The Tobago Yaws Hospital 1902-1921

The harsh working and living conditions that enslaved Africans in Tobago endured did not include access to clean water and sanitation arrangements. As a result, diseases were common during slavery. While some afflictions resulted from the conditions aboard the slavers and on the estates, others were introduced from Africa.

It was common for estates employ doctors to treat sick enslaved patients, rather than face the risk of their labour population being decimated by a disease outbreak.

One such disease that caused deep consternation, because it was one of the most common diseases in Tobago, was yaws – framboesia. This was a very feared, disfiguring disease introduced to the island from Africa, and was prevalent among the enslaved African population.

The problem was that it posed a special challenge. There were attempts to provide some form of treatment – which aggravated rather than relieved the condition: western-trained doctors were not familiar with this disease, which had not featured in their training regime. Some of the larger and wealthier plantations kept the services of a doctor or an enslaved “medicine man” who carried out the instructions of the doctor, who refused to come into close contact with affected patients.

Views on the disease were prejudiced: according to one doctor, yaws was “a dirt disease” caused by the “dirty habits of dirty people,” and was treated as the disease of “dirty people” – the Africans.

It was a highly feared disease because of the extent of disfigurement it caused, which provided the natural basis for isolation, since no one would willingly associate with yaws victims except those who had previously had it.

People were isolated by fear, since the aetiology of the disease was not understood. Patients were abandoned in huts in the most distant parts of the plantation, where they were left to fend for themselves. They would be accepted back to plantation life to serve as nurses for other afflicted people.

However, isolation did not cure the island of the menace, because fresh cases arrived on the island with each new boatload.

The system helped to control both its spread and its visibility. Yaws houses existed on many Tobago estates. The large estates, such as Auchenskeoch, Betsy’s Hope, Charlotteville, King’s Bay, Lowlands and Merchiston, maintained individual units; smaller ones like Lucy Vale and Trois Rivieres shared facilities.

This system remained in operation until 1838. Emancipation undermined control of the disease, because with freedom, labourers across the island, where the free villages were established, nullified the isolation, making the disease become more visible, much to the alarm of the administration.

The attitude of the freed African population was very different from that of the ruling class. They were indifferent to what was considered normal and commonplace, and they felt it better for children to contract the disease while they were young. To the ruling class, the opening of schools facilitated the spread of yaws.

The effort to curb the spread of the disease led the administration to pass the Medical Aid Ordinance in 1882, which offered free medical attention to all labourers over 60 and their children under eight.

But this was not compulsory, so many yaws sufferers did not seek any treatment, and as a result, the incidence continued to rise. Parents, who were described as “irresponsible,” were blamed for the increase, and the island’s medical officer suggested treatment should be made compulsory and managed by the police. Parents who neglected to submit their children for treatment should be fined, a yaws hospital was to be established, and a constable associated with the hospital appointed to identify cases of yaws in the community and require them to submit themselves or their children for treatment.

Driven by concern that the disease was approaching epidemic proportions, putting the entire population at risk, the medical fraternity became convinced compulsory treatment was the answer.

They demanded more cleanly habits among the population, who, they lamented, were treating the disease too casually, using remedies such as scrubbing patients in rivers with corn husks, and applying sand and salt to open wounds, which officials believed facilitated the spread of yaws among students.

But the administration could not respond to calls for compulsory treatment because of its financial challenges.

The Colonial Office felt action was essential to prevent yaws from spreading across the region. In 1887 the island’s government decided to fund treatment and medicines for yaws patients, and the Tobago Board of Health made treatment available to all of them.

As the island’s position improved, pressure was put on parents in Scarborough: many were threatened with penalties if they did not comply with the regulations and bring their children for treatment.

The Legislative Council eventually voted £150 to buy medicines to supply all district medical officers with medicine as the start of compulsory treatment for all those afflicted.

The start of this programme revealed the true extent of the disease. Between August 1887 and December 1889, 1,423 cases were treated, showing Tobago was one of the most affected islands in the region – and the disease was still on the increase.

In 1889, the yaws suppression clause came into force. It banned bathing yaws patients in rivers, with imprisonment for non-compliance. In practice there were few convictions for non-compliance; and it was recognised that prosecution would not provide the goodwill required to encourage compliance.

So a year later, in 1890, yaws was again on the rise in Tobago. Given the situation in Trinidad, with which it was now united, it was recognised that action was needed in both islands.

To provide separate accommodation for yaws patients, the yaws ordinance of 1896 required district medical officers to list the numbers of cases in their districts and find places where dispensaries should be sited. The dispensary system gave patients a week’s supply of medicine, to be replenished in the following week.

Yet cases continued to increase, so there was concern that the dispensary system was not as effective as was expected.

Yaws hospitals were established across the unified colony. The Tobago Yaws Hospital was set up in 1902. Yaws searchers were paid fees of one-two shillings to intensify the fight.

However, the most effective medication was Salvarsan and injections of Novarsenobillion, which were administered in the district medical offices, reduced the number of cases and made the yaws hospitals redundant. The Tobago Yaws Hospital was closed in 1921.