VII. Disease and Its Treatment.

By Sir William Macgregor.

IN these few lines special stress is laid upon the fact that one of the greatest--in my humble opinion the most significant and ominous of all--misfortunes that have befallen the Pacific Islanders has been the introduction among them of not a few of the most serious diseases that afflict the white man, without at the same time providing the means of combating them. A striking example of what this means was furnished by the epidemic of measles that overran Fiji in 1874-5, to which between a third and a fourth of the whole population succumbed. The disease was, so to speak, in new soil, and flourished accordingly. The psychical effect was also an important factor in the epidemic, and influenced the very high rate of mortality; while at the same time the vitality of those that recovered was lowered. Hardly less remarkable was the severity of the various forms of venereal disease, and of dysentery, diseases that, differently from the epidemic of measles, assumed endemic form and became domesticated.

Now, the great mortality reported in the press as having occurred in some of the Pacific Islands from the world-wide epidemic of influenza, directs in a special manner our attention to the general question of epidemic and other diseases among the islanders. The subject could be considered from the point of view of the introduction of disease; and from that of dealing with diseases actually existing, whether domesticated or of recent introduction. If the German [78/79] possessions in the Western Pacific are, as should be the case, put under the administration of Australia and New Zealand, the introduction of diseases new to the islanders may best be left to those Dominions, where the principles and practice of an efficient quarantine are well understood and carried out. In Australia quarantine safeguards were established on a firm and scientific basis many years ago, chiefly on the initiative of the Hon. Sir Charles Mackellar, then Medical Adviser of the Government of New South Wales.

But the strictest quarantine may fail; and in any case there remains the great and serious question of the diseases already domesticated in the islands, which of themselves, unless at an early date means are provided to minimise their effects, will before long reduce the inhabitants of many of the islands to the verge of extinction. There are cases on record where islanders returning home from a term of years on sugar plantations, have brought with them dysentery that has in one epidemic killed half of the inhabitants.

Of the women and girls that were recruited from the islands for plantation work, few or none went back home without venereal disease of some kind. In one case itch was introduced by a consignment of old clothes--among which figured not a few cast-off police uniforms--and that disease, being entirely new to the natives, assumed quite a serious form, but fortunately did not extend to tribes that wore no clothes. In certain places in the Pacific malarial fevers are not known, while in others they- assume the worst form. Ophthalmia, bronchitis, pneumonia, and skin diseases are common. These and other diseases not enumerated make serious inroads on the island population.

Can any practical measures be taken to alleviate this state of matters, bearing in mind the improbability that any form of administration will be able, for financial reasons, to [79/80] provide, except in very rare cases, a staff of qualified medical practitioners sufficient to meet all requirements?

There can be no doubt that much could, and therefore should be done.

I would most earnestly urge on all Christian Missions at work in the Pacific Islands to have every missionary and teacher, white or coloured, man or woman, put through a course of medical instruction that would enable them to alleviate and mitigate the maladies that now menace the different races of the islanders.

This would be nothing new in missionary work. Indeed, it would only be following the practice of the Founder of our religion, as told to us in each one of the synoptic gospels. The first Christian mission sent out had a double purpose: to preach the approach of the Kingdom, and to cure all infirmities. We know that long before the advent of Christianity, medicine was a sacred art, intimately associated with religion. And we are shown, as for example in Harnack's Verbreitung des Christentums, that the Fathers of the primitive church studied and practised medicine.

Many years ago, when it was clear that the Fijian race was losing in number and that the treasury of the Colony could not afford a sufficient staff of qualified medical officers, a scheme was submitted to the Governor, Sir William Des Voeux, and sanctioned by him, whereby some ten or twelve approved students from the Methodist missionary colleges should receive a systematic course of instruction in medicine, and that they should then be appointed to their respective provinces as "Native Medical Practitioners." Their training was entrusted chiefly to Dr Glanvill Corney, I.S.O., who from 1888 to 1908 was Chief Medical Officer of the Colony. How far this scheme was successful may be gathered from the following note by Dr Corney. What is stated therein [80/81] demonstrates the capacity of the Pacific islander to learn and to practise what is urged above.

"In 1885 the Government of Fiji invited the chiefs to send forward eight or ten young men of proved intelligence, and of good character and family, with a view to their being given a course of instruction in the rudiments of human anatomy and physiology, supplemented by suitable teaching in the wards of the Colonial Hospital, with practice in minor surgery and domestic medicine. The proposal met with a willing response, almost every province contributing at least one student; and these were housed near the Colonial Hospital, where they received technical and disciplinary training from the medical officers and the matron during a term of three years each. Particular attention was paid to such ailments as pneumonia, bronchitis, dysentery, conjunctivitis, and other diseases to which the natives are specially prone, and to the methods for arresting bleeding. General sanitation, both public and individual, and prophylaxis were, of course, included.

In course of time the most promising and careful of these students became useful adjuncts to the labours of the District Medical Officers; and even in parts of the islands out of reach of the latter. As a measure of their ability and precision it may be mentioned that three became in rotation dispensers and anaesthetists at the Hospital, and one of these served with unvarying success for more than a dozen years. Before very long their number reached fifty. Incompetent and otherwise undesirable candidates were generally detected and eliminated from the class long before entering upon a third year of study; but, when the sounder ones had completed the full term, they were subjected to a stiffish examination, written, oral, and practical, and those that passed satisfactorily were awarded a Certificate to that effect. They were then appointed to a provincial post, at first under the supervision of a European Medical Officer, but by degrees their usefulness was availed of, as I have said, for the benefit of the native population of remote [81/82] islands where no European medical officer was ordinarily within reach, and after some natural hesitation and an occasional rebuff on the part of a biassed and ignorant people, they became greatly appreciated, and no province deemed itself properly equipped without one or more of them, so that the total number of these "Native Practitioners," as they were officially called, has been maintained, and remains at present at more than fifty, year after year.

More recently--1906 or 1907--a class of native women for training as midwives, with particular reference to antisepsis, has been instituted at the hospital under the supervision of the Matron; and many of her pupils have become very popular in the communities amongst whom they work. The course is necessarily much shorter than three years; I believe it is now limited to six months, but something depends upon the number of deliveries available for them to be present at."

When I opened the School for Tropical Medicine at Townsville a few years ago, the superintendent informed me that he would be most happy to receive and instruct European missionaries in tropical medicine on terms exceptionally favourable to them. I have no doubt that the same facilities would be extended to the coloured missionary or teacher.

Then again, one or two duly qualified medical missionaries in each mission could train, or partially train, the coloured or native staff of teachers, who could perhaps have part of their instruction in such matters as anatomy at Townsville, Fiji, or elsewhere.

No doubt assistance would be given by the Federal Government of Australia, and by the Government of New Zealand, who would probably supply such medicines and medical outfit as would be required for the medical missionary.

Valuable information and guidance could be obtained from [82/83] the experience gained in Fiji in regard to tuition and general outfit.

That such a training as that outlined above would add to the status and influence of the missionary and teacher cannot be doubted. We see it in the New Testament; and it has been proved many times in the Pacific. Dr Paton, for example, relates how some cures he effected on Tanna saved his own life when in grave danger.

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