A Yankee doctor in paradise

by S. M. Lambert

When I got there they were all Christians; maybe that was because it was so easy to find a church. The Catholic church had a £600 belfry and a splendid mosaic altar. Things like that were prosperity’s blow-off, and when the Rotumans didn’t know what else to do with their surplus they built another fine concrete monument. There were monuments everywhere, mortuary, honorary, sumptuary. It was like our wealth-parade in the Coolidge Administration. Rotuman pig-feasts were costly milestones in every life. It cost £100 worth of celebration for a baby to be born, £200 for a man to die, £800 for him to be properly married.

And on the doctor’s side of this generous picture I found Rotumah heavily laden with hookworm, yaws, tuberculosis and leprosy. Over 90 per cent of the inhabitants were covered with scabies. A sticky, hot, fly-and-mosquito-ridden island, with hardly a breeze to break the dead monotony of climate.... A stone wall, built along the shore road, kept in the pigs and kept out whatever breeze might blow. That didn’t matter much in Rotumah, where the people seemed too lazy to draw a deep breath.

Most of the elderly men, by the way, had elephantiasis.

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Because elephantiasis was something I had to meet as I went along, it may be apropos to explain what I have mentioned before: that it is not a disease, but the manifestation of a disease. The disease is filariasis, caused by the filarial worm, a long, threadlike creature that lives in the lymphatic glands. The eggs pass into the lymphatic and blood streams and hatch into microfilariae. The low power of a microscope will show them in a drop of blood, but their sex cannot be distinguished. They take on sexual form in the body of the mosquito which has drawn up infected blood, and the mosquito injects them into the veins of the next victim.

Now definitely male and female, they make their way into the lymph glands, grow and breed by millions. The female lays her fertile eggs, which complete the cycle by becoming microfilariae. Because there is much destruction of microfilariae in the mosquito’s body, and because there is much wastage of the parasites in the reinfection of a human, the disease is rather slow to develop. Mosquitoes may bite millions of times before enough male and female worms accumulate to cause symptoms. It usually takes years of residence in a mosquito-infected native community before these ideal conditions meet.

With the proper number of parasites comes filarial fever, which is accompanied by inflammation and abscesses in the lymphatic and subcutaneous tissues. The inflammation subsides, but some of the swelling remains in dependent members of the body, arms, legs, breasts, vulva and scrotum. These swellings may be caused by dead filaria worms, which block the glands whose function it is to drain a dependent area; thus the dead worms might impede the return flow of lymph and cause an overgrowth of skin and subcutaneous tissue, slowly piling up to a huge size. The skin grows rough like an elephant’s hide, and the monstrous limbs add to the elephantine look.

Filarial fever seems to have little effect on longevity, but causes a lassitude which results in a great labor loss. And when it becomes elephantoid it impedes any form of activity.

An interesting phenomenon is connected with these minute organisms. The activity of the microfilariae which the mosquito puts into the blood stream is similar, in one way, to the habits of the mosquito that has carried them. That is to say, if the mosquito is a night-biter, the microfilariae are active during the night only. During the day they seem to rest quiescent, deep in the recesses of the body. But if they have been introduced by a day-biting mosquito their behavior is just the reverse—they are day-active. In the Pacific the disease is transmitted by the Culex fatigans and by members of the Aedes family. The Pacific branch of the Aedes clan is a daytime feeder while the Culex fatigans is a night worker. So afflicted island people suffer from an infection that does twenty-four-hour duty.

In the Ellice group so many elderly husbands were disabled by elephantiasis of the scrotum that they often asked for surgical operations in order to restore domestic harmony; for it was “the fashion” for old men to marry young wives. At Funafuti Dr. Mac Finney told me that one swollen applicant, who had come quite a distance, gave his age as ninety. (They date their ages from the coming of the missionary.) The patient looked a trifle passé, but Mac Finney did a clean job, and hoped he would recover.