TUBERCULOSIS[100]
The tubercular taint in the Fijians, though less marked than among some
of the Polynesian races to the eastward, is sufficient to influence the
vitality of the race by impairing its power of resistance to other
diseases, both in children and adults. It is seen in the form of
phthisis, strumous ulcerations, chronic bone diseases, and most commonly
as strumous ulcerations of the face, nose, pharynx, or throat, which is
named tubercular lupus. More rarely it appears as _tabes mesenterica_ in
infants, tubercular peritonitis, and tubercular disease of the internal
organs.
All these forms of tuberculosis are more common in the windward parts of
the group, in Kandavu and in Thakaundrove, where the Tongan admixture is
strongest; they are less common in Western Vitilevu and in the mountain
districts, but even in these, where the Melanesian blood is purer,
tubercular disease is far from uncommon. Half-castes are especially
tainted with struma in all its forms, and from this it would appear that
the Fijian does not bear crossing with the European, for while the
negro-Fijian half-caste is usually healthy, the English Fijian cross is
peculiarly subject to phthisis, lupus, and chronic disease of the bones.
Pulmonary tuberculosis occurs as haemorrhagic phthisis, as acute, rapidly
breaking-down pulmonary tubercle of young adults, or as chronic fibroid
phthisis in older men and women. Though the returns of the Colonial
Hospital do not show a large number of deaths from this disease, it is
probable that many die after returning home after a period of treatment,
and in the outlying districts may die without making any attempt to get
to the hospital.
Lupus, though it may make its appearance at any age, is developed most
commonly at puberty, and is most destructive in its results from fifteen
to twenty-five or thirty. It attacks the face, nose and neck, and it
usually destroys the fauces, palate and pharynx; the soft palate is
entirely destroyed, and the only remains of the pillars of the fauces
are scars of cicatricial tissue. The mouth then appears as a vast cavern
instead of being filled with the usual structures, and the nose may be
entirely eaten away. The disease is commoner among women than among men.
I remember seeing a family of high rank in Lakemba, whose women were
remarkable for beauty. The sons were fine, sturdy fellows, to outward
seeming quite untainted, but of the three daughters the eldest had no
face, the second was marred by a depression at the root of the nose,
betokening the first ravages of the disease, and the third, a girl of
sixteen, was the most beautiful girl in the island. "She will soon be
like the others," they told me; "they were more beautiful than she is,
and look at them now!" It was comforting to notice that her impending
fate did not seem to damp her enjoyment of the hour.
Strumous ulcerations of the limbs are the commonest diseases in Fiji.
Thus, out of 621 cases admitted to the hospital in 1892, including
people of many races and every kind of disease, there were 104 cases of
"ulcers" in Fijians alone--the total number of Fijians admitted being
only 246; that is to say, more than 40 per cent. of the Fijians were
admitted for ulcerations of strumous origin. This disease, which the
natives call _vindikoso_, takes the usual form of an indolent, excavated
ulceration, sometimes extending down to the bone. It generally runs a
slow course, and when of large size, the resulting _cachexia_ is
serious. It is generally left uncovered, or at most wrapped in a filthy
piece of native cloth, and unwashed for days together--a fruitful
breeding-ground for flies and parasites.
[Pageheader: FIJIANS ARE TAINTED WITH STRUMA]
To the same taint are due tubercular glandular enlargements, chronic
disease of the bones, with deformity and enlargements, necrosis of the
long bones, and the tuberculosis of abdominal glands, which is believed
to cause many deaths among children, and not improbably also tubercular
diarrhoea both in children and adults.
Yaws (_thoko_) occurring in children of tubercular parents is probably
intensified, and children whose constitution has been weakened by a
prolonged attack of yaws are more prone to die of some form of
tuberculosis. It has also been noticed that adults who bear the scars of
severe yaws in childhood are more prone to contract some form of
tuberculosis in after-life.
The possible identity in the origin of all these diseases offers a wide
and most interesting field for scientific investigation. It is but a
step, for instance, from yaws to syphilis, and from syphilis to strumous
diseases of bone and skin (especially those prevalent among the Pacific
Islanders), and from struma to pulmonary or general tuberculosis. If
such an investigation be too long delayed there is the danger that the
races who furnish the material may have ceased to exist.
The undoubted facts are these:--
(1) That the Fijian race is tainted by various forms of tubercle,
acquired and inherited;
(2) That the taint is more marked where there is an infusion of
Polynesian or European blood;
(3) That females are more affected than males;
(4) That the disease is on the increase;
(5) That the inherent debility of the race is partly due to this taint.
FOOTNOTES:
[Footnote 100: I am indebted to Dr. Lynch, who has made a special study
of the subject, for the medical portion of this chapter.]