Formosa--Japan's Experiment
‘DOCTORS, not soldiers, won Taiwan for Japan,’ Count Shimpei Goto, whose death was recently mourned at Tokyo, often said to me. Himself a doctor, he took pardonable pride in the system of public health and sanitation he had established on the island when he was its Civil Governor, from 1898 to 1906, the most critical period in the administration of the then newly acquired Japanese territory. So successful in Japanese estimate was that system that to this day it is maintained in all its essential features, and the Japanese often point to it as a distinct contribution to the world’s store of knowledge and experience in colonial management. This pride I had always thought very much exaggerated until a recent accident imposed upon me a month first of agony and then of forced idleness in the government hospital at Taihoku, the capital of the island. The experience was even more unwelcome than unexpected, but it was one which I did not regret, as it afforded me an opportunity of seeing for myself what Count Goto meant by his favorite expression, ‘the conquest of Taiwan by medicine.’
I
To the West, Taiwan is known as Formosa. It was the Portuguese who bestowed this poetic appellation upon the island. Early in the sixteenth century the Portuguese, having established a base of operation at Macao near Canton, fitted out an expedition in quest of land in Chinese waters. When the mariners were greeted by the alluring sight of a large island, they cried, ‘Ilha Formosa!’ (‘Beautiful Isle!’) Never was a more expressive name conferred upon an isle of the sea, for Formosa, with its verdure, its azure mountain ranges, its lofty peaks rising majestically above the clouds, is one of the most attractive islands in the world.
Beautiful to the eye, Formosa was, when Japan took possession of it, far from a bed of roses. Its Chinese population, 2,900,000 strong, consisted for the most part of insurgents, brigands, and bandits, keeping the country in constant turmoil. As for the aborigines, they looked upon all foreigners, whether Japanese, Chinese, or Europeans, as sworn enemies whose skulls furnished grim ornaments for their family shelves. The whole island seethed with lawlessness, and all peace-loving souls went about their daily tasks literally carrying their lives in their hands.
Nor were insurgency, banditry, headhunting, and general lawlessness Japan’s worst heritage from the Chinese regime. Dangerous as they were, she was prepared to cope with them. What confounded her was the hydra of opium, holding in its toils the population of the island in appalling numbers. Under Chinese rule opium smoking or eating was not unlawful, with the result that by the time Japan succeeded China as the mistress of Formosa one Chinese out of every eighteen had become an incurable addict. To paraphrase De Quincey, opium, that mysterious key, had opened for the Chinese the doors both to paradise and to perdition, and Japan found it impracticable to close them in the face of the clamoring multitude. Had she declared the old practice abolished by a stroke of the pen and backed up the declaration by force, all Formosa would have risen in rebellion, the law-abiding joining the lawless in one great and violent protest. To the islanders the use of opium had long been a legitimate recreation, and to prohibit it, for reasons which seemed to them at best specious and unconvincing, would have been unpardonable, depriving them of their birthright and, what was worse, inflicting upon them unnecessary suffering. It was not only irresistible craving for the sensual satisfaction afforded by opium, but the intense pain caused by a sudden denial of the drug, which rendered an abrupt suppression of the practice extremely difficult.
As an American authority tells us, an addict, if suddenly forbidden to smoke, ’ coughs and chokes and suffers excruciating pains in his feet and legs. He becomes so weak presently that he cannot stand; he falls and writhes in convulsions; he vomits and doubles up with abdominal pain; his face becomes pinched and drawn; perspiration rolls from his tortured body. He may die in complete collapse. Suicide sometimes terminates the unendurable agony.’
Imagine 160,000 or more addicts in this frightful condition in a territory of 13,800 square miles. Surely the non-addict half of the population would have sided with the addicts against an inhumane government causing such a widespread suffering. The resultant upheaval would have strained the administrative capacity of the colonial government and overtaxed its military resources. Add to this the perils of malarial fevers and plagues levying periodic toll of human lives, and the task of the Japanese in Formosa was anything but enviable.
II
Such was the condition which confronted Japan in Formosa in 1896. Her immediate task was to suppress insurgency and brigandage by force of arms. Apparently this was not so difficult, though in reality military operations, unless coupled with humanitarian measures, could never win over a rebellious people. As for the opium evil, the administration was frankly at a loss to know what should be done about it. Not a few urged drastic measures of suppression backed, if necessary, by military force. They argued that unless the drug habit was stamped out at once the Japanese immigrating to the island could not long be free from its contamination.
Thus the first two years of Japanese rule in Formosa passed in a state of uncertainty and suspense. The country, pacified only apparently, still seethed with lawlessness and discontent, while the opium vice, plagues, and fevers continued to play havoc among the natives. It was at this critical moment that Dr. Goto came to the island as Civil Governor. Enjoying the full confidence of Baron Gentaro Kodama, Governor-General, Goto was given a free hand in civil administration.
We may pause a moment for a glimpse of Goto himself, for without doubt he was one of the most interesting, most brilliant personalities upon the political stage of modern Japan. Born of a poor family in a rural town, he studied medicine while working at odd jobs, and started his professional career in a small local hospital. Who could foretell that this country physician would so distinguish himself as governor of Formosa that he would later be given four portfolios in four different cabinets? While still a minor official in the Department of Home Affairs at Tokyo, he leaped into the limelight in a most dramatic fashion. He had heard of a former feudal lord, Count Soma by name, who had been held in captivity at his own mansion by his entourage, conspiring to depose him upon the ‘framed-up’ ground of insanity. The whole affair was stranger than fiction, a great romance of love and jealousy, of loyalty and knavery; and Goto, inspired by a sense of justice, not, perhaps, unmixed with a love of adventure, plunged into the drama determined to expose the intrigue of which he thought the unfortunate peer a victim. For this knight-errantry Goto was arrested and incarcerated by the machination of the same crooks who plotted the riddance of Count Soma. In the end, however, Goto was exonerated and emerged a great hero, an idol of the people, inspiring songs and stories in praise of his gallantry.
The episode gives a clue to the character of the man who, in seven short years, put Formosa upon its own legs. He had both vision and courage, and conceived his ideas not merely to meet immediate needs, but with a view to posterity. When Goto assumed his duties in Formosa, one of the first things he did was to establish at Taihoku an extensive research laboratory for the twofold purpose of studying local diseases and of investigating the natural resources of the island. At the same time he launched the plan of binding the whole island, so to speak, with a chain of hospitals. First, he built twelve main hospitals in twelve important centres of population, each on a scale so large that people thought them so many white elephants on the hands of an administration still unable to support itself. Then the island was divided into twelve sanitary or health districts, each with a main hospital in the largest city and a number of branch hospitals and dispensaries in smaller towns and in villages.
In adopting these ambitious measures, apparently unjustified by actual needs, Goto had in view not only public health, but also the political and military situation still pregnant with evil possibilities. He argued that suppressive measures carried out at the point of the gun might strike fear and hatred into the hearts of recalcitrant natives, but could never inspire genuine respect, much less affection, and that, unless something was done to ameliorate the ill feeling already excited, Japan had no alternative but to face long weary years of futile struggle. It was, therefore, imperative that the colonial administration should take some steps of humanitarian nature to win the hearts of the island people, and the most effective means of attaining this end was, as Goto saw it, to check the diseases to which the natives had succumbed in droves.
III
And so a great army of efficient doctors were invited to Formosa from Japan to take charge of the hospitals erected and equipped regardless of cost. With them also came biologists, chemists, and pharmacologists in large numbers. It was soon ascertained that the malarial fevers were spread by mosquitoes, and that there were at least ten varieties of these diseasecarrying insects. Exterminate the mosquitoes, and the fevers would be exterminated. At once the government-general ordered a general mobilization for ‘house cleaning’ throughout the island. And house cleaning in this case did not merely mean sweeping or washing the inside of dwellings — it meant also cleaning the gardens, the yards, and even the fields. Under official surveillance marshes and stagnant waters were drained or sprinkled with kerosene, sewers and cesspools were covered, brush around dwellings was cleared — everything, in fact, was done to destroy the haunts and breeding places of the mosquitoes. The process was repeated as often as the authorities thought necessary.
In addition the government ordered that all houses should be cleaned twice a year. To this day this order is enforced with unvarying regularity every spring and autumn. During my recent visit in Formosa I chanced upon one of these house-cleaning days in Taihoku, the capital. Walking through the Chinese section, I saw all furniture, all household utensils, all mats and rugs, and even merchandise, piled up pellmell in front of houses and shops, while the process of scouring and scrubbing was going on inside with all the vigor a Chinaman would bring to bear upon his task when under an official vigilance. The regulation, of course, also applies to the Japanese. Thus twice a year all Formosa, purified from head to foot, as it were, experiences a reassuring sensation that at least for the next half year the dread plagues which used to prey upon the inhabitants will have no chance to creep into its homes and shops.
To the native all this was a newfangled idea, at first incomprehensible, useless, irksome. He could not see any earthly relationship between the malarial fevers and the brush and sewers and cesspools around his house. They had stood there for ages and had served useful purposes, and if the fevers got the better of him once in a while that was because he had somehow or other angered one god or another which stood guard over his ancestral abode. And as for the semiannual house cleaning, why so much patter and pother when he was sure that the gods would visit the scourge of plague upon him whenever and wherever they saw fit? Even the hospital, opened largely for his benefit at enormous cost, he failed to appreciate. He even thought it a place where the Japanese tortured the sick to death.
Such was the first response of the natives to the health measures. Disconcerting as this seemed, it was anticipated from the beginning. But under a persistent campaign of education, coupled with the demonstrated efficacy of modern therapy, native skepticism gradually gave way to sympathy and appreciation. Soon the hospitals were crowded with patients, and the Japanese doctors, once objects of fear and suspicion, became good Samaritans in native eyes. Even the periodic cleaning so meticulously carried out under official orders ceased to be irksome. Nor is this surprising, for no normal man can fail to appreciate the fact that plagues have virtually disappeared and that mortality by malarial and other local fevers has been reduced by 60 per cent. Nowhere else, perhaps, can the sick and wounded be tended so cheaply at such wellappointed hospitals as in Formosa. In all seriousness, the Japanese advise you to go to Formosa if you expect to be sick or wounded!
As is evident from the foregoing, the government, with its network of hospitals and dispensaries, established a virtual monopoly in the medical profession. This was, however, a temporary expedient to meet urgent needs in the first stage of the new régime. As the government medical school turned out in increasing numbers native practitioners trained in modern science, branch hospitals and dispensaries in towns and villages were gradually abolished, leaving only the twelve main hospitals in twelve larger cities. In addition there are thirty hospitals for infectious diseases maintained by provincial governments. My personal experience in one of the twelve main institutions is so enlightening that I am tempted to describe it at some length.
IV
It happened this way. I was going to a village of savage aborigines, headhunters until recently, up in the mountains some ten miles from Taihoku. I was riding in a sort of chair car, a four-wheeled two-passenger affair propelled by a Chinese coolie upon a narrow track of frail rails winding up the foothills. At a sharp curve our car collided with another loaded with coal, for the track was single. I was pinched between the two vehicles, and as a result acquired a couple of fractured ribs and cut and bruised legs. The coolies improvised a stretcher and carried me on it down to the foot of the hill, where a motor ambulance from the government hospital at Taihoku was awaiting me.
And now about the hospital. As my pain subsided I began to learn something of the extraordinary nature of the institution. I found out to my great amazement that being a patient there cost only one third as much as it would to live at a first-class hotel in the same city. I was given a suite of two rooms — the larger one for myself, the smaller for my two nurses. The price was only four yen, or less than two dollars, a day, including the necessary surgical attendance and materials and medicines. The room rent did not include the cost of food, but you would hardly believe me if I were to tell you what I paid for my food. For three wholesome, even delicious, meals brought to my bed on a dainty lacquered tray I paid only one yen and eighty sen, or less than ninety cents, a day. For breakfast I had a hot soup a la japonaise and three dishes, occasionally including two soft-boiled eggs. For tiffin and dinner I had another bowl of soup and four or five dishes of fish, eggs, vegetables, and occasionally a little meat. All this for ninety cents! If I was too sick to eat or preferred to have food sent in from outside for a change, I did not pay the hospital for the meals so omitted.
Charges for operation are equally low. Operation fee for appendicitis, for example, is from twenty-five yen ($12.50) to thirty-five yen ($17.50). What struck me as most extraordinary was that the fee for an ordinary maternity case is only three yen, or about $1.50. Including all other hospital charges, a Formosan mother can bring her child into the light of day for a few dollars in the accepted modern way. I know a number of my friends in New York, all men of modest means, whose hospital bills for a confinement case amounted to a thousand dollars. One paid two thousand for his first-born, and became then and there an advocate of Sangerism! The government of Formosa, it seems to me, might raise the charges at the maternity hospitals to the American level, if it would preserve the island for Japanese immigration.
As it is, the government maintains the hospitals at a great loss. Annual expenditure of the twelve hospitals runs well over a million yen, while their income is less than half a million. The hospital at Taihoku, the largest of the > twelve, is housed in enormous brick buildings erected at a cost of 3,200,000 yen. It is equipped for four hundred in-patients and hundreds of out-patients. The number of patients treated at this single institution is more than six hundred thousand a year.
V
So much for the hospitals and the control of plagues and fevers. Even more difficult was the control of opium. Again the genius of Goto proved equal to the task, conceiving the idea of exterminating the drug evil by weeding out addicts by a license and ration system, coupled with a government monopoly which would regulate according to actual needs the importation of raw material and the manufacture of refined opium therefrom. Under this system no one without a license issued by the proper authorities was permitted cither to sell or to obtain opium. An addict could obtain a license only when the fact of his addiction was established by examination by an authorized physician. The quantity of opium for daily consumption was determined by the degree of addiction, and was designated on the license, as well as in the pass book with which each licensed addict was provided and which he must produce whenever he wished to obtain his ration from the licensed dealer. The quantity of opium the dealer was permitted to sell an addict at a time should not exceed his (the addict’s) ration for three days. The dealer was required to enter in his retail book the names and addresses of the addicts who obtained opium of him, together with the quantities and prices of opium sold to each. Should the entries in the dealer’s retail book disagree with the entries in the addict’s pass book, the police authorities might investigate the discrepancy, thus minimizing the chances of the addict’s purchases exceeding his prescribed ration.
This Japanese system is, contrary to popular understanding, widely different from the system which is in effect in all European colonies in Asia — India, Ceylon, the Straits Settlements, the Federated and Unfederated Malay States, British North Borneo, Sarawak, Brunei, Mauritius, Hongkong, Iraq, the Netherlands East Indies, and French Indo-China. Under the Japanese system both opium dealers and addicts are licensed; under the European system dealers are licensed, but addicts are not. In practical operation the two systems bring about vastly different results.
India furnishes the best illustration of the European system. There the addict neither is licensed nor has his ration regulated by the authorities. The only restriction is that no licensed dealer may, to quote from The Truth about India Opium, published by the India Office of the British Government, ‘sell to any one person at one time more than the quantity of opium which an individual may lawfully possess.’ Note the language used in designating an opium buyer. This document significantly uses the term ‘any one person’ or ‘an individual,’ instead of ‘a licensed addict.’ Anyone in India, whether an addict or a nonaddict, may obtain opium from any licensed druggist or vendor. True, the quantity he may buy at a time is limited to something between 360 and 540 grains according to locality, but as there is no rationing system enforced by means of license and purchase book, he may make repeated purchases at different shops by disposing of the amount of one purchase between times. In India not even minors are prohibited from smoking opium, while in Formosa no minor is permitted to smoke.
In order to put the license and ration system into effect, the Formosa Government had to ascertain the number of addicts. This was no easy task, as Formosa under the old régime had never taken a census. But without waiting until the enumeration was completed the government in 1898 licensed 95,449 addicts. In 1900, as a result of a more thoroughgoing survey, the number increased to 165,752. During the following ten years 50,000 more addicts, who had escaped the previous enumerations, were given a license. Yet in spite of this addition the total of addicts decreased year by year. In 1900 total addicts, as we have seen, numbered 165,752. By 1926 these had decreased to 33,755. As the government issues no license either to non-addicts or to minors, the majority of the licensed addicts at present are over fifty-five years of age. Only a few, less than twenty, are between twentyone and thirty years of age, while about 24,000 are of various ages between fifty-one and seventy. Therefore, in fifteen or twenty years hence the opium-using population will become a negligible quantity, thus fulfilling Goto’s prediction that in fifty years Formosa would rid itself of opium addicts.
The monopoly and license system in Formosa has killed two birds with one stone — solving the opium question on one hand, and on the other providing the natives with modern hospitals and other means of improving public health.
The system, as conceived by Goto, was not a means of revenue. Whatever profit it has made has been expended for hospitals and general health measures. The average yearly receipts of the opium monopoly are about 1 per cent of the total revenue of the island. Compare this with similar receipts in other colonies. The opium revenue of the British Administration in India is about 3 per cent of the total, while in the Straits Settlements (British) it varies between 30 and 60 per cent. In the Federated Malay States (British) one fifth of the total revenue comes from opium, while the Dutch East Indies get 11 per cent of their revenue from the same source. The British Administration in India conducts the cultivation of the poppy, as well as the manufacture and sale of opium, as a government monopoly. It issues a license to whoever wishes to cultivate the poppy, and advances the necessary funds to enable the planter to tide over the period between the sowing and harvesting. The crop, when ripe, is collected by a government agent and taken to the government factory at Ghazipur. Opium thus manufactured is either exported or turned over to the Excise Department, which retails the drug to the natives through some 6400 licensed shops.
Perhaps the greatest significance of the Japanese system in Formosa lies in the new moral idea it has created. The rigid governmental supervision has made the natives, especially those of the new generation, look upon opium smoking as a vice — something which fixes odium upon those who indulge in the practice. The young Formosans have little desire to seek the questionable pleasure at the expense of their honor and reputation. This moral change is even more important than the tangible achievements of Japan’s opium policy in Formosa.
VI
Thus far we have dealt largely with the Chinese population of Formosa. Besides the Chinese, there are 85,000 aborigines still remaining outside the purview of civilization. What has been done for them in the way of health improvement?
Strangely the savages have, with few exceptions, been free from opium smoking. This is largely due to the fact that they had no real contact with the Chinese when the Chinese were free to use and sell opium without restriction. For two hundred years the Chinese abused and maltreated the aborigines, cheating them out of their lands and crops and robbing them of what few chattels they possessed, even their Lares and Penates. Thus the savages of the mountains came to regard all Chinese of the plains as their deadly enemies, thirsting for their blood and hunting for their heads. Occasionally there was barter between the mountaineers and the plainsmen, but the Chinese seldom offered the savages so costly an article as opium. So the aborigines escaped the curse of the drug.
But the very cause of their immunity from opium proved a serious obstacle to the Japanese administration in its efforts to extend modern health and therapeutic measures to the savage districts, for the head-hunters, having been illtreated by the Chinese, had come to look upon all foreigners as their enemies. To make them the more dangerous, not a few of them had guns, possibly taken from their Chinese victims. In these circumstances the employment of force by the authorities was inevitable, at least in the first stages of pacification. One after another the tribes have surrendered before forcible measures, handing over their rifles to the police with great reluctance.
With the savages reasonably tamed, the government has launched health measures in their districts. But it has been found impracticable to station official doctors or persuade private practitioners to settle in such districts. As an expedient the police assigned to savage regions have, in many instances, been trained to minister to the sick and wounded. At first these primitive folk were even more suspicious of modern therapeutics than were their Chinese cousins, and their suspicion is not yet entirely dissipated. To convince them that the medicine contains no poison, the policeman-doctor often has to partake of a dose before giving it to his patients. Imagine his predicament when he has to make rounds of calls among his savage patients! Another difficulty is that these childlike mountaineers expect the doctor to work miracles. If a medicine does not produce immediate effect they think it useless and the doctor a fraud. But with a persistent campaign of education and with the extension of the public-school system to the savage districts, such obstacles will be gradually removed. Already some of the tribes are sufficiently civilized to produce from among their own numbers a few physicians trained at the government medical school.
The savages are susceptible to all sorts of ailments and diseases to which humanity is heir, and mortality among them has been inordinately high. Malarial fevers, smallpox, and other epidemics are very common. To the aborigines all sicknesses are ordained by the gods, and the only way to alleviate the former is to appease the latter. They are particularly fearful of epidemics, looking upon them as the most terrific form of divine wrath. A man afflicted with an epidemic is left utterly alone to die or pull through; for all, not excepting his closest kin, run away from him as one cursed by the gods. Naturally, before the advent of the Japanese, the savages had no doctor, not even a quack, among them. All they did to dispel a sickness was to appease the gods by sacrificing a pig or a fowl, or to hire a diviner who would rub a stone or a twig over the head and affected parts of the patient, repeating the while a sort of prayer.
One of the most unsanitary practices in the savage community was that of burying the dead within the hut of the surviving family. A hut, commonly eight or nine feet square, has four beds built directly on the ground, one in each corner. The usual custom was to bury the corpse under the bed used by the nearest relative of the deceased. As the hole was not dug deep the odor was unbearable, not to mention its effect upon the health of the occupants of the hut. When a few years ago the government ordered this practice stopped, the savages lifted their hands in holy horror, declaring that the spirit of the deceased would never rest if his body were buried out in the open field. But the hue and cry was short-lived, for the aborigines soon found out the benefits, both spiritual and material, of the innovation.
The abolition of tattooing was another salutary change, at first opposed but now heartily welcomed by the savages. Tattooing as practised among the Tayals, the largest of the nine Formosa tribes, was frightfully crude and barbarous — something totally different from ‘civilized’ tattooing. The tool used was a piece of wood, about an inch wide and some six inches long, planted with rows of metal needles. This sort of metal brush, after being dipped in a pigment of pine soot, was repeatedly hammered into the flesh. The process was completed at one sitting, or rather ‘lying,’ lasting for three or four hours. For the boy, the ceremony used to take place at fourteen or fifteen years of age, usually after he had cut off a head, in commemoration of his entry upon man’s estate. For the girl, too, it was observed at about the same age. The boy was tattooed on the forehead, the girl on both checks, extending from mouth to ear. He or she would lie heroically on a mat while the teeth of the brush were pounded through the skin. The pain must have been terrific, and when the operation was over the whole face was so swollen and feverish that the victim of this savage custom had to endure days of agony.
When the government issued orders against this practice, the old folk complained bitterly. ‘If our boys and girls were not properly tattooed,’ said they, ‘we should not know when they passed their childhood, and how homely they would look!’ The younger folk welcomed the decree, at first rather timidly. Though they were glad that it would spare them the ordeal of tattooing, they were not certain whether they would look ‘nice’ without observing the established custom, and, what was more important, whether the gods would be pleased. But as tattooless children grew up and married with nothing evil happening to them, both young and old were convinced that the government was more beneficent than the gods, and how happy they are now that the new generation need no longer suffer the terrible torture which the old endured with stoical resignation.
VII
It is not my intention to give the impression that Japan’s colonial administration in Formosa is ideal. Politically and commercially, her policy there is frankly one of imperialism, and like all policies of this nature it has its weaknesses, which for lack of space I cannot discuss. Yet, considering that Japan had no colonial experience until she acquired this island, what she has achieved here may be regarded as a fair success. Towards the natives the administration has been benevolent, if absolute. Financially, it became independent of the home treasury in less than ten years, and, what is more, has since always had a comfortable surplus. Under its financial protection Japanese ships have developed trade between Formosa and the islands to the southward. Already the exports of the island have reached 263,300,000 yen, as against imports of 186,400,000 yen. All this has created a prosperity undreamed of under the Chinese regime. One might think that the natives would be happy and contented. But they are not. They are beginning to be restive, clamoring for participation in government with a view to ultimate home rule. Nor is this surprising, as the Japanese administration itself has helped to create native interest in politics by a modern system of education. It has established eight hundred and sixty-two primary schools, nine intermediate schools, eleven girls’ high schools, and sixteen technical schools. In addition there are three normal schools, a higher middle school, a medical college, three commercial schools, an industrial school, and a school of agriculture and forestry. Even a university is now being established at Taihoku. If education be a source of enlightenment as well as of discontent, the school system Japan has developed and is still developing in Formosa may yet prove her own sorrow.