JOSE RIZAL : HEALER as HERO

by Ma. Dominga B. Padilla, MD


This lecture was originally delivered by Dr. Padilla at Sentro Oftalmologico Jose Rizal on the occasion of Jose Rizal’s 150th birth anniversary in 2011. This chronicle of Jose Rizal’s life and achievements reveals how our national hero dedicated his life to our country. In celebration of Sight Saving Month, we honor Jose Rizal, the ophthalmologist, by looking back at history and hopefully, in the process, inspire seasoned ophthalmologists to reignite their passion for the field and for the new generation of ophthalmologists be able to emulate Jose Rizal’s enthusiasm for lifelong learning.

So much has been written and said about Dr. Jose Rizal. Historian and Rizal expert Ambeth Ocampo jokingly likens interest on Rizal to a cottage industry, with multiple versions sprouting up all over the place but this comes as no surprise. By any standard, Jose Rizal is one of the most interesting, brilliant, enigmatic, charismatic and controversial figures in history. There always seems to be something new to discover about him.

This year in particular, it being his 150th birth anniversary, almost every columnist, every commentator, every radio and television station, has something to say about some special “little known” facts about our national hero. During the past year there have been numerous reports, in all forms of media, about Rizal as a sportsman and excellent student; as someone who had prophetic dreams, as a world traveler, a romantic, an artist, a political activist, as polyglot who spoke 22 languages and dialects, and of course, as a writer and martyr. Even topics as mundane as where he tied his horse when he visited his childhood sweetheart, have generated interest. The list goes on and on.

Amidst all this hoopla, one aspect of Rizal barely explored or discussed in much detail, is that of him as an ophthalmologist. I guess ophthalmology is not a very exciting topic for the lay person and not one to fire up the imagination, but it is one very important facet of Rizal.

Rizal-the Healer and Rizal-the Hero are inextricably linked. Ophthalmology was not his real passion. But like his political writings for which he is most famous, which sparked the first revolution for freedom in Asia and led him to a destiny he did not plan for himself, his becoming an ophthalmologist was also driven primarily by love. He wrote what he wrote because of a deep love for country. He became an ophthalmologist because of a deep love for his mother. His suffering motherland was under an abusive and oppressive foreign power and through his written work he hoped to open the eyes of both his countrymen and the Spanish Authorities. He longed to give his mother sight just as he longed to bring vision to his “blind” countrymen. He wanted to heal them both. In this quest he also achieved one of the major driving forces in his life. From an early age, thanks to the influences from his mother’s side of the family, he wanted to prove that contrary to what the Spanish imperialists of his time claimed, the Philippines was a country rich in culture prior to the coming of the Spaniards. He wanted to spread the word, both to his own countrymen and to foreigners alike, that we had an identity distinct from that of our conquerors. An identity we could be proud of. An identity we had to rediscover and nurture because that would be our ticket to real freedom.

It is with this premise in mind that I would like to discuss Rizal the ophthalmologist and the physician. I will discuss the teachers from whom he learned his ophthalmology, the surgical techniques he would have used; even as I revisit him as a patriot and martyr who also happened to be a very “human” being who at times could be vain, unrealistic, self absorbed, and stingy but who was also funny, superbly intelligent, tremendously talented, feisty, romantic, and witty. A great man blessed with an almost irresistible charm, childlike honesty, insatiable curiosity, and above all, an exceptional devotion to country.

JOSE’S ROOTS AND EARLY EDUCATION

Jose Prota Rizal Mercado y Alonzo Realonda was born on June 19, 1861, to parents Francisco Engracio Rizal Mercado y Alejandra II (Franciso Mercado) and Teodora Morales Alonso Realonda y Quintos. (Teodora Alonzo). They were rich farmers who had been granted a lease of a hacienda and accompanying rice farm by the Dominicans. Jose was the 7th of 11 children. He had only one brother, Protacio, much older than him, more like a second father than a brother, and one who would play a vital role in his life. Protacio, together with the rest of Jose’s family, lifted and supported Jose throughout his life and ordeals. In many ways he was the wind beneath Jose’s wings.

Jose, or Pepe as he was fondly called, was a 6th generation patrilineal descendant of Domingo Lam-co, a Chinese immigrant entrepreneur who sailed to the Philippines from Jinjiang, Quanzhou in the mid-seventeenth century. In order to escape the anti-chinese sentiments of the Spanish authorities, Domingo changed his name to “Mercado” to indicate their Chinese merchant roots. From Rizal’s mother he received traces of Spanish and Japanese blood. Teodora’s father was a Spanish Mestizo named Lorenzo Alberto Alonso, from Binan Laguna. Teodora’s mother was Brigida de Quintos, from Pangasinan. The historian Austin Craig mentions Lakandula, the Rajah of Tondo at the time of the Spanish Incursion, as an ancestor as well.

In 1849, because of an order by Governor General Francisco Claveria for all Filipinos to change their surnames based on a list of surnames provided by the Spanish government, the Mercados had to change their surname. Jose’s father Francisco adopted the surname Rizal, (originally “Ricial”, the green of young growth or green fields). But this change of name caused confusion in business since most of his businesses were begun under his old name. So he decided to use both surnames and settled on the surname “Rizal Mercado” as a compromise. But most of the time he still used the old name Mercado and dropped Rizal altogether.

Rather confusing times weren’t they? Other questions that always crop up are: Why was Rizal named Jose Rizal and not Jose Mercado? And was his second name Prota or Protacio? In his baptismal certificate it was really Prota. It is a version of San Protasio. The name Protacio was used later in his school registration, just as the family name Rizal and not Mercado was used for his school registration when he entered the Ateneo. Why Rizal and not Mercado? Because by the time the young Jose was to enroll in the Ateneo Municipal de Manila, his older brother Paciano had already gained some notoriety with the authorities as being identified with the three martyred priests Fathers Gomez, Burgos and Zamora, particularly with Padre Jose Gomez, who was his teacher and mentor. These 3 Filipino priests simply wanted Filipinos to be able to serve as Parish Priests. This idea was “unheard of”, unacceptable, and was “dangerous thinking” as far as the Spanish Priests were concerned. So, the Spanish Friars who, during the Spanish occupation were in charge of local governments and served as everything from Parish Priest, to Mayor, tax collector, censor, etc, etc,… linked the three priests to the Cavity Mutiny, charged them with subversion, and publicly executed them in 1872 together with 10 other martyrs at what is now called Trece Martires, Cavite.

As a side note, my great, great grandfather Crisanto de los Reyes, paternal grandfather of my Grandmother Dominga de los Reyes Padilla, financed the Cavite mutiny. He was sentenced to death but was eventually exiled to Spain then proceeded to Marseille, France where he stayed for 5 years, only to return to the Philippines in 1881. But this is another story altogether.

The influence of Padre Burgos in the face of the oppression of the colonizers, capped by this execution, greatly influenced the lives of Paciano and Jose. Indeed, at very early ages, both Paciano and his younger brother Jose, already started advancing “unheard of” ideas about freedom and individual rights.

The young Jose Rizal resented the fact that he was advised by his family to use a different surname and of this he writes: “My family never paid much attention to my second surname (Rizal) but now I had to use it, thus giving me the appearance of an illegitimate child.

Jose’s family had hoped that by changing his surname he would be able to move around freely as he would be dissociated from his older brother. How ironic that the name “Rizal” would later gain much more notoriety with the Spanish authorities than the name Mercado could ever achieve, and that Jose’s family would be made to suffer because of him. Thus, it would seem that this “notoriety” or “fame”, depending on from where one stood, was a destiny Jose could not escape. It is to his family’s credit however, that later on in life, they all used the surname Rizal, to show pride for, and solidarity with, their son Jose, throughout his struggles for their country.

His mother was his first teacher, and at a very early age his parents noted a very sharp mind in Pepe. He excelled in almost everything he did. His natural intelligence was further bolstered by the fact that his parents kept one of the biggest, if not the biggest, and most impressive libraries in the Philippines then.

It was said that Rizal’s home library had no less than 1000 volumes. Their family library was impressive even by today’s standards. Jose truly loved his books, and this love of books was evident in letters he wrote to his brother while in Europe. In 1885, while desperate for money as a student, he wrote to his brother Paciano that he would easily part with his ring to raise funds; but hoped that Paciano would be able to send him money soon enough so that he would not have to part with his books that he had scrimped and saved for.

Rizal kept very meticulous accounts of how he spend his limited funds while studying in Europe. And it is quite interesting to note the he often was willing to go hungry, sometimes eating only coffee and bread once a day, but he spent considerable amounts on his books.

In 1884 he wrote a rather ill tempered letter back home when he found out that some members of the “guardia civil” borrowed a book of his and did not return it. He writes:

“Tell me if the book taken away by the military men has been returned already, and if not, what book it was. How nice, that while I economize in order to be able to buy books, anyone can get away with them. I’m tempted to buy all books in German with the certainty that no lieutenant of the Civil Guard will understand them……. “

He went on to ask his family to please make sure the book is returned and that the civil guards don’t get a chance to put up their own library with “involuntary donations”.

It was Jose’s love of books that exposed him to the humanities. And he admits that it was two books, namely Harriet Beecher Stowe’s “Uncle Tom’s Cabin”, and Eugene Sue’s “Wondering Jew”, that inspired him to write the “Noli me Tangere.” But more about that later… He excelled in School.

After being tutored by Justiniano Aquino Cruz in Binan, Laguna, he was sent to the Ateneo Municipal de Manila for secondary education where, upon graduation, he was among the nine students who got the grade of “sobresaliente” or outstanding.

He continued his education at the Ateneo Municipal de Manila to obtain degrees as a land surveyor and assessor, and, at the same time, he also enrolled at the UST Faculty of Arts and Letters where he studied Philosophy and Letters. Note that he did not originally enroll in Medicine. Caring for the land was his major interest, and this he would be able to use to achieve his amazing feats while in exile in Dapitan.

It was only upon learning that his mother was going blind due to cataracts that he decided to study medicine with the intention of specializing in Ophthalmology at the UST Faculty of Medicine and Surgery. So from 1879 to 1882, he studied medicine, agriculture, surveying, and Philosophy and Letters, all at UST. He got his Bachelor of Arts Degree from UST. During those days, UST was the only academic institution in the Philippines authorized to grant academic degrees.

However, he did not complete the Medicine program because of what he claimed was the discrimination by the Spanish Dominican friars against Filipino students. And so in 1882, unknown to his parents, he secretly left the country with the help of his brother Paciano, in order to complete his medical studies in Madrid.

Although the completion of his medical education with the intention of becoming an ophthalmologist was his reason for going to Europe, Jose Rizal also had a “secret mission” that only he and his brother Paciano knew about. He was to go to Spain and travel around Europe in order to learn more about their forms of government, their ideas, and their life in general in preparation for the liberation of the Philippines. That was the deal they had with Paciano.

By the time Rizal left for Spain for further studies, Spain had already lost some of her colonies in the Americas because of armed revolts. Simon Bolivar led the independence movements of the Latin American colonies that lasted from 1806 to 1825 and which led to the liberation of Panama, Venezuela, Columbia, Ecuador, Peru, and Bolivia.

Internally, Spain was also in political turmoil, with the liberals fighting the conservatives, with civil wars, with governments and monarchs fighting coup de etats, with the intellectuals led by students and professors fighting for more intellectual freedom, and with the Catholic church slowly loosing its hold on power in the state.

This was the Spain that Rizal encountered during his travels. It was the other Spain struggling to also be free of its old self. The liberals in Madrid were especially enraged with the way Spain was treating the Philippines and wanted reforms. It was in Madrid, surrounded by warm and reform-minded people, both Spaniards and Filipinos, that he joined the Masons.

Indeed there were two Spains during the life of Rizal, the enlightened one that he so loved and thrived in; and the one still in darkness as epitomized by the oppressive Dominican Friars in the Philippines. These forces were desperate to hold on to a waning power and would do almost anything for this end.
 

Fig. 1 : Illustrados in Madrid (Rizal is in the second row, 5th from the right).
MEDICINE AND OPHTHALMOLOGY TRAINING IN EUROPE

Rizal studied at the Universidad Central de Madrid where, in 1884, he finally earned his degree, Licentiate in Medicine. A licentiate is similar to what we now call a Bachelor’s Degree, but with a more vocational focus. During those times, further medical education was not necessary to call oneself a physician or practice medicine. However, one could go on to obtain a Doctoral Degree after passing examinations, and writing and orally presenting an approved thesis.

As a Medical Student, Rizal was the typical class “ObC”. He kept meticulous notes about his classes, his activities, even his expenses. It was in these notes that he described the student demonstrations and consequent arrests that occurred at the University of Madrid because of the Speech of Professor Morayta during opening assembly, demanding greater freedom of thought and expression in the academe, thereby causing the church to excommunicate him. This triggered demonstrations among the students supporting Professor Morayta and consequent arrests. So tense and volatile was the situation that classes were suspended for days. Independence, free thought, reforms: these were the cries of the times.

Rizal began to write his thesis for his doctorate in Medicine. But because of financial constraints and because he was rather in a rush to become an ophthalmologist as he was receiving letters from home about his mothers continuously failing eyesight, Rizal did not stay long enough in Madrid to be able to orally present the thesis. Without completing the requirements for a doctorate, he left for Paris to study Ophthalmology.

In the 19th century, Ophthalmology was already a separate, flourishing and dynamic specialty in Europe although there were no formal residency training programs yet. One became an ophthalmologist through preceptorships under the tutelage and supervision of well-known professors. If you were good and your mentor liked you, then you were allowed to personally assist them in the clinics and in surgery, and actually perform some of the procedures. Training was very personalized.

Rizal went on to Paris to train under the famous oculoplastic surgeon, Dr. Louis de Wecker (also known as Louis von Wecker) where he served as assistant at de Wecker’s clinic for 4 months (from November 1885 to February 1886). He then proceeded to Heidelberg where he trained under Dr. Otto Becker. He completed his doctoral thesis in Germany and just mailed his thesis to Madrid hoping that they would accept it in that manner. To orally present it would mean an extra trip to Madrid, something he could not afford at the time. But Madrid did not make an exception for him and he never completed his doctorate.
 

Fig 2A: De Louis de Wecker    Fig 2B. De Wecker’s clinic in Paris    Fig 2C:De Wecker with assistants

 

Dr. Louis de Wecker (1832-1906) was one of the foremost ophthalmologists of the 19th century. Although he did not hold any academic position, he was a prolific author and an active teacher. He was innovative and daring, and somewhat controversial. It was from him that Rizal learned the surgical techniques he used to operate on his mother’s cataracts as well as other surgical procedures.

Dr. de Wecker was a pioneer of several ophthalmologic procedures. He introduced ophthalmoscopy to France and advanced ocular surgery. He also did a lot of his procedures under topical anesthesia using cocaine, doing away almost totally with inhalational anesthesia for ophthalmologic procedures. It is interesting that the debate on type of anesthesia, whether topical, regional or inhalational anesthesia was going on in the late 1800s, and in a way such a debate still continues concerning some procedures in ophthalmology. A review of medical journals during the late 1800s will show numerous third person accounts of ophthalmologists raving about de Wecker’s surgical techniques.

He modified strabismus surgery and used sutures for the first time for strabismus. He was the first to advocate sclerotomy for the treatment of glaucoma, and was the first to use the term “filtration”. He also pioneered a technique in optical nerve decompression which drew a lot of reactions in the ophthalmologic community because is was done without any direct visualization:

“De Wecker (I872) approached the optic nerve sheath by a transconjunctival approach between the lateral and inferior rectus muscles 1 cm from the limbus. He went via Tenon's space and used a spatula to luxate the globe up and medially. He then used a specially designed neurotome to feel and then incise the sheath in an antero-posterior direction and he tried to include the edge of the posterior scleral canal at the entrance of the optic nerve. He had no direct view, and the pupil disturbance he described suggests interference with the posterior ciliary nerves. He also was reputed and reported to have a very efficient method of cataract surgery.

In the January to June 1886 edition of the Cincinnati Lancet-clinic, correspondence from Paris described de Cataract technique as a form of extracapsular cataract surgery using an ab-interno limbal incsion similar to the Graefe technique and most likely using a Graefe knife that is still being manufactured today. He had his own style of capsulotomy using his forcep, making the opening to the anterior capsule similar to today, meaning on the anterior suface and not in the superior portion. It is logical to conclude that this is the surgical technique Rizal used for his mother’s cataracts.

De Wecker was also doing a lot of iridotomies and iridectomies, for many indications. Among them was as preparation prior to cataract surgery for zonular cataract and for those large lenses that were causing some rise in IOP, for angle closure glaucoma, for corneal leukomas. He fashioned the de Wecker iris scissors, not just for iridotomies, but also for doing capsulotomies for after cataracts. The de Wecker iris scissors is still being used today, and many types of de Wecker scissors are manufactured by various makers of fine instruments.

Fig 3: De wecker Iris Scissors and de Wecker Curette

 

Other instruments named after de Wecker include the de Wecker curette for I and C, and the de Wecker forceps. A study of the history of retinal detachment surgery will also show that de Wecker was one of those who introduced the thermocautery (1882) as a method of puncturing the sclera to drain fluid from the sub-retinal space. A rather controversial procedure that de Wecker did a lot of was corneal tattooing. He was primarily an oculoplastic surgeon and many of the patients he attended to suffered from unsightly leukomas.

In one of Rizal’s letters to his family, he describes his work at de Wecker’s clinic:

“From 50 to 100 patients go daily to the clinic of Wecker; there are days when they perform as many as 10 major operations. Many cross-eyes are set right. . . . In the past days a young woman tall, very tall, taller than myself by at least one palm, very elegant, beautiful, with a bad white eye that could not see, went there also. Wecker had to blacken her eye which was not hard to do, for it only needs time. As it is a luxurious operation, she could not complain of pain and she smiled. It is true that the eye is rendered insensitive so the patients get up and say that they have felt absolutely nothing: there are those who do not notice the operation and they only know it when they begin to see.”

What Rizal described was a corneal tattooing procedure of de Wecker. He was the first ophthalmologist to use India ink for the procedure.

We could go on and on about de Wecker as a surgeon. But the long and short of it is that Dr. Jose Rizal trained under one of the most progressive and renowned eye surgeons of his time. But he could not stay in Paris much longer. He felt that he had learned all the surgical procedures he could learn with Dr. Wecker. He wanted to learn ophthalmoscopy/funduscopy; and other basic aspects of ophthalmology. So, he informed Paciano that he would move to Germany.

“With respect to the study of the ailment of the eyes, I am doing well: I now know how to perform all the operations; I only need to know what is going on inside the eye, which requires much practice. In Germany, I am told that this is taught well, but one has to be registered and pay a sum of $10 a month. . . . If I see that, in effect, the cost of living is cheap, I will have myself registered, and if it is not I will see to it that two or three months will suffice for me. In six months, I hope to speak German, study a profession, continue my specialty; in five, living among Filipinos, I have learned French.”

He was undaunted by the thought of having to learn a new language. To him learning new languages came easy. By the end of his life he could speak 22 languages.

So off to Germany he went. He met some students at a pub and asked them who they could recommend to him as an ophthalmology professor, and they pointed him in the direction of the University of Heidelberg Eye clinic of Dr. Otto Becker. If Dr. de Wecker was a surgical giant, Dr. Otto Becker was a pioneer in ophthalmic pathology who created numerous works about the eye. He wrote a text on the anatomy of the normal and diseased lens and collected more than 1800 pathologic specimens. Two ophthalmic eponyms that contain his name are:

- Becker's phenomenon: Pulsation of the retinal arteries in Grave’s ophthalmopathy.
- Becker's test: A test for astigmatism that uses diagrams of sets of three lines radiating in different meridians.

Fig. 4 A younger Dr. Becker Former University of Heidelberg Eye Clinic

Dr. Otto Becker (1828-1890) was an academician from whom Dr. Rizal learned the basics of ophthalmological examination and diagnosis. Rizal writes:

“I practice in the hospital and I examine the patients who come every day: the professor corrects our mistakes in diagnosis; I help in curing and although I do not see as many operations as I do in Paris, here I learn more the practical side. . . . [I plan] during the spring of ‘87 to return again to Paris and observe the operations of Dr de Wecker who, as a surgeon, seems to me very superior to all the others I have seen until the present. From there I can return to the Philippines and open a decent eye clinic.”

By choosing Drs. De Wecker and Becker as his primary teachers in Europe, Dr. Rizal was able to complete a rather short, but well-rounded education in ophthalmic surgery, diagnosis and treatment. We can assume that he knew how to do extracapsular cataract surgery, strabismus surgery using sutures, corneal tattooing, lid surgery, iridectomy and iridotomy, capsulotomy for after cataracts, and sclerotomy and filtration for glaucoma. He may have even ventured into optic nerve sheath decompression. He also knew how to do ophthalmoscopy, a relatively new science and skill in the late 1800s.

He was dying to come home, not just to be able to finally treat his mother but because he was homesick, lovesick and troubled by so much of what was going on back home.

For one, the letters from Leonor Rivera, his first great love, had stopped coming; and his friend Jose Cecilio kept writing to him about how she had grown frail and weak from her sadness and her longing for him.

We now know that the letters from Leonor stopped because her mother had bribed some people at the postal office to intercept the letters that Rizal and Leonor were writing to each other. Hence, the last letter they received from each other came in early 1884. So she thought that he had forgotten her although a greater part of her heart and mind could not believe that this was possible. There must be an explanation. And indeed there was.

Leonor’s Mother did not approve of Rizal because to her he was a Filibuster and trouble maker, and she was convinced that her daughter would have no stable future if she married him. She was actually right in a way, and one could not really blame her for trying to protect her daughter from an unstable and painful future.

Paciano also told him about how life was getting more difficult for their family as the Dominicans started to demand higher and higher rent for the land that their family was leasing, and the price of sugar was going down. Two factors which were making it more and more difficult for their family to make ends meet. The abuse under the hands of the Dominican friars was also being experienced by almost all the families in Calamba, but Rizal’s family was singled out.

Both the persecution by the Dominicans and the disapproval of Leonor’s mother were greatly the result of the political speeches and writings that Rizal had been spawning out while in Europe, which found their way back to the Philippines. These became the talk of the town. Even before he published his first novel, “Noli me Tangere”, Rizal was already sending essays to the Philippines speaking about nationalism and love of country and these essays were published in a Filipino paper which was eventually closed, possibly due to essays of Rizal that were being published. He also delivered speeches in Europe at gatherings attended by Filipino and Spanish intellectuals who sent copies of his speeches back home. But the straw that broke the camels back was yet to come in the form of the “Noli me Tangere”.

In 1882, after reading Uncle Tom’s Cabin and the Wandering Jew, Rizal was inspired to write a book that would expose the woes of the Philippines in the hope that this would in turn lead to the reforms necessary to improve the life of his countrymen. But none of the Filipinos in Spain supported this idea. It was only his friend Ferdinand Blumentritt, who had become like a second father to him, who really encouraged him in this endeavor.

So every evening after completing his studies, he would write his book, one that would shape the history of a nation waiting to be born. This he would do while learning Italian and French, as well as completing his Course in Medicine and Philosophy and Letters at the University of Madrid.

He was terribly homesick, and the only balm he found for homesickness was hard work. He did pretty well in studies; but as one could see, his forte was not so much in medicine as it was in the humanities. In Medicine he received "fair" in two subjects, "good" in four, and "excellent" in two. In his course in Philosophy and Letters he received "good" in one (History of Spain), "very good" in one, "excellent" in four, "excellent with prize" in one (Greek and Latin Literature), and "excellent with free scholarship" in two (Spanish Literature and the Arabic language).

That Jose Rizal was able to complete a novel like “Noli me Tangere” while living the life of a struggling student in a foreign country, learning foreign languages; often having to make do with one meal a day because of lack of funds, is testament to his discipline and extraordinary resolve.

From the start of his stay in Europe, even while still in Madrid, the lack of money was always a problem. He depended on his father and brother to send him money, and oftentimes this was late. The persecution and unfair taxation practices of the Dominicans who “owned” the land also added to the money woes.

There came a time when he reduced his daily expenses for food to thirty-five centavos. On June 24, 1884, the day in which he won a prize in a competition in Greek, he did not eat at all, because he lacked money. He used second-hand clothes which he bought from a pawnshop." The next day he wrote in his diary: "I am hungry and I have nothing to eat and no money."

While in Germany, he sometimes had to go without any lunch because of budgetary constraints. So what he would do was to leave his room at the boarding house at lunch time and roam the streets of Heidelberg where he would watch people having lunch; then return after a credible period of time to his boarding house so that his land lady would think that he went out for lunch. He may have been hungry, but he always wanted to keep his dignity. Kawawa…

He continued writing the “Noli me Tangere” throughout his ophthalmology training and he finished writing the book in Berlin on February 22, 1887. In Rizal’s own words:

“Noli me tangere, a phrase taken from the Gospel of St. Luke, means "touch me not." The book contains things that nobody in our country has spoken of until the present. They are so delicate that they cannot be touched by anyone.. . . I have attempted to do what nobody had wished to do. I have replied to the calumnies that for so many centuries have been heaped upon us and our country. . . . I have unmasked the hypocrisy that under the cloak of religion has impoverished and brutalized us. . . . I have lifted the curtain in order to show what is behind the deceitful and dazzling promises of our government.

Even after the book was completed, money was again a problem and Rizal thought the book would never be published because of lack of funds. But providentially, his good friend Dr. Maximo Viola, a wealthy Filipino who also finished medicine in Madrid, called to say that he was on his way to Berlin and wanted to travel around Europe with Rizal before going back to the Philippines. He bankrolled the publication of the book.

The very first copy of the book was sent to Blumentritt who, aside from being a historian and professor, was the grandson of the Imperial Treasurer of Vienna and a staunch defender of the Catholic Faith. He had misgivings about the contents of the book and was convinced that it would get Rizal into trouble. However, this did not dissuade him from translating the book into German and eventually writing the preface to Rizal’s El Filibusterismo. In an accompanying note to the Noli me Tangere Rizal wrote to Blumentritt: “I have not wept over our misfortunes, but rather laughed at them. No one would want to read a book full of tears. . . . “

Other copies were bound and sent to leading intellectuals around Europe who in turn found a way to send the copies to the Philippines. Rizal’s brother Paciano translated the Noli into Tagalog, and this was how it became known to and read by Andress Bonifacio and other Filipinos who otherwise would not have been able to read his novel.

Jose Rizal was a political activist with a passionate devotion to his country and a superb gift for writing. It was said that he could come up with poetry upon request at almost the drop of a hat. It is this talent, above all else, that gained him the most admiration from his countrymen and from the enlightened intellectuals of Spain, Germany, Vienna, France, and other countries; just as much as it also earned for him the seething hatred of the Spanish Friars and Authorities in the Philippines.

Before he left Berlin he met Dr. Virchow, the “father of Pathology” who invited Rizal to become a member of the Berlin Anthropological Society. “That Virchow, an eminent European scientist, would offer the young Rizal such an honor is a tribute to the magnetism of Rizal’s personality and intellect, as thus far in his career he had made no significant contribution to science. “

Rizal was set to return to the Philippines after Germany, but not until after he traveled with his big hearted friend and financier Dr. Maximo Viola to Vienna where he met Dr. Ernst Fuchs with whom he worked for a short time. The traveling companions also went to Dresden where Rizal was already held in high esteem by scientists such as Dr. Adolf Meyer. They proceeded to visit Switzerland, and many cities in Italy. After all this gallivanting, Rizal finally headed home from Marseilles on July 5, 1887, eager to finally operate on his mother’s eyes, to see his family, and to reunite with his sweetheart Leonor Rivera.
 

HOME AT LAST (August, 1887 to February, 1888)

Many of Rizal’s friends tried to prevail upon him not to come home and to instead establish practice in Hong kong or to just remain in Europe until after they were sure what effect his explosive book would have.  But his longing for his family, country, and sweetheart would not keep him away.

He never saw Leonor Rivera again.  Her family had moved to Dagupan and his parents admonished him not to go to her anymore because Leonor’s mother vehemently disapproved of him.  Rizal the dutiful son heeded their wish. But his love for her, and her love for him, continued long after this. He still held some secret hope that one day they may still be reunited.  In the meantime, he could console himself with the love of his family and with his chance to finally put up his “decent clinic” and treat his mother.

He was able to establish a good practice in August 1887.  He immediately operated on the left eye of his mother, and this was a success; although there are conflicting views on what kind of operation he performed.   Some accounts claim that he performed an iridectomy as a preparation for the subsequent cataract surgery on her left eye in 1892, which was eventually done in Hong Kong.  Some say he did the cataract surgery in Calamba.  Whatever it was that he did, it was successful.  It was also the first such surgery in the country.  He did well as an ophthalmologist and people from all over flocked to see him.  In five months he earned P5,000.00.

If the surgery on the left eye went well however; the right eye, which he did while in exile in Dapitan, was a disaster.  From Dapital in 1894,  he wrote to his family:

I have operated on Mother with much success and she could see with much clearness immediately after. The post-operative course went well for three days, but encouraged by this, she did not follow my instructions and she got up and lay down alone, removed and put back the eyepad, always telling me that nothing was going to happen until her eyes became so inflamed (she suspected that during the night she received a blow.. . . The operative wound gaped, the iris prolapsed and now there is violent inflammation. Nothing can quiet her and she reads and goes to bright lights and rubs her eyes. . . . Now I can understand why it is prohibited for one to treat members of his family”

She eventually developed an endophthalmitis and the eye was lost.

Even as a young man, Rizal was already viewed with awe by his town mates.  His added feather, that of being the only Europe trained ophthalmologist in the country, and possibly in Southeast Asia in 1887, just added to his stature.  Filipinos both in the country and abroad were also delighted with him because of his “Noli me Tangere”.  All this added to his celebrity status.

In a letter from London, his good friend Antonio Regidor wrote after reading the Noli:

"I have today finished your most interesting story; and I confess frankly that I have never read anything truer or more gratifying in reference to this shame which curses our society…. If we pass from persons to the politico - philosophical - social implications of this book it is a perfect mirror of some, if not all, the great evils that afflict our land. You exhibit naked the cancer which most needs to be remedied . . . and by doing this in a humorous vein which you carry through so skillfully by relating history and anecdotes of daily occurrences, either employing irony or sarcasm, you hold the facts to ridicule and draw from the reader a cry of indignation.

"You are still a child and have already produced this red hot shot against that system! “


Naturally and expectedly, the Spanish priests, most specifically the Dominicans, were upset.  A committee was formed at the University of Santo Tomas to study the book.  After the thorough review, the rector of Santo Tomas reported to the Archbishop: "In returning the copy you sent us, we have noted with a red pencil the statements against Spain, the Government and its representatives in these Islands. With a blue or black pencil other statements, impious, heretical, or scandalous, or objectionable for other reasons. All the narrative, absolutely all taken together and in its details, the important and unimportant incidents, are against doctrine, against the church, against the religious orders, and against the institutions, civil, military, social and political, which the Government of Spain has implanted in these islands. Noli Me Tangere of J. Rizal, printed in Berlin, if circulated in the Philippines, would cause the gravest dangers to faith and morals, would lessen or kill the love of these natives for Spain, and stir up the passions of the inhabitants of the country, and cause sad days for the mother country."

A decree was immediately issued banning the book from the Philippines, further ordering that all copies of the book be confiscated and deporting every Filipino found in possession of the book, confiscating his property and giving said property to the person who told on him.  As expected, the effect of the decree was to make the book more popular.  People would read the book in secret, bury them in the ground when they knew guards were coming, and dig them up again once the coast was clear.

Five months after Rizal’s return, Governor General Emilio Terrero had him called to Malacanang to confront him about the accusations of the Dominican community concerning his book.  Rizal assured the governor General that he meant no harm to the government but did expose some of the injustices of the Dominican Friars.  He asked the Governor general to read the book before judging him.

The Governor General read the book, and was said to be secretly pleased at its exposure of the friars. There was competition between the civil leaders and the Dominicans who often wielded more power than the civil authorities.

The next time Rizal was interviewed, Terrero was very friendly, and concerned for Rizal's welfare. He even gave him a bodyguard, Lieutenant José Taviel de Andrade, a Spaniard, whose brother was later to be assigned to defend Rizal at the kangaroo court that sentenced him to death.  He became one of Rizal's warmest admirers and friends, and remained so to the end of his life.

Because of the book,  Terrero ordered the investigation of the notorious and unfair taxation practices of the Dominicans.  Rizal and his townmates were pleased as this would allow them to finally document and stop the Friars from continuing their oppressive fees, rents and taxes.  But they thought wrong.

Rizal wrote a very factual report, supported by documentary evidence, of the practices by the Dominicans.  The report was signed by 79 individuals from Calamba.  Several months went by, but the Governor General did nothing to address the problem.  Instead of making things better, the report just made things worse for Rizal, his family, and those who signed the report.

The Dominicans were just too powerful.  Instead of addressing the problem and correcting the injustice, Governor General Terrero advised Rizal to leave the country immediately for his and his family’s safety.  He could not protect Rizal from the wrath of the Dominican friars.

And so after a mere 6 months back home, Jose Rizal found himself a wanderer once more.  He would never get to see his beloved hometown again.

A WOUNDED WANDERER

The years 1888 to 1892 saw Jose Rizal transformed from the idealistic, hopeful, rather naïve dreamer to a more serious, sadder, and realistic reformist.  Many would even argue that he evolved from a reformist to a revolutionist.

The escalating persecution against his family and friends in Calamba, a persecution that eventually resulted in the destruction of their homes, the loss of their hacienda, and their exile from Calamba, was a constant thorn he had to carry in his heart throughout the years he was away.  He was forced to leave home primarily for his family as his presence in the Philippines was deemed too dangerous for him and for them.  He was also persuaded to leave because his supportive family and friends believed that he could do more for the country  in Europe where he was more free.

His departure did not stop the persecution; but at least he had a few more years to write and work in the Propaganda movement in Spain.

Rizal traveled to Hong kong then to Japan then to the United States then onto Great Britain, France, Belgium, the Spain before eventually returning to Hong Kong in 1891 en route back to Manila.

Almost as soon as he reached London in May 24, 1888, Rizal embarked on studying and writing in the British Museum Library where he found one of the few remaining volumes of  De Morga's Succesos de Filipinas (Events in the Philippines), which had been published in 1609.  He first heard about this book when the Governor of Hong Kong, Sir John Bowring, visited his uncle’s home in Binan while Rizal was living with him as a boy.

This book was very important to Rizal the patriot and the anthropologist, as he believed that he could annotate it so that it would serve as concrete evidence that when the Spaniards arrived in the Philippines, we were not “living in caves and eating raw meat” as was the popular belief among Spaniards and Filipinos at the time, but rather we had a distinct and rather sophisticated civilization.  We had thriving agricultural practices and industries such as mining, fishing, metal work, weaving of silk, etc., and we traded actively with various countries around Asia.  The would book proved that in many ways the Spaniards had done the Filipinos a lot of harm.

Rizal copied the entire book word for word, annotated it to correct what he felt were misconceptions and misinformation, and had it published at his own expense.  He ardently believed that if Filipinos became aware of this truth, it would help them overcome their inferiority complex that was keeping them enslaved to a foreign power.  For centuries, the Spaniards had instilled into the Filipino Psyche that he was nothing before the Spaniards arrived, and he would amount to nothing but an indolent slave.  In many ways, Rizal pushed himself to achieve what he achieved in order to prove to the Filipinos and to the world that we were much better than we were made out to be by our colonizers. It is sad that up to this day, our country as a whole has not yet totally freed ourselves from the mindset of conquered slaves.

By then Jose had come to realize the power of his pen.  He saw the effect the Noli me Tangere had and set out to write its sequel.  But this sequel was a much darker book. It would have none of the humor or parody of the Noli Me Tangere.  It would explore violence and upheaval as a solution to the country’s ills. And although at the end, one of its main characters, Father Florentino,  would shoot violence as the best means to achieve liberty, he would speak of the need for sacrifice even to the point of death:  I do not wish to say that our liberty is to be earned by the edge of the sword. The sword enters very little into our modern destiny. But we must conquer by merit, by lifting up goodness and greatness even to the point of dying for it; and when a country arrives at this exalted stage, God will provide the weapon, the idols will be shattered, the tyrants will fall like a pack of cards, and liberty will shine forth like the first dawn…. Love alone realizes wonderful achievements, virtue alone can save! Pure and spotless must the victim be. . ."

Few people realized that even then, the author was starting to come to terms with his destiny.  And while many of his friends felt the ending was hanging, even advising that Rizal would have to write another book to show the readers exactly what they must do to achieve the liberty, Rizal was slowly planning his return to the Philippines, where he could show the world in action, and not simply in words, what kind of sacrifice was necessary for liberty.

The book was to be called “El Filibusterismo”, and would be dedicated to the three martyred priests, Gomez, Burgos and Zamora.  While he started writing the book as early as 1888 while in London, the book would be eventually published in Ghent in 1891.

About the Women:

During Rizal’s brief stay in Japan he learned enough Japanese to act as an interpreter for Japanese passengers en route to the United States.  It is said that he learned Japanese from a pretty daughter of a Samurai named O-Sei-San.  Popular belief is that he may have carried on a romance with her.  But I am certain that there would have been nothing inappropriate; not just because of his lingering love for Leonor Rivera, but also because I don’t think Rizal would have been so foolish as to act inappropriately with the daughter of a Samurai.

It was during this rather intense period that Rizal met many of the women who were said to have fallen in love with Rizal.   Twice, namely in London and Paris, Rizal left suddenly because of the affection of women.  During both occasions he left because he did not wish to be disloyal to Leonor who, despite their not seeing each other, he still believed to be his fiancee’.

While in London he lived with the Organist of St. Pauls Cathedral, Mr. Becket.  His daughter, Gertrude Becket was falling seriously in love with Rizal.  So although he wished to continue researching at the British Museum in London, he chose to leave for Paris.

Valentin Ventura, with whom Rizal lived in Paris during the following year, wrote jokingly to his friend in London just before Rizal's departure: "It is rumored here that you are running away from a fire for fear you may get burned; you are acting wisely; it is better to apply a remedy in plenty of time."

While in Paris, he became very close to the Bousted Family and one of their daughters, Nellie, became a good friend who even used to fence with Rizal.  They had a mutual attraction; and when this attraction grew too strong to handle, again Rizal fled.

You see, Rizal was a sincere feminist long before it became fashionable, just as he was very ecumenical in his ideas about religion.  He believed in equality of men and women and that both should be held to the same measure of responsibility and moral behavior.  This may have explained why he fled as soon as he felt there might be romance blooming.  In his heart he was still engaged to Leonor.

This laudable attitude towards women was evident in his piece entitled “To the Women of Malolos “.  Marcelo de Pilar, with whom Jose Rizal Founded the La Solidaridad in 1889, asked Rizal to write a letter addressed to the women of Malolos who had the courage to hoot at some dishonorable friars in their town.   What Rizal wrote was close to a novel.  At one portion he tells the women:

"I do not expect the country to have honor and prosperity so long as woman is a slave and ignorant and does not know how to protect the steps of her child. . . The friars have blinded her, bound her, and left her feeble-hearted; and they live without risk, because while the Filipino woman is enslaved, they can enslave all her children. This is the cause of Asia's prostration -- the womanhood of Asia is ignorant and in slavery. Woman is powerful in Europe and in America, because she is free and educated, with clear intelligence and a strong will of her own. . “.

Leonor Rivera, eventually married an Englishman as a result of the machinations of her mother.  After he found out that she had become engaged to another man, Rizal tried to mend his broken heart by going back to Nellie Bousted and asking her to marry him, a move that many of his friends in Europe approved of.  However, two things stopped the marriage from happening.  One was that Nellie was a very conservative Protestant and one of the conditions she placed to prove Rizal’s sincerity was for him to convert to her religion which Rizal, being a very liberal minded Mason, found too conservative for him.  So he refused.  The second reason was that Nellie’s mother did not approve of her daughter marrying a physician who did not have enough clients to make a decent living.

FINDING THE PATH BACK HOME ONCE MORE:

Did Rizal practice ophthalmology while in exile during this period?  Some of his letters, particularly from Brussels, make reference to his spending his time in the clinic as part of a regular schedule that included going to the gym and the library.  So perhaps he did. However, one cannot imagine it was a very active practice in Europe as he spent most of his energy for the propaganda movement and oftentimes was without any money.

By 1891 Rizal was desperate to go home.  The situation was getting worse and worse for his family and those who supported him; and he wanted so much to be there with them.  He also pretty much had it with the propaganda movement and the Filipinos in Europe.   Rizal was unwittingly dragged into the politics of the propaganda movement and without his knowledge rival groups were pitting him against del Pilar for the leadership of La Solidaridad.  When he heard this he wrote to del Pilar that he would resign from the La Solidaridad.  He was then its honorary president and del Pilar was its president.  In Rizal’s letter he told del Pilar that he would rather resign than risk the failure of the movement. 

Fig. 5A: Rizal at a masquarade ball wearing a turban. He enjoyed these very much. With him are Nellie Bousted (standing 3rd from left) and Felix Resurrection Hidalgo (second from right)
 
Fig. 5B: Various studio photographs of Rizal. His Favorite was the center photo as it is.

He also was disgusted by the debauchery, described by Rizal as the “drinking, gambling and whoring” of many of the Filipinos in Spain when they were supposed to be fighting for reform and liberation for the Philippines. Not to think Rizal was beyond having fun. He enjoyed drinking with friends, bought lottery tickets, and enjoyed going to balls, especially masquerade balls. He also loved to visit studios to have his picture taken; perhaps proof of vanity. But he never lost sight of the main purpose for which he was in Europe. What made matters worse was that he found out that some Filipinos were using his name to raise funds from back home and from around Europe purportedly for the movement, only to use the money to support their hedonistic lifestyles. Rizal was fed up.

Because of all these he had lost all faith in the capacity of the Filipinos in Spain to fight for the Philippine cause. He wrote: "If our countrymen repose their faith only in us who are here in Europe, they make a great mistake. I do not wish anybody to be deceived.... This general credulity that we may be able to aid from these distant lands seems to me to be a great error. The medicine must be applied close to the wound”.

And so when he had enough funds, he set out for Hong Kong. He could not go straight to the Philippines as his family begged him not to go home as they were sure he would be arrested when he got home.

It was only when he eventually returned to Hong Kong in 1891 that he again engaged in a real practice as an “oculist”, as Rizal referred to himself. It is said that while in Hongkong, he impressed a prominent Portugese physician by the name of Dr. Lorenzo Marquez with his eye surgical skills that Dr. Marquez eventually referred all his eye patients to Rizal. Hence he had a thriving practice in Hong Kong.

Fig. 6: Rizal’s Professional Card in Hong Kong

So successful was his practice in Hong kong that he was able to bring most of his family members to live with him there.   It is also believed by many that,  he operated successfully on his mother’s eye in Hong Kong.  While there he took a steam boat to Borneo and he communicated with the British government and won a concession of 100,000 hectares of land in Borneo for the Filipino Community so that they could start a colony there.  He tried to get permission from the Governor General for him to start a colony in Borneo but he never got it.

He could have remained in Hong Kong were it not for the ache for his country that continued to torment his soul. But the actual kick or slap in the face, so to speak, was a scathing article that appeared in the La Solidaridad.

Because Rizal had stopped contributing articles for that paper, and because he would not help the revolutionary party, he was accused of settling down comfortably in Hong Kong and abandoning his country's cause.  The attack called him egotistical, cowardly and weak, and said he dreamed he could win his country's redemption with pious words.

This attack upon his honor was unbearable to Rizal, and he defended himself through an article sent to del Pilar.  However, he also admitted to del Pilar that the article was a blessing in a way as it awakened him.  Rizal wrote:  "Who knows, however, whether after all it is not for the best? It has shaken me awake, and after long silence I enter the field anew. Again I assure you, though, that I enter the field without taking arms against you or any other Filipino. I am going to promote the Propaganda again and strengthen the League." (28)

Against the frantic protests of friends and family, Rizal prepared to leave for Manila.

Before he left Hong Kong however, he left two letters with Dr. Lorenzo Marquez with instructions to open them upon his death.  The first letter was addressed to his family, the other to the Filipinos.  Both had similar contents and showed clearly that Rizal was aware of the dangers he was facing by going home.  He always believed he might die before the age of 30, and so it is quite probable that when he set forth for the Philippines, he half expected to be executed almost immediately.  I reprint here the second letter:

To the Filipinos:

"The step which I have taken or which I am about to take is very hazardous, no doubt, and I need not say that I have thought much about it. I know that almost everybody is against it; but I know also that almost nobody knows what is going on in my heart. I cannot live knowing that many are suffering unjust persecutions on my account; I cannot live seeing my brother, sisters, and their numerous families pursued like criminals; I prefer to face death, and I gladly give my life to free so many innocents from such unjust persecution.

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