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Chapter XVIII
yaws (Thoko)

While the decay of custom has been hastened by the introduction of new diseases, it has not been accompanied by any attempt to eradicate the old.

Chief among indigenous diseases (if diseases introduced before contact with foreigners may be called indigenous) is yaws, called by the Fijians thoko, or by its Malayo-Poly-nesian name-tona, and by various dialectic modifications of that word, which is also used in Tonga, Samoa, Tahiti, and many other Polynesian islands.

The disease is but little known to the medical profession in Europe, either in practice or in medical literature. Its medical designation is Frambœsia, so called from the strawberry-like eruptions that accompany it. By the French it is called "Le Pian." In Great Britain it is now extinct, but in the Hebrides and in the south-west counties of Scotland it was met with under the name of "sibbens," or "sivvens," as late as the beginning of the nineteenth century.

It is common throughout Africa, Malaysia and Polynesia. Being contagious, it was carried by means of the slave traffic from Africa to tropical America and the West Indian Islands. From the east coast of Africa and Madagascar, about 340 years ago, the Dutch or Portuguese traders carried it to Ceylon, where it still bears the name of "Parangi Lede" or "Foreigners' evil." Hamilton noticed it in Timor in 1791, saying "it seldom terminates fatally and only seizes them once in their lives."¹ Crawfurd, who wrote in 1811-1817, noticed it in Java.

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Dr. Martin, the able editor of Mariner's Account of the Tonga Islands, writing in 1810, was the first to recognize the identity of tona with yaws, though he never saw the disease. But the existence of tona was recognized by Captain Cook and numerous other visitors to the South Seas during the last and the beginning of the present century, though they were not aware of its real nature.

The premonitory symptoms of yaws are, as a rule, insignificant and obscure; the appearance of one of the sores is generally the earliest indication that a child is infected, but adults have noticed pains in the limbs, fever, restlessness, or languor. The first sore, called the tina-ni-thoko, or mother-yaw, is usually a large one about half-an-inch to an inch in extent, and is often surrounded by a group of smaller sores. It generally appears on the site of some wound or scratch, more often about the lips. Those that follow are generally developed upon some part of the body where the skin is delicate, such as the neck, the groin, or the axillæ, or in parts where the true skin joins the mucous membrane. Doubtless the lips of children are first infected owing to the child's habit of putting the hands to the mouth, the hand being the part most likely to come in contact with the virus of another child.

After an uncertain interval a crop of pabules, or in some cases blebs, begin to appear, the face and the parts already mentioned being their favourite point of appearance. If the eruption begins with blebs the case is spoken of as thoko se ni niu (cocoanut flower thoko, from the resemblance of the eruption to a spray of the unexpanded flowers of the palm).

In the next stage a soft warty excrescence, which is the matrix of the sore, pushes its way through the true skin by forcing it aside rather than breaking down its substance. On reaching the surface the granulations which form this out-growth exude a fluid which is highly contagious. It forms in time a crust or scab, the reddish appearance of which is very characteristic of the yaws eruption. If this be removed by means of oil or a poultice, the granulated surface of the sore beneath it has that resemblance to a raspberry or mulberry which has given the name of Frambœsia to the disease. In page 272some cases the crust assumes a curvinilear outline, recalling the appearance of the well-known Pharaoh's serpent. These are especially seen about the corners of the mouth, the neck and the axillæ, and constitute the thoko ndina or true yaws. In other cases they retain a circular shape on all parts of the body, and are then called thoko mbulewa or button or limpet yaws. During the healing process they become converted into annular or horse-shoe patterns, the centre receding before the periphery.

The sores may remain for two weeks or they may persist for fully two years. Throughout the progress of the case they may number anything from one to several hundred. The commonest number is from six to twenty or thirty. Weakly and ill-nourished children take the disease more easily than strong ones. While the active symptoms seldom last for more than two months, the dormant features last much longer, and some of the tertiary consequences may appear at almost any age.

The chief ill effects from thoko are dysentery, diarrhœa, and marasmus; sometimes the joints are implicated, even the larger ones, such as the wrists, knees and ankles, and partial paralysis may follow; pot-belly is a frequent concomitant, and tabes mesenterica are believed to follow it. In a later period of life the feet of those who have had yaws as children become affected by the disease, and on account of the thick and horny skin by which the soles of shoeless races are protected the extrusion of the growing yaw through the sole becomes an acutely painful process. Not only do the typical granulations known as sutkuvi and soki force their way through the skin, but the sole is also liable to a cracking and peeling form of excoriation called kakatha, which is nearly as painful and is also said to be contagious. The Fijians do not recognize the connection between any of the sequelæ of yaws and the original disease, and hence perhaps the indifference with which they regard it.

An idea of the serious nature of yaws may be gathered from the cases in which it has been contracted by adult Europeans. Such cases have been numerous enough in Fiji to impress the page 273European settlers with dread and disgust. In most of these cases the disease has permanently shattered the health of the person attacked, its tertiary effects simulating those of neglected syphilis, for, while no less severe, they have proved quite as ineradicable. They are shown in permanent impairment of the digestive functions, emaciation, inflammation of the bones or joints, intractable ulceration, and marked constitutional weakness, thus producing liability to other diseases such as diarrhœa, dysentery and pneumonia, and not infrequently ending in death. From this it may be readily imagined that the consequence of yaws to native children can be anything but trivial. With Europeans as well as with natives an attack is more likely to pass off easily when contracted in childhood than when taken in adult life. The most favourable age for getting over it safely seems to be between two and three years.

Yaws is communicated by the inoculation of virus from one of its characteristic raspberry-like sores to the abraded surface of the skin of another person. But, though the natives have never discovered this for themselves, they do not, as in other diseases, attempt to explain yaws as the work of a malignant spirit. The fact is that they scarcely believe yaws to be a disease at all. They think that if a child makes a good recovery it becomes more plump and healthy than one who has never had the disease. Mothers are pleased when the first symptoms make their appearance, regarding it as the best thing that could happen to their children to set them on the high road to a vigorous manhood, provided that the disease is not contracted at too early an age. At Mbau, however, the chief women appear always to have recognized the contagious nature of yaws. They say that in former time the children of high rank were not allowed to enter the houses of common people or play with their children, and in consequence of this exclusiveness they seldom contracted yaws until they were of an age to resist its ravages. Thus some escaped it altogether, and the majority had it very mildly. Andi Alisi and Andi Ana are cases in point, so were the late Andi Kuila and Ratu Joseva. Now-a-days there is scarcely an exception page 274to the rule that every Fijian child contracts yaws. Whatever may have been the case formerly, it is now quite common for children to contract the disease while suckling and teething; not infrequently before they can crawl, and even at as early an age as three or four months. When this happens the eruption sometimes recedes prematurely; this is the only danger feared by the natives, who usually attribute the recedence to ndambe, i.e. incontinence on the part of the parents, or to ramusu (internal injury). When the eruption recedes, as it undoubtedly does in some cases, the child becomes sickly and feverish and subject to diarrhœa, and whether these symptoms be spontaneous or secondary, death is more often the result in these cases than in others. The native treatment is purely empirical: native drugs are administered in the expectation of causing the eruption to reappear, but if the attack pursues its normal course no attempt is made to heal the eruption; on the contrary, it is intentionally abandoned to the chances of easy and plentiful development. In very severe cases natives have occasionally made application to the European medical officers; but, as a rule, it is only when the eruption has almost disappeared, and only one or two of the sores persist, that the Fijian mother will allow any interference with it. The usual native treatment in such cases is to apply a poultice of the leaves of the lewe ni sau, or some other native herb. The more modern practice is to heat a piece of rusty hoop iron red hot and to rub a cut lemon on it, and then to apply the ruststained juice as a mild escharotic. It is said that in West Africa the natives use a decoction of iron filings in lemon juice, with the addition of ants and a portion of the pepper plant for the same purpose. As the old Fijians had no metals, it is possible that they have learnt the recipe from Europeans who have read of it.

The Fijians do not claim to have any positive remedy for the cure of yaws, nor, indeed, do they desire any. They are satisfied that native medicines suffice to "drive out" the eruption if it has prematurely receded, and that if they do not succeed in such cases the child will die. The great body of the people cannot be made to grasp the idea of inoculation. page 275While some admit that yaws can be caught from one person by another, others assert that the cause is intrinsic and that every Fijian child must, or ought to, develop it, and that it is solely a Fijian disease about which white men are naturally ignorant. In Mathuata the "wise women" administer medicines to bring on the disease in cases where children do not readily contract it. They believe that the occurrence of yaws in a child of a proper age—from two to six years—is a good augury for the future physical strength and mental vigour of the subject, and they think that persons who escape its contagion will grow up stupid, clumsy, and dull (dongandonga), and useless mentally and physically. The fear of contracting disease in adult life, when it affects the patient far more severely than in childhood, disposes the Fijian mother to look favourably on the acquisition of the disease in infancy. They are, indeed, far more anxious that their children should contract yaws than are the uneducated mothers of English factory towns that theirs should contract measles. The desire of getting over inevitable diseases during childhood is the same in both cases, but the Fijians have less excuse, for yaws is not only a far more virulent disease than measles, but it might be far more easily stamped out if the Fijians could be disabused of the idea that it "grows out of the child." In the days of slavery, from commercial considerations, the West Indian planters insisted on segregation in yaws-houses, and were partly successful in keeping the disease under control. But as soon as the West Indian negro was emancipated and permitted to revert to his own careless life, the disease began to gain ground very rapidly.

It is impossible to estimate the mortality directly due to yaws. In the yaws-hospitals of the West Indies the mortality amounted to less than the annual death-rate of the islands. When it occurs during the first year of childhood in Fiji it is almost invariably fatal. Indirectly, there can be no doubt that it is sapping the vitality of the whole native race. Some authorities—Hutchinson, for example—hold that it is possibly syphilis modified by race and climate. Syphilis is practically page 276unknown among the Fijians, but although there are many points of difference that prove the two diseases to be distinct, it is highly probable that, from its close relationship to syphilis, yaws has an enervating effect on the child-bearing functions of the native women.

Though it would now be extremely difficult to stamp out the disease, much might be done to keep it under if the natives could be convinced of its contagious nature. In the mountain districts of Tholo Tinea desquamans, or Tinea imbricata (Tokelau ringworm), which infected nearly 25 per cent, of the native population a few years ago, has now so far yielded to the efforts of the people themselves that it has been almost entirely stamped out in some of the provinces. As soon as they were convinced of its contagion, and understood that the Government would supply remedies to those who chose to pay for them, they buckled to the work in earnest, and needed little driving by European officials.