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
The military hospital at Papeete is the only one in the French colonial
possession of the Society Islands, numbering one hundred and sixty-eight
islands and containing thirty thousand inhabitants, of whom eleven
thousand live in Tahiti. As some of these islands are more than one
hundred miles apart, it is somewhat strange that the French government
has not taken earlier action in establishing small cottage hospitals in
a number of the larger islands, as in case of severe injuries or sudden
illness the natives of the distant islands are not within reach of
timely medical aid and the transportation of a sick or injured person to
Papeete from the far-off islands or villages by small schooners or
canoes is necessarily slow and in many instances dangerous. The Sanitary
Commission now stationed in the islands will, it is to be hoped, act
promptly in remedying this serious defect in the care of the sick
natives.
The Military Hospital at Papeete is an old structure of brick and
cement, situated near the western limits of the city in a large square
yard inclosed by a high stone wall, surmounted by a crest of fragments
of glass, which imparts to the inclosure a prison-like appearance, the
austerity of which, however, is much relieved by beautiful tropical
trees, shrubbery and flowers in front of the entrance and in the
courtyard. The hospital proper comprises seven buildings, only one of
which is two stories high. The hospital has accommodations for forty
beds. The officers' rooms contain two beds each; the remaining space is
divided into small wards for privates and civilians. In one ward, the
windows of which are strongly barred, are kept the military prisoners,
and another small ward is devoted to obstetrical cases. The rooms and
wards are well ventilated and clean, the beds comfortable; the hospital
furniture otherwise is scanty and antique. The drug-room is large,
richly supplied with capacious jars, mortars of all sizes, herbs, roots
and a complete outfit for making infusions, decoctions and tinctures,
which reminds one very vividly of an apothecary shop of half a century
ago. This department is in charge of a pharmacist who, besides mixing
drugs, does some chemical and bacteriological work in a small and
imperfectly equipped laboratory. The operating-room is an open
passageway between two adjoining wards, and all it contained suggestive
of its use were an operating table of prodigious size and decidedly
primitive construction, and, suspended from the wall, a tin irrigator,
to which was attached a long piece of rubber tubing of doubtful age. The
hospital is well supplied with water, and contains a bathroom, a
shower-bath and modern closets. The hospital is in charge of the
government physician, who is always a medical officer of the colonial
troops, detailed for this special service, usually for a period of three
years. From the official reports I gleaned that on an average this
institution takes care of about three hundred and fifty patients a year.
At the time of my visit the number of patients did not exceed fifteen,
among them one in the prison ward. All of the patients were the subjects
of trifling affections, with the exception of three cases of typhoid
fever sent to the hospital from one of the atoll islands. The patients
are being cared for by three Catholic sisters and orderlies as they are
needed. The poor are admitted gratuitously; private patients pay from
six to fifteen francs a day. The hospital is beautifully located on the
principal street of the city and faces the charming little harbor. A
small private hospital for the foreign residents and tourists is needed
here and under proper management would prove a remunerative investment.
THE ISLAND OF PLENTY
O Christ! it is a goodly sight to see
What heaven hath done for this delicious land.
BYRON.
The wealth of Tahiti is on its surface. Its mountains are not pregnant
with precious metals nor has nature stored up in their interior material
for fuel and illumination, as none of these are needful to make the
people content and happy. The Tahitian has no desire to accumulate
wealth; the warm rays of the sun reduce the use of fuel to a minimum,
and the millions of glittering stars and the soft silvery light of the
moon in the clear blue sky create a bewitching light at night, which,
more than half of the time, would make artificial illumination a
mockery. Then, too, Tahiti is the land of gentle sleep and pleasant
dreams, where people do not turn night into day, but rise with the sun
and retire soon after he disappears in the west behind the vast expanse
of the ocean. God created Tahiti for an ideal island home and not as a
place for get-rich-quick methods, speculation and bitter competition for
business, for
Where wealth and freedom reign, contentment fails,
And _honor lacks_ where commerce long prevails.
GOLDSMITH.
Tahiti's fabulous wealth consists in its inexhaustible soil and the
perennial warm, stimulating breath of the tropic sun. It is the island
of never-fading verdure and vigorous and never-ceasing vegetation. The
fertile soil, the abundant rainfall throughout the year, the warm
sunshine and the equable climate are most conducive to plant-life and
here these conditions are so harmonious that there can be no failure of
crops in the Lord's plantation. There never has been a famine in Tahiti,
and there never will be, provided the government protects the
magnificent mountain forests—nature's system of irrigation. Tahiti's
food-supply is select and never-failing, and is furnished man with the
least possible exertion on his part. The bounteous provisions nature has
made here for the abode of man are a marvel to the visitor and after he
has once seen them and has become familiar with them he can not escape
the conclusion that he is in
A land flowing with milk and honey.
JEREMIAH xxxii:22.
The food products and fruits grown in the forests without the toil of
man are admirably adapted for the climatic conditions, being laxative
and cooling, and undoubtedly account for the excellent health of the
natives before the invasion of the island by the Europeans. The island
was destined for the natives, and the natives were suited to the island.
Man's rich with little, were his judgment true;
Nature is frugal, and her wants are few;
These few wants answer'd, bring sincere delights;
But fools create themselves new appetites.
YOUNG.
Content with what the sea and forest provided for them, these children
of Nature lived a happy life, free from care, free from morbid desires
for wealth or fame.
O blissful poverty!
Nature, too partial, to thy lot assigns
Health, freedom, innocence, and downy peace, —
Her real goods, — and only mocks the great
With empty pageantries.
FENTON.
No sullen discontent nor anxious care.
E'en though brought thither, could inhabit there.
DRYDEN.
The Tahitian people, before they tasted the questionable advantages of
European civilization, had much in common and lived happily in the full
enjoyment of Nature's varied and bountiful gifts. Tribal life was family
life, and public affairs were managed to suit the wants of the people,
and if any one in power failed in his duties, the people took the law in
their own hands and corrected the evil, usually without bloodshed. If
the people were not prosperous according to our ideas of life, they were
at least happy, and
We must distinguish between felicity and prosperity; for prosperity
leads often to ambition, and ambition to disappointment.
LANDOR.
TAHITI'S NATURAL BREAD SUPPLY
The Tahitians have no corn or grain of any kind out of which to make
bread. They found in the forests excellent substitutes for bread, and
more healthful for that climate, in the form of breadfruit, wild
plantain and tubers rich in starch. This is the kind of bread they have
been eating for centuries, and which they prefer to our bread to-day.
When the island was densely populated and the demand on nature's
resources exceeded the supply, the natives had to plant trees, roots and
tubers in vacant spaces in the forest, high up on the mountainsides,
where they grew luxuriantly without any or little care, and by these
trifling efforts on the part of man the food-supply kept pace with the
increase of the population. Trees and plants distributed in this manner
found a permanent home in the new places provided for them, and have
since multiplied, and thus increased greatly the annual yield. Evidences
of dissemination of bread and fruit-yielding trees and plants by the
intervention of man are apparent to-day throughout the island by the
presence of cocoa-palms, breadfruit and other fruit trees, and
plantains, in localities where nature could not plant them, in places
formerly inhabited but abandoned long ago when the population became so
rapidly decimated by the virulent diseases introduced into the island by
the Europeans. To-day the fruit and fruit-supply is so abundant that it
is within easy reach of every family and can be had without money and
without labor. We will consider here a few of the most important
substitutes for bread on which the Tahitians largely subsist: