In 1803вЂ“1804, an epidemic labeled вЂњ okuuвЂќ by the Hawaiians killed an estimated 5,000 persons on Oahu as King Kamehameha and his army prepared to invade Maui. 1, 13, 15 These records are reviewed recognizing that modern concerns for diagnostic and numerical precision were an unfamiliar concept to many of the people involved, Pacific islanders and their observers alike. Most of the existing records were narratives from ship's captains or resident missionaries scattered across the Pacific Ocean. 1, 15, 16 Few enteric pathogens (apart from Shigella) are capable of asymptomatic carriage as well as the great infectivity and extreme lethality described during early Pacific island epidemics. 2, 13, 14 Pacific island populations died at high rates from infectious diseases that must have been introduced by single sailing ships that had no symptomatic sailors on board indeed most ships had not been into another port for weeks to months before landing on a Pacific island. Mortality is an unmistakable clinical endpoint, but descriptions of illness before death during the 19th century reflected the then current worldview of miasmic diseases, in addition to more than a tinge of racial superiority by western observers of the Polynesian and Melanesian populations. Although amoebic dysentery is an alternative possibility, 20th century dysentery epidemics in the tropics were shown to be overwhelming due to shigellosis, once microbiological cultures were obtained and many of the putative amoeba shown to be leukocytes in the stool. 7 вЂ“ 11 Although historical reports are often hard to fit into modern diagnostic categories, the descriptions of obvious blood in stool makes it highly likely that many of the early epidemics were indeed due to bacillary dysentery. Shigella species are the most common cause of lethal (bacterial or bacillary) dysentery epidemics, and have been important factors in both historical and recent military campaigns and other complex public health emergencies. 3 Despite these limitations, the historical record offers the only definite information regarding potential explanations for the extraordinary mortality of first-contact epidemics.Дysentery is a febrile infection leading to frequent defecation with blood, pus, and mucus in the stool. 5, 6 Most of the highly lethal Pacific epidemics preceded the scientific revolution created by Pasteur's discovery of the microbiological nature of infectious diseases, and were described by the few literate observers in archaic terms. Pacific islands were the last geographic points included in the global pathogen pool, and the admittedly fragmentary record of the earliest epidemics may offer insights into the mechanisms of mortality that presumably once existed for all human societies when they transitioned to live in interconnected populations. 2 вЂ“ 4 The reasons behind the tremendous mortality remain largely unexplained, but apparently now no longer exist in the same island populations. 1Д®xtraordinary infectious disease mortality depopulated many of the Pacific islands soon after they were first contacted by western explorers and sailors.

вЂњIt occasioned a great mortality-so much so, that the natives state, the living were not able to bury the dead.вЂќ James Jarves, Hawaii. 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.

Other possible risk factors include human leukocyte antigen homogeneity from a founder effect and pathogen-induced derangement of immune tolerance to gut flora. 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. 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. Bacillary dysentery caused by Shigella is the most likely infection causing some of the most lethal island epidemics. Although the mortality was great, the lack of medical observers makes determination of what happened during these historical epidemics largely speculative. Infectious diseases depopulated many isolated Pacific islands when they were first exposed to global pathogen circulation from the 18th century.

How does dysentery kill