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Chapter XIX
tuberculosis¹

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 hæmorrhagic 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 page 278large 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.

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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 diarrhœa 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.