1ived. [ had n0 reaS0n for being suspicieus, but a:s my eye 1~8


FOR THEIR OWN GOG>r> traveled ever the, stacked cases I said te ene of the insflectors without knc;l\ving exaetlo/ why, "['ed like to see ene of these tins." ~ teek it in my hands, looked it 'over, and sa'w it was correctly la!Deled stra.w!DerFY jam. Nothing apparently was wFong. Nevertheless, "Bring me a plate, please," I asked the inspecter. When I emptied out the centents of the tin, it seemed an unusually small amount compared to the size of the container. Examining it more carefully, I feund it had a false bottom. Every one of the forty-eight tins in the €Fate was then eflened, out enJ,¥ four containeed epium. An examinaIlion of the several thousand crates in the shipment showed that the Chinese, mathematically computing the probabilities of detection, had filled just four cans out of each forty-eight in every case. Other smuggling devices were_ even harder to cope with. Although the Filipino backyards were overrun with chickens and roosters, eggs Io wene comparatively scarce. Consequently, huge quantities were shipped f.rom China. iii.. favorite ruse of the opium smugglers was to insert a hypodermic needle into an egg, withdraw carefully all the albumen and then refill the cavity with opium. When the hole was expertly sealed, the illicit contents couled only be discovered by breaking the eggs. Thousands of dozens were shipped by each Tuesday's steamer £nom Hongkong, aned for a time the customs inspectors broke every sing.Ie egg· that came in. But it was obviously impossible to open every tin of food or break every egg that passed through the various customs houses, and undeubtedlya great deal of opium must have slipped through, no matter how alert the inspectors were. In fact, the Chinese succeeded in getting large shipments of bulky aned perishable lettuce and cabbages flasse~ in Fight uneder our noses. They could always be bougl\t in the Chinese quarter. Once we found a case labeled shoes which, under the first layer of slippers and boots, was made up of forbidden vegetables. In 1908, just before sailing for the United States on leave of absence, I went to say goodby to Governor General Smith. "['m senry yeu're net going to be here for our monster opium bonfine," he said. "]t's going to imflFess the Chinese tremendously, edon't you think sol" \ I explainea to him that in my opinion the Chinese, instead of. being impresseed with our high moral purpose in burning the seized 169


FOR 'DI-UHR OWN GGOD The Filipines, in spite ef our best efforts to persuade them of the v3!lue ef the Bureau ef ScienGe in the development of the Islands, had never appreciated it fully, regarding it mainly as a place for the white collar class to earn an easy living at the expense of the populace. Governer General Harrison encouraged them in this misapprehension and his Cabinet natUl'ally reflected his own attitude. I remember fhe indignation of the new Secretary of the Interior lDlennisen, upen Fe€eiving an estimate ef some sixty odd dollars for tne JDhotegraphing of ceFtain molluscs. He even made a speeoh on this subject, whioh a.eused great antagenism and a storm of articles in ~he press. His theme was that since the Filipinos were not interested in the Department of Ichthyology of the Bureau of Science, why should they pay money to provide a few scientists with pictures to gloat over? "I could pay the whole share of the insular government in one teacher for the Mountain Province for the cost of these photographs. I am not unaware that the world outside of the Philippines may possibly prefer the photographs of the molluscs to teachers in the Mountain Province, but can there be any doubt in the mind of anyone that my duty is to spend that money for the interest of the Philippines rather than to further what may be €0nsidered the interests of the scientific world at large? "

Mr. Dennison, however, had not taken the trouble to inquire into the purpese of the appropria~ien. In the Philippines there was no winaow glass; in its place the window trames were filled with three-inch JDanes of the translucent mollusc shell. The Department of Ichthyology had learned how to propagate the mollusc and was trying to extend the market for this purely Filipino industry to the United States where ether uses could be developed. To this end the disputed photographs were to be sent to the Smithsonian Institution. Mr. Dennison assumed tnat it was his function to determine whether the money should be spent en what the Americans thought was geod fer the Filipinos or for what the Filipinos themselves wanted. ]i)UFing the years of Gevernor Harrison's aaministration the Bureau 0£ S€ience almest entirely lost its Feputatien, and so many unscierltific r,epoIts were published in the Philippine Journal ot Science that its 17 1


AN AMERiCAN DOCTOR'S ODYSSEY' FreEessiena~

staneing a!lse VIlas un<ile~minea. ~,E the Bateau ou Seience were te be ou utility, it VIlas necessaFY to have en its staff men whe loved research for its own sake. Such men could not do good werk in the midst of the pelitical atmespher.e which existee from 191 J te 19,2 1 in the Phi[.ip>pines, wheFe alLmost evel'o/ neWSFawel' issue bFeught FumOFS of reeuction in their sallaries er e;ven abe1itien of pesitiens, and where scientific wovk was subject to constant hostile discussion by membClrs of the Legislature. ]n a few years the Bureau was dismClmbeFea, its staff clisFersecl, anGl! its apFl'oFr.iatiens for reseaFch r.estwietea almost te the ;vanishing peint. The 'Bureau of Wealth suHered aimost eq.ually hem the change in administFation, but it was stFangely due te Gevernor Wal'Fison himself that ene of the most aevance<il Fieees eu' legislatien in heailth was J!lut through. My FersQnai relatiQns with him weFe always extrem(lly pleasant. He J!lFobably found me useful as a consultant, because I had been tnreug,h al~ the Freceding aeministratiens. 1 was accustemea to have bl'eakfast wi~n him eften at Malacafian, and afterwarcls we wouM ride dewntewn tege~her. One Farticular merning Governor Harnsen's attention happened to be attracted to a peculiarly lurid example of patent medicine aevertising en a bildmeaFd. He peinted it out te me. "~sn't that a baa idea!'" he aske<il. "Frightful," I agreed. "Peer people waste their small savings on things which are useless, el!!pensive, an<il eUten habit-forming. Here , in the ~slands the c;reeuleus FeJin1!latien will accewt as t;Futh the wilaest cla¡ims te a panacea, anG! the patent meaicine evid fleUl'ishes like the ' green eay tree." "Why don't we step it then!" "Pm surprised yeu ask that lijuestien. TheFe's the Fee clause in newspawer centFaGts." "What of it!" "Yeur expeFience in the American Congr.ess must have taught yeu nothing effective can be done in legislating against the pl'eprietary meeicine intel'ests llieeause they a'Fe tee powel'f.ult." "Afiyhew, you dFa,ft a billl ane bl'ing it te me tomofFew." "That's enly twenty-feur heUFs. I can?t do a goee jeb en it in that time."


" !Ii want it qui~IMo/. Tomorrow." ~ sat ~p alN tifiat nig;lit p<'llmaing out a draÂŁt on my typewriter, and ~hen mar-Icing; out heFe ana inseFting there with a penci,l unti,l I myself Gou1<l1 haFc!I~y make sense of it. I woraea it far more stringently than was Fea1Qy neGessary, but wantea to have enough extras in it so as to be, preparea for the inevitable and necessary COmFlnDmises. At dayl!ignt ] nac!l a Fough aratt ready which 1 took to the Governor General's @flice as soon as it was open. @oveFnor ffiarrison glanced through it hastily and said, "That's fine. ff,ust what we want." "1'hen :Ji'1'1 take it to the Attorney General and get his advice." "Glh, no, n0, no. The biM is aM right as it is." "'But it may not be in the proper legal phraseology. I'd much Father Rave him go oveF it." "You've wFitten lots df laws, Doctor, ana I'm a la,wyer myself. 'iDnis ~oc;jks aU Fight to me." '''WeM, at least let me make you a clean draft." "No, [ want it just as it is." Me was Governor General. He kept the document . .At six the nellit moroning a boy knoGked timorously on the door of my !teem at the Army anGt Navy Club, and saic!l some gentlemen had Ga,laea to see me on business. "'EeN them I'm in my ofliGe eMery morning at eight," I replied GFossly. "1']1 tFansa~t business with them then." 1fhe aoor was shut. 'Ii was preparing to resume my slumbers when the &mollie Game again. "1!hey won't go away, Doctor," the boy expiainec!l, looki~g a trifle scaFea. "Tney say it's important and they must see you immediately." With Fesignatien I put on my aressing gown and started down the [ong staiFway to the lobby. Even before I had I'eached the bottom, tne waiting group spiea me. AN had papers which they began waving - eXGitabiy in my EaGe. "You're the feNew who committed this outrage," ene ef them sneuteid. '~hat aFe you tal~ing abeut;.?" I asked in amazement, and then suc!l<deMy Feeognized two OF three representatives of the patent meai\ cine interests. "You fiaa this outrageous law passea," another shouted.

In


AN A'MERICAN :DOCTOR'S ODYSSEY "I aenlt !mew anything about any law. When the preposea patent mediGine bila g0es to committee you'l!l h:we an 0pp0FtUnity to present your views." "How can wei It's a law already. It's be!ln enacted." He shoved a paweF into my hancii ana there was my bi'll, w0nd fOF word as I ham drawn it up, ~he stmictest of its lcina eyer passem. it was und0ubte<d!ly a law, but the histon' of its mysterious passage stilll rllquired explanation. Subsequently l learned that, as soon as 1i had allpa~tea £rom the GIilVel1lleF GeneFa!l's @ffi.Ge, he haa had it c@pie<d and sent h>y specia!! messenger t@ the U ppeF [Mouse. 1ihe Fresiment of the Senate had said, "Here's a bill which @ur very g@lild £fiend GoveFnor General Harrison has sent down. He's appaFently mUGh interested in it. ~t d0esn't aifeGt any of us, ami [ propose that, i£ he wants it, we suspen~ ~he ~u[es, Feacii it by titre, aned pass it." The motion haed bllen made and sewnded, and the bill had bllen passed by acclamation. When the House had met at four that afteFno@n, ~he Speaker had risen aned anneunGeed, ":Here's aJ bill~ which @UF very dear bien<ffi GoveFn@r Genera!! Harrison wants. The Senate has just passeed it. L et's show our respect for the Governor General and pass it aJso." By six o'clock the bill had been back @n HarFison's Glesk. He haa signea it immediately, aned i~ hal!! bec@me a [aw. !I! was given tJ:\e j@b of enforcing it. The law was so stringent that maga~ines (@ntaining patent medicine adveFtising could ll<Dt be shipped into tl'ie Philippines unless the formuJae weFe published. Patent meediGine G@nGeFf.lS f.r.om al!l @ver .tn.e earth raiseGl a h@wl. Our on[y C(J)Ullter t@ this was that we haa n@t attempted to prohlbit the sale of nostrums, but merely Fequired publication of formulae. If this were dene, h@wever, an~b0Gly could slle that tile .ingreaients @f pink J)lil!ls at one ciiellar a bex were pF0h>ably nothing but Bbu@'s carbenatll of won whiGh could be bought in any drugstore for fifteen cents. Be(ause the measures ef the Hea!!th Bureau had been so criticized, when G0veFn0r WaFFisorr had amved and haed begun dismissing AmeFiGans en eveliY Il.and, it was assumed that :Ii sheul<rll be a·m eng tihe first to go. When the weeks passea and J still remaine<ll, a newspapeF war began to wage around the FumOFS. The United States press, of all ~74


FOR THEIR OWN GOOD snades of J!>oii~ic [opinion, and Ilven the trade journals took part. Tele¡ grams, letters, and newspaper clippings made a pile waist-high, all protesting against my being interfllred with and stating that my dismissal would be an outFage. Finally President Wilson stilled the troubled Jourmmist;ic wateFs by issuing a statement that I was not to IDe removed. Governor Harrison then broached the subject for the first time by echoing the President's words and saying such an idea had never entered his head. Paying no attention to the clamor, I pFoceeded with my duties.

175


CHAPTER

00 2.

1FHlffi HEAVENLY FLOWER.

S

MALLPOX is as loathsome as leprosy and claims many more "ictims. Millions of Jileople, who could so easily have been saved, have died of this disease. Hundreds of thousands have IDeen Gl~omed by smallpox to lifelong blindness. Every ba'Zaar in Ineia is ill!leol with these helJilless ana piti.ful martyrs, groJiling their way thFough eternal darkness, or led stumMing!y about by those who aFe alFealily ovenburGlened witli poverty and sickness. 'iJi'his heaFdbFeaking eonolition is olue to the stubbo~n retllsM to aeeeJil t the simJille ane effectiive l1emeolÂĽ that sGience has to offer. ~he worid, if it so wil!!eol, cou!la IDe ÂŁree ot this most horrible Glisease. One of the most satisfjing suecesses of the Bweau of Health in the Philippines was the almost comJillete obliteration of smallpox. It was the more satisfying beeause it need never be fean~a again. Forty thousand peoJille, most ot them children, were alive at the end of each year who, in ~imes Jilast, would have been aeaa, ana thousands upon thousands weFe saved from blinolness and disfigurement. The microbe which causes smal!lJilox has never been disGoverea. !But the disease is one of the most GOntagious of a.l!! human affiietions. lihe erouption OIT the ski~, the IDrea~h, ana tne clothing ot the Jilatient ean ali'Jilarent,lo/ convey the aisease to otheFs. 1"heFe is even a SIi!lORg Jilossibi~ity that the infection may IDe eaFFiea thFough the aiF. $malil'pox Jilatients used to be kept on IDoara hulks anehoFea in the Trtames, ana it was notea that people who lived on the lee side of the smal1FoJli 1'7 6


TWE HEAiVENLY FLOWER shiPls sufljeFecd IDa<!l!lr ÂŁFeID tile <disease, whiie ameng those to windward there were few cases. Smallpox has existed as far back as we have any records. It was in lndia and China in 300 B. c. In the sixth century A. D. it was epidemic in Southevn Fl'lInce ans. Nor-thern [taly. Among the Crusaders it wrought fearful havoc. The first settlers brought it to this country wheFe it killed more Indians than the bullets of the Puritans. In virgin terl'itory it reaPled a frightful harvest. With the increase in travel dUFing the Eighteenth Century it was spread far and wide. !Long IDefore vaacination was diswvered, attempts had been made to lessen the ravages of smallpox. It had already been observed that anyene who had once had the disease would never sicken of it again. 1Fhe Hins.us, Chinese, and Persians practised inoculation; that is, they tFansferres. pus ÂŁrem the pock of a sick person to one who was well. This "sowing the smallpox," as it was called, caused a true case in the person so inoculated. One most unpleasant Chinese method was to seak a shiFt in smal1Plox pus and put it on the victim; another was to Mow the dried pus into his nostrils. The hope, often futile, was that smallpox thus contracted woulill be milder in form, but too often the procedure ended in fatalities. In India, wherCl inoculation was directed by Brahmins, it was semewhat better managed. The prospective patient, to get him in the best pessible physiGai condition, was placed on a special diet and rest Feutine before the ordeal. The Brahmins would then soak a pad in pus mixed with holy water from the Ganges and apply it to the upper ai'ID. As time went on and attempts to reduce mortality spread westwan;!, methods of inoculation began to approach the modern i,dea of vaccinatien. In Turhy a wound was made in the upper arm, the pus inseFteS., and a walnut shel~ ties. 0veF it. Lacly Mary Wortley Montagu, wife ef the British Ambassador, indefatigable observer and chronicler of everything and nothing, described the inoculation parties at Constantinople in 17 I 6. Greups of people would gather and arr.ange te have an old woman ceme "with a nutshell full of matter of the best SOFt." !Lady Montagu's correspondence with friends at home was responsiMe for introducing inoculation into England. Macaulay wrete a particularly graphic description of smallpox

177


AN AMERICAN DOCTOR'S ODYSSEY during the Seventeenth Century in England, where it had been estimateed ~hat eim,].y five out of every t;housand escaJileed., and one out of 'foul' cliec!i. "'Dhe smallpox was always present, filling bhe chuFch yaFds with cOFp.ses, tormenting witll constant fears all whom it had not yet sbricken, leaving on those whose lives it spared the hideous traces of its power, turning the babe into a changeling at which fhe mother shuddered, and making the eyes and 0heeks of a bebrObhed maiden objects of hOFror to the lover."

MOl'e than hwl'f those EiVing had DOFne pookmal'ks. To fue without them had ileen eonspicuous; an unmarked face had fueen useful in describing a fugitive. Two-thireds of the inmates of the early blinCi asylums of Lonclon weFe there be~ause of smallpox. 'I1he disease ~ould not be shunnecl am! ea~h new generation had brought new viotims. The iEngJ:ish fashion of inoeulation was to take sma!lJlJjlox mrus from a f.u!l[y cile:velopeed p,OCK: anci! insel't it unc!ier the skiin of a! weN person. It was founed the cilisease w,h en incducecd in this fashion was ~uch mild(m, and ga.ve a mortality of only one percent, but since it was as Gontagious as sma!l!lpox normaNy contFaGtecil, this methoa invo'lved isolation for a numbeu of weeks. iI'Fiencds used to be ino~u1ateed at the same time aned pass the period of seclusi'illl in each other's Gompa;ny. Apparently the Sa,nskrit text" macde mention of the prote0tive qualiti€s of eowpox. But although fhis vital fact may once haiVe been known, it had long been buried in an obli;vion from which it c!iied not emerge unt;iJ the end of the Eighteenth Century when iEedwared Jenner investigated t·he claiF¥ maied's €hance statement that persons infeGt€cii £Fom sOFes on tihe uededeFs of cows with cow,pox eSClaFlecil the mane fata~ malacily. ]n J. 796 he va~cinated eight-year-oied James Fhipps Ml)ith virus taken from the sore on the hancils of a milkmaic!i who haed been infecteed while milking a cow. $ioc weeks 1,ate!' he inoculated this same boy with smallpox, and the disease did not take. JenneF's paper, announcing his dis~oveFy, was r.eje~teed ID¥ the Ro¥ai Society, aned he, Jlke iIDl'. ~ohn Snow, hacil to Flubilishi at his own eJqDense. Wowever, unlike many of his GOnfFer.€S, he attainecil high honors eduring his 'lifetime £Fom universities, ~eaFneed societies, sovereigns, and €ven from the AmeriGan Imlians. The elllightenec!i on€s

1'7 8


THE REAVEN!LY F'LOWER af a warM :wl'm had sa 1ang suffer.ed from this I:ilight r.ecognized that his cantFibution, differing from so many which had been mere steps in the Gonquest of a disease, heralded the possible annihilation of smallpox. Immediately after ~enner's announcement a storm af controversy, for. and against vaGcination, arase. It was possible that, having seen the too often fatal effects of inoculation, the great mass of the people accepted this heritage of fear and classed vaccination with previous eXjl>eriments towar.ds immunizatian. Professor Benjamin Waterhouse af HBlIVard University took up the cudgels for vaccination, as Cotton Mather had done almost a century before for inoculation. He vaccinated his awn family, only to find that the newly born but already 1usty anti-vaccinatianists were at once up in arms. He had to take his childFen to the smallpox hospital and actually expose them to the disease before people would believe they were immune. When he was asked to argue the merits of vaccination, he always rejoined that ane fact in such â&#x201A;Źases was wort¡h a thousand arguments, and he was ready to demonstrate the fact. Waterhouse sent some of the virus to BFesident Thomas Jefferson in 1801, and himself vaccinated some of Jefferson's family. Spain, often considered an unprogressive cauntry, has been a leader in introaudng vaccinatian into her calonial empire. In 1803 a ship sailed aown the Guadalquivir with twenty-two children on board. During the voyage they were vaccinated by passing the contents of the vesicles from arm to arm so that it could be preserved until they Feaohea Manila. Three years later. that city had a Bureau of Vaccination, and in 1850 an institute for the manufacture of virus. Systematic vaccination was inaugurated in many of the provinces, but at best the work was sporadic and often interrupted by lack of funds. SmaiJpox existed throughout the Philippines. Under a Spanish law vaccination had bJeen compulsory, but lack of efficient organization - preceding the American occupation had made it largely ineffective. Each year during the dry season a huge temporary hospital had to be eFectea at Manila ta take care of the hundreds of victims, the g~eat mrojaFity of whom died. ~he Filipinos were not against vaccination per se, out they had become accustomed to see the law not observed. 1Ihe swong fatalistic philosaphy which ruled their conduct permitted 179 '


TRE HiEAVENLY FLOWER I,fii·8,,/,''1/!,o/ J'leepie w,eFe vaeoinate€l. itt was net aU smeeta saiiliing. ]n seme districts the vaEcinators were regarded as busybodies interfering with the routine of life. In Iloilo much patient effort was tequired to oveFceme the false rumor openly circulated by the mal-disposed that vaccine haGi seen pUFJ'losely infeoted with leJ'lresy am! that all those whom the lancet tou(d\.ed were doomed to the living death. In another outlying Giistrict, it was necessary for the mayor, the head of the peliGe feFGe, and myself, to be publicly vaccinated befo17e the timid weFe neassured. ]n J'lrevinces whe17e violent objections were encountered, the vaccinators were as a rule withdFawn at once. vVe bided our time. In six menths an unvaccinated pueblo would turn its eyes enviously from its own sick to the fortunate neighboring pueblo where tiny arm scars had taken the place of horribly disfiguring pocks, blindness, or death. 11he chief men in the unvaccinated pueblos would themselves request that the vaGcinators return. Fer example, in the province of Albay, sitter eJ'lP(!)sitien was encountered in TabaGO and Malinao. Many of the inhabitants £Iem sefere the vaccinators. But in the foliowing year there were forty deaths in those two localities alone, and not another (!)ne among the 234,000 J'l(!)J'lulation of Albay. SimilaFly, great opposition was encountered at first in Antique P,rev.inGe f.nim intrnnsigents whe even threatened the lives of the vaeoinatoFs. However, by the use of tactful persuasion, a number submitted. Shortly afterwards smallpox broke out, and the death rate m(!)untem. Here was visible proof that those who had been vaccinated, even when they weFe nursing the siok, mid not contract the disease. llhe pe(!)!'lie of Antique cried for help and welcomed the same vaccinators whom a short time before they ham driven away. Patience worked wonders in Albay and Antique, but the outlying miSbriGts presented an entiFely Giifferent tyJ'le of prohllem. Bagac was an isolated barrio of two thousand inhabitants in the province of - Bataan, situated in the path of the monsoon, accessible by sea only during short seasons, and by land requiring strenuous travel over a wretched trail. Frem 1896 to [901 the district had been in the threes eE waF and rebeHion and there.fere neglected. But in the 1905 eJ'limemiG of smallpox, there was an outbreak at Bagac; and it would have been criminal negligence had we not attempted to protect it. As soon F8I


2\N AMERI,CAN DOCT@R'S OIDYS$E¥ as one of tne vil!lagers had mrought the news that every house in the bar.Fio haal one or mOFe cases, [ irnrnealiate1y loaded a launch, stun!iy as a tugmoat, wi~h :vae0inators anal sU\llN[·ies. We piowe!!l cdow.n the Bay, through tl1e 'Soea Chieo, ana up the coast until we arrived off the village. Twenty-four houFs a day, w.hile the Northeast Monsoon blew, the gr.eat FoilleFs pilea up on the sandy meaeh w.here great Doulaers prohrudeal here and there. 'The shore shelved so steeply that anehorage was out of the question. We had to lower a boat in the open sea, anal thought ourselves ~UGky to surge hhrough on top OF a nuge comber and Jan@! on the fueach w,itl1out upsetting. The results pl'oveal worth ~he effort. '.fwo weeks later there were no new (ases of smaltlpox in Bagae, ane soon the disease haa rusap-peared compieteiy. Many regions in the Islanas were so remote that to reaeh them requiFed tr.om two to three weeks of toiling over ro~ trails and ~hr.ough mOl'asses. Since the ordinary glyeerinizecd lymph wouM not remain potent off the iee for more than ten days at tl1e longest, no vac_0ination seemed possible. We trcied to get ordinary lymph to these eommunicies, mut it nad lost its poteney ana our time was wastea. Vaccine in powdered form was tried, and also the so-callecl dry points, but the percentage of success was so small and the !!Ianger of infeetion so great t'hat their use was amanaonea. liJnless everybody eould be vaccinateal, the danger of infeetion always lurked in the backgrounal. It was impottant to r.each to the uttermost pal11!s of the Islanals. Sinee ] €ouia not improve the transpOFtation, the length C!Jf time for preserving the potency of the lymph haa to be extenGled. I devised a smali portable ille box which nearly lifowMe<il the period aluring which the vaeeine llouM me keNt pC!Jtent after it haa left tne laboratory. A tight box, fiUeal with ice, was placed inside a Jarger box, so that the aiFspace IDeliween 1ihe two wou,l a serve as insulation. The :virus was put in smal~ opaque Feceptades and [aid upon tfie ice. The whole was then !!.ocik:ed and sent to the distrillt medical inspector who had a auplicate key. Sometimes the bexes went by gO:VeFnment !launeh or fuy banes, sometimes by caFretelas OF carabao <larts. Where there were no l10ads into the wilderness, the carts were mounted on sk;ids so they woultd sliale over the mua, amd the earabao woulGl ro1!low the stFeams, 18:!


THE HEAVENtLY FLOWER semetimes hal.f swimming. Whenever bhe anima[s gr.ew hot and tirecl, they woule:!lie down and willow, but somehow or ether they would manage to get through. Even occasionally the l'ittle ice boxes reached their destinations on the backs of runners. The empty bexes were Feturned by the same devious Foutes to the Bureau of Health; there was a continuous stream of them going in and out of the centrai office. Wi~h all our efferts it was impossible to reach some of those who, thl'eugh no fault ef their ewn, we~e maintaining the seedbed of the disease. When ] was heme on vacation in 1908 I spent an evening at Menlo Park and submitted the question to Edison. He already had wealth to spare and was planning to devote the rest of his life to inventions which weuld be valuable to the world though they might pFoduce no money. In a smal'l bla~k book were entered just such pFoblems. He had already experimented with a box which would give out carbon dioxide, but the little escape faucet kept freezing and defeating its own PU!1poses. He was so interested in what I told him that he said he would set to werk again to try to overcome this e:!i.fficulty. But Edison never solved the problem. An even better solution was discovered in Java by the Dutch, who are a very resourceful people. l1hey ut;ili<zeu the knowledge that the strength of a virus may often be stepped up by inoculating hom one type of animal to another. They introduced human seed vaccine into a rabbit, rabbit vaccine into a Galf, and calf vaccine inte a carabao. The resulting serum was emulsified with t\vo parts glycerin, ane:! then sent out in glass tubes enclosed for safety in bamboo containers. This vaccine, which will last more than a month in tropical heat, is now saving thousands of lives in the East. In 1915 the Indian government was about to erect vaâ&#x201A;Ź0ine plants at gr.eat cost in the mountains, because vaccine could not be manufaotured during the hot season in the lowlands. I had - just learned of the Dutch discovery, and suggested that use be made of it. By adopting the Dutch method India was saved the expenditure of theusands of rupees. We had develope!!! a system ef making our vaccine which was efficient and cheap. We would buy carabao calves, shave a place two feet square on each one, and with a knife dipped in cowpox vaccine 18 3


TME HEAVE:NLY FLOWER @iseas€, !la@ harok!e@ baek to ~he !Eighteenth Century, taken the Gontents of a pusbule trom the smaHpox case shordo/ be.fore death, and inoculated a number of the inhabitants. In a little over two weeks the epidemic had followed. The population of the islands in the group totalled two thousami. One thousand alreaay had bhe clisease befoFe my vaeGinatoFs, fol' whom I sent immediately, could aFrive. Of the remaining thousand, eight hundred were vaccinated, and of these not one contracted smalJpox with a successful vaccination two weeks old. Two hundred had fled in terror of the disease and we could not find them. The Filipinos in the outlying islands, in their ignorance, were apt to be afraid of vaccination until they became accustomed to it. There were always evaders; even on shipboard where we rigorously enforced va~cination we had to watch care£ul[o/. I happened to be out on business in the harbor one day ancd passed by a ship on which the crew was being vaccinated. One Chinese after another was swarming down a line into a lighter tiecd to the stern. A£ter my vaccinators were satisfied that everyone on the ship had been aeeounted for, I orderecd one of the crew to cast off the lighter. When we boarcded it, I never saw a more astonished lot of coolies. They chattered and gibbered in cdismay at having been caught as we lined them up and ordered them to baFe their arms. LegalJy I had the right to have anybody vaecinated; if necessary I could call on the police for assistance. But I preferred to use other means if possible. The Filipinos seldom made any protest after the first few yeal's. Most of the oIDj,ectors weFe unvaccinatecd Americans, among whom the mortality was twice as high as among Filipinos. When any of my vaccinators encountered one of these conscientious objectoFs, he had instructions to send him straight to me. One noon hour I was sitting all alone in my office, and a great enOFmous American blacksmith entel'ed. "You're the guy who's goin' to vaminate me, are you?" he began truculently. "No, l'm not," I answered. "I don't want to vaccinate you if you don't want me to. My duty is to tell you what risks you are running. This eontagion is so wicdespread that I don't know any unvaccinated person who hasn't caught the disease. A health officer's joys are feV{. lt gives me pleasure to attend the funeral of someone who has died I8S


AN AMEmCAN }DOCTOR'S OIDYSSEY of smillJilQJ!i b~tmuse he was not vacGinat~d. Only last week ]j went to ene of thQS~ fun~rals. AM ['m geing te ae is tell you that yeu're running a tel'FifiG l'isK, I!n!lt i,t yeu eden't want to b~ vaeGinated, it suits mit per£e€dy. ],l!t announce in f,nlt afiteFn0(m papltl'S that you a:re an antivaccinationist. When yeu come mown with sma!!lp(!))(, ['[1 have that item printe<!l ailsa, aned I'll do the same with yQur meath netice. Y (!)u know, of eeur-Slt, that you havlt IltSs than a fifty4ifty chance to pull through. But 'Pm delighted that you are (!)ffltring yourself as a human ex;perimltnt." "Aw, eemlt en, vaecinate m@,» was his only ret(!)rt ~e this harangue. LiKe a weil-cdiscipiined <!log h@ felllowea m@ to tfie special littllt VaG: cinatien oflke maintaineed to aecommoaate any whe came t(!) be vacGinated. No force, no persuasion, no wiles, were necessary (!)n the G@fma,n [slana of Yap. [ (!)bsenred when [ went there in l~rr that vMoination aay was a neliday.. Native runners w.ere sent out in atdvance to a®visll the cemmunities that at a cet1!a:in time the aOGt(!)F would arrive pr@pllred to vac0inatll aN who might desire it. "the entire village would appear en masse to avail themselves of this w(!)ndO:l"£u1 oppeFfuJiity to be (!)rnamcmtea with the sears of which tho:y wo:re so p"oud. VacGination was a Fare treat because the Yaps were aceustomea to infliot weunas upen tnemselves a,na te keew them epen by kequent sGFatoning, eF fuy rultibing with sa,n<!l, bamboo, er she~llS. As seen as a scab f(!)r.mo:m from the vaccinatien they wouled scratoh it off, se as to make tho: FO:sl!liting scar as large and rouna and white and beautiful as possible. The de€teF in charge told me that nati¥es frequently asked to ber,r ew vaccine ana a lancet with the id€a ot vaccinating themsel¥es anG! aedj1!lsting the si,z e (!)f the scarifkatien te theil' ewn ~ancy. [n Minaanae, whioh was under milita:ry Fl!llt:, and where tnlt influence of the 'Bureau of Hea,l th was nebulous, tho: Army aoctors as a matter of routine vaccinate<!l the treeps, and for prete0tion also vaccinated tho: Moros in the vicinity ef the military pests. In the course af time it beGame eviao:nt to tihe MOFes of t'ho: liiaok country that tho:ir brethr-en wno ha~ been ¥aecinate<il dia net get sma~tJ!lel!i. One <!lay abeut three hundro:a Meres, a~ allmo:a witn krisses, appea~ed with a .flag (!)f truco: outside one ef the Air-my camps. "We have come ta be vaccinateed," their datto annauncea. r86


1!1ME HEAVENLY; FLOWER 'Fhe post surgeon met the datto in a field nearby ami said, "I'm very sony, but] can't vaccinate you. I haven't any vaccine." 1Jj\he datto r.epliee in a mauer-of-fact way, "We ~a,me to be va~­ cinatee, not to ~isten to any foolishness." The surgeon caught the glint and heard the whisper of drawn Misses. He thought quickly. "Without doubt you're in urgent need of vac~ination," he agreed. "I'll see that you are accommodated at 0nc~."

:He Fetir.ecl, therefore, to his office, and returned shortly with a bottle of eisti1!led water. With a scarifier he carefully scratched each arm and applie:d the sterile water. When he had finished the last brown arm, he said to the datto, "One time is not enough. The:re will be no scar from this. You must €Orne ba~k again on the tenth eay." The satisfie:d savages Feturnee to the jungle and the doctor hurried to the telegr.aph operator. His message to me relijuested a large supply of vaccine, which I despatched to him at once. It arrived in time, and at the end of the ten days the Moros all reappeared. This time they were e.ffectively vaccinated. . Our vaGcination record in the Philippines was unique both in its wholesale nature and in the totall lack of injurious after-effects from in£ection. I"n the course of a few years 'we performed twelve million vaccinations; practically no cases of smallpox occurred among the properly vaccinated, no one die:d as a result of vaccination, and not one arm or le:g was lost. This was absolutely unprecedented; even in GeI'many, where the most moeern sanitary practices prevailed, out of every miNion vaccinations several people died or lost arms or legs be~ause of infection in the woumd. ]! hae conceived the notion that, if the scarification weFe not dresse:d but a:llowed to dry, tetanus germs would be less likely to gain a foothoM. Much to our gratification it _ turned out that, in trying to avoid tetanus, we avoided nearly all infection. Of the hundreds of nurses who served in our hospitals, only one contraeted smaNpox. She had been vaccinated, but, since she die not Ilelieve in the practice, she had rubbed the virus off with alcohol. ]n time our system workee with a high degree of efficiency. The death rate was reduced from forty thousand anriually to seven hundred, and the: fatalities occurred in districts too remote for us to reach 18 7


AN AMiERlCAN ~OCTGlR'S OlDYSSEY 0l' among umraeoinated chilcll'en. Ohildh00d furcnished the smailp'0x reseFv0il'. 1['he FiJipinos wh0 Fea€hed the adult suage hacl either had it 0F weFe imlFllmirzee. 11'iQeFe ailways rema,inee a few Wh0 t00K to the hi~[s, d1m!Dee trees, or nid in ee]laFs to evade ehe va€€inat0Fs, ancil those kep't smaN f0ci of infecti0n perp'etuatee. if everyboey in the Islands had been vaecinated thel'e w0uld ha,ve been n0 smal1lp'0x. Ln Manila, wnere we had complete C0ntr01, fihere was not 0ne eeath hom the clisease in the seven rears p'I1i0r to ~~;)I4, iWheI1e !Defore tiheFe ~ae !Deen th0usancils. One ot the greatest eatastr.0pnes in m0aer.n times !Degan in the PhiliJilp'ines in 1918 when fifty th0usa,ncil pe0p'le, m0st 0f tnem di.ildren, l0St their lives tF0m sma!llwox, and the t0tal eventually l'eaGhea almost a hunered thousand. [ hae Ibeen awa,y fF0m the :Es1anes f0r thl'ee years, traveling from 0ne 0ut 0t line way p'[aee to a,ll0ther, and nad Just awiiVecl in die Unitecil States. ~ was 0n tne train ifF0m New 1'"0I1k to iB0stVl a,ncil Ii'Fom tilie wineow saw signs which in tlflieet askecil, "Pe0ple of Massachusetts" h0w muoh longer wiU you stane f0r tnis Erightful practllee of ;vaccination? 'Fhe l"bilip'p'ine lslanes, which ha,ve been mtee and vaunted S0 mueh as ha,'I'ing been treed £r.om smallpox, n0W have one hun&ee tih0usancil ee<!tihs. Wha,t betteF e;vieenee d0 Y0U wa,nt 0f the vwll!ldtlSsness 0f vaecinati0n?" Soon af.terward l! was FecaUea to the Philip'pines as one 0f Genera[ W 00d's aevistlrs under a return 0f the oid regime. We, as an aeministrator, was ap'pJailed ane WOFrteG! by the smallp'ox situation; as a physician he was intensely interested in the eauses 0f t'his reGrudesGence of a,n infeetion ONce sta,mp'@e 0Ut. He Joinecil m@ in my seaFGh. We sta,rtee w,i th tne G!~iJcilr.en. Wre [00kecil up theiF heaJt;h FeGOFds, whieru €er.tiliee tn@y hae wN Ibeen vae0inatee. We then insJilecteG! tne l'Iea,ltih Service at Manila and found tne vaccine hae been manufactUFee ancil sent out regu!larly. To maktl a final €he@k we went to the scho0ls. [n dassroom a£ter dassro0m we found to OUF indignati0n that, in spite of the reeoFcils., the ehi1dFen haG! n0t been iVa€0inatee. Natural!!y we wa,ntee to lioo FesJil0nsilbi1lit;y. We disc0vel'ecil ~hrut ~0Ga~ nea,hn 0flker-s had c0nsistelltly faisifiee t~eiF reJil0Fts. ln some instrunces many m0Fe vaceinat40ns hae been rep'0rtecil by them than w0uld na,v e been p0Ssible with the .quantity 0f vaeGine sent to the vaecinat0Fs. :En other 188


THE HEAVENLY FLOWER cases, Father than de their jobs they had thrown the vaccine into the waste pap~I' caskets where we founa it. Thus 3J !luge unvaccinated pefmlation h~d ceme into being, ~nd it had enly been necessary to Mow upon the ever pnesent spark to start the conflagration. The oeUows had been used; the spark had 'kindled into flame. Century-long exposure to the disease had bred no immunity. The Filipinos had died like flies, and the heat of the conflagration was so intense as to affect those who were only semijin~pne0fed oy vaccinations 0f too long standing. Between ]9 [8 and 1920 the Islands had lost . twice as many lives frem smallFox as the United States had lost from casualties in the World War. The death toll could have been avoided. The figures showed conclusively that ninety-three percent of the deaths had ocGurred among the unvacoinated. I described to Wood my previous meth0ds :which had pnoved so successful. He put the saine regulations int0 efliect a,nll[. the Islands were 0nce m0re freed of the disease. The prCDblem of eradicating smallpox from the Philippines was no different from that anywhere else; it merely involved the thorough and repeated vaccination of everybody, without exception. Unless lecaJ. sanitary officials in every country can be made to realize that infants must be vaccinated shontly after birth, that unprotected transients must submit to the operati0n, and that everybody must be peviodically revaccinated, smaNpoll1 will continue to prevail. If the so-called special visitations of Providence for the purpose of c0nvincing people of their errors, could be logically considered in the categ0ry of sanitary measures, then the awakening of a sanitary sense of the people â&#x201A;Źaused by a virulent epidemic is productive of good. If the tenets of the believers in New Thought and Christian Science were tFue, this dass of people would never have smallpox. For surely no Thigotry could be more pronounced than that manifested by the antivaccinationists of the Philippines. Fortunately these fanatics, al- though vociferous, were small in numbers and not influential in the 1.egislature, and the unvaccinated among them contracted smallpox S0 negulanlr that they were no pnoblem. It seems aIlm0st incredible that, in spite ,of the absolute prCDof that effeotive vaccination maKes smal!lflOx impossible, there should still be aissenters. Daniel Webster, in one of his less inspired moments,

18 9


AN

AMERI~AN

DOCWOR'S OElYSSEY

sai~,

"eempwsety vaccinatien is an eutFage and a gress interfercm€e with bne [jIDer.ty of the peoFie in a lana ef treeaem." 'He failea tQ Fealize that free(!\(;>m must not ee grantea to those who have Froved themselves unwer.thy of it by endangeI'ing ethers. The constructien en fire ha'Zaras is net pe~miHea; wny shouM anti-vaGdnatienists IDe aJ[ewea te geneFate sFaFks w,nich threaten tne lives ef the FUIDlid Even new, in these supposeilly en1igntenecl days, the i'l!l-founaea . daims that vaccination proauces haI'mfuJ. effects cluring menstruatiQn, pregnaney, Jaotatien, and e",dy infaney are toe frequently respectecl, even ey the advecates ef vaC0inalllen. i1!n tne United States ancl England sOGieties have IDelen founded Qf those whose one idea seems te bel that aU the ills of the worM are aue te vaaGination. Strange to say, o€casienalily the prime meyers in these anti-vac0ination seGieties ape physioiMls, aJltheugh it is difficlrlt ite unaerstand how any observing memical man ceuM queslllen eXFedence ana the eviclenae ef science so rar as to cloubt the theFeughly esta~ lishei!! fact that va€€inatien wrevents sma;llpox. ,Simell !Louis iKat'Zeffi, rte <[uete enly ene out o£ many, asks in Physical Culture: "Mow long are the poisoned pus peddlers to be allowed to run wild and fatten their pUFses ana tile insane asylums, hospitals, and graveyaFds? Pr.iestlly despotism is bad, but medical despotism is inta\eralile. "Smallpox is a filth JUness which follows dosely upon fi'a grant violations of the laws of hygiene and health. No person is susceptible to smallpox or any other. filth disease so long as he is in a state of health. . . . Compulsory vaeeination r.ani<s witih human slaver.y. and r.eligious peFs.eutian, and is one of the most flagrant infringements upon the rights of tihe human Face. The more vacoination is practiced to the neglect of sanitation, the more smallpox flourishes, but when sanitation is practiced and vacoination neglected smallpox disappears. Vacoinatian will be negleoted and smallpox will disappear. wlnen medical supeFstifians and! medical intoj'er.ance nave disappeared."

In IDenver, Celeraao, chiF0p,ractors leuilly precJaimed the uselessness on vac0inatien as a preteGtien against sma,]lwex, an@ fer a time suc€eeaea in \Viinning a large sect.ien ef the puetie te rtheir peint ef view. But just as surely as a dry shaving wil!! burn when a mat0fi is applied, just so will the unprotectea contraot smal!lpox when exp,osea 19 0


'FHoE

~EAViEiNiLY

FLOWiER

to the contagion. As time went on, it became increasingly apparent that the unprotected were fUFnishing all the vietims while the properly vaccinated were escaping. Finally the unvaccinated chiropractors began to contract the disease. One of them who fled not only himself died, but started smallpox in faraway Arkansas which had previously IDeen free. 1 have always felt stnongly on the question of vaccination, because smalJlpox is a disease we ought not to have. On almost everyone of my woFld trips 1 used to meet anti-vaccinationists. 1 remember in Jilanticuia,r one man who was tmveling with his beautiful daughter. He was nabidly against vaccination. When she contracted smallpox and died in Singapore, 1 never saw a man burdened with greater remorse. His lesson was a bitter one. He said to me, "1 alone am to blame. 1 pitted my puny opinion against the judgment of the medical world, and this is what has happened." Anti-vaccinationists should be attacked everywhere as a menace to the welfru:e of mankind. The disfigurement, blindness, and death for which they are respo'nsible should be brought home to them. Their false doctrines are too costly and should not be allowed to spread. There ane very few anti-vaccinationists now in the Philippines. Most of them have died of smailpox.


A!lLA$ ANiD A LACK


ALAS AND Pi.. l.ACK sU\!l\!lly wibh him te 1ast euring our world trip. Mereever, he was an official representative to an internationa!l meeting te whi~h he had been invitee by the United States and, as such, entitled to diplomatic immunity. "He can't de any:thing Eke that," insisted the ebdurate inspector. "Well, if you won't let him off, I'll have to go down and interview the Collector of the Port, who's an old friend of mine," I replied. When I reached his office, he had gone to lunch, and I had to wait IUltil two o'clock before he returned. I told him the story and, although he demurFed at first, finally, on my statement that Calderon was a prominent Filipino on a diplomatic mission, he gave me an order for release. I returned to the pier, exhibited the document, and saw CaldeFen restored to freedom. Since my ewn baggage had net yet been inspected, I went off to attend to it. But when I returned I found no Calderon. I discovered him again under guard. "What's the matter now?" I demanded. "li een't knew," he lamented. "This is a terrible country." I seught the inspector and asked, "What's my friend done now?" The inspector, who had been somewhat annoyed over Calderon's Fdease, exclaimed triumphantly, "He is a smuggler. You got him out ef the dgarettes, but let's see you get him out of this. You said he was a Filipino. Then what's he doing with this big sealskin robe? How ceuld a fellow hom a het place like the Philippines have any use for such a thing? You can't tell me he isn't trying to smuggle it into the country." '[ knew better than to argue; I hailed a taxi and returned once more to the office of the Collector of the Port. After I had explained the nature of the new contretemps he said, "I'm afraid I can't help you this time. '['he inspector is Jilerfeetly right. We can't overlook such a serieus offense." "You'll cause a lot of trouble," I interposed. "This man is a guest of bhe nation. I assure you he has merely borrowed the robe from a hiend in Shanghai because he's a,fraid it's going to be cold in Siberia." After !Iluch persuasion ane the assurance that the rebe was not to remain in the United States, the Collector of the Port reluctantly agr.eed te sign a second order for Calderon's release. This time I

193


t,his

S0m:

of


.M.:A$ ANID A iI'..Ai0K me, the elevator was on its way to the twelfth floor. I waited there for some time, but he did not appear. With visions of his being l0st in a city where things m0ved far too rapidly for him, I returned to the ground floor. Calderon was nowhere in sight. I asked the starter whether he had seen anybody answering Calderon's description. "Oh, yes," he assUFed me. "He's just gone up." "Then I'l!! go up again, but i£ he comes down while I'm gone you keep him here until I get back." iii returned to the twel'£th f100r, but he was n0t there. When I once mone emerged into the lobby, I burst upon a tremendous scuHIe. Calderon was loudly shouting as he struggled with the starter, "He's trying to arrest me!" He had mistaken the uniform f0r that of the police. I placated the starter, explained to Calderon, and, taking him by the arm, conducted him to his room. This was by no means the end of my troubles. October came, and the days grew fairly cool. When Calderon donned his bright yellow overeoat he attracted attention wherever we went. A group of small boys w0uld often follow us, shouting derisively, "Look at de guy in de yel1la coat! " I spe!lt half my time pludcing Calderon b0dily from in fr0nt of aut0m0blles and street €airs, interpreting for him, and trying to find ~he kina of food which he f0und palatable. I was almost a nervous wreck before I located a Filipin0 to l00k after his wants. Thereafter I c0uld leave Calderon happy and contented in good hands while I went about m0re important business. Calderon had received an invitation to go to the Lake Mohonk Conference, which was concerned with helping the Indians and other dependent peoples of the Unitc:d States. He thought this might afford an 0pportunity to obtain additional funds for his Gota de Leche Society in the Philippines which had for its 0bject the distribution of milk to p00r children. Calderon, who was an extremely well educated and intel!ligent man, wrote an excellent address in Spanish, which his F>ilipino guiae then translatea int0 English. rt was still effective, Ibeeause the Spanish idi0m is bea.uti£u1 even in translati0n. He practised his l1Pc:ech daily ana, aItliough he scarcely knew the meaning of the w0rds, he could repeat them perfectly in English. He made such an I95


AN AMER1CAN DOCTOR'S ODYSSEY impression ~hat a Gansiderable sum was valuntarily con~riIDuted to the Gota de iLe0he, even though, as a rule, maney was nat solicited at these can£e~enGes.

Calderan's success haa been sa great iliat 'I suggested we interview Nathan Straus, wna had done so mUGh for the eause of pasteu~ized milk in America and Europe, and see whether we could interest him in donating a pasteuriiZation plant for Manila. We were reGeivea by bath Mr. ana Mrs. Straus. !fne farmer was nat impressea with aur story, but his wile shawea g,reat interest. When he abjected that he had Jilut in aId the milk piants that he caFed ta, she r.emindea him that this was an American resJilonsibility, and he ultimately agreed to have one which happened not ta be in use shipped to the lslands. Calderon had become so amusing in his idiosyncrasies that I wanted to continue the fun. AGcordingly, when we embarked for Hamburg in December, ] Jillacea aver the eaar of his stater.oom a little sign :whiGh read, "I?rafessor a£ Music." :Ji1heFeatter he was canstantly being invitem ta play and sing, particularly by the ladies, who taok a tremendous 'fancy to him. Me was tataAiy unable to unaer-starn;! his popularity. We refused each £Fequertt request ta perform, and i[ invariably explained he was tao shy to make a publiG appear-ance. As we drew nearer and nearer to Hamburg, ]i natiGed that he was beoaming miraGuilously stauter ana stauter. ]j fina~1y grew allarmee and said, "Maw is this? Yaur trausers ar.e so tight if'm afraia they'll burst." The explanation was simple. Me had bought a dozen suit~ af long underwear, and as the days grew colder had ad@ed the suits one by one until he was wearing four, ancilloC'lkea exactly Eke a stuffed pOIfloise. ]n spite of his Wlaerwear ana the I'aoe, he was shi;vering when we reached the Custams Office on the Russian trantieF. lt was bi~ter GaM. Just as the train was about ta leave, two Amer.iean laaies appeared, much distressed because tney haa no reservatians. 'CWe'll offer them our compartment," I saicil. 'Fhere was na JillaGe far us ex~eJilt third class, ana we had haa na breakfast. Russian was nat includea in my l\nguisti~ equipment, mut I had a French time-table, and] believee that by £aroJilaring this :with the time of arrival at stations, I £ould piek out a cilining Jillace. But tfie train dia nat keep its scheaule, so that I soon lost track of where we I96


ALAS AND A LACK

wer,e. At every step [~ushea eut te try my languages, ene aFter anetheF, but the big, whiskeI'e~ Russians shoek their heads in bewilderment. By the time I had finished asking in six languages how long the train Wa6 going to stop, it was usually pulling out again. The thel'memeter was far below zero, and still we had had nothing to eat. Ii'oor Calderon was nearly congealed; I have never seen any¡ bedy S0 cold in my life. I took his pulse and found it so weak I was akaia he would litemlly freeze to death. When we reached Warsaw I was trying to figure 0ut whether he could be buried there, and what my auties were to a friend under such circumstances. Abeut seven in the evening an ancient Jew entered the compartment, and [ immediately addressed him joyfully in Yiddish. He was the first person auring that long, miserable day who had been able to under¡ stanG a werd 0f what] had saia. He informed me the train wouM stop about ten at an eating place, and I promised him anything he wanted for supper if he would lead us to food. Three hours later he produced steaming borsch, black bread, and tea. Calderon's face began to resume its natuFrul wIor, ana he was soon able ence more to articulate. The next morning we were at St. Petersburg. The great cold of Russia was naturally uppermost in Cal<deron's mind, and when he <disGevered a French-speaking staff at the hotel, he had listened morbi<d~ te their haFFO\v,ing tales of unfortunates who had lost limbs or ha<d been frozen to death. I asked him whether he cared to walk along with me to call on the American Ambassador, and explained that the exerGise would keep us warmer than if we hired a sleigh. AGGer,<ding to his usual haiDit, Cal<deFon kept trailing behind. It grew Gelder and wider; his hands were practically ankylosed. I had to do something to make him move faster and stir up his circulation. "If you don't hurry up, you'll lose an ear," I warned him. He kept in step with me fer a few mements, and then began to dawdl~ again at .his usuai gait. Finally I turned around. An expression ef simulated horror came over my face. "It's too late! You've lost an ear!" He clapped his hand to his head, but it was so cold he could feel notning. ''What am i going to do without an ear?" he wailed. "If yeu don't hurry, you'l1lose the ether one," I admonished him pitilessly.

197


AN AMIilRJ:CAN DOC]fOR'3 ODYSSEY From that time on it was ]j who haa aifficulty in keeping up with Calci!eFon. As we arew near the iEm1;,ass~ he roec::ame :worFiea aroout his appearanGe. "H you keep your head away fr.om the Ambassador, he WQn't notice it," I comforted him. "Aona we'lli only be there a short time-it won't waFm u!'l enougll. to Meed." All thFough the interview he keflt his head carefully averted, ana on [eaving Jjlll!1lee his Goat Gohlar Ufl Qver- his head. A13 soon as we .etUFned to the hotel he rushee to the mwror. He was so relievea to find his ear inta@t, that he f.orgave me om the spot for the wick]! had playea uflCDn iiim. Soon afterwar<ils, hQmeware boun<il on the Trans-SiroeFian, we arF,ive<il at the ene CDI the tine at Muk<ilen. ln CDreeF tCD Ibuy a ti€ket on the Qhinese railway tCD Feiping I had to have Chinese money, but it was then thFee o'cIo€k in the mOFning. [ found a nOCDk slightJ)' shelteFea f.rCDm the wincl w,h ere ] depositea OUF many pieces of roaggage with Crol<ileron to watch over them. BeGause trunks ha<il to pay first Glass postage rates, we ham. 1ig,htene<!i CDUFS by putting everything pCDssiMe in bags which Gould be keflt in our comflartment. I starte<il out tCD finlii a fllaGe to change my t;wentyo<iloliaF goM pie€es, an<d hUF.J;ie<il along lihe eaFk stFeets until] saw a light over the entrance to a gambling place. Much time was taken up in haggling oveF a satisfaetory rate CD£ exehaage, Ibut 1 was ultimately content an<il starte<il to retrace my steps tQWaFa the statiCDn'. As I drew near I Gould see CaideFon fast asleep, an<il a Ibig Chinese in the very aot of. piGK;.ing ufl one or the trunks an<il hCDisting it on his shoulder. I yeNed ana sflrintee after him over the frozen Fi€e pad<ilies. Before I GCDuhil overtake him he uFCDflp>e<il ~He trunk rout kep>t en fiunning. Witheut its weight he gathered spee<il, an<il his p>igtail stoo<il out behin<il him. I haa no inten~iQn of Garrying the trunk roaGk. 'I €aught held ef his j:ligtaH, sTewed him dewn, tUFned him aroun<il, marchea him back to the trunk, made him pick it up, and we returned together. T:his :was the 'last of my a<iLventuFes with ]D)F. CaMeron. ~n spite of net feeling at hQme in a strange enviFenment, throughout eu!' trip he ha<il acquiFe<il an amazing amount of. scientifiG inf.eFmatiCDn, which he had assimiiate® thovoughly. Me roecame IDean of fihe Government Me<ilical SchoCDI in Manila an<illater PFesi<ilent of the University of the il"hiJiflflines.


·; ALAS AND A LA!OK 'Fhe wr0blem 0£ ~beFcui0sis haed its FJecuIia,r a,nd w~pli~ating features in the Pbi!l,ipFJines. The dietary was unsuitable for its cure; but, in adedition, the people had the insanitary habit of eating with the fingers, a lack of proper exercise, superstitions concerning the con~raGtion 0f the disease, and an aJmost unshakable fear 0f night air as a pois0nous tbing. They usually slept closely t0gether in groups on the fl00r. Betel nut chewing made the custom of expectorating in public and private universal and practically incurable. Legislate as we might, bhe fi[thy habit of spitting stili continued, even among the more intel1ligent. Added to this was their utter resignation to the disease as a thing inevitable. N0t only did we have the ordinary preventive and curative measunes against tuberculosis to organize and enforce, but we had to devise ways of c00king and preparing native products so that they wouled be both nourishing ami acceptable to the masses. But it is often easier to be baed than g00d, and, similarly, easier to be insanitary than sa,nitary, and the East likes best the easiest way. We began an active eedu€ational campaign for the prophylaxis aned treatment of the disease. But euring the people of their superstitions was as great a task as converting them to a new religion; tuberculosis had long been regarded by the FJublic as necessa~i1y fat3iI, and it was difficult to convince the a,flli€te~ that it often yieleded to the simplest hygienic measures; they wanted a sign before they would believe. . In the Philippines more people died of tuberculosis than of any other disease, and there was hardly a family that had not lost at least one member. One-sixth of the deaths were directly attributable to it; only Calcutta approached Manila in its mortality rate from this cause. 11he tubercle bacillus, which was discovered by Koch in 1882, is excepoionally hardy. If not exp0sed to sunlight, which kills it in a few h0ufs, it m3iY live for six m0nths. The defensive forces make every effort to kill the tubercle when it gets into the body, but can only succeed when the blood is rich and healthy. The frail physiques of Filipinos make them particularly susceptible. For th0usands of years doctors have trieed -to find a remedy that would ~ure tuberculosis, but S0 far have had to fall back on nature. Sunshine and fresh air are the enemies of disease the world over. . Formerly it was the practice to recommend a change in climate, but

199


eJqlerience has amIDly demonstrateGi that treatment is more G1ewenaent on pFoper nutriti(m ana Fest than on meteoFologicrol Gonditions. The benefits of favorable clima6£ envir.onment are oftentimes mOFe than offset by the inconveniences of ttavc!l, i(meiiness, and homesidrness, and the necessary status of IDatients among strangers. However, proper hygiene ana aiet, the attention to the little things peoulia,r to each inai¥iaual Gase., together with appropriate meaicati0n for speeia[ 00nGlitions as they a,rise, Gan Thest be superv,ised in a sanita'FiNJiIi!. One of the FFin01pail OThjCl£tS of SUGh a,n institution is to teaGh the ]!la,tients to hel]!l themstilw,es a,n€IJ not me a G1a,nger to otheFs. 'iD1ie inHueFlGe exel'tea my those who have recoveFecd is the gFeatest p0weF in the eGlucational GFusaae against this aisease. One enthusiastiG Fatlent Feturned cur.eGl is wOFth mOFe ehan aN the circu1aFs and litet:ature that couid be IDroduceGi on the subJeet. ]-;I 0 disease makes such a drain I'n the res0urces 0f families., fOF its long, insiGiious G0urse prtlvents its unf0rtunate viotims fmm ea,rning their living, thus 0ftentimes tlnf0rcing a £0ndition 0f demt anGi aGtual yvant. I consiaereGi that thtl govtlrnment sh0ula take .up the buraen of FroMiaing a tumereulosis aispensary and a hospitaA for chroniG cases at Manila anGi a sanitarium at Baguio. Hlven i,f the great misery, sufferiFlg., anGi edes]!laiF of. stri0ken Mietims, of .r ebtives a,n~ f.rienGis anGl 6h0se aeIDenedent U,]!l0n ~hem, we~e to 'me ignored aJtogether, anGi tilie qNestion £0FlsiGieFea ~Fom its finaneiro] as]!leet a[oFle, it wouM The, [ thought, a matteF of wise, pumlie poliey to reliev.e, in ]!lart at ieast, this arain on the ]!lFoduotive caIDaGity of the GOuntFY, whioh was measur.ecd in milli(iJns every year. DF. Calederon and I Feturned from our trip with a gooed knowle€!ge of what the rest of the worM was doing. But I realizeed that the hO]!le of freeing the Philippines was in largtl measure dependent upon raising the economic standar€!s. Until the l'i[iFin0s eouled omta,in bJetter fooed and make more general use of milk they were tremenedousLy handieappeGi. 1E1his was exceUently i~lusliffat€d bJy t1ie situation in lEUFOJiltl wl\.eFe bJefore the Wa,r the tubJeFcWl0sis Fattl in Austria aFlGi Germany G0m,JilaFtlcft fav0rabJly with that of Gr.tlat Bl'itaill an€! Arn.er.iea. ks the War JilFOgFessed, tuTheFcu[osis bJegan to increase. !I!n some seotions it Fan as high as in the past. But after .he War, tlv.en though oveFcwwding was 200


&LAS AND A LACK univers~)

even th0ugh there was no money, the tubelJculosis rate at once climbea a0wn because the Austrians and Germans were again getting fhe ~ats ana 0ther f00d essentiaJs of which they had so long been deFFived. Nature evidently intends that every child born should take part in the great drama of life and live until all the purposes which have ca!lled it into existence have been satisfiea. So determined is she that heF Flans be successf,ul that she has apparently established a law fixing a direct ratio between the birth rate and the infant mortality rate. A high death rate among infants, unless brought about by epidemic diseases or other special causes, is normally offset by a higher birth rate. Nevertheless, it is the duty and desire of the health officer to save as many of them as he can. No one wants the children to live more than the health ofll.~er, because the bearillg of heahhy children is a blessing to womankina and to the world at large, while the bearing of sickly children soon to die is a misfortune to humanity. The tiny graves in ~he cemetery are seen by many, but few hear of the efforts made by self-sacrificing physicians and faithful workers in the children's cause to Frevent these graves. The death rate among young Filipino children was appallingly high. In Manila every other baby died before its first birthday. General debility was a common condition among children. The bodies that these babies inherited from weak parents could not withstand the germs of disease. Another cause was the obstetrical practices which prevailed. It a woman had too small a pelvis to give birth easily, not infFequently a Fope was wouna around her waist with a man pulling at each ena to f0rce the birth. Many children alS0 had died of tetanus neonatorum, oeGause the midwives, according to an ancient and common Oriental custom, had dressed the cord with manure. The midwi:ves were an organized but untrained and unlicensed group. By the exercise of much diplomacy we took the leaders among these (:jld women into camp, teaching them more-scientific and humane meth0ms. In a gltea,t campaign of education we.issued free packets by the hunaFeds of thousands for dressing cords, and finally they were used. When the midwives had been converted, midwifery schools were started over the Islands, and the decree went out that before 201


AN AMiEiRICAN Ji)(I)C'FO:R'S ©D;YSSE¥ any woman should praotice 0IDstewicS she must procure a license. But impFoper nutFition was the major Gaus~ 0f the high infant m0,\1rtal1it.y. 'Fh~ sbrouggle f0r m0re acle'luat~ f00Gi has IDIl~n iong and still continu~ . The us~ of mmk on a larg~ scale was practicilly unknown in the PHilippines, as wdl as in many 0ther trCilpical countries. 1'h~ p0ver.ty 0£ the pe0pie macle pn0perly maFketeld C0WS' milk, either f,F~h or cannecl, impossilile to obtain tlXGtlpt oy chaFity. Glrdinary cows' milk was extremely expensive, because cows aicl not d0 well in the !Islands. Thtl nat;ivtl grasses hacl [jultl sPlintls whi€h, when tlaten, causecl tiny wounds in the intestina!l tract. When thtlse hea!led 0ver they lett scar tissue which ultimately causecl such contFactien that the natural glan€!s wertl clestr-oytlcl and the €OW €0u1lcl n0t aIDs0Fb what she ate. Shtliitera'llly starvecl to cleath. in my early tlnthusiasm, !I tritld to stant a hercl 0f a hundred ancd fifty, bu~ aN ditld. goats wtlr~ €0mmOn and fiour-ishecl, lDut the 'li'hiJ.ippine varitlty gave very 11tde rn.i!lk. ] t 0€€urFe6i to me that if we €0uiGi Gress an [sian€! g0at, which Gould stand the climate, with a Maltese goat, which lactated g(mer0usly, we might get a satisfaet0I'Y hylDricl. ·'Fhe agricultural clt;paFtment t00k this up ancl a IDreetil 0f goats was pn0G1ucecl which seemed to fill the requiFements. I believeGi we G0uld use the slog,m, "a g0at in every fami~y ," ancd have an0theF eheap method 0£ seeming mitk, out the iFi~ip in0s dit1l not take to the idea. Whatever milk the p00rer Glasses used came Mm0st exclusively fr0m the earalDa~la, 0r female wateF buffalo, whieh is, by nature, a dirW anirna[ ancl clmIiht~~s GOntributea its ~ul~ shllir.e te the sum of impUl'iti~ that vitiated the infants' milk. The Filipin0s hllive a; clegree of uncleFstanding with the Garabiao "",hieH the white ,pe'0Jl>Te ha,ve ntlver seeme~ aMe to attain. Wilen Manila was fiFst oCGupied by American tF00PS, a MajoF, in his delig,h t at getting ashoFe, went fer. a long walk 0n the 0utslIDrts 0f the city. While Grossing lli fi€lM he was 0bseFv~~ fuy lli caFabao, w1i.i€h pl;(Dmptty ohaFgeGi him. Th~re happtlnecl to De a tree in the micldle of the field, which htl reached with three leaps ancl a bouna. [t was then ab0ut five in the llitttlFn0en. ;[;lie 11£ttld his \<0iee in ~iaintivtl apptlal but n0m0cd¥ llins\verecil. He woulcl nmuin quitlt for a ftlw momtlnts ancl thtln cauti0usly begin to Glescend, blut each time a warning, "pff..shshsh"Cilo,00(iJ0" would sencl him hUF,J;,iedJ1y baGk to his peFGh. M0ur afte·, HOur the Maj0J; sat in a 202


ALAS ANID A LACK CF@teh @F fte tr-ee, anGl h@Ul' after h@m the carabae waiteGl untiringly bel@w. The lang night passed. Finally, at about six in the morning, a fouryear-oM ehiM toddled over the field anGl led the carabao unprotestingly a.way by its nose rope. The brave Major then made good his escape. The Major had probably been wise in his policy of watchful waiting, because many people have been gored and killed by infuriated carabao. 1i1he animal has n@ sweat glanGis except in his nose, and if he does not ha'Ve an opportunity t@ soak himsel'f once a day in water, or at least in mud, he will go loco. I1hough erdinarily slow and deliberate, under such eonditiens he will attaak anything on sight, preferably a white pers@n. At all times he loves mud and fiJth, and if, while dragging his caMi @r sleGlge, he comes t@ a mud puddle, he will promptly lie down, and @nly unaer the mos1 urgent suasion will he move on. The scarcity of milk was accentuated by the rinderpest epizootic which, in its slow girdling of the wer1d, had fina.lly reached the lBhi'Lippines. [t carried awa.y trem seventy-five to eighty percent of the carabaos-hunGlreds of thousands of animals that were indispensable in cultivating, reaping, hauling, and disposing of the agricultural produets upon whioh the prosperity @f the Islands was totally dependent. RinGierpest is a dysentery in came which has a ninety percent mor¡ tality rate. I have gone thl'Ough fields where hundreds and hundreds of these dead animals were lying. At that time we could do nothing for them except keep a strict guard at the quarantine stations and try t@ pFev.ent the infected animals from rubbing noses with those as yet untouGhed. So many cattle perished that for years meat had to be imported from Australia, and milk became almost an unknown quantity. FinaJlly, an army veterinarian named KeIser developed a vaccine which maGle eattle immune to rinGierpest, but the Filipino owners were suspicious of it, anGl the veterinary corps were not always consiGlerate of their sentiments and prejudices. It was extremely pathetic when the only arumal upon which a family depended for the necessary work of the rice field succumbed to the Glisease. No meney with which to inGlemnify the owneFS was available until the United States Congress appropriateGl a milli@n dollars, the only money ever contributed to the Philippines.


AN AMERICAN IDOCTOR'$ ODYSSEY iEven when the caraballa had recavered in numbers, difIkul~es arase amaut the natUFe of the milk, whioh cantained twice as mUGh butter fat as ol'dina'FY caws' miJk. it eaull~ IDe ei'luted in ha~f aned stiH! na:\<B the proper amount af fat, out sucn liiilut4en maeB the ca~bohydrate cantent en~rely out of proportion. 11"0 remeey this, the dealBrs in carabaNa milk triee aM sorts of Bxperiments, hoping to make the procluet correspond ta cows' milk-rice, 'starch, ami other substances, many of which preduGed weird loakoing miJIitures and bacterial eaunts that walrl:d have staggere<;i a stallistiician. Regulating the traee in Garamalla milk was eemplicated because there were no big prodooers, and keeping watch aver every carabal!la owner was an obvious impossibility. We tried at one time posting inspectors on the raads, but there were sa many tracks ane trails by whiGh milk eould enter Manila that thB attempt proved a failure. As always, our reGaUFSe was eel:l(!atian. Nurses went freID nome ta home to talk ta the heusBwiiVes. U[timatdy, several sumstitutes for fresh eaws' milk were eisGaverem. The Swiss developee a methae af preparing natUFal milk with no preservative ane net neated enough to coagulate the casein. It kBpt well, weule net transmit disease, and Game not me infected so long as tne tin was unapened. rnt eoulcl! be mought fer deve!J! Gents a quamt at the gFeceFo/ stare, and in time it came ta be gener-ailty usee ~hFaugih­ aut the East. Another diseavery, maee at the Peiping Hospital, was that a subs~i­ tute for milk itself coule be manufactured from the soya bean. With the addition af coe-liver oil and calcium it closely resembJIed nalluraI mii]Je A nummBr of ehiMren were fee only an this tead trom the time they WBFe th'Fee weeks ale, were examinecl! reguIarly, ane pFavBe to me healthy and normal in every way. I was eonvinced that the "eat only what you crave" idea was nonsense when I saw haw chadren wha had never had any other fooe lovee this soya bean milk, because to an adult it was one a.f the werst-tasting deealrtiens that eouId be imagined. PiI. Filipina. eeliege gFaeuate in ehemistFo/ fram <!:elummia UniveFsit;y then made !l.er c(mtributian. She faune that eJ!itract ef banana amde<d to the soya bean mixturoe maee it taste Eke fresh mit!R:. The ~i'liJDina housewife (!an naw make this milk in her awn koitGhen, using a little 204


ALAS AND A LACK ha,nl!lJ!lliess feli ~he bea,n and aading the ether inglietilients accoraing te the pFesâ&#x201A;Źribed aireetions. The soya bean has proved of inestimable value to the East and promises te enlarge the dietary. I once attended a delicious full course iun0h in the Bureau of Science Laboratory in Manila where everything ÂŁrem soup' ~hliough steak to cake was made from this bean. Another food deficiency was responsible for one of the most debilitating and crippling diseases of the Orient. Beriberi is as needless as smahlp'ex and a aisease abeut which I feel as strengly. Each year it takes a teN ef over a hundred thousand lives. In the War of 1895 between Japan and China nearly half the Japanese troops had it; in the Russo-Japanese War of 1904-05 eighty-five thousand cases were reperted. It was estimated that in the Philippines at least five thousand aied and! twenty-five thousana were made ill frem it annually. Among the poorer classes beriberi was particularly prevalent; peeple for whom the government was directly responsible suffered badly. Bilibia Prison was fillecl with it. On more than one of my leper collecting tr-ip's the captain ef the Basi/an pointed out a lighthouse where thelie was no light, and on investigation we would discover keeper and assistants dead of beri~eri. Or more often the American flag would be flying upside down as a signal ef distress. In almost every instance we woulcl fincl the cr:ew, although still able perhaps to tena the lamps, seriously il'l. Beriberi caused a multiple neuritis aff~cting both the motor and the sensory nerves. The extremely painful inflammation brought about a p'a,Ftial and even complete loss ef the use of the muscles supplied by these nerves, and particularly affected the heart. One of the most apparent manifest-ations was the drepsical appearance. The patient ultimately became bedridden, and large numbers died from heart failure. [ remember the imFression mal!le upon me by the huge hospital for mer-iberi incurables at Singapore, where these poor people were crawling around on their hands, dragging their paralyzed legs behind them. The disease was too far advancecl for a cure; it might easily have been pFeventel!l. _ Ma,ny causes were assignea fer beriberi, such as overcrowding and peor ventilation. 'The Frend'!. clung to the theory that it was infectious long after it had been proved otherwise. Many claimecl it was due 205


AN AMiERl€:AN iDGCTOR'S @Di¥SSEY to oaeteria on rice whieh pFolilucea a t0xic conaiti0n. Tne discovery off t:he true S0urce Game with the opening up of huge rubber plantanions in tne $1!1:aits S~ttlements amli 1VlaJay States. Chinese ana Inaian laborers w~re imJD0l1tee, ane pr0mptl'y a~ve10pee beriberi. The British government empioyea two scit'lntists, iW~lli'y w. Fraser aned A. T. Stant0n, to w0uk en this Ii'F0blem. 'iDhey an:i,v ea at t;}}e stal1ding cenclusi0n that this hOl'l'ible affiktion was clue to a fooa deficiency; that beFloeri was a disease br0ught about by the absence of certain ch~mical C0nstituents essential to ~he nouF,i shment ef tine human b0ay. Whey grad\]" aI!1'y founcil out that Vitamin 'B was missing fmm l1iae which hae been polished; the 0uter surface of the rice grain c0nt:aining sulDstances essential to n0uFish the bo®y nae been gFeune away. Those who ate unp0lished Ree eid net get berllDel1i. !E:uroJDeans and Americans aid not have it lDecause they received Vitamin 13 fr0m other foods which Orientals or.dinarily did n0t eat. After trying out 1ili.eiF theory 0n chiCKens, 'Fraser and Stant0n tested it on inmates of the insane asylum at Kuala LumJDur. The results were ,th~ same. ,],h0se whe ate li'0lishea rice came d0wn wt~n lDer~beri; t1i0S~ fed 0nly unJD01ishecdi JOiee remainea healthy. 1iney then wi~ed a fUl1t:her experiment. 'I1he government was building a railway in Malaya, and ~hr~e hunawu of the w0FkeFs j0ined in the test. Ma.J:f were put 0n a miet 0f unJD0iishea riee; ha1£ 0n li'etish~d. 1fi\he btl!~r groNJD Game dewfl with beFib~ri. Then the diets Wt'lFe reversed. The sick gmup recovt'ln~d an4 the wdlJ. group came down with the Iil'isease. ]t wa1'rantelil the fig" liluG~i(:m tnat a miet which induaed Vitamin (g was a Ii'Ft'lventive £el' beribel1i. After fihe British had made the diswvery, it lileveloJDelil that 1"r0fess0r C. Eijll;man in ffava nalil eausetil lDeFilDeFi in ohiekens fuut had never applied the same test to humans as the British haG done. Fraser and Stant0n GeteFmined further how to tel[ whether riee was 1i'01ishecdJ te the Iilanger p0int. ~f when stainelil with metnylene blue 0r i0dine the gmins took a deeli' c010r, then the rice was IileScient in Vitamin B, and, therefore, beriberi mig.h t Fesult. If the grains stainea slighthy, the !lice was safe te use. This test was ellltr.eme.ly valuable, because it was se difliou[t to judge with th~ naked eye how muoh of the €Oating had been !lemoved trem the kernel. A more exact index was to <;!eteFmine the am0unt 0f Ii'hosph01'uS JDentex;ilile. ~f it: centained 206


ALAS AND A LACK EOUF-tenths 0ii one petâ&#x201A;Źent er melle it was safe; if less, it might cause beribeFi. At the first meeting of the Far Eastern Association of Tropical Medicine at Manila, in 1908, the two British scientists read the story eÂŁ their' ep0ch-making discovery. I decided to try it out at once among those fol' whom I was directly responsible. Before the Fraser ami Stanton report, we had striven in vain to wipe out beriberi entirely at Culion. By adding to the rice more meat and mongos (beans resemMing lentils), the number of eases couled be reduced, but many of the inmates preferred to deny themselves food rather than eat mongos, so that we had starvation as well as improper diet to deal with. At the beginning of 1910 the use of unpolished rice was made compulsory, aned be~iberi stopped immediately. With this evidence Forbes issued an order that only unpolished rice should be used in all government institutions. But soon commissary officers, prison wardens, and others directly charged with carrying out the oreder began to be besiegeed with complaints, and it was but natural that they sheuld take a ceurse of least resistance and recommend that the use of unpolished rice be dis: ')ntinued. It was asserted that a penurious government was attemptinb to cheapen the diet at the expense ef inmates ind employees, who, consequently, often re[-used to eat it. However, we insistegl up0n strict obedience, and when its use finally became general, the results were startling. The thousand deaths ÂŁrom beriberi in government institutions that formerly occurred annually ceased altogether. During the autumn of I glI I a great shortage of rice occurred throllghout the Orient, and certain grain interests attempted to corner the world market. The price soared one hundred percent. In some instances to protect its people from extortionate prices, the Philippine gevernment also plunged, and beught and bought until it had broken the corner as far as the lslands were concerned. In a short time it had the cost to more nprmal figures, but in so doing had been forced to buy great lijuantities of polished rice. So much was on hand that large issues weFe made te Cuiien in November, 19II, and continueed until February, 1912. I was away at the time or I should have protested. Dur-ing January cases of beriberi \;Iroke out among the inmates, and 20 7


ALAS AND A. lLACiJK ~ cday el' twe its weig>ht woulcd begin te inGFease, and the par.alysis to leave its limbs. [t was just like a miracle. Nevertheless, we were cdeaJing with a symptom and not getting at the caus€ of the dis€ase. Another paper eutlining progress on beriberi was read in 19 I I at the Mongkong meeting of the Far Eastern Assoei. ation ef Trepical1. Medicine. Among the most convincing proofs were tnat th€ Hongkong jails, fermerly riddled with beriberi, had been freecd of the disease, and the entire native army in Java had been cured. The Associatien adepted a reselution that all governments with East· ern possessions should be petitioned to have white rice barred and only unpolished rice used. The next day the French delegates moved to reconsider, asserting they weu1d like to present certain facts. At Saigon, in Indo·China, there was a monastery and a nunnery. Both monks and nuns ate the same diet of pelished rice. If we could explain to their satisfaction why the women always had beriberi and the men never, they would be glad to join us in signing the petition. We had no answer at the time. It remainecd for a !Netherlander, Kuenen, years later, to discover that if vice were thoroughly washed, th€· protective substance was removed as eff€ctively as though it had been polished. In Saigon the dirty men had not washed their rice, while the cleanly women had rinsed theirs thoroughly. The campaign !lgainst beviberi was held up for years because of French cdubiety. 1 r€alized that solution of the beriberi problem would be of tremendous humanitarian and economic advantage and be one of the gr.eat forward steps of modern times. A simple method of protecting ·the poor against themselves would be to tax white rice. This would work no hardship on them, betrause the price of unpolished rice would not be .raised. But harmful polished rice, even at a few cents' higher priee, would be put eut of their reach. On the other hand, those able to afford the polished rice would not be hurt by it because their living scale would allow them to include a more varied diet. In spite of much opposition, I managed to get a bill to tax white rice passed by ene House of the PhiEppine Legislature, but adjournment took place before the other House could consider it. Later, owing to the unsettled condition of the rice market, the Legislature was not disposed to take any action. 20 9


AN AMERICAN DOCTOR'S OIDYSSEY Ror years [ have peddleG! my taoc iG!ea ar!'l1:lnG! the wOldd. Over and over again [ have I"0inte~ out t;hat its action woyjd me automatie, beeaus_e l"eol"le wouM IbNY, the eheaFer unpolisned riee a,nG! beriberi woulcil disal"l"ear. Tine Wa,r interfel'eG! il'lii~h my I"'lans. Mter.warms [ inteFeste.G Sir William ®sler, then Prof8SSoF ot MeG!iGine at Oxford, anG! Viscount Bryee, who agreed to use tohern influe!1ce wluh the British government to impose such a tax. But bdore they eoulG! take any action, both of them died. Though I"FOgresS has been slow, ~ eontinue to pediihle tohe iG!ea. iIlt is I"el'fecta,y arnarz;ing tihat, in face of the miraeulous results £tom so simple aJ dietary reform, increcllulity, with its attendant sacri1ice of life and health, should stilill"ersist. But [ am com,ineed that if someboG!y couid pl'ove toG!ay that €ancer was GauseG! by the eating of wliite mreaG!, twenty-five years £rom now most peol"le woulG! still be ea~ing white I!>re:J.cll.

210


THE HOUSE OF PAIN

CHAPTER 14.

UNDREDS of thousands of lepers still exist throughout the world as social pariahs, thrust out of society because they have, through no fault of their own, contracted a repulsive disease. Far beyond their physical suffering is their terrible mental anguish. No criminal condemned to solitary confinement is confronted with such torture and loneliness. Shunned by friends and acquaintances, who are in terror of even coming within speaking distance, the unforturiate victims soon find themselves alone in a world in which they nave no part. The few who come in Gontact with lepers instinctively QFaW back ÂŁ.rom them, se that nermal social relationshiF dies at birth. Patients, when aveiedeed by everybody, sit idle and brood; a human liieing devoid of hope is the most terrible ebject in the world. The treatment of cases or leprosy toeday is sometimes as inhuman as in former times. In India a leper is often cast out by his own relatives, and has to go to the government for relief. The Karo-Bataks of the East Coast of Sumatra eXp>el a leper from their villages, and at night surround and set fire to his hut, burning him alive. The Yakuts of Siberia, in their great terror of leprosy, force the leper _ te leave the community, and he must henceforth live alone unless he finds some other leper to keep him company. Even in the United States lepers have not always been treated ~in@1y. The peoFle of a West Vi~ginia town, wh_en they once feuned a [eper, Flacecft him in a box â&#x201A;Ź:Ir aned nailed the door shut. The train edepaFteed. It was the middle of winter, ' and before the doer was finally opened, the man had starved and frozen to death.

H

211


AN AMERICAN DOCTOR'S ODYSSEY Leprosy is the mast anciGnt ami exclusivClly Iluman of diseases. It has faNowei1l man in 3111 his migrations. The anGient records arCl nGt pr:eeise, ana it is im\p0ssible ta SalY with €eFtalinfiy trhat Egyptian paPYFUS, er SanskFit Rig-Veda, OF Chinese Farchment., or Jewish @.ld Testament Feferrecl definitely to w,h at we know as leFrosy. Syphilis and yaws and various skin ailments have €liniaal symptoms often readily confused with it. One of the oldest works in Chinese mediGinCl, cal~Cld Su-yen, 400 B. e., clClscl'ioea a aisClase w;hi.h certainly hai1l the GharactClFistics af leprasy. 'traa,itien aSGFibes an eJcistenGe of meFe than two thousalncl years te leFr:esy in Ohina. lit is daimCld that iBui1la'hist priests used to frighten peoFle into conversion by threatening thClm with the disease should they d0se their ears eo the holy teachings. Far centuries overpopulation and misery have sent thCl Chinese Gut int0 ill Farts 0f the warld, and they halve carriecllepFGsy with them. LepFosy amang tihe Jews is undeumtedly veFo/ alcl, alltheugh fF0m the clesCFiFtian in Leviticus ~ I ~b 4-8~, many aiifCll1Clnt £orms of.i1lisease appear te halve meen inclueed with leFrosy. Moses, one of the fust -great sanitarians, laid down a system of reg;u:Iatlons for those having leprosy, threatening thCl Jews with the wrath ef Yahweh if they disobeyed. At interv.als af seVCln days the isolated GnllS wer:e examined my the priClsts, whe attempted ta cilClanse them by tile feilowing ~itual: 4. 1i1l1en shall 61\e pr:iest command to take for lIim t'hat is to be cleansed two bil'ds alive and dean, and cedar wood, and seadet, and hyssop. 5 - And the priest shall command that one ,,£ the biFds be killed in an earthen vessel over running water. 6. As for the living bird, he shall take it, and the cedal' wood, and the sGarlet, and the hyssop, and shall dip them and the liv.ing bird in the bleed of tlle bir.d tilat was killed even the Funning water:. 7. And he shall sprinkle upon him that is to be deansed £rem the leprosy seven times, and shall pronounce him clean, and shall let the living bird loose into the open field. 8. And he that is to be cleansed shall wash his dothes, and shave off all his hair, and wash himself in water, that he may lie clean; and after tllat he shall Game into the Gamp, and shall taFry abroad out of lIis tent seven days.

If after the alternate periods af examination ana isolation the lesians persisted, the a€cused was declared leprous. HCl haa te go aut with 212


'IiHE HOUSE OF PA[N cl0~l\es t0rn anlii divtied, bareheaded, with l\is face Go:verea, and hair uncut, ery.ing to a!l!l he sh0uld meet "Tame! Tame!" "Unclean! Unclean!" 'The oFigins of leprosy are hidden in the mists of antiquity. But the FOutes 0f travel, for- tFade or for conquest, have been the paths of aisease as weN. The Phoenieians may have bartered leprosy for sandalwooa and spices; the Achaians crossed the wine-dark sea for Helen, but their slaves , may have brought leprosy back to the shores of GFee@e; :leprosy is supposed to have foll0wed the armies, and was brought my Pompey's legions from the cOn<iJ.uest of the East; and the SolcdieFs of the Cross who set forth to rescue the Holy Sepulchre, staggered back bearing the Gross of leprosy to the Christian world. By the middle of the Twe1ÂŁth Century leprosy was in Scotland, NorWilly, the Shetlana [slands, H011and, Denmark, Sweden, and parts 0f Russia. There were many leprosaria in England-seven in London alone, am0ng them St. Giles, founded in IIOI. In Scotland the leper h0uses were called spetels, and the disease to the Scots was the mickle ai~.

1'here is great controversy and doubt as to how many leprosaria existea in Europe in the Middle Ages. One reading of Mathew Paris gives nineteen thousand in 1244;, 'hut this is vehemently disputed. Certain[y there were many tltousanas. Mezeray, the, Rrench historian, says that in the time of Philip Augustus, 1223, there was no city or town which was not obliged to build a hospital for lepers, solid and dUFable. Louis VIII in 1226 left legacies to two thousand leper houses. In Spain the first lepr0sarium iWas founaed by Ruy Bivar, the Cid. 1n 1284 sequestration was required by Sancho IV ef Castile. The Castilian monarchs had a special interest in the disease, because more than once a leper had sat on the royal thF0ne. S0me eontena that in the Fourteenth Century the religious orders megan to found hospitals for the lepers, known as Hospitals of the Holy God, but more popularly'as lazarettos, in honor of St. Lazarus, the Bible beggar, while others say the name derives from the island of St. Lazarus in Venice, which was the site of one of the first lepf0saria, 1fhe ~epresaria in the Mida1le Alges were directed by the ecclesiastics of some nearby m0nastery. They were endowed in different ways. Many of the rich lepers had to take at least a part of their patrimony 21 3


THE HOUSE OF FA-IN Item, i for-bid you to touch little

child~en,

or any young people what-

soever.

Item, ~ for.bid you l\enceÂŁoFth to eat or drink with companions, save they be kpers." The leper then put on the leper garb of black with a veil over his mouth, and received from the priest the cliquettes with which he must warn ef his approach. The priest finally took leave of him in these WeFQS, "Thou sh:vlt not be discensolate fer being sequestered from all ether.s, for theu shalt have thy part and portion of all the prayers of Holy Mether Ohurch, as if in person thou wert daily attending divine service with the others. Only take care, and have patience. May God be with thee." In some rustFicts the leper at the close of the ceremony was made to desceml inte an open grave in the cemetery and undergo a pretended inhumatien, but more oÂŁten was merely led outside the church and in (!>Focession concductecd to his cabin in the fields. Before his door was planted a cross on which the priest hung a box for alms. The leper houses of wood, surrounded by palisades, were invariably located outside the villages in the country, but usually in close proximity te a traveled highway, so that begging might be fruitful. At a l'e(!>er's cdeath, his hGluseholcd ,utensils weFe broken if of earthenware, burned if ef woed, and passed threugh fire if of metal. The corpse was buried under the cottage and, in certain regions, a cartload of lime was ttlu:own into the grave. At a later period lepers were very rarely kept strictly to their houses, in accordance with the prohibitions given by th; priest. Privileges were oÂŁten accorcled them which weulcl seem to fit in peorly with the theory that tile M~dcllie Ages were cegnizant ef the extremely contagious nature of the malady. They had the right to circulate in the environs of the town, provided they did not pass a certain road, square, bridge, or river. On certain days and hours of the day they might enter the city, although they could not eat there nor frequent taverns. But they hacl to beg, and a begging space was usually carefully specified. Of,ten a weN persen weul!d be theFe to Feceive alms fer them. They also had to buy provisions, and attended church, where a special plaae was assigned them, since they were net admitted to the common confessional. 21 5


AN AMERICAN J1}OCTOR'S ©D¥SSE¥ UsuaHy at [EasteF the lepclFS woulG! go "out of their tombs iike Chr,ist himself" anci enteF fer seveFal cd'ays in fhe ~ities er vilHages to JPartioip>ate in this uniIVeFsai Christian festi~aL On the other hand, J.epeFs might be subjected!, to extreme sever:ity. At ViGenza anyone who found a leper wamdering in the ci~y er its environs hacd a right to hunt him eut with a whip, even thc:lUgh he were ringing his "leprous beN." Tihe tr:eatment of leper:s was a eur:ious cemp>ouncd of herFoF ami! eempassien, in wllieh, as tfie Y(lars went by, tile ~attcw gl'ad'ually gainecd ~he as~enGieney. Wile cdiseasecd ones became something sacred; in France they were ~l[ed les malades de Dieu, Ies chers pauvres de Dieu, or Ies bonnes gens. Anyene who help>eG! them rea~hed the heights ef sacrifice, and thereby attainea the greatest honor. Hans Wolbein painted a pictuFe in ~ :p6 ef !!Elizabeth ef Hungary, patron saifit ef <'jl!leens, sUGGeFing a group> 0f lep>ers. Albrecht [j)iiFer a[se tFeate<il the sl!lbjeet by painting the [·imQs of the lep>ers as ~ripp>lecil OF amp>ut~t(lG!, and the skin GoveFed with OlotGhes like th0se of a ie0paFd. It is obvious that the horr:or rather than the accurate portrayai of the disease was the artists' aim; they desired to e~ress the heroism of those who help>ecd lepers. Matilcda, wife of Menry I o£ Englancd, Countess Sybil 0f Flancders, ROGhi~G!e 0f Hainadt, and St. Cath(ll'ine ef Siena were among tae great peFs0nages wae be1ie~ec1l they weFe honor,i ng themselves by Ganing for lepers. And Ambroise Pare, physician to' Henry II 0f France, and o£ten regarcded as the father of mocdern surgery, at the end of his cdiscourse en lep>rosy gives the ac;tvi~e that, when the lepers are separatecd from the w:oFld: "one face them as l<;indly and gently as possible, haNing in mind they are like to ourselves, and, should it please God, we might be tOUGhed with the same malady . • . And it is necessary to admonish them that although they are separated from the world, yet at all times they are loved by God wl\ile bear-ing patiently their cross."

.At the ti,m e thr.el!lgh0ut iEUFepe it was a consistent policy te stamp out the cdisease by iS01ati0n in col0nies or hospita[s. Even a ihealhhy person who hatd been known te have been touchea by a [eper might be

216


THE HClUSE OF PAIN e-anisaed bF0m sooietÂĽ. ProobJal!J1y such measunes hacl a m0st imp0Ftant influence in preventing the spFeacl 0f the malacly. The leper house period in England lasted roughly ÂŁr0m the Eleventh through the Fourteenth Century. The disease died down in Europe much in the 0rder- in ~hich the c0untFies had been attacked. One 0f its m0st rema,rkable features was its rapid decline in the Fourteenth and Fifteenth Centuries. Nobody knows why leprosy occurs in one place and not in another. As For-ank Oldrieve., SeGFeta,ry of the British Empine lLeprosy Relief Asso~iation, expressed it, "There is a caprice of distribution which it is difficult to explain, and it does not seem to depend directly on climate, geological forma~i0n, or such-like physical conditions; for leprosy is found in m0unta,inous distritls, on the plains, on the coast, in the interior, in a'll vaFie~ies of climate, a,nd on all kinds of geological strata." LepFosy never breaks fresh ground unless it has been introduced fr0m without by a leper; and a sure and safe way of stamping it out is by iS0iati0n. For example, lepers were unknown in Hawaii until 1859, but thiFty-two years later one out of thirty of the population was leprous. A Chinese introduced the disease into New Caledonia in 1865, and four thousand cases grew up in twenty-three years. The mst instan~e in the 1.oyalty Islands was in 1882, and on one tiny islet sioc years [ater there were sev~nty cases. h is generally assumed that a sufficient concentration of cases in any small area will soon result in the appearance of other cases among peFsons wh0 frequently come in contact with them. This is strikingly il!lustrated in the Island of Nauru in the central Pacific Ocean, south of the Equator. Although only about twelve miles in circumference it supports a population of about twenty-five hundred. In 19 2 0 there were four cases of lepr0sy on ~he island, in 192 I sixty, and in 192 7 three hunwed and rthir.ty-seven, 0r about 0ne in seventy of the popUlation. Mor.e than three million lepers are supposed to exist in the world, the great strongholds being India, China, and Japan. India has a mihli0n OF more cases., and China is in much the sa,me positi0n. There are f0l1ty thousand in Burma alone. South America has had large invasions; Colombia is said to have over one hundred thousand lepers. 21 7


AN AMERICAN IDOC'FOR'S ODYSSEY Aiso the islamds 0f CeyJ0n, Java, Hawaii, and many 1s1ands in the West ~ndies have suffeFed terrilbly. ~n K0Fea, oUl1,i0usly, the disease is €0nfined to the s0uthern haJ,f 0f the peninsuia. iLepF0SY 0ccurs now in Eur0we 0n1r in sp0radie f0rm; a few centers remain in ~ta!ly, Finland, Russia, Norway, and Sweden, but they are diminishing Fapidly. About sixty years ago the disease in N0rway was declining, but then it began to swread once m0re. J:t also reappeaned in H011and a£ter a long absence. AhhlDugh there are many persons in England today aflli~ted, there b.ave been n0 indigen0us cases f0r the past fitity yeaFS. The weight of auth0rity w0uld seem to in<dioate that lepF0sy <di<d not exist on the Western Hemisphere before the tl0ming of the Spaniards, but afterwar<ds it spread thFoughout $0uth Ameriea, ami was augmented by the tFaHi€ in slav:es, am0ng wh0m weFe lepers. Contez erecte<d the first h0spita,] ot San Lazan0 in Melliieo. ]~ ~sn lihe first w,hite man 0f wr.0minence was dedareci a [eper ,in CaFtagen~ C010mbia, tnen the center of the slave trade, anci stiJ!! a f00US 0f .leprosy. Leprosy was brought to the United States with the slave traHi€, tile FFench settieFs 0f Louisiana, and worldwicie immigration. The <disease n0W spFealiis in but f0ur of the states-FIIDFiilla, iLouisiana, w'exas, anC!l Cvlif0Jmia, aT~a0ugh at 0ne time it e0uld De G0ntmGtecf in Minnesota. If the same inciidence pFevailed in this country as in the Netheplan<ds East In<dies, whel'e the rate 'sometimes runs as high as ten cases peF thousand, we w0uld have 0ver a miNion lepers instead of a few huntdred. New Y 0Fk: State prlDoeecis on the tneory that cases 0f lepmsy intr0<duee<d witfiin its lJoJ;<ders aFe no tdanger to otheFs, and is [0at1h to segregate, especiailly if theJ;e is any objection on the part 0f the patient OF his friencis. In New Y 0rk City there are <dozens 0f lepeFS, but n0 one contraGts the <disease from them. MassaGhusetts had a leper settlement on Penikese Island nea~ Buzzards Bay, of which the normal capaeity was nineteen. Al!l but one 0f these weFe 0t foreign birth or parentage. A very inteFesting st0ry is t01<d in c0nnecti0n with the entrance 0f lepr0sy into the Philippines. One of my pre<deeessors, Major E. C. Carter, had put in print a story to the effect that the Japanese, ann0yeill 218


THE HOUSE GlIf1 PAirN

oy the effe1tts efthe SFanisli Catilie]iâ&#x201A;Ź Chureh te imF1ant Christianity in Japan, liad, in retaliation, loaaed one hundred and thirty-four lepers on a shiF and despatGhed them te Manila, saying, "]if it is C0nverts you want, b~gin with these." J awan r.esentea Major. Carter's statement so deeply that the United $tates was requested to make a public withdrawal and an apology for this ad!legea outlanaish ohar.ge. It aevolvea uFon me to make a aefense. AGcoraingly, I had the royal documents at Seville searched. In Section V, ar.awer II, bundle XXI]], it was recorded that PhiliF IV, King ef Spain, aGknowledged the receipt of a communication from the Captain General of the Philippine Islanas, on June 8, 1632, in which His Majesty haa I)een inf0rmed that one hundred and thirty-four "convel'1:ed Christians" who haa been sent over by the Emperor of Japan, had arri.ved in Manila Bay. The Most Christian King had directed that the "c0nvertea Christians" be welcomed with a parade, and that, in adcdition to the five hundred reales already set aside for their receptien, two hundred more be expended for their maintenance. In that same year ene hundred and thirty of them were admitted to San Lazare Hospital. 1Fhese fads weFe submitted to the Japanese government, which then neF0rted they had a!J.reacdy confirmed the story from their own records and withdrew the aemand Eor retraction. They were, however, of the opinion that these lepers had been deported from Japan for sanitary neasons, but admittea cautiously that theFe might have been some . lepers among the Japanese Christians who were banished when the feuda!l! system had beceme dominant in the Empire. By reyal decr.ee promulgated in 1830, leper settlements were establishea at Manila, Cebu, ana Nueva Caceres, in which some feur hundred lepers lived. Only those were gathered up who were in such aavancea stages ef the aisease as to be loathsome to the public or objects of charity. Even though not allowed to live in the same houses as the healthy, frequently they were pel1mittea to mingle freely with the p~ople in the markets and other places. Friday under Spanish rule was lepers' day, when the affiicte<d walkea the streets seeking charity. If aIms were not forthcoming, they would squat patiently in groups in M.ent of a residence or al0ngside a ship. No effective guard was maintained at Cebu, where at one time whole parties of lepers left the 21 9


AN AMERICAN ElOCTOR'S ODYSSEY h0sJ!lita~ a:m! seblllelil Q0w,n in ntmd)y t0wns. San Nic0!as ana @J!l0n, which a~e now foci of leprosy, wel'e in ali probability mo of the J!l0ints to which they flea. SUJ!lposea~y aue to this early laxness, two-thwds of the Philippine lepe~s now €0me from Cebu, whi€h has only a seventh of bhe J!leJ!lu[abi0n. Wh@n the United States Army arrived in bhe PhilipWines theusancls ef lepers were at large. Some wel'e eking out a miserable existence on iS0latea sandspits, others begging in the market Pllace, ana still others trying to earn a Wibiful ~iving. T1heir labors, w,hieh ef necessity ham b0 be those ~equiring !little stl'engbh, s0mebimes, m0st unof0rtunately, haa included making cheese or hanciling foomstufl's in grocery stores. The spreaa of the aisease had been Plra~tiGally uncheeked. The attinuae 0f bhe iF<iliPlino Plublie haa flucbuatecd between a greab horror of it, am0unting alm0sb to panie, ana the greatest ailllousness. The San Lazare HospitaI for lepers at Manila is an 01<d stone building €onstrud:ecd by the FrancisGans in q84. It was maintainea by tne inc0rne £rom tne cdlsbr,ict 0f Sa:n Lazar-0 eutsiae the wa[~s, granted ' the [!\'a~heFS f01' this Plurpose. At th,e time [ t00k centI<dl, the :Hespitatl contained two hundred ana f0l'by-three leJ!lers. Here, as in se many ether instances in the Philippines, SUGcess in aeailing with the lepF0sy Pl~0blem eouM be 0btainecd 0nly thr0ugh a pl'0gram e£ eauea1iing the puMic. 'iJi1he J!le0ple haa te me taught net te shun the leper, but lePlrosy, and that the leper whe cenceailecd his cdisease was a €enstant cdeadly menace to bhe community in which he Evecd. Lepr0sy is one e£ the rnest I'epuisi¥e aiJ'rn@nts that afllicts man. Of the two main types, one, the neural or anesthebic, exhibits little outward evicdence, an€! the other, the cutaneous er hJ\PerbrePlhic, is rnaFked by lesions which ferm 0n the su~face bissues. The we tyPles 0£ten 0ceur t0gtltner. ~ n neitheF aFe the [esiens c0nfinea to a single tissue. The first signs ef leprosy artl often indicatecd by an tlflliargement of the lebe ef the ear, or an infi~tration or ul~er of the septum of the n0se. Then erybhemateus, or red SJ!l0tS G0mmomy appear, 0n which aU S0m of ointment al'e apt to be tr.iea, n0ne ef ;which is efll.eaGieus. When I have aesoribed these s},mPltems at ~ectuFes, I have e£ten netiGed h0w here ana there a mtlmeer ef tfie audience would feel his tlar. Cilcoasienally a£ter ene 0f these aadresses I have haa semeone cerne knoclcing at

220


THE HOlbJSE OF PAIN my hetcl a00r ~ate at night, saying "Bect0F, [ seem to hav.e a noaule in my ear.] want to have an examination to see whether I have leprosy." Lepr0sy begins insidiously, progresses slowly, and may last for twenty 01' thirty years. Aretaeus, a Greek physician of Cappadocia who eame to R0me in the First Century A. D., wr0te an account of the disease which h0lds true today: "Shining tubercles of different size, dusky red or livid in color, on face, ears and extremities, together with a thickened and rugous state of the skin, a diminution or totil loss of its sensibility, and a falling off of all the nair except that of the scalp. The alae of the nose become swollen, the nostrils dilate, the lips are tumid; the external ears, especially the lobes, are enlarged and thickened and beset with tubercles; the skin of the "heek and of the forehead gFoWS thick and tumid and forms large and pmminent rugae, especially over the eyes; the hair of the eyebrows, beard, pubes, and axillae falls off; the voice becomes hoarse and obscure, and the sensibility of the parts affected is obtuse or totally abolished, so that pinching or pUnGtuFing gives no uneasiness. This disfiguration of the countenance suggests the idea of the features of a' satyr, or wild beast, hence the disease is, by some, called satyriasis, or by others leontiasis. As the malady proceeds, the tubercles "rack and ultimately ulcerate. Ulcerations also appear in the throat and nose, which sometimes destroy the palate and septum, the nose falls, and the breath is intolerably offensive; the fingers and toes gangrene, and separate joint after joint."

The ancient world often mistook other diseases for leprosy. There is an innocent skin disease, char-acterizea by white spots which changes the epidermis and turns the individual affected into the Biblical whited sepulchre. The lesiens of yaws and syphilis may resemble leprosy; lupus vulgaris, or tuberculosis of the skin, may be as disfiguring as leprosy, but can usually be cured by proper treatment. Once at Or.is in Samar I f0und awaiting me in a leper compound at the edge of town a hundrea of the most mutilated, repulsive individuals I had ever seen. For years these tragic figures had endured the stigma and menta!! anguish inseparable from leprosy, but not one of them was a leper. A temporary hospital was opened, the cases were successfully tneated, and the patients were released. The manifestations of leprosy differ widely throughout the world. The inGidenee in the Philippines is Felatively high but the type is mild 221


AN AMERICAN IDOcrOR'S O;DYSSEY compared with Gert3lin other Gountries. India has the more serious nerve type, ami the tuberculoid f017m is predominant in South Abi<>a. In the lPhi'liwpines about one-qU3lFteF of the eases aFe Jilurely Gutaneous, wit!\.out mU0h nelWe inv01v~ment . !lin sue!\. instanGes., the disease fiFst appears with a sma[l round patGh on the skin, w.hite or red, or w.hitish and scaly in the Genter with a red margin. No pain and no itch are experienced, the principal symJiltom being the lessened sensitivity to feeling. After the disease has lasted a few years the nerves usua.hly become invoLved, and, ultimately, in those who lliNe ~ong enough for the sk,in maniFestl!6ons to disaJilpeaF, only neurall manifestations remain. Americans are not immune to lepllosy in the Philippines; as far as can be determined the incidenee among those who ~ive in the lower social strata is as high as among Filipinos. Anesthesia among lepers is ertremely Gommon. One of the earliest authentiâ&#x201A;Ź aGGounts of the anesthetie features of [eprosy oceurs in the 0hronides of W~iam of 'FYFe. iM'e teJils now it was diseoverec!l tl'iat Baldwin, son of Amory, the IGng of Jerusalem, was a leper: "One day the future king was playing witli his Gornrades and in the course of the game the hands and arms of all were scratched. The other children uttered cries, but !Baldwin made no Gomplaint. His tutor remarked upon it. At first he believed that the ehild, tlwough valiance and bravery, was hiding his pain, But Baldwin, questioned, affirmed ' that he felt none whatsoever in the region of the scratlihes. Mis '<ir;'" and hand had gone to sleep, and even when his tutor bit him, he did not feel the bite."

] have often seen a lighted eigaFeue burning into the fingers of a leper w,itflout his being at alN awalle of it. ~ven the oaor of burning flesh did not attract !\.is attention, because the sense of smeli was 3Ilso gone. AnesthetiG leprosy attacks the trophic nerves, which carry impulses throughout the body, causing the blood to bring essentiwl elements to damaged tissue. Or;dinariily, if the fingers of 2 well person aFe mel'ely dFawn a0ross a piece of lilaJiler, a few sUF.faGe GeUs of the skin are I1uboelil off. But nature telegraphs by means of these tFophic nerves to headquarters that tissue has been Femoved, and at onGe the blood supply opens, the Fepair is made, and the hand heals. But this telegraph system 222


WHiR HOUSE OF! P:A:IN

in lepers is c0mpieteiy eut of order. 'Nature is not aware that any cells have been removed, and the result is they are net replaced, but are gone feFe'lel'. iILc;peFs fFequently have wom their hancls down until they. are no meFe than bats. Wounds in anesthetic cases heal with great difficulty. A slight injury, sui!h as causecl by running a thoFn in the feot, eÂŁten starts an unheallable uleeF that pFoduces a cleep hole and discharges feul pus. We keep such weunds dressed and try to make them bleed, but the ulcers often booeme se bad that the bone is exposecl and the feet often have to be amputated. A characteristic iesion is interosseous atrophy" where the tissue between the bones at the back of the hand is absorbed. The anesthesia is net alCcompanied by paralysis, because the motor neli'Ves are net affected and sriN retain their funotions. The nerves ef the eye aFe sometimes attacked, often resulting in frightful suffering fu:om iritis. The larynx may be affected and the voice becomes hoarse. l.epFosy is he~rible te live with and difficult to die with. Death selclom comes unless from some other cause. The average life of a ieper is probably about ten years after the disease first becomes appar.ent. }l,t Culien a patiliolegical survey of the causes of death showed that twenty-four peFcent died ef tuberculosis and sixteen percent of nephFitis. The mortality at the colony was high, but it was b!!lieved to be materia[l~y l0wer than it w0uld have been among these people in their homes. Many of, them had been beggars and wholly dependent upon public charity for their living. The great majority of cases during the early yeaFs were se far arilvancecl when admitted that they were pFaÂŁtiealliy beyond human aid. There are usually two male fer one female leper. Why this is so ne ene has been able te tel.J. When I visitecl any leper colony for the first time I used te ask, "How many men have youl" '<We have two hundred." "T hen you halve ene hundred women." Whe imvariable reply was, "Yes! ' Gerhard Armauer liIansen, a Norwegian doctor of Bergen, in the early. 1870's first proved lepFosy due te a baci.JJus. This microbe, ",hich usuaLly gFews in bunclles of Fectilinear sticks reSembling the Chinese puzzle, is too small to be seen with the naked eye. Whenever this baciLlus can be demonstratecl in the tissues, it may be stated beyoncl 223


THE MOUSE OF PMN it ememelo/ c;liffieult to olDtain any positive pFoof as to the exact time at which the c;lisease was acquired. Some people have believed that mosquitoes were responsible for the transmission of leprosy. But lepra bacilli are found only in the intestinal contents and do not reach the proboscis of the mosquito, which is inserted directly into a blood vessel of its human victim. The evidence against flies is greater; their feet could easily carry bacilli from the siek: to the well and it has been proved that flies retain the bacilli in tili.eir intestinal tFaots for several c;lays after feeding upon leprous mater,ia:J.. Something more than orc;linary contact is apparently necessary before tFansmission can take place. What this is we do not know. But it is also true that leprosy does not occur in areas in which there is no leper. This fundamental faet was the foundation stone on which I built my policy. The segregation of lepers has been subjected to much criticism in the past. Many have held that attempts at rigid isolation have generilly defeated their own ends because victims of the disease were driven into hiding, whereas if treatment were offered and assurance given Ilhat there would be no forcible aetention, lepers would voluntarily apply fOF medical attention aned thus open .ases could be rendered mUGh less comml!l!licable. i\?Iowever wic;lely eminent medical men may differ upon this question, the incontFovertible fact remains that every leper who is capable of giving off lepra bacilli is at least one eenter of infeetion if the bacilli can find suitable soil in which to loage. The real gains against lepr.osy are aue to the disinterested cooperation of physicians, researeh workers, and sanitarians who have shar-ed their knowledge and experience and helped governments and institutions to oFganize systematic measures of isolation and treatment. Their aim has not merely been to relieve the afllicted but to Jilroteet w.hole populations. These modern crusaders will not be content until Jeprosy has been banishea from the world. The recent trend has been for more and more wuntries to rewgnize their responsioiiities ana earnestly to try to eontrol the disease ana give tne ~epeFs adequate caFe. 1i1he T!Jnited States has a creditable FecoFd in taking care of leprosy 225


AN AMERI<£:AN DOCTOR'S ODYSSEY at hIDme and in its depenedllnGills. When ] made my first trijil areund the weFll! in 1'!)(!)8 I sjilent a month at Molekai, whe~e Father IDamilln !laed ~afuereGi SID [eng. At tnat time this jilface :was foremost in ,the treatment IDf ~ejill'esy. 1fhe Geleny occupied on!1y half the island, fuut the thl'ee hundred aned fifty inhabitants were <!ut off by a precijilitous mIDuntain fFom all communicatien with the othllr section. Leprosy was called mai pake, or the ChinllSe Eyil, by ' the iEiawaiians. iLt haed pFebaMy been DFought out- By the €IDIDlies i~jilortlld fer wOFk en rthll sugal' FlantatiIDn.s. ;]it haed sFllllaed Fapi~y in the ir&.lands, edue partJy te the fact ~hat the lM}awaiians do nIDt sh~ink ft.IDm these afHicteed with the edisease. They had tried yal'ious remeedies ef their own, scaFifying themsdves with pieees of glass, eating the flesh of cats, drinking Pain Killllr, and consulting the Kahuna, or meedieme man. A place of iselatiIDn haed fttst Delln set asiede my iKamehameha, aned the United States government had ca~ried en uhll wIDrk. NIDt IDnly was everything edone fIDr the lepeFs' eomfovt ana £01' advaneing our . knewledgll of the disease, but many luxuries haa been introduclld. The lepel's also profited by exercising their tranchise. The politiGal jilarties IDf Hawaii weFe abIDut evenJy divieded, se that the vetllS ef the lepers eeuled almost swing the eleetion. Menee they WIlFe cherishea se1ioiteusly my the lea<ders ef Beth Farties. N ati<ve eratoFs hal'angued the inmates ef the 'celony, but tIDek caFe to have the platforms ereGtCi!d near the shere and with palm Jeaf screens to jilrotect themsel;ves from possible contagion. But mOFe substantial bait was required. The fel'mentCi!ed taro dish cal!lCi!d poi was particularly dCi!leotaBle te the Hawaiians. One political aSp1rrant would guarantee, in case he were deoted, tID jilFev,ide eaeh [epeF with one poun<d of poj a may. Tlhe other aspirant 'weuld then pFemisCi! two pouneds of poi. At the time of my visit the bid had Been raised, and each lCi!per was entitled by law to seVCi!n pounds of poj a Glay, fat mOFe than hCi! could possibly eat. The lepers wllre taking a<dvantage ef their strategic position anm favoring a law whiGh would givCi! thCi!m the right to seM the poj whi0h had Been thFust up0n them anm retain the pFOCCi!e<ds. A stud,y 0f the histIDry of [Ci!pr0sy in Hawaii shows that untiI isolation was Garried out, the number of lepers was c0nstantly IDn the increase. It may be argued, hIDwever, that the Hawaiians are unusuaHy 2/};6


llHoE :MOUSE elF !PAIN suseeptible to leprasy, whi1e the Japanese, who aFe naw numerically pFedominant, are not. Thus, although the total number of lepers in Hawaii has been Fesuw;i, it is not certain whether this reduction may not be due to the lesser susceptibility of the Japanese and other introduced races. When ]j became Directal' of Mealth of the Philippines I realized that ane af my most important duties wouM be to isolate the lepers whase ·numbers weFe estimated anywhere from ten ta thirty thausanS, rlthough affieia.JiL¥ a little less than four thousand were reGaFded. TheFe were twelve hunsred new cases seveloping every yeaF anS pFactieaily nothing was being done about them. Segregation is a!lways cruel. We did not want to separate husband anS wife or children and parents. But segregation is cruel to relatively few whereas non-segregatien threatens an entire people. I be[ieved that isolation not only pratected others from contracting lepresy but, furthermore, was the most humane solution for the leper himself. Instead of being shunned and rebuffed by the world, he couM have an opportunity to associate with others of his kind in pleasant relationship. In the Fhilippines the lepers were sensitive and praud and quick to notice any infringement ·upon their human rights. A!mong the Filipinos fumily ties aFe unbelievably strong. Every step would haNe to be tallieQ most tact£ully; otherwise the Filipines weuld eoneeal their lepers, er even actively eppose segregatien. First, the Golony wauld have to lie prepaFed, and, then, the Islanders would have to be educated to the benefits of the plan. Almost at the very inception of the civil government, negotiations had been carried on by WOFcester which led to the setting aside of· Culion Island far a leper colony. Culion is one of the Caljlmianes graup between the Sulu and China Seas, two hundred miles southwest ef Manila. It is twenty miles long and twelve miles at its widest peint. The population was then about eight hundred; more than half were haFmless, wild Tagbuanas, without fixed abode or title to land lIeyand that af possession. Outside the town of Culion there weFe etrly, eight smail hauses. '['fie !Bay of Culian is almost lanGl!loeked, and is surrounded with marvelous green hills. lihrough the water, calm and blue and Grysta[ deaF, aFe plainly visible coral and marine plants of almost every 227


AN AMERICAN DOCTOR'S ODYSSEY con~eivable

hue. Across the Bay is the Island 0f COI'0n, over which hangs in the earLy morning a G!iaphan0us blue haze. The rising sun graG!uailliy cleaFs the air, 0n~y to have the mists gather again as the sun sinks. C()1'0n has [0ng bJeen a ~0G!estone f01' those who specialize in coral. Beautiful to 10()K at, it is almost impossible to investigate. 1fhere are S0me tiny coves with a little sand in them where a boat Gan bJe landed. Otherwise the wh0le sh0re is a sheer cliff, usuahly unG!er~ut three to four feet; at 10w tide a r0wb0at can glide bene:.th c0infOl"tabl¥. ']1he gr:eenish-blue surface 0f Cor-on is buiit uj\l 0f th0usan@s 0f ra,zor-shaIiP plates, like meat deavers, set peFpendicularly and S0 sharp and so close together that the toughest leather is sliced to rib" bJons afteF a few steps. Only one man has been able to penetrate any distan~e. When his sh0es w:eFe G0mpletely shr-eG!deG!, he bound twigs upon his feet, pFo~eeding ~ut;jous1y for a few pa~es, an<d then n~pair.­ ing the G!ami1.ge with m0Fe tw,igs. Culion was valuable for its fOFest pr0ducts and haG! good fishing grounds. Thus it was a constant temptation for poachers. [n aG!rution, the many wild carabao were a lure to sj\lortsmen. We were glaG! to have these G!anger0us anima,ls shot, anG! we would grant speGial permits to th0se who wished to try theiF skill. But so many mighty hunters haGt ~0me to grief at t!he h0rns 0f the mrabJa0, that it was customary fo~ a smaH relief expeG!ition to ee kept in readiness. Once the DFother of G0vernor General Harris0n, an internationa.J1ly ren0wneG! Nimrod, scorneG! our warnings, and set forth boldly. When dawn 0f the next day bF0ke without his having returned, the relief party staFteG! 0Ut anG! @iscover.eG! him, gun[ess and hatless, in the t0pm0st IDaFt 0f the tall!tesl tFee in the <vicinity. At first the pian had been to 10cate the lepe!' G010ny 0utside the old town 0f Culion at a place ca'l!led Halsey Harbor. In January, I ~03, fi,£ty-nine [aborers anG! ftv0 foremen haG! arnived, constFucted a weir to supply fresh fish f0r: the camp, and tt.itlG! till get the natives till saw planks f0r a wharf, bJut 6his haG! pr:0ved to be beyonG! their. skill. M0re0ver, siesta fi our: f0r the l'iiipin0s haa seemea to G0me the m0ment the foreman tume@ his back. iL0nesome f0F their Wlllmen, ' aina disG0ntenteG! at the wor.king G0naiti0ns, as S00n as they were paid, they had said, ''We want to go home." Finally eeribJeri and malaria 228


'iF~iffi

W;(5)US'E @li1

F~ i[aN

had set in, an~ ~ne site had had to be aIDaniionea fer afl0ther. IJr, 1i:~cle ev,er a year. later st~ps had been taken te pUFohase the vil~age of (julien ana rtt:ansfer its inha~itants to ~he !Island of Busuanga, near. <EeFen. '['1here weFe a number of geod houses, and a'lse an eM teFt, dating ÂŁnom the tllme ef the Moro naias, where the Filipinos, ~1ili.eugn eutnummering their assailants twenty te ene, had judged it meFe p,rudent to hide lihan to fight. 'TIhe p,l'eblem et Cul'ion was ene et the mest ardueus whicn faGed me when r teek effice. [ became whelily responsible for the umlertaJhlng, whieh preved mer.e difficult than I could ever have anticip,ated, even in my wiiaest dreams. The actual building bJegan in 1905. [Ev,ery imaginable twJe ef seeiai <iJ.uestion pl'esented itself. Not enly Jieuses ami a hespita~ had te be GOn~tFuGted and separate quarters fer the nonJlepel's built, but streets had te be bid eut, wharves censtrnuGtea, bueys planted, a' sewer system instarlled, amusement haNs ,anill a pesteffice piannea. Arnangements haa to be made for pubEc eFaeF, feF munidpai1 eFainanees, for fuanking, and fer disinfecting letteFS. Wie never ceultil be SUFe ef hoMing laber any length of time. Good mechanics haa no aesiFe to undergo the isolation. Seme left after a few aays' weFK, and the class that ceula IDe induced to ge often lacked slill!1 ana 'made blundeFs which sometimes teek menths to corFect . .At ene tllme th~ee nunar-ed weltlmnen laid dewn their tools and ~etired te a safe distance at tne first repont that a shiplead of lepers was soon to al11'ive at the Island. IDelays wer.e censtant ana inevitable. TheFe was no telegt:aph, and mail steameFS aFrivea amy once every three weeks. Mereover, captains et vesseis carry.ing DuiMing mater.iais whe weFe unfami'l[ar with 1lIie polit eften woulcl andier far off, ana ~he supplies had tq be lalDoFieusly landed in sm~l boats. Seme~imes a part ef a machine would IDe [ost in transit. ~his islantil in the China Sea w.as ten thousana miles ff,em a maFket; aN supplies nad te ceme from the United States. It teek fe ur te five menths to procure even an odcl screw which might lDe mis.sing. il!n May" 1906, we pFepaFea te transfer the thFee hundFed ' and s~-fiv.e inmates of the San Lazaro Hospital at Cebu ,to CuE on. @ÂŁten, before and afterwaFds, we haa to contena with fear. A gever n.

229


THE MOUSE OF PAIN presenting feF tFansfer te Culien their insane, blind, cripples, and ether inGurables whe had beceme public chavges, and seme were surp~isea ana Jilainea w.hen we t:ejeGted ~hem. ]n bne first cellectiens enly alleut halif these reperted as iepeFs were authentiG cases. i1!n the early days the very werd lepresy struck unreasening terrer inte the hearts €If these suspected, and a number went inte hiding. There was a yeung leper girl in Cebu whem the lecal autherities were never able te preduce when we arrived. Finally her brether was strieken and taken te Culien. On eur next visit she gave herself up veiuntar,ily. When I asked her hew she had eluded us se leng, she exp,lainea that the telegraph eperater was her £riend, and had infermed her in advance when we were due. She weuld then speed away te a cave back in the hills where she had always had eneugh feed cached te last her until we had gene. ;Ii have never seen remerse that equaled hers. Her heart was I!)j;e~en. I usecd te talk with her eaeh time I visited Culien, and each time she weuld say te me, "I theught I was feeling yeu and all the time the enly persen I feeled was myself. I infected my brether, and if enly I had given myself up it weuld never have happened." One €If eur mest prelific seurces €If infer matien as te evaders was the anen;ymeus cemmunicatien. If a Filipine wants te secure revenge en an enemy, he sFlies upen, him unti,l he discevers seme evidence te FepeFt te the autherities. Curieusly eneugh such delatiens as we reeeived were, in the main, cerrect. On ene eccasien we were teld that i£ we were te ge te a certain heuse in the center €If Manila, and k;neck three times, and then again ence, a trap deer in the ceiling weuld epen, and there we weuld find a leper. We fellewed these instruetiens, and feund the .leper. Semebedy haa a grudge against his fami1ly, and was trying te get even. The anenymeus letter writer was net always accurate, hewever. We ence reeeived infermatien that the sen €If a mayer in a small previnGial tewn was ill with lepresy. When we went te the heuse we feuna him in bed with all his clethes en. There was nething wreng with him but malaria and a skin rash. We furnished him quinine and a eake €If seap, with the stem advice te use beth. He FeGeverea shertly. The Filipine is alse likely te be unscrupuleus when he is attempt-

23 1


AN AMlERJ€:AN IDO€:'f@R'S ODYSSEY ing to secure a p0litic;a1 a<ilvantage. When I arrived 0ne day at a small. t0wn, the mayol' Fep0Ftea he had aU the 10cal lepeFs Feaay in waiting. On the way to the detenti0n l;miMing one of the pr0minent citizens appFoachee me and askee me to hell" him, saying his daughter, who was perfe<rt1y healthy, hae been shut up with the lepers. Since this was aJ very G0mm0n St0FY, ] was not particularly impressed, IDut t01a him I would 100k into it. ] was s0mewhat sUFpFise<il to iflnd that he was right. His claughtel', a mea:ut~£Ul girl, hatd been ht!Feea int0 camp with rea~ ~ept!rs, rollih0ugh she haa not the slightt!St sign of <the aisease. iJj 0Faefecil her rCllleasea a:ncil then demaJnaed of the [oGaI health officer, "Why ait;! ¥ou lock heF up?" "The mayor toM me to, ami! I have [0 obey his orders." "'But what reason dia he have?" "Her father is a candidate. The present mayor thought he could win the election if he Goula brand his Fival's daughter with the stigma o£ ~eprosy." At the very inGeption 0f gathering up the ~epers it became 011I' Mea jil01ky not to Gonftne anY0ne at €:u!lion from wh0m lejill'osy maei11i c0ula not me l'eGovered and eemonstratea my miG1'osG0piGal ClXaminat;i0n. Fidijilin0s haa so maJny slbin diseases that an oGcasi0nat miS" take mig!!!t ea~i1'y haJv.e met!n made in d~agnosing non-~epers as [epCll'S. We neve)" pla~eci! anyonCl 01'1 the ship untii bom thFee to five lepF0sy experts, acting as a !BoaI'd, were unanimously satislied that t;he man or woman had lepFosy. If WCl eFFea it was 0n the side of sa.fClty, mu~, as far as I know, n0 mistake was evet: maae. The reason "more Gases. are now being found is that since those days many relinemClnts in diagnosis have been maae. The more recent complete Irnowledge is of great value because the ea1'ly stages of the disease are the ID0St infective. F 0r the eliniG3:1 examination of tne anesthetiG £o~m the susped was blina'f oldea. Then his skin was touchea with a G0tton swab, a: feather, a «a:me1's ha,i r mrusn, 01' a pajile1' spil[, ancil he was asked to incilic;atCl whene ne haa been toU(,hem. The neaa and the point 0£ a jilin werCl pressed adtet:nateXy aga,inst suspeetea spots, aJna nne jilatient was askea which Gausea the m01'e pain. TClSt tumes, 0ne liilled with h0t watClr ana the otiher with cola, were held against his skin, and he was mea to 222


THE HOUSE OF FAIN te~l which was wa~m and whiClh was cold. Finally, a scraping was taken from the septum of the nose with a blunt, narrow-bladed scalpel, ana put under the microscope. The actual work of Gollecting the lepers and caring for them after they were gathered together presented obstacles, many of which at times seemea insurmountable. Most people have a spontaneous im,. pulse toward charity and a soâ&#x201A;Źial conscience which impels them to do good, but these emotions are often dissipated in the face of actuality, particularliy where the task is loathsome and repellent. When it (lame to transp10rting rep1ers to a seapom:, p1feviding their subsistence, aiaing them aboard the steamer, making the necessary meaical examinations, and attending to their needs, experience again and again demonstratea that only those of my doctors who were possessed of superior wurage and capable of supreme self-sacrifice could be induced to Clontinue at the work. Often lepers had been confined in a barbarous manner by the local officials at the outskirts of towns. Once when we arrived in a province we found them in an abandoned warehouse, where they had been shut up for weeks pending ouI' arrival. Some were literally rotting away. ] had severall doctors with me, most of them long experienced in work of this kina, but they became so nauseated by the foul stench ~Fom the gangrenous, putresâ&#x201A;Źent ulcers that they could hardly bring themselves to handle the patients. One old woman in particular was no m0re than a mass of aecaying flesh, rotten as a corpse long exposed; she looked as though she were going tQ fall to pieces. It was with the utmost aifficulty that I final1y summoned the courage to gather her up ana carry her on board in a basket. There was always, of course, the danger of infection. On one oc(asion cholera broke out on the Basilan in the midst of a collection trip in the Southern Islands. I ordered the boat to make for Culion as quickly as possible, but at best it would take several days, and the quarters on board were too small for effective isolation. After we arrivea at Culion, I immediately segregated the lepers in groups of ten, so that if one group should become infected, it alone woul,d have to ee quarantinea. One lepF0us W0man was not only violently insane, eut also came aown with cholera. She wou,ld keep no clothing on and, since she was eompletely uncontrollable, she was a aeadly

233


AN AMERICAN DOCTOR'S O'DYSSEY menace te everyone. 1t requireed a physical smuggle, but if finally succeedetd in pinioning aned impFisening her. [n the process she sOFateheed me SID aeeply in the arm Vhat ill still!l blear the scar. It is extremely unpleasant tID be s~rat~heel oy an insane [el?eF with Gholera, and I lIDst nID time in cilrenching the weuna with disinfectant, tnIDugh I coula not ble certain that it would prove effective. There is no way to tell who have ana who have not immunity t0lepEosy, but my mind is n0W at Fest, be~ause the wenty years ef pIDssible incubation h3Jve passea, ana] have n0t yet e¥iaeneed any signs of i.eWF0sy, In the i.ight 0f our wresent IrnIDwleage ] blelieve that iS0latiIDn is the best c0urse in a country sueh as the Philippines, but it will take a long time to prove that it ~n wipe out the aisease, because many cases in the incubation perioa cann0t be aet~ted. By 1908 at least one ~0He~ion OF lepers ha<rli been made a.1!l oveF tne Archipelago, and a number. in many prov,inces. F0Ul' years later every Fe~0gni,zea lewel' was in c0nfinement. O~Ft"in elements in many communities were n0t 0pen to peFsuasion, ana there f0rce was necessary. The oblstreperous cases oMen belongea te the criminal classes, so that sometimes we had to resort to legal €0mpulsion. But most of the patients wh0 were to become the inhabitants ot Culi0n were pel'suaded Father. than c0mpelled to go. ~Faauaily the terrOF it caused was lost thFougn IDur eaucati0nal pFopaganaa, and! lepeFs weFe iur.ea theFe by h0pe 0f etlre. It must be said to the crerut of the FilipiD0s that the effort to segregate lepers was never seri0usly opposed. 1n the majority of cases they €00perated, even though this often invoivea the lifei0ng sepaFation of wiFe born husoand, sister rr.0m blrIDtheF, ohiM fFem paFents, 3Jna fl1iend kIDm £riencl. On[r in compFehentding tiliis can it fue Fea~izecil what f0rblearanee was exereisea by the iFilipinIDs. I can stiU hear ringing in my ears the cries of anguish of the relatives and frienas wh0 used to follow us down tID the boat drawn up on the open beach. As we rewea out to the Basilan, and the Basilan steamed IDUt tID the 0pen sea, ] €0ula see them standing theFe, ana heaF faint eehoes IDf tilieir gr.id. i1it was an eJq!lerienee to wlil,i0h [ never became haraened. iii knew that even as the rBasilan was l'Hill a0wn 0n the horizon they would stiU be there, straining f0r a i.ast glance at those whom they never expectea to see again. 234


CHA1?T1ffiR 15.

T

f>RISONERS OF HOPE

HE Basilan had no sooner landed its first grim cargo at Culion

than I realized that my responsibilities toward the lepers whom I had uprooted from their homes had only begun. Transporting them there and providing them with food and lodging was merely a prelude to the real work. After the novelty of their surroundings had ceased to attract and divert the lepers, they often became homesick, and yearned for their 0M associations. In every way we tried to make their life as neaDly as poss\~le like that of their 0wn villages, always remembering Culi0n was a town 0f invaiies. We put Tagalog with Tagalog, ]i[0cano with Hocan0, Visayan with Visayan, Moro with Moro; they wouM mix during the day but at night liked to be with their own kine. [Little by little we beauti6.ee the place with trees, palms, and shrubbery. I designed a semi-open air theatre, with Chinese spirals ana other roof decorations, but the workmen were unabie to follow my intention so that when finished it resembled no known style 0f architecture. It served its purpose, however. It was so constru~ted that those who needed protection muld sit under the roof, and the rest in chairs around the outsiee. Filipinos are born actors and the lepers took eagerly to dramatics. Besicles putting 0n plays of their own, they enjoyed greatly the films with which gener0us motion pieture companies kept me suppliecl. Fiiipinos are natural musicians also. I have always believed it w,ould be possible to hand fifty bana instruments at rand0m to fifty

235


AN AMERICAN DOCTOR'S ODYSSEY Filipinos ana hear sweet musie at once. The Filipinos have maae musie fOl' the entil'e East. I h,lVe hea1'a the l'hythm ef their Spanish meleeies eeh0ing £liem ean~e £leel's ana theatnes at CalGutta, Bemeay:, SingapeFe, ane everywnere else in tne OF,ientThe lepers were no excepti0n. Cullan teak great pride in its band ane praotised faithfully. This we enceuraged, beGause the musie eheered them en0rmously. The le!Del's at Sian Lazaro at Manila had a particulady gem;! stringed eFGhes(;Fa which used te gl'eet me on every visit. G)nce a-£ter a 10ng absenGe r was welcemeG! as warrrilly as ever eut oeserveG! with sUl'prise tnat ne musk was en hanG!. "Why den~t yeu play?" I asked. ''We Gan't." "Why not?" ]n dume repLy they heM u!D their hands; they had 1iteral!ly pia-y@G! their fingers elf. Gur fil'st ceUectiens ef [epers weFe eem!D0S€G! of those who w@re so ill as te ee nearly helpless. The Giisease had preduced such Ggntractions of limes, des'truGtion gf tissues, losses gf fingers and tees, impairment of museular !Dower, anG! genernl e@bility, that only a few could p(lFfo~m the heavy wel'k conntUit'ed with agriculture, which we he!DeGi weultll eiverf them as wel!l as Gent~ibute towa-I'm their. sup!DeFt. A\!lso, rna-ny haG! fever severa-l eays during th(l menth, an€l! meFe were entirely Bedfast. It was not easy to keep the semi-weN oGeupied and G!istracteGi. Because of the !Dublic's gr.eat fear of infection, they CQuld not weave hats aD !Dalm er dresses of jusi cleth, carve knil1kknaoks e1' hammer bFass ash il!rays £er geneFaJ sale. We did net even advecate the rnanufactuFe ef these haneia;acGtseeGause the innate F1ilipine dis!Dositllen te take life easy, while deplorable for the healthy, is net at a!l!l a bad thing for lepers. They die little werk other than that entailea by their ewn domestic requiFements. At first we (;Fied seFVing CQQked f00G! in a cafeteria, eut when aUF OeciG!entail meth0ds ef pl'e!Daratien obvieusly aid net !Dlease eur patFens, we gave them tihe row fee~ ane let tnem prepare it to sait their own tastes. S0me real's later Miss Hartley EmeFey, an abile food chemist, went to Culion as a volunteer te aevise ways of cembining prepel' G!ietary with Filipin0 gustatory pFeferenees. The most ~6

.


PRISONERS OF HOFE aavaneea €lIS1lS haa been colleGted earlier; tihe later Gomers were in tme initial stages of the aisease, ana cc:msequently not so ba<dly inGapaeitatea. !Basing his action em Miss Embrey's aaiViee, Generall Wooa arFaIlged fer the empioyment of competent gaFaeners. Ubi tubers weFe introauGed from the Batanes and leafy vegetables were grown with great SUGeess. They started tiny sugar plantations, the output of whieh was purchased by the government and reissuea as food to the lepers. Cattile Faising was started. We also enGOUFagea them to fish, ana they paac!llea EttIe ba!lsas of lashed bamboo to the huge fencea fish tmps ana to other waters. They aid well at fishing, and daily we purGhasea large quantities. In addition to buying their produce we gave them a gratuity of twenty cents a week, and established a store at which small comforts were sola. In order to avoid all risk of infeGtion outside, special meney was used, which circulated only in the Geiony. We helpea the townspeeple to set up an organization with a presjdente, or mayor, and ten councillors, all of whom they elected themselves. They were allowed to make their own regulations, and punish offenaers. The first woman suftrage in the East was established at Culion in 1908. The women were influential in elections, and invariablY' piGkec;l out, fhe west loeking man for presjdente, no matter ;what his qUaitifications. A former sergeant of Constabulary who had developed leprosy was Ghesen to captain a leper poliGe force of twelve, which grew in size with the expanding colony. We dia not attempt to restrict the liberty e£ the inmates; as far as we weFe concerned they could escape wheneveF they were se mindea. The idea was that they were to prevent ~hemselves fttom running awa.y. Very littile went on in the colony that the pollce and secret serviGe . men did not know. Nevertheless, being lepers themselves, it sometimes happenea that they were at one with those who grew teo ~onely. The rdugees woul<d make rough rafts of bamboo with sails wev,en of pa:lms, ana hide them away in some sa·fe place. Then, when the e€Gasion was pFopitieus, efli tihey woul<d sail into the China Sea. O£ten the lepers came £rom distant islands, hard to reach with impFov;isec!l craft, and in the endeavor to gain home an occasional one 12 37


PRISONERS 01'1 HOPE stanc;ling. As a !}r.eung weman she hacl! lett GlulFtFes ana her family ana fr,ienas te aevote her life to lepers, the most frienclless ef uuman beings. With her own gaiety she lightenecl the burden of the hopeless. She haa an extraordinary fadlity for languages, which she cultivated S0 that she might bring to eaGh of the patients under her care a~dea cheeF. In J,une, 1926, General Wood ana his staff attended the ceremony of presenting her a gold medal, cast especially for the oecasion and given in recognition of her remarkable services over this long perioa ef time. Gr.aauates frem Philippine nursing schools are now sharing the burden. Their zeal, both from a scientific and humanitarian point of view, spurs them on to great heights of self-sacrifice. lndiviauals who are willing to abandon the pleasures of the world fer lepeFs aFe rare, but, when found, usuahly exhibit complete abnegation of self. The American lay brother Dutton, who insisted on remaining at Molokai, was a case in point. No one knew whether he weFe truly a leper, since he weuld never :vllow himself to be examinea, meFely imply,.ing that he was lepFous. To the lepers around him he was a friend, reading te them and advising them. He worked teward their intet:ests indefatigably, writing letter after letter to Gabinet ministers, politicians, millienaires, and presidents. By his solitary effoFts he_ sueceeded in Faising moderate sums, which he turned into the common fund for lepers. The aoctors who went to Culion, altheugh again they lacked the Feligi0us inspiratien of the Sisters, possessed in full measure professiena~ zeal and enough human eharity to enable them to stand the loneliness of the life ana the particularly trying and disgusting cluties. The treatment of the foul-smelling gangrenous ulcers on a single patient often required more time than a major surgical operation. 'l remember one occasion and only one when a physician deserted. I haa promised him a relief in ten days, but several Filipino aoctors had found excuses at the last moment for not sailing, and I was unavoidably detained in the em!eavor to find one courageous enbugh. Nevet.theless, i[ Fegardea my tardiness as no excuse for abandoning a post of â&#x201A;Źonfiaenee and trust, especially as he had left the hospital full ef sick. 239


AN

.AMlER~CAN

!DOCTOR'S OID'¥SSE¥

Life fOI1 the staff at Culion was ex€eedingly monotenous. Few diversions anl!i little humer mFeke the meneteny ef the daily reund. The ceming e£ visitel'S was heraJcded as a great event. @ne ef the doctors, whe was semetning ef a wag, was asked to be prepared te enteFta,in a gentleman whe was ceming to, inspect the we~k, and whese reJjlutatien fer pFollibitionlst sen~iments was we~l known. Prohibitionists have always meen a temptation to jokesters. The docteF had a bey climm a eocoanut tFee, puncture a nut with a hYJjlodermi€ needle, draw out some of tbe mi'lk, amd replace it with whiskey. "Phe prohibitionist in due ceUFse aFr.ived, an@ atter haH a day's inspection in the het sun, his tengue was fianging eut with thirst and his mouth was cotton weo!. '''Wouldn't you like te ha:ve a drink ef eocoanut milk?'" asked the doeter. "'FbeFe is nething quite se delieieus when yeu are not an@ tiFe@." "E1he visiter weleomed the pFeposal and the bey was sent up te fetch dew!] ~he deetoFed ceGean~t. !Ji1he tep was slashe@ eflj and t;ne juice poured eut befere his eyes. After draining the bumper, ne smacked his 1:ips and said, "Pve never tasted anything se pleasant in my [i,fe." "'the inspeGtiion was finished in a SpiFit ef hilarity. Elach time l paid a visit to Culien theFe was usually a Jjlublie FeGeptien, cemplete witn manneFs, a ba,rnd, an@ a,n impFessive JjlaFaGie. The duty of presenting petitions weighs heavily upon aN Filipines, ne matter hew unimpoFtant th@ subje@t matter may me. My coming effeFed a,n ~exa,rnpled eJjlpo~tunit}! te fuHl.N this ebligiltien. Sulili pecitiens 1 was usuarly able te nand!le witn a, fair <degr.ee of diplomacy, but once] feumd myself obliged te retreat ingleriously £rem a mass attaai(; of the wemen e£ Culion en the questien ef segFegatien of the sexes. We had provided separate sleeping quarters fer men and wemen but did not ferbid them te ming,l e my <day. (\;eFtain weJl-mea,ning persens wno had inteFested themselves in the lepers were hOFrifie@. They brought pressure te bear en the government, and the GovemeF GeneFatl issue<d erdeFs. One part of t;he ]island was ,to me set aside for 240


PRISONERS OF HOPE bne women ami suroroundea wi~h a very, high banbea wire fen€e. lt was ill finished anG! prepareG! for occupation when I arrived on my next trip. But I found that the sequestration had not been carried out in a€Cordance with the decree. "Why hasn't this been done?" I askea the eoctor in charge. "The women simply won't go," he replied. "Short of a couple of r.egiments of constabulary we can't do anything with them. If you think you can persuade them, you· go ahead and try." "Let's c;aJd a meeting," ] suggested. I had o£ten addressed them befor.e and anticipateG! no trouble. W'hen the women were assembled, [ climbed up on a soap box and stood under the blazing hot noonday sun, looking down on the bobbing mass of black umbrellas, tippea back to frame ~he £UFious fa€es. I explained to them that separation was believed to be for their own good, and that in any event the instructions of the Governor General must be carried out. The Filipino women are even better orators than the men. One of them rose and G!elivered a fervent harangue to the effect that the ~est of the world, after having segregated tnem, had not before seemeG! to concern itself with their welfare, and why should it take this unpleasant interest in them now? The women of eulion had asked for no protection worn the men and did not want any. AmotheF · Febel followed with an even more impassioned address. She worked upon the audience, already aroused, until they began to shout, "Kill him! Kill him!" The umbrellas shut with a 10uG! concerted swish, and with steel points sparkling, they con:verged towards my midriff. As the rush Degan, there Bashed through my mind a picture of the ignominious fate which awaited me-punctured to death by umbrellas. I held up my hanG! and shouted at the top of my lungs. ''Wait a minute! Walt a minute!" Fortunately one of the leaders heard me, and with a stentorian - voice repeated, ''Wait a minute! Let him talk! Let's hear what he has to say." liihe umbrellas were poised in mia-air, steel points still aimed at me. "If you feel so strongly about this, I promise you will not be 241


AN AMERICAN DOCTOR'S ODYSSEY iselated until! ] have hae a tailk with the ~everner Gcmerall! I give you my w:ercil that ne further attempts wiN be made te cawy. eut the oreer until <lifteF we have hae this confeFenGe!" Slowly the peints weFe 10weFecil, and the wemen ci!isbanded. r was s<livee. ~ went te the GeverneF GeneFal as iii had pFemisee. "It's ne [enger the respensibility ef the Directer e£ Health te !larry out SUGh erders. ]'ve made every reasenalDle effort, and I'm net going to risk my lifll again." Me agreee that etlher means sheukl IDe feune te meet ebJections. "Ehe w:emen eontinuee to iivCl as they fia~ dene fenner]y, but ultimately homes were llstablishee for the iYoung girls. 'Fhe Sisters teek charge of them, and sa·w that the dool's were securely lecked at night, although a; rumer was Gurrent that <li Sabine r<liie hacd once been planne~ and exeoutea. We haci! discoUF!!gCld marriagll because we eie net want the leperS to contFaGt lasting Felationships which might entail suffel1ing later if ene partner sheulcl be €UFea ana eismissee £Fem COOon. But whlln tney pFeci!ueecii effspr.ing witheut oenefit ot dergy., mernJ neeessities dbtrueCld upen meei!lai enes, and our religieus aaviseFs insisted they must marry. Our concern before had been to prevent propagation, IDut new tihe bi.th rate began te inGFease. [,epFesy is mest easi!lr eentr.actee in elli[(;IIheoe; the Clar'Jliest age at which it can be eetllGted is abeut two, Mthough generalily it evinGClS its prClSence at from thFee to four years. ]lessibly thll eentraction ef the disClase in infaney is eue te the close Gentaot of IClpFeus parllnts and ehj[eFen. Statisties shew: that i,f babies <lil'e fiet Fllmevlle f,Fem their methers IDefere they ar.e six months eM, apprex;imately haU ef, them will beceme leprous. That heFeeity plays little part in the tFansmissien ef leprosy has been SHewn at Meiobi, wherll the ehi[dt:en of [epevs aFe IlClmeVlld a few days <lifter biFth te beautifully appointeci! homes in Wonolulu, one for beys and another for girls. There they are eaFllcil for until they reach the age ef twenty-ene. During the thirty years this system has ellen in eflieet, not ene ehiM, acceFeing to tne Fepor.t, has eveF deveieped leprosy. ~he pFeblem ef what shorue ee dene with the chilci!ren bern at Culion offeree gt'eat eifficulties. No law existed, as in Mawaii, 242


PR1SONERS OF HOPE whereby we ~auld take them from their parents. The duty seemed ta devol:ve upan me oÂŁ persuading the matheFs of Culion to surFender their \!;abies. ] used ta get them together and harangue them for hour.s, appealing to their mather love, and elCplaining how their children wallid. almost certainly contract leprosy UIl'less they were put in a safe home outside the colony. After having my pleas fall an deaf ears time after time, on onc< occasion my persuasive powers must have became transcenedental, because twenty-six mothers, inspired winh nhe spirit aÂŁ se1f-edenial, offered me their children. "He that will not when he may, When he will he shall have nay." "All right," I said. "The beat sails tomorrow morning at eight. Have the chilcdten Feady." J: orederecl the Basilan prepareed at once. Canvas was stretched around the Failings, se that the babies could nat fall overboard. I arranged to take six Sisters with me to watch over them and give them praper GU"e on the twenty-four hour trip. Leng before eight o'clock the children arrived at the bea~h. Everybody was crying; the children were crying, the fathers were crying, the IDetheFs were orying, and the Eriends were crying in sympathy. l.amentation was loud in the laned. [ could stand it only so long and then rushed to the bridge and told the Captain to be ready to leave the moment the last child was on beard. The hawsers were cast off, the engine FaDm bell jingled, and we slowly pulled out, leaving a weeping baned behind us on the shore, aned Fedu~ing the audible criers to twentySl!l1i.

'['he Basilan puffed placiedly over the beautiful calm waters of Culion. The Sisters could be seen moving about efficiently in their _ starched caps, quieting the children, and feeding them. I viewed the peaceful scene complacently, proud of the way I had managed the w hele a,ffair. But just as we left O!lFOn Passage I felt the fi!st faint suggestieo or Feughness. The Basilan shifteed uneasily, rocking gently from side to side and up and edown. Then things began to happen that I had not anticipated. The English Channel is a mill pond compared to 243


FR!rSONER.S OF HOPE jumps in history. Doctors, nurses, and ambulances we~e there ready to take over, and I streaked for my office. I figured that I had done my share in delivering the babies fFom the devouring sea. I was just relaxing before the huge pile of mail which had accumulated in my absence when the telephone rang. "HeMo," I said unsuspectingly. "This is the hospital. You'll have to come up here right away." ''Why? What's the matter?" "We ea,n1t Fegister those babies of yours until they've been identified. We don't even know theiF names." "'That's simFde," ~ assUFed the head nurse. "Each child has a tag aFound its neck, giving its name, age, and parents' history." "They may have had tags when they started, but they're ravenously hungry and must have eaten them. They're not here now." I sighed resignedly and set off for the hospital. Sure enough, the tags were missing. 1 picked up a baby, turned her over a few times, and then said, "This is Pepina de la Cruz." I laid her down and picked up the next. "This is Juan Cabonegro," and so I went down the line. After the first five or six identifications, the watching nurses accused me of homs pOGus. "Come en now, [)O~tOF, you'Fe making up those names." '[ assured them I was not, and fontunately was able to prove it. IDuring the voyage I had had plenty of time to become acquainted with the babies and, since I had a numbered list, I soratched the number of each baby on its finger nail- merely as a precaution. Number I was Pepina, and Number 2 was Juan, and so on. Long before we reached Manila the names and corresponding numbers were engraved in my memory. My original intention had been to put the children in an orâ&#x20AC;˘ phanage, but meanwhile they were kept in the hospital, theoretically to l1ecover bom the effects of the voyage. A week went by, plaintive aF'peals from the hospital coming in daily. "Please take these babies away. 1i1hey're perfectly he<l'lthy. They don't be.long here, and they'r.e taIl;ing up spa~e that we neea for the sick and eating us out of house and home." I was conscienâ&#x201A;Źe-stricken, but was also in a quandary. If I put my 245


AN AMERICAN DOCTOR'S ODlfSSEY twenty-sioo eharges in the orphanage, 1 might be exposing four hunared other childFen to lepF0sy. The babies weFe possibly in the ineubation stage of the disease, even though they b0re no evidence whats0ever of illness. I temporized and leEt them wheFe they were. !l simply dil!! n0t know what to do with them. One a·ftem00n a rep0rter from jihe Bul!letin apFJearea in my efficre to get a St0FY. "]'rn teF'Fibly serry," i saiGi, ''but [ haven't an}'thing for yeu t0may, anGi mesides Jj'm vepy busy. ¥0U'tl!l have to exeuse me." '$he nep0FteF setded himset£ ffi0Fe firm~y in his chair. "1i1he eGiit0r says yeu'Fe ~ways ge0Gi [01' a st0!,}" am:! Pm supp0seGi te stay nere until Y0U teN me 0ne." I was suddenli)' inspiFed. Filijilin0s weFe very fonGi of ehhlGiFen. !lit oceuned to me that, if pn0perl¥ approached, they might be inGiuGeGi to adopt my babic:s. I haG! no qualims because the risk was slight if they weFe taken into pFiiVate hemes. "I'M tehl you a story," I said to the rep0rter. "But I'll <do it only if you'l'l premise to put it on the front page anGi give it a four"\!0lumn heaGi." It was a slade day f0r news and the Fep0rter agreeGi. I then t0IG! him ab0ut my nomeless babies, wh0m I .(:JUIG! not put in the orphan asylum meeause [ might theremy fue en<dangering many 0thers. I urgecd him to puil] the vox humama St0FJ as mUGh as he [iked mut, in 0rciler. that ncfu0Gi.y mignt IDe misleGi, he must make it perfeocly clear. in every, paragFapl1 that fuese weFe the chiJdren 0t lepF0us par.en~s. "Put in Y0ur aFticle that we'N have them at the office at eight in tne m0rning may after tom0rrow. There will be lawyers on hand te dFaw up the d00uments for legiiil aGiopti0n, anGi the babies can me taKen away at once." The reporter ruGi a beauti:fu1 job. Martin Egan's Manila Times and the other afternoon papers seized his St0ry and elam0rated up0n it. When I arrived at the 0ffiee the fellowing m0rning, I G0uld net imagine at first wnat the sh0uting, milling GFOW<d was theFe fOF. tt tuFneGi eut that 1illese hunweGis of jile0pie were clamor.ing f0F ~bies. I pushee my way int0 the 0flke anm f0un<d tnat the infants weFe being <disFJ0seGi 0t witn glleat eel@r.it)!. @uaIlantees ;w.eFe meing given, signel!!, anGi sea!Ie<d bef0ne a n0tary jilumlic, and everything was in jileFfeGt 1'0Fm. I left the eetails to ~lte officre f0llGe, ane turneCii to my <daily routine.


PRISONERS OF HOPE At ten o'clock the chief clerk sought me. "ÂĽeu'll have to go out there," he said. "Why, what's wrong?" I asked. "The babies are all gone." "That's fine. What more is there for me te do then?" "But the people are still there. They want babies. They won't go away without babies. And there aren't any more babies." ''Well, tell them there aren't any more." "I have teld them, but still they won't go away." There was nothing to do but tend to the matter myself. Barely had I opened the door when I heard the cry, ''We want babies! We want babies!" "My good peqple," I expostulated. ''With the best intentions in the world, we cannot produce babies on such short notice-" ''We demand babies! You promised us babies!" At this moment a second inspiration struck me. Among my other responsibilities was the orphanage. Without any great success I had tried for years to arrange for the adoption of these orphans, who were without home care and love. I held up my hand to still the clamor. "All right, you'll have babies," I promised. "We'll have more babies in here tomorrow morning-a- choice collection and plenty to go around." Fifty orphans were brought to the office and by noon they too were all gone. As quickly as possible I installed a regular baby department with shelves put up where the babies could be placed. Rarely were the foster parents particular as to type. Usually they took the babies as unquestioningly as those bestowed by nature. But one morning a woman returned, carrying a baby on her hip. " I don't want this one," she complained. ''Why, it seems like a nice baby. What's the matter with it?" "I think it has some Japanese blood. I don't like the Japanese." ''That's all right, we'll take it back." I tossed it up on the shelf, pulled down another, and handed it to her. "How is this one?" "Oh, this one is fine," she said, and departed. But in no time she was back again. I was slightly annoyed. ''We can't keep exchanging babies every few minutes. What's wrong with this one?" 247


NN AM£'RICAN IDOC1WR'S O!9YS;SliEY "I bought the JJ apanese IDaby a wh0te 0utfit of tlolihes. This baby is mueh bigger. N0thing's g0iag to fit iiim." I turned to the shelves, looked here and there for a moment, and then pu1led d0w.n a third IDalDy. "Will this 0ne fit the cl0thes?" [ asked. "Yes," she agreed, ana went away with it. On bhe wl'10te my tiieviee had IDeen at great SUGGess, IDut it was only an expedient and Gouid not be repeated. (:hildren ID0I;n therea,fter at Cuti0a, aUF.i ng the Matrison regime, were left in the colony, and many 0f them contracte.lilllepr0sy. 'Whcm General W00d t00l!: control S0me permanent compromise had to be f0und. !Ji1iie plan uTbimately ad0pted was to aililow the balDies to Femain with their mothers for six m0nths, and then plaGe them f0r tw.o yeatFS in a nursery situ<lte~ 0utsime the repel' limits. 1Jh0se wli0 IDecame afHicted with the disease during that peried wer;e Feturnea to their paFents; those wh0 Femained free of it could be sent, wilih their p<lrcmts' appr0va[, to WeHatrevi1l!le neatr Manila. @n<ly a smal'l percentage of the chiftclren treated in this manner beGame leprous. When ~ went to ~he Philippines little was known, excel!lt in a generai ilVay, about the treatment 0f lepF0sy. The pF0sl!le€ts 0f cure were m0st cdisG0uraging. l'lJUI'lare@s 0I reme@ies aad been 1!Fiecl, but on[y failure ha@ followed. From time to time an isolated CUFe had been r~1!l01<te@. 'ili'his @0uftd IDe aserilDed to a nurnlDer 0fi neasons: the diagnosis might not have been satisfact0ri1y C0nfirmed, the reGovery might ha'Ve IDeen sl!lontaneous, 0r the reliability 0f lihe rep0rts might haNe been in dQUDt. Experience with th0usands or lepers in tne ilslan@s taught me that oCGasionally intiiividuais ailternately ree0ven:m and re1atl!lsed, an~ €luring tJ\e peri0d 0f temp0liatry Fec0very it was impossilDle to pr0ve leprosy, even by microsc0pica,1 methods. Maay 1!Featments f0r leprosy, like th0se f0r tulDercul0sis, seemecl to Gause S0me improvement. Furtherm0re., unaer better l'iygienie conditions and hospital eare, 0r f0r 0ther reaS0ns n0t underst00d, the <disease is 01iten aFEeste@; in a few instan@ es irnl!lr:0vement Fesuhs, so that occasi0nabfy apl!larent eures may take place with0ut any tFeatment. 1i1he pe0ple 0E the Islands had employed iVarious native remooies. 24 8


PRISONERS OF HOPE The Filipinas useld to tie on the leprous lesions cel'1:ain leaves which had a Gaustie effect. The Maros, who ealled the disease Epul, prac¡ tiseld chaFms u!ilan it. The patient was taken to some unfrequenteld spat in waads ar mountains, put naked ' inta a Idisemboweled bullock, and lett there twenty-four hours, during which the tomtom beat incessantly to accompany the incantations of the medicine men. This was supposeld to transfer to the carcass ail the impurities of the human body. Whether the charms had any effect is doubtful, but thr.oughout the treatment of lepFasy it has been observed that heat may have a beneficial reaction. In Japan the value of thermal springs has been known for hundreds of years. Hot baths to elevate the temperature are a desirable part of all modern treatments. The protein reaction and fever caused by vaccination was als0 decide!dly helpful. F9r a time we had high hopes brom the use of X -mys, applied as near the burning point as possible without actually inflicting permanent injury. In two cases slightly burning the skin produced an apparent cure, but the method was so severe that it could not be generally used. The Bureau of Health continued a policy of trying any suggested remeldy which seemed to give hope of affording relief. Other apparent CUFes occurred, but unf0rtunately all of the cases relapsed 0r Idield £FOni some other disease after a period of one year. In the case 0f Felapse the infection had simply existed quiescent, unperceived, only to break out again under. pr0pitious circumstances. It sometimes seemed as though the mere intuition of the less progressive people grasped more than the scientific wisdom of the Western World. The common people of the East can often, by a mere glance, Idetect a leper when the American or European physician, after a clinical examination, fails to find evidence of the disease. In such cases, bacteriological examinations will often show that the ignorant native is right. Dr. Strong was once riding through the streets of Manila in his carromata when a Filipino sanitary inspector st0pped him and informed him the driver was a leper. Dr. Strong was outraged, but the inspector'~ diagnosis turned out to be true. It nas l0ng been known to the natives of India that chewing the leaves and the twigs of the chaulmoogra tree has a beneficial effect on leprosy. There was a pre-Buddhist legend, centuries old, that a 249


PRISONERS OF HOPE cases haa beeome negative. We pFomised that if any patient remained so far two years we w@uld release him. When this actually happenea, far the first time in hist@ry hape was aroused that a peFmanent cure might be f@und for this most hapeless disease. Few can imagine with what a thrill we watched the first case to whioh chaulmoogra was administered in hypodermic form, how we watched for the first faint suspicion of eyebrows beginning to grow in again and sensation returning to paralyzed areas. We took photographs at ÂŁFequent and r.egular intervals to compare progress and to eheek an our observations, fearing our imaginatian might be playing tricks upon us, because in hundreds of years no remedy had been found which had more than slight influence on this disease. But I was not satisfied. The treatment was still so slow in bringing about improvement or recovery that, after the first flush of excitement, the interest of doctars, nurses, and patients all began to wane. T a Femedy this and to aisc@ver more effective preparations of the ail, we brought over chemists from America. They failed. As we went deeper into the subject it became more and more clear that the worM's kmowledge of leprosy was still very primitive. If further progress wer.e to be made, the resources of science should be coorainated. ]n II'!) I 5 I visited CaJcutta and there met Sir Leonard Rogers, who had just succeeaed in curing amoebic dysentery with the emetine treatment. I endeavored to interest him in our research work, telling him we were on the first rung of the ladder but, strive as we would to reach the next one, we could not secure a footing. Although Sir Leonard was interested he said, "I've been in India many years now, and I feel I'm entitled to a rest. I'm just about to retir.e and return to England." But he had made a mistake in having me as his guest. I kept after him hammer and tongs until he agreed to postpone his retirement and work on my problem. In only a few months, with the assistance of an Indian chemist, he was able to make a chaulmoogra oil pr.eparation which halved the time of treatment. ]) eontinuea my eff@rts to enlist the services-of as many scientists as p@ssible. When I next passed through Hawaii, I called the attention of the Molokai authorities to the progress in India, and sug251


AN AM1!HUCPl.N DOCi.r:OR'S ODYSSEY" gested that they take up the wonk in their laboratory from a new angle. The use of ethyl esters al!lowed us to ascend at one bound se;venal rungs of bhe ladder of pnogness. Many cases so treated recovered amil only eight percent nelapsed after a year on so. By this time the United States Department of Agriculture C€lnsidened chaulmoogra of such vitaI imp!ofbance that J. ip'. Rock was sent ar€lund the world to make a survey of the potential supply. The true chaulmoogra. is the TaFakt€lgenos kun2lii. rt has a fruit about the size €If an onange, Govered :with a tawny-£ol0ned, fibrous rind and containing numeFOUS oval, bean-like seeds. 'Fhe oil in Wal'm weather is a brownish-yellow liquid; when Gool it is a soft solid with a oharaeteristic odon and acrid taste. Tne G€llilection 0f the seeds, whien wene offered in the nati:ve bazaars of Burma, Siam, and even in China, was in the hands of the jungle pe€lp'le of BUFma, wh€l ald€lwed at least fifty percent €If the enop to be eaten by wad pigs ancil 0ther animals, when they were nat themselves frightened away by tigers and elephants. The dealers in the -ail had neveF seen bhe tree in its native state. Wrh en the <:nop of 'iFaFaktogen€ls failed in 19>12, the oi] of a related speGies, the Hydnocarpus wightiana or anthelmintica was used. This led to years of experimentati€ln t€l see whether the oils of allifld trees hal!l the same efl'eGt as "Farakt€lgen€ls. As experience accumulated it gradually became appancmt that the OMS of any €If the tnees of the family to which the Ghaulmoogra bel€lnged were ecqual'1y effiGaGi€lus. Many c€lntFadiet:€lry rep0fbs, h€lwever, had to be sifted and testecil. Mr.. Rack had f€limd forests of Hydnornrpus in Burma, some of the trees fifty to si.J!;ty feet till, G0ver.ing the steflp hi1!lsides in the lilaGk country. In Siam the trees were, in some plaGes, so wmmon that soap was made from the oil. Plantations have since been started in many coun~ries, so that the supp'i¥ €If €haU'lm0€lgna iW,il~ lie assured!. The Hydn€lrnrplis group is now m0st commoniy used in the fOFm of ethyl estens, whieh €l\use less local irritation than the other ohaulm0€lgFa oils. H'€lwever, the eh0ice of whieh t€l use is determinel!l Iiy the ease of pr€l€ur.ing, €ost of delivery, purity and £neshness, and keeping qualities. SU€Gess in treating lepr0sy has beG€lme as imp!€lr.tant a fact€lr in 25 2


PRISONERS OF HOPE plieventing its spnead as segregation. ]t is dbvious that if a c;hild with an infective lesion is promptly discovered and successfully treated a mest important focus of infection is eliminated. The course of leprosy is of such great chronicity that final conclusions about the theFapeutic value of a drug or method cannot be arrived at until after it has been usee;! for several years. Both clinical estimates and microscopic examinations are subject to many errors. I sometimes compare the treatment of leprosy with an automobile which has been going down hill with no brakes. Present day treatment has previded brakes. These do not always stop the car, but they do slow it down; sometimes they stop it completely, and occasionally it is possible to reverse the machine and put it back on the road te health. Mtheugh ef ne case is it possible to state definitely that it can be cured with the present chaulmoogra oil treatment as standardized at Culien, ten percent of the patients recover, and fifty percent have a cosmetic cure, that is, the outward lesions disappear and the disease makes ne fur.theF pnogliess. ]n the ease ef thirty percent the e;!isease is arrested, and ten percent are entirely uninfluenced and keep on getting worse. Among lepers who have not had the disease more than four or five years and are not beyond the period of young adult life, in certairi greups vary,ing with the country, sometimes twenty-fi,ve percent can be paroled. Such lepers are ordinarily examined at stated intervals for a reasonably safe period. The earlier a case of leprosy can"be detected, the greater the likeliheed ef recovery. In Zambeanga live two girls who wene paroled in I9II when they were ten and twelve years old. I have been watching them since their childhood. They are grown up and married, and have children of their own. They bear a few scars which wiN never disappear, but they are well, and show no signs of leprosy. Several thousand lepers have now been freed from Culion after having the treatment, but one of the great unsolved problems is what to do with those who have recovered but who are badly disfigured. Many were deeply conscious of the stigma attached to them when they Iieturned to their eld homes. Often they begged to be allowee;! to stay at Culion, and a clean section of the Island was set apart for them where they could earn their living. '253


AN AMERICAN DOCTOR'S ODYSSEY mtheugh 0haulmeegra ei~ lllFeliluces a certain measure of suc~ess, the seaFch continues GOnstant1y fer more effe~tive remedies. MerGUFoahreme, bismuth, neo-satvarsan, X-ray, diathermy, anything that effers twen the remotest hOJile is tested eut. Dr. Gordon Ryrie, an eJ(;Jiler,t in dye theFaJileuti€s, became interestelil in [eJill'esy ,anlil went te the Sungei Bulon li.eJiler SettJemtmt, near Kuala LurnJilur, in Malaya. He argued that since coal tar dyes, which aFe used to stain bacilli, promptly kill them in the Jaberatery, why sheuld not the same Fesuit \iiepFeduGed in the human beGiy,F After seme eXJilerimentation IDr. Ryrie feund that flhe blue dyes had a definite therapeutic effect. First he ttied methylene blue, and then trypan blue. It was a mest startling sight to see him werk. Within a minute ami a hallif after the intravenous ingeatien, the surface lesiens of leJilrosy beeame dearly outlinee, ~ ust as theugh they had been paintee upon the skin. Even lesions net ereinarily visible to the eye became blue, ane graeua:lly the whele boey turned ineige. A\t the ena of a week the lepFeus nodules Thegan te setten a:nd te bie !lbsedJed. '['he blue GeIer vanished1 about sioc weeks a£ter the llist injeetien. Semetimes in three months all the external symptoms clisapJilearee ane the ease became negative. For a time it lodked as though a Fea~ Femedy hae been found, but unierturtateLy many of tnese Gases snoFdy Feiapsed. Flu011esain is being given intravenously, and acts as weN as trypan blue. Recently a Califernia p)1al1macolegist named C. D. Leake pnr ducee a synthetic preJilaFatien which he caHea chaul-phosphate. This is new being tried eut at tne iBFa'Lil leJilresarium at rue de JaneiFo, and the lepers of Panama are being injected with it. Toe many disappointments in the Jilast Jilrevent us ttom beGOming excited abeut a suppesed new Femeey untiJ it has been comJilletely testea,. $e far nene has JilFov:ed mOFe effieacieus than ahau[meogra ethyl esters. But meanwhile the quest gees en. Dr. Ernest Muir of Calcutta, one of the foremost 1eprologists of the werM, has maee many cent~ibut·ions te the theery eE the disease. I have never seen any man w'nese where seui is mere in his we!'!!:. He is always Feaay to talk of lepresy, worKs with it aI!l day leng ami probably <dreams ef it aM night. 2:64


PR1SONiERS OF HOPE '['he British EmJilire has m0re killown lepers than any other politicall entity. Atter Sir Leonard R0gers FetUFnea to Englam;l he was instrumental! in 0!1gal'li'Zing 1ihe British EmJilire JLepnosy Relief Ass0ciation which, in turn, organized branch societies in India and many of the coloni€s, and made a survey of leprosy in Africa, Ceylon and the West Inaies, and through its sister society a survey of India was maee. Recently, with adequate isolation, much has been done in Jamaica, Bdtish Guiana, CYJilrus, ane other places. ChFistian Feligious societies haNe always interested themselves in caring for iepers, and have been virtually the only ones. AU other religions have, as a rule, held aloof. But sympathy for the affiicted, a Christian tenet, has done much to alleviate the sufferings of these unfortunate people. The American Mission to Lepers, fostered by the Presbyterian Church, works in many foreign countries, particularly in ]ndial. Leprosy in the Unite<d States, although not commensurate in importance with many other diseases, has received a great deal of attention. Estimates of the number of lepers here vary from twelve hundred to two thousand. Most of the sufferers are aliens in whom the disease had not been sufficiently advancea to be detectible at the time of their aclmission. But, since they were here, their care automaticaltly became .a nationall obligation. As early as 19 I 3 Surgeon General Rupert Blue was .advocating a National Leprosarium. The American Mission to Lepers took a leading part in demanding such leglslation. In 19 I 7 Congress appropriated two hundred and fifty thousand dollars for the construction of a hospital in which all lepers in the United States should be cared for free 0f cost. 'The gov€rnment then had the problem of selecting a sit€. Mm0st insurmountable obstacles were eneountered. Senators, representatives, chambers of commerce, business men, one delegation after another, raised a trememdous uproar at the slightest rumor that a leprosarium might be established in their paFtiGular vicinity. A well-known publicist began writing.articles criticizing the government for its delay in' choosing a site. A year had passed ana no hospital haa been started. The government could make no adequate defense. I haJilpened to be in Washington at this time. The Assistant

255


AN AMERICAN DOCTOR'S ODiYSSEY Surgeon General, wh0 haa been on my staff in the Phili~pines, saia, "I'm worried over all this cFiticism. Noboay wants to have a leper h0spital anywhere near. Maven't you any suggestions?" "It sounds easy enough to me," I replied. ''What would Y0U do?" he aSKea eageFly. "I'd app0int a committee of three to locate this disputea site, ana sinGe this man has been ¥0UF ehid eritie, ]'a make him the dlaiI'man. Cut 0Ut the Fea taJile. Let t1iem hav:e a liberal: travel ing al'lowanae. 'F>hey think it's S0 easy. Let them struggle w,ith the pF0bllem." Whe members 0f the c0mmittee set out on their travels. Like Y el~ow-Dog iIDJingo, they Fan until their. tongues hung out, ana wherever tlley pickea out a likel¥ place, no 0ne woul@. [et them St0p. 'Fheir hunt went 0n and 0n ana on; I haa forgotten all ab0ut them. One drizzling November night I arrived at Gulfport, Mi~ sissippi, with no idea in my head ex€ept how comfortable it would ble to get to the hotel ana into bea. But no sooner. haa I stepped off the train than I was surrounded \)y an exceedingly aetermined-I00lcing QF0wa of men. "This is the guy," 0ne 0f them sh0utea. "Come al0ng with us," gli0wlea another thlieatening,ly. ~ €0ula sm~.l!.IJ pungent not ,taF, and Gaught sight of a bag of featheFs not veFY wel!l e0neea[ea in tne 0ffing. "'\M'hat have !L a0ne?''' iii aemandea. "Y0u've a0ne en0ugh," came the menacing FeJilly. ''We're going to make an examJille of Y0U." Things were going very bad!ly until one of the ruffians, peering more closely, said, "Sa¥, we g,o t the wrong fellow. This guy hasn't any whiskers." Then, rather belatedly as I thought, they asked who I was, and when ]j was able to prove my identity, they let me go with Father surly apologies, but witn no explanati0n as to what it was ruN ab0ut. i!fs S00n as I FeaGhea the h0tel [ asked the cleFk at the desk if by Ghanee any membler. of the leJilT0sy c0mmittee were staying tneFe. "5lhshshshshshsh," he WlhispeFeiil. "'Keep quiet !'" ''Why, what is it,?" ~ 'I'\lhisper.e~ oaGk. Whe sibilants eontinued. "There's a vigi1lance G0mmittee that wants to tar ana feather one of them. ilit's suspected he's going to re€0m256


PRISONERS OF HOPE mend locating a leper colony on Ship Island just off the coast. He's hiding up in his room and we're going to smuggle him out of town on the first tFain in the morning." 'iJi1lle neJGt time I saw the Assistant Surgeon General he was again despondent. "The whole committee wants to throw up the job," he complained. ''What shall I do!" ''Don't a~cept their resignations. They undertook to do the work. Let them finish it." Eventuahly the committee recommended the purchase of the l.ouisiana State Leprosarium at Iberville. The avarice of man intervened between this eharitable purpose and its accomplishment and Louisiana put a prohibitive price on her institution, plainly trying to hold up the federal 'government. But finally the purchase went through in 192 I. Leprosy had been endemic in Louisiana more than two hundred years, and had been sustained b¼ contact with tropical America. Not until 1894 had any attempt been made to segregate the lepers. BefOFe that they had begged on the streets, eaten at public restaurants, and traveled in public conveyances. Even after a home had been found for them on Indian Camp Plantation, Iberville Parish, seventy miles born New Orleans, they had had to be transported there by night on a coal \:large, towed¡ by a tug, and the feeling in the parish for a long time had been so strong that the existence of the home had been threatened. On the site of the old leprosarium the government has now erected at Car-ville the best equipped leper colony in the world, until recently in charge of Dr. Oswald Denney. Its laboratories contribute much to the study of the disease. Most of the four hundred inmates are Asiatics or West Indian Negroes. Saddest of the inmates are the leprous. representatives of the creole families of New Orleans. Because of the assumed disgrace attached to their state, they rarely report their cases until they are in so advanced a stage of the disease that it is impossible to help them. A large per~entage of tile creoles develop leprous iritis, one of the most agoni'2ling afflictions in the world. Leprosy itself is not normally painful, but it frequently takes this particular form in Louisiana. Its victims suffer so frightfully that morphine can hardly be given in

257


AN AMERICAN DOE110R'S ODYSSEY large enough quantities. Mest of the time bhey sit begging pitifully te be lciNecd. 1Ilhere was ene weman e£ the highest sociall class there, ence handsome, new her'Fibly clisfigurecd, :whe day a£ter. day suffered bhis to!1ture. [, a Qector, felt sad and humele that] €oulti not prevent such suffering. Everything imaginable is clone at Carville te make the lot of the lepers easiel'. Specialists of aU sorts ceme weekly fer consultation. I particularly admirecl the resident dentist. iLepresy affects the jaw eenes £r.eGIucm1ily, and aFtifieia~ rep!ro(!ju€tiens have te be made. When lep!resy gets inte the respiFatery p!assages the ereath !Decomes unbearably fou'!. A special machine has been devisecl to pump gas inte the affected areas to make them less offensive. But what makes the wOl:k heroic is that this clentist is constantly running the danger ef breaking the skin of his hands and allowing the infection to enter. Net leng age a surgeon in iFa~is GUt himself whiJ.e eperating upen a patient ancl later clevelep!ecl leptosy. Golf and tennis instFucters are avaiiallle, ancl a moving pieture machine affords entertainment in the evening. ]n the magnifieent new hosp!ital builQlng every inmate has a private room, beautifiul'ly furnished ancl equipped with a radio. Whis seemed to me a very p!al'aaise, ancl ] sailiL te ene of tihe ~epeFS, "¥eu must !De vel'f happy in yeur new quarters." "Ahhhhhh, the govemment sheulcl a tione it long ago." The inmates of any public institution usually feel that they are entitlecl to whatever they can get from the gevemment. At Carville the inclep!endent spirit is enhanced by the hct that the patients are al'lewed to meeicle f0r themseliVes what treatment tlcey want to take and how leng tIley want to take it. No other leprosarium in the wer.ld ap!preaches Carvil!le in I!emfort or lavishness of equipment. At Culion i had ~ways had to stmggle with pitifully inadequate funtils. Even se, it t00k approximately a third ef aN the appropriations ef the health service and a twentieth ef the entir.e revenue of tne i1islands te care fer lep!Fosy. When GeVel'ne_F HarriseR ha'n<ilea e:veF the Feins to lihe iJ;11i[ipines, iI satilly watched the calesin ef gevernment hur.de teward dest~uctien. Lt is true the Fhilippines were POOl', but they were wasting what money was available in non-essentials, er misusing it like children.

258


PRISONERS OF MOPE I had many detractors among the Filipinos, who for yeaFs had wndu€ted 2 €ampaign against me. The Oriental is adept at making charges. ].f I halil permitted it, all my time w0uld ha·ve been taken up in answering the accusations leveled against me. But when the Legislature decided to cut in half the appropriations for the Health Department, thus threatening our provisions for lepers and insane, I kne'!V the time for action had come. I appeared before a Committee of the House, all hostile, all with their minds previously made up. F0r a whole day I talked to them, pointing out the inestimaMe servk es the Health Bureau had performed for Manila and for the Philippines. I made no impression. They merely listened imperturbably. After I had argued for half the next day, I realized that I was losing rather than gaining ground. I had only one recourse left. BefoFe the Americans had come, the insane had often been chained like d0gs undeF the houses. Fires were common in the dry nipa pa!lm huts, and, in the frantic rush to escape, the insane had usually been forgotten and abandoned to horrible deaths. We had gradually built hospitals for the insane and taken in as many as we could of the worst €aSes. Grirply I played my last €ard before the impassive Committee. "Gentlemen," I saia, "Y0U lfuJow that the only lunatics in your asylums are of the most'dangerous kind. Among them are murderers, incendiaries, and the like. I can barely maintain them with my present funds. If you cut the appropriation according to your proposed bill, I shall have to release half of these maniacs. But to make it clear that the responsibility is not mine, I shall have a sign fastened al'cmnd the neck of each: 'Dangerous Lunatic: Likely to IGll. At Large Because the Philippine Legislature Refuses to Provide for My Care.' This will make a great newspaper story. It will go over the whole world, and bring you a reputation." ''You wouldn't really do such a thing, would you?" one of the Committee asked in obvious alarm. "Certainly I would, and, what is more, the same holds true for Culion. HaH the iepers there will have to be turned loose. They are in an advanced stage of the disease, and not pleasant to view. They are capable of spreading leprosy wherever they go. I have just enough

259


AN AMER[cAN DOC1FOR'S OlJ)iYSSE¥ maney left to bring them to Manila. But I want everybady to mow that when the lepers are £reed in the streets, I am not responsible for this act, either, and around the neck of each will be a sign: 'Re. leased and at Large, BeGause the Legislature Refuses to Appropriate Funas for My Care.' "That wiill make an even better. newspapeF story. It will. be news everywhere, and partiGular.ly in Amer.iGa. ¥ ou are demanding yaul' independence an<!i sar yau are ~apaMe af seLf-government. What impFession do ¥au think this wiill make in the Unitea States?''' They capitulated ancil the a~prop'riatian was restarecil. I had won my victory, but it was shart-lived, beGause, with my departure to join the RaGkefeller Foundation, the Legislature had its way. Governor General Leonard Wood took particular interest in the leprosy problem. He was hOrFifled to find that, because of lack af funds, only one out of six of the p,atients at Culion was receiving the ethyl ester treatment. Ta secure further appropriations, he used all his-influence with the Legislature, whi€h in the early aays was gr.eat. A maFe sGientific stafli was instal!led, a first-class ohemist employecil, and an expert on nutrition set to work. Dr. M. Windsar Wade was tFansferrea £rom the GhaiF ot pathology at the UniveFsity of 1ili.e ~hitippines and made F.'a~halagist at Cullon. Mast important af ill, the manufa€ture of GhaulmaagFa ail ethyl esters was unaertaken at the calony itself, thereby l'eciluGlng the cost of the treatment and permitting many more to reCleive it. The effects were almost instantaneous; two thousand cases became negative in a few years. But the lack of funds was still a severe hanaicap. Every mor,ning General W ooa used to meet with his advisers ana conduct infarmal ciliscussians an every con€eivable pFoject which might be of utility to the Islanas. Leprasy was aften on the table. General Wood was o£ the opinion that it waula be a Gomparatively simple matter to raise one mil~ion aa~lars from the generaus American public ta establish a laboratoJ"¥ at Culion ana buila a hospital far lepers at .Cebu. [(;t seemecil to me that it w(;lUM be essential far €;;enevaJ] Waoa to lend his name to the unaerta~ing. But he cauld not be maae ta see that this wauid have any arawing power. I Wked to /lim aff ami on for days, saying that what he haed aone fOF Cuba wou'lcil soan 260


PRISONERS OF MGPE be fargatten, but the worled would always remember him for his efforts on behalf of lepers. His ather advisers were unanimously with me in this opinion. Finally he agreed. Mrs. Dorothy Paul Wade, the wife of Dr. Wade, offered to help in any way she could. General Wood said he would write out an al1peal, aned, if she could get this published in the press af America, he was sure the response would be ample. Those who had had expeFienee in raising Funds were not so certain that this method would get us what we aN wanted, but, since Wood enjayed such popularity, they aemitteed they might be wrong. It must be saied to the credit af AmeriClaIl journalism that, although Wood had incurred much opposition during his candidacy .for the Presidential nomination on the Republican ticket, the entire press of America, Republican and Democratic alike, published his appeal in the form of an editorial. The results, however, were disappointingly small; only a few hundred dollars were raised. It was then suggested to the General that the only way to make the campaign successful would be to place it in the hands of experts in the money raising field. This was abhorrent to his New England conscience. Believing that the entire amount should be devoted to the purpose far whieh it was inteneded, he could not bring himself to aNaw a percentage of any maney raised to be diverted toward the Gost of the campaign. Mrs. Wade workeed with amazing celerity and by the end of a month had arranged for a series of magazine articles on this great human need. The magazines, like the newspapers, were liberal with their spaGe, but again the results were terribly meagre. After trying faithfully to do the job as General Wood wanted it done, Mrs. Wade begged him by cable to allow the campaign to be put in the hands of professionals. Among those who seconded her appeal was Peter B. Kyne who wrote the General in part as follows: "The needs of a lot of poor Filipino devt1s of lepers on the other side of the wodd will appeal to our publiG with just about as much force as the starving Armenians appealed to them. The Filipino isn't a romantic figure and nobody cares a hoot about him. . .. I have no faith in the average human being having born within him a hunch that he ought to do something for another average human be.ing; I think there are about five per261


iFRiliSONIEiRS

@p1

[f,[@PIil

':F'lle next intellnati(mal aeti\lity: unaeFtaKen by the MemeriaJ was te su&sidize the Lntel'national IYepresy 1.\lsseciatien se that it ceuld publish a c:Iuam:erly International Journal ot Leprosy, undeF the editership eli D r. Wade. iLn nhe past a discovery made in I.ndia might net be known in Bnazil. New the Asseciation attempts to coerdinate the fielCis of FesearGh carefuilr , so that there may be no duplicatien of elfert. Lt sel"iVes as a clearing heuse fer information, and focuses the newer methocds ef resear.eh upen lepFosy, 'ifhe Memorial also finaneec;i a werld-wiae survey of tFopical diseases undertaken by the Natienal Resear.oh Council. A Medical Boar.d was formed to supeFvise the Fesearch acti'Vities in pathology, baoteriology, and epidemiology of leprosy. Great aeumen has been shown in husbanding the resouFces of the Memorial. '!Fhe trustees desired to use fhe brains ef the best possible seientists, but sii!laries fer sueh men weuld have been a tremendous amino TlleFefere, they ananged to work through various American unilVersities; each year, fer example, a professor of ene of the sciences gees to Culien on llis SalDl'>atical leave, his tt:aveling expenses being de!ir.ayeCli by the MemoFial. Me a8preaches the problem with a fresh point of v,iew, ami usua!lly teUFs the trepies, observing pFegress elsewhere, . befoFe returning heme. He becomes so interested in the subjeet bhat, upen Feaehing his univeFsity, he utilizes the resources of his own aepartment on. lepFosy, thereby tremendously enlarging the scope of researeh. "f,he Memorial aids as weN in diseovering young scientists with taJent whe need mOFe tFaining, and gives them fellewships to go to Culien or ether places to study:. I,t alse works in close con junction with the League of Natiens, whioh seveFai years ago appointed a <kern mission en LepFesy with a full time Secretary. The efforts of tllis Commission have Fesulted in steps te organize international reseaFoh eenteFs at T eKyo and ruo de Janeiro. For thousands of yeaps any man, woman, or child on whom the I!;light ef lepFosy haa ,failen, Imew himself condemned te a living cileath. Even thirty years ago no hope . could be held out te these unfom:unates, whe were net even permittea by an unkind ProvidenGe to die ef their disease, but must linger on for years oli unteld sulferi!lg and degradation. W herever I have gone over the face of the

263


AN AMERICAN DOCTOR'S ODYSSEY eal'th I have visitecll eolonies of lepers, ami the Ghange that has taken place is no Jess than miFawlous. Nothing in my li.fe has given me so mueh aoy as to see the lignt oÂŁ nope slowlo/ IcinGl[ei!ll in faees once set in ~ines of cdespair. '['he [epers now feel themselves on the thFesnolCi of CieliveFanGe. They are patient beeause of the CflanGe, however slight, that they may be once again restoFecd to the worM of men ancd life. "]n his nipa hu~, high on ~e hill of tile Leper. eity, old Lazaro de Paerusza sits in the little bamboo doonvay sta~ing seaward! with eyes that l~pr.osy has [ong sinee blinded. We tur.ns over. and ovep in gnaded patient fingers a battered pair of binoculars. G>ne of the padres gave them to him when his sight fipst began to fail to help his dimming eyes grope seaward towards the ships-the little trudging coastwise ships ~at, onee in three weeks, in foup, in six, come tacIcing through the reefs with help for Culion. Eaeh day he waits, [istening, fan the new ship that is to bring Ameviea's merey to those who live bey,ond the gpave. 'No ship t"day, matanlla?' ~hey asK him at tihe end of an empo/ day. We listens. We hears the night. Il'1he peefs chant under the moon. The w,ild dogs howl ill the hills as !!hey Fummage among the shallow graves. He shakes his old head and smiles, wisely and believingly as children smile. 'Darating. Darating din Bukas,' he says in the vernacular--say,s it for all the patient, bmned thousands at eulion-'tomonFOw. Tomorrow it will come.' ''


CHAIPTER 16.

DIVIDENDS FROM PH1LANTHROPY

y 1'9141 I believed that my werk in the Philippine Islands had been a~Gemplisheed. The gneat pes~ilences had been brought unaer eentFel, aned ~he JllGhipelago had become a healthful place for tihe white man te live in. The il"ilipines, who haed been a natien of invalieds, weFe well advanced in convalescenee. A permanent health erganization ha<ii been established. In the course of creating this, it haa eeGome ' ineneasinglo/ apparent that the logical methoed of eraaieating disease was ta attack it at its seurce and to create condit!iens uneder which 'it (euled not fleurish. It was this larger field of JllFeventive mediGine whic/\. dF~W me, but I was not certain as to the pFeeise fovm my pal'ti~ipatien shoulcd take. [Jj was s~ll a member of the United States Public Health Service, w/\.ieh had elq'laneded ÂŁrem the Marine Mospital Service, and I had nemaineed ,in clese teuch with the Surgeon Generals. 'The Service was Genstantly spl'eaeding out, aned at the moment was undertaking a camFaign fer pUFe watel', a matter which would affect millions of people in w.hic'/\.. I was vitally interested. Furthermore, many oppor_ runi~es for usefulness outside t/\.e Service had presented themselves eduring my later years in the Islaneds. l1he Canadian Pacific Railroad /\.aa askea me to install a combined railway and steamship medical system which weuled be more economical and efficient than their eJcisting ene. I had been consulted frequently 0;;' sanitary measures, and haed often drawn up plans for civic health organizations. ] /\.ad â&#x201A;Źonwibuted vaFieus suggestions to a new state health law for Massa-

B

ana

265


AN AMERICAN DOCTOR'S ODYSSEY 'enusetts whi0R Ge:v.(m'l(~r iD>a:v.i~ ~. W,allsh ha~ asked me te aaministeF as soon at it was passed. 'Fhis was the oppol'tunity whiGh appealea to me the most, and I was negetiating with GeveFner Wallsh when Wiclcliffe Rose, the alJle, reseuFGe.ful, ana GenstFuâ&#x201A;Źtive reader of tne newlY-â&#x201A;Ź1;eated ReGkefeller Feunaation, <!arne to Manil~ te dismss pFoposals fOF tlle aevel01!lment 0f health werk threughout the Eastern Hemisphere_ We eonsideFea plans for the prevention of disease" which subsequentJy Game te have tr.emenaeus influenGe ul!len the aestiny of the inhabitants of the Ol'ient. "Fliis openea for me an ol!lpeFtunity for world-wide service. I told MF. Rese that I was coming to the United States in a few menths and then would go further inte the matter ef goining the Rookefel!ler Feuntdatien. On July ~3, ~914., T leEt Mani~a with mixea emotllons. iii was in many ways glatd te get away but, on the otheF hantd, ![ was leaving the place which haa IDeGOme home to me. As I sailea aown the Bay, a~est everr buiJding en the s~Jine Ga[~etd up memories. I har;t hard wOFk eveFeoming tlle sad refleGti0n that, after. all, the masses of the people had no Genception of what had been d0ne. On my arvival in the United States I went to see G0veFnor Walsh. I toM him how much !E appFe0iated his Gourage in placing tvaining ana eJ!per.ienGe aIDove pei[tieal darner in fa:v.or of a nati;ve son anal seeking a heahh officer from far away Manila. Hav,ing heard that he had obligated himself t() appoint me State Health Officer to oFganize the serviee unaeF the new law, [ Feilized the embarrassing I!lositien in wnicn iii was piaoing him, yet 'Ii haa to ask Sim to r.e~ease me. The potentiilities for wOFld serviGe untder tne aegis of the Rockefeller Founlllation seemed to fit in better with my aspiFations. I j0inea the R0ekefe}ler F0undation fomhwith. !N0IDotdy haa any deaF iae~ exa0t1o/ wher.e a:ny 0'f us wene te fit in, IDUt we a!.r.eaay halll our metto. We weFe to beGOme 'heartily sil!k: in the ensuing year.s of its inGessant repetition; nevertheless it expressed the concept on which we weFe to Gonduct our eper-ation~"The Well Being 0f Manklinr;t." Before Mr. John D. R0ckefeller, Sr., began to aispose 0f his wealth on a lange scaJe he s0ught a plan for distributing it commensurate

266


DI\I'Iim>ENiJi!>S FROM PH[LAN1FMROPY m&h the sUJ!ler,human effiGiencÂĽ with whioh it haa been aecumulatea. We a1!lawed it ta become known that he was open to suggestion. NatllFal!ly, innumemble iaeas wene eagerly presented. He lookea into them caFe fully ; none appealed to him. In 1901 the Reverend Freaerick Taylor Gates, who had begun his assaoiation with Mr. Rockefeller by securing from him six huntdr.ea thousand dollars for the University of Chicago, read Sir WilHam Osler's Practice of Medicine. With unbounded admiration and enthusiasm he rushed to Mr. Rockefeller and said, "I have the idea! 1l1he world isn't getting its full share of benefit from scientific discoveries. This knowledge must be distributed in a practical way to !<elieve the ills af the warld." Mr. Rockefeller was already convinced that education and health, two words almost synonymous in his mind, .ather than indiscriminate charity, would make philanthropy produce dividends. The Gates suggestion â&#x201A;Źaincided with his own sentiments, and the attempt began to find a definite application. In 1901 the Rockefeller Institute far. Meaical Research was chartered with a pleage of two hundred thousand dollars from Mr. Rockefeller for grants-in-aid to inves- _ cigators in institutions. Later, millions were available. Dr. Simon Flexner, Professor of Pathology at the University of Pennsylvania, ~ecame its leaaer ana the Rookefehler Institute developed into the outstantding research laberatory of the country. ]ntensive invescigation w~ begun en a special group of temperatezone diseases about whioh comparatively little was known. The r,esOIlFGes of the Institute were brought to bear upon the medical sciences for science' sake, but practical application was also kept in mind. Studies were made and improved treatments were developed for suoh diseases as rheumatism, infantile paralysis, diabetes, and heart affections. The knowledge of pneumonia was greatly eoctended and mortalil'y tr.emendously lowered by various sera. With Dr. Flexner was associated Dr. Alexis Carrel, whose manual i!lexteril'y in special phases of surgical technique is unsurpassed. He became famous particularly for his successful transplanting of living allgans, and growing tissue in a test tube. In accordance with the changing theories of the importance of pFeventive medicine, however, Mr. Rockefeller did not wish to spend

267


.AN AMERICAN IJt)()CTOR'S ()D1rSSEY his meney pFimarily in curing disease, but also desired to eduGlte man in aveiding it. This pFecess welJld extend over many years and ..equiFe mi~liens ef del!laFs. lit mlist inev.italHy pte;ve i1u~i~e urness a way ceuld IDe found te reach une@ucated minds. Mr. iReckefel!ler invited a smal!l group ef lea<ders of the mediGl! pFefession to meet him. "1 want te ask yeu gentlemen a question," he said. "Is there a disease affeeting ~arge numIDers of people of wniGh you can say, '] !mew aN abeut &his and I can rure it, not in fifty OF evellJ eighty 1\lement e£ nile €a5e5, But in ene hundFec;JJ Il'ercent'? FurithermeFe, it sNeuW IDe pessible te pFev,ent by simll'le means. h slleiJlla be a disease of which the cause Gan IDe cleaFly seen-nothing se vague as microscopic baGteria, but some&hing visible te the naked eye. If you couid name me such a <disease yeu would not nave to disceUI:se in vague gcmer.alities abeut puID1ie health, but wewd have something €enGFete whieh ~he masses €eulld understand, anGt €On€eming wlliGh they €eu'lcd IDe een;vinced by la,rge-scale demensttatiens." iNeIDedy had ever IDefore ]ilFesented suoh a preblem te these eminent physicians. 'Fhey sheok their heads and said, awe must have time to think this ever." Fortunately for the answeF, Dr. Charles W. Stiles of the Ynited States Publie Mealth SeFvi€e was wri&ing and pFe]ileunding the &temendeus im]ileFtanae e£ lIeekwel''ID, er UReinariasis, in the Seutlh, and DF. Bailey K. AshfeFd lIad pointed out the aes&ruetien it ha€l wrought in FueFt0 Rice. Fortified IDY this infermation, the little gr0up ef seientists retuFned te Mr. Rockefeller. '<We have your disease," they said. celt is hookWOl1m. [t ruffeets miHions. We !mew a!H abeut it. It can be cdefinitCl!\y cured, it is Il'nev,entaMe, and the wel'm Gan IDe seen." 'File heoKw0Fm first came into ]ilrominence in €Onnectien witll the bui1ding ef tile St. Gothard Tunnel in r880, aIltheugh it had been identified by ~he Italian Dubini-in 1838, whe named it anoyiostema, hoek-mouth. Tile Ita1ians, whe are the runnel IDuilclers of the world, sup]ililed mest ef the laID0rer.s fOF .the St. GOllhaFd. They felt! siGk in suGh numlDeFs ~hat the werl!; Game te a stanastiilil. The caiamiteus illnesses weFe aserllDed te the evil eye OF te tne m0uutain's anger at being bored ful!! of heles. But science offeFed another e)[planation. 11he tunnel had been

268


]!),W [DEN©£ FROM PHILAN'iFWROPY

pollutea by the workers. 1ihrough ova in the feces the disease was Giagnosea as ancylostoma infection. The heat haa compelled the men t@ wonk naR:ea, s@ that the worms haa been a'llowed tree entrance thr@ugh the skin, and the disease had spread rapidly. Not until sanitary measures had been taken was it brought under control. Somewhat later the cammon affii£tion among miners, known in C@rnwall as Miners' Anemia, was found to be due to the same cause. But the flurry in hookwo~m was soon over, and for many years th.e disease became merely a matter @f record in medical textbooks. Hookwo~m next became a subject of importance just after the United States had occupied Puerto Rico. When a frightful hurricane haa wrought tremendous damage, Dr. Ashf@rd, of the Army Medical Service, observed that the people were not recovering from their pFivations as speedily as, with good food and proper care, they n@FmMly should. Th.eir skins were white and colorless, their gums pale, their hair dry ana brittle. Their blood was of such poor quMity that it was incapable of nourishing their bodies properly. Their appetites were unnatural and they were constantly fatigued. IDhilt:iren weFe stuntea; their boaies so ema<:iated that they had angel-wing shoulder blades. Obviously they all were suffering from anemia. DF. Ashf@Fa wantea to fina aut why the inhabitants of an entire district should be anemic. In examining them thoroughly he found, first, ova and then the wonns themselves. Although the latter did net c@l'1'espena to the des£ripti@n in his textbooks, he had no doubt they were hookworms and responsible for the unparalleled anemia. He brought specimens to America which were later examined by i1Dr. Stiles, his fo~mer Professor of Helminthology. Dr. Stiles had already suspected that the people of the South had hookworm. The £otton-mill workers, like the Puerto Ricans, suffered _ tFightful1y tFom anemia. They would Fest all day Sunday, work well M@nday, get al@ng fairly Tuesday, be all tired out Wednesday, ana thereafter do little work the rest of the week. In North Carolina the sufferers were eating clay. Noboay knew exactly why. Nature may have been appeasing a hunger in this strange diet, since the native clay contained iron, one of the best remedies for anemia. lOr.. Stiles identified Dr.. AshfoFd's find as a new variety of h@ok2tl9


D1VlDENIDS FROM PHLLAN1'M'R!OPY capable of remaining in one spot for many weeks in patient anticipation of a fCilOt or ankle. It was once believed that the young parasites entered the human alimentary canal by being swallowed in water or food or carried en earth-soiled hands or utensils te the mouth and thence to the stomach. This is possible in theory, but, actually, never seemed to occur. Later investigations have shown the worms have elected to travel by a mudh more complicated r:oute. Looss, the German Professor of iRarasite1egy at the Cairo Medical SGheol, put a patch of infected mud on his hand and discovered from the small punctiform places that the worms had penetrated the skin. He mistakenty supposed entrance had been made through the hair follicles, but it has now been determined that the worms can squirm directly through the epidermis with astonishing rapidity, sometimes even overcoming the obstacle of socks or stockings. The resultant irritation, known as ground itch, produces ulcers when scratched. Those who go barefoot are more likely to contract hookworm, because their feet are apt to come in direct contad with ground which has been soiled by human discharges. Once inside the human body, the young worms wriggle their way inte the lymphatics er veins, are carr:ied along to the right heart, and are then p.umped to the lungs, whel'e they abandon swimming and tali:e to the air. NatUre tries to expel these foreign substances; they are coughed up thFough the windpipe and then swallowed. Down the oesophagus and through the stomach they go, finding their journey's end in the small intestine, where they set up housekeeping and in less than a week begin in their peculiarly roundabout way the business of raising a family. Any people who have to feed a collection of intestinal worms as well as themselves are bound to lose the race against those not so handicapped. By dwarfing their bodies, inhibiting the development of _ their minds, and r:endering them mor:e susceptible to other diseases, dir:ectly and indirectly, hookworm has caused incalculable damage. It has slaughter:ed members of the human family by the thousands, and render:ed them ill by the millions. Mr. ROGkefeller made available a million dollars to develop methods for the control of hookworm. Having set the machinery in

27 I


is:N

2\:.MIi:R:1!e~ :ID©C'T~R'$

(j)[))¥SSIlY

IR0ti0n. he GnaFaGteristillll!!l¥ retiF€cd DF0m aiMDufn1iheF Genn€eti0n with it. W"lielhlilfe iR0se was 'I:i.fte~ £F0m the <ihair 0f phi!les0phy at the tJru¥eFsity 0£ 'Ji:ennessee to n~<!l tine Re~k€£dJ€F Sanitary. CemrniSi' si0n, a$ it was (laMed. 'This new e~gani'Z;ati0n was te epeFate in the S0utlh, wheEe tihe iReGkefelllet @en~ Eaucatien B0aFcd, £a"oFea with a F ecder.al chaEteF and encdeweGt with m0Fe than thittly tnil!I:i0n cd'eMaFs, had a!lreaay 'DFoken gfoun€i with its agpienrlwal. imWFo"e-


DIVl'(ii)EN,[)S !FROM !PHILANTHRlOP¥ after it. We cdo not need any Yankee help." 'they chose the surest way to kill any campaign, showering hookworm with ridicule by dubbing it the "Jazy worm disease." Dr. John .A. Ferrell had been chosen to lead the attacking forces in North Carolina. Under his direction survey after survey was made, wi~h the utmost caution and care, to determine the extent of hoekwerm ineidence in the South before any further step should be taken. iElr_ Ferrel!! haFlpened ene day to meet Jesephus Daniels on ~he street in Ra!leigh. MI'. Daniels, then editer of the Raleigh News and Observer, had obligingJy been running a great deal of publicity in his €0lumns showing the widespread hookworm infection as preved by the surveys. Latterly his attitude had changed. IDr. Ferrell seized his opportunity. ''What's the matter, Mr. Daniels! You don't seem to like our hookworm campaign any more. You've been pret~ critical lately. Why!" "You've told us how bad we are in the South. But you don't do anything about it. When are you going to start!" "Right now, Mr. Daniels," Dr. Ferrell said. "You are a fair minded man. I want to make you a fair proposition. You know what a ne'er-do-well John Doe is. We believe he's a ne'er-do-well because he's teo tirecl to wovk, and he's too tired to work because he has anemia, and he has anemia bemuse he's fillecl with hookworms. Will you do me a favor and watch what happens to him in the next two months!" . "That's fair enough," repliecl Mr. Daniels. "Certainly I will." I.nside the allotted period, by the use of thymol, which was then the accepted hookworm vermifuge, John Doe gained weight, was proucl of his muscles, got a job, and started in earnest to support his family. Mr. Daniels was as good as his word; he observed the cure and faithfully reported it. When dispensaries were opelled in rural communities and each and all weFe invitecd to come for examination and free treatment, they weFe at first, even though uncdeF semi-public supervision, eyed askance. But e~her wondel'S €Ontinued to be worked. The same chilclren who before hookworm treatment had shown low mentality aGeorcding to the Binet test, when given the same test after treatment

273


DI'YI'l!lENDS FROM iPHILANTHROPY of the Sanitary Commission. The outcome resulted in iaeas whiah, at comparati<vely low cost, affected the human race fundamentally. Eventuail1y tifie eJq)enditures of the states ~hemsel<ves inereased to twa and one hal'f mil!lion dol'lars, or tenfold over what they had been. Mr. RoGkefeller himself was pleased. "This thing seems to have worked out very well," he commented. "I know now what I want to ao with my money. I made it all over the world and will spend it theFe. Get the people interested in their diseases. Hookworm seems the best way, although something else may come up later. But get lmawJeage inta the minds of the peaple." Accordingly he capit3ilized the Rockefeller Foundation at a hundred million dollars. As the field af activities braadened, many changes were to take place, but the Rockefeller Foundation as first organized, had four subsidiaries. An investigation of Industrial Relations was to be under-¡ taken unde. the diFectorship of Mr. W. L. Mackenzie King, but since he was unable to participate because of the War and his rapid political aavancement, this portion af the program was dropped. In the War emergency a temporary War Relief Commission was established which dispensed vast sums to the stricken nations of Europe. The Eunction of the China Mediml Board was to establish higher stanaards of meaical education in China. The aheady existing missionary schools, owing ta the paucity of their financial resources, were badly staffed. The China Medical Board undertook the job of substituting schools which would 'function more efficiently. Eventually it bought out the Medical College at Peiping, and built in its place one af the finest groups of medical school buildings in the world, senaing members of the existing staff to AmeFica for further eaucatian. The RockefeNer Sanitary Commission, which had operated only in the South, was supersedea by the International Health Board, - which disregarded boundaries, .working among any peoples and in any climes. The eventual aim of this organization was to build up the fie3ilth aepartments of aountries needing assistance in dealing with their own diseases. We wauld help them set up a machine with the hope that in time it might be able to function efficiently by itself. In order ta do this, an opening wedge had to be driven by teaching

275


AN :AMER'LCAN lDOcrOR'S @ID¥SSEY ~(;mtrol

ana preventive measures a~inst hookworm, malaria, and yehlow fever. Wicl4iffe !Rose, the !Ei>ire~to1' Gene~ OF the ]nterna~iona,l Herulth Boa1'a, was assisted by Jerome D. Greene, Secretary of the ROGkefeller Founaation. Among the members of the Internationall Health Boa,rd weFe Stan' J. MUFph;y" Mr. iRoGkefelilerls eonfiaentia[ [a~er and peFsonal firiend, ~resiaent Charles W. Eliot of l'Iarvara, my old confrertl General William E. Gorgas, and Walter Wines Page, publisher and Ambassaao1' to the Court OF St. James. Mil! these men were specialists in fielas in whioh MiT. Rockefdler consiaeFea himself a noviee. One of m¥ first auties witl'i the Rocke£elileF organization was to attend a confer.ence of some of the leamers in mtlaicine cal'lea to aiscuss the question of a s~hool to train men for public health service. Among them weFe Warny FFa~t jfuason, Br.esiaent of the University of Chicago, ID1'. Maton J. Rosenau of Harvara, whose volume on Preventive Medicine was a classic on the subject, ana Dr. William l'I. Welch of Johns H0l'?kii~s, henereci as the aean eF Amtlrican mtlaicme. Unexpecttlaly the aemand from the South for. -men trainea in public health had sllliPassea the numbeF of those available te fi1l the jel)s. The erldinary pl'i¥sician Jacked the spe~iat tlaucation to fit him for a positien of this type. Unless thtl demand were met quickly, much aamage might be done by impFoperl¥ tFainea electors. :Expe~ienGe ham I;lFevea it ul¥wistl to place an M. iIQ). witl'iout aamitiomd qualifications at the head of a health service. We might COnGeFn himself too greatly with aiFect cquestiens of merucal relief, rather ~han lihe [anger pnefulems ef pr.eventi.ve meaicine. It was deciaed te establish master scheols to train ltladers ana teachers. After a therough survey Johns Hepkiins was enaowed with a mililien del[ars ana !lQ)F. WeIGh became IDinecte1' ef the fiFst m0aer.n school of hygiene in the lJnifea States. A few years later Harvara was similarly enaowtla. ] haa been int1'oaucea to the gFeat !OF. Welch for thtl first time when I haa been a medical stuaent. At this seGond meeting we beGame great mends and 1'emainea se auring his lifetime. He was p,Fomably. tne most mniil1iant and aMe meaiGa~ man pFeouced in ~he

276


DW[iI)ENDS FiR(i)M PHILANTHROPY United States. After studying extensively in Germany, he had returned to found the first pathological laboratory in this country at Bellevue Hospital, New York City. Later, in the nineties, he was mainly responsible for the organization of the Johns Hopkins Medical School on a system which ultimately had a profound influence in shaping American medical education and giving it world leadership. Many of the most eminent members of his pFofession, such as Dr. Simon Fle~ner, Dr. William G. MacCallum, and the Nobel Prize winner, Dr. George Whipple, had Been his pupils. When Presidents ami other high offieials wanted medical advice, E>1'. Welch was sent for. He was acclaimed not only in his own country but throughout the civilized world. Nobody knew how he managed to keep up with all his appointments; he faithfully attended the meetings of the Rockefeller boards, and also those of the Carnegie, the Milbank, and other benefactions. He engaged in countless additional activities, and never missed one of his classes. Now, at the age of sixty-five, Dr. Welch was undertaking to organize this new School of Hygiene and Public Health at Johns Hopkins. He traveled over the world and in the end evolved a postgrnduate public health ins~itution, different from the others, which has become the model for all later schools. Nobody ever saw this fat li~tie man, perfectly bald, with pointed 'Van Dyke, take any exercise. But he had most amazing physical stamina. He was over seventy-&ve when he attended the opening of the Peiping Union Medical College. Some of us had laboriously climbed the Mountain of the Ancients at the Summer Palace, from which one of the finest views around the Chinese capital could be obtained. As we reached the summit. and the beauty of the vista spread before us, one of our party panted, "Too bad poor Dr. Welch can't see this," just as we caught sight of the old gentleman himself, calm and unwinded, smoking away on his big cigar. - One of the outstanding characteristics of Dr. Welch was his inte~ledual curiosity. One day as we were walking in Manila and I was detained fOF a moment, he wandered off and returned beaming. "What's the history of the monument in that little square around the earner?" he asked. ''What monument?"


AN AMERICAN TI>OCTOR'S O:DYSSEY "The one ta the Spaniard Wiha in~rodu~edJ smaUpox vaccination inta the Philippines." IDUIling al.!! my yeaFs at Manila, anG! in spite af my intense interest in the subject, :Jj had never known that SUGh a statue existed. lik Welch was never too liJUsy ta tallk: to those who sought his advi~e, and was kindly and gFaeious to all. But he woula seItdam answer lettens. The Filipina doetars were natunvll1y most an:xiaus to meet him. He was extremely affafule and woulG! say, "'Now yau must wFite me ;what yau aFe Glaing. it'm always interesteGi ta hear." But I knew that in his taom in Baltimare were p.iled stacks af ~etteFs which he haGi never openeGi. [J]n fact, the only way to get a Feply From him was ta send a tdegFam. He could nat be reached by telephone ex€ept at the school aF at the Maryland Club which, in his day, useG! ta revalve araum;! him. '[1he peFsanalliliy at uhis human G!ynama was sa vivid that ahl pFesent were eleetFified when he entered a raam. G0nversatian eeasetd; everyone waiteG! for what he might have to say. 'ira any medical sub;; jeot he GOuld hli"ing eolor, ana cauld hold the uninitiated enthta!lled. He coulG! discourse b~illiantJy on pali~fCiS., aF, if the conversatian shoulG! tUFn ta New England cemeteries, he €oulG! quote quaint ~pitaphs by lihe aazen. . 'Ehe staries talGi abaut iIi}r. Welch weFe innumerable, paFticularXy in regard ta his un(;aIIny memory. Onee he was mveling across the Paome with :Dr. [Flexner on the Committee that resulted in the arganizatian of the China Medical BoarGi. At ane of the inevitable ship's entertainments Dr. Flexner recited a poem of sixty verses. DF. We101\., who haG! listened alitentive!r , mUl1mwea aFJaiagetiea!i1y afterwaFGls: "ill>" F~elliner, cllGl'h't you mallie a mistake in the secane line of the eighteenth verse?" Dr. Flelliner, wha took gneat pride in his own memory, was annoyed. "I caulan't have dane such a thing. I'll show you the text," and sought the GOrrect vension in the ship's library. But Dr. WelGh was, as always, right. !Elr. W eieh was as £amuIiar Wiith ather meaiGllil! subjeets as with his own. On ane oceasian at PeiFJing 19r. Robent T. ilLeipeF, af bi~haFZia fame, in the midst af an address on hdmintholagy, was taken ill and fainted. The situation was awkward. Dr. Welch was asked whether '27 8


iID)[J]V[lDElNIDS FiR€>M

iPWluLA~'[i'HROP¥

he would speak: to ~he audience. He obligingly took up Dr. Leiper's speech and to 01l!" amazement c0ntinued it. !N0body ev.er saw a note on the innumerable speeches made by IDr. Welch during his many years of public life. When honored by President H00ver on his eightieth birthday, he considered it would be misGourteous not to have something prepaxem. He ascended the platfoI1m, put his manuscript Qown on the desk, and, as he went along, regularly turned ,page after page. Afterwarms a reporter asked him for a copy. "Ger.t3linly," replied Dr. Wel~h, with a twinkle in his eye, and handed over the sheaf of perfectly blank pages. But after Dr. Welch died, bundles of musty papers and memoFanma were cliscovered under an old stairway in his home. Many anm many of the postprandial talks he had given had been previously outlined 0n scraps of paper. Apparently anticipating that he would be GaJiled upon, he ham prepared himself, and at need had probably directed the conversation along lines to which his talk would be aprop0S. My /iFst m0nth with the R0ckefeller Foundation I spent at its 0flkes in Washington, going over the various phases of future operations with Welch and Rose. lit was agreed I should make a thorough survey of the East and thereafter propose a plan based on the same effective methods already in use in the United States. First of all, I had to return to the Philippines to close out my work there, and then continue to Borneo, Java, Malaya, Siam, Ceylon, India, anei! ElWpt. In addition to making surveys of health conditions and the possibilities of working in the various countries, I was to report on the sta~us 0f memieaJ emucation. Rose believed that one 0f the important means of extending medical knowledge was to provide fellowships so that earnest young men from Tokyo, Sydney, or Bangkok could lear.n £r0m Par,is, Berlin, or L0ndon, Bost0n, Baltimore, or' New _ York AG€ording to the system we developed, our fellows were not neGessaFily recruited among th0se wh0 ham graduated at the heads of fheir classes. By the more usual method of selection, a fifty percent sueeess had been high. We ch0se instead those wllo had in practical W0Fk memonstrated ability and capacity for leadership. It was some-

279


AN AMERICAN DOCTOR'S ODYSSEY' times dHl:l.eult to make ~his pian uncilerstood in the eountl'ies for. whiGh fellowships were being Gonsider.oo. ~he itndian gover-nment, for example, kept pFesenting me with lists of those who had passed their examinations with the highest mar-ks. By our method we rarely nacil a fai!lur-e, and a ~a"ge number of our fel~ows now oecupy leading positions tnroughout the world. lin the course of many years I intel'Viewed thousands of these enthusiastic seekers after lrnowledge. I always tried to give peFsonal attention to those wnose choiG.e had fallen upon Amer,ican sehools, and arranged to have fhem invitecil into nomes, so t'hat when they Feturned to their far countries, they would have a broader picture of what we weFe like. [t was eliJ.ua1hly neeessal"o/ te present the nabits of the East to ourown yeung stall! members, not o~¥ to show them how inexorably the Orientalls weFe yeked to their ancient and onerous customs, but that patience must be cultivated before the yoke could be removed. These G"Femising young rp.en weFe being trained var.iously as specialists, diFectors, advisers, an~ teacneFs. Many dicil fine WOFIi:: in the field. I have arlways been proud of them and pFofQun®ly grnteiiul, for they were constantly dealing with people who did not understancil what they wanted, who weFe eken suspicious" sometimes antagonistiG, and altmost always apathetiG. At extreme personall saGFilke they isolated themselves from nome ties and triends and, year. after year-three hundred and sixty-five days on end-faith£ully car-riecl out our pr.ojects. One of, the harcilest alimegations was cmtaifea oy OUF stipulation that the local health or.ganizatien shoulcd FeGeive cFedit for whatever suceess might be aGcomplished. As a rule our- men were never heard of in the outside world. Seientists usuaNy want the fFuits of their laber in tne saaF,e of pubtie r.e€ognition, bl:lt we e01:l'ld not a!hlow this. I symF,athized deeply, but coula do nothing save enwUFage them in their work. Seme of our men received flattering olliers outside tl\.e Foundation , at muen Iligner. sallaries than our oFgaAization paia. 'WIe weFe not sorry to see them go elsewher.e, because in so e:foing they were Gar.rying out the larger purpose of extending h~th Imowleage; in many cases we even helped them to go. We ourselves always made a 2 8@


IDWIDEND$ FROM PHIIlLANTHROPY special p0int not to employ persons who were already doing good work under other auspices. When I joinecd the Rockefeller Foundation, Mr. John D. Rockefeller, Jr., had already given up his business directorships and was devoting himself to social service under the able tutelage of the men his father had chosen. But before many years had elapsed he had taken his place at the head of the table, not by right of inheritance, but by right 0f ability. Sober and ser-ious, with a stern sense of moral 0bIigfl1ll0n spr.illging from his religious background, home environment, and the strict sch001 0f piety in which his father reared him, fie regards himself as a trustee for the millions placed in his keeping. On the 0ther hand, Mr. Rockefeller, Jr., has a lighter side not oÂŁten realized by the public. He has a fine sense of humor, loves . g00d stories, and likes to tell them himself. He has found time to make himself a connoisseur of porcelains, one of the most esoteric of collectors' hobbies. At Hongkong we went through Sir Paul Chater's collection, which was supposed at the time to be one of the best in the world. As his discerning eye wandered over the cases, again and again he w0uld point to a piece and say, "That is not genuine." When Chater diecd and the CGl1ection went to the British Museum, many of the items were aiscarded as counterfeit. 1"Faveling with Mr. R0ckefeller was an amazing experience. He was hyper-{;onscientious ab0ut his wstoms declarations, sometimes including more than the law demanded. He was equally sensitive to the requirements of the swarms of newspaper reporters and photographers who awaitecd him at every station. While the rest of us would employ our brief stops in stretching our legs and pacing up and down the platform, he would devote himself to the unpleasant cduty of being interviewed. The incredibly bad-mannerecd curiosity about the whole RockefelieF family was a revelation to me. On shipboard Mr. Rockefeller G0ulcd never escape impertinel)t ' inquisitiveness. Everybody would gatheI' around to watch him play deck tennis. As we would sit after cdinner in the Rockefeller suite, a w,ind0w w0uld be raised cautiously, and several pairs of eyes could be cdetected avidly peering in. N0t a day passed that Mr. Rockefeller did ~ot receive several dozen letters from passengers on board, all asking for aid. When we 28r


AN AMERICAN DOCTOR'S OD'YSSEY visited the 'PhiliJllpines, airplanes circled overheaa dropping requests 0n the shiJll. Me t00k ahl letters seri0usly, insisting 0n kn0wing the €0ntents OD eaGh, se that ne~hing might be e:verIeokea f0r whioh he feit respensifuiEty. He spent his time inaefutiga1'>Iy en sueh maUers. I always felt sorry for him, !)flllaUSe he seemed to have so little timfl for recreatien. Alm0st everybeiily who came neal' him haa an ulterier motive. As we left the haH aMflr one of the big banquets dUl'ing the deaicatien ceremonies of the Feiping Unien Meaical Co'llegfl I seught to get a few weFms wi~h him e0nGeFning ellF pnegFam £01' tl\.e nel<!t aay, IDut during the shert walk fFem the taMe te the aeor, at this pUFely seeiai function in his h0n0r, he was aec0sted by three Gii£feFent individuals begging fm' m0ney. Dozens 0f times] have bflen askea for letters of introauGtion by people who s0ught to use me as an approach. 1Fhe magiG e£ the [R,e€ke·fehler. name fll<!tenas te ahe [J!oundati0n. lnnumerahile x:e<quests aFe Fecei¥e<d whid1 are net in~uG!ea within the genflrall SC0pe 0f its Giivisions; these range fFom m'he ~eas0nablfl to the luaicrous. "I'm a widow. I have a mortgage Goming due nel<!t week. li neea tW0 thousand aollars. Please send a dieck by return mail"; 0r, "Weuld like aN ~itfl!'ature on the harmfulness of Giganette sm0kiing. My bey is twentY-0ne ana smokfls a €igaFette a eay." A m0tner asks heIJll feF her baby suffeFing £F0m e€Zema, a man wants aia te impF0ve his eyesight, a weman desiFes meaiGaiI a<dvice afu0ut her sister's sinus, a father would appreciate a menthly pension of f0Fty dollars to educate his five daughters, a d0ctor wishes a subsidy to permit him te .educe his fees, amateur secieties suggest infa~lible schemes for werM peace if pFev:iaea with funas, an in¥ent0F s.eflKs in¥estigati0Jl ana JlllleI'Fl0tien ef his hair r0et r.flsascitat0F, a n0te Dr0m an immigliant at E1~is Is'land says, ":HeFe [Jj am, Ml'. R0€kd'diel'., please send my eheck for a miltlien aoID.ars here!' All such mail is carefully perused. 'fhe same GOllFtesy is shown in the offices ef the iF0unaation as MF. R0ckefeller himself displays in his p>ersenal Gerr.esp>onaence. 1Fhe s€epe of the R:eckefeJllflF F0unaati0n was net sufficientily br0aa te incluae ;vfl the phidanthF0pies eM Mr. Reckefeller, Sr. Wis wife had had many eharities which ne wishea to have continued, including tihe C0nstantinople C0llege for Women. But one of the 282


!IDtrWiD'ENI>S FRCDM

iPH]LAN1i'Hi~OPY

peculiarities of the existing Rockefeller organizations was that each (me, aJmost immediately after birth, had developed a policy. In refe~Fing l\e"luests for aid to his various philan~hropies, Mr. ROckefeller, SF., would often be met by the reply, "This does not fall within our policy." Finally he established the Laura Spelman Rockefeller Memol'ial, wiEch among other things was to carry on Mrs. Roekefe~ler's benefactions and serve as a catch-all. Following the policy of all the other philanthropies, however, the Memorial promptly developetd a policy of its own. Mr. ROCKefeller, Jr., experienced the same type of difficulty as his father in his benefactions. When insulin was first discovered the appeals were almost beyond belief in number and poignancy. Although the wording was practically identical at times with the fantastic examples just given, the genuine need behind them was obvious. "My only son has diabetes. I'm a poor woman and a widow. I cannot affoFd to BUY insulin. Can you, Mr. Rockefeller, with all your millions, sit stiII and see my son die?" Mr. Rockefeller showed these pathetiG letters to the Institute, and aSKed whetheF something could not be done about them. "This matter does not fall within our policy," he was told. "It would interfeFe with our other work." Re ~hen appeailed to the Foundation. "Oh, no," was the reply. "We're only interested in preventing people from getting sick. We're very sorry indeed, but we can do nothing." !We finailly took his problem ta the Spelman. "Oh, no. We cannot ga into this, it does not fall within our program." In one af our conversations, Mr. Rockefeller told me of his deep WnGem. "This is a real neea and must Be met somehow," he said. "Then you'll have to set up some organization to take care of it," I warned him. "It's humanly impossible for one person to investigate alJ those claims, some of whioh are ce~ain to be fietitious. You would also have to have some method of distributing the insulin to the authentic cases." "Can you suggest how this could be worked out?" "[I; can think of one way. The administration 9f insulin requires a great deal of skill and knowledge. The medical profession now has no appartunity to learn the necessary teGhnique. Why not give money

28 3


F>'liW~iJi)fffiNID$

iFR©M iPHlLANTHRlOP¥

ill, Great Britain's admewledged best, in English in which the most croitical could find no trace of abhorrea Yankeeism, he aroused vo. €iferous praise from audien€e ana press alike. Mr. ¥incent's memory was cemparable to that of Dr. Welch. Like tne best public speakers he was able to incorporate into his reperteire any anecdote er bit of desITiption. We would often ride uptow.n tegether on the crewded, rumbling, rattling, rolling subway. Wis attention weula appar.ently be diviaed between his newspaper and tine amusing in€iaents [ was tel11ing him. A week or two later my stevies w.ould appear refurbisll.ea in his ewn inimitable manner. Whenever anyb0dy wanted to know anything that might have a rem0te connection with the health field, he came to the International Health Boara. At the home effice, the most important achievements were fre quently off the record. Countries unable to obtain laboratory ana hospital supplies asked for assistance in filling their orders. Cities lavge ana small, near ana far, solicited advice-how to plan and staff their. health organizations, where to obtain competent instructors for liheir medical schools, how to purify their water, how to build their sewers, and how to constr.uct their hospitals. We welcomed the oppoFtunit;y to extend aid of this character. 1Iihe [ntemationa!l Health B0ard's achievements in proving the importance of hookwerm eradieation had areused interest in the meaical laberator.,ies of the worJa, and many were anxious to do Fesearch for their own countries. '[he laboratories at Amsteraam were exceeaingly desirous of studying dog hookworm, which was analegous to the human type, but, because the canines of the Netherlands never had been attacked by uncinariasis, we were requested to send them a thoroughly infected animal. Rose asked me whether I could supply one. I wrote to a dozen fI1iends in the South, trusting that among so many I could procure a speeimen. But not a single r.epl.y was forthcoming. When the time came for a follow-up, I resortea to speedier methods and sent tw.e};ve telegrams. A few days later, to my amazement, not one but twe1,ve aegs ar.rived, aH in the same afternoon. The offices wer.e fi!liea with seunas ef yelping, whining, ana barking. Sailings te the Netherlands were infrequent. Each of twelve girls 0f the eflice staff agreed to take a dog home for a few days. But 285


mVl!IDENiDS FR.C>M RHlLANTHRC>PY wer.e needed, nhe ~nteFllati0na!1 Hea!lth iB0ar-a bOFr.owed ilie br.ighter 1ights of the RockefelLler. Institute. Far example, Hideyo NoguGhi helpea us in 0ur yell0w fever research. Whcm Dr. Fllexner had first been' in the East, Noguchi had wanted ta r.etmn with him to the University of Pennsylvania, but Dr. Flexner had refused on the gmund that there was not room in his laborat0ry, and had forgotten the incident. A year later Noguchi had waJked in, saying, "Her.e I am. I'm your assistant." He had proved such an apt pupil in Bhiiadelphia that Dr. Flexner had found him indispensable and had brought him to the Rockefeller Institute. Sometimes he would work night and day for forty-eight hours steadily, without eating 0r even telephoning his family. He was full aÂŁ temper.ament and scarcely anybody but Dr. Flexner c0uld get al0ng with him. This curious little fellow had been so long from home that his own countrymen could not understand him, and his English was eq)laJily incamprehensible to us. But in a siege of typhoid he unexpededly feamed Spanish, which apparently came easier to him, and iliereafter he and I compromised on that language. Though Noguchi was valuable to the world, the members of the aGGounting department c0ula have dispensed with him gladly. He aF0ve them aJmost tr.antic. They would give him a thousand dollars for expenses and little book in which to note down his daily disbursements. But when Noguchi returned, his little book would invariabIy be blank. It went without saying that the money had been [egitimately used, but it was aruy p0ssible to guess in a general way the manner of its spending. Publicity came to Noguchi unsought; he was a man who attracted attention. But he was unfortunate in that his undertakings which seemem to pr0mise the m0st brildiant Fesults dim n0t always eventuate. When he was sent to Guayaquil, Ecuador, to study yellow fever, which he had never seen before, cases were produced for him which both the local physicians and a clinician sent down from Chicago eel'1:ified as authentic. Naguchi took blo0d from these patients and found organisms new to 'science. He cultured these and injected them into guinea pigs and rabbits, thereby producing a disease which was apparently ÂĽel28 7

a


AN AMERICAN ElOCTOR'S ODYSSEY iow fever. Assuming that the diagnosis of the p>hysieians haa been correGt, he bdieved he had disc(DVered the yel!i@w fever organism; unf@rtunatei,y f01' his reputati@n, it rurnea out to be one which eauselli a form of the infecti@us jaundice im@wn as icte~ehemoHhagica" @F Weil's dis<lase. He haa alFeady workeGJ on this aisease, but the typ>e of @rganism he found in Ecuaa@r differed from that with whieh he was familiar. Since icteFohemorrhagica haa mst been aiscoveFea in Jap>an, Noguchi was extremely aruc:i@us to @btain same @f the or-iginaJ strain for e@mpaFison w.itl\. A!meFiean jauncl,iee, ana rtw@ unsuccessful attempts were made to transmit the cultuFe. Once when I was at the Kitasate Institute in Tokyo, Dr. K Shiga, head of the bacteriolegiGal laboratory, asked, "Will you helfl us get a stFain of icterohemorrhagica t@ the R@ckefeller lnstitute?" "What a@ ]j h:we t@ a@?" "Oh, very ~ittle," [ was assurecl. "Y@u just nave te take a few guinea p>igs WIth you on the steamer, ana every eight days y@u inoeulate a healthy one from one that is dying or has just died. We'll suppIy you with everything neGessary, and put the guinea pigs on tne ship." "AJ!1 right," I agreeGl, anGl flF@mp>tly f@rg@t am@ut the whoie matter.. '$b.e Canadian iE'acifie !Liner, Empr,Bss of Russia, was C!r.@wt'iea ; every cabin was taken. ln mine ]; f@und waiting fer me six guinea pigs, two of which had been inoculated the Glay before, and four healthy @nes te earry on the strain, together with bales of leaves anGl cabbages. My Foom companion at once objeeted violently to the idea @f traveling with sick pigs. I symp>athized with his rep>ugnanee, bieeause t he oGler in the hat eenfinea space was un<;!@ubtedlly aisag,r.ee- . able. [ haa en1y been in tne F@om a few m@me,nts w,h en the steward informed me the guinea pigs must go back on shere. My only hope was to interp@se delays. The stewara was still objeeting and I was upholding my end @f the argument with unruminishea vigor when the ship> got under way. "~f y@u'thl let this go @vernight, l'il fu: it in the m@r-ning," r promisea, ana he finailay departe(il. But before I couM do any fixing, the captain ana the purser and the doctor all p>aicl me an @Hieial visit. The eaptain deliveFea the

288


Ultimatiilm. "¥rou'illl I:!av.e te get dd ef the ~hele iet. We aan't ~un ttl\.e risK: ef infeating eur Fassengers tFem sick ~igs." "But it is mest im~e~ant f0l' me te get tllem te the Unitea States." ,,~ w,en't have them on my ship. The whele business has get to gt'l= al!l YOUF eIa £eddeF and e:v.erything else." "<£:eli!la li dis@ss this first 'IV,ibh the docteF?" I asked. Wiifih tile captain's censent ~ aF~ealed to the decter's professional in.stinats, eJqillaining my ebjeGti¥e. "You ten the captain it's perfe€tly safe to Ila¥e these pigs en beaRd. Yell knew they can't infect the ~assengeFs. if Gan unaeFstand the ebjections to having them in the f,eem, but it yeu ask him te let me keep them in the shi~'s mOFgue, I'm sune ne'hl agree." 'Ehe a<!i€tor added his entreaties te mine, and cages and food were tnansfeFFea te the mer:gue. For a few aays the gentle guinea pigs, >'v,niGh suffer se uncem~iainingJy from so many of man's diseases, scam~eFe<d aFeund meFl'ily an<d nibbled ~heir cabbages, unaware of how neaFly tlley had come te an igneMe end unaer the butcher's cleaver. [lj1Fem tile time we left Tekye it was raining and blowing, and allmest ahl the passengeFs on beara were seasick. But the pigs remainea in goed health. On tile eighth day I inoculatea a nice little white-eaFea ~ig. ']1he neJit mOFning the pigs feund a new reommate tying en the rubber' slalil a1ileve them. A Chinese passenger haa dieed. JII.€GeFding te the custem e£ his r:ace he haed ~aid a edeposit in return Fer a guarantee £Fem the steamship company that he would not be lDur.ieed at sea, but woulcd be Fetumed to the tomb of his ancestors, in oFder that he might I'eceive preper hemage Frem his own descenedants. "Fhat morning the steI'm readieed gate pFoportions. I feund that my guinea Figs weFe a~~arent1o/ very sick £Fern the effects' of the fel'mai1in wlt'h whiGh the ceF~se haed been embalmed. The second '!Ii1e~e-ineculateed Fig haed dieed aUI'ing the night, aned it was necessary - ~Ilat ene ef the weN enes be inoculated immediately. I sat flat on the fleeF with my feet well braceed' ami picked up the heallthy blaGk ~ig. AC(leFa'ing te instructions, I pFe~aFed him by shaving the hair £.Fern fiis lDelly, aned put him aside temporarily. Selecting a shiny scalpel, with the greatest of caFe J] Began te Gut out the liver ItFom the aeaa ~ig.


AN AMERICAN DOCTOR'S ODYSSEY Just as ] was at the most deliGate stage of the eperation, the ship gave a tFemcmaous lUF€h. The aead C:hinese abeve me slid off 1ihe taMe, ana sat en my shoulaeFs., wiuh his [egs aFouna my neck. [ dia net dare move. The slig'htest siip might mean a eut ana consequent infection fnom a disease with a particularly high mertality. With the pig before me ana both hanas e€Gupied with SGalpel and tweezers, I had to ~ontinue. The ship woula roU one way and a wld nakea leg would swing in f.rent of me, then ba~k it would FOll in the ofpesite ciLirectien amd the ether [eg weulcil jGilt my aDm. [ haa to [eave the ioy, stifF body ~tradcdling my shou'Iders unti~ [ had finishea elCtracting the liver ana rubbing it on the denuded berly of the black pig. The moment I had finishea I heaved the body back on the table and, with the aid of the morgue attendant, lashed it down so that su~h an aCGiaent might not Fewr. W!kn we neachea Van€ou~er, en!ly thnee pigs wene [eft. They haa a>lready enauFed much ana the conditien of two of them was aubieus. It was midwinter ana they had to be kept warm. I toek them into the sleeping.ear with me, conGealed under my raincoat. But that evening they were discoven::a; the conductor per:emptorily told me to Femove them to the baggage Gar. "But it's se cela the guinea pigs will C!tie." 11he €enauctor p,ulled eut a> beak of Fegula60ns, and I haa no recourse out obeaience. By this time we were welll up in the Canaaian Rockies ana it was eighteen below zero. The first thing in the mor-ning I hurFied forward the long length of the swaying train to look at my guinea pigs; they were aJ.il frozen stiff. I sent a telegram to the [nstitute at ence, inferming tli.em of the mishap" and received a netUlin wiFe te bFing them Mong, but be sUlie rte keep fhem fFozen. Tremenaous excitement attenaed their anrival at the Grana Central Station. A Rockefeller Institute ambulanGe, uniformed attenaants, ana even Noguchi himself were theFe. The train had barely , slid noiselessly te a stop when the guinea pigs weFe snatched from the baggage ear ana rushed to the labeFatoF}', wheFe Nogu<!hi, in spite of the man!)' misaawenfiUlies, sacceedea in revi;ving the ieteFIJhemorrhagica organisms. The pigs haa fulfil[ed their destin}'.


CHAPTER. 17.

A DRUMMER OF

IDEAS N undertaking the position of Director for the East of the International Heallth Boaud I was obligated to spend most of my time away rr.om the United States and practically ostracize myself from any permanent ties of family or home. For twenty years I traveled furiously on my mission, peddling my line of ideas. Research wo~kers in the United States would be brimming with experiments they wanted tried out in the tropics, and tropical health officers were eager to have projects tested in the big laboratories of the outer wodd. I carried in -my head health ideas gleaned up and down the whole creation. Until a few years earlier the various medical services of the East hat'! been united only in their laissez-fair.e policy toward the native populations, looking with suspicion upon one another and jealously guarding their own secrets. Each health service had revolved smugly in its little sphere, and much labor hac;! ceen wasted in solving problems which had already been successfully met in other l:mds. Governor General Forbes had given concrete form to the idea of _ inter.nationatl medica~ cooper.ation. He had issued invitations to all countries East of Suez to send c;!elegates to the first meeting of the medical men of the Far East to be held at Manila, March, 1910. ~apan, China, Tsingtao, Ceylon, Hongkong, Straits Settlements, the iFec;!erated Malay States, India, Siam, Netherlands E ast Indies, and Australia had responded, and the Far Eastern Association of Tropical Medicine hac;! come into being.

I


AN AM'ER1CAN DOCTOR'S ODYSSEY MeFe impom:ant than tne papers l1eacil eF even the iaeas e;xchangeed had been the persomvl relatienships estaMisheed among the medi<;;tl representatives of widely edivergent FaGes and C0untries. Yellow, brown, ancil white had met in ~ cemmen Gause, and eaGh hacilleaFned that the essentialls of his prebfems wene Gemmon te alIi. 'fheFeatt(;';r our brethren threugheut the East, in fuM fu:aternity, had met wifh us every other year at some Eastern capital. The results of these meetings were so gratifying aned so valuable that on my trips for the iReckefeJlleF ]i:ouncilatien I vlllr,ieed my itineFary wlknever neeessary te attend them. UsuaUy I followed the sun on my jeurneys, and Vanwuver was my first stop. British Columbia ailreacly had a health service, but semetimes efficia!ls w,eFe unSUFe of themselves and felt the neecil of being Gonfirmeed in their pFocedUFe. They would present me witll many problems, and we wouled pore over them, trying to pick eut the seund kernels which might bear fruit. GeneFa!l~y I tFaveled bam the Pacifie Geast te Henelulu. Altheugh we naa neither personnel neF meney investecl in Hawaii, not only the government but also private organizations of business men were spending libera~y in promet;ing health. The Americans in Hawaii had estaMishecil SUGh high standards of p,lantation sanitation as te make MllIwa,ii a paragon thFeughout the East. Nere i[ Geulcd learn much. The give and take in ideas exceeded that in any other place. I couled study the methoeds of lepresy tFeatment at iKalihi, and in return help with plans for the eFaedicatien ef plague, which was endemic in the back: GeuntFy of Maui, ancl which was [ookecl upen as a stigma. Each ceuntry I visited had a different set of questions to be answereed. The §apanese weuM accumulate a huge quantity ef statistical edata w,itheut being themselves SUFe ef w:Jlat te ede with it. Their interest in science as practised in the laborate!'}' was tremen, dous, but not sufficiently vital to induce them to sink their professienal rivalries fer the geeed ef the muntry. The aim ef t'he Founedation was te IDFing abo1!lt eeneerteed aetien in hea[th wo~1f llIncil iE, as its l1ep,.esentative, tried to make myself peFsona grata to rival factiens. Šut of respect for the Reckefeller Foundation they would come together, and this was a big step toward GeneiHat;ion. 29 2


A IDRtJMMER OF IDEAS Forem 'ifekyo I went to 'P'eiJiling, wheFe ~he China Medical< BoaFa was already at work. Its activities cdid not fall within my province, but ]j was f.Fequently consultea. I alr.eady had had experience in China. 1n 19II I had been asked to erganize a health service in Seuth China. Many of the questions put uJil to me, however, had been far afield from sanitation. The first thing the au~orities haa wantea to know was what te ao with the army which had just €onquered Kwantung Province and refused to go heme. "How: can you aisl!!ana an army!" they asked me. After prolonged cogitation I suggested that the wall along the water £ront of Canton should, in the interests of sanitation, be demolished. ''Why not set your idle army to tearing it down!" I suggestea. The solaiers were put to work, and the wall had practically vanishea before, one by one, the disgruntled laborers had abandoned their unexpected task and had slipped away to their homes. At one and ~he same time the ends of health had been attained and the army cdiHiculty settled. The problem in China was controlled I!!y the value placed on human excreta. China has no sewers. Ea€h night in urban centers the eXCFement is collected by coolies, who carry it in wooden buckets to barges Mong the river. These are pushed up the streams and canals into the interior, arid almost everywhere farmers and gardeners may be seBn JilUF€hasing their supply, which they convey to their fields of rice and mull!!erry. There they dig it into the ground for their crops, eF moisten it with water and sprin:kle it over growing vegetation. Thus a relatively light infection in Chinese cities may become a serious factor in sJilreading the disease to agricultural districts and, through the infected vegetabl~, back to the cities. All gardeners and rural ceolies work barefooted or bat:e-Iegged. Under the mulberry trees, where it is dark and shady, the hookworms wait for the unwary. At Shanghai, as a private individual, I used te meet the authorities of the Internatienal Settlement at ainners and luncheons, and talk ever a dezen different things. I used te impress upon newspaper eaitors the need for better water, so that they would begin intensive camJilaigns; ultimately both water pu~ification plints and sewers were built in Shanghai. In the normal course of events, this would have

293


had neve. meen mr.0ught under €ontr01 a.lth0ugh, as always ",hene !El1reneh [nfiuen[e preedominates, a Pasteur. :Ilnstitute had Deen etrecteed. @ne thing that imptressecil me was the intense F nench jealeusy 0f 0ther nati0ns. [ was t0M, for· instance, that it was a cFiminal 0fFense f0r any nati;v:e ef ~ nalo-China to [0me to the U niteed States f0r an ealucation; he W0Ult;! fOFfeit his citizenship thereroy. The ruins of Angkor Wat in Cambealia trank wifh the seven wonders 0f the world. A c0mplete city, with a magnificent style of arGhiteetune to be seen nowhere else, haal roeen built by the Khmers. Where tliis raGe had C0me from nobody Knows, and where it has gone is e\ijilall..lo/ shr0uedeal in mystery. This amazing city, supposeal by the natives to have been built not roy men but by mighty demons, was 0nly aisG0veneal in 1860, and n0 start to clear away the jungle was made be£0t e 1908. Since then the F Fench have worked long and hard to make it accessible to tra,velers. They a'lso desired to bring home to theil' 0wn people some impression 0f its gmnaleur, and when I was 1iliene they were taking impFessi0ns of seme buildings for the French (i;ol0nirul Expositi0n in Paris of 1932. 'F0 test out their carefulness, if made sCFatGhes on a bleck 0f stone; when I examined the replica later in F ar;is 1 saw even these sCFatches exactly repnoduced. SinGe I c0uld bring litt!le to the Fl'ench in Indo-China and take little fr.om them, '[ .went ~heFe seM.om. M 0re often on leaving Hongkong, [ sailed to the Philippine ~slands, where if was coming home. ;Ii was still regaFdeal as DiFeet0r 0f Health, and was deeply touched my the many kindd,y attentions of the FiEpinos, who had come to reallize what '[ had been trying to do. At MaJacanan with each Governor Genetral I weuld go over the jDFoblems which, though fam i!liar, were :;A;ways Ghanging. I woulal gFeet oM frienals, Fevisit old haunts, never failing to pay a fFiendly caM at the (i;uli0n leper col0ny. After. ab0ut six weeks I would start S0uth, invariamIy stopping at Zamoeanga. HeFe Dr. FajaFdo, heaed of the Minedanao health serviee, alisplayeed the affection 0f an oled boy gl'eeting his former master. [l[e was Prying out aId sorts of advan[ed preventi;v:e methods, among 1illem Gh0Iera vac[ine, which up to that time even Manila had hesitated to use. ifi1Fom Zambeanga across the SUlu Sea to Sandakan was not a long aump. BFitish N0rfh Bornee was Fun by a €hartereed company for divi29,1'


A DRUMMER OF IDEAS tile stel"s te his heuse aeubJie tne 0l1a.inary height te sa~e lumber, ana was tawping his trees in two plaâ&#x201A;Źes, although it was an accepted faet that a rufuber tree could stand no more than one. Anether F.ubber estate was located on Fich soil, said to be ten feet thiek1, whieh had been the bettem of a lake within the memery of the olaeF Fesiaents. Between the trees had been sewn the creeping passiflora fetida, which shut out all other growth and could, at interv:ds, be roMed up like a carpet, leaving the ground bare and free of iWeeas. The poles ef the recently completed telegraph line between Sandakan and Jesselton, the other capital of Borneo, were kapok trees, which have only straight, right-angled branches upon which the wires were strung. These telegraph poles had the advantage of not deterierating and alse of raising a valuable crop ef cotton. In other plaees where ordinary poles were used, for some unknown reason, wila elephants teok exception and pulled out the posts and threw them away almost as seon as they were replaaed. '['lie Reckefekler F ounaation representa~ves in Borneo sometimes had a hard time socially because the feeling against Americans was very strong, and few amenities were extended. The planters blamed the Americans fer the bursting ef their rubber boom; from the height of el"ulenâ&#x201A;Źe in 1925 they haa been plunged into depression a few years later. It is not a simple task to gain the cooperation of people who believe they have been robbed. I would go aJong the coast of Borneo, occasionally stopping at the [slana of Labuan and the iE'rotect0rate of Brunei on the way to Kuching, the capital of Sarawak. There I was the guest of Sir Charles VyneF Brooke, the White Rajah, who governed the country under British I"rotection. To my surl"rise the British in Sarawak seemed te have, lost the art of wolite living in the British sense. My experiences gave me the distinct impression that visitors were not particularly desired. The Brooke family took little interest in health work, and the authorities in eharge seconded this attitude. I was amazed to see that everyone seemed se afraid of the Rajah that he was not discussed even in whispers. Because I had credentials from the Colonial Office in London, I was admitted to conference with His Highness and explained to him 297


AN AMERICAN DOCTOR'S ODYSSEY n0w tw0 ~0urses were 0JDen in a bMkwanli €0Un~ry such as his. A little might be c;!one in many fieldls, anGi sU0h a~i0n, th0ugh it would have only a slight elfeGt on sidrness ana Gieath rates, woula be commenaed by the by critie; 0r, s0mething essentiru, aJ[though ~€Ss sJDectaoular, mignt me ci!<me wlii€H, at €omwaratiiVely smaM eut!ay, weu'l.Gi Flreauee larger rt::sults. We kept a man there unGier saJary for ever a yeaF and a !'tealth JDlan was werkeGi out, but the gevernment never JDut it into elfeet. FFem Ku€ning iii saiied te SingaJDeFe, in Ma!lay" the "City eu <tihe Lien," whiGh haGi meen transfermed my Sir Stamfera iRafHes trom a fishing village into the Emporium of the Orient. It was now a great worM trade center and Great Bz;itain's m0nster navru base in the East. Chugging te ]0hnsen's ~ier threl:lgn the G!i:veFsified shipping was a fitting intr.eGiuGtion to tne eenglemerate hfe Qf this ext!la0FGiinary c0smopolis. The Rames H0tel, one of the famed hostelries of the world, was alm0st rulways GF0wdeGi. WerM t0urists wllre arriving on evet:y, steamer and! peoJDle wet:e df0JDJDing in £r.0m China, Japan, the il"hill'iFlpines, Siam, iBUFma, InGiia, Ceyl0n, anGi Bur.0pe. Gln the huge veranaas 0vedeoking the Bay, amiGi meautiful JDaIlm tre€S, the pUnKahs . swayea noiselessLy mack and f0rth, i€e tinklec;! in glasses, anc;! constant €alils weFe heat:<d f01' stinga whiskey anGi sec;!a. iBef0Fe iR0se haa startec;! his D~I41 tQur 01' the East, he !'taGi r.eaHzea that kn0wledge 0f hookworm control was, net yet perfectec;!. A funaamentatl questi0n haGi to be answered, '<Was anemia fli0m hookworm Giistinguishable f,rem that cause~ by matlaria or other diseases?" MaJaya seemed te elfer the mest epJDertunity f0r a sUFi\Tey. With the cooperati0n 0f the gevernment a commissien was aJDpointed by the Roekefeller FounGiatien, c0mposeGi of the American c;!octors, S. T. DarLing anc;! M. A. Barmer, assistec;! by the iBz;itish aoetor, M. P. Ha€ker.. Dr. Darling, the heac;! of fhe Commission, nac;! meen in Panama with General Gorgas, where he had mac;!e impertant centributiQns towat:a the success of the health serviee. D F. Barmer. had been Professer e~ Bacten-iefegy at the Kansas Mecli€al Ce!!kge. One 0£ !his most mr-iiJ!iant ~amen-atory achievements haa been the aiscovery 0f a way ef isolating a single bacillus. The great !Koch was teld abeut his 2~8


A IDRJI1JMMER 0])1

~iIf)EliiS

mebl'ie~

at the "El:lme·r-Gu[esis Cengr.ess e£ 1~@8, but Keeh ha<d peehpe0hea it. iIDF. !Bar.wel' haa then sua;:essfu[[r, dem0nstrntea it to him. BeGause fie l'iacil se wel!l prevetd himsel'f, we breught him over. te the BUlleau of Science· in the BhiliFpines, w,here he made many praetieall diseever.ies, bri1l~iant in their simplicity ana r.evelufienary in their effeGt en the c0ntrel ef aisease-bearing mosquitoes and ether aspects of tfepi(la[ meaicine. After he joined the lnternational Health Board, he ae'l'eloped a methoo of segr.egat.ing heekwerm eggs by which examinations weFe immensely faeill itated and speeaea up. One ef my liFst jebs in the FedeFated Malay States was to pFepaFe the way fer the Darling Commission, lina a place for its meIhbJeFs to stay, al',Fange inteFViews, and, since they had no licenses to practise there, te seCUlle the neGe86ary permission. In addition, I drew up a list ef peints en whioh ful1ther hookworm knowledge was desired, sueh as whefher thymel or ehenopodium was more efficient, the after effeets ef the treatment, :what kined of purge to use, the aiet, the relatien between the age ef the patient and the severity of the infeetion, ana whether neGators weFe less resistant than ancylostomes. The final floint was te deteFmine te what degFee uncinariasis infection was a menaGe te the hea[th an~ worlcing efficiency ef the peoples of the OFient. The Commissien plannea te make the same type ef survey in Java ana SumatFa, and te eheck theiF findings in Fiji, wheFe no ' malaria ex;istea te c0mpliGate the stuay. ,M uGh hoekworm work was eiVentually done threugh~t the Straits Settlements. Dr. Paw ~usseI.l gave many leetures atf t alacca, where lange numbers of Chinese and l'ami!! laborers had been imp0rtea to IDuiM a new aam. His au<il:ienee toek to heart the letter if not the spirit of his exhertations. A gr.eup ef Chinese Goolies, after hearing one ef his talks en hookwerm infection, almost killed two Tamils who haa vielated seme of tihe r.egulations he had laia down. A.nother Malay Gen'lel't was insp>iFem: by his teaehings to build a latrine of which he was so p>reud that 'he fastenea the door with a padlock lest anyb0ay aefi[e it. ~n Java as wel!l as the FedeFatea Ma,lar States I secured permission £01' the ll>arling Commission's survey, but accemplished little else for many year.s. It was aifficult ta make headw.ay "against the harcl,heaaea

!

2~9


AN AME'R[[CA.N DOCTOR'S ODYSSEY DutGh who, beeause of tilieir brilliant achievements, considered tilu:mselves seH-sufficient. In the beginJUng, I was under suspicion 0n the theory ~hat I was there for the chief purpose of winning approval for a Standard Oil concession. I €0uld have answered any direct Gharge, but nebulous implications are not so easily combated. The Dutch all= thol'ities, h0wever, were always h0spitable and courte0us in !listening to suggestions. It required a long time for an idea to penetFate the heads 0f this stubbom pe0pie" rout, 0nGe it was in, they could be €0unted up0n never to ~et it go. Ama so rn persevered. Fr0m iBatai\liia [ l'etraGec[ my steI?s (0 Sing:!'p0re, ana ~hen€e a0l1= tinued to Sia.m, where in the uplamds 0f Chiengmai we tumed ola Buddhist tempfes to our uses, transfOI,ming them int0 tilieaters wliere we GOuld display the life eycle 0f the hookworm. Thence I took the train back to Malaya, stopping fOF a few hours at the beautiful islamil of Penang. The c0ngestion of smail waterGraft at this por,t of entry into Siam and the northern coast was terrific. No adequate doclcing facilities were available, and people and merchandise had to be landed in sma1\! boats. . ]t is an 0vernight j0urney ]}y train rr.om iPenang to Kuala Lumpur, 1rn0wn [0cailo/ as K-L, tilie capital of the iE'1eaeratea Ma,lay States. lt was one o£ the first Gities in the W0rla to aaopt t0wn planning, brought ab01:1t By a W0man's or~ni'Zation. Every house plan had to be sulDe mitted and aCGepted as harm0nious to the wh0le. At Kuala Lumpur, during and after the War, I saw flourishing one ot the most affiuent gover,nments in the world. !flie shipments of rubber and tin were S0 large that only a slight export duty on them sufficed to provide for all government needs. It was a taXpayers' Ut0pia. Comm0dities of all sorts could be had for little 0r nothing; good Havanas were ten c<mts apiece. I thought travd in the Unitee States was comfortable, but it did not compare with that 0f Mala.ya. For fifty Gents I c0uld acquire a compartment with a bed, screeIlCld windows, shower bath, fans., ana rurrning watel'. Ow.ing to its tremendous weMfh, the government of the ~ederated Maiay States did not fee~ in need 0E OUF financial assistanGe; aillI it desirea was ideas. illn Sumatra, by suggesting metn0ds 0£ hookw0rm and beriberi control, I was able to pr0ve the c0mmercial value 0f sanitation to 300


!P;, lID:RlffiMiM iEliR

OF [ iIDIilMl

rOFeign fir.ms witn huge p1antations just €oming into p,Foduction. 'if1he it)ut0h tnmtment of nne maial'ia] mangFove swamps taught me in tUFn muoh whi0h GOu1c!! IDe usea elsewheFe. !Froom Belawan lIDdi, the Ghief port of SumatFa, 'l went to 'Rangeon, €apital of Bmma, rich with oil, riGe, teak, ana rubber, and boasting the gFltat gelii!en Shwe Dagon. ,[,he Burmese weFe a aooile, easi[y lea Fa€e, inclinea to IDe lazy. 'iJilhe health service seught the help of tne :wipungis, the priests, who would assist, fm; example, in rounding up tne people feF vaccination. 1Fhe upper classes assimilated know leage r.eadilo/, l'JUt gambLing an~ the pursuit of pleasme eften macle them umd iable in medialll wOl'k. Students haa to be paid to attena the rnedid bFanch of the University, and the government haa to let ~l'iem bring a!long their va!lets. liIhe Burmese weFe so ashamed of ~heiF meclkal schoe! that they woulcl not even permit me to see it. Personall'iabits weroe net a problem among the Burmese. They weFe d eairly ana usea [atrlnllS. But the heavily populated part of the coun~y was low-lying, and whltn the subsoil water rose in flood time, the people lDecame infeotea with hookworm from the overflow. Nen I lande~ at Colombe and spent approximately three weeks looking oveF opemtions antil stuaying, in the field, the development of the hookwoFm crampaign. Ceylon was one of the most important route. !Jjn tne eaFly clays t he Foundation was using this stops 0 11 islancl to clemonstrate tne Fesults of hookworm research. We concentFa:te~ mU0h effort t here, recrause we believecl that what was aCGomplished in Ceylon would he applied in' other British celonies. Even though the ocstacles weFe gFeat :lincl the cl iscourageme~ts many, in <Ceylon we leamea more about the practical application of hookworm !mowJedge than anywhere else in the world, and in the end the results weFe gFatifying. Then [ €Fossed by Adams BFiclge into Southern Inclia, first stopFing at MaclFas, ancl a.fterwaFds geing north to Glcutta in Beng:lil. 1 woulcl sFena clays ancl evenings getting acquaintecl with the men of tne l!ndian Meclicral Servi€e, tne most effectively oFganizecl bocly of mecliml men in the wedd, w.ho hacl contributed the great bulk of our lffiowlltdge of tFopical meclicine. 'lihe British who 'composecl it, a~le., efficient, and unassuming, pnoceecled steadily toward their geal in spite of the magnitucle of their problems.

mr

30 '1


AN AMEiRKAN !DOCTOR'S ODYSSEY Sometimes it WC!luld seem desifable for me to go tC!l Simla. Two nights and a day were consumed in a 10urney whieh might have borne a superficial appearance to a vaGation, but it was maae for a purpose; I met the important people there at a time when they had leisure for dis0ussion. Many of the researoh prC!lblems C!lf India were being workel!! out at the BC!lmbay BacteriC!llogiGa] LaoC!lratC!lry. [ usel!! to stay with the GC!lrnmanding officer C!lN the grounl!!s, ana, cC!lNsequendy, vailuahile time was nC!lt taken up in estaID1ishing m¥ status. ~ne fndian Mel!!iGa.! £eliViGe was trying to stam a sellC!lC!l] C!l£ Hygiene, a project dear to my neam anI!! C!lne in which I was deIig,h ted tC!l IDe ef assistance. BC!lmillay, one of the scientific mediea~ centers C!lf India, was disputing with Otleutta for its location, a'l though ultimately Caloutta won. On the long voyage from BC!lmbay through t1).e Red Sea anI!! the Suez Canal I had time to GC!llleet my thoughts, and most of my material had been organized when I reaGhed Egypt. The WC!lrld War hal!! stC!lpped our hookworm labot;s there, and fC!lr years my visits were C!lf an advisory nature on1y. Egypt was one of the most tempting countries in which the Rookefei[er !\1eunl!!ation CC!lutd be C!lf serviee. Its reSC!lurees were tremendous IDut the knowlel!!ge C!lf hC!lw tC!l awpty them effectively was meagr,e. iIlg}qilt arso C!lffered uneqjuafed C!lppm;tunities ,fC!lr resear0h, li>eing C!lNe ' of the few places in the WC!lrll!! where the aney lC!lstoma exists alC!lne without the necator. Furthe~more, it is afH.ietel!! with the C!lutstanrung prC!lbJIem of bilharzia. Thousands of tourists, the cultured of all countries, well-informed, inteilligent, and thinking peC!lple visit Egypt eaeh year, and have been doing so for a eentury or mC!lre; scarcely one ameng them has even heard ef bilharzia. Yet out of the twelve million Egyptians who are crowl!!el!! into the narrow, desert-bordered belt of fertile green that fringes the sinuous ceurse of Father Nile from Alexandria in the IDelta te IAssuan by the cataracts, six miilion have this disease, three mill:iC!ln are seri<llUsly handieapped fuy it, and C!lne mi1llien are bel!!.fast. A tiny tFematC!ll!!e WC!lrm, eaa~ed a fluke frC!lm its fisn-liKe shape, fleMs ~he mescendants C!lf the Fharaelils in a self-impesel!! but none the tess vise-like grip. Here, as everywhere else in the trC!lpica~ worll!!, th e Chief responsi-

302

l


A DRUMMER OF IDEAS bility for disease rests upon the lack of cleanly habits. Bilharzia could be er.adicated if nhese could be inGulcated. With other r.esearch workers the Ro~ke.fd!leF ~oundanion is now engaged in attempting to solve this proolem. TJntil Egypt has been freed of this devastating disease, she will always be under a serious disadvantage in taking her place among the nations of the world. From Alexandria I embarked, sometimes for Athens, because we were conducting ma!laria investigations in Greece, sometimes for Naples, and sometimes for Constantinople. Wheuever I landed, after a ShOFt stay I would take the train for a brief tour of the capitals of Europe. I would spend a few hours at Budapest to inspect the Institute of Hygiene, and then go on to Vienna which, long before the soeial conventions had permitted it in other countries, had made clinical material available for students. Czecho-Slovakia hela special interest beeause it had a newlyorganizecd government with young ideas and an enthusiasm un hampetecd by an already existing bureaucratic administration and weighed down with precedent. In Germany the great problem after the War was to know how to apply sanitary measures with the â&#x201A;ŹOnsent and help of the people. In nhe imperial days an orcder had no sooner been given than it was carpied out., ancd usuahly;-carriecd out well. But the Republic had to instruct and persuade. I never ornittecd Paris, where the Foundation maintained an office for the Commission on Tuberculosis, which was making extensive surveys-a wOFk later taken over by the French. I learned a great many things that eould be suecessfully applied in such places as the South Seas, where the tuberculosis incidence was high. The French, although they may well claim to be among the world's most intelligent people, had steacdfastly refused to be convinced of the soundness of our conception of medical education. Because we wished to disseminate this special type of knowledge through Frenchspeaking people, the Foundation tried to accomplish this purpose by helping the Belgians at Brussels to develop a modern medical school. At AmsteFdam and The Hague I would interview people from cabinet ministers down, and discuss particularly the problems of Java. My chief point of contact was Dr. W. Schiiffner, famous authority 30 3


P.l DRUMMER â&#x201A;ŹlF IDEAS r.lll'alI cilist~i~ts. When pepulatiens were ti<ansfeF,r ea hem unprefitalDle fanas to virgin femile regions, the train that carried the people had a hospital car with doctor, nlll'ses, medicines, and complete hospital equipment. I'll swecial plague sec~ien had been formea in the Health Department. ]n various cities larger and more scientific laborateries had been eFected which made smallpox and cholera vaccine. Before it had been possible to erganize health work, a great smallpox epidemic had bFeken out and many aeaths had resulted. But now every infant over feur months old had to be vaccinated. Russia also had had frightful malaria after the War, but within a few years had installed the most approved system of combating it. Anti-malaria stations were opened ana aistribution of quinine arrangea. Russian delegates made a practice of attenaing foreign meetings on malaria, and working industriously they steeped themselves in the world's knowledge of the disease. ] was partiâ&#x201A;Źularly struck with the manner in which the Health Department nanaled venereal aisease, which was being treated solely hom the infectious standpoint. This is in great contrast to our attituae; estrich-like, we stick eur heads into the sand and refuse to recognize that syphilis causes greater havoc than any other disease in the Ohristian world, and that efforts to aeal with it should not be handicappea by regarding it as punishment for sin. Venereal disease, like cholera or plague, is primarily infectious and should be handled acGeFdingly. The situation willr.emain hopeless as long as a prominent l1ealth officer of the leading state in the Til nion can be refused the use of one ef the great radio broadcasting systems because he mentioned the wora syphilis. After the Revolution of 1917, when the experiment in Communism w,as gust beginning, the Soviets made one serious errer in the health field. They had assumed that ne special preliminary education was needed before a student could enter medical school. Four or five years were lost before they learned that good doctors could not be made in this wajl. Their excuse was that the Marxian doctrine is not compiete; her.e were beams toe short for Marxian houses. Nevertheless Das Kapital remained their Bible, albeit in modified form. 305


~

BRUMMER OF ][),EAS

mOFe, Washington, Chic:ago, San Francisco, delivering lectures and anem;iing meetings, renewing e1<;l associatiens, making new centacts and investigations, and picking up new ideas which would be helpful cdlll1ing my next world tour.


CHAPTER '18.

M'UCH iHA VE ] 'f~AVE1LED

M

OVEMENT, change, flux nave govemea the pattern of my life for many years. The ~hrob of engines, the mournful warning of fogh011Os, white-jack(!ltea stewards, tourists vocal with erronecilUS info~mation; gentle seas, l'ough seas, calms, ana typh@CilOs, lanedb![s @nce strange but later familiar, g@!den sand and green Jungle, heat and edripping humidity; alien cust0ms and alien faces, whi~e skins, yeJlow skins, hF@w,n skins, black skins, the patter 0f many t@ngues; trains swaying ai@ng uneven r@adbeds and nurol~ng @veF le;v:ei @nes, snri~l WihistJes in the nignt, n@tels //'lith sTeep¥ pOl'teFs; €0tS, feather IDeas, w00aen paJlets; i0wJ humming Rol[s Royces aned rattling F@FedS, flat roaas meeting the hel'ilZ@n, white r@ads cuding ulll m0untains; cities large aned smaN with priaeful citilZens anxi@us to cdispiay civi€ wares; hospita,ls everywhere, "'I1his is the ward for such ana such, and this is @ur operating theater, aned this is the laboFatory, ana so on"-1 can stil[ Fepeat fhe whole stery backward and forwardit makes me weary now to think of the hundreds of miles of hospital c0rridors traversed in c0ntemplating meaical education in laneds near and remote; interviews with these f.riendtly ancl h0stile, tongue 4ry with hours ef ta[k, pointing spFightly st0ries with hidc;len morals, explaining ~he same thing 0ver aned @:ver, mustening the 0ic;l arguments of menit agains~ p0Iities. ,Mmest <!lways I t@@K with me @ne 0f the youngeI' d@Gt@l's, eitlleF from New Y 0rk @r his post in the East, ~e shew him what was IDeing d@ne in c0untries other tHan his own. ())ften I nad lllieasant c@mpani0n308


ship, :whieh was not diF6e1ilr in the tine of muty. In 11')\1 6 [ was accompaniem Iliy one of my olm fnienQs\ iIDr. W iJllia:m George MaeCailum, who ha<il l}eeome one of the WOFJd'S leading pathologists, anm was author o~ one of the best textbooks on this subject. Dr. MacCaIium, w,ho was then enjo}'ing his Sabbatical leave from Columbia UniiVeFsity, saim he was tired of performing autopsies on victims of the same oM diseases anm the same old races; he wanted to see what he â&#x201A;ŹoUl'cil [earn from tne vietims of tropical malamies. But in the beginning of our journey the oFporotunities for autopsies were so few that he was r.emucem to missecting snarks. MaeC:a!Num was stiIDl hal'ping on autopsies when we arrived at the iFiJi [ slan<ils anm loudly expFessem his annoyance because nobody had cllied recently in Suva. At the Governor's dinner I sat next to the Cnief ff'ustice anm endeavoFed to amuse him by describing MacCallum's maeabFe enthusiasms. '''Well, ] ~fiink ]i could arrange something for him," the judge re' mar.Kiem. "M ow?" "1Ii'wo ClFiminals are going to IDe executed here next Monday. I GoUlm easily arFange to nave' their IDodies turned over to him." [ explainem that unfortunate1y MacCallum could not wait until Monmay; because W6 were sailing Sunmay. "Oh, that's easily enough arrangecll. I'll have the execution advanGem to Saturmay. ,[:hat'l~ be a simple matter." Confronted with this proposition, ~ had, to beg off on the grounm that ] Eoulld not feel Fesponsible for hurrying two wretches into eternity IDefore their. time. ~ pF6cedem MacCailum to Manila wheFe [ arranged to have him temForarily appointem a city pathologist. I told him the glad news when ~ met his !;,oat at six in the morning, but, omitting aN mention of tne CUFr6nt cholera epicllemie, warned him that, if he once accepted, he must perform auto.psies on, alii IDomies brought to the morgue. Mace:a;llum was S0 melighted at this opportunity to increase his knowledge that fie fturriem thFOugh his bnealiJast and r.ushed me off to the mor.gue. ~ive b0mies weFe a[reamy awaiting him. ]; left him bUIDbling witn enthusiastic anticipation. He did not appear at lunch, nor at dinneF. Alt eleven in the evening h6 mFaggecl himself wearily into the

30 9


AN AMERICA.N IDOcrOR'S ODYSSEY hetel, having seen a great dea!l mare of cholcr.a than he had bargained for. Ten meFe GaSes haa come in bef0r.e he had finishea the first five. A£ter the seGena aay he was Feady te .esign, out '[ teld him he weulii! nave te remain at ~east two weeks to establish his geGd faith. ~he result was that the ch0lera ehapter in the Fevisea edition ef his b0Gk was one of the best. MacCallum had done spe~iaJ. research on mrularia ana haa made ene of the great centx:ibutions to the kinewleage of the aisease by his disceveIW ef the sex life ef ~he ma,lari~ parasite. A.t SingapeFe he was overjoyed te find many victims ef malaria on w.hem he celli€! perferm autepsies. These were se pFofitable in aaaing to his stere of informatien that seme yeaFS afterwaras he returned te make filirther studies. But in the meantime the British haa performed the !'Ier~ulean task ef Feau€ing the aisease to a negligiDle figure. Pra€tiGal!ly nobealy in Singap>ere was new ay;ing of malaria. We ra,iled at me f0r men~hs theFe3!tter. "Yeu sanitaroans h:lNe ruinecii rthe lDusiness or the poor patholegist." Unfami1iar with the vagaries of tropical climates, MacCallum had great diffictil~ in adjusting his clothing to fihe differing temperatures. On neaGhing Van€Ouver he had steGked up with winter clo~hillg ana cliscaFae& his light weight suits. At Fiji he had Feversed the WrG€ess, thrGwing away his newly-a€<ijuiFe€! winter 0utfit" 3!ncl liJuying a summer ene. At Syaney he had pur€hased new winter. clothes ana left behind his summer ones once more. I lost tFaGk of the numliJer of times he went through this jettisoning process, but when he aFrived in Java he was in his winter eJ0thes and dripping in the insufferaMe heat, always p>Fotesting to me that he was, "Very €emfeFtalDie, thanl~ yel:l." Net untiH his resistanGe nad been eVeF€eme te tehe ,weint whe·Fe he would a<ilmit he was genuinel:}' suffering <die!! ] wred u€e his latest eaition of tropical clothing, whioh I had surreptitieusly tetrieved. His pride by this tllme had Gompletely melted, and his gratitude was unalleyed. l1hreugh so mu€h traveling I had had to ~earn aU sox;ts ef e*J!>e<il'ients ane!! FlreWaFe rer ailIl serts ef emergeneies. My wandFebe nad to Flroviae fer a wide range in temperature, ana seGia[, 'lDusiness, and sport requirements. I feund there was only ene way of being sure I aid not leave anything essential behind. I made an all-inclusive list, a

3 1@


..

MUCH ¥IAV£ I TRAVELED €Opy of which was kept in each bag. By this means nothing was ever la€king, even when 1 had to pack and set f0rth at sh0rt notice. ~ caruiea an 0ffiGe aesk with me in the shape 0f a speciaHy designea waFaFohle trIlfik. When it was opened, a lea,f in the middle could be pulled down, thus converting it into a desk. There were plenty of pigeon holes. One drawer held a traveling library, another served as a catch-all for papers, and below was a suitcase ready packed with everything I needed for brief trips, including a typewriter and complete desk equipment. In the other haH of the trunk my clothes were c0Mealea hlehind a folding d00r_ ]t was a painful experience to see the massive trunk being m0ved inch by in€h up the ship's gangway; one slip and it would have gone to the bottom of the sea. Only in Egypt where the stevedores are reputed the strongest in the world did I ever feel confident; but there one 0f them woul€! pick up the three hundred pouna load, walk up the gangplank with it on his shoullder and deposit it on the deck. A turn of the Key and I would be ready to work; through the tropics it was pleasanter on deck. I always suffered considerable anxiety until I had the trunk in my p0ssession. Once when I had to search for it in the hold, I found it labeled, "Dr. Heiser, deceased," and had gFeat difficulty in pr0ving that I was :!!live. Seasickness is a malaay of m0ment only to the sufferer, but it is nevertheless very serious to the constant traveler. I am not one of those fortunate 0nes who are naturally immune, but I did learn how to prevent its occurrence. Until I had become more or less immune, my simple but effective remedy was to lie in bed with my feet higher than my head, even eating with my head at this lower level. A still better €ure is to have some absorbing inteFest to divert the mind. Once in weather so rough I could haFdly stay in my bunk, where I was coddling myself, a sick call came from the steerage. I somehow staggered to my feet and answered it. Shortly I became s,o occupied that r forgot all about my unpleasant nausea. ln 1915, when the War was weli under way, some of the steamers iilelegated for neutral passenger traffic were unspeakable. I atlways chose an upper berth, because 0f its aavantages; I could 100k out the p0rthole and, if my cabin mate weFe seasick, I preferred to be located a10ft. One night, while traveling on the Union Steamship Line, I 3 11


was awakened by the most terr.inG pain in my big toe. W Figgling it on[y made it warse. I thrust my foot over the eedge aned my anguish inereaseed. When I hurriecd1y switcheed on the light, there was a huge rat hanging on with a bulldog grip. The more I shook, the haFMer the Erightened rodent heM an, aned the further his teeth sank inea my toe. iBut as soon as ] puNed my foot baek on the beed, he let ga aned s€ampeFeed aft, lea¥ing me to <dr-ess my wounds. In aededitian to Fats, t·he ship car-vied a fuM c0mpiement 0f F0aehes. 'Fhey wc;)Ulc;i l'un over the tables, even in the cila.ytime. But they haM S0me c0mpensataF¥ attl'lbutes. Na €J,j.jFapaedist cauM have maede his E:ving on this ~ine. Passengers w,ho weFe affiicteed by earns waul@ ftn<il them neatly Femoveed by ma11ning. The Foaehes would gna,w dawn until they reachecdl a sensitive spot, the faat wauld! then automaticta!lly be moved, aned, thus disturbeed, they wouled scamper off. Even more annoying than the Union' Steamship Company was that far famed [ine, dear to all !British hearts-the Peninsular & Oriental. I have experienced all the vexatians and humiliatians which Kipling has described sa well, and, in ac;lditian, many of my awn. My intr,adUGtian ta the P. & O. came when I baal'ded one af thei!' ships at Suez, en raute fOF the first time ta the Philippine Islands. ] haed left my hea,vy baggage at PaFt Saicil while ~ went ta Egypt, aned hadJ aFFangeed f0F the ship to piow: it lip there eeeause ill pia,nnecil ta meet ;jt at the 0thel' end 0f the Canall. 'ifhe offieiMs af the Jine w0U!ld n0t vouchsafe the time of the vessd's arrival at Suez. iBut, f0Ftunately, ] haed one eye open whcm it finalily came at three in the morning. With a natural anxiety to £in<il aut before we left whether my baggage had came 0n b0aFd, I repaireed to the purser and' made inquiries. He was as affenedeM as thaugh never in his life ha<il he heard such a questian. He grew Fedder and rededer, aned swelled an<il sweHed like a turkey g0bbier. ~i­ nally he managecil ta s~utter, "The luggage is the business of the 'Poul'th Officer.~ "Where is the F:au~th?" ceil! ed0n't kmaw." iUter searehing heFe a,ned theFe an the da~K:ene<il ship, [Jj finailly cFawJed edown the hatch bdcder aned loeateed the Fourth in tne hd<il with the eargo. JlI,gain [ inC!juirecl paliteiy far mf, trunks. He la01q!<il

3 I2


MlUOH HAm J! 'FUW!EVED at me in a stem aned lefty fashion. "Do yeu reaLly expect me to keep in mind aill the luggage that comes on board?" "I theught you might be able to refer to your list." «We have r.egular hours for attending to luggage. Tomorrow at four." I couled not see how that information would avail me if my trunks were not on the ship. But his decision was final, and I went to bed. iii was stilLI tired when I awoke at nine and decided to have breakfast in my reom. I t:ang for the steward. He came. I oFdereed breakfast. "Are you iilll, sir?" he inquiFed.

"No." "Breakfast is only served in the cabin when the passenger has a certificate born the doctor that he is too sick to come to the table," he parroted. I tried to induce the steward to change his mind, but he persisted it was against the rules of the company. Since I was more tired than hungry I stayed in my bunk until noon. Then I repaired to the dining r.oom for lunch, expectantly anticipating my soup. vVhen I indiCiateed tocmy waiter that I was ready, he €oFrected me with the information that I mignt be ready \mt the captain was not. Fortunately f0F my aJ1lpetite, the <:apmin, a pF0Ud individua!l in a grand uniform, S00n entcFed and ·was majestically seated. Then, and not until then, a special steward by his side banged on a big gong, and the soup ceurse appeared. I soen learned the rigid etiquette of dining on the P. & O. A hardy indi'lidual who said, "I won't na'le any soup, steward, I'll have the fish," was met by a stolidly reproving glance. "The soup is being seFved, sir." The hungry man would have to possess his soul in patience until another sonoreus bang announced the captain had pnished his last spoonful of soup and the fish was being b0rne ceremoniously through the sw.inging doors. Whoever came late had to start with the course Wihieh the captain was then engage<d in consuming. ]j remember 0ne dinner at Amen iWhere we had arrived late in the a·M:em00n. The custemary rule on most lines was dinner jackets in the evening, although if a passenger had been ashore until too. late

31 3


AN .AMERKAN IDOCFOR'S ODYSSEY to dress, it was automatically waived. But not so on the P. & O. Sitting next to me at table wllrll a young Hungarian count and his bride, neither of whom spoke Eng;lish. He came on board just as the souFl gong had struck, rushed into ~he dining F00m, and sat down. The steward said, "I'm very sor-ry, sir, but we can't serve Y0U." 11he C0unt obviously aid not undeFStand and pointlld again to what he wantea on the bili of far-e. "Youlll] have to leave the aining Foom, sir. We ao not serve anyonll who is not in eVClning &Ilss." Sti]l the Count aid not un!!l(lrstan!!l. 1Ehe waiter then steFlJi'ea 100hinel him, lifted him out of his GhaiF, anc;i escoFtlld him kom the room. rn lateF years a gFeat eoncession was made to the tropic hllat g0tng through the R(ld Sea. [ saw a sign whieh read, "Gentlemlln will be permitted to dance in flannd trousers, but this will not excuse thllm from formal dress at dinner." Conversations on shipmoar!!l are always the same, people get tirlld of !!leck tennis, organizing ships' Goncerts, metting on th(l daily run, and avoiding bores. By way of ruvertissement, I sometimes submitte!!l my iist of ten wOl'ds, whiGh nomody )I,(lt has sFlell(ld successfully. I uSl:Ia1liy prdaGed it my remaFking that iR'Fesident li[iot of HarvaFd ham miss(ld thFee, and that newsFlaFlIlF (lditoFs haa fueen kmown to miss fiNe or SIX. T1he sFleNing test wOFked willi equal eflkacy on land. On one 0Gcasion the Gopper king, John Ryan, was present, took the test, and missed feur. A few weeks later li met him walking along BFoadway. He came up to me with his mig beaming smile. "I haven't seen you since I boasted I was the champi0n speller of Miehigan." "Are you sure you can spell those words now?" I asked. "Of course I can." "[ doumt it." . , "PH show you. li'li do it right here." TheFe in the mi!!ldlle ef CFowdâ&#x201A;Źd iBFoadway, j ostle<d by FlassIlFs-fuy, he serl];jbled out the words as I gave them to l1im. !A,gain, to his gf'llat ehagr..in and sUFp>~ise, he missed four. Mis eliiFlerience was by no means unique. I learned to count upon eer-tain Fesponses which were almost in-

3I 4


MTJCH HAVE I TRA.VELE'D varia!;,ie. I1hough numerous ancl cliversifiecil, the explanations offer.ed fer mistakes f@l!I@wed a set pattern. The British always usecl t@ claim I was using the American way of spelling. I would refer them politely to the Oxf@n\ Dictionary. With eager look one of them would Fush t@ lihe shiJ'l's library. Sure that he was right, he would skim over the pages until he came t@ the word. Momentarily dashecl, he would then rush with equal confidence to the next word he had missed, only to have his hopes once mere blasted. On one trip I had been asked by Mr. Rockefeller te ma~e a report @n lihe Constantineple Col~ege for Women, which was anocious to secure adclitional funds. I went through the various divisions until finally I neached the English Department. I was introduced to the hea<d, a spinster, ferbidding in demeanor. To alter the monotony of the inspection [ began as foNews: "ÂĽou're the head of the department?" ''Yes.'' "Y;ou teach English?" ''What else weuld I teach?" "I suppose you give instruction in spelling?" ''We pride ourselves on 'our spelling." ''Weuld you mind if I tested you?" "What clo you.want to test me for? I know how to spell." "Of course," I said, "if you don't want to give me information-" The President of the college, who was standing by trembling in her boots, conveyed to the English teacher in whispered asides that it was important te tr.eat me with civ;ility. An abrupt change in attitutde followed. "Certainly you may test me," the English teacher saicl. "Have you a pencil and paper?" "[ usuahly spell out loucl." ''We'll use pencil and paper if you den't mind." I gave her the list. Confidently she wrote down the words and handed the slip to me. Seven were wrong. Further whispers followed, which evidently convinced her of the enormity of her guilt; [ never saw a balloon collapse mor.e quickly than she. I had already determined that the time was not propitious to recommend more money for the institution, but to this day those 3 1ÂŁ


MUCH HAlVE I 11RAVELED Amgk0r V'i1:at, ~hicl'l is supp0sea to be ,the acme of Oriental perfection. UnaWaFe that their efforts wene being wasted upon me, country continuea to vie with country. But by this time I knew that I did not CIne to see more dancing. When not a word of it was breathed at Singap0Fe [ sighea with relief. I thought I was final~y done with spenaing evening a.fter evening at this business. But at Siam the word that I was a connoisseur of dances had again precedea me. The Crown Prince had arranged a special exhibition, beginniNg at nine and ending at thFee in the morning. Beautiful as they w.eFe my appreciatllon waS dimmed by tlie fact that I had to Be up and about my duties at eight. if was now sure I must have seen the end of dancing, but hardly haa I stepped ashore at Rangoon than the wife of the Governor said to me, "'W e've heM up OUF annual dancing fete until your arrival. We thought you, as an authority on Eastern dancing, would be particularly interested to see it." That afternoon she gave a tea party to whiGh aN social Rangoon tore its hair to be invited, and I was regaled with the native danees of Burma. I went to India. In Madras, TravancoFe, and Bombay the nautch dancers swayed to the shrill piping flutes. I continued to Egypt-the daneing girls of CaiFo swung wildly to the monotonous minor of AraBiG music. Not until I had ~e£t the East eid the competition for my unofliGial approval finally end. In the diverse forms of entertainment offered me I could more readily adapt myself to the ainners and the luncheons, though they weFe often e0mposea of smnge fooes consumed .acc0rding to strange Gustoms. I remember my first formal Chinese dinner. Graciousness is inheFent in Chinese hospitality. When plans were being perfected for a National Health Service in China, I was tendered a banquet at the Winter Palace of the former Empness Dowager. We were rowed in the m00nlight to one of¡the lake pavilions on a barge, beautifully decorated with palms and wistaria and varicolored paper, which might have bel0nged to the glamorous Tsu Hsi herself. Apologies were many ana pnofuse that the sixty-course dinner was not enough for my honor; it shou~d have consisted of one hundred and twenty. At seven o'clock we were seated at a round table, each with a little bowl before him. In the center of the table was a large 3 17


AN AMERICAN DOCTOR'S ODYSSEY bowl from which the guest of honoF first sel"'Vec;! himseLf with chot>sticks; atteF that a geneFal sClramble took place. lEach diner I'etainec;i his own bow[, rout the ~enter one Ghanged as ~OUFse foiloweGl GOUFSe in amazing suc~ession-sha~ks' fins, birds' nest soup, unrecognizalJ1e foods which, nevertheless, hac;! a delioious flavor. The ordering of such a formal Chinese dinner was a fine art; two c;!ays might be devoted to planning the appFopriate c;!ishes anc;! their fitting sequence. After two hours, even though my portions had been small, I be~ to feel that [ hac;! had enough:, but by ten 0'el06K ] had C;!igestecd dIe first courses am;I hatd gained my second wind; it seemea to make no <!Iifference thereafter how mUGh more I ate. The meal reached a high point when we wel'e servecl eggs, blaek with age, buried for three hundre<!l years. They were not so unpleasant as might be assumed, but tasted rather like pOOl' quality cold storage eggs. The Chinese esteemetd them as one of theiF greatest clli1icaGies, ana d lerishetd them fOF their anti!!juity. ~ â&#x201A;ŹOnsitderea this merely part of their aneestor worship. The Westerner at a Chinese table cannot identify much of what he is eating, but the initiate kiiows the dinner fS neacing an end wflen the Fice antd tea appear. The fruit course is never servetd at the main table; the ne~essity fOF shifting to a sicle one whene it is displayetd pFovi(l/es an op>poFtunity to change pa~tneFs . Watermelon seeds, whieh are eaten before, dUFing, and afteF the dinner, are much prizetd. My hosts woulcl skiliHully extract the kernels with their teeth, but I found it took practice. Chinese wines of varying flavors are tFeely served; I found Suehow most to my taste. Glasses are eonstancly Fep>lenishetd antd tongues aFe loosened at these bright am;i charming Qhinese f,unetions. '!fhe Jap>anese affairs often Gompare with them in length but not in sprightliness ot ~onversation. Most Chinese foods are pleasant. But oCGasional exceptions are ~ound. At a dinner given me in Hangchow the piece de resistance was many-leggetd, live bugs several inches long and resembling roaches in color. ]'Ihese were served in a bowl GOveI'e<il with a glass bel!!. It is bad form not to a~Gept a helJlling, no matter now sma~l, of everything offered. 1 was supposed to lift the ~ov:er quielcly, graD the WAggling animal with my chopstll,eks, pop it into my mouth, ancil Clrush 3 18


MUCH HAVE

r

TRAVELED

it IDefore·· it coula start to <w.lwl. i[ founa that ill neeaed GonsideraMe courage to ~ite this unfortunate insect, and, since I was a novice at the practice, it would invariably begin to squirm around my mouth before I Goulld administer the quietus. i[ have eatenlai!l sorts of fooa in al!l sorts of places. It has always astonished me that Americans and Europeans in the tropics spend much money importing fruits when they are surrounded by all varieties of deli€ious native species; on a short trip through Central America I once encounterea fourteen fmits di,fferent from those in the United States. For some reason or other when I first went to the Philippines I had never heard of the mango. The Rohilla Maru had landed me in Manila, about six in the morning, and I reached the hotel in time for eight o'clock IDreakfast. My taIDle was located near that of an Ameri€an woman who had orderea a strange-looking fruit of a rich yellow color. I was avid for new experiences and wished to make myself at home in this new country. "I'd like to have one of those," I said to the waiter. Not wishing to appear ignorant, I watched how the lady handled hers. She tilted it on end, with a dexterous stroke cut down the two sides, and then ate each of these with a spoon. It looked very simple. I ti1ted back my mango siIhilarly, and started to cut. But when it dia not slice with the ease of hers, I exerted force. The juice exuded and spurted over· my arms and on to the tablecloth. When I had hacked it open, I set to wo~k with my spoon, but again the juice would not stay in the fruit; a geyser spouted up to my chin. [ wondered uneasily how many JileoJil1e were watching my exhibitic;>n. Stealing another look at the lady, I observed her take the four-inch kidney-shaped seed, insert her fork into it, and eat it delicately with absolute unconcern. I adopted the same nonchalance. I pressed my for.k against the seed as ~ haa seen her do; it would not go in. I pressed harder, but· to no avail. The breakfasters began to nudge one another, and I was conscious of eyes focused upon me. In desperation I tried again. The more pressure I exerted, the less successful I seemeid. The veins of my neek IDeGame turgid and my face cyanoti€. By now the whole dining rooin was watching me. I was determined to su€ceed. With a final terrific thrust the fork slipped and the large

31 9


AN AMERlCCAN DOC'iJi'GR'S ODYSSEY flat stone sh0t the length of the l0ng aining Foom, hit the oP!!!l0site wa:!l with a crash, and fell to the fl00r with a loud thud. A r0ar of laughter went Up! from my delightecl auclience. I was shortly set right as to what I should have done. My fiFst mistake had been that I hacl not eut from the stem encl, and consequently had bleen working against the grain. I had made the same eFror in eating the f.ruit, aJso s!!looning it against the gFain. ~inano/, when il had essayecl the seecl, Jj haa n0t known. that I shoulG! haiVe insevted the fovk, 0ne p!F0ng at a time, into the s0ft plaGes bletwtlen the ridges. Even w.ith the blest 0f care mango eating is a!!lt to ble mtlssy. The juice makes an irFem0vabie stain w.hich in a m0ment 1;Urns blacK:; in mango season hard1y a whittl napkin can be found in the Islands. It was always pOp!ularly saicl that the pr0per way to enjoy the fwit was to relax in the bathtub. AfteF my not too brilliant fust performance r set to work to master the fine art of mango eating ancl this eventuated in securing me many dinner invitations at Malacafian. Whenever any Governor General had clistinguished ¥isitors Wh0 haa never eaten mang0s, r rceGeivea a summons. Sinee it w0ulcl haiVe been indelicate £0r him to give cl:ireeti0ns '0n how to hand~e the £Fuif, he would intF0cluce me as ~li.e IDi!le0t0r of Wealfth, w,h0 w0u!lcl e~0ulHil the p!Fop!er methocl of eating mangos hygieniea1'Iy. ]j beeame Philipp,ines instruGter in the teehnique of mango eating. A very str3!nge tl;;uit is the durian, whi0h grows on a large tree ancl is larger than the lar.gest 0range. It is protected by spines ana filled with seeds which wn black: as it ripens. I once tried to eat 0ne. I held my nose and found it n0t so bad as I had fear.ed. A traveltlr, who more than haLf it century age wrote a bIDok on the Malay AFchipelago, describecl the saV0r of the durian as a "rich butterJlike custar-a, highly flavorecl with alm0ncls . . . but intenmingled with it €ome wafts of flavor that €a~r to miIid €Fearn eheese, 0ni0n sauce, bF0wn sherFY, anG! other inec;mgr.uities." [I; !!lossesses IDne 0f the m0st !!lenetrating anG! disagpeeable 0f a!Ii1 0([0rS in the wo"Id. 1& p01eGat 01' EmblUFgeF 0f the "ipest ¥intage are miM in e0lFlpaFis0n. On one oecasion ]j was tFaveling witl'i my chief assistant, Dr. Wi'!:bur A. Sawyer, now IDireet0r 0f the International Health Division, 0n

32 @


MUCH HAVB: I 'fRAVE'LE'D the train worn Bangkok to Penang. The tJ;ain had no diner, and we had, therefare, taken our luncheons in a hamper. About the middle af the day a Chinese, the only other occupant of the compartment, baught a ripe durian at a station and began his lunch by slicing it carefully in half. Bad as a durian is while yet unopened, it is infinitely worse when the rind is cut. We called a guard, told him we were absolutely overpowered, ana asked him to persuade our traveling €omparuan ta eat his durian on the platform. The Chinese gathered it up and abligingly departed. We unwrapped our ham sancdwiches and began to eat them shartly aliter our fellow-passenger had come back. We had scarcely bitten into them when he startecd to make gestures of repulsion, ·shook his head, and ejaculated, ''Whew! Whew! Whew!" as though he were overcome with disgust. Then he, too, called the guard to whom he spoke in Malay. The guard turned to us and asked whether we would mind stepping outside to eat our lunch. Since the Chinese had been so polite in acceding to our request, we felt we could do no less than return the favor. To a final "Whew!" we also left. When we had finished our innocent sandwiches and returned, the jocular Chinese loaked up at us with a big, broad grin on his face. I €annot imagine why, but nathing would satisfy Dr. Sawyer after ~his untiJ he Msa could secune a durian. Not finding any ripe enough far immediate consump~ion, he compromised on a green one. At Penang he packed it away in a wicker hamper which, with the rest of our baggage, was left in a storeroom of the hotel at Colombo while we made an inspection trip of the provinces of Ceylon. As we approached the hotel on our return, even a block away we were aware af a terrible odor. It grew stronger and stronger as we drew nearer. We were astonished to see the whole courtyard in an uproar. The hotel staff was opening doors, poking at the ground, searching vainly to find the source. It was as though a hundred rats had been dead for some weeks. When Dr. Sawyer ca!llecd for his baggage and the door of ~he stoFeraam was opened, the smell almost knocked us down. The durian, a fruit unknawn in Ceylan, had been ripening successfully in ~he hamper. '['he dauntless Dr. Sawyer was still determined to eat it. r said, "You certainly won't be allowed to open it around here, but if you 321


MIT!§OM HAVE !Ii TiRAVELED to unfinishee eetails in Rang00n. "'Pm awfuHy sorry," I said to the agent, "but I don't think I'll take that ticket after all." The train departed, but had proceeded only a hundred miles when it was w17ecked; over fifty persons were killed and several hundred w0unded. My three days were employed in helping to set bones and sew up w0unds. The fourth escape occurred at Bagdae. Mr. Charles R. Crane, the fOl'mer MinisteF to China, with whom I was traveling, urged me to aeG0mpany him in his motor car the next morning, but the exigencies o£ my itinerary caNed for my arrival at IDamascus at a certain time. We were b0th dinner guests of King Feisal, and as we parted at eleven o'clock I ann0unced my decision that I had to go by the more direct Foute. Mr. Crane left at six in the morning; at nine his automobile was ambushed by Arab tribesmen. The man sitting next to him on tht: back seat of the automobile was killed. I would almost surely have been that man. My first trip for the Rockdeller Foundation in 1'915 was in many respects the most interesting of them all. The War, so recently under way, complicatee almost :!Ill of our undertakings. But having set ourselves to the task, we coule not turn back, even though we had to mark time in some placflS and sUFmount unexpected obstacles in otheFS. Echoes of the maude could be heard in many countries of the East. At this time the British had their hands fu1l not only with their avowed enemies the Germans, but also with native unrest. When I arrivee at Singapore, the recent mutiny of the Fifth Light Infantry, an Indian regiment some seven hundred strong, was still the allabsorbing topic of conversation. Nobody knew the exact cause of the outol'eak, but the mutineers had killed Britishers wherever they could find them, thirty-seven in all. They had then gone to a camp where thFee hundred Germans were interned and, after driving off or killing the guards, had invitea the Germans to come out and lead them. This offer had been rerused. Singapone had been entirely unprepared for the outbreak, and pandem0nium ~esulted. The small British gunboat Cadmus landed sev.enty-five men, and these, with a few hundred Singapore volunteers, met the largest gr0ups of mutineers and dispersed them. Four hundree gave themselves up within forty-eight hours, and saii:i they 32 3


AN AMERICAN IDQC1!OR'S ODYSSEY ha€l been fOFced to join the mutiny by their eomrades, but had n~ver fired a shot. Two thousand t~rFitoriwls shertly arrived, a Japanese gunboat landed seme marines, and the man hunt was en. At first, the mutineers were shot on sight, but many escaped and hid in neaDby swamps, where th~y were not foun€l for sev~ral weeks. As soen as they were caught they w~re tri~d by military court martial and many, as examples, weFe cendemned te b~ shet. !Ii attende€l the impuessive tunGtien, Mavoh 25, when twenty<tWe et them weRe execut~d oeferr~ a €uew€l of ten theusand, mest1y MaJay an€l Chinese. ()\:ltsi€le the grey, moss-grown waNs of the pllisen till~ white velunteeFs formed an ewen squar~. '['e the beating of drums and the blowing of trump~ts, th~ pFisen €loors were flung op~n, ami a seGtion of turbaned Sik:hs em~rge€l w.i th the prisoneFs. EaGh of the twenty-~wo marche€l stea€l,fastly, without a sign of tear, te a post of woe€l, cquite new, which 'ha€l been €!riven into the turf. Each cam~ to attention while being tied, and, with ~yes unbandage€l, stoical1y fa€~d th~ squaFe. The ofliGer in charge read in clear tones the findings of the Gourrt maDtial. Th~ khahdad territorials IaGed the Gond~mn~m men. "!l"Fesent"-a pause, "'FiF~!"-and a sharp crash. Th~ t~rr·i­ toria~s weve wi:l!l.ing but their maroksmanship was not pevfeot. All the nmt;ineers were net dea€l, an<d t;he efliGeFS of the fiFing squa€l had te cileswatGh these s~i'br living w,i th hn3il ou!lilets. ] watohe€l for an expression ef hat;r~€l, or pity, er herr'Fer, en the £aces of the multitude. No ~metien whatsoevev was displayed-nothing out stelid indiffeFenGe.

Berne by human, animal, an€l maohine power, on sea, en land, an€l in the air, ]j have t;ra·v eled over the globe. Almost everywhere in the East human muscle is the most important facter in transporta~on. Rickshaws are omnipresent, pirlled by one man en level greund with ama:oing spee€l an€l endurance. But in the meuntains of Imiiw, wnerre the grades ave steep, riekshaws aLe manne€l by twe, feuF, and even six F,unner.s. At the base eli each hill!1 in die uwlan€ls of ifapan wusheFs wait an€l, at the Fiekshaw's aWWFoaeh, mash out to assist their Fe.ltJ'ow Goe'lies up the hil!l, an€l t.hen, wit.h theirr coppers, rrettiFn to r.esume their flatient waiting.


MUCH HAVE I TRAVELED Often wheFe trails forbacle wheeled vehicles, I have reclined in litters eaFFiea by four bearers. lin China I ha¡ve been lifted in sedan c!lairs, ancdi a!1so Immpea in wheelbalTows w.ith huge wheels whieh have benches ai(mg each side where four or more passengers sit back to baek and have little places for their feet. One coolie trundles this enormous load, the wooden axle groaning and howling with each revolution of the wheel. The excellence of a wheelbarrow is judged by the chaFacter and volume of its squeak; no luck will attend the aourney on a squeakless one. ]n some fllaces I have been carried ashore from boats, my legs aangling around the neck of a porter half my size who somehow staggered through the shallow water under what must have been an almost overwhelming weight, invariably landing me dryshod. I have embarked on every imaginable type of water craft-hand propehled houseboats, lighters, barges; canoes on Canadian rapids, flunts on the "Fhames, gondolas in Venice, sampans on the Yangtzekiang; in the Philippines unstable ban cas and enormous cascos holding fifty tons; on the Nile, qahabeahs, aided by soft winds against their toweFing sails; in the vale ~f Kashmir, luxurious, awninged boats, made comfortable with: cushions of gay colors, drifting down the ff'helum towaFd the Indus, past ~ne towering peaks of the Himalayan wondedana; saiiing vesse~s of every description_schooners, junks, praos, and swift,' two-masted lorchas, which used to speed from Iloilo to Negros with such celerity that only a good steamer could keep up with them; greyhound liners, battleships, private yaohts, coastwise steamers, tug boats, and wheezy launches in which I would sit by the _hour waiting for the engine to be started. ~n land 1 have driven behind six-mule teams and the horses of Egypt, of purest Arab stock, racing the twelve miles from Cairo to the Pyramids in an hour. I have ridden in the gharry of India, and the four-wheeled carriage of Singapore; calesins, carromatas, calesas, carretelas, and carts of the Philippines; buckboards, droshkies, sleighs, and sledges. Perhaps the most amusing animal-drawn vehicle was the two-wheelea saau of Java, sometimes pulled by a horse so sm~ll that, reversing the role of passenger and burden bearer, I have stuck my head between his front legs ana carried him. On one occasion, when the horse .apparently saw the house in which he had been born and started

32 5


CHAPTER 19.

W

SNAKES IN EDEN

HEN the British in 1795 added Ceylon to their Empire, they be~ame overlords of a country with a storied past but no ap· parent future. The massive ruins of Anuradhapura, once a city cover· ing two hundred and fifty square miles, was no more than a shrine for pilgrims, who came to gaze with reverence upon the sacred Bo tree, gFewn from a slip of that under which Buddha himself had sat at Benares. !It had survived two millcmnia, and bade fair to continue for severaol more. The island, which had known the yoke of Hindustan, !Pertugal, and the Netherl:mds, retained only vestiges of its ancient Fiches~few divers descended to the famous pearl fisheries, the gold mines were abandoned, the peeple had grown weary, and grubbed liiut listlessly for topaz, sapphire, and ruby, the palaces were tumbled down, and the jungle had crowded into the groves of cinnamon and ~raamom; it was said the British had conquered no more than an Clmpty shell. But, once again, after many vicissitudes, the Fragrant Isle has bloomed. Although net many decades ago the coffee trees on the great plantations were destroyed by blight, and the cinchona industry was lost to Java, -in place of these, pungent tea shrubs now flourish lmruriantly on every mountain side, and latex flows from the rubber trees and have bFought new prbsperity. In the lowlands the fronds ef the useful cecoanut shade breaa reads, and add to the country's Fiches. Because of its economic prosperity, Ceylon was looked upon in the East as a prize colony, although many serpents flourished in ti).is Gar· 32 7


SNAKES IN EIDEN caste edemaneds. Miinedus, fer examp>ie, lose caste whenever they leave their ceunm-y and travel over water. This ceuld be restored by religious 'ceremenies at the temples of Dhanushkodi or Rameswaram w.hen they returned fr.om Ceylon. Be<illiuse the Tamills had a superstitious fear ef light, no wimiows were I\u.ilt inte the barrack-like "lines" in which they lived on the plantations. Each family had two rooms; in one they slept, and in the other cookeed on the floor. Smoke and dirt were everywhere. More insanitary than aU else was the indisoriminate soil pollution. This was a gFeater health hazard to the Tamil than to many other peoples beClause his skin was as thin as that of the white man, and hookworms could penetFate it easily. The planters haed leng before made up their minds they would aHow no interferenGe from the local health authorities. They would neither giÂĽe nor receive aid in dealing with the hookworm situation, beGause they were convinced the intrusion of sanitarians would hurt businruis. I was well aware that Lored Crewe, when at the India Office, nad thueateneed to step their labor sup>ply unless they took active steps to edeal with the hookworm situation; they had then made evasive but piausible answers, and things had gone on as before. 'Fhe resistance ef the planters haa to be overcome, but our policy demanded also that we conduct eur work under the official auspices of the Health Service: Consequently, my first step on landing at Colombo was to call upon the incoming head of the department, Dr. G. J. iRlutherford. AFter the amenities had been complied with, we began ediscussing the new venture in heahh launched by the Rockefeller Foundation and what it purposed to do. ''What's the present hookworm situation in Ceylon?" I asked. "It's frightful," he promptly admitteed. ''Why shoulc!l that be? You have laws enough to cover any action you might take, haven't you?" "Yes, we have, but the tea planting interests are all-powerful, and they aFe opposed to taking adequate measures against hookworm. We issue a Fegulation-they get it suspended. We're helpless." "WeuJed you have any objection to a survey made under the ausp>ices of the Reckefeller Foundation-supposing it could be arranged with the planters?"


:AN AMERJiCiAN TIl©e'T1C>R'$ @iI1l¥£SE¥ "N0t ie~."

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net. Let's ta.ilK ablout tnis as a hlusiness p Foposi~ien. How mUGh does it eost yeu te hlring a [abeFe, hene from Mamras!" "What's a cemm,eFeial secret." "] &on't Gare ahleut your exaet figure. it'm not III business. But moes it eest yeu a hunmrem !1upees!" "AlIII of that." "Mew many laberers do yeu have te impo~t!" "Aleeut a hund~em tlleusancd a year." ""Jj'J:iat Funs into quite 3) sum of money, doesn't it! Now, on every estate yeu have a hespitaL It may be large er smal1l, but it is consta,ntly eecupieGi. Dectors a,nd nurses alone must cost you a let. And am !Ii eeFFeet in assuming that you haNe to pay your laeereFs whether OF net they aFe working!" "'(es." "$uppese we coullli Feeuee tile hespita!1 expense by half." "1i1llat wouM eerta,in[y save us a great meal." "Welle's anether impeFta,nt point te be considered. The Tamil W01'!}en tenm te be steri[e hleeause of anemia from hookworm. If they eeui<il pFeduee chilch,en, you weuldn't have te ering ever fresh labor ill! the time. You eeuilli Fa~se yew ewn. Wouldn't that be advantageeus in the fong nun!" " !lit wou'M inerease our prefits tremendously-that goe5 without saying." "$0 htlrulth and the planting eusiness have something in cemmell alitier alii Now, there's a way to test out these arguments I've been giving you. Suppese yeu wertl to pick eut some estates employing sevtlFal tilieusan<illaDeFers anm ailow the Rockefdler F ounedation to bring in tllOperts te edtlmenstrate whether we eeuld cure them without, having thtlm run away. Yeu'd oe the juedge of our suecess." "':Ii eden't stle how that eould edo us any harm. But we weuldn't want our ewn Health Dej;>aFtment ~encerneGi in any way. They're aU tangltled up in Feed tape, aned we.uM only make a lot of trouble. Yeu'd nave te leave tl1em out of it." ''It'm a¡f,raid we ceuldn't ed'o ~hat. If you don't like your present Wtlal]:th iDepal1tment, it's your pr.iviiege to recommend a change. But \'le Gannet go anywhene at thtl request of a commercial orrganization

3.F


SNAKES IN EDEN cious tapeworm, and had a ninety-one percent efficiency against hookworm as compared with thymol's eighty-three. Carbon tetrachloride, tetrachlorethelene, and hexylresorcinol are being used now. €Jur first action in the Ceylon campaign was to treat thoroughly a small number of estates for hookworm. The results were amazing. Wospital attendance and charges dropped immediately, and the geneFal death rate was slilliln greatly reduced. Whereas before the camr.aign large nummers of cOlillies failed to replilrt for work, afterwards bae lablilF turnover was reduced. The treatment was rapidl y extended to Iiltner estates, and in 1912.1 tWIil hundred thousand coolies were being £r.eea of wo~ms. A£ter demonstrating what we could do in the way of cure, it was time to start education in preventive measures against hookworm. The cOlillie lines in 1915 were not equipped with latrines. Every planter believed it futile to build any because he was convinced the Tamils couid never be induced to use them. But by this time we had proved the economic value of our methods so completely that we could lay Glilwn conditions. We notified the plantation owners that we would dlil no mOFe work on the estates until they had installed them. Accordingly, the planters erected latrines and we helped to instruct ~he cOlillies in their use. An effective method of enforcing compliance was tlil fine 'a cOlillie a few cents for each .dereliction. We had not been instilling lat~ines for many years before a Tamil who was preparing tlil sign on again would ask wnether the particular plantation to which it was proposed to send him was equipped with ·them. Districts now vary fFom thirty to ninety percent in installation, and their use has become an accepted part of the customs of the people. In time the number of Tamils imported from India was reduced, because the working fOI:ce on the plantations was not so depleted by sickness and death, and the women, having recovered from their anemia, began to bear children. In the end the planting interests coopeFated whole-heartedly and themselves went through many a struggle on behalf of sanitation. A£teF we had demonstFated under controlled conditions on the estates that hookworm could be both cured and prevented, the campaign was extended to the villages, a far more difficult undertaking.

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SNAKES IN EDEN BUllhdliistoS t.he de\!;tors. i]j wou1cl see a 0rowd gathered in the street; one man would point to a shop and aU, with a ~oncerted rush, would aive into it. Three minutes ana the place would be gutted, ana not a trace of "accounts aue" would be left. Dr. Rutherford told me one aunaFea and fifty injured were brought into the hospital during O)1e night. This was by no means the end of the disturbance, although a Colombo paper soothingly stated that everything was "practically quiet in Kandy except a few assaults and murders." Final'ly British territorial troops restored peace. 'I1he Mohammedans, in retaliation, started many lawsuits for damages, which were upheld by the courts .. Bitter resentment was felt against the government by the Sinhalese, some of whom are still paying ~osts. Our work was going on in Ceylon when the Donoughmore Commission's recommendation for self-government went into effect. This movement was synchronous with the ~ising tide of Indian national feeling. An attempt haa been maae in Ceylon to safeguard the rights of minorities, but the Sinhalese, who were in the majority, tended to aisregal'd the claims of Tamils and Burghers to hold office, even though they had been born in the country. Under British control many Burghers had been taken into the Civil Service, but now their advancement was threatened by the Sinhalese. The political situation in Ceylon was typical of that encountered elsewhere in the East. Petty politics, unwarran~ed attacks launched fuy amfuitious office seekel's, vague pl'omises never fulfilled, evasions ana pnocrastinations, publie announcements conveniently forgotten, were everyday happenings. Politics had to be considered at every turn. There often seemed to be no chance whatsoever of getting action on oUl'many plans and projects. Our repFesent.atives sometimes bec<)me S0 clow:n-hearted that they recommended withdrawing until things sh0uld settle down. But in spite of individual disco~agement, the Rockefeller Foundation perseverea in its attempt to make Ceylon a modern health ~0mmunity. Experience proved that the best way to popularize a movement so foreign ta the customs of the people as hookworm prevention was to prosecute it as though it were the only thing in the universe 335 \ \ \


AN AMERICAN IDOCTOR'S ODYSSEY le.£t u.ll(;lene. 'iJiihe history 0£ the @ev.i0us life ancl habits 0f this wi!1y worm had to be bl1'0ught heme to every resi@ent ef Ceylen. Te prepare the way, lanteFn sli@e lectures were given and puMie exhibitions aF,!'ange@, showing the parasite an@ its eggs under the miGFoscepe. W0 make the @emenstratiens mere GeJ;1v,incing the Vlmagers were aJ[owed to take part. 'They weFe first aske@ to SC00P up meist eaxmh, and put it in a glass funnel. Wate!' was poure@ .through this and they ceuld wateh with their. ewn eyes the larvae being washed 0ut 0£ @irt they ha<d watl!:edl ever mai~y. People universal1y seemea to show more interest in the biol0giGa! proMem invelved than in the I'avages caustld by the disease. '['he aim was to make even the mest ba€kward members of the wmmunity thel<eughly famil'ia,r with the bieiegy ef h0ekwerm, thus mreating better unaersta,nding 0£ the me~h0tds ~OF its centl'ol. A small dispens.ary was ofttln opened in the house of the Htlaaman of the town, who was instructed to peFsuatdtl the villagers to apply feF tFeatment. When th€l¥ shewed Fei1:1Gtanee, the simple aevice was a<'l0ptem of treating everyone £er neekwerm whe appliea at tne hospital er dispensary, even though his Gomplaint might be as far afield as a broken leg or a toothaohe. The number treatetd in this way Fose te over a mi]lien a year. Heokwel'm Fe[,ief was suppiementetd oy the estaMishment e£ Hea,lth Units throughout Ce¥lon, which assumed resp0nslblility fer all wenk in a particular district. They Wtlre staffed by a doater, a numbler ef plUMiG health nUFses, mitdw:i:ves, antd sanitary inspectoFS. When ne epidemiG ~eomecd iIll the effing, these nurses always clireGtea their attention towa,r@ maternity and blaby welfare werk, because the problems of both are Gonstant and serve as the best avenues o£ appreach to gener.al tlduGatien in health meaSUFes. 1Dhese Wealth Units a1@ net blossem f0I,th overnight. They met oppositien fFom aN classes and reiigi0ns. A dector w0uld approaGh the Mehammedan Ghief of a vitl1age with a list of questiens. "What's Y0ur aeath rate?" he would begin. "!lit is t,he wil)jJl eE Milah that aM m,ie; S0me mie ¥elil1g, some eM." ''What's your numbler 0f births?" "Allah alone can say." "Is yeur wateF sa,fe ami petable?" 33 6


":W~st@1'o/ Fec@r,61s n@ 61eath EFom thirst." "What is the :niYg,ieni€ €ofl(;Ilti@n @f ¥@ur vil1lage?''' "Alilah sent M alhomet wh@ Fr@ved the tmth with fire ana sword. !N@w, iILamb @f the West, cease your lijuestioning. It can do you OF @tineFs no g@od." !Eo train d0ct0Fs to eope with these and alil other possible situations ;whieh might aFise, better instruction had to Be provided in !!l!e Mea'ieal Sch@01. This pFesented a maj@r problem. The Sinhalese Iii.e~ievecl ~heir sehool to be @ne of the Best in existenGe, and support feF any r.adiea1 change was alm@st impossiMe to obtain. Practicalily aim the instFuction was by lecturers 0f the old didactic type. Criti0ism on the gener-al hek of interest and the inefficiency sh0wn by tihe d@ct@rs in the h@spitalls always Br@ught the triumphant rejoinder tnat they had Gjualifiea Before the British Generad Medical Council with flying €@leFs. 'Fh0ugh I might be c@nvinced .that bot/! diagnosis ana treatment were 0ften inceFFect, I could make no answer. When the Sinhallese gained political control, they insisted on having the teaGhing 0f the ancient Hindu system of Ayurvedic medicine SUWW0Fted By ~he g0vernrnent. As the pFp tagonists of modern science, we nad to disc0urage a methocl by whidi a practitioner, en route to a patient's Bec;lside., wouic;l detel1mine the treatment he was going to FFescFibe b¥ the numBeF of Buttons on the coat 0f the first man he met. [in the Fenaissance 0f Lnaian nationalism, Ayurvedic m~dicine had naturalhlr been stressec;l, and many schools had been started all ever :Lnaia. IUne 0f the largest of t·hese was at Benares. When I was taken @n tihe usual tour of inspection, the Bresident, a Hindu, solemnly aisWiayed the m@st ridicul@us things. A£ter he had finished I said, " iii tFust y@u w@n't eonsider me nuc;le, But hew can you betieve in what you have Been sh0wiJilg me this aftern0on?" " Y;0U never get very far or go very fast by attacking an estaB- !J;ishelil instituti@n eir,eGt," the Brahmin repliec;l. "You have notiGed that ti}f the side @f G0UFSes in kyurvedie we have installed others in anatemy., histoI0g¥, and chemistry. Wherever possible, we enGOurage 0ur stueents te take nhese ceuFses. '[hose who d0 so aile intelligent en0ugh to see the absurc;lities in kyurvedic, and wilil discard them OD tneir @wn velition. iBut if I wene to challenge the Ayurvedic system

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AN AMERICAN 'DOCTOR'S ODYSSEY itself, [ W0U!a not get the meney 1 neea f01' the sGheol, and the litrle we have gainea would be lest." ~his answer impnessea me as IDeing seuncd in its psyc;h01ogy, ami seemea to 0ffel' hepe that the time would eeme wilen we woula n0t have to c0ntena with this par-ticulaF obstacle. Because the daims ef this extraordinary mater-ia meaica weFe put forwax:d by such leaaers as Ganahi, wno degmatical!ly asserted medeFn meaicine was sorcery, i1ihe g0vemment 0f India, unaer C0lonel Ohopml! 0I tae [.naian Meaicro~ ServiGe, has spent theusands 0'£ cl01laFs in the endeav0r to aetermine whether it pessessed any tiling 0£ value. S0 fal' the Fesults have been meagre. [t is tr;ue that certain Ayurvedie arugs were founa to have proper-ties with whieh we wer-e net familial'. But we haa aeveloped drugs fOF the same purpose which were far m0ne efliGaoieus. F0r example, Ayurveaic beastea abeut its llrunchi a owe f01' aysentery, out Garoasene is se far superi0F as to IDe !beyenGIJ €ompa,risen. 11he maFGll ef medierol pF0gFess in the !l!ast for a time iWas retardea by the poet-philosopheF, Rabinaranath Tagore. He had arrivea at Peiping on his way thnough the Orient, adaressing nuge audiences everywhere and advecating a return l1:e Eastern idealism instead 0f foNewing Western materia,1ism. This was ;vir;tual!ly an attaek en meaern seience. Beeause he was !being haillecd !by aM the aa"j{skinnea races as an example 0f an Eastern intel!lect ackn0wle<ilgecl by the West as of equal calioFe, his wOFds caFFiea great weight ana were extremely detrimental to the oIDjectives ef scientific meaiGine. I might very likely fail, but r thought r coula a0 no [ess than try to diveFt the tFena of his lectures. Such vast numIDeFs ef admir-eFs wer-e IDesieging !Fagore's <ilua,rteFs tllat I haa g!'eat aiRkulty in seGUFing an interview, IDut finaMiY was usherea into his presenee. He lookea like a patFiarch, with his beautiful, long, white hair and flowing beard, and he eharmed me with his seft, peFsuasive v0ice and aelight£ul manner. We talkea £01' a leng, long while ef this anI!! 0f that. Me elaIDeratea his t:heel"\Y that nebhing peFmanent eF wer-ta wlli~e in health €eu:ll!! IDe a€€Omp~ishec!l unless the spirituai anI!! huma,n inter-est e£ the masses weFe fiFst wen. He apparently was impressed by my obsel'vati0n that <disease had made it largely impossible f0r ]ndians to smile, ana agFeed thor-

as

338


SNAKE$ IN EDEN eughIy with my stand that no government or private organization Gould give health; people had to achieve it by their own efforts. Tagere was of the opinion that the Indian Medical Service had failed because it had not established itself in the hearts of the people, and intimated that if the Rockefeller Foundation were to work diFectl.y thFough him its results might be very much better. I answeFed that, though we required the formality of government coeperation, we used our own judgment and oUF own methods in estahiishing ourselves in the hearts of the people, very much as he advornted. Tagore's suspicions of us as allies of the government he so mistrusted were al1ayed, and he was persuaded that we had the same end in view as himself. But he was convinced that the only right way to go about attaining it was through the system of ancient India which he was so stoutly Fecommending. This remark gave me the opportunity for which I had been looking. "You've had a Western education," I said, "but you're decrying everything Western science has contributed to the world. Yet the mere fact you are here is a testimonial to its accomplishments. The steamship which carried you GOuld never have been produced by the eid Gulture which you uphoM." "iL ceuld have come everland." "Not in your Gondition of bea[th," I replied. "You couldn't have Geme at aM. But I'm mest interested in what you have to say about Mindu materia medica. You claim it has much value. But you don't mow, and the only way of testing its merit is in the modern resear0h laboratory, the greatest institution for truth that man has ever evolved. It is absolutely impartial, its findings are not colored, it is simply seeking the truth. A lot of the remedies which you suggest as effective have been scientifically proved of no value. I think you yourself would be satisfied if you followed the steps in the laboratory that have been taken to arrive at this conclusion. Before you say anything more, would you go and see in this city of Peiping one:: ef the finest laboratories in eJcistencel" The philosopher agreed to ge, and I maae arrangements for his FeGeptien at the Meaical Cellege. This was eur only conversation en the subject, and [ had no oppoFtunity to find out when I ~w him later whether his visit had converted him to my way of thinking.

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AN AMlERIGAN E>©G1'OR'$ OD¥SSEY But I followed his aeddFesses atfei'u11y, and never again to my Knowledge did he speak against Western medicine. Obstacles aned ediscouragements weFe of aJmost daily eccurren€e in Cey,lon, but in spite of them OUF effor.ts were eventual1y successful. With the assistance of the Reckefeller Foundation, Ceylon now has ene of the most moedem health services ef any country ef similaF pepulation in the werld. GUF funGtion was te hasten this aec0mplishment fuy sever.all edecades. €:eylen was 1lhe fuest iMustMtieJl tihat €0ullhl be teumd ef what MF. RocKe£el!!er. had meant w.hen ne siliGi., "ffi'hiJanthF0py must Wily edividentils." Both born the eC0nern1C an~ the humanitarian stanedpoint, benefits accrued faF meyontil our expectations. :Not oruly was tIle health of the population impF0vel!! and its happiness increasea thereby, but this very impFevement in health proeduced weaJth in increasing proportiens. The fitty thousand edellars we spent to wiGien the circle still further, over the yeaFs bnlUght abeut governmentaJ appropriations for health of at least five mi\lli0ns. [mpertant as it was te cempfete the hoekworm edemenstration in Ceylen, the eventual goa~ was te make such demenstratiens unnecesSilFY fuy traoking heek;w:oFm to its place ef origin ami eral!!icating it. i1it weu[ed IDe useless to w.iWe eut t he Gi,isease in «:e¥~en i,t Fefnfe@tien wene censtantly te Feour £rem the sour.ce ef lamor suppl¥. "'Ii'e ll'er,suatile the autheFities et ~nedia e£ the shoG~ingly high Tamil heekwerm infectien was the fiFst step in the ~0ng maFch towartW stamll'ing heekwer.m out of MadFas, which was a radiating center of infectien, senl!!ing Tamils th0usancds of miles westward acress the world to Trinidad and British Guiana, southward into Malaya anG! the lower tip ef Africa, ana eastward to Burma and the South Seas. As seon as prepar-atiens for. the survey in Ceylon hal!! been maede, I had set eff fer [ndia. Whatever elatien I may have t elt over tihe successful outeeme was dampened oy having to stant the same ~abe­ l'ious Itounci ever. again. 1Fhe· pFov;inciail HeaJ[th Service et Macdms disdaimeed am auther.ity. in ~ ceuntry which hal!! an aveFage e£ 0ne h,medFel!! and ninety-fi:v:e wersens Eving on each scquaFe mNe, the iGiea t·hat heekweFm was centrelJlafule iWas ·I!!enigroatel!!. ~ t was the ell!! Q!'}' ef the impessiDle gom,; it ceuled net fue done. Af.ter. inter.v;iewing men heFe and there- at Calcutta, !!Delhi, anI!! Simla- trading health ideas 340


SNAK!ES IN !EDEN as I went aIlong, I found, surprisingly enough, that the source of authority was the man at the top, Sir Charles Pardey Lukis, Director General of the Indian Medical Service. [ called immediately upon Sir Pardey at Simla. He was an intelligent and pleasant gentleman, but skeptical of the hookworm figures with which I presented him. He could not believe that our estimates filt filver seventy percent infestation could be correct, but assured me he was open-minded and willing to be convinced. He intimated, however, that it was out of the question for anything to be started in war time. [ retfilrted with a descriptifiln filf British colonies in which health Vlfil~k was going on in spite of the War, and described enthusiastically fhe impressifiln I had received that the British government was very pFoud of those officials who could keep things moving in a normal manner, and even undertake new things during war time. The next day I went into the matter with Major F. Norman White, the Assistant Director General, sounding him cautiously on the prospects. He also was affable, but less easy to convince. He said he feaFed the government would decide to postpone any such unaertaking as a hookworm survey until after -the War because the Indians might take advantage of war conditions to start an uprising. Any innovation might have an uniooked-for effect, however innocent filF phillanthropic its rea~ filbjeets might be. Majfilr White attempted tfil discourage me further by saying it was inconceivable that an American doctor, new to the infinite compiexities of Indian psychology, could make any ,headway when the iEndian Medical Service doctors, with years of experience behind the!ll, had such great difficulty. I suggested that many of the things which appeared theoretically hard often proved simple in actual practice, and we believed the best plan was to proceed cautiously with test demonstrations, working out the procedure as we went along. Any man we sent could be relied upon for tact, and with Major White as guide might achieve success. '[ Feturned later to the attack on Sir PaFdey, and we spent several evenings tallking until midnight. At the end of these conferenees Ile asl!:ed me to sulDmit a letter with our proposals. I did as he asked, but, lDeeause the chiefs of the Indian Medical Service did not believe fhe heekworm situation could be as serious as I had represented 34- 1


AN AMERICAN DOCTOR'S ODYSSEY it, they decided te have their own men verify my estimates. Since almest all their regular members had been absorbed in the War, Sir Pardey selected to make the investigation a native docter, MhasImr, and a Catholic priest, Father Caius, the latter a cempetent chemist who had already been worlcing in his laboFatory on varieus remeclies fOF hookworm. "the two investigators reported a ninety-seven petcent infeotion, a figUFe far higher than ours. 1i1he lnclian MediCll!l SelTViGe was horr.ified ever ~he enermity ef the problem, but tl!e War teoK se mU0h ef its atten1iien that several years eiapsed befeFe we wer.e eai.l!led uJllen fer any further par.t in [nclian health a·fIiaiFs. Meanw'J:!ite, reseaFGh weFk on heGkwerm was proGeecling in many quarters ef the worlcl. lOr. Norman StoN, with Dr.JJohn GFant, who hacl been studying the disease in China, evolved a method for cletermining the severity of infeetion. By counting the number of eggs in one gram of feces, he could estimate the number of worms in the individual. Dr.. Wilson G. Smillie, working in Alabama and Tennessee, feund that the presenee of fifty hookworms or under micl not constitute a serious menaGe to health ancl Geulcl be disregaFded; many more were requir.ecil to preciluce anemia. :As 8een as the gevel'llment ef ]nrua was ~Fee ef its war ebligabiens, :lind haGt askecl the iReekefeller iFeunclation te GGejilerate, we tUFned this newty clis€eveFecli know'leage about l'ieeKwer.m te jilr,aeticail use in MadFas. :I:t had been estimateG! that the oost e£ a heekWOFm Gampaign aveFagecl abeut ene clellar per person. I'heFefel'e, it weulcil cost fi£ty miHion clol!laFS a year. in Madras :lIlone. We rucl not .have this money; neither alicl the ]nalian government. Even haa we had it anal treatecl the population, it weulal all have had to be done ever again the fellowing year. Obviously such an enormous problem would remain unsolved until some new method ef handling it ceu1cl be evel;ved. To begin with, we stationetil men at eaoh emigratien Gamp, and pleddingly examinee every 0utward-beund 1i':lImil for fiis alegFee ()£ infestation, indutiIing pletting llis fuioohplace en an enormeus diam. At the end of thFee years' p:llinstaking examina1iien, it was app:lltent tnat the emigFants with heaV}' infestatien Game £rem a few wciNdelineated distr.icts. ]f these foei eeulcl be deane~ ujil, it was probable that less heavi~r infeetea GenteFs woulcl eventually beceme tf.ee, 342


SNAKES iN EIDEN because hookwaFm tencded to disappear of itself. We checked our information by l00king up meteorological records of certain swampy aFea,s an~ fauna they ;were distinctly ~orrelated with the major hookwaFm infestati0ns. We then knew exactly where to direct our attack at a cost within the grounds of possibility. Since this section of India was disseminating uncinariasis throughout the tropical world, a tremenaous step taward its conquest will have been taken when it is stamped out of Madras.

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GMAlPTEiR

2®.

'JrRE WHITE MAN'S

LA$T ltiEiFUGlIE


TiE4lE WHI'ifE MAN'S LAS:r REFUGE When not a single ebject remained in the gaping bags, he turnecd away. "You £an ge," he said gruffly. ''Who's geing to put my things back in the bags?" I mildly inquined. "You are!" Before ] could think of a:n effective rejoinder, there was a loud honking from the street, and a brilliantly appareled offieer brightenecd the doorway. "Is this Dr. Heiser?" he inquired. "I'm the Gover-noF's aicde. His Excelllen€y has asked me to leok after you. Is your. iuggage ready?" ] waved my hand toward the wreckage. "The customs officer has been making an inspection." The aide turned te him sharply. "Dr. Heiser is a guest of the gevernment. Repack his bags immediately and if one thing is missing or cdirty, you'll hear. from His Excellency." We left a subdued inspector, meekly dusting, folding, and packing. On this visit I found Australia generally inclined to be inimical. ~n the first place the friendliness she had formerly evidenced to the United States had been metamorphosecd into hostility, and the resentment against Americans as such was strong because they alleged we were aveiding the risks ef war while reaping fhe financial benefits ef neutFality. llhe¥ tee\t: cdelight in annoying us whenever and wheFever pesslble. I, persenally, suffer.ed under the further handicap of being an emissary of the Rockefeller Foundation. Ev~n the august tutelage of the Governor General could net help me in that quarter. The odium and curiosity attached to the Rockefeller name was inevitably refleeted upon anyone associated with it. My life would have been a burden had I even had the Foundation address printed on my baggage. In those days offers of help frem the Feundation were looked upen with suspicion, particularly by the anti-capitalist Australians. 'iFlie StandaFcd Oil Company was in suoh bad repute that the health effieiais, relthough we had been £r.iends since the days when they had visited the Bhilippines, shied at the sight of me. Insteacd of Irecei'ling me in their offices, they would conduct interviews walkip.g 345


AN AMERICAN IDOC'fOR'S ODYSSEY up and down in the park, wheFe our conversations could not be overheard OF our assoeiation be so obvious. Any. FepFesentati,ve of the iRoekefelleFs was bouned to be looked at askance in a â&#x201A;Źountry which haed been pFo-laeor and anti-<apitaI From its very beginnings. Most Australian legislation hae been drawn up to the ene of fettering capital. In the eyes of Australians I was the agent of the arch capitalist. The eeep-seated hatree of large coEporations was enhanced by a lurking suspiGion that OUF work was in the natuFe of a sGheme to sup,eI>imp,ose AmeFiGa:n eGonomie contFol upon ingenuous foreign countF,ies. The influence exercised by lallor in Austl7alia was enormous. lEven when I had first gone there in [9II anybody could be arrested f0r working more than eight homs a eay, aned many papers had listecil vi0lators. New South Wales caFefully defined the minimum wage as ~llle which p,Fovieed foocil an@ aeequate shelter fOF a man, his wiife, and two ehiIcill'en, ane, in aedition : "fuel, clothes, boots, furniture, utensils, rates, life insurance, savings, aGcident or benefit societies, loss of employment, union pay, books and newspapers, train and tram fares, sewing-machine, mangle, sehool requisites, amusements and holidays, intoxicating liquors, tobacco, sidmess and death, d0mestic help, unusual Gontingenoies, Feligion, or <!haoity."

I was â&#x201A;Źonstantly running int0 other exampies. <'Jne of the most extravagant was in the Northern Territory. Originahly part of South Austra,lia, wlii.h saw it go with little reluctanee, this vast expanse of desert, inteFspersed here and there with grcaq;ing lane, has tUFne@ out to IDe a w.hite elep,hant to the iFeeera~ government. POFt 1i!>arwin, tne ehief .ity, seemee like one oE 0ur own WesteFn towns with its Fight-angled streets and one story buildings, its [aGk: of trees, ane the red soil which Fose in clouds of aust uneer the great heat. Even in this latitude of 0nly twelve aegrees south the air at night felt almost cFisp. The prospevity of the town had clepeneecl on a huge, rniJl1ion-ciohlar plant which the Vest!1f Meat w'0rks 0f London nad ere@tee theFe, @Fawing its eattle f.FOffi the big Fanges to the south. But labor, in the so-<~lee sl0w strike, had forgee a deaclly weawon 24 6


1FHE WMITE MAN'S LAST RBFUGE to satisfy its demands. The normal daily load carried by sixtyfive stevedoFes was three hundred tons. But when a ~hip cha~tered by the Vestry CorpoFation would come in to take on cargo, this would be reduced to fifty tons, thereby increasing the loading time sixfold. Since all vessels have demurrage clauses in their charters, if they aFe delayed in port too long, the profits are entirely consumed. The meat plant had to cl0se. ~lie laborers, who had thus done themselves out 0f the only existing a0DS, were S00n in a starving conditi0n, and the Australian govel'nment had to support them. I was 0nce on the S.S. Montoro which was taking free supplies to Fort Darwin. When we arrived Sunday m0rning the f0reman of the steved0res came on board. He told the eap,tain, "If you want us to unload your ship today, you know you'll have to pay double." Dock laborers in Australia were paid a base Fate of eighteen shi1lings, with nine extra for tropical service, and d0uble rates for Sundays and night work. The captain might fume but, .to avoid demurrage, he had to agree, even though the ship was bFinging food to be distributed to these very men as a dole. At eleven the fOFeman €arne t~uculently on board again and demanded drinking water. One 0f the ship~s 0fficers lost his temper and sh0uted, "To hell with Y0U! Get your 0wn water!" lin this laDoF democracy stop wor-Iii 0rders might be iss\led on all 0C€asi0ns. The f0reman, judging· the water situation warranted tdrasti~ action, issued a stop work order. Immediately all the stevem0res adjourned to the town, whieh was some distance from the harb0r, for a drink. By noon they had retunied, but, since union regulati0ns did not permit them to start work until one, another hour was lost. At five o'clock their supplies were not yet unloaded and the f0Feman dictated, ''We'll have to get double wages for night work." Again there was nothing to I cio but submit and pay the quadrupled rate. The captain estimatem that each laborer had received twentyfiv,e dol!lars for carrying his own groceries. CDn another 0ccasi0n the S.S. Victoria had cargo to transfer to an0ther ship and pulled alongside the vessel in order to make the shift d\re~tly. "Fhe union issued an ultimatum which compelled her to dock on tihe 0ther side of the wharf and pay regular unloading rates for 34-7


AN AMERICAN DOCTOR'S ODYSSEY having the cargo placeG! on the piel'. Each piece haG! t e be weighed and then transferred on truGks the few feet to the other side. RegJJlar rates had to be paid fer the reloaG!ing eperation also. Had the Victor-ia's captain not submitted, he woUlG! have been in the same sorry predicament as the captain of another vessel on which I was once a passenger. Fitty mules were awaiting shipment at TownsviUe, QueenslanGl. But beGause it was a heliday, thsugh only a miner ene., the stevedel'es ·refused to load them. Rathel' than dday sarling until t!J.e ne*t da¥, ~he Gap~in Gemmandeer.ed his crew anGl" with the volunteer aid of mest ef the passengers, the Fefradery animals were brought on lDoand. But the eaptain paia dearly for his expeaient because he found himself on the blaGk Est and could net return again to 'Fownsville. Australia is a country full ef Gurious phenomena. The aborigines, tel1med biackfellews by the Australians who, even though they have lived in the land only since I788, called themselves the natives, are more pFimitive than the Negritos of. the Philippines. These sllFVivors from the ne0lithic age burla no houses, wear no clothes, cultivate ne crol"S, but live en wiltd fruits anG! game, kiNea by beomeFangs and Glubs. ~heir en.}y se<!iai greul"ing is in dans, each beaving the name ef its tetem, usuaU\)[ a biFGl, and their enir tab00 is that n@ man anGl woman of the same bire name shal.!! marry. 'F'11ough enJ.y an estimated fifty thousand aFe left, their wild! n0madie ~ife has kept them coml"aratively free of the diseases of dvilizea man. The bird life is equally stFange. 1Fhe emu, the national bird, eannot fly, but kieks sidewise as wel!l as baekward; the mallee hen makes its ewn incubator out of de€Omposing vegetable matter; the b0wer bird builds playhouses anG! gaFeens, and adorns them with sheils and bright seeds; the kookoobJurra, or laughing jackass, is a friendly fel'low, with an uproar;ious laugh. Australia is geolegically the eltdest ~and sUl'faae, and the Avers rise neal' the coast and flew inlane. lit was cut eft f,l'em the Fest of the ear;th befere the develewment oE mammals !Deyend tne mest Wr.irnitive maFsul"ial stage. The ll:angaFee, whieh sheuldnave eeased Eving theusanas ef year.s ago, is ef many sl"eGies and ranges in size f.Fom that of a mouse te 24 8


THE WHdTE MAN'S LA:ST REFUGE that af a man: the wallaby baunels along with gigantic leaps at fifteen miles an hour; the beaver-tailed, duck-billed platypus, webfaoteel yet daweel, lays eggs and suckles its young, has no external ear and yet Gan hear; the striped anteater also lays eggs, but hatches them in her poud!; the bear-like wombat and the rat-like bandicoot are other denizens of this str-ange land. Lower sti1!l anel mone anachFonistic in the scale of evolution are tile iguanas which corR;scnew up trees after binds' eggs, and the legtess ~izarels, knawn as slow worms, twa feet lang, so bri~tle they eFeal!: in severa[ pieces when grasped, and the abundant skinks, in ""hich legs have disappeared, leaving oruly a solitary toe. My own eyes were witnesses that these things were so, but I had ta take an faith the yahoo, whose feet point backward, so that when ,"unning from you it seems to run toward you, and the bunyip, the great Beast in the Bush, which none has seen and survived to record its hOfrendous pFoperties. However mythological these ·l atter beasts may be, undoubtedly a tremendous wild buffalo with a space of ten feet between the tips al1 his hams roams the backcountry, and the Great Barrier Reef is haunted by sheNfish whi€h can bite an oar in two. The little brown l1ifle fish swims along until it sees an appetizing Bug poised on a limb, taR;es aim, lmel brings it elawn with a weU-airected squirt. At the museulp in Dunedin, New Zeahnd, I saw the extinct. moon bird, an~ heard the welkanfirmed stary of the kea bird, the harmless mauntain parrot which, after tasting the fat of dead sheep, developed a voracious appetite for this delicacy, attacking the live animals and killing so many that a price was put on its head. When some sport-loving Bfiton introduced the rabbit into Australia, an animal familiar to us but a novelty in this outdated land, the result was startling. Only an aelding machine could cope with the rupid increase. Poisons, baunties, and packs of half-tamed dingos failea to aiminish them. FinaUy, to keep them from digging the ve'"¥ grass Foots aut of the grazing Jands, a hundred thousand miles an fenees were erecteel. The fences haa ta be exteneled further and further untii eventuaUy they. averlaBped and enclosed the rabbits insteaa. The AustraJians have at last tuFned the tables and have ~on-

349


AN AMERICAN DOCTOR'S ODYSSEY vertea these "vermin," whieh, as white men, they themselves will not eat, into a profitaMe cr0p>; ene ship> sometimes carries a millien rabbJit carcasses to L0m10n. 'Fhe AustFalians haa even more trouble c0p>ing with the eaetils., which had escaped fr.om a; de~orative garclen billa and now e0VllFS virtually thousands of acres. The p'lants 0tten grew higher than a man's head, and were so hazandous that cattle eften became imprisened ameng them. Seientists seught the w0da 0veF for a ca;etus p>est, amd have enJy recently securea S0me promising insect enemills. In a country where the p>roincip>a:l tx:ee, tne eucalliyptus, hela its leaves sidewise to eonserve meisture, and where chex:ries had tili.eir pits on the 0utside, which had to be crushea to r.each the fruit, the inhabitants alS0 naturally haa peculiarities. For instance, any man or woman who resistea the ep>p>0rtunity for self-expl'ession to be found at the P01lS, unaer the cempuls0ry veting act, haa to pa¥ a

fine. Because 0f the laudabie aetermination that every0ne should be allowed ample time for recreati0n, Sunday WM observed with thll utmost rigiclity; douMe fares were chax:ged en the trams ana not even a bJotcle of s0da water coula be bJought. Ficniclcing in pax:ks OF in the outSkiFtS 0t the eitills WM a universal pastime, ami! herse Facing was a p>assi0n among all classes. £0 great was the Ilntliusiasm for. games that a cricKeter who showea IlxtFaendinary prow~ had a purse maae up for him whiGh sometimes amounted to thousanas of pounms. Austrwlians weFe so determinea that their eountry should beleng te the white man that thllY put into effect the most stl'ingent immigr.ati0n regu1ati0ns, even rigicil1y G0nw0lling British subjeets. T hew simple device was to p>resent the pFospective immigrant with an Ilaucational test. The indian, for example, who WM c0nstant1y appearing on the aoorstep, might be askea questions on trigonometry 0r ancient hist0ry. Since he coula not possibly answllr them satisfaetorily, he WM autematica~ly Feturnea to his p>ort 0f el'igin. Cultists 0f ill ~inas were a1S0 unwelcome, a1th0ugh there WM n0 lega!1 bar.·rier to tfieir entrance. 'When Chl1istian Seientists began their propaganda, the aect0rs 0f Melbourne sent thllm a public challenge, saying the superiority of mind over matter would be freely admittea

350


'Fl'I'E WHiTE MAN'S LAST REF1UGE if they couM nefrain £rom vomiting after being given a €ertain injectian. £ince Sp>OFtS avershadowed all else in Australia, the pop>ulace was agag ta see bhe ardeai ey apomovphine, but the Christian Scienbists nefuse~ ta submit, and when their answ.er was heralded by mhe pFess they weFe discredited. Intruders might be kept out by various means, but Australian internal difficulties had by ~o means been settled. Warfare of one som or another was a,lways being waged against a neighboring city, state, ar even the Federal government. Because each state cansiderea itsei'f autonamaus, inteFstate jealousy, p>alitical and economic, was intense. Railroad gauges changed at each boundary, New South Wales being the only one to possess standard width. This was discauraging ta a traveler, who had to clamber off and on trains five times in making the journey from Brisbane to Perth. Great Britain itself was nat exemp>ted from jeruIousy. I soon [earned that il' wauld have to omit Colonial Office, governor general, ana imperial completely from my vocabulary. But it was rather odd, in this demacratic country, to see how knighthoods were prized, and the kingly palace in which the Governor General was maintained. No state would consent to have the capital of the new Federation, which was cFeatea after fifty years of bickering, permanently tacatea in the city of anather state. lFhis rivalry finahly culminatea in abanaoning a perfectly gaad cap>ital at well-to-do and slurnless Melbourne, oeauti£ully set beside the river among hills and trees and already equipped with public buildings and innumerable metropolitan faeilities, for the desolate district now known as Canberra, halfway ootween Syaney and Melbourne and many miles inland. A hunan:d years £ram now CaneeFra will probably be one of the wotild's finest eities. The streets are beautifully laid out in accordance with madel'll tawn planning schemes, ornamented with statues and fountains and planted extensively with trees. But at present it is - a little trying for the visitor. Building has been started on opposite sides of the immense rim, and it is often miles from one government eaifi~e to anather. ~ caula ao little at Sydney in 1916. The Federal authorities weFe not sufficiently p>owerful to compose state differences and embark on a national health program. Only Queeensiand was eager to have 35 1


'FH)E WHITE MAN'S LAST REFUGE The influenza epiaemic, which spared no Gomer of the continent, IDrought to ~ight the inefficiency and con£usion of the states in dealing with a aisease of SUGh vital GonCern to aU. A plan was form mated ta centraJi(Ze heailth operations under Federal control, with each state l'emaining Fesponsible for most of its former functions; hence it wouM cooperate rather than criticize. The Quarantine Service, which was alr.eady Federal, was to be the nucleus of a National Health Ser.vice. 'iI!1he great obstacle to the establishment of the proposed Ministry af Health was the alllegea opposition of Prime Minister W. M. Hughes. This AustraJian leader, who had conducted his country brilliantly through the War, was a person of importance. The frequent Fequests for his presence in London had added to his prestige. By 1'92 I a Rockefeller representative was no longer held in anathema. ln fa€t, he was welcomed in an aavisory capacity. As a neutral, wit'haut an ruce to grind, I was asked to approach the dreaded little man with ar-guments for the Health Ministry. Dr. ]. H. L. Cumpston, DireGtar of the Quarantine Service, arranged the interview with Mr. Hughes. I had no premonition of the unexpected turn the conversation was to take. In the first place, it was disconcerting to find the PFemier sa aeaf that my arguments, well practised for intonation and phrasing, had to be shouted. Deaf people usually fall into two categories: either they whisper so low that no one can hear their words, or th,ey are under the impression that everyone else is also deaf .. Premier Hughes belonged to the latter persuasion. He could hardly curb his impatience while ~ was setting fortA the aq~uments for the new ministry. As soon as [ had finishea, "[ don't believe in your ministry," he roared up at me. "'Lt's ridiculous!! It's wrong!! I'm not going to have any more ministries! " "How ao you think it ought to be done?" I bellowed down. "No more ministries!! Have enough of them already! Doctors don't mow how to run a ministry! Make it a diy,ision! Start on tuber€ulosis!" "That's absurd!" I practically screamed. "It's an illogical plan! There's nothing sound about it!"

353


AN AMiER[CAN DŠCFOR'S ODYSSEY He leeked at me in amazement. "Yes," he agreed, "it's bad." His amazement hardl,y etiJ.ua1ed mine. The gFeat man whem everybl0dy had appFoached en hands and knees was actually IDeing meek. Before he GouM retFaet his admission, I fellewed up my advantage with further sereams, "You'Fe anly a lawyer trying te tell me abeut something at whieh ]i've spent mo/ life!" ] had out-sheuted him cemp,'lete1y. We was in a virturul state of eo~lap,se. ".Hew do yeu thinK! it eught te be dene? '" he asked. "¼eu've heaFd the pia,n! 'iriliiat's w.hat yeu eught te de! Y;eu'iVe a g'Feat eflfl0I'tunity IDefere Y,0U! iJjf o/0u aon't aeGep,t it, yowN aeseFiVe to IDe GalJled backwaFa." ''Wel1, why can't we d0 this 0UFsclives? We've fllenty af men." "Y0U haven't a man with moaern training," said I, still yelling at the t0P af my lungs. "'H0W sh0uld we go aID0ut it then?" "We'll lena yeu 0ur men, and we'thl have YOUFS trained f0r you in Eur0pe and Ame~ica, to Feplace them as soon as p0ssiMe. The whele thing is fOF the benefit ot AustFailia. @reat Britain has a, Ministry 0f Wealth, and so sh0uM you!" "Ji'eF,haps we sh0uld," he agneed. ~ was n0t g0ing to giiVe him a m0ment's pause in whiclii te Fa1lf !i.is seatteFed f0Fees. "Cer:taiiruly Y0U sheuJliI," 'Ii yehled. "Y0U 0ught te tha,ve d0ne it t0ng age!" "Wii~ Y0U help us?" Me was a!lm0st timid. "Of G0urse we'M help you. iii liIon't h01d a,nything against you just because you a,re ll0t familiar with health administrati0n." "AM I'ight, I'hl do it." il could haFdlly believe that ]i had heard aright. 1'he tumult anlil the sh0uting diec;i. I toM him ~ w0uld submit the plan f0r a Ministry 0f Heatlth at 0nce ta the R0ekefeller F0undat;ion, and bFing him the Feflly as S00n as received. "iI!'m veFY glad 0/0U talKed tihis wa,y to me," !i.e said iWith a humMe and a contrite hearot, as ill t00k my dewal1ture. !Ii)F. CCu~p,st0n :was S0 enG01:lragelii tliiat he sa,ilil even though nathing sh0uld G0me 0f t!i.is flI'0mise, meanw.!i.ile he was u:ving 0fi gFeat dr-earns.

354


THE! WHITE MAN'S LAS!F REFUGE ~n

two mays 1 had the agreement of the Foundation to its paFt in the Jilla,n, and Feturned to Mr. Hughes' office. I llead him the .aMen ofFer to assist in the formation of a Ministry of He:rlth, ami presentecd ·him the plan. With some return of his former pugnacity, he began, merely from habit, to pick out insignificant paragraphs helle and theFe to criticize, saying it appeared we thought hookworm was as impolltant as the Ministry of H ealth. "The public can only gFaSp one idea at a time. Any proposition which expects to win popu~ar appITOva~ must contain se. tions which wiN app1y to eaeh indi" idua'l." 11his was sound statesmanship, but I could not afford to let him get the upper hand. My voice rose immediately. "Of course, hookWOllm is important. That's the way you're going to get people interested-focus their attention on public health. Then y.ou'll get the thing that AustFaiia needs the most-support for a central health service." Having made this last stand, he whole-heartecdly approved the entire proposal. By means of an Order in Council, a M inistry of Health was established the neJrt week. L abor gave it unanimous support. When we fina,lly withcdrew from Australia, which had been so antagonistic in the fueginning, the Federal iPar.liament passed a vote of thanks commending the Rockefeller Foufl(dation for its work there. New Zealand bore the standard of the white man's last refuge even higher than Australia. The cost of democracy was equally high, ami the same labor troubles were. in evidence. Once my steamer stopped at Auckland cduring a big strike in which practically all shipping was tiecd up and more than a thousand people were strandecd. iN 0 cargo GOulc;l be unloaded. The strikers, however, respected the sacrosanct €harac~er of the mails, and were willing to undertake their cdelivery to the piel', but when they found that a little cement dust had siftecd on to the mail sacks, they immediately demanded cdouble rates for landing "dusty eargo"; ship and passengers were deta,inem two da;y.s pending the settilement of their claim. 'if1l\e eight-hour law was ohserved most punctiliously along the water front. I remember on€e at Wellington watching horses being 355


TWE WHITE MAN'S LAST REFUGE go abroad with greater safety? None of the members of the mediGal pmfession with whem I discussed this paradex had a solution te efFer. 'Fhe New Zealand government was taking seriously its responsibilities to the original inhabitants, the Maoris, and was trying to give them the benefits of modern civilization. Over seventy-two thousand of this most advanced group of the highly intelligent Polynesians still existed and warranted every effort made in their behalf. They wene found in aLl wa1ks of life; the Minister fer the Cook Islands and the Maoris was himself a full-blooded Polynesian. But the conscience of the government spread beyond its own confines. Far away to the northeast it had a dependency in the shape of a small gmup of islands named after the explorer Cook, and supposed to be the original home of the Maoris. The Cook Islanders had by no means pregressed so far as the Maoris, although they were not wile peopie in the sense.of the Igorots or Moros of the Philippine lsla:nds. New Zealand also accepted the League of Nations mandate for Western Samoa, and has spent huge sums, infinitely greater than any return it has ever had, in elevating the living standards of the Samoans. These kindly, hespitaMe, and docile Polynesians, like the nest of the inhabitants of the South Sea [slands, were decreasing yearly in numbers. New Zea1ane was much chagrined over the slow progress of her health wonk, and welcomed our assistance. Our campaigns against hookworm and yaws among the ~ook Islanders and Samoans were only two out of many such 'labors which we undertook in this island-studded section of the bvoad Pacific.

357


CHAl?'fER

lPARA$[TEIll LOST

2] .

fAiltA$~TES

S

AND IR.EGAINJED

OME years after the WorM War had ended, I was sitting 0ne day in the office 0f the Australian Minister of the ilnten0r at Melbomne, engaged in a lengthy disGussion of health affairs. When it was evident that OUF Gonversation w0uld C0ntinue for some time, t;he Minister asked, "'Would Y0U mina if ]i inteFrupt! 'TheFe's a man 0utsiae wh0 has been waining to see me f0r S0me time. ] Kn0W what he wants a,na it willi! 0n!1y take a few minutes." ~n the sha1J1iJy inaiiVimua~ w,h o entereti! ] re€0gnized t;he mal} wn0m 0nce ill ha~ 100Keti! ~p0fl as aFn0ng rthe m0st envialhle 0J1 m0Ftruls. His appearanee FeGahledi to my mina the 10ng.ago m0ming when my stea,mer was apPf,0aGhing an islanti! n0rth 0f New Guinea. S10wly anti! peacefuHy it r0se £f,om the sea until it appear.ea like the gre(;)n anm gold lid 0f a sugar bowl resting al0ne 0n a bright blue taelecl0tJi and €r0wned with a white knob whiGh, as we aFew nearer, res0lved itseYf into a spacious h0use. From the white coral sands of the sea's eti!ge th0usands 0f coeeanut pa!lms flowed like a green tide up the gentle s10pe tewaF'" the summit. TW0 German br0thers wen": the s0le possess0rs 0f this enehanting islana 0f MOF0n. ] lateF st00ti! with 0ne 0f them 0n the GFest 0f tihe Fise., with the sea rim GUFling IDei0w us, as ne deser.ibed his iay:]ilie existence. Am the [anm that he G0uT~ see was !lis. iN0 1I\(0Fk, n0 W01'!'Y t;r0ulhled him; n0thing rustU!11iJem the solitume of his existenee sa,ve the s10w processi0n 0f ships ID0und f0r Singap0re, T0kyO, Syclrtey.

;358


PAUS[,[,ES LOST AND PARASITES REGAINED When the fanqr took him, he might fish or cruise in his magnificent sch00ner yacht, or he might bide at h0me, r.eaaing a book from his weH·st0eked limrary, i,l~umined by light from his own electric plal'lt, wh.ile sipping drink!s cooled by his own ice machine-a luxury then unheal'd of in the South Seas. This ClaIm and this sumptuousness were the fruits of the hundrea th0usand cocoanut palms, each of which produced an annual revenue of 0ne do~lar. Turn and turn about one brother would take the hun· aRea thousana dohlars and scatter them lavishly over Europe, while the other sat ia1y on the veranaa and watched the workmen gather the cocoanuts. But the War came and Australia and New Zealand eagerly snapped up the rich German spoils of the South Seas. Now here was my host of that halcyon aay, who had lost his earthly paradise, tramping from ministry to ministry in the vain h0pe of its return. Rrom the fil'st time ~he eyes of white men feasted upon the IDeau· ties of the South Seas, these islands have symbolized escape from a world that is too much with us. According to tales brought back by , travelers, nature on sea and land offered a freedom from trouble and from labor, tile air was soM and balmy, and the women beauti· flrl and kina. The sea was full -of fish, wild hogs ran everywhere. As soon as a cllild was weaned, it was put on a diet of taro r.oot, and taro gr.ew S0 freely that ' an effortless kiccl<: brought it from the bountiful ear-tho The lJnited Fruit C0mpany, with all its research and cultiva· tion, produced no finer bananas than those which nature, unaided, here provided, and everywhere cocoanuts 'and oranges supplied both f00d ana drink. For the Islandel'S life consisted almost entirely of aiYersion, and they questionea tile greater satisfaction to be deriyed kom w0rk as comparecj, with leisure. Even Europeans, after a short s0joum among them, tended to accept this view. The South Sea Islands, genemli y speaking, are those east of - Australia and south of the Equator. With the exception of American Samoa:, they ar.e ali under the sovereignty of the British Empire or tile F.l'eneh Repubiic ..The origin of ~he Islanders is largely a matter of €0njecture, but by drawing a line north and south through the iJ:\1iji iLslands they may be divided racially into Polynesian and Melanesian, although the Gilbert and Ellice Islands are inhabited by so·

359


AN AMEIUC:AiN DOCifGlR'$ GiE>YSSEY cal'lea Mi(mmesians, light in camplexion, but with the slant eyes which betray a Malay strain. '['a the east are rIlhe iRol~nesians, the pUFe race of tall, J,lFown, straiglit"hairea men. 1'a tne west the Palynesian strain faaes 0Ut until it vanishes in the negroia interioF of aark Papua. In the middle isra,flas the admi*tuFe is crol!lea Mela,nesian. 'I1!1e eaurse of the :Faiynesian migFation eastward ma,y be tracea oy isolatea isla,nds still remaining predominantly Polynesian. ';Dhe 10ng, straight haiF f0und in the C00k, Samaan, and Tanga, ar Friendly, gF0UpS graaual1y G0i1S to become a frizzy mass an the head of the Fijian, and kinks tighter and tighter until in Papua it is a mere woal. 'Fhe Fijian damdy takcls such gl'eat pFide in his BraCK, ar sometimes reddish, pal~ tnat he spenas haul'S in trimming it, so that not ane hair shaH be aut af place. Me will, nawever, have no hair on his face. Shaulcil any have the hal'aih00d to appear, he, with equal harmihoad, usuaJlty plUCKS it fovth with twa clam shells. Sametimes he shaves, using sharks' teeth, broken bothles, or per-haps a Imife of split bamlb00. 1Fhe Fijians, witn their beautifu1 shouMeFs, naFraw waists, gFeat thighs, anm hanasome calves are mare perfect physica1 specimens than the !Palynesians wh0, although large and well-favmed, a,re apt ta be soEl: fFom t0a little eJl:ercise. The beauty 0f the Rijian b0cly was we'l!l displayed by the picturesque lava lava, much like the Malay sarong, six feet lang antd a yand wime, varying in fashian and c010r with the tlilhie. Far women the modest Mother Hulbba,rtd, the missiona'ry's cantribution to m0rality in the South Seas, was uniiVersal. Only naw, with the decline of missionary influence, is same small traee af waist line beginning ta 6Feep in. 1Fhroughaut the S0uth Seas the rrllssianaries were, in the Nineteenth Century, the aaminating fOFce. On their. a,rrival they faund the [slandeFs engaying a, system 0f G0mmunail ewneFship. ]f a, new house were needed, all joined in and built it. Nothing was spent en maintaining law ami order; there was nothing ta stea,l because the g0eas of 0ne be10ngecd ta al!!. For any ~ittfle infr.aeti0ns of theiF GUSt0lNS, the e1aers of the vil!lage hela ceurt 0f a Imnd; but there were no pris0ns nOF jails. 'FIRe missi0naF,ies w,eFe hal"l'ified at these canÂŽit.iaBs. ]n the Caak

360


iF~~$[,iIi'ES

JJ©S1F .AlNIID

P~M$[J)'iJi'ES

iRiIil@Pl.mED

iMancds ~I\.ey insistetd that pr-eper-~ must ee seeur-em fr0m aggnession I!>y pasting . it w,ith ~oeeanut omnebes nailecd te tne nouse. ~ f a man sheU!l~ take a f.lig fer bis ewn use, he must not only retu~n the ene ~elenieusiy r.emt'iVecd eut. an additienal ene as welL I'n their efferts te r.elel'ID nati;v.e mer.ads, they hacd enacted some highly amusing legisla1llen. Me gentleman, fer examp>le, ceulc;! go wa!lKing with a yeung lacdy a~er- aarR: unless he carried a ~ightecd tor-eh in one hancd. ,["he ~slanders amiaMy but stubeorn~y clung te seme of their- an"ient pr-aetiees. ~n spite even of r.eeent gevernment pressu~e, the l"ij ians wi1!l net be peFsuacdecd rte give up> kere kere, a custem wnich requiFes that anyene must sur-Fencder any possession an ether of equal rank may cdemana. lfIhe Governer teM me the unhapp>y experience ef a ~ijian 0xfeFa gr.aduate who impertecd silk shirts which se caugnt 1ihe fangy et his fr.ienas that ne !lest them as last as they arrived. Seme Genneetien might be traeecd l!itltween the universal aversien te wer.k ancd nhe p>eFJuIlaFity ef Feligien which, until the advent of the mevies thr.eatenea te aisplaee it, furnished diversion but reC!Juired ne e»pencii1il:lFe ef efliort. T in e Tenga [slands seemed to me te consist almest exdusively ot cl:1UFGbes an<il yet meFe chuFohes. Methodism was t1'1e state religion and leng ~elmecd enormous power. Even as recently as 1;wenty years !lge, wilen a r-estr-ktive sanitary and medical aGrt was cdr.atted ami aoeut to be veted upon by the native Parliament, the €:hUFGh quashed it in its entirety eecause it centained a pltev;ision that en[y ~uaHfied cdei§tors GoUld praetise medicine, and the pFe,p.enents ot tihe bill Fefused te excise it. As a· means te an end the missienaries had eeen cdi~pensing a tract ' with each pill, hop>ing that l!ietn woUlcd teac:h ilie pEep>eF destinatien. They woulcd iose pFestige iE, mer-ely eecause they dicd net knew hew to practise medicine, they were aeeaAtecd from aoing so. ' Amthr.ep>elegists eelieve tnat RenneH [sland, one of the Sc;jlemens, ailtneugl\. it ~,ies far te the w.est ef the dividing iine, is Polynesian, or p>esslMy even p>reJPelynesian. The Rennelll Islanders have pad practic;aJJLy ne Gentlet with white FJeep>le, and their r-eligion is undiluted ey ©I\.vistian dectrines. WeFe is te ee feuna a p>rimitive religion in a praGrtiealJily pure fel'm. Twe main geds, a grandfather and grancdson, ar-e tremlli1ingly worshipp>ea. 'fhe sinner entreats his ancesters te intereeae with tJle gFanEifather goa, whe may thus be induced te inter-

36r


AN AMERICAN DOC']1QR'S ODYSSEY eeae w.ith the ~eater and m01:e fear£ui grandsan gaa. The priest, however, stand'ing before his peopie with his talking stick in his hand, communicates directly with the granason god in a strange hobole gobble, and inteliPrets the holy answers to a eowed and submissive papUlaGe. ~he tabso is aU-pawer£uij the RenneM ilslanaers are governea by fear a£ everything-their environment, their enemies, and even their friends. Ritual directs every aGt af their lives, ana ail sickness is, ipso facta, punishment far same infraGtian af the tabso j they recogni'Ze that somehow they must liave offended against the ol'ders of the grandson. Nat far from tiny Renneillies the huge mysterious island o£ New Guinea, peapied by a myriaa wild tribes. (j)IlJ,y the fringe af Papua has been eJqlloFeGi tnaraugMy; no one knows what riEM'les o£ ra€e ar sOl'cery lit; hidaen in the jungly interior. l1he cannibals and killers who dwell there ar-e also rulea oy terror of unlmown forces. As thr.oug,haut the South Seas, sickmess and heatlth are depenaent upan pu1:i puri=--wit~hGr.aft. fJur.j, puri is not piG!\:ea up casllaillly j the finer points are expounded in a $Gliool which accredits its graduates in SOFCery. 1ihe death a£ an enemy may be semred in Papua with great simplicity by emplaying the vililage sarcereF. Whis meaiGine man, who always has some aistinguishing mark upon his house, serving the pur~ pase of the doctor's shingle, assumes £ul1 d!arge of the affair, and the person seeking r.evenge may r.etire £ram active participatian. In the Mekea aistFiet, the sorcereF stuaies the habits a£ the prsspeetive victim, particular-Jy the paths alang which he is accustamea to ga and the hours at which he frequents them. Next the witch aoctor secures something wliich· has meen close ta him, such as a loin cl0th, althaagh it is daimea even 3l hail' wil!l clo. The sorcerer unstops the erid of the bamboa rod in which he keeps a venomaus snake always on hand for just such emergencies, releasing it into a pot. 1!ihen he buiMs a fire unaer the pat, in which the piece af €lath has a!lr.eady !been placed. The unsuspecting '\!,ictim walks alang the usual path at the aCGustamed haur ana the snake, releaset1l from the pot, associates the oaor of the man with that af the maddening heat, ana makes straiglit and unerringly for him.

362


PARASITES LOST AND PARASITES REGAINED A:nather if>apuan method of carrying out vengeance is for the witch daetor merely to point a sharpened human bone in the exact direction of tile man ta be killed, the theory being that the bene wiN speed stFaight thFough the air, pierce the body, and return to the sorcerer's hand sa quickly that its flight may not be seen. Strange as it may seem, cases of death from such fantastic conjurations have been reported on evidence that cannat be lightly dismissed. In such instances, hawever, the man who is to die has been informed a curse had been put upon him. Bad aim is impossible; if death does not follow, th.e failure is ascrilJ(:d ta the employment of a more powerful opposing SOFcerer. Opportunity to observe puri puri at first hand was afforded on the sugar plantations of Queensland, which had been obliged to impont hundreds of Kanakas, as the South Sea Islanders are popularly â&#x201A;Źailed, ta serve as temporary labor. A Kanaka worker from one of these plantatians onGe came into tl\.e little hospital at Mossman, and said the finger had been put upon him-he was going to die Thursday at eleven. "Sun he come up," he pointed to the horizon. "He come a10ng here," his hand rose almost to the meridian. "Now he stap along place," his outstretGhed arm was motionless. "Close up me die." iDr. Philip ClaFk, the pl\.ysician in charge, examined the Kanaka thoFoughly-blood, urine, heart, liver, lungs-nathing was wrong. Nevertheless, the man persisted he was going to die, lay down upon a cot, and refused to rise again. Dr. Clark had had previous experience with the effects of mental suggestion upon Kanakas. When he Gauld not jally the victim of the spell out of his idee fixe, he sent far I\.is fareman to persuade the Kanaka nothing whatever was the matter with him; that he was not gaing to die. The foreman came, leaned over the bed, peered into the black man's eyes, shook his head, and turned away. "Oh, yes, Doctor, close up he die." At precisely eleven o'clock an Thursday morning the man's heart, whiGh IDr. Clark t~ti6.ed te be normal, suddenly ceased to beat. IDt. S. M. Lambert, then in Clharge of the Rockefehler Foundatian's wOFk in Queensland, several times came into direct contact with this form of pur; pur;. On one of these occasions he happened to stop at a Seventh Day Adventist Mission Station, around which was a 363


AN AMERTCAN ID©crOR'S ODY$SEY c011ection of Kanaka villag~, la~gdy dependent for food anm tobacco on the missionaFies. The latter weFe puz'ZIled by the smnge condition of a Kanaka named Rob who had come to them in teFFOF announcing that Nebo, most influential of the neighborhood wit€h doctors, had placed a spell up)Qn him. Rob., without physical appeaFance of iHness, was at the p>oint of meath. Dr. Lambert found he Iiaa no temp>eFatuFe but an ala~ming[y weak pulse; since he c0uld discover no tFace of disease., ~hene was litt!le he could suggest as a ~em­

emr·

As :t last Fes0rt, one of ~he missional'ies went d:iFect!lr to Nebo ana spoke seveFely. "1f you mo n0t remove uhe spell up0n Rob, rou and your tFibe wil11 get no more food OF tobacco. l'0U come bad!: with me and teN Rob that he wi'lI get well." Ilr. lLambert watched caFe£ully what hap>pened. Rob was lying helpless on the bed. In spite oE all tnat had been done fOF him, his vitality was steadilr ebbing. Nebo leaned over the sick man and assUFed him no spell had been Gast up>on him; it was aH a mistake antil there was n0 need fOF him to illie. Rob's face slowlr broke into a bl'oaa smite. BefoFe the day was over, his grey, duN skin, tIlat infall!lible index of il!lness in the blaCk man., was shining hea'l thily anm he was about his wOFk as usual. ~n Jii\i~i tihe w;iteh doet0F's CUFse is kifiown as ndr.aunikau. The S01'ceFeF maKes 3i [iure fiFe and tl~en, accoFding to ritual, Gi~cles aFound an<;i aFounm, reciting his incantations and <thFowing stFange an<d nor-mm objects upon it. "When ] do that, the man <dies," the witch doctor. says, and each Fij~an believes implicitly that he himself can be so willed to death. N draunikau is a problem in the English colony of, ~i1i, where witchcraft has to be denied 0fficiallr, and where a man cannot be jailed for a crime that does not c:Jcist on tne statute books. But in Austr3ilian Papua witchcraft is a criminal offense. Cnce ;when a WOVKman on a Papuan J!llantation announced he had had a sp>~l!l put up>on Ilim and was about to <die, the skeJ!ltical owneF, wno vwu1d stand n0 sueh nonsense, sai<d, "'Wel~, ma)lbe so; fuut ¥o\!ll~l clie £r.OID this ,fiFSt," ana he took a whip> to him, anm wIlen the man Fan, he ehased him. 1!he man did not die; tne wnite man's magic was stronger. The Australian Commc;)flwealth had an economic interest in t.lie

364,


iP:A:MS:ITES [LOS1' ANEl FAiRA:SITES REGAINED diseases of those living a!leng the ceast, because of the rapid development of rubber and cecoanut plantations there. When it appeared evident that tlie natives were heavily infected with hookworm, the Rockefeller Foundation was invited to make a survey. The Melanesian aversion to labor was not so strong as the Polynesian, but in oFder to keep a force of eight thousand steadily at work the year. round, three times that number had to be held in readiness; en the average the Papuans would not stay on a plantation mere than a year at a time. This disturbing habit of theirs caused considerable harodship to tlie planters, but was an advantage from our peint ef view, because the larger the number emJDloyed, the larger weuld be tJie number Feceiving instruction in anti-hookworm propaganda. Dr. !Lambert carried out a remarkable demonstration of what could be done with savages who had no communication with neighboring tribes. Papuan dia!lects could be numbered by the hundreds; in some Fegions he found as many, as three language groups in five miles. Aleng the coast, however, pidgin English offered a common speech. This idiom had been introduced in the early Nineteenth Century by tile sand3!l-wood troaders, in erder to facilitate their commercial dealings. !Ek :n..ambert learned pidgin Engllsh. Wheroeller a superstition weuld ser.ve his purpose, he was prompt te utilize this alse. 'fhe snake, which played so large a part in Papuan life, was, among other things" believed to cause disease by taking up its abede inside the bodies of the sick. The sorcerer who, to give him Ilis due, worked harder at curing than at killing, with incantations pretended to suck the ghost of the snake from the mouth, ear, or umbilicus of the patient. AfterwaFds he gave ocular demonstration of his pewer by spitting a small snake from his mouth. If the sick man happened to be suffering from a fear malady, naturally he would often get better. 1'his snake theory gave Elr. Lambert his opportunity. Holding in his hand a little bottle of heokworms, which his audience accepted as snakes, lie would begin the stery of the hoekworm cycle: "You altogedda boy. You listen good 'long dis story. One big fella sick he stop 'long bell' b'long altogedda boy. Name b'long dis sick him he

365


AN AM'ERECAN OO>e1!'®R'S 0:D¥SSIlY hooli:wor-m. You look 'long dis bottle. Gottem plenty small fella snake he stop. Dis fella he stop 'long in bell' b'long bo,y. Tooth he gottem. Mim he Rai kai bell' b'long boy. Blood! he eome. Wim he kai kai blood b'long boy. S'pose boy he kai kai. Kai kai he no b'long boy. Snake he eatGhem fust time. Now dis fella snake he allee same pidgin. He gottem hegg. S'pose boy lie go 'long bush. 'Now hegg he come out 'long ground. Now Fain he come down. Sun he Gook him dis fella hegg. Bimeby one small fella pic!kaninny snake. Mim he eome up inside 'long hegg. Now hegg he bFdke I\im. Now him he walk: about gFound quick fel1a too mUGh o liloy lie Gome 'long. I;Ie put liim foot 'l'ong dis small fella prdcaninny. Quid, fella lie come up inside foot b'l'ong boy. Now I\e go, he go, I\e go. liIimeby ne come up 'long heaut b'long boy. Now he come 'long wind. Now,lie Game 'long t'roat b'long boy. Now 'he sGratch him t'Foat. Boy he swallow him. He go down 'long bell' b'long boy. Now , dis l'ong time dis fella pickaninny he stop inside bell' b'long boy. He come in fust time he small fella too much. You no sabe look: him 'long eye b'long you. He small fella too much. You sabe look him 'long big fella glass. Now he stop 'long time in bell' b'long boy. He more big. Now he eome 'long bell' b'long boy. He gottem tooth. We sabe liiai kai bell' b'long boy. He sabe kai kai blood. Boy him he lose him blood. He weak fella too mUGho Wim he siek too much. DIose up he die." ~tl\ougn

the iFapuan hali! aeGep~eli! the elijiliana~ion of snakes as natur-al, he haG! to rotl constantty neassmed that htl was not l!lutting himseU in jeopanay lily all10wing examination of s~ools. iWiis unquestlloning a&el!ltanee of the sUJi1eFstition that the boay eXOFeta, as wdl as the paring of hrs fingernaiJ OF a aFopped nair, might tlXJi!ose him to his enemy's 'Vengeance madtl it aoubli}' aifEGuit to win his eonfiaenee. The work was, as usual, stafted on the plantations. But prisoners in the Central Jail at Port Monesby, none of whom eould Vtlry well protest, also maae exetltlent subjeGts. The prisoners were not merely under complete supeFvision, but, aue to the peGuliaF system of pfomotion effec~ive in prison eircl.ClS, they, alIso offeFed an exeel!lent means of sl!lreac;iing health eaucation in the districts we cou!ld not r.eaeh. The AustFaiians have 'tempeFee theiF own se¥ere ,iaeas of ~ustiee to the mores of theiF surojeet jiJeopie. M uraer has to be tFeated in the 11ght of the Papuan eoneel!ltllon that ta~ing human life was no Grime, roeGause a man was not a man, native style, until he had Jillilea. ']jl,lie l!leF£e0~1¥

366


PARASITES LOS'F AND PARASITES REGAINED police query, "IDid you ki1l this man?" directed to the culprit, always elicited a l!Jaastful, "Oh, yes." Only at 1'llre intervals was a gallaws set up fol' a publie hanging, and then almost always to sellVe as a warning to leave white men alone. In the ordinary course of affairs the guilty ones were let off with a short jail term, and, after having learned the rudiments of civilization, they graduated and were sent baek to their own villages as constables. Badges were hung on their naked chests to distinguish them from their fellow tribesmen, and they beeame the sole representatives of law and order in their awn neigh:borhoocls, where they usually performed their duties with vigor and determination. In Papua as well as other places in the South Seas the Rockefeller Foundation made a demonstnition in hookworm control, but it concentrated its efforts in Fiji, a British crown colony which to all intents and Plll1Pases represented the center of the South Sea Islands. Of the mor.e than two h~dred islands in the Fiji group, an1y Viti Levu and Vanua Levu are of any size; many of them are mere atolls almost awash at high tide. In spite of the inviting verdure, the cooling breezes, and the pleasant prospects, Captain Cook had sailed straight through the middle af the group, not risking a landing because of the fierce aspect af the natives. 'the sandalcwaod traders began timorausly frequenting Fijian shores at the beginning af the Nineteenth Century, but not until r826 did the missionaries first arrive. During our Civil War British cammercial interests had seen an opportunity for .profit, and the fields in halWest time were white with bUFSting 'cotton bolls. This industry died a natural death in the seventies when the United States again â&#x201A;Ź3.ptuFed the markets. Then in the eighties the Colonial Sugar Refining Company brought renewed prosperity. Sugar and bananas were ellP0rted by the energetic planter-so Travelers sailing eastward from the coast of Asia have often noted that the variety of vegetable and animal life steadily diminished with eaeh successive landfall. Apparently the Archipelagos of the South Seas, like AustraJ.i:i, had been cut off from the mainland before the develapment af mammals; the ubiquitous pig was, introduced by Captain Coak. Fiji does not even possess bedbugs, white ants, leeches, snakes, or croeodiles. But it has a few native marsupials, among them

367


PARASITES 1.051' AND PARASliTES REGAINED questi0n of heahh to the fove. The planting interests could not protest against herulth measures, because ~he government was the m0re p0werÂŁ1rl ami ~hey were ~fFai<d 0ÂŁ !.osing their in<dentufed labor. 1'Ihe I:>aFling Commissi0n in 1'915 <determined that hookworm had not been started by the Indian coolies as at first assumed, but was en<demic among the native population. The survey was simplified because no mixture of blood had taken place between Tamil and Fijian; hence the tw0 could be examined separately. It was found that, although the 'iL'amiJ e00lie was a[most one hun<dved percent infected, his was the ancylostoma whereas the Fi~ian harb0red the necator. Curiously enough, half-Glste and European children were almost free of worms, alth0ugh they ran barefooted throughout the year. Nobody knows how the Fijians would get along if a paternalistic g0vernment should force them to compete 0n equal terms with the Tamils, who h~ve a monopoly on industriousness. Few of the Tamils imp0rted to w0rk on the plantations now return to India. They like the Fiji Islands, and it is a long way home. After they work out their indenture the Colonial Sugar Refining Company sets them up on small plots of land, where they can have their own fields of sugar cane. Now half the population of Fiji is Tamil. When I first saw these Indians in Fiji in 1'916 they lived in miserable h0uses and filth;y villages and seemed to have no desire for anything bettet. I was much interested in 1934 to see the changes one generation had wrought. Everything was in vast contrast to the conditions which stili exist in India. The Tamil had dropped many of the handicaps of his religion, and much of the caste 'system had been abolished. Ib.ateiy a movement among the older Indians and their holy men to in<du~e the new generation to return to the ways of their fathers met with little SUGcess. They were happy where and as they were. They had been miraculously transformed from a dejected, downcast, <docile, uninterested people, who could not even play, into one which was healthy, alert, sport loving, and mentally so progressive ~at they were agitating for sch00ls and the vote. They owned fine fat Ilattle ana ricli lands, and had, on their own initiative, built a superior type OF house, each witli its neat latrine. They had well earned their reputation for industry and thrift. ::I"his regeneration had been accomplished by mass treatment for

369


AN AMERICAN IDDe'iIi1<OR'S G;QYSSiEY hookwol'm. Nothing like it has ever happened in history. At last the 'Famil smiles. Carnegie with his libraries Ilad been befere us in t he iI)liji IsIancils, ami his donatiens had been well publieizea. 'Fhe local newspapers, confusing the twe philanthropies, anneunaea that ]j haa ceme to F1i ji to stuay the habits e£ the bookwerm, assuming p"e~haps that the Carnegie volumes had somehow become infested. The schoel children, anxieus te shew respect to the newly-aooivea boekworm investigater, enterecil a competitien, ana one inspittecl F>ijian young laay ~urne<d in an essay entitled "Parasites Lest and Parasites Regainecl." I have always believed that no more fitting tide coui!!l, by any fortuiteus circumstanae, have been €hesen. Hookwol'm preventien was the pl'imer used in teaching the FeepIes of the South Seas that it was possible for them wIl to ha,ve souna boaies. 'But because ef the pl'eVailence of ya,ws, whi0h a[![ the !lslan<ders had heretefol'e taken fol' gmntea, neo-sahrarsan injections proviaed an epen sesame to their hearts, although they were at mst timerous ef ~l'eatment for fea,r e£ "aFiving tl:iem in." Many of the 0ni[!!lren welle being entirely cleFrivea of the Fhysicai exuberan€e which is the inalienable right ef Ghildhoea. £eme, with the aid of canes, had to hOF en their heels be€ause e£ the uleers en their tees, er walk en their tees beaause ef the ulcers en their heels. Others £Qula not will!: at ali, but weulGl hiteh themsehres along in a sitting Fosition. One of the times when iI have fueen Froudest ef being a member 0f the meai€M Jilrofession was when I saw the [mes wrought among the chiidren of the South £eas by the praotitioners, who gave them back their ohildhood, so that they wette able te laugh ana run al\d Flay ence mere. The second gtteat GUrse of the Seuth Seas was filariasis, er elephantiasis. Patrick Manson, a SGetch physician in Arnoy, maae the bJ1ilJ1iant cilis€every in 1879 that the filaria ble0awer.m was GOIlNeyea £rem ene human being te anether through the agency of the mos~uite. Wnen I was traveling about with Dr. Lambert through Fijian ana Samean vi~lages I eften sleFt in l1ati~e gFasS huts ana, though we both carried nets, I was frequently bitten by the vicious mosquitees whiGh swarmed everywhere. The Imowledge that almost ha,lf the peoJille arouna me ha~ fi~ariasis maae me feel aistinctly uncomfert-

370


PARASITES l.OST ANID PARAS'lTES REGAINED able, because any ene of these mosquitoes whicq were biting me might ailreaay have dined on one of the neanby sufferers. Dr. Lambert, :wihese slcin haa apparently become immune, (ouM sit around in his pajamas and apparently not be bitten, while I would be complaining and s~ratching incessantly at the huge welts. After Manson's original observation it was later discovered that the filama is a white threaa-like worm which, after being deposited by the mosquito on the skin, bOFes its way into the lymphatics and blocks them. ])ue to this blocKage, a tremendous,enlargement of the tissues may take place. A leg, for instance, may attain the size of that of an elephant, hence the name. Filariasis, which is fortunately not painful, takes years to develop. Although thtl presence of embryos can be detected at an early stage by blooa examination, no cure has yet been found. Unless the victim (an be remevtla to a temperate climate soon after infection, the progress of the disease cannot be al'rested. Surgical operations give only me(hanical rcilief, but any surgeon who could cut out one hundred and twenty-five pounds of excess tissue naturally found favor in the eyes of the Islanders, and many such operations were performed. If the adult filaria could be tracked to its hiding place, a patient could be cllFed, but it is eften se securely concealed that even the most thorough autepsy, sometimes lasting for days, in which every organ is dissected, fails to reveal its presence. Not until something was learned about the breeding habits of the filaria-bearing mosquitoes was any effective measure possible against this disease. Only a few years ago it was 'determined that discarded Goeoa,nut shells which were fiBea with water by every tropical shower runishea iaea1 breeding places., With this information in its hands, the Samean gevernment passed a law compelling cocoanut shells to be broken up, burned, or piled upside down. The incidence of filariasis in Samoa has been declining since then. Unlike the French, whose interest in their colonies did not seem te include mueh humanitarianism, the British were greatly concerned ever the pFogFessive depopulation of the South Sea Islanas. Scientists genera,l[y believe that the main cause of the diminishing numbers is the lack ef immunity to introduced aiseases. It has been generally held

37 1


AN AMERICAN DOCTOR'S ODYSSEY that British nationals haa been Jarge1y responsible for the high death rate £rom t;his eause, alth,ough the Ohinese traaer must alIso bear a pertien ef the bla:me. Mud'! eviaenee" heweveF,has ~een aeeumulateci! te preve that infant mOFtality is largely aue to aiet ci!eficiency, as weli as the dif!i.eulties in induGing Felynesian mothers aaequately to care fer their young. The fostening of cemmunications caused these newly intreduGea diseases te run through the p0,pu~ations like wilafire. Tubercul0sis, measles, and I:Jneumenia t0ek a teJ1rifule tel.!!. Waves ef ba0illa:ry aysentery swept over the Av0hipelagos. The measles eJ'liaemic in Fi~i was the major catastrophe of its histoFY; over a thira of the pOJ'lulatien died, MOFe recently, influenza was impertea, causing an estimatecd less of ten to twenty J'lerccmt in the aistricts affected. it is inteFesting te speeulate upon the J'lhysical €hanges whi€h must take plaee [n a peeI:Jle cdUFing d'le preeess ef acquiring irnmuniliy. 1'nose wne ha:ve net fueen el\Pese~ te such diseases as measles and tubeFcu1esis wil'! pFebably h;tve certain cha:FacteFistiGS whieh are lest to the world by their death, ancd the survivers will have certain physical qurulicies whieh wiM make fer a cdifferent line e£ evolution in later generatiens. ReeentJo/ an air.pla:ne ~euncd fe1' the g0lafi~lds ef New Guinea aisceveFecil in tne interier aJ strange I:Jeeple as yet unImown, lighter in sk[n, who livea in viilla:ges, had stFeets and neat fielcds, careful!J.y feneed. A doctor eoula expel'ience no more exdting adventure than to eJI:ploFe some such communit;y, hitherto completely iselated from all GOntact witn ci¥llizatien, te tabulate the indigenous aiseases., and ruso te elqileriment with methoas ef providing ag:tinst the rnvages en aisease wnen the eemmuni€3:tien barniers aFe bFe~cm aown. Nething iilefinite was K>nown in [9I5 abeut the Felative impertanee of, the causes ef cdepeJ'lulation in the South Seas, ex€eJ'lt iliat the p,rocess was going on at a rapid rnte and something should be cdone about it. The Polynesians were veFY desiFable residents feF British colenies. Tlhey were sueh ddig,h tful, ehaFming peeple, ana their oultune so J'leFfectly CeFJ..feFmea to maf.lY a:menities ef Efe ~hat pFaeticaNy eve1'\}"ene became immediately fFiendily te tnem. They got on wel] with white people. Their high degnee of intel!ligenee quaiified them te rank equally with the British in ecducation ana in prh'ileges, and, as

37'1.


!Il:4!M$~,],iES

lfuOS'iF AN®

PAiRAS~"FiES

~he¥

R!Ee';A,]NEID

cilisaF.1l!'eaneCl, the unassimilable Japanese ancil Chinese were taking thew places. iEt ha<il adways \)'een aiffioult te get dodms frem heme fer senlice in tne South Seas because of the extremely isolated life. This iselatien eausea many wno dia make the jeurne¥ to mecome adaiotea to alleeheI or cilmgs. Furthermere, such eiferts as had alreaay been maae te give me<ili€al instr.uctien te South Sea Islanders had been inadequate. [ have v:isited hospitals where I founa uAtrained natives hancil~ing aangerous mediGines of which they scarGely knew the dosage, ana mak;ing aiagneses SUGh as "feverish," "bJa<!l food," and "bad lii1eea." Austra!lia, 'New Zealand, and Great Britain were aN enaeavoring te find seme solution. Tne AustFa~ians. ppoposed to balance the birth ancil the aeath pates by a system of hospital ships traveling hem pent ta pal't. 1i'he uti!lization of the waterways for this purpese sounaed as Feasam(ble ta them as it had to me when we had first tried it out ameng the Meros in the Phi'l:ippines. Hewever, I had leal'ned then that haspita11 ships were not feasible. 'Fhe expense was heavy, and an:Iy relati:vely few people ceuld bJe benefited; the sick could not be bFeught easily ta the ports. 'Flh e Bvitish had fiFst sought the Geoperation of the League of Nations ana t;hen haa appreachea the Reckefeller F eundation. We, as inteEestea spectatars ef the ;v,arie<il efferts, were delighted at the chance ta affer suggestions. Teaching the people to take an interest in their awn health preblems was one ef eur fiunaamental tenets. ]n this case we were tlneeupagea by tne sanguine eJCPectation that a school for w.tining iflolynesians ana Melanesians in medical practice had a bJetter chanGe for SUGGess than those erected in many Oriental er Latin coun1;ties wheFe the elOfleriment had been tested out previeusly. ''Why a'e n't you pwv,ide a suitable meaical education far these l'Ieapie?" we asKea . "British doctar5T-white men on high salaries requiring leng v:aGations-cannot be aependea upon for any certain tenUFe. F,ur.thel1moEe, you shoula have meaica,l representatives who a!Th-eady !bnow the custems, languages, and superstitions of their ewn peeple, whe Can !live among them permanently, who have the iAterest oE the €euntry at heart, and w'h a ceuld ae the job at a cest the gover.nment Gould sustain. You have a unique opportunity here, because

373


AN AMERICAN DOE1]'QR'S ODYSSEY you have a people intelligent enough to absl'lI1b the necessary knowleedge." A sma-H, primitive school was a!lready oper.ating at Suva, the eentr.ally loc:ated c:apita~ oÂŁ the 'F.i ji Islaneds. With a population of amout fiv;e thousaned, mOFe than a quarteF white, it was already a thriving port of ca.l!l for many steamship lines. Several three-story GOncFete builcdings gave an air of Gommercial pFosperity to the main street, and a trnio of moving picture houses, an Otis elevator, and other fleshpots of civili!Zlation eater.ed to the univeFsai edesil'e to be a:mused. The hospital ship iedea was a&anedoned and, without any gFeat enthusiasm, a; plan was agreeed to whereby the Rockefeller Foundati0n would assist in reorganizing the Suva school and tuFning it into an institution to serve the whole South Seas. Ultimately seven Island aaminist;f.lttions=AmeAean Sa:moa, New Zea[ana Samoa, Tonga, [j'iji, the Solomons, Cook Islands, and one of the Fr.ench islands-sent students and helped to supp>oFt the school. IDr. Lambetm, Deputy Centr.al Melltical Autho!1iuy of the Western Pacific High Commission, with amazing good natuFe and tact, has Deen able to eonciJiate the vaFious [sla-ned administrations and settle their edilfeFences. His most notable achievement has been to ineduee them a-l!l to join in the supp>ort of a eentraJ lep>er Golony at Mokogai, 'Fiji. His latest proposed devdopment is a Western Pacific Heahh Serv;ice for the entire South Seas, in whioh a system of promotion my meFit w,iJ!l spur. ~hite health oflkeFs to ambition thFough the knowleedge that they will have an opportunity to advance fFom remote posts to mOFe aeci:ve ones. When the Central Medical Sehooi was first startea no more than a thFee-year COUFse f0r training meedic:al proctiti0neFs was wntemplated. Althoug'll. ] already haa gr-eat faith in t he menta~ eapaeity of the Polynesians, even I was astounded at the facility with whiGh the students forgeed aheaed. Nor- was it mel'e Fote 1earning whiGh wowed enable them to pass examinations; it bec:ame obvious they weFe entitled to further eedueation, aned the three-year COUFSe was ltmgtheneed to four, in preparation for turning out Fegu~arly I!!uaiifieed physicians. 11he most striking aspect of the school was the spirit of vitality which inÂŁuseed it, and the eageFness fOF leaFning eviedent in every class374


PA:RAS1!l'ES IlJOS!F AND PARASI'DES REGAINED Feom. iLn the course of one of my routine inspections, the Professor of Anatomy suggested, "Would you like to ask any question?" I feared that, according to the time-honored custom, some prize pupil had been groomed to impress the visiting examiner. "May I ask anyone I wish?" "Oh, yes, anyene." I looked aFound and selected a student whom I was sure could not have b_een a brilliant Samoan strategically placed for my attennien, ancll<equestecd him te cdesCFibe the bra€hial plexus. To his query, "'Weuld yeu mind if I demonstrated on the blackboard because I can cde it better in that way?" I saicd ef course not. He thereupon took up, some red, blue, ancd white crayons, and made a drawing superior te any such extemporaneous art I had ever seen, all the while commenting fluently on the complicated nerve network. Fortunately, I had been handed a textbook, or I should have been completely lost in trying to follow him. The practitioners from the School went back to their native villages dressed in the tribal style except for the formal addition of a Geat, so indivisible from the idea of British caste. But they were thinking along new lines, and bearing nee-salvarsan and hookworm demons1iI:atien paraphernalia. Their health prepaganda, so enthusiastically supported oy the peeple, breught abeut a larger percentage of latrine instalilations and use than any other country has achieved in a similar space of time. Depopulation stopped where health work was well established, and the numbers of Polynesial).s and ' Melanesians in the South Seas, with the intreduction of modern preventive medicine, are apparently increasing year by year. Our task was not finished when we graduated medical practitioners; we had to make sure no slip-up sheuld occur after they had been back in their own environment for some time. It was inconceivable that yeung men, straight from their grass-roofed huts, bred to the terrors - e£ spelJs and charms, and with only a relatively slight amount of mining, would no~ oGcasional1y sink back to the level of the community. iEven in the classroom the face of every Fijian student became like a €arVen image when ndr;aunikau was mentioned. Not one of them 375


PARASrn'FES LOST ANID FARAS[TES REGAiNED annoy. Befere the rebel!lion they had, to a great extent, used latrines but, because the New Zealand Health Department approved this pmctice, they promptly abandoned it, and, in derision, even polluted the door-steps of the officials. On the whole New Zealand was lavish with money and attention, and usem force only to assert her sovereignty. But finally, her patience near exhaustion, she withcrew the medical practitioners, and in Femote districts closea hospitals and dispensaries. At the time of my ÂĽisit with Dr. Lambevt, the people in some rural areas had had only ner'ba:Lists en whem te depend, and many sick weFe brought to us for eUF ministrations. [ interviewed many of the chiefs. The most powerful among them was Fau Mui Na, weighing thne hundred and nine pounds, fisherman and philosopher. It was said that but for his intervention, the Europeans in Apia would have been wiped out at the beginning of the Mau movement. I also met Mataafa, a descendant of the former iKing of that name, who had been educated for the priesthood and spoke beautiful English, German, and French. H is daughters entertained us with sitting, knee, and standing dances. Near F oa (pronouncem, "Fona," because the early missionaries' printing eutfits had been mefieient in certain letters) we had an impe~tant public meeting with thir~y-fo1!lr chiefs and orators. At times it [eoked as theugh we might IDeeome involved in Island politics, but finatlly we made them unclerstancd that in all civilized countries neutFality exists in medical affairs; even between peop'le who are at war. The Samoans were afllicted with much illness. Filariasis was common there as elsewhere in the South Seas. Blindness, due to ophthalmia and also trachoma, was frequent. But out of the population of fiEty thousand only twelve insane were in confinement, and no others weFe known that required restraint. This may have been due to the absenee of syphilis, wh,ich in turn was due to the high incidence of _yaws; we conducted three successive campaigns in Samoa for the treatment of yaws. Yaws is a hOl'rible disease, but it has this virtue that te its presence may be due the absence ef syphilis, which commenJy makes its appearanGe with the white man's advent. Samea impressed me primariiy as being a land of unfinished dlurches. Every one of seven villages had one or more, usually con377


1r':ARASrnTES [,OS1' ANTI) PAiRASIlFES REGAINED saw to it that she remained a virgin until the chief decided the time had come for a p!olitical union with a neighboring tribe and a new taupo took her place. vVhen she slept, four women surrounded her, one at either side, one at her head and one at her feet. She was the centel' of all life in the c0mmunity-entertained visitors and officiated at the mixing of the kava. Kava, the universall South Sea drink, might be considered semisaered; two people never met for wnversation without the bowl betlWeen them, and no welcome was complete without it. The degFee 0f ee.em0nial va.ied with the imp0~tance of the occasion. Any visitor who could not play his part in the highly formalized and set ritual was branded as a ba~ba:rian. The government encouraged kava beâ&#x201A;Źause its elaborate preparation fulfilled all convivial needs without the inebriating eHects of alcohol. In my experience every Oriental G0untry had indulged in a native alcohol made from cocoanut, sugar, or rice. The absence of SUGh a beverage among the South Sea Islanders must have had a profound influence upon their history, and especially their sex life. At the fiFst ,kava ceremony 1 attended, the taupo placed a small fluantity of the pounded, shreaded, and dried root of the piper methystioum into a huge iFon sugar kettle, added a little water, then sW00shea the sp,ongy mass up and down time after time, wringing it out as th0ugh it weFe [aundry ami tossing it aside for her helpers to shake. With this ana new root constantly added, the process was Fepeated again and again until the kava reached the proper strength. The serving of the kava was tremendously important. The taupo filled a half cocoanut shell and handed it to the cupbearer who, gorgeously arrayed, taking so many steps this way and so many steps that, finally, with a deep bow and a genuflection, presented it to the guest of honor. Before 1 put it to my lips, 1 spilled a few propitiatory drops on the ground. This libation stamped me as someone who - was familiar with local eustoms, and won appro~al. As 1 drank the kava, which had a flavor reminiscent of root beer, everybody sang and clapped. In some vihlages etiquette demanded that each gulp sh0uld be attuned to the ,rhythmic beat of hand on hand and I was G0nsci0us that my Adam's apple was the focus of attention. When I

379


AN AMlER[GAN !DOCTOR'S) OE>YS$EY ha~

drained the €Up, I sent it spinning with a twist of the wrist into the center 0£ the fale. Not unfi,l it st0,pped its gyFations diel the €Upmea.FeF pick it uJ!> and J!>Fesent it to llhe tawpe f0r r.efi!l.!1ing. Simuftane0usly wi~h the kava pFeparati0n, sp(;laK:ing was going fol'ward. Sam0ans l00k up0n 0Fat0ry as an art f0r which there should be specia!l training, and, unlike ourselves, they endeav0r to discourage amateurs born engaging in afteF ainner speeches. The position 0f triba~ orat0F is hereditary, ana he is next in crank to the chief. [n S0me wlaCies he is prime ministeF; in others he is m0l'e J!>ew:erful than the chid himselt j)i nevel' hea.Fa the R0cke{eJllel' F>0unaation aCidaimet;!! in su€h glowing terms as a great humanital'ian force which exercised its beneficence in the furtherm0st l'eGesses of the g100e, even extcmtding te this poor little island. I must admit I was flattered to hear extelled so eloCijuentJ.¥ virtues [ had neyer before kll<'n'>'n iI p!!lssessetd. Where the el'a.t0r had: obtainea the r0mantic St0ry of m¥ past j)i de net knew, mut even me!le amalLing was his dis0l'iminatory use of the !English langl:lage. I was n0 such master of my native tongue. I was contemplating with dismay the pr0spect of having to reply in kina, 0F at least t;ry to ellipiain g'Faeefully away my eloGUtionary shortGemings, when my aJ!>J!>l1ehensiens iWeFe a1Ilayed, by being infel'me~ that anotheF eFaf0r weu!l~ take my plaee. My m0utlipieGe repiied to tfie praise of the RocR:efel!ler F0unaati0n with praise of the virtues of the tribal chief ana his queen in wel!l-r0untdea, beautiful phrnses such as I could never have uHerea. The w0Fds of the virtuoso spadcled so entertainingly that the ohief's speaker was spurFetd to emuiatien. 'Fort.unately, the G0mpetition dia net bee0me S0 keen as a.t ,some kava eer.em0nies iW,h ere these veEbail tourneys sometimes took homs. After the kava €UP had pr0€eeaed down the Me in stri0t 0F(ier 0f rank, and abter the last oration had been made, the danGes began, enaless in their variety. Both men and women engagea in these" although they l'areIy t0uehed eaeh 0thel', usual!ly sitting Gr0ssJleggea, twisting ~heir b0aies ana al'ms, swaying te the aee!!lmpa,n iment 0f strings ancil drums, sometimes m0ying si[enttl:y, sometimes singing mel0dies 0f surpassing beauty basea on hymns leal'ned from the missionaFies, an~ more poignant even than those of our 0wn South. At evening enter380


FARAS[,[,ES LOST AND PARASITES' REGAINED t~inments

fihe a~n€es often €ontinuea fr,om nine unti~ four in the mor-ning. 1!he speetators at this late hour were exhausted, but the performers wouled have kept on with unabated zest as long as any audience remained. ':I1he missionaries have discouraged many native dances. The hula is seen no mOFe either in Samoa or Fiji, although it is beginning to reappear in the Cook Islands, where the government has not discouraged it. iln [F,iji, as in Samoa, I was able to visit many of the remote islands. l'he Governor kintdlly lent us his yacht, the Adi Beti. The friendly Fijian people also expressed by ritual and symbolism the courtesy which was part of their daily Jives. As soon as the native canoes drew wibhin hailing distance of the yacht, a gFeat shout of "Sabuaf" (sambu'la~ would greet us. We would call back the correct reply of "Molif" which meant literahly "orange juice," or, "your words are sweeter than oranges." Then would follow the impressive ceremony of pr.esenting the whale tooth tabua (tambua), a compliment bestowelilJ upon those whom the Fijians esteem their friends. The original tabuas were of wood, and probably had some phallic significance. Their exchange was an affair among chiefs, and acceptance obligated the l'ecipient to grant any request the donor might choose to make. I1he wh2[ers haa left in their wake the teeth of the great cetaceans, and the bulk of the -tabuas in use today still date from the days of Moby Dick. Any additions to the Boating supply have to be gleaned from dead whales washed up on the beach. Tlhe Fio,ians also had their kava ceremony which they c~lled yarl0na (yanggona). This was herd in the mbure, or assemblage place, but in F.iji each person had to make his own speeches, with the aid of an interpreter if necessary. Here, too, we were entertained afterwanas. ] remember in particubr one occasion at Masi, where Nitavua, chief of the Curomoce tribe of firewalkers, set before us an elaborate - repast of five kinds of root vegetables, excellent crabs, shrimp, duck, €hicken, roast pig, and oysters. But even the yaqona and the feast died not satisfy Nit~Vua's sense of hospjtality. He arranged a firewalking ceremony for our benefit. The secret of firewalking, supposedly the exclusive property of this tribe, had been handed down for many generations. It seems that

38r


AN AMERKAN VOCTOR'$ Q1Jd>YSSEY onGe, manY' years ago, a ratu, OF ehief, caugh~ a deviJ devil in the form ef an ~d. l1he de\!ill cleViil began to tempt the ratu in exefiange f0l; I\.is £nee<irem. "I'll make yeu the richest man in the Islan<il," it pFornisecl. "]'m ahea<ily the richest man." "I'M make you the biggest chief." "I'm alreacly the biggest chief." "['~I get Y0U the most beautiful women." ,, ~ lila'Ve ~hem ab ea<!L¥." FinruJily the dev,il <ilevi~ saicil, "I'M c0nfer upon you the ability to wa!Ik thr0ugh fire with0ut fueing hurt." 'ili'he e.xtF~me form 0f punishment among thB Fijians was to <ilrive an un,f ortunate victim through hot pits S0 that he diecl, ancil th~ promise 0f immunity from this t0rture wa~ pow,eFful enough to win the ratu. ']1he d1eviil devi!! whisp,erecl the seer.et to I;\'~m., r-eeei,y,i ng ,fu;~e<ilom in 17eturn, and t;heFeaker rthe inil'iates eouM walk unharmed thr0ugh fire. ]n p17ewar-ati0n for 0ur a!1ri'Val at Masi a fire hacl fueen kept burning for days in a pit some foUF feet deep and fifteen feet in diameter; the byer of limestone b0ulders afu0ve ancl beI0w hacl become red N0t. lEven a,ftel' aU the emfuers were mked out and the stones haG! pale<il to {!ir.ey, tliley st;i!!I] liadiate~ sueh intense heat as to set fiFe to the cl0thes ef anY0ne wh0 st00d 1'00 near the ~<ilge 0f tne Fit. :fust fuefore the fiFewaiking was to take piace, [ tied a f0l<ilecl handkeFchief 0ver the en<il of a long pole an<il touched afuout a dozen stones, one after the other, with the weignt and speecd whi~h I estimated wClUld approximate that of a man wa;lk;ing Cljuicklly an<il lightiy over tliem. At a gi;v:en signa~ aID0ut a <il0zerr fuaref00t GUF0mOGe IFushecl int0 the pit am! stewpe~ ropiG!ll y aCF0SS its d1iametel'. i[ was amMle<il to fined when they emel'ged fl'om the pit t;nat them feet gave n0 evi<ilenee of burning 01' 17ed<ilening. My han<ilkerGhief also, a.fteF being washecl dean of soot, sh0wecl n0 evi<ilenee of haViing fueen fuurnecil 0r even s€0FGned. One el<Ji>lanation, t&0ugh it &0eS n0t <iluit~ satisfy me, was that eaGh Fer,f0r-mel' €uF~ed his feet to ~0rm an insu!lat;ing air cup. :i3e'j10Fe this C0till:~ liie heate<il to an int0feFab1e tempeFatuFe, he haid stepped to an0theF stone.


P:AMS~'F!E$

]LOST ANID PARA$[,],ES

REGA~NE])

A.s S00n as the ~ast man was 0ut 0f the pit, massawe, a sugary vine, and eanth, were thr0wn in to make a bed on which taro and yams were left to bake for several hours. WAile one of the firewalkers was arr-anging the tubers, the heat was still so intense as to set his grass sIGr,t 0n fire, and rapid action had to be taken to save him fr0m burning. I sometimes found it difficult to reconcile the friendly hospitality and g00d fellowship of the Fijians whom I encountered with the tailes of their former Gruel practices. Heavy war canoes, sometimes a hunclrea feet long, were for good luck launched over the live bodies of men used as rollers. It was also the custom to put a live slave in each posthole of a chief's house before setting in the post. Far' from 0bjeoting to this sacrifice, the slaves esteemed it a great honor; they w0u'lcll aSk to be S0 buried and grasped the post with both hands as it was put on top of them, thus assuring their future happiness. . The Fijian habit of which everyone has heard was cannibalism; a pr.is0m:r was thr,0wn i~to an '0ven simibr to but larger than that used f0r firewalking. Cannibalism, shocking as it 1S, served two purposes for the Islanders. It prevented the spl'ead of disease, because the inhabitants of one village never dared stray far beyond their own Dounaaries, and it aJso satisfied a meat hunger. In the back countries tnere was no game, and sea food was carried up with much effort. "Ehis d0es not explain cannibalism on the seacoast, where fish were abundant. Long before we were acquainted with vitamins, the Islanders knew the value of fish livers. ]n the ola aays the ratu used to ha",e ,his pris0ners brought out early in the morning for an inspection, to see on which he and his wa!'riors would dine that day. Eating human flesh was a ceremony -the heart for courage, the liver for wisdom, the genitals for virility. A prisoner's on[y ohance to escape being roasted was to sneeze, because thereby he showed himself lacking in fortitude, and no selfrespecting cannibal would eat any but a brave man. "I will give you me," the chie.f would scolmfully say, and the prisoner would humbly vepi}', "MoN." But after this cravelil action he could never for the rest 0f his days associate with his fellows. Cannibalism is supposed to be extinct in the South Seas, but oc-

383


PARASUES LOST AND PARASITES REGAINED that trilJe again made war on them, they would capture a man and eat him-net feF food, but as an extreme ferm of punishment. Then the missienaries came aleng. The chief haed not invited them anâ&#x201A;Ź! haa net been at aJil interested in what they had to offer. But the missionaries would not go away, even though he kept asking them to depart. Finally, the tribe had to eat a few to make them undetstaned they were not wanted. The old gentleman assured me earnestly aned with eonviction in his eye it was no pleasure to eat the missionaries; he feund them e~tFemely tough.


¡ FISM S'f.ORIES

sameI' winged fish leap, skim, and dive. My cabin was close to the water, and We elecwic light by which I read shone out over the waves. M'any times these cold and clammy visitors from the deep would ~ome shoating on ta my bed. I wauld revenge myself for the shock by sending them to the galley, and the next morning would enjoy a tasty fish breakfast. In the eal'ly dars in the Philippines Governor General Forbes was an enthusiastic fisherman, and I learned about fishing from him. llfiel'e w.eFe no bright tFol1ing spoons then, and, although we fished inaustriously, we caught comparatively little. Governor Forbes later bl'ought out the first modern trolling outfit, and most of us soon had similar ones. Immediately we began pulling in the most beautiful fish-tremendous fighting pompano which grew in Island waters to eighty paunas, Spanish mackerel, bonito, barracuda, and the lapu [apu, a species af gFauper blue with red dots, or bright red w.ith Mue aots. @ovellflor Forbes, who displayed the same vim and energy in his piay as in his wovk, had a neat trim boat built with a square stern in ol'der to have free play with the rods. I remember once in clear; deep water, when Governor Forbes had a good stl'ike, I looked over the side and said, 'eyou've hooked a sea bass." !Me also¡ leaned over, and I'eplied, "You're wrong, that's a red snapper." I peered more intently, "It's a sea bass or I never saw one." Meanwhile he was slowly reeling in his tackle, and when it came to We surface, we looked triumphantly at one another. One hook had a sea bass and the other a red snapper. lI!n the course of my inter-island voyages I had discovered many goad fishing waters, and was able to introduce General Wood to them. One morning in 1924 we were cruising off Apo Reef on the West Coast of Mmdoro. After a fairly good morning, a lull came. F'inally the General's line began to run out slowly. I sank back on the cushions, sayiI1g, "Geneml, it's ,hardly worth drawing in. That can't lbe mu~h of a fish. Thel'e isn't enough pul'! to it." "Gh, ![ dan't know. It may be a long thin one swimming toward us," he I'eplied defensively, "and that's why it doesn't offer much resistance."


388


FISM STORIES !£1he £eubli Sea Islanders had perfeoted methods of catching fish whien sur,passed an~hing develeped by Westerners. "You think yeu i.IlmeviGans are spertsmen," they would say te me. "You don't even know what seFt ef fish you're going to catch. We're choice in our tastes. We like eruly certain kinds." The young men proved their contention unmistakably by showing me how they did it. In the late afternoon several of us would paddle tewaFd the neef. When fish were seen swimming below, one of the yeutihs w0u!cd put 0n water geggles, which fitted tightly into the eye s0ckets antW fastened with a sbl'0ng cerd around his head. With clear underwater vision thus assuFed, he would dive over the side and glide so quietly down among the fish that they did not seem to be· Gome alarmed. The water was translucent, and I could readily watch £r:em tne side of the canoe what was going on. The Islander would select ~ ~i&ely fish and, stroking it gently on the belly, gradually wOl'k his hanc!l t0waFd its head. Then, with a quick movement, he would sEp a finger into its gills and bring his prize to the surface. If it met appr:oval, it w0uld be hauled in; if not, he would descend again for an0ther. The less skilled' fishermen used a pole witli a barbed end on whiGh the fish was hooked. Geing fishing for bonito in Samoa with Chief Fau Mui Na was a pieas3int eJqlel'ience. We padd!led 0ull in his specia1 bonito canoe, built sburdNy to hold his enormeus weight. He was very proud of it; the woedwerk was all lashed, and the joints were sealed with lead and tar. Fore and aft it was decked over, and raised pegs indicated his rank as ehief. The paddles were heirlooms from his grandfather. He brel!led for b0nito from a flexible bamboo pole set upright in the eanoe, and used a baFbless h0ek 0f tortoise shell tied to a piece of mobher 0f pearL While at Beqa (Bengga) I saw an entire Fijian c~mmunity join in their remar:kable fish dive. At low tide, when about a foot of water covered the selected mile-long reef, a party of fifteen was stationed at each end. All were spaced equally across the reef along a vine n0pe, tied tegether, which must have been a haH mile in length. GFaduaMy trhe two parties approached one another, each man helding trhe vine with one hand and beating the bottom with a pole as he moved forward. Curiously enough, the fish, which were swarming in

389


AN AMERICAN DOCTOR'S OI:>YSSEY with the rising tide, never attempted to eSC!pe under the slack vine. By, the end of abJOut two hours of this slow motion, the gap between nne two lilanties had eecome no mOl'e than a few nundned yanllls aGllOss. A!bout a hundrelll more vil1lagers now trushed in ami grabbing the vine with snouts and laughter, helped to herlll the fish toward the V-shaped apeFtune which was being formed and where others weFe holding a huge net in readiness. By this time the waten ha<d Gome up aJmost to ~he shouldeFs ot tlie p>artiGipants, wno whoopelll ana danced anllleeat the surface with their !DaddIes until ~Iie ~eap>ing, "nurning fish weFe dni:ven into the net. Then still others sailed a boat to the outer eedge of the reef, and the net was heaved on board, ladefi with a ton of finny prizes. Each islaned group in the South Seas has its own fishing customs. In Papua nets of tremendous strength are maede trom the webs of giant spieders, whicn indefatiga:M~ spin their geometriltal pattems Irom tFee to tree. !JiIhe Santa Crueians use spillier welbs in an even stranger manner. Out of cocoanut fronds they construct an octagonal. kite, the tail of which serves as a fish line. The lure is merely a mass of cobweb, wailing along the water. When the garfish leaps for it, he entangles his recurveed teeth inextriltably in the sticky suestance aned is easi~\y tretrieveed. illn AustraJ1ia tne fishermen of the Great !Bar,rier R!ee~ use edynamite in a special way. Clr.dinarily the detonation burst.s the blaedlller of the fish so that tney sink aned must be gathered up by diÂĽing. But the bright Antipoedeans have ediscovereed that if the dynamite is plaGed near tree coral, this phenomenon apparently edoes not take plaGe, aned the stunned fish float on the surface. llne C:ook lslands ar.e great [umps of coral into whieh the eebing aned flowing tillies have eaten Gaverns, ami! there the snarks, replete with fooed, love to lie. But the semi-amphibian natives are e"lua:LJ:y familiar with these lagoons aned know also the favorite resting places of the somnolent sharks. A Cook Islander, aCGorllling to report, wiJl diiVe until he finds one tIiat pleases him, and tIien "talk to it." Wis right han<d str,oKes its thl'oat w,l'ii[e his [eft, with forgiiVa1>le dupiicity, slips a noose around the eo&y of the gFeat fish, 'Wihieh is tnen hauled, ignominiously, tail first to the sunface. 'It is also said that an oM woman in Samoa was on even gl'eater terms of familiarity with sha17ks.

390


'FISH STORIES She would stand on the foreshore and call until the vicious b~utes came siiently to her. F,ishing fOF shar-ks is great sFJort as long as the fisherman himself is not the bait. ]n 1923 I was insFJecting health progress in Central A\merica where there were no roads from one Gountry to another ami, as yet, no airplane service. Because the capitals of these countries are all far inland, I had to make the long journey around by sea. "Dhe hot, humid, and dusty journey from Guatemala City to San jose was espeoially tedious and tFying. I left at sioc in the morning, and it was not until late afterneon that I arrived at San Jose. From my hotel window I could see the gentle swell of the broad, empty Pacific purling on a fine sandy beach. The cool-looking water was so alluring that I changed quickly into my bathing suit and hurried down to the deserted pier. As I gatheFed speed for a Funning jump off the end, I was faintly Gonscious of shouts and yells behind me, but the water called me irresistibly, and I dived in. I swam slowly and steadily until I began to tire, and then Folled lazily over. My gaze was idly wandering when it was suddenly arrested by the pierhead, which had miraculously become black with FJeople. Faint cries of "Tiburon! Tibttron!" Game to my ears. Almost at the same momen~ huge, dim shapes loomed through the Grystal-clear sea. The water seemed suddenly icy. I was entirely surrounded by enormous sharks, their yellow-green eyes all fixed unwinkingly upon me. My first startled impulse was to frighten them away by splashing and making a noise; but my Feason checked this rash action. I had swum out leisurely with l'ong, steady strokes, never moving fast. l1he shar-ks had not yet attaoked me, and perhaps would not so long as I made no violent move. I resumed, therefore, my studied, rhythmic motion, turning quietly toward shore. Playfully the sharks swung around with me. Occasionally one would come so close that I Gould almost feel the clammy brush of his tail, and imagined I could see the ominous white of his be~ly. Nobody who has not looked into the cold, glassy eye of a shark swimming beside him in the water can ever realize what a horrible experience it was. I began the leng swim back, the longest swim, I believed, that 39 1


AN .AMERiJ1(/AN DOCTOR'S ODYSSEY anybody ever had, and, stroke for stroke, the sharks kept pace with me. I steelea my muscles to their aeliberate mechaniGal task. UsiIlg a side stroke I swam like a slew-motian picture., with harilly a ripple or splash. After what seemed haul's, I was eft the end af the pier, aned llauM see the aganized e~pressians a£ the peaple, who weFe momentarily eX[llecting ta see me edevoul'eed. But when Jj reached the little iran laader I died nat obey my impu!lse ta leap far it. I graspeed aRe rung cautiaus1y. Nathing haBpenea. 'itfien [ H,t ted the other hanlil w,itn eCijua~ <delioeratian. ID put ane faat an the iaed<der. StiH nothing nappen ea. }\\nother foat. iNothing. Once £Fee af tne water i sWaFmeed up the laededeF withaut pausing ta wave farewell to my late Gampanions. Not until then had 1 edareiil to take a fulil-sized breath. The next eday the steamer I was to take came into the harbar and anGhored just where I haa met the sharks. The sailors bega,n fishing for them with salt p0rk. As soan as one was hookeed, they let down aver the line a Fape with a noose on its ened, aned eased it a,l ang until it Feadhed the shal'k's tail. '["hen they tighteneed it suclldenly, sa that the sha-vk was firmlly Gaught, and! the ship's wineh CloulGt lift nirn. {)ne a£ \ihe snal'ks weighelil mal'e t'ha-n a tan, aned eould na,ve sWail!1aw.eed me easiJ:y, with Faam to spaFe. I was tnank£u] aver my eseape., but puzz'led as to why 'Ii had n0t been attackecl. Later when I became aGCijtlainteed with !Fau Mui Na [ toM him that I had heared 0f his eJqJertfiess in lassoing sharks, and I askeed him whether he would show me haw he rued it. "We'll go out this very afternaon," he promised. Aecordingly, we embarkeed fF0m his private fishing island in a pr.ecal'iously balanceed autriggel' Ganoe, aCGompanied by a mother ship. "We aon't GatGh aUF snar.ks with sa-It p0Fk ba-it," the ehief saiiil. "We r.erul1ly fish fOF the fun af it. Catching sha-l'ks willh ru ha0k isn't G0nsiedel'eed ~p0J;t.ing heFe. We use 0UF hands as ba-it." "Don't pe0ple ever lase thew hands!" "P,ractical'ly never." "How do you d0 it!"

39 2


FISH STORIES

"]i'11 show yclU." We paddled just outside a barrier reef. The chief put his hand in the water, and trailed it slowly. Soon a shark drifted up and moved as gradually after his hand. As the fish drew alongside the canoe, a noose was gently dropped be~ween it and the hand; the shark, unheeding, followed through. When the rope had passed back of the fust fin, it was cautiously pulled tight. If it were to slip over the tail, the shark would struggle and the boat might be upset. 11he moment the noose was taut, Fau Mui Na withdrew his fingers. "iLt's ill in knowing how," he said. "If you move your hand slowly, the sj1ark wiN also move slowly. If you move it quickly, off will â&#x201A;ŹOrne your hand." The shark was allowed to swim off lazily for about fifty yards, and then was eased around and pulled near the boat. A member of the crew was standing ready with a long-handled mallet, and, as it came within reach, stunned it. The line was then passed to the mother ship, and the great fish was hauled aboard. In two and a half hours we caught more than a dozen specimens, each from six to ten feet long. This exhibition may affoFd an explanation as to why I had escaped unscanhecd at San J0se. My instinct had been right, and slow-motion was Jjlrobably the secret. . The Feport has often been spreacd about that a South Sea Islander with no other weapon than a knife will engage a shark in submarine combat. Dr. Lambert made the offer of twenty-five dollars in many islands to anyone who would perform this feat. Even though such a sum of money represented a fair-sized fortune in those latitudes, no one volunteered. There has been much controvel'S}' as to whether sharks bite human beings. But Manley Beach at Sydney, Australia, has to be surreundecd with iron fences behind which swimmers are supposed to stay. Airplanes patrol the air aD0ve and, when a shark is sighted, an a.\ar,m is sounded and the bathers flee to safety. Even so the papers almost weekly carry stories ef Feokless people who have disregarded ~he waFnings and been mangled by sharks. In my hospital experience I fiave tFeated patients whose legs had. been bitten off by sharks. A crocodile may also bite off a man's leg,

393


AN AMERICAN DOCTOR'S QIDY3SEY but its €anine teeth tear ani!:l Grush; a shank's GUl'Vea razor-like teeth shear cleanly tfuough the bene, leaving an unmistakable manl!:. 1 was anxi@us to de my J!laFt in quashing tne fal!I:aey that snank:s de net bite human beings. 11 GoeksUFe iEng.lish magazine nad ieng offened a Feward to anybody whe weu!d sena in an authentic aCGeunt of a shark bite. :Ii watohed as the years went IDY, and no case apparently :was submitted; the reward was continued. FinaUy, I carefull.y photegFaphea a femur- shewing the easilly identifiable toethmar-ks, ana daimea the meney. M ¥ ~etteF was unaOlmowledgei!:l. 'I Wllete again" and, a£teF a ~hiFi!:l eommunicatllen, !r reaeived a netlla.e that the Feward had been withmrawn.

394


CHAPTER.. 23-

A GREAT LITTLE

PEOPLE

"WE

ARE spending seventy-five million yen a year on health," said the Japanese when, in 1924, they requested that a general survey be made. 'CWe are not accomplishing as good results as other countries in our class. Either it is useless to spend money on health, or we are not doing it in the right way. Every ministry has eeen instructed to receive you and give you all the information you want. We have provided you with an interpreter. Use him or not as you wish. Everything ~s wide open to you. We want to know what is wnmg.". By boat, by train, by motor, and by rickshaw I traveled up and down Japan in search of the difficulties. To ride in an automobile in Japan was a harrowing experience. The chauffeurs drove like mad through streets so narrow that pedestrians had to flatten themselves against the walls to avoid our headlong rush. From one end of the Archipelago to the other all roads were a moving mass of humanity, where no one seemed to give precedence, and bicycles and rickshaws and handcarts darted here and there, all in the greatest confusion. Every street was filled with color, sound, and motion. Smiling butterfly girls in gay kimonos clop-clopped on wooden getas over uneven pavements. From little handcarts or danger@usly swinging poles men soM their WaFes. The appearance of the landscape of the Island Empire was as fragile and delicate as a print by Sesshu. This country where every tillable acre was in cultivation, and where tillable acres were so few, 395


AN AMERTCAN D<5>CFOR'$ ODYSSEY presented an endless panerama ef meuntain aned va;lley, of cheFishea Miews ef sacred Fu~i¥ama, of ~he torii ef the lrulami Sea, ef red laequeF mriages €enne0~ing islet Woi~h islet, e£ aancing [ilali'er lantems ana g~i~teli\ing fineflies en meautiEul winaing streams, of giant [acy cryptome~ias, twistea awarf li'ines, ana gorgeous chtysanthe;:mums, of flowe;:ring cherry ana plum in the;: spring and blazing maples in the fa.l1. I founa the perfectien of ~his fOFmal fairylana, aesignea with SUGh vaFie~ ef €harm, naa bc:en sadly maHea since I had Jast sc:c:n it. line Fea<il! te the inGempaFa1iJle summer Fesemi en M1iyanoshita, se beautiful with its garaens ana pools, haa be;:e;:n almest cemplc:tely destreyea in the gFeat earthquake ef the year lDefore, and, after the rains, was little mOl'e than paste upon the sitiles of the precipitous slepes. Huge sliaes had stri[ilWc:d the steep meuntain ef its le0se 'V0lcanic materoia'l. 1Flk j0Ul'ney up along the road~ which was scarady wiae eneugh fer the car, Fe;:minae<il me 0f my ha.zaraous aays 'l'l'itih the ]tailian a~my in the IDolemites. In Japan, vehi€les foliow t·ne;: English fashi0n 0f driving 0n fihe left hand side of the road. Bc:aause we were cir€ling u[il the mountain on the left, we haa to take the;: outside whc:ne;:ve;:r we met vc:hiGle:s €Oming toward us. IDsualtLy we;: haa to mack cilewn the cUFVing aangepeus peaa to a; plaee whieh we he[ilea weuld ~e;: wiae e;:n0ugh !li0F passage;:. i13(:dow us was a gorge thousanas ef fc:e:t dc:ep, ana en the;: inner siae;: of ~he;: roaa a big, he;:avy oxcart that at any moment might te[il[ille us ove:r the mrink as it g.ound [ilondeFously past. In the towns the cem[illeteness of the dc:meliti0n by earthquake: ana fire was much greater tnan anything ]j haa anticipatea. In ene;: e[ilen square at Y ekeRama; ~he fl@c:ing inhamitants had! s0ught Fe;:rugc:, dragging the;:ir nousel\ora ge0ds with them. But spa.rks haa fal!len on the bedaing ana, in the resu'ltant €onflagrat.ien, fifteen hunclte;:a peo[ille haa aied. I sadJy viewed the ruins, wh@re I coula find ne vestige 0f the homes in which "1 had meen so many ~imes lavishly enter;tainea, ana f0r a~l my searching could not tFace my fOFm@F hests. My fl'iends hacl disapwearea and nebeGly Imew what haa De;:€Orne ef tlhem. Nine menths a.fter the SneGK, Yekehama was stM as depr@ssing as the waste;: lanas of the Jonnstown flood, er the vicinity of Arr.as

39 6


a.iftllF ~ne GeFma.n Demmarament. Twistlld ' iren, briek, ane neniruIarnmable memnis w.ere pilee high. ®nliY a few ef the street.. hae mllen sl\.ovellee c;:I'llan. , ~t ,];ekye, eni!!, sllventeen miles a.way, the eamage had also been GensiGllrabie. Only properly erected, ' reinforeed concrete buiMings !lam wi~hsteea fhe shecks and thll fire. The escape of tl\.e [mperial iWotd, that fantastic structure eesignea by !Frank Lleye Wright e£ Chicage, w!lese contract was said te have callee for making it Ilarthquakll proof, was mest astenishing. Its enormous size ane its immllnse, unsupl!'e~tee ceilings had marked it for destructien. 1);1hat it stooa intaot in the miast of fall1ing ruins was a great triumph £01' AmeniGan aesign anti! construction. lRd'Juilaing was going forwara rapialy, but well-informed foreign r-esidents tela me that the Japanese did not fully realize the farrllacl\ing finaneia!l dfect ef 1ilie tremendous aisaster, and that, haa tihey aenll se, the)! weule net hav:e centinued to create a baa impFessien by attllmpting te maneuver the fereign insurance companies, espeeiaUy thll British, inte paying fiFe lesses. Common opinion sllemea te be that the !Japanese, officia~ly ana privately, were tI"¥ing te Ilxpleit foulligneFs. In thll dIeIT to prevent them from owning [ana, tihe government was pFehibiting peFmanent reconstruction in the city' er port arllas, claiming time was needed to permit the earth to sllttJe befoFe maKing' a survey fer. a new town plan. Any Japanesll in a foreign ceuntry was apt to be a spy, usuaUy seI.f-appeinted. I was teM that the gevernment had received literally theusanas of unsolicited notebeeks and photographs made by its natiena!ls in ether countries. Examples of amateur spying had fre<l.ulln1liy eccurred in my Philippine Ilxperiences. Japanese fishermen, wl\.o l\aa v:irtual'ly cpntFolllld the inaustry around Manila, had surrll,ptitiously but meticulously soundecl the entire Bay, although the infenmation ceuM do their GeunWy ne possiblll good; for twenty-five cents a Geoaetic $urvey chant a£ these waters, scientifically accunatll in IlVIlI:}! eeta.il, might havll blllln purchasea by anybody. Apl!'a!7ently tl\.ll Japanese caula not believe the chants were accurate. "I'his was ne iselatlla instance. At another time a Filipina with a hlro\l;en leg l\aa I;;een canried te the nearllst d6ctor, whe happened to hie a !Japanese. But the "aooter," te everybedy's consternation, a.fter

397


A.N A.MERKAN DOC'['OR'S ODYSSEY fumbling D0r S0me time, ha~ fuiaJl1¥ Gon~essecl he diGi not h:we the fa,intest iaea n0w to set the oone. Mis aGimission haa na~ralNy been reporteGi to the Constabulary who, in searching his offiee, haGi founa, insteaGi of pills and instruments, plans of the United States Nava,l Station at Olongapo. BeGause 0f theiF €0unter fear that foreigners might ais€over thew military secrets amd thereby gain some f00thold in their country, the Japanese had enacted aN sorts of protective rules, including a pro¥ision that no foneign waFsnip might enter Tokyo . .fA week anter the eartnquake, n0wever, an A,meriean Na<val vessel, in defianGe 0£ regulations, is said to have steamed straight to the city and made fast to a government pier. The Japanese folded their hands; in a few hOUFS they expeetecl to see the AimeFiCian flag flying oveF Parliament '£;louse. But, to their 'IDewilGierment, insteaGi oli manning the guns, fhe miClGiies weFe panting and sweating over unloaaing I'ice, medicines, bandages, splints, even building materiah hastily des" patchei!l from Manila. 1ilhe ff apanese ~aeK:eGi a sjDoI'ting instinet in the Anglo-Saxon sense, and Gou1d not understand it in otners. We were among the first ujDon the SGcme with assistance, and they looked up0n our action with amazement; it was not only c0mpassi0n:ate but startlingly efficient. "How eou!h;t we hav.e been so mistaK:en?" they asked. "We ha(IT.e sent aId OUF young men to Germany to I)e eGiueated. 'What a biunder! :H we had trusted to AmeriCian ideas, what progress we should have made!" For. a short time theFeafter no countq' sto0d higher in Japanese estimation than the Ynited States; we were r-egaFded as tI;ue trienas, and Gould nave had anytning we wantea. §ajDan, ailways avid for ~earning, showed her admiration by deHeGting 'hundreds of her sru. dents to this country. We Febuffea tnis gesture with sGant GOUFtesy. By our JajDanese immigration ~egislation, Caiif0Fnia inspiFeGi, we immediately ancil loud[y proclaimed that no ffajDanese shoult1l enter the United States. Alth0ugh this pr0hibition did not include students, visit0rs, meFchants, or those wh0 weFe classed as temporary residents, the billl was r-egar,ded as a nati0nall aiFr,0nt. The g00®wiJIl wnieh l'iad €0me as a result of our gener0us action was lost almost overnight. Resentment ~inst AmeriGa was extFemely bitter in all "IuaFters. 39 8


A GREA1" LIU1.E PEOPLE 'Phe subject was an the lips of everyone in government cirGles with whom I talked. The American Ambassador, Cyrus Wood, in a conversation with me, stated that his previous relations with the government had been so pleasant that the merest suggestion on his part of a GOurse of action had been followed. This had been particularly helpful whenever Japan's actions to close the Open Door in China, in accordance with her Twenty-One Demands, had seemed inimical to the lJnited States. An Amer.ican adviser to the Ministry of Foreign Affairs, with wham I talked, was well qua1ified to interpret the Japanese point of view because he spent half his time in Tokyo and the other half in the Japanese Embassy at Washington. He told me that after the first unofficial intimation that an Exclusion Bill was under consideration, Prime Minister Hanihara had despatched a "grave consequences" note which Secretary of State Hughes had seen and with which he had apparently sympathized. Japan had been awaiting the negotiations customary to abrogating treaties, even one so nebulous as President Roosevelt's Gentlemen's Agreement by which, if we passed no Exclusion Act, Japan would prevent all emigration. The Japanese had kept the pact in spirit and in letter, but our passage of the Exclusion Act, though within our legall rights, had broken it in spirit. We last by oUr rash action. Had we put them on a quota, something like one hundred ana fiÂŁty could have entered the country legally, and we should have haa the aid of their government in its enforcement. But the moment the Gentlemen's Agreement was abrogated, they were under no obligation to keep their nationals from caming to the United States. It is more than likely that California is receiving more Japanese, via Mexico, since the Exclusion Act was passed than before. One morning when I was calling on Foreign Minister Shidehara, an intelligent gentleman wha had been educated in the United States, he lamented, "It's too bad this should have happened. I'm afraid public r.esentment is going ta last far years. If Washington had only let us know before taking this step we might have prepared our people, and it would have been so much better." "I don't see how that could have helped."

399


'A GREA'if U'fl"'LiE !l"EOFLI!l b0ardeed a tram alreatio/ well fiNed with J aflanese aned had haredly seated myself when the gentleman beside me rose, bowed, and with a sweep of his hand indicating the other passengers, asked coldly in English, "ShaH we leave the car at the next C0rner, or will you?" Since it was their country I replied, "If my presence is objection. able to you, l'llleave," and accordingly I alighted at the next corner. The intensity of feeling thus expressed eventually died down, but the hurt aned the slight remainea in the backs 0f the Japanese minds. ~0hn D. R0ckdeNer, ffr., ah~ays symflathized with the Japanese sen· sitiveness, ana, to show that aN Ameri~a did not feel hostile, he gave a milii0n dollars personally to rebuild their once fine library. They ac€eptea this gift, even though, I fear, they privately looked upon it with suspicion, lest some string might be attached to it. We might, for instance, try to impose an American style of architecture. Never· theless, the gift helped to create, in academic circles at least, a more favorable attitude toward the United States. The Rockefeller Foundation had no cause for personal complaint in making the survey; cooperation was complete and full. Every office was open, every request was granted, every record was avail· aIDie, even to the accounting systems. lt was hard to determine whether these apparentily 0flen facilities were being offered frankly 01' only as a means to an end. I sometimes gained the impression the ff apanese were "merely t0lerating the presence of our men in order to have their own trained. On alll my Japanese trips I took with me Dr. John B. Grant, Pro· fessor of Hygiene at the 1"eifling Union Medical College, an ex· tremely able young man wh0se popularity in China and Japan was unparalleled. He was one of the best administrators developed by the Rockefeller Foundation and was of inestimable aid on this survey. When Dr. Grant discovered what he took to be a discrepancy in the ifapanese accounts, the greatest distress was aroused. As I was going eut of the hotel one aay I noti€ed a truck unloading huge volumes b0rne by a staggering line of porters. The sight was, to say the least, unusual, aned in curiosity I foll0wea them, to find the tomes being aefl0sited in Dr. Grant's reom. Alth0ugh the Finance Department haed merely changed its fiscal year, it was going to prove that nothing haa been falsified. 401


AlN AM£'lU,CAN !mlOC1fOR'S O'IDYSSEY The Japanese aFe the most hospitable peaple in the worl&, and me as I have rarely been entertained elsewhere. I shall never forget my first dinner at the Maple Club, given by tht Japanese Cabinet, at whiGh Dr. Grant and I were the only Americans. Because I had been a bachelor for many years, a hale in my soek btlow the water line made little impFtssion upon me. But, sinee shoes are nO.t warn in Japanese hauses, such nonehalanee would not do; I had, as a pneeaution, pFavided myseli£ with aJ supply af new black silk soeks sa that [ would nave a new, pail' avai['able for eaeh function. For this pa,vtiowar dinner [ ganbe~ mystl,f in mo~ning dlothes, nht aG€eptfl& attiFe for evening weal' in Japan, ana one of my new paiFs of socKs. Thus confidently fontified ~ flntered dIe Emousine whieh had Deen sent for me. The ffapanese Fflaiize that the difficulties a strangflr flXperiences in any foreign Gountry are inereasea in theirs btcause he cannot even read the signs. 'Ilherefore they allways thoughtfully pravide means of wansportation. We arrivea a little before six. My shoes were whisked away but, instead of being GonduGtfld dil1ectly to the Feception Foom, ] was Ftgaled with the beauties of the Maple Club's rock garden, reputedly the finest in the €Ountry. ik was a pel'ftGt [ate attemoan in jiune, the hflight af the iris season, as the SUmmfll' months aFe chara0te~ioze~ in ff,apan. My gaide can&u<rtecll me mown wintding paths and over EttIe bFimgflS, anm past fel'n gr,attos where gald'fish tilVinlcled, F,ippling Etcle waterfalJls, shFubs, and flawering plants. !ffiverywhere bloomt& gOl'geaus iris, the most lovely I have ever seen, shading from purest whi~e to deepest purple. 'Posed here an(;} theFe amang the rocks weFe geisha girls in brilliantly embFoideFfld kimonos of the latest summer style. Feasting my eyes upon the attractions of the scene, animate and inanimate, I did not notice that the many steps if had takfln aJong 1lhis maze of gravel paths, taFruous as the dwarf tree trunks, had had tneiF effect upon my bail silk sodes. Not until I Feached the r;ecewtion Faam did I suddenly rea1ioze that ane af my toes was peeping sh¥ly farth. ~nstea& a£ bending over as was my w.ont in jawan, ~ dr:ew mysei'f up ta my fulJl neight, so that the shom; jiapanese witn whom] was eonversing would have to tilt tneir heacds up at me. By the use af this subterfuge, I trusted the aisgraceful €ondition of my toe might enttr~ained

402


A GREA'T UTILE PEOPLE escape unnoticea. ] carefully c0vered the exposure with my 0ther £00t, ana congratulated myse.J.f that nOBody had apparently FemaFkea it. A.fter a FOuna 0f courteous conversational exchanges, the paper d00rs were slipped aside, and we entered the dining room. I was unable to hide my foot discreetly under the table, because there was none. The seating was on the floor in the shape of a horseshoe, and I, as guest of honor, sat in the depth of the curve. I tried unsuccessfully to fola m¥ legs unaer me in the appro;ved fashi0n. I imagined I c0ula see d0tted lines from the guests' eyes focused upon me, ana then I noted with unbounded horror that there had been a hernia of the big toe and it had popped through the sock. Tightly constricted as it was, it had become as fiery red as the tail light of an autom0bile. I hastily concealed it under my leg, but try as I might it w0uld sl[p 0ut and the burning gazes were renewed. ff apanese ainners last a long time. A geisha sits bef0re each guest, entertaining him with song and sprightly talk; if he is English she speaks to him in his ·own langill!ge. Sometimes she drinks sake with him. As the waitresses patter in with each course, she prepares his fooa, and, realizing that taking a bird apart with chopsticks is no easy feat, she assists him. Between C0urses all the geishas join in a BaUet. But even the aelightful ~v,itticisms of my charming geisha failed to make me oblivious of my toe, and the sake in this instance proved no Lethe. For at least two hours I struggled with the recalcitrant digit, But when at last the dinner was over and the signal was given to rfse, another embarrassment was in store for me. At Japanese banquets h0t sake is a.lways ser.vea in tiny. pOFCeJain cups, and ~ourtesy aemanas that each diner approach the guests of the evening and with a pr0found b0w drink a cup of sake with them. Although this is not a particularly strong Grink, if there are forty diners the odds are heavily against the guests, and considerable alcohol is consumed. IDF. Grant, who was sitting some distance down the horseshoe, failed to Fise with tilie Fest of us. A h0~Fible thought struck me. Mr. R0ckefel!ler was the premier pr0hiBiti0nist of the world, and one of his officers was so drunk at a Japanese banquet that he could not rise to his feet! 403


AN AMERiCAN DOCTOR'S; ODYSSEY

;r aJiljil1l0a0hee ill:k Grant wita a firm "¥0u've g0t (0 get up!"

t;Fea~ and! whi~Jilerea severel;y,

He ~ooked up at me appealingly but made n0 eif0rt to rise. 1 t00k him by tIle arms ane Jiiited him, he sank JimWly back again to the £I00F. ilin even stemer U0nes il sai<il, "Y0u1ve simply g0t to stand up!" 1 li£ted him again; again he sank baCK. "Are Y0U drunk?" 1 demanded. "N 0!" he rejilliec;i indignantLy, "€ertainll¥ n0t!" "Then whr ed0n't Y0U stand uJil?" By this time our whispeFS had risen to audible tones and our Japanese hosts were hovering solicitously about. "1 can't. My ~egs are paFally-'Zea." ilimmeediateliy trfie Japanese bent 0ver him eoncernecilily, massageed his legs vigor0usly, and Grant was soon on his feet. Pr0bably my- wntorti0nary e£l'0rts to hiede my t0e haed allone been l1esp0nsiMe tor s~wing me tr.0m the same Gramps. 1 reallize<ii also that in my eif0rts to wnf0Fm to 1;he cust0ms 0t the €0untry r had erFeed 0n the siede of elegance. Therea£ter, at a[11 tuncti0ns, instead of silk s0cks 1 wore stout cotton ones similar to those with which the §apanese JilFoteeted themselves t1'0m such Jilre<ilicaments. Because 0t the universaJl p01iteness an~ wurtesy of the Japanese, many situations that might 0therwise have proved awkward were smoothed 0ver. C0urtesy is extended even to that strongholed of nudeness, the oust0ms service. illf a wst0ms 0fficer edis€Overed t0ba€c0 in my baggage, he w0u[c;l say with aJ b0w, "¥011 jilr0baMy w0n't neeed this in Japan. We'l!l keep it for Y0U and FetUFn it to Y0U when Y0U leave." kny attempt to bribe them would pr0bably be fo11oweed by a jail sentenGe. '['he honesty ot the Japanese public ser.vices G0ntrasts striKingly 'Minh €0nG!iti0ns elsewaeFe in the lEa·st. One of the nati0nai handicaps was the Japanese inability to leam foreign languages well. 1 sometimes founG! it extremely diffiGUlt to discourse with men who supp0sedly were eeducateed in English. German helpeGi me en0Fm0usly, Ij;jut, even S0, €0nveFsatiC!lll was edise,C!lnnected. ]t seemeed very edlffieUlt for fhem to grasp the spiFit C!lf a question, aned their abbreviated vocabularies weFe edisttessing. When

40 4


A GREAT LI'iITLE PEOPLE I came to mnaw them better, tlley would often confess their humiliation. A gFeat part of their bowing ana scraping was due to embarr.assment; it a!lso gave them time to formulate their answers. Another obstaole to mutual comprehension was the lack of a sense of humor as Americans understand it. Our oral fun-making was readi1y intelligible to the Chinese-which may in part account for the greater ease with which we get along together. But the Japanese found cause fOF laughter chieflÂĽ in the vulgar joke. ~he Jileople alte, nevertheless, at heart merry, and sometimes, to my own amusement also, played pranks upon me. In this country of sma1l people, nothing is built for tall men. The berths on the sleepers, some of which are compartment trains, are only five foot ten, and are, so narrow that when I lay on my side my doubled-up knees protruded. One hot night I had been twisting and bumping bhis way ana that in acute disGOmfort when a brilJiant idea struck me. I adopted the simple expedient of stretching out full length ana letting my feet stick through the window. With a sigh of relief ] sanK into deep slumber. I GO not know how long I had been thus happily occupied when I returned to consciousness with a convulsive start which jerked my feet back into my compartment. The train was no longer moving. To see who or what had so disrespectfully tickled my toes, I peered out, and found my window surrounded by a group of adult Japanese, convufsed with laughter, to whom my large, bare, white feet had proved an irresistible lure. Only a tall person knows what another tall person suffers. Heads aFe Mways being bumped undeF low <:ioorways, feet or shoulders pFowuae trom blankets. But in New York hotels, at least, his feet will not stick out. The 'Constitution of the State, due to the efforts of bhe Six Foot Association to alleviate his agonies, provides that no hotel bed shaN have a sheet shorter than eight feet. In my Eastern travels I was happiest in Java, where appurtenances are built to /it the taM Dutch; I was apt to beGOme stoop-shouldered in Japan. Tihe Japanese weFe very sensitive about their size. Newspaper Fepo~ters used to come daily to my hotel for a stpry. I had early aeveloped a method of si<:ietraclcing them. "Gentlemen," I would 'say,

40 5


AN AMERICAN DOCTOR'S ODYSSEY "Pm a guest ef the gevernment. Whatevel' yeu wish to know must be obtainelil £l'om officia.l SOUlrees." 'Fhis shlmting Iileviee weFke~ beautiWlIy; medkall offieials, ailways incl:ined te be jeaieus of eutside interference, weFe Iilisal'med because they reaIizelil [ was not trying to steal their. thunliler. After 1 had made my exwses to the reperters for some time, ene of them sailil, "Look here, we've been around day after day anlil you aiways ]lut us off. Come en new, give us at least one stery." "All] Fight," ~ said. "1 €an?t give yeu ene, but, if yeulH kee]l my name eat of it, I'M telJ.l yeu where Y0U can get one. Xi eu've a. sGientist here in Tekyo who has made a certain fish extract which possesses the propertY of stimulating growth tremenlilously. lihe children to wh0m he is giving it are growing larger and larger. If you see Dr. - - , he'U give yeu the Iiletaiis of his eKperiments." The nellit ffierning the st0ry of the magie grewth ]lewdel' a]l]l€ar€c;f in alJ.l '[,e~e n€wspapers. iE\€€ause this was suell. im]lol1tant m:ws fe the Japanese., the Asseciated P17ess and Reuter €eF>Fespenlilents pic;k€1il it up, ana, to give it more than local interest, sent it out over tp€ir wires under my name. When 1 reachelil the United States 1 found awaiting m€ bundles of newsPJa]ler dip]lings ana letters by the hunIilFeds fr.em littl€ shert ]lee]lie aM eve. the w0Fllil. 1fhe tenCl? ef t'he fatteF was, ,,~ saw in - - paper that yeu sa:i61 a j a]lanese had! invented a grewth pewder. 1 am five feet talJ.l. :Ii wa:nt to be six. Hew much of the powliler wouM I ha:ve te take te grow this extm fe0t? Hew much weuld it cost?" Th€ velume of letters was se great that it taxed the offi€e force €onsilileFabty te answer tht>lm anlil e*]l"ess my I'egrets at being unable to hdp. il! n€VeF saw a: story ]l€l'sist as a.0ng as ~hat of the magi€ growth jilOWa€r. Finaliy, it was ]lut into plate anlil syndicated throughout the worllil. My name was inextricab'ly linkelil with it, and hardly a voyage passed that somebody Iililil n0t ask fer further infermation about it. . The members of the JaJilanese ]lFesS are as ]lel'tinaciolls anlil I"e. seuFeeful as theil' bFothers ef the feurtih estate elsewheFe. One warm June meFning, wem out a:ntel' the leng night's tra:in vilil€ and the many courtesies tendered me, I steppelil e£l' the train at T ekyo to face a camera squad realily for action.

406


P.1 GREAl' LliITLB PEOPLE "'Have you seen Dr. Heiser?" one of the photographers asked me. "Oh, yes," I replied mendaciously. "He's just behind me on the tr.ain. He'N be off in a minute." I nad no desire to answer questions, and certainly not to pose for photographs, an ordeal which I have never faced with composure. 'Ii iWas hot anld tired, an<!l aspire<!l soleI}' to a refreshing bath. I betook myself quietly to the Hotel Imperial, and soon was merrily sloshing around in the sunken tub provided for captious foreigners. iN"o locks safeguaFd doors in Japan; the Japanese have never felt the need of them because, unlike Christians, they do not indulge in petty pilfering and have no sense of personal privacy. Having finished my bath, I walked unconcernedly toward the outer room, but just as I was framed in the doorway my startled glance fell upon several cameras in position. With one bound I knocked aside a hand, poised to set off the flash. "Even in J apan," I protested, " you wouldn't run a photograph like that-of a man without any clothes on." "Oh, no," one of them replied. ''We'd cut off the bottom and nobody would know the difference." 'Fhe pictUFe of a bald-hea<!led man in this decollete pleased me little more than the idea of the full-length nude. I had prevented a major catastrophe by my prompt action, but I was still unclothed, and there' is somet,hing about sueh a state that produces a distinct feeling of helplessness. In the ensuing argument I found myself at a great disadvantage. The photographers had been sent on an assignment, and were determined not to Feturn to their papers without pictures. Nevertheless, while keeping up my end of the controversy, I was slipping on a garment here and there, and, as my se1f<â&#x201A;Źonfi<!lence returned, my arguments increased relatively in potency. Once safe inside .my clothes, I was a match for them, and was able to persuade them to retire. Everything had to be done strictly according to rule in Japan; no <!leviation was allowed. At the smaller hotels in the interior the ritual of bathing was an experience to remember. Although the people were unbelievably clean, the result was accomplished by means of a little two-quart receptacle of water, not much bigger than a washbasin. But, because they suspected that the Anglo-Saxon might be up to his well-known trick of plunging, before he had washed himself,

407


#,;

@RiE.A1F UW[)El FiJil©'J?ILE

€empa,Fing their seheedu[eed aFFiv.aJ with the time-ta\;ile. AU waste metien was eliminatec!! in ioaeding ships OF f.Feight cal'S, aned the musGu[aF €eer.ainatien of the €e01ies, l'Ietwithstaneding their hanedicap in size, was aedmirable. 1E1he j apanese s'hewe<il the same efficieney in aU their operations outsiae the eounlil'iy. When I first went to Man0huria in I9I6, in the clays when it sti'l!l belonged te China, the Japanese-owned South Ma,nehurian Ra,ihead was the acme o£ perfectien, with beautiful l1eadbeed and American-type PuNman cars. The railr.oad had a, fine hesFitrul and maintained a, medieaL scheel. [ t is extraoFed'ina,ry te observe tha,t the Japanese are the only Orientails w;ho ha,ve been able to rise abeve their own self-s-atisfaction and ha'Ve" FurthermeFe, edisturbed the mass inertia of other Orientals wi1ili whem they have come in contact. iJin KeFea aise, which Japan was endeaver,ing. to pull up te Western stanedands, a goeed job had been edone from a machine standpoint, an<il much mOFe meney was being spent than was collecteed in revenues. Ener.meus pubIie woroks haa been undertaken, agriculture develeFled, sohools intf.eeductld, and h0spitals built. The Japanese died net seem faveFabl¥ disF0sed te the effo~ts of the missionaries, and hence taxea their Flr0petty heavily. Apparently in an effort to ease tnem 0Ut. entiFely, the Japanese would builed bigger and betteF hospitals ef their, ewn near missionary aisFlensaries, and thus greatly aiaea in elevating the stanedaFeds e£ medkal practice. Ln 1'9 I 6 Ji sa,w the boraer JTapanese town of Antung, planned along the best lines, with wiede streets and preper drainage, in the making, but it seemeCl! te Gause ne emulation in the Chinese town across the '¥3!lu River. Kerea was hilly and £ull of huge loose surface rocks. Even S0, the valleys were intensivelo/ culti'Vated, m0stly with rice. OXlm wene apFarent in laFge numbeFs, carrying great i0ads 0n their backs. '['he countrysiede was brewn and sere and heavy in frost. [ffiveryene was dFesseed in white c0tten cloth and this, in the pl'evailing tFeezing weather, gave me a, chilly sensation. The stiff, silly, MaoK n0Fsenarr. headgear worn by the iKoFeans to protect their topImets leekeed like silk hats severn~ sizes t00 small, and contrasteed gretesquely and startlingly with the whiteness ef their other 8etlJ.ing. iIin sFlite e£ the Japanese impFevements over Korean ancient cus4-0 9


AN

AM~RKAN

[[)OC11OR'S ODYSSEY

tems, the [<;eFeans weFe extFeme'1y l1es~ile to nheir everJoFds, an<ii eften assassinatea tnem. SUl\lervisien was S0 Figi<ii in K01'ea tnat tyFanniciae was practised mostly outside the Gountry. I 0nre happenea to be at G0vernment H0use in Singap0re when the present Mikaao, then Cr.ewn iPrince, was t0uring the Iilast. !We was namwaNy invitea to an official dinner, ana a guaFd of honor was sent to the pier to esC0rt him. Pifteen minutes bef0re the appointed dinner hour the telephone rang, and the request was ma€le that iclentieal arrangements f0F Iteceiving the P l'ince be ma<de at another pier, but to [eave tile fiFst guaFd 0£ non0r wneFe it was. @0vernment aides seurl'ie® around in mad haste, an<d a second guard 0f honor was made up and despatched. The hour eame an<d went with0ut a Prince. Twenty min" utes lateF he put in an appeamnce with fl0 guard at all. After Ills official guaFdians ha<d been satisfiea with their Gemplex pFeparations to throw 0if any possible assassins, they had sent him ashore in a sampan, an<d he arrive<d at G0veFnment House in a rickshaw. r ha<d an extr.emely interesting interv-iew with 'V:iscount Gete, formeF H0me Minister an<d gcmeFaJllo/ Fegal'aed as one 0£ ffapan's ablest statesmen. Me was a fine l00king old gentleman, with a goatee, and had charming, GOurtly manners. He was at first exceeclingly cautious, But in the enm my £tank treatment of the situati0n GaiNea fOFth an ellluai] £'rankness £rom him. Me gr:eahly <depiorea tilie Japanese tendency to analysis rather than to synthesis and admitted this tendency stood in the way of their pr0gress. He saia the japanese regarded! BurBank as being unseientific ami! 0nly successmrl aC0identaNy. Me himsefE e0nceded that But bank haa macle iml\lol'tant ciiscoveries <despite his erude metho<ds, an<d venturelll the belief that many of Amel'icals a0hievements were due to ner backing people who were following unpFovea "-hunohes" not verified by logical Feas0ning. I t0M Viscount @0t0 ] was [ear.ning man¥ things; japanese [aBOFatories, in b0th numBers and equipment, were a SOllFee of constant amazement to me, and weFe -superior to ours in their distribution. Goo<d bacteviologieal examinati0ns couM be maae in almost every ne0k anc;l C0FneF ef the country. !But ~ als0 p0inte<d 0Ut that Japan, on acc0unt of the moaern GiviJizati0n she ha<d a<doptea, ha<d gr-eatJy increase<d her health nazards, and if she were to keep heF place in the -sun she must avail herself 0f heaith control measures. She had 4~0


A GREAT LITTLE PEOPLE te take cognizance of her diseases caused by faulty nutrition and soil J!lolilution, and a,lso her. l'ising typheid and high infant mortality rates. The theFoughness of the Japanes'e was by no means extended ~o alii branches of mec.dicine. Curiously enough, dentistry was not held in high regard, because their German teachers had not believed in focal infections. The Japanese medical profession itself had the worst teeth I have ever seen. LeJ!lrosy was aJ!lparently on the wane, although only the most ad'lan€ea <lases, and these Felatively few in number, were segregated. llhese at laFge wer.e under the ever-watchful eye of the police, who saw to it they used o~ly their own utensils and did not come in close contact with well persons. The increased cost of living had caused more and more crowding and poorer diet in the homes of working people. The most seFious disease menace, ther.efore, was tuberculosis, which had fastened itself up@n the €ountry; the ineidence was atmest twice as high as in the United States or England, and the rates approached the worst slum centers of the world, Japanese soientists concerned themselves little with the practical applicatien @f existing knowledge. It was their constant dream to discover a sJ!lecific fer tuber€wesis or some other disease. In their zeall they·@tten made unreliable Feports. To prevent these reaching the outside world, a small committee in Tokyo took upon itself the task of suppressing them. I have never felt more strongly about what is being done in the name of pr.eventive medicine than after visiting a Japanese hospital. It was an arbitr-ary use of power in a futile endeavor to control things that w@uld never hapJ!len. Such force and insistence were pla€,ed upon non.essentials that as much effort was wasted in making the machinery run as though a hundred horsepower motor were hitched to a lawnmower.. Japanese hospital rules a~c.d regulations made any visitor feel bacteria were going t@ rise up and bite him. When I once visited a tuber.Gul@sis sanitarium, I was J!lut through a most amazing rite. Fir.st I was encasec.d in a pair of boats which carne to my hips, and then the regulation hospital gown, which was so short'on me that a pontion ef my booted legs was exposed. This caused the attendiug staff m,uch

4II


AN AMERKAN DOCTOR'S OIDYSSEY €enCeFn, rest seme pesslble inf€etien might make its way ~hrough the area n0e preteeted by the gown. Only after a gauze bee mask ana a hood haa been adjusted was I allowea to enter the pr€Sence of the pati€nts. On em€r.ging, i[ had te wacl!e thr0ugh a huge tank of IDichJeFia€ solution, after whiGh an attenaant, striving vainly en tiptoe to reach my threat with his atomizer, pulled up a little steplaader IDeside me, steod 0n it, ana €arefully sprayea my r€Spiratory Jilassages to kiM any pessilDle tuIDereJes whid'l might IDe ~ur,lGng ther.e. Finailly, [ was requested to gargle, and, feeling thoroughly Jilurifiea, I was allowecl to depart. In the cholera hospital, the wheels of the ambUlance whieh €arriecl! in the patienfs hal1l to Fun fhrough tr,oughs of disinfecting S0:J.Utien. The same type of rules haa IDeen imJilosecl in Korea during cholera epidemies. At the gateway to public buildings, herses and pe0ple were oID1iged to tFamp thr.CiJUgh similar solutiens, and, IDefere ;)jny letter couild 0e mai~ecl, ~fie Gerrespenedent haed to wash his nanas in a germieicl!al basin piaced by each mai'lbox. 'In the ~ight of moedeFn knowleclge their precautions were ridiculous. [n the applicati0n 0f maritime quarantine regulations the Japanese wer.e striot. When an A\meriGan Assistant Secretary e£ $tate was enee traveling in the East, he was put in lijuawntine, IDe€ause a case of plague haa occurred on his ship. In high edudgeon he cabled Washingten to get him out, J)ut tne Japanese hea1lth officers were adamant te rom r.epresentatiens. Me pretested inedignant1y that this was an unheara o£ numi~iatien. His hum0rless jaiJers, a eare£u] peopie, searehed the records and found that the King of Sweclen had onee IDeen in quarantine. Sinee reyalty ebvieusly outrankeed a mere Assistant Seeretary e£ State, tli.e latter eontmuecl to l'anguish until the inou0ation peri0a was 0ver. The German-trained men in charge of Japanese meedicine adhered to the procedure 0f the age of IDacterio10gy; they aeveloped kn0W 1eclge a10ng the Iines o£ K,ech, il"asteur, aned Lister, 0Ut haed an entire laGk 0f appreciatien 0t the nee<d to have it usea in the lives 0f the people. Shibas<!buro Kitasato was the 0utstanrung merucai scientist. 11he e0ncentration on bacteriolegy rather than heailth was largely clue to the pewer ef his pers0nro~ity anel abiEty. 412


AiEter K1tasate's memara!iJle aehievement in tr.:dfing <i!<;,wn the plague Iilaeil.!lus, he was [eaaecl with honoFs. But, unfartunately, far tne pnagness af rnedieine in Japan, he be€ame in:volvecl in ,a clispute with the ge:ver.nment, ancl resignecl inclignandy fFam his pasitian as heacl af the [mpe~i:l'l Institute for linfeetiaus IDiseases. NeveFthe~ess, his pFestige was so gneat that by p>ublie subsc~iption a labaratory was buih espeGiaHy fer him. Kitasato's a€ti0D. lecl ta a aisastrous schism in the meaical p>rofesSi0R. :We n0t an[y t00k: the maj0rity at his staff with him but also the [eaaeFs in baGteFi010gy, incluaing Shiga, who haa discovered a aystmtery ba0iNus ana was a most important figure in the Japanese mecliGal warld. The govemment had te builG! a new organization £F0m ~he gnouna up. What one faction wanted, the otheF fought, a[tn0ugh the government, which had n0 other source of sup>ply, hacl ta ouy the vaFi0us sera and vaGcines manufactured by the Kitasat0 laborator.y. The prablem was wmplicated further by the fact that the g0vernment aw,ned aN the universities, with the major exeeFltllon a£ the :Keia, which set the p>aee for tlie rest. When the Kitasat0 gF0Up> thFew its weight behincl tne Keio., the govemment medi€al sGhaol languished ancl the rift gFew wider.. [Be€ause af this cleavage among Jap>anese scientists, which had lasted f0r thir.ty yeavs., aH pFofessional dealings with them had to 1i>e €anaucted with aeli€aGJ ami €auti0n. 'Fhe jealousy was so intense that when iDactors Flexner and Welch went to Japan, they were reeeive<il oy one graup and ignorea by the ather. They actually had to ~eave the country ami retum, S0 that they might be officially wel€amecl by the op>posite faction. 1fhFough the exercise 0f care the R0ekefeNer Foundation had always been able ta maintain f.riencl<ly relations with all parties to the dlsFlute. :Ii w0ul<il never eompromise with their petty animosities althaugh, sinGe aUF survey came at a time when anti-American feeling was running sa high, r haed to allaw it to be made more or less um:ler cover; the politicians were afraid if they a€cep>te<il help> openly from America tit might inteFfeFe with their p>0litieal future. IDealing w,ith the Japanese govemment haed ~ne great advantage. @nce an arrangement was agreea upan we cauld be sure it would be

41 3


& GREAT LITTLE iJ!'EOPLE

teFest him in nutl'itien as an impo~tant factor in edisease, a,l thougn the Jal"anese themselves, in their own laborateries, had proved the importance of diet by producing stones in the bladders or kidneys of w.hite Fats with a ediet edefiGiency, and haed edissolved them again with {>Fel"er diet. But ~itasato, like se many other Fesearch scientists, saw no further than the ediscovery, aned, assuming it would immediately be ad0l"teed by the people, did not realize that usually more effort is FequiFeed to b~ing a discevery into use than has gone into the original Itesearch. After our survey was completed it was obvious that the didactic teaGhing should be largely supplemented by the inculcation of meth¡ oeds to bring modern scientific knowledge into the lives of the people. "Fe aGGoml"1ish this a medel'n schoel of hygiene and I"ublic llealth for Japan was recommended, and this was finally agreed to by the Jal"anese government. The development of new knowledge was to I)e enGourageed in every way, but equal importance was to be atta0hecd te its JilFacbical applicatien. The chief difficulty in founding a Health Institute in Japan lay with the stubborn eledeF groups, still heaeded by Kitasato. He had no faith in it, because he had spent his life in the cloistered seclusion ef the laboratory: He did not believe in his heart in what we were recommending, but,. because he realized I was above the battle and had no personal objectives in my long persuasive efforts, he finally acquiesced. We inveigled a group of these elder scientists to come to the United States to observe the frienedcLy cooperation in American scientific circles, aned see how research workers in bacteriology and the men who applied their disceveries could work in harmony together. The ancients were still dubious after their expedition to AmeFica, but they ceuld be counteed upon at least not to oppose the venture. Onee the Health Institute had been decided upon, the great problem - was hew to apportion the control. Aedmittedly the elders had to be put in Gharge, but it was very hard for them to change the guiding Jilrincil"les they had acquired in their youth, and the reverence' for age was S0 great that, although¡ the younger men might know better, they weFe still apt to bow respectfully before the-older wisdom. De415


:AN AMlEiR'liCAN il.0DC!r©R:'£ ODYSSEY ter;minee to haNIl a boay of yaunger mlln with pFogrllssive iaeas to seuve as a GheGk, we stipu1atea, "¥ou'M have to have an aavisory ~om­ mittee." Dur.ing the mano/ Yllal's I'equired to esta1>lish the Mea~th [nstitutll, we brought many of these young men to AmeriGa on feNowships, selecting the appliGants Gare£ul1y f,Fom both government ana Kitasato groups, so that by the time the Health [nstitute should bll r;llaay to ojilen its doors, there wouM be a sta·ff of young men who w(inrld have [ost to some eJlitent theiF aneestor warship and woula ehampion thew own ideals even against the eldllrs. Aher this new school has a suHieient number o£ graduatlls it is the hope that pllrsonall idiosynorasies, habits of mina, and thll old Gel'man wncept of hygiene, whiGh is still strong, will be overGome, am! that the apjillication of pFeventi,ve meaieine wiN IliIlGome a reality.

416


CHAPTER 24-.

PICKING UP BROKEN THREADS

HE Harrison bonfire which had blazed so merrily for many years and around which the Filipinos had danced so blithely, finally flickered and went out, leaÂĽing only dead ashes. They were still!l warm when General Wooa and former Governor General Forbes came to poke among the ruins te see what of value remained. I was on my 1921 trip and saw a paper with American news only eccasionally. I was cognizant that President Harding had appointed t.hese two eld f.rien9s of mine to report on the condition ef the Philippines, but did not know premsely where they were. In the course of my travels I arrived at Sandakan, Borneo, just in time to see the S.S. Eastern, which I had expected to take to Manila, steaming eut. I had a choi"e of waiting in Sandakan several weeks for the regular sailing, or of taking an extra week to retrace my steps to Singapore, and going thence by another line to Manila. The following morning, still perplexed as to what I ought to do, I was walking ru.leng the haFbor fRont. Low down on the horizon I saw faint trails of smoke. ''What ships are those?" I asked the Cap- tain of the Port. "Haven't you heard?" he replied. "Early this morning we rereivea wora the Wood-Forbes party was to pay an unexpected visit te the Geverner of Borneo." My gloom lifted as the gossamer wisps grew i~to bla~k smudges. Just at that moment the Governor's aide came along. and I saw a 417

T


la,unGR making Feaey to [g<l'v,g. "<i:ouM ~ g0 0ut with Y0ul" :J! askg<;{ him. "Of CQUfSe, j;f Y0U ~muM like to, aut m~hink thg Q0~grn0r is gxp'~cting Y0U to aGG0mp>any him." "rn f ¥QU a0n't minl!i, i['1!i ratner U0in Y0U." As we gFaeual!Ly diFgw n~ar, 'Ii FeGegnizgiit tne 0id @eneral A Zava, <l'n i nh~rit<l'!1§e £F0m tne Swanisli, antd ~1\.~ .fir/litZo, the cl~JllatG!1 a0at 0f thg p't eVi0us C;;0V~Fn0r Ggn~raas. I G0u[a se~ IihF0ugh my glassgs titat we ~lse W~F~ 0ajgets en SGlllifiiny;. iii w.as., 0f G0 urs~, in 0iviiian G10thes, fuut my il'aGg was wel!.l G0neCla[ea ay Iny ImgCl bclmgt; thCl arliiving plarlo/ was SCUDF¥ing abQut. iL Goula !i.gaF ~fiCl buglg s<'lI<1nl!iing amd Sgg S<I'it0Fs ti.nga U~ stifHy 0fl thg a eGk. ~t the t0Jll 0E thCl gangway, the offi«gr salutecil smar.tly. ''WhClFg's the @Cln~l.!il ? " ~ askga,.


Pil1CK~NG

UOP .!BROKEN 'FHREA:DS

imp(:lssible for me to be in both places at once, we talke:d by wireless. 1 e:ven Garriea (:In an animated chess game by wireless with General McCoy. Seven yeal'S dr(:lpped away as we inspe£ted island after island which 1 had so often visited as Director of Health. At each stop we heard the same (:lId oharges and c(:luntercharges, discovered sh0cking examples of delayed justice, and heaFd the same addresses of welcome pitGhed in the same old florid ve:in. The independence leaders had agitated well; the keynote of many 0f these orations was independence, though many Filipinos themselves realized that the time was not yet ripe for independence without a protectorate. A warm welcome awaited me in Manila. Myoid associate and prize cholera fighteF, Dr. Vicente Jesus, wh0 was now Director of Hea,!th, seemed overjoyed at my return to share his responsibilities. He had already had a desk placed beside his, and offered to retire temp0rarily while 1 was there. 1 was never more touche:d than by this demonstration ' of trust. General Wood asked me to stay with him at Malacafian during my visit. My acquaintance with him dated from 1903 when he had been in command at Mindanao. Then and later, when he had been head of the Philippine Divisron of the Army, we had often consulted t0ge:ther on pFolhlems of hea'lth. He was a delightful man to be with, urbane, courteous, and ful1 of interesting anecdotes. Like Theodore ¡ Roosevelt, his close friend, he surrounded himself with unusual people, and naa the gift of setting them at their ease and drawing them out. One evening when we were alone at Malacafian, coffee and cigars were: brought out on the veranda, which overlooked the Pasig _ RilleF_ Between the pallm tFees the native life could be seen hurrying up and d0wn this artery of trade and traffic in endless procession. '['he General had been offered the position of head of the University _ of Pennsylvania, which was clamoring f(:lr his return to take up his post there_ President Harding had just offered him the Governor Generalship of the Philippines and he was obviously pondering the pFCilblem. 1 obtruded upCiln his thoughts. "1 don't know YCilur ambitions," 1 said, "and, .of course, it's none Cilf my affair, but i suppose you still would like to be President of the United States. If Y0U stay hene 1 believe you might as well 4 19


PICK[NG TJ!F B'R OKEN 'ifHiREAIDS sanes of railway passes hae been issuee. Sugar companies had started up en a shoe string and then borrewed government funds without adequate security. One hunclred million pesos had been lost in banking s€hemes. To cap the climax, the silver metal reserve behind the currency had been SQld to India, so that the peso had fallen to thirtyeight cents. General Wood had to get an emergency loan authorized by the United States Congress te put the Islands on their feet finan€ia!l!ly. Tihe repert of the Mission GQnclueed that an immediate grant of ineepentilence weule be "a betrayal Qf the Philippine people," and that "unaer no circumstances should the American government permit te be established in the Philippines a situation which would leave the United States in a position of responsibility without authority." As soon as General Wood had reestablished financial credit, he turned his attention to the Bureau of Health, which had fallen hopelessly into politics; its ramifications were so extensive that innumerable plums were to be had for the plucking. Since I had built it up originally, he believed I was the one best qualified to resurrect it. The Rockefeller Foundation €oncurred, and I spent several months making a survey and offering suggestions for its regeneration. The Foundation furnishee fund's and expert advisers and placed its FeseurceS at my eisplOsat 'Ln oreer to enSUFe the fulfi'1ment Qf my survey I talked to Manuel Quezon, pointing out on a chart how the death rate had risen s~eacl'ily since I had left, and how the whole future of the Islands depended on getting the Health Service out of politics. He agreed with me completely, and induced the principal leaders of the Legislature to sign a document that they would support me loyally. This they €ontinued to do, e.ven through the thick of their contest with General Wood. The Health Service was ovedoaded with old fossil men, educated - in past epochs, who had no cenception of modern hygiene in its S€ientific aspects, ana who were tQO old to learn. Improvement was impossible until yQunger men were trainee. Filipino students weFe sent en fellowships to take post-graduate courses in American schoQls. As they returned, the standards of the Medical School were gradually, raised to their former eXGellence. Eventually they formed the 421


AN AMERICAN i!JCi>CT<0R'$ ODYSSEY

staff of a new School of Hygiene-with the exception of India the only one East of Suez. The nursing s~hools were also restoFem with the aid of importecl experts. The slow business of education had to be sta~ted al!l over again to convince the Filipinos of the value of the Health Service. Not until then would the Legislature vote money of its own volition. 'Fhe Bureau of Scienee pFesentea a more aiffioot pFobiem. OnJy with adequate guarantees of a GeFtain tenure of office for a number of years eould a aesiFable set 0£ men IDe induw;l to aecept Jj1ositi0ns again. 'Dhe Philippine ifiournal oj Science had also lost its standing, IDut in time its former reputati(!)A was to a g¥eat el<tent regainecl. The state 0£ the lepeFs ana the steps taken by GeneraJ W 00d to remedy their cleplorable situation have already been describem. Equal[y distressing was the G0nclition of the insane. Those uncler wnfinement were existing almost like animals and Feceiving inacle<iJ.uate attention born the authorities. More were roaming the country at will; many insane women were becoming pregnant as fast as nature w0uld allow. General W ooa was hODFifiea to find the e)!:tent to whieh the GaTe 0f the insane haa aeteFi0rated. I was m0toFing with him one noon on our way to JunGIl when he happenea to spy on the street 0ne 0f the pxim:ipail iEl1i!J:ipin0 mocrors 0£ Mani[a. 1J11he Generall, Wh0 was a[wa,ys a man of action, St0pping his car.; haiJed the cloctor. "Pm g0ing to the insane hospital," he saia. ''Won't ¥0U C0me along?" "'But I'm just on mIY wa,y to lunGh." "Skip lunoh and come with me." Such a request from the Governor General could not be rusn;:garded. The doctor perf0FGe joined us. General Wood spent two hours meticulously pointing 0ut every harrowing detail. He had missed lunGh but made a €Ofiivert. The <doctor became one of the araent supp0rters of appLOflriations for the large moaern asylum which was ultimatei¥ ereoted. Apl\larentJ.y there was a-lways a genuine desire ana willingness 0n the pa,rt o£ the 10Gal weopie to e00werate with the Rocltefe]ler iFounclation cordia-Ny an~ 0pen[\y. But they were s0metimes timi<d 0wing to the fear that they might lose prestige ana influence among their own people. It was aiffieult to make mUGh aavanGe, but we clid prevent 422


iPI:OK[nNG U!F BROKEN 'FIoIDR'EADS further r.etregt'essien and disse'lution aur.ing this trying per.ied ef lltlGenstructien. @n the mel'ning ef May 13, 1922, in the midst ef our busiest c!la~s, the !Evitis'h er.uiser. Renown, bearing the Prince of Wates, now '[(,ing Edwarc;l ViJ![J:[, c!lropped ancher in Manila Bay. 1i1he Prince bnded at neen, bat befere fie ceuld have any lunch he had to review the craok iNindl. Ca.VaMy on the Luneta, and the eFack Censtabulary cempany at Ma,laeafian. Mtheugh he must have already experienced similar c!lemonstl'atllens eE lOeM p~iede hundreds ef times, he haed to scheol fiis Geuntenanee te pleasant app,reciation. To my mind his charm of manner. was much heighteneed by his appar.ent embal'rassment. In· stead ef a jill'ince ef twenty-eigfit, he gave the impression of a yeung bey of eighteen who haed never. per.formed such a functien in his life. 1l'ne Ji1rinee haed obvieusly been br.eught up in the true British tl'aediniens ef the dangers ot the noenday sun. His ama'Zement was manifest when he ebserved the Gevernor General essay bareheaeded the shert j@urney f.rem ~he gevernment offices where he had been Fe~eived te the palaee where he was finally to have lunch. He was apjilaFentJy e£ twe mineds over donning his helmet but after a few mements' hesitation cen€luded te be on the safe side and wear it. By wa,y ef Hurther enterta.inmen~, General Wood had arranged a pole match fe)" the afternoen. Me ana I were watching from the gnandstand w.hen by aeGident e\l1' r:eya,l guest was struck on the head with a. baJIl. 'Fhe game was stepped and the Prince was carried off the field. @enenal Woeed exclaimeed, "Come en, Heiser! We'd better go ever." We 1ump,ed inte his autemebiiJe aned dashed across the field ~e the snable, where we found the Brinee lying on a bench vyith an ineh and a half cut in his for.ehead. A severed artery was spurting a stl'ea.m of bleeed w.ith each heart beat. The Frince, still conscious, blinkeed up at me with fiis one good eye - aned said, "Won't you leek after me, Doctor, and have my surgeon h~lp you?'" ] clappec!l a comjilress en tihe weuna at once, aned said, "We'd better c!le tihe Fest of tihe dressing at MalMafian. The stable's not a geod jiliaee." 1Jl:etanus germs may aLways be lur.king abeut a stable; conse· ~23


PKKING UP BROKEN THREADS perfectly well I'm feeling miserable. 1 hardly slept last night at all. iLo@l{!" Ami he displayed the most beautiful case of hives I have ever seen. [fi1@Ftunately he suffered no ather iill effects from the ingeotllon. The Prin,e's fondness for dancing was common knowledge, and also his idiosyncrasy that his partners should preferably alternate between blonde and brunette, and that none should be as tall as he unIless, of WUFse, she happened to be his hostess. His choice of partneFS, whi,h seemed S0 sp@ntaneous, was often managed. He w@ulcl pr.ivately have the best dancers pointed out to him and would then ask them to do him the honor; they would sparkle with delight under the exhilarating thought that he had selected them out of all the beautiful bevy. The publicity attendant on the goings and wmings of the Prince caused him much concern. Amusing anecd@tes are told about his attempts to attain a measure of privacy. In Japan, where privacy is at a premium, it is said he staged one of his greatest successes. The Japanese were determined that he must be entertained every moment. Once when he came -from an 0ÂŁlicially escorted inspection into the anteroom of the quarters provided far him, he excused himself to the Japanese general detailed to ao,ompany him, walked into his own apartment) and hopped threugh the French window into his Rolls R,oyce which his chauffeur, acwstomed to these escapes, was driving slowly past, according to instructions. He crouched in the bottom of the car as it passed the sentries and nobody saw him. No sooner was he @utside than he quickly changed into the street clothes waiting in the Hmousine, and immediately abandoned it for a rickshaw. ']jIhe general in the anter00m first grew tired of waiting and then allarmed; finally he instituted inquiries. When the news leaked out that the Prince had vanished, the tocsin was sounded. The Japanese pride themselves on being able to locate any foreigner within their gates in a few hours, but they could not find the most conspicuous figure in the w@rld. The Prince frequently changed rickshaws, wandered about, shopped, and when he grew tired returned to the palace , and waiked c@oNy int@ tile bed[am of police and detectives. While the Prince was in Manila we had several sets of tennis together. When, once or twice, he suspected I was not exerting myself, 42 5


AN AMERi!!CAN J[}OCiI'OR'S ODiYSSEY he was mucn annoyeal. He alislikecl excessively the fanfare ancl a£daim whi€n greeted his eV'ery aJllpeaFanGe. When ne wou:rG! walk: in from the CO\ll1t everymocly wCilulcl rise. "Look here!" he woulcl say, "t'm just a tennis !,>iarer." AlthCilugh the PFin€e was .aole tCil assume with startling rapidity whatever !,>ubii€ attituale fi.tt~<ll the mCilment, he was funclamental1y a sooer-mindea person. He would often in je€t a serious note in a £r,ilVolous ~om'ersation, as when he saicl serflileprecatingly that he haa Deen able to aC€Cilmp>1ish ver¥, little in tne worM oe;YCilnal aJllJllearing as the mocld for "what the well,4-ess~Q man will welar." The terrible discCilmtCili"ts 0t men's alr-ess as alecre~<ll by GCillliventiCiln in the East seemed to cause him much clistress. As SOCiln as he was East of Suez he macle it a point never tCil w~ar a waistcoat, anal tCil replace the hot Mack a'inneF coat with a ceCill anal €Omtortallile white mess jacket. "You travd thFough tihe Orient a great deal," he saicl to me. "Why eCiln't YCilU set the fashiCilIIJ 0f wearing mess jallketsl" "I'm a£raid my influence W0U!ldn't £arry very far," I smilecl. "¥es, it woulal. W ~'d get the thing staFted, ancl think what a m(;)0n it w0wl<ill De t(;) m~n will tnr0ugh tne tr0!,>iGS." .Becaus~ I was se thoroughly in accorcl with th~ FrinGe's sentiments [ agFeeciL te de my bit. When [ arF,iiVed in Cwlc::uHa a few menths later i[ was iniVited to a f0rmaJ alinner at tihe Bengal Club, at whi0h !Ii knew a mlack dinner ceat,w0ulal IDe de r-igueur. But it was so steamy anal unJllleasant that tne mere tnCimgnt ef mroaQel0th was amhorrent. I ale€i<lled that 1 GOu1G! follow no better sartorial examJllle than that of Wiis Rieya! iWiighness, an<it app>eareal., uherefeFe, in a mess jacket. My host was 0mvieuslif most uncomfertaM~, but [ remaineal serene. "] see that mess jackets aren?t :being wern," [ rema. keal afFabfy. "['N ge back and change if yeu like. 1t's euly a few llilollks. But, perha!,>s 1'& better say first tnat W.R.iHIi. has I'e!jjuested me to wear a mess ja€ket whereveF I go in British tel'ritery. If yeu gentlemen in ~akutta='"

This Jllut a cliff~rent aspect on the matteF. 'The news tfiat iii had been aoting as peFsenal !,>hysician te the PFince haal been €ableal aN over tne British worlal . .A meeting ef the !Meuse C0rrunintee was

426


lPlCKlNG tIP BROKEN THREADS Gailee at once to discuss this upheaval in all accepted social canons. After weighty deliberation i~ was agreed that under the circumstances exception should be made in my case. All during the .banquet I could se~ the news going around from mouth to mouth. "H.R.H.-mess ja€kets." And then they would look intently at me as I sat cool and complacent, a white beacon against the backgt'ound of oppressive black. W'hen ] atteneea a second banquet only a few nights later every man in bile room was attiree in a mess jacket. lfust iDefore the Prince left the Philippines I paid my official farewell cal~ on the Renown. He asked me into his quarters ane presented me with a silver cigarette case, thanking me for my services, both official ane unofficial, and saying, "Doctor, do come and s~e me in London." "That would be very pleasant." "Just let me know in advance. I want you to come down to my farm. I'll show you I sometim~s work too." The visit of His Highness had provided a pleasant ' interlude in the miest of our labors which, as he hae observed, were heavy indeed. Immediately after Geill!ral Wood's appointment as Governor <Generrul., Octooer 5, 19'21, the Filipino leaders had been meek as €hiidren who had broktm their toys through disobedience and wanted th~m mended. Like a kind father he repaired some of their favorite playthings but others, which had been given them under the mistaken impression they knew how to use them, he removed until suoh time as they should prove their maturity. If he were to rehabilitate the Islands he must take back the executive powers Governor General Harrison had allowed to lapse. The Legislature'S submission was short-lived. After the first year he had to face a terrific political agitation organized against him by Quezon, who consistently opposed every measure General Wood proposed, and accused him of autocratic methoos, even going as far as to demand his reeal!l.. ilJn rooting out the gra-ft ane €o~r.uption which had permeated the government service, General Wood hae to make ma-ny removals, but even the most justifiable one would cause the most frigHtful 42 7


AN AMERICAN 1E!)()C1"OR'S 0DYSSEY abuse in the Fmpino press. The General paid no attention to the Glamor, but held to his appointed COUFSe. He knew that he had the administration at home behind him. General W ood was aiways held up by his opponents as an extreme example of militaFism, but in l'eality he was diFectly the apposite. 1 remember one particular. o~casion when he had a matter he wantea appraved by a group of leaders. He in¥ited them to the g0veynment office for a discussion. "[fie eonfeFen€e Degan at nine-tillivty. in the mOFniFlg. 'He set £o11;h his ",iews in great detail. His auaitoFs were not in aecoFm with them, !Dut oeeause ot F ,iilipino avel'sion fa jaining issue with som€one in authority., they Femained silent. Genera[ Wood was extremely patient. He expounded everything over again. And a third time. 'I1he Whale morning went by and the lunch hour arrived. The Gover-nor said, "1 suppose you g€nt1€men are hungry. Won't you take Juneh with me?" The silent opposition became vocal and accepted politely; an agr€eable hour was passed in amieabl€ conveFsation. Aliterwards a.hl ad. journed once more to the oHi€e, and Waod resumed his unrufHed Found of argument. He tailked at the Committee members :lil!l! tfie aliternoon. 'They had pFactical'1y nothing to say--€entain1y not ''Yes.'' When seven a'hloGlil eame., Genera~ Wood said, "You gentlemen must fue stawea. Won't you have GlinneF with me?" IDhe session [astea unti~ [ate in the evening and was begMn a~in the next mOFning. The secona day foHowed the pattern af the fiFSt until finaNy, worn down by the Govemor's um.veaI"¥ing calm, ami replete with good food, they eapitulated. Filipino legislators weFe ol.1ly siJent when it served their pur;poses. More often, though, they eondueted their business with formality, dignity, and decorum, they talked, and talked, rolways with waving arms and grane;!iloquent gestUFes. GeneFal Wood attempt€e;! to win his victories !Dy p,aeific means, aut unfartunate1y he was o£ten foreed to use his veto power. A:s he exp'lained to me, the fuiHs which he vefoee;! ane;! for wfiich he :was lDeing GFiti€izee;! so mudl in ~he press hac;! FlFacticailr a!l[ been l'ejeeted after ~onsu[tation >¥ita tlie ~l[ipino [eae;!ers. Many of tlles€ biNs were af a Ellivolous natUFe and designee;! ta fOFce any canstcientious administrator into eJl:ereising his preFogative. Eighty-seven of 42 8


PICKlNG UP BROKEN THREADS tnem ;weve passecil the desing night ef ene Legislatur-e, aned it was humanly impossible fer any member te know what they all contained. Even Quezon aned his co-agitator Osmeiia were astounded when they later saw the contents of the bills they haed approved. !Lt ;was assumeed by observers that these bills had been railroaded twough witn the full understanding of their worthless character and for the express purpose of forcing the General to use his veto power. The charge of tyranny was duly made by the Filipinos. Even in the United States General Weod was branded as a militarist, aned it was saied constantly that he was dominated by the sabre and the spur aned his methods were anything but pacific. His detraotors pointed accusingly at his ex-officio cabinet which was compesed ef Army efficers, sometimes called the cavalry, kitchen, or muehaoho cabinet. But the explanation was simple. The Legislature was trying to curtail his activities by their oft-repeated and effective metheed of cutting aown appropriations. These had been so reduced tnat ne money was available to p"ay fer any advisers, and General Wooed had bleen feveeGi to blorFow from the fumy, whioh gladly lent its best men. Fortunately, the character of these officers was such that no accusation ceuld staned the light of investigation. Major General Frank McCey han had a leng aned distinguished career as General Wood's aide-de.,camp in Cuba and, because ef his gift of diplomacy, was to be appointed by President Coolidge to serve as peacemaker in the first presidential election in Nicaragua after the insurrection. ']jihe chid fame ef Celonel Gordon Âťohnston also rests upon his peace time activities. He was doing fine work in connection with the Guardian Society. The quar.tering of any army upon a people is follewed by many illegitimate births. The military occupation had Jasted se long in the i[slands that the numbers of these children had reached the appalling figure of eighteen thousand. The mestizos of other races-Spanish, Chinese, and English-ranked high socially because their fathers saw to it that they were provided for materially. 'But the casual American soldier had generally evaded responsibility for his left-handed offspring. Many of the Filipina mothers, peor Cho-<:ho-sans abandoned oy their Pinkertons, were forced to form new connections in which the ohildren of the former alliances played

42 9


PICKING UP 'BROKEN THREADS

-

Though the peliticos' campaign against General Wood was fierce, he r.etained the aemiratien ane affection of the masses. Certain safeguar.es hae bleen placed areund aJi.l the preceding gevernor genemis, but no neee ef these was ever felt in General 'liN ood's case. Several times I have been riding through the provinces with him in his automobile when an old tao who had heretofore hardly dared lift his eyes to the GaGique, now held up his gnarled hand, confident that he wouM net be rebuffed. General Wood never failed to stop. The tao, with patient eyes ane shy smile, would appreach in a respectful way, ane say he wished to thank the GeneFal for ail the fine things he was doing for the Filipinos. As the years went by, one after another, they told more and more upon General Wood's strength. He often admitted to me he felt exhaustee after. struggling with Filipino officials in the effort to push them to some constructive aetion. We had all experienced this fatigue, but we did not semehow look for it in a man of General Wood's abundant energy and robust physique. The Governor had !llore reason for exhaustion than any of us fully uealizee at the time. When he had been in Cuba as Governor General yeaFs before, he had one eay Asen sudeenly from his desk and his head had come in contact with gFeat force against an old-fashioned oi[ Gounter weight lamp, hung low trom the Geiling. The triangular iron handle had penetrated his slrnll, ane the in jury had been followed by a tumor of the brain and a certain amount of paralysis of the left side. The tumor had twice been removed before he had gone to the Philippines. He should nave returned to Dr. Harvey Cushing at the ene of his first two years, but had been at that time in the thick ef the fight ane would not let go. Because General Wood was an int~rnational figure, he was frequentJy photographed for news reels; often he was shown pre-views. '[ noted how stoically he looked at them, but it was apparent that it hUFt him terribly to watch how painfully he lifted himself in and out of boats or automobiles; he had been so proud of his physical strength. Only after six years, when he believed his work was nearly finished, weuld he consent to go home long enough to have the operation performed. But by then the tumor had grown to enormous size. 43 1


PleKING U!P BROKEN THREADS ments, but that as leng as the U nitea States weultl not aedare a definite policy teward the PhilipFlines it was useless to attempt anything beyond keeping the situation peaceful. T1heedore Reasevelt, jir., took office uFlen Gavernor Davis' vesignation. He had inherited to a conspicuous degree his father's charm of manner, ana became tremenaously popular ameng the F ilipinos. He came from the Governor Generalship of Puerto Rico speaking Spanish, was hail-fel!low-well-met with one and all, radiated cheerful enthusiasm, ana played upon the hear.tstrings af the emotional FiEpinos who ÂĽibrated ta his masterly touch. He devoted himself to them and made much of them seciahly. Not even former Governor Harrison in his heyday had won greater plaudits. I discussed with him, among other things, the anomalies of malaria in the Islands. Like his father he talked so continueusly it was difficult to make a point with him, and his canversation was peppered with quotations from Kipling and the Bible in sUFlFl0fit oÂŁ his theses. The last Governor General of the Philippines was Frank Murphy, now representing the authority of the United States in the new eommanweallth. Altheugh many believed his former public services as Mayor of Detroit were not sufficiently broad, by his acts he proved an exceeaingly able administr.ator in a difficult situation, and became well liked by the Filipinos, who admire those who know how to play the political game. We were mor.ally bound to gieve the Filipinos their independence. President McKinley made the first commitment, and in the Jones !Bin we again assured them they should have independence when they had a stable government. The moot point has always been the definition of a stable government. Does it rest upon the maintenance ef law and order? OF upan self-sustaining power economicaily? The heart of the question at the moment is indubitably one of economiGs. The Fiiipinos have been raised by means of the tariff privileges we have granted them to a standard of living formerly unheard of among. Orientals. If we shut them out completely it is hard to see how they can exist. I have a great deal of confidence in the Filipinos. They in return ha.v:e a real liking for us, ana feel their destiny is with us. Thausands 433


"!Pepin0! !B~ing me my cl0fhes. ~et me a J'im0usine. I'm g0ing to lBa!1timor-e." 1lhen twning again to me, he sp0kie impulsively, "1 want to talk to )Iou on the way to fhe station. After ¥0ur 10ng el<peFienee in the ~slanms f0U Know them £rom a health standpoint better than anyID0dy else. ~ want Y0U ancl General MacArthur and General HarID0Fd to C0me 01:lt and advise me. 'think it 0ver and let me know :whether y.ou'll aeeept." [ teId him h0nestly that I had little inclinati0n to do so; that ~ hacl given many years 0f my Life to estaIDlish a Health Service whieh he hacl ahl0wed to clecay. "See what's been done to the Bureau 0£ Science whiGh is S0 bacl~y needed by your people," I reminded him. "Oh, we'hl fix that up again ail ri~ht." "Wow are 0/0U g0ing to cl0 it?" [ inquired. "I've just been talking to !J]:heomore R00seve.It. He says you used to have a revenue of sixty mihli0n. N0w Y0U have f0rty; 0nce Y0U are 0utside the United States tariff wall, Y0U w0n't have mOFe than twenty. That wiH barely cover the abs0iute neeessities of g0vernment. How's there going to be anything leEt f0r the Health Department!" " ]i have that ill solvecl," he GOnficlently asserted. "How?" "iL'iVe just been in lFelancl, ancl have been studying the workings 0£ the [ouery there. We ean have mueh better ones in the Philippines, anC11 we'l!l seN m0st 0f the t,ickets to y.ou Americans. The lottery will De umier state GOntrol, and direeted under the best auspices. It will \!iT-ing in several milli0n d01lars a year ano/how, and perhaps as much as ten mil[ion. Y0U can haNe it all for the Department of Hea.Ith. I want yoU' to IDe the aMY one to say how it is to be spent." ]j hacl no doubt of the sincerity of his intentions. Quezon had aclmittea once to Genera,} W 00cl that he was swayed by his white bl00d in 0ne direeti0n and IDy his Oriental in another, but in spite 0£ himself the predominant sway was toward the white. He has mUGh f0Fee, energy, and m0ra" Gomage. He may have a successful Gal'eer as weN as a tempestuous one. in spite of the many attempts 0n his life made by his politieal opponents, he has no physiGaIJ. fear . .&1 aut0moIDile sa[esman onGe infol'mea him an arm0l'ecl car could 4'35


AN AMiEiRirC:AN DŠC1'QR'S GlIi>YSSEY be manufae~ured to pl'oteGt him against cranks for not mu<;h mOIre than the price of ~he mose! usetil by OIrainaf}' citizens. "No, sir, ['11 have a 1antilaulet, an open car. A statesman shoultil know how to tdie in the peFfol'man~e of his duty."


AN OUNCE OF PREVENTION

CMAPTER 25.

"MONG all tr,@pical diseases malaria is supreme. In my exit is the most persistent, the most destructive, the most widespread, and the m@st difficult of them all to control. PIague is terr;ible, but the p17ecise method of its transmission is known, and rats !tan be eliminated_ Cholera, smallpox, and beriberi have n@ excuse for being. Dysentery and typhoid could be wiped out. Though leprosy creates horror it seldom interferes with the mar~h @f progress; the po@r and l@wly are the principal sufferers. But fol' malaria ther:e is no speGific and the problem @f prophylaxis is enormous in its complexity and expensiveness. The method of its widespread control is not yet @ut @f its swaddling clothes. Those races touched by the shaking finger of malaria have undergene a pr@gressive decadence. 11ne "glory that was Greece" faded out bef@r:e its onslaughts and will not shine again until the minute po@ls in her broad rocky river beds cease to be a tlu;eat. The "gnandeur that was Rome" paled ~enturies ago and only recently has bne Iight flared lip. llhe Campagna, the fentile farmland region around Rome frem which the early Republic derived both its food and the men for its conquering peasant armies, has been the scene of necurrent waves of malaria. The drainage operations of the Etruscans had kept it heallthy, but under Rome the p@pulation steadily declined. When fever and chills swept over the marshlands, the terrified populace sacrificed to the Goddess Mephitis, who, with her baM head, great paunch, swo!Jen veins, and emaciated limbs, tyl\'ified

f i perience

431

\


AN AMERICAN DOCTOR'S ODYSSEY ~he essence of heFrer. The citry itself remainetru free because ef thg Cloaca Maxima an~ its cemmunicating systgm of intedoGlcing pel'ous earthen pipes, whieh antedatel1t our modgm subsoil c;ltainage instaUations by several centuries. l'he iDarbarians 19st al'my atter army of ~heir non-immunes; AlaIlle himsel'f is said te have dig(j! of malla~ia. i1PeJDe after Fope tried te rgclaim these Pontine marshes in vain. Net until "11 Duce" 19d the stagnant waters in huge canals to the sea did the land oncg mor.e become fertilg and the cities enee more spring into Me. 1t is magnificent and aiso startling te see Sabauclia ancl lLittoFia, mocleFnistical!ly designed f1'0m church to peasant dwelling, rising renas€ent from ~e desolation that was. Whgther maJiaria was endemic in thg New WerleJ befeFe the arrival! of the disceverers ana eXJDloreFs is a matter ef d~spute. CClrtainiy calenturas WClre mentiQned early and often in €ontempofary accounts. The first SJDanish venture of Celumbus in Mispaniela had tQ be abandoned beeause of thg "fevers." HaM 1:hg inhabitants of ]amestewn, eneireltltd lby the miasmie Vil'ginia marsl\tls, citied wi~hin six m~mths of thgir arrival. Up and down the coast the first sett,kments were established iDy thg water courses, and tlven after the JDienetlrs haa mevgm intQ the primeval! fOrtlSh, in clearing it they [ef,t poels ami stanaing water. Mereever, JDower to saw thg Iumlber am! grind the grist to heuse and fgtld those whe, all unaware, were inviting malaria into ~heir midst, was furnished by innumeraiDle millponds. lE"rom earliest times the €0nNeotien et marsMami and ma[aria haa made itself ap>partlnt. Miasmas 01' mephiti€ airs arising, par~icu!larly at night, £rom these moist regiens, were blametd for the disease, ana the neighboring inhabitants believed sa,fgty could be assured only by closing tlv:ery mel'll' anm winaew against their eJilWanGg. When men began to apply scitlntifie wen-is. to their 01liservations of natura[ j!llienomena, they claimga malaria was dug to thg "dg€0mp>osition ef organic matter in low areas which thereby tteed pgisonous gases," This theery that alsease was air. iDerne haa iDeen, tFom time immemerial, accepted as a reasen f0r ep>i(j!gmics. Malaria, espe0iahly, was subject to this piausiiDle explanation. Malar-ia, "bad air," was ftrst so callea by an italian, 'Torti, in

11-3 8


~N

@l!!JI:IlCE @F1 PR,JilVEN'F[t@N

[,:5 3, anG! in.nreG!uGed into iEnglana in 1827 as a speciific name for the ma[aay known war,iousl¥ ana vaguely as marsh miasma, paiudal poison, ague, jungle fewer, hii!l feveF, trepica'l fev:er, intermittent ana I'emittent fever, or, simpiy, fever of the country. 'File ehi1lls ana fever so often aescrihlea by the ancients we·re unaoulitedlr mMar.ia, hleGause the symptoms are so distinctive that there was !little dlanGe for confusion. H ippoGrates, a native of Aegean Cos, haG! sturuecil tile c;Lisease in Asia Minor, whetie it was preva,l ent in tile Fifth Centur¥ B. c;:., althol!gh it had not yet extencilea to Attica. The iFa61leF of Medieine haa a'iviaea these fevers into quotidian, teFtian, ana: quattan. This same clifferentiation of ty,pes is still retainea; in nne quotiaian form the attadk rewrs daily, in the tertian every other aay, anc1l in the (;juaFtan every three a ays. ~he ehiNs, which last peF,haps fi fteen minutes, are usuaHy aGcom!\laniea hly the most "iolent paF0lo/sms. I have seen the malaria wara in a hlilspital actua11y tFemole from the violence of the shivering; a single oed VlioulG! move on the floor. The initia.l stage is followed ID}! bUl'Uing fe'Ver wfiidl rises to a peak, a·fteF which profuse peFspiratllon IDFeaks out ami the patient graclua1lly returns to normal tem!\leFature, ancil remains so until the nex;t attack. 1f1he Tenth CelttUFy lkahlian !\loet, AI MutanabbJi, descrihlea in the flill!lowing verses the ruseasewfiich haa become his companion. "I wateh for !ler time of arrival without desire, Yet with the watchfulness o£ an eager lover, And she is eveT faithrul to her appointed time; But faithfulness is an evil When it casts thee into gr.ievous suffering."

Mallaria is Iilften a.eadly in its action. ~ n the cerebral form, parasites oecome so thick in the blooa that they clog the capil'lavies of the IDrain ana ' cause almost immediate aeath, ana the same may be true if they loage in the kianeys. But a far larger numhler of cases are chronic; the parasites gradually aestFoy so many rea Mooa corpuscles that extreme anemia r.esults. 'ifhe patient's liver does not £unction propetily, he has frightM nead'acfies, c;a:nnot eat, and tall:es no inteFest in anything. 'Fhe,most indiGative symptom in tlie ciliagnosis of malaria is the el'11argement

439

I


AN AMERICAN DGle:!FOR'S OI}¥:SSEY of the sFleen "which often makes the beNy Fr!i)trwile mightily." i[ have seen many a ehild S0 lDailly afRieted that his spleen bump,em against n,is side as he wa,lkem, Father like a bex showiflg t'lu'0ugh a mag. T ,lilis eCimlliitien is Geiil0quiaNy caJ!lea ague eaR:e. Because malaFia is age-eld, physicians 0f every period have made attempts at oures. One of the Roman metheds was te place unmer the heam of a patitmt with quartan fever a copy of Womer, openecl to the fourth b00k where the healing of weunded Menel'aus is describem. lin the Mimdle Ages tneatment was lttJe mere efficacious. Patients were blem, ·were acUvisea te ehange the air, fea W0I'IDW00m, [ett'uGe, crocus, linseea, given warm water to make them perspire. At times when an epidemic raged, huge bonfires were lit to purify the bad ail'. But long before the disease was given its present name, its rememy was kn0wn in South America. In 1600, SF<IInish missionaries used the bark quina quina in IL.0xa, Peru. Don FFancisco Il.epez Canazares, COFFegicdor of iE;exa, was liimseU 0unea in 1683, anm thoughtfu:llly sent a supp,iy 0f the bark to Lima, six hunmrecil milles away, for the use of Francesca, de Rivern, secend wife of Don Luis Ger0nim0 Fernandez me Carera, Viceroy of Peru, stricken with tertian fever. She recoverea anm took a sUPFly back with her te Spain. Her ph\ysician, Juan cdel Vego, foUowem hen with more ef tilie bar:k, which he dis]llosecil ef at Sevime feF ene hWlmred reailes a Founa. in 1742 that industrious Swecdish naturalist, Linnaeus, whe cilemicated his life to dassifying and naming botanical specimens, made a slight erFor. He gave this barK: the name 0f ccinohona, after the deceased fifst wife of the Viceroy, Anna, Countess of Chinchon, whe. had never Deen te Peru, had never been i'1l of m:vlaria, and ham neven taken the medieine·. iEle£0Ee tlilat it haa Ibecm knewn as Jesuit's Powder or BanK, because the Jesuit ol'der, as the Fower behinm the throne in Peru, ham a menepely of quinine sales. 'Tihe priests received its weight in gold frem those who coulm afforcd to pay; te th€ poor it was free. The supply was never eCilual to the demand, and in the effort to amiust the ba1anee, the tnees of South America w€r€ striF]lled eli thein lb<llnK am! ilargei,y aestFeyem. The fa.iiluF€ ef the Seuth Ameriean gevernments to protect the seurce of sUPFly £rem this cleStruction brought €ffor:ts to cultivate cinohona elsewhere. [ n 1852 s€llas ana plants were intnoduced into 440


AN OUNCE OF PREVENTION tae Buiten7io~g Bota:nica[ Gar,men in }aiVa, w,her,e the iDutch tendem them carefully. Four hundred and fifty live plants weFe transpoFted to India by Sir Clements Markham with great difficulty. Soon the Ceylon plante1'S had the monopoly on procluction. But then Charles LedgeF, in ~8 65, mame it possible for the industry to take a great forward swicle b:y grafting a Brazilian variety on another wad variety which had a strong root system and would flourish in less fertile soil. Until that time cinchona production had not been successful in Java. But t,he Dutch found they ham icleal conditions for the cultivation of this grafted cinchona. The Ceylon planters had to cut down their trees and set tea shrubs in their places. With perfectecl technique, the Dutch no longer killed the tree by stnJilping the bark. They keJilt the supply perpetual by constant thinning and pruning. Now, only the young twigs, which have the largest percentage of alkaloid, are used for bark. With the monopoly thus securem, the price was kept so high that thousands died because they could not afford to buy. The lDutch always insisted it cost them a great dea!l to Jilrocluce <quinine, but skeptics suspected that, since the expense of extracting the alkaloid was known to be relatively small, the profits must be unduly large. The task of bFeaking the Dutch monopoly seemed for a long time utterly hopeless, but, because the price of quinine was a matter of worlcl-wide importance, I suggested to the Health Section of the League of Nations that this was a type of activity admirably suited to its purposes. The League fell in with this idea and began from Geneva a campa:ign of "Jilitiless puMicity," subtly plannem and beautifully carried out. Its effectiveness lay in its simplicity. The figures of quinine production appeared at stated intervals in League bulletins. "Over nine hundred tons out of a thousand were produced in the Dutch East Indies. The Jilrice in 1890 was such and such; now in 1917 it has risen -to such anm such." The great difference between the early low cost and the later high one told its own story. Years were spent in bringing down the price. But on each of my European trips I visited Geneva, and each time I talked cheaper quinine. If the officials evidenoecl- a lessening of interest in it, I would spur them on by trelating some of the harassing tales I had heaFm of fellow human beings who were afll.icted with malaria: and

441


AN OUNOE OF PREVENTION cently prt'Jdueed two synthetic arugs, plasmochin ana atebrin. However, they alle apparently not yet entirely satisfiea with results, be~ause they have maae no attempt ta capture the warld market. ]n a nummer af respects, piasmachin and atemrin are mare effective than quinine, particularly in treating the malignant types of malaria, mut many drugs that seem so good in the first trials prove to have deleterious after effects. Until more is known about these drugs they shaula only be administered by a physician. Quinine, an the other hand, can be taken by anyma~y, and seldam more than temporary <ileafness ~~ults ÂŁllom averidosing. Until recently the me1ief was firmly established that quinine was a specifie for malaria, and had a lethal action on the malaria parasite. Later research throws doubt on this sweeping canclusion, but, nevertheless, quinine cannot be dispensed with in malarial treatment. Nar is quinine a prophylactic for malaria. The drug has not yet been fauna which willI lciJ!l aLi fOl1rns and stages of the parasite ptlamptly. Although as lang as quinine is taken there will be no attack, the parasites are ever lying in wait, ready to appear, if, as too often happens, the patient wearies at the long and tedious treatment, and staps it too soon. "The Raman fevers are faithful aecording to an imprescriptable l'igllt. Wham anc;e they have touGhea they ,do not abandon as lang as he [ives." Thus despairingly wrote Peter Damian in r060 from his malariaridden bishopric of Ostia, the ancient port of Rome. It is true malaria may recur in one year, or two years, or after many years. The parasites hide away in the deep recesses of the \Deay, SUGh as the spleen and the mene marrow. One of the paradaxes with which the subject of malaria abounds is that often when latent eases are remaved to cold climates the disease recurs; it is also true that the colder the climate, the greater the hope for a complete cure. ]t had b@en abvious for a long time that water played an important pallt, but no one was able to bridge the hiatus between cause and effect until the end of the Nineteenth Century. Then Sir Patrick Manson, wha, after his suecessfu1 demonstrations in filaria, was stili eagerly interested in research on the theory of insect transmission af diseases, stimulated Major Ronald Ross, a former pupil, to try various

443


AN OUNCE GF PREVENTION m0a:iwn. Many ~aeunae in 0ur kn0wleage stilll rema,in. But when an infeGted anopheline bites a human being, with its saliva are intro¡ ducea a number of rod-like objects, pointed at each end, called spoFoz0ites, which, with graceful undulating movement go swimming off into the hlI00d .s~Fea,m. F0r eight or nine days they disappear completely from view. Repeated examinati0n of the blood reveals no trace of them, and nobody as yet knows what is taking place. When they next C0me int0 view, they have changed their shape completely. !Finy little rings, called schizonts or trophozoites, much smaller than the rOlus, n0W are aiscoveFable inside the red corpuscles. These increase rapidly in number and size, some becoming sexual and others non-sexual. Each Gell of the latter type at regular intervals divides itself into as many as fourteen smaller ones, and whenever this segmenta~ion takes place, toxins are freed-thus accounting for the periodicity of the disease-and the human host suffers chills and fever. The sexual forms, the gametocytes, go circulating in the blood stream and do n0 harm. But if some of that blood happens to be suckecd up by an anopheline mosquito 0f the right variety, then the sexual life of the plasmodium begins. The female cell is fertilized inside the mosquito, and then elongates, penetrates the wall of the moscquito's stomach, and attaches itself to the outside of the gut in ~he JDeritoneall cavi~. '['here it hlegins to grow, and forms a cyst which eventually bursts ana frees a vast number of sporozoites. These penetrate all parts of the mosquito'S body, some of them lodging inevitably in the salivary glands, ready to be deposited in a human with the m0squit0's next meat During the twelve days required f0r this process, she cann0t infect a human being. At no time, apparently, does she receive any injury from incubating the plasmodia. Malaria flourishes in a broad zone on both sides of the Equator, ~here it assumes vast prop0Ftions, creating great economic loss a,nd taking a high to.fil (!jf human lives. It is also endemic for some distance into the temperate zones, diminishing, however, in frequency and severity. Poor old Africa, from which the slave trade broadcast S0 much disease, is, as usua[, assumed to have been the seed bed. But the largest centers are in Asia. In India it is the arch-destroyer; haH the three hunared and fifty million population are estimat\!d to suffer fFom it, and one million die annually. These are stupen~ous

44S


AN AMERICAN DOC'fG>R'S ODYSSEY figur~s.

'iFuFkflY, SJ'Fia, iFa.lestine, Malaya, Si3lm, Inee-China:, ~ava, Sumatra, the Philippines, ane ehinal aFe aU intensely mruari3l1. In E UFope therfl have been outbFeaks in the Netherlanes and Englane until recent times. Huge epidemics eecurred euring and after the Werle WaF in MaGedenia., Senbia, Rumania, ant!! !Russia. GJlfleGe and l!ta1y aFe bad~y alffectee. But in Denmank ane NeFWay ma1arra is practical'ly unknewn. Why some plaGes are exempt er why tli.fl seeming immunity of othel'S is sueeenly bn1lken down is difficult to explain. Pena,ng was nealthy until e~cupied in 1780 1>y the British, ane 1>flcame malaAeus a few yeaFs bter; 0learing off fhe aungle ane exposing the pools did Il0t seem sufficient eX]Dlanat;ien. Chile ant!! Barbades were bee of it until 19'2.7 when GaSes began te O€CUF. tr'hel!lgh toeay largely c0nfinee te the not ceuntFies, maiaroia edoes eecur in tne 1LJnited States, at one time extent!!ing as far north as Wiscensin. At the first settling it was Gemmon in ConnectiGut, but disappeared, only te Feturn when ItaEan immigrants, whe swarmet!! in te o@@uJilY the a1>aneenee fal'ms, brought the infeGtien in tneir veins. It was so pFeva1ent in the nineties along the Sel!lll<li t;nat when tne Cambr-iege crew Game over £rem maiaFia-free England to wmpete in the races, during the courSfl ef tihe final training near- New Londen seme ef bhe ea,r-smen caught maiaria and subsequently [est to Yale. IJi1ney Glaimed it was just ano~ne!' e£ r(!h0SCl t!!amn ¥ ankee wicks. Yea!' by year the malaria line in this Geuntry is Fe€eding. The diseasfl was once 1>ad enough in Washington to interfere with the sittings ef Cengr.ess. But eraining ane improving tihe sUFl'eunding [an<;l i\.as gFa€tuaidiY elimina,teGi the anephdes ther.e. ~n tne $eu~n, broadlly speaking, maiaria is largely man-maee. Railr.0ae embankments and the mOFe recently built autemoliile roaes were thrown up acress the ceuntry, anGi tQe erainage culvents weFe often a li~tle hig,her tihan the ~evel ef the wateF in I1ne 1iFen€hes eF lditches. 1i'fuese createt!! perfect aFtift@ia1 bneeding plaees fer mesquitoes, wnich aat!!ee to the ever-present edanger frem swamps. Since the aim 0f tihe 'l!nternational Wealth Boare was to pre mete JiluMic nealth so t.hat feGall headth t!!epaptments Goult!! get a, degitimate sharfl ef appropFiatiens, aned as Reekwerm demonstrations graduaJldy began to achieve this ebject, tile subject of malaria grew mOFe ane m0Fe imFortant. Ae€oFeing,ly, Wfl em1>arked en a pFogram wnich

«6


indueeed hJ0th a study ef the inGiden€e of nhe edisease, aned the t}lpe and fureeeiling nabits ef the mesquito reswonsible, so that GOntrel Gouled be attempted at the [arvae stage. Our hope was finally to devise means :wher.emy peeF Gemmunities might effect GOntrel at a Wrice they GOll.M alliered. mn [ 9 F 6 ~he inter-national Herulth iBea[ed made a demonstratien at Cressett, fu:R:ansas, that a cemmunity cewd be freed ef malaria by treeing it ef mesquitoes, aned within a reasenabie Gest. When this was sllG6essful the werll: was graduail[y extended until in 192 I a general atta€K uwen. the clisease was -being made. 'The pe!1JillelCing ~uestiens raisee £rem the entemologicaI angle preyecW maJaria to lie a paradox et waradexes. Many ideas and theeries :were Gompletely upset; even the nemenclature of mosquitoes hae te be efianged as our knewIedge of t'}Ipes was extended. All! pregress in ma!laFia GOntrol is aGcemplished by a narrewing process. lt was a tremeneeusly Gemplex stuedy in itself to determine which mesCijuitees caused what disease and where. Yellow fever and dengue, or breakibone fever, as weN as fj,laria and malaria, are transmitted by the fuite ef a mesquito. . 11here :were over thirty species of anopheles in the Philippines and twenty-twe on the lslancll e£ Luzon alone, but only one or two were an impeFtant factor in cal'rying malaDia. Mo~eover, a given sWecies miglit be dangereus in ene Gountry and not in another. In [Batavia, ffava, where the geegraphical anc!l! climatic GOnditions were Wract.i€aNy identical with tliese of Manila, £rightful malaria was transtnittee by the same anepheles which was harmless in Manila. To compiicate the preblem in the South Seas, ma1laria was extremely severe .jH lihe New Reb~iedes, mut was tetaihly lacking in neighbering New Callecilonia whi€h was in €enstant communication with it, aned where no quarantine precautions were ebserved by the French. MaJaria was extremely v.icious in Asia, diminishing in intensity with lihe c1Iistance theref.rem. 'Elie Recli1efeller Foundation representati¥e in Siam, Elr. MiIfel'd E. Bames, found thipty-four varieties. 1fnere were net quite so many in the IDuteh East Indies, enly three or tEemr in IDutch New Guinea, in Australian Papua oniliy ene., aned Fiji, tfieugh it swarmed w,ith GuJ:elli, had no anepheles· whatever.. Fer a long time it was believed in Europe that the maculip~pnis 4!47

, \

\


AN AMERICAN DOCTO'R'£ OElYSSEY was the only malaria-'Carry,ing anopheles. But sflveral factors seemed tiIDn of italy whel'fl the maaul\pennis wnfusing. 1'IDr example, in on(l sfl@ was numeFIDUS 1;heFe was fi(j) rFlrulaFia, and in anIDt'h er wheFfl it was SGarce, malaria was very biad. The lavvae IDf mIDscquitIDes fFom biIDth regions appflared identical. Finally the simple idea of examining the eggs ocwrred to a retired sanitary inspector named Faleroni, and, instead of 0nfl maculipflnnis, he was able tID eistinguish five var-ifltiflS. l'1urther imvestigabion sh0wed some 0f these car.Fie~ malaria ane SIDme d,i d nIDt. FurtheF progress in reseaF€h in [taly was hamperee biy the &if!iaulty of finding infected m0scquit0es in beclrooms, their wmmon and logical hiGiing places. Ordinarily not more than four pereent IDf thfl anopheles in a given regi0n aFe infecteGi, but if the bedroom is clar;k the anopheles, after biting, rClmains and hiGies theFfl until it is time fIDr: another: mClai. ]f this llieeFID0m is IDcaupiec1l by a pers0n with malaria the pClFcentage 0f hazara tID others in thCl home is nOI1mal'l.y greateF than the percentage of mosquito infection in the district. Dr. L. W. Wackett, the Foundation's malaFiologist in Italy, tooK: one thousand mosquitoes from a bedroom in an ltalian home where ail the membiers had maJaFia, and found in eveio/ case the anIDpheles haa fed IDn GIDWS' b1ID0& [It ham aihwa'Ys been assumedJ they ha<d biefln seGUI1ing nourishmeJlt b0m the humans in the house, but aGtua!l!J.y they ham IDnly been taking shdter after their mila!. The anopheles is not usual!ly found above the 3,@00 foot levd; 2,000 feet was the height in the il"hilippines, biut under rare conditi0ns it flew higheF; 4,500 in MaJay:!, 6,@QO in Mexico. 6,$00 in Lebamlfi, and 8,0G)0 [ll! the Hima!layas. . The hOFi'wnta!l flight IDf the anIDphdes was disc0veFed tID extend faF beyonm tihe hunclred yarms once set as the limit. AlthIDugh the large sturdy-wmged New Jersey culex has bieCln known to mvel forty miles, the average distancfl for thCl anopheles is abIDut one mile. At Camp £totsenberg in the Phiiippines indiviGiuaJ mosquitoes wolilm fly over tW0 milles to get a feeding 0f IDlo0d, but ~he average was t00 lIDw to dID much naFm at that <il:istanGe. Mosquit0es are m0st peFsistent in their. seareh for a bl00d mClal. In Georgia we selected fIDr our e~eriment a certain swamp caused 44 8


AN OUiNCE OF PREVENTION by one of the numer@us limestone @utcrops which, whenever they o~cur in [@w gr,@und, bFing about the accumulation @f water, difficult t@ arain. !Ln tIEs maFsh many anopheles wene kn@w,n to breed. The nearest house was a mile away over the crest of a hill, and between the swamp ana the house were many pine trees which had been ringed by turpentine gatherers and later died, leaving the branches bare s@ that mosquitoes could not hide among them. One summer a gr@up @f cohl~e students was assembled, and each one stationed in a wee with a huge mesquite net. All the insects caught were sprayed with a carmine stain. When released, they invariably flew in the direction of the house, although it was out of their sight and had no lights. If the weather were windy, they might proceed no more than a tree or twa, ana remain sheltered on the lee side. If the weather were mare favoroble, they would make greater progress, but always at Right. S@@nel' @r later; if they surv,ived, they arrived at the house, Feady for the anticipated ainner. lin every survey which was made, the first task: was to study the habits of the local mosquitoes. The culprits had to be run down, and then enough facts detected about them so that the proper offense measures might be taken. In the Philippines ma[aF,ia was widespread from the Bashi Channel in the No~th to the Sulu Sea in the South. The approximately two million cases a year resulted in from ten to twenty thousand deaths, although practically none of these occurred in the prin<:ipal cities of Manila, Cebu, or Iloilo. Malaria interfered with every enterprise. In getting the lumber out of the forests and raising sugar cane in the fields, laborers died by the hundred. Because of malaria, Mindoro, a great and fertile island in sight of the m@uth of Manila Bay, was supporting @nly a sparse population of semi-civilized people. Hunweas had died there under the Spanish regime in the effort to start sugar plantations, and the first American attempts fared little better. - Although as a direct cause of death malaria ranked fourth in the [slands, as a humanitarian and econ@mic pFoblem it ranked among -the first. Outside of Manila we had to deal w,ith extensi,ve population shifts during the vaFious harvest seasons. 1t was the rule that laborers went

449


AN AMERICAN DOCTOR'S ODYSSEY from their nativ:e towns to distant ones or to the mountains to c;:ollert forest pwd.ucrts. On sueh oceasions they Frequently l;mi.lt ~ean-to sheltel's along cd'itdles in whiGh anopheles brea abunaantJ.y. iLt was 4iffieu:lt for tne lay mind to ass0ciate cdangeF with anything which appeared as harmless as a m0squito. Many of the F,iJipinos adhereed tenaciously to the bad air bheory ana absolveed the mosquito nrom ali blame while she went on with her deacdly w0rk. The simple-minded tao Goula see no ediFeet eause aned effeGt, partieulaFly since the m0squito &ite aid n0t annoy him as mueh as i~ aid a tnicker:-slcinnea Face. He had s0joumea 0n terms of a ":live and let !lve" relationship all his aays. In Manil<l, if the innocent clay mosquito, the steg0myia persistans, or the equally blameless night mosquito, the fatigans, were allowecl to breed, the Bureau of Mealth was promptly accused of lrumess. ~he f,atigans Breed in c:irain piWes, septic tanKs, ancit eessp00is, ana the persistans ch0se rain barrels, h0use gutters, eans ana B0ttles. During the first year of the mosquito campaign the househciYlGler was given instructions by the mosquito squaa of the Bureau or Wealth. Receptacles were emptied, other colleGtions of water wer:e cover:ea w.ith petroleum, ana storm gutters w.eFe frequently Bushecl out by bhe F ire flepartment. ]f mosquitoes weFe ther-eatter f0una BFeeding on pFivate wnemises, the oceupants were 1istea on the 110'1il of dishon0r in the dai1!}' newspapeFs. This pr0Gedure had a very g00d effect. The â&#x201A;ŹulpRts' names became bywords bhroughout the town. Whe few remaining aelinquents were taken before the eourt, where fines for maintaining a nuisance were imp0sed. !Fhe enforcement of these measunes resultecl in eliminating pFaetical!lo/ ill the m0squitoes iWihiGli ann0Y man. For years we could not a>Ceount for the aosenGe of malaria! in Manila, whieh had so many anopheles mosquitoes. Furthermore, the great vaNeys of the Islancls were also praetical!ly free of the cili~ ease. This too was a great puzzle. Some pF0gress haa Deen macle by oilting bhe surfaGe, draining, ana e~perimenting with ~arvae eating fish while !(i was EiliFeet0F of Health. liihe !Bureau of Sciencre !laa impo!1tea Texan gambusia~x­ traordinary minnows able to li;ve equa[lly weN in salt, Fresh, running, or stagnant water. But in the Philippines they were unable to fu1ftlJl 4-50


AN OUNCE 01'1 PREVENTION theiF high pUFpose beeause of an even more extraordinary fish. The peripatetic dalag, or mudfish, pursued the tasty gambusia with avidity, and even hopped overland from pool to pool in quest of these delectable morsels. In the fountains and similar places the gambusia weFe able to keep the water free of larvae; in the ponds and esteros they were quickly eaten by the questing dalag, who himself often tutnishee £ooe for Filipino appetites. ln spite of allI our attempts at control, the problem was by no means near. a solution. ~he eampaign was gi:ven new impetus when I r.etUFned to the Islands in 1921. One evening after dinner Governor Gener-a!! Wood ane I were sitting, as was our custom, on the veranda of Ma.Iacafian. "I've a very pleasant surprise for you," the General said, "I've sClCured a million dollars for you to spend on malaria. According to the health reports, thirty thousand people are dying annually from it, ane it's time we wiped it out." "General," I replied, "I wouldn't know how to spend as much as that productively. From what I've learned about mosquitoes, the mere expenditure of money won't help toward the solution." ''Why not? That's the way they did it in Panama." ''But they never lI.ad to sanitate more than a few square miles in the Canall Zone while we ha'Ve tll.ousands." "Of €ourse you can get rna of it if you'hl drain the swamps. l1hat will cut malaria down right away." "But, General, we're running into all sorts of contradictions in the study of malaria. Isn't it possible that swamps may not be responsible for malaria here?" "They have everywhere else. Why not here?" "Nobody's proved it, and it's not a scientific way of finding out." "Well, that's the way I want it done!" was General Wood's categorieal response. I €onsidered that the Genera,l, himself a medical man, should not have taken such an attitude. ''In that €ase, General, I'd better stop," [Ii sa,id. "iI' can't proceed that way. ]it won1t be difficult for you to /ine someone to work on the problem as you may direct, and your method may be Fight. I hope it is." The sunject was dropped on this uncompromising note. But the 451


AN AMERICAN JY)OCG:TOR'S OIDYSSEY next morning, a,fter ~ go@d night's sleep, tfie General, as was his wo.nt, repented his gruffness and was extremely apologetic. ''What do I know about malaria? F@rget everything] sa,ied, aned teN me your ideas." "In the first place, I'd like to know whether all the edeaths ascJ;fbeed to malaria are Feally due t@ that cause. And, if they are, 'Ped like t@ find out why al!l the measures we';ve taken in the ma'laria,} districts have s@ faF Been i!'racbiEahl:y indl'eotiiVe. [ suggest asking the ] nteF' nabi@na1 iHeailth B@a,r-€1 f@r- ndi!' in getting a geed nlMavi@l@gist her.e t@ make a survey." Wooed agreeed to this pl'0gr-am witheut a moment's hesitatien, aned as soon as possible Wa,lteF 10. 'if,ieedeman was bFought to the lslanids. He seleGteed f0ur towns, eaoh repr.esenting a geographical t}lp~ne hirl town, one lowlaned, one bordC!Fing a lake, and ene lake village influenceed by running wateF iirom nearby hillsides. Fortunately the species of an0pheles which carried ma.laFia flew only late at night, the exact time edepending somewhat on the moon. On edark nights, contrary te mosCijuite custems in the Uniteed £tates, where the flight Begins at sunoewn, they aid not put in an appeal'an~e until twe[ve.thinty I'll' ene. We knew that we ~@uled sit er meve w:.ith perfe~t sa.fety tlnti[ Beehime- it was imp@sslble te sit en a s@Eeened veranaa: in the !E'hi~ippines in c@mifort fuecause tne 'SGEefmS shut off the BFeeze aned maede the heat intoleFalDle-but must sleep under mesCijuito bars if we wishe~ to aveiii! infeetion. T he Anopheles minimus was ~lFeady Gonvicted of guilt. But in the Philippines it was never feumd in the house eduring t;he daytime. Be· fore any preventive measures Gould be taken, its home must be Iecatefd. All sorts of expeviments were made. Ameng others, beeds were aFrangeii! in trees so that biting haroits at mifferent elevations might be studied. J1he bems wel1e iDaitem with men anm the sides of the m@sCijuite IDaFs lett epen. A\t about diven bite 1ir-st minimus arl'i<ved f@l' her meal, rout the roar-s weFe not ~esea uRti~ enough ham enterem fer e;xpeFimenta~ pUFi!'eses. A\t twe e'eleolr" a.EteF liJaving fed, the inseets were beceming fdistinctly uneasy, at t,hFee they weFe agitatemly seek· ing an exit, at four they weFe practiGal!1y committing mass suieide, 45 2


jamming their heads li>etween the intersti€es @£ the nettings, and even bFeal!;ing @ff their wings. ,[,he¥ were oli>vi@usly m@tiiVated by s@me ttemendclUs !i.@ming instinet. ~£ter ha,¥ing been s!\,rayed with Gaxmine, the prisoners weRe releaseGi anGl immediatel¥ a hunt was @l'ganizeGi. Stones were overtllFueGl, blames @£ gmss a,nd leaves scr-utinized, ttee trunks examined. 1Vhe sear0h €Ontinue~ f@r two years and eost thousands of doldars but tdtimatldy the hiGiing place of the minimus was ferreted out. lin file iJilhilippines the streams were always Iined with bamb@o, and where the Gurrent undercut the banks, the bamboo r@@tlets f@rmed a tangled mass int@ which the e:lusive minimus would retreat during the da,ytime. ]t 'Was thus proved that madatia in the islands was ass@eiated with the swi£t running waters @E the f@othiills. Had Wood's miNion been spent in draining swamps, it wollid have been completely wastea. 'This funGla,menta:!l GI'isG@very gave us the infermati@n required for a fu;esh star,t in ma,laria contrel. Riee GhafF was scatteRea en the surface @f the stream, and as it fI@ateGi al@ng an @bserver neted where it stopped in the Ettle edGlies. ]n th@se plaees larvae OF wrigglers were oMen found in abundanee. lIDhe eggs of the Anopheles minimus were laid among the bamboo ' r,@@tlets @n the sur-£aee of ~he water. Semetimes in the course of one Ma,y the Ia,wae w@u.ld ferm, and with the chisel-shaped egg breakers on the baGks ot their heads w@U'lcl cut their way through the sheIk 1f1l\.ey w@uM then lie on the surfMe t@ feed, breathing air with tiny tubes pushed up thFough the surfaee film, and brushing into their m@uths any minute panticles whieh might float their way. These :wrigglers w@uld take a weeK: t@ devdep into adult mosquitoes-if the water weFe GolGl, even l@nger. 1Ji"l\.e proli>lem @f eradieating the minimus would have been difficult @f seluti@n had we rrot been able to utilize the wenderfUl discovery maGle li>y Dr. Barber that the a\;etoarsenite of copper c@mp@und known £ommerciailly as Paris green, when mixed with ninety-nine Farts @E fine GIry Foad dust, and re:leased in douds above the surface of the stream, w@uld kiil the laFiVae. '['he mixture is s@ efFective that i~ larvae weFe living in a &sh in a l'o@m, ana somebedy around the

45.3


AN 0UlN([)E

~}j1 PR!EViE!N'F~@N

the World War the Jews a~rivecl in great numbers at their ancient but long cleserted home with the intent of making it self1:ontained, ana of esta!)1ishing prosFJerity on a firm agricultura[ basis. Most of the Zionists were sentimental ancients or young enthusiasts with few children. In spite of all that can be done, no more than a quarter of tlhem are in agl'icultlUre. They pefsis~ in drifting into shoFJs; TeIAviv is a typical East Side New York. The country as a whole is most desolate. Its series of steep hills ana naFFOW val!leys aFe coverecl my loose stones about the size of a fist. The few arable sections are found near the seacoast and in the Jorclan Valley. In the former, citrus fruit is grown, but the climate is so clry that every orange tree must be surround,ed by a dike through whioh water has to be pumpecl at frequent intervals, thus creating aclclitional water hazards. The Jordan Valley is fertile, but, owing to the pernicious malar.ia which abounds there, cultivation has been a:lmost impossible, and those who have made the attempt frequently paid with their health, if not their lives. It was for years impossible to determine the sour€e of the malaoia so pnevalent in the district aFouncl Tibenias, because it was certain anopheles could not breed in the brackish waters of the Sea of Galilee, and no other possible bneeding grounds coulcl be lomted. Final~y, some tiny springs were founcl in the hillside. American engineers introduced expert methods of dynamiting and blasting to d.ain the stagnant pools and swamps. Strings of eXfliosive were laid £Fom these to the lowlands and then exploded, making channels instantaneously. Streams that could not be dealt with in this manner were treated with Paris green. The cultivation of the land made a,vai.Jable by the irFigation project was in itself a cleternent to mosquito breeding. \ Some yeat'S ago the All America Cables had a small station on the West Coast of Nicanagua, the staff of which was losing as high - as fi-fty hours a week from sickness among its few employees. One of the Rockefeller engineers was clespatched there, and found the station 10catecl in a dent in the high Ilil!ls 0ut of whioh water wi€klecl ana collected in the station. By digging a circular ditch around the back of the town, the weeping water. was collected in one place, and

455


there w~a~eiil with iE'ar.is gm:en. One tlleusanlil h0UfS ef time ¥earl'Y weFe s:wem te that smaiN gFeup en GaMe empTeyees lDy t his simple liIev,iae.


AN OUNOE OF PREVENTION health officer merely haa to !drive along the road and could see at a glance whether the coolie had done his job, whereas chemical analysis was required to discover whether water had been treated with Paris green. The principal trouble on Malayan plantations, determined only after long search, was found to have come from cutting down the jungie, because maculatus larvae, which, unlike the aault mosquito~, lovea sunlight, would breed like mad as soon as the pools were exposea, w.hile in the aark they would not multiply. If the planters I'eft:ained born felling the jungle, or if after felling they encouragea second growth, the anopheles could be kept under control. Singapore in the old days was a veritable death trap. Gilbert Brooke, who held the office of Chief Health Officer of Rural Singapore, became so interested that he regarded mosquitoes as his avocation as well as his vocation. He made a hobby of these insects, and was writing a book about them, largely compiled from a huge mass of literature. Brooke read me a long poem from Vergil in the o~iginal, and then translated a passage which he interpreted as pl1(DVing that the gnats therein described must have been culex mosquitoes. 'Fhe mosquito aanger in $ingapoFe came not only from maculatus but alS0 from luchlowii, although the former was stili the chief offender. The cost of dealing with them was high, but fortunately the Straits Settlements in those days of the rubber boom could afford it. Every time the slightest excavation was made, the maculatus would breed plentifully. The site of the new city reservoir had been an old coffee plantation long abandoned because of its malaria rate. The huge granite boulders in the stream beds which fed it were flattened with dynamite, so that no pools could remain in the dry season. The crevices in rocks with pot holes, which gave rise to such intensive breeding, were fiHed with cement, making a smooth surface thr.oughout. On the hillsiaes subsoil pipes were laia, coveFed with Cl1Ilshed stone and several feet of earth seeded with grass. The lutdlowii breeds in br.ackisn water, Singapore lies right on the s~ and the spring tides always flooded the flats with salt water. Thereafter, when the daily rains diluted these residual pools to 457


AN AMER[CAN IDOG!rOR'S ODYSSEY the Fight degree OF salinity, the lu~iowii flourished. Subsoil arainage was begun for their elimination when the Naval Base, whieh was to prove British p'0wer to the East, was started in 1~23. But the short-lived pacifistic Labor government stopped the work, and it was not recommenced until 1925. The onrush of the jungle in tFoJili€all lanas is so swift that the 10Gation of &hese pipes, laia eighteen mcmths befo~e, iWas lost ana eould not even IDe found. [t was nelleS= sary to lD~gin the wOFk ail over again. il!n most of the eountF,ies to wb.iGh iL went, IIlhe hea'l th autll.oF>ities were exeeedingly anxious to seeure ll.eiJ!l in their ma~aria profulems. iJ"usll.ed more or less fuy the native members, tihe Ceylon gove~nment was anxious to start an island-wiae malaria Gontrol camp'aign, ana intimatea that large sums, possibly a million rUJ!lees, eouM be maae available. But the firm poliey of the Founcdation was never to embark in any undertaking without a thoFoughly competent SUFV@Y having first been maae. ~his survey revealed that, althGlUgh there were eighteen types of anopheles on the lslancl, the on! y proved carri@r was culieifacies. lt haa a wide range of breeding J!llaee~ slow moving sandy rivers and pools., lDut also irrigation channels, quarries, op'en drains, 0l@aF f,Fesh sun!1it water, even hoo/fprints of eattle. $J!lesiail att@ntioll was p'aid to Anuroahap'ura, a seetion of eeylon so arid tnat in the aays of its magnifieenee water naa fueen bFought in by eanals fOF storage and iFFigation purp>oses, ancl thus hacd cr@atea its own malaria problem. We founa that reservoirs and canals still leaked abundantly through cFawfisll. holes ana seepage a!long peneflftlting roots. The hazard of many years ago had been further inGFeas@alDy borrow pits beside the railroad ana leaks from riee p'addies. lit was a question of effioient engin@ering to make the maiaria disaJ!lpear. Malaria could be wiped out anywhere if enough money were sJ!l@nt, but the question of ecollomicahly feasible control, J!lartiGulafJy in F>ural areas, was GonstanMy arising. iln Ceylon the survey showe~ the average per capital cost wou'l'd be sHe Fupees, ana no islana-wide eamp'aign weulcd De Jilraetieable at this figUF@. It is one of the p'araaexes ef maiaria that in ~ndia it ee£emes eJ!lidemi€ with heavy rainfa~l, whi!le in Ceylen the aeath rate sears with drought. The reason fer this is €lear uJ!lon analysis. In the 458


AN OUNCE OF PREVENTION Punjab, the vast plain drained by the Indus, pools are left in the depFessions of the land a,fteF the rains in ~ uly and August, and in tnese tl\.e mosquitoes breea. ]n Ceylon, the geogrcaphy is quite diffevent. 'Fl\.e south central part of the isla,nd is a mass of hilIs and mountains wl\.ose peaks rise to seven thousand feet. From these flow numerous rivers and streams, many of which are only outlet channels for the storm water of the monsoon. Pools remain as drought shrinks the riveFs. ~n Octaoer, I <!)34J, bega,n the worst drought in the history of Ceylan, accampaniea by ane af the major malania epidemics of history. In the ensuing seven months, out of a population in the affe~ted aistrict of three million, half had the disease. In same places the infection was one hundred percent. Eighty thousand lives were last in the periad, viNage,Iife was paralyzed, agri~ultural operations ceased, trade and business stopped almost completely. The whole medi~al force was mobil~'Zed, the school houses were taken over as ciinics, and everybody was supplied with free quini"ne. At the height af the epi<ilemic, more than sixty thousand a day were treated. An expert malariologist, supplied by the Britisli government, was at once called into consultation. Hitherto such epidemics had been FegaFded as inevitable but after an exhaustive study he reported that, aithough oepi<ilemics ÂŁauild nat be halted once unaer way, it shouIa be possible, by combining alI known methods and, especially, training the river beds to eradicate breeding places, to prevent their recurrence. Allover the world students, research workers, field and laboratory scientists ar.e working on malaria. Until some method can be devised whioh is capable of general application, there is little hope of !Dringing the <ilisease under complete control. The most that can be said today is that if enough money is spent, a malarial district can be made healthy; but it is a long and persistent task, and only unremitting care meets with success. 1n the tropics there is no end to malaria control; as soon as antimalaria measures are stopped, tl\.e 'disease recmrs. At one time Bom!Day was ouiiaing a new port area, and nearly all crews of ships that anchoFed in that section of the Bay caught malaria. The situation became so serious that ships were short-handed. It was finally dis-

459


AN AMEREeAN DCeTCR'S; ODYSSEY cCDVeFed that Fain had colleeteed in half-comvieted basements neaFby, a;ned the m0s<jJuit0es haed i:Jl'eGi there, thus infeGting the sa;il0rs. iIDhe w0t.k 0f Fiiiliiling the !il01't ar.ea 0f m0s<jJuit0es was S0 we:l!l ed0ne tnat the dty fatners said, '''W.e nave n0 malaFia"; aniil Glied a;way with the aJilpr0priati0n. Malari~ at once returneed. iEven with the kn0wledge at our c0mmaned, mala~ia conwol is not aiways possible. In the 'lEast Feligion S00neF 0r [ater steJils up-0n the seene. ~n lEl0mi:Jay the iFa;rsees, Wln0 f0l!l0W1 a; strange cmft, wene edominant in the business afEairs ot tne eity. 'They are to oe enâ&#x201A;ŹOUnterecd everywhete in the cit;y, reaediJy edistinguishable by their 0iiliil wooden hats, covereed with yellowish and MaGI!' oilcloth. They live in huge tenement-like structures i:Juilt a!70und a little courtyard in the mieddle of whiGh is a weii, s0metimes thifty feet edeeJil. Gn the F00fs a;Fe vast eistel'ns. 'Bonn weUs ana eistel'ns ane uncoveFeGi beGause alii Parsees regaFed the f0UF d~ments-eaF~h, ail', fiFe., aned wateF-as saered and unGontaminable. In Bombay the malaria Gar.rier is Anopheles stephensi, so peFfectly uri:Janized that it will breeed in alm0st any G0ntaineF, aned is e<ijua~ly at h0me in aeeJilest weN 0F high-i:JuiJt cistern. Not until after years of veFsuasi0n aned tne exereise 0f constant unyieIaing presSlJEe w0uM the influentia;[ ii'a;Fsees SGFeen theiF GisteFns anCil wel!ls. The Parsees ultimately withcdFew their objeGticDns, but religi0n mus~ still be edealt with in 0ther parts of Inaia. The r.ecentiy POWeI'M spokesman, Ganedhi, flying in the face of all model'n scientifiG know!. eage aned ign01'ing the tremenc;i0us numbeF of humans being slain by,' sueh sma;liI inseets, is r.ep0FteGi as ha;v,ing stated in the Times of ifndia, June, I~3S, "We have no Fight to take the li;ves 0f m0s<ijuit0es, illes, lice, rats, 0r fleas. They have as mUGh right to live as we."


CHAlPlIJER 26.

AND MAKE PERSUASION DO THE WORK OF FEA,R

HEN I first began tmveling for the Rockefeller Foundation, the run from Singapore to Java was a bright spot in the itinerary. The Melchoir Treub and the Rumphius were the <rrack passenger liners of the K.P.M., the most powerful corporation in the Dutch East IndieS. These boats, which -resembled luxurious yachts, were built for comfort ~n the tropics. Passengers could practically live on deck, taking refuge from the brief but daily showers in little shelters specially provided. The voyage was comfortable and pleasant. Fat Dutch ofliGials speht most of their time puffing placidly on cabbagy cigars which glowed like red hot chimneys, and, in the company of their equally fat Mevvrouws, gulping foaming schooners of beer at the little deek tables. With the low Sumatra coast on our right, never out of sight of islands, we steamed the five hundred miles to broad and shallow Batavia Bay. At dawn of the second day we approached the breakwater which proteâ&#x201A;Źts Tandjong Priok. Neither at this modern port nor at the old capital of Batavia, seven miles away, was there any hint of the strange beauty hidden within the island. Low-lying Batavia itseLf looked like any town in Holland. Its stone-walled canals, with gates to regulate the sluggish flow of the current, sometimes traveFsed the centers of the enormously broad avenues, built on the generous Sâ&#x201A;Źale of the Dutch themselves. 461

W


AN AMERICAN DOC'FOR'S ODYSSEY 'ifhe tiaalt flats @f Bata'l'ia, mone Plesti1en~ia!l than these of Singapore, had offered no terrors t@ the Seventeenth Century col@nists f.F@m the ZuyaeF :lee, who ham Gome tram a c@unl!ry in which malavia claimed then an annua,l tithe. ]n Batavia, whieh ironicaLly enough means Fair Meadows, they clung in~repiilly to the homes they had ereGted there. But the m@rtality was s@ @verp@weFing----e"Ver a miW1i@n diea in twenty-two years of the !Eighteenth Century-that the Git;y ultimately was aband@ned to natives and commerce; the burghers now came a@wn t@ it @nty far w@rlcing h@urs, ana r-eruFn as ear,ly as Pl@ssible to Weltevreclen (Well Content ~ where they J..ive in t4eir plastered tinted houses on ground only a little higher but far mere healthful. Even in Welte'l'reeen-Batavia Centrum as it is new cahlea-the heat is intense, and the mosquitoes, although not malaria carriers; maee it impassible f@F me to work in my hate] room. The whole islana swarmed with insect me, from butterflies to termites, and at sundown the air was resonant with their thFobbing sounds. They weFe an @mnipresent pest. T 'h e Govern@F Genera[ founa Weltevreaen much t@@ het. Me m@ved inland to Buitenzorg in the 'hills which, although not in sight £rem Batavia, aFe neveF much mare than an hour h@m the G@ast. 'Phe w@rld's mast beautifUl! b@tanical garaens form a Plrivate park for his mansion. On the sl@Ple of SalaK volcano, which thr@ugh the Genwies has fertiLized its hillsides, grow specimens of every ~ree, shrulli, Pliant, ana vine Kn@ wn t@ the tF@Plics. T hroughout its spacious ael'es the Dutoh e~periment with tea, rubber, cinchona, sugar cane, rice, nutmegs, cloves, ane pepPler in ol'aer to aeveloPl them f@F eommel'€e. ']lhough the £undamental Plul1P@se is eG@n@mic, the faithful botanists who have lab@rea there have nev:er saer;ificea beauty to utility. Five thousana aut @£ the sU!: thousana kn@wn varieties @f orohies @Plen eJ{o~ie M@@ms, ana tI1ee fuehsias @f incompar-allile beauty are c@vered with dusky r ed and purple blossoms. Its primeval f@Fest is watered by a riveF, and on its numerous ponas fI@at the most maw el@us water Mies ] have ever seen. Not many miles fr@m the iB@tanical Gardens lies a mysterious plantation, encircled by a high stene wall. Within this encl@sure, which n@;visiter ever enters, gnaw the GinGh@na tiFees of Java. 1Fhe seeFets 4-62


AND MAKE PERSUASION of oultivation anm extraction thus jealousIy gUaFmed have made the Dutdl supFeme in the produGtien of quinine. 1l"his was by ne means lihe enJ,y â&#x201A;Źontribution of the Dutch te memieine. They intromuced chenopodium for the cure of hookworm. In their laboratories they had develeped the smallpox vaccine, sought vainly for so many years, that would remain effective for long perioms under tropical temperature. They were the first to experiment with choleFa vaccine on a large scale, testing it on the inhabitants ef eaeh a~ter.nate bleck in Batavia. Practicru11y no cases oC0urrem in the bllocks pretectem by the vaecine. In Sumatra, where hundreds of labOI;ers on rubber plantations used to die annually, administering the vaccine had cut the number down to one or two. In the extremely difficult situations that confronted them, the Dutch seemed to possess to an unusual degree the ability to combine the soientific with the practical. They directed their efforts to finding speoific r.ememies for treating tropical diseases and working out econemical methods for dealing with health matters. it was a Netherlanmer in Java who invented the bored hole latrine, one of the greatest contribu60ns to sanitation in the East. At last in dealing with the terrible problem of soil pollution a method was devised, the chief value of which lay in its simplicity. By boring a hole in the ground fourteen to siooteen inches in diameter and ten or twelve feet deep, preferably to ground water, a cheap, odorless latrine could be made available to all races and te suit aN purses. The Americans, who are the well-drillers for the world, soon perfected drilling equipment, as easy to use as a carpenter's augur, which still further simplified installation. ll'.l'le berem hole ~atrine has many amvantages. Years of researeh eonduoted by the Rockefeller Founmation have shown that, under almost all conditions, such lat~ines constitute no danger to wells or other demestic water supplies. Even the poorest peasants of Java can afford this safeguard and literally hundreds of thousands are being constructed annually. MFS. Marie D. Buck, a pnomineht teacher in Madras, states: "We expect every student to become a bherough Gonvert to the B. H. L. ana to ieave us eager to install them in his home, school, and playground, as a disease controller and annihilator of the main reason for making

463


AND MAKE PERSUASION numbers of people would be affected, but this was not easy of acaomplishment beâ&#x201A;Źause they were con",inced of their ability to handle their herulth pFoblems wi~hout outside aid. [ relied on the old mmi'liar hookworm route to gain entranae to java, and, following my rule to begin with the man at the top, interviewed Alexander W. Frederick Indenburg, the Governor General, a difficult undertaking, since high Dutch officials are not in the habit of seeing casuail visitors. With the temperature at ninety, the humidity at saturation point, 3!nd not eneugh breeze to move a piece of tissue paper, ~ avrayed myself in Fedingote, heavy trousers, stiff shirt, patent ~eather shoes, and a silk hat and made my call. I briefly described to the Governor General the development of the hookworm campaign in the United States ; how it had gradually eJlitended to foreign countries, and how it served as an ente.ring wedge to make even the most lewly people acquainted with the goocd Fes~ts that fel1ewed pulili~ health measures; I told him how our Board believed that a system of health could not be imposed upon a people from above, that it must come from below, and that it was only by patience rather than by force that permanent progress in health lines could be gained; I explained how hookworm was so simple that even the most ignerant could understand it, that our experience ¡so far had been that through its treatment a desire was cFeated in the masses for better hea'lth conditions, and that as soon as this was accomplished we believed the battle was half won; I laid special stress upon the improvement which might be expected in the economic efficiency of the people, and expressed our desire to make an infectien survey in Java; and finally I suggested that, if suitable arrangements wuld be made, we would send a medical officer to ~oopeFate with the medical officells ef his own service. ' The Governor General was very polite and affable. He would be happy to look into this, would advise me if anything were to be - done, and gave me a letter to his Chief Health Officer, Dr. W. T . de Vogel, who would make the necessary arrangements for the IDarling Commission's survey_ DF. de Vogel intimated that when it came to control measures, his department was probably better able to handle them than our new organization. He agreed Feadily, however, to let the Darling 465


AND MAKE PERSUASiJiON "Yres." "Zis mOFning you have sent one cablegFam?" "¥es, wnyl" "Eet ees net zee Eengleesn. It must be zee Elengleesh." ''What's WFong with it?" "Eet has zee word p-s-y<-h-o-l-o-g-i-c-a-l. Zat ees not zee Eengleesh." "Of COUFse it is! It's a perfectly good word." "Nol! lEet ees NO'if zee Eengleesh." " l cannot be responsible for your English eduGation. I'll leave it to any iEng.lish-speaking person." That seemed to end her doubts, at least momentarily. She began on anether tack. "You have anozzaire word. Eet ees also zee code." ''What's that one?" "E>-a-r-l-i-n-g. ] have leeked in zee dictionary and eet say 'one sweet zing.''' "Darling is not one sweet thing. It's the name of a man," I assured the girl desperately, aware by this time that the whole dining roem had ceased eating and was listening to this absorbing conversation. "Oh, no-o-e, darling means 'one sweet zing.' It must be zee €ode. [ cannot sena eet." "I insist en your sending it! It has to go through Singapore anyhew. Let them decide." ''Wel!l,'' hesitatingly, "I don't zink I can send eet." ''You go ahead and send it," I ad jured her, slammed down the telephene reJ;eiver, and passed through the length of the dining r.eom to the accemFaniment ef IDlewing l00ks from the diners, all of whom were convinced that I had been communicating with "one sweet zing." The Hotel des Indes is a remarkable place. Javanese hotels are - run on different principles £Fem those of any elsewhere in the werld. '['hey aFe more like sma'll villages, consisting 0f a series of €ettages with tw0 apartments, one ab0ve the other. For the time 0f the guest's eacuFancy, one of these, composed of veranda, sitting reem, bedroem, bath, and cubby hole for the boy assigned to him as his personal servant 'by the hotel, is his private dwelling. This boy 467


AND MAKE PERSUASION

r

was ememely curious. I puzzlea until I discovered the answer. When they enteFed an American hotel or restaurant, believing it the 10GaI custom, they would mistakenlÂĽ start at the top and eat their way through the a la carte bill of fare, a difficult feat, even for those in tFaining. The appearance of the Dutch, heavy and big-boned, was decidedly unattraGti;ve. Nor coula the Javanese, with their wizened faces, be juc!lged beautiful by Western stanaaras. Only the mestizos, combining the llJest featur.es of both races, we~e hanasome. Fortunately theFe were many of these, because the Dutch and Javanese intermarried &eely. Pam: ot many IDutch women's lack of charm was due to the habit of sitting around in sarong and jacket until late in the atternoon. This coula be excused on the grounds of the great heat, but not on those of esthetics. The nights were so sticky and hot in the lowlands, especially since a mosquito net was indispensable, that it was the invariable custom to provide a long bolster called a Dutch wife. By placing one knee over this, the sleeper could expose a larger area of epidermis ana receive the benefit of the maximum amount of air. The Dutch were still far behina other countries in the fundatnentals of tropical ventilation, so necessary in a country where the monS00n seMom blew. This seemea oaa in the light of their many remar.kabie conquests ot other tropiGa,l problems. The homes, scrupulously whitewashed and aecoratea with blooming plants in the tradition of the old country, had no jutting verandas. Instead, the middle of the front three rooms meFely lacked an outer wall. Whatever breeze there might be could enter this open-air sitting room only trom one directi0n. Cholera was otten severe in Batavia before the general application of vaccine. According to a Malay custom, when an epidemic was raging, in order to avoid registering their dead, they used to drag - the bodies to the "partioular lands" and abandon them there. These wen: private goveFnment grants, exempt from the Dutch health Fegulati0ns, most of them 10catea in the outlying distriot ot Batavia cal'.led Meester Cornelis. 1iihe danger of cholera was als0 present in rural communities, where villagers bathea their boaies and washed their rice in the same 4 69


AN AMERlICtrni BGlc:D<0R'ÂŁ ODYSSEY str.eams which they p0ilute~. These dessas, as they were cailea, were surrounaea by Fice paaaies ana <!aIle fields. Most of tile houses were built flat on the ground, S0me made of suale, or woven bamboo, Qthers of a substanee resembling our aaobe. [n most !lases they nacl Ileavily thatched roofs. Although the Duteh conquered eholera, plague was still an uns0lved pr0b>lem in thielUy Ji)opulatea ffava. an one 0E my trips [ JeaFned thene naa been a ltuniilFed tnousancl cases, chidl,;y in lilie m0uAtain dist~idts. 'if1he au~h0rities asKe~ my opinion, ana &ffened me eveF;}' faei!lit;y for 'Visit;ing ~he plague ar.ea. ]n tile course 0f inspecting the rustriets affectea ]i Ilad a fine opJi)ortunity to see a great aeall of Javanese village life. We F0dtl in procession with a native oflkial on hOFseback, ana everywheFe we stoppea we were sUFFouncled by eUFious multituaes. Even as we inspected the rat-pr00t houses, ~arge numbers tramped after. us. AJ1 the eountryside came to make a holiday. At many points along the route we were gFeetea by the native gamelan or anklong bands. At Karangkobar a great show was stagea for my benefit which was in many. I'espects simi!lar to the lfugao fiestas in which I usea to Ji)af1iie-ip,ate in tne Philippines. 'Fae IDutch meta0d OF eeaJlihg wi~1'i plague was to aemQ~ish eve!,), h0use in an;y vi~ijage in whi@h the elsease appeaFea. ]n putting the IDuilclings togetheF again, they dever1y split tne IDamlbo0 p,0ies in haH, laying the enas of the semioiFcle OF one section int0 tile C0ncave sUFfaee of the otaer so that no endosed space ,f0F hadilQring rats was lefit. Naturaiijy the plague disappeared in that town, but it was mor.e than likely to appear in the one ahead. After completing the inspection, ] informed the Dutch ÂŁrankly that first of all the pFimary sourees of infection, the grain wareh0uses in the port cities, sh0uld be dealt with, and, since they had only ab0ut a miJili0n aoiijaFs to spend on piague, the meth0d they were pUFsuing in the .,i!lJ.ages-was n0t Ekeiy to be suceessfut iLn attemp>ting to guaFd against the liLisease tlhey waited unti!L something happened, aAd tnen G0neentl'ated heaWly. Qn tne in,feeti0n itseiH. 1J))he idea of teaFing aown anal FeGOnstruGting fitty thousand houses annurulily was a pr0gram wnilih w0uM Ilave awea any IDut a aete~minea Dutchman. My ad;v;iee was to map the Foads over whicn grain w4s

47@


a~ustomed to travel, because along those routes the plague would sw:e1y travel also. Instead of expending so much energy in a town already infected, I suggested taking a lesson from our enemy the fleas, and Keeping one jump ahead of them. The wholesale destruction of a town was spectacular, but the otherwise efficient Dutch never caught up with the plague. Their plan was nothing more than a stem chase. l'he Dutch, on the other hand, claimed the sectionall method I had used so successfulJy in the Philippines was impossible in Java mecauserats could not be eliminated from the thickly thatched 1'oofs. l'1ur1lhermore, it was their duty to keep their population happy, and, since the Javanese never wanted anything done, they believed that in attack;ing infection after its appearance, they were interfering about as much with native habits and customs as circumstances warranted. The Malay was not easy to work with. In his native state he was highly superstitious. When asked his name, rather than bring down upon his head the bad luck supposed to follow a direct answer, he would turn to a friend and ask, ''What is my name?" Although nominally Mohammedan in Java, he still believed in hantu, evil spiFits which lived in trees ami lurked about the houses at night, and this hantu influence was believed to be sinister toward his family, animals, CFOPS,- and even his own person. The Ma~ay inabi[ity to stay awake was so serious that the Dutch would not trust the Javanese to operate trains in the darkness; consequently they did not run at night. Because prospective travelers had to be routed out of bed so e;l.rly in the morning to catch trains, traveling was particularly tiresome. In spite of this inconvenience, however, the two-day trip along the mountain range which ran the length of Java was most scenic and impressive, particularly the section between Batavia and Djokjakarta. At Djokjakarta the Dutch had Gompromised with the Feligion of - their subjects, who fervently worshipped the Sultan as divine, by peFmitting him to keep up a shadow of his formeF rule. I had an ead feeling that it was, to say the least, unusual to find white Chris- â&#x20AC;˘ tian solc:liers guaFcling a Mohammedan potentate in a country rulecl my a European nation, especia1ly when I recalled that this rule had now extendecd over a period of several centuries. For my interview 4?I


AN AMiEiRKAN DOCTeJR:'S O:9YSSiEY wi~n ~hft

Sultan ill was G0nmueteGi by a iClutG·h 0fficeF thr0ugh his kr-aton, leosely calle!:m the JilaIaGe!:., whiGh, ~ike th0se 0f aU Eastel1n potentates, consistftGi of a series 0f builGiings. Within tne stone walis, which sheltereGi some ten th0usanGi f0l'l0wers, was encl0sure after end0sune. '!IDhe JilFi:vate mwel!ling 0f tihe SuJtan was J0cat!ed wi~hin the fourth enGl0sun:, as weFe the!: har.em ap!artments guarded by the princes, and a public rftCepti0n r00m, 0rnately decorated with gilt carvings and scintilJating with mirrors. PiGtures of Quee!:n Wilhelmina ana tile Netherlands r0y:d £ami'ly eertified his iOY<lllty to th.e S0UFCft 0E his inG0me. The $ultan Jivea in c0i0r£ul if n0t regal surroundings. Within the gr0unds para@ed resplenaent bir@s of paradise an@ peac0!clfs. Many F00sters weFe <IIls0 being e!:xeFGisea, eaeh 1,V,itll his sJileeial maie attenaant; wGkfighting was 0ne 0f the $Uiltan's prinGiF<lil diveFsi0ns. Glistening shining carp, said to be very highly prirzea by the Sultan as anticles of f00d, swam lazi!l.y in a p0n@ int0 whiGh drainage tr0m the ll0yai Jila!lace e!:mptie!:Gi. 'En0l1mous perg0las @0tte@ tFu: lawns. illll aCG0r@anGe :with the tftnl'lts of the!: M0'hamme@an religi0n, worship couid not be pl'll1mitted unmer the dftaF sky. [t was generalily assumed that this meant serviGes sllouM be G0nmuete@ in a mosque, but the $ultan haa @0@gft@ b01lfl tile iSSUe!: aHd tllft !i.eat by ereeting these 0Jilen-air StllU@tUFes wllien were cheap, pFovide!:d shadft, and at the!: same time might be interprete@ as meeting r,he @emands 0f his religion. M0llft attFaGtiwe than fhe kr.aton were the fairly m0dern FUinS 0E tile ne!:arl~y Water. iJ?alaee, built lDy a iJi'0rtuguese adventUFftr. Mtll0ugn when I first saw it, it had been abanGione<d for 0nly five years, it was aiFea@¥ in a state 0f great @isrepair, and the jungle ham crept 0ver it. Many unmergr0unGi water-e001e@ Ghambets haGi been built to JilFOvide Fei'id f.F0m the tF0pieal heat, an@ ~F0m these in all[ diFeeti0fls led Jilassages, apJilarently designed to <IIfF0Fdi ready means 0f eseape. Less than a hunared years' ago was @isc0vered the greatest 0f aU J:wanese ruins, wllieh the aungle had swalil0wea up €0Hl,Wletely. T1he • iButGh had been 10ya4 to tne anticquarian tmst lef.t in tneir hanes, and had carefully r.emoved the clinging tendr..ils kom B0rob0eaoeF. 11his magnificent Felie, @eseFted with the Mohammeaan concquest of the island, remaineGi stili to bear witness to the physical e*F>l'es-

4172


AND MAKE PERSUASION si0n of the Buddhist faith. Tier on tier the huge lava blocks, fitted w.ithout mOFtar, held by no Golumns and n0 supporting arches, !lose majesticaI!lo/ above the plain. E;ach terrace was dec0ratea with Bas reliefs, repFesenting the life of !Buddha and symbolizing the spiritual development of man. From the top of the temple the eye swept the countryside, fecund with rice, sugar, and cocoanuts. The pretty streams, the gentle people, the fertiie GOuntry, and the harmonious landscape, impressed me with the th0ught that, after all, man did not aefile aU he t0uchea, and even aid much to make it more beautiful. Boroboeaoer stands as a cherished relic, but the ever-present volcanoes are still regardea with superstitious awe and reverence by the Javanese who live among them. The mild and kindly Tenggerese had a sort 0f Feligion, half Brahmin, half animistic, centered around the worship 0f Bromo, the most famous of Javanese craters, which Feax;ea itse1f w0m the Zand Zee not far from Soeraba ja at the eastern ena of the island. The morning I made the ascent the mists in the valleys at sunrise looked like great ocean billows, and the mountain tops stood out like islets here and there. At times I had the illusion that waves were being washea against the shore. Then the mists thinnea, and the lowlanas appear-ed aimly, as though seen through clear water, Ait M0engal Pass, eleven hundrea feet up, we looked down into the "Lanascape of the Moon" which was in reality the bottom of the old Tengger Volcano. The narrow and shallow steps cut up to the cFater's rim, an hour's ride further, were difficult to climb because they had been deeJilly covered with ashes from the constant eruptions. Steam e:q :>i0si0ns were 0ccUFring at the b0ttom w.ith an awe-insJiliFing n0ise. At the edge 0f the crater shelters of huge timbers had been built, and when it was time for an eruption, the guide urged us into one of these. From there I saw the actual eruption, its showers _ of h0t r0cks and ashes spurting into the air and thundering down. On the return j0urney the a~m0sphere was tmnsparent and pel" lucid and the seenery majestic. Java was the most volcanic island f0r its size in the woda, and Jile~iodic eruptions from one or more of the Graters sent out great clouds of fine ashes which drifted and settled over the landscape. The soil thus fertilized was watered by 4-73


AN AMERICAN DOCfOR'S (i)J)YSSEY ~he

maily rains, cfeating imea.l cenditions for plant life. Even the teps o£ t;he mountains were sewn with crops et potatoes, c:ar,r ets, lebbUGe, an€i Gefn. AJ1 java was Eke a gar-clen; neb an araIDle plot went untillea 0n this islanm 0f thirty miNion inhabitants. [.alang, tfue universal grass pest ef fhe Eastern tropies, coulm not grow bec:ause o£ the intensive cultivation. :Ii was a<lways _reminded of what would be p0ssibJie in t;he Philippines, so impFesseGli was I with tihe great wealth of Java's J:lF0mucts=its SUgflF, kaJ'l0k, wineaJ:lJ:lies, mang0es, G0Ceanuts, ~ubbel', and sJ'lices. l~Figation ditehes f0r the hhiek-stamiI.ing rice racliated in ali directiofts like the veins 0£ a leaf. [t was smnge to see r,jee being plantem and harvested in the same field. Sugar cane, ten feet high, grew in vast fields. The land was pFepared by heaping uJ'l, wifh hoe-like chanding tools, large masses (!J£ earth between w,hiGh meep c:anaJs weFe ie£t. Sugar harvesting seemea t(!J De a tremenm(!Jus (!Jperati0n in which enorm(!Jus numbers were emJ'lloyem. 1i"he I'oads weFe literally Gongested with carts carrying Gane to the mills. !rhroughout the islam!!, traveling by train, motor, 0r horseback, it was imp0ssible te get 0Ut oE sight (!Jf a human being. Javanese, in their flat, neatly tied wbans, t;lie suedued c0101's 0£ d\eir Faiment pr(!Jmueing a teFil;a eotta effeGt, tr0epem uJ'l anei down ae(!Jut their IDl1siness ef gaining a E;velihoem. i[ couilii net helJ'l being impFesselii by the faet that the ;white man made beasts of bur-men out ef these peep Ie. But it was prebably the mense peJ'lulatien rather than the Dutch deminanee which mame them so eager te werk. i1n seme piaEes Malays are indifferent anm inmolent, but in Java, whefe tl\.e stFuggle £er existenGe is more severe, they. are wiae awa1!:e anm aI:Rlhit;i0us. ] I\.ave never seen m0re willing labor anywhere. 'Ehey seemed te toi~ f.Fem sumise te sunset witih a eheeFfulness beyonm bdief. When I mst went to Java ~he peasantry were gtmtle peeple, Gfinging anm never standing in the -presenGe of ]Duteh offiGials, wh0 Firlem with a heaVf liana, al~(!Jwing tihe Javanese 0nJy in·ferier pesiti0ns in tihe Ci;v.i~ SewiGe" ancil maintaining m0mesti§ liiiseipiine ~iteFaol!1y Ihy spankiing. ~hey had been fer year-s imJ'l0sing uW(!Jn these M0hammeman Maiays, miffering from them in 3!lm0st every resJ'lect, laws and negulati0ns whiGh suitem t!heir own icleas of hygiene. But by

474!


AND MAKE FERSUASlON 1926 the Javanese were becoming more and more restive, and more and more aggt'essive in thew resentment. ,[,hey held parades protesting against !li)utch dominacian, bie¡w up> bricdges, and killed their masters, ""ha for sa many years had punished them as though they were chilcdren. The reign of terror was so strong at Weltevreden that every house had to be protected by a night watchman. Thousands of Insurrectos were sent to exile in New Guinea, where they still remain. After years of alutiaus preliminary skirmishing on our part to secure an invitatian fram Java, the Duteh suddenly capitulatecd ancd askecd us ta Gooperate in health work. This sUrt'ender was due to an unpremeditated circumstance. I was in Geneva serving on a Commission to draft an International Sanitary Code, of which the retired Chief Health Officer of Java was also a member. Hardly had I finished my adcdress to the Health SeGtion of the League of Nations on the aetivities of the Rackefehler Foundation when he dashed up, shook my hand, and said, "Now for the first time I understand what the Rockefehler Foundation is trying to do. I'm going to see that you receive an invitation to go to Java at once." True enough, the invitation shortly arrived. In the ten years which had elapsed since I had begun my visits to J)'a'Va, the situacian had ehanged. A new Gavernar General had been appointecd who hacd become familiar with modem publicity methods while Minister to Washington. He had substituted an official palicy of persuasion for that of force in dealing with the J avanese. The members of the Civil Service, however, trained in the old tracdition, fauncd the orders of the Gavernar General abhorrent, and gave lip> service only. We had the feeling we were being aJlowed to make aur demanstration only in order that they might demonstrate to us how wrong we were. We encountered both active and p>assive resistance on every hancd from the rank and file of Dutch offieialdam. The Chief Health Officer, Dr. van Lonkhuyzen, said in so many wards ta aur repFesentative, "Pm sorry you've come, and the originaL invitation was only sent because it was fareed upon us by higher Government officials." We were assigned to Serang, an insurrectionary cdistrict about sixty 475


ANW!> MAKE PERSt!JASJiON Wealth Officer for an eJq>lanatien. "It's not customary for the people te begin using the latrines until a£ter they've taken the treatment," was his excuse. "¥our £ampaign has been going on for some time. Isn't there a town where the people have already been treated?" I inquired interestedily. "Oh, yes, we have seme latrines which have been constructed for several months in another town." "[r,et's go theFe," I suggestee. "Oh, it's much toe far, ane the heat is too great." ''Well, let's have something to eat first and then go." A\£ter lunGh the Feluetant officials climbed back into the automobile ane we motered ferty mil~s to another village. More hot and mOFe tired, they once again dismounted and once again the procession fermed. It was the same story. The latrines which had been built fer several months hacl sthl1 not 1i>een usee. "1 surrender," said Dr. van Lonkhuyzen. "I thought we had something on you. But I'm convinced now. We must have public heallth eeucatien in Java." Meanwhile Dr. Hydrick was perfecting his technique of instruction. He took advantage of the peculiarly Javanese institution of the mantri; a te~m usee te eesignate a native technician in any field. It was astounding to see te what an enent the mantri, who usually pessessee a good academic background, was being used in the diffeFent gevelrnment eepaFtments. He might be a postal or telegraph heIFer, or an agriculturist, or a nurse or operating assistant. Since Dutch doctors did not understand what was meant by public health nursing, it toe was regaFdee as a menial euty and delegated to the mantri. Dr. Hydriek learnee beth Dutch and Malay, and then instructed a selected group of mantris in the story of hookworm. Each mantri - wouid go into a Javanese horne, sit on the floor with all the family colJ1ected about him, describe the hookworm, and demonstrate its presence in the soil with the Baermann apparatus. They usually seemee to understand it but, talGng no chances, in a few weeks' time he weuld go back and repeat the story. Upon a third visit he would questien them. They welcemed this epportunity to repeat the less(;ms

477


A.N

AMER~CAN

])OC'FOR'S ODYSSEY

they haG! learneG!. M'e wouid ask, "Where cloes the hookworm [i¥e?'" 01' "How <ilo you get anemia?" If they eould not answer, the mantr-i knew his instvuGtion ha<il been poor. On the four.th interview tbe sehoo] Ghil<ilren wer-e also present. Am ola grey-heaalla grana,f ather might be corr-ectea by a little Ghif<il. !But invariably an animated discussion wouid begin, all appealing to the mantri as judge to <ileGicle which was Fight. [ spent a great <ilea,l of time myself going £rom >liNage to 'l'illage ancl From house to house. ~ sa.w eniidr.(Wl singing health sGmgs with gusto, but eJ<iperienGe in many €ountries lea me to question whllther the woras of thesll songs haa any effect 01' made any imF'ressi0n 0n the chil<ilr.en's minds. This business of bFinging the offllrings of seien€e to a rUFail Jilo,F'Ulation, ancl of making them a pa,vt of <ila,ily lives ha<il many pitfalls and retijuireG! the patilln€e of ff 00. 1"rying to wnite my impressions amid fier€ely biting mosquitoes and thousan<ils of bugs, ants, and flying things that GFa,wlea, <ilown my ne€k as wel1 as constanhlo/ obscurea the page, :I\.eightenem my a<ilrniratllon fOF thll intr.eF'ia souls who stayea there from day to clay and strugglea with the heallth Jill'oblem amid the filth, and, even WOFse, the skepticism whidl! €ontinuea on the pa,Ft of many of tl\.e :Dutch ofli.eia,ls. 'ltortunatelo/ Wll j;\atW the fu[llcneaFtem sUJilJ1loF't of the new Go:vernor General, who saiG! to me, "\(;ou know tne situati0n we're uF' a~inst. We're ready to finance your work up to the hilt. We have one hundred thousand dolla,rs available." iLt was not aim <ilone at onGe mut >when the iIDutGh CiMi!! Servi€e was fina.l1y €onvertea, it entere<il tl\.e field of e<ilucation with evevy bit of its abundant energy. Moving pictures, eharts, health-mobiles, pamF'hlets, printeill matter-a,lll were use<il for proraganda purF'oses. Udtimately a Museum of Wealth was instal~ed in a, large ouilill'ing sF'eeidy remomele~ for the jil1JIiPose. OF'en-a,ir movies anG! speeohes were held on the immense Koningspillin in Weltevre<ilen,; sometimes as many as thirty thousan<il Javanese attenae<il. But these wer.1l mer-elr olitwarm manifestations of a €orotF'iete ehange in F'oint of view. !MeIring to 'mring about this FeversaI was our great contvibution to Java. Every aSjilirant for the Netherlands Colonial Service haa to go to sehool for severa] years at the Coloniall

417 8


AND MAKE

PERSUAS~{)N

]nstitute in Amstenaam. He [ear-nea the Maby language, the feik. religion, and customs. But the whole system of teaching has been changed at its roots. Where once the student was taught to cemmand, new he is instructea in the principles of persuasion. ~ene,

+79


lIHIUS'YLIMG THE !lffiA$ll


!W!{J$1]!UM@ 1JiiNlIil E.AI$1]! te have the genera~ elteet spei!lea. ~ust epposite the Natienal Museum ef !Fine Ants a sJilFinkle of Fain peppered my top hat so that it ~eekea as theugh it haa sulteFea a se¥eFe attacll! e£ sm3i~lpex. [l;1inaVly, we l1ea~hea the bend ef the Menam in the heart ef the city wheFe the gFeat wal[, with its cFenelatiens shapea Eke the ace of spaaes, end'ese-a the King's compeuna. 'Fhe sentries at the gate peeFea susp,i0ieusty inte the ~ar, ignoFing the fact that it was ene ef the King's ewn, ancl tlitat ene ef the K,ing's own aiaes was sitting by my siae. @nce w,itrhin, we went unchaJ!J.engea between fines and lines e£ piekets, whe eame te attentien as the car swt<pt by. [ later leaFnea that a cow's crest en tile cax: weUld aamit anyone who had the forty-two ticals to pay for the proi"ilege. AI£ter twisting ana tUFning ancd passing thFough three additional sets ef gates, al\!Ji ef which naa to be openea, we entered the inner enclesure, iWlheFe ChUlulongkem the 'Or-eat, the King's father, had aaaea the ehakkFi 'Ela[aGe to the inmlmerable ethex: buildings, which displayed a1!1 fotms of Eastem ar~hitectUFe, simp1e and ornate. T lh ere was Ieeat@a the i[j)usit Mahapr.asit :MIaI'! w,l\ich "hela in arel\itectural ferm net seme lmiMer's plan, but an antist's dFeam of the fantastic." There a[so was the Feyai Wat !l"hra Kee . .AI myriaa smai! beNs unaer its eaves sweelli,y tinlded in everoy !litMe ~Feeze. Thousands of pieces ef glass, inoF\lsted in the wahls, glintea in the suI). j within its sacrecd inteder, fiigh en his atltar, sat the {ireat Emerald Budcdl\a. ~tteF being intreauGea in ene ef the FeGeptien roems te a number o£ miiitary eflkers, w,he tmte!1tained me most politely in exce'llent Eng[ish, 1: was cenaucted GeFemenieusly between rows of military ofIiceFs ef high rank: to a ene-Feom bungaJew which, in contrast te the splenaor ef the main palace buildings., was smaN ana unpretentieus. I was shewn at ence inte the p,resenGe of the King, whe was aressed as a colonel ef a: !British regiment. The x:eom w,as almost filled with admirals, genera!ls, ministers, ana ether officiaoJs, aill adeFnea with gorgeous uniforms. 1i:he silent, steut, meen-fa~ea menaFch graeiously metiened me to a ~hair. ana seated himself en a wicker settee. After the usual inanities aeout the weatheF had been exehange9i, he suaaenly askea, "What cde yeu thinll! ef eUF mecdiC3i1 s~hee]?'" " Ir'm net preparea te talk about it, Your Majesty." "i want te 1roew."


AN AMEiRICAN DOCTOR'S ODYSSEY "¥rein' M aojesb¥, ~ hep>e yeu'tIll eXQuse me." "BUb I want te lGfiew." He must have observed thab [ had oeen glancing [urieusly at the semi'GiEde of faees surrounding us. App>aFcmdy beiieving I was embaF'Fassec;r at bhe pFesenee ef these c;i'i gnitar.ies, he tur.nee to rthem anm sai<il, "Yeu'I'e dismissed." Neme<ily move<il. " iii say, yeu're dismisse<ilP' the King reiterated in an unmistakable ~ene e£ €emman<il. 'ExpFessions e f astenishment swrea<il ever their faces. ReluGtantly, with sabI'es clanking, they £le<il eut, and bhe ether deer closed behin<il them. "'Now we'r.e alene, tel~ me ameut my mecliea!l s0Ree1," the IGng persistem. ''Your Majesty., really I can't." "Ne ene ever teNs me the truth. I hear only what everybocdy thinks l'<illlke te hear. ffillease give me yeur £I'ank epinien." ] was censcieus ef dozens e£ lDeady eyes peeFing between ~ne slats ef the Venetian olinds. 'Fhe olDvious assumption was that the King's enteurage, who ha<il been barre<il from the Foom, \Were geing Ito make ceI',tain ~heiI' K;ing sheu!l<il not me assassinatem. "IDees YeuI' M:a;jesry, rea:l~y want te knew/'" "Yes, I <ile." "Then, I'll tell Y euI" Majesl'y,. I have visite<il medillal s€heels all over ~he world, 'West as weN as East." "¥es, yes." "I Iiegret very much to say that Your. Majesty's Royal. Me<ili€al Scheol is the poeliest ] ha·v e eveI' seen." As Ehough he weI'e en spr.ings the King leape<il up and eaaeulated., "'Fhis cannot me!" !He paeea uw an<il <ilewn angFi~¥. "'[1his is simp[y eutrageeus! 1i'his cannot IDe! Nomedy ever told me that." "Y our Majesty aske<il me for .my frank owinien. l've given it." "But every yeaI' :J]'lIe sent a gI'eup of eur oest yeung men te Eurepe amI: America. 'Seme ef bhem are teaGhing in the sCRee1 new.." "I've seen yeur young men. Many of them have piGke<d up our. mad habits, and few of eur goed ones." "Den't they use their time prewerly in Americal" 4'8~


HUSTLING THE EAST' "I'm just making an observation, which is beside the point. The !fundamental rufficulty is that Your Majesty hasn't a good scheol." "Mr geveFnment has no meFe ÂŁuneds that cewc!l be used for that pUFpese." "Siam has beautiful colleges of fine arts. What good do they edo if the people aFe sickly and die before their time? It is reasonably assumeed that Siam has a death rate of thirty to forty per thousand. Dead people eden't enjoy fine arts. The first thing Siam ought to do is get good heahh." I went en to explain to him that curing his subjects of heokworm weuld make them happier and improve their economic efficiency, theFeby making little Siam more powerful j further that our sole desire was to cooperate with the medical officers of his own government, but first he would have to produce good ones, and this could only IDe breught abr;lUt in a better training school. "'W'heFe edo they have a betteF scheol?" demanded the King. "'In the Philippines." "Oh, the United States is disgus~ingly rich. You Americans pour millions into thJlt country. It's quite understandable, of course, why a schoel there shoulCi have high standaFds." "I beg Y eur Majesty's pard'on, but the Uniteed States has never centributed anything te the PhiJ,ippines." "Then you must grined the I"ilipines down with taxes so that they cannot get their heads above water." "No, Your Majesty, they're the lightest taxed people on earth. Three doliars per capita covers everything. The Siamese tax rate is far higher than that." ''Wel!!, what can I edel ] can't afford any mOFe money." , "Your Majesty would not need to. Competent instructors cost little mOFe than inmmpetent. The Rockefeller Foundatien would be glad to supply the nucleus of a foreign staff and provide fellowships so that the Siamese would eventually be able to take over the instruction." 'Fhe King thought for a few moments, and then saied, "This is my gelcden eppertunity. I'm usually so burdened with foreign advice that I Clan't take any action that dees not trample on the rights of somebedy. But now the War has freed me to some extent of advisers. I'd like to pay for my own teachers. Could you recommend suitable ones?" .j:83


HUSlfUNG THE EAST appeinted te oflke. The amount of intrigue and £Ountermoves that went en oadestage was unbelievable. The cemmunity presented the pictuFe e£ a few w.hites quarFeiing ameng themselves, and a huge native mass that cilid net know w.hat it wanted. Because Maha Vajiravudh firmly believed that his numerous white advisers should be replaced with Siamese, he fell in readily with the Rockefeller F0undation policy of extending aid by training and guiding the Siamese and then allowing them to continue the work themselv;es. Tne tdifliculty was te dir-ect the royal attention te health and away £rem his hobbies of building pallaces, repaiFing wats, and increasing the army and navy. The King was also said to be busied trying to find surnames for his eight million subjects, none of whom had any. Trying to keep names and titles sooight in Siam dro:ve me nearly to distraction. Almost all the officials, and especially the Princes, had moue than one, and even these wel'e changed ever¥ few menths by the King. I sometimes searched for days and even then was unable to fined the later names of men I haed known well on previous trips. To make matters more cliflicult for the visitor, the spelling differed in the various provinces. This son of Chululongkorn, ecducated at Oxford, had one Occidental idea which conflicted with the Oriental traditiens of his country. He had steadfastl!y re£used the recquest of his subjects that he wed, according to ancient Siamese custom, one of his own half sisters, although he himself was a pl'oduct of half sister marriages for four generations. The story went that Queen Victeria, whese great pet he had been, had told him polygamy was wicked, and he had promised her not to marry into his own family. He remained in a quandary for years, but finally !li£teed a commener to I'eyal rank. '['he King's avecation was supposed to be writing plays, but he had also composed a primeI' on hygiene and education, good in every way except tnat it recommended a lecal quack's medicine for stomach trouble. He was supposed to have a deep sentimental interest in insanity, and it was -also reported he had paid out of the privy purse the ex;penses ef ene year's vaccination campaign. But the King's rn.edical enthusiasms had been bacdly directed. The Medical School fully deservecd the reputation I had ascribed to it in my interview with him. The entrance I'equirements were those of the 4- 8S


AN AMERICAN iElOCll0R'S ODYSSEY eighth gFade. Mmest any mll'le was admitted who ceuldi read ana w.r.ite and was ef average intdligence. 'Fhe scheet was depl0I'ably ['acking in equipment. No laberatory facilities were pFovided, and net one micFescepe was available for student use; in fact, theFe were only a half d0zen serviceable micr0scopes in aU Siam. In addition to die regular rurriculum a course in Siamese therapeutiGS taught the application of local herbs, barks, flowers, and ground sharks' teeth, The oM Chinese materia medica was alse included, and dFugs w.e~e presoribea for a0sage wit'hout any scientifie testing ef u/ieir mec!lieinall value. The study eu physies had to be attempte~ because the subject had not been taught in pre-medical scheol. Sometimes the study of anatomy was omitted entirely, because ne teacher was available er because the students objectea te the eaer ef the €lissecting reem. 'Fhe instructor in bacteriol0gy CiJ.uite oDvieusly eught te have been working in medicine. Textb00ks in Siamese ceulcl not be kept up-to·date be(;ause the language laGked means for eXFressing the recent medical termin0iogr, anld censeC!)uently neither teacher nor student was a1!Jle te avail rumseT,f ef scientific disceveries as they occurred. The only solution appeaFecl to be that classes should be conductecl in English, but this, I was assured, was impracticable unless the Siamese could be persuaclecl ef nhe inaaeCiJ.uacy of tl\.err. own [anguage. More0ver, the attitude of the students would have to be ehanged. As one of the prefessors told me, "Siamese will learn accurately ff0m a book aN the steps 0f an eperation, but they have no desire to werf0I'lIl it." They also 0IDjeGted te having exalIDinatiens heM, and the auth0Fities, in the desire to have everything as pleasant as possible, would often omit these annoyances; a favored pupil was sometimes allowecl to cemplete the four-year ceurse in eighteen menths. The majority of the stuc!lents sat in the sl!ade ane smeked pink letus lea,f oigars. Siam's greatest need £rom a health point of view was undeubted'ly the imprevement of its medical education. Qnly thirty students graduated per year, which meant that one new €loct0r was turnecl eut almuaJ[~¥ te tend eacl! 2,66,666 Siamese. mhe few stuiilents educatecl abread feund when they returned that their profession was se unprofitable and held in such low public regarcl that they usually went into the a~my.


HUSTLING THE EAST In the midst of this inefficieMY and lack of proper facilities sat Prince Rangsit, whe was credited with being one of the genuinely puB1ic-spiri~ed men of Siam. Although not himself a dector of medieine, he had ~een educated in Germany in pedagegy, and was struggling valiantly to make progr.e5s and improve the condition of the SGhool. But he had been able to accomplish little beyond repairing some of the more decrepit ole buildings and fitting up additional lecture moms. SheFtlly a,tter I reaehed t;he Philippines, Prince Rangsit, using the name of ~0m M0m Jainad, arrived. During his sta,y of almost a m0nth Governor General Harrison arranged for him to see everything that might be of value or interest to him, and I conducted him pers0nahly from hospital, to school, to Bureau of Science, and even to the Fire Department, so that he might see how America ran her affairs in the Orient. Whatever lurking suspicions might have remained in his mind as to the a,ltruism of American motives apparently weFe thorougMy allayed. [n the c0urse of our conversations, Prince Rangsit became more and more confidential', and gave me details of the difficult situation in which Maha Vajiravudh found himself. The King had a good heart and did not desire to believe anything unpleasant about anyb0dy; conseCijuently he was freCijuently deceived. Prince Rangsit's fum belief was that if the cliCijue which controHed the King's public attitude did not take kind1y to the new medical program, its futUFe was hopeless. Too overwhelming a victery for the Allies would also make the situation more preGarious for Siam because the balance of power, which made for their sole safety, would be upset. The beginnings ef OUF long lab0rs in Siam were complicated by the tangled skein 0f p0litics. To win the confidence of the Siamese generally was a difficult task. They were suspicious of almost every proposition put before them, although they were somewhat less wary of Americans, than of Europeans or Japanese, who were not demanding their share of appointments. Al\nost every time they had come in centact with the white race they had iost semething. Both French anl BFitish, on tr.umped up excuses, had, in the most approved empirebuilding fashion, appropriated choice sections of their territory. MOFe bitter to endure were the extra-territorial rights which had 4 87


AN AMERICAN DoeTOR'S ODYSSEY been fastenea upon the Sia-mese by the leaming EuroJ!lea-n nations, Japan, and ourselves. The subjects of a-ll countries having consuls in Siam-Great Britain, Franee, Netherlands, Denmark, Norway, Sweden, Spain, Portugal, Italy, et a-l.-weFe exempted kom Siamese laws, which were maae by r,oyal mecFee anm were not often tikelf to be in accordance with Western lega<l proceoUFe. Moreover, every Fegulation affecting foreigners had to be approved by their home governments, and when no statutes of their own eovered the situations, the English common law was usee. The Siamese were allowed to charge milly a three per€ent customs duty, and this did not provide sufficient income. To make up the deficit they were compellem to adopt an onerous and difficult system of taxation such, for example, as taxing each fruit tree. Most impot;tant £Fom our point of view, bJefore any sanitary regulation €oulm be put into effect, the consent of the foreign powers had to be secured. Siam was constantly trying to rid herself of extra-territoriality. l.ong years ago she had attempted to negotiate a treaty with Great Britain by which this onerous oMigation wouM be aboiished in relillFn for the cession of Trengganu, Kedah, ana other possessions on the Malay Peninsula. But Great Britain stipulated that the agreement would only be effective when she judged the Siamese courts were fun€tionrng to heF satisfaction, anm that, in any case, a Britisn jumge should sit with the court when a !British subject was €Oncerned. Siam did not agree, but lost the provinces just the same, and with them some of the ri€hest tin mines in the world. A hea<lth organization in the momel'n sense was non-existent in Siam. The few health a,ctivities carried on were in the hands of foreigners. Our Minister was asked to assist in obtaining two Americans for the so-called Bangkok eity Health Service. He submittea two names, but as soon as this news was spream abJmam, the British pFotestem a,na demanded these appointees should hold office only until the emil of the War when British successorS must be assurea. The Siamese government resisted feebly but finally had to agree. Siam's eJqDeFien€e wi. h [France, whieh was nibJbling off fuits with every treaty, was e!'jua.]j]y unfortunate. ']'0 obtain Freneh approva-l for the abolition of ellitra-territoriality, the Siamese had agreed, among other things, to keel" a Frenchman, practically in perp,>etuity, at the 48'8


"l!JS'iFJLIN@ 'iFiHlE iElAST head ef the Pasteur Institute. It was diFected by the French, although built a:m! subsidizea at Siamese e"pense. When 1 first went te Siam, the War was geing badly for the Al'Iies, and France had her back a~inst the wa:ll. The French incumbent had gene to the front, leaving cont:r.e~ to Siamese. Mismanagement was evident, the place was edirty, rabbits were edying in their cages. Out of the edozens of biologiGals usuahly manufaotuxeed in suoh an institutien, only Fabies and smallpox vaccine were being made. I shuddered to think of such tremendous fOFees being plaeed in the hands of half-educated and whelly untraineed Siamese. At Prinee Rangsit's request I suggested a new head for the Institute. But the J:<ir.ench no seoner heard that the Siamese had ehosen an Ameriean, than the Frenchman was released from service and scurried back te Fesume his position. Tw~ edays later the American, Dr. Ira Ayer, apll'eaFed. 1Ihe bewildeFeed Siamese had to do something about this eentretemps aned hastily created for him the post of Sanitary Adviser to the Minister of the iJ;nteFioF at a higher sa,lary. Some years afterwareds I was in Siam while a frightful cholera epidemie was raging. I ¡was then on sueh intimate terms with the leading Siamese that r coul~ talk with the utmost frankness to them in private, because they knew 1 would not humiliate them in public. "'itihis e]!liedemie is edisgFaeeful. Why don't you step it?" ''We wouled if we could get the cholera vaccine. But M. - - is so busy with his private practice that he has no time to spend at the ]nstitute, and we aFe forbiedden to make the vaccine ourselves." Eventually the French were shamed out of their attitude, and eeased insisting on the letter of tiheiF rights. Siam had had a long series of American advisers, beginning with Edwa"i Ii. Strobel from Harvard, who had pleased Chululongkorn se muoh he haed theFeafter had a preedilection for advisers f.rom that institution. Francis Sayre, a graeduate of Harvard Law School, nego_ tiated many of the aFrangements fOF relinquishing extra-territoriality. trpen his suecessful conclusion of treaties with foreign powers in 1927, Siam was immediately enabled to increase its Fevenues by advancing the eustoms duty, thus relieving to a great extent the internal tax bureden. My first imptessions ef Siam aned the Siamese had made me wonder 4 89


AN AMlERllCA.N iffilOe1i1@R:'S CliElf¥'$$lEY whether we eeuM evenGeme tae mentall te!1FeF an<il le~haFg;¥ 0n this raGe, whiG/\. appeaFeG! te be a hi}'briG! be.ween C!:hinese anG! Ma,lay. 'Fhe m0Fe ] in~uiFed, !\:eweveF, the mere nepdul I beGame. 1i1ne iDal'deF te intFeG!ucing sanitary measures was net insuweFable. Altneugn tihe Siamese naG! ne I'evenence f0r the melllica~ prefessi0n, er any sGienee, as sueh, they haG! ne re1igieus eiDjectiens te Im!l!1ing rats 0r, broom the meaica[ woint of "iew, n0 taiD00 as regaF<ils lIuman eX€l'eta. 'illlhe f,10Fwation was awpaFent:iy not ineFeasing) an<d the miIQion and a hll!llf Chinese did mest ef the pFeGiuctive laber. ']lhe BudG!hist Siamese, [life the Christian Fil~pines, centFol!leGi only a small!! par.t 0f the C0mmeFGe o£ their own c0untry. The earning weweF of the Siamese [aiDerer was from fifty to ene hundr.eG! peFcent greater t;ihan that e£ the maff 01'ity 0f otller Orientals, se that Wl'es[Deots ef the eeun~'s being aIDle to sUFpen a highe. stanG!aFG! ef E<ving weFe exe(lll(lnt. In Siam theFe was tne gr.eatest G!iveFgtmce IDetween upwer ana leweF classes. The latter weroe eempietdy il!liteFate. Cwtme was G0nfiflea 1;e a small minority, mest ef wnom haGi iDeen eG!ucateG! in Burepe. Whey im[Dressed the tFa,veier as being among the werJd?s mest p!'leasant p!ee. pies, Genversant with ar.t, literature, polillics, ana fine humanit.ies, a,ni!l. weFe seciai1.y gracreus. As ~ saw eUF p,1rogram in Siam, fne first step was to staFt a n00K:werm campaign; seGend, to stimulate the g0vernment te set up! nigher mei!l.ieal standaFG!s; anGi, third, to £Feate schelarships feF meclieai stiudents. It was eiDv.ieus that in Bangkek polities wouM nampeF us to such an extent that [ seen discal'decl t·h e idea ef iDeg.inning weFk in the eapitall. The p!reper pFeaeG!ure seemeG! to IDe te maKe a raJiliGi smvey and te initiate eperations in a rural area whiGh was heavi'Ly infested, and quickly prove tne vaiue of G!emenstratiens. Al!i sorts ef cempLieatiens had to be smeotned 0Ut iDefeFe heornerm werk ceulcl be inaugurated. In s[Dite 0f the King's agFeem(lnt, his ministers haa te be dealt with, one iDy one, and pers\>ladeG! te c00JileFate. Many Siamese 0flkials weFe tnank eneugn to state they £euM n0t unG!erstand hew such help! as the ReGkefel!leF FounG!atien 0ffieneG! G01!lM be entirely G!isinteresteG!. Tne susJilicions of the interesteG! feFeign p!0wers hatii also te The ~uieted. The British Minister ana Consul had 1;e iDe €0nvillWil we na~ ne intentien 0f r<;p!lacing British with American G!0eto1's. By ilip10matie 4.90


man~u:vering, ana eu); "emmen inter-est in lepT>osy, I maae tl'iends w.ith

mil. MeFid~n ~~~Ii~w, the Br,itish mea'ical adviser.

Theugh not antipatihetiG, when [J] toie him ef eur intention to start in the interier, he tilenigratelli the ii!lea anGi saia we GeuM make fl0 heaaway with the pr-epena~Fant tewer classes. But if we were determinea to centinue eur feo~haFlliy venture, we shouM at least cenfine our aGtivities to the up>p>er classes, who might unllier.stane eur ebjectives. And if any pFOgltClSS at aliI were to be maee we must first get on eur side the r,oYail p~in~es w,ho, [ike Rangsit, had been eaucateGi abroaGi. Clnce the meGiicail pr,efession ceulGi IDe giwen gLeater pres6ge, it might IDe possiIDle te disFCl~Fa class eistinGtions anlli have men frem eelew in key positions. $eGia~ rank was no Thar to pelitiCail advancement in Siam, !But even the up!per.-dass Siamese, in Dr. Car;thew's epinion, wantea te IDe left a1ene, anlli resented the disturIDance te their tran'1uiUity when it was peinte~ eut to them hew much plague or chelera or other disease e!ciste<ii in their. millist. "Tihey want te IDe ~ensidered civilizelli only in eFcler te make favor.able impFessiens on foreigners so that they can negetiate leans. l1he ~iamese are interesting and piausible cenversatienaiists, but when steae,fastness is needelli, they'il probaMy fail." On ~he whole he leokeGi upen what we were trying te do as hopeless. In spite ef !Dr.. Carthew's warnings, we Gontinuelli on our chosen p>at'h. '[1he pFeliminaFf survey inaicatea as a strategic peint of attack lihe aneient neliltlhe~n city ef ehiengmai near the Bu~mese bOFder, once cap>ita~ e£ the 'Lao langlliorn, new a pr.o:vinGial unit of Siam. 1t haa long IDeen an important tra:clle Genter. fer- ehinese, Burmese, ana Siamese, an~ the teak trade was mairuly cenlliuctelli tr.em there. On my fir-st visit ef inspeetion te Chiengmai with Dr. Sawyer, my Gempanien en that tfip, we traoverselli a series of plains, dry anCjl warm even in March, and intersectet'l everywhel'e with klongs, that were the Feall'ifies e£ communiGation. :Each of the three days' journeys enmea at a town e'1uippeGi with Gem£eFtable rest houses. "With" provided IDed - an~ mealls; "without" turnishe<d a ~ot and alJl.eweGi the tFaveler te supply his own be<dGiing ana footi!. The thirGi day we rode on a cons1!f.U<ttion tFain, sitting in com£oftaMe wicker chairs at the tront of a flat car. ]t was an uneX]Dectellily pleaSant method of travel. A canopy pFetelited us fr,em the sun, anm, since the car was pus'hed ahead, the smoke and embers trom the woolli"buFning engine drifted behind us. 491 \


AN AMER[CAN DOCTOR'S ODYSSEY As we climoed through cooler mountain wasses, dense with bamboo thiokets and forests, we eould see "elephints a pilin' teak, in the slushy, squdgy creek." Siam was almost entirely dependent for livelihood ami prosperity on rice ami! teak. The trees were fehled, twimmed, anal rolled into a stream, where they lIoated along lazily until the coming of the dry season. On the mud-caked bottom they would lie until the next years rains once more lifteal them forward. Three years of alternate motion and rest sometimes e'lapsed before the logs final!ly clriEteal dow.n the Menam highway to Bangkok. Almost immediately upon my arrival in Chiengmai 1 met the British Consul, who invited me to dine with him. "Pd be delighted," i[ replied. "Where shall [ eome?" "I'll send for you." Twenty minutes before the dinner hour a tiny turbaned mahout, gaily alressed in crimson and white and gold, appeared before me. "The elephant waits," he announced. "What's that?" 1 interjected. "1 don't want any elephant." But the boy did not know enough English for any extenaled expostulation, and willy nilly 1 had to comply with what was apparently the customary method of attending dinner parties in Ghiengmai. 'l\he EttJe fellow conducteal me to the door and with his hook prodded the elephant, which sank ponderously to its knees. 1 climbed the short ladder into the howdah and seated myself on a cushion. The mahout leaped nimbly to the elep>hant's head and we were reaaly. The great beast lumbered to its feet, the howdah lurching pre€ariouslo/. [ was not at all prepared for what followed. As we set off 1 was shot forwaral and then suddenly back, until 1 thought my head woulal be jerked off. lt did not seem possible that [ €oulal stay aloft. 1 was entertainea at Chiengmai most coralially. One pleasant afternoon 1 was receivea by the Chao Dara, widow of the late Chululongkorn, and daughter of the last Lao King. She lived in royal dignity, and her train of servants were r.equiFed to enter anallea:ve her pr.esen€e on their hands and knees. She took me to a spacious open haM wheFe the expert silk weavers of Chiengmai had been gathered together. 'Fhe fiancee of the King had decided to wear the Lao skirt as €ourt dress

49 2


HlJSTLliNG THE E!AST instealil af the ' IDFeeches-like penung 0f the $0uth, and, be~ause the Chaa Dara p0ssessed to an unusual degree the gift of artistic expression C0mmon to Siamese, the designing of these garments had been entrusteed to hel'. Materialls, beautifully patterned in blues, pinks" gneens, and Feeds, shat with goid and silver, were rippling fFom the busy la0ms. Chiengmai was noted for its lacquer craftsmen. One quaint little Sii0p was filled with round lactquer boxes in every stage of manufacture. l' gazed in fasGination at the dexterity 0f the wOFkmen as they fi1Ied in the interstices of the woven bamb00 frames with thick waxy material, then applied a beautiful smooth surface of red, black, or gold lactquer canceaJing the framework, and, lastly, scratched fine patterns on the sur.face and fiNed them in with pigment. 'The shop was 0ve1'hung by pallms and stately, oil trees, and looked at the ruined brick wall of the ancient town across the moat. In this a Lao, armed with a basket-like net hanging from the end of a long bamboo pole, was patienMy fishing fa1' the tiny fish that flickereed under the lily pads. M0St common of ail sights in Siam was the endless procession of priests, bright in their yellow robes, wh0 everywhere, with their begging b0wls in their hands, were asking for r.iGe. The greatest chann ta the tr;~weler in Ohiengmai, as in ad!l Siam, lay in the wats. Alm0st everywher.e I tur.ned rose a temple, gl0wing in blue and gold and red, or stately in its dim, and quiet I'uins. The gateways were guarded by grotestque edog-like images that would frighten away a host of evil spirits, unless perchance they /NeFe p1'atected by a sense 0f humor. On the eaves the little bells, designee f0r the same purpose but in a pleasanter hum0r, jingled tunefully. At either end a series of overlapping gables, each surmounted by a strange, snake-like projecti,on, suggested to the lnternatiional Health B0ard mind a hookworm rampant. We had sent iDr. M. E. !Barnes, an exceNent choice, to Chiengmai. His early upbringing had made him at 'home with the Oriental mind. Born in India, he knew Hindustani, and had a sound linguistic basis an whieh ta build. He learned nat 0nly the Lao tangue but also the Siamese, n0t an easy task because the differentiatians between the two are so subtle. 'Fhe Siamese language is supposed to be among the most difficult in the warld-with its seven tones commensurately more 493


AN AMERICAN ]:!)OCTOR'S ODYSSEY clifficult than the four-tonecl Japanese or Chinese. Seldom coulcl a foreigner master all seven, but Dr. Barnes knew enough of them to be able to give public addresses. The Siamese were always affable and pleasant, ever reacly with the making of fine promises, but taking an eternity to carry them out. Dr. Barnes woulcl ask vimagers to Gome to a certain place at a ~eruin time; they would not be there. He would request local offioials to make announcements; they wouJd not be maae. To cope with this amiable lenhaFg}', lDr. Bames devised an extraoFclinaFily effe~tive system of using the 'Buddhist priests. Although most of them were illiterate, they likecl to be considered progressive, and :Dr. Barnes cliplomatiGaJ!ly turned this vanity to his own ends. He proved to these bonzes how, when the Rockefeller Founclation cured their people, they would be the ones to reap the rewards of gratitude. I was fortunate enough to be able to attend the opening meeting of Dr. Barnes' hookworm campaign in the Wat of Amphur Sansai near Chiengmai. It was filled to the walls with men, and even a few women had timidly crept inside the temple door. From the cllusky recesses befor:e them a great gilded Buddha, smiling and complacent, gazed out at the sea of dark faees. The Ciimly-lightecl temple, the image, the talil piHars, the chief priest Gtraped in yelilow, the Fever:ent auclience in their: penungs, pr.esented a picture impressively Orientai, and one pervaclecl with a spirit of satisfaction with tl'iings as they are. Seated on their heels on the Boor, these men ancl women waited patiently to receive the message for which they hacl oeen summoned. The only foreign intrusive notes were struck by ~he hookworm chart which hung on the front of the altar, and by the models of latrines displayed on teak tables, carved and inlaid with mother of pearl. In sing-song Lao Dr. Barnes described nhe busy little hookworm in their midst; there were signs and sounds of approval. Then Major Boriracksh, Medical Officer of the Siamese Army, added what was obviously enthusiasti~ â&#x201A;Źorroboration. Although I could unclerstancil no word of what was being saicl, the Siamese seemecllike ~hildten [istening to a story hour. Dr. Barnes scored a signal success in Chiengmai, and grew to be admired and trusted by the Siamese as few foreigners had ever been.

494


HiUSTLlNG THE lEAST lBecaus~

oÂŁ his a0l\:i~vements there we were able to stovm the citadel of Bangkok, and take up the vital questions of a first -class medical school and an efficient health service. [n Bangkok we ha<d more or less the same problems which had confr.onted us in tile iPhilip>pines, IDut nothing ~ike th~ authority to carry till'ough reforms. The Siamese were so receptive to ideas, an<d so many peop>le were offering aavice gratis, that the result was often a jumbl~. They had violated all the principles we hel<d dear in the establishment of a me<dicml center IDy limil<ding the main school across the Piver, an<d the pathological laboratory on the city side. Insanity was prevalent, much of it due to overindulgence in the <dangerous drug IDhang, or hashish, a derivative of Cannabis Indica, the ~ndian hemp pfant. Smoking, chewing, OF drinking hashish was an el!itremely common habit whiGh the government was loth to stop becaus~ the foreign advisers made no objection to this source of revenue. The Siamese had abandoned the practice of chaining their insane to posts, an<d had buNt an asyJum across the Menam from the tity p>r.op>er. But in the year which had elapse<d since its building, not a single Siamese official of any rank had paid it a visit. The approach to this series of small buildings, each of which looked unhappily like a Gage, was along a beautiful klon g, shade<d with blooming trees, but the p>ools in the groum!s themselves were stagnant and covered with poisoneus gFeen slime. A separate enclosure was set aside for mad priests, which maae me wonder how many people were driven crazy by religion. Fermerly beriberi ha<d kept <down the number of patients until the Health iDepartment, under my inspiration, fed them unpolishe<d rice; thereafter so few die<d that overcFowding became serious and only the city insane could be accommodated. The publiG market, which belonge<d to the privy purse, was highly insanitary. lit was comp>letely clese<d in by a set of crew<ded and dirty shacks in which lived the peeple whe prepared food and ices for the ven<dors. In a filthy well were kept fish destined for public consumption. After trying for years to have this market renovated, the Health !IDep>a~tment finally took a series of p>hetegraphs an<d sent them to the King. He was shocked and at once ordered repairs made. But then the government officials also went to the King, and said, since it was understood the building was te be torn down soon, repairs 495 \


AN AMERIâ&#x201A;Ź:AN DOCTOR'S {)DYSSEY were useless. This same excuse served to hold up improvements for years. The serious health JDroblems 0f Bangkok aid n0t 0bttmde 0n the flu1r. lie notice, but the Sia!llese were extremely sensitive ab0ut their m0s<ijuitoes, which were criticized by every foreigner. Although not malama carriers, they were the worst pest I had ever seen anywhere in the world. When I first went to Siam in 1915, at every dinner party my hostess, upon receiving me, w0uld, as a matter of course, hand me a smalll bottle fiHed with 0il 0f eucal~Jiltus which I was sUF1Jil0sed to pour over myself in liberal quantities in the n0pe of disG0uraging insects. But mosquitoes swarmed in such numbers that the JDreventive was of no avail, and I usually returned to the hotel with my feet, ankles, and hands swollen beyond recognition. Guests used to Gover their legs at table with bags. The last time I was there Flit had become JDopular, and every hail'f hour a servant w0uld pump a! lifuer3!1 supply under tne table, while the guests sflFinkled neck a!nd arms with Sketalene. I was often asked by the Siamese what they could do about mosquitoes, and I advised a survey to determine the cost of control. But they never seriously put themselves to the task of eradicati0n. The man who might fiave done something about this and 0tneF far mere impontant matters was Prince :Dhamrong, the leaming el'deF statesman of the royal famiJy. lit seemed to me that he represented the highest point Siamese civilization attained under the old regime. He was .harming and gracious in his manner, philosephic in his comments, anm it was always a pleasure to C0nverse with him. Mad there been many otners like him OUF road in Siam would have oeen . far smoother. He had a magNificent estate, 3! mest tasteful!1y furnished house, and a garden beautifully planted with flowers, among which there were many evidences of Buddhist ornamentation. We said he was not only a professed Buddhist, but also one in actual practice. The moral code of Buddhism, in his oflinion, was much like that of Christianity. "I assume you are a Cnristiail as I am a Buddhist," he said. "[t has always interested me why religions are so at odds. What they reaLly disagree about is the hereafter. But I as a Buddhist !mew nothing of it, and you as a Christian know no more. Why should 49 6


HUSl'.LING THE EAST theFe be all this acroimony abJQut something we neither of us know anybhing abJout;;? 'Fhe guess ef a Buddhist may as weU be Fight as tne guess of a Chl'istian." l1he offici:!>l with whom I had mest to do was Prince Sakol, proneunced Sakon, one of the King's first cousins who had recently graduated fFem Ox;ford and gave pFomise of becoming very efficient. In 1915 he hacii bJeen considering going into the Treasury Department, but r had persuaded him to cast his lot in the public health field by shewing him nhe far greater epportunities ther.e. According to a pe(ml'iar €ustom in Siam, each generation of tit1ed .persons lost er stepped <down one gra<de of nobility, eventually becoming plain nais OF misters unless, by the performance of some meritorious deed, new titles \\Iere conferred upon them by the King. Prince Sakol was anxieus te prove himself, but he labored under the great handicap of having marl'ied a German giFl when he had bJeen in Europe" and Siam and its l'igid social system had seemed very far away. Upon his retur.n he feun<d his wife ostracized' and himself looked upon as having lost caste. Nevertheless, by merit and determination, and in spite of the unhappiness of his social lot, he rose steadily and in 1926 succeeded Jainad, the fOFmer Rangsit, as Director of Health. Even FFince Sakol, honest as he was, would exaggerate our alleged s'heFt€emings in £ulfil!ling OUF paFt ef the eontract, and minimize those ef the Siamese. Mis bur<den ef cemplaint was that our agreement Galled for two foreign doctors, and he submitted records shewing that, owing to vaGations, lapses of a few months had occurred during the past two years of the five-year centract. But he ignored the fact that the Siamese had transferr.e<d men eut ef our units or failed to furnish them altoge~heF. Theil' capaGity, like that of trained lawyers, to split into infinite <details seme ineonsequential matter and obsoure the impoFtant point when it suited their purpose was at times most trying to the patience. Eaoh year, as their proportionate share of the budget increased, the Siamese seemed to believe that we were taking something out of theiF .peGkets. We knew, of COUFse, that this sentiment was a defensive Feaction because of their own reaiized yet unacknowleclge<d shol'toomings in complying with their agreement with us. The FrinGe who should have been King after the death in 1925 497


AN AMERICAN DOCTOR'$ ODYSSEY et Malha 'Va-jiFaV1udh (iRa-rna Vi[~ was $englda, tlie en~y ava-i'laMe son of the first queen, but practising medieine appea-leal to him m0Fe than a throne. He had received an M.D. from Harvard MediGal School, but unfortunately haal been recalh:~d for a funera~ before he haa an eJilportunity te serve an intemeship in the Uniteal States. 'iI'1he King had frowneal upon the ialea of any member of the reyrol family being in a subordinate capacity in the hespitall at Bangkok. Prince Songkla, therefore, had gone to the Missionary Hospital at Chi engmaio Because of his talents and influence, he was, abeve alH otheFS, most useful to us in removing friction anal adjusting diffeFences. His early death was a great loss to Siam. On Prince Songkla's refusal to be king, his half bFother Prajamhipok was chosen. K,ing Pra jamhiJilok was always quiet, efficient, sincere, and a conscientious worker. But lie was net the best ef the Jilrinces. The power behind the throne was FrinGe Nagor Svarga, pro¡ nounced Lakan Siwan, head of the Supreme Council of Five and an able administrator. He had much initiative, hard common sense, a-nal a desire to have the government administratien in Siam .eaoh a high degree of efficienGY. He made quick decisions and pushem his projects through to successful conclusiens. Although an opponent of FFince Sakol, he was a great f.riend of Dr. Bames whe, believing he was the ma-il best fitted for tile position and anxious to see the l'Iealth DepaDtment under his direction, persuaded him to become Minister of the Interior. Hope was eXJilressed on all sides that the new King wouM inaugurate a more pregressi,ve regime. But the putting ef pJ1inces and other titled peFsens into high places stilil continued, regardless of their training for the jobs. The cringing attitude and the deferring, even in scientific matters, te those of higher rank, was cemmen. lt was especialily amusing to observe the attitude ef Prince Sa~el's subordinates, who would ,deliver no opinions until he had given his. Since our views otten reached the Prince only through these same subordinates, delays anal misunderstandings were inevitable. Ma-ny ministers !7equiFed their heads of depaFtments to sit en the floeF in their presence, and aluring the later years of FrajaalhiJilok the former custom of requiring servitors to appFoach him on all fours was resumed.


HU$1i'MNG 'FME EAS1F liffntil a few years ago Siam was perhaF's the most peaceful country in the world. The pe0F'le had no democratic rights and did not possess ~he ;vote; a!I~ ordeFS were issued from the capital at Bangkiok. But apparently they were F'erfectly satisfied and contented to have an absolute monarchy. Almost out of a clear sky came the Revolution, aimea at the pz;in~es who, wit;hout FegaFd to meFit, had so long held ail the important offices. Its causes were so ill-<defined that nobody couia quite put his finger upon them. Among the reasons offered was that America, by its example in granting so many poweFs to the Fi~il"inos and F'roviding them with an Occidental standard of living, had stirred up the fires of independence smoldering here as elsewhere in tJie East. When King PrajadhiF'0k had returned from his cataract operation in New YOFk in 193 I, Prince Nagor Svarga had told him a revolution was bFewing, but the King would not believe it. "You're the King," said Nagor, "and I can do nothing, but you could stop it if you would do such and such things," and he outlined a course of action. But the King meFely intimated he would institute reforms in the near ÂŁUture. Long ' bl:lfo~e he was pFepared to move, the revolutionists won over the Army, and then it was too late. The Revolution of 1932 altered the monarchy from absolute to eonstituti0nal, with an ' eleetive assemb1.y and an executive council. Most of th0se who had formerly been assistants now became ministers. On the whole, the best men weFe chosen, and few reprisals weFe attemF'ted; the royal famiiy Fetained most of its F'r0F'erty, although rull were banished except the King. I later met Prince Nagor Svarga, now called Parabitra, exiled in Bandoeng, Java. lt sel:lmed odd to see this Prince who, at Bangkok had lived in such regal splendor, now occupying a simple burtgalow. I called to mind how only a few years before, when the Far Eastern Associati0n 0f Tropical Medi~ine had held its 1930 meeting at - Bangk0k, Pvince Nagor Svarga had outd0ne himself in prov,iding welcome. The atmosphere had been one of hospitality, that in Siam was so F'eculiaFly inspiring with its sincerity. To terminate the festivities, he Bad given a reception and dinner to one hundred and thirty guests, served luxuriously in his immense grounds. Afterwards he had offeFed for our entertainment a gorgeous spectacle in 499


AN AMERICAN DOCTOR'S OIDYSSEY which several hundred Siamese portrayed a Bucddhist play in dance. In 1935 King !Prajacdhip0k refused all requests to return fr0m LonGi0n, whither. he had g0ne f0r a second oFeration, bleeause tne Revoiution hacd deprived him of so ma:ny powers, chiefly that 0f pardon. He ablcdicated his thFone and remained in England. The pr.esent heir apparent is the son of Prince Songkla. His m0ther is struggling to keep him at school in Switzerland and out of the confusi0n of Siamese p0litics. Many of the trying Gustoms of the oM gover.nments are being C0ntinued in the new regime. The higher-ups make plans in secret without consulting the bureau chiefs, who never know the 0bjects of the policies they are cdirecteGi to pursue. The office force finds it diffi.â&#x201A;Źult to realize the olGi days are gone, and that they may express opinions without knowing what their superiors think. They still speak in whispers, a:nd wait for aN plans to be hanclecd d0wn to them fr0m above. The great pr0blem in meclical education in these later years was whether to have a large number of poor doctors or a small number. of very goocl ones in Siam. The POOf ones could undoubtedly give relief to many people, and the few good ones could only reach a limited numbt!r. I had been c0ncerned with this question for thirliy years and !OImd it exceealngly d.iffioult to ae0iclt! which was the blt!ttt!r course. But I knew that aealing with environmental sani'tati0n sudi. as water and sewage would produce much greater results in the form of a reduced death rate and morbidity than all the junior aoctors could ever accomplish. The Siamese ultimately saw the matter from the Rockefeller Foundation point of view. . To Dr. A. G. Ellis be10ngs the maj0f creclit for. builaing up the Medical School in Siam. He had bleen selected by the Founclation as Director and later employed by the Siamese themselves. It was ama'Zing to mt! that any human being could have livecl through the daily round of disappointment and discouragement. He was able to see the hands of progress move around the clock, although they weFe turning S0 slowly no one else c0uia Gietect their m0tion. iLt W<J.S aue to his sacrifiCiial efforts that the Mea'ical School, wi~h a Ciomp>letelÂĽ Siamese faculty, became a modern institution. As far back as 1926 it haa seemed advisable for the International

500


HUSTLING THE EAcS'f Health Divisian to withdraw frem Siam, for a time at least, until the gevelmment, af its ewn initiative, sheuld present a sound plan fer Gentinueed â&#x201A;Źael!'eratien. 1i'lie attituede was aN tee JDve:valent that we were liorGing tile Siamese to ede something they were not convinced they wanted to edo, aned that we en1y offereed them fellowships, which they keenly desireed, in order to bribe them into doing something the value of which they considered debatable. They apparently failed to understand that we were theFe to help them in their struggle for seme~hing better. On the other haned, they were so innocently nice that we haa a feeling we ought to heip them, and that any failure on their l!'art must be due to their not having understood. My conclusion was that if the Rockefeller Foundation's investment were to yield worth while results, a well-qualified adviser would be needed on the scene for many years. ]n 1929 the Foundatien finally withdrew completely from Siam exceJDt for sueh an adviser. Dr. '!Louis Scliapiro, who had dene briiliant werk in Panama, volunteered for this thankless task. He had refused oUF offer of retirement, ahhough he knew his term of life wauld be shortened by any strenuous labor, saying he would rather die in harness. He bemme a tremendous favorite in Siam. It was edUring his service that a sanitary engineer was brought from the Uniteed States to edevelop the instahlation of reservoir and pipe line edistributien systems in the cities and tewns of Siam. By efficient prodding, and helpea in every imaginable way by Prince Nagor Svarga, he even succeeaed in starting health centers. When Dr. Schapiro died we did not replace him. lin many ways over the years we haed saved the Siamese from doing unpFofitable and unwise things and aften from spending money fe0IisMy. But we had ourselves often forgotten the Siamese wene the product af a civilization that edid not want. to hurry, and that, even when they tried, they were pulled back by the accumulated hab- its of centuries. The few progressive Siamese were still as scattered eorks, babbing upon a vast OGean, struggling against winds and curFents that aften Garrieed them far born their goal. Only when I ~ooked baGk over fifteen year-s af work could progress be noted. Many men whom I used to see in bygone years had passed on, yet things continuea to mave, and even made slow advance from an Oc501


AN AMERICAN DOCTOR'S; ODYSSEY cidental viewpoint. Graft and corruption, which haa been so pFevalent, were steadily lessening; efficiency slowly increasing, ana finahly the Siamese had come to accept, all though pr.0bably they never â&#x201A;Ź0IDpletely understooa, the Rockefeller Founaation form of al.truism.


CHA.J?T~iR.

28.

PEARL OF GREAT PRICE

NE by one the fertile regions of the earth have been swallowed up By the land-hungry nations. Albyssinia alone Femains as the ~aFgest unaeveloped area of pFoductive terrain in the worM. Even now most AmeriGans and many Europ>eans have little idea of its aesirability. This temperate zone paradise in the heart of equatorial Africa is seâ&#x201A;Źurely hemmed in by the Barren wastes of the Sudan, tlhe inhospitable shores of West Africa, and the ~weltering deserts IDordering the Red Sea. Comparatively few foreigners are familiar with its clear spark1ing days aned bFight biue skies, or have viewed its fOFesteed mountains ana translueent streams. NeveFtheless, its European neighbors, Italy, FranGe, and Great Britain, who hold the sterile Rea Sea coast once controlled by Abyssinia, are keenly aware that the Albyssinian government, in spite of its boasted five thousand yeal'S of continuous existence, has not kept step with the civilized world. T heir urgent craving to unbar the gates to these gFeener pastures is, if not excusable, at least quite undeFstanaable. Although my work for the ReGkefeller Foundation had, in the course of twenty years, taken me into practical1 y every portion of the two hemispheres, it was not until 1933 that I visited Abyssinia, or Ethiopia, as the inhabitants pFefer to have their country called. ,]}he Foundatien, which was then engaged in an attempt to eradicate yehlow fe:ver born the worM, haa cablea me a request to collect for them some bleod samples in that remote mountain land. One mOFning in early May, with the thermometer at IIS degrees, 50 3

O


AN AMERICAN DOCTOR'S ODYSSEiY the Messageries liner Leconte de Lisle a.nehol'ed off Jimuti, the gateway of Abyssinia. I haa expeGtea to ma~e immeaiate connections for the Abyssinian capital, Addis Ababa. This aid not seem unreasonable, since both railway and steamship line w~e French--owned. But the train, which ran only twice a week, haa left ten minutes mefore our arrivatl. I had four days to wait for the next one. Somewhat impatiently I inquired my way to the hotel. It turnea out to be much like that one finds in a village in France, even to the little sidewalk cafe. Ther-e French offieials and L(lvantines wel'e tFying to shelter their drinks from the dust which rose in douds as the motor cars chugged laboriously through the hot sanay streets. The days wore on but the thermometer remainea static. Although many years in the tropics had maae me pride myself somewhat on my inaifference to heat, J.ilhuti was an oven in which I was slowly being baked. The only way I could get a night's sleep was to throw off blanket, sheet, and pajamas, and turn two large ele<rtric fans upon myself. At table an open shirt, no coat, and shorts was the accepted dress. The United States was at this moment fervently engagea in going off the gold standard. As the dollar tobogganed down, those travel(lrs in foreign pa.rts, including myself, lookea on bewildered and helpless. American money, before the War praeticailly unknown, haa in succeeaing years become standaFd. American tourists, eager to spend thew dollars, had literally made them all mighty throughout the world. The urGhin who dived for coins in J.ibuti harbor knew their va[ue. Now, a'1most ovemignt, this confiaence was destr.oyed. I trustfully took my American Express Ghecks to the Bank of IndoChina, the only one in town. The cashier shrugged his shoulder-s; he could quote no rate of exchange. He would, as a special favor to me, cash one check fol' twenty dol!lars, but no mor-e. SinGe the br-e to Addis Ababa was a:lmost three times this figure, it appeaFee that, for lack of a few francs, I might be prevented from Garrying out my commlSSlOn. In the waite hot surul:ight I went tramping ÂŁFom p'laâ&#x201A;Źe to p,laGe, hoping to find some merchant who would take my money. My hoF'es were not unduly high; I knew the normal reluctance of the FrenGh to extend credit would be enhanced consider-aMy by the current finan504-


PEARL OF GREAT PR[[CE cia! G~isis. Lt was by the sheeFest good luck that I finally encountered a shopKeeper whe owea biEs in ~he United States whioh we coulm pa:y witili. my e~Fess ohecks; from him ~ obtainem seventy moihws. !J:1he fiFSt of the long three days required for the railroad journey -the tFain mid not run at night-lay through sanm barrens, stippled thickly with blaek rocks, caHed, from their obvious resemblance, nigger heads. I coula see occasional dust devils whirling in the distance; al)out noon one of these engulfed the train. I hastily banged the winaows shut, eut the fine choking dust penetrated everywheFe. Witllout any ventilation, the heat was so intense that sand and sweat cakea on my face. My teeth grated on the fine particles and my eyes soon became as bloodshot as those of the desert inhabitants themsdves. The one electric light which, with true French economy, was the size of a glass bead, gave little illumination inside the compartment, ana ham not tile slig,htest effect upon the outer darkness. Water of any SODU is "rare; the riveFs which come rushing from the mountains of Ethiopia are sucked into the desert long before they reach the sea. Moreover, malaria and dysentery, the age-old enemies of man in the tropics which have so often defeatem his plans, are ever lying in wait. After climbing steadily all day long, at nightfaN the train pulled into Dire Daw.a, at an altitude of nearly a mile, ana, in contrast to the coast, meliglltÂŁul!1y Gool and rek.eshing. This was the border of Ethiopia, the legendary country where Prester John and the Queen of Sheba once had ruled. Pandemonium was raging. At least five hundred of the coffee-colored, hooked-nosed townspeople, gesticulating and shouting wildly, were gathered around the station. I innoGentJ.y assumea they were celebrating the arrival of the train, but Jj soon discover-em my erJ;Ol'. We Wel'e to be the victims of their mareaDic holiday. Ln apparent delight at the opportunity of humiliating white people, the black soldiery rudely pushed us into the Gustems House with their guns. One after another, the passengers' bags - were seized, roughly opened, and each article held up for the edifica~ion of the crowd. Whenever ,a bit of feminine lingerie was flourished triumphantly in the air, the ho"Wling mob greetea the misplay with appreciative shouts of joy. I wuld sense the resentment of the inspectors, who seemed to regard us with that intuitive aversion which so many Americans feel toward members of the black and yellow races. 50S


AN AMERICAN DOCTOR'S ODYSSEY When my turn came, ]1 elililbitea ta the Customs Officiall a PfWmit £ram the Ethiapian Minister a£ Fareign Affairs, which I canfiacmtiy e*pectea waulc;! (}xempt mY' peI1sana~ melangings £rem fueing passea in re¥iew befer.e trne pepulatien ef iIBlire iJWawa. W:itheut even pFetcm<iling to examine it, he wavea it aside. I asked him, by signs, te take me to his Ghief. !But the latter, glancing at it lDriefly, merely Fepliea, "We don't know what that is." Still unw.iHing to lase faiili in the effieiency ef this document, I seught the <Dustoms @ffice U;p the str.eet. 'iJ.i1he enU,y. comment ef the aepar.tmcmt heaa was, "We never henar ~hese things"; fol' the ~hird time !Ii was oraerea te open my mag. Obeaiently I returnecd to the station, en1y te £ina that the shaftlived interest had subsiaed, ana the crowa was melting away. One by ene the guards, w.ith the inspectian en1y haM ever, were ruse cdeparting, and in a few marnents [ was ~e£t aJene with my still unopenec;i mag. ]t was simpliGity itseH; ] merdy summonea <Ii peffter to carry it te the heteL 'fhe seGene day's ride was somewhat less monotenous than ilie first. l1fieFe were occasiona:l scrubby tFees afid evcm small patchc::s of ooltivated lana. The thira day we slia threugh lush val1eys, skiritetil steep river €allens, ana chuggc::a up weededJ highlanas. ]t was tilirfiou!lt ta lDdic::ve taat these IDeleotable 'iV1euntains ceuld lie en1y twenty-faUF heUFs away from the aFia inferno Qf the coast~ regians. I couM weill understand wl\y Lta!lian eyes shaulcd strain tewara them so coveteusly. In the last few haurs of the thira day we meuntc::a abruptly fF0m tliree te eight theusana feet. l'<1r.am the meun~<liin rim, l0elcing far aown eveF tfie terr.aceGi eFcl\artils of apple an<it peal' ana peach, antil the fields e£ wa'Ving grain, 1 ceul~ see the tile<it roofs of Aadis AlDabia, lying prettily in its grove of eucalyptus trees. As soon as I haa aepesited my bag in the hetel, I started out f0r a brisk wrulk te str.eteh my Jegs anc;i sniff the sp!1ing £ragr~c::. 'J] had gene na m0Fe than haH a mire wfien i[ was ste.ppetil by senwies, ana taken te a g,uana hause. [ haa net the faintest idea ef m¥ eifense, mut [ have rulways aeemea it unwise te misplay anger. unmer SUGh circumstances. I smiletil my p1easantest, ana began te pass oigarettes among my capters. They receivea these ovel1tures amiably, but, when-

506


PEARL OF GREA1!

PR~CE

ever I attempted to go on my way, their bayonets promptly barred my passage. I knew not a word of Amharic, the language of the country; but I trieed in