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.