It has already been shown that the decay of the Fijian race is due, not to a low birth-rate, but to an excessive mortality among infants. The mean annual birth-rate for the ten years 1881-1891 was 38.48. This compares very favourably with the mean annual rates of European countries, which vary from 42.8 in Hungry to 25.9 in France. In England the rate is 35.3.

The excessive mortality among Fijian infants makes it necessary to examine very closely the practices of the native midwives at the risk of wearying the reader with somewhat technical details.

Native midwives are generally the ordinary medical practitioners, and are termed Vu-ni-kalou (skilled in spirit-lore), or Yalewa vuku (wise woman), though that term belongs more properly to the wives of the hereditary matai sau (canoe-wrights and carpenters). These women keep their craft secret, and as a consequence it often becomes family property, being handed down from mother to daughter. The natives assert, however, that so far from the craft being regarded as hereditary, any person who thinks she has discovered a new remedy is at liberty to follow the business when so inclined. This opens a wide field to quackery, of which any woman with more cunning or self-assertion than her neighbours can avail herself for the sake of credit or of gain.

None but a few of the female relations of a lying-in woman are admitted to the house when she is in labour, the mixed attendance customary in Tonga on such occasions not being tolerated. When the labour pains begin the woman assumes page 207a squatting posture, but during the throes of childbirth she lies back in the arms of two friends sitting behind her, who support her shoulders while the midwife stations herself in front. From a physiological point of view this is a disadvantageous position, but it appears to be adopted by chance rather than design, it being a natural posture for a people who both sleep and sit on a matted floor. The midwife makes a digital examination for the purpose of ascertaining the presentation, which is generally normal. The membranes are not tampered with, and nothing else is done until after the natural birth of the child. Then the midwife clears its mouth of mucus with her fingers or with her lips. Midwives differ on the point of the moment at which the umbilical cord should be severed. Some of them seem to know that the cord pulsates, but they do not understand the reason, for the Fijians know nothing of the circulation of the blood. They generally wait until the child breathes or cries out. If it emits no cry the general practice is to compress the cord between the finger and thumb, and to squeeze the blood onward towards the child. Sometimes they rattle a bunch of kitu (gourds) near its ear in the hope of awakening it. Neither artificial respiration nor a dash of cold water is ever resorted to, though cold water is used in Tonga in extreme cases, and the natives mention cases in which children must have perished through the neglect of this precaution. The cord is then measured from the navel to the knee, and cut square across with a mussel-shell, or a bamboo knife. Now-a-days scissors are sometimes used. It is never severed by biting as is done by some natural races, nor is it ever tied or knotted. Native opinions vary as to whether bleeding occurs in consequence of the cord not being tied. The midwives deny that it does, but some women declare that it is a good thing for the "bad blood" to drain out of the cord. Severance of the umbilical cord without ligature is not so unsafe as might appear, for the experience of obstetricians goes to show that there is less risk of hæmorrhage when the cord is left long, though, of course, bleeding is more likely to occur from a clean transverse cut than from an oblique page 208cut, or a laceration. After division the fœtal end is wrapped in a shred of bark-cloth, and coiled down on the abdomen. The blood that oozes from it is absorbed by the cloth, which is changed occasionally.

As soon as the child cries and the cord has been severed an attendant washes it in cold water. A drink of cold water is given to the mother with the view of stimulating the uterus to contract and expel the afterbirth. Retention of the placenta is the one contingency dreaded by native women, but the midwives say that it is as rare as it is dangerous. Among the inland tribes the midwives often introduce the hand to extract the placenta, but among the coast people they believe it to be an experiment which is better left alone. In cases where the drink of cold water fails in its intended effect, herbal infusions are administered, and poultices are sometimes applied externally, but the safe expedient of compressing the uterus by placing the hand on the abdomen is unknown to Fijian midwives—a surprising fact in a nation of masseuses. It seems clear that Fijian mothers sometimes die from retained placenta, and that the blame is laid at the door of the midwife if she has ventured upon any manual interference. One woman stated that some of her friends went through life in dread of pregnancy through the popular fear of retained placenta.

The occasional retention of portions of the membranes appears to puzzle Fijian midwives. They lay particular stress upon the impropriety of removing such fragments—ai kumbekumbe (cleavings), they call them—even when they have been extruded spontaneously, but, on the contrary, are careful to tie them down in loco under a bandage of bark-cloth, trusting the rest to nature. They admit, however, that women to whom this happens are usually feverish for some time, and they evidently think the situation dangerous.

After the conclusion of the third stage of labour some midwives of the inland tribes introduce the hand as far as the bai ni yate (lit., fence of the liver) or the tuvu ni ngone (fœtal source, i.e. Fornix vaginœ), and, bending the fingers, clear out all the clots they can find. Others adopt the better page 209practice of raising the mother to a sitting posture to facilitate their discharge by gravitation.

An infusion called wái-ni-lutu-vata (medicine for simultaneous birth) is sometimes taken during the later months of pregnancy, to induce an easy labour and the descent of the placenta at the proper moment.

Among the hill tribes of Vitilevu labour seems to be more easy and expeditious than on the coast, and yet, notwithstanding their less varied experience, the midwives of those tribes enjoy a higher reputation for skill, and also follow more orthodox methods than their sisters among the more enlightened tribes. Both, however, display the same ignorance of the rudiments of physiology, and are as empirical in their midwifery as in their treatment of ordinary sickness.

The infant mortality is attributed by many Europeans to the hard work done by the women during pregnancy, and immediately after childbirth. The native belief is that a woman should do no heavy work up to the time of quickening, but that thenceforward the more she works the easier will her confinement be. Though this maxim is universal, the practice during pregnancy varies with the individual and the locality. Among the hill tribes women leave their house as early as the day after their confinement; they generally do so about the fifth day. Cases are recorded in which a woman has gone out in the morning in an advanced stage of pregnancy, and has returned in the evening with a load of firewood on her back and a new-born child in her arms. But at Mbau, and among the higher classes generally women are kept to the house for a full month, and among the high chiefs the bongi ndrau (hundred days) are observed, the mother abstaining from all but purely domestic occupations for that period.

Accidents of childbirth seem to be rare with Fijian women. All the midwives that have been questioned agree that malpresentations are uncommon, and that only one case of an arm-presentation had occurred within their experience. When abnormal presentations do occur they are regarded as being the fruit of an adulterous connection, and when the child dies, page 210as it invariably does, the death is put down to this cause instead of to want of skill on the part of the midwife. The Vital Statistics put the still births at 6 per cent., and in a few provinces at 10 per cent., but it has been ascertained that many of these represent cases of fœtal death before delivery.

In western Vitilevu, the centre of belief in witchcraft, confinements used to take place out of doors. A temporary hut is run up near the yam-garden, often at a considerable distance from the village, and the pregnant woman takes up her quarters there for the event. No preparation is made beyond taking a rough creel, padded with dried grass, for the reception of the newborn infant. The people use neither mat nor bark-cloth for the purpose, being loath to destroy it afterwards, and saying, "How will you get rid of the blood with which it will be stained?" The hut, too, is floored only with grass. As a rule there is no midwife, and the woman does all that is necessary for herself. The key to these primitive customs is the belief, in witchcraft. The most effective tools of the wizard are the excretæ of the intended victim. If the woman was attended during her confinement a grassblade, stained with blood, might be secreted by a malicious person, and used to compass her death. She uses no mats because mats are too precious to be wantonly burned, and every mat she had uśed would be a weapon in the hands of her enemies. So she brings her child into the world unaided, and burns the hut and all it contains before she sets out for the village. Now, mark how superstition works for sanitation. Whereas the child of the coast is brought into the world in a stuffy hut, and swaddled in dirty bark-cloth, reeking with impurities, the inland baby and its mother are guarded against infection by a law of cleanliness more rigid than any that the Mosaic code enjoined.

As the Gilbert Islanders are credited with being excessively prolific, and are said to be the only race in the South Seas that would increase if artificial means were not used to prevent the population exceeding the capacity of the islands, it will be well to compare their methods of midwifery as page 211described by Tearabugu, a professional midwife. On her island—Tamana—much attention is paid to pregnant women. They do no work during the first two months of pregnancy. At the seventh month they are anointed with oil; about the eighth their limbs are given passive exercise, and they go to a separate house to be shampooed by expert masseuses, in order to train their muscles to bear the labour pains. The umbilical cord is measured to the middle of the child's forehead, and cut, but not tied. The placenta is extracted by hand if it does not come away naturally. In cases of malpresentation the midwives know how to give assistance. The mother does no work during suckling, and, if it is necessary to wean the child prematurely, a substitute for the mother's milk is found in a butter made from the fresh fruit of the pandanus. The midwives are reputed to be exceptionally clever, and the labours easy and safe. Tearabugu could not remember a single case which had terminated fatally for the mother. She said that four or five children are considered enough, and any above that number are not allowed to come to maturity. All the women practise abortion because they are so prolific. If they did not they would have from ten to twenty children apiece. But neither medicine nor instruments are used. The common method is to pound the abdomen with a billet of wood, and this is not fatal to the mother. Now, however, the practice is being abandoned, because the missionaries have persuaded the people that it is dangerous.

Lactation

The Fijian child begins life with a dose of medicine. As soon as it has been washed in cold water a little of the juice of-the candle-nut-tree (Aleurites triloba) is put into its mouth to make it vomit. Then a ripe cocoanut, or in some places a plantain, is roasted and chewed into a pulp, which is dropped into a cocoanut-shell cup. A piece of bark-cloth, shaped like a nipple, is dipped into this, and given to the child to suck. The mother's first milk, being considered unwholepage 212some, is drawn off, and for the first day, or, in the case of a chief's child, for the first three days, the baby is put to the breasts of a wet nurse, if its rank is sufficient to command her services. The wet nurse is strictly forbidden to bathe or fish in salt water, and there must not be too great a disparity of age between her own and her foster child. When the mother's breasts are full, her child is given to her to suckle, but now, as in the old days, the children of chiefs are suckled by more than one woman. In Tonga the mother suckles her child as soon as the milk comes.

In one respect only have the ancient customs relating to suckling children begun to break down; the missionaries have tried to discourage the employment of a wet nurse, probably because her own child is likely to suffer from neglect.

Among the common people it has always been the custom for two girls from the wife's and two from the husband's family to feed and tend the new mother, unless her rank is too lowly to entitle her to the services of more than one. The two grandmothers of the child, if living, also help to tend the mother. But at the tenth day they all leave her to the care of her husband. This custom fits into the waning practice of concubitous marriage, (q. v. ante), for if the husband and wife belong to different islands the wife's relations are unable to contribute their services to her support. During the first ten days the mother is confined to a vegetable diet. She is forbidden to eat what the native call ka ndamu (red things, i.e. fish, crabs, pork, or broths made therefrom), and is fed upon taro or breadfruit puddings (vakalolo), yams, taro, or spinach. At the end of ten days she goes about her housework, and if she cannot command the services of her relations to enable her to lay up for the bongi ndrau (hundred days), she resumes all her ordinary outdoor work except seafishing, for, as the natives say, "there is dambe in the sea, and if the mother wets her leg above the calf in salt water, her milk will be spoiled."

It is perhaps owing to their hard work and low diet that Fijian mothers so often suffer from a deficiency of breast milk, and that so many children die from matha na mena suthu page break

Women Fishing with the Seine.

page 213 (drying up of the milk) and londo i suthu (privation of milk), i.e. from the death, absence, or neglect of the mother. When the mother's milk fails her breasts are oiled and steamed and painted with turmeric, and are kept warm by bandages of bark-cloth, while she eats spinach, mba vakoro (a mixture of spinach with shell-fish), and drinks fish soup and spinach water. Kava, which was absolutely forbidden to women of the last generation, is now drunk by both pregnant and nursing women under the belief that it induces easy labour and promotes a flow of milk when all other means fail. But if the flow of milk is re-established, the more nutritious diet is at once discontinued, for quantity is all that is aimed at.

When the milk fails or the mother dies the child's chances of surviving are slender indeed. Its grandmother will carry it from house to house imploring nursing mothers to give it suck. With one accord they all begin to make excuses. They have not milk enough for their own children; there are many other women more able to than they. In Thakaundrove a woman who is not nursing sometimes takes the place of the mother. She is fed on spinach, and is oiled and tended like the real mother, and in course of time, if the child continues to suck her breasts, the milk comes, and the child is reared. There is a well-attested case—and it is said to be by no means a solitary instance—in which the grandmother suckled the children during the mother's frequent absences from home. They were the children of her youngest daughter, and yet she contrived to induce a flow of milk for each of the four children in succession. It is not surprising that all the children died in infancy, for such milk could have little nutritive value.

Statistics show that, even counting the children that are fortunate enough to find a wet nurse to adopt them, in at least three cases out of four the death of the mother means the death of the child also, and that the mortality is only a shade lower in cases where the mother is deficient in breast milk. The father's absence from home is also a fatal condition, for the mother is then obliged to take her baby with her to the plantation, where it is left under a tree while its page 214mother works in the sun. Among the Motu tribes in New Guinea a sort of crèche is improvised in the corner of the field; every nursing mother goes to work with her child slung in a net bag. These bags are slung from the branches of a tree, and are guarded by one of the women told off for the duty in rotation. I remember coming suddenly upon one of these trees at a turn in the path. Its dead branches bore a round dozen of this strange fruit—fat brown babies fast asleep with their knees doubled up to their chins and their flesh oozing from the meshes of the net bags. Near the same village I saw a woman, who had probably lost her baby, doing her maternal duty to a sucking-pig and a puppy.

The only substitute for milk known to the Fijians is mba water, i.e. water in which the stalks of the taro (Calladium esculentum) have been boiled. It contains a large proportion of glucose, a little starch, a trace of albumen, some malic acid, a pinkish or pale violet colouring matter intensified by acids, water and cellulose, but no tannic or gallic acids. The microscope showed it to be free from oxalate of lime or other raphides. In the uncooked stalks and leaves there is a highly acrid oily matter, which, however, is completely dissipated by heat even below 200° Fahrenheit. Mba is not unlike boiled beet stalks, and the sweet and mucilaginous liquor must be a palatable and not unsatisfying food for a child in ordinary health, though it is far from being as nutritive as mother's milk. It is strange that the Fijians have never thought of adding to it the strainings of grated cocoanuts which abound in every village, though even so the food would still be deficient in proteids.

In Tonga, on the other hand, children are generally reared safely by hand upon a diet of cooked breadfruit made into a liquid with cocoanut-milk. I have heard of one instance of a child that was reared on sugar-cane. The Gilbert Islanders use a butter made of the fruit of the pandanus made fresh every day, and they also give their children young cocoanuts to suck through a hollow rush.

Weaning

If all goes well the child is weaned when three or four of both the upper and lower incisors appear. For a month or two before this the mother has been in the habit of giving it a slushy mess of yam to prepare it for solid food. While weaning it she gives it chewed yam or taro in addition to mba, and there is something to be said both for and against this practice. The saliva is rich in ptyalin, which does not act upon proteids or fats, and is therefore not secreted in any appreciable quantity during the first year of infant life. As the starch that is so plentiful in yam and taro is insoluble, it must be converted into something more digestible before it can be assimilated. The acid of the gastric juice would retard this conversion, but the ptyalin of the saliva, like the diastase of malt, has the property of converting moistened starch, when kept at a warm and even temperature such as that of the body, into dextrin and glucose, which are easily as-similated. Thus, while the mother feeds her child upon a diet which it is not yet prepared to deal with, she supplies from her own mouth the necessary moisture, warmth and ptyalin for making it digestible. Without the chewing the mashed yam would produce diarrhœa.

On the other hand, the human mouth is the hotbed of bacteria, which, though innocuous to the adult, may well be hurtful to an infant. The Fijian uses no toothbrush but his index finger, which is seldom as clean as the mouth it is intended to cleanse. It is therefore possible that the fermentative action that causes diarrhœa in children may be set up by the chewing, and the germs of specific constitutional disease may be sometimes introduced. Tuberculosis and leprosy, so far as our present knowledge of them goes, appear likely to be transmissible in this way, and the Fijians are largely affected by both tubercle and leprosy. Most Fijian mothers are heavy smokers, and the residuum of tobacco may well impart a poisonous property to the food.