- Alternative Names
- Scrub Typhus
Solomon Islanders lifestyles were active, through garden work, hunting and fishing; most people were physically fit and obesity was rare. Solomon Islanders lived in isolated communities with little contact between islands and none with the world beyond. They were what epidemiologists call a 'virgin soil community', not exposed to many of the diseases of the major continents. (Scragg 1977) The people always suffered from endemic diseases such as malaria and yaws, hookworm, tuberculosis and dysentery, and 150 years of contact with the outside world has brought many newer ones. Recently introduced varieties of tuberculosis and dysentery have probably cloaked similar indigenous diseases. Influenza and polio epidemics have caused periodic disasters, often contained within particular regions. Malaria, spread by Anopheles mosquitoes, remains widespread and causes a heavy death rate among infants and children. The BSIP Annual Report for 1931 (p. 7) recorded, 'It may be truthfully said that no permanent resident European, Asiatic, or native escapes infection. The mortality resulting from the disease is serious especially among native children'. Tuberculosis was also a serious cause of mortality and pneumonia was the largest killer of plantation labourers. Yaws was a common disease, and on islands like Malaita and Makira the infection rate was in the vicinity of 60 percent in the 1920s. Yaws eradication campaigns began in the 1920s, but were not fully successful until the 1950s and 1960s. Both malaria and yaws were less common at higher altitudes. Malaria and yaws adversely affect the fertility of women. In the past up to 40 percent of babies died from malaria, and ravages from frightful yaws sores were common. Hookworm, like malaria, caused anaemia, and could be fatal when combined with other diseases. There were also many pulmonary diseases and parasitic skin diseases, filariasis, opthalmia, elephantiasis and disorders of the lymphatic system. Those that survived into adulthood developed some immunity, and although a few people survived into old age most adults died in their thirties or forties. Poliomyelitis epidemics occurred in the late 1920s and the 1950s.
As already noted, Solomon Islanders' immune systems before European arrival operated in an isolated environment. Since the number of people on any one island or location was small, introduced epidemic diseases never had a large enough base population to multiply and spread over an extended period. Limited incubation periods also meant that sailors carrying epidemic diseases had often passed their infectious stages before they reached the islands. Although new indigenous migrations through the islands probably introduced new diseases, we know nothing of these. The Mendaña expedition in 1568 may have introduced disease epidemics, but probably just strains of the common cold. (Coppet 1977) The whalers, traders, missionaries and labour recruiters inadvertently brought new diseases such as tuberculosis, measles, mumps and chicken pox. Although they created a level of immunity, they caused steady decline in Solomon Islands populations during the second half of the nineteenth century, though rarely at the massive levels seen in some other Pacific populations, where up to 90 percent of people died.
It is impossible to know exactly how many Solomon Islanders died from introduced diseases, but there is every reason to suppose that the populations of most islands declined at least 50 percent from 1850-1950, and in some places the figure may have been higher. People were exposed to new diseases through contacts in the labour trade (q.v.) (mainly to Queensland and Fiji) and the Anglican Melanesian Mission's movement of students to New Zealand and Norfolk Island, and those returning home sometimes brought sickness. After the Protectorate administration was established in 1896 ships arriving from overseas had to call at the government headquarters at Gavutu-Tulagi and were quarantined if there were epidemic diseases aboard. Outbreaks of measles and smallpox coming from German New Guinea were moderated in this way in 1897-1898, although local people still moved freely across the British/German border between the Shortlands and Bougainville. C. M. Woodford's initial appointment was related to controlling the spread of these diseases. (Boutillier 1974, 4) Nonetheless, medical services (q.v.) were slow to develop and over the coming decades remained a combination of government and especially mission-sponsored hospitals and clinics.
The most prevalent type of dysentery was bacillary, not amoebic. Charles Fox (1958, 153) credited a dysentery epidemic in 1848 (before mission or labour trade influences) with significantly decreasing the population of the Solomon Islands. A dysentery epidemic between February and May of 1898 affected several Nggela villages and the Melanesian Mission at Siota; forty-seven out of sixty-seven people at the station were sick and eleven died, mostly young boys. Widespread epidemics in 1913 and 1915 may have killed 10 percent of the Protectorate population. Outbreaks on plantations caused mortality rates as high as 5 percent in 1915, and from the mid-1910s through the 1920s the rate averaged between 2 and 3 percent. On Makira it is thought that one-third of the population died; in some areas whole villages were left empty. In 1928 an epidemic occurred in Tulagi's jail that killed 10 percent of prisoners from Sinalagu, Malaita (arrested for the massacre of the William Bell (q.v.) party, though most of the prisoners were innocent). The 1931 Protectorate Annual Report (p. 7) judged this form of dysentery to be endemic.
Measles came into the Protectorate via the labour trade-from Queensland and Fiji in the mid-1870s-and killed large numbers of people. Exactly how many died is difficult to calculate, but when measles was introduced into Fiji in the 1870s the disease killed one-quarter of the population. (Cliff and Haggett 1985) Other measles epidemics were less severe and many probably went unreported. For instance, in 1900 a mild epidemic was spread by labourers who had returned from Queensland. (AR 1899-1900, 5) Measles was reintroduced in 1914-1915 and in 1927-1928, although the latter outbreak was very mild and had entirely disappeared by early 1929. (AR 1927, 10; Shanks, Lee, Howard and Brundage 2011)
Chickenpox occasionally appeared in epidemic form. (AR 1932, 5)
Influenza epidemics spread through the islands during 1886, 1902 and 1924. A 1966 flu sickened one-quarter of Honiara's people. The 1918-1919 worldwide influenza pandemic reached the Solomons but had little effect because the authorities halted labour recruiting to plantations. (Shanks, Lee, Howard and Brundage 2011)
Poliomyelitis is a paralysing disease of the nervous system caused by a virus infection. There was no cure until Dr Salk at the University of Pittsburgh developed a vaccine, a version of which became widely available in 1963. There was an outbreak in 1928 and in May and June of 1929 in several places in the Protectorate. It struck first in three places, almost simultaneously: Su'u on Malaita, Savo, and in Marovo Lagoon of New Georgia. In June more cases were discovered, one in Tulagi gaol and two among labourers on Guadalcanal plantations. In all, 276 cases were reported and sixty-three people died in the outbreak. Authorities never established why it did not afflict more, although it was thought that plantation, mission and government-imposed travel restrictions probably limited its spread. No labour recruitment or return of time-expired labourers was allowed from June to 9 September. (AR 1929, 4, AR 1932, 5)
Another polio epidemic began in Honiara, on Malaita and at Hobu Hobu in the Western Solomons in November and December of 1947. The origin was unknown and puzzling, as it often occurred in isolated areas. Almost eighty cases were recorded by January 1948. A second outbreak in mid-1951 afflicted three hundred people and several died. (Fox 1958, 79; PIM Dec. 1948, June 1951, July 1951)
Yaws is a chronic disease of the tropics, contagious and debilitating, with disfiguring ulcer-like symptoms. It was widespread in the Solomon Islands. Often nearly everyone in a village suffered from yaws. Small children would develop a rash covering their whole body and then lumps would start to erupt. The head around the nose and mouth would become affected, and the body generally. Flies would swarm around the eruptions and the appearance was repulsive. It was almost a stage of growing up and parents accepted the disease. It usually passed and in about half the cases the skin would clear up again. In other cases, though the body healed, one sore would remain, almost always on the lower limbs, and gradually grew. Sometimes it would go on for years until part of the victim's foot had been eaten away, or there would be a large ulcer on the calf. The smell was terrible and when one entered a village the smell from sores often pervaded the air.
Yaws can be cured with two injections of long-acting penicillin, a drug not available until the 1940s. On Malaita and Makira in the 1920s, the infection rate was 60 to 65 percent, and up to 90 percent among coastal people. The disease produces a heavy sickness rate and high infant mortality. Intravenous and intramuscular injections of neo-arsphenamine were begun in the late 1920s, aided substantially by the Rockefeller Foundation Campaign on Malaita, when tens of thousands of injections were issued. The director of the 1928-1931 campaign was Dr S. M. Lambert, with Dr Menzies in charge of one unit and Gordon White, assistant to Dr Hetherington, in charge of the other unit. Each European had two Islander assistants and a medical dresser. Native Medical Practitioners, missionaries and members of the Foundation's medical team all gave injections throughout the Protectorate and brought huge relief from the debilitating disease. During 1930, for instance, the Rockefeller Assisted Medical Campaign gave 32,702 injections to 18,704 Solomon Islanders for yaws and treated 12,904 cases of hookworm. In 1932, 21,628 injections were given for yaws. The missions also participated in the campaign: in 1929 the Methodist Mission gave 1,748 injections in the Gizo district and the Anglican Melanesian Mission gave 696 injections at Fuambu on Malaita. Individuals travelled long distances to get the 'nila' (needle). (AR 1930, 13-14, AR 1931, 6; Boutilier 1974, 28) However, the drugs used were not totally effective and the 1920s-1930s effort was partly wasted. Penicillin made the real difference.
When the World Health Organisation Yaws Campaign in the BSIP began in June 1956, 14.7 percent of the population still suffered from active yaws. Thirty thousand Solomon Islanders were surveyed and treated with penicillin injections during the first six months. The team leaders were Assistant Medical Practitioners Enele Karuru, Zevanaia, John Kilatu (q.v.), David Dawea-Taukalo (q.v.), R. Tozaka and Gideon Zoleveke (q.v.) Working initially on Small Malaita, Malaita, Choiseul, Shortlands and Vella Lavella, almost one-third of the inhabitants of the Protectorate had been surveyed by early 1957. The team moved to Nggela, Guadalcanal and Rennell and Bellona later that year, and during 1958 continued work in Guadalcanal and on other islands. In 1959-1960, 20,296 people were re-surveyed on fifteen islands, and only twenty-eight cases of yaws were found, but others were thought to still exist in isolated inland areas. The re-survey of Malaita in 1963 showed that the incidence of the disease was 0.17 percent, and overall yaws had been almost completely eliminated from the Protectorate, although there was a new outbreak in Honiara squatter settlements in late 1970, the disease having been reintroduced from Malaita. (Crichlow 1929; PIM June 1956; NS Jan. 1957, Sept. 1957, Jan. 1958, Apr. 1960, Feb. 1961, 31 Aug. 1963, 15 Jan. 1971; AR 1929, 11)
Leprosy has occurred all over the world since ancient times. It is a disease of the peripheral nerves caused by the bacillus Mycobacterium leprae, which in many ways resembles the organism of tuberculosis. There are two main types of leprosy: nodular or lepromatous, and neural or tuberculoid. Leprosy is also known as Hansen's disease. After attacks of fever, areas of the body, particularly the face, harden and become insensitive to touch, ulcers occur and finally gangrene of the toes and fingers appears. It was a widespread disease in the Solomon Islands and almost all languages have a name for the disease. It was most prevalent on Guadalcanal and Malaita.
Leprosy was originally treated with oil from the Chaulmoogra tree (Hydnocarpus laurifolia) found in India, but the oil caused nausea and had little therapeutic value. In the early twentieth century the oil was administered by intramuscular and subcutaneous injection, which was painful and had debilitating side effects. In the 1940s, sulphone drugs became available to treat leprosy. One of them, dapsone, gives the best results and doses are administered over a number of years, although the scaring is permanent. More recently, anti-bacterial sulphonamides, followed by the Rifamycin group of antibiotics, has made leprosy relatively easy to treat.
Protectorate officials were always aware that leprosy existed, but treatment was rudimentary. The first confirmed diagnosis came in 1922 and the government began moves to combat the disease, drawing on funds provided by the British Empire Leprosy Association. (Boutilier 1974, 31) In 1929, for instance, thirty-four patients were treated, in 1931 there were sixty known sufferers in the Protectorate and the disease was thought to be increasing. By 1932, seventy-five patients were undergoing treatment in colonies and another fifty were out-patients. (AR 1932, 6) The Melanesian Mission maintained Kwaiba'ita colony near their Fauabu hospital on Malaita and the Methodist Mission maintained another in the Gizo District, both subsidized by the government. Tulagi Hospital also had an isolation ward for patients. Leprosy sufferers were not compelled to accept segregation and treatment and infectious cases frequently refused treatment and remain foci of infection in villages. Some patients could not understand why yaws could be cured with two injections while their leprosy was longer-term and not similarly reversible.
In 1937, Government Medical Officer Dr Nathaniel Crichlow (q.v.) conducted a survey of leprosy on Malaita that suggested there was an incidence of about one percent. Treatment would have cost £15,000 per annum at a time when the entire medical budget for the Protectorate was £15,000. Dr Ross Innes from Brisbane was seconded to the Protectorate staff in 1937-1938, paid for by the British Empire Leprosy Association, to complete a larger survey. There were however no funds to implement his suggestions. (Boutilier 1974, 32-33; Crichlow 1929; Fox 1958, 34, 153; NS 8 July 1966; SCL 18 July 1898, 9, 15 Jan. 1899, 2 Mar. 1902, 44; Bennett 1987, 175; AR 1927, 10, AR 1929, 4)
In 1949, it was estimated that 1 percent of Solomon Islanders suffered from leprosy, but there had been little attempt at treatment, except by the missions. During the 1950s and 1960s, the Protectorate Government and the New Zealand Leper Trust Board provided a constant source of funds to eradicate leprosy in the Protectorate. In 1949, the government used a £60,000 grant to establish as a Leprosarium the eight thousand acre Tetere plantation forty-eight kilometres from Honiara, previously owned by Burns Philp Ltd. (PIM Apr. 1949) It initially had fifty patients and was staffed by a government supervisor and two Catholic nuns. By 1961, £22,000 had been donated to the missions and to Tetere Leprosarium, with an additional £16,500 given for the upkeep of the Leprosy Relief vessels purchased by the Catholic, Methodist and Melanesian missions.
The Malaita Council built a village for leprosy patients at Ombafou, which inspired other Councils to do the same, and in 1958 similar villages had been established on Guadalcanal, Isabel and Nggela. (AR 1957-1958, 36) The number of new leprosy cases in the Protectorate continued to decline, from 144 in 1964 to 58 in 1968, to 26 in 1974. In 1969 613 were still known to be afflicted. BSIP Medical Officer Dr Roger Webber reported that in the 1960s there were isolated villages in central Guadalcanal where 'everybody either had leprosy or were the children or helpers of people who had' (Webber 2011, 204; NS Apr. 1961, 31 Mar. 1969, 30 Sept. 1972; AR 1929, 11, AR 1931, 6, AR 1967, 53, AR 1969, 55, AR 1974, 78)
Hookworm was as common as yaws, and so prevalent as to be expected everywhere. The same early teams that worked to eradicate yaws also treated people widely for hookworm, giving them tablets.
Whooping cough was introduced from Australia during the late 1920s. (AR 1930, 13)
Gonorrhoea was common, but syphilis was not, probably because of a natural immunity provided by yaws. (Pirie 1972)
Malaria is transmitted to humans through the bite of female mosquitoes carrying the malarial parasite. The parasite is always transmitted by mosquitoes of the genus Anopheles, which generally feeds at night. The parasite is deposited into the human blood stream and then makes its way to the liver where it takes up residence and multiplies into approximately forty thousand new parasites within just five days. The parasites travel back through the bloodstream releasing toxins that cause high fever, chills and sweats. Once bitten, it only takes about two weeks for the first attack to take place. Because the parasites reside in the liver, the disease may recur months and even years after a person is first infected. Humans suffering malaria are debilitated and require rest. The main and mildest form is that caused by the Plasmodium vivax parasite. The second and most dangerous form endemic in the Solomon Islands, malignant tertian malaria, is caused by the Plasmodium falciparum parasite, which often blocks blood vessels leading to the brain, and frequently produces coma, delirium and, if left untreated, death.
The main drug used against malaria in the past was quinine, made from the bark of the cinchona tree. It remained the drug of choice until the 1940s. One of the standard, easily available sources of quinine was bitter tonic water, which contains very low levels. During the 1930s, Atabrine, synthesized quinine, the common trade name for the malaria drug quinicrine, became available, and it was used by troops during the Second World War. A visible side effect was that it turned human skin and urine a bright yellow, roughly the colour of a ripe lemon. Some troops believed that Atabrine made them impotent, which, combined with the alarming colour, led many to try to avoid taking their allocated tablets. Other side effects varied in intensity from mild to debilitating, depending on the individual: headaches, nausea, vomiting, abdominal cramping and dizziness and skin rashes. Those who were strongly allergic to Atabrine took quinine. (Cline and Michel 2002) Solomon Islanders seldom had access to such drugs and had to suffer from malaria's effects, moderated only by their own techniques of coping with fevers and the use of smoke to chase away mosquitoes.
Malaria was found everywhere except on some of the outlying islands, though it was not transmitted at the higher altitudes of the biggest islands. It probably acted as a population inhibitor and shaped some settlement patterns. (Groube 1993; Parsonson 1966) Malaria remained the principal health problem in the Protectorate until the 1950s. In 1960, with the assistance of a World Health Organisation adviser, chemical spraying eradication campaigns were begun. (AR 1959-1960, 39) The Malaria Eradication Pilot Project commenced in 1961, designed to determine whether the interruption of malaria transmission was technically, as opposed to administratively, feasible. The Project was trialed on Guadalcanal and the New Georgia area. The method used was to spray a residual insecticide on the interiors of all human-use houses in an area, at six-monthly intervals. The result was a dramatic fall in the incidence of malignant tertian malaria, and on several islands there were no malarial infections in babies and infants born after the spraying campaign. Local study showed that, of the world's malaria parasites, the Solomons strain of P. vivax was probably the most resistant to then available drugs. It required no less than a twelve-week course of treatment to achieve eradication in 100 percent of those infected. To administer treatment required an extensive network of voluntary aid posts to diagnose infections and administer the anti-malarial treatment. (AR 1963-1964, 49)
A pilot malaria eradication programme, sponsored by the World Health Organisation and the BSIP Government began on New Georgia in July and on Guadalcanal in September 1962, and then moved to Savo and Ontong Java Atoll. In 1963, spraying began in Western Solomons and was scheduled to begin on Malaita in 1966. After the first spraying, the incidence of malaria fell from 30 percent to about 11 percent, with results better for the elimination of Plasmodium falciparum than for Plasmodium vivax. By mid-1966, 28 percent of the population were covered by the spraying operations. (NS Feb. 1962, June 1962, 31 Aug. 1962, 15 Jan. 1963, 31 Mar. 1963, 31 July 1963, 31 Oct. 1963, 7 May 1966) The pilot eradication programme ended in 1964 and the transmission of malaria had been greatly reduced.
A new government and World Health Organisation programme began in 1965 and ran till 1969. Twice-yearly spraying programmes were carried out in the original project areas, Guadalcanal, Savo, the New Georgia Islands, and the Shortlands, with an extension planned for Choiseul, Rennell and Bellona, Isabel and Ontong Java. A full pre-eradication programme was planned to begin in 1970. (AR 1966, 46, AR 1967, 52) By the end of 1971 DDT spraying operations had been extended to the areas of 140,000 people in Central, Western and Malaita districts. Spraying was to be extended to Eastern District early in 1972, which was expected to cover another 15,500 people. Only Bellona, Tikopia, Anuta and the Reef Islands were excluded, since the vector mosquito Anophelels farauti was not present there. The overall result was a dramatic reduction in the total number of malaria cases. Rennell Island and the 'high bush' areas on Malaita were also excluded due to the rapid disappearance of the vector. (AR 1971, 65) In the 1970s, the highest rates of malaria were in Central and Malaita districts, with Central having the most reported cases, mainly from the Guadalcanal Plains. In 1974, spraying had been stopped in the New Georgia Islands, the first part of the Solomons to move from spraying to surveillance. In other areas dwellings continued to be sprayed with DDT residual insecticide at a rate of two grams per square metre once every six months, or in the areas of highest infection every four months. (AR 1974, 75)
Tuberculosis was the second major public health problem after malaria. Tuberculosis is a common and often lethal infectious disease caused by various strains of Mycobacteria. It usually attacks the lungs first and can affect other parts of the body. It is spread through the air when people with an active Mycobacterium tuberculosis infection cough or sneeze. Treatment is difficult and requires a long course of antibiotics. The antiquity of tuberculous in the Solomon Islands is not known. It was certainly spread through the external nineteenth-century labour trade and the internal labour trade of the twentieth century, and by movement of mission personnel through the islands. (Wigley 1977)
Authorities began to develop control programmes in the 1950s. In 1954, a Fijian Assistant Medical Practitioner experienced in tuberculosis work arrived and began a survey in the Western Solomons. At Roviana, 3,634 persons were tested, with 1,811 found to be positive, and the majority of the negative reactors were inoculated with B.C.G. vaccine. (AR 1953-1954, 29) In 1960, the government estimated that 3 percent of the population suffered from an active form of the disease. No attempts had been made to search for cases, but intensive treatment was given to patients who presented themselves to hospitals. Extended use of out-patient treatment worked well to curb the disease. (AR 1959-1960, 41) Efforts to combat it were based on mass B.C.G. vaccination, particularly among the young and those in contact with known cases. An effective triple-drug course of standard treatment was administered to everyone found to have the disease, with close supervision and follow-up at the Central Tuberculosis Registry in Honiara. However, the concentration of resources on treatment of malaria meant that treatment of TB was slow. (AR 1963-1964, 50) During 1965, there were 1,163 notifications compared with 1,156 the previous year. The number of new cases notified continued to decline markedly: 1966 (516 cases), 1969 (378) cases, 1971 (366 cases), 1974 (305 cases). The decrease was seen to be the result of the extension of domiciliary treatments through improving Rural Health Clinics and increasing public awareness of the effectiveness of the programme. The infection rate remained higher in Eastern and Malaita districts. (AR 1966, 46, AR 1967, 53, AR 1969, 54, AR 1974, 78)
New Cases by Presumed District of Origin of Infection
(Rate per one thousand estimated population)
|Central||122 (2.3)||118 (2.6)||80 (1.7)||93 (1.6)||117 (1.8)||101 (1.4)|
|Eastern||63 (3.0)||44 (2.0)||65 (3.0)||55 (2.5)||58 (2)||33 (1.4)|
|Malaita||157 (3.1)||136 (2.7)||191 (3.7)||150 (2.9)||112 (2.0)||142 (2.5)|
|Western||36 (1.2)||36 (1.2)||30 (1.0)||43 (1.3)||36 (1.0)||29 (0.8)|
Vaccines: After the poliomyelitis outbreaks in the late 1950s the government imported Salk vaccine from Australia and vaccinated several thousand people. In 1959-1960 the government introduced some protective immunization of all children under age five with a Canadian quadruple vaccine against polio, whooping cough, diphtheria and tetanus.
Scrub Typhus (Tsutsugamushi, camp, ship or Jayl fever), known locally as Inelua fever, is found only on Santa Cruz Island. Epidemic typhus is caused by a microscopic organism called a rickettsia, spread by a body louse. A new type of typhus usually found in tropical areas was spread by the Trombiculid mite. There was no effective treatment until the use of tetracycline began in 1952. (Webber 2011, 249; NS Dec. 1967)
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- Kwaibaita leper colony near Fauabu hospital, Malaita
- The effect of yaws on a baby
- The effect of yaws on a woman
- Treatment at Kwaibaita leper colony near Fauabu hospital, Malaita