Part 8
When England and France began to show us the advantages of their civilization, we were, as races then went, a great people. Hawaii, Tahiti, the Marquesas, Tonga, Samoa and New Zealand made a respectable figure on the earth's surface, and contained a population of no small size, better fitted than any other possible community for the condition in which they lived. Tahiti, being the first to come in close contact with the foreigners, was first to suffer. The people, who numbered, according to Cook, two hundred thousand in 1767, numbered less than twenty thousand in 1797, according to the missionaries, and only about five thousand in 1803. This frightful mortality has been often doubted, because Europeans have naturally shrunk from admit ting the horrors of their own work, but no one doubts it who belongs to the native race. Tahiti did not stand alone in misery; what happened there happened everywhere, not only in the great groups of high islands, like Hawaii with three or four hundred thousand people, but in little coral atolls which could only support a few score.
These are strong words, but they are nevertheless only too true. Civilization brings to savage races curses as well as blessings. The primitive people are more receptive of new vices than new virtues.
In 1880 the number of inhabitants had again increased to thirteen thousand five hundred, but since that time it has been reduced to eleven thousand, as shown by the last census. When Captain Cook visited the island he emphasized particularly the absence of acute diseases. In speaking of chronic diseases he remarks:
They only reckon five or six which might be called chronic, or national disorders, amongst which are the dropsy and the _fefai_, or indolent swellings before mentioned as frequent at Tongataboo.
The fearful, swift depopulation of the island was caused by the introduction of new acute infectious and contagious diseases, such as smallpox, measles, whooping-cough, la grippe, etc., which among these people was attended by a frightful mortality. It was only three years ago that an epidemic of measles, a trifling disease with us, claimed several hundred lives, including many adults, and extended to nearly all of the islands of the entire group. The disease that is now threatening the extinction of the race in a short time is pulmonary tuberculosis. The natives are extremely susceptible to this disease, and the small native houses, crowded with large families, are the breeding stations for infection.
The French government has at last recognized the need of taking active measures to improve the sanitary conditions of their colony and protect the natives against the spread of infectious diseases. A corps of three physicians, sent by the French government on this mission, made the voyage from San Francisco to the island on the steamer _Mariposa_ with me. The names of these physicians are: Dr. Grosfillez, surgeon-major of the first class of the colonial troops; Dr. H. Rowan, a graduate of the Pasteur Institute, and Dr. F. Cassiau, of the clinic of Marseilles. The military surgeon receives an annual salary of fifteen hundred dollars, the two civil doctors twelve hundred dollars each. They are under contract for five years. They have been given judicial power to enforce all sanitary regulations they see fit to institute. They will be stationed at different points and will establish a requisite number of lazarettos, something which will fill a long-felt and pressing need.
PRESENT PREVAILING DISEASES
The average temperature of the inhabited part of the island, which can not be less than 78 to 80 degrees Fahrenheit, has a relaxing influence on the natives and much more so on the small contingent of whites. The Europeans and Americans find it necessary every three to five years to seek for a few months a cooler climate to restore their energies and vigor. The government officials and officers of the small garrison are not obliged to serve for more than the same time consecutively, when they are relieved from their posts and commands. It is this relaxation which, to a certain extent, at least, is responsible for the great mortality of comparatively mild, acute, infectious diseases, and the severity of pulmonary tuberculosis among the natives. Tuberculosis of the lymphatic glands, skin, bones and joints appears to be extremely rare. The moisture-laden atmosphere and the suddenness with which the cool land and ocean breezes set in after the heat of the day, are conducive to the development of rheumatic affections, which are prevalent in all parts of the island, more especially during the rainy season in midwinter. The same can be said of bronchial affections and pneumonia. The free and unrestrained intercourse among natives accounts for the rapid spread of tuberculosis and acute infectious diseases among the entire population and from island to island.
The sanitary commission now engaged, in efforts to reduce the mortality of the natives will establish rules and regulations which will have for their object the prevention of dissemination of acute as well as chronic infectious diseases, and will undoubtedly accomplish much toward the preservation of the race; but these officers will meet with stubborn opposition on the part of the natives when attempts are made, in their interest, to curtail their personal liberties. The ties of relationship and friendship among the natives are very strong, and become most apparent in case of misfortunes and sickness. Smallpox breaks out almost every year, and claims its share of victims. Vaccination is supposed to be compulsory, but the natives are inclined to escape it. Vaccination is done gratuitously at the Military Hospital for all natives who can be induced to submit to it. Under present conditions it is almost impossible to reach the inhabitants of the small atoll islands.
Like in all tropic countries, tetanus is of quite frequent occurrence. The small native pony is found everywhere, and as the rural natives are all barefooted and spend much of their time in the jungles in impregnating the flower of the vanilla-bean and gathering fruits, wounds prone to infection with the tetanus bacillus are of frequent occurrence.
Malarial diseases are comparatively rare, although the plasmodium-carrying mosquitoes are numerous and aggressive, and children in the country districts are nude, and the men limit their clothing to the wearing of a loin-cloth. No case of typhoid fever has been known to have originated in the island. For this there exists a satisfactory explanation. The exemption in this island from this disease, so widely distributed over the entire part of the inhabited globe, is due entirely to an abundant supply of the purest drinking water supplied by the numerous mountain streams. Nearly all the inhabitants live on the coast, near the outlet of a brook or stream, where, consequently, there is no danger whatever of water-contamination. I found three cases of typhoid fever in the Military Hospital, members of one family, who had been brought there from one of the neighboring atoll islands.
Varicose veins, varicocele and hydrocele are very common. The absence of anything like a large ulcer in many cases of large and numerous varicose veins of the leg, I attributed to the toughness of the skin of the bare legs. Venereal diseases are widespread throughout the entire island, and more especially in Papeete and the near-by larger villages. For over a hundred years the natives have suffered from this scourge brought there by the European sailors and adventurers. Syphilis has been transmitted from generation to generation until it has contaminated the major part of the population, for
The gods visit the sins of the fathers upon the children.
EURIPIDES.
and
The wickedness of a few brings calamity on all.
PUBLIUS SYRUS.
The length of time the disease has existed among the natives has established a certain degree of tolerance or immunity, as it pursues a comparatively mild course, as I found very few instances of the ravages of the remote results of syphilis. I saw only one case of saddle nose, caused by tertiary syphilis.
Leprosy is not as prevalent as in the Hawaiian Islands, but isolated cases are found in nearly all the islands belonging to this group, being more prevalent in some than in others. Segregation has never been attempted. The lepers mix freely with the members of their families and neighbors, and are not shunned by any one. I was informed that many of the lepers, much disfigured by the disease, seek an island where many of these unfortunates have founded a colony for the purpose of escaping from public gaze. There, away from relatives and friends, they spend their short span of life and await patiently the final relief which only death can bring.
O Death, the Healer, scorn thou not, I pray. To come to me; of cureless ills thou art The one physician. Pain lays not its touch upon a corpse.
ÆSCHYLUS.
Elephantiasis in its worst forms has taken a firm hold on the natives, especially the inhabitants of the near-by island of Moorea. There this disease can be studied in all its stages, from a slight enlargement of one of the extremities to colossal swellings, which, when the upper and lower extremities are affected at the same time, make it necessary for the patient to crawl on his hands and feet in dragging himself from place to place. Regarding elephantiasis as it exists in Tahiti and the other islands of the French colony, I will make use of a few extracts taken from a valuable paper on this subject by Dr. Lemoine, recently in charge of the Military Hospital, and published in one of the government reports. According to this author, who has seen much of this disease in Tahiti and surrounding islands, it may affect most regions of the body, and not infrequently makes its appearance as an acute affection with all the symptoms characteristic of lymphangitis, including quite a violent continued remittent form of fever, which lasts two or three months. The acute form is, almost without exception, complicated by synovitis of the joints of the affected limb, which he regards as almost pathognomonic of the disease, differentiating it from ordinary forms of lymphangitis. After the subsidence of the acute symptoms and in the chronic form the disease is essentially a chronic lymphangitits, accompanied by marked enlargement of the veins. According to his observations the regions most frequently involved are the lower extremities, external genitals, and lastly, the hands and forearms. Three years ago I was given an opportunity to see at the hospital and poorhouse at Antigua, West Indies, ninety cases of elephantiasis, and not in a single one of them did the disease affect the upper extremity, while in the French colony of the South Seas this is not infrequently the case. I do not know that a satisfactory explanation has ever been given why the disease should behave so differently in fixing its location in the two groups of islands. Lemoine, as well as other writers on elephantiasis, has seen the disease become stationary by the removal of the patient to a colder climate. Europeans become susceptible to elephantiatic infection after a prolonged residence in tropical countries where the disease prevails.
Lemoine does not agree with Manson, who believes that elephantiasis is caused by the _Filaria sanguinis_, and is suspicious that the essential parasitic cause is a yet undiscovered microbe. He made blood examinations night and day of patients under his care, and was unable to constantly detect the filariæ in their embryonic state in the peripheral blood, and consequently claims that the presence of filaria in the organism is not an infallible diagnostic indication, and that their abundance is not proportionate to the intensity of the disease. The fact that the elephantiatics improve in colder climates he regards as another proof that filariasis is not the essential cause of the disease.
In a number of cases extirpation of the infiltrated enlarged lymphatic glands was followed by decided improvement, and in the case of a Tahitian the improvement remained at the end of three years. He has also operated on a number of cases by partial excision of the mass, first on one side of the limb, then on the other, with decided benefit to the patient in most of them. In some cases deep incisions through the entire thickness of the indurated mass afforded relief and resulted in diminution of the size of the swelling. He relates the details of the case of a native, fifty years old, the subject of elephantiasis of the lower limbs, that he operated on in two stages several weeks apart, removing first a large section from the anterior and later from the posterior part of the swelling, and as shown by the accompanying illustrations in the report depicting the condition of the limbs before and after operation, with an excellent result. However, in some of the cases the benefit thus derived did not last for any considerable length of time.
In making the excision, the superfluous skin is excised with the underlying indurated tissues, and the skin margins reflected for some distance in order to create sufficient room for a more liberal removal of the deep tissues. In one case, that of a woman thirty-eight years of age, the patient died two weeks after the second operation. Death was attributed to loss of blood and the debilitated condition of the patient when she entered the hospital. In another case, a Tahitian, thirty-five years old, affected with elephantiasis of all limbs and the external genitals, he operated successfully on one of the arms, the seat of an enormous swelling below the elbow. The excised mass weighed fifteen kilograms. Owing to the large size of the swelling, the operation proved one of great difficulty, and on account of the tension incident to the approximation of the margins of the flaps the sutures cut through and the wound ultimately healed by granulation. At the second operation nearly the entire mass was removed, with the result that the wound finally healed after a prolonged suppuration and the patient was relieved of the incumbrance caused by the great weight of the swelling. The relief afforded induced the patient to request additional operations for the removal of the swellings involving other regions of the body, but as the surgeon soon after left the island his desire could not be gratified.
The climate of Tahiti is not congenial for pulmonary and rheumatic affections, as the atmosphere is too moist. It is admirably adapted for patients the subjects of nervous affections in all their protean forms. The quietude, balmy air and pleasing surroundings are the best therapeutic agents to secure mental rest and refreshing sleep. It is in the treatment of such affections that a trip to Tahiti can not be too strongly recommended.
THE KAHUNA OR NATIVE DOCTOR
For centuries the practice of the healing art was largely in the hands of priests. They ministered to the body as well as the soul. Their practice was purely empirical and the surgery, even of the most skilled, rude and often brutal. The human mind is very much inclined to look upon disease and the methods used to effect a cure as something mysterious. Even at this late day many people who are well educated and who in everything else seem to possess a liberal amount of good common sense, have very strange ideas in regard to disease and the means employed in treatment. Promises to cure and a liberal expenditure of printers' ink render them an easy prey to mysterious methods. All races and all tribes have always had among them men and women in whom they confided in case of accident or disease. Very often priesthood and medicine were combined in the same person. Among the ancient Tahitians the chief was at the same time priest and medical adviser. The American Indians had their medicine-men, the Tahitians and other South Sea Islanders their Kahuna. It is very interesting to know something of the early practice of medicine and surgery among the Tahitians. Captain Cook gives them great credit from what he saw of their surgery:
They perform cures in surgery, which our extensive knowledge in that branch has not, as yet, enabled us to imitate. In simple fractures, they bind them up with splints, but if part of the substance of the bone be lost, they insert a piece of wood, between the fractured ends, made hollow like the deficient part. In five or six days, the rapooa, or surgeon, inspects the wound, and finds the wood partly covered with the growing flesh. In as many more days, it is generally entirely covered; after which, when the patient has acquired some strength, he bathes in the water, and recovers.
In speaking of medicine he says:
Their physical knowledge seems more confined; and that, probably, because their diseases are fewer than their accidents. The priests, however, administer the juices of herbs in some cases; and women who are troubled with after-pains, or other disorders after child-bearing, use a remedy which one would think needless in a hot country. They first heat stones, as when they bake their food; then they lay a thick cloth over them, upon which is put a quantity of a small plant of the mustard kind; and these are covered with another cloth. Upon this they seat themselves, and sweat plentifully, to obtain a cure. They have no emetic medicine.
In referring to the few indigenous diseases he adds:
But this was before the arrival of the Europeans; for we have added to this short category a disease which abundantly supplies the place of all the others; and is now almost universal [syphilis]. For this they seem to have no effectual remedy. The priests, indeed, sometimes give them a medley of simples; but they own that it never cures them, and yet, they allow that, in a few cases, nature, without the assistance of a physician, exterminates the poison of this fatal disease, and perfect recovery is produced. They say that a man affected with it will often communicate it to others in the same house, by feeding out of the same utensils, or handling them, and that, in this case, they frequently die, while he recovers; though we see no reason why this should happen.
On his fourth voyage to the Society Islands Captain Cook learned to what fearful extent syphilis had spread throughout all of the islands of the group and became aware what ravages it had caused among the natives. On visiting new islands he did all in his power to protect the natives against this scourge by excluding all women visitors from the ship and by strictly enjoining persons known to be infected from landing. On the probable effects of these new regulations he comments:
Whether these regulations, dictated by humanity, had the desired effect, or no, time only can discover. I had been equally attentive to the same object when I first visited the Friendly Islands; yet I afterward found, with real concern, that I had not succeeded, and I am afraid that this will always be the case, in such voyages as ours, whenever it is necessary to have a number of people on shore.
Massage as a remedial agent in the treatment of disease originated in the Orient, and the Tahitians were familiar with it and frequently made use of it. On this subject Captain Cook can speak from personal experience. During his stay in Tahiti in 1777 he suffered evidently from a severe attack of sciatica, the pain extending from the hip to the toes. King Otoo's mother, his three sisters and eight more women came on his ship one evening for the purpose of giving him treatment and remained all night to fulfill their well-meant mission. Here is the account of the treatment to which he was subjected by the women:
I accepted the kindly offer, had a bed spread for them upon the cabin floor, and submitted myself to their directions. I was desired to lay myself down amongst them. Then, as many of them as could get around me, began to squeeze me with both hands, from head to foot, but more
## particularly on the parts where the pain was lodged, till they made my
bones crack, and my flesh became a perfect mummy. In short, after undergoing this discipline about a quarter of an hour, I was glad to get away from them. However, the operation gave me immediate relief, which encouraged me to submit to another rubbing down before I went to bed; and it was so efficient that I found myself pretty easy all the night after. My female physicians repeated their prescription the next morning, before they went ashore, and again in the evening, when they returned on board; after which, I found the pains entirely removed, and the cure being perfected, they took leave of me the following morning. This they call _romee_, an operation which, in my opinion, far exceeds the flesh-brush, or anything of the kind that we make use of externally. It is universally practised amongst the islanders, being sometimes performed by men, but more generally by women.
PHYSICIANS IN TAHITI
Tahiti is not an Eldorado for doctors. The entire island has only eleven thousand inhabitants and the great majority of them are too poor to pay for medical services. The only place in Tahiti where a doctor can be found is in Papeete. At the time I visited the island there was only one physician in private practice in the capital city, Dr. Chassaniol, a retired naval surgeon, the only private practitioner in the whole group of islands. The bulk of medical practice is in the hands of the government physician, always a military man who has at the same time charge of the Military Hospital and takes care of the sick poor, and supervises all matters pertaining to sanitation. The only other physicians in the island are the naval surgeons on board a small man-of-war almost constantly anchored in the harbor of Papeete. The government physician is privileged to practice outside of the hospital, and from this source he receives the bulk of his income. As the resident physician and the government physician are the only qualified physicians in the whole archipelago, it requires no stretch of the imagination to realize that until the present time the French government has not made adequate provisions for their subjects who require the services of a physician.
The Tahitians have not lost their faith in their Kahunas or native doctors, who without any medical knowledge, practice their art. These men, with a local reputation as healers of disease, are to be found in nearly every village. They are well thought of and are influential members of society in their respective communities. Like the medicine-men of our Indians, they make use of roots, bark and herbs as remedial agents, and the natives, like many of our own people, have more faith in this mysterious kind of medication than in modern, concentrated, palatable drugs prescribed by the most eminent physician. To the credit of these native medicine-men, it must be said that they give to all afflicted who apply for treatment not only their services, but also the medicines without any expectation of a financial reward or even the gratitude of their clients.
HÔPITAL MILITAIRE