PAPERS for the Original Department should be in hand one month in advance, and contributed to THE MEDICAL FORTNIGHTLY exclusively. A liberal number of extra copies will be furnished authors, and reprints may be obtained at reasonable rates, if request accompanies the manuscript. Engravings from photographs furnished free. Contributions and books for review should be sent to the Editors, 318-320 Century Bldg., St. Louis. COLLABORATORS. ALBERT ABRAMS, M. D., San Francisco. ARTHUR R. EDWARDS, M. D., Chicago, Ill. RICHARD T. HEWLETT, M. D., London, Eng. HOBART A. HARE, M. D., Philadelphia. H. M. WHELPLEY, M. D., St. Louis. Fighting Cholera in Manila. BY CHARLES MINOR BLACKFORD, JR., M. D. much alike in subject-matter. but differed widely in significance. One of them told of an outbreak of cholera in Mecca, the other announced the appearance of the same disease in Manila. The first aroused apprehension throughout the civilized world, while the other excited fears only among those personally interested in the Philippine Islands. Both cities are centers of extensive commerce, and from either the dreaded plague might spread over wide areas, but while cholera in Mecca is a menace to the world, it is no more dangerous in Manila than was the outbreak of typhus fever in New York ten years ago. Mecca is totally lacking the means of preventing or checking the disease, whereas, since the American occupation, the sanitary condition of Manila has become equal to that of any city in the world, with the possible exception of Havana. On March 3, 1902, the health officers of Manila were notified that Asiatic cholera had appeared in Canton, China, and on March 8, it was reported from Hongkong. Most of the green vegetables imported into Manila come from the Canton region, and the American quarantine officer at Hongkong was at once notified that no vegetables would be admitted without a certificate from him. On the 19th of March, the importation of vegetables was absolutely interdicted, and the health inspectors were ordered to be on the lookout for all persons with suspicious bowel troubles. The next day the authorities were informed that two patients at the San Juan de Dios Hospital were developing symptoms of cholera. Dr. Richard P. Strong, the director of the Biological Laboratory, made cultures from the excretions, and succeeded in securing the characteristic "cholera red" reaction. He reported officially the presence of Asiatic cholera, and General Chaffee was requested to establish at once an armed patrol along the Mariquina River from the point at which the city supply of water was taken, up to and beyond Montalban, the last town on the river. This portion of the valley is about twelve miles long, and has an estimated population of about 14,000. Many of these people get their water supply from the river, but a greater number use it for bathing, washing soiled clothing, and as a receptacle for refuse of every kind. As numbers of them make daily visits to Manila, the danger of having the cholera carried back with them is manifest. The patrol was established promptly, however, and was very efficient, for although the disease eventually appeared in the Mariquina valley, it was held in check, and the river was preserved from pollution. By accomplishing this almost impossible result, the army made it practicable to avert a general epidemic in the city, and thereby saved thousands of lives, but the task was one whose difficulty can be appreciated only by those who have had experience in quarantine work. The disease was of a most malignant type, more than 90 per cent of the earlier cases ending fatally. It was soon noticed that the pest was restricted almost entirely to the Farola or Lighthouse district, a region included between the Bay of Manila, the north bank of the Pasig River, and a tidal creek that connects the river with the bay. It was largely built up in wretched shacks and shanties, often built over foul open drains, and inhabited by people whose personal habits are filthy in the extreme. An effort was made to quarantine the district, but many of the imprisoned persons escaped under cover of darkness, and the disease spread so rapidly among the remainder that it would have been inhuman to continue the quarantine. As local conditions made efficient disinfection impossible, the inhabitants were moved to a detention camp, and the whole area was burned over on March 27th. The property so destroyed was carefully invoiced, and all personal belongings that could be disinfected were thoroughly sterilized and returned to the owners, but the remainder was assessed and paid for. Cholera promptly appeared in the detention camp, but each case was isolated as it developed, and no new ones occurred after the first forty-eight hours. The burning of the Farola district was followed by a great reduction in the number of cases, but those that appeared were widely scattered over the city, and investigation showed that in most instances they were persons who had escaped from the Farola district during the quarantine. Manila possessed a large number of shallow wells in close proximity to latrines and water closets, or to the open ditches thai served as sewers. The city board of health had been making bacteriological examinations of these wells, and ordered such of them as were found to be infected to be filled up, but this process was too slow, and an order was issued that all wells be closed. It was carried into effect with great expedition and thoroughness by Mr. J. L. Mudge, the Superintendent of Streets, Parks, Bridges, Docks and Wharves, but as this action entailed hardship on the districts that were not supplied with the city water, the government ice plant was ordered to increase its production of distilled water to the limit of its capacity, and depots opened at which the pure water was distributed free of charge. The Chinese used it liberally from the beginning, but the more ignorant Filipinos imagines that the authorities were trying to poison them. This notion was soon overcome and the demand for distilled water became so great that it was necessary to send water carts of large capacity perambulating about the streets. In anticipation of an outbreak of bubonic plague, a well-equipped and permanent detention camp had been constructed, capable of accommodating 150 inmates, and fortunately this was available from the first. The military authorities supplied tents that largely increased the capacity of the camp, and a cholera hospital under canvas was established for those who should develop the disease. Drs. J. W. Jobling and T. K. Hunt were put in charge of this hospital, and proved themselves most admirable men for so trying and dangerous a post. For eight weeks they worked amid the dead and dying, relieving one another every twelve hours and never wavering throughout this terrible time. Male nurses who did their duty faithfully and well, were obtained without much difficulty, and much praise is due the three female nurses, Misses Anna M. Seagran, Marie A. Kolp and Elsie Weinberg, who volunteered for this repulsive service. No one who has seen Asiatic cholera at its worst, can imagine the strain on body and mind that the work entailed. Even the last offices for the dying had to be performed by this devoted band, for not a single minister of the gospel, Protestant or Catholic, visited the hospital. The Spanish residents asked and received permission to establish a hospital of their own, and a large building that had been used as the second reserve hospital was placed at their disposal. It was named the Santiago Hospital, and was in charge of a corps of Spanish physicians, friars and Sisters of Charity. When the hospital at the detention camp became overcrowded, the wards of the Santiago Hospital were opened to all that could be accommodated, and it proved a valuable agent in saving life. The work of the sanitary authorities was seriously embarrassed by a stupid and persistent opposition. For weeks the presence of cholera was denied by "ignorant, misinformed and ill-intentioned persons." daily list of deaths did not run up into thousands, the native Filipinos refused to believe in the existence of the disease, and their minds were poisoned by tales of horrible maltreatment in the detention camps and of deliberate murders in the hospitals. When the Farola district was burned, it was widely circulated that the dwellings of the poor were destroyed to make room for the palaces of rich Americans, and as stated above, it was asserted that the distilled water was poisoned. This opposition was not confined to the ignorant classes. At the beginning of the outbreak, a meeting of the Spanish and Filipino physicians was held, and their aid promised the sanitary commission. It is regrettable that the promise was fulfilled in but a few cases, for they not only failed to report cases that came to their knowledge, but materially added to the burden on the American officials by false reports and by decrying the sanitary measures. A notable exception was seen in the conduct of Dr. Ariston Bautista Lim, the most prominent Filipino physician in the city, who neglected his private practice to aid the insular board of health, while Drs. Manuel Goez and Luis Arbella did much investigation and emergency work, besides helping to allay groundless popular fears and prejudices. The results of the action of the board of health were highly successful, and for months the disease was kept in check. "With its congested population, its lack of any adequate system for the disposal of human excreta and its many insanitary districts, the city affords a natural breeding ground for cholera," and yet for three months the highest number of new cases was 38, and that was reached on the first of May. During the second week in May the decline was so marked that it was believed that the end of the epidemic was at hand, and wholesale reductions were made in the force of sanitary inspectors and emergency employees. The error of this step was soon seen in a rise in the number of cases, but the maximum was reached on July 26, when 91 cases were reported. This, however, was the greatest number during the epidemic, and contrasts most favorably with the thousands of former visitations. On August 1, the detail of Colonel Maus as Commissioner of Public Health came to an end, and Dr. Frank S. Bourns was appointed in his stead. Dr. Bourns is the son of a missionary and was born in the islands, though educated in the United States. A graduate in medicine from the University of Michigan, he was for a time professor of pathology and bacteriology in the Southern Medical College in Atlanta, from which post he resigned to go to the Philippines on the outbreak of the war with Spain. His admirable professional training and his familiarity with the conditions of life on the islands, made the appointment a most excellent one, and he sacrificed his private interests to undertake a hard and thankless task at a critical time The native and Spanish hostility reached a climax about this time of Dr. Bourns' appointment, but by making some changes in the policy of the bureau, he allayed much of the enmity and even secured the aid of many of the opponents. From July 6 to August 2, there were 1222 cases of cholera in Manila, but in the succeeding four weeks the number fell to 668, and in September to 296, while October had but 88. Estimating the population of the city at 302,000, these figures show that only 1.38 per cent were attacked, whereas in the provincial municipalities the numbers ranged from 13 to 32 per cent. As American sanitarians ended the reign of yellow fever in Cuba, so they have destroyed the rule of cholera in the Philippines, and generations yet unborn will "rise up and call them blessed." SWEDEN is said to have the lowest death rate of any civilized nation. During the last ten years the annual average has been only 16.49 per thousand. DEGENERACY IN EUROPE.-At a recent meeting of the Nationalist Congress at Cassel, Dr. Moritz of Alsberg, speaking on inherited degeneracy through social influences, asserted that physical degeneracy in European countries is becoming more and more evident, as marked by a decrease of physical resistance had a tendency to illness and weakness. Alcoholism he declared the chief cause of inherited degeneracy, to cure which alcoholism must be wiped out. He borrowed an idea of the members of some of our State legislatures in the suggestion that a legal certificate of health should be required before a person is allowed to marry.Medical Record. |