Having, in the three preceding chapters, given an account of the state of religion and morals in these islands, I shall now proceed to develop the next most important feature in the description of human habits, and shall therefore endeavor to set forth the state of useful knowledge to which they have arrived. In the first place, I shall treat of the healing art; not only because it stands prominent in the general history of human science, but because, in all early stages of society, it appears to have a particular connection with, and often to depend entirely upon, certain religious ceremonies; nor is this to be wondered at, for, seeing that the operations of the animal economy are so far involved in mystery, as frequently to escape the scrutinizing search of the most cultivated mind, how can it be otherwise but that a people, among whom the sources of knowledge are scanty, and the opportunities of experiment on the animal economy both rare and hazardous, should look to the gods for relief from those miseries which evidently proceed from an unseen hand. A considerable portion of the curative means of these people are, therefore, very naturally, invocation and sacrifice. Nevertheless, as the animal economy is subject to a variety of accidents, the causes and operations of which take place, and pursue their progress, more or less, under the evidence of the external senses, appropriate means of cure are frequently had recourse to, and operative surgery is therefore not in a contemptible state of cultivation.
All the remedies practiced among them may very safely be ranked under these three heads, namely invocation, sacrifice, and external operations. As to internal remedies, they sometimes, but very seldom, use infusions of a few plants, which produce, however, no sensible effect, either upon the system or upon the disease, and we may readily conceive in how little esteem such remedies are held when the King’s daughter, whose life so great pains were taken to preserve, took none of them, nor did anyone think of proposing them. The idea of giving these infusions was first taken from the natives of the Fiji Islands, who have the repute of being skillful in the management of internal remedies. Though almost all the surgical operations known and practiced at the Tonga Islands have avowedly been borrowed from the same source, and followed up with a considerable degree of skill and success, yet the Tonga people have generally failed in the former, and for the cure of constitutional ailments, depend upon the mercy of the gods, without any interference on their own parts, except in the way of invocation and sacrifice. In such a state of things, it would be natural to suppose that they frequently make use of charms, amulets, etc. to assist in the cure; but this, however, is never done, for they have not the most distant idea of this sort of superstition, which prevails so much over almost all the world, even in the most civilized countries. The natives of the Hawai’i Islands, however, appear to have some knowledge of medicine, but whether from original discoveries of their own, or from the information of Europeans, I could not obtain any information from those Hawaiian natives who were with me at Vava’u. One of these Hawaiian islanders (a petty chief), professed some knowledge of the healing art, and it so happened that I was once the subject of his skill. Feeling myself much indisposed by a disordered state of the stomach and bowels, attended with headache and drowsiness, this Hawaiian proposed to give me some internal remedies, while a native of Tonga, on the other hand, very much wanted me to lose some blood (by scarification with shells on the arms, legs), etc. The remedies proposed by the Hawaiian were an emetic and a cathartic. The cathartic consisted chiefly of the sweet potato grated, and the juice of the sugar cane; to this, however, was added the juice of some other vegetable substance, with which I was not acquainted. The emetic consisted of two infusions, one of certain leaves, and the other of a particular root, both unknown to me, The Hawaiian informed me that the root was necessary to counteract the effect of the leaves, which was very powerful, and might, in a large dose, and without such addition, kill me. Upon this discouraging information, the native of Tonga, with his scarifying shells, redoubled his persuasions, ridiculed the remedies of the other, and, on understanding what effect they would have, laughed most heartily at the idea of curing a sick man by means which would make a healthy man sick. The remedies of the surgeon, however, were not more agreeable than those of the physician, and the patient was at a loss to know to whose care he should entrust his health; when the latter signified his intention of taking some of his own physic, which was the best proof he could possibly give of his confidence in it. Two equal doses were accordingly prepared; the patient took one, and the doctor the other. The cathartic was first given, and the emetic about an hour afterwards. The emetic operated in about another hour, and the cathartic, in conjunction with it, in about two hours and a half. They both evinced abundant evidence of their respective properties, and the following morning I found myself perfectly well. Which happy result the man who wanted to bleed me could by no means attribute to the remedies I had taken! The Hawaiian, notwithstanding, was much laughed at, particularly about his cathartics, obtained at length a considerable share of credit for his skill. Finau took his remedies twice with very good effect, which encouraged some other to try; but as these circumstances took place only a short time before I left, and consequently only a few trials had been made, I ought not to speak of them as constituting the medical knowledge of the Tonga people; but as this Hawaiian chief was a man of considerable judgment, and, as I have every reason to think, a good observer, I indulge the hope that no ill success, at an early period, has destroyed confidence in the adoption of two such useful remedies.
The ceremonies of invocation in behalf of sick people have already been described in the account of the sickness of the late King’s daughter. The sacrifices adopted on similar occasions are tutu’u-nima and no’okia; cutting off fingers and strangling children — these also have both been described. No’okia [ceremonial strangling] is only done for very great chiefs. I shall now proceed to speak of their operative surgery, and constitutional diseases, as far as my observation can lead me to speak with accuracy.
No native of Tonga undertakes to practice surgery, unless he has been at the Fiji Islands, where constant wars afford great opportunities of becoming skillful; and no native of Tonga would employ a surgeon who had not been thus schooled. Nor would anyone, as I believe, undertake an important surgical operation, unless he feels himself confident in what he is about to perform. It must be said of them, that they are not rash in their opinions. When a surgeon performs an operation, he never fails to obtain a present from the patient or his friends.
The three most important operations are kauso, or paracentesis thoracis; tokolosi or an operation for the cure of tetanus, which consists in making a seton [A medical term descriptive of this procedure.] in the urethra; and poka or castration.
Kauso. An operation which is performed to allow of the escape of extravasated blood, which has lodged in the cavity of the thorax, in consequence of wounds, or for the extraction of a broken arrow. There are no other instances where they think of performing it. The instruments they use are a piece of bamboo and a splinter of shell; sometimes a probe made of the stem of the coconut leaf. I saw a number of persons on whom the operation had been performed, and who were in perfect health; and two instances of the fact itself I was an eyewitness to. The one I am about to describe was performed upon a Fiji islander, who had received a barbed arrow in the right side, between the fifth and sixth ribs; not in a line directly below the nipple, but about an inch backwards. The arrow had broken off about three inches from the point, under the third row of barbs; and from the rise and fall of the thorax in the act of respiration the whole piece was perfectly concealed from any external view. The barbs and the point were of the same piece with the arrow. They are made thin under each barb, on purpose that they may break. The barbs of this arrow were about a quarter of an inch transverse diameter, and the stem of the arrow under each row of barbs about the eighth of an inch.
A countryman of the wounded man wished to perform the operation, but the patient desired that a friend of his, a native of Vava’u, should manage it. This proved that he placed at least equal confidence in his skill as in that of his countryman; for he had seen him perform the operation several times before, at the Fiji Islands.
The patient was now lying on his back, but a little inclined to his left side; and this was considered a favorable posture for the operation. It was a fine clear day, and the weather warm. Had it been rainy or cloudy, or had the patient felt himself cold, fires would have been lighted in the house, and a burning torch held to his side, to relax the integuments, and to render by such means the wound more favorable. The wound had been received the day before; and on pressing the finger upon its orifice the broken end of the arrow could not now be felt, except by the pain which such pressure gave the patient. In the first place, the operator marked with a piece of charcoal the situation and length of the intended incision, which was about two inches; the small wound made by the arrow being in the centre of it. The integuments were now drawn upwards, so that the black line lay upon and parallel with the superior rib; an assistant pressing his hand above, and another below the situation of the intended incision, with a view to keep the integuments firm and steady. The operator having now chosen a fit piece of bamboo, began his incision, and carried it down to the bone, the whole length of the mark, which was done with five or six motions of the hand, aided by considerable pressure. In this part of the operation a shell could not be used, on account of its liability to break. The integuments being now allowed to return to their natural situation, the incision was cautiously continued with a splinter of shell, midway between the two ribs, dividing the intercostal muscles to nearly the same extent as the external wound, to allow of the introduction of a finger and thumb to lay hold of the arrow. During this part of the operation, however, the end of the arrow became perceptible, protruding between the ribs at every inspiration. The operator, as soon as possible, secured it with the finger and thumb of his left hand; while with his right he proceeded to widen the incision on either side, that he might take a deeper and firmer hold, and secure, if possible, the second row of barbs. To facilitate the operation, he now slipped the noose of a string over the barbs he held between his finger and thumb, and having secured which, his left hand was no longer in the way of his right; for by drawing the string as far as prudence would allow, he kept it pressed upon the superior rib, and thereby preserved the arrow from receding at every expiration. The incision was now carried through the intercostal muscles and the pleura, sufficiently to allow of the introduction of the finger and thumb of the right hand, with which he endeavored to disengage as much as possible what might obstruct the barbs; while with his left finger and thumb he laid hold of the end of the arrow, and kept gently twisting it, always one way, so as to break down those obstructions which could not be removed with the other hand, taking care, however, not to use so much force as might be supposed liable to break the barbs; and in this way, in the course of two or three minutes, he withdrew the arrow, bringing with it a small portion of the substance of the lungs, which could not be disengaged. During this part of the operation the patient was almost insensible; he was held by those about him, to prevent any mischief arising from his struggles, which at times were violent. The operator now carefully examined the arrow, and being satisfied that every barb (of which there were three rows) was entire, he ordered him to be gently turned on the right side, so that the wound was depending, and to make it more completely so, a quantity of ngatu was placed under him in two situations, namely under the shoulder, and under the pelvis, in such a way that the orifice of the wound was evidently the most depending portion of the thorax. The patient being now perfectly sensible, the operator desired him to make a full inspiration, enquiring whether it gave him much pain; and being answered that he could bear it tolerably well, he desired him to make several full inspirations from time to time, but not so as to fatigue himself, and occasionally to move his body gently. By these means a considerable quantity of blood was discharged. A few hours afterwards the operator introduced between the ribs a portion of banana leaf, smoothly folded several times, and anointed with coconut oil, as a pledget to keep open the wound. He ordered his patient to be kept perfectly quiet, not to be spoken to, no noise to be made, nor his attention to be attracted in any way: to live chiefly upon vegetable diet, or if he had any kind of meat, fowl in preference to pork, or if pork, it was to be very small in quantity, and without the least fat, with coconut milk for drink, in any quantity that he felt disposed to take. The first night he had a great deal of pain, much thirst, and little sleep; the following day he was much easier, a great deal of blood was found to have been discharged, and a fresh pledget was introduced, which was renewed every morning as long as any discharge was apparent. When the discharge of sanguinous fluid ceased, which was in about nine or ten days, the operator introduced his probe, to be sure that the cessation of the discharge was not occasioned by any obstruction. He then contented himself with a more superficial pledget, that the external orifice might not heal too soon; and the patient was allowed to change his posture occasionally, but not for a long time together. As he grew better a little more meat was allowed him; but the use of kava was interdicted until he got tolerably well. The wound healed in about six weeks, without any sort of dressing or washing; the patient was confined to his house about two months, and was not perfectly recovered till near a twelvemonth, when he seemed as healthy and as strong as ever, with scarcely any cough having supervened in the meanwhile. This was considered a very dangerous wound, and a very well conducted cure. I do not know that they are acquainted either with the exact situation or existence of the intercostal arteries.
The successful chest surgery performed by this Polynesian physician exceeded the skill and knowledge of his European contemporaries. His understanding of anatomy, surgical procedures, wound drainage, and healing were adequate for his surgical task and remarkably coincident with modern practice. Infection was probably reduced by using fresh-made bamboo instruments for each operation. The Tongan habit of cutting open the dead bodies of their enemies probably provided them with a good source of anatomical knowledge.
It often happens that the arrow, not being a barbed one, is withdrawn without any difficulty; but still the surgeon thinks proper to perform the operation of kauso, not by enlarging the wound made by the arrow, but by making another at some little distance from it, in a part which, either from judgment or education, he deems more safe and proper. In all those persons whom I knew to have undergone the kauso it had been performed in nearly the same situation as the one above stated.
I have observed in the before-mentioned case that the wound was not washed, and it may here be noticed, that in all cases of considerable wounds produced by pointed instruments the patient is not allowed to wash himself till he is tolerably well recovered, nor to shave, cut his hair, nor his nails. All these things they say are liable to produce kita (tetanus), [also a general term for a relapse after a sickness] unless the wound be of such a nature, and in such a situation, that it may with safety be first laid completely open, then there is no danger. I never witnessed a case of tetanus produced by these means; but I met with many who said they had seen it in persons who had got nearly well of their wounds. But happening to wash themselves too soon, spasm supervened, and death was the consequence. They notice that wounds in the extremities, particularly in the feet and hands, are liable to produce tetanus. In persons already wounded, sudden alarms, or even any sudden noise that calls the attention abruptly, is liable to produce this complaint. They never allow females to be near men thus wounded, lest the mere stimulus of venereal desire should induce this dangerous complaint. As to cutting the hair and nails, they positively assert that the mere sensation of these simple and common operations has not infrequently been productive of these dreadful consequences. The man whose case we have just mentioned was eight months without being washed, shaved, or having had his hair or nails cut.
The Tongan observation that wounds with pointed weapons are more likely to result in tetanus is correct. The micro-organism that produces tetanus grows only in closed wounds, removed from atmospheric oxygen. It will not grow and produce its deadly toxin in an open wound. Unless the tetanus bacillus (Clostridium tetani) infected their water supply, which may have been the case, washing the wound would not have increased the danger of infection by this micro-organism. It is true that wounds of the hands and feet are more likely to result in tetanus. In these parts of the body there are fewer blood vessels, hence a poorer supply of blood and oxygen; this provides a better climate for the growth of the tetanus-producing organism. It is also true that the risk of tetanus is less in a penetrating wound that can be “first laid completely open.”
Kita. A disease very common among the Tonga people; but still more common among the natives of the Fiji Islands, who, from their warlike habits, are more frequently in the way of it. They adopt, however, a remedy which the Tonga people have borrowed of them, and consists in the operation of tokolosi, or passing a reed first wetted with saliva into the urethra, so as to occasion a considerable irritation, and discharge of blood; and if the general spasm is very violent, they make a seton of this passage, by passing down a double thread, looped over the end of the reed, and when it is felt in the perineum they cut down upon it, seize hold of the thread, and withdraw the reed, so that the two ends of the thread hang from the orifice of the urethra, and the doubled part from the artificial opening in the perineum; the thread is occasionally drawn backwards and forwards, which excites very great pain, and abundant discharge of blood. The latter operation I saw performed several times; but only twice for tetanus, arising in both instances from wounds in the foot. In these cases the spasms, but particularly the convulsive paroxysms, were exceedingly violent, extending to the whole body, neck, face, trunk, and extremities. In neither case was the jaw permanently locked, though on every accession it was violently closed for a few seconds. A native of the Fiji Islands performed one operation, and Hala’api’api the other. They both happened at Vava’u, at different times. In either case the disease came on suddenly, three or four days after the wound was received, which was from an arrow not barbed. The moment the symptoms became evident tokolosi was performed. In the short space of two hours one of them was greatly relieved, and the other in about six or eight hours. The following day the one on whom Hala’api’api operated was quite well, and afterwards had no other attack; consequently the thread was withdrawn. The other on the second day was not quite free from spasmodic symptoms, and a paroxysm coming on, the seton was moved frequently, which in two or three hours gave him great relief, and he afterwards had no other attack. It was though prudent, however, to keep in the seton till the fourth of fifth day, when it was withdrawn. The effect of this operation was a considerable pain and tumefaction of the penis, but which gradually subsided (in about five or six days). The artificial openings in both cases healed spontaneously, without difficulty.
These are the only two cases of tetanus in which this operation was performed that I can speak of with certainty, having been an eyewitness of them. I heard of several others at the Ha’apai islands, and at the island of Tongatapu, some of which were equally fortunate. From what I have heard and seen of the success of this operation at the Tonga Islands, I am disposed to believe that about three or four in ten recover by the aid of it. The Fiji islanders, however, speak of the happy effects of this singular mode of cure with much more confidence than the natives of Tonga; but as they claim the merit of the discovery, they are probably rather too profuse in praise of it.
The “tokolosi” operation has no counterpart in modern medical practice. Our present-day understanding of the disease of tetanus would lead us to discredit the procedure as being irrational. However, it is not wise to dismiss as valueless the arts of primitive medicine. The recoveries Mariner witnessed would appear to be remarkable.
Tetanus is not the only disease for the cure of which the operation of tokolosi is performed. It is adopted also in cases of wounds in the abdomen, upon the mistaken notion that any extravasated blood in the cavity of the abdomen is capable of passing off by the discharge from the urethra. I saw the operation performed once in this case, and, as the man was considered in a very bad state, and notwithstanding got well, the cure was attributed to this remedy. It is also performed for relief in cases of general languor and inactivity of the system; but, in such instances, they only endeavor to produce irritation by passing the reed without any thread or artificial opening. The present King had it thus performed on him for this purpose; and two days afterwards he said he felt himself quite light, and full of spirits.
The natives of these islands are very subject to enlarged testicles, and for this they sometimes perform the operation of poka (castration). My limited observation on this subject does not authorize me to speak with any degree of certainty in regard to the precise nature of these tumefactions.
These cases of enlarged “testicles” — actually it is the scrotum that is enlarged — are a manifestation of the disease of filariasis. These scrotal enlargements, technically, hydroceles, are a form of elephantiasis.
The disease is caused by a parasite worm, called filaria, which enters the body from an infected mosquito. The disease continues to be common in Tonga; the parasite can be detected in 40% to 60% of the present population; but only a small percentage of those infected develope enlargements of the scrotum or limbs as a consequence of the infection.
Their mode of performing this operation is summary enough; a bandage being tied with some degree of firmness round the upper part of the scrotum, so as to steady the diseased mass, at the same time that the scrotum is closely expanded over it, an incision is made with bamboo, just large enough to allow the testicle to pass, which being separated from its cellular connections, the cord is divided, and thus ends the operation. They neither tie the cord, nor take any pains to stop the bleeding; but, if the testicle be not very large, and the epidydimis not apparently diseased, they perform the operation by dissecting it from that body with the same instrument. The external wound is kept from closing by a pledget of the banana leaf, which is renewed every day till the discharge has ceased, and the scrotum is supported by a bandage. A profuse hemorrhage is mostly the consequence of this operation. It was performed seven times within the sphere of my knowledge, during my stay; three of which I was a witness. Not one of the seven died. One of these cases was that of a man who performed the operation on himself. His left testicle was greatly enlarged, being about five or six inches in diameter, and gave him, at times, severe lancinating pains. Two or three times he was about to have the operation performed by a native of Fiji, but his courage failed him when he came to the trial. One day, when I was with him, he suddenly determined to perform the operation on himself; and it was not much sooner said than done. He tied on the bandage, opened the scrotum with a very steady hand, in a fit of desperation divided the cord and cellular substance together, and fell senseless on the ground. The hemorrhage was very profuse. I called in some persons to my assistance, and he was carried into a house, but did not become sensible for nearly an hour, and was in a very weak state from loss of blood. This affair confined him to the house for two or three months. There was one rare instance of a man, both of whose testes were affected with species of sarcoma, to a degree almost beyond credit. When he stood up, his feet were necessarily separated to the distance of three quarters of a yard, and the loaded scrotum, or rather the morbid mass, reached to within six inches of the ground. There was no appearance of a penis, the urine being discharged from a small orifice about the middle of the tumor, that is to say, about a foot and a half below the os pubis. The man’s general health was not bad; and he could even walk by the help of a stick, without having any sling or support for his burthen. It was specifically lighter than fresh water, and considerably lighter than salt water, so as to produce much inconvenience to him when he bathed. He died at the island of Foa, about two or three months before I left Vava’u.
As to fractures, and dislocations of the extremities, it may be said that there is scarcely any native but what understands how to manage at least those that are most likely to happen; for they are very well acquainted with the general forms of the bones, and articulations of the extremities. They use splints made of a certain part of the coconut tree. For broken arms they use slings of ngatu. In fractures of the cranium they allow nature to take her course without interfering, and it is truly astonishing what injuries of this kind they will bear without fatal consequences. There was one man whose skull had been so beaten in, in two or three places, by the blows of a club, that his head had an odd misshapen appearance, and yet this man had very good health, except when he happened to take kava, which produced a temporary insanity. Fractures of the clavicle and ribs I never saw. The most common surgical operation among them is what they call tafa, which is topical blood-letting, and is performed by making, with a shell, incisions in the skin to the extent of about half an inch in various parts of the body, particularly in the lumbar region and extremities, for the relief of pains, lassitude, etc. Also for inflamed tumors they never fail to promote a flow of blood from the part; by the same means they open abscesses, and press out the purulent matter. In cases of hard indolent tumors, they either apply ignited tapa, or hot breadfruit repeatedly, so as to blister the part, and ultimately to produce a purulent surface. Ill-conditioned ulcers, particularly in those persons whose constitution disposes to such things, are scarified by shells; those that seem disposed to heal are allowed to take their course without any application.
In cases of sprains, the affected part is rubbed with a mixture of oil and water, the friction being always continued in one direction, that is to say, from the smaller towards the larger branches of the vessels. Friction, with the dry hand, is also often used in similar and other cases, for the purpose of relieving pain.
In respect to inflammations of the eyes, which sometimes rise to a very great height, attended frequently with a considerable purulent discharge; they frequently have recourse to scarification by the application of a particular kind of grass, the minute spicula with which it is replete dividing the inflamed vessels as it is moved upon the conjunctiva. To assist in reducing ophthalmic inflammations, they also drop into the eye an acid vegetable juice, and sometimes another of a bitter quality; the first is called vi, the latter, polo [the pepper plant]. The species of ophthalmia to which they are subject, though sometimes lingering, is stated scarcely ever to have produced serious consequences, and is not considered contagious. I neither saw nor heard but of one man who had lost his sight by disease.
In cases of gunshot wounds, their main object is to lay the wound open, if it can be done with safety in respect to the larger blood-vessels and tendons, not only for the extraction of the ball, if it should still remain, but for the purpose of converting a fistulous into an open wound, that it may thereby heal sooner and better. If they have to cut down near larger vessels, they use bamboo in preference to the shell; the same near tendons, that there may be less chance of injuring them. They always make incisions nearly in the course of the muscles, or, at least, parallel with the limb.
The amputation of a limb is an operation very seldom performed; nevertheless it has been done in at least twelve individuals. I saw one day a man without an arm, and curiosity led me to inquire how it happened. I found that he had been one of the twelve principal cooks of Tuku’aho, the tyrant of Tongatapu, and all had submitted to the amputation of their left arm. The mode in which this operation was performed was similar to that of tutu’u-nima; only that a large heavy axe was used for the purpose. The bleeding was not so profuse as might be imagined, owing, no doubt, to the bluntness of the instrument and violence of the blow. This stump appeared to me to be a very good one; the arm was taken off about two inches above the elbow. Ten of the cooks were stated to have done very well; of the remaining two, one died of excessive hemorrhage, and the other of mortification. There was also a man living at the island of Vava’u who had lost a leg in consequence of the bite of a shark, which is not a very uncommon accident; but there was something unusual in this man’s particular case. His leg was not bitten off, but the flesh was almost completely torn away from about five inches below the knee down to the foot, leaving the tibia and fibula greatly exposed, and the foot much mangled. He was one of those who chose to perform his own operations; with persevering industry, therefore, he sawed nearly through the two bones with a shell, renewing his tedious and painful task every day till he had nearly accomplished it, and then completed the separation by a sudden blow with a stone! The stump never healed. I had this account from the man himself and many others.
Tefe. The operation of circumcision, is thus performed. A narrow slip of wood, of a convenient size, being wrapped round with ngatu, is introduced under the prepuce, along the back of which a longitudinal incision is than made to the extent of about half an inch, either with bamboo or shell (the latter is preferred); this incision is carried through the outer fold, and the beginning of the inner fold, the remainder of the latter being afterwards torn open with the fingers. The end of the penis is then wrapped up in the leaf of a tree called, ngatae, and is secured with a bandage; the boy is not allowed to bathe for three days. The leaf is renewed once or twice a day. At the Fiji Islands this operation is performed by amputating a portion of the prepuce, according to the Jewish rite.
The operation of the ta-tatau [the Tongan way of saying and spelling, tattoo], or puncturing the skin, and marking it with certain configurations, though it is not properly surgical, yet I mention it here, as it is very apt to produce enlargements of the inguinal and axillary glands. The instrument used for the purpose of this operation somewhat resembles a small tooth comb. They have several kinds, of different degrees of breadth, from six up to fifty or sixty teeth. They are made of the bone of the wing of the wild duck. Being dipped in a mixture of soot and water, the outline of the tattoo is first marked off before the operator begins to puncture, which he afterwards does by striking in the points of the instrument with a small stick made of a green branch of the coconut tree. When the skin begins to bleed, which it quickly does, the operator occasionally washes off the blood with cold water, and repeatedly goes over the same places. As this is a very painful process, but a small portion of it is done at once, giving the patient (who may justly be so called) intervals of three or four days rest, so that it is frequently two months before it is completely finished. The parts tattooed are from within two inches of the knees up to about three inches above the umbilicus. There are certain patterns or forms of the tattoo, known by distinct names, and the individual may choose which he likes. On their brown skins the tattoo has a black appearance, on the skin of an European a fine blue appearance. This operation causes that portion of the skin on which it is performed to remain permanently thicker. During the time that it is performed, but sometimes not for two or three months afterwards, swellings of the inguinal glands take place, and which almost always suppurate. Sometimes they are opened with a shell before they point, which is considered the best treatment; at other times they are allowed to take their course.
Infection from tattooing must often have occurred because of the non-sterile procedure used. The infection would drain from the skin into the lymphatic glands in the groin, and suppuration would indeed result. Draining the abcessed glands by incision was effective therapy.
We need not wonder at the absorbents becoming so much affected when we consider the extent of surface which is subjected to this painful operation; even the glans penis and the verge of the anus do not escape. It is considered very unmanly not to be tattooed, so that there is nobody but what submits to it as soon as he is grown up. The women are not subjected to it, though a few of them choose to have some marks of it on the inside of their fingers. The men would think it very indecent not to be tattooed, because though in battle they wear nothing but the mahi [a strip of tapa cloth worn between the legs], they appear by this means to be dressed, without having the incumbrance of clothing. It is a curious circumstance, that at the Fiji Islands, the men, in the contrary, are not tattooed, but the women are. The operation is managed by their own sex, though by no means to that extent to which it is performed on the Tonga men, contenting themselves chiefly with having it done on the nates [buttocks] in form of a large circular patch, though sometimes in that of a crescent; and most of them have it also done on the labia pudenda, consisting of one line of dots on each side, just within the verge of the external labia.
I cannot with certainty say that the glandular ulcerations above alluded to are always produced by the tattoo, though in all likelihood, when it has recently been performed, it is the exciting cause; but the people are very subject to scrofulous indurations, glandular enlargements, and ulcers. They call the disease kahi [a general term for swellings caused by disease]; the parts affected are the groins, axillae, and neck; though many other parts of the body are also liable to ulcers, which they call pala. These diseases sometimes run on to such an extent, and assume such appearances, that I believe some travellers have mistaken them for syphilis. It is certain that some individuals affected with pala have been obliged to submit to the loss of a nose, the cartilaginous and softer parts of that organ becoming completely destroyed.
The disease called “pala” cannot, from the brief description Mariner gave, be precisely identified. The word, pala, means to decay, rot, ulcerate, or to have a sore. As a noun, the word means a festering wound, sore, or ulcer. The ulcerative disease that Mariner observed most likely was yaws, a disease caused by an organism in the same family as the one that causes syphilis, but which is less severe; and is, as Mariner said, not venereal. A number of fungus infections may cause ulcerative skin lesions which are particularly severe in warm, moist climates. These are the so-called ‘tropical ulcers’ which are still common in Tonga.
Yaws, not the tropical fungus infection, could result in the loss of the cartilage of the nose that Mariner observed.
Another possibility is leprosy. This disease is caused by a micro-organism of the same genus as tuberculosis. There is some doubt that leprosy occurred in the Polynesian islands prior to the beginning of contact with Europeans and Orientals. The disease has now spread to many of the islands.
Almost certainly syphilis, measles, smallpox, and a host of other infections disease did not exist in Polynesia until they were brought there by the crews of European ships.
It must be also mentioned at the same time, that the natives are subject to gonorrheal discharges, attended with painful urination. The circumstances appear very equivocal; but I have every reason to believe that the venereal disease did not exist under any form, either at the Ha’apai islands or Vava’u, during the time that I was there; although, to my certain knowledge, three of the survivors of the Port au Prince’s crew had gonorrheas at the time the ship was taken, one of whom had brought it from England, and the other two had contracted it at the Hawai’i Islands. Several others of the ship’s company had also venereal affections; but they fell in the general massacre on board. In the first place I must observe, in respect to those labouring under the diseases called kahi and pala, that the complaints are either not venereal, or that the venereal disease subsides in them, and the constitution cures itself spontaneously. 2dly, That the organs of generation are never affected previously to the more general disease coming on. 3dly, That these diseases are not known to be, or believed to be contracted by sexual intercourse. 4thly, That though these diseases in some constitutions produce fatal consequences, yet very frequently the appetite and strength, and fulness of flesh, remain much the same as if no disease existed, though this happens in pala more than in kahi. In respect to the gonorrhea to which they are subject, they are for the most part very mild in their symptoms, and get well in a few days; besides which, they are not capable of being communicated between the sexes, or at least this is not known or believed to be the case. In regard to the three men of the Port au Prince’s crew, they got well without exactly knowing when or how. The consternation occasioned by the capture of the ship and the destruction of their countrymen, and the alarm and state of anxiety in which they were for at least two or three days, had produced such a change in the constitution, or at least in the disease, that it had actually got well before they were aware of it. I inquired among some of the oldest men if they had ever seen or heard of such a disease as syphilis or venereal gonorrhea (describing the general character of it, and how it was communicated), and learned that a woman, a native of one of the Ha’apai islands, having had connexion with one of the men belonging to a French ship, became on fire (as they expressed it), and died afterwards in a very bad state. This was all that I learned respecting what might reasonably be supposed to be true syphilis.
The French ship the Tongan people spoke of must have been the expedition of D’Entrecasteaux. in 1793. Captain Cook tried to take measures to prevent the infection of the islanders with venereal disease, but admitted that he was not successful. There may have been many women who “were of fire” (feverish) in addition to the woman the chiefs told Mariner about.
Pala frequently gets well spontaneously. The remedies commonly used are scarification of the ulcered surface, powder of turmeric sprinkled over it, and sometimes a bitter vegetable juice dropped on it.
They have among them another kind of ulcerous disease, which they call tona, very distinct from the two last described, children being for the most part subject to it; and it is one of those diseases which only occur once during a person’s life. The patient is first seized with general languor and debility, attended with loss of appetite. In a few days an eruption appears in different parts of the body, but particularly in the corners of the mouth, axillae, groins, parts of generation, and anus; the pustules at first are exceedingly small, but at length increase to about half an inch in diameter; fungous excrescences grow out of them, exhibiting a granulated surface, and discharging a viscous fluid, which concretes round the edges. These pustules come also upon the soles of the feet, and increase to a considerable size, giving very great pain. I was not acquainted with the state of the pulse, etc. The disease generally lasts several months, and sometimes a couple of years. From the symptoms thus far described, there is not much doubt about its resemblance to what is called the yaws. The remedies they use for it are a certain bitter juice dropped into the ulcers, and rubbing off the fungous excrescences with coconut husk dipped in sea-water.
“Tona” is the modern Tongan term for the disease of yaws. With the advent of antibiotics the disease has been eliminated from Tonga.
They are subject also to a pustulous eruption, chiefly confined to the feet, but which sometimes affects the hands. It usually appears between the toes, and has in its external character a strong resemblance to psoriasis, and itches very much. It appears in the form of small pustules with whitish heads, which, when rubbed off, generally discharge a watery fluid. It is supposed to arise from walking in clayey places without the opportunity of washing the feet afterwards. It is not thought to be contagious; it usually lasts about four or five days. The name they give it is ngou’a. They use no remedy.
They are also subject to a disease called fua [the Tongan term for elephantiasis]. If I describe the symptoms of elephantiasis, I shall have related with tolerable accuracy the history of this disorder. Labillardiere notices the disease, and calls it elephantiasis. They use no remedy for it.
Messieur Labillardiere was on the voyage with Captain D’Entrcasteaux. The fact that enlargement of the scrotum, loho-fua, in some cases, and the legs, ve’e-fua, in others, was due to the same infection was apparently understood by the Polynesian but not by Mariner. After the filaria parasite enters the body, elephantoid enlargements result from a complicated series of body reactions to the invading worm. Enlargements occur only after a long term infection by the parasite.
The disease called momoko [literally, cold. The word appears to refer to the chills caused by the fever of the disease.] usually lasts from four to seven months. In the latter stages it somewhat resembles tuberculosis. It comes on with occasional chilliness, loss of appetite, lowness of spirits, wasting of the flesh. Shortly succeed swellings in the groin and axillae; general debility, paleness of the lips. As the disease advances the patient stoops very much; experiences pains in the chest, and across the shoulders. Sometimes, but not often, a cough, and expectoration now supervene; the debility and emaciation become extreme, and death relieves the patient from his sufferings. These are all the symptoms which I can speak of with certainty. They use no physical remedies.
Feke-feke appears to be a sort of mild irregular intermittent illness. The paroxysm usually lasts from two to eight hours, and consists of a cold and a hot stage; but is seldom succeeded by perspiration. The returns of the paroxysm are very uncertain; sometimes two, at other times three, four, five or more days intervene. The patient is sometimes perfectly well for a month, and then his disorder returns.
The disease Mariner calls “feke-feke” has symptoms that are characteristic of filarial fever. Periodically, persons infected with the filaria develope attacks of chills, fever, painful extremities, and general malaise. The periodic febrile illness of malaria did not, and does not, exist in Polynesia. A more sever febrile illness, Dengue fever, has been known to spread through the Polynesian islands; but there is no evidence that it existed there before the nineteenth century. The fact that Dengue fever did not appear to be present in Tonga during Mariner’s time gives support to the notion that this mosquito-born disease reached the islands at a later date.
In regard to diseases properly belonging to females, I have very little to communicate. The women are in general tolerably healthy. During the menstrual period they anoint themselves all over with a mixture of oil and turmeric, to avoid catching cold; and they do the same after lying in, on which occasions women always assist, to the perfect exclusion of the other sex. Respecting the circumstances of birth, and the separation of the child, these things are kept a profound secret from the men. The men also occasionally use this mixture of turmeric and oil in time of war, when the weather is wet, to prevent them from feeling chilly, for at that time they have scarcely any dress. On similar occasions I anointed myself all over with it, and found it to have the desired effect.