History of medicine in the Philippines

According to sociologist and anthropologist Marianita "Girlie" C. Villariba a babaylan is a woman mystic who is "a specialist in the fields of culture, religion, medicine and all kinds of theoretical knowledge about the phenomenon of nature." In ancient Filipino society, the babaylans are believed to be a woman who had been possessed by a spirit, or a woman who had dreams or had encountered life-altering experiences, or a woman who has inherited the role to become a "mystical woman" from an elder babaylan. Their functions include the role of community leaders, warriors, community defenders, priestesses, healers, sages and seers.[5] Babaylans could be women, but there were many instances of gender fluidity amongst those who held the title, similar to the ways third gender, and two-spirit, functions in the role of many other pre-colonial societies.

The albularyo (the "herbalist", herbolario in Spanish[3]) is the "general practitioner" and the "primary dispenser of healthcare" in the hierarchy of traditional folk doctors in the Philippines. Because of the mass amount of different dialects spoken in the country, they have a diverse set of names depending on the region (suranho, sirkano, baylan, hapsalan, tambala, mananambal, etc.).[6] He or she is knowledgeable in the use of medicinal herbs. The skill of the albularyo is commonly handed down from one generation to another in a family-line, involving apprenticeship. Abularyos are mostly the elders of the Barangays.[6] The common folk diagnosis is that patients become sick due to supernatural "illness-causers" such as a duwende (dwarf), a nuno, a lamang-lupa (a "creature from the earth or underground or under the soil"), a tikbalang, or a kapre. He or she usually includes forms of prayers, such as bulong ("whispering" prayers) or orasyon (oration or "prayer recitation"), while treating patients. Albularyos may also practice rituals to drive away evil spirits, such as the performance of the kanyaw (cutting and bleeding chickens, then draining their blood on particular perimeters of the house), or the slaughter of pigs to search for the right type of liver that would reveal the cause of an illness. Sacrificial offerings are also sometimes used during treatments. Some albularyos choose to treat patients only on certain days of the week, such as Tuesdays and Fridays, or on the feast days of the Sto. Niño and the Black Nazarene, with the belief that healing powers are greater during those days.[2] The methods and practices used by albularyos vary per region.

In Cebu, located in the Visayas region of the Philippines, a traditional albularyo is called a Mananambal and their work of healing is called panambal.[7] Like the general albularyo, mananambals obtain their status through ancestry, apprenticeship/observational practice, or through an epiphany and are generally performed by the elders of the community, regardless of gender. Their practice, or panambal, has a combination of elements from Christianity and sorcery which appear to be opposites since one involves faith healing while the other requires Black magic, Witchcraft, etc.[8] The combinations are a reflection of the legacies left from the conversion to Catholicism of the islands from Spanish colonization, since the Indigenous of Cebu had direct contact with the Portuguese explorer Ferdinand Magellan, and on-going Indigenous practices before colonization. The panambals cover natural and supernatural illnesses using a wide range of methods. Two common methods used are herbal medicine and orasyon, healing prayers deriving from a bible equivalency called the librito.[8]

Mananambals treat major and minor ailments. These ailments include but are not limited to: headache, fever, cold, toothache, dengue fever, wounds, Infection, cancer, intellectual impairment, and other illnesses thought to be caused by supernatural creatures.[8] Aside from biological treatments, patients may also come to mananambals to form or break any form of relationships from marriage to friendships.[7] Treatments are dependent on the type of sickness and on the mananambal themselves.

The hilot may refer to either the manghihilot or the magpapaanak:[2] The manghihilot ("massager", "folk massage therapist", "folk chiropractor") uses massaging techniques to treat sprains, fractures, and other similar conditions that affect the skeletal system and the musculatory system, including ligaments. The practice treats illnesses a variety of ways based on its own universal law and natural Law (physical manipulation, herbal remedies, and dietary/life style advice).[9] Manghihilots are either chosen by maestros or master albularyos, or through apprenticeship.[9] Gender is not a limiting factor since they can be any gender. When chosen, their trainings include a pilgrimage to a sacred mountain to perform the oracions, or words enabling the communication with the spirit world or the panawagan.[9] Similar to the albularyo practice, the hilot is a fusion of spiritual and medicinal practices with physical manipulation and the focus of healing the whole body being the main distinctions between the two practices. Illnesses were referred to as pilay and were defined by imbalances in the body which are explained by their enkanto, or unseen entities, elements, and manifestations in the body.[9] This practice shares similarities with India's Ayurveda and Traditional Chinese Medicine. The magpapaanak, the other "hilot", is the folk "midwife" who does prenatal visits and check-ups to pregnant mothers. Normally a woman, she delivers babies during childbirth and often performs the ritual called the suob (a form of "aroma therapy" performed while placed under a cloak).[2]

The mangluluop is a folk specialist who makes a diagnosis based on the resulting appearance of a burned concoction composed of freshwater shell or saltwater shell (kalanghuga), salt, a piece of palm leaves that were blessed by Catholic priests during Palm Sunday, and charcoal resulting from coconut shells, coconut midribs. The burning of these materials is done while placed inside a tin plate accompanied by prayers and invocations and the making of the sign of the cross three times over the body of the patient. Depending on the appearance and shape of the burned materials, mangluluop refers and sends the ill person to either the albularyo, the mediko, or the manghihilot for further treatment. After the ritual and after telling the patient to which folk doctor to go next, the freshwater or saltwater shell is powdered by the mangluluop and prayerfully applies the powder following the steps of how to make sign of the cross on the patient's forehead, palms, and plantar arches of the feet. The remainder of the concoction is then thrown under the stairs at the entrance of the home to prevent evil spirits from re-invading the house.[2]

The manghihila (the "puller") uses the technique known as panghihila (the "pulling"), wherein the patient is rubbed with coconut oil accompanied by the use of a mirror, strips of cellophane paper that were used as wrappers of cigarette boxes, strips of banana frond, or wrappings of medicinal leaves. The type of "pull" felt during the massage therapy becomes the basis of what causes the ailment (i.e. the "smoothness" of the pull of the material used or the lingering or hovering or the strength of resistance of the applied material on a specific spot of the patient's body).[2]

The mangtatawas (literally "user of tawas") determines the cause and nature of illnesses through the use of potassium alum, locally known in the Philippines as tawas as one of the primary ingredients. The other materials used in the diagnostic procedure are candles, eggs, mirrors, plain paper, and paper used for rolling cigarettes.[2]

The mediko is a folk doctor and a specialist that combines folk medicine and some techniques used in western medicine. He or she prescribes medications and at times uses acupuncture to treat ailments.[2]

Filipino faith healers come from either spiritist groups, diviners (a group that practice divination) or from persons who were previously saved from illnesses or death and had encountered epiphanies or mystical experiences who became convinced that they were destined to help sick people after receiving healing powers bestowed upon them by the Holy Spirit or other supernatural beings. Some of them started as an albularyo, a mediko, or a hilot. Some faith healers are psychic healers (faith healers who heal patients remotely), whisperers of prayers (whispers prayers over the affected part of the body of the patient), prayer blowers (blows prayers on affected areas of the patient's body), anointers that rub saliva over the affected area of the patient, healers who hovers crucifixes and icons on the body of the patient, and psychic surgeons (folk surgeons who performs "surgery" on a patient without the use of surgical tools).[2]

The shamans from the Philippine Cordilleras are folk healers that heal ailments based on the beliefs of people collectively known as the Igorots (includes tribes of the Bontok, Gaddang, Ibaloy, Ifugao, Ilongot, Isneg, Kalinga, Kankana-ey, Ikalahan, I'wak and Tinguian). Their culture believe in rituals that involve offering of prayers and sacrifial animals, belief in supreme deities or supreme beings, lesser ranked deities, intermediation by seers or human mediums, and pleasing and appeasing the anito (spirits of the dead, ancestral spirits, or spirits from nature) to prevent them from inducing diseases and misfortunes. They also cling to animism, ceremonies that are believed to cure physical and mental imbalances, those that counter witchcraft, and those that leads to bountiful harvests. Sacrifices, feasts and dances were performed as a form of thanksgiving and as entertainment for gods and goddesses. Other tribal healers dispenses magical amulets to use against illnesses and the pouring animal blood on the human body to avoid and escape death.[2]

Common disease during the Spanish period in the Philippines were diarrhea, dysentery, and leprosy.[3] There were also the presence of cholera, influenza, smallpox, beri-beri, dysentery, bubonic plague, scurvy, rheumatism, asthma, syphilis, tetanus, toothache, and ulcers.[3] Many Filipinos believed in pasma (a resulting condition similar to spasm which involves the occurrence of hand tremors, sweaty palms, numbness and pains[10] after the body's exposure to "unhealthy cold" and water), the state of nausog ("distress" caused by an unfamiliar person), and "personalistic sorcery".[3]

It was in 1830 when the "true pharmacies" were established in the Manila, Philippines. In 1871, a faculty of pharmacy was formally established at the University of Santo Tomas, and was later followed by the opening of "well-appointed drug stores".[2]

Both the Spanish government and Spanish missionaries established a number of hospitals in the Philippines. The first hospital was erected by the Spaniards in Cebu during 1565. That first hospital was later transferred to Manila for the purpose of treating sick and wounded military personnel. The establishment of other health and charity institutions soon followed.[2] The missionaries who established the early hospitals in the Philippines were the Franciscans, the Brotherhood of the Misericordia, the Brotherhood of San Juan de Dios, and the Dominicans. There were also lay government people who became founders of hospitals during the time period. Among the early hospitals in the Philippines were the following:[3]

Manila had the Hospital Real de Españoles (Royal Spanish Hospital, existed from 1577 to 1898), the Hospital de los Indios Naturales (Hospital of Native Indians, existed from 1578 to 1603), Hospital de Santa Ana (St. Anne Hospital, founded in 1603, still exists today), Hospital de la Misericordia (Mercy Hospital, existed from 1578 to 1656), the Hospital of San Juan de Dios (St. John of God Hospital, established in 1656, and still existing to the present), Hospital de San Lazaro (Hospital of St. Lazarus, a hospital for lepers established in 1603, still exists today), Hospital de San Pedro Martir (St. Peter the Martyr Hospital, 1587 to 1599), and the Hospital de San Gabriel (St. Gabriel Hospital, a hospital that is specialty for the Chinese community of Binondo, 1599 to 1774).[3]

In Cavite, the Hospital del Espiritu Santo (Holy Spirit Hospital) existed from 1591 to 1662. This hospital took care of sailors, marine personnel, shipbuilders, and carpenters among others.[3]

In Laguna, the Hospital de Nuestra Señora de las Aguas Santas de Mainit (Our Lady of the Holy Waters Hospital in Mainit, Mainit being the name of a place with hot springs in Laguna) existed from 1597 to 1727 and then was re-established from 1877 and still existing up to the present.[3] The hospital was built by Franciscan missionaries on top of the location of hot springs in Los Baños, Laguna due to the therapeutic effects of the natural springs to the body of sick people, as they had observed from Filipinos of the time who bathe in hot springs despite of being ill.[3]

In Naga, the Hospital de Santiago (St. James's Hospital) existed from 1611 to 1691. Another hospital also named as the Hospital de San Lazaro (Hospital of St. Lazarus), which is different from the one catering to leper patients in Manila, existed from 1873 and is still functioning today.[3]

The Central Board of Vaccination was established in 1806. After 1883, caraballa calves as well horse, goat, deer, and monkey were used for producing vaccine. By the end of the Spanish regime in 1898, there were 122 vaccinators in different Philippine provinces in addition to so-called vacunadorcillas (vaccinators, or vaccine givers) assigned to each town.[2]

Drugs and medicines from China and from some regions of Southeast Asia were part of the medical trade during the Spanish period in the Philippines. A 1637 report of Don Juan Grau y Monfalcon attested the procurement of "valuable drugs" from a Cambodian king in 1600. A 1590 report of Bishop Domingo de Salazar, OP, confirmed the existence of shops with doctors and apothecaries managed by the Chinese in the Parián of Spanish Manila.[3]

In Spanish Philippines, childbirth were managed by the traditional matrona (a type of comadrona or midwife), by the mediquillos, and by some parish priests. Childbearing manuals written during the period include Fr. Julian Bermejo's Instrucciones para las Parteras, a fin de evitar los abortos y que los niños que mueran sin el bautismo (Instructions for Midwives to Prevent Abortion and Death of Unbaptised Babies) and Fr. Gregorio Sanz's Embologia Sagrada (Sacred Embryology). Bermejo's Instrucciones was the "earliest attempt" to manage fatal childbirthing complications.[3]

The benefit of general surgical procedures was not available to common Filipinos during the Spanish era. Although Spanish surgeons were skillful in performing amputations and mutilations in the 1800s, their services were only available to by Spanish officials stationed in Manila. One such surgery was performed by Don Juan Ventura Sarra in 1675 on his patient Don Manuel de Leon to cure the latter's obesity and corpulence. The surgery involved removal of "lumps of lipids" from de Leon's abdominal cavities. Another recorded surgical treatment performed by Ventura Sarra was on a governor named Don Juan Vargas Hurtado in 1682, an operation that removed an abscess from Vargas Hurtado's hip.[3]