insights

Literature

Medical

An elusive, fragmentary and yet satisfying journey through a landscape

self examination

Book

Review

By Nicolas Rothwell

In the country of the blind, the one eyed man is king, so the saying goes; but in the country of the colour-blind, what there of the neurologist, the privi leged observer, the man of knowledge? In a remarkable Pacific memoir, Dr Oliver Sacks, the Western world’s most persua sive explainer of the tics, tricks and mys teries of the human mind, explores the strange Micronesian realms of Guam, Pohnpei and Pingelap - each, in its own way, a special kingdom of medical wonder and pathological challenge.

The Island of the Colour-blind, an account of two separate journeys under taken by the engaging, fluent Dr Sacks on the trail of unusual diseases, unfolds its tale in tranquil, gradual fashion, com mencing with the author’s childhood mus

ings on primitive trees and broadening

only in the most relaxed and tentative style to include his more developed themes: the splendours and miseries of neurology; the subtleties and sadnesses of island societies; the collision between tra dition and modernity; the texture, the feel of individual, disease-stricken human life.

Perhaps it was an inevitable coming together: the inquisitive Dr Sacks and the bizarre medical conditions of the Pacific a cluster of colour-blindness cases on the Pohnpei atoll of Pingelap, and the beset ting sicknesses of Guam, known by their local name, lytico-bodig, and as yet unde ciphered by modem medicine. In com plex, glancing narratives, reinforced by detailed footnotes on such fascinating top ics as radiation, cycad growth, obesity, and pigs in the Pacific, Dr Sacks tells the story of his brief journeys. The Carolines, he tells us, are “some of the most remote and least known islands in the world” but after a trip with Dr Sacks, their atmo sphere is palpable. Chance encounters and profound episodes succeed each other, until not only the quality of Pingelap colour-blindness, but the nature of atoll

life is captured, pinned down, conveyed.

In this little community of 700 souls, one in 12 is ‘achromatopic’ - completely colour-blind, seeing no hues, only shades of grey. Why? The explanation is intrigu ing: a population collapse in Pingelap spread a particular gene widely through the surviving community. Hence, in the glare-ridden, gleaming ocean, a group of squinting, half-blinded islanders, afflicted by their specific disease-cluster, known in the local tongue only as “ maskun ” - “not see”.

Dr Sacks travels back to lethargic Pohnpei, describes the lost city of Nan Madol and, before leaving, tastes the local kava, or sakau. This provides his most poignant pages. He is told that this Pacific drug is “one of the moral vines which holds us together” and in him it certainly produces impressive visual and auditory effects - which he proceeds, as- a neurolo gist, to gloss. It must have been one of the most mirrored, self-reflecting highs on record. Guam, however, -offered a more painful spectacle of disease. Here, the lyti co-bodig, an illness with affinities to Parkinsonism, motor neurone disease and Alzheimer’s rages in a given age-section of the Chamorro population. Virus, genet ic condition, environmental contaminant?

No one knows what provokes the multiple effects of the diseases which seem distinct yet inter-related. Cycad flour poisoning, mineral deficiency and mineral toxicity

have all been proposed as sole causes, and found wanting. Perhaps the illnesses, which have come almost to define an aspect of Guam’s life, may be the result of some complex combination of factors, Dr Sacks and his various colleagues and col laborators in this neurological detective story suggest, in between lyrical descrip tions of the old ways of island life and the present crudities of American military intrusion. So intensely do the resident doc tors involve themselves with the lytico bodig that they come to identify with it, as if it held the answer to some Pacific puz zle: indeed, Dr Sacks too feels the call of the disease, which, perversely, is dying out just as medical science gathers itself for a final assault on its secrets: “So it will be with Pingelap; and so, in all likelihood, it will be with Guam - odd genetic anoma lies, swirls, transients, given a brief possi bility, existence, by the nature of islands and isolation. But islands open up, people die or intermarry; genetic attenuation sets in, and the condition disappears. The life of such a genetic disease in an isolate tends to be six or eight generations, two hundred years perhaps, and then it vanish es, as do its memories and traces, lost in the ongoing stream of time.”

How elusive, how fragmentary, and yet how satisfying, ultimately, this strange, casually composed, almost off-hand book proves to be: its effect is one of smooth passage through a landscape of self-exam ination, through a human laboratory. The Pacific, that most evocative of stages, speaks to Dr Sacks, and speaks, through him, to his reader. He closes in a develop

ment-threatened primeval cycad forest

upon Guam’s companion island, Rota.

Here he receives an intimate impression of the antiquity of our planet, and the slow processes of life’s evolution: “Standing here in the jungle, 1 feel part of a larger, calmer identity; I feel a profound sense of being at home, a sort of companionship with the earth.” ■

The Island of the Colour-blind by Oliver Sacks. Published December 1996 by Picador, £16.99 (UK)