YAWS (_Thoko_)
While the decay of custom has been hastened by the introduction of new
diseases, it has not been accompanied by any attempt to eradicate the
old.
Chief among indigenous diseases (if diseases introduced before contact
with foreigners may be called indigenous) is yaws, called by the Fijians
_thoko_, or by its Malayo-Polynesian name--_tona_, and by various
dialectic modifications of that word, which is also used in Tonga,
Samoa, Tahiti, and many other Polynesian islands.
The disease is but little known to the medical profession in Europe,
either in practice or in medical literature. Its medical designation is
_Framboesia_, so called from the strawberry-like eruptions that
accompany it. By the French it is called "Le Pian." In Great Britain it
is now extinct, but in the Hebrides and in the south-west counties of
Scotland it was met with under the name of "sibbens," or "sivvens," as
late as the beginning of the nineteenth century.
[Pageheader: THE SYMPTOMS]
It is common throughout Africa, Malaysia and Polynesia. Being
contagious, it was carried by means of the slave traffic from Africa to
tropical America and the West Indian Islands. From the east coast of
Africa and Madagascar, about 340 years ago, the Dutch or Portuguese
traders carried it to Ceylon, where it still bears the name of "Parangi
Lede" or "Foreigners' evil." Hamilton noticed it in Timor in 1791,
saying "it seldom terminates fatally and only seizes them once in their
lives."[99] Crawfurd, who wrote in 1811-1817, noticed it in Java. Dr.
Martin, the able editor of _Mariner's Account of the Tonga Islands_,
writing in 1810, was the first to recognize the identity of _tona_ with
yaws, though he never saw the disease. But the existence of _tona_ was
recognized by Captain Cook and numerous other visitors to the South Seas
during the last and the beginning of the present century, though they
were not aware of its real nature.
The premonitory symptoms of yaws are, as a rule, insignificant and
obscure; the appearance of one of the sores is generally the earliest
indication that a child is infected, but adults have noticed pains in
the limbs, fever, restlessness, or languor. The first sore, called the
_tina-ni-thoko_, or mother-yaw, is usually a large one about
half-an-inch to an inch in extent, and is often surrounded by a group of
smaller sores. It generally appears on the site of some wound or
scratch, more often about the lips. Those that follow are generally
developed upon some part of the body where the skin is delicate, such as
the neck, the groin, or the axillae, or in parts where the true skin
joins the mucous membrane. Doubtless the lips of children are first
infected owing to the child's habit of putting the hands to the mouth,
the hand being the part most likely to come in contact with the virus of
another child.
After an uncertain interval a crop of pabules, or in some cases blebs,
begin to appear, the face and the parts already mentioned being their
favourite point of appearance. If the eruption begins with blebs the
case is spoken of as _thoko se ni niu_ (cocoanut flower _thoko_, from
the resemblance of the eruption to a spray of the unexpanded flowers of
the palm).
In the next stage a soft warty excrescence, which is the matrix of the
sore, pushes its way through the true skin by forcing it aside rather
than breaking down its substance. On reaching the surface the
granulations which form this out-growth exude a fluid which is highly
contagious. It forms in time a crust or scab, the reddish appearance of
which is very characteristic of the yaws eruption. If this be removed by
means of oil or a poultice, the granulated surface of the sore beneath
it has that resemblance to a raspberry or mulberry which has given the
name of _Framboesia_ to the disease. In some cases the crust assumes
a curvilinear outline, recalling the appearance of the well-known
Pharaoh's serpent. These are especially seen about the corners of the
mouth, the neck and the axillae, and constitute the _thoko ndina_ or true
yaws. In other cases they retain a circular shape on all parts of the
body, and are then called _thoko mbulewa_ or button or limpet yaws.
During the healing process they become converted into annular or
horse-shoe patterns, the centre receding before the periphery.
The sores may remain for two weeks or they may persist for fully two
years. Throughout the progress of the case they may number anything from
one to several hundred. The commonest number is from six to twenty or
thirty. Weakly and ill-nourished children take the disease more easily
than strong ones. While the active symptoms seldom last for more than
two months, the dormant features last much longer, and some of the
tertiary consequences may appear at almost any age.
The chief ill effects from _thoko_ are dysentery, diarrhoea, and
marasmus; sometimes the joints are implicated, even the larger ones,
such as the wrists, knees and ankles, and partial paralysis may follow;
pot-belly is a frequent concomitant, and _tabes mesenterica_ are
believed to follow it. In a later period of life the feet of those who
have had yaws as children become affected by the disease, and on account
of the thick and horny skin by which the soles of shoeless races are
protected the extrusion of the growing yaw through the sole becomes an
acutely painful process. Not only do the typical granulations known as
_suthuvi_ and _soki_ force their way through the skin, but the sole is
also liable to a cracking and peeling form of excoriation called
_kakatha_, which is nearly as painful and is also said to be contagious.
The Fijians do not recognize the connection between any of the sequelae
of yaws and the original disease, and hence perhaps the indifference
with which they regard it.
[Pageheader: MODE OF INOCULATION]
An idea of the serious nature of yaws may be gathered from the cases in
which it has been contracted by adult Europeans. Such cases have been
numerous enough in Fiji to impress the European settlers with dread and
disgust. In most of these cases the disease has permanently shattered
the health of the person attacked, its tertiary effects simulating those
of neglected syphilis, for, while no less severe, they have proved quite
as ineradicable. They are shown in permanent impairment of the digestive
functions, emaciation, inflammation of the bones or joints, intractable
ulceration, and marked constitutional weakness, thus producing liability
to other diseases such as diarrhoea, dysentery and pneumonia, and not
infrequently ending in death. From this it may be readily imagined that
the consequence of yaws to native children can be anything but trivial.
With Europeans as well as with natives an attack is more likely to pass
off easily when contracted in childhood than when taken in adult life.
The most favourable age for getting over it safely seems to be between
two and three years.
Yaws is communicated by the inoculation of virus from one of its
characteristic raspberry-like sores to the abraded surface of the skin
of another person. But, though the natives have never discovered this
for themselves, they do not, as in other diseases, attempt to explain
yaws as the work of a malignant spirit. The fact is that they scarcely
believe yaws to be a disease at all. They think that if a child makes a
good recovery it becomes more plump and healthy than one who has never
had the disease. Mothers are pleased when the first symptoms make their
appearance, regarding it as the best thing that could happen to their
children to set them on the high road to a vigorous manhood, provided
that the disease is not contracted at too early an age. At Mbau,
however, the chief women appear always to have recognized the contagious
nature of yaws. They say that in former time the children of high rank
were not allowed to enter the houses of common people or play with their
children, and in consequence of this exclusiveness they seldom
contracted yaws until they were of an age to resist its ravages. Thus
some escaped it altogether, and the majority had it very mildly. Andi
Alisi and Andi Ana are cases in point, so were the late Andi Kuila and
Ratu Joseva. Now-a-days there is scarcely an exception to the rule that
every Fijian child contracts yaws. Whatever may have been the case
formerly, it is now quite common for children to contract the disease
while suckling and teething; not infrequently before they can crawl, and
even at as early an age as three or four months. When this happens the
eruption sometimes recedes prematurely; this is the only danger feared
by the natives, who usually attribute the recedence to _ndambe_, _i.e._
incontinence on the part of the parents, or to _ramusu_ (internal
injury). When the eruption recedes, as it undoubtedly does in some
cases, the child becomes sickly and feverish and subject to diarrhoea,
and whether these symptoms be spontaneous or secondary, death is more
often the result in these cases than in others. The native treatment is
purely empirical: native drugs are administered in the expectation of
causing the eruption to reappear, but if the attack pursues its normal
course no attempt is made to heal the eruption; on the contrary, it is
intentionally abandoned to the chances of easy and plentiful
development. In very severe cases natives have occasionally made
application to the European medical officers; but, as a rule, it is only
when the eruption has almost disappeared, and only one or two of the
sores persist, that the Fijian mother will allow any interference with
it. The usual native treatment in such cases is to apply a poultice of
the leaves of the _lewe ni sau_, or some other native herb. The more
modern practice is to heat a piece of rusty hoop iron red hot and to rub
a cut lemon on it, and then to apply the rust-stained juice as a mild
escharotic. It is said that in West Africa the natives use a decoction
of iron filings in lemon juice, with the addition of ants and a portion
of the pepper plant for the same purpose. As the old Fijians had no
metals, it is possible that they have learnt the recipe from Europeans
who have read of it.
[Pageheader: CHILDREN PURPOSELY INFECTED]
The Fijians do not claim to have any positive remedy for the cure of
yaws, nor, indeed, do they desire any. They are satisfied that native
medicines suffice to "drive out" the eruption if it has prematurely
receded, and that if they do not succeed in such cases the child will
die. The great body of the people cannot be made to grasp the idea of
inoculation. While some admit that yaws can be caught from one person
by another, others assert that the cause is intrinsic and that every
Fijian child must, or ought to, develop it, and that it is solely a
Fijian disease about which white men are naturally ignorant. In Mathuata
the "wise women" administer medicines to bring on the disease in cases
where children do not readily contract it. They believe that the
occurrence of yaws in a child of a proper age--from two to six years--is
a good augury for the future physical strength and mental vigour of the
subject, and they think that persons who escape its contagion will grow
up stupid, clumsy, and dull (_dongandonga_), and useless mentally and
physically. The fear of contracting disease in adult life, when it
affects the patient far more severely than in childhood, disposes the
Fijian mother to look favourably on the acquisition of the disease in
infancy. They are, indeed, far more anxious that their children should
contract yaws than are the uneducated mothers of English factory towns
that theirs should contract measles. The desire of getting over
inevitable diseases during childhood is the same in both cases, but the
Fijians have less excuse, for yaws is not only a far more virulent
disease than measles, but it might be far more easily stamped out if the
Fijians could be disabused of the idea that it "grows out of the child."
In the days of slavery, from commercial considerations, the West Indian
planters insisted on segregation in yaws-houses, and were partly
successful in keeping the disease under control. But as soon as the West
Indian negro was emancipated and permitted to revert to his own careless
life, the disease began to gain ground very rapidly.
It is impossible to estimate the mortality directly due to yaws. In the
yaws-hospitals of the West Indies the mortality amounted to less than
the annual death-rate of the islands. When it occurs during the first
year of childhood in Fiji it is almost invariably fatal. Indirectly,
there can be no doubt that it is sapping the vitality of the whole
native race. Some authorities--Hutchinson, for example--hold that it is
possibly syphilis modified by race and climate. Syphilis is practically
unknown among the Fijians, but although there are many points of
difference that prove the two diseases to be distinct, it is highly
probable that, from its close relationship to syphilis, yaws has an
enervating effect on the child-bearing functions of the native women.
Though it would now be extremely difficult to stamp out the disease,
much might be done to keep it under if the natives could be convinced of
its contagious nature. In the mountain districts of Tholo _Tinea
desquamans_, or _Tinea imbricata_ (Tokelau ringworm), which infected
nearly 25 per cent. of the native population a few years ago, has now so
far yielded to the efforts of the people themselves that it has been
almost entirely stamped out in some of the provinces. As soon as they
were convinced of its contagion, and understood that the Government
would supply remedies to those who chose to pay for them, they buckled
to the work in earnest, and needed little driving by European
officials.
FOOTNOTES:
[Footnote 99: A Voyage round the World in H.M.S. _Pandora_, by Mr.
George Hamilton, surgeon. Berwick-on-Tweed, 1792.]