Description

Henry Alfred Alford NICHOLLS (1851 – 1926).

Roseau, Dominica: Printed at the “Dominican” Office, [1879].

 

Yaws is a tropical infectious disease of the skin, bones and joints caused by the spirochete bacterium Treponema pallidumpe.  It is commonly spread by casual physical contact, often by children at play.  The disease starts with the appearance of open lesions on the skin, but if left untreated, it can lead to chronic fatigue and severe, permanent disfigurements.  While not generally fatal, Yaws could be severely debilitating.  The disease was historically confused with other ailments, such as syphilis, that had very different means of transmission.

 

Yaws is an ancient disease that is thought to have originated in Africa, and which spread to the West Indies via the slave trade.  However, it was not properly identified until 1679, when it was described by the Dutch physician Willem Piso.  Severe outbreaks of Yaws occurred throughout the Caribbean but seemed to especially affect the Leeward Islands.

Historically, there was no definitive cure for Yaws, although proper measures could suppress its symptoms, while quarantine could stop its proliferation.

Curiously, there were apparently very effective traditional West African methods of treating Yaws, which were employed by slaves in the West Indies.  However, slave owners tended to discourage these means, incorrectly believing that they were part of ‘Vidoo’ or ‘Obeah’ rituals.  Instead, many plantations had ‘Yaws Houses’, where infected slaves could be quarantined until their outbreaks receded.

A cure for Yaws would not be developed until the mid-20^th century, when it was found that the disease could be eradicated by penicillin, and later, types of antibiotics.

 

The Case of Dominica: From Scourge to Success

Dominica, one of Leeward Islands, which had been a British colony since it was conquered from France in 1761, is the most rugged, and in the opinion of many, the most beautiful of all Caribbean isles.  Although it has an area of only 750 sq. km, the extreme nature of its terrain ensured that many places were hard to reach, posing challenges to the management of public health.

In the wake of the abolition of slavery in Dominica, which was phased out by 1838, the island’s economy fell into a steep decline, as most of its once great sugar plantations failed.  While liberated, most of the former slaves become struggling subsistence farmers or fishermen, while the island’s public treasury was perennially stretched thin.  The old ‘Yaws Houses’ closed along with the plantations, and for some years there was a vacuum in public health oversight that allowed Yaws to spread, resulting in severe outbreaks in various quarters.  Soon Yaws became a mortal threat to the island’s productivity, as Dominica became the most severely affected place in the entire Caribbean.

Finally, the colonial government established a ‘Yaws Commission’ to combat the disease, under the leadership of the highly competent and driven physician John Imray.  In a major advance, in 1871, the commission opened the first specialised ‘Yaws Hospital’, at Morne Bruce, near the capital, Roseau, while another such facility was established, in 1876, at Prince Rupert’s Bay, in the island’s north.

It was correctly reasoned, what while Yaws could not then be definitively cured, it could be effectively suppressed by isolating the afflicted and providing them with good hygiene, diet and exercise.  While the road would be difficult, the hospital system eventually proved to be a great success, ensuring that Yaws became an obscure nuisance as opposed to an existential threat to Dominica’s livelihood.

In April 1877, the energetic and brilliant English physician Henry Nicholls became the Medical Superintendent of the Dominica Yaws Hospitals, and he soon brought Imray’s well-conceived treatment system to a whole new level of effectiveness.

The Present Work in Focus

This exceeding rare survivor is the “Third” annual report on the state of Dominica’s Yaws Hospitals, written by Nicholls, in 1879, in his role as Superintendent.  It provides the most detailed and authoritative record of the dramatic events in Yaws treatment that occurred during the previous year (1878).  The work was printed in a charmingly crude fashion on striking blue paper, in Roseau, by the press of the island’s main newspaper, The Dominican (established in the 1840s).

Nicholls commences his report by articulately expressing the nature of the dire situation Dominica had recently endured:

During the year 1878 the Yaws question, which has caused much anxiety on account of its vital importance to the welfare of Dominica, may be said to have arrived at that stage at which a solution may be discerned at no very distant date.

Within the last few years, the disease has attacked so many of the families of the peasantry that considerable alarm has been felt among all classes throughout the island. The disablement by yaws of a great number of agricultural labourers could not have but a deteriorating influence upon the commerce of an Island in which the staple products are raised from the soil; and the willing acquiescence of the Legislature in adding to these burdens laid upon a heavily taxed and impoverished community, by the imposition of a special yaws tax, testifies to the gravity of what has not inaptly been termed “the yaws question.”

The efforts made a year or so ago to hold in check, and if possible, subdue the ravages of the disease were unhappily not successful, and in consequence of this failure considerable doubts as to the practicability of grappling with the malady were entertained by many persons in Dominica and elsewhere.

As will be seen by a study of the various papers upon the subject already made public, the failure of the first efforts was due mainly to the ill-chosen sites of the hospitals and to the imperfect organization of the yaws administration.

Nicholls then proceeds to describe the recent circumstances of the Yaws hospitals and the reforms he has enacted that resulted in marked improvements in “the yaws question”.  In Section I. The Hospitals, Nicholls discusses how Dominica’s two established Yaws hospitals were closed and their operations and patients consolidated into a new Central Yaws Hospital.

In Section II. The Patients, he notes that 970 patients circulated though Dominica’s Yaws treatment system during the year 1878.  He states that “The majority of the patients admitted into the yaws hospitals belongs to the labouring population.  Nearly all the inmates are negroes or dark coloured persons, but a few are of light colour, and one of the patients of the Central Hospital was born of white parents.  No statistics as to the liability of any particular race or class to be attacked by the disease can however be arrived at from these facts, because the native peasantry run far greater risks of infection, and they also compose the bulk of the population”.

In Section III. The Disease, Nicholl’s elaborates upon Yaws’s origins, symptoms, pathology, diagnoses, treatments, while providing interesting case studies of specific numbered patients.  Rounding out the work is Appendix A: History of Two Cases in Which the Disease Appeared a Second Time in the Same Individual; Appendix B: Dietary of the Central Yaws Hospital; and Appendix C: Statistics showing the longest and Shortest Time under Treatments, period of Life &c., of 466 Cases discharged from the Central Hospital.

Describing the present Report, which was said to have been published “Early in the year 1879”, Edwin Donald Baynes, the Acting Lieutenant Governor of the Leeward Islands, wrote: “It was a long document, giving particulars of the work accomplished to the end of the year 1878, and containing a detailed account of the disease with a good deal of statistical medical information.  It showed that 606 patients had been under treatment in the Central Hospital from the 11^th October, 1877 to the end of the year 1878, and that of this number 471 were discharged cured, 24 died, and 2 absconded” (Baynes as quoted in Nicholls, Report on Yaws in Tobago, Grenada, St. Vincent, St. Lucia, and the Leeward Islands, pp. 115-6).

 

Baynes then provides excerpts from Nicholls’s report that aptly capture its spirit:

 

The dietary of the hospital is a great improvement upon that in ordinary use by the people, but it might be rendered more nourishing by the substitution of fresh meat for salted fish and pork, the necessity of economy in the expenditure will not, however, permit of a more costly diet.

 

In the case of children, and those who are in a debilitated condition, a special dietary is allowed, from which salt food is excluded. Two extra meals are also given in these cases, one at 7 a.m., consisting of arrowroot and milk, or eggs and milk, and another at noon which consists of soup made from fresh meat, and to which is added rice or vermicelli.

 

The yaws hospital are excellent schools in which to teach the people better and healthier habits, and it is often seen that the dirty, indolent, and insolent boy or girls soon becomes so changed as to be scarcely recognisable, the bright, intelligent look, and the polite greeting indicating that example and precept are not utterly thrown away.

 

At the Central Hospital none of the patients are allowed to go without exercise.  The grounds are cultivated in farine manioc, sweet potatoes, eddoes, pigeon peas, and plantains, by the stronger men and women, and the children are made to weed the land, and to cultivate flowers in several beds which have been set apart for the purpose. Some of the women act as nurses to the children, and others are employed at needlework. Several of the men and boys follow the occupation of fishing, a small boat having been bought for the use of the hospital, and by their exertions fresh fish is often substituted for salt in the dietary.

 

From a consideration of this report, it will be seen that the yaws administration is now settled upon a satisfactory basis. The hospitals which could not be worked in an efficient manner have been closed, and a large central hospital has been established. The account already given of the 15 months’ work of this hospital is most reassuring, and it will doubtless be received by the people with feelings of satisfaction.

 

The large number of cases admitted to the hospitals has taken everyone by surprise, for the extent to which the disease prevailed in the country was not properly known until special yaws constables had thoroughly explored the districts which were thought to be free from the infection. Then, when patients were brought in by dozens from their hiding places, the extreme gravity of the question was felt, and the hope of subduing the disease within the short time estimated was seen to be futile.

 

During the year 1878, 29 patients were admitted to the Central Hospital from the town of Roseau, and, in two instances, I had to issue warrants for the forcible removal of the patients before the relations would consent to deliver them up. These facts will give an idea of the number of infected persons concealed in the country, and of the difficulties which beset the authorities in dealing with the matter.

 

Now that the prevalence of the disease is known to its fullest extent, effectual measures can be taken to subdue its ravages.

 

The present organization is working in a satisfactory manner, and I see no reason why the efforts now being made to rid Dominica of this loathsome malady may not finally be crowned with success, if these efforts be continued for a sufficient period of time.

 

Sir Henry Nicholls: Game-Changing Physician of Dominica

Sir Henry Alfred Alford Nicholls (1851 – 1926) was a revolutionary figure in the modern history of Dominica.  He was a physician who radically improved the public health of the island’s people, as well as an internationally renowned botanist, horticulturalist, legislator and enthusiastic promoter of Domnica.

 

Born in London, the son of a surgical instrument maker, he was educated at St. Bartholomew’s Hospital, London, and received his M.D. from the University of Aberdeen.

In 1876, Nicholls moved to Dominica, where he became the protégé of John Imray (1811 – 1880), the Scottish physician, who having practiced on the island since 1832, was responsible for pioneering modern public medical practices to the island, notably leading the fight against the surge of Yaws.

In 1877, Nicholls succeeded Imray as the Medical Superintendent of the Dominica Yaws Hospitals, and upon the latter’s death, in 1880, became the island’s Medical Officer of Public Institutions.  In these capacities, he made great headway in reducing the prevalence of Yaws and other infectious diseases in Dominica, leading him to be appointed, in 1891, as the Special Commissioner to investigate Yaws throughout the British West Indies.  His resulting report on Yaws, published in 1894, was hailed by the Colonial Secretary Lord Knutsford, who wrote Nicholls: “your report is a monument of your ability as a scientific expert”.   

 

Nicholls went on to author a globally transformative paper on the treatment of Yaws.  He also served as editor of The Leeward Islands Medical Journal, and made major contributions to the research of malaria, tetanus and the hookworm disease ancylostomiasis.

 

Nicholls extensively explored Dominica’s rugged countryside, studying it flora, while conducting novel horticultural experiments on the estate, St. Aroment, he inherited from Dr. Imray.  His was responsible for award-winning agricultural displays at the 1886 Colonial and Indian Exhibition in London.

 

In 1922, Nicholls became the Principal Medical Officer of Dominica and was knighted shortly before his death.

A Note on Rarity

 

Like all ephemeral 19^th century West Indies imprints, the present work is an exceedingly rare survivor.  We can trace only a single institutional example, held by the Royal College of Physicians of London Library, while we are not aware of any sales records for any other examples.

 

References: Royal College of Physicians of London Library: 23-4-g-2(7); OCLC: 969505658; David F. CLYDE, Two Centuries of Health Care in Dominica (1980), p. 188; Robert A. MYERS, A Resource Guide to Dominica, 1493-1986, vol. 2 (1987), p. 326; Henry Alfred Alford NICHOLLS, Report on Yaws in Tobago, Grenada, St. Vincent, St. Lucia, and the Leeward Islands: addressed to the Right Honourable Lord Knutsford, G.C.M.G., Her Majesty’s Principal Secretary of State for the Colonies (London, 1894), pp. 115-6.