PRESENT PREVAILING DISEASESThe average temperature of the inhabited part of the island, which can not be less than 78 to 80 degrees Fahrenheit, has a relaxing influence on the natives and much more so on the small contingent of whites. The Europeans and Americans find it necessary every three to five years to seek for a few months a cooler climate to restore their energies and vigor. The government officials and officers of the small garrison are not obliged to serve for more than the same time consecutively, when they are relieved from their posts and commands. It is this relaxation which, to a certain extent, at least, is responsible for the great mortality of comparatively mild, acute, infectious diseases, and the severity of pulmonary tuberculosis among the natives. Tuberculosis of the lymphatic glands, skin, bones and joints appears to be extremely rare. The moisture-laden atmosphere and the suddenness with which the cool land and ocean breezes set in after the heat of the day, are conducive to the development of rheumatic affections, which are prevalent in all parts of the island, more especially during the rainy season in midwinter. The same can be said of bronchial affections and pneumonia. The free and unrestrained intercourse among natives accounts for the rapid spread of tuberculosis and acute infectious diseases among the entire population and from island to island.The sanitary commission now engaged, in efforts to reduce the mortality of the natives will establish rules and regulations which will have for their object the prevention of dissemination of acute as well as chronic infectious diseases, and will undoubtedly accomplish much toward the preservation of the race; but these officers will meet with stubborn opposition on the part of the natives when attempts are made, in their interest, to curtail their personal liberties. The ties of relationship and friendship among the natives are very strong, and become most apparent in case of misfortunes and sickness. Smallpox breaks out almost every year, and claims its share of victims. Vaccination is supposed to be compulsory, but the natives are inclined to escape it. Vaccination is done gratuitously at the Military Hospital for all natives who can be induced to submit to it. Under present conditions it is almost impossible to reach the inhabitants of the small atoll islands.Like in all tropic countries, tetanus is of quite frequent occurrence. The small native pony is found everywhere, and as the rural natives are all barefooted and spend much of their time in the jungles in impregnating the flower of the vanilla-bean and gathering fruits, wounds prone to infection with the tetanus bacillus are of frequent occurrence.Malarial diseases are comparatively rare, although the plasmodium-carrying mosquitoes are numerous and aggressive, and children in the country districts are nude, and the men limit their clothing to the wearing of a loin-cloth. No case of typhoid fever has been known to have originated in the island. For this there exists a satisfactory explanation. The exemption in this island from this disease, so widely distributed over the entire part of the inhabited globe, is due entirely to an abundant supply of the purest drinking water supplied by the numerous mountain streams. Nearly all the inhabitants live on the coast, near the outlet of a brook or stream, where, consequently, there is no danger whatever of water-contamination. I found three cases of typhoid fever in the Military Hospital, members of one family, who had been brought there from one of the neighboring atoll islands.Varicose veins, varicocele and hydrocele are very common. The absence of anything like a large ulcer in many cases of large and numerous varicose veins of the leg, I attributed to the toughness of the skin of the bare legs. Venereal diseases are widespread throughout the entire island, and more especially in Papeete and the near-by larger villages. For over a hundred years the natives have suffered from this scourge brought there by the European sailors and adventurers. Syphilis has been transmitted from generation to generation until it has contaminated the major part of the population, forThe gods visit the sins of the fathers upon the children.EURIPIDES.andThe wickedness of a few brings calamity on all.PUBLIUS SYRUS.The length of time the disease has existed among the natives has established a certain degree of tolerance or immunity, as it pursues a comparatively mild course, as I found very few instances of the ravages of the remote results of syphilis. I saw only one case of saddle nose, caused by tertiary syphilis.Leprosy is not as prevalent as in the Hawaiian Islands, but isolated cases are found in nearly all the islands belonging to this group, being more prevalent in some than in others. Segregation has never been attempted. The lepers mix freely with the members of their families and neighbors, and are not shunned by any one. I was informed that many of the lepers, much disfigured by the disease, seek an island where many of these unfortunates have founded a colony for the purpose of escaping from public gaze. There, away from relatives and friends, they spend their short span of life and await patiently the final relief which only death can bring.O Death, the Healer, scorn thou not, I pray. To come to me; of cureless ills thou art The one physician. Pain lays not its touch upon a corpse.ÆSCHYLUS.Elephantiasis in its worst forms has taken a firm hold on the natives, especially the inhabitants of the near-by island of Moorea. There this disease can be studied in all its stages, from a slight enlargement of one of the extremities to colossal swellings, which, when the upper and lower extremities are affected at the same time, make it necessary for the patient to crawl on his hands and feet in dragging himself from place to place. Regarding elephantiasis as it exists in Tahiti and the other islands of the French colony, I will make use of a few extracts taken from a valuable paper on this subject by Dr. Lemoine, recently in charge of the Military Hospital, and published in one of the government reports. According to this author, who has seen much of this disease in Tahiti and surrounding islands, it may affect most regions of the body, and not infrequently makes its appearance as an acute affection with all the symptoms characteristic of lymphangitis, including quite a violent continued remittent form of fever, which lasts two or three months. The acute form is, almost without exception, complicated by synovitis of the joints of the affected limb, which he regards as almost pathognomonic of the disease, differentiating it from ordinary forms of lymphangitis. After the subsidence of the acute symptoms and in the chronic form the disease is essentially a chronic lymphangitits, accompanied by marked enlargement of the veins. According to his observations the regions most frequently involved are the lower extremities, external genitals, and lastly, the hands and forearms. Three years ago I was given an opportunity to see at the hospital and poorhouse at Antigua, West Indies, ninety cases of elephantiasis, and not in a single one of them did the disease affect the upper extremity, while in the French colony of the South Seas this is not infrequently the case. I do not know that a satisfactory explanation has ever been given why the disease should behave so differently in fixing its location in the two groups of islands. Lemoine, as well as other writers on elephantiasis, has seen the disease become stationary by the removal of the patient to a colder climate. Europeans become susceptible to elephantiatic infection after a prolonged residence in tropical countries where the disease prevails.Lemoine does not agree with Manson, who believes that elephantiasis is caused by theFilaria sanguinis, and is suspicious that the essential parasitic cause is a yet undiscovered microbe. He made blood examinations night and day of patients under his care, and was unable to constantly detect the filariæ in their embryonic state in the peripheral blood, and consequently claims that the presence of filaria in the organism is not an infallible diagnostic indication, and that their abundance is not proportionate to the intensity of the disease. The fact that the elephantiatics improve in colder climates he regards as another proof that filariasis is not the essential cause of the disease.TAHITIAN CHILDRENGROUP OF TAHITIAN CHILDRENIn a number of cases extirpation of the infiltrated enlarged lymphatic glands was followed by decided improvement, and in the case of a Tahitian the improvement remained at the end of three years. He has also operated on a number of cases by partial excision of the mass, first on one side of the limb, then on the other, with decided benefit to the patient in most of them. In some cases deep incisions through the entire thickness of the indurated mass afforded relief and resulted in diminution of the size of the swelling. He relates the details of the case of a native, fifty years old, the subject of elephantiasis of the lower limbs, that he operated on in two stages several weeks apart, removing first a large section from the anterior and later from the posterior part of the swelling, and as shown by the accompanying illustrations in the report depicting the condition of the limbs before and after operation, with an excellent result. However, in some of the cases the benefit thus derived did not last for any considerable length of time.In making the excision, the superfluous skin is excised with the underlying indurated tissues, and the skin margins reflected for some distance in order to create sufficient room for a more liberal removal of the deep tissues. In one case, that of a woman thirty-eight years of age, the patient died two weeks after the second operation. Death was attributed to loss of blood and the debilitated condition of the patient when she entered the hospital. In another case, a Tahitian, thirty-five years old, affected with elephantiasis of all limbs and the external genitals, he operated successfully on one of the arms, the seat of an enormous swelling below the elbow. The excised mass weighed fifteen kilograms. Owing to the large size of the swelling, the operation proved one of great difficulty, and on account of the tension incident to the approximation of the margins of the flaps the sutures cut through and the wound ultimately healed by granulation. At the second operation nearly the entire mass was removed, with the result that the wound finally healed after a prolonged suppuration and the patient was relieved of the incumbrance caused by the great weight of the swelling. The relief afforded induced the patient to request additional operations for the removal of the swellings involving other regions of the body, but as the surgeon soon after left the island his desire could not be gratified.The climate of Tahiti is not congenial for pulmonary and rheumatic affections, as the atmosphere is too moist. It is admirably adapted for patients the subjects of nervous affections in all their protean forms. The quietude, balmy air and pleasing surroundings are the best therapeutic agents to secure mental rest and refreshing sleep. It is in the treatment of such affections that a trip to Tahiti can not be too strongly recommended.
PRESENT PREVAILING DISEASESThe average temperature of the inhabited part of the island, which can not be less than 78 to 80 degrees Fahrenheit, has a relaxing influence on the natives and much more so on the small contingent of whites. The Europeans and Americans find it necessary every three to five years to seek for a few months a cooler climate to restore their energies and vigor. The government officials and officers of the small garrison are not obliged to serve for more than the same time consecutively, when they are relieved from their posts and commands. It is this relaxation which, to a certain extent, at least, is responsible for the great mortality of comparatively mild, acute, infectious diseases, and the severity of pulmonary tuberculosis among the natives. Tuberculosis of the lymphatic glands, skin, bones and joints appears to be extremely rare. The moisture-laden atmosphere and the suddenness with which the cool land and ocean breezes set in after the heat of the day, are conducive to the development of rheumatic affections, which are prevalent in all parts of the island, more especially during the rainy season in midwinter. The same can be said of bronchial affections and pneumonia. The free and unrestrained intercourse among natives accounts for the rapid spread of tuberculosis and acute infectious diseases among the entire population and from island to island.The sanitary commission now engaged, in efforts to reduce the mortality of the natives will establish rules and regulations which will have for their object the prevention of dissemination of acute as well as chronic infectious diseases, and will undoubtedly accomplish much toward the preservation of the race; but these officers will meet with stubborn opposition on the part of the natives when attempts are made, in their interest, to curtail their personal liberties. The ties of relationship and friendship among the natives are very strong, and become most apparent in case of misfortunes and sickness. Smallpox breaks out almost every year, and claims its share of victims. Vaccination is supposed to be compulsory, but the natives are inclined to escape it. Vaccination is done gratuitously at the Military Hospital for all natives who can be induced to submit to it. Under present conditions it is almost impossible to reach the inhabitants of the small atoll islands.Like in all tropic countries, tetanus is of quite frequent occurrence. The small native pony is found everywhere, and as the rural natives are all barefooted and spend much of their time in the jungles in impregnating the flower of the vanilla-bean and gathering fruits, wounds prone to infection with the tetanus bacillus are of frequent occurrence.Malarial diseases are comparatively rare, although the plasmodium-carrying mosquitoes are numerous and aggressive, and children in the country districts are nude, and the men limit their clothing to the wearing of a loin-cloth. No case of typhoid fever has been known to have originated in the island. For this there exists a satisfactory explanation. The exemption in this island from this disease, so widely distributed over the entire part of the inhabited globe, is due entirely to an abundant supply of the purest drinking water supplied by the numerous mountain streams. Nearly all the inhabitants live on the coast, near the outlet of a brook or stream, where, consequently, there is no danger whatever of water-contamination. I found three cases of typhoid fever in the Military Hospital, members of one family, who had been brought there from one of the neighboring atoll islands.Varicose veins, varicocele and hydrocele are very common. The absence of anything like a large ulcer in many cases of large and numerous varicose veins of the leg, I attributed to the toughness of the skin of the bare legs. Venereal diseases are widespread throughout the entire island, and more especially in Papeete and the near-by larger villages. For over a hundred years the natives have suffered from this scourge brought there by the European sailors and adventurers. Syphilis has been transmitted from generation to generation until it has contaminated the major part of the population, forThe gods visit the sins of the fathers upon the children.EURIPIDES.andThe wickedness of a few brings calamity on all.PUBLIUS SYRUS.The length of time the disease has existed among the natives has established a certain degree of tolerance or immunity, as it pursues a comparatively mild course, as I found very few instances of the ravages of the remote results of syphilis. I saw only one case of saddle nose, caused by tertiary syphilis.Leprosy is not as prevalent as in the Hawaiian Islands, but isolated cases are found in nearly all the islands belonging to this group, being more prevalent in some than in others. Segregation has never been attempted. The lepers mix freely with the members of their families and neighbors, and are not shunned by any one. I was informed that many of the lepers, much disfigured by the disease, seek an island where many of these unfortunates have founded a colony for the purpose of escaping from public gaze. There, away from relatives and friends, they spend their short span of life and await patiently the final relief which only death can bring.O Death, the Healer, scorn thou not, I pray. To come to me; of cureless ills thou art The one physician. Pain lays not its touch upon a corpse.ÆSCHYLUS.Elephantiasis in its worst forms has taken a firm hold on the natives, especially the inhabitants of the near-by island of Moorea. There this disease can be studied in all its stages, from a slight enlargement of one of the extremities to colossal swellings, which, when the upper and lower extremities are affected at the same time, make it necessary for the patient to crawl on his hands and feet in dragging himself from place to place. Regarding elephantiasis as it exists in Tahiti and the other islands of the French colony, I will make use of a few extracts taken from a valuable paper on this subject by Dr. Lemoine, recently in charge of the Military Hospital, and published in one of the government reports. According to this author, who has seen much of this disease in Tahiti and surrounding islands, it may affect most regions of the body, and not infrequently makes its appearance as an acute affection with all the symptoms characteristic of lymphangitis, including quite a violent continued remittent form of fever, which lasts two or three months. The acute form is, almost without exception, complicated by synovitis of the joints of the affected limb, which he regards as almost pathognomonic of the disease, differentiating it from ordinary forms of lymphangitis. After the subsidence of the acute symptoms and in the chronic form the disease is essentially a chronic lymphangitits, accompanied by marked enlargement of the veins. According to his observations the regions most frequently involved are the lower extremities, external genitals, and lastly, the hands and forearms. Three years ago I was given an opportunity to see at the hospital and poorhouse at Antigua, West Indies, ninety cases of elephantiasis, and not in a single one of them did the disease affect the upper extremity, while in the French colony of the South Seas this is not infrequently the case. I do not know that a satisfactory explanation has ever been given why the disease should behave so differently in fixing its location in the two groups of islands. Lemoine, as well as other writers on elephantiasis, has seen the disease become stationary by the removal of the patient to a colder climate. Europeans become susceptible to elephantiatic infection after a prolonged residence in tropical countries where the disease prevails.Lemoine does not agree with Manson, who believes that elephantiasis is caused by theFilaria sanguinis, and is suspicious that the essential parasitic cause is a yet undiscovered microbe. He made blood examinations night and day of patients under his care, and was unable to constantly detect the filariæ in their embryonic state in the peripheral blood, and consequently claims that the presence of filaria in the organism is not an infallible diagnostic indication, and that their abundance is not proportionate to the intensity of the disease. The fact that the elephantiatics improve in colder climates he regards as another proof that filariasis is not the essential cause of the disease.TAHITIAN CHILDRENGROUP OF TAHITIAN CHILDRENIn a number of cases extirpation of the infiltrated enlarged lymphatic glands was followed by decided improvement, and in the case of a Tahitian the improvement remained at the end of three years. He has also operated on a number of cases by partial excision of the mass, first on one side of the limb, then on the other, with decided benefit to the patient in most of them. In some cases deep incisions through the entire thickness of the indurated mass afforded relief and resulted in diminution of the size of the swelling. He relates the details of the case of a native, fifty years old, the subject of elephantiasis of the lower limbs, that he operated on in two stages several weeks apart, removing first a large section from the anterior and later from the posterior part of the swelling, and as shown by the accompanying illustrations in the report depicting the condition of the limbs before and after operation, with an excellent result. However, in some of the cases the benefit thus derived did not last for any considerable length of time.In making the excision, the superfluous skin is excised with the underlying indurated tissues, and the skin margins reflected for some distance in order to create sufficient room for a more liberal removal of the deep tissues. In one case, that of a woman thirty-eight years of age, the patient died two weeks after the second operation. Death was attributed to loss of blood and the debilitated condition of the patient when she entered the hospital. In another case, a Tahitian, thirty-five years old, affected with elephantiasis of all limbs and the external genitals, he operated successfully on one of the arms, the seat of an enormous swelling below the elbow. The excised mass weighed fifteen kilograms. Owing to the large size of the swelling, the operation proved one of great difficulty, and on account of the tension incident to the approximation of the margins of the flaps the sutures cut through and the wound ultimately healed by granulation. At the second operation nearly the entire mass was removed, with the result that the wound finally healed after a prolonged suppuration and the patient was relieved of the incumbrance caused by the great weight of the swelling. The relief afforded induced the patient to request additional operations for the removal of the swellings involving other regions of the body, but as the surgeon soon after left the island his desire could not be gratified.The climate of Tahiti is not congenial for pulmonary and rheumatic affections, as the atmosphere is too moist. It is admirably adapted for patients the subjects of nervous affections in all their protean forms. The quietude, balmy air and pleasing surroundings are the best therapeutic agents to secure mental rest and refreshing sleep. It is in the treatment of such affections that a trip to Tahiti can not be too strongly recommended.
The average temperature of the inhabited part of the island, which can not be less than 78 to 80 degrees Fahrenheit, has a relaxing influence on the natives and much more so on the small contingent of whites. The Europeans and Americans find it necessary every three to five years to seek for a few months a cooler climate to restore their energies and vigor. The government officials and officers of the small garrison are not obliged to serve for more than the same time consecutively, when they are relieved from their posts and commands. It is this relaxation which, to a certain extent, at least, is responsible for the great mortality of comparatively mild, acute, infectious diseases, and the severity of pulmonary tuberculosis among the natives. Tuberculosis of the lymphatic glands, skin, bones and joints appears to be extremely rare. The moisture-laden atmosphere and the suddenness with which the cool land and ocean breezes set in after the heat of the day, are conducive to the development of rheumatic affections, which are prevalent in all parts of the island, more especially during the rainy season in midwinter. The same can be said of bronchial affections and pneumonia. The free and unrestrained intercourse among natives accounts for the rapid spread of tuberculosis and acute infectious diseases among the entire population and from island to island.
The sanitary commission now engaged, in efforts to reduce the mortality of the natives will establish rules and regulations which will have for their object the prevention of dissemination of acute as well as chronic infectious diseases, and will undoubtedly accomplish much toward the preservation of the race; but these officers will meet with stubborn opposition on the part of the natives when attempts are made, in their interest, to curtail their personal liberties. The ties of relationship and friendship among the natives are very strong, and become most apparent in case of misfortunes and sickness. Smallpox breaks out almost every year, and claims its share of victims. Vaccination is supposed to be compulsory, but the natives are inclined to escape it. Vaccination is done gratuitously at the Military Hospital for all natives who can be induced to submit to it. Under present conditions it is almost impossible to reach the inhabitants of the small atoll islands.
Like in all tropic countries, tetanus is of quite frequent occurrence. The small native pony is found everywhere, and as the rural natives are all barefooted and spend much of their time in the jungles in impregnating the flower of the vanilla-bean and gathering fruits, wounds prone to infection with the tetanus bacillus are of frequent occurrence.
Malarial diseases are comparatively rare, although the plasmodium-carrying mosquitoes are numerous and aggressive, and children in the country districts are nude, and the men limit their clothing to the wearing of a loin-cloth. No case of typhoid fever has been known to have originated in the island. For this there exists a satisfactory explanation. The exemption in this island from this disease, so widely distributed over the entire part of the inhabited globe, is due entirely to an abundant supply of the purest drinking water supplied by the numerous mountain streams. Nearly all the inhabitants live on the coast, near the outlet of a brook or stream, where, consequently, there is no danger whatever of water-contamination. I found three cases of typhoid fever in the Military Hospital, members of one family, who had been brought there from one of the neighboring atoll islands.
Varicose veins, varicocele and hydrocele are very common. The absence of anything like a large ulcer in many cases of large and numerous varicose veins of the leg, I attributed to the toughness of the skin of the bare legs. Venereal diseases are widespread throughout the entire island, and more especially in Papeete and the near-by larger villages. For over a hundred years the natives have suffered from this scourge brought there by the European sailors and adventurers. Syphilis has been transmitted from generation to generation until it has contaminated the major part of the population, for
The gods visit the sins of the fathers upon the children.EURIPIDES.
The gods visit the sins of the fathers upon the children.
EURIPIDES.
and
The wickedness of a few brings calamity on all.PUBLIUS SYRUS.
The wickedness of a few brings calamity on all.
PUBLIUS SYRUS.
The length of time the disease has existed among the natives has established a certain degree of tolerance or immunity, as it pursues a comparatively mild course, as I found very few instances of the ravages of the remote results of syphilis. I saw only one case of saddle nose, caused by tertiary syphilis.
Leprosy is not as prevalent as in the Hawaiian Islands, but isolated cases are found in nearly all the islands belonging to this group, being more prevalent in some than in others. Segregation has never been attempted. The lepers mix freely with the members of their families and neighbors, and are not shunned by any one. I was informed that many of the lepers, much disfigured by the disease, seek an island where many of these unfortunates have founded a colony for the purpose of escaping from public gaze. There, away from relatives and friends, they spend their short span of life and await patiently the final relief which only death can bring.
O Death, the Healer, scorn thou not, I pray. To come to me; of cureless ills thou art The one physician. Pain lays not its touch upon a corpse.ÆSCHYLUS.
O Death, the Healer, scorn thou not, I pray. To come to me; of cureless ills thou art The one physician. Pain lays not its touch upon a corpse.
ÆSCHYLUS.
Elephantiasis in its worst forms has taken a firm hold on the natives, especially the inhabitants of the near-by island of Moorea. There this disease can be studied in all its stages, from a slight enlargement of one of the extremities to colossal swellings, which, when the upper and lower extremities are affected at the same time, make it necessary for the patient to crawl on his hands and feet in dragging himself from place to place. Regarding elephantiasis as it exists in Tahiti and the other islands of the French colony, I will make use of a few extracts taken from a valuable paper on this subject by Dr. Lemoine, recently in charge of the Military Hospital, and published in one of the government reports. According to this author, who has seen much of this disease in Tahiti and surrounding islands, it may affect most regions of the body, and not infrequently makes its appearance as an acute affection with all the symptoms characteristic of lymphangitis, including quite a violent continued remittent form of fever, which lasts two or three months. The acute form is, almost without exception, complicated by synovitis of the joints of the affected limb, which he regards as almost pathognomonic of the disease, differentiating it from ordinary forms of lymphangitis. After the subsidence of the acute symptoms and in the chronic form the disease is essentially a chronic lymphangitits, accompanied by marked enlargement of the veins. According to his observations the regions most frequently involved are the lower extremities, external genitals, and lastly, the hands and forearms. Three years ago I was given an opportunity to see at the hospital and poorhouse at Antigua, West Indies, ninety cases of elephantiasis, and not in a single one of them did the disease affect the upper extremity, while in the French colony of the South Seas this is not infrequently the case. I do not know that a satisfactory explanation has ever been given why the disease should behave so differently in fixing its location in the two groups of islands. Lemoine, as well as other writers on elephantiasis, has seen the disease become stationary by the removal of the patient to a colder climate. Europeans become susceptible to elephantiatic infection after a prolonged residence in tropical countries where the disease prevails.
Lemoine does not agree with Manson, who believes that elephantiasis is caused by theFilaria sanguinis, and is suspicious that the essential parasitic cause is a yet undiscovered microbe. He made blood examinations night and day of patients under his care, and was unable to constantly detect the filariæ in their embryonic state in the peripheral blood, and consequently claims that the presence of filaria in the organism is not an infallible diagnostic indication, and that their abundance is not proportionate to the intensity of the disease. The fact that the elephantiatics improve in colder climates he regards as another proof that filariasis is not the essential cause of the disease.
TAHITIAN CHILDRENGROUP OF TAHITIAN CHILDREN
GROUP OF TAHITIAN CHILDREN
In a number of cases extirpation of the infiltrated enlarged lymphatic glands was followed by decided improvement, and in the case of a Tahitian the improvement remained at the end of three years. He has also operated on a number of cases by partial excision of the mass, first on one side of the limb, then on the other, with decided benefit to the patient in most of them. In some cases deep incisions through the entire thickness of the indurated mass afforded relief and resulted in diminution of the size of the swelling. He relates the details of the case of a native, fifty years old, the subject of elephantiasis of the lower limbs, that he operated on in two stages several weeks apart, removing first a large section from the anterior and later from the posterior part of the swelling, and as shown by the accompanying illustrations in the report depicting the condition of the limbs before and after operation, with an excellent result. However, in some of the cases the benefit thus derived did not last for any considerable length of time.
In making the excision, the superfluous skin is excised with the underlying indurated tissues, and the skin margins reflected for some distance in order to create sufficient room for a more liberal removal of the deep tissues. In one case, that of a woman thirty-eight years of age, the patient died two weeks after the second operation. Death was attributed to loss of blood and the debilitated condition of the patient when she entered the hospital. In another case, a Tahitian, thirty-five years old, affected with elephantiasis of all limbs and the external genitals, he operated successfully on one of the arms, the seat of an enormous swelling below the elbow. The excised mass weighed fifteen kilograms. Owing to the large size of the swelling, the operation proved one of great difficulty, and on account of the tension incident to the approximation of the margins of the flaps the sutures cut through and the wound ultimately healed by granulation. At the second operation nearly the entire mass was removed, with the result that the wound finally healed after a prolonged suppuration and the patient was relieved of the incumbrance caused by the great weight of the swelling. The relief afforded induced the patient to request additional operations for the removal of the swellings involving other regions of the body, but as the surgeon soon after left the island his desire could not be gratified.
The climate of Tahiti is not congenial for pulmonary and rheumatic affections, as the atmosphere is too moist. It is admirably adapted for patients the subjects of nervous affections in all their protean forms. The quietude, balmy air and pleasing surroundings are the best therapeutic agents to secure mental rest and refreshing sleep. It is in the treatment of such affections that a trip to Tahiti can not be too strongly recommended.