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By Carla Garnett

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"The great sickness sits at the masthead... We have fallen upon a new age Infectious disease is spreading among us." — English translation of a Fijian meke (chant)

It was supposed to be a good thing. In fall 1874, King Cakobau, the most powerful ruler of the Cannibal Islands (now known as Fiji), signed a deed of cession giving Great Britain control of the archipelago and securing naval protection for the dozens of tiny islands located in a then fairly remote part of the western Pacific Ocean. The Fijians would maintain their lands, according to the agreement, but would become a British Crown colony. England took the nation under its wing and, by all accounts, the Cannibal Islands were glad to go. Mutual satisfaction.

Continued...

But, by spring 1875, the story had changed dramatically. The islands were in the grip of a devastating epidemic. By the end of that year, nearly one-third of the 150,000 Fijian people were missing and presumed dead. According to Dr. David Morens, medical epidemiologist in the Virology Branch of NIAID's Division of Microbiology and Infectious Diseases and medical historian, things began to go downhill just after — of all things — a diplomatic pleasure cruise. Morens told the fascinating story, "Death in the Cannibal Islands: History of an Emerging Infectious Disease," at a recent seminar offered by the National Library of Medicine's History of Medicine Division.

"Anyone who's ever gone to medical school will have heard of this epidemic," he began. "It's in hundreds of textbooks, an obligatory paragraph that introduces the concept of a 'virgin soil epidemic.' The term was coined earlier than 1875, but this is the epidemic that popularized it. Though the details have never been known to a larger audience, the fact that there was an epidemic and the impact and the implications of it have changed the way we think about infectious diseases."

Settling a Wild Frontier

Morens set the scene: At the time, around the mid-1800's, the Pacific was being opened to western colonization. The Fijian islands were being overrun by colonists from various nations, including America. Although communication and transportation were difficult issues for this distant nation, there was an advantage to the region's relative isolation. Because of the long distances and slow travel, infectious diseases that were spread person to person — particularly by the airborne route — were kept out of the islands. As a result, the population in Fiji had no exposure to the disease that would so diminish their number, a disease later identified as measles.

King Cakobau of the Cannibal Islands

"It was kind of like a wild, crazy frontier era," Morens said, describing the presence of the Ku Klux Klan (which had invaded Fiji decades earlier), and the practices of cannibalism, and kidnapping and involuntary servitude of the Fijian and Polynesian residents. As the leader of the largest of the islands, King Cakobau — who had accepted the lotu (converted to Christianity) a couple of decades earlier and wanted his nation to settle down — had petitioned the British government several times over the years to adopt Fiji. His request had always been denied until 1874, when a more conservative government took over in Britain and agreed to assume the nation. The deed of cession was officially signed on Oct. 10, 1874, by 13 Fijian leaders, including Cakobau.

In December 1874, Cakobau was invited for a state visit to Sydney, Australia, the closest seat of the British government at the time. It was only fair, it was thought, that the former king — who had traveled all over the Pacific, but never to a western city — be honored with a trip to a city most like his new government. A British ship, the H.M.S. Dido, was sent for Cakobau and his party of 50 to 100 people, which included his wife, two grown sons and a chaplain. The trip would take 19 days. The Fijians were to be feted, the former king and his wife put up in the finest hotel. The sons, however, were to stay aboard the ship, which was docked in the Sydney harbor. The visit went well. Cakobau was said to be fascinated with western culture, particularly with such devices as magnets and elevators. The group departed after a week's sojourn.

Thirteen Cannibal Islands leaders sign the deed of cession on Oct. 10, 1874; shown interpreting the document for the Fijians is David Wilkinson (c).

En route back to Fiji, two passengers — Cakobau's firstborn, Ratu Timoci and the chaplain, Mesako — became ill. Dr. W.C. Chapman, the ship's surgeon, diagnosed the disorder as measles. In fact, according to Morens' research, the city of Sydney had been battling a measles epidemic at the time.

"Nobody thought what kind of a threat this might pose," Morens said, pointing out that the incubation period for measles was 14 days and the trip back to Fiji took 19 days. The sick men were immediately isolated in a hut aboard ship. In theory, he continued, given that the quarantine laws [no ship was allowed into port with a quarantinable disease; and if there was such a disease on board, the ship had to fly the international symbol of quarantine, a yellow flag] were in place, there should have been no problem. The ill folks and presumably any other passengers who might have been exposed would be quarantined and treated until the measles ran its course.

The Fijian party is given royal treatment aboard the British ship Dido, en route to Sydney, Australia.

"What happened next is a terrible and ironic story of mistakes and missed opportunities," said Morens. "Somebody forgot to put the yellow flag up. The ship sailed back into Levuka harbor without a yellow flag."

The Plot Thickens

In addition, an embarrassing complication had occurred. Ratu Timoci, a Christian married to a Polynesian princess and the heir apparent to the former throne, contracted an additional disease — gonorrhea. While in Sydney, he had not stayed aboard the ship as previously intended. He had climbed overboard every night and visited the local establishments of ill repute. That he had fallen sick under such circumstances was scandalous. Political damage control became not a small consideration. So, sidetracked by trying to hide Timoci's social ailment from the newspaper, British officials and administrators were reportedly arguing among themselves aboard the Dido on Jan. 12, 1875, when Timoci and the other passengers (all of whom should have been quarantined from the healthy population until their measles exposure status could be determined) climbed onto smaller boats and headed for the shores of Fiji.

Ratu Timoci

"The story gets worse," Morens said. The Fijians' armed constabulary — all friends of Timoci's — hastened to greet the returning travelers. Then, in another sheer bad-luck coincidence, a big 1-day meeting was planned for Jan. 22 to gather for the first time ever the 69 chiefs of all of the Cannibal Islands at one place at one time to discourage any possible rebellion against the cession.

Thus, a measles outbreak that could have been contained to two at the least and 100 ship passengers at the most, was now poised to infect dozens of far flung territories as their leaders returned — unwittingly exposed to the disease — from the big confab. Then during the next few months, routine travel and transportation took over; as more and more boats visited among the various islands, more and more residents were infected.

"The epidemic raged throughout the Fijian Islands," Morens said, pointing out that there was no direct communication to London and no official confirmation of the epidemic status of the disease until June 1. "There was virtually no place that was left untouched. What was it like to be in Fiji at that time? The horror that must have been there is unimaginable."

A Fijian pounds the lali, a wooden drum used for war calls, cannibal feasts, summonses to church and, in this case, announcing a public health crisis.

Approximately 40,000 people were killed, he said. When measles invaded a village, practically everyone became sick at one time, thus disabling the entire community. Starvation, fever and dysentery set in. "Reportedly," Morens said, "you could hear the 'pounding of the lali' [death drum] from miles away and smell the stench of rotting bodies, too many to be buried."

Suspicion, Distrust Grow

An armed rebellion by the island tribal chiefs ensued. The Fijians, who had never experienced an illness like this before, drew the conclusion that the British were trying to destroy them through genocide and take over their lands. Distrust of the Crown government grew. Islanders abandoned the lotu, and returned to traditional practices of murder and cannibalism. Although King Cakobau did not succumb to the disease, his brother Savanaca, a prominent politician in his own right, was the first famous Fijian to die in the epidemic.

"There appears to be only one reason for the decrease of the natives," said Josefa Sokvagone, a Fijian who gave remarks in public testimony for an 1893 report on the epidemic. "It's the white chiefs who live among us...They are blighting us, the natives, and we are withering away...They are great and we are insignificant."

NIAID's Dr. David Morens has researched the epidemic and shared his work with Fijians.

Western response to the devastation varied, dividing between the political and the medical, observed Morens. Queen Victoria, when finally notified, was enraged that her new subjects were dying at such an alarming rate, and launched an investigation. She also sent in armed Fijians led by British soldiers to quell the rebellion. Prominent physicians and health officials in the western medical community by and large concluded publicly that the Fijians were an inferior, "degenerate" people, left vulnerable to measles and other infectious diseases by their own inbreeding and faulty genetics.

"Here in 1876 the lesson being learned by the western world is that uncivilized people are not prepared to face the modern world," explained Morens, noting the burgeoning eugenics movement's influence at the time. This ill-conceived notion persisted, he continued, until at least as late as 1922, when Dr. Victor Vaughn — one of the fathers of pediatrics and of epidemiology — was quoted in a discussion about the Fijian epidemic: "Fortunately, these children die," Vaughn reportedly said, "but they do not die from infectious diseases, they die because they are unfit to live."

History Teaches

It is precisely these kinds of pseudo-scientific conclusions and erroneous judgments that Morens said he hopes medical history lessons — like the one he gave on the Cannibal Island measles epidemic — can help current and future public health officials avoid.

"One of the things that's interesting about history to me is to be able to see what we can find of relevance to modern times," Morens concluded. "Think about what lessons this epidemic story has for modern times."

A newspaper clipping shows the first graduating class of the Fiji School of Medicine.

Besides the instructions in disease containment and genetics left for scientific posterity, the epidemic also had at least one tangible positive outcome, he said. It forced Britain to establish Fiji's first medical school, which graduated its first class in 1888. A medical historian by avocation as well as vocation, Morens visited the facility several weeks ago, and found that today's Fijian medical students know virtually nothing of the epidemic and its part in their history. When he mentioned it and his research in passing, he was invited back to share the whole story.