74 AROUND THE WOULD VIA INDIA. 



fectious diseases introduced by the whites, notably 

 measles, smallpox and tuberculosis. Vaccination is now 

 generally practiced by the naval surgeons, and the na- 

 tives subject themselves willingly to this prophylactic 

 measure. The spread of infectious diseases among the 

 natives is favored by their habits. Their affectionate 

 nature and the strong ties of friendship bring relatives, 

 friends, communities and different villages in continu- 

 ous and frequent contact with the afflicted, and in this 

 manner infection is carried in all directions, and in a 

 remarkably short time by progression from place to 

 place will reach the most remote parts of the island. I 

 imagine that any efforts to cut off free communication 

 between the sick and well would appear as an infliction 

 of cruelty to the natives, and would meet with their 

 displeasure, if not persistent opposition. It is this free 

 intercourse among the people that accounts for the 

 rapid spread of measles and other acute infectious dis- 

 eases over the entire island. The natives have abso- 

 lutely no comprehension of the importance, much less 

 of the necessity, of enforcing sanitary precautions. 



Tuberculosis affects most frequently the lungs, as 

 this organ becomes most frequently predisposed by ca- 

 tarrhal affections, which are very common; next in fre- 

 quency are 'the bones and joints, and lastly, the lymph- 

 atic glands and intestinal canal. Leprosy is unknown 

 in Tutuila. On the other hand, elephantiasis is very 

 common. It is estimated that of the male population 

 over 40 years of age, 50 per cent, are suffering from this 

 disease. It attacks in preference the lower extremities, 

 but not infrequently the upper become involved, and 

 scrotal elephantiasis is by no means rare (Fig. 17). 

 Dr. Odell has operated on a number of cases of scrotal 

 elephantiasis successfully, in which the mass removed 

 weighed twenty and more pounds. The disease is much 

 more common in men than women, undoubtedly be- 

 cause they are more frequently the subject of lesions, 

 which determine infection. The disease is occasionally 



