Vol 36 No 2 Perspective PDF

Yes, Dr. Jose Rizal was a real ophthalmologist

Ma. Dominga B. Padilla, MD, FPAO

By any standard, our national hero, Jose Rizal, is one of the most interesting, brilliant, enigmatic, charismatic, and controversial figures in history. There seems to be always something new to discover about him and debates around him prevail to this day. It is no wonder, therefore, that this year 2011, the 150th anniversary of his birth, almost every columnist, every commentator, every radio and television station, has had something to say about some special “little known” facts about our national hero. During the past year, there had been numerous reports in all forms of media about Rizal as 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. Questions like “was Rizal really an ophthalmologist?” or “did his mother go blind because he experimented with her eyes?” still get asked too often, even by fellow physicians. This is sad, and rather unfair to Dr. Jose Rizal. For truth be told, not only was Jose Rizal an ophthalmologist, he was a pretty good one. Furthermore, Rizal the ophthalmologist and Rizal the hero are inextricably linked. Ophthalmology was not his real passion. But like his political writings for which he is most famous, and 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. In 1858, three years before Rizal was born, Sir John Bowring, Governor of Hong Kong, visited Rizal’s Uncle Alberto in Binan. Sir John imparted a lot of knowledge to Alberto Alonzo, and most significant among them was information about a book by the Spaniard Morga, written in 1609, that documented the situation in the Philippines when the Spaniards first arrived in the 1500s. These stories were passed on to Rizal and were engraved in his heart. This knowledge in the face of the injustice he and his family experienced under the Spaniards inspired him to look for and copy this book one day if only to prove that, contrary to what the Spanish imperialists of his time claimed, the Philippines had a rich culture and advanced civilization before the Spaniards came.1 He carried this dream with him throughout adulthood and fulfilled it more than 20 years later. He wanted to spread the word 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. His quest to become an ophthalmologist afforded him the opportunity to acquire the tools to do just this. His quest to become an ophthalmologist also provided him with the stage to be the best poster boy the Philippines and the Filipinos could have. It is with this premise in mind that I discuss Rizal the ophthalmologist. I will delve into the teachers from whom he learned his ophthalmology—the surgical techniques he would have used as this would be the only way to understand the kind of ophthalmology he must have practiced. This vital aspect of his persona was inseparable from the totality of Jose Rizal, the 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, witty; a great man, blessed with an almost irresistible charm, childlike honesty, insatiable curiosity; and above all, an exceptional devotion to country.

Roots and Early Education

Jose Prota Rizal Mercado y Alonzo Realonda was born on June 19, 1861, to Francisco Engracio Rizal Mercado y Alejandra II (Francisco Mercado) and Teodora Morales Alonso Realonda y Quintos (Teodora Alonzo). They were rich farmers who had been granted lease on a hacienda and accompanying rice farm by the Dominicans. Jose was the seventh of 11 children. He had only one brother, Paciano, much older than him, more like a second father than a brother, and one who would play a vital role in his life. Paciano, 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 sixthgeneration patrilineal descendant of Domingo Lamco, a Chinese immigrant entrepreneur who sailed to the Philippines from Jinjiang, Quanzhou in the mid-seventeenth century. To escape the anti-Chinese sentiments of the Spanish authorities, Domingo changed his name to “Mercado,” indicating their Chinese merchant roots.2

From his mother, Rizal received traces of Spanish and Japanese blood. Teodora’s father was a Spanish Mestizo named Lorenzo Alberto Alonso from Binan Laguna. Her mother was Brigida de Quintos from Pangasinan. The historian Austin Craig mentioned Lakandula, the Rajah of Tondo at the time of the Spanish invasion, as an ancestor as well.3 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.2

Why was Rizal known as Jose Rizal and not Jose Mercado? This is 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, having been identified with the three martyred priests, Gomez, Burgos and Zamora, particularly with Padre Jose Gomez, who was his teacher and mentor.

These three 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 they linked the three priests to the Cavite Mutiny, charged them with subversion, and publicly executed them in 1872 together with 10 other martyrs in what is now called Trece Martires, Cavite. The influence of Padre Burgos in the face of the oppression of the colonizers, capped by his execution, significantly shaped the lives of Paciano and Jose. Indeed, at very early ages, both Paciano and Jose already started advancing “dangerous” ideas about freedom and individual rights.4 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 where one stood, was a destiny Jose could not escape from. It is to his family’s credit, however, that later on in life, as their persecution in the hands of the Spaniards escalated, they all decided to use the surname Rizal; a surname they carried with pride throughout their struggles and Jose’s eventual martyrdom for their country.4

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 his family’s having 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 1,000 volumes,6 impressive even by today’s standards. Jose truly loved his books, and this love of books was evident in the 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.6 After being tutored by Justiniano Aquino Cruz in Binan, Laguna, he was sent to the Ateneo Municipal de Manila for secondary education where he was among the nine students who got the grade of “sobresaliente” or outstanding upon graduation.

He continued his education at the Ateneo Municipal de Manila to obtain degrees as a land surveyor and assessor. At the same time, he enrolled at the University of Santo Tomas Faculty of Arts and Letters where he studied philosophy and letters. He did not originally enroll in medicine. Caring for the land was his major interest, and he would prove this during his exile in Dapitan where he turned his prison into a paradise. 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. From 1879 to 1882, he studied medicine, agriculture, surveying, and philosophy and letters, all at UST where he eventually received his Bachelor of Arts Degree. 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 to complete his medical studies in Madrid.5

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 to join other forces with other reformists, and learn as much as he could so that he could work for the reforms he and his brother so longed for in the Philippines. That was the deal he had with Paciano.7 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 coups d’etat, with the intellectuals led by students and professors fighting for more intellectual freedom, and with the Catholic church slowly losing its hold on power in the state.

This was the Spain that Rizal saw 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 also joined the Masons (Figure 1).1 Medicine and Ophthalmology Training in Europe Rizal studied at the Universidad Central de Madrid where he earned his Licentiate in Medicine in 1884. A licentiate is similar to what we now call a bachelor’s degree. 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. Rizal began to write his thesis for his doctorate in medicine. But because he lacked funds and was rather in a rush to become an ophthalmologist as he was receiving letters from home about his mother’s 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.1, 5

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 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 at surgery, and actually performed some of the procedures. Training was very personalized. Rizal went to Paris to train under the famous occuloplastic 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 it to Madrid, hoping that they would accept it in that manner. To orally present it would mean an extra trip to Madrid, which he could not afford at the time. But Madrid did not make an exception for him and he never completed his doctorate. Perhaps, this is the basis for the mistaken notion that Jose Rizal was not really a doctor.

Dr. Louis de Wecker (1832–1906) was one of the foremost ophthalmologists of the 19th century (Figures 2-3). 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 various types of surgery, including the cataract-surgery technique he used to treat his mother.

Dr. de Wecker was a pioneer of several ophthalmologic procedures. He introduced ophthalmoscopy in France and advanced ocular surgery.5 He also did a lot of his procedures under topical anesthesia using cocaine, doing away almost totally with inhalational anesthesia for ophthalmologic procedures; rather revolutionary for the time.

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. He was the first to advocate sclerotomy for the treatment of glaucoma, and was the first to use the term “filtration.”5

He also pioneered a technique in optic-nerve decompression that drew a lot of reactions in the ophthalmologic community because it 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 suggested interference with the posterior ciliary nerves.”7 He was also 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 Wecker’s cataract-surgery technique as a form of extracapsular cataract surgery using an ab-interno limbal incision similar to the Graefe technique using a Graefe knife that is still being manufactured today. He had his own style of capsulotomy using his forceps, making the opening to the anterior capsule similar to today, meaning on the anterior surface and not in the superior portion. It is logical to conclude that this is the surgical technique Rizal practiced and used for his mother’s cataracts.8 Future letters regarding his mother’s surgery would tend to support this. Other procedures Rizal learned from de Wecker were iridotomies and iridectomies used for many indications. Among them were as preparation prior to cataract surgery for zonular cataract and for large lenses that were causing some rise in intraocular pressure (IOP), for angle-closure glaucoma, and for corneal leukomas. He fashioned the de Wecker iris scissors not just for iridotomies, but also for doing capsulotomies for cataracts.

The de Wecker iris scissors is still being used today. Other instruments named after de Wecker include the de Wecker curette for incision and curettage 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.9-10

A rather controversial procedure that de Wecker performed a lot was corneal tattooing. He was primarily an occuloplastic surgeon and many of the patients he attended to suffered from unsightly leukomas. In one of Rizal’s letters to his family, he described 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.” 6

What Rizal described was a corneal tattooing procedure of de Wecker. He was the first ophthalmologist to use India ink for the procedure.11 We could go on and on about de Wecker as a surgeon. But the long and short of it is that 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 from Dr. de Wecker. He wanted to learn 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.” 6 So off to Germany he went to study under Dr. Otto Becker at the University of Heidelberg (Figure 4). If Dr. de Wecker was a surgical giant, Dr. 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 1,800 pathologic specimens. Dr. Otto Becker (1828–1890) was an academic from whom Rizal learned the basics of ophthalmological examination and diagnosis. Rizal wrote: “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.” 6

And he did eventually return to the Philippines to open a decent eye clinic; but not before he wrote Noli Me Tangere. Through regular letters from Paciano, Rizal knew 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. While Filipinos in general experienced abuse from the Dominican friars, Rizal’s family was especially singled out.

This was largely 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 and became talk of the town. Even before he published Noli Me Tangere, Rizal was already sending essays to the Philippines, works that spoke of nationalism and love of country and which were published in a Filipino paper that was eventually closed down due to pressure from the friars. While in Europe, he also often delivered speeches very unflattering to the friars at gatherings attended by Filipino and European intellectuals, who sent copies of his speeches back home. But the last straw was yet to come in the form of Noli Me Tangere, which he wrote piecemeal, every evening, after completing his studies.

He achieved this masterpiece while learning Italian and French and completing his course in medicine and philosophy and letters at the University of Madrid. And he did all this while often having to make do with only one meal a day because of lack of funds. From the start of his stay in Europe, even while still in Madrid, 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 Domincans who “owned” the land also added to the money woes.1 There came a time when he reduced his daily expenses for food to thirty-five centavos. On June 24, 1884, the day he won a prize in a competition in Greek, he did not eat at all. 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.”6

He continued writing Noli Me Tangere throughout his ophthalmology training and finished it 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.” 12

With funding from a friend, Maximo Viola, Noli Me Tangere finally saw print. The very first copy of the book was sent to Rizal’s dear friend Ferdinand 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 its sequel, El Filibusterismo. In an accompanying note to 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…”1

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 Andres Bonifacio and other Filipinos who, otherwise, would not have been able to read his novel. As expected, Rizal’s first novel delighted Filipinos, but scandalized and enraged the powerful friars in the Philippines. It was to this atmosphere that Rizal returned home in August, 1887.

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 his sweetheart, 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, which was a success, although there were conflicting views on what kind of operation he performed. Some accounts claimed 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 said he did the cataract surgery in Calamba.6 Whatever it was that he did, it was successful. He did well as an ophthalmologist, and people from all over flocked to see him. In five months he earned P5,000, a sizeable sum at that time.1

If the surgery on the left eye went well, the right eye, which he would do while in exile in Dapitan, was a disaster. From Dapitan 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 postoperative 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 eye pad, 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.” 13 She developed an endophthalmitis and the eye was lost.

Even as a young man, Rizal was already viewed with awe by his town mates. His being the only Europetrained ophthalmologist in the country, and possibly in Southeast Asia in 1887, 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. But this was also the reason he was eventually forced into exile.

The Spanish priests, most specifically the Dominicans, were naturally upset. A committee was formed at the University of Santos Tomas to study the book. After the thorough review, the rector of Santo Tomas reported to the Archbishop that: “….the 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.”14

A decree was immediately issued banning the book from the Philippines, further ordering the confiscation of all copies and the deportation of every Filipino found in possession of the book, confiscation of his property and its turnover to the person who told on him. But as expected, the decree only made 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.

Persecution after persecution followed, and despite the fact that Governor General Emilio Terrero was said to be secretly pleased by the novel’s exposure of the friars—there being competition between the civil leaders and the Dominicans who often wielded more power than the civil authorities—and despite the fact that he actually encouraged Rizal and his town mates to document the atrocities of the friars in Calamba, in the end, the Dominicans proved too powerful. Instead of addressing the problem and correcting the injustices, 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.1

And so after being home for only six months, Rizal found himself a wanderer once more. He would never get to see his beloved hometown again.

The 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 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 and to visit London to fulfill a childhood dream.

Almost as soon as he reached London on May 24, 1888, Rizal proceeded to study and write 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, thereby fulfilling something he had been passionate about since childhood. This was the book his uncle told him about when he lived with him in Binan. These volumes were to be translated into English and published in the 20th century by Blair and Robertson as The History of the Filipino People.

This book was very important to Rizal, the patriot and the anthropologist, as it was 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 sophisticated civilization. We had thriving agricultural practices and industries such as mining, fishing, metalwork, and silk weaving—and we traded actively with various countries around Asia. The book proved that in many ways the Spaniards had done the Filipinos a lot of harm.1

Rizal copied the entire book word for word, 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. In many ways, Rizal pushed himself to achieve what he achieved 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, the Filipino people have not been totally freed from the mindset of conquered slaves.

It was also during this time of exile that Rizal wrote the sequel to Noli. But this sequel was a much darker book. It would have none of the humor or parody of Noli Me Tangere. The book would be called El Filibusterismo, and would eventually be published in Ghent in 1891. Dedicated to the three martyred priests, Gomez, Burgos, and Zamora, 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 down 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 …” 4

Few people, even his closest friends, realized then that 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 gain 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.

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 petty politics of the Propaganda Movement as well as with the debauchery of the Filipinos in Spain. Not to think Rizal was beyond having fun. He drank in moderation, bought lottery tickets, and enjoyed going to balls, especially masquerade balls (Figure 5). 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.1

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.” 6

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

It was during his stay in 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 Hong Kong he so impressed a prominent Portuguese 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. Dr. Marquez also became a close friend. It was to him that Rizal, before returning to the Philippines in 1892, would entrust two letters with instructions that they be opened 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.

A passage from his letter to “The Filipinos” is inscribed on the Rizal Monument and reads: “I desire, furthermore, to let those who deny our patriotism, see that we know how to die for our duty and for our convictions. What matters death if one dies for what he loves, for his motherland, and the beings he adores?” 6 Life in Hong Kong was actually good. So successful was his practice that he was able to bring most of his family members to live with him there. In fact he could have remained in Hong Kong were it not for the ache for his country that continued to torment his soul. And so against the frantic protests of friends and family, Rizal, accompanied by his sister, returned to Manila on June 26, 1892. He was arrested less than two weeks later for charges that had to do with his “anti-Friar sentiments,” expressed in his writings, for extolling Father’s Gomez, Burgos, and Zamora as martyrs instead of traitors, and for his efforts that, according to the authorities, “were meant to tear from the loyal Filipino breasts the treasure of our holy Catholic faith.”

The Final Years

On July 8, 1892, Rizal was placed on a boat and exiled to Dapitan to serve his sentence; and in typical Rizal fashion, he turned what should have been a prison island into a paradise where he spent some of the happiest days of his life. While in Dapitan, he not only practiced ophthalmology but also general medicine, general surgery, obstetrics and gynecology, and even dentistry. He opened and ran a school for boys, beautified and lit up the city, grew magnificent fruit orchards, collected various species of plants and animals, some of which would later be named after him by his scientist friends in Europe, and met his “dulce extranjera,” Josephine Bracken. It was ophthalmology that brought her into his life, as she traveled to Dapitan to bring her stepfather for treatment. That Filipinos and foreigners alike would travel to Dapitan to consult with Rizal for their eye problems was testament to his prowess and reputation as an ophthalmologist.

Rizal met his martyrdom on a crisp, cool morning on December 30, 1896, in what must be one of the worst miscalculations in history. His execution was meant to stop the pockets of revolts around the country from escalating into a full -blown revolution. Instead, it proved to be the spark that would ignite it. Amidst the many mysteries and debates that still surround the life and death of Rizal, this truth is undeniable. So is the fact that although he never wrote any scientific papers in ophthalmology, Dr. Jose Rizal was indeed a skilled ophthalmologist who in death, as in life, helped his people see the light.


1. The Life and Writings of Jose Rizal. http://www.joserizal.info/index.html. Accessed June 12, 2011.

2. Jose Rizal. (2009, January 15). New World Encyclopedia. http://www.newworldencyclopedia. org/entry/Jose_Rizal?oldid=903007. Accessed June 9, 2011.

3. Craig A. Lineage, Life, and Labors of Jose Rizal, Philippine Patriot, Philippine Education Company, 1913.

4. Rafael VL. On Rizal’s El Filibusterismo. UCLA Center for Southeast Asian Studies. Accessed June 10, 2011.

5. Ravin TB. Jose Rizal, Philippine National Hero and Ophthalmologist. Arch Ophthalmol 2001; 119: 280-284.

6. Rizal J. 100 Letters of Jose Rizal to his Parents, Brothers, Sisters, Relatives. Manila: Philippine National Historical Society. 1959.

7. Bilson FA, Hudson RL. Surgical treatment of chronic papilloedema in children. Br J Ophthalmol 1975: 59: 92-95.

8. Paris Correspondent. Cincinnati Lancet-Clinic. 1896; 16: 610-611. 9. Hirschberg J. The History of Ophthalmology. Blodi FC, trans. Bonn, Germany: JP Wayenborg, 1992.

10. Kreissig I. Primary Retinal Detachment: Options for Repair. New York: Springer Berlin Heidelberg, 2005.

11. Roy JN. Tattooing of the Cornea. Can Med Assoc J 1938; 39: 436-438. 12. Alzona, G. Jose Rizal: A Biographical Sketch. International Congress on Rizal: 4-8 Dec. 1961; Data Papers. Edition 2. National Historical Institute, 1979.

13. de Ocampo G, Fernando A, Sevilla C, Tamesis J. Dr. Jose Rizal: Ophthalmologist. The Tenth Annual Rizal Lectures. National Historical Institute, 1979.

14. Retana WE. Vida y Escritos del Dr. Jose Rizal, Madrid: Liberia General de Victorino Suarez, 1907.