Volume 95, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Infectious diseases depopulated many isolated Pacific islands when they were first exposed to global pathogen circulation from the 18th century. Although the mortality was great, the lack of medical observers makes determination of what happened during these historical epidemics largely speculative. Bacillary dysentery caused by is the most likely infection causing some of the most lethal island epidemics. The fragmentary historical record is reviewed to gain insight into the possible causes of the extreme lethality that was observed during first-contact epidemics in the Pacific. Immune aspects of the early dysentery epidemics and postmeasles infection resulting in subacute inflammatory enteric disease suggest that epidemiologic isolation was the major lethality risk factor on Pacific islands in the 19th century. Other possible risk factors include human leukocyte antigen homogeneity from a founder effect and pathogen-induced derangement of immune tolerance to gut flora. If this analysis is correct, then Pacific islands are currently at no greater risk of emerging disease epidemics than other developing countries despite their dark history.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Jarves JJ, , 1842. History of the Hawaiian or Sandwich Islands. Boston, MA: Tappa Et Dennet. [Google Scholar]
  2. Buxton PA, , 1926. The depopulation of the New Hebrides and other parts of Melanesia. Trans R Soc Trop Med Hyg 19: 420458.[Crossref] [Google Scholar]
  3. McArthur NR, , 1967. Island Populations of the Pacific. Canberra, Australia: ANU Press. [Google Scholar]
  4. Spriggs M, Rallu J, Kirch P, , 2007. Population in a vegetable kingdom: Aneityum Island at European contact in 1830. , eds. The Growth and Collapse of Pacific Island Societies: Archaeological and Demographic Perspectives. Honolulu, HI: University of Hawaii Press, 278305. [Google Scholar]
  5. Cliff A, Haggett P, Smallman-Raynor M, , 2000. Island Epidemics. Oxford, United Kingdom: Oxford University Press. [Google Scholar]
  6. Diamond J, , 1998. Guns, Germs and Steel. London, United Kingdom: Random House. [Google Scholar]
  7. Manson-Bahr P, , 1920. Bacillary dysentery. Trans R Soc Trop Med Hyg 13: 6472.[Crossref] [Google Scholar]
  8. Boyd J, , 1957. Dysentery: some personal experiences and observations. Trans R Soc Trop Med Hyg 51: 471487.[Crossref] [Google Scholar]
  9. Howard M, , 1991. Medical aspects of Sir John Moore's Corunna campaign, 1808–1809. J R Soc Med 84: 299. [Google Scholar]
  10. Connolly MA, Gayer M, Ryan MJ, Salama P, Spiegel P, Heymann DL, , 2004. Communicable diseases in complex emergencies: impact and challenges. Lancet 364: 19741983.[Crossref] [Google Scholar]
  11. Woodward J, , 1863. Outlines of the Chief Camp Disease of the United States Armies as Observed during the Present War. Philadelphia, PA: J. B. Lippincott. [Google Scholar]
  12. Bahr P, , 1914. A study of epidemic dysentery in the Fiji Islands, with special reference to its epidemiology and treatment. BMJ 1: 294.[Crossref] [Google Scholar]
  13. Corney B, , 1884. The behaviour of certain epidemic diseases in natives of Polynesia with especial reference to the Fiji Islands. Trans Epidem Soc London 3: 7694. [Google Scholar]
  14. Anonymous, 1896. Report of the Commission Appointed to Inquire into the Decrease of the Native Population. Suva, Fiji: Government Printer, 200. [Google Scholar]
  15. Williams J, , 1845. A Narrative of Missionary Enterprises in the South Sea Islands: With Remarks upon the Natural History of the Islands, Origin, Languages, Traditions, and Usages of the Inhabitants. London, UK: J. Snow. [Google Scholar]
  16. Schmitt RC, , 1970. The Okuu: Hawaii's greatest epidemic. Hawaii Med J 29: 359364. [Google Scholar]
  17. Schmitt RC, Nordyke EC, , 2001. Death in Hawai'i: The Epidemics of 1848–1849. [Google Scholar]
  18. Hope BE, Hope JH, , 2003. Native Hawaiian health in Hawaii: historical highlights. Calif J Health Promot 1: 19. [Google Scholar]
  19. Martin P, Combes C, , 1996. Emerging infectious diseases and the depopulation of French Polynesia in the 19th century. Emerg Infect Dis 2: 359.[Crossref] [Google Scholar]
  20. Shanks GD, Lee SE, Howard A, Brundage JF, , 2011. Extreme mortality after first introduction of measles virus to the Polynesian island of Rotuma, 1911. Am J Epidemiol 173: 12111222.[Crossref] [Google Scholar]
  21. Corney B, , 1913. A note on an epidemic of measles at Rotuma, 1911. Proc R Soc Med 6: 138154. [Google Scholar]
  22. Howard A, Rensel J, , 2007. Island Legacy: A History of the Rotuman People. Victoria, Canada: Trafford Publishing. [Google Scholar]
  23. Scragg R, , 1977. Historical epidemiology in Papua New Guinea. P N G Med J 20: 102109. [Google Scholar]
  24. Davies M, , 2002. Public Health and Colonialism: The Case of German New Guinea 1884–1914. Wiesbaden, Germany: Otto Harrassowitz Verlag. [Google Scholar]
  25. Shlomowitz R, , 1987. Mortality and the Pacific labour trade. J Pac Hist 22: 3455.[Crossref] [Google Scholar]
  26. Bahr PH, , 1912. Investigations on Dysentery in Fiji. London, United Kingdom: London School of Tropical Medicine. [Google Scholar]
  27. Shlomowitz R, , 1989. Epidemiology and the Pacific labor trade. J Interdiscip Hist 19: 585610.[Crossref] [Google Scholar]
  28. Mac Gregor W, , 1900. An address on some problems of tropical medicine: delivered at the London School of Tropical Medicine on October 3rd, 1900. BMJ 2: 977.[Crossref] [Google Scholar]
  29. Daniels CW, , 1890. An epidemic of dysentery. Practitioner 45: 343346. [Google Scholar]
  30. Townes JM, , 2010. Reactive arthritis after enteric infections in the United States. Clin Infect Dis 50: 247254.[Crossref] [Google Scholar]
  31. Christenson B, , 2006. Oscar costa-mandry and posthurricane bacillary dysentery. Clin Infect Dis 42: 16501651.[Crossref] [Google Scholar]
  32. Manson-Bahr P, , 1958. The march of tropical medicine during the last fifty years (footprints on the sands of time). Trans R Soc Trop Med Hyg 52: 483499.[Crossref] [Google Scholar]
  33. Scadding J, , 2006. Reflections on my studies of the effects of sulphonamide drugs in bacillary dysentery in Egypt, 1943–1944. J R Soc Med 99: 423426.[Crossref] [Google Scholar]
  34. Cliff A, Haggett P, , 1985. The Spread of Measles in Fiji and the Pacific. Canberra, Australia: Australian National University. [Google Scholar]
  35. Burnet FM, , 1968. Measles as an index of immunological function. Lancet 2: 610613.[Crossref] [Google Scholar]
  36. Anonymous, 1875. The Measles in Fiji. Melbourne, Australia: The Argus. [Google Scholar]
  37. Davies S, , 1894. Epidemic measles at Samoa. BMJ 1: 1077.[Crossref] [Google Scholar]
  38. Lynch G, , 1905. Measles epidemic in Fiji during 1903. J Trop Med 8: 8287. [Google Scholar]
  39. MacDonald H, , 1911. Report to Chief Medical Officer, Fiji. Suva, Fiji: Government of Fiji. [Google Scholar]
  40. Cherry J, Feigin R, Cherry J, , 1987. Measles. , eds. Textbook of Pediatric Infectious Diseases. Philadelphia, PA: Saunders, 16071628. [Google Scholar]
  41. Morens D, , 1981. Measles in Fiji, 1875: thoughts on the history of emerging infectious diseases. Pac Health Dialog 5: 119128. [Google Scholar]
  42. Shanks G, Hussell T, Brundage JF, , 2011. Epidemiological isolation causing variable mortality in island populations during the 1918–1920 influenza pandemic. Influenza Other Respi Viruses 6: 417423.[Crossref] [Google Scholar]
  43. Clemente JC, Pehrsson EC, Blaser MJ, Sandhu K, Gao Z, Wang B, Magris M, Hidalgo G, Contreras M, Noya-Alarcón Ó, , 2015. The microbiome of uncontacted Amerindians. Sci Adv 1: e1500183.[Crossref] [Google Scholar]
  44. Chistiakov DA, Bobryshev YV, Kozarov E, Sobenin IA, Orekhov AN, , 2014. Intestinal mucosal tolerance and impact of gut microbiota to mucosal tolerance. Front Microbiol 5: 781. [Google Scholar]
  45. Kirch PV, Rallu JL, , 2007. The Growth and Collapse of Pacific Island Societies. Honolulu, HI: University of Hawaii Press. [Google Scholar]
  46. Jensen KJ, Larsen N, Biering-Sorensen S, Andersen A, Eriksen H, Monteiro I, Hougaard D, Aaby P, Netea M, Flangan KL, Benn CS, , 2015. Heterologous immunological effects of early BCG vaccination in low-birth-weight infants in Guinea-Bissau: a randomized-controlled trial. J Infect Dis 211: 956967.[Crossref] [Google Scholar]
  47. Samb B, Aaby P, Whittle H, Coll Seck A, Simondon F, , 1997. Decline in measles case fatality ratio after the introduction of measles immunization in rural Senegal. Am J Epidemiol 145: 5157.[Crossref] [Google Scholar]
  48. Friedlaender JS, Friedlaender FR, Reed FA, Kidd KK, Kidd JR, Chambers GK, Lea RA, Loo JH, Koki G, Hodgson JA, Merriwether DA, Weber JL, , 2008. The genetic structure of Pacific islanders. PLoS Genet 4: e19.[Crossref] [Google Scholar]
  49. Kayser M, , 2010. The human genetic history of Oceania: near and remote views of dispersal. Curr Biol 20: R194R201.[Crossref] [Google Scholar]
  50. Blackwell AD, Gurven MD, Sugiyama LS, Madimenos FC, Liebert MA, Martin MA, Kaplan HS, Snodgrass JJ, , 2011. Evidence for a peak shift in a humoral response to helminths: age profiles of IgE in the Shuar of Ecuador, the Tsimane of Bolivia, and the U.S. NHANES. PLoS Negl Trop Dis 5: e1218.[Crossref] [Google Scholar]
  51. Wilson T, Reid J, , 1949. Malaria among prisoners of war in Siam (“F” Force). Trans R Soc Trop Med Hyg 43: 257272.[Crossref] [Google Scholar]
  52. Dunlop EE, , 2005. The War Diaries of Weary Dunlop. London, UK: Penguin UK. [Google Scholar]
  53. Lee M-S, Kang M-J, Huh S, , 2013. Causes of death of prisoners of war during the Korean War (1950–1953). Yonsei Med J 54: 480488.[Crossref] [Google Scholar]
  54. Morens DM, Folkers GK, Fauci AS, , 2004. The challenge of emerging and re-emerging infectious diseases. Nature 430: 242249.[Crossref] [Google Scholar]
  55. Shanks GD, Brundage JF, , 2013. Pacific islands which escaped the 1918–1919 influenza pandemic and their subsequent morality experiences. Epidemiol Infect 141: 353356.[Crossref] [Google Scholar]
  56. Baruzzi RG, Abdala N, Black FL, , 1982. Measles and measles vaccination in isolated Amerindian tribes. II. The 1978/79 Xingu epidemic. Trop Geogr Med 34: 712. [Google Scholar]
  57. Kumar S, , 1999. Jarawas threatened by measles outbreak. Lancet 354: 1624.[Crossref] [Google Scholar]
  58. Reid A, , 1912. Heredity and disease. BMJ 2: 13181321.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 03 Mar 2016
  • Accepted : 30 Mar 2016
  • Published online : 03 Aug 2016

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error