In the late 1950s he extended his studies to the very large population of Chamorros who had migrated to California. They had, he observed, the same incidence of lytico-bodig as the Chamorros in Guam, but the disease might only develop ten or twenty years after they had left Guam. There were, on the other hand, a few non-Chamorro immigrants who seemed to have developed the disease a decade or two after moving to Guam and adopting a Chamorro lifestyle.
Could the environmental factor, if there was one, be an infectious agent, a virus, perhaps? The disease did not appear to be contagious or transmissible in any of the usual ways, and no infectious agent could be found in the tissues of those affected. And if there was such an agent, it would have to be one of a very unusual sort, one which might act as a ‘slow fuse’ – John repeated the phrase for emphasis – a slow fuse in the body, setting off a cascade of events which only later might manifest as clinical disease. As John said this, I thought of various post-viral neurodegenerative syndromes, and especially again of my postencephalitic patients, who in some cases only started to show symptoms decades after the initial encephalitis lethargica – sometimes as much as forty-five years later.
At this point in the story, John started pointing emphatically through the window. ‘Look!’ he said. ‘Look! Look! Cycads!’ Indeed I saw cycads all round, some growing wild but many, I now saw, cultivated in gardens, as we drove to Talofofo to visit another patient of John’s, a former mayor of the village, whom everyone called the Commissioner.
Cycads only grow in tropical or semitropical regions and were new, alien, to the early European explorers when they first saw them. At first glance, cycads bring to mind palms – indeed the cycad is sometimes called a sago palm – but the resemblance is superficial. Cycads are a much more ancient form of life, which arose a hundred million years or more before there were palms or any other flowering plants.
There was a huge native cycad, at least a century old, growing in the Commissioner’s yard, and I stopped to gaze at this splendid tree, fondled a stiff, glossy frond, then caught up with John at the front door. He knocked on the door, and it was opened by the Commissioner’s wife, who ushered us into the main room where her husband sat. Sitting in a massive chair – rigid, immobile, and parkinsonian, but with a sort of monumental quality, the Commissioner looked younger than his seventy-eight years and still exuded a sense of authority and power. Besides his wife, there were his two daughters and a grandchild – he was still, for all his parkinsonism, very much the patriarch of the house.
In a deep musical voice, as yet scarcely touched by parkinsonism, the Commissioner told us of his life in the village. He had at first been a cattle rancher, and the village strongman, able to bend horseshoes with his bare hands (his hands, gnarled now, and slightly tremulous, still looked powerful enough to crush stones). Later he had been a teacher in the village school; and then, after the war, he had been drawn more and more into village affairs – very complex and unsettled after the Japanese occupation, and with all the new pressures of Americanization on the island, trying (without being ‘backward’) to preserve the traditional Chamorro ways and myths and customs – finally becoming mayor. His symptoms had begun eighteen months ago, at first with a strange immobility, a loss of initiative and spontaneity; he found he had to make a huge effort to walk, to stand, to make the least movement – his body was disobedient, seemed disconnected from his will. His family and friends, who had known him as a driving, energetic man, first took this as aging, a natural slowing down after a life of intense activity. Only by degrees did it become clear to them, and him, that this was an organic malady, an all-too-familiar one, the bodig. This fearful, thick immobility advanced with frightening speed: within a year he had become unable to get up alone; once up, unable to sense or control the posture of his body, he might fall suddenly and heavily, without warning, to either side. He now had to have a son-in-law, a daughter, with him all the while, at least if he wanted to get up and go anywhere. He must have found this humiliating in a way, I thought, but he seemed to have no sense of being a burden, imposing on them, at all. On the contrary, it seemed natural that his family should come to his aid; when he was younger he too had had to help others – his uncle, his grandfather, two neighbors in his village who had also contracted the strange disease he himself now had. I saw no resentment in his children’s faces or their behavior; their helping seemed entirely spontaneous and natural.
I asked, a little diffidently, if I might examine him. I still thought of him as a powerful authority figure, not someone to lay hands on. And I was still not quite certain of local customs: Would he see a neurological examination as an indignity? Something to be done, if at all, behind closed doors, out of sight of the family? The Commissioner seemed to read my mind, and nodded. ‘You can examine me here,’ he said, ‘with my family.’
When I examined him, testing his muscle tone and balance, I found fairly advanced parkinsonism, despite the fact that his first symptoms had begun little more than a year before. He had little tremor or rigidity, but an overwhelming akinesia – an insuperable difficulty in initiating movement, greatly increased salivation, and profound impairment of his postural sense and reflexes. It was a picture somewhat unlike that of ‘ordinary’ Parkinson’s disease, but more suggestive of the much rarer post-encephalitic form.
When I asked the Commissioner his thoughts on what might have caused his illness, he shrugged. ‘They say it is fadang,’ he said. ‘Our own people sometimes thought this, and then the doctors too.’
‘Do you eat much of it?’ I asked.
‘Well, I liked it when I was young, but when they announced it was the cause of lytico-bodig I quit, we all did.’ Despite concerns about the eating of fadang as far back as the 1850s (which Kurland had reiterated in the 1960s), the notion that it might be dangerous was only widely publicized in the late 1980s, so this quitting, for the Commissioner, must have been relatively recent – and he was evidently nostalgic for the stuff. ‘It has a special taste,’ he said, ‘strong, pungent. Ordinary flour has no taste at all.’ Then he motioned to his wife, and she brought out a huge bottle of cycad chips – obviously the family supply, and one which they had not thrown away, but were still at pains to keep, despite the decision to ‘quit.’ They looked delicious – like thick corn chips – and I was strongly tempted to nibble them, but refrained.
The old man suggested we all go outside for a photograph before we left, and we lined up – his wife, himself, and me in the middle – in front of the giant cycad. Then he walked slowly back to the house, a regal figure, a parkinsonian Lear, on the arm of his youngest daughter – not merely dignified in spite of his parkinsonism, but somehow gaining a strange dignity from it.
There had been some controversy about the local cycads for two centuries or more. John was interested in the history of Guam and had copies of documents from the early missionaries and explorers, including a Spanish document from 1793, which praised fadang or federico as ‘a divine providence,’ and Frey-cinet’s 1819 Voyage Autour du Monde, in which he described seeing this harvested on a large scale in Guam.[48] He described the elaborate process of soaking and washing the seeds, and drying and grinding them to make a thick flour ideal for tortillas and tamales and a soup or porridge called atole – all this is illustrated in his account. It was well known, Freycinet remarked, that if the seeds were not washed sufficiently, they might still be highly poisonous: