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Diagnosis was made without any bacterial examinations, unless someone protested. The law stated that “All protests and petitions shall be given careful consideration and if the diagnosis is questioned, no person shall be permanently removed to the Culion reservation, or other place of segregation or detention, until the diagnosis of leprosy has been confirmed by bacteriological methods.”

Initially, three hundred and seventy people with leprosy were sent from the old camp at Cebu (Nueva Caceres) to Culion:

For the distant provinces there were periodical “leper collecting trips” or “expeditions” by Coast Guard vessels, in charge of some senior officer of the Bureau of Health, accompanied by a bacteriologist from the Bureau of Science – neither of them necessarily familiar with leprosy. They plus the local health officer at each port of call constituted the diagnostic committee which had to decide who among the cases and suspects presented should be taken to Culion. The examinations were made at whatever time of day or night the vessel arrived and except at Cebu in all sorts of places where the patients had been housed – yards of local jails, temporary huts on isolated beaches, or even less suitable places. The faulty conditions indicated were not due to carelessness of indifference; it was simply impossible in those days to do much better.

For decades, in the absence of a cure, leprosy treatment was experimental. From 1906 to 1910, the people were treated orally with chaulmoogra oil therapy; then from 1910 and 1914, they were given injections of refined chaulmoogra oil, based on the treatment developed by Dr Elidoro Mercado of San Lazaro Hospital, and after, from 1914 to 1921, they received the chaulmoogra-based ethyl esters. In spite of initial optimism, none of these treatments proved to be particularly effective. In 1918, the Director of Health reported that of the 1,922 patients treated between 1912 and 1916, only 3 per cent had shown definite or probable improvement; 73 % were unimproved; 21% had quit the treatment. (3)

When Leonard Wood became Governor General of the Philippines, on October 15, 1921, and in 1922, he increased the special treatment fund so that Culion could employ more staff, expand and broaden the scope of their technical work, and focus on treatment and research. As a result of new treatments based on the Mercado mixture, several thousands of patients were paroled, although many did not want to leave the colony. Consequently, the negative barrio, Malaking Patag, was established, but it was not a lasting success.

In this period, segregation became decentralised in the Philippines by establishing regional leprosaria and outpatient skin clinics. In addition, attempts were made to care for and to protect the children of patients. Several new committees were set up:

Between 1925 and 1931, the anti-leprosy campaign, later named as the Leonard Wood Memorial Fund, began and the doctors became increasingly optimistic about the possibility of successful treatment:

… at Culion in the Philippines, H W Wade and C B Lara reported 6,000 cases treated in 1921 to November 1926, with 629 recoveries, which with discharges to the end of 1926, would reach over 800. As the result of this unique experience, they concluded that the modern treatment is decidedly superior to the older ones, especially in early cases, and they continued: ‘Though they are admittedly much less effective on well-established, advanced cases, the results obtained in the Philippine Islands during the last few years show that a not inconsiderable proportion of such cases (probably 15 to 20 per cent) can be apparently cured if treated intensively, under proper conditions.” “Recent Advance in the Treatment of Leprosy and its Bearing on Prophylaxis” The Practitioner (April 1928)

From 1914 to 1921, Culion enjoyed a reputation for being the largest leprosy colony in the world.

In 1932, when Theodore Roosevelt Jr became Governor General of the Philippines, he abolished the Philippine Health Service, the Office of the Public Welfare Commissioner, and the Tuberculosis Commission and combined these under the Bureau of Health and Public Welfare.

Culion began to decline with the financial crisis of 1933, when staffing was reduced. That year marked the peak of population on Culion, just short of 7,000. After 1935 the population began to decrease because the new provincial leprosaria were opened. The Philippine Congress passed an Act to establish three more leprosy colonies: Tala (Manila), Vigan (Ilocos Sur), and Cagayan, in 1937. In 1938, the prohibition on marriage between those with leprosy and those unaffected was lifted.

From 1936-1941, the average admissions per year to Culion shrank to only 240. By the end of 1941, there were less than 5,500 people on the island. Then during the war years, 1,256 people fled Culion in 1942, and many failed to reach their destinations, while half of the 4,000 who remained died.

In summing up the fifty years of Culion’s existence, in 1956, Dr Lara concluded, “Culion has not, however, achieved its primary goal – i.e., the control of leprosy in the Philippines – in either of the two distinct and successive rules assigned to it: first, as a proving ground for the efficacy of segregation; second, as the center of organized specialized treatment aided by research. In the disappointments and, in certain respects, disillusionments attending its waning years the writer has developed, and still entertains, the hope that Culion may yet contribute to leprosy control by means of prevention of the disease through some kind of immunization.” (36)