Tb In Tonga

Visitor Urges Use of A New Vaccine

AT our urgent request, Dr. Ed ward Jacomb (at present visiting Norfolk Island, en route to the New Hebrides) con sented to discuss the problem of Tuberculosis in Tonga, which he recently visited. He declares that the incidence of TB in Tonga is high, and very grave; and it is said that the Government of Tonga is not doing enough to meet the scourge. Dr. Jacomb advocates the use of BCG vaccine.

Dr. Jacomb was a legal practi tioner in the New Hebrides over 30 years ago. After he retired to England, he studied medicine and qualified as a medical practi tioner. He did not practice, but engaged in research work during a long residence in the Channel Islands.

WHAT is known as BCG vaccine, which is a valuable immunis ing agent against TB, was discovered twenty or more years ago; but, owing to an unfortunate accident, was for long discarded as a practical method.

Within the past few years, how ever, it has been revived with great success. It has been found to pro tect during infancy and childhood (the most dangerous period for in fection); and I was assured by Dr.

K. MacKlnstry, CMO of Jersey (Channel Islands), who for the past four or five years has been system atically inoculating all children born in Jersey within a few days of birth, that tubercular meningitis is now unknown there, and that he has good reason to hope that within a generation the island will be com pletely free from the scourge.

It should be noted that BCG only immunises; it does not cure persons who have already contracted the disease. There is still no cure for TB. Many cases are benefited by open-air treatment in sanatoria, and some cases have benefited from in jections of aureomycin.

For a long time, the main diffi culty in systematic treatment of communities remote from Paris and Denmark (for long the only two centres where this BCG vaccine could be procured) was the evanes cent viability and consequent loss of efficacy of the vaccine, which only lasts for some nine days.

Within the past two or three years, however, what is known as Freeze-Dried BCG has been evolved at the Pasteur Institute in Paris.

This, with proper care, remains potent up to six months, and so it is completely suitable for use in tropical countries, and especially in such places as the Pacific Islands,

with scanty and difficult communi cations with the outside world.

This Freeze-Dried BCG is now also manufactured at the Common wealth Serum Laboratories in Mel bourne, according to Dr. Poole, head of the Tamavua Hospital for TB in Suva, and so is readily available for this part of the world.

Dr. Poole told me that it is now being used systematically in Fiji, though a number of the more re mote islands have still to be dealt with. The immunisation is being carried out mainly by Native Medi cal Practitioners.

It seems obvious that BCG Freeze-Dried vaccine should be used in Tonga; but up to the time I left, in July, it was not, and (according

to Dr - W. G. Burrows, the then CMO there) there was little pros pect of it being so.

I was informed (this is only hear say) that a Dr. Black, one of Dr.

Burrows’s predecessors, had urged its employment on the Tongan Gov ernment, and that the only reply he got was that as there is already in existence a cure for TB (aureo mycin) the BCG vaccine would be a needless expense. No doubt, for the same reason, other procedures advocated by the medical men are regarded as needless. This, of course, is nonsense, and merely goes to show what must be expected when supreme power is handed over (as it has been by us in Tonga) to people who are not sufficiently trained for a self-government.

The CMO in Tonga in 1939 (when I first visited the Group)—l forget his name, but he was an Australian —told me that in the preceding six

months he had put in over 30 re quisitions and recommendations on medical matters to the Premier’s office (then in charge of the late Prince Tugi) and that he had not had a single reply to any of them.

The present Crown Prince and Premier is currently reported to have advised his people not to have so many children, and to have advo cated modern methods of birth control, as he considers the Group is becoming over-populated. If this be so, it would serve the purpose well to continue to refrain from in troducing immunisation by BCG vaccine—the ravages of TB will act as a better method of birth-control than perhaps even he anticipates.