V - -^ X\ lW%J ; .** >* ^ .^ 0' x ^ H ^ V x v -^ * 0° * npOl : «.*i KAUAI NIIHAU ^-SQ^jb MOLOKAI gsTsf^^PSiL MAUI LANAI <6^ M^,! 1 ^. KAHOOLAWE^S ^""^ HAWAII £§>£$' ^^T* \ \ HAWAIIAN ISLANDS. Discovered by John Gaetano, Spanish navigator, about the year 1555, on one of his voyages between Acapulco and Manila. Named by him the "Mesa Islands." Their exact position was hidden from other European nations by the Spaniards, for 223 years. On January 18, 1778, Captain James Cook, R. N., re-discovered the Islands. The islands of Niihau and Kauai were the first lands seen. The Hawaiian Islands extend through four degrees of latitude, 18° 30' N to 22° 30'N; and six degrees of longitude, 154° 30' W to 160° 30' W. The total area of all the islands, large and small, is some 6,454 square miles; and they possess a climate "Second to None" in the universe for healthfulness. ^^^fpl'lllllfjlplllllllill "THE PATH OF THE DESTROYER" A HISTORY OF LEPROSY IN THE HAWAIIAN ISLANDS AND THIRTY YEARS RESEARCH INTO THE MEANS BY WHICH IT HAS BEEN SPREAD BY ATA St. M. MOURITZ Formerly Physician to the Leper Settlement, Molokai. Four Maps and Sixty-Nine Illustrations, Colored and Plain. HONOLULU. 1916 ^ M i | i i ii i ii i i | ii || I UI l Ji ii iiii | n l , 1 ; vii'^" i iii i "i i i j PBi ^ , , <■ ■ ""' ' ' ' " ♦ *w COPYRIGHTED. Entered According to Act of Congress, in the year 1916 by A. MOURITZ In the Office of the Librarian of Congress. All Rights Reserved. °fC k2 »9/ 6 PRINTED IN HAWAII. PRESS: HONOLULU STAR-BULLETIN, LTD. HONOLULU, MDCCCCXVI. LC Control Number ©GI.A455015 tmp96 028684 THIS THE FIRST AMERICAN BOOK ON HAWAIIAN LEPROSY is RESPECTFULLY DEDICATED TO The noble hearted members of the 58th Congress, who generously answered the pleadings of the Hawaiian people for aid to the afflicted of their race, and appropriated the necessary funds to es- tablish and maintain a Leprosarium at Kalauwao, Molokai. £ Ji O K/ < 7 ^ bJD D .5 S- ° PROLOGUE. The Hawaiians are a very affable, agreeable and lovable peo- ple, just as much so as any other on our earth; but in contact with disease, all their desirable traits are seriously discounted by their lack of care, because they endanger all of us "by failing to obey the most simple rules of health, necessary for their own salvation and self-preservation." It is a most pitiable condition, evident to the most unobserv- ing, "that an atmosphere of leprosy clings to and surrounds the unfortunate Hawaiian.'' Why? Because he fails to realize the danger that menaces him, apart even from the extreme receptivity of his system to the bacillus of leprosy, a condition lacking in other races domiciled in Hawaii nei : this being an indisputable fact, then he (the Hawaiian) is the w r eak link in our chain of national health defense. It is presumably allowed that the commonhealth is the com- monwealth, this being so our duty is plain, we must stand shoulder to shoulder with the Hawaiian, brace him up, and support him until he can stand alone, like other races ; if he stumbles and falls we must raise him, comfort him, sustain him again, like our own brother. The eradication of leprosy can well begin in the school room, like other benign and essential advances; here can be instilled in virgin soil, free from the weeds of prejudice, the first principles of good health and self-preservation. The causes of the decadence of the Hawaiian race are very complex ; but the added result indicates that it is due in the main to the standard set by modern civilization, which carries in its train attendant disadvantages, to wit: New things, strange clothes and foods, housing, diseases, medicines, habit-forming drugs, etc., and alcoholic beverages. The strain is too severe, the Hawaiian falls and drops out ; he is not sufficiently fortified ; because of his too brief emergence from primitive life. Civilization blights aboriginal races, the Hawaiian is no ex- ception ; the harsh side of civilization kills by kindness, it may re- semble the Greeks bearing gifts, in contact with primitive races it is treacherous. Apart from its limitedly contagious properties, the disfiguring repulsiveness of leprosy alone demands its segregation ; its specific contagion, compared to that of Tuberbulosis, is less than one-tenth of one per cent. PREFACE. With the rapidly changing conditions in Hawaii, much valu- able material relating to leprosy will soon be lost and buried in oblivion. Because no one else has written the history of leprosy in Hawaii, I have taken up the subject, I admit, with some hesitation and misgiving. I have also made a special and close study of the cause and means by which leprosy has been spread ; the conclusions I have arrived at are stated in the pages of this book, but perhaps my statement that "Mouth Infection" is the chief means by which leprosy has been spread will not be well received ; because the song of the siren of inoculation has warbled so long and loudly over the land. I assume that my views founded on probable evidence of the cause of the propagation of leprosy in Hawaii, if accepted, will lead the Hawaiian people from the shades of darkness, also other races; and that all will be ultimately snatched from the jaws of death. This Monograph does not cover the entire field of leprosy in Hawaii ; historical, ethnical, etiological, and superficial phases of pathology, are alone dealt with. What work I have done has been carried on in leisure moments, which I have been able to snatch from the working hours of a busy life; under many difficulties, hindrances, defective apparatus, poor quarters, and lack of assistance, skilled and unskilled. Not being a Croesus, I could only afford limited time and money. My diction and composition are faulty and not free from platitudes. I plead that it is better to make a poor attempt than none at all, do nothing, assume a somnolent attitude, fold the hands until a little sleep comes, etc. ; resulting in valuable material on leprosy vanishing forever. The language used in this Monograph is mostly non-technical, it is intended for the laity and the professional reader. Words not in common use are explained in the Glossary. THE AUTHOR. Honolulu, August 15, 1915. I HAVE ACQUIRED MUCH VALUABLE DATA ON THE EARLY PREVALENCE AND SPREAD OF LEPROSY IN HAWAII, FROM THE FOLLOWING SOURCES: ISLAND OF OAHU. Alexander, Professor W. D. (Deceased). Board of Health Reports. Brickwood, Miss Louisa. (Deceased). Dayton, David, Esq. (Deceased). Emerson, Mrs. Ursula. (Deceased). Fathers of the Catholic Mission. Fitch, Dr. G. L. (Died June 4, 1904). Forbes, Rev. A. O. (Deceased). Hoffman, Dr. Edward. (Deceased). Judd, Albert F., Esq. (Died May 20, 1900). McKibbin, Dr. Robert. (Deceased). Parke, W. C, Esq. (Deceased). Records of the Hawaiian Board of Missions. Trousseau, Dr. George. (Died May 4, 1894). Whitney, H. M., Esq. (Died Aug. 17, 1904). ISLAND OF MAUI. Archambaux, Father Gregoire. (Deceased). Burgermann, Father Andre. (Deceased). Everett, T. W., Esq. (Deceased). Fornander, Abraham, D. C. L., Ph. D. (Deceased). ISLAND OF HAWAII. Coan, Miss Harriet. (Died July 23, 1906). Fathers of the Catholic Mission. Kauhane, Rev. J. (Deceased). Loots, Father Bonaventure. (Died March 9, 1899). Pouzot, Father Charles. (Deceased). ISLAND OF KAUAI. Rowell, William. E., Esq., C. E. (Died March 18, 1916). Wilcox, Luther, Esq. (Died July 3, 1903). ISLAND OF MOLOKAI. Moellers, Father Wendelin. (Died Sept. 1, 1914). Oliver, Dr. Richard. (Died Aug. 12, 1902). Swift, Dr. Sydney B. (Deceased). / have made use of the work of the following persons: Bertram, Brother, St. Louis College, Map of Molokai. Robert, Brother, St. Louis College, Maps. Waiamau, John, Artist, seventeen years a resident of Kalaupapa. Williams, J. J., and C. Weatherwax, Photos and Views. * TABLE OF CONTENTS PART I. Page Dedication : ..-. 7 Prologue — - - 9 Preface — — 11 Introduction 21 Abstract of Contents 24 Chapter I. Leprosy in Hawaii — 27 Chapter II. Early History of Leprosy in Hawaii 29 Chapter III. Climate of Hawaii, and Diseases 36 Chapter IV. Leprosy in India, Biblical and European 45 Chapter V. Syphilis, Leprosy, Ethical Phases, Extinction.... 54 Chapter VI. Segregation : 63 Chapter VII. The Law of Segregation and its Enforcement.. 69 Chapter VIII. Excerpts from Board of Health Reports 83 PART II. AGENTS ALLEGED TO SPREAD LEPROSY. Chapter I. Vaccination 93 Chapter I. Mosquito 95 Chapter I. Flies 98 Chapter I. Fleas and Bedbugs '... 101 Chapter I. The Breath of the Leper !.... 103 Chapter I. Bacilli Leprae External to the Leper... 109 Chapter I. Carriers of Leprosy Ill Chapter I. Awa 115 Chapter I. Salt Fish 117 Chapter II. Deductions 124 Chapter II. Poi vs. Leprosy 125 Chapter III. Inoculation 138 Chapter III. Inoculation Experiments by the Author 140 Chapter III. The Alleged Successful Case of Keanu 152 Chapter IV. Immunity or Non-receptivity 157 Chapter IV. Bacterial Infection 158 Chapter IV. Dr. Hansen's Bacillus Leprae 161 Chapter V. Contagion 164 Chapter V. Leprosy Not a Disease of Animals 168 Chapter VI. More Male than Female Lepers 179 Page Chapter VII. Miscellaneous Topics 186 Chapter VII. Volatile Oils in Leprosy 186 Chapter VII. Possible Cause of Different Forms of Leprosy 187 Chapter VII. Alcohol, in Leprosy 188 Chapter VIII. Artificial Leprosy 190 Chapter VIII. Epilogue 193 Chapter IX. Glossary 194 Chapter IX. Physicians to Leper Settlement and Leprosarium 198 Chapter IX. Chronological Table 199 PART III. PERSONAL REMINISCENCES. A Responsible Office . . 203 Autobiography of Mr. Ambrose Hutchison 204 Fr. Damien, Autobiography of His Work at Kalawao 211 Fr. Damien, Priest, Leper, Popular Hero 229 Fr. Albert Montiton . 249 Fr. Gregoire Archambaux 251 Fr. Charles Pouzot . 253 Fr. Andre Burgermann 254 Fr. Wendelin Moellers, In Memoriam 254 Thirty-one Years in Office, R. W. Meyer 262 R. W. Meyer, History of the Leper Settlement 265 Brother Joseph Dutton . 283 Franciscan Sister's at Bishop Home 286 Rev. C. M. Hyde, D.D 288 PART IV. REPORTS ON LEPROSY THIRTY YEARS AGO. Republished by Request. Report of Queen Kapiolani 295 Report of Dr. J. H. Stallard 313 Report of Dr. E. Arning 320 Letter War re Dr. Arning and Board of Health 341 Report of Dr. A. Mouritz 357 Report of Dr. G. L. Fitch 382 Report of Dr. R. Oliver 398 PART V. Laws Relating to Leprosy 401 ILLUSTRATIONS PART I. Page Map of the Hawaiian Islands — Frontispiece. 4 Federal Leprosarium 8 Relief Map, Island of Molokai 20 King Kamehameha V 26 Map of Honolulu _ 31 Taro Plant 38 Hawaiian Grass House 42 Walter M. Gibson 48 Home of the "Pacific Commercial Advertiser," A.D. 1883 50 Elderly Hawaiian (w)* 57 Map of the Leper Settlement 67 Kalaupapa From the Sea 77 The Landing at Kalaupapa 81 Dr. George Trousseau 87 PART II. Hawaiian Type (k)* 97 Hawaiian Type (w)* 105 Hawaiian Type (k) 114 The Meal of Poi and Raw Fish 126 Our Harbinger of Hope (colored). 129a Preparing the Poi 130 Caucasian-Hawaiian (w) 133 Chinese-Hawaiian (w) 137 Dr. G. A. Hansen 159 Convent of St. Anthony 171 Our Racial Amalgam 176 Hawaiian Japanese Girl 181 Chinese-Hawaiian 185 Caucasian-Hawaiian _ 197 * (k) kane or male. * (w) wahine or female. PART III. Fr. Damien, Aged 26 Years 212 Catholic Mission, Puna, Hawaii 224 Fr. Damien, Aged 34 Years 230 Hala or Puhala Tree 233 Page Kalauwao, A.D., 1884 - -- - - - 239 Fr. Damien, A.D., 1887 ---- 245 The Tomb of Fr. Damien - - 248 Kalaupapa, Where Fr. Wendelin worked 255 Fr. Wendelin - - - ----- - 257 Fr. Wendelin and His Class 259 King Kamehameha IV. — - — - 268 Queen Emma - - 271 Lieut. Ira B. Dutton, A.D. 1863 284 Lieut. Ira B. Dutton, A.D. 1877 284 Brother Joseph Dutton, A.D. 1907 284 Rev. C. M. Hyde, D.D - 287 Fort Street Church, A.D. 1884 290 PART IV. Queen Kapiolani 299 Kalauwao Hospital, A.D. 1884 303 Queen Liliuokalani 309 Charles R. Bishop 328 Bernice Pauahi Bishop 337 Haleakala, Residence 345 Henry P. Baldwin 350 Baldwin Home, Kalawao 356 The Bethel Street Church, A.D. 1883 361 Rev. Francis W. Damon 366 Chinese Mother and Babe 371 Genuine China 377 Genuine China 381 Chinese-Hawaiian 385 King Lunalilo 390 The Lunalilo Home 394 Nodular Leprosy, Mild Nodular Leprosy, Medium Nodular Leprosy, Severe Pigment Deposit in Skin of Breast.... Leprous Maculation The Leper Ear \ Colored Section Dual or Mixed Leprosy Dual or Mixed Leprosy Neural Leprosy of the Hand Neural Leprosy of the Foot Neural Leprosy of the Foot Leprous Ulcers of the Ileum PART I. o £ O oo Q ig CO INTRODUCTION. Much has been said and written about "THE BLOT" that leprosy is to the Hawaiian Islands; hence the inference is drawn "that many TOURISTS and other visitors have hesitated to visit Hawaii on account of the prevalence of the disease." In order to refute this assumption, I submit the following state- ment, and first ask the question: Among what race is leprosy endemic? Please carefully read the following figures. FIRST AMERICAN CENSUS, A. D. 1900 Race Population Lepers Ratio Approximate Race Percentage Whole Population Approximate Hawaiians— . Foreigners.—. 37,635 116,366 964 63 1 to 39 1 to 1847 24% 76% Total 154,001 1027 100% In India the ratio of lepers to the healthy is 1 to 1864. The above table "shows" in a total foreign population, 76% of the whole (composed of a large majority of Asiatics, and a very low propor- tion of Caucasians), only 63 lepers exist; whereas, the Hawaiian population, only 24% of the whole, produces 964 lepers. These figures disclose that the foreign race is practically free from the ravages of leprosy; hence the fear of becoming infected in Hawaii need not cause alarm to any visitors, or even residents on our shores. What can carry more conviction than these figures? If they do not convey a lesson of comparative non-leprous infection to the foreign population domiciled here, nothing that I can write will be more convincing. The reader can also draw T his own conclusions from the follow- ing story. During the years 1884-, 85, 86, 87, I resided at the Leper Reservation on Molokai, and during those years I entertained twenty-seven visitors and tourists. Over forty other applicants were turned down and refused permission to enter the Reservation, the chief desire of these people being to see the lepers and take photo- graphs. If the Board of Health once let down the bars of entrance, they would be pestered by many applicants for admission. When the sanitary committee of our Legislature announce they 22 THE PATH OF THE DESTROYER propose to visit the Leper Settlement, they are immediately inun- dated with requests for steamer transportation to Molokai. In recent years, to avoid refusals, and not offend voters and others, the date of the steamer's departure is concealed. The applications of would-be visitors are not by any means con- fined to friends and relatives of the lepers. Strangers, tourists and others also apply. About the second week of the month of July, 1907, the Pacific Commercial Advertiser records on one of its front pages the doings of one, Jack London, and his friends at. the Leper Settlement. From time to time the mainland papers have printed exag- gerated and untruthful stories concerning the status of leprosy in Hawaii. It is unnecessary to reply to them; their best refutation lies in the eagerness of visitors to gain access to the Leper Settle- ment. THE DEATH RATE OF ALL THE ISLANDS FOR THE YEAR ENDED JUNE 30, 1913, WAS 3,232: OF THIS TOTAL, ONLY 48 DEATHS WERE CAUSED BY LEP- ROSY, OR OUT OF EVERY 67.33 DEATHS, ONE WAS DUE TO LEPROSY. THE DEATH RATE FROM LEPROSY PER EACH 1,000 OF THE POPULATION AMOUNTS TO 0.22. OF THE EIGHTEEN PRINCIPAL CAUSES OF DEATH, LEPROSY OCCUPIES ONLY THE 14TH PLACE WITH 48 DEATHS. Hawaii has nothing to conceal. A final cold, clinching, de- liberate fact is That SEVEN-TENTHS (7/10) per THOU- SAND is the extent of the prevalence of LEPROSY amongst all FOREIGN RACES domiciled on her shores. It is in evidence as a painful and undisputed fact that in Hawaii nei, leprosy is a scourge peculiar to the Hawaiian race, and its kindred offshoots. It is also a singularly significant fact, that with scarcely an exception Those FOREIGNERS both MALE AND FEMALE who have acquired leprosy are those who have been in particularly promiscuous, friendly, and intimate CONTACT with Hawaiians; viz., visiting, eating, and sleeping in their homes. It is fitting to add — Hawaii declines to receive any lepers from Continental United States or elsewhere. Our aboriginal racial material is altogether too susceptible and explosive, without THE PATH OF THE DESTROYER 23 any addition of fresh tinder, to possibly kindle into activity the supply we have already on hand. The Census of the year 1910 gave the number of Hawaiians as, Males 13,439 Females 12,602 Total 26,041 Caucasian and Asiatic-Hawaiians are excluded from the above figures. ABSTRACT OF CONTENTS. 1. The Bacillus Leprae, discovered by Dr. Gerhard Armauer Hansen of Bergen, Norway, in the year 1868, is a plant microscopic parasite which finds its most desirable and only habitat in the human body, and its presence and development therein produces the three forms of leprosy — (a) Nodular or Tubercular, (b) Mixed or Dual, (c) Neural or Anaesthetic. Dr. Albert L. S. Neisser of Breslau further elaborated and added to Hansen's Bacillus the important, features of its being non- tnotile, non-flag ellate, and non-sporogenous. 2. Leprosy is limitedly contagious to the careless contact; practically non-contagious to the careful. 3. Leprosy cannot be conveyed by the breath of a leper, even if the contact is close. 4. Flies, fleas, mosquitoes, and bed-bugs may be ignored as active causative factors in spreading leprosy. 5. The Bacillus Leprae exists outside the body of the leper, in graves and toilets, these locations as a means of spreading leprosy may also be ignored. 6. There are carriers of leprosy, who carry the bacillus at varying intervals in certain parts of their bodies in the neural form, but infection from these foci of the disease cannot be con- veyed to contacts. These carriers of leprosy are few in number, and as a factor in spreading leprosy they may be safely eliminated. 7. The main entry of the Bacillus Leprae into the system of man is through the mouth and digestive tract, and this is "the path of the destroyer." 8. The mouth and its contained fluid, the saliva, is for all practical purposes, the source of contagion to the healthy. 9. Leprosy as a hereditary affection is of doubtful proof, and also hereditary predisposition (so-called) ; nearly all such cases can be explained as being post-natal infection. 10. Leprosy cannot be inoculated upon any dermal surface by ordinary means in man (in my experience), but the fetich of inocu- lation will not down in this community — it dies hard. 11. Leprosy is not a disease of animals. They are not recep- tive to inoculation on dermal or mucous surfaces. They are appar- ently inoculable by intraperitoneal injections of the blood serum from dermal blisters or bullae. Feeding leper serum mixed with fresh pancreatic juice of the pig, together with previous alkaliniza- THE PATH OF THE DESTROY ER 25 tion of the gastric juice, and administered to certain animals, pro- duces a disease resembling human leprosy in some cases as early as four months. 12. The blood per se is not a permanent habitat of the Bacillus Leprae. 13. Vaccination performed aseptically, or even septically, fails to fill the bill as a cause of spreading leprosy. 14. Salt fish, raw fish, poi and awa cannot convey or com- municate leprosy unless contaminated by leprous contact. 15. A "de novo" development of leprosy cannot occur. My apology and justification for coming to the front and in- flicting the before mentioned statements on the public, is contact and practical acquaintance with nearly 4,000 cases of leprosy. Thirty years ago, by request of the (then) Board of Health, I wrote a report on leprosy, very much against my own will. My views at that time were crude, immature, and in the main theo- retical, whereas today I am in possession of extensive experience and facts. INCUBATION The incubation of leprosy is the most difficult to fix of any known disease; the victim may suspect where, but rarely when he he became infected. The necessary work to obtain definite infor- mation on this phase of leprosy is enormous; one investigator can- not possibly reach reliable results. In the 1,100 cases of con- jugal relation mentioned on another page, I could obtain only nine wherein it was possible to draw any partially accurate conclusion. One. — Length of incubation . 5 months. Four. — Length of incubation 8 to 12 months. Three. — Lenth of incubation 12 to 15 months. One. — Length of incubation 15 to 20 months. Minimum length of incubation, average 10 months. Maximum length of incubation, average 15f months. KING KAMEHAMEHA V. Born December 11, 1830. Died December 11, 1872. Before ascending the throne known as Prince Lot. He had acted as president of the Board of Health before becoming King. On December 28, 1863, the first official mention of leprosy came up at a Board of Health meeting, on the request of the King. As King Kamehameha V, he signed and approved the "Act to Prevent the Spread of Leprosy," on January 3, 1865. He ascended the throne November 30, 1863. CHAPTER I. LEPROSY IN HAWAII No indigenous word for leprosy exists in the Hawaiian language. The exact date when leprosy first appeared in the Hawaiian Islands cannot be exactly determined ; it is only possible to sur- mise when it did, and in the absence of absolute facts, it is the only course open. There is no word in the Hawaiian vocabulary for leprosy. "Mai Pake" or Chinese Sickness, is generally in use to define lep- rosy; also "Mai Alii' (the chief's sickness), but it is doubtful if this name (Mai Alii) strictly is intended to define leprosy; it more properly fills the condition to which we apply the word scrofula. It is reasonable to assume that this word "Mai Pake" has some connection with the Chinese and leprosy, under two condi- tions. Either some Chinaman presented visible evidence of the disease to the Hawaiians, or else on interrogation, the Chinese stated they were conversant with leprosy and had it in China. Chinese visited Hawaii in various ships subsequent to the year 1830. The first Chinese coolie emigrants from Hong Kong landed at Honolulu January 25, 1852. The name "Mai Pake" does not necessarily presuppose that the Chinese introduced leprosy into Hawaii, it simply assumes the Chinese connection with the word. Abundant and conclusive evi- dence, however, exists that the Chinese coolie has carried leprosy into other countries. There is scarcely a leper hospital in the West Indies and South America that has not had a Chinese leper inmate. I admit that the mere fact that there is not a distinctive word in the Hawaiian language for leprosy argues nothing, but I also assert, from many years' contact with the Hawaiian people, that when they are in doubt or perplexity about new words, they naturally turn to the foreigner for aid — all thinking people will admit this. History repeats itself — look back twenty-five years, where does the Hawaiian language derive such words as "Mai Bubonica,'' year 1899 bubonic plague) ; "Mai Kolera," years 1895, 1911 (cholera); "Piva Lenalena," year 1911 (yellow fever)? Due importance should be attached to this clear evidence. Discussing this same question at Kaunakakai, Molokai, in the year 1885, with the late Professor W. D. Alexander, a brilliant and logical mind, yet withal a most unobtrusive, modest, and silent gentleman, I stated my case, on the cause of using the word Mai 28 THE PATH OF THE DESTROYER Pake as outlined above, and asked the Professor what he thought of it. He answered: "All you state is probable, tenable, convincing, and, short of absolute proof, you make out a strong and plausible case." Some thirty-five years ago, discussion on the question of the origin of leprosy in Hawaii came prominently to the fore. Those who maintained that the Chinese origin of Hawaiian leprosy was vague and uncertain argued and stated their views as follows: "It has been asserted that leprosy was introduced by a China- man, and consequently was called Mai Pake, or Chinese Sickness, as the Hawaiians had no name for the disease. "First. How is it that one Chinaman caused such a spread of the disease thirty or forty years ago — 1856 or 1846? "Second. If the disease was introduced by the Chinese in proportion to their intimate contact and association with Hawaiian females (especially young girls), we should expect to find a larger proportion of females than males affected with leprosy, and yet we all know the contrary is the fact." The answer to the first statement is: Nowhere do the up- holders of the Chinese connection with leprosy assert, that China was the sole origin of the disease in these islands. Possibly Hawaii was infected from more than one source. Leprosy may have been carried to the islands by the varied and mixed peoples which comprised the crews of the numerous whale ships, said crews being recruited at ports of the Azores and Cape de Verde Islands, East and West Coasts of Africa, Mozambique, India, West India Islands, and Malayasia; almost all these coun- tries are seats of endemic leprosy. The answer to the second allegation, "the intimate and close association of the Chinese with young Hawaiian girls as a possible cause of spreading leprosy." This statement presupposes and asserts that leprosy is conveyed by inoculation, like syphilis, which is an absurdity — in fact, leprosy even in the conjugal relation is the least likely to be communicated of any disease that can be said to be so conveyed, and cannot be compared with syphilis and tuberculosis in this respect. Nine years after Capt. Cook rediscovered the islands (1778), Hawaiians visited China. Chief Keawe Kaiana and three Ha- waiians sailed for Canton, China, in August, 1787, with Captain Meares in the "Nootka," and remained there three months. Kaiana and other Hawaiians visited China again in 1788, in the "Iphigenia" and "Felice." CHAPTER II. EARLIEST KNOWLEDGE OF LEPROSY IN HAWAII The best, most capable, reliable, and earliest accounts of dis- eases in Hawaii are from the pens of the early American mission- aries; the pioneer pilgrims of this mission arrived at Kawaihae, island of Hawaii, March 30, 1820, landing from the "Thaddeus." Twelve successive companies came to Hawaii over a period of twenty-eight years, ending in the year 1848. These gentlemen wrote freely and ably, and were keen ob- servers of the diseases of the Hawaiians, their food, their morals, customs, habits, and methods of living. The Rev. Charles Samuel Stewart landed at Honolulu, Oahu, April 27, 1823. In Volume I, page 163, will be found the follow- ing entry in his record of daily events of date May 22, 1823, twenty-five days after his arrival in Honolulu. "Not to mention the frequent and hideous marks of a scourge, which more clearly than any other, proclaims the curse of a God of purity, and which, while it annually consigns hundreds of this people to the tomb, converts thousands while living into walking sepulchres. The inhabitants generally are subject to many dis- orders of the skin; the majority are more or less disfigured by eruptions and sores, and many are as unsightly as lepers. The number of either sex, or any age, who are free from blemishes of this kind is very small, so much so that a smooth and unbroken skin is far more uncommon here than the reverse is at home. "July 4, 1823. Indeed, we seldom walk out without meet- ing many whose appearance of misery and disease is appalling, and some so remediless and disgusting that we are compelled to close our eyes against a sight that fills us with horror. Cases of opthal- mia, scrofula, and elephantiasis are very common." The prevalence of disease amongst the Hawaiian people ninety- two years ago clearly indicates that the Hawaiian race must then have been grievously stricken with many skin and blood maladies, and possibly leprosy. In the year 1810 the Island of Oahu had sixty foreign resi- dents, of many varied nationalities. The population of the Hawaiian Islands at the census in the year 1823, was 142,050 — all aboriginal Hawaiians. I have pre- viously stated the pure Hawaiian population, per United States census in the year 1910, was 26,041 souls; these figures show a 30 THE PATH OF THE DESTROYER decrease in the Hawaiian race of 116,009 in eighty-seven years, at the rate of about 1,333 per annum. Mr. Brickwood, a resident of Honolulu, at one time post- master, recognized in the year 1840, the disease of one Ahia as leprosy — he was chief in the bodyguard of Kamehameha III. Mr. Brickwood had prior knowledge of the disease in Egypt. Ahia's case attracted much attention, from the prominent office he held, also because he was very popular and much beloved. He died in the year 1856; his wife died in the year 1860, she was not a leper. George Naea, the husband of Queen Emma's mother, was a leper in the year 1838; he died in 1854. His wife was not a leper. Honolulu, a man residing in Nuuanu Valley, was a leper in the year 1839; he died in the year 1860. Mary, his wife, never contracted the disease and was living in the year 1884 at Moanalua, Oahu. In the year 1835 Kamuli, a Hawaiian woman, was living at Koloa, Island of Kauai, and there developed leprosy. She died in the year 1848, at Waiohinu, Kau, Hawaii. Her husband remained free from the disease until the time of his death in 1857; but her sister, and two half-brothers had become lepers before the year 1838. I have selected these few cases of leprosy because their history was well authenticated ; the description of them clearly indicates that the Nodular form was the disease in evidence (swollen, lumpy face, large and pendulous ears, no eyebrows, large, swollen hands and feet, and peculiar musty, offensive odour from their persons). To my mind, this is clear proof that leprosy prevailed to a moderate extent in Hawaii as early as the year 1830; also that some of the "remediless and disgusting cases" observed by the Rev. Charles Stewart in the year 1823 were quite possibly a double combination of diseases, to wit, leprosy and syphilis. The history of the foregoing cases of leprosy comes from highly reliable sources, viz. : Professor W. D. Alexander, Rev. Sereno Bishop, D. D., Luther Wilcox, James Dowsett, Dr. Robert Mc- Kibbin, and Miss Louisa Brickwood. All these persons are now dead. Dr. Hillebrand, an able and accomplished German physician, observed Chinese coolies affected with leprosy in Honolulu in the year 1848. However, positive evidence free from a shadow of doubt is still lacking as to how, when, and from whence? leprosy invaded Hawaii. MAP OF HONOLULU. Kalihi Leper Hospital, left foreground. Kakaako Leper Hospital, right foreground. Leper Detention Station, middle foreground. 32 THE PATH OF THE DESTROY ER About the year 1864 the rapid spread and great increase of leprosy began to alarm the community, and steps were taken to check the spread of the disease by segregation; and on the 3rd day of January, 1865, the law "To prevent the spread of leprosy" was enacted by the Legislature of the then Kingdom of Hawaii. Honolulu was officially declared a city on August 30, 1850. On December 13, 1850, the first Board of Health was organized by order of King Kamehameha III, by and with the advice of his Privy Council. The members of the board were composed of Dr. T. C. B. Rooke, Dr. Geo. A. Lathrop, C. Hoffman, M. D., Benjamin F. Hardy, G. W. Hunter, Richard Hill Smith, and W. Newcomb — seven members, four to act as a quorum. It was not until thirteen years afterwards that the subject of leprosy came to be discussed by the Board of Health. In the year 1863 the report of Dr. Hillebrand, of the Queen's Hospital, for the month of April, calls attention to the rapid spread of the new disease, called "Mai Pake'' by the Hawaiians. The Doctor terms the disease genuine Oriental leprosy. At a meeting of the Board of Health held on December 28, 1863, a report of the Mai Pake (Chinese disease) came up for the first official discussion. Prince Lot, when holding office as Minister of the Interior, presided as president of the Board of Health — he afterwards became King Kamehameha V. At a Board of Health meeting held February 10, 1864, it was brought out that leprosy was spreading on the "other islands," a census of lepers was ordered and the medical members of the Board of Health, Dr. Hoffman and Dr. Hillebrand, were requested to go into the question of heredity, contagion, first origin, and similar causes. At a Board of Health meeting held May 25, 1864, "Mai Pake" was again discussed. A letter published in the "Pacific Commercial Advertiser," May 21, 1864, reports rapid spread of leprosy in Kona, Hawaii, and advises that immediate steps be taken to prevent the spread of the disease. At a Board of Health meeting held August 10, 1864, Dr. Hillebrand states that Mai Pake is spreading and recommends isolation. Kamehameha III died December 15, 1854. No enactment against leprosy or any discussion on the subject took place during the reign of this king. THE PATH OF THE DESTROYER 33 Kamehameha IV died November 30, 1863; the only official mention of leprosy during the reign of this king was, as previously stated, by Dr. Hillebrand in a Queen's Hospital report, dated April, 1863. During the reign of Lot, Kamehameha V, an act to prevent the spread of leprosy was enacted, w T hich is here given in full. AN ACT TO PREVENT THE SPREAD OF LEPROSY, 1865 Whereas, The disease of leprosy has spread to considerable ex- tent among the people, and the spread thereof has excited well- grounded alarms, and whereas, further, some doubts have been expressed regarding the powers of the Board of Health in the premises, notwithstanding the 302d Section of the Civil Code, and whereas, in the opinion of the Assembly, the 302d Section is properly applicable to the treatment of persons afflicted with leprosy. Yet for greater certainty and for the sure protection of the people : Be it enacted by the King and the Legislative Assembly of the Hawaiian Islands, in the Legislature of the Kingdom assembled : Section 1. The Minister of the Interior, as President of the Board of Health, is hereby expressly authorized, with the approval of the said Board, to reserve and set apart any land or portion of land now owned by the Government for a site or sites for an estab- lishment or establishments to secure the isolation and seclusion of such leprous persons as, in the opinion of the Board of Health or its agents, may, by being at large, cause the spread of leprosy. Section 2. The Minister of the Interior, as President of the Board of Health, and acting with the approval of the said Board may acquire for the purpose stated in the preceding section, by purchase or exchange, any piece or pieces, parcel or parcels of land, which may seem better adapted to the use of lepers than any land owned by the Government. Section 3. The Board of Health or its agents are authorized and empowered to cause to be confined, in some place or places for that purpose provided, all leprous patients who shall be deemed capable of spreading the disease of leprosy, and it shall be the duty of every police or District Justice, when properly applied to for that purpose by the Board of Health, or its authorized agents, to cause to be arrested and delivered to the Board of Health, or its agents, any person alleged to be a leper within the jurisdiction of such police or District Justice ; and it shall be the duty of the 34 1 HE PATH OF THE DESTROYER Marshal of the Hawaiian Islands and his deputies, and of police officers, to assist in securing the conveyance of any person so arrested to such place as the Board of Health, or its agents, may direct, in order that such person may be subjected to medical inspection, and thereafter to assist in removing such person to a place of treat- ment, or isolation, if so required by the agents of the Board of Health. Section 4. The Board of Health is authorized to make such arrangements for the establishment of a hospital where leprous patients in the incipient stages may be treated in order to attempt a cure, and the said Board and its agents shall have full power to discharge all such patients as it shall deem cured, and to send to a place of isolation contemplated in Sections 1 and 2 of this Act, all such patients as shall be considered incurable, or capable of spreading the disease of leprosy. Section 5. The Board of Health, or its agents, may require from patients such reasonable amount of labor as may be approved of by the attending physicians, and may further make (I have never known of a single instance where the foregoing regulation re laboi to be performed by a leper, was enforced — Author) and publish such rules and regulations as by the said Board may be considered adapted to ameliorate the condition of lepers, which said rules and regulations shall be published and enforced as in the 284th and 285th Sections of the Civil Code provided. Section 6. The property of all persons committed to the care oi the Board of Health for the reasons above stated shall be liable for the expenses attending their confinement, and the Attorney General shall institute suits for the recovery of the same when re- quested to do so by the President of the Board of Health. (Never enforced — Author. ) Section 7. The Board of Health, while keeping an accurate and detailed account of all sums of money expended by them out of any appropriations which may be made by the Legislature, shall keep the amounts of sums expended for leprosy distinct from the. general account. And the said Board of Health shall report to the Legislature at each of its regular sessions, the said expenditures in detail, together with such information regarding the disease of leprosy, as well as the public health generally, as it may deem to be of interest to the public. Approved this 3rd day of January, 1865. KAMEHAMEHA V. THE PATH OF THE DESTROYER 35 Section 302 previously referred to is as follows: When any person shall be infected with the small-pox or other sickness dangerous to the public health, the Board of Health, or its agents, may, for the safety of the inhabitants, remove such sick or infected person to a separate house, and provide him with nurses and other necessaries, which shall be at the charge of the person himself, his parents or master, if able; otherwise at the charge of the Government. Here is legislative enactment relating to leprosy which ante- dates a law passed in 1909. The framers of this later law evidently overlooked it. AN ACT TO AMEND SECTION 4 OF CHAPTER 62 OF THE PENAL CODE Be it enacted by the King and the Legislative Assembly of the Hawaiian Islands in the Legislature of the Kingdom assembled: Section 1. That Section 4 of Chapter 62 of the Penal Code be and the same is hereby amended so as to read as follows: Section 4. "The Board of Health is authorized to make arrangements for the establishment of hospitals, on each island, where leprous patients in the incipient stages may be treated in order to attempt a cure; and the said Board and its agents shall have full power to discharge all such patients as it shall deem cured, and to send to a place of isolation contemplated in Sections 1 and 2 of this Act, all such patients as shall be considered incur- able or capable of spreading the disease of leprosy." Section 2. This Act shall become a law from and after the date of its passage, and all laws in conflict with the provisions of this Act are hereby repealed. Approved this 11th day of August, A. D. 1884. KALAKAUA REX. Other laws relating to the care, treatment, and segregation of lepers will be found at the end of this book. CHAPTER III. CLIMATE OF HAWAII From Dr. Alonzo Chapin's description of the Hawaiian cli- mate in the year 1836. (He was a Missionary physician.) "Situated in the very midst of the vast Pacific, without any extensive inland causes to affect the temperature, and remote from the cold, chilling winds of the temperate and frigid zones, the Sandwich Islands possess a remarkable evenness in the degree of atmospheric temperature; cool breezes by day from the sea, by night from the mountains, serve to mitigate the burning heat produced by a vertical sun, and to render the climate pleasant. The ther- mometer varies but little from day to day, and even from month to month ; and what is particularly to be remarked, all portions of the islands, along the shores, are alike in this respect. Districts most parched by heat and drought do not differ essentially in tem- perature from those sections where almost daily showers and per- petual trade winds prevail. As we recede, however, from the low- lands along the sea and ascend the mountains, a change is imme- diately perceived, and along their extended sides we may procure almost any degree of temperature. The greatest heat marked by the Fahrenheit thermometer at Honolulu was 85°, lowest, 55°. PHYSICAL FEATURES, TELLURIC AGENCIES, ETC. The interior of each island is uniformly elevated, and among them are found mountains of the first order of elevation. Those on Hawaii rise to the height of about 14,000 feet, and have snow on their summits a great, part of the year. The whole group are of volcanic origin, numerous extinct craters of different periods and dimensions are scattered over the surface, and two large volcanoes, Maunaloa and Kilauea, are still in action, affording immense currents of liquid lava. The shores of the islands are much diversified and furrowed with frequent ravines, some of great depth, which furnish courses for the impetuous moun- tain streams. Plains of different dimensions, varying from a few rods to many miles in extent are frequent. More commonly, how- ever, the mountains extend with a gradual slope entirely to the beach, and here and there present bold and black lofty precipices to the dashing of the waves. The sides of the mountains, if we except the loftiest, are verdant entirely to their summits, and pre- THE PATH OF THE DESTROY ER 37 sent immense tracts of exceedingly fertile soil. The leeward shores have generally an arid and even sterile aspect, owing to the infre- quency of rain, and cultivation is there promoted mostly by irri- gation from the streams, and it is only the tracts immediately contiguous to these which possess much verdure or will admit of cultivation. The condensation of the vapor from the moist ocean- borne trade winds in their passage over the mountains produces continual rains on their summits, which, extending backwards to- wards the sea, keeps the earth wet much of the time and gives rise to a luxuriant growth of vegetation. Hence the windward sides of all the islands are, unlike their leeward shores, extremely fruitful and productive. The streams originating from springs and rains on the summits of the mountains, pour down their sides with great impetuosity, and after a few meanderings are turned aside from their course to irrigate the lands and replenish the fish ponds, or are discharged directly into the sea; and I know of no body of water emitting sufficient miasma to create sickness along its borders. I have occasionally met with stagnant ponds which emitted a foul and offensive odor, and could in no way satisfy myself of the reason for the exemption of the inhabitants along their borders from fevers, but by supposing the effluvia to be diluted and ren- dered inert by the continual currents of winds. (The true reason is because no malaria transmitting mosquitoes infest Hawaii — Au- thor). Small marshes abound, but are fed by springs and the pure mountain streams, and are thus prevented from becoming noxious. They speedily dry up during a few weeks' absence of rain, and the rivers also disappear unless kept alive by frequent showers and the small pools, which remain at such times and which abound after every rainy season, do not become sufficiently putrid to exhale a fever generating miasma. (We have the day mosquito, the species that infects man with yellow fever, but we have NO yellow fever in Hawaii. Dengue is probably spread by the night and day mosquitoes, but it is a very mild disease in Hawaii, and is not endemic. — Author. ) If any one variety of soil has a specific power to produce malaria, it does not exist in Hawaii. The upland soil is formed of decomposed lava, the lowland plains along the sea are constituted of a mixture of alluvium washed from the mountains and decom- posed coral. Its immunity from noxious exhalations is the same, whether parched with drought or merely moist, as when the evapor- ation is most abundant after the rains. THE TARO PLANT. The tops are cooked and eaten like spinach. The root furnishes the famous Hawaiian poi. THE PATH OF THE DESTROYER 39 The staple article of diet is poi made from the taro plant, the Arum Esculentum, which is more generally eaten by the Hawaiian people than any other vegetable ; it grows like the Arum Triphyllum in wet or damp situations only, and when uncooked is exceedingly styptic and acrimonious — these qualities are destroyed by heat. The natives prepare it for use by thorough cooking, pounding it to a pulp, and adding sufficient water to make a thick paste, in which state it is called poi, and thus prepared, it is eaten with one or two fingers, according to its consistency. As an article of diet it is simple and nutritious, and after the fermentative process has com- menced it is preferred by the people. The sweet potato, the pala, a fern root, the tops of pulu fern, the nut of the kukui, the banana, many varieties of seaweed, along with a great variety of fish and Crustacea, are eaten raw. The meat of the pig, dog, fowls, beef, mutton, salt salmon constitute the chief articles of Hawaiian diet, most of these are cooked, baked in an underground oven. The equableness of the climate and the simplicity of the Hawaiians in their regimen and most of their habits of life are, compared with other civilized countries, such, that the variety of their diseases is neither numerous nor complex. Their remoteness from other lands is so great that few contagious diseases are imported amongst them. The diseases most common are fevers, ophthalmia, catarrhs and asthma, rheumatism, diarrhoea, dysentery, cutaneous diseases, tuberculosis, dropsy, venereal diseases, and they occur in frequency and in about the order I have mentioned (this was in the year 1836) ; diseases sometimes occur epidemically, as was the case with catarrh, repeatedly, and croup once during my residence at the islands. Many other diseases not specified were often met with. Fevers, though this is the most frequent and numerous class of diseases among the native population, they are by no means the most malignant and fatal. They occur in almost every form, but when idiopathic, are usually remittent. They are, however, most frequently symptomatic of other diseases. The excitable state of the system, which predisposes so strongly to febrile attacks, is not common to these islands, and the universal custom of the people to repose during the hottest part of the day aids in counteracting other unfavorable influences. The simplicity, too, of their diet and habits of life is not calculated to promote a state of excitability. Their food is mostly vegetable and fish, with but a scanty 40 THE PATH OF THE DESTROY ER and irregular supply of meat; until of late they made no use of alcohol, and no stimulating condiments so freely employed in civilized countries. Their only drink is water, kokoolau tea, awa they use, prepared in a none too cleanly fashion. Cold, which operates more extensively than any other morbific agent, produces probably more than one-half of all the diseases which exist, and more than three- quarters of all the idiopathic fevers on the islands. The habitations of the natives are considerably scattered, but in a few instances crowded together in such numbers as to exhibit the dense appear- ance of large towns and villages. There is, however, throughout, an entire exemption from those pestiferous exhalations which so extensively poison the at- mosphere of populous places in hot climates. All animal and vegetable substances thrown away by the people or cast up by the sea are quickly devoured by the number of hungry dogs and swine, so that no detriment is experienced from their putrefaction. The dwellings of the native population are merely slender frames of posts and poles tied with strings and covered only with thatch; they are generally small, often so low as not to admit of standing erect within, and in their best condition serve as an imperfect protection from the wind and rain and the excessive heat of a vertical sun. Every atmospheric change is quickly felt, cold and dampness easily penetrate, and no sooner exist without, than they are felt within. Add to this their leaky condition, the almost naked state of the inhabitants, their common practice of sleeping at night on the bare earth outside of their houses, and their habit of con- tinuing long in the water and exposing their bare bodies to the strong currents of wind, when overcome with heat and perspir- ation, and it will not be surprising that diseases incident to such causes should abound. Fevers induced thereby are very prevalent." Robert Crichton Wyllie, Prime Minister of the Hawaiian King- dom, requested answers from all of the American missionaries in the Hawaiian Islands, in May, 1846, "On the Influence of the Native Houses on Health." Rev. Titus Coan: "Native houses are usually too small, too low, too dark, not well ventilated, too filthy, and too perishable in their materials and construction." Rev. J. Green: "The native houses are certainly defective, exceedingly so, most of them are without partitions. Still, nearly all could make improvements in their style of building comfortable dwellings." THE PATH OF THE DESTROYER 41 Rev. E. W. Clark: "The houses generally are grass huts, many of them miserable; some have permanent partitions, but not the majority. Less improvements have been made in houses and in dress and furniture. Natives accustomed so long to a mere shelter do not feel the inconvenience of their houses." Rev. R. Armstrong: "The houses are generally too small, without ventilation, floors, windows, or partitions, and extremely unhealthy. Many are very damp from the ground, as well as from the rain.'' Rev. B. W. Parker: "The native houses are almost invariably small, poor, and uncleanly." Rev. A. Bishop: "The houses of the common people are de- fective in almost everything w T hich constitutes civilization." Rev. J. S. Emerson: "The native grass houses, when built well, are probably more healthy than any others, if they are not suffered to be damp by having no floor. The convenience of windows w T ould be great, but expensive. Floors would greatly induce to health, partitions would aid much in advancing moral purity, but neither are much sought by the people at present." Rev. J. Green: "The method of living in small houses having no partitions, and crowded with men, women and children, is exceedingly unfavorable to the formation and strengthening of the virtuous habits, but exceedingly favorable to the vicious pro- pensities." CERTAIN AILMENTS UNDERMINING THE HEALTH OF HAWAIIANS If it be a fact that the aborigines of America were affected with syphilis and gonorrhoea before Europeans visited them, it is certain neither disease existed or was known in Hawaii before the visit of Captain James Cook in January, 1778, and the "Lady Washington," from Boston, July, 1785. At or about this time the foreigner is credited with having introduced into Hawaii the two above diseases, w T hich rapidly spread amongst the native Hawai- ians; following the well-known pathological law, "any infective dis- ease finding new fields, is always more virulent than the same dis- ease prevailing amongst older communities." CUTANEOUS DISEASES, SCROFULA AND EPIDEMICS Still quoting Dr. Chapin (because the Hawaiian people num- bered 108,579 about the time of the Doctor's observations, and he had a larger aboriginal field to survey than we have today). THE PATH OF THE DESTROY ER 43 "Though the Hawaifans are remarkably fond of the water and are fastidiously particular in their practices of washing and bathing, they are, nevertheless, somewhat uncleanly in some respects in many of their habits of life. Beasts and fowls occupy the same habitation, and not unfrequently on the same mats with themselves; their oft-repeated ablutions may be regarded as timely. The kapa, or native cloth, is worn without cleansing, till having become foul with dirt and vermin, and too ragged to serve longer the purpose of covering or protection, it is laid aside. Hence diseases induced or exacerbated by such causes have a fruitful soil, and flourish luxuriantly. The itch is extremely prevalent, and often assumes a virulence unknown in our own country. The pustules, becoming confluent, are converted into large and troublesome ul- cers; other scabious diseases exist. Scrofula is not only frequent, but extremely malignant.'' Quotations from other missionary workers are here stated, concerning diseases of Hawaiians. Mr. Coan: "The principal diseases are of the venereal, scrof- ula, and cutaneous character. The climate is very healthy." Mr. Green: "No contagious or epidemic diseases prevail at Makawao, occasionally influenza prevails; since I have resided here few diseases prevail." Mr. Bishop: "No contagious diseases except cutaneous erup- tions, which are very prevalent and distressing. Most prevailing and mortal diseases are due to venereal corruption of the blood." Mr. Emerson: "The itch and venereal diseases are destruc- tively contagious." In answer to another question of Prime Minister Wyllie's "How far is the health of the Hawaiian affected by the enervating effects of indolence and indifference as to anything beyond the mere wants of animal existence?" Mr. Coan: "Physical, mental, and moral inbecility, diseases and vice, are extensively engendered and sadly perpetuated by indo- lence and indifference to anything beyond the mere wants of animal existence." Mr. Green, greatly affected: "Nothing compared with these as a source of suffering, both moral and physical. Here is the fruitful source of vice, misery, and death. The nation is rusting out." Mr. Clark: "Indolence here, as everywhere, has a debasing influence on the moral and physical condition of the people. It 44 THE PATH OF THE DESTROYER is the mother of vice and disease. As artificial wants increase, the character of the people is generally elevated." Mr. Parker: "Both the moral and physical health of the natives is most seriously affected (injured) by their indifference and improvidence." Mr. Bishop: "Indolence is attended with enervating effects on the constitution. This is evidenced in females who have noth- ing to do, and yet they are more subject to sickness than the men. Perhaps there are other causes productive of sickness in many females, the consequences of vicious idleness." Mr. Emerson : "This people are indolent and many of them are improvident, and sickness and death are often the result of this improvidence. They have no beds for the sick, and no suit- able food or diet in such cases. Their houses, mats and sleeping places often generate disease and prevent the effects of suitable remedies, if administered, and often deter from the attempt to administer remedies that would be suitable, if circumstances would allow of their use. But whether this indolence and improvidence are peculiarly inherent in the Sandwich Islands, or the result of a system of oppression long practiced, in connection with the ab- sence of that stimulus produced by artificial and imaginary wants connected with civilization, is yet to be proved." Mr. Gulick: "Very injurious and to a considerable extent. Yet this indifference appears to be merely the result of the system by which, till recently, they were deprived of nearly all their rights, and thereby precluded from the hope of materially better- ing their condition." Mr. Johnson: "I think the moral and physical health of this people is in some degree injured by indolence and indifference to the wants of both body and soul." CHAPTER IV. LEPROSY IN INDIA The secretary of the government of India states that at the present day, "there appears to be at least three centers of com- paratively intense prevalence amongst the teeming millions of people," viz.: "(a) The Beerbhoom and Bancoora districts in the lower provinces of Bengal; "(b) The Kumaun district in the northwestern provinces; "(c) The Deccan and Konkan in the Bombay and Madras presidencies, respectively.'' ( ? From these great and ancient races were derived the Ha- waiians. — Author. ) Indian Report, page 80, Messrs. Lewis and Cunningham, assistants to the sanitary commissioner of India, state: "That leprosy has been known in India for 3,000 years, but with regard to our definite knowledge of its actual causation, it is to be feared that we have not, except phraseologically, advanced very much on the etiological views recorded by Atreya, many centuries before the Christian era, which were to the following effect: "When the seven elements of the body become vitiated through the irritation of the wind, the bile, and the phlegm, they affect the skin, the flesh, and the spittle and the other humours of the body. These seven are the causes respectively of the seven varieties of Kushta (leprosy), the Kudig of the Javanese." This medical philosopher Atreya lived at least 2,000 years before the Christian era and wrote the 'Charaka Sanpita' on the pathology of the disease, extracts from which are as follows: "The man who neglects the disease at its commencement is sure to die, for it becomes incurable." He described 4,000 years ago the various kinds of leprosy, the descriptions of which are so clear that they accurately delineate the disease as it is existing today. "The Kushta (leprosy) thus produced causes much pain and suffering — none of these varieties result, however, from the vitiation of a single humour. Kushtas are of seven, or eleven, or a larger number of a kind, and these, constantly irritating the system, become incurable. The wind, the bile, and the phlegm, being vitiated, react on the skin. When the wind is most vitiated, ' it produces the Kadala Kushta. 46 THE PATH OF THE DESTROYER When the bile is the most vitiated, the Audumbara. When the phlegm is the most vitiated, the Mandala. When the wind and the bile are affected, the Rishyajihva occurs. When the three, the bile, the phlegm, and the wind, the Sidhma is produced, and the three together produce the Ka- kanaka." The causes of the disease Atreya states to be as follows: 1. Excessive physical exercises after exposure to too much heat or too much cold. 2. Taking food after surfeit. 3. Eating of fish with milk. 4. Using barley with several other grains, such as "Hayanaka," "Dalaka," "Karsdusa," along with venison, milk, curdled milk and butter milk. 5. Excessive sexual intercourse. 6. Long protracted excessive fear or labor. 7. Fatigue, interruption of catarrh, vitiate the phlegm, the bile, and the wind ; hence the skin and the three others become slackened. Thus irritated the elements corrupt the skin, and other humours and produce Kushta (leprosy). The premonitory symptoms of Kushta are as follows: ''Want or excess of perspiration, roughness, discoloration, itching and in- sensibility of the skin, pain, horripilation, eruption, and excessive pain in the parts that are about to fall off. The worms that form in leprous eruptions destroy the flesh, skin, veins, muscles, and bones and when affected by these worms, the patient suffers from spontaneous discharges of blood, insensi- bility, loss of sensibility of the skin, mortification, thirst, fever, dys- entery, burning weakness, disrelish, and indigestion. The Kushta then becomes incurable." LEPROSY OF THE BIBLE The Biblical leprosy may have been derived from this same source, "the cradle of the world.'' Atreya was the first writer on leprosy, followed several cen- turies later by Moses, as set forth in the Book of Leviticus, and it is reasonable to assume that the people of Israel carried the dis- ease into Egypt; hence the warning in Deuteronomy, Chapter 28, verse 27 : "The Lord will smite thee with the Botch of Egypt, and with the Emerods, and with the Scab, and with the Itch Whereof thou canst not be healed/' These must have been THE PATH OF THE DESTROYER 47 some dreaded and incurable diseases. While the Greek word "Lepra" means scaly, or skin disease, instances where true leprosy was the disease, and that it was contagious in those times is evi- denced in the casting out of the lepers, their clothes and homes being destroyed. That the leprosy of the Bible was evidently regarded as con- tagious, that skin manifestations were in evidence, and that it was also incurable, may be inferred, and is set forth in the appeal of the ten lepers to "the Master Physician, Christ," for aid. "We are incurable, aid us." "We stand afar off, contagious." And one, when he looked at his clean skin (where the disease had been) and saw the changed condition, gave thanks to God ; hence his skin must have been one of the main situations of his leprosy. THE LATE PRIME MINISTER W. M. GIBSON'S VIEWS The late Walter M. Gibson, Prime Minister in King Kala- kaua's reign, and also president of the Board of Health, a bright, clever, incisive writer and speaker, brings forward the theory, "That, inasmuch as the Polynesian race (the Hawaiians are a part), had their origin in India and gradually moved away from that cradle of all mankind, where leprosy has been known to exist for 3,500 years, it is within the bounds of probability that, they carried the seeds of leprosy with them," and when syphilis was brought to Hawaii by the crews of Captain James Cook's ships, it fanned the latent leper taint into activity, and this accounts for the prev- alence of leprosy in Hawaii today. Mr. Gibson was an able and convincing writer, and elabor- ates and freshens up his theory with very plausible statements, anyone can read them in full in the Board of Health reports of previous years. But alas! all that fine writing and elaborate argu- ment is lost on the Author (one of the self-assertive doctors, as he is pleased to call any of us who have the courage to express and maintain our own opinions). The bacilli of leprosy and syphilis, instead of attacking each other, sleep together like firm friends, and 3,500 years of leprosy passing through the bodies of the Hawaiian people should have rendered and given them some immunity. The Gibson theory works the wrong way, and is in conflict with the laws and doc- trines of our most able pathologists and bacteriologists. I present some more of Mr. Gibson's statements: "Leprosy has attacked at times every race in the world, but its chief abid- h WALTER MURRAY GIBSON. King Kalakaua's Kuhina Nui or Prime Minister, 1882-7. President of Board of Health, managing editor of "Advertiser" and the Hawaiian ver- nacular newspaper, "Nuhou." Orator, diplomat, writer, able, shrewd; resisted and easily out-ma- noeuvred the efforts of his opponents to remove him from office. He was OUSTED from office by the Revolution in Honolulu, June 30, 1887. The political battles in the years 1884-86 in the Hawaiian Legislature had some semblance to the British troubles in the time of Charles I, only King Kalakaua and two-thirds of his parliament opposed a one-third minority. Cromwell, Ireton, Bradshaw, Fairfax, and Hampden, had similar repre- sentation in the Hawaiian Legislature. Mr. Gibson died in exile in San Francisco, California, January 21, 1888; his body was brought to Hono- lulu for burial. THE PATH OF THE DESTROY ER 49 ing places have been beds of the fell disease — in Java and other isl- ands of the great archipelago, where the natives present most striking affinities with the Hawaiian race; the diseases that affect them also afflict the Hawaiians. The Javans treat as outcasts all who are suffering with the Kudig, or leprosy, and the unfortunate ones have voluntarily segre- gated themselves upon small islands, where they are supplied with means of subsistence by their friends." CENSURE OF THE DOCTORS The late Walter M. Gibson, when president of the Board of Health in the year 1886, seemed to express surprise that the medical profession should be so divided on the question of: (First) "Contagiousness of Leprosy;'' (Second) "The absence of an una- nimity of opinion on the cause of the spread of the disease in Hawaii," and (Third) "Failure to check or cure it." Mr. Gibson was one of the brainy men of that by-gone age, the days of the monarchy; he was a fluent, able, and interesting speaker. I set forth one of his caustic declamations against the medical profession in Hawaii. "The sooner medical men get down to some sensible base and conclusions on leprosy, the better it will be for all mankind. The average thinking layman in Hawaii Nei can draw con- clusions on the subject of leprosy as good, if not better, than many members of the medical profession. The layman is not wedded t@ any pet theory, does not try to look wise when he talks on this subject of leprosy. Is it not a fact that doctors pretend to know a great deal more than they do know? Their so-called dogmas, theories, and nescience change with the wind, their views are bewildering, prone alas! at times to be blindly self-assertive, dogmatic, and tyrannical; pledged to indi- vidual schools of thought, and sometimes their attitude to each others' theories and arguments assumes the fierce form of dog- eat-dog! This may be overdrawn, but if you reflect, gentlemen, you must admit its truth. In order to cure the Hawaiian race of its ills it requires the spirit of divine love, not the stern, scientific methods of London, Berlin, Paris, New York or elsewhere." ■ -' "8 « bJ3 S .s > co a, - 3 '-d sh - „ CO rs cu S-l 3 £ 8 w» 43 J3 •-c G cu 5"? s -d > © CO G -d ~ u co <£ Hh ;_, ^ cu -21 CU G Oh 3 cO en O IH oo o G co S-d o "d CU ' o .-a cl W-jg cd cu CU 43 43 43 co 3 ~ u + J CO O cu pH fc 43 *|: '■3 W s u, £2 rt p4 — > ^~M bJD .S M c - THE PATH OF THE DESTROYER 101 ease disappearing, it cannot be truly claimed that the cause or alleged cause of the disease was the true cause. I have examined hundreds of flies and never once succeeded in finding the leper bacillus, although bacillus tuberculosis was fre- quently found. Some more specific cause and peculiar to the Hawaiian race must be sought for, in order to explain the greater prevalence of leprosy amongst that race. The house fly fails to fill the bill. I claim in the face of all the foregoing statements, the house fly may be excluded as a spreader of leprosy- FLEAS AND BED-BUGS These insects are generally permanent occupants of houses and rooms; they do not travel around like mosquitoes and flies. If there is to be any infection with leprosy in any given house by fleas or bed-bugs, it presupposes a leper occupant of the house and non-leper companions. Both these insects are parasites infecting the human race, and derive their nourishment from the blood of the victim who carries them on his or her person, clothes, or bedding. There cannot be a supposed universal spread of leprosy through these insects, because every house does not contain a leper. Having examined fleas and bed-bugs from leper houses and failing to find any bacillus leprae, I question if these insects can convey leprosy to a non-leper; they are purely blood suckers, and the blood of the leper is not a permanent habitat for the bacillus leprae. EXPERIMENTS ON LEPERS I have fastened both fleas and bed-bugs, in small impromptu cages made out of corn plasters, the cover of a microscopic slide affixed to the opening, and strapped the cage to the inner surface of arms, thighs, and sides of abdomen, both on leprous lesions and healthy skin of lepers; the insects being allowed many hours to feed — from one to four hours. On thorough examination, no leper bacilli were discovered, either in the expressed blood from the insects' digestive tract, or in the insects' body, triturated with alcohol and the solution centrifuged. Discussing the possibility of a healthy person being infected with leprosy by the bites of fleas and bed-bugs, subsequent to these insects having bitten a leper, I take the same ground as I have done in the alleged fly and mosquito propagation or spread of leprosy. 102 THE PATH OF THE DESTROYER The Hawaiian race has no monopoly of fleas, nor are its mem- bers infested with a preponderance of fleas and bed-bugs in their homes, yet they have excess of lepers; these insects infest all races alike, and each race should show a percentage of leprosy propor- tionate to its number. The greater the number of people, the larger the field foi the fleas and bed-bugs to spread leprosy. The smaller the number of people, the smaller the field for the fleas and bed-bugs to infect with leprosy. More fleas and bed-bugs biting the people, more lepers. Less fleas and bed-bugs biting the people,- less lepers. Thanks to the multitude of races in Hawaii, we can tenta- tively approximate the most probable cause of disease in any one race. Amongst all the previous alleged reasons for the cause of the spread of leprosy I have discussed, viz. : vaccination, mosqui- toes, fleas and bed-bugs, under each of these factors common to all races, the Hawaiian race is always paramount as the exponent of leprosy. A more specific and peculiar property attaching to the Hawaiian race must be sought for than insect infection, to which all races undergo similar exposure. The flea by preference seeks the healthy skin to get his blood supply for food. The bed-bug sucks blood from any surface, healthy or diseased, apparently dis- playing no preference. Those who are in attendance daily on lepers in homes and hospitals, like doctors, the Brothers and Sisters of Mercy, and other attendants, are fully exposed and are, and must be bitten by fleas (I have had ample personal experience on this point), but after 10, 20, 30 years even, no development of leprosy has taken place amongst these people. How often can we determine in a given case of syphilis or tuberculosis, the exact means of infection. If we are in doubt would we seek a flea or bed-bug explanation as the means of in- fection? We would be justified in so doing, knowing that syphilis and tuberculosis are inoculable; but we do not assume that hypo- thesis. Why not analyze the means of leprosy infection on a broad basis? We have a disease which is prevalent mainly in one race. Why is this? How does this race differ in every respect from the others? I will discuss this later. From all the foregoing experiments and statements there is every reason to assume that fleas and bed-bugs, as agents in the spread of leprosy, may be ignored. THE PATH OF THE DESTROYER 103 DOES THE BREATH OF A LEPER CONVEY THE DISEASE? All the evidence bearing on this question tends to prove that the breath of the leper, even if the contact is close, does not con- vey leprosy to a healthy person. The attendants on lepers — nurses, Brothers and Sisters of Mercy; in fact, all those in direct contact with the disease, rarely acquire it. There are no figures to show in an asylum or settle- ment, that even 1/20 of \ r / c of the above class of contacts ever acquire the disease from inhalation or even any similar channel. No more striking testimony can be produced than that afforded by the conjugal relation. The leper wife, or the leper husband, occasionally conveys the disease to his or her healthy consort, they may live together co- habitating for years and yet the healthy wife or husband may or may not become infected. What a different disease leprosy is from syphilis in this re- espect — the aspect of cohabitation — here syphilitic infection of a healthy partner is generally a foregone conclusion. Syphilis is not conveyed by the breath, and even in tubercu- losis conjugal infection is uncertain, but the method of infection in these two diseases does give a clue to the way leprosy is con- veyed. If leprosy was conveyed by the leper's breath we would have more prevalence of leprosy amongst all races, not, as here in Ha- waii, a one-race disease — Hawaiians. I append a table bearing on Conjugal infection and Non-infec- tion with leprosy. STATISTICS DATING FROM YEAR 1880 TO YEAR 1902 Male and female lepers living in the Conjugal relation. 1. Place of collection, segregated on Molokai 845 2. Place of collection, in detention at Kakaako 191 3. Place of collection, various islands of group 64 Total 1,100 Male lepers 739 Male non-lepers 361 Female lepers 361 Female non-lepers 739 Total 1,100 Total 1,100 Total of persons living in conjugal relation 2,200 104 THE PATH OF THE DESTROYER Maximum years of cohabitation 18 Minimum years of cohabitation 8 Average years of cohabitation 13 Husbands who became lepers — 101 Husbands who did not become lepers.— 260 Wives who became lepers 159 Wives who did not become lepers 580 Of the husbands, 101, who became lepers, — 84 of their wives had Nodular leprosy; and seventeen Neural leprosy. Of the wives, 159, who became lepers, — 136 of their husbands had Nodular leprosy; and twenty-three Neural leprosy. In an original total of 1,100 clean husbands and wives, 260 (23%%) became infected, and 840 (76%%') remained clean, after an average of thirteen years of cohabitation. Did these 260 previously clean husbands and wives acquire leprosy by the breath or through sexual intercourse? I answer: by neither of these channels does the specific infective agent, the bacil- lus leprae, enter the system. Digressing a little from the subject of infection from the breath of the leper. The lepers give birth to many children, most of them succumb- ing soon after birth — some are born dead, or abortion takes place. I have seen over 200 children, the offspring of lepers, sometimes both parents were lepers. In no single instance were there any signs of leprosy on the children at birth. If we did not know syphilis was inoculable, we quite as likely might assume it was spread by the breath ; the presence of syphilis is generally in evi- dence at. the birth of a child of syphilitic parent or parents. In later years the child of the leper may show the disease, and we might too hastily assume that infection from the leper parent or parents was conveyed to the child at the time of con- ception. This theory is untenable. The child of the leper is like the child of the tubercular parent — the infection is acquired post natal. Hereditary predisposition in leprosy is becoming a waning doc- trine. It is obsolete. I used to be one of its disciples; more mature experience has convinced me of the fallacy of my position. In tuberculosis, a well-known contagious disease (through spu- tum, etc., and being inoculable), the majority of those who have HAWAIIAN TYPE. Pure Hawaiian Girl. 106 THE PATH OF THE DESTROYER been exposed to infection through conjugal relation escape the disease. We may safely conclude that the breath of the leper is similar to the BREATH of the syphilitic, and that it is devoid of in- fective properties. THE BIRTH RATE AMONG LEPERS Sterility in former years was more in evidence amongst the lepers than it is today. Formerly most of the cases of leprosy when sent to Molokai were of long standing, five to seven years or more, and some over the latter limit. Of necessity the longer duration of the disease sapped the vitality, and the fertility of the leper was impaired or lost entirely. The segregated leper today arrives at Molokai with a milder and much shorter duration of the disease than formerly, averaging about one to three years standing. The leper birth rate is very little below that of the non- leper rate, or normal, but premature births and lack of vitality cause most of the children, the offspring of a leper parent or par- ents, to succumb at or shortly after birth. It is most remarkable that the children of lepers who reach maturity are free from defects of mind and body. Neither morons nor imbeciles are found, and nanism in any form is absent. I append an analysis of the birth rate amongst one hundred and seventy leper couples. Fertile Sterile 93 Couples 1 Male, Leper 62 1 1 1 1 Female, Non-Leper 62 1 Male, :>n- Leper 31 Childre 3 n 85 1 Female, Leper 31 Born 77 Couples Male, Leper 51 Female, Non-Leper 51 Male, Non-Leper Female, Leper 26 26 I .1 Children Living Children Dead 168 217 THE PATH OF THE DESTROYER 107 EXPERIMENTS ON THE LEPER'S BREATH In order to satisfy myself if the breath of the leper was a possible means of spreading leprosy, I experimented as follows: Twelve-inch squares of double folds of antiseptic gauze were suspended over the faces of lepers at distances by actual measure- ment of 12, 6, 3, and 1 inches from the mouth, for periods of half an hour to three hours, and in two instances in comatose lepers for a 12-hour period; cases were selected free from cough, tranquil ordinary breathing being present. This experiment was performed on twenty lepers. The gauze, after exposure to the leper's breath was carefully soaked in 5% carbolized water, as little fluid being used as possible; after stand- ing six hours the washings from the gauze were centrifuged, care- fully examined and search made for bacillus leprae — none were discovered. On five other lepers — two advanced tubercular cases, one mild case, and two of the neural form of leprosy — a similar set of ex- periments were carried on with gauze squares on the same lines as in the preceding cases, excepting that the leper was instructed to breathe deeply and cough, but not expel mucus from the mouth, the squares of gauze being held in CONTACT with the mouth and nose for a period of five minutes. The gauze, after contact, was soaked for six hours in a limited quantity of distilled water, the washings centifuged and carefully examined. Bacilli were found in limited quantity in the two advanced tubercular cases. In the mild case and the two neural, the washings from the gauze failed to show bacilli. Mosquito nets surrounding the beds of six tubercular (or nodular) cases of leprosy in advanced stages of the disease, the nets not having been laundried for a period of many months, were soaked for six hours in a limited quantity of distilled water, the washings carefully examined for bacilli — all six washings gave negative results. All this evidence tends to show that if the bacillus leprae exists outside the human body, it must be of very rare occurrence, except in the direct presence of the leper. Tables, chairs, and the dust of the rooms in daily use by lepers gave negative results; in no instance were bacilli found, although other observers claim they do exist. The British Indian Commission of 1891 reached the same results that I have done, finding no bacilli on the seats, walks, or in the bathing houses of the lepers. It is a well-established fact that 108 THE PATH OF THE DESTROYER syphilis is never conveyed by the breath, the specific infective ma- terial, syphilis bacillus, must be implanted direct on a mucous, or abraded dermal surface in order to convey the disease. The foregoing experimental evidence tends to prove that the bacillus leprae, to infect the healthy, must also be implanted on a mucous surface, which surface must possess certain suitable specific properties. It is very probable that the leprous bacilli in contact with the air after passing through the nose and mouth are cadaveric bacilli, and as such, are incapable of spreading leprosy. The evidence afforded from the prevalence of leprosy in Ha- waii amongst the foreign races, also tends to negative the possibility of leprosy being spread by the breath of the leper. Out of an estimated foreign population of 160,000 in the year 1912 there were only 105 known lepers, which may be accepted as a fairly correct estimate. So much contagious and infectious disease is communicated by the breath, it is fair to assume that if leprosy was so communicated, it must affect all races equally. Pulmonary tuberculosis (a dry sputum and a breath-infection spread disease under certain special conditions), in this present year, 1915, selects no special race, but finds in Hawaii its victims amongst all races. It attacks the Jap- anese, Portuguese, and the Hawaiians, also other races, and it is a worse scourge than leprosy. It may also reasonably be deduced that if pulmonary infec- tion through inhalation of the leper's breath, was one of the causes leading to the infection of those in contact with leprosy, it would not be confined to one race in Hawaii (the Hawaiians), but each race would show a more equal infection ratio ; also the disease would be much more prevalent. I assume the same ground as in other alleged causes of leprosy previously discussed. More people to inhale the breath of lepers means more leprosy; hence the more numerous the people of any one race, the greater should be the number of lepers, and vice versa, less people, less leprosy. LEPROUS TUBERCULOSIS Leprosy first infects its victim and is often followed by tuber- culosis; but how often does a tuberculosis victim acquire leprosy? I know of few such cases. Both leprosy and tuberculosis will thrive in the same lung, THE PATH OF THE DESTROYER 109 but the dry sputum from the leper's lung shows no virulent in- fective power like the dry sputum of the tubercular subject. Lepers react strongly to injections of tuberculin, just as se- vere as if their disease was tuberculosis; this reaction is due to deposits (tubercular) in the organs, glands, and other tissues of the leper. The complication of leprosy with tuberculosis is very frequent; these cases may fairly be termed ones of leprous-tuberculosis, leprosy being the primary disease. At certain intervals the typical symptoms of leprosy prevail and progress, then come remissions, the leprous symptoms remain in abeyance, later T. B. comes to the fore as the aggressor and destroys the leper. The destruction of the epiglottis, the stenosis of the larynx, the visceral deposits, intestinal and stomach derangements in the leper are just as frequently caused by T. B. as leprosy. The physician may cause certain symptoms of leprosy to im- prove by suitable treatment, but when the disease is complicated by the presence of T. B., the futility of expecting any beneficial result from any treatment soon becomes apparent. The presence or non-presence of tuberculosis in the leper will generally account for the rapid or slow progress of the disease. LEPER BACILLI EXTERNAL TO THE LEPER Do leprous bacilli exist outside the person of a leper? I answer in the affirmative, in the leper toilets, in the leper s grave, and in the various articles of food and drink which he touches and handles. The intestines of the leper, when his disease is advanced, con- tain the bacillus leprae in large numbers, hence the dejecta act as a vehicle of expulsion. In leprous diarrhoea and dysentery, due to destruction and ulceration of the mucous membrane of the ileum and large in- testine, the shreds of exfoliated mucosae contain the bacilli which are expelled with the movements of the bowels. Faeces and mucus collected from the seat of the leper's toilet contain abundance of leper bacilli. The leper ulcer of the bowels is closely allied to and resem- bles the tubercular ulcer. The solitary and Peyers glands are in the main implicated, hence the ulcers are observed in the ileum; frequently the caecum and colon are involved, the morbid changes being confined to these localities. 110 THE PATH OF THE DESTROY ER The ulcers are irregular in shape, situated transversely to the mesentery. The spread of the ulcer, following the course of the vessels, involving at times the whole circumference of the bowel. In size the ulcers vary from one-half to one inch or more, with thickened edges, at times markedly indurated. The floor ot the ulcer often shows signs of recent hemorrhages, at times new cicatrization processes are in progress. (See Plate 73, Ulcers of the Ileum.) I have examined the graves of three lepers. All the corpses had been buried over two years — exact dates unknown — the soft parts of the bodies had all been dissipated. The liquid and a semi-pulpy material in the coffins yielded plenty of bacilli ; but are the bacilli alive ? I claim they are not. From the evidence afforded that leprosy is not pathogenic to ani- mals, there is further corroboration. These bacilli are within every reasonable doubt cadaveric. It is scarcely within the bounds of probability that any person could become infected with leprosy from either the toilet or the grave of a leper, under any circumstances. In the month of May of the year 1885, Dr. Edward Arning, pathologist and bacteriologist for the Board of Health, and special leprosy investigator, visited the Leper Settlement in the course of his studies. The doctor being desirous of examining a recently buried leper corpse, I showed him the grave of Akana, a Chinese leper, buried about six months, on a hillside, the surroundings and soil being good for drainage. To avoid wounding the feelings of the Hawaiian people, who have an aversion to desecration of the graves of their friends, like ourselves, even for the advancement of science, the corpse of the Chinaman was chosen for exhumation. However, a mistake was made and when the coffin was opened and the corpse came into view, no queue was visible, it was not the body of Akana, the Chinese, but that of Keliikipi, a Hawaiian about twenty-eight years of age, affected with nodular leprosy. This man poisoned himself with opium (cause unknown), his corpse had only been interred three months, but it suited Dr. Arning and he later obtained abundance of bacilli from the de- composing tissues of this corpse. Examinations of buried lepers' corpses clearly demonstrate that the bacilli resist the products of dissolution and putrefaction. Are they alive? I have stated before, I doubt if these bacilli could infect a healthy person, as they are most probably cadaveric. Dr. Arning was in doubt on this same question, but unfortunately be- THE PATH OF THE DESTROYER HI fore completing his investigations on this point, he resigned his position as leprosy investigator for the Board of Health and returned to Germany. Other investigators came after Dr. Arning, holding official positions with the Board of Health, but sooner or later the re- lations between the doctors and the Board became strained, and one after the other have left office on account of various troubles. Dr. Arning pursued his investigations from November, 1883, to December, 1885. After him came Dr. Lutz, in the year 1889; he worked about two years as leprologist for the Board of Health, then w T ent to San Paulo, Brazil. About the year 1896, Dr. Alvarez was appointed to office as pathologist to the Board of Health, and held office some three years, till 1899. In the year 1909, Dr. Wayson, a resident of the islands for about fourteen years, took charge of the Kalihi Re- ceiving Station and held office until April, 1914, when some un- pleasantness with the Board of Health caused him to resign his office. The many drawbacks, hindrances, and petty tyrannies dis- played towards leprologists, have not tended to advance the esteem or enthusiasm of the outer world physicians towards the scientific study of leprosy in Hawaii. ARE THERE CARRIERS OF LEPROSY? On this point I put forward certain facts I have discovered in my thirty-three years of professional practice in Hawaii, and in reply to the above I answer that there are carriers of leprosy. They are very exceptional, however, and their presence at large in the population I claim is no factor in spreading leprosy. First, there are cases of leprosy that manifest in the skin and nerves all the signs of leprosy, and the bacillus leprae may or may not be present. Without any treatment or special change in the conditions of their living, eating, or occupation, the disease dis- appears for months and years, sometimes becomes active again, making no further progress than it did at the first onset. These cases puzzle the doctors, but not the laity, who affirm, "these peo- ple never had leprosy, the doctors have failed to make a correct diagnosis, the disease must have been blood poisoning, syphilis, eczema, or something else; those stupid doctors ought to be sued for damages!" I especially call to mind five cases which first came to my no- 112 THE PATH OF THE DESTROYER tice over twenty years ago. These cases showed pronounced signs of leprosy, and had been declared leprosy by competent physicians. The official examining board being then composed of three medical men, the agreement in diagnosis was unanimous — "Con- firmed Lepers." Four of the five cases were ordered deported to Molokai. There came some hitch and these lepers (?) never left Honolulu. Three of the cases are alive today, their leprosy is not progressive, and the friends of the people loudly affirm that they never had the leprosy. I saw every one of these five lepers, or alleged lepers, and treated two of them, and these said two cases claim that if they did have the leprosy I cured them — a very vague and dubious compliment. I regard these cases as permanent carriers of leprosy. The disease has apparently aborted, but it would be impossible to say in the present state of our knowledge, whether they can com- municate the disease or not. They were found free from leper bacilli when a subsequent bacteriological examination was made, but is the freedom perma- nent? I claim not. Examinations in leprosy should extend over months and years, so peculiar are the freaks of leprosy even in this twentieth century. This is one form of Carrier or Dubious Carrier of Leprosy. Second, amongst 124 females — Hawaiians, Caucasians and Chinese-Hawaiians, healthy in every respect excepting bladder, vaginal, uterine and ovarian diseases, whom I have examined in my gynecological work during the past sixteen years, the vaginal secretion in seven of these women contained the bacillus leprae, derived from specimens of mucous secretion taken just within the introitus vaginae. Specimens of the vaginal mucous taken far in- side the vagina and from the cervical canal showed no bacilli; which in all of the specimens did not count thirty bacilli on the slide. * * * These seven cases had all clean husbands, but had daily con- tact with female lepers. Under vaginal douches of sublimate solution, used to alleviate the various diseased conditions from which they were suffering, there was complete disappearance of the bacillus leprae, and on later examinations none could be found.. Any inference to be drawn from the cases must be purely speculative. What I do know from years of experience is this: The semi- THE PATH OF THE DESTROYER H3 nal fluid frequently contains no leper bacilli, and neither does the menstrual fluid nor the vaginal secretions in the female leper. The presence of bacilli in the vagina I claim is an "accidental contamination/' they have no permanent habitat in that canal in the leprous female; cleanliness and douching with plain warm water will clear the vagina. The bacilli enter the vagina from the anus in uncleanly females, and the best proof is that cleanliness keeps the vaginal passage free. I have notes of examinations of forty-two leprous females in whom the vaginal secretion was carefully searched for bacilli, and only found in four cases. As stated in the above cases, cleanliness, with the use of soap and water ablutions of the anus, and plain warm water douches in the vagina, eliminated the bacilli, and repeated examinations thereafter failed to reveal their presence. In Hawaii, as in other countries where leprosy prevails, there is present abundance of evidence to prove that the disease is not conveyed by sexual intercourse ; this condition being apparent to both the laity and physicians. The fact that leprosy prevails amongst children of tender age, even as early as three years, should be also borne in mind, in considering this conclusion. I am convinced that the communication of leprosy by a leper to his or her healthy consort by sexual intercourse, as a means of spreading the disease, may be ignored. Hawaii bristles with evi- dence to support this claim. STERILE LEPER BACILLUS Carriers of leprosy can be found amongst the cases of neural or anaesthetic leprosy, which have apparently aborted or become ster- ile, such a condition may be temporary or permanent. Take the case where the chief visible evidence of the disease is the impli- cation of the nerves of the elbow and forearm, the median and ulnar, causing the claw hand and loss of surface feeling of the skin of the forearm, hand, and fingers; the typical hollow between the forefinger and thumb ; the adductor pollicis, and the first dorsal interosseus muscles being those especially attacked, which the ulnar nerve supplies. The leprous infection never makes any further progress, but leaves the hand permanently deformed and damaged, so that neurectasis, massage, or electrical treatment are of no benefit. This trophoneurosis of the hand is solely due to peripheral and non-central lesions, and is generally caused by infective neuritis. HAWAIIAN TYPE. THE PATH OF THE DESTROYER 115 THE USE OF AWA A POSSIBLE CAUSE OF SPREADING LEPROSY The chewing of awa root, if the chewer is a leper, and the mixture that results, viz., awa juice, leprous saliva and water, is drunk by a healthy or non-immune person; it is certainly a most likely method of causing a limited spread of leprosy, because awa drinking is falling into disuse from year to year. Even when the use of awa was very much more in vogue than it is today, it was never a universal practice amongst the Hawaiians. Awa, kava are names given to an intoxicating liquid made in Hawaii from the root of the piper methysticum. It is in use in the Samoan Islands also. The intoxication produced by alcohol differs from that of awa ; the rapid pulse, mental excitement, loquacity, etc., are all absent. The awa drinker resembles a person under the influence of a nar- cotic. Awa intoxication makes the drinker silent, stupid, drowsy, with incoherent dreams; speech is affected, causing stuttering, the muscular power is much weakened, there is lack of co-ordination, and in the chronic drinker, temporary motor paralysis occurs. Awa acts more on the spinal cord than the brain. The chronic awa drinker becomes a most repulsive object, his conjunctivae are deeply suffused, injected, and thickened. Conjunctivitis with purulent discharge is a prominent feature, ectropion or eversion, ptosis, and thickening of the edges of the lower lid are also con- comitant symptoms; the skin becomes dry and harsh, and covered with scales which frequently cover the whole body and face. Apathy, uncleanliness and a general slovenly appearance fills in the picture, somewhat resembling the chronic alcoholic drunk- ard. Very advanced cases, to a certain extent, resemble leprosy, and it is sometimes mistaken for this disease. An alcoholic solution of awa root injected into the skin causes anaesthesia, followed by paralysis of the peripheral nerves for several hours. Internally awa is used for gonorrhoea, vaginitis, leucorrhoea, cystitis, and for kidney troubles by the Hawaiians. It somewhat resembles cubebs in its action. Foreigners use awa for gonorrhoea and cystitis. It is some- times prescribed by physicians in Hawaii for these diseases; also it is used in alcoholic solution, or unguent in pityriasis versicolor, in psoriatic affections in leprosy, and in Lichen ruber planus. The method of preparing awa in Hawaii is as follows: A 116 THE PATH OF THE DESTROYER portion of the root is washed in water, peeled, and a sufficiently large enough piece to fill the mouth is introduced therein and chewed vigorously, the resultant solution of awa juice and saliva being ejected from time to time into a bowl or calabash. When all the juice is extracted from the chewed piece of the root a new piece is substituted. Sometimes a little water is taken into the mouth to aid the process. Perhaps two to three pints of saliva and awa juice may be obtained by the chewer. To all this, water is added to thin down the liquid and increase its bulk. This solu- tion of awa may be drunk fresh, but more often is put aside to ferment, which process begins in about twelve hours and is aided by the ptyalin of the saliva. The preparation and drinking of awa spittle is not pleasing to the eye or stomach, and where the chewer is a leper, a syphili- tic, or a tubercular subject, which is not rare, the prospect of con- veying any of these diseases to a healthy person is quite probable, and is much enhanced if abrasions or sores are present in the mouth of the chewer; he certainly is a dangerous person to pre- pare awa. Unfortunately, the Hawaiians cannot comprehend the risks of infection that lie in a diseased awa chewer. The Hawaiians are the only race in Hawaii who use awa; if the chewer is healthy, disease is not likely to be conveyed by its use. Awa made by a clean, healthy person contains no bacillus leprae, but if made by a leper, the bacillus is rarely absent. Awa drinking in Hawaii nei is generally confined to the adult portion of the Hawaiian race, and is not often used by the young members. / claim that "here is an agent or factor in use," and peculiar to one race, that will account for a certain number of cases of leprosy; also that this disease can be conveyed to some healthy persons by drinking awa containing the bacillus leprae; if its use is frequent, then infection of the healthy victim is frequent and con- tinuous until his or her leprosy becomes developed and visible. I now conclude: "The bacillus leprae, in order to infect a healthy person, must enter the digestive tract through the mouth, from thence a general systemic infection occurs through the mu- cosae of this tract." Furthermore, most of the cases of leprosy can be accounted for by this method of infection. The human mouth is par excellence a situation for bacteria to develop, flourish, and obtain a temporary nidus, preliminary to passing into the stomach and intestines. THE PATH OF THE DESTROYER 117 To sum upon this awa question : Drinking awa uncontaminated by a leper can be no cause for spreading leprosy, remote, or even predisposing; its main effect in chronic drinkers is, as I just wrote, to produce an artificial psoria- tic change in the epidermis and outermost layer of the dermis, conjunctivitis, thickening of the eyelids, and ectropion or eversion of the lower eyelids. On the other hand, contaminated or infected awa, a com- pound consisting of leper saliva or spittle extract of awa root and added water (just as often used by the chewer to wash his mouth, and from thence he ejects this washing into the awa mixture in the bowl), can most assuredly infect a healthy drinker. In this in- fected awa, there is every reason to conclude and believe that the bacillus leprae is alive; because the saliva affords one of the best media for developing bacteria, is free from pus and other morbid products (which tend to produce cadaveric bacilli) ; the even mouth temperature, and the bacilli also protected from atmospheric changes by their own cell wall and the viscid saliva. The bacillus leprae, introduced into the digestive tract under all the above conditions, is in one of the most advantageous posi- tions to carry infection. There are other agencies that I claim are more prominent and effective in causing the spread of leprosy than infected awa (I will discuss these later) ; all of which, in their use and con- sumption are peculiar to the Hawaiian race — the race chiefly affected with leprosy. Out of apparent evil often comes good, it is the dark cloud with the silver lining. In no other country of the world but Hawaii are the conditions, bearing on the means by which leprosy is spread, so favorable for its elucidation. It is practically a mono- race selective disease in Hawaii, a peculiar feature, and if we study all the causes leading up to this, we must reach, little by little (even if we blunder on to it) the truth and the answer to the questions: 1. Why is leprosy so prevalent amongst the Hawaiian race? 2. Why are the foreign races so little affected by the disease? 3. By what means does leprosy infect a person? SALT FISH AN ALLEGED CAUSE OF LEPROSY Has salt fish, well cured or imperfectly cured, any inherent property that endows it with specific power to cause leprosy? A 118 THE PATH OF THE DESTROYER theory promulgated by some authorities, who maintain "that a fre- quent salt fish diet is a chief cause of the spread of leprosy." This doctrine is not tenable, and cannot be brought into the field to illustrate the cause of leprosy in Hawaii, excepting in two special phases — a chemical and a mechanical — and both of these agencies are merely factors capable of conveying leprosy, but not producing it. Salt fish, when not infected by the saliva-coated fingers of the leper, can convey no leprosy, but if the salt fish is contaminated by the leper's fingers, it contains leprous bacilli, and certainly can infect a healthy person partaking of this leper-handled fish, pro- vided he is not immune. A leper eating fish out of the same dish as his healthy com- panion, pursues a method of eating wherein lies every possibility of infection of this companion. The leper's fingers convey pieces of fish to his mouth, which fingers carry saliva on the return from his mouth to the fish, and the process goes on all through the meal and at each meal — fingers from mouth to fish, and from fish to mouth, and so on, with con- stant repetition of the process. The mechanical aid that salt fish gives as an agent or factor in conveying the disease, consists in the more prolonged fingering required to detach the tenacious bone adhering to fish, in morsels suitable for the size of the mouth, especially when, as is usually the. case in Hawaii, the dry fish is eaten uncooked. The fingers of both hands have to be used for a long period in breaking up the dry fish to a suitable size for entering the mouth. At every por- tion of fish carried to his mouth the leper coats his fingers and finger nails with saliva, and, hence bacilli. The leper bacilli exist in large numbers in the mouth of the leper at the beginning of the meal, but whether the fish in the dish is continuously infected by the fingers of the leper, is diffi- cult to determine and the results obtained vary a great deal. Each and every contact of the leper's fingers with the fish is a risk to the person or persons eating with him. The fish present in the dish is fingered by the healthy eater, or eaters, who each takes a morsel of infected fish, then comes the leper's turn, then the healthy eater, and so on, until the appetite is satisfied ; all the fish being eaten at that meal, or the uneaten fish remaining in the dish being put aside for the next meal. In the interval, the contami- nated fish may be placed before some guest visitor, or an absent member of the family at meal time. This guest or visitor may THE PATH OF THE DESTROYER 119 be a foreigner (a white man). Of course, the leper in the farm'])' does not appear to eat, or appear at all, but this visiting foreigner is fed with fish and poi, and if there are the remnants of fish left over from the last meal at which there was a leper eater, this foreigner or guest may or may not be unwittingly infected with leprosy, from the leper-infected remnants of poi and fish set over from this said meal. In the house of his friends, said for- eigner may eat time and time again in the same house and under the same circumstances, and then marvel where he contracted leprosy. (Here lies one illustration of the alleged mysterious spread of leprosy.) I have conversed with and questioned many foreign lepers in Hawaii, and put the question to some of them: "Did you have contact with lepers?" They all make generally the same answer: "I never saw a leper until I came here" (Leper Settlement), and next almost invariably is added, "I never have had anything to do with native women" — hinting at and thinking that I am a believer in the almost universally held idea in Hawaii that leprosy is spread by sexual intercourse. Continuing the questions, "Did you live, sleep, or eat in the houses of Hawaiians?" The answer comes, "I have lived and slept and I have eaten poi and fish when I was visiting or traveling around, but there was no leper present that I saw or heard of!" Often I have gotten the direct evidence I wanted — the foreign leper stating, as the case may be, "So and So is a leper here (Leper Settlement). I used to know him well; he never came to our house, but I went to his on a friendly visit and ate poi and fish with him, but he then had no leprosy." Just as often as not, other members of the family in the house where this leper foreigner had eaten, were lepers before his host and entertainer became one. Following patiently every clue, the spread of leprosy can gen- erally be traced, each case of leprosy to another case. It is no mysterious disease as alleged, the path of infection shows a trail, sometimes clear, sometimes hidden. Investigating the unknown and hidden features of any sub- ject, it is more prudent to seek simple causes and effects and ex- amine them carefully, before proceeding to study the more complex ones. Applying this reasoning to the solution of the cause of the spread of leprosy, we at first are struck at the marked selection •of that disease for the Hawaiian race. 120 THE PATH OF THE DESTROYER Here we have an absolute fact, prominently outlined before our eyes. Next we may safely conclude that whatever race is the most affected with leprosy, here will be found abundance of material to work upon, and it will not. repay us to spend our time in the narrow field afforded by "sporadic cases,'' so-called, prevailing amongst foreign races in Hawaii. ANY FOOD that is handled by a leper is a possible source from which other cases of leprosy may originate, the infection be- ing carried by the fingers and finger nails. The specific infective principle is the leper bacillus, carried in the saliva-coated fingers. If the leper has ulcerated fingers, I as- sume there is no added risk, because an ulcerating pus secreting surface, carrying bacilli in contact with the air, are in all prob- ability cadaveric. The limitedly contagious character of leprosy to those in contact daily for years, adds weight to my assumption. The more finger contact any article of food receives from a leper, the greater the probability of more intense infection of that food with bacillus leprae. Salt fish, owing to its tenacity and bone-adhering properties, is pre-eminently an article of food, where the mechanical factor comes into play (illustrating that salt fish plays the role as an agent or factor of conveyance only, for the bacillus). Salt fish generates no bacillus leprae de novo, and no bacilli are found in the fish until the leper infects it. Salt fish does contain even when properly cured, Forster's bacillus, motile circular or irregularly circular bacilli, but this bacillus is non-pathogenic, and resembles in no manner of way the bacillus leprae. EXPERIMENTS WITH FISH Portions of salt salmon, mullet, akule and aku, all fish in common use daily amongst the inhabitants of Hawaii, were care- fully washed, triturated in a mortar, and the washings carefully examined and found free from the bacillus leprae. Portions of these same fish, uncooked, were given to lepers to chew and churn up in the mouth, the chewing continued for two minutes actual time. The contents of the mouth being then ejected into a sterilized cup and the contents carefully examined. During twenty-five years, at various times and places, I carried on these experiments on sixty-five leper male and female adults, all cases being mild or moderate ones — no advanced cases were taken. Out of these sixty-five cases, fifty-three of the slides THE PATH OF THE DESTROYER 121 showed numerous leper bacilli, and in remaining twelve cases no bacilli were discoverable. But this need not be taken as absolute negative evidence, it holds good simply for the examination at that date. In the face of all this evidence, it is reasonable to assume THAT THE USE OF CLEAN SALT FISH, PER SE, IS NOT A SPECIFIC CAUSE OF LEPROSY, BUT WHEN INFECTED OR CONTAMINATED BY THE LEPER IT ACTS ONLY AS AN AGENT, FACTOR, OR MEDIUM OF CONVEYANCE OF THE BACILLUS TO THE HEALTHY. To sum up : THE CLAIM THAT EATING SALT FISH IS A CAUSE OF LEPROSY, OR A CAUSE OF THE SPREAD OF LEPROSY, CAN ONLY BE MAINTAINED BY AS- SUMING THAT PREVIOUS INFECTION OR CONTAM- INATION OF THE FISH BY LEPROUS CONTACT MUST HAVE TAKEN PLACE. SALT FISH A CHEMICAL FACTOR IN LEPROSY Salt fish, by reason of its contained salt and daily use, tends to alkalinize the saliva and diminish the acidity of the gastric juice in the stomach; by both of these chemical changes in the composition of these secretions, the bacillus leprae is more likely to flourish and live in the digestive tract. The excessive use of salt as an article of diet with any food also tends to bring about the same result. The Hawaiians do eat largely of salt — the poi, their staple food, a starchy paste, is insipid and tasteless without salt. The salt in use in the Hawaiian home is not the refined powdery salt like that in use on a foreign dining table, but is composed of large, coarse crystals, which crunch under the teeth like our rock salt. This Hawaiian salt is much more saline, biting, and savoury than refined salt; bitter also, from excess chloride ot magnesia. As an alkalinizing agent, it is far more effective than ordinary table salt. By actual investigation and test, I found that an average Ha- waiian eater consumes from one and one-half to three tablespoon- fuls of this coarse salt at each meal. This excessive use of salt is a serious drawback to digestion ,- skin troubles, stomach disorders, and kidney irritation, prevalent 122 THE PATH OF THE DESTROYER amongst the Hawaiian race, can all be traced to the excessive use of salt. The mouth is a favorite seat for the development of many bacteria — alkaline saliva, high, steady temperature, decaying and fermenting particles of food adhering to and lodging between the teeth, caries of the dentine — all furnish a suitable nidus. Six known bacilli, peculiar to the mouth, find a permanent home in unclean mouths. Several micrococci, Friedlander's pneumonia bacillus, Frank- el's pneumococcus, diphtheria bacillus, tubercule bacillus, syphilis, and leper bacilli, all find a lodgment and home in the mouth. The saliva is generally alkaline, but not in every person, and by using litmus paper, four different states are revealed — faintly acid saliva, neutral, alkaline, and strong alkaline. The excessive use of salt produces the two latter conditions, which favors the development of bacilli of typhoid, cholera, leprosy, and many others. The stomach in its normal condition is not suitable for the development of bacteria, but many germs can withstand and survive the action of the gastric juice. When the acids of the stomach are weakened, or even neutral- ized, which happens at intervals, bacteria are placed in a more favorable medium for their growth ; in like manner, the excessive use of salt by the Hawaiian race can produce this very condition of the stomach which will aid the bacillus leprae. It is from this view, "eating salt fish in excessive quantity," that brings out the chemical agency, or factor, or quality that aids the spread of leprosy. The salt in salt fish, by its alkaline prop- erty, changes the gastric juice, and also the saliva in composition, the acidity of the former being much diminished and alkalinity of the saliva made strongly alkaline. The salt in the fish, if the fish has been infected by leprous contact, merely acts as an agent, factor, or medium of assistance, by its alkaline property on the secretions of the mouth and stom- ach, and only to this extent does it aid and favor the development of the leper bacillus in the digestive tract. The excessive use of salt in the diet or its absence is no specific cause of leprosy. By experiment and test. Refined Granular Table Salt 60 grains added to a l-to-500 solution of H. Cl.=Faintly Alkaline. 80 grains added to a l-to-500 solution of H. Cl.=Neutral. 100 grains added to a l-to-500 solution of H. Cl.= Alkaline. THE PATH OF THE DESTPnyER 123 Coarse Crystallized Hawaiian Salt 30 grains added to a l-to-500 solution of H. Cl.=Faintly Alkaline. 50 grains added to a l-to-500 solution of H. Cl.=Neutral. 65 grains added to a l-to-500 solution of H. CI. =Alkaline. 80 grains added to a l-to-500 solution of H. Cl.=Strongly Alkaline. If the standard of alkalinity of the saliva is to be gauged by litmus paper, then it will be necessary to modify the statement that the saliva is an alkaline fluid at all times. The saliva from time to time varies in its reaction to litmus paper, being acid, faintly acid, neutral, alkaline, and strongly alkaline. The saliva in man is a clear, viscid fluid, secreted by the salivary glands. It contains ptyalin, its chief active constituent, a digestive ferment; the saliva lubricates the mouth and softens and moistens the food, thereby aiding mastication and deglutition. The ptyalin converts starch into maltose (malt sugar). The saliva is secreted by the submaxillary, parotid, and sub- lingual glands; lingual saliva is secreted by the glands of the tongue. Parotid saliva contains no mucin (a protein). It is thinner and less sticky than the other varieties. Sublingual saliva, from the sublingual gland, is the most viscid of the salivas, its reservoir or pocket under the tongue is a favorite location for the bacillus leprae. CHAPTER II. Deductions. 1. Having weighed and considered the extreme com- plex features surrounding leprosy in its multiple and varied aspects, I assume and maintain that leprosy is a primary mouth infective bacilligenic disease. 2. I also assert and maintain that man is infected by leprosy through the mouth, and its connecting passage, the ali- mentary canal, or digestive tract. Also that the bacillus leprae first finds lodgment and nourishment in this canal, and thereafter reaches its various selective tissues of the body by penetrating the mucosae of this same alimentary canal, di- gestive tract or path, (hence my selection for the name of this monograph). 'The Path of the Destroyer." 3. The mouth with its contained saliva in the confirmed leper is the main source of contagion to the healthy. Man is infected through the mouth in seven- tenths of the cases of tubercular or nodular leprosy. I have not yet reached a conclusion on the many differ- ent features of the nerve form of leprosy, but in so far as I have gone, "mouth infection" will also explain the manner of infection in this form of the disease. If we could check, stop, or shut off pulmonary infection in tuberculosis, we would shut off nine-tenths of the cases of that disease, because primary pulmonary infection will account for nearly all the cases: Local T. B., bone T. B., Glandular and Intestinal T. B. alone remaining. Similarly if we could shut off mouth infection in leprosy seven-tenths of that disease would be shut off, and we might possibly eradicate it. THE PATH OF THE DESTROYER 125 POI VS. LEPROSY Clean poi, fresh or sour, contains no bacillus leprae, but poi infected or contaminated by leprous saliva-coated fingers and fin- ger nails contains the bacilli, and is a menace to a healthy or non-immune eater. I claim it is ONE of the chief agents that has caused, and causes, the spread of leprosy amongst the Ha- waiian race. Of all the people domiciled in Hawaii, the Hawaiians alone are the main eaters of poi; this peculiarity of food is almost en- tirely confined to them, and also with monotonous repetition I add, they are the race for which leprosy apparently has a remarkable predilection. Poi is a sticky, bluish gray paste, made from the root of the taro plant, arum esculentum. It grows in shallow ponds or patches, with soft mud bottom, covered with water to a depth of about one foot. There are many species of taro, both of the wet kind and dryland kind, which grows at an elevation of about 1,200 feet above sea level; this taro receives its moisture from the rain and dews. The water-grown taro is the staple article of diet, and forms the daily food of 95% of the Hawaiian people. The root is cooked, peeled and pounded to a paste with added water. The flour paste of the bill-poster or the paper-hanger is poi counterfeited except for the color, and this flour paste poi is in common use today, instead of taro poi, owing to the high price of taro. Poi is easily assimilated and is highly nutritious. Within a few hours after being freshly prepared it begins to sour, due to the starch largely present in its composition, taking on amylaceous fermentation. The insipid taste of fresh poi palls on the Hawaiians, and they prefer poi which is two or three days old. Abundance of salt is also eaten with poi to remove its insipidity and lack of relish. The containers for the poi are wooden bowls, calabashes (so- called) or true calabashes — large dry gourd shells, or porcelain bowls of foreign manufacture. The family calabash is of large diameter, rarely less than twelve inches, and when full contains an average depth of ten inches of poi. The calabash of poi is the recipient of all the fingers of the eaters who surround it and are in sufficient contiguity; these details fill in a picture of pleasure, health and ultimate satiety, provided all the eaters are healthy. I will ask the reader to picture in his mind six people sitting r THE PATH OF THE DESTROYER 127 around a dish, and all eating out of this dish with their fingers coated with flour, or starch paste, or poi, a tenacious compound requiring the finger to be deeply inserted into the mouth, and strong suction applied to remove the paste. I now turn on the light of a morbific current, and ask the reader to imagine what would happen to these six eaters, if some ignorant, thoughtless person semi-convalescent from cholera or ty- phoid fever (both primary mouth infective diseases), or a syphilitic with recent mucous mouth lesions, were to stir round this dish of paste or poi with unwashed, infected, and unsterilized hands, and begin eating and eating until he had finished his meal, and after him the six eaters began to eat the same poi or paste with its possible disease infecting contents — this same occurrence happening at the three daily meals. Any person of common sense will admit, that the danger of infection from the above diseases to the six innocent eaters is very great. Now this is exactly what takes place when a leper eats out of the same poi bowl with other healthy eaters. Amongst the Ha- waiians the leper sits right amongst them, puts his fingers into the same food that they, the non-lepers eat, they know of his pres- ence and avoid him not, and this condition goes on maybe for months or years. Then one of the eaters with the leper develops the disease (leprosy) : this makes two lepers. These two lepers remain eating, sleeping, and living with the other healthy occupants and another case of leprosy shows up later on; afterwards, either from immu- nity or some other accidental protective precaution (separate eating bowls, perhaps), no other inmates of the house develop leprosy, then the disease will be looked on as non-contagious by the surrounding neighbors. (This is the picture presented to us physicians in Ha- waii, and it is not overdrawn, it occurs daily.) FROM THE ABUNDANCE OF EVIDENCE AND VISIBLE PROOF OF THE SPREAD OF LEPROSY IN THE HAWAIIAN ISLANDS, IT IS HARD TO CONCEIVE HOW ANYBODY, LAYMAN OR PHYSICIAN, CAN DOUBT THE COMMUNICABILITY OR CONTAGIOUS- NESS OF LEPROSY. WHAT DULLS AND BLINDS THE REASONING FACULTIES OF THE NON-CONTAGION- ISTS IS THE SUPPOSEDLY SLOW PROGRESS AND DE- VELOPMENT, APPARENT IMMUNITY SO MANY SEEM TO POSSESS, AND THE IMPERCEPTIBLE MAN- 128 THE PATH OF THE DESTROYER NER, APPARENTLY, OF ITS COMMUNICATION, WHICH HAS LED THEM TO ASSUME THAT LEP- ROSY IS NON-CONTAGIOUS. In contact with disease, the Hawaiian, without specially be- traying his creed, is a believer and apostle of fatalism. Careless, even to recklessness, whether the disease be bubonic plague, cholera, tuberculosis or leprosy, with which he is in contact, the Hawaiian stands his ground, makes no attempt, to move away from the point of infection or to protect himself or take any precautions what- ever; but when he becomes a victim of a fatal disease two states of mind will be in evidence, utter sangfroid and stoicism, or pa- thetic appeals for aid when it is too late. During the time I have lived in Hawaii — over thirty-two years — I have been amused and interested in observing the prac- tice of the native doctors whenever opportunity presented itself. Implicit confidence is placed by the Hawaiian in the skill and learning of his kahuna, kauka, or doctor, but lack of confidence and fear generally is the rule when brought in contact with a foreign physician, who is lacking the essentials of Hawaiian prac- tice, porcine and gallinaceous beliefs. The native doctor is generally crafty, shrewd, and at times unprincipled. Whatever skill the ancient Hawaiian physicians possessed, in modern times like today it is a lost art, and most, of its graduates belong to the university or school of superstition. The modus operandi of the Hawaiian doctor is as follows: In- cantation for the recovery of his patient plays a minor role, as also do the medicines he administers, but he himself (the doctor) requires his fee and also that he shall be fed on the best of the land — suc- culent pig, chicken, gin or brandy and so forth. This high living is essential, for if the kauka becomes weak or feeble (a very com- mon occurrence), the disease in his patient's head, lungs or stom- ach will get the best of him (the doctor) and then death stares the patient in the face. Therefore, the doctor must live on the fat of the land while his patient may starve. Often times when the financial limit of the patient is ex- hausted and his death is becoming apparent, the kahuna, seeing no more prospective fees, and to save his own neck (being un- licensed) urges the patient and his friends to seek the services of a foreign doctor, telling them, "the nature of the disease has changed to a foreign sickness, and hence the need of a haole or foreign doctor!" I have given dozens of death certificates, knowing full well iiii Ol'R HARBINGER OF HOPE. We have here our Venerable Medicine Man — Kauka Kukaepele, M. D. (Doctor Sulphur). A Distinguished Member of the Faculty. Note the placid features of the Kauka. He is taking his dail\ sun bath, and his favorite laau — popolo — this accounts for the Doctor's hue physique, and contempt for haole hair restorers. Observe the Doctor's left hand possesses six fingers. The average white doctor has only four fingers, which amply suffice to abstract fees from his patients' pockets. THE PATH OF THE DESTROYER 129 that I was covering up the work of a kahuna. What else could be done? the body must be buried, no evidence could be obtained proving negligence or malpraxis, and if prosecution was undertaken, acquittal would be certain, Mr. Kahuna would triumph and pose as a martyr of haole persecution. The average native judge gets "cold feet" in a kahuna trial. The Hawaiians dread the power of the kahuna, regard him as an ogre. To resume the consideration of the subject of poi. Leprous bacilli can be found in the leper's calabash; this is highly significant, and is a striking indication that the leprous bacillus has a clear field for entering the digestive tract of a healthy person, eating out of the leper's calabash. The poi, of course, only acting as an agent, medium, or factor of conveyance of the bacillus leprae which originally was conveyed ' to the poi by the saliva-coated fin- gers of the leper. EXPERIMENTS ON POI INFECTION In order to test this method of infection, I experimented on twenty lepers during twenty-five years from 1884 to 1909, on every island of the group except Niihau. The leper was instructed to put his fingers to his lips, the index and middle fingers, and insert them well into the mouth as done in sucking off the poi; next step, the fingers were plunged into the poi, the exact spot being marked. Immediately a sterilized test tube of the largest size was pushed into the poi, at the spot where the fingers of the leper had been inserted. The cylinder of poi thus obtained was carefully examined, and in the whole series of twenty cases the bacillus leprae was obtained easily in every case. Again, I secured the washings from the leper's calabash, when it was being cleaned, and also obtained bacilli. Outside the body of the leper, his aw a, his salt fish, and his poi, all contain bacilli, and possibly other articles of food also. The saliva of the leper, a secretion in which it is reasonable to assume the bacilli are alive (and I claim that the saliva of the leper is not likely to contain cadaveric bacilli), is the only se- cretion in direct contact with the air, where non-cadaveric bacilli should exist — no clothing covers the oral orifice, hence direct trans- fer of the bacilli from this locality is more likely than any other. The tears of the leper contain no bacillus leprae. The pos- terior nasal secretion contains bacilli which pass into th* phi i n'ov PREPARING THE POL The pestle or pounder in the man's hand, the poi board or platter with poi, ready for placing in the calabash visible in the background. The tare plants, sheath and root in the foreground. THE PATH OF THE DESTROYER 131 and back of the throat, they would therefore reinforce the bacilli at the back of the mouth and base of the tongue. The secretion of the anterior nares, pouring out on to the upper lip, I claim, having free contact with the outer air, lacks infective properties, the bacilli are weakened, possibly cadaveric, and if some of this nasal discharge enters the mouth, which it must do at times and in sleep, mixing with the bacilli of the mouth, it will simply augment the numbers of bacilli in that cavity but not add to infective power of the saliva. Rice, bread, crackers, raw fish cut in pieces will present less surface for infection by the leper's fingers than poi or salt fish. These former articles of food require less handling to detach a piece suitable for the size of the mouth. In rice, a spoon is generally used for eating; if the fingers, the fingerful is pulled cleanly away, the remaining rice is not messed or mixed up by the leper's fingers. This same statement applies to bread and crackers or biscuit if eaten whole, and not broken piece by piece in a common dish by leper fingers. All these foods are less fingered than poi, which takes the first rank in finger contamination and in the depth of entrance of the finger into the mouth, the compression of the lips and cheeks aiding the strength of the act of sucking; the finger nails also aid the carrying of bacilli, practically the fingers with each plunges into the poi concentrate and mix in bacilli. The poi is cold when fresh, but the fermentative process always present after the first day, produces warmth which must aid the bacillus. Hot cooked food, or cooked over food would most likely destroy the bacillus, but fermentation would scarcely reach any damaging tem- perature high enough to end bacillary life. One Hawaiian method of kissing, pushing the tip of the tongue into the opened lips and mouth of the kisser or kissed is a dangerous practice, if one or the other happens to be a leper, tuberculous or syphilitic, etc. In Hawaii the leper receives the "maximum of contact" with the healthy, eating, sleeping, living in the same room, and the longer I observe these conditions the more I wonder that there are not more lepers. The opinion is held by some, that the saliva-coated finger of the leper when covered with poi prevents any infection of the poi in the calabash, the bacilli contained in the saliva being sucked again into the mouth with the poi on the finger. 132 THE PATH OF THE DESTROYER In a slow eater this condition is a plausible possibility, but the leper has generally a voracious appetite, due to his diseased stomach, and proceeds to scoop up the poi from the calabash as fast as possible, and during this process he scatters minute droplets of saliva, visible and invisible, over the surface of the poi, also with each plunge of the index finger, the bent second phalanx of the adjoining finger, together with the terminal phalanx of the thumb, come in contact alternately with the leper's mouth and the surface of the poi. The presumption that the coating of poi on the leper's finger is of sufficient non-permeability to isolate a bacillus like the bacil- lus leprae, 3m (microns or micromillimeters) in size, a micron being equal to 1/25,000 of an inch, and also the fact that 10,000 bacilli could easily occupy the surface of an ordinary finger nail, throws grave doubts on the correctness of the above assumption that a leper eating poi does not contaminate or infect it. I have stated already that in the cleansing of the leper's calabash the bacillus leprae can be detected in the washings, irre- futable proof that the leper does infect the poi. SUMMARY OF CAUSES ALLEGED TO SPREAD LEPROSY IN HAWAII Common to all Races Indigenous and Peculiar to the Hawaiians Vaccination. Poi eating with leper. Mosquitoes. Eating raw fish with leper. Bed-bugs. Eating uncooked food with leper. Fleas. Excessive use of salt. Pediculi. Awa drinking with leper. Sarcoptes Hominis. Eating with fingers. SOCIAL HABITS PECULIAR TO HAWAIIANS ( Intimate ------ \ Marrying Leper Contact I Prolonged -----> Living ( Promiscuous - - - - J Sleeping RACES NOT EATING WITH LEPER Practically all Caucasians and Asiatics * * * On the subject of pediculi or lice, sarcoptes hominis or itch, ft-- in "S*'^ r/i/ » ,Mj \ $ 'Tiff. ,l ■■#*■ CAUCASIAN-HAWAIIAN. 134 THE PATH OF THE DESTROYER as possible spreaders of leprosy, I have grave doubts if either of these parasites could infect man with that disease; if an affirmative answer is given, "then these parasites must be looked on as spread- ers of syphilis, tuberculosis, etc." What physician can assume this position? The direct entrance of the bacillus leprae must be looked for in the digestive tract, as I have before stated and dis- cussed. SIGNIFICANT CONDITIONS The last American census, year 1910, enumerated Asiatic-Hawaiians 3,734 Caucasian-Hawaiians 8,772 The Asiatic-Hawaiians are in the main comprised of Chinese- Hawaiians, who total possibly 90% of the whole. Leprosy does not prevail extensively among them, they are much less affected with that disease than are the Caucasian-Hawaiians, and both of these races suffer much less than the indigenous or aboriginal Hawaiian. Exact figures are difficult to obtain, but a fairly accurate ratio of the prevalence of leprosy amongst each of these three races is as follows, computed for thirty years, 1884-1914: Race Unit Ratio Hawaiian -... lto lto lto 32 Caucasian-Hawaiian 140 Chinese-Hawaiian 210 Caucasian-Hawaiian Chinese-Hawaiian LEPER POPULATION Thirty Years (1884-1914) One Leper to Every Seven {« Aboriginal awaiians This ratio is figured on the list of segregated lepers for the above period of thirty years. The Caucasian-Hawaiian is generally an eater of poi, due to the fact that the Hawaiian mother is usually the dominant con- sort in the matter of food supply, hence its more frequent use than rice or bread, due also the fact that in former years poi was much the cheapest of these foods. THE PATH OF THE DESTROYER 135 As a general rule the Caucasian father is not as careful a provider, or as good a disciplinarian as he should be; laxness is the rule in both of these necessary paternal qualities. The daily food of the Chinese-Hawaiian, as long as he or she dwells under the paternal roof, is for the most part rice. The Hawaiian mother naturally, and from her bringing up, prefers poi to rice, and these two articles of food will be more likely to be found in her home than in the home of a Caucasian-Hawaiian family. What I have written, some pages back, that poi is a much better vehicle for conveying leprosy "when infected by leper fin- gers" than rice, receives further support when it is apparent that the prevalence of leprosy is greater amongst the Caucasian-Ha- waiian poi eater than amongst the Chinese-Hawaiian rice eater. The evidence that I am continually deducing all has the same trend, and always points to the digestive tract as "the path of entrance of the destroyer" (the bacillus leprae into the human system ) . A JAPANESE POI EATER On the lands of a certain mercantile enterprise employing over 1,500 Japanese men, there lived a Japanese, one of the number of these laborers, and pursuing the same vocation as the majority of them, viz. : working in the fields. This Japanese had resided in Hawaii for thirteen years, had always lived and worked on the same plantation. In the thirteenth year of his residence he became a leper, and for eleven out of thirteen years, until his leprosy showed itself, he had resided with a Hawaiian family. His diet was poi, which, of course, in a Ha- waiian household forms the daily family meal three or more times a day. This Japanese laborer had almost entirely discarded rice as his daily food, and he only ate that article of diet when he visited his friends. When I first saw the man, although he had marked signs of leprosy, it had not become well known that he had this disease, but his Hawaiian house companions easily recognized it in its early stages. I interrogated this Japanese and got his history as before re- lated ; it also came to light that in the Hawaiian house where he resided, there was a leper, a male Hawaiian adult, who ate pro- miscuously with all the members of the family and inmates of the house. 136 THE PATH OF THE DESTROYER Here is an instance of one man out of 1,500 others develop- ing leprosy under the very conditions that I assume are the means of spreading the disease amongst, the Hawaiians. I questioned this Japanese leper on his family history and contact with leprosy in Japan, and the possibility of his carrying the disease with him; his answers to all my questions negatived the idea of his acquiring the disease in his home country. Provided Japan was free from endemic leprosy, the history of this Japanese laborer would furnish very positive evidence on the point I have previously claimed, viz.: the leprosy carrying quali- ties of infected poi. The weak link in the chain of evidence is the bare possibility of Japan being the country where the primary infection occurred. Thirteen years, however, is a long period of latency even for leprosy, which alternates its periods of activity and quiescence in a manner peculiar to itself, and different from all other known diseases. CHINESE-HAWAIIAN. CHAPTER III. INOCULATION Inoculation may be considered under two headings: Accidental, known or unknown, and Positive Inoculation. Accidental inoculation infers the infection of a skin wound with no desire to acquire or produce pathogenic conditons. Positive or deliberate inoculation may be defined as the in- sertion of a virus into a wound of the skin with the ultimate object of communicating a pathogenic infection. My own experiments, extending over many years, have led me to conclude that leprosy cannot, be inoculated on any dermal surface in man or animals by ordinary methods. This experience being in accord with the results previously attained by most workers in the field of inoculation. In spite of the barren results obtained and the failure of the attempts to inoculate man with leprosy, there is a widespread idea and opinion held by many physicians and the laity in Hawaii, that inoculation is the mainly responsible agent for the spread of the disease. This fetich will not down, it dies a hard death. The many years of toil and study that I have spent investigat- ing the subject of, "where and how does the bacillus leprae enter the human system?" I have previously detailed in past pages, (all the facts deduced on this subject clearly indicating the digestive tract), and this evidence would appeal with greater and more con- vincing force to physicians in Hawaii, were they not enchanted and hypnotized by the song of the siren of inoculation. To assume that the extensive prevalence of leprosy amongst the Hawaiians is due to inoculation, is a most unstable claim. Until leprosy can be demonstrated to be positively conveyed by inoculation, and inasmuch, even then, as no race has a possible monopoly of inoculation as a medium for communicating leprosy, it can hardly be conceived and accepted, that the Hawaiian race is alone susceptible to inoculation, and that all other races in Hawaii escape being infected with leprosy because they cannot be inoculated. This is a most untenable contention, yet it is the threshold on which believers in inoculation must stand in Hawaii nei. INOCULATION EXPERIMENTS. In the year 1844, Dr. Daniel Danielssen, Norwegian physician, veteran leprologist, (Danielssen's disease, Anaesthetic or Neural THE PATH OF THE DESTROYER 139 leprosy being called after him), inoculated himself, two assistants and one nurse, attendants, at the Bergen hospital, with leprous blood, serum, and blood from leprous tubercles, and failed to in- fect himself or any of the others with leprosy. In the year 1856, at the Lungegaarde hospital, Danielssen again inoculated himself, and four other persons, the same fluids of the leper's body being used. No subsequent infection with leprosy oc- curred in any of these five persons. In the year 1858, Danielssen again inoculated two persons with the same leprous fluids, no resulting leprosy developed. From the years 1868 to 1875 in Italy, Doctors Guiseppe Profeta, and Cagnina inoculated themselves and eight others with leprous fluids, blood and blood serum. The whole ten persons so inoculated failed to develop leprosy in a single instance. If deliberate attempts fail to inoculate man with leprosy, it must then be a vague and doubtful possibility whether man can be inoculated by accidental and unknown conditions. In previous pages I have brought forward the vast field that European leprosy affords us, to ponder over and consider, and the great aid it gives us in studying the disease in Hawaii. In Europe a disease that numbered its victims by millions, ultimately almost became extinct, can scarcely be claimed to be a disease spread solely by inoculation. Syphilis has been known for many centuries to be inoculable, but there are no present indications of the disease dying out. We do not know that leprosy is inoculable in man. Were we positive in our knowledge that it was, would we expect it to be- come extinct? — the answer must be NO, for in the absence of rigid preventive measures, any inoculable disease widely spread, is very unlikely to disappear, and certainly not a chronic infective disease like leprosy. Syphilis, an inoculable disease remains with us, and no country is free from it; on the other hand leprosy for the most part has ceased to exist, but yet maintains itself by certain endemic centers in a few countries. All the evidence in Europe tends to strengthen the non-in- oculable character of leprosy, otherwise we must be led to accept the statement, that a "disease which scourged Europe for 600 years and over, died out of its own accord, was spread by inoculation," a deduction open to grave criticism, because this source of communi- cation, (inoculation) existed from the beginning, all through the course of the disease, even to the end, remains today as a universal 140 THE PATH OF THE DESTROYER cause; and the same field for its spread is as open as ever; yet, only -limited areas of certain countries contain endemic centers. INOCULATION EXPERIMENTS ON KOKUAS AT MOLOKAL In the incipient stages of leprosy, it is natural to conclude that it would be possible to start fresh foci of disease in clean, and uninfected parts of the body of a leper by inoculation. If we could successfully accomplish this, it would be a great advance and we could learn much more about the etiology, the inoculability, period of incubation, etc., and make definite progress in our knowl- edge of the cycle or life history of the bacillus leprae. This is one of the first snags I encountered in investigating the pathogenic features of leprosy; the creation of "FRESH FOCI" of leprous infection in the leper cannot be accomplished, I never succeeded in doing so, the many experiments I carried out on this "LEPROUS RE-INFECTION" basis all ended in failure. Whilst the non-successful production of new infection centers, weakens the probability of certain local lesions of leprosy being of purely local origin, it by no means negatives the position maintained by some leprologists, that in certain lepers, leprosy has well defined local foci of disease, which if eradicated by excision, general systemic infection will be lessened or stopped. To proceed. Thirty years ago the Leper Settlement on Molo- kai maintained abundance of healthy kokuas, all ready and willing to be experimented on by inoculation, serums, or any other means likely to develop leprosy; the artificially made lepers hoping to obtain board and lodging, for the remainder of their lives; being listed as lepers — a livelihood, and existence without working being provided by the Board of Health. What other country of the world save in Hawaii, would people be found willing to take the chances of acquiring a loathsome and incurable disease?, the sole object to be gained for the loss of health and shortened lives, being maintained at public expense. From the Hawaiian point of view no risk attends a careless contact with leprosy; this condition alone ought to furnish sufficient evidence to the world, and account for Hawaii being a strong, and prolific endemic focus for that disease. Amongst the greater number of the 225 male and female kokuas residing at the Leper Settlement, in the early '80's, there was an ever present desire amongst them to be placed on the books and listed as lepers. THE PATH OF THE DESTROYER 141 I was pestered and annoyed daily with requests to examine purposely caused lesions of the integument, generally consisting of incised, contused, or lacerated wounds, wilfully allowed to fester, and become ulcerated, aided and aggravated by irritating substances, salt, tobacco juice, sulphur, kerosene oil, acrid juices from raw taro, awa, soot, salt petre, and a multitude of other substances all calcu- lated to produce superficial or deep inflammation of the skin. Feigned pains, aches, paralyses and anaesthesia, all made to order, to fool the doctor. To imitate the leprous alopecia of the supra-orbital ridge — plucking out, and burning of the eyebrows was resorted to ; counterfeit leprous ulcers of the plantar surface of the feet were also common forms of malingering. A splendid field for experimental work was at hand, and stretching all questions of professional ethics, I did not hesitate to avail myself of the opportunities afforded me for testing the inoculability of leprosy. My chief regret is that I have so little to offer in results obtained on this much debated question. Over a period of three years, I selected ten male kokuas, and five female kokuas, suitable in every respect as subjects for experi- mental inoculation. A preponderance of cases of leprosy generally develop between the ages of 20 and 35 years; there is apparently at this period of life some real or apparent susceptibility to the disease, and these fifteen selected kokuas fell within the above age period. "A." Male Hawaiian kokua, 31 years of age, free from leprosy, had resided four years at Kalaupapa with his leper wife, her disease being of six years standing. This man claimed that various sores on his arms, body, and legs were due to "Mai Pake" or leprosy, and demanded that he be placed on the books of the Settlement and listed as a leper. The imposition was easily apparent, the wounds on the skin being self inflicted with hot tobacco ashes, afterwards salt and kerosene oil being rubbed in. I taxed "A" with causing his own sores, he stoutly denied any malingering practices, and claimed his skin lesions were truly leprous, and he could produce witnesses to prove it. I informed "A" I would use certain measures to decide his case. He specially stipulated his non-desire for hypodermic treat- ment, but agreed to submit to any other medicines I might see fit to use. Daily, both the dispensaries at Kalawao and Kalaupapa, offered abundant supplies of leprous serum from burn vesicles, (due to 142 THE PATH OF THE DESTROYER thermal anaesthesia) and steam scalds. Leper patients applying for remedies to dress these injuries, furnished this fluid from blisters, caused by the contact of heat and steam on their hands and feet. The loss of sensation, due to various tropho-neuroses, causes the lepers to acquire extensive skin lesions due to contact with fire, boiling water, and steam. These vesicles yield varying amounts of serum, from a tea- spoonful to several ounces or more. This blister serum is rich in bacilli leprae. Hawaiians have a marked dislike for hypodermic injections, whether morphine be used or any other drug, fluid or other vehicle. I rarely could persuade any Hawaiian to submit to the use of the syringe to administer leprous serum. However, in one or two in- stances I succeeded in doing so. In the month of December, 1884, I took up the case of this man "A", and scarified three centers for inoculation with leprous serum, one, inner surface left forearm; second, base of neck near sternal end of left clavicle; third, left side of abdomen near the umbilicus. At all these scarified points leprous serum was thoroughly rubbed in with a lancet. The sores on his arms, legs, and body were cleansed with warm creoline solution, and afterwards dressed with borated vaseline, to each ounce being added 4c.c. of blister serum; the patient to dress his sores twice a day, the morning dressing being made by my dispenser. At the expiration of eight weeks the three points of inoculation had healed, were barely visible; some of the old ulcers on the limbs and body, had lessened in area, others no improvement, and so the case progressed from month to month. One year after inoculation there were no signs of leprosy; shortly after I again inoculated two foci on the pectoral muscles. Up to the year 1895, when "A'' died of acute nephritis, the re- sult of alcoholic excesses, no signs of leprosy had showed themselves ; a period of over eleven years having elapsed from the time of the first inoculation. Three other competent physicians examined "A'' in 1895 and pronounced him not a leper. "B". Male Hawaiian, 28 years old, lived at Kalaupapa, and took care of his mother, who had leprosy for five years. This man "B" claimed he had leprosy, on the strength of most of the integument of his body, limbs, and face being affected with the psoriatic change produced by drinking awa. Patches of tinea versicolor were scattered on the neck and dorsum. I explained to "B" that his skin trouble was not leprous, and THE PATH OF THE DESTROYER 143 on questioning him he admitted his desire to acquire leprosy, which would prevent him being ejected from the Settlement, (as an un- desirable, which he was, and lived up to the name), on the death of his mother. In the month of December, 1884, I scarified a patch of "BV skin the size of a quarter dollar, over both lumbar regions, and rubbed into these scarified spots a liberal supply of vesicle serum, and blood obtained from a young leper woman. At the end of two months the inoculated foci showed a little discolored skin, and a small blister applied to these inoculated spots, by painting cantharides collodion, gave a vesicle fluid devoid of any leper bacilli. "B" is alive today (1914), left the Settlement in the year 1902, after a residence of 18 years. He shows no signs of leprosy. "C' Male Hawaiian, kokua, aged 24 years, living at Kala- wao, with his leper wife. In the same month, and at the same time, December, 1884, as "B'\ was inoculated. I performed the same operation on "C", inoculating a sore in the web between the finger and thumb of the left hand, using blister serum and leprous blood ; the w T ound healed at the end of two months, no signs of leprosy ever showed themselves. In the year 1908, twenty-four years after inoculation, "C" died on Maui of cardiac disease. "D." Male Hawaiian, kokua, 31 years of age, living at Kala- wao with his sister, a leper of eight years duration. At "D's" own request, and to refute his claim of being a leper, I inoculated four foci with leprous serum in the month of Decem- ber, 1885. The inoculated spots chosen were, inner surface each thigh, at base Scarpa's triangle; and both inguinal regions. "D" mar- ried a leper woman ; he never developed leprosy, lived 24 years at Kalaupapa, and then moved to Honolulu. I occasionally see him on the street — he shows no signs of leprosy or any other ailment. "E.'' Male Hawaiian, kokua, 25 years old, has a leper wife, her disease being of four years' standing. "E", because of rheumatic pains, and patches of leucoderma on his hands, feet, and nape of the neck claimed he had leprosy. He had lived one year in the settlement, and had been examind by several physicians, amongst them Dr. Arning, who failed to find any bacillus leprae in his tissues or secretions. In April 1886, at "E's" own request, I inoculated him over the left pectoralis major, immediately above the nipple, the site chosen was the seat of extensive pigmentary deposit of tinea versi- color. A scarified patch size of half a dollar was thoroughly coated 144 THE PATH OF THE DESTROYER with leprous serum, and saliva furnished by his wife. The scar remained visible for six months, and six months later, April, 1887, a section of the scar failed to reveal any bacilli. At this date I inoculated "E" the second time, with blood and blister serum, on the inner surface of his left forearm, midway be- tween the elbow and wrist. Fifteen years afterwards in the year 1901, "E" showed no signs of leprosy. He had had two leper wives, and on the death of the second, left the settlement; was pronounced not a leper sixteen years after the first inoculation. Since "E" left Molokai, I have lost track of him. "F." Male Hawaiian, kokua, 29 years old, his leper wife died five years ago, in the year 1880. On September 10, 1885, "F'' appeared at, the dispensary at Kalawao, and applied for treatment for gonorrhoea, multiple deeply excavated soft chancres on the fraenum, and glans penis, double inguinal buboes. Under the use of sublimate lotions, a dusting powder of boric acid and iodoform, his chancres and gland trouble showed improvement, his gonorrhoea slowly yielded to injections of 1 to 500 zinc chloride solution. "F", like all the previous cases I have related, was anxious to contract leprosy, and he broached the subject to me several times, and requested me to enter his name on the leper list. He was not a leper, and I declined to do so. With his permission on two oc- casions, at intervals of a month, I administered hypodermic injec- tions of 4c.c. of leper blister serum, making the injection intra- muscular, into the right buttock. After the second injection, "F" refused any more, although no inconvenience, abscess, or tenderness followed the two previous ones. It took four months for the buboes to heal, and during the later part of the treatment "F" used my favorite application in such cases — borated vaseline and 4c.c. of blister serum added. Up to January, 1888, "F" never developed leprosy; twenty years afterwards, and twenty-three years after, 1 had given him the injections of leper serum, "F" showed no trace of any disease. He had married three leper women, and when the last one deceased, he was sent out of the Leper Settlement, charges of gambling, and illicit alcohol distilling being registered against him. "G." Male Hawaiian, kokua, aged 26 years, went to reside at the Settlement in 1884, with his sister, a leper. "G'' was a confirmed awa drinker, presented a most repulsive appearance — purulent opthalmia, thickening and eversion of the upper and lower eyelids, bright scarlet conjunctivae, and his entire THE PATH OF THE DESTROYER 145 body a mass of awa scale — patches of rupia formation in places, and foul ulcers due to neglect, dirt and foul living, excessive use of awa, and salt foods. "G" informed me he was a confirmed leper, everyone so stated, and the people of the Leper Settlement thought me a very poor doctor because I failed to recognize and accept him as a leper, and so list him on the books of the Settlement. He fur- ther informed me that my obstinacy and stupidity in not listing many other kokuas as lepers, was one of the reasons so few lepers called on me for assistance. I let "G's" tirade wear out, they were weekly repetitions, and finally I informed him that. I would find out shortly, if he was a genuine leper; he was to call around next day. I shaved, cleaned both axillae, the only apparently non-diseased dermal surface remaining, scarified two foci in each axilla on the arm and chest surface, and thoroughly rubbed into the scarified surfaces about half a teaspoonful of leprous serum; the points of inoculation readily healed. Twelve months afterwards, sections of the skin of the in- oculated spots failed to reveal any bacilli. I inoculated this man in May, 1886, and he died a non-leper in 1897, eleven years later, from acute alcoholism. "H." Male kokua, Caucasian-Hawaiian, 31 years old, segre- gated in 1883 as a leper. After residing ten months at Kalawao, "H" was pronounced a doubtful case, and was returned to Hono- lulu for further examination. There he was declared a non-leper, liberated for six months, then re-declared a leper, and again sent to Molokai. There are very many cases similar to "H's". The same measures, examination, re-examination, arrest, and freedom have been carried out. The only pronounced signs of leprosy visible on "H" were atrophy, paralysis of the interossei muscles of the left hand, wasting and paralysis of the forearm extensors, extreme flexing of fingers on palm, ectropion with constant lachrymal discharge flowing on to the cheeks. The phalanges of the right large toe had been destroyed by absorptive caries and necrosis, a large healed ulcer was revealed at its favorite seat, the junction of the meta-tarso-phalangeal articu- lation, the ball of the toe — a pressure ulcer due to nerve supply defects ( Trophoneurosis ) . Although past ravages of leprosy were in evidence no bacilli could be detected. The case being one of aborted leprosy, and a species of leper carrier which I have previously described. "H'' requested me to determine if possible the absence or 146 THE PATH OF THE DESTROYER presence of leprosy, and to this end I inoculated him with leper serum on a surface about the size of a half dollar, over each lumbar region. Six months afterwards a discolored area of skin, correspond- ing to the point of inoculation, alone remained to indicate the seat of operation. He died in 1901 at Kalaupapa from acute dysentery. From the date of inoculation, February, 1887, to the year of his decease, no active development of "H's" latent leprosy took place. "I." Male Hawaiian, kokua twenty-four years old, his wife a Chinese-Hawaiian, a leper, had resided three years at Molokai. "I" was affected severely with tertiary syphilis, and had ulcers on the anterior tibial surfaces of both legs, necrosis of the nasal bones, perforation of both the hard and soft palate. It is a repetition all through these cases, kokuas alleging in- fection with leprosy, and clamoring for rations granted to lepers. Dr. George Fitch, (the same who claimed leprosy to be the fourth stage of syphilis, account of which I have written of in earlier pages of this book) had treated this kokua "I", giving him 40 grain doses of potassium iodide, three times daily for months. Under this treatment the symptoms, and active lesions of syphilis improved, and the large area of ulceration on the legs would heal; on the discontinuance of the iodide all the symptoms would break out again. "I", like all the cases I have previously related, was eager to get leprosy, or have his syphilis called leprosy, and expressed his desire to undergo any treatment or means which would accomplish this end. I therefore decided to try inoculation with leper blister serum, always hoping I might succeed in each case, and determine the possibility of inoculation. Level with the umbilicus and three inches external therefrom, I made two centers of inoculation the size of a dollar, in the month of October, 1885. I watched the case until 1888, but T' never showed any signs of leprosy — his syphilis remained stationary; he died in the year 1897 of locomotor ataxia, cerebral hemorrhage being the immediate cause of his death. Dr. Oliver, who had watched the case, failed to detect any leprous manifestations during the twelve years "I" lived after inoculation. "J. ' The tenth, and last male subject on which I performed inoculation, was a male Hawaiian kokua, who had resided six years at Kalaupapa. In January, 1887, at his own request, to decide if he was a leper, I inoculated "J" between the shoulder blades, and in the lumbar regions ; made three foci, and scarified the wounds deeply, well into the deep layers of the skin. Thirteen months afterwards THE PATH OF THE DESTROYER 147 sections of skin from the points of inoculation were examined by two physicians, and each of these acting independently of the other, pronounced the specimens free of bacilli. INOCULATION EXPERIMENTS ON FEMALE KOKUAS. "O." A female kokua, Hawaiian, 28 years of age, husband three years a leper, and a very bad case. This woman used awa to excess, and alcohol also; led a very dissolute life, increasing her pocket money by prostitution, in which she was aided and abetted by her husband. She had gonorrhoea, with profuse purulent vaginal discharge, chancres on the labia and abundance of venereal warts scattered about the vulva. "O" strenuously insisted she had leprosy, and accused me of displaying prejudice against her, and favoring the claims of othei kokua women by listing them as lepers. This case was an excellent one to determine whether the vagina was a permanent seat of the bacillus leprae. Never once did I succeed in finding bacilli though all her many consorts were lepers. "O" made no fuss or objection to the use of the hypo- syringe, and I gave her l.c.c. injections of leper vesicle serum ever} 7 month. When her chancres had been cleaned, and disinfected, I had her use borated vaseline and leper serum added as described in previous cases. I watched "O" for two years, but no signs of leprosy ever appeared, and shortly afterwards, in the interests of law and order she was ejected from the Settlement. I examined "O" for leprosy in the year 1898, twelve )ears after the serum injections; she was not a leper. "P." Hawaiian female kokua, aged 25 years; husband a leper five years. This woman was very uncleanly, her skin was scaly — patches and crusts covering the entire trunk, thighs, nates, and axillae, mostly due to the sarcoptes hominis, or feminae. Extensive ulcerated surfaces existed on the nates, and inguinal regions, front of the thighs. The groins were the seat of ulcerating buboes, both the inguinal, and femoral glands being affected. This woman loudly asserted whenever she saw me, that she had the "Mai Pake" and clamored for rations, as she and her hus- band had to exist on his one ration. Previously this woman had been declared a leper, and later on this declaration was revoked, and she was listed as a non-leper. Under persistent sulphur treatment and tonics "P" improved, 148 THE PATH OF THE DESTROYER much to her own surprise, and she was not pleased with the change as the prospect of her rations and general care by the Board of Health vanished. "P' had profuse and fetid leucorrhoea, cervical catarrh and ulcers of the cervix. After these troubles were much relieved, and the genital passage free from pus, I repeatedly searched the vaginal secretions for bacilli, but never could find them. With the patient's consent, I freshened up old chancres of both mucous and dermal surfaces of the labia majora, and rubbed well into their surfaces, leprous vesicle serum and blood. Four times I so inoculated "P" at intervals of four months, the results were the same as in previous cases recorded — no leprosy developed, from 1887, date of inoculation, to the year 1900 when "P" died of fever. Her first husband died in 1890, and then she married a second leper husband who survived her. "Q." Hawaiian kokua, female, 35 years of age, had lived fourteen years at Kalawao, and had four husbands and three chil- dren, all of whom, the husbands and children, died of leprosy. Her first husband, with whom she had three children, all lepers, died a leper. Husband No. 2 was a kokua, developed leprosy two years after his marriage to "Q'\ and died shortly afterwards. Husband No. 3, was also a clean kokua. One year after his marriage to "Q", he became a leper and died three years after the disease showed itself. "Q" was petite, and very comely and graceful, remained a widow for four weeks, when husband No. 4, a mere youth came on the scene. Within one year he developed leprosy and died eighteen months afterwards. No children were born with her three latter husbands. "Q" decided she had had enough husbands, and refused the advances of all other suitors. She did washing, sewing, hat making and mat making for a living. Naturally the speedy way in which all the husbands of "Q" became lepers caused considerable comment and gossip ; she was examined by many physicians, and all pronounced her not a leper. "Q" was very clean and neat in person, her skin was free from blemish. I searched her nasal secretion, the saliva, the blood, its serum, faeces, and vaginal secretion, and had the same examined by other physicians; no bacillus leprae could be detected. At one period of my residence at Kalawao, I had difficulty in getting my wearing apparel washed and laundried, and being in considerable pilikia, I engaged "Q" to wash for me, my usual THE PATH OF THE DESTROYER 149 washerwoman having died, and as a physician at the Settlement requires no elegant starched bosom shirts or Beau Brummel clothes, a very modest wardrobe suffices. In due course, "Q" showed up all ready to begin washing, and scarcely had she rolled up her sleeves, when Father Damien came racing along to my house, and begged and implored me not to employ "Q," offering to obtain the services of another kokua washerwoman. Father Damien recounted all "Q's" past history, and how husband after husband had fallen victims to leprosy, all of which 1 knew. I did not discharge "Q," as I felt no fear of getting leprosy through her laundry work for me; she was clean and neat, neither drank alcohol, nor smoked, and was no doubt immune to leprosy. I may say here that Father Damien was most careless and reckless in his associations with lepers, seemed perfectly indifferent as to whether he fell a victim to leprosy or not. I repeatedly scolded and rebuked him for having leper cooks and servants, he turned a deaf ear to all my remonstrances; yet he displayed genuine concern and alarm when he thought I was taking an undue risk, by employing "Q" to wash my clothes. This woman "Q'' had fears that she would be deported from Kalawao. During her fourteen years of residence all her friends and relations outside had died, and she regarded herself as a home- less outcast, if she had to remove from the Settlement. I regarded "Q" as immune, as are numbers of the Hawaiian race, but immunity cannot be definitely determined until pro- longed contact with leprosy has taken place. "Q," apparently one of the Hawaiian race, lacked the thick lips, wide nostrils, and broad nose from tip to base, of the pure Hawaiian ; her type was East Indian and Hawaiian, and I pon- dered over the idea, wondering whether some previous Indian ancestor had not conferred immunity on "Q," which in part ac- countea for her resistance to infection. "Q" was perfectly willing to acquire leprosy, if such a condi- tion could be brought about; she was perfectly indifferent as to the ultimate result — she would gain her chief desire, life-long residence, food and lodging. I acceded to her importuning and on two occasions at intervals of four months, I injected 2 c. c. of leprous vesicle fluid into the lumbar regions, 1 c. c. into each flank. The second injection, later on, was made between the shoulder blades, and also into the abdominal muscles below the ribs, in the mid-axillary line. Of the many instances in which I injected 150 THE PATH OF THE DESTROYER this vesicle serum, "Q" was the only case where marked reaction occurred; headache, chills, fever temperature 103.6, bodily pains, nausea, and profuse sweating, all followed the injections for four succeeding days. This reaction scared "Q," she thought I pro- posed to kill her right off, and any further injections were declined. "Q" lived fifteen years after being inoculated, but no leprosy ever appeared ; she had lived twenty-nine years in contact with the disease. "R" Kokua, Chinese-Hawaiian woman, aged twenty-four years, husband Chinese-Hawaiian, a leper, had resided two years at Kala- wao, since spring of the year 1883. In March, 1885, "R ' came to the dispensary for relief from skin troubles, consisting of eczema impetigo, scabies, multiple ul- cers of legs, abundance of warty condylomatous growths on both labia and round the anus — ulcerating inguinal buboes. "R" claimed she had leprosy and pala or syphilis, and had been so informed by Dr. George Fitch, who had also treated her. I could not satisfy myself that her skin and other troubles were due to syphilis, so used no antisyphilitic remedies. "R's" genital passage was free from disease and from bacilli, which I was always seeking in order to confirm or eliminate the vagina as a permanent seat of the bacillus leprae. Creoline solutions and sulphurated potash baths worked im- provement in "R's" skin troubles, and later the large ulcers were dressed daily at. the dispensary with borated vasaline and leprous vesicle fluid added. This woman, anxious to obtain rations, wished to be listed as a leper. After three months' treatment "R" was much improved, I afterwards gave her 30 grains of potassium iodide with iron potassium tartrate, her ulcers and other troubles changed for the better as long as treatment was kept up ; ceasing to use the remedies, a relapse immediately took place. I lost sight of "R" and forgot all about her case. When warm medicated baths were installed at the Settlement the lepers using them derived immediate benefit, and their general health and comfort were greatly improved. "R'' took medicated baths twice a day, and when I saw her last in the year 1898, she had to remind me who she was, so great was the change in her appearance, that I failed to recognize her. Her syphilis was practically eliminated, if she ever had it, and her freedom from leprosy was only too apparent. "R's" first hubsand had died ; afterwards she married a sec- ond leper husband, with whom she had two children, both free from leprosy. THE PATH OF THE DESTROYER 151 "S," Hawaiian female, twenty-six years of age, born at Kalau- papa on holdings, homesteads outside the control of the Board of Health, for all purposes she was one of the Leper Settlement resi- dents. These original residents (kamaainas) continued to live unmolested alongside the leper homes for twenty-nine years, then the holdings were condemned and the dwellers thereon expelled from the Leper Reservation. "S" was one of these kamaainas. None of them ever developed leprosy; there were 38 or 39 of them, male and female. "S" married a kokua, he subsequently contracted leprosy four years after their marriage. They had no children. "S" claimed to be a leper on very poor evidence; she, like most other kokuas, had no desire to leave Kalaupapa. Her hands and feet were devoid of sensation, but there were no changes in the skin, muscular structure, or blood vessels. "S" had gonorrhoea, cystitis, ovarian and uterine disease, was addicted to taking alcohol in excess (the home-made kind), and these drunken debauches would be continued for days. "S'' had been repeatedly examined in Honolulu for leprosy, the decision always being not a leper. She used to be a frequent visitor to the dispensary at Kalaupapa. I inoculated her on dif- ferent occasions with blood and serum obtained from facial le- promae of her husband, on the arms and back at intervals of four months. These inoculations were made in November, 1886, and when she was examined by a medical commission nine years after- wards, in the year 1895, no leprosy was in evidence, and she was ordered deported with the other kuleana holders on the condem- nation of their homesteads. In the year 1904 "S" was not a leper. She had lived over thirty-five years altogether, in contact with leprosy. Neither gonorrhoea nor syphilis affect leprosy; each runs its course irrespective of the other. The record of FIFTEEN inoculations of kokuas with leprous fluids shows every case was a FAILURE and produced no results. A CELEBRATED CASE Within the past twenty-five years, two events connected with the history of leprosy caused the eyes of the world to become fo- cused on Hawaii, gave these islands prominent and unenviable notoriety, and caused them to be regarded as a focus of endemic contagious leprosy. 152 THE PATH OF THE DESTROYER First, the successful inoculation or alleged inoculation of Ke- anu, the Hawaiian murderer. Second, the infection of Father Damien, Catholic priest at the Leper Settlement, who fell a victim to nodular leprosy; together with the rapid progress and fatal issue of his disease. (a) The case of Keanu fails to carry conviction on the ab- solute inoculability of leprosy, because the operation performed on him was not one of legitimate inoculation; a better definition would be transplantation of leprous flesh. (b) The infection of Father Damien illustrates what may happen to anyone who is careless and imprudent in contact with a contagious disease, and cannot be construed to indicate that leprosy is positively contagious to all contacts. I will now give a brief history of the case of Keanu, the Hawaiian murderer, whose death sentence was commuted to im- prisonment for life, with the added proviso "that he submit to in- oculation with leprosy." Under no circumstances was he to be pardoned and given his freedom, as has been stated in certain mainland publications. KEANU, THE MURDERER In the gray dawn of the morning of February 16, 1884, on a lonely and unfrequented part of the Kohala-Waimea road in the district of Kohala, island of Hawaii, Keanu, a Hawaiian, club- bed, beat in the skull with a wooden bludgeon, and murdered Charlie, a Japanese of diminutive stature and feeble strength. This Japanese with the "haole" name of Charlie, was married to Ka- maka, a Hawaiian woman, and the illicit and clandestine liason between Kamaka and Keanu led to the murder. Keanu determined to get the Japanese out of his way, and he premeditatedly murdered him under the circumstances before stated, purposely waylaying the man, addressed words of welcome to him, pretending friendship when he encountered the Japanese, he threw him off his guard, assaulted and beat him to death with- out provocation. In due course the body of the murdered man was discovered; suspicion pointed to Keanu, and Kamaka gave damaging evidence against her paramour. Keanu attempted to prove an alibi, asked for change of venue from the Hilo Circuit, which was granted May 8, 1884, by THE PATH OF THE DESTROYER 153 Judge Lawrence McCully, and the case was transferred to the July term of the circuit court at Honolulu. " Before Chief Justice A. F. Judd on July 9, 1884, Keanu was arraigned for murder in the first degree. He pleaded not guilty, his counsel being Kaulukou and Poepoe. Paul Neuman, attorney-general, and Austin Whiting, deputy attorney-general, appeared for the crown. The trial occupied two days, the direct and circumstantial evi- dence strongly implicating Keanu. The jury brought in a verdict of guilty as charged — murder in the first degree. Keanu's counsel applied for a new trial, advancing the usual well-worn pleas that the verdict was contrary to the law and evidence. Five days after the jury's verdict had been rendered; on July 16, 1884, the Supreme Court sat and heard the arguments of Keanu's counsel for a new trial. Under the judicial procedure then in force, the trial judge also sat as a reviewing judge, together with the other associate judges of the Supreme Court. At the hearing of Keanu's appeal for a new trial, Chief Justice A. F. Judd, Associate Justice Lawrence McCully, and Associate Justice J. J. Austin, occupied the bench. Two days after the hearing of the evidence for a new trial the Supreme Court, on July 18, 1884, unanimously denied the mo- tion, and Keanu was sentenced to be hung on the last Tuesday of October (28), 1884. Chief Justice A. F. Judd was an excellent and competent Hawaiian scholar, and for Keanu, if he had the slightest possibility of proving his innocence, no better judge could have sat on the bench to aid him than the late Albert Francis Judd. Keanu, at the time of his sentence to death was forty-eight years old, his physique was massive, and his weight at least 250 pounds, broad-shouldered, and of erect carriage, about 5 feet 10 inches tall — he w T as a formidable antagonist for the average man to tackle. I have not been able to get access to all the documents in the case, but I was informed by the late Dr. George Trousseau, "that the Board of Health petitioned the late King Kalakaua's Privy Council of State to commute Keanu's death sentence to life im- prisonment, and for the advancement of science he (Keanu) was to submit to inoculation with leprosy." The Privy Council acceded to the petition and its terms. 154 THE PATH OF THE DESTROYER INOCULATION OF KEANU Keanu was confined in Oahu jail, and on September 30, 1884, he gave his written consent to Dr. Edward Arning to inoculate him with leprosy. Dr. Arning excised a leproma, about the size of a small hen's egg, from the cheek of a young leper girl and transplanted and embedded this leprous flesh into an incision, which laid bare the belly of the supinator radii longus muscle of Keanu's right fore- arm; the leprous tissue or leproma was sutured in position. Twenty-five months after this operation, October, 1886, Keanu showed the maculation of nodular leprosy all over his body, the nerves and lymphatic glands near the seat of the wound also showed implication. The infection in the various selective seats of the body peculiar to leprosy became apparent (ear lobes, helix, cheeks, forehead, supra-orbital alopecia, etc.), in the year 1887; in the fall of that year, some three years after inoculation, Keanu was a confirmed leper, apparent to all the inmates of the jail, wardens and prisoners. I examined Keanu in February, 1888, at the request of the United States Minister, G. W. Merrill, at the Oahu jail; the details of this examination were forwarded to Washington. All through the year 1888 Keanu's leprosy progressed rapidly. He became a menace to the prisoners in the jail; no proper ac- commodation for him existed in the hospital of the prison, there- fore it was determined to remove him to the Leper Settlement on Molokai, where all facilities existed for the care of lepers. Keanu was transferred to Molokai, landed at Kalaupapa Feb- ruary 6, 1889, and died at Kalawao, November 18, 1892, eight years and fifty days after his so-called inoculation with leprous tis- sue; he had then reached the age of fifty-six years. Twenty-five years ago, the average duration of life of a Ha- waiian affected with nodular leprosy was about eight to ten years, so that Keanu's tenure of life was about that of the average leper. Dr. Swift, who resided four years (1888-1892) at the Molo- kai Leper Settlement, made known the fact that Keanu's relatives were affected with leprosy, and that he (Keanu) had lived in the same house with these leper relatives. This discovery raised the question whether Keanu was a leper previous to his inoculation. Most old residents of Hawaii know well that the Hawaiian family relations are described in a very loose and careless fashion by the Hawaiians themselves; such appellatives as cousin-brother, cousin-sister, brother-cousin, and sister-cousin mean what? Even THE PATH OF THE DESTROYER 155 today a man frequently has plural wives, he will live and co- habit with his married wife and her sister; the reverse — one wife with two husbands — is even more common. Punalua is the techni- cal term used in these cases. These intimate relations are not pe- culiar to Hawaii, they exist in many countries. In the case of Keanu, his maternal cousins, so-called, had leprosy before he did, and they may have been in reality his own brothers and sisters, viewing the matter in the light of the peculiarly loose and bewildering family relations and associations maintained in Hawaii. All the data and features connected with Keanu's case can- not determine the question of the inoculability of leprosy in man. By no such possible method could the average person accidentally become infected with leprosy, similar to the measures pursued in Keanu's case. Transplanting and imbedding leprous tissue into the healthy person cannot by any manner of means be termed inoculation, which I have defined at the beginning of this chapter; no argument can convince me that it 5s. It is an extraordinary method of infection. Transplant tubercular glands, scirrhus, epithelioma in bulk to any non-immune person and that person will probably become in- fected; such an experiment is of no value to determine the average every-day infection or non-infection of mankind with any of these diseases. The same remarks apply to the Keanu experiment, which was unique, extraordinary, but one way or the other could not possibly meet the issues that face us on the inoculation question. In the face of all my own experiments, those of others, and my general knowledge of the cause of the spread of leprosy, I assert and claim, as I have done previously at the beginning of this chapter, "that leprosy cannot be inoculated in man or animals on any dermal surface by ordinary methods. I also assert that the chief cause of the spread of leprosy is not by inoculation/' There are fair indications that certain essential conditions are necessary for a successful invasion of man by the bacillus leprae. Preliminary. — (a) Receptive System. Preliminary. — (b) Mucous Surface. Preliminary. — (c) Presence of a FERMENT at point of en- trance to the Human System. Preliminary. — (d) Presence of LEPROGEN in the tissues. The bacillus leprae possibly possesses a certain inherent power to extract from the tissues of man a fermentogen, or a substance 156 THE PATH OF THE DESTROYER which may be converted into a ferment, which enables it to exist and develop primarily. This said ferment later causes the tissues to liberate LEPRO- GEN, a pabulum which MAN alone possesses; it is presumably absent from the tissues af animals, hence they are generally im- mune to infection with leprosy. It has appeared to me for many years, that the secrets of the cause and production of leprosy in the human system cannot be revealed through hemal investigation, on which workers have spent years and years of study without results, which ought to convince them of the fruitlessness of continuing along these lines, in attempt- ing to prove leprosy as a disease carried in the blood, hence inoc- ulable. A greater prospect of success lies along other paths, which I advocate, to wit: the secretions and fluids of the alimentary canal. I am in possession of certain data bearing on alleged inocu- ation, but utterly irrelevant and immaterial to the subject, these data I have gained during my many years of investigation. Some of the facts, so-called, are startling, but in a book of this nature, intended for the general reader, are unprintable without shocking public morals. * * * To end this chapter I repeat the very significant fact that fresh areas of infection cannot be produced in the incipient leper, nor when the case is advanced. Fresh areas of infection can be started in the syphilitic, in the primary and secondary stages of the disease, by inoculation, and also in tuberculosis in animals. I have made over one hundred attempts to inoculate new areas of the disease, in LEPROSY, in mild cases of the nodular form, and never once succeeded. Absolute proof of the inoculability of the disease has yet to be demonstrated. CHAPTER IV. IMMUNITY Immunity, the condition of being immune, is security against any particular disease, and differs from susceptibility to the extent only of being less susceptible. The various conditions of immunity are as follows: 1. Natural Immunity, the immunity with which any person is born. 2. Acquired immunity can be acquired in various ways. 3. Active Immunity, conferred after recovery from an infec- tious disease, such as measles, small-pox, scarlet fever; one attack is usually preventive of a second. 4. Actual Immunity is conferred after an attack and recovery from a contagious disease. 5. Immunity by Inoculation, successful inoculation of vaccinal virus as a protective against small-pox, a non-permanent immunity, requires a repetition of the operation after a varying lapse of years. 6. Passive Immunity, inoculation with an antitoxin or an at- tenuated virus. It yields the same results as when the bacteria themselves are used. 7. Inherited Immunity. The foetus in utero receives an im- munity from the mother, being subject to the same disease which infected that parent. 8. Racial Immunity. Natural immunity possessed by race or group of people. It is questionable whether actual immunity recovery after an attack of contagious disease, could not be applied to the abortive changes in nerve leprosy, the disease ceasing to become active; this conservative action is without doubt due to some toxin liberated in the tissues of the body which heads off, starves, or kills the bacillus leprae. Susceptibility to disease is present in all cases, varies amongst different races of men. Race susceptibility consists of three forms: natural, acquired, and inherited ; it is very doubtful if any of these conditions are applicable to leprosy. BACTERIAL INFECTION The infective agent must be possessed of pathogenic properties, such as the status of the bacillus leprae to man, but not to animals. 158 THE PATH OF THE DESTROY ER In man the parasitic bacteria cause disease, and generate toxic products in the system called toxins. Each toxin must accumulate a certain degree of strength and quantity in the system, and the amount of toxin that each individual will succumb to, varies ac- cording to his resisting powers, be they great or small. The incubative period of any disease is determined as to its length or brevity, by the presence in the system of a certain definite amount of its toxin, in order to sustain it and enable it to do effec- tive work. The bacilli of leprosy locally cause mechanical obstruction in the blood vessels, and gradually bring about breaking down and destruction of tissues. During the recurrent attacks of leprous fever the infective toxin enters the blood, and is the cause of the various phenomena which ensue during the course of the fever. This toxin seems to be excreted by the bacilli, in order to aid them to overcome certain opposing conditions in the system of the leper. MOST PERSONS ARE IMMUNE TO LEPROSY From the strikingly visible evidence put before us in Hawaii, it is absolutely safe to conclude that most people are immune to leprosy, save the Hawaiian, who is essentially lacking, but the rem- nant of the race is becoming more immune every day. During the years 1888 to 1902, segregation was at its maxi- mum, and the prevalence of leprosy amongst the Hawaiian people amounted to almost 4% of the population. Due to increasing im- munity, continuous and more effective segregation, the percentage of leprosy for the year 1915 has fallen to 1^4%. LUX IN TENEBRIS It is quite a lengthy period of years from the quaint and crude description furnished us by Atreya of the Kushta, leprosy, 2000 B. C, to the late sixties of the nineteenth century, when Dr. Gerhard Armauer Hansen, Norwegian physician, working with in- domitable courage, under most adverse conditions, was able to drag from the shades of darkness and demonstrate to the world, "that the tissues of the leper contained a microscopic vegetable para- site, in form a bacillus," which bears the name today of bacillus leprae of Hansen. Dr. Hansen was born in the year 1841, and died in 1912. Dr. Albert Neisser of Breslau, Germany, further investigated Hansen's Bacillus, and with improved methods of staining, and the DR. GERHARD ARMAUER HANSEN, OF BERGEN, NORWAY He discovered the Bacillus of Leprosy, A. D. 1868, in the twenty-seventh year of his age. Born 1841. Died 1912. 160 THE PATH OF THE DESTROY ER oil immersion microscopic lens, was able to corroborate Hansen's dis- covery, and the presence of the bacillus always in that form, ab- sence of spores, and its non-motile character. Today, with bac- teriology, founded on a firm basis, improvement in staining methods and microscopic construction, it can be truly said, "we have got the bacillus leprae, or leper flea popularly called," and it rarely es- capes being found in the tissues and secretions of the leper. Dr. Hansen had the advantage of having a vast field of lep- rosy to work amongst in the leper hospitals in and around Bergen, Norway. The veteran leprologists Dr. Daniel Cornelius Danielssen (1815-1894), and Dr. Carl Wilhelm Boeck (1808-1875), were his coadjutors. About the year 1868, Hansen found the leper bacillus, con- tinuous investigation always gave him the same results, and in the year 1872 he showed his specimens to other bacteriologists; these, working independently, reached the same conclusion as Hansen, finding the bacillus always present in leper tissues. Some forty years ago, 1874, the bacillus leprae was unani- mously accepted as being peculiar to leprosy; it was invariably found in various tissues of the confirmed leper. The genius of Hansen made plain a subject upon which absolutely nothing was known, and which had been an enigma to physicians and philoso- phers for more or less 5,000 years. In Biblical times, from the Book of Leviticus, we learn noth- ing of the cause or treatment of true leprosy, and so on to the be- ginning of the Christian era. From about. 25 A. D. to 33 A. D., the active years of the miraculous work of our Lord, lepers were cured, but nothing per- manent was revealed to mankind. The cure of the disease and its cause remained as great a mystery as ever. From the death of Christ, all through the early years of the subsequent Christian era, to the first thousand years after this event, history is silent on any discoveries about leprosy. The disease was known, must have been latent, before spreading all over Europe in the middle centuries. Through all these years no advance in the scientific knowledge of the disease was made, until the persevering Hansen discovered the bacillus, and thereby threw the first beams of light on a subject hidden in the densest darkness for fifty centuries. I have yet to learn if Dr. Hansen ever received any reward for his splendid discovery. Even that great discoverer, the German physician, Dr. Robert THE PATH OF THE DESTROYER 161 Koch (1843-1910), of bacillus tuberculosis fame, I believe also went without reward ; he received no letters patent of royal titles, or grants of money or lands — prizes often handed out to civilians for various achievements not a fraction of the value to humanity compared with the work of these two scientific physicians, whose discoveries have benefited all peoples at no cost to any government or the public. The years of tedious work necessary to reach the climax of the discovery of these two bacilli, lepra and tuberculosis, were given freely and voluntarily for the good of all PEOPLES, by both Dr. Hansen and Dr. Koch ; their reward, except for the fame and publicity accruing to them, must come in the "Hereafter." HANSEN'S BACILLUS LEPRAE In Hawaii this bacillus shows some slight modification from the European and Indian forms. The bacillus leprae is smaller, shorter and much more slender than its ally the bacillus tuberculosis, which it much resembles; it is apparently immotile, has pointed or clubbed ends. The average measurements of forty specimens of bacilli, was 3 m. (microns or micro-millimeters) in length and .4 m. (microns) in width ; these specimens were taken from forty lepers, eighteen to thirty years of age, of good development, and a medium progress of the disease had been reached. A micron equals ^fUo oi an inch. The bacillus leprae is easily stained by Fuchsin and Gram's solution; it is also more easily decolorized by the acid and alcohol washings used in the staining process, than the bacillus tuberculosis. The bacillus leprae in Hawaii differs from the Indian speci- mens in the thickness of the cell wall, and the diameter is also greater. The granular contents of the cell are more pronounced, and these class of bacilli are in a large majority; the homogeneous appearance of the cell contents is very indistinct, the staining of these contents is more difficult. The presence of spores and flagellae is negative ; there is gen- erally a preponderance in the microscopic field of the granular or old type of bacilli, as they might be termed. The homogenous bacilli are not largely represented ; they are possibly young bacilli or those of recent development. The ordinary Fuchsin stain does not show up the bacillus in Hawaii as it does in the Indian and European varieties. Other observers have noted this ; there is a blurred appearance, due prob- 162 THE PATH OF THE DESTROYER ably to a higher albumin content of the cell wall, which prevents and lessens the permeability of the stain. Bacteria multiply and increase through segmentation or fission ; the type of bacteria called bacilli elongates, usually about its center, the cell wall becomes puckered or indented, gradually a septum or division is thrown across the width of the cell connecting its oppo- site walls; this septum divides the cell into two parts, forming each a separate cell or parent, successive divisions later taking place. The new cells may exist separately or form part of a group. In order to protect their contents, the cell walls of bacteria are generally remarkably resistant and tenacious. They resist physical and chemical destruction in a remarkable manner, and many spores and bacteria resist a temperature of the boiling point, 212° Fahr., for hours before they succumb. The bacillus leprae seems not to possess intense resisting powers, all evidence tending to prove that it is of feeble vitality, and is easily rendered inert and sterile by changes of temperature and unsuitable location, and cannot thrive and flourish under the conditions which enable the bacillus tuberculosis to exist. THE BACILLUS OF LEPROSY Organs, tissues, secretions, etc., where bacilli are FOUND, although there are many variations in its presence. Liver. Jejunum mucosae. Spinal cord. Spleen. Ileum mucosae. Saliva. Lungs. Colon mucosae. Nasal secretion. Kidney. Peyers patches. Sputum. Testicle, at times. Solitary glands. Faeces. Ovary, at times. Lymphatic glands. Nodules. Tonsils. Sebaceous glands. Milk, at times. Salivary glands. Skin, superficial layer. Thermal blebs. Sublingual glands. Skin, deep layer. Mouth ulcers. Nerve sheaths. Lymphatics. Tongue ulcers. BACILLUS NOT FOUND Blood, except in leprous fever. Placenta. Urine. Uterus. Tears, variable. Semen, variable. Milk of nursing mother. Sweat. Menstrual blood. Brain. Lochia. . FOETUS. THE PATH OF THE DESTROY ER 163 Bacillaemia, the presence of the bacilli in the blood, occurs during the febrile attacks in leprosy. The organs, tissues and secretions of two still-born children, both sets of parents being lepers, presented NO bacilli. Leprosy is rare before the fifth year of age; the youngest case I know of occurred at three years and two months. The parents were not lepers, but the child was given to an aunt to bring up shortly after its birth. This woman was a leper, and the food of the infant was pap of sweet potato chewed and churned up in the mouth of the leprous aunt. The lymphatics are permanent habitats of leprous bacilli, the thoracic duct contains almost invariably large numbers, and the mesenteric glands. The blood is no permanent habitat of the bacillus leprae. CHAPTER V. CONTAGION, ETC. The entire history of the spread of leprosy in Europe neces- sarily leads to the conclusion, that it must have been contagious on that continent, otherwise we are at a loss to explain the wide extent of the disease and its centuries of prevalence. In the early years of the outbreak of leprosy in Europe, the housing, social customs, contact and many other conditions favor- able for spreading the disease, resembled the situation prevailing in Hawaii until a decade or two ago. Thirty years of experience with leprosy in the Hawaiian Islands has convinced me that they afford a strikingly rich, virgin field for observation and investigation. The most promiscuous and freest commingling of the leper and the healthy has taken place, and the result attained has been, and is strikingly in evidence. The number of lepers in former years was as high as four per cent amongst the aboriginal race, a higher rate than can be found amongst the people of any other country. The contagium of leprosy, that specific virus or material in which its infective power resides (the bacillus leprae) is mild, and has no such virulent properties as the contagium of tuberculosis (the bacillus tuberculosis). Did this high degree of contagion exist in leprosy the Hawaiian race would be doomed to speedy extinction. The columns of my daily records, for any two years, show re- sults almost identical in the three diseases I have selected, to ap- proximate the relative degree of prevalence of each : Tuberculosis One hundred and ten cases. Syphilis Thirty-four cases. Leprosy Nineteen cases. Prevalence of a disease affords some clue to its contagiousness, therefore, — Leprosy in prevalence and infective power would aver- age 1 9-10. Syphilis in prevalence and infective power would aver- age 3 2/5. Tuberculosis in prevalence and infective power would average 1 1 . For these approximate figures the Hawaiian race has been taken solely for comparison. Leprosy is limitedly CONTAGIOUS to the CARELESS THE PATH OF THE DESTROYER 165 contact with the disease, and is practically NON-CONTAGIOUS to the CAREFUL. I have stated before, that in the conjugal relation the infection of the healthy consort even in tuberculosis is uncertain, and in leprosy is much more so. Although Hawaii is, and has been an active center of endemic leprosy, the following figures show that a large majority of the Hawaiian race are free from the disease. EIGHT CENSUS PERIODS HAWAIIANS. 1866 | 1872 | 1878 | 1884 | 1890 | 1896 j 1900 58,765 | 51,531 | 47,508 | 44,228 | 40,622 | 39,504 | 37,635 1910 38,547 Average 44,792 SEGREGATED LEPERS HAWAIIANS II 1 1 1 1 1 Total 105 | 536 777 | 680 1,179 | 1,100 | 957 | 658 | 5,992 Average number of lepers at each census period 749 It has never been possible to segregate all the lepers. Num- bers have hidden themselves, or have been concealed by their friends, many have died in the early stages of the disease from other complications. The following figures give a fair estimate of the number of lepers. SEGREGATED From the year 1866 to the year 1886 — 20 years 3,119 From the year 1886 to the year 1906 — 20 years 3,313 From the year 1906 to Jan. 1, 1915— 9 years 785 7,217 UNSEGREGATED From the year 1835 to the year 1865 — 30 years 686 From the year 1866 to Jan. 1, 1910—44 years 1,793 2,479 (Approximate estimate.) YEARLY AVERAGE, 33.50 Calculated on a ^2 of 1% basis of the population at census period, and deduced from continuous questioning of the inhabitants of all the large islands, and from my own personal travels and investigations during 28 years. APPROXIMATE TOTAL OF ALL LEPERS... 9,696 166 THE PATH OF THE DESTROYER The records kept of segregation, both at Kalihi and the Leper Settlement, in the early periods of its enforcement, are very im- perfect; as a matter of fact the Schooner "Warwick'', and many other vessels, landed lepers from Maui and Hawaii direct at Kalaupapa, whose names were never entered on the books of the Settlement. I repeatedly discovered serious errors and discrepancies during the period of years between 1868 and 1877. Shipments of lepers direct from Honolulu were duly entered, and tallied on the whole, with the books kept in Honolulu by the late Deputy Marshal Dayton, and the chief clerk of the Interior department, John Hassinger, also deceased. The segregation of lepers has been irregular, spasmodic and efficient only at certain periods. This is only too plainly evident in the testimony supplied by the yearly number of lepers segregated, as per following figures, which indicate activity and slackness, alternately; depending in the main on election or non-election years. Year Total Admissions 1866 . . .. 141 1869 . 190 1870 57 1873 415 1876 75 1878 209 1880 51 1883 300 1886 43 1888 571 1889 307 1892 105 1893 209 1899 61 The efforts to stamp out leprosy by segregation have taken on the status of a political football, the party in power being assailed by the outs, who return the attack in kind. Both political parties have been offenders, using the care and segregation of lepers as a target or a cudgel, depending on the state of the case. The segregation law hits severely the Hawaiian race, the mem- bers of that race furnishing nearly all the lepers. I have stated before, the Hawaiians are in the main opposed to segregation and look at the enforcing of the law as a tyrannical act. THE PATH OF THE DESTROYER 167 Money has the same power in Hawaii as elsewhere; position and influence also has its weight, and it has been alleged immunity from arrest and deportation to Molokai can be purchased, but no proofs of this allegation have been furnished. The Hawaiians have the majority of votes, and to placate voters and gain their votes the enforcement of the segregation law has been purposely allowed to lapse temporarily; it is here where the advantages of Federal control would become manifest; then we would have efficient segregation; not as in the past, with leaks and weak spots glaringly in evidence. All the reasons I have set forth above and in a previous chapter, will give ample information to the outside world why segregation of lepers has not made a better showing, and is my reply to the oft-asked question from various governments: Why does leprosy keep up its activity in the face of decades of segre- gation? All of the foregoing statements and figures, although they may be open to criticism, should go far to convince any unprejudiced person that the Hawaiian people are far from being a race of lepers, as has been thoughtlessly and unjustly alleged by some, on a very superficial knowledge. The same aspersion on the status of the Hawaiian people in regard to the prevalence of syphilis has also been made. This is also unjust and untrue; my experience and that of many other physicians has been that syphilis affects the Hawaiians very mildly, and prevails in a moderate degree only. The free and close intimacy maintained by the Hawaiian peo- ple in contact with lepers, and the resulting prevalence of leprosy, corroborates the statement of the late Dr. Tilbury Fox, famous ex- pert on skin diseases: "It is in those places where leprosy is on the increase that the freest intermingling of the leprous and non-leprous takes place.'' Dr. McNamara's statement on the condition of the leper in India, shows a marked contrast to the attitude assumed in Hawaii towards the leper. "Although lepers move about amongst their countrymen, they are isolated from them. Whoever saw a healthy native touch, much less eat, with one affected with leprosy? "In many parts of India, the fact of admitting a leper to a general hospital is sufficient to drive every other person out of it.'' It is reasonable to suppose that a person, susceptible to leprosy, can re-infect himself every time he comes in contact with a leper. For example, eating three meals a day with him — such a case would also show more rapid progress than one not so frequently 168 THE PATH OF THE DESTROYER infected; it also becomes apparent that we may be able to account for varied lengths of incubation by analyzing and studing occa- sional exposure to infection, and continuous and frequent exposure. Length of incubation is very deceptive in leprosy, owing to the complex and multiplicity of causes that may hasten or retard the progress of the disease. Sooner or later the incipient leper gradually accumulates suffi- cient toxin in his system, the leprosy shows itself, and he himself is in a condition to infect other susceptible persons, and becomes an independent distributing focus of fresh infection. LEPROSY IS NOT PATHOGENIC TO ANIMALS Fortunately for the human race, leprosy is not a disease pre- vailing in the animal kingdom. If this disease had other allies external to man, it would be in a position to scourge mankind in a manner similar to tuberculosis. If the sputum of the leper possessed the same infective property as that of the tuberculosis victim, also if leprosy existed in the ani- mal kingdom, and hence aided the spread of that disease, it would not be an extreme inference to draw, that annihilation of the Ha- waiian race would have come about ere this. In Hawaii it would cause the most indifferent of us to shudder, to realize that our cows, horses, dogs, cats, chickens, pigs and our fish could become affected with leprosy. Such a state of affairs would be a most appalling calamity. # * * Providence has decreed that man alone shall be the host for the bacillus leprae, whilst tuberculosis is inflicted on both man and animals. In and around the hospital enclosure at Kalawao, the various domestic animals acted as scavengers, consuming the debris and leavings of the kitchen and dining room and of the hospital wards. The contents of the bedpans and chambers, owing to the ab- sence of suitable toilets, were emptied around at some distance from the hospital buildings, resulting in a rank growth of grass which cat- tle and sheep fed on with impunity, the pigs and chickens eat the faeces, kitchen swill and refuse was consumed by the dogs and hogs. Left-off dressings and poultices of sweet potato, linseed, and bread, were also an addition to the diet of the scavenger animals and the cows. THE PATH OF THE DESTROYER 169 No animal showed any ill effects from their morbid meals; on the contrary, they kept in prime condition. Some of the dogs and pigs presented a mangy, hairless and scabby appearance with many cutaneous ulcers, but no true leprosy. The so-called rat leprosy was never in evidence at Molokai. The non-pathogenic infective property of leprosy to animals cuts off a formidable source of leprous infection to man; hence, when the last leper becomes defunct, leprosy will disappear off our earth, because there will be no other suitable host remaining to nourish and keep alive the parasite, the bacillus leprae. A significant axiom. — Any person, be he doctor, priest, nurse, attendant, or other, who ABSTAINS from taking ordinary care to protect himself from any known or suspected contagious disease, has no one but himself to blame if he falls a victim to a disease with which he is hourly, daily, weekly, and monthly in contact. Postulate. — Any man who assumes without absolute irrefutable proof that leprosy is non-contagious is taking a dangerous position ; and yet there are hundreds who do. Read the report on leprosy of the Royal College of Physicians, London, in the year 1867, who decided that leprosy was a non-communicable disease. I hold a diploma from that august body, yet I must differ from the findings set forth that leprosy is a non-contagious malady. The communicability of leprosy again came prominently to the fore about the year 1890, chiefly owing to the world-wide adver- tising Hawaii obtained through the case of Fr. Damien. Leprosy was claimed to be an imperial danger and a menace to the British Empire ; an investigation was ordered. The Prince of Wales' commissioners visited India and made an exhaustive investi- gation, deciding that leprosy was not an imperial danger — that it spread "by ways and means unknown," also the general trend of the evidence obtained by this commission led them to conclude that leprosy was non-contagious and need not be segregated, a conclu- sion arrived at from the status of the disease in India. Primary mouth infection diseases, like cholera and typhoid, from whence they enter the alimentary canal, will never infect a CAREFUL CONTACT, and I apply this same statement mark- edly to those who have intimate contact with the leper; but, un- fortunately, this very condition of non-infection by leprosy of a careful contact, is used as an argument that the disease is non- contagious. Now this pernicious assumption has lured hundreds of un- 170 THE PATH OF THE DESTROYER fortunate people to their doom, and the disease continues its activity, and keeps spreading and spreading. Previous to the year 1883, the question of nursing for the lepers had received no attention; it being quite impossible to obtain trained and faithful nurses in Hawaii, owing to the loathsome and repulsive nature of leprosy. Mr. W. M. Gibson, president of the Board of Health, in January of the above year, appealed to Bishop Herman, Bishop of Olba, head of the Catholic mission in Hawaii, to obtain Sisters of Charity from one of the many sisterhoods in the United States to come to Hawaii and help in the care of the leper women and girls. Bishop Herman designated Father Leonore as agent to go on this mission, King Kalakaua giving him also a royal com- mission. After petitioning over fifty different religious sisterhoods, a favorable reply was given by the Franciscan Convent of Saint Anthony, at Syracuse, New York State. Before acceding to the appeal for nurses for the lepers, the question was long and seriously debated in a solemn chapter of the Sisterhood, and finally twenty-four Sisters nobly volunteered their services. Of this number six were chosen, and accompanied by a Mother Superior, Sister Marianne, arrived at Honolulu November 8, 1883. Whilst there have been some changes through death and transfers, Mother Marianne is still alive, and others of the original band still survive. Five years were spent nursing and taking care of the sick lepers in the Kakaako hospital near Honolulu. November 14, 1888, the Mother Superior and other Sisters transferred to Kalaupapa, and are now at the Bishop Home for women and girls. For over THIRTY-TWO years these Sisters have been con- tinuously in contact with leprosy in its most severe, loathsome, and repulsive conditions, and lo ! NONE of them have become affected with the disease; hence the conclusion is drawn by many people that, leprosy is non-contagious, whereas, the real solution and an- swer to the cause of the Sisters' immunity is their cleanliness and careful contact. Washing and cleansing ulcers, wounds, and other duties of a nurse, are fearlessly and conscientiously performed hour after hour. When their duties are over, personal cleanliness is never forgotten, and contaminated hands are carefully cleaned. Did you ever hear of a Sister eating with her leper charges? The answer is NEVER, and you never will. : ij^|?S|'. «;"' -N-.'- V.'*» '-1 ^3> ^^i-^f-'-'%^^^m^^tmMmlm^i ...! If ".»" -"V^"* dflMBMv* . _ ■iffi,:.; 1 ■1 ... UK [8* Mr "V^v"* V M » B 1, I! a 1 >. 'ft ■ ^1 -'"" &■ -11 i 1 pi mra ... iv«. ... 3i 9 - 1 * / - 111 172 THE PATH OF THE DESTROY ER All food and drink partaken of by members of the sisterhood is scrupulously clean, and not contaminated by leper contact or hands. All their cooking and laundry work is performed by non- leper servants. Careful contact is the explanation of the cause of the freedom of the Sisters from leprosy, not the non-contagious character of the disease, and this statement applies to many other diseases besides leprosy. Immunity may be falsely assumed as the cause of non-infection with a contagious disease, whereas the true explanation may be discovered in the extreme carefulness of contact or contactee with the disease. Where there is so much difference of opinion on the contagious- ness of leprosy, it is better to err on the safe side and accept the dicta of wisdom and experience, which indicates contagion — at least in Hawaii — and where also non-contagion is the ally of ignorance and inexperience. Because a prolonged and intimate contact with leprosy fails to infect in all cases, it is no good ground for con- cluding the disease is non-contagious. The frequently made statement that So and So lived amongst leprosy for years and never contracted the disease, is simply a confession of ignorance of the lurking danger, and is equivalent to stating that many soldiers go into battle and never receive a wound, therefore there is no danger — this is only a partial truth. There are numbers of houses in various parts of the islands where case after case of leprosy has developed amongst the in- mates, father, mother, or children and grandchildren becoming lep- ers; these conditions all indicate that leprosy in clinging to a dwelling is truly A HOUSE DISEASE, and its presence can lie explained on other grounds than heredity. In these houses frequent and continuous facilities by divers intimacies to acquire leprosy are ever present, and this is the daily routine. The disease is propa- gated or spread because it is contagious, not because of its hereditary tendency, and the intimate family association with the leper night and day is the foundation of the contagion in these leper houses. A soldier on outpost duty is greatly exposed to danger; he knows his peril and is ever ready and alert. A doctor, priest, nursing Brother or Sister at the Leper Settle- ment should know they are in the front rank of the danger line, and should be constantly on the alert and careful, and maintain a high standard of cleanliness, eating food_ not exposed to leprous contamination, admit no lepers to their rooms, have no leper cooks THE PATH OF THE DESTROYER 173 or laundry work performed by lepers, and also maintain the highest standard of cleanliness of hands, teeth, clothes, and the whole person. I assert anyone in contact with leprosy in its worst form (and living up to the standard of cleanliness I have outlined) need not have any fear of becoming infected with the disease, but let slovenly and uncleanly habits be the rule, then the risk is very much in- creased and no surprise need be expressed if the person pursuing uncleanly methods of living becomes a leper. I claim there is very little risk of leprous infection at the Settlement to careful persons ; the danger is ever present and known ; outside the confines of the Settlement leprous infection is just as likely to occur, hidden foci of leprosy lurking outside where they are unexpected, like the highwayman hiding around the coroner. I have knowledge of ONE Catholic priest who had leprosy, yet he never visited the Leper Settlement. I also know of two physicians who had leprosy, and neither of them had ever set foot on Molokai. * * * In a previous chapter, I have drawn special notice to the sub- lingual reservoir being the habitat of the bacillus leprae, the pocket formed by the inner surface of the cheeks and the inferior maxilla, is also a frequent situation where the bacillus leprae can be found, and I venture to assert that no external or visible signs of leprosy may be in evidence on the face, yet the bacillus may be lurking in the mouth, and in addition to what I have written in a previous chapter, it is quite within the bounds of possibility that many people may eat with and kiss a carrier of leprosy of this character without being aware of it. In this connection, I call to mind the solemn and pathetic declaration of two white women who became lepers: "Before God in Heaven we never saw a leper until we were taken to Kalihi ; we cannot believe we have leprosy, we never slept in native houses." One of these women had never touched, and avoided, if possible, shaking hands with any Hawaiian; never had eaten poi, or had any close contact. The other woman was not so discreet, admitted having eaten poi, but had carefully cleansed her hands with soap and water before and after eating, admitted kissing Hawaiian girls and other female members of the household where she was a guest. Both these women had nodular leprosy and were addicted to using alcohol in excess. There is this comfort for mankind. The bacillus leprae is a very feebly contagious parasite, a statement which any reflective and thinking layman in Hawaii can corroborate. Its contagion is far 174 THE PATH OF THE DESTROY ER from virulent, judging from the remarkably small number of for- eigners affected with leprosy in Hawaii in the past fifty years. When Fr. Damien fell a victim to leprosy and later suc- cumbed to the disease, his semi-tragic death created a marked change and revulsion in the opinions previously held about the non-con- tagiousness of leprosy. A certain element of the British public be- came alarmed when they learnt of the case of Fr. Damien; rushed into print, and almost hysterically proclaimed leprosy to be an imperial danger and menace. The London College of Physicians, who were the chief ex- ponents and advocates of the non-contagiousness of leprosy, as stated in the declaration of their conclusions in the year 1867, began to hedge, and materially modified their opinion in the year 1887. Later on, in the year 1889, soon after Damien's death, the said college recanted, veered around, and admitted the contagiousness of leprosy. Even Norway, a stronghold of non-contagion views, due to the teachings of Boeck, Danielssen, and Hansen (of bacillus leprae fame), began to switch, became converts to the views of the con- tagionists, and warmly advocated and supported them. What caused this revulsion in the opinions of these famed Norwegian leprologists, Danielssen and Hansen? (Boeck having died in the year 1875.) 1. They had seen the beneficial check to the spread of leprosy in Norway by only partial segregation, even this had caused a marked diminution in the disease. 2. The rapid and continuous spread of leprosy in Hawaii. 3. The infection of Fr. Damien with leprosy. If no other effect has been produced by the history of the life and death of Fr. Damien, it at least has wakened the medical profession from their lethargic state, and made them regard leprosy as a lurking danger to those in contact with it. The general clinical view that we have of leprosy ought to convince us that it stands alone in a class by itself — its presumed length of incubation is remarkable, but some other pathogenic bac- teria act the same. Individual predisposition may or may not determine the con- tagiousness of leprosy, even in the face of the stereotyped general and vague remark that, "Whatever lowers the standard of health, must necessarily be a factor in inviting leprous infection." I cannot accept this statement in the face of the numbers of Hawaiian lepers I have known, who possessed a splendid physique, whereas puny THE PATH OF THE DESTROY ER 175 and ill-developed Hawaiians failed to contract the disease under similar conditions of exposure. Apparently cured or aborted cases of leprosy may, and do, break into activity on fresh contact with the disease. There are good and valid reasons to believe that fresh seats of infection have been brought into activity. In three cases of leprosy where the disease had remained qui- escent for four, seven, and nine years respectively, and there was no contact during these periods of time with lepers, subsequent exposure and daily contact with nodular leprosy caused the disease to become active in the four-year case aften ten months of contact; in the seven-year case after twenty-two months of contact; and in the nine-year case after seventeen months of contact, and in all, the disease remained permanently active and never again became qui- escent, and finally killed these victims of secondary infection, or re- infection. THE PROVED FACT THAT PROLONGED AND IN- TIMATE CONTACT WITH LEPERS SELDOM INFECTS PRIESTS, DOCTORS, NURSES OR OTHER CLOSE CON- TACTS, IS STRONG EVIDENCE IN FAVOR OF THE LIMITED CONTAGIOUSNESS OF LEPROSY, IT ALSO POINTS TO THE ALIMENTARY CANAL AS THE RE- CIPIENT OF THE BACILLUS LEPRAE; IF SYSTEMIC INFECTION TOOK PLACE BY THE BREATH, SPUTUM, NASAL DISCHARGE, INFECTED DUST AND OTHER LIKE AGENTS, THEN IT IS PLAIN THAT ALL THE ABOVE CONTACTS MUST ASSUREDLY SHOW A GREATER RATIO OF INFECTION. The leper may reach the usual span of life, but such cases are few and far between in Hawaii, and are mainly comprised of the neural type. Mr. Ambrose Hutchison, whose history will be found in this book, has had the disease over forty-seven years. Now comes the important point. During the long periods of latency and quiescence what is the bacillus leprae doing? I claim it is dormant, and its capability of transfer and infection is very remote; the leper in this state is a carrier of leprosy of doubtful danger. OUR RACIAL AMALGAM. Japanese-Chinese-Hawaiian. Father is Japanese-Hawaiian. Mother is Chinese-Hawaiian. THE PATH OF THE DESTROYER 177 During these periods of inactivity some cases of the neural type of leprosy show no bacillus in the nasal and buccal secre- tions, a small minority do. When as rarely happens, the nodular and mixed forms of leprosy take on lengthy periods of quiescence, the mucous membrane of the mouth will generally show continued activity of the disease in the form of tongue ulcers and erosions of the buccal mucosae, in the scrapings from these lesions, bacilli can be demonstrated. Nasal discharge with ulceration of the septum nasi, may or may not have an important bearing on the question of contagion; many abortive or quiescent cases of leprosy continue to have nasal discharge, as practically the only active symptom of the presence of leprosy all their lives. The disease makes no progress, although bacilli are present in the nasal discharge; until further research demonstrates the contrary, I claim the bacilli are dead (cadaveric) and harmless. In one such case, this alleged active symptom of leprosy has continued for over thirty years, without any change in the general health and tissues of the body of the person so af- fected — a foreigner. These nasal aqueous discharge and mucous mostly contains bacilli, mutilated and of defective formation, and it is reasonable to assume that the blending of the acrid watery dis- charge and air contact, are the factors which render these bacilli cadaveric and harmless. From the very nature of the source I regard the bacillus leprae in the mouth as formidable and to be dreaded ; this I have discussed in previous pages. There are also strong reasons to assume that like its ally, the bacillus tuberculosis, the bacillus leprae is FACULTATIVE ANAEROBIC, it can exist and reproduce itself at a better advantage where there is NO oxygen. Closing this chapter on contagion, I may reiterate. — Conjugal contact with syphilis generally infects the healthy consort; with tuberculosis infection does occur, but most of the healthy consorts escape. With leprosy, owing to its slow progress, there is more prolonged exposure to infection than in the average run of tuber- culosis cases ; yet in leprosy most of the healthy consorts also escape infection. To conclude the subject. — There is an ominous preponderance of evidence in Hawaii, all of which tends to prove and affirm the. contagiousness of leprosy. 178 THE PATH OF THE DESTROYER HEREDITY Post natal infection. — Most, if not all the cases of leprosy occuring in the children of leper parent or parents can be so explained. Significant facts, tending to prove that leprosy is not heredi- tary through the leper mother, are the following: Absence of the bacillus leprae in the FOETUS, PLACENTA, and LOCHIA CHAPTER VI. LEPROSY MORE PREVALENT IN THE MALE SEX Leprosy prevails more frequently amongst the male sex, the ratio of infection compared with the female is about 2 to \]/\. Almost all the countries of the world show a preponderance of male lepers. That it is not due to the large excess of males in the popu- lation is evident from the following figures taken from the last census, year 1910: Race Male Female Excess Male Excess Female Hawaiian 13,439 4,438 1,812 12,602 4,334 1,922 837 104 Caucasian-Hawaiian Asiatic-Hawaiian 110 Total .. 19,689 18,858 941 Total Females 18,858 Excess of Males. 831 The text-books on medicine inform us that males are more sub- ject to nephritis, pneumonia, etc., because they are more exposed to the weather than females. When I was an immature medical stu- dent, I used to ponder over this statement and wonder how it could be proved, and concluded that exposure was a very remote cause indeed, unless the kidneys and lungs were damaged previously from some other more obvious cause. Whilst the exact reason of the more frequent prevalence of leprosy amongst the male sex cannot in our present knowledge of that disease be determined to clearly meet all objections, neverthe- less I will endeavor to show that the male is more exposed to con- tact with the disease than the female, and this phase or state of more exposure to infection may account in a certain measure for the greater prevalence of the disease in the male. Many conditions prevail in Hawaii bearing on THE CAUSE OF EXCESS MALE LEPROSY that do not exist in other en- demic leper countries. I do not feel competent to discuss this matter as it exists external to Hawaii, my statements alone apply to this latter country. The Hawaiians are gregarious in their habits, and travel from place to place; any steady occupation is unsuitable to their tempera- 180 THE PATH Of THE DESTROY ER merit, they are pleasure loving, and any sustained effort of mind or body palls on them. I speak of twenty years ago. The Hawaiian pursuing his daily labor away from his home never carried any dinner pail, but ate and slept in the house of some friend near to his work. If the Hawaiian was a fisherman, just as often as not, after being several hours in the sea, he was perhaps miles from his home. He landed and slept at the nearest house. If he went up into the mountains and became belated or be- nighted he sought a nearby house. The cowboy miles away from his home at meal times, sought the nearest house for food and shelter. Hospitality with the Hawaiians is or was a remarkable vir- tue; no stranger was ever refused food or shelter. The female Hawaiian, while not a stay-at-home person, did no such traveling about from house to house, eating here and there. In former years, horses were cheap and numerous, the unfenced lands bordering the roads gave free pasture to horses whenever their riders rested. There was more traveling two decades ago than today, and greater facilities existed for frequent contact with unsegregated lepers. The female Hawaiian generally remained at home except per- haps on Sundays, or bi-weekly visits perhaps were paid to the nearest store, sure to have a Chinese proprietor. If the woman wished for food, poi was rarely to be had, but bread, tea, cake, and pie ; furthermore, the woman was not likely to have a leper companion during her meal — the Chinese avoid the leper. The food supplied was fresh and cooked, not promiscuously handled by any chance leper. The male Hawaiian, on the other hand, in his travels may be said to have had invariably poi and fish for his meal, all his fellow- eaters using the same dish, and if there was a leper amongst them, the visiting Hawaiian would not avoid his company, but eat and drink and sleep with him just as likely as not. The report of W. N. Armstrong, president of the Board of Health, to the Legislature, year 1882, states as follows: "There are probably 2,000 lepers in the Kingdom or 5% of the whole native race. It is probable that as many more have the seeds of the disease.'' Leading the life the native Hawaiian led at that time, rest- less, moving frequently from village to village, sleeping and eating when and where he saw fit, the probability of promiscuous con- tact with lepers would be a certainty, and the traveling Hawaiian HAWAIIAN JAPANESE. 182 THE PATH OF THE DESTROYER would take no steps to avoid contact with them; on the contrary, he would court their society, smoke their pipe, eat out of the same dish, sleep on the same mat and so forth. The contact of the traveling Hawaiian with leprosy was not once, twice, or occasionally, it was continuous; the traveler would rest a week or two, then begin again, hence the prospect of infec- tion was practically ever present. Mr. W. N. Armstrong's statement about the number of lepers and possible lepers reaching a total of 5% of the population is not far from the truth, the subsequent years of segregation go to prove its correctness. "In said year 1882, 706 lepers were in segregation at Kalawao." Further on in his report Mr. Armstrong states, "there are 400 lepers in Kakaako and Honolulu City." The hospital at Kakaako was a sham, segregation was in name, not fact, the leper and non-leper could kiss each other, smoke the same pipe, pass in food through the leper-proof fence (?). Now I except Honolulu on this more frequent exposure of the male to leper contact, in this city the sexes would have equal exposure and opportunity of contracting leprosy. In the districts of the islands not closely adjacent to the larger villages and towns, poi is manufactured and kept for sale in some house or small store. The taro patches contiguous to the homes of the Hawaiians were leased to some head man or Chinese, who manufactured the taro into poi, and from whom this article was purchased. To my own knowledge in ten instances, a leper worker was employed in these poi factories, one Chinese poi maker was a leper, two Cau- casian-Hawaiians were lepers, and the remaining seven leper poi makers were of the Hawaiian race. The residents residing near the poi shop sent a member of the family to obtain the family poi, and from close observation I observed it was generally a member of the male sex, very occasion- ally a grown girl, or young woman. If poi had to be obtained at some distance from the home, a mile or more, some male mem- ber of the family (grown up) was sent for it. It is just by such evidence as this, furnished link by link, that a chain of more exposure of the male can be built up and the pre- ponderance of the disease in that sex explained in part. Again, let us suppose a young girl or a young woman has the leprosy, the disease makes no difference to the Hawaiian lover; he will visit and eat with her, and she may possibly infect him. The girl may tire of her lover, and another comes on the scene, she infects him, and the process goes on indefinitely. THE PATH OF THE DESTROY ER 1S3 I have a history of four cases where young women, Hawaiians, had leprosy, and where, owing to the arrival of a stepmother, the brothers and half-brothers were driven from the house; later on in the absence of the stepmother, clandestine visits were paid to these young women by their brothers and lovers. Of course they ate with them, the usual diet of poi and fish, and to be polite, the women in the case stirred up and freshened the poi (with un- washed hands), the usual proceeding. The result later — four brothers of these girls or young women acquired leprosy, and two of the lovers. It is not the penile inoculation that spreads the disease, it is the leprous contaminated food — poi, fish, or whatever else may have been handled by the leper, or that has direct contact with his mouth. In promiscuous Hawaiian hospitality lurks hidden danger. The preceeding remarks are an attempt to show that the male is more exposed to leper contact than the female, and may acccfont in part for more male than female lepers. I reiterate, the contagium of leprosy is so mild that it deceives many competent observers, and leads them to conclude that the disease cannot be spread by contact. They judge the infective prop- erties of the leprous discharges by the high standard of tuberculosis infection. In order to explain the low degree of contagium of the secre- tions and dischages from the leper, we must conclude that free contact with the air renders the bacilli inert, causes them to lose infective properties, and become cadaveric, all of which statements I have made under other headings. In former years I held to the idea that menstruation was a factor to be reckoned with in lessening the receptive status of the female to leprosy, but I have retreated from that belief with my wider and longer experience with the disease. At the present day my views are, in the light of more mature investigation, that the menstruating female and the non-menstruating are equally liable to leprosy. I have known forty females, all over twenty-five years of age, who had never shed a drop of blood from the uterus, and not one was a leper, although ten of them had leper relatives. Two conditions, in the role of the progress of leprosy in Ha- waii, appear to have changed during the past twenty-five years: A. The greater susceptibility of the male seems to be de- creasing. B. The period within which most cases of leprosy develop in the female is now between the ages of eighteen to thirty years. 184 THE PATH OF THE DESTROYER NUMBER OF SEGREGATED LEPERS AT MOLOKAI JUNE 30, 1915. Males 382 Females 256 Total 638 Males approximately 60%, females 40%. Over 81% of the lepers are Hawaiians and part-Hawaiians. Hawaiians 522 Caucasians 61 Asiatics 55 Total 638 NATIONALITY Hawaiians 416 Caucasian-Hawaiian ) -j^/- Asiatic-Hawaiian ) Chinese 32 Japanese 13 Korean 10 American 3 Belgian 1 German 6 Porto Rican 2 Portuguese 46 • Russian 1 Spanish 2 Total 638 ANNUAL TOTAL OF SEGREGATED LEPERS AT MOLOKAI, AS OF JUNE 30th. YEAR NUMBER DECREASE INCREASE 1910 614 1911 595 19 1912 622 .... 27 1913 683 .... 61 1914 666 17 1915 638 28 64 88 INCREASE 24 ASIATIC-HAWAIIAN TYPE. Chinese Father — Hawaiian Mother. 186 THE PATH OF THE DESTROYER MISCELLANEOUS TOPICS PERTINENT TO LEPROSY There is this significant evidence to indicate that the alimen- tary canal is the main location of the general systematic infection and entero-toxism that exists in the leper. "THE SOLE REMEDIES THAT HAVE ANY BENE- FICIAL EFFECT IN LEPROSY ARE GASTROINTESTI- NAL STIMULANTS AND DISINFECTANTS, WHOSE ACTIVE PRINCIPLE IS A TERPENE, ISOMERIC WITH OIL OF TURPENTINE." The active principle of cashew, eucalyptus and gynocardia is a volatile oil somewhat complex in composition, a mixture of isomeric hydro-carbons (terpenes), all have the formula Go H™. All the above remedies will certainly retard the progress of leprosy, but there is no cure in sight. Carbolic acid, iodoform, creosote, bismuth salicylate, naphthol, salol, thymol, sodium sulpho-carbolate, and sodium salicylate are gastro-intestinal antiseptics and disinfectants, but they all lack the stimulating principles of the volatile oils. Amongst these drugs sodium salicylate is the only one of any value, also magnesium salicylate, which should be pure (contain 85% of natural salicylic acid, not the artificial, and 15% of magnesium). Pathogenic bacteria thrive best in alkaline media, hence the lactic acid producing Bulgarian bacillus is a valuable remedy in leprosy. Attendants on lepers, who are exposed to continuous intimate contact should take salicylate of soda in one-gram doses twice daily, two days a week at intervals of three days. The salicylate is excreted in the saliva, and its presence can be detected for several days after taking; it has a powerful germicidal action against any bacilli which may inhabit the mouth; also, one day of each week, four grams of magnesium salicylate should be taken two hours after each meal. PRIMARY AND SECONDARY PHYSIOLOGICAL EFFECTS OF THE VOLATILE OILS Externally. — Stimulation of the skin, redness, tingling, even vesication. Internally. — Stimulation of the gastro-intestinal tract, hence increase of vascularity, saliva, gastric juice, and fluids of the in- testine, and excitation of the unstriped muscular fibres. In average doses the volatile oils are stomachic and carmini- THE PATH OF THE DESTROYER 187 tive, in large doses they assume irritant properties. The stimu- lation of the stomach accelerates the heart and central nervous ganglia, skin secretion and mucous membrane of the bronchi. Ex- creted by the kidneys, they irritate and stimulate (hence are diur- etics), and the genito-urinary tract is also acted on in like manner. Eucalyptus oil is powerfully antiseptic and disinfectant. In medicinal doses it stimulates the heart reflexly through its action on the stomach ; it imparts its odor to the breath, disinfects the urine and faeces, acts on the skin as a diaphoretic, on the bronchi as an expectorant, on the kidneys as a diuretic, and stimulates the mu- cous membrance of the bladder. Much increase in the dose, over five minims, irritates the stomach, causing vomiting, diarrhoea and pain, slows the heart and lowers the temperature, depresses the nervous centers and may cause hematuria. The therapeutic action of eucalyptus and gynocardia or chaul- moogra oils are almost identical, the latter causes more stomach irritation, and hence is more nauseating. It is possible to explain the reasons why the use of gastro- intestinal stimulants and disinfectants fail to effect a more effective and permanent benefit in leprosy, based on the theory that intes- tinal antiseptics destroy or diminish the benign and protective bac- teria which exist in the intestinal tract under normal conditions, while the volatile oils are destructive to the bacillus leprae and its toxins, they also destroy and eliminate the various bacteria, which are helpful and assist the normal intestinal functions. POSSIBLE EXPLANATION OF THE THREE FORMS OF LEPROSY— NODULAR, MIXED, NEURAL When several members of a family are affected with leprosy, the same type is present in all — nodular in all, or neural in all. Why the nodular type should specially select the skin and mucous membranes, and the neural type have predilection for the nerves and sheaths cannot be definitely determined from our present knowl- edge of the disease. Undoubtedly the primary form of leprosy is nodular, then comes the intermediate, the mixed form, possessing features com- mon to the nodular and neural forms, and lastly comes the neural form. Possibly each receptive individual has some peculiar condi- tion of the system that determines his type of leprosy, hence the members of his family will all have the same type following that of the parent. 188 THE PATH OF THE DESTROYER It is conceivable that the bacillus leprae in its initial entry into the system has a FIXED INSTINCT OF LOCATION defi- nitely determined, which leads to the bacilli seeking the skin and mucous membranes and locating there, causing the phenomena and appearance of the disease which we name nodular or tubercular leprosy. This form of the disease is the usual and most prevalent type, and the cause of the change, modification, or deviation therefrom must be sought for in some idiosyncrasy of the body tissues and secretions. It is reasonable to assume nodular leprosy can be changed to neural leprosy under this theory, and also this meta- morphosis must take place in the early stages of the bacillary life in the human system. It is reasonable to assume (which alone is possible in our present limited knowledge of the true condition), that some mem- ber of the pathogenic bacteria of the intestinal tract may be re- sponsible for this change of INSTINCT OF LOCATION, which determines and decides the selection of the bacillus leprae for the nerves and nerve sheaths. The change must be made before the bacillus seeks its home by means of haemal and lymphatic circulation, and the bacillus aero- genes capsulatus, present in excess in cases of marked intestinal putrefaction, may be a possible factor; polyneuritis and muscular atrophy are commonly associated with the presence of this bacillus. If this bacillus can have an augmenting influence in cases of intestinal derangement, and aid morbid lesions in the nerves, both central and peripheral, it is reasonable to conceive that the bacillus leprae arriving on the scene may have its instinct of location moulded and changed by the paramount influence of the B. aero- genes capsulatus, and the bacillus leprae, instead of locating in the skin and mucous membranes, locates in nerve and nerve tissues. ALCOHOL IN LEPROSY The injurious effects of excessive use of alcohol upon the system are only too well known to the pathologist, and even to the educated .layman. An agent that causes grave changes in the structure of the arteries and nerves cannot be looked at askance with leprosy lurking around. The identical morbid changes that leprosy, by the aid of its bacillus, produces, to wit. : peripheral neuritis, arteritis with arterio- capillary fibrosis, etc., is also produced by the abuse of alcohol in its verious forms and grades; quite apart from its irritant and THE PATH OF THE DESTROYER 189 poisonous effects on the other portions of the human system, alco- hol cannot be looked on in any other light than a faithful ally of leprosy. From an experience of over three decades, I can assert with- out fear of contradiction that the deluded creatures who are in the clutches of alcohol, drinking to excess when in contact with lep- rosy, are much more liable to contract the disease than those who use alcohol moderately or do not use it at all. This statement is also applicable to tuberculosis. Every word that the late Dr. Brinckerhofr" used in his able and classical thesis on the connection of ALCOHOL and LEP- ROSY I endorse, and also his clear and incisive conclusions on the subject matter of his thesis. The abuse of alcohol in Hawaii by a certain race cannot < be viewed by any thoughtful person, save with mingled feelings of sorrow and dismay. The rapid decimation of this race is markedly due to the ex- cessive use of alcohol. It not only destroys the present members of the race, but also the coming ones. Healthy and sturdy chil- dren cannot be begotten by drunken parents. The ravages in the system of man induced by the ABUSE of alcohol are due to : 1. Its direct irritant action. 2. Its deleterious influence on the vaso-motor nerves, which control the expansion and contraction of the walls of the blood vessels. 3. Organic visceral lesions and degenerative changes. In the stomach, congestion, chronic catarrah, fibroid and glandular de- generation. Atrophy of various organs, tissues, and nerve centers. In advanced "tipplers," grave nervous lesions as absolute dementia, peripheral neuritis, extreme muscular trembling and weakness, paralysis or ataxia, epileptiform attacks, finally coma. 4. The decomposition and entrance into the circulation of the poisonous elements of the alcohol. 5. Interference with tissue — metamorphosis, oxygenation and nutrition. It seems unnecessary to state that the stronger alcohols, rum, whiskey, brandy, and gin, taken repeatedly and undiluted on an empty stomach, are among the most insidious habit-forming and destroying agencies of the human race on our planet; also their presence and continued abuse is one of the greatest blots, menaces, degradations, and disgraces of our much vaunted civilization of the twentieth century. 190 THE PATH OF THE DESTROYER As long as our so-called paternal government degrades itself and stoops to license the drink trade, just so long will its victims and dupes swell the ranks of maniacs, degenerates, consumptives, and lepers. In alcoholic peripheral neuritis trophic changes occur in the nails, skin, muscles, due to defective nerve function ; the symptoms are milder than in the infective neuritis of neural leprosy. Peripheral alcoholic neuritis is certainly a first cousin to leprous neuritis. I am strongly of opinion that the disease called syringomyelia (abnormal cavities or spaces in the substance of the spinal cord), as described by Drs. Jean Martin Charcot of Paris, and Moritz Schiff of Germany, is neural leprosy, modified by the effects of alcohol, and this disease may be transmitted from parent to off- spring. The peculiar disease met with in Brittany described by Dr. Morvan, and bearing his name, carries all the earmarks of nerve leprosy complicated with alcoholic neuritis. Briefly stated, the history of alcohol and disease in Hawaii is as follows: From July 1, 1908, to June 30, 1914, a six-year period, amongst the Hawaiian race 5,835 deaths were registered, an aver- age annual mortality of 972 and a fraction over, about 27 per mille or thousand. The death rate of continental U. S. is some 18 per mille; about 10% of the deaths are caused directly and indirectly by alcohol. The Hawaiian death rate is 33% more per mille — computing on a 14% basis gives 136 deaths due to alcohol, out of the annual death rate of 972. These 136 deaths represent an annual toll levied directly by alcohol on our weaker brothers and sisters, who cannot resist the temptation, drink to excess, and are sacrificed on the altar of the alcohol god. ARTIFICIAL LEPROSY I have failed to inoculate by skin abrasion, rabbits, cats, rats, guinea-pigs, and in one instance a mongoose (a fierce and untamable animal), this also being the experience of many other workers in the same field. I will brieflly describe the method and results obtained. Whenever I had a supply of leper blister serum, I inoculated the above animals in pairs, except the mongoose, one experience with this animal was enough. I chose the inside of the ear for THE PATH OF THE DESTROY ER 191 the seat of inoculation, because the animal cannot, lick the wound, using antiseptic measures, scarifying a surface about the size of a ten-cent piece, rubbing in the blister serum similar to the operation of vaccination. All these experiments failed to produce any leprous infection. I continued the experiments for several months with no suc- cess, then, chiefly due to lack of assistance and proper care of the animals, some died, others escaped from the pen. I had remaining one rabbit, two guinea-pigs and one cat, and in the tenth month from the date of their first inoculation, I killed them, the resulting examination by the naked eye and the microscope, gave no signs of leprous infection. In the summer of the year 1885, I examined a monkey Dr. Arning had inoculated (with blood serum and the juice from a leproma), some ten months after inoculation had taken place; at that time nor subsequently did any systemic leprous infection occur. The next year the doctor left Hawaii and returned to Germany, but I learnt afterwards that the monkey had died never showing any signs of leprosy. Some twelve years elapsed, and, being firmly convinced of the improbability of reaching any results from dermal inoculation, I decided to try to obtain leprous infection through the mouth and alimentary canal and peritoneum. I was able to obtain a limited supply of leprous blister serum from the burns due to thermal anaesthesia, and when this supply- failed me, I resorted to cantharides collodion. In our winter, so- called, when the temperature does not exceed 23° Cent., this blister serum can be kept several weeks, a solution of boric acid in glycer- ine being added, otherwise decomposition occurs. Using the same serum by intra-peritoneal injection in a guinea- pig, and injecting 2c.c. once a month for four months, no signs of leprosy showed up to the tenth month, when the animal died from dysentery. Six animals, two cats, two rabbits and two white rats, were given three times a week for two months 1 c.c. of leprous blister serum in milk per os, the gastric juice being previously alkalinized by the administration of 2 c. c. of liquor potassae. In the third month the rabbits and one cat died. In the fourth month one of the rats died, and on examination, the mesenteric glands and liver showed traces of leprous infection, the bacillus leprae being present. The exact cause of death I could not determine. At this time, the end of the fourth month, the surviving cnt and rat appeared apparently healthy. 192 THE PATH OF THE DESTROYER Bearing in mind the excessive use of salt by many Hawaiians and its effect on the gastric juice (all of which I have discussed in previous pages), led me to imitate as far as possible the tem- porary alkalimzation of the gastric juice with liquor potassa, far more powerful and speedy in effect than sodium bicorbonate, but this changing of the gastric juice from acid to alkali inhibits or stops pancreatic secretion, which I consider aids, and is a necessary adjunct to favorable development of the bacillus leprae. I added therefore to the milk fed to the cat and rat small quantities of fresh pancreatic juice, expressed from the pancreas of the pig, when I could obtain it, as well as the leper blister serum. When I had no supply of fresh pancreatic juice, I used ten grains of the white powder, extract of the pancreas or TRYPSIN. At the beginning of the seventh month from the commence- ment of these feeding experiments, the rat showed considerable emaciation, loss of hair giving it a mangy appearance, a few email papules developed in the skin of the chest, sides of the abdomen, and inner surface of the thighs, the free edge of the ears showed decided infiltration. These signs of undoubted leprous infection made slow prog- ress, but owing to the rapid emaciation, I gave no more leprous blister serum, changed the rat's food to finely chopped meat, cheese, chopped egg, cracker, all to no effect, the animal succumbed the middle of the tenth month to leprous dysentery. Examination of the body and organs revealed leproid deposits in the liver, spleen, mesenteric glands, and mucosae of the ileum, with ulceration ex- tending into the colon and rectum. Sections revealed bacillus leprae in large numbers. Owing to lack of time, proper quarters and facilities for carrying on further work, and having to change my residence, I killed the cat, a young male, which showed leproid deposit and infiltration of the flanks, muscular wasting, skin atrophy, and con- siderable alopecia of the cheeks and forehead and abdomen, all the internal organs and intestines were healthy except the liver, which revealed leproid nodules yielding bacilli. They could also be de- tected in the leproid skin infiltrations. I spent nearly five years in the aggregate experimenting; met with poor success, but I gained experience. Cultures I never attempted, due to lack of time and skilled assistance. THE PATH OF THE DESTROYER 193 EPILOGUE In the Preface of this book I have given certain reasons, stating how I came to write it; I now add further supplemental causes which influenced me to come forward and make public my views and experiences with leprosy. In the year 1909, Mr. Joseph Dutton, the venerable manager of the Baldwin Home at Kalawao, whom I met in the year 1886 (when he first arrived at the Leper Settlement to take up his work amongst the lepers), wrote to me and asked me to write my experiences with leprosy. I gave him a negative answer. In the month of March, 1912, I received a letter from Mr. E. A. Mott-Smith, who filled the dual offices of secretary of the Territory of Hawaii, and president of the Board of Health, ask- ing me to supply him with certain information on leprosy, also advising me to go on with my leprosy investigation and write up the subject. I hesitated. I may add Mr. Mott-Smith was a most genial and tactful president of the Board of Health ; his education in law materially aiding him. He is also a great authority on leprosy and its prevalence. I believed at this time that other workers in the field of leprosy, of more modern education, were better outfitted and could do better work than I could. During the latter years of the late Father Wendelin's life, he often spoke on the subject of leprosy and its collateral bearings, and urged me to publish my notes and work on that disease. On the last day of April, 1914, when the priest's death ap- peared imminent to himself and his physicians, he desired me to promise to write my views and knowledge of leprosy for publi- cation, especially he besought me to give my views on Father Damien's case, and also to write all I knew of his life, whether it was favorable or unfavorable to his reputation. I assured Father Wendelin that if anyone could influence me to act as he desired, he himself could. After due reflection and mature consideration, I condensed and put in writing the material which is spread on the pages of this book. END OF PART TWO GLOSSARY Alii, Chief, Prince, Leader. Alopecia, Baldness. Anaesthesia, Loss of sensation. Anamnesis, Past history, memory. Anginal, Suffocative Spasms. Arterio Capillary Fibrosis, Thickening, narrowing of small arteries. Ataxia, Irregular Muscular action. Atrophy, Wasting. Axilla, Armpit. Bacillemia, Bacilli in the Blood. Bacilligenic, Caused by a Bacillus. Bacillus, A little stick, rod or pencil, a genus of micro-organisms. Bubo, An inflamed gland. Buccal, Pertaining to the mouth or cheek. Cadaver, A corpse. Caries, Ulceration of bone. Carpus, Bones of the wrist. Chancre, A venereal sore. Colon, The large intestine. Cystitis, Inflammation of the Bladder. De novo, Anew. Duct, Thoracic, A small canal, carries Lymph; in back of the chest. Duodenum, A portion of the small intestine. Ectropion, Eversion of the edge of the eyelid. Elephantiasis, Elephant-like, Leprosy. Endemic, Peculiar to a people or locality. Enter o-toxism, Poison generated in the bowels by toxins. Femoral, Relating to the thigh. Fibroid, Resembling fibers or bands. Flagellate, Whip-like. Focus, Plural Foci, central point or points. Gland (an acorn), A small or large fleshy mass or organ. Gonorrhoea, A contagious discharge from the genitals. Gumma, Soft gum-like nodules of Tertiary Syphilis. Gynaecological, Pertaining to diseases of women. Haole, Foreigner. Hawaii net, Greater Hawaii, all the islands of the group. Haustorium, A drawer or sucker, blood sucker apparatus of the mosquito. Helix, Rim of the Ear. Homogeneous, Like, of the same kind. Horripilation, Rough skin, goose skin, erection of the hairs. Hydrochloric Acid, HC1. Idiosyncrasy, Peculiarity. Ileum, Distal portion of the small intestine. THE PATH OF THE DESTROYER 195 Impetigo, A skin disease, isolated pustules or boils. Infective Neuritis, Inflammation of a nerve due to presence of bacteria. Indigenous, Native or native born. Inguinal, Relating to the groin. Jejunum, A certain part of the small intestine. Kai or Makai, Towards the sea. Kamaaina, An old resident, a child of the land. Kane (k), Man or male. Kauka, Doctor. Kokua, Assistant or helper. Lepraphobia, Fear of Leprosy. Leprogen, Food or Pabulum of the Bacillus Leprae. Leproid, Like Leprosy. Leprologist, Expert on Leprosy. Leproma, Leprous Tumor or Nodule. Litmus Paper, Blue and red, it indicates alkalies and acids. Lochia, Uterine discharge after child-birth. Lichen Ruber, Skin disease, scales and small lumps or papules. Locomotor Ataxia, A disease of the spinal cord. Lux in Tenebris, Light in the Darkness. Lysins, Bacteria Destroyers. Mtfi, Sickness. Metacarpus, The bones of the back of the hand. Metatarsus, The bones between the instep and the toes. Mono, Single, limited to one. Moron, Feeble-minded, not an imbecile or idiot. Nanism, Dwarfed, ill developed. Necrosis, Death of Bone, or Soft parts. Nephritis, Inflammation of the kidneys. Neural, Pertaining to the nerves. Neuritis, Inflammation of a nerve or nerves. Nodular, Node, swelling or lump. Osteomyelitis, Inflammation of a bone and the marrow. Ostracism, Banishment from Society. Ovary, Female sexual Gland. Pabulum, Food. Pake, Chinese. Pali, Precipice. Pathogenic, Disease producing. Pathognomonic, Pointing out a Disease. Pectoral, Relating to the chest. Peripheral, Distant from the center. Peritoneum, Serous lining of the abdominal walls. Peritonitis, Inflammation of the peritoneum. Peyer's Patches, Lymph glands in the small intestine. Pilikia, Trouble in any form, or cause, etc. Pityriasis, A skin disease, branny scales. 196 THE PATH OF THE DESTROYER Placenta, A flat cake, the after-birth. Pneumococcus, A globular or spherical micro-organism. Poi, An edible paste made from Taro, Bread Fruit, etc. Popolo, A Hawaiian medicine used for cough, stomach and eye diseases, etc. Prodromal, Approach of a disease. Psoriasis, Scaly skin disease. Psoriatic, Like psoriasis. Pulmonary, Connected with the lungs. Pylorus, The opening to the bowel end of the stomach. Pyaemia, Blood poisoning. Recrudescence, Recurrence. Rupia, A skin disease, blisters and scabs. Sclerosis, Hardening. Solitary Glands, Lymph glands in the small intestine. Spore, Reproductive element of lower Organisms. Sporogenous, Reproduced by Spores. Sputum, Matter ejected or spat out. Subclavian, Under collar bone. Syphilis, A contagious venereal disease. Tachycardia, Rapid action of the heart. Tarsus, The bones of the instep. Telluric, Connected with the Earth. Thenars, The muscles of the ball of the thumb. Thrombosis, A plug or clot forming in a blood vessel. Tinea Versicolor, Yellowish patches on the skin due to a fungus. Traumatic, Due to any injury. Trophoneurosis, Lack of nutrition, due to nerve disease. Tubercle, Small solid elevation of the skin. Tubercular, Similar to Tubercle. Tuberculosis, Infection of system with Bacillus Tuberculosis. Uka or Mauka, Inland, towards the mountain. Uterine, pertaining to Womb or Uterus. Vaccinophobia, Fear of Vaccination. Vagina, Female Genital Canal. Ventricles, Lower cavities of the heart; (right and left). Wahine (w), Woman or female. CAUCASIAN-HAWAIIAN. 198 THE PATH OF THE DESTROY ER PHYSICIANS OF THE LEPER SETTLEMENT Year Name 1879 N. B. Emerson (dead). 1880-81 C. Neilson (dead). 1882-84 G. L. Fitch (dead). 1884-87 A. A. St. M. Mouritz. 1888 C. A. Peterson (in office five months) ; dead. 1888-92 S. B. Swift (dead). 1892-1902 R. Oliver (dead). 1902 F. H. French (in office four months). 1902 W. J. Goodhue (holds office). PHYSICIANS OF THE FEDERAL LEPROSARIUM Year Name 1909 W. Brinckerhoff (dead). 1909-11 D. H. Currie. 1911-15 G. W. McCoy. 1915- D. H. Currie (in office). THE PATH OF THE DESTROYER 199 CHRONOLOGICAL TABLE A. D. 1555, Nov. 27. — John Gaetano discovers the Island of Hawaii. 1778, Jan. 18. — James Cook re-discovers Niihau, Kauai, and Oahu. 1779, Feb. 14. — James Cook killed at Kealakekua Bay, Hawaii. 1785, July 22. — Ship "Lady Washington'' arrives from Boston. 1787. — Chief Keawe Kaiana visits Canton, China. 1788. — Chief Keawe Kaiana again visits China. 1804, June 13. — Russian ship "Neva" arrives, introduces cholera ( ?). 1804. — Severe epidemic ravages the islands, "Mai Okuu." 1820, April 14. — First missionaries arrive from Kailua, Hawaii. 1823, May 22. — Rev. C. Stewart observes lepers (?) in Honolulu. 1827, July 7. — Roman Catholic missionaries arrive from France. 1835. — Leprosy recognized at Koloa, Kauai. 1840. — Mr. Brickwood observes leprosy in Honolulu. 1848. — Dr. Hillebrand observes Chinese lepers in Honolulu. 1850, Aug. 30. — Honolulu officially declared a city. 1850, Dec. 13. — First Board of Health meets. 1853, April 28. — Mormon missionaries arrive, five. 1853, May 13. — Severe epidemic of small-pox prevails. 1860. — Queen's Hospital erected. 1863, Dec. 28. — First official discussion on leprosv bv Board of Health. 1865, Jan. 3. — Act to prevent the spread of leprosy enacted. 1865, Nov. 13. — Kalihi Leper Hospital opened. 1866, Jan. 6. — Lepers first arrive at Kalaupapa. 1873, May 10. — Fr. Damien arrives at Kalaupapa. 1875. — Kalihi Leper Hospital closed. 1881, Feb. 4. — Epidemic of small-pox prevails. 1881, Dec. 12. — Kakaako Leper Hospital opened. 1883, March 31. — Lunalilo Home opened. 1883, Nov. 8. — Catholic sisters arrive to nurse lepers at Kakaako. 1883, Nov. 8. — Dr. Arning, leper expert, arrives. 1884, Sept. 30. — Keanu, the murderer, inoculated (?) with leprosy. 1885, Nov. 9. — Kapiolani Home dedicated for non-leper girls. 1886, July 1. — Leprologists Drs. Fitch and Arning leave Hawaii. 1886, July 29. — Brother Joseph Dutton arrives at Kalawao. 1888, Jan. 21. — Walter M. Gibson dies at San Francisco. 1888, Nov. 14. — Nursing sisters arrive at Bishop Home, Kalaupapa. 200 THE PATH OF THE DESTROYER 1888, Nov. 19. — Fr. Wendelin arrives at Kalaupapa. 1888. — Kakaako Hospital abolished. 1889, Feb. 6. — Keanu arrives at Settlement from Oahu jail. 1889, April 15. — Fr. Damien dies at Kalawao. 1892, Nov. 18. — Keanu dies at Kalawao. 1894, May 4.— Dr. G. Trousseau dies. 1895, Aug. 22. — Cholera breaks out. in Honolulu. 1895, Nov. 2.— Dr. John Brodie dies. 1899, Dec. — Bubonic plague breaks out in Honolulu. 1900, Jan. 20. — Chinatown swept by fire. 1902, Aug. 12. — Dr. Oliver dies (ten years at Leper Settlement). 1902, Oct. 9. — Fr. Wendelin leaves Kalaupapa after fourteen years' residence. 1904, June 4. — Dr. Fitch, leprologist, dies. 1909. — Federal Leprosarium opened at Kalawao. 1909. — Dr. Robert Koch, of Berlin, visits Hawaii. 1910. — Dr. Moses Clegg cultivates the bacillus leprae. 1911, Feb. 23. — Cholera again invades Honolulu. 1911, Oct. 27. — Alleged case of yellow fever at Kalihi. 1912. — Dr. G. A. Hansen dies, discoverer of bacillus leprae. 1914, Sept. 1. — Fr. Wendelin dies. 1915, June 7. — Charles R. Bishop dies, founder of Bishop Home for girls. 1915, June 22. — Rev. F. W. Damon dies, spiritual worker amongst Chinese lepers. 1916, Jan. 6. — High Chiefess Grace Kahoalii dies; semper fidelis. 1916, March 18. — W. E. Rowell, C. E., dies, a man of noble char- acter ; his companions through life were faith, hope and charity. (He taught the author the Hawaiian language.) PART III. PERSONAL REMINISCENCES A RESPONSIBLE OFFICE In connection with the transfer of the first shipment of orphan girls from Kalaupapa to the Kapiolani Home, which I have des- cribed in a previous chapter, occurs the name of Ambrose Hutchi- son, deputy or resident superintendent of the Settlement, an office of great responsibility, for upon his shoulders fell all the burden of the management and general conduct of everything pertaining to the affairs of the Leper Colony on Molokai. Mr. Hutchison held office for fourteen years, 1884 to 1897 — although a victim of neural leprosy, and often rendered unfit by exacerbations of leprous fever and other ailments that followed the progress of the disease in his system — he stuck manfully to his post, and often alone and unaided met serious and unforseen diffi- culties with commendable foresight and judgment, and just as often a certain other official claimed all the credit that was due to Ambrose Hutchison. Mr. Hutchison is a Caucasian-Hawaiian, and now ranks as the second oldest resident, having arrived at Kalaupapa in the month of January, 1879, his period of residence has reached over thirty-seven years. His malady first showed itself about the year 1868, so that he has had leprosy FORTY-EIGHT YEARS. For many years he has been free from the ravages of the disease, which .shows apparently the exhaustion of the pabulum or leprogen in the tissues necessary to the sustenance of the bacillus leprae, or the non-activity of his disease may be due to the production of lysins which have destroyed the reproductive powers of the bacilli. When I resided at Kalawao (1884), Mr. Hutchison was quite a young man (in his twenties), yet he displayed marked ability and highly creditable administrative powers for a man so young. I repeat the responsibility of his office was great. In those days the steamer and mail service were not of the best, and the facilities for landing freight at Kalaupapa were of a negligible quality, boat after boat would be overturned in the surf ; the water supply was poor and scanty — a three-quarter inch pipe being the delivery for 800 people. Mr. Hutchison being the resident official, executive and rep- resentative, was the target for all the growlers and kickers, he steered his way, however, through the various problems that came 204 THE PATH OF THE DESTROYER up from time to time in a manner that would have done credit to much older heads. For acting as superintendent, sheriff, purveyor, and supervisor of all the details of the civil administration, he was paid the muni- ficent salary of $30 per mensem! This same office today pays its holder with perquisites $400 monthly, and there is less responsibility at the present time than there was thirty years ago, because the act of a present-day super- intendent is the direct, act of the Board of Health. This body directs the policy of that official, whereas when Ambrose Hutchi- son held office, he himself was the author and originator of any policy laid down and pursued. The Board of Health's direct policy only came into existence with the inauguration of a resident superintendent in the year 1897, on the decease of Meyer. In replying to my request for his life history, Mr. Ambrose K. Hutchison wrote me as follows: Kalaupapa, Molokai, Nov. 6, 1914. In compliance with your request to give you the particulars about myself. It is with great reluctance that I take my pen to write about this matter, for it recalls to memory the pathetic side of my life as a Condemned outcast and Prisoner. That you are not asking me about my life history from mere curiosity, but for scientific research, and knowing well your ability to carry on the same into the dreadful malady, which has been such a virulent scourge of the Hawaiian people, without any sign of abatement after many years of vigorous segregation ; having gathered the knowledge in your practice among the people here and else- where to write on such a subject, for that reason, I without reserve willingly give you a history of my case. (Signed) A. K. Hutchison. I herewith reproduce Mr. Hutchison's Autobiography. "Thirty-five years ago, I and eleven other fellow unfortunates were marched from the leper detention station, adjoining the old police station on King street, a little Ewa of Nuuanu street, through the streets of Honolulu, guarded by policemen, down to the Esplanade, and put on board the little coasting steamer "Mokolii" bound for Kalaupapa, with the Hon. S. G. Wilder, president of the THE PATH OF THE DESTROY ER 205 Board of Health, and Dr. N. B. Emerson, newly appointed resident physician for the Leper Settlement, as passengers. We arrived at Kalaupapa Sunday morning, January 5, 1879. After landing, our names, ages, and places hailed from were taken down by the Settlement officials; we were left on the rocky shore without food or shelter. I had to accept the shelter and hospitality of a friend living at Makanalua about a mile and a half inland from the landing, hence my building a house and taking up my residence there, which has been my home until recently, when I moved to Kalaupapa. All those fellow passengers that landed with me have passed away, and I am the sole survivor and the longest living resident, save Hoolemakani (w), she has been a resident since the founding of the Settlement in the year 1866. My connection as an employee of the Board of Health com- menced November 1, 1881, when I was put in charge as chief butcher and beef dispenser. On September 25, 1882, I was pro- moted to the position of head storekeeper of the Board of Health store at Kalawao. I made good and gave satisfaction. On March 8, 1884, I was appointed and given full charge of the Settlement, filling the position of resident superintendent, and continued uninterruptedly in the management until the close of the year 1889, when I was officially informed of the appointment of Mr. T. E. Evans, as superintendent who was to take charge on January 1, 1890. When Mr. Evans paid his first official visit, I of course tendered him my resignation. He refused to accept it, and asked me to continue in office as his assistant, which I did, but shortly after 1 was struck down with paralysis and my recovery was despaired of, but due to the devotedness of my late beloved wife, and the care I received, together with the medicine furnished me by my good friend, the late Dr. George Trousseau, I recovered, after undergoing great physical agony. Mr. Evans resigned after his trouble with the lepers who as- saulted him; he was succeeded by Mr. W. H. Tell, but before a year had passed, he also had some trouble which displeased the Board of Health, and I was asked to assist Mr. Tell. I was then convales- cent enough from my severe illness to be able to work, but my as- sistance did not save him, for the Board voted to remove him from office. On the 19th of October, 1892, I was again put in charge and continued with the management until December 31, 1897, when 206 THE PATH OF THE DESTROY ER I resigned and declined further work, and went out of office at the above date. I served the Board of Health faithfully for fourteen years, giving the best that was in me to fill the arduous duties of my office. MR. HUTCHISON'S AFFLICTION— NEURAL LEPROSY I must have had neural leprosy ten or twelve years (about 1868) before my banishment to Molokai. The first symptoms I noticed were, absence of feeling over my right, knee cap, either to touch, pinching or needle prick, the loss of sensation gradually spread down to the ankle and foot; shortly after my left knee, ankle and foot became affected, devoid of feeling; boils broke out simultaneously on both knees. The color of the skin remained natural, but presented a harsh, dry appearance, at this time dif- ficulty of breathing through my nose manifested itself, especially at night, and when sleeping. I next noticed the wasting of the ball of my right thumb, and the web between the thumb and index finger, ring worms appeared on my face and neck, the soles of my feet began to harden, and the skin became fissured, forming sores and deep ulcers down to the bone, which healed with difficulty. I next noticed the wasting of my left hand, and the muscles of both arms, the skin of my forehead seemed drawn excessively tight, gradually all the symptoms I have mentioned progressed at an even pace and very slowly. My present condition, — I am physically maimed and weak, and a wreck to what I was before the attack of paralysis laid me low. I am without pains, sores, or ulcers on any part of my body, my hands and feet are much muti- lated from the ravages of the disease in the past. I think the leprosy has exhausted itself in my system. I have no relatives living or dead who have had leprosy, I have never lived with lepers until I came to Molokai. My boyhood was spent in a boarding school in Honolulu, under the tuition of Archdeacon George Mason. I was born at Honomaele, Hana, Maui, and I am 58 years old. I have never had a true mother's care. When I was a month old I was given away to my mother's sister, — she was widely known and famed amongst the Hawaiians as a expert kahuna or doctor, well versed in the use of herbs and treatment of sickness. I have a faint recollection of a man with large ears and bloated face, swollen hands and feet, who used to come to the house where THE PATH OF THE DESTROYER 207 we lived to be treated by my foster mother. This man's disease in after years I realized was leprosy. I may have become a leper from contact with this man. I also was vaccinated with the matter or lymph taken from another boy's arm, from either of these sources of contagion I believe I contracted leprosy, or it. may have been from other unknown sources. (Signed) A. Hutchison." Mr. Ambrose Hutchison's history of his life is highly enlighten- ing and interesting, and brings out the following points. 1. The remarkable duration of his malady, 48 years. 2. The harshness and hardship of his transportation. 3. His noble resignation to his hard fate, 36 years in con- finement and banishment from the outside world. 4. The suspicion and life long idea that vaccination may have been the cause of his contracting leprosy. 5. His contact with a Leper at his Mother s house. I men- tioned in previous pages that contact with a leper has occurred in almost all cases of leprosy; on careful investigation, and inquiry this history can nearly always be obtained. There is no possibility of a de novo development of leprosy. Mr. Hutchison states he was landed at Kalaupapa, and practi- cally dumped on the shore, no provision being made for the re- ception of himself and fellow passengers. This shiftless and dis- graceful neglect no longer exists, the fault lay with the Honolulu authorities, who persistenly failed to notify in advance the Molok:;i officials of the coming of a new consignment of lepers. This unpreparedness of the officials to receive newcomers worked an injury to the enforcing of segregation, and caused the leper to dread being taken to Molokai, also fake information was spread all over the Islands about lepers dying immediately after being landed at Kalaupapa. This has happened when the leper was in a very exhausted condition, both from the advanced state of his disease and from sea-sickness. Bearing on this matter I re- late two cases. In our winter months when the north wind prevails, accompa- nied with driving rain, the temperature falls on Molokai as low as 58° F. ; this condition of the weather, together with the thin and scanty clothing generally worn by the inhabitants of Hawaii, makes a sick person feel cold, and is liable to induce pneumonia. On one such night, with similar weather conditions described 208 THE PATH OF THE DESTROYER above, there arrived at Kalaupapa about midnight the steamer "Mokolii" with freight, and about forty leper passengers. There was a heavy surf breaking, the wind was from the North and a driving, chilly rain was falling. If it were not for the able handling of the small boats by the Hawaiian seamen (among the best in the world), they would have been swamped, overturned and broken to pieces on the rocky shore. By a miracle, none of these disasters occurred, and both freight and passengers landed in safety, the latter drenched to the skin by rain and sea. No advices had been sent, in advance of any intention to ship lepers to the Settlement, but the officials were not caught unpre- pared, both Father Damien and Mr. Ambrose Hutchison had steaming hot coffee and warm food for all who were landed. (The date of this was January, 1885.) "LITTLE MARY" I was at the landing, waiting in the lee of the freight house, sheltered from wind and rain, when I was accosted by a diminutive, girlish figure, asking if I was Father Damien, as she carried a let- ter from the Sisters at Kakaako detention station ior him. This little girl, not full ten years old, told a pitiful story — she was soaked to the skin with rain and sea, and shivering with cold, was anxious to get food, shelter and a place to sleep. She was self-possessed, in- formed me her father had died on the steamer, and was buried at Pukoo, a port of the lee side of Molokai; also on the steamer, too ill to be landed was her little brother 6 years old, who was a leper as well as this little girl herself. I speedily passed her along to Father Damien and some kokua women, who fed and warmed the child and gave her dry clothing. Her brother was landed at daylight much to the child's delight. This little girl's name was Mary, and her great dread and worry was that she would have no house to shelter her, hence the letter to Father Damien from the Sisters asking him to exercise his good offices in getting this family settled. The "Mokolii' could and ought to have made direct trips from Honolulu to Kalaupapa, but the Board of Health in their (?) wis- dom did not see the necessity of this, hence the steamer made the whole circuit of the island of Molokai before coming to Kalau- papa. This arrangement caused untold misery and suffering. The S. S. Mokolii was small, 96 tons burden, (under the old method THE PATH OF THE DESTROYER 209 of measurement) had no accommodation for passengers well or sick, excepting on deck. This vessel was far from speedy, could steam 6 knots per hour, had a free-board of 3 feet, yet this miserable little tub of a steamer was kept on the Molokai route for fully 25 years. This little girl Mary, kept repeating to me her dread of be- ing left out in the dark and cold, with no house for shelter. Later on, I asked the child who told her this, she answered, "Father and other people." Mr. Hutchison's experience on land- ing was evidently the rule, and not an isolated exception, the con- ditions attendant thereon must have been wide spread and known all over the Islands. "NAOMI" Here again is another case bearing on this point. Naomi, a Hawaiian woman afflicted with leprosy, lived for ten years in the forest between Wailau and Halawa, Molokai, leading a life of terror and anxiety, fearing that at any moment the police would find her. The great and ever present fear of Naomi was separation from her husband, and then having no one to take care of her, and no house to shelter her at the Leper Settlement. This woman informed me she would have given herself up and surrendered voluntarily, were it not for stories which she had heard from others about certain conditions at the Leper Settle- ment, viz., paucity of houses, the first comers filling all the houses, and later leper arrivals having to seek shelter on lanais, under walls or trees, no one to pound poi, or get food or wood for fire and cooking purposes. About the year 1902, Naomi's leprosy (which she had had about 12 years) had progressed to the extent that it had destroyed her hands and feet, and also her eyes, — she was helpless, — her fingers and adjoining metacarpal bones, also her toes and the metatarsi had all been removed by slow sloughing and necrosis. Her husband was devoted to her, fortunately they had no children. Owing to the necessity of seeking food, the poor shelter from the rain and cold wind that a residence in the mountain forest entailed, and the exhausted condition of Naomi, the husband decided to move her into the Halawa valley ; there on the hill side, in a lantana thicket, he built a small grass house for her, and shortly after she was arrested there by the police of Molokai on information fur- nished bv an enemv of the familv. 210 THE PATH OF THE DESTROY ER Naomi's condition was very pitiful, the leprosy had ravaged her body as I have before described, and she was bedridden and totally blind, yet her husband quietly and respectfully asked me not to separate them, stating that he would look after her as long as she lived, and he would allow no person to come to the house or its surroundings. I told the husband and Naomi that the Sisters at the Bishop Home would receive her and care for her, and where she would want for nothing. On thinking the matter over, I decided that Naomi was so weak and exhausted, that there was every prospect of her death on the steamer in transit to Honolulu. I notified the Board of Health, they accepted my view, and Naomi remained where she was, the husband devotedly caring for her until her death, and living faithfully up to his promise to allow no visitors on his premises. Throughout the pages of this book I have frequently brought up the subject of the hostility manifested towards segregation to Molokai, some of the objections and complaints are only too well founded. The question of transportation to Kalaupapa from Honolulu has never received the attention it should, the method pursued is practically the same as it was nearly fifty years ago. I introduce here part of a letter I wrote to the editor of the Pacific Commercial Advertiser and published June 21, 1914. TRANSPORT OF LEPERS NOT THE BEST "There is a decided need for improvement in transporting the sick to Molokai. On April 30 ult. forty-nine lepers were taken from Kalihi to Kalaupapa. The accommodation provided for them was the steamer's deck, crew and leper mixing of their own sweet will. These unfortunate people were landed at night on a surf- bound, rocky shore, and treacherous landing. The same conditions of transport have been in operation forty-eight and a half years." A PERSONAL EXPERIENCE THIRTEEN YEARS' RESIDENCE AND LABOR AMONG THE LEPERS AT KALAUWAO BY REV. JOSEPH DAMIEN, CATHOLIC PRIEST. By special providence of Our Divine Lord, who, during His public life showed particular sympathy for the lepers, my way was traced towards Kalauwao in May, A. D. 1873. I was then 33 years of age, enjoying a robust, good health — Lunalilo being at that time King of the Hawaiian Islands, and His Excellency E. O. Hall, president of the Board of Health. A great many lepers had lately arrived from the different islands; they numbered 816. Some of them were old acquaintances of mine from Hawaii, where I was previously stationed as a mis- sionary priest ; to the majority I was a stranger. The Kalaupapa landing-place was at that time a somewhat deserted village of three or four wooden cottages, and a few old grass houses. The lepers were allowed to go there only on the days when a vessel arrived ; they were all living at Kalauwao — about eighty of them in the hospital, in the same buildings we see there today. All the other lepers, with a very few kokuas (help- ers), had taken their abode further up towards the valley. They had cut down the old pandanus, or puuhala groves, to build their houses, though a great many had nothing but branches of castor oil trees with which to construct their small shelters. These frail frames were covered with ki leaves (Dracaena terminalis), or with sugar-cane leaves — the best ones with pili grass. I my- self was sheltered during several months under the single pan- danus tree, which is preserved up to the present in the church- yard. Under such primitive roofs were living pell-mell, without distinction of ages or sex, old or new cases, all more or less strangers one to another, those unfortunate outcasts of society. They passed their time with playing cards, hula (native dances), drinking fermented ki-root beer, home-made alcohol, and with the sequels of all this. Their clothes were far from being clean and decent on account of the scarcity of water, which had to be brought at that time from a great distance. The smell of their bodies, mixed with exhalation from their 1 ■' FATHER DAMIEN, Aged twenty-six years. THE PATH OF THE DESTROYER 213 sores was simply disgusting and unbearable to a new-comer. Many a time, in fulfilling my priestly duty at their domiciles, I have been compelled not only to close my nostrils, but to run outside to breathe fresh air. To protect my legs from a peculiar itching which I usually experienced every evening after my visiting them, I had to beg a friend of mine to send me a pair of heavy boots. As an antidote to counteract the bad smell, I made myself accus- tomed to the use of tobacco, whereupon the smell of the pipe pre- served me somewhat from carrying in my clothes the obnoxious odor of the lepers. At that time the progress of the disease was fearful, and the rate of mortality very high. These are a few of my recollections of what I have seen and experienced at the beginning of my labor here. The miserable condition of the Settlement at that time gave it the name of a living graveyard, which name I am happy to state, and hope to prove hereafter, is today no longer applicable to our place. From the accession of King Kalakaua to the throne up to the present time, His Majesty's Government, assisted by Christian charity, has endeavored, little by little, according to means and cir- cumstances, to improve the situation of the lepers, and to make them more comfortable. Consulting my own observations and experiences only, without any memorandum book or register, I intend to show here what contributes much towards the comforts and benefits of lepers, and what is obnoxious or injurious to them, and will prove these two statements by putting our good situation and comfort in parallel, with what I found here at my arrival, as already explained. THE DIET OF THE LEPERS The food on which a leper has to live exercises a great in- fluence on the disease. Our Hawaiian taro, containing a great quantity of starch, and being easy of digestion, is our best vegetable. So far, I have never seen any bad effects from it, even in fevers and other temporary ailments to which our lepers are so often subjected to. Hawaiian people in general, but especially our lepers, cannot go well without it. I remember that, some ten years ago, the place having been about three months without taro on ac- count of the scarcity of that vegetable, several deaths occurred in consequence of it, and the majority of the people looked emaciated, although they had plenty of rice and sweet potatoes. The administration having to supply weekly from six to seven 214 THE PATH OF THE DESTROYER hundred people, each with twenty-one pounds of cooked taro, a few words concerning the manner how it is obtained may be desirable. At the northern side of Molokai are three large valleys, viz., Halawa, Wailau, and Pelekunu, in which the cultivation of taro is the chief business of a considerable number of natives. On them especially we have to rely for our regular supply. The high cliffs preventing all overland road traffic, the cooked taro, or paiai, has to be brought by sea either in open boats or a small schooner, as was done from the beginning, or in a small steamer latterly. The steamer's service has been highly appreciated by the public on account of its regularity, schooners and boats being often pre- vented by calm or rough weather from arriving when the food is wanted ; unavoidably, our people are then deprived of their good poi, which is left to rot where it was cooked, causing great loss to all concerned. If poi cannot be obtained, the issue of rice or hard bread takes its place, of which there is always a certain quantity on hand, though it is recognized that, with the exception of the Chinese, neither native nor foreigner could live on rice as principal food. A certain number of our people, with their more or less mu- tilated hands, succeed in raising a few sweet potatoes, which answer well for a change in the diet, or in case of emergency. Unfor- tunately some of our Hawaiians are much addicted to the use of a certain beverage made of sweet potatoes, which they allow to ferment, and thus obtain an obnoxious, intoxicating drink. They are very fond of it, but it makes them excited, and has a bad effect on their system, as have all other alcohols; and I wish to express here my sincere thanks to our local administration for having wisely prohibited the use of it. Besides their regular food, a pint of good milk provides them advantageously with a wholesome, nourishing beverage in the line of diet. The question naturally occurs to the mind of the reader, how can a sufficient quantity of milk to supply such a number of people be procured? May I be allowed to explain my views on this. This Settlement, in the greatest, part, affording the best kind of grazing for stock, I would suggest to the administration with all my might to increase as much as possible the number of good milch cows. UNFORTUNATELY, ON ACCOUNT OF THE GREAT AMOUNT OF MEAT WANTED, ABOUT FIVE THOUSAND POUNDS A WEEK, AND THE FREQUENT FAILURE OF THE ARRIVAL AT THE REGULAR TIME THE PATH OF THE DESTROYER 215 OF BEEF CATTLE, OUR BUTCHERS ARE SOMETIMES OBLIGED TO KILL OFF MORE OR LESS OF OUR VALUABLE MILK STOCK, WHICH KEEPS THE LAT- TER ON A DECREASE, AND THEREFORE LESSENS TERRIBLY THE SUPPLY OF MILK. Let me regretfully state, it is now several years, up to the present day, that not one-tenth of our lepers outside of the hospital yard have been enabled to enjoy the benefit of a small daily supply of milk. I beg leave to be allowed to make here a suggestion for the benefit of the Board of Health and for the lepers. May it be proposed at the next Legislature to make, besides the regular appro- priation for the support of the lepers, an additional one, such as to provide the necessary means for buying at once as many head of cattle as our beautiful plain for grazing can support, — say from 500 to 1000 head, of which a certain number should be used for breeding and milk, and the rest for beef cattle. In regard to salmon, as a substitute for meat, I simply will state that it may do once in a while, but the less the better. THE WATER SUPPLY OF THE SETTLEMENT From the landing-place of Kalaupapa up to Kalauwao we have no regular water stream. Fortunately, at the upper part of the Kalauwao valley there is one, but the water is not very abun- dant, though sufficient, if properly managed, to supply this one village. When I first arrived here the lepers were obliged to carry their water in oil cans from that gulch on their shoulders, or on horses, under the greatest difficulty; there also they used to wash their clothes. The scarcity of water at that time accounted, to some extent, for their living very dirty. In the summer of A. D. 1873, we received some water pipes, and all our able lepers were only too willing to help in laying them, and in building a small reservoir. Since then Kalauwao has been well supplied with good water for drinking, bathing, and washing, and has been proved to be a better place for living than Kalaupapa, where the people continue to resort to rain or brackish water, and in dry seasons they are obliged to come to Kalauwao for it. On studying this question of water supply, I was informed that at the terminus of the valley called Waihanau (water arise), which valley is located a little more than one mile southeast of 216 THE PATH OF THE DESTROYER Kalaupapa, there is a natural reservoir. At one time in company with two of our intelligent white men and some of my boys, I went to investigate the truth of it, and, after two thousand feet of travelling in the gulch, we arrived at this truly beautiful reservoir, built by Nature's hand in the form of a circular basin; its diameter in one direction is 72 feet, and 55 in the other. On sounding its depth we found twelve feet of water at a short distance from the bank, and eighteen feet towards the center. The water being ice-cold, none of my boys dared to swim across to ascertain its true depth close to the high cliff, where probably it is deeper. The water looks very clear and has an excellent taste. I should remark here the statement which a native, who, during the period of ten years, has made it his business to deliver water to any part of Kalaupapa for a certain fee, made to me, viz. : "That if no other source in the vicinity affords any water during very dry seasons, this basin has never failed to furnish any amount needed." The above statement was acknowledged to be true by a great many more of the old residents who had seen that reservoir and confirmed it. This, and the large overflow in connection with the drainage from above, leaves me to conclude that there must be a large feeding source below. This reservoir is perfect and per- manent in itself, without incurring any expense or labor. Now, instead of going to Waikolu to obtain a water supply for Kalaupapa, as was intended, which would be besides the diffi- culty of labor of building a reservoir and for laying from such a distance, say over five miles, the amount of pipe required for that purpose, a very large expense to the Government, therefore I simply recommended the laying of good pipe from this Waihanau reservoir. The question of supplying water for Kalaupapa has been for a long time under discussion, and never thoroughly investigated, under the impression that it would cost too much, and there the matter rests at present. My desire being to see the work carried on without any fur- there delay, once I was sure of getting this supply of beautiful water at a comparatively short distance, and wishing to give all information necessary, I have taken the pains to measure the exact distance, which I found to be from the reservoir to the Kalaupapa store-house thirteen thousand six hundred and eighty (13,680) feet. All this distance is on an uninterrupted, gradual decline; and having on hand a better reservoir, and a surer supply of water than we have at Kalauwao with a 2-inch pipe for half the distance, and THE PATH OF THE DESTROYER 217 1^-inch for the remaining part, without a doubt the Kalaupapa village can be abundantly supplied with good, pure water. And having here a man capable of executing such a work, with many hands to assist him, I think that the expense above the cost of the pipe would be but a trifle. THE DWELLINGS OF THE LEPERS Good ventilation being in general one of the first conditions of hygiene, it is much more necessary for our lepers, on account of the foetid exhalations from them being much greater than from any other disease. In previous years, having nothing but small, damp huts, nearly the whole of the lepers were prostrated on their beds, cov- ered with scabs and ugly sores, and had the appearance of very weak, broken-down constitutions. In the year 1874, the great question was how to improve the habitations of the unfortunate people, the Government appropriation being at that time barely enough to provide them with food? During that winter a heavy south wind blew down the ma- jority of their half-rotten abodes, and many a weak leper laid there in the wind and rain, with his blanket and clothes damp and wet. In a few days the old grass beneath their sleeping mats began to emit a very unpleasant vapor. I at once called the attention of our sympathizing agent to the fact, and very soon there arrived several schooner loads of scantling to build solid frames with. All the lepers who were in distress received, on application, the square laths to thatch the grass or sugar cane leaves to. Afterwards rough N. W. boards arrived, and also the old material of the former Kalihi hospital. From private and charitable sources we received shingles and flooring. Those who had a little money hired their own carpenters; for those without the means the priest, with his leper boys, did the work of erecting a good many small houses. Besides, some new comers who had means built their dwellings at their own expense. In 1878, after the inspection of the Settlement by a special committee, of which Your Excellency, then a member of the As- sembly, was chairman, sent by the Legislature to Kalauwao, the Board of Health having obtained a larger appropriation by a special recommendation of that committee, at once erected a good many comfortable houses, and also provided several other comforts for the lepers, of which they were greatly in need. 218 THE PATH OF THE DESTROYER Lime has always been supplied by the Board of Health gra- tuitously for whitewashing the cottages, and thus, little by little, at comparatively small expense to the Government, combined with private and charitable resources, were inaugurated the comfortable houses which constitute today the two decent-looking villages of Kalauwao and Kalaupapa. I estimate the number of houses at pres- ent, both large and small, somewhat over three hundred, nearly all whitewashed and, so far, clean and neat, although a number of them are not yet provided with good windows. These houses, of course, cannot have the proper ventilation they need, and naturally create an unpleasant and unhealthy smell ; I therefore humbly pray that the Board will be kind enough to take steps and see that this still-existing evil be soon remedied. In conclusion, I am happy to remark that, if I compare the present with the past, the unfortunate people of today are not only more comfortable and better off in every respect, but their disease in general is a great deal milder and less progressive, and, in consequence, the death rate is not so high. This is greatly due to the improvement in the houses. THE CLOTHING OF THE LEPERS The Settlement being situated at the northern side of the island, and backed at the south by very high and steep mountains, the climate is naturally cool. The winter season brings forth generally a long spell of cold weather. The disease, too, at a certain stage, interferes much with the free circulation of the blood, and therefore our lepers often complain of cold. Those who have suitable and warm clothes to protect themselves from the inclemency of the weather resist it generally very well, but for those who, through neglect or destitution, have barely enough to cover their nakedness, the cold and damp weather has a bad effect. They then begin to feel feverish and cough badly; swelling in the face and limbs sets in, and if not speedily attended to the disease generally settles on the lungs, and thus hastens them on the road to an early grave. On my arrival I found the lepers in general very destitute of warm clothing. So far they had received from the administration a suit of clothes and a blanket; but some of them being very neglectful and filthy, in a few months nothing remained but rags. Those who had friends in the outer world were fortunate in receiving from time to time a few articles '»f clothing, but the friendless and the poor suffered greatly. There was no store at the time within the limits of the Settlement where THE PATH OF THE DESTROYER 219 they could buy a few garments or other necessaries, and those who received or could earn some money had to entrust it to the captain of the schooner to buy for them what they were in want of. We all greatly felt the necessity of a suitable market store, and, on a very sound principle, the Molokai store was inaugurated by the Board of Health in the summer of 1873. To start with, a thousand dollars out of the appropriation was invested to lay in the first stock, and with a certain percentage above the cost price to cover current expenses, the store has since then been running on its own account, supplying our people with any article they may wish to buy. Each year the the Board issues an order for six dollars to each leper to enable them to buy at the said store what they are in need of, especially in the line of clothing. So far, this store has proved to be a success and a great convenience to the people here, and we could not do very well without it. Besides the allowance by the Board of Health, Christian charity has given us a helping hand in the matter of clothing, and assisted us to our great satisfaction. In previous years it was nothing unusual to receive from time to time a cart-load of clothing for distribution to the needy; for instance, such as were received a year and a half ago from the hands of Her Majesty Queen Kapio- lani, and those who assisted her in filling the leper subscription. Thanks for the aid in the past. May the future prove that untir- ing perseverance of charity continues to assist the Board of Health in supplying the unfortunates of Molokai with all their necessities; especially with warm clothing, because, may I here remark, that the yearly allowance of six dollars to provide clothes and other indispensable articles is quite insufficient for those who have no private means, and no friends Or relatives to give them a helping hand. I beg to lay this statement, based on a long experience, be- fore the honorable Board of Health for future consideration. The allowance granted by the Board, combined with Christian charity and some private industry, of which I intend to speak hereafter, has greatly ameliorated the condition of our lepers and provided them with comparatively good clothes. EXERCISE FOR THE LEPERS Leprosy is a constitutional disease by which, generally, the circulation of the blood is partially obstructed, the nerves and muscles more or less paralyzed, and the limbs are often disabled in one place or the other, which varies in almost every case. 220 THE PATH OF THE DESTROYER A person afflicted with leprosy, who quietly gives himself up to the ravages of the disease and does not take exercise of any kind, presents a downcast and sloughy appearance, and threatens soon to become a total wreck. Therefore exercise, as a daily occupation, is highly commendable to invigorate the system, giving a fresh impetus to the general movement, of the muscles and to the free circulation of the blood, thus averting many pains, sores, and other consequences of a prostrated constitution. In former days (from 1866 to 1873), all the lepers being collected at the rather small village of Kalauwao, the majority jf them passed their time in sleeping, drinking, and playing cards, while only a few others cultivated the fields; and horses being limited at that time, a minimum number only of the inmates could enjoy the exercise of a horse-back ride. Later on, all that tract of land at Kalaupapa having been annexed to the Leper Settlement, traveling was at, once increased to a great extent; going from one village to the other became not only a healthful exercise and pleasure, but of a frequent necessity; horses too have increased, and are easily procured. This tract in- cludes a very fertile piece of cultivable land — over two hundred acres are fenced in along the foot of the mountains. Every leper is privileged to occupy any vacant portion of it he may choose to cultivate, as some were already accustomed to do in the Kalau- wao fields. Traveling on foot, riding on horseback, and cultivating the soil are the most healthy occupations of our lepers. Let me, there- fore, bring to notice that, up to the present date, about nine-tenths of the entire population are enjoying these invigorating occupations and exercises, while previously only about one-tenth could do so. Such daily exercises as can be obtained here does not only strongly aid in checking the disease in its rapid progress, but also averts many ailments which otherwise might befall the victim. Induce- ments of this kind, in regard to daily exercise for the welfare of all afflicted which this Settlement affords, cannot likely be gotten up in any other asylum in the world. In regard to the wholesome exercises obtained by cultivating the soil, a few facts showing how it has been and should con- tinue to be encouraged, may here be brought under observation. Soon after that piece of land mentioned above had been put at the disposal of the lepers, many whose hands were not too much mutilated began at once to plant a patch of sweet potatoes, and very soon had an abundant crop. THE PATH OF THE DESTROY ER 221 During the winter when the boats which had to supply the Settlement with taro were prevented from arriving on account of the bad weather, the local administration was fortunate enough to get a weekly supply of sweet potatoes from those who had a quantity at their disposal, and thus not only prevented a temporary famine, but the money usually paid to the outsiders for paiai was paid into the hands of our lepers, and, little by little, money came into circulation among the poor people. This being a great en- couragement, very soon the majority had some potatoes of their own planted, and shortly afterwards they petitioned the local administration to obtain instead of their weekly rations its equiva- lent in money. This having been granted, numbers of lepers availed themselves of this opportunity to obtain some cash to buy their little necessaries with. This system of paying money, instead of giving the weekly supply, continued for about eight years, varying in amount accord- ing to the- harvest of sweet potatoes, and sometimes through the deficiency of taro. Besides the great benefit of a healthy exercise for the sick, their monthly ration money not only alleviated the condition of those who availed themselves of it, but brought money into circulation, and created between the two villages many other kinds of small industries. The Leper Settlement store, too, at that time had a larger business, because there was money in the hands of the people, who, in general, called there to provide for all their different needs. Up to within recently the people were in comparative ease at the Settlement, but at present the system of paying the equivalent of rations, on account of abuses having been taken away, though they have enough to eat, they are, nevertheless, getting in very poor circumstances. This system was very beneficial for the health and comfort of the lepers, as I have shown, and not any more expensive to the Board of Health, therefore, in the interest of the great ma- jority, I humbly suggest that the administration will have the kind- ness to resume the old practical system. THE KOKUAS, OR ASSISTANTS, WHO ACCOMPANY THE LEPERS TO THE SETTLEMENT On this important subject, distinction has to be made between married and unmarried kokuas. I think it is but justice, and in accordance with Divine and humane law, that faithful husbands 222 THE PATH OF THE DESTROYER and wives of lepers should be allowed to accompany their partners to their exile at Kalawao. In the fulfillment of my duties as priest, being in daily con- tact with the distressed people, I have seen and closely observed the bad effect of forcible separation of the married companions. It gives them an oppression of mind which, in many instances, is more unbearable than the pains and agonies of the disease itself. This uneasiness of the mind is, in course of time, partly forgotten by those unfortunates only who throw themselves into a reckless and immoral habit of living. Whereas, if married men or women arrive here in company with their lawful mates they accept at once their fate with resignation, and very soon make themselves at home in their exile. Not only is the contented mind of the leper secured by the company of his wife, but the enjoyment of good nursing and assistance, much needed in this protracted and loathe- some disease, and which no other person could be expected to im- part. I am happy to be able to state that the marriage ties of lepers have been more respected by His Majesty's Government during the past few years than they used to be ; the physical and moral life at the Settlement has greatly improved, and the lepers are much better taken care of. Besides this, our good kokuas are not only of great help and assistance to individual lepers, but they are also of great value to the local administration for carrying on all work needed for the welfare of the place. May I bring to the notice of the honorable members of the Board of Health that not only is our Settlement benefited by such kokuas, but the public at large are rid of a dangerous element ; and I must assert that it is my solid opinion that all persons, with a very few exceptions, who have co- habited in the matrimonial state a certain length of time with a leper are a standing menace to society at large, of which only too many proofs have unhappily come under my personal observation. I here leave the medical profession to settle to what extent the danger of contagion or non-contagion through cohabitation may extend. I am happy to give the present Board of Health credit for their lenient action in this important matter, at the same time I am obliged to mention that I disapprove the coming of all others but married kokuas to the Settlement, with the intention of making it their place of abode. My disapproval of seeing unmarried kokuas settle here is based on the following reasons: THE PATH OF THE DESTROYER 223 1. Because, with the exception of a few old people, un- married kokuas are not generally faithful and persevering in assist- ing those patients in whose favor they were permitted to come here. 2. They are, in general, a source of immorality and a tempta- tion to lead the lepers into bad habits, and, through their bad example, sometimes create trouble in the place. 3. Because, having no natural tie here, they, after a long inti- macy with the lepers, may leave the place whenever they choose, and although the disease may not yet be visible, it is highly probable that they carry the germs of it to their homes, and thus become a well-fitted medium to spread the disease amongst their numerous friends. 4. They are of very little use here, if of any at all. They will not do anything for the poor sufferers except for payment, with the proceeds of which they go gambling and generally go around from house to house and help to consume the poor lepers' scanty rations; they have no fixed abode, and are too lazy to work for their own support ; in some instances they even try to obtain the lepers' clothing by some means or other. For these serious reasons I venture to recommend to the authorities that they be more strict in the future than they have been in the past years; and, to prevent imposition, let proof be shown of legal marriage before a permit is granted. Moreover, temporary visits which may be allowed to elderly people should be always of the shortest possible period, and the strictest severity should be resorted to in order to prevent any healthy child or young person from entering the Settlement. THE MORALITY OF THE LEPER SETTLEMENT I feel myself obliged to beg leave of Your Excellency to be allowed to speak of a very serious matter, in which I officially appear as one of the principal agents. To avoid criticism I will, with a liberal mind, lay aside as much as possible all difference of creed and opinion, and show how needful a step has been taken for the temporal and eternal welfare of our lepers by drawing a parallel between the past and the present, and between those who yield and do not yield to moral training. Previous to my arrival here it was acknowledged and spoken of in the public papers as well as in private letters, that the great- est want of the lepers at Kalawao then, was not having a spiritual leader or priest, the consequence of which was that vice, as a general THE PATH OF THE DESTROYER 225 rule, existed instead of virtue, and degradation of the lowest type went ahead as a leader of the community. On the arrival of a new number of lepers, the old ones were soon at work to impress them with the erroneous axiom: "Aole kanawai ma keia wahi," in this place there is no law. Not only in private conversation, but in public meetings, I myself heard this doctrine proclaimed ; and for a long time, indeed, I was obliged to fight against its appli- cation being made to the Divine law as well as to human law. In consequence of this impious theory, the people, mostly all un- married, or separated on account of the disease, were living pro- miscuously without distinction of sex, and many an unfortunate woman had to become a prostitute to obtain friends who would take care of her, and the children, when well and strong, were used as servants. When once the disease prostrated them, such women and children were cast out, and had to find some other shelter; sometimes they were laid behind a stone wall and left there to die, and at other times a hired hand would carry them to the hospital. The so-much-praised "aloha" of the natives w T as entirely lacking here, at least in this respect. As already mentioned in other pages, the Hawaiian "hula'' was organized after the pagan fashion, under the protection of the old diety Laka, who had his numerous altars and sacrifices, and I candidly confess that I had hard work to annihilate Laka's religion and worship, and thereby put a stop to the hula and its bad consequences. Though the people had reached the climax of despair, both of soul and body, may it be said to their honor that I found them less addicted to sorcery and the doings of the "kahuna Lapaaus," or native doctors, than I had found the old natives in Hawaii — circumstances which encouraged me much to stay permanently amongst them, with the quasi certain hope of my ultimate success as a Catholic priest. By a short digression I will speak of another source of im- morality, viz. : the evil effects of intoxication. I first have to explain how they obtained the material. There grows very abun- dantly along the foot of the mountains a plant which the natives call "ki" (Dracaena terminalis), the root of which, when cooked, fermented, and distilled, gives a highly intoxicating liquid. The process of distilling being very crude and imperfect, produces, natu- rally enough, a liquor which is totally unfit for drinking. A short time after my arrivel the distilling of this horrible liquid was carried on to a great extent. Those natives w T ho fell under the influence of it w^ould forget all decency, and run about in a 226 THE PATH OF THE DESTROYER nude condition, acting as if they were totally mad. The conse- quences can be easier imagined than written on paper. The local authorities have endeavored to stop all those horrible proceedings, but for a long time they were unsuccessful. It being discovered that certain members of our police were in league with the evil- doers, the "luna nui" and myself went around and both by threats and persuasion, they finally delivered up their implements which were used for distilling; some of the most guilty perpetrators were convicted, but were pardoned under the condition never to do it again. (See page 238, the dissolute element abuse Damien.) For a long time, as above stated, under the influence of this pernicious liquor, they would neglect everything else except, the hula, prostitution, and drinking. As they had no spiritual ad- viser they would hasten along the road to complete ruin. A good many of the sick and prostrated were left dying there to take care of themselves, and several of them died for want of assistance, whilst those who should have given a helping hand were going around seeking enjoyment of the most pernicious and immoral kind. As there were so many dying people, my priestly duty to- wards them often gave me the opportunity to visit them at their domiciles, and although my exhortations were especially addressed to the prostrated, often they would fall upon the ears of public sinners, who, little by little, became conscious of the consequences of their wrecked lives, and began to reform, and thus with the hope in a merciful Savior, gave up their bad habits. Kindness to all, charity to the needy, a sympathizing hand to the sufferers and the dying, in conjunction with a solid re- ligious instruction to my listeners, have been my constant means to introduce moral habits among the lepers. One of the great moral improvements which helped to do away with licentiousness was the granting of inter-marriage licenses between lepers who were not prevented from marriage by a previous marriage tie, and many a couple are today living at the Settlement in a decent manner. I am happy to say that, assisted by the local administration, my labors here, which seemed to be almost in vain at the begin- ning, have, thanks to a kind Providence, been greatly crowned with success, as, at present, there are very little, if any at all, of the above mentioned evils committed. THE PATH OF THE DESTROYER 227 MEDICAL TREATMENT Leprosy, from time immemorial up to the present, has always been recognized as an incurable disease. In laying my views be- fore Your Excellency, with regard to medicine, I must, draw dis- tinction between a developed and an incipient case. In regard to the first, a judicious medical treatment may be followed up with advantage, to ameliorate the condition of a leper, to alleviate his pains, and to stay somewhat the progress of the disease; but not with the view of obtaining a perfect cure, for such a blessed effect we must look for, and can only hope, in a supernatural gift. Perchance, in the near future, through the increasing interest and untiring perseverance in the study of the disease by the most intelligent physicians and scientists, a proper specific for the cure of leprosy may be discovered, which to my knowledge has not yet been found. In regard to an incipent case, where the disease is not yet de- veloped, there, in my opinion, with proper medicine, good diet, cleanliness, complete separation from all leprous persons, and other necessary means, taken with perseverance, there only the hope to eradicate the disease from the system, or at least its progress en- tirely checked, may be entertained. It is now about twenty years since this Settlement was established, and this term may be divided in three separate periods. As I arrived here at the end of the first period, 1866 to 1873, I can only state how I found things at that time. I remember well that the poor people were without any medicines, with the exception of a few physics and their own native medicines, from which, I judge, it had been the same from the inauguration of the Settlement. It was a common sight to see people going around with fearful ulcers, which for the want of a few rags, or a piece of lint and a little salve, were left exposed to dirt, flies, and ver- min. Not only their sores were neglected, but anyone getting a fever, diarrhoea or any other of the numerous ailments that lepers are so often heir to, was carried off for want of some simple medicine. In the same year of my arrival at the settlement, 1873, there arrived a white man, a leper himself, who had been an assistant to the doctors at the Kalihi hospital. He had quite a practical knowledge of simple medicine, and having been put in charge of our hospital, he especially attended to the patients there, while I, for my part, attended largely to those living outside. Our stock 228 THE PATH OF THE DESTROYER of medicine, the greatest part of which was always supplied by the Board, consisted of the most common necessities. Very soon, the people perceiving that by the use of such simple medicines as we had to dispose of their troubles were generally greatly ameliorated, and therefore they begun to call more and more for the simple remedies, and thus gradually a perceptible improvement took place. As we had no doctor during this second period, we tried to do the best we could. To His Excellency Walter M. Gibson, President of the Board of Health. Dear Sir: I herewith enclose the report of my observations and action at the Leper Settlement during a residence of thirteen years, which Your Excellency requested me to prepare. Hoping that it will meet your views, I remain Your Excellency's most humble servant, J. DAMIEN, Catholic Priest. Kalauwao, March 11, 1886. FATHER DAMIEN-PRIEST, LEPER, POPULAR HERO Joseph Damien de Veuster, otherwise popularly known as Fr. Damien, was born at Tremeloo, a small village near Louvain, Belgium, on January 3, 1840, and died at Kalawao, Molokai, April 15, 1889, of nodular leprosy, aged forty-nine years, three months, and twelve days. His parents were in humble circumstance, his father owning a small farm, less than ten acres. His studies for the priesthood were pursued at the University of Louvain, and afterwards at Paris. He arrived at Honolulu on March 19, 1864. Previous to his taking up his residence at the Leper Settlement, he had charge of the work of the Catholic Mission at Kohala, island of Hawaii, and the Puna district. ARRIVES AT KALAWAO On Saturday, May 10, 1873, Bishop Maigret, head of the Catholic Mission in the Hawaiian Islands, and Fr. Damien landed at Kalaupapa, Molokai, from the steamer "Kilauea." The Bishop returned to Honolulu on the same steamer, after addressing the assembled lepers and informing them, that Fr. Damien would remain and make his home with them and devote his life to their spiritual welfare and care. The Leper Settlement had been in active operation since January, 1866; the lepers, for a period of more than seven years, being without any resident priest. In the year 1872, Brother Ber- tram had built a church at Kalawao, which was dedicated on May 30th of the same year to St. Philomena by Fr. Raymond Delalande. The Protestant church at Kalawao, "Siloam," was erected in the year 1870, and was in charge of a native Hawaiian pastor. PHYSICAL APPEARANCE Fr. Damien was in the thirty-fourth year of his age when he began his w T ork amongst the lepers. When I went to reside at the Leper Settlement, in the fall of the year 1884, Damien was then in his forty-fifth year. He was active and vigorous, of good physique, upright in his carriage, measured 5 feet and 8 inches in height, weighed 204 pounds, his chest was 41 inches in circum- ference, his hands and feet were shapely, although his fingers were stubbed and calloused from toil. FATHER DAMIEN, A. D. 1873. In His Thirty-fourth Year. THE PATH OF THE DESTROYER 231 His features were regular, his face fleshy, round, and of good dimensions; the color of his eyes brown, his hair black and abun- dant; his forehead of average breadth and height. He had a clear ringing voice, possessed a powerful barytone, and was a good singer. The view of his full face gave the onlooker the idea of force, harshness and sternness, due in part to the squareness of his chin and lower jaw. His profile was handsome, was softer and more in harmony with the entire cast of his features than the view his full face presented. Very few of the photographs of Fr. Damien do justice to him; his face as sculptured on the monument at Kalau- papa bears but an imperfect and faint resemblance to his features. Having a wealth of hair, he roamed about bareheaded, result- ing in his face becoming bronzed by exposure to the wind and sun's rays. The first meeting I had with Fr. Damien the dark copper color of the skin of his forehead attracted my attention, it was the visible proof of the invasion of the Destroyer. TEMPERAMENT His temperament was mixed, nervo-bilious, the former element predominating; he was easily excited, easily peeved, supersensitive, and difficult to get along with at times. Damien and I clashed and snapped repeatedly. His years of residence at the Settlement had made him an autocrat on all matters; he had very fixed views and brooked no interference with his will. His unyielding attitude on many affairs outside his proper sphere of work brought him in conflict with the Board of Health and the workers connected with the other religious sects at the Settlement. Kalawao had its loafers, illicit distillers, gamblers, thieves, card players, card sharpers, ladies of easy virtue. On all these classes Damien waged continued warfare, they demoralized his flock and led them astray. Very naturally the debauched and dis- solute objected to be interfered with, and when attacked turned their guns on the attacker. Damien was a good fighter, like all Bel- gians, and held his ground ; sometimes the combat was equal, some- times unequal and Damien had to retreat, he bided his time and returned to attack as defiant and undaunted as ever. When the dissolute and debauched element got the worst of the battle they craftily begged for forgiveness, assumed an air of repentance and reform, and bided their time, which came when Damien absented himself from the Settlement to attend to his parishioners' spiritual welfare on Kona side of Molokai. 232 THE PATH OF THE DESTROYER THE ENTIRE ISLAND OF MOLOKAI HIS PARISH The whole of the island of Molokai was included in his sphere of work, and not alone the Leper Settlement. The Catholic Mission was shorthanded for years and could not spare another priest for the district of Molokai, outside the Leper Settlement; hence the work devolved on Fr. Damien, and he put as much energy and zeal into his work there as he did at the Leper Settlement. He succeeded in erecting several churches on the leeward side of Molokai, doing most of the carpentering and painting with his own hands. He also found time to visit the remote and semi-inaccessible valleys of Wailau and Pelekunu, and minister to the spiritual wants of the people there. In his report to the Board of Health in the year 1886 ; Fr. Damien relates the conditions in existence at the Leper Settlement at the time of his arrival in the year 1873. (Page 211.) DAMIEN'S LEPROSY NOT CONTRACTED ON THE , ISLAND OF HAWAII It has been stated, and the story is still existent, that Damien had contracted leprosy on the island of Hawaii before he went co the Settlement, and his going there was a necessity, not choice. Not a particle of reliable evidence has been or can be produced to support this contention. I visited Kohala, Hawaii, (Damien's field of work prior to his leaving for Molokai) in June 1889, and made special inquiries on this point as to whether Damien showed any signs of leprosy; those questioned had heard some vague story bearing out the state- ment, but definite and reliable evidence was not forthcoming, the general opinion was, "that no visible signs of leprosy existed on Damien's person when he took his departure for Molokai." During the years 1888-89 I resided at Hilo, the headquarters of the Catholic Mission on the island of Hawaii, and while there I acted as physician to Fr. Charles Pouzot, the venerable head priest of the mission, where he had worked and toiled for nearly fifty years. Questioning all the members of the mission on this same subject of "Fr. Damien being affected with leprosy," no evidence could be produced to support any such contention. HIS ONLY SHELTER— A PUHALA TREE Fr. Damien having no home or accommodation when he landed at Kalaupapa, took up his abode under the branches of a 1 HALA TREE. Similar in appearance and size to the tree at Kalawao under which Fr Damien slept when he arrived at Kalawao, 1873. Puhala and Lauhala are names also used to describe this tree. 234 THE PATH OF THE DESTROYER Puhala tree (Screw Pine or Pandanus) at Kalawao, contiguous to the site of the present church, no other shelter being available, ex- cept an empty room in a house occupied by lepers, which did not appeal to him. Now, had Damien maintained the same attitude towards contact with leprosy throughout his period of residence at Kalawao as he did on his arrival (when he declined to live in a room where lepers lived), the history of Damien, "the martyr priest of Molokai," would in all probability never have been written. NIGHTS OF BLEAKNESS AND DISCOMFORT The Puhala tree generally and by preference selects rocky, ground to germinate, its aerial roots and their surroundings afford a choice nidus for centipedes, scorpions, ants, mosquitoes, roaches; and fleas carried by mangy cats, dogs, and sheep, who seek shelter from sun, wind, and rain under its branches. As if all this is not enough, sleep at night is also interrupted by tree rats and noisy chattering birds, such as the mynah and sparrow, and roosting poultry. I once was compelled to spend the night under the spreading branches of a Puhala in the district of Puna, Hawaii, whilst I did not have all the vermin companions I have enumerated, I had some of them and hereafter would always advise any traveler or way- farer not to camp under a Puhala tree. Yet, under all the discomforts I have mentioned, Fr. Damien began and carried on his work at the Leper Settlement. COMPARISONS OF "CONTAGION EXPOSURE" Twenty-five years ago amongst the Hawaiian race the average duration of a case of nodular or tubercular leprosy was eight or ten years, and of the neural form ten to twelve years. Amongst the foreign lepers, nodular leprosy ran a more pro- longed course, with a minimum duration of ten years. The visible active stage of Fr. Damien's leprosy began towards the end of the year 1884; he died of the disease April 15, 1889, the apparent duration being only four and a half years. The true duration of his disease was between ten and eleven years, for during the summer of the year 1878, whilst acting as assistant superintendent of the Settlement, true prodromal symp- toms of leprosy manifested themselves, to wit, chills, osteal pains slight swelling and tenderness of the joints, slight irregular fever, THE PATH OF THE DESTROYER 235 tingling, numbness of the extremities, supersensitive and painful sensation in patches along the extensor surface of the upper and lower extremities; all of which signs, even in the absence of skin lesions, clearly indicated primary infection of Damien's system with leprosy. After about five years of intimate contact with lepers (from the year 1873 to year 1878), he suffered the before men- tioned symptoms. AN UNCHARITABLE ASPERSION In a previous chapter on the subject of "Inoculation," I have stated that a widespread opinion exists, even in lay and professional minds, that leprosy is spread by inoculation, and solely by that means. This unproven and untenable assumption has caused the greatest anguish of mind to many unfortunate lepers of our race. They are unjustly accused of having acquired leprosy through clandestine sexual intercourse with some female leper, without a particle of proof that leprosy can be so acquired. Even in this twentieth century in Hawaii, I regret to write, the Ghost of Immorality stalks abroad, haunts the footsteps of the unfortunate leper, and if he is sensitive and refined, adds untold misery to his hard lot. In previous pages I have patiently endeavored to enlighten the advocates of inoculation and teach them that "penile inocu- lation by chancre or otherwise, is not responsible for the spread of leprosy from INDIVIDUAL to INDIVIDUAL, but that CON- TAMINATED food is, also contact with the leper's mouth, un- less the CONTACT (male) or CONTACTEE (female) is IMMUNE by reason of NON-RECEPTIVITY of the SYS- TEM, or CAREFUL CLEANLINESS. I have reason to believe that the unfortunate Damien was spared the torment and distress of even suspecting that his infec- tion with leprosy would be attributed to immorality. Be this as it may, when it first become publicly known that Fr. Damien had leprosy, some such accusation of his acquiring the disease by im- moral acts must have leaked out. The matter was abruptly brought to my notice in the early part of the year 1885 by a certain prom- inent physician who visited the Leper Settlement at that time. On or about May 7, 1885, this certain physician stated to me whilst we were eating breakfast: "Dr. Mouritz, Fr. Damien will come to the dispensary at Kalawao at 10 o'clock, I want you to be there, we can then see how his leprosy is progressing. I 236 THE PATH OF THE DESTROYER also wish to specially examine him for evidence of other diseases. We will make a thorough examination." I assented. In due course and at the appointed time Fr. Damien arrived, serene and undisturbed. When asked to disrobe, he readily con- sented; we found sufficient proof that he was undoubtedly a leper, but nothing more. We searched his mouth, throat, and cervical glands, also care- fully scrutinized his entire person and found absolutely NO TRACE of any other disease. This event happened nearly thirty years ago, but the details are fresh in my memory; strange to say the "victim" of our examination did not display any re- sentment, and did not seem to realize the important bearing the discovery of any incriminating evidence might have on his future. Fr. Damien possibly realized that the syphilis-leprosy theory which was then hypnotizing a certain portion of the popular mind, might be invoked in connection with his acquiring leprosy, he well knowing that syphilis can be inoculated innocently and accidentally, no question of morality intruding itself in such a case. The contact of Damien with leprosy was always careless and reckless during the few years I was connected with the Settle- ment. I never hesitated to scold him and lecture him, because it set a bad example to other non-lepers. PROLONGED AND INTIMATE CONTACTS Mother Superior Marianne, and some of the Sisters have had prolonged and intimate contact with leprosy, both at Kakaako and Molokai, for a period over thirty-two years, and they are free from leprosy. "The Immunity of Cleanliness" is their guardian and protector. Mr. Joseph Dutton has had the same class of contact as the Sisters for nearly thirty years, night and day contact, week in and week out, year in and year out, but I never knew or heard of the Sisters, the Rev. Mother, or Mr. Dutton eating from the same dish with other lepers. From the date of Fr. Damien's arrival, May 10, 1873, to the time of his death, April 15, 1889, is a few weeks less than sixteen years (some twenty-five days less). Mother Superior Marianne and some of the Sisters spent five years at Kakaako detention hospital, and have passed over twenty- seven years at the Bishop Home, Kalaupapa; in all a total of over thirty-two years, almost double the contact and exposure that THE PATH OF THE DESTROYER 237 Fr. Damien was subjected to, but the venerable Mother and Sis- ters are free from leprosy. The same statement applies to Mr. Joseph Dutton, who has lived continuously at Kalawao since July, 1886, nearly thirty years, under conditions of prolonged and inti- mate contact with leprosy — he is also free from the disease. The late Fr. Wendelin lived nearly fourteen years at Kalau- papa, exposed to the same risks of contagion as Fr. Damien, but up to the time of his death in Honolulu, September 1, 1914, he showed no signs of leprosy. Fr. Wendelin took only the ordinary precautions that any prudent man would to avoid leprous infection; on the other hand, Fr. Damien took no precautions whatever. In the kindness of his nature, he never forbade lepers entering his house, they had access to it any time, night or day. I named his house "Kalawao Family Hotel and Lepers' Rest," free beds, free board for the needy; this designation I believe could not be improved on, it exactly fitted the daily prevailing conditions. In marked contrast was the atti- tude of Frs. Albert and Wendelin towards lepers who came to see them and ask for aid, neither of these priests admitted lepers to their private apartments, visiting lepers were received on the lanai or in their studies, the leper visitor stated his business briefly and departed. A MODEST REPORT In his report to the president of the Board of Health in March, 1886, Fr. Damien gives only a modest and limited in- sight into his self-chosen, dangerous, and arduous work amongst the lepers; what he does not mention are the following vital facts: His house stood in close proximity and to the LEE side of the burial ground connected with his church, in this said burial ground over 1,000 leper corpses were buried. Owing to the rocky nature of the ground in some places, the corpses were not regularly dis- tributed, in places two, three, and four coffins were placed on top of each other, naturally the soil became over saturated with the soluble products of the corpses, and the percolating rain drowned the maggots and other grubs; hence decomposition went on very slowly, the surrounding air being filled with foetid and foul va- pors emanating from these semi-decomposing corpses, and to add to the gruesomeness of the surroundings, the closeness of the coffins to the surface of the ground encouraged the visits of scavenger dogs and pigs, and by these animals rooting and disturbing the graves, the odor around Fr. Damien's home was similar to a 238 THE PATH OF THE DESTROYER charnel house; but such vital conditions essential to good health as pure air, did not worry the priest. Forty years ago leprosy in Hawaii, in its advanced stages, was very much more severe and loathsome than it is today; also when the leper arrived at the Settlement his disease was of many years' duration, his tenure of life was very brief; hence there was a high annual mortality. In the seventies the smallness of the leper houses and absence of ventilation made the foetid breaths, the smell from the foul ulcers of the dying and semi-putrid cadavers so nauseating that it sickened the strongest stomach. Here worked Damien night and day, living and sleeping in this polluted, foetid atmosphere; cheerful, careless, and care-free. In addition, his food cooked and handled by a leper; his clothes washed by a leper, even his pipe smoked by a leper when he (Damien) carelessly laid it aside — not once but often — and so surrounded by a multitudinous aggregation of disease-producing conditions "that his escape from leprous infection would have been marvelous, and even miraculous." The resulting climax came about; Fr. Damien succumbed, fell a victim to the dread "Incurable Destroyer," and passed on to his reward. His own view on becoming a leper was, "If Providence sees fit to afflict me with the leprosy whilst I am working amongst the lepers, I will gain a Crown of Thorns, whether I am worthy or not." The brief period of five months elapsed between the arrival of Fr. Wendelin coming to aid Damien and the latter's death. Fr. Wendelin arrived in November, 1888, Damien died in April, 1889 OPPOSITION TO DAMIEN Several writers who have given to the world what purports to be a history of the life of Fr. Damien, have commented on the fact that hostile opinions were held about the priest in the village of Kalawao, the scene of his earthly labors. This is noth- ing remarkable; quite a minority of the residents were opposed to the ways and the work of the priest. This opposition and non- appreciation of the man came in the main from two sources : A. The non-members of the Catholic Church; this opposition was not personal, it was in fact only friendly rivalry. B. The dissolute and debauched Hawaiians and a few for- eigners. This opposition to Damien was personal, and highly slanderous. (a) Fr. Damien was a most zealous, untiring worker on be- half of the Catholic Mission, and everything pertaining to the C « cj 05 ■ W _c bX) - 3 eg -C as « pq u.S O Q M as >> -a c -° -a O 0) - . 3 PLiP Xi < - CO M Q, J3 O = 3 «J < < hi < \4 O > w 2° H O ~ C "5^ p -f 5 . « 03 s - a g . O "~" 03 D In u OJ — i n £ £ >, a, "3 >,— ' > 3 ~> 1> procure in the Paumotus, materially improved his psoriasis. Father Albert's appearance when he first went to Molokai gave the impression that he was a leper; scaly hands, face, and alopecia of the hairy surfaces of the body, also chin, cheeks, and eyebrows. In the month of March, 1884, Dr. Ed. Arning visited Kalaupapa with Princess Liliuokalani (her report is on page 295 of this book). The doctor saw Father Albert (who had now given up all hope of relief from his skin affection), and in. THE PATH OF THE DESTROYER 25 i duced him to persevere in the use of the remedies he prescribed;, heroic doses of arsenate of soda, and externally, salicylate of bis- muth ointment. Under this treatment the psoriasis yielded, and after several months Father Albert's skin assumed its natural state,, and he was practically cured of a disease of twenty-five years' existence. Father Albert though sixty years of age was quite active, and easily took care of the needs and welfare of the lepers living at Ka- laupapa and Iliopi. These villages were very sparsely settled, the bulk of the lepers residing at Kalawao. Frequently he repeated to me his desire to spend the rest of his life at Kalaupapa, because he enjoyed good health and was free: from the misery of his companion psoriasis, which possibly might return if he changed his residence. Something, however, came into his life and altered all his previous hopes of permanent residence at the Settlement. He informed me one day in March, 1885, he was leaving the Settlement for other spheres of labor, his disease had left him, and he felt with renewed vigor he could undertake other duties; that Fr. Damien was still hearty and strong and could amply cover the field of work of the Leper Settlement. Fr. Albert had no signs of leprosy during his residence at Kalaupapa, and left the Settlement free from any taint of that disease. He died in Spain in the year 1894. FATHER GREGOIRE ARCHAMBAUX Father Gregory, a priest of the Catholic Mission, who had lived many years in the Hawaiian Islands, arrived at Kalawao near the end of the year 1887, and resided with Father Damien for about four months. The Father had undergone all the hardships of poor food, and hard work, being located at Hana, Maui, a damp, rainy dis- trict, and latterly at Lahaina, Maui. In his time the numerous steep and rocky trails which ran through the various large gulches made traveling arduous and dangerous, especially in the periods of heavy, rains and freshets in the rivers, which had to be forded on horseback, no bridges spanning the streams. Dr. Beratz, a very able and accomplished Austrian physician, was drowned in the year 1871, in one of these streams when in flood. The rainfall in the mountains of the Hana district is very- heavy, as much as 300 inches per annum in the Keanae Valley. 252 THE PATH OF THE DESTROYER Amongst these inhospitable surroundings in a sparsely popu- lated district, Father Gregory passed many years of his life, sleep- ing anywhere, wherever he happened to be at nightfall — in caves, grass houses, and other homes of the Hawaiians, any place that he could obtain food and shelter. In these situations he encountered typhoid, small-pox and many cases of leprosy. He slept repeatedly in rooms with lepers, and had to EAT the food of the family, which practically means contaminated with bacillus leprae. Father Gregory was affected with incipient NODULAR LEPROSY. He was French, nearly six feet tall, of powerful build, complexion dark and swarthy, he had abundance of black, wavy hair, and a remarkable thick and long growth of eyebrows, which his leprosy had not yet begun to diminish. He had been pronounced a leper by a board of examining physicians, and came to the Leper Settlement with the object of remaining there per- manently and aiding Father Damien. Besides leprosy, Father Gregory suffered severely from asthma, and posterior spinal sclerosis, taking the form of "Lightning Shocks/' affecting the muscles of the lower extremities, which at times brought the Father to his knees involuntarily, and sometimes with ludicrous explosions from the onlookers. His leprosy gave him very little inconvenience, but the copper- colored macules and infiltrations caused him visually great an- noyance, hence he vigorously applied sublimate of mercury in strong lotions — 60 grs. to a pint of Eau de Cologne — in hopes of eradicating the aforementioned skin troubles, but he only succeeded in creating centers of traumatic eczema, which, when healed, left the skin more red and copper colored than it had been before the sublimate lotion was used. Both the macules and the small, slightly elevated areas of infiltration were devoid of sensibility and failed to sweat; these two conditions being almost pathognomonic of leprosy. Mercurials and iodides produced no effect, so there was no question of the nature of his disease, because syphilis is the main cause of loco- motor ataxia or posterior spinal sclerosis, and has symptoms re- sembling leprosy and may even be present complicating this disease. During the few months Father Gregory stayed at Kalawao, his asthma was much aggravated, and his appetite and strength be- gan to fail rapidly, and I suggested a return to Kakaako. Father Damien also thought it best, because Father Gregory was unable to perform any service, and was an added burden to him (Damien). THE PATH OF THE DESTROYER 253 Father Gregory was only too pleased to return to Honolulu; the Board of Health raised no objections, and shortly after the Father left Kalawao for Kakaako, where his asthma and nervous disease became gradually worse, and he died there Nov. 12 in the year 1888. He had often been connected with the Leper Settlement, act- ing as temporary priest for many years. * * * FATHER CHARLES POUZOT Father Charles, the venerable priest in charge of the Catholic Mission work at Hilo, Hawaii, was well on to seventy years of age when I became his medical attendant in the year 1888. He had ministered to the spiritual wants of his parishoners in the Hilo district for well nigh forty years. North of the Wailuku River, which runs through the town of Hilo and empties itself into Hilo Bay, the climate is rainy, almost resembling the Hana district, where Father Gregory was located. South of the Wailuku River, the climate is less rainy. Hilo town has a rainfall of about 15 inches a month. Father Charles, like most Catholic priests in the country dis- tricts fifty years ago, led a hard life, visiting the sick and- dying at all hours, irregular meals and poor food were his lot; rain- bound, he frequently had to eat and sleep with Hawaiians, who are always hospitable and at times too kind for their own good. Father Charles had stomach trouble and suffered repeated attacks of acute indigestion, with lurking appendicitis, but I dis- covered a more interesting condition in the course of a clinical examination, to wit: specific neuritis affecting the nerves of the left forearm and hand, due to leprosy, which was quiescent and had aborted, but it had left marked atrophic changes in the muscles, the typical hollow between the thumb and forefinger was there, defective sensibility of the hand and skin of the forearm; there were also atrophic changes in certain areas of the body, higher in color than the neighboring skin, and insensitive; thermo-anaesthesia and symetrical enlargement, or bulbing of the ulnar nerve above and below the elbow joint completed the picture. As usual, the atrophic invasion of neural leprosy had confined itself to its favor- ite seats, the interossei, thenars and extensors of the hand. Father Charles, unlike Father Gregory had never visited or had any connection with the Leper Settlement. The acquiring of leprosy by these two priests tends to show that a healthy person 254 THE PATH OF THE DESTROYER is exposed to contagious foci of leprosy outside of Molokai, and inasmuch as the cases of leprosy are lurking, or may or may not be detected, there is a certain element of greater risk, because the danger is unexpected and a person is caught off his guard. FATHER ANDRE BURGERMANN Father Andre, who spent many years at Lahaina, Maui, and .also had charge of leeward Molokai, and paid transient visits to the Leper Settlement, was another priest who had symptoms of leprous neuritis, almost identical with those of Father Charles Pouzot. In addition, Father Andre had ataxic symptoms, and the "Lightning Shocks," similar to Father Gregory, together with in- coordination, disturbances of sensation, and loss of reflexes. He was well on to sixty years of age when I observed his condition in the year 1894. The suspicious changes in his left hand were caused by neural leprosy, which had aborted, as it very frequently does in this location. Father Andre did have intimate contact with leprosy at the Leper * Settlement, and lived at Kalaupapa from July, 1878, to July, 1880. The acquiring of leprosy by these four Catholic priests, Andre, Charles, Damien, and Gregory, all Europeans, is fairly conclusive that leprosy is contagious, that it spreads fro?n individual to in- dividual, and a de novo development cannot be maintained. IN MEMORIAM FR. WENDELIN "Now I lay me down to sleep, I pray the Lord my soul to keep." Entered into rest at the Catholic Mission premises, Fort street, Honolulu, Father Wendelin Moellers. He fought the good fight, and passed away on September 1, 1914. He was born on March 21, 1850, near Miinster, Westphalia, Prussia, and was the youngest of six children. At the time of his death he was in the sixty-fifth year of his age. He studied for the priesthood at the University of Louvain, Belgium, and was o M-l o 2 : < .s < "2 W 5 256 THE PATH OF THE DESTROYER ordained priest in the year 1878. His first sphere of work was at Tahiti and the Marquesas Islands, where he labored for seven years. He came to the Hawaiian Islands in the year 1885, and was placed in charge of the district of Koolau, Oahu. HE GOES TO DAMIEN'S AID Owing to the rapidly failing health of Father Damien at the Leper Settlement, Father Wendelin was sent to his relief in the month of November, 1888, and he remained at the Settlement until October 9, 1902, nearly fourteen years; during all these years he labored nobly and did excellent work, the mantle of Father Damien falling on Wendelin's shoulders after Damien's decease, at. whose obsequies he officiated. During Father Wendelin's term of office and under his splen- did administrative ability, the churches, the schools, the Baldwin and Bishop Homes reached a high degree of spiritual efficiency, also the general religious work of the Settlement went on apace; all of which progress would have delighted the heart of Father Damien, had he then been living. In Father Wendelin's period of residence at Kalaupapa, marked changes and improvements took place. The lepers had better housing, and their material comfort was vastly improved, an abundant supply of water was brought into the Settlement from Waikolu Valley, the conditions of sea transport were much changed for the better. Special personal work of Father Wendelin was the building of St. Francis Church at Kalaupapa, a large and handsome build- ing destroyed by fire on August 12, 1906. DOES NOT CONTRACT LEPROSY Father Wendelin was eminently just and upright, plain spoken almost to bluntness, no taint of scandal ever tarnished his name, he was most abstemious in his habits and endured the life of pri- vation and toil that falls to the lot of most Catholic priests. He was exposed to the same risks of contact with leprosy as Father Damien, but the FELL DESTROYER never infected him. Father Wendelin spent fourteen years at Kalaupapa in intimate contact with leprosy, ' and after leaving that land of SORROW he lived twelve years longer, but never a trace of the disease showed itself. In appearance he was slim of build, stood about five feet six inches tall, had a very small head, his gestures, walk and speech 'RAPID FIRE" WENDELIN, COOLING OFF. A. D. 1910. Sixty years old. 258 THE PATH OF THE DESTROYER were rapid and full of action — he was playfully called "Rapid Fire" Wendelin — his temperament was of the typically nervous type. He weighed about 140 pounds. GIFT FROM THE LEPERS When Father Wendelin took leave of his leper parishoners, they performed a most pathetic and touching deed. The poor and needy lepers with stinting and saving, raised enough money to pro- cure from Paris a gold chalice of exquisite workmanship, which they presented to the departing priest as a token of their love and esteem. The subscribers were not confined to the members of the Catholic Church, the other churches also contributed. The last twelve years of Father Wendelin's life were spent at Lahaina, Hilo, and Honolulu from February, 1909, to the time of his death. To me personally this Catholic priest was especially attrac- tive. He was an able debater, his arguments were clear and in- cisive, if they were not absolutely convincing; it was impossible to cut them down clear to the base, there remained a snag or stump that was impregnable. Prussia, of course, is the dominant state of the German confederation, and the peculiar racial traits of the Prussian showed themselves in Father Wendelin, and explains his clash with the Board of Health. He possessed a charming freedom of speech and expression, remarkably rare in a Catholic priest. He spoke and wrote what he thought was right, and signed his name, no beating and stabbing behind the back; deceit, guile, and chicanery found no dwelling place within him. In these modern days of insipid mediocrity, de- bates and discussions with Father Wendelin were highly illumina- tive and entertaining. OVERWORK CAUSES BREAKDOWN He did not spare himself, with the never failing result — his health gave way — hurried and scanty meals, irregular and inter- rupted hours of sleep began to tell their tale, stomach trouble showed itself, then heart starvation, next irritable heart and tachycardia, next organic heart disease, muscular degeneration, and finally came dilatation of the left ventricle with thinning of its walls ; all these changes occurred slowly ; later shortness of breath, ♦hen the decision, "I must see a doctor," but it was too late. Father Wendelin had reached sixty-three years of age, and rebelled FR. WENDELIN AND HIS CLASS. A. D. 1910. 260 J HE PATH OF THE DESTROYER against his physician's orders to rest; hence the mischief done to his heart could not be stayed or repaired. THE SWEEP OF THE REAPER During the summer of the year 1913, the cardiac symptoms began to trouble him, shortness of breath on very slight exertion and excessive heart's action, all these symptoms gradually increas- ing until March, 1914, when other grave symptoms occurred — anginal attacks, lung engorgement, and temporary thrombosis of the pulmonary artery. During the last few days of April, all the indications pointed to his speedy death, but under the skilful treat- ment of his physician, Dr. St. D. G. Walters, he improved, finally taking to his bed May 1, 1914. June, July, August passed, Father Wendelin's death being expected on five different occasions, so alarming and continuous were the anginal attacks. After three days passed in a semi-comatose condition, the end came on Sep- tember 1, 1914, and he passed quietly away to his reward. Dr. Goldsmith's lines, written in the year 1770, are a fitting tribute to Father Wendelin's life: "To relieve the wretched was his pride, In his duty prompt at every call, He watched and wept, he prayed and felt for all. Beside the bed where parting life was laid, And sorrow, guilt, and pain; by turns dismayed, The Reverend Champion stood. At his control Despair and anguish fled the struggling soul; Comfort came down the trembling sinner to raise, And his last faltering accents whispered, praise. At Church * * * Truth from his lips prevailed with double sway, And fools, who came to scoff, remained to pray. His people's welfare pleased him and their cares distressed; To them his heart, his love, his griefs were given, But All his serious thoughts had rest in Heaven. As some tall CLIFF, that lifts its noble form, Swells from the vale, and midway leaves the storm, Though round its breast the rolling clouds are spread, ETERNAL sunshine settles on its head." THE PATH OF THE DESTROYER 261 In the year 1888, Bishop Herman desiring to send another priest to aid Fr. Damien, addressed a circular letter to all the eligible priests of the Mission, asking them if they were willing to go to the Leper Settlement. Some of the priests gave favorable answers, some pleaded un- fitness, some made no reply. Fr. Wendelin gave his answer in a few words: "My answer is our rules,'' which was tantamount to stating, "I obey my Bishop, and will go where he orders me to go." Fr. Wendelin was chosen. During the last year of Fr. Damien's life a strange event took place; the coming to the Leper Settlement of Fr. L. Conrardy from Oregon. He came at the special instigation of Fr. Damien, who acted against the wish of Bishop Herman ; the affair was very displeasing to the bishop and the priests of the Mission. Fr. Damien was stubborn, self-willed and refused to listen to any remonstrance; he determined to have his own way and acted accordingly. Fr. Conrardy was of a different order of priests from those of the Catholic Mission in Hawaii. He remained seven years at the Settlement, and later he labored amongst the Chinese lepers near Canton. He died at Hong Kong, August 24, 1914. The Conrardy affair might have developed into a very un- pleasant situation, but it was smoothed over and mollified by the tact and diplomatic finesse of Fr. Wendelin. THIRTY-ONE YEARS AN OFFICIAL OF THE LEPER SETTLEMENT I have previously related that one R. W. Meyer held the position of agent of the Board of Health and superintendent of the Leper Settlement. He resided at Kalae, a locality immediately above the steep sides of the Kalaupapa pali, which, at the trail of Kukuihapuu, reaches an elevation of 2,200 feet above the sea, which ebbs and flows directly at the base of this mountain. The late Charles Warren Stoddard in that, entertaining and pathetic little book, "The Lepers of Molokai," admirably des- cribes the difficulties of ascent and descent of the palis adjacent to the Leper Settlement; the angles of elevation in various parts of the old trails, such as Stoddard described in the year 1884, vary from 30° to 90°, the average angle of ascent is steep, about 40°. Meyer had a long record of service, holding the position of superintendent of the Settlement from its inception in the year 1866 to 1897, when he deceased. He had resided on the island of Molokai some forty-seven years, coming to Hawaii from Australia, to which country he had emigrated from his birthplace, Ham- burg, Germany. He was well educated and wrote and spoke fluent English, came from a good family, had the average German characteristics — stolid, level-headed, a clever thinker, and a stickler for obedience to his will and discipline. Meyer had an estimable Hawaiian wife, Kalama. His atti- tude towards the Hawaiians and treatment of them, whether they were lepers or not, always gave me and many others the impression that he was a little harsh and severe in his dealings with them ; he judged them by a too high standard. Living on an isolated island like Molokai, Meyer's continual association with inferiors, mentally and socially, made him very arbitrary. During Meyer's tenure of office the clandestine travel up and down the Kukuihapuu trail was kept to a minimum, permits to visit the Leper Settlement were held up if they showed the slight- est informality; a hawk's eye was kept on all the traffic passing by his gate, which was located on the road to the Settlement; all this very much conduced to efficient segregation. For the several years I was connected with the Leper Settle- ment, there was one everlasting growl and complaint about its management, and the source of trouble was centered on Meyer, but in justice to the man, I must add most of the growls, kicks and fault-findings were unjust and frivolous. To give satisfaction, THE PATH OF THE DESTROYER 263 to please and placate the numerous and varied collection of lepers, the holder of the office of superintendent would require to be of the type of the Archangel Gabriel, and even then dissatisfaction would exist. I know all this from personal experience. Sick people, the world over, are fault-finding, complaining, fretful, irritable and discontented. Those who are in constant con- tact with the sick, expect to meet with all this trouble, and the Leper Settlement furnished a full quota of chronic growlers from amongst the various races in segregation. R. W. Meyer paid quarterly visits to the Settlement, spending a few days there, a period of time, the lepers decided, was much too brief to be of any real service to them; an absentee official was not to their liking. Meyer mostly depended on the reports and the conditions out- lined therein, furnished by the deputy superintendent. When com- plaints were made to him (Meyer) personally, by the lepers about poor quality of food and its insufficiency, leaky houses, poor qual- ity of the blankets and clothing supplied from the local store, shortage and irregluar distribution of oil, soap, and matches, and a multitudinous variety of other complaints, Meyer returned an in- variable grim stereotyped answer. "You are well treated; compare your present condition and circumstances with what you had to put up with before you came here. Here you have nothing to do, have beef, poi, rice, salmon, hard bread, sugar, all supplied in liberal quantities. What more do you want? Your complaints are most unreasonable and unnecessary." The growlers would ease off for a little time, and then begin anew with renewed ardor. All physicians connected with the Leper Settlement prior to my taking office, were invariably unjustly criticised and subjected to unkind and sarcastic comments by Meyer, whose dislike of doctors was considerably augmented by the severe criticism on the manage- ment of the Leper Settlement made by Dr. J. H. Stallard, of date March 13, 1884, in a special report to the late A. S. Cleg- horn, then a member of the Board of Health. A. S. Cleghorn, husband of Princess Likelike, sent Dr. Stal- lard to the Leper Settlement to investigate the truth and circum- stances calling for the continual complaints coming from the lepers, concerning "shortage of their rations, suffering from cold due to insufficient personal and bed clothing," and many other troubles. Dr. Stallard in his report criticised, strongly arraigned and severely censured the management of the Settlement, which stung Meyer, and he answered Stallard in kind. The shortage of beef 264 THE PATH OF THE DESTROYER and other food shown up by Stallard was only too true, and Meyer's answer failed to change the merit and justice of the com- plaints of the lepers. (Dr. Stallard's report will be found in another part, of this work.) The continual complaints and troubles connected with the unsatisfactory management of the Leper Settlement ultimately reached a climax. In the month of February, 1886, I was ordered to report at Honolulu at my earliest convenience, and when I did so, I was urgently requested to take over the entire management of the Settlement. I promptly declined the office, having troubles enough as the physician of the Settlement. I did not care to butt into a hornet's nest and take further responsibility. In those days of political bitterness and factional strife, holding government office was no sinecure. The next year, in June, 1887, there came a change in the gov- ernment and its officers, due to a bloodless revolution. Later on when a new Board of Health assumed office (and manifesting real or apparent hostility towards me), it, gave me a sufficient loophole to resign my position as physician to the Leper Settlement and the island of Molokai, an office I had never sought, and reluctantly accepted; but I gained experience in leprosy, which repaid me for many discomforts and troubles. REPORT OF R. W. MEYER Superintendent and Agent of the Board of Health at the Leper Settlement, Molokai, April, 1886. REMARKS BY THE SECRETARY OF THE BOARD OF HEALTH The accompanying report of Mr. Meyer, agent of the Board of Health at the Leper Settlement, in reference to the Settlement, is very interesting, in so far as it gives a somewhat connected view of the condition of things at the Settlement since its establishment, by one who was connected with it from its inception; but as Mr. Meyer has not. been an actual resident, but has lived some ten miles distant, and only paid occasional visits to it, say once in three months, he has not had the fullest opportunity to observe the condition of affairs, or to aid in carrying out every reformation that has or might have been carried out, or of accurately noting the various changes that have been made. Therefore, Mr. Meyer has not dealt minutely with some of the most interesting events in the history of the Settlement at regards the phases of leper life, such as the Lepart, Walsh or Ragsdale management, when the last named was practically a king among his fellow sufferers, and hold- ing in his will the power of life and death ; nor to the labors of the resident physicians, from the days of Drs. Emerson, Neilson, and Fitch, to those of the present active incumbent, Dr. A. Mouritz. Information on these several points will, however, be found more fully set forth in other portions of this general report. REPORT To His Excellency Walter M. Gibson, President of the Board of Health. Dear Sir: In presenting my report of the Leper Settlement for the past two years, I am led to reflect upon the great difference existing in the comforts and ease enjoyed by the lepers at the Settlement of today, when compared with the first few years of its establishment, now just twenty years ago. It may, therefore, not be amiss to recite briefly the history of that time, as it shows a constant endeavor on the part of the government to improve the condition of these unfortunate people, and as I have been connected with the affairs of the Settlement ever since the very commencement (1865-66), I am in a position to speak from personal knowledge. 266 THE PATH OF THE DESTROY ER Leprosy had already existed on the islands for about twenty years before it seriously attracted the attention of the government, and even then the nature of this disease was poorly understood, and the great magnitude of the calamity was not realized, except- ing by a few men of the medical profession, who urged the neces- sity of segregation as being the only means known through which this terrible disease had been stamped out in other districts, and it was justly hoped that segregation here would lead to a similar favorable result; and it probably would have done so, had it been possible to rigidly enforce the segregation of lepers, even as late as the time when the law of segregation was enacted (1865), for the known cases of leprosy on the islands at that time were com- paratively few. The present site of the Settlement, which was established in 1865, was deemed to be the most suitable spot for the isolation of the lepers on the islands, one-half of it being bounded by an almost vertical mountain wall, from 1,800 to 2,000 feet high, and the other by a deep sea, with a precipitous shore, excepting only in two places, one at Kalaupapa, and the other near Kalauwao, where in good weather boats can make a landing safely. The tract of land constituting the Leper Settlement projects from the main body of the island, and forms a kind of shelf, in- cluding probably an area of about 5,000 acres, abounding with every variety of soil, and everything necessary to supply the wants of natives (fruits, taro, potatoes and many other vegetables can be grown here to perfection), and leaving a large area of land to be utilized for the raising of stock; the sea abounds with fish, and before this place was occupied by the lepers, it sustained a very large and thriving population. Unfortunately the place is not well watered. There is, how- ever, on the eastern boundary of the Settlement a considerable and never failing mountain stream in the valley of Waikolu, which is about a mile, or a trifle more, distant from Kalawao. There are other springs in the valley of Kalawao, and one or two in the valley of Waihanau, but all at considerable distances from the habi- tations. These springs, however, during very dry times are sub- ject to suffer diminution of water, and the one at Kalawao at such times is liable to dry up. It was thought at that time if such a place as above described was given to the lepers, where they could live unmolested, they might, with the assistance of some of their families, make comfort- able homes for themselves, without incurring much greater ex- THE PATH OF THE DESTROYER 267 penses to the government than the cost of collecting them together, giving them an outfit of clothing, a few other necessaries, and the transport to the Settlement. And such of these unfortunates who were known to be possessed of means, and who had not managed to place them in the hands of friends, in such a way that they could not be got at, had to pay them over to the government as a reimbursement for expenses incurred in their behalf. The original inhabitants of the place owned a great many pieces of land and houses, the houses being mostly thatched ones, and only three or four were wooden structures; the lands were mostly planted with taro, potatoes, and other vegetables. Most of these houses and lands were purchased by the government for the accommodation of the lepers, and the planted lands for their support. All the first shipments of lepers were allowed to take their wives and husbands with them, or a son, and in some instances a daughter, but children were not permitted to accompany them. The Board of Health bought for future use for the Settlement some young heifers, a few horses, one or two pairs of oxen, and a cart for the use of the lepers, and they were expected to obtain their living from the growing crops, to take care and re-plant them and live there precisely in the same way as natives do in any settlement on the islands. Unfortunately, segregations proceed slowly, and six months or more had elapsed from the time of the vacation of the place to the time of the arrival of the first shipment of lepers, and when they arrived they found the cultivated fields overgrown with weeds, and they had very hard work to save enough to eat for themselves. However, they managed it, commenced to like the place, and got along very well until after considerable intervals one or two more shipments of lepers arrived. No food was given these people excepting what the first com- ers were willing to give them, which was not much ; they were willing to work for themselves, but not for others, and the first trouble arose through it. Fortunately, the place was overrun with a native pear, and natives had lived on this fruit previously, and these beans supported them till the Board concluded to furnish these people with food for a sufficient length of time to enable them to raise their own ; but that time, with many, never arrived ; finding that they got food any way, they made no efforts to work for themselves, and supplies had to be bought. And many really could not work, their hands and feet being too sore. It was also KING KAMEHAMEHA IV. Husband of Queen Emma. Founder of the Queen's Hospital, A. D. 1860. Born February 9, 1834. Died November 30, 1863. THE PATH OF THE DESTROYER 269 found that they could not obtain sufficient fish or meat for their support, and they received from the Board small allowances of salt beef or salmon. They were allowed three pounds of meat and one bundle of paiai per week, and nothing else. Some became desti- tute of clothing, and this was supplied them annually, and only to such as had no means or friends. The men received each a pair of blankets, a denim frock, a pair of pants, a hat, and some of them shoes. The women also a blanket, a shirt of blue or brown cotton, and a calico dress; with this they were expected to get along for a whole year. For a considerable time there was nobody to look out for these people, a man was sent there just to receive them, show them the houses, and give them their weekly allowances of bread and paiai. As already stated, water was scarce, and had to be carried considerable distances, and it may be imagined great inconvenience and considerable suffering arose from it. It was but natural that troubles also arose between them which led to quarrels, and, as there was nobody to settle these matters, they had to do it themselves the best way they could. Many of them were approaching the latter stages of the disease, and those who had no friends or relatives with them suffered more or less ; but I must say, to the credit of these people, that, as a rule, they almost always found a friend in their extremities. There was no hospital or building in those days where they could be taken care of. It became necessary to appoint a superintendent, and an elderly gentleman (Mr. Walsh), with his wife, was sent to the Settle- ment to fill this position. This gentleman having been an officer in the British army, was accustomed to discipline, and he tried his best, and succeeded to a certain extent, to bring some system and order in the affairs of the Settlement. A hospital was erected, the building still standing, and the worst cases were taken there under the immediate care of the superintendent and his wife. Food was prepared for them, and they got other things, such as a little bread, rice, some tea with sugar, and as by this time the heifers had become cows, there was some milk for them also; thus really for a time considerable suffering from want of attention was re- lieved. Unfortunately, the superintendent and his wife did not understand the Hawaiian language, and many of his endeavors to establish rule and order were not understood by the people, and constantly little troubles arose between him and the people, and they became as discontented as ever. The poor man fell sick and died, and his widow became superintendent ; as assistant, an 270 THE PATH OF THE DESTROYER old sea captain was sent up, but these two could not agree — neither of them could speak with the people, and matters did not. improve; and, in addition to these troubles, the lepers did not receive their full allowance of meat, which was only three pounds per week. It culminated in the discontinuance of the foreign superintendents, and natives t or half-castes were tried, and, as experience has proven, with the best results. Natives are perfectly willing to submit to considerable pressure, even oppression, if it comes from one of their own people, but not from a foreigner. It was often difficult to supply the Settlement with food, es- pecially during the winter season, when the landings are bad; an attempt was therefore made to cultivate the valley of Waikolu with taro, and manufacture the paiai on the spot. This business was undertaken by agents of King Kamehameha V in 1870; the valley was leased to them at the regular market price. Agents were appointed to prosecute the work, and, I am sorry to relate, that some of these agents, in their anxiety to please the King, took away from the lepers all the taro patches they had cultivated for their own use without the least remuneration. One poor leper alone lost twenty patches. Of course, this proceeding put a stop to any future cultivation of lands by the lepers and their families. Thus matters continued at the Leper Settlement without material changes till the death of Kamehameha V (in December, 1872), when, with the ascension to the throne by Lunalilo, a new Board of Health was appointed. Segregation was held by the new Board to be the only means of arresting the progress of the disease, and the most energetic efforts were made to effect the isolation of lepers, and without regard to person. Lepers were no longer allowed to take their wives or husbands with them, and visits to the Settlement ceased to be permitted, excepting only under the most strenuous circum- stances, and only for a brief interview. The injustice of claiming the means possessed by lepers was at once discontinued ; and in the instances where it had been col- lected, mostly from the poor widows, it was refunded to them. The wants of the lepers were considered, and their weekly rations of meat increased, and they were also allowed a greater variety of food, and henceforth received five pounds of meat, or if they wished, three pounds of salmon per week; also one bundle of paiai containing twenty-one pounds, or, if they wished, either ten pounds of rice or seven pounds of bread or flour, and five pounds of salt per month. QUEEN EMMA. Wife of Kamehameha IV. Foundress of the Queen's Hospital. Born January 2, 1836. Died April 25, 1885. 272 THE PATH OF THE DESTROYER A little labor was considered to be beneficial and even neces- sary for the lepers; and, to encourage them to cultivate the lands again, they were allowed the choice to receive the cash value of their weekly supplies of food in lieu of the food itself. This arrangement, subsequent experience has proved to be of great benefit to the lepers as well as to the Board. The lepers managed to cultivate more food than was necessary for their own use, and during winter months, when it was difficult to bring food from adjacent valleys, there was a supply at hand which was bought from the people at the regular market price; thus many of them obtained means to supply wants which were not filled by the Board. Some accumulated money enough to build houses and surround themselves with other comforts, and all without costing the Board one cent more than it would have done otherwise, and it was really rather a saving. The difficulty of giving the lepers an annual supply of clothing caused it to be discontinued, and, instead of it, a store was estab- lished containing every variety of staple goods, to be sold at less prices, only with sufficient advance to cover the expenses of its management and attendance; and such lepers, instead of receiving clothing, were given a bill to the amount of six dollars, for which they could draw at the store what they wished, and these bills were given out just before the commencement of winter on the 1st of October. This arrangement has not been unprofitable to the Board, and it has been of the greatest comfort to the lepers up to this day, and in fact, it would be impossible to do without it. The great bulk of food consumed at the Settlement has chiefly been purchased from the people living in the adjacent valleys of Pelekunu, Wailau, and Halawa, and from there it was mostly brought by the planters to the Settlement in their own boats, sub- sequently in boats belonging to the Board, and by men hired for that purpose. As already has been said, during the winter season it is at times impossible for boats to land, and food cannot be landed. To meet this difficulty, a stock of provisions — bread, flour, and chiefly rice — has to be kept on hand to be used in such emer- gencies. The valley of Waikolu, which forms a part of the Board of Health lands, seemed to offer the means to obviate all the diffi- culty, and another attempt was made to cultivate the same. A contract was made with the male friends, or relatives of the lepers living at the Settlement to cultivate this valley for three years. They were to plant, take care, and prepare the taro, and deliver THE PATH OF THE DESTROYER 273 it to the officers of the Board ; and they were to receive as re- muneration one-half of its market value. This plan promised to work well in the first and part of the second year; but the people got tired, and when the three years were up they were unwilling to continue the work, and it was given up again. Besides lepers there existed, and still exists, a large number of people, males and females, who had been allowed to accompany the lepers during former years. Most of these, having no other homes, found the place a very likely one, where they could make an easy living, chiefly obtained from the lepers. To prevent the too great increase of these people, as well as to discourage idleness, the old time-honored Hawaiian rule of "poalima" (fifth day) was established, and which was then in force all over the islands. It simply consists in that every able-bodied male has to give one day's labor per week to the Board, and in turn they were allowed to enjoy the privileges the land affords — precisely the same as the lepers, with the exception, however, that they receive no rations for either food or clothing. To this rule, being accustomed to it, all cheerfully consented, and it has been kept up strictly until re- cently, but the rule has not been abolished. A limited number of these people called kokuas, or assistants, are absolutely necessary to live at the Settlement, for the per- formance of the work connected with the slaughtering of animals, receiving and distribution of food, preparing food and providing fuel, local police, messengers, etc. ; but all those regularly employed are exempt from the poalima rule, and, in addition, they receive food rations from the Board. Hospital accommodations were increased, and bedsteads fur- nished to the inmates instead of their being compelled to lie on the floor or mats, as heretofore. Water pipes were laid on from the spring in the Kalawao gulch to the hospital, with intermediate taps for the use of the people living all along the road, which relieved them of the great burden of going for the water and carrying it considerable dis- tances, and they also had more water. When His Majesty Kalakaua ascended the throne (in 1873),* most of the gentlemen composing the Board of Health under Lunalilo, with the exception of the president, remained in office for some time, and matters continued to go on very much the same way as under Lunalilo. * 1874 — Author. The number of lepers at the Settlement had increased by this time to about 800, and, in spite of all their efforts to effect their 274 THE PATH OF THE DESTROY ER isolation, numbers always remained behind. Want of sufficient means was probably the cause that segregation was enforced only spasmodically. By this time the biennial Legislature evinced more interest in the condition of their unfortunate fellow-men at the Settlement than had been the case previously, and at nearly every session a committee was appointed to visit the Settlement and report on their modes of living, sufficiency of food, houses, etc., of the lepers; and, in consequence of one of these visits during the Legislature of 1878, of which committee Your Excellency was chair- man, the Settlement received the special attention of the Legisla- ture, which resulted in an increase of their weekly meat rations from five to seven pounds; a number of cottages were also erected, and the lepers received additional necessary articles, such as soap and kerosene oil, and their allowance of ten pounds of rice was change to nine pounds, with one pound of sugar. Previous to this, the Settlement had received very little medi- cal attention, a physician used to come from Maui, two or three times a year, visit the Settlement for a few hours and return. Sub- sequently, efforts were made to obtain the services of a resident physician, the Legislature having provided an appropriation of $10,000 for a physician for the Leper Settlement, which has met with varying success. By this time, 1886, all the grass houses at the Settlement have disappeared and given place to wooden cottages, which are white- washed, inside and outside, twice a year, for which purpose, lime is furnished the people by the Board free of expense to them. There are now, at the present day, according to a recent counting, in all 327 buildings at the Leper Settlement, which in- cludes all the hospital buildings, dwelling houses, store, store- houses, and drug-shop, and five places of worship, of which two are Catholic, two Protestant, and one a Mormon church. Of these buildings, 109 belong to the Board, partly purchased, little by little, from the lepers, but chiefly built on purpose for their accommodation. The rest of the houses are owned by lepers, built by them at their own expense, and some of them quite handsome ones; they number in all 213 houses. Most of these houses are of various sizes, and accommodate various members, but they have small rooms, probably more than three or four times the space allowed under ordinary circum- stances; all these houses have windows and doors, and thus, as they are but one-story buildings, they have all the necessary ventilation. THE PATH OF THE DESTROYER 275 There are now many more houses than existed eight or ten years ago, when the number of lepers reached 800 and upwards, whereas, at the present day, there are but 652. From this alone, it follows, that they are more comfortable, with regard to lodgings, than they have been. The Leper Settlement, with all its houses neatly white- washed, w T ith its churches and other buildings, its surroundings, imposing scenery, certainly presents a very pleasing and cheerful appearance, especially on fine days, when the population turns out. The lepers are allowed to own horses and they may frequently be seen in large numbers all dressed up and enjoying themselves at their heart's content, some few also have carriages, and they may be seen driving; they have, also, a music band, very creditably managed by one of the lepers. Were it not that these unfortu- nates carry the evidence of their misfortune in their faces, it would be impossible to distinguish this Settlement from any other of the same size on these islands. It is probably superior to many. For the lepers w T ho reach the advanced stages of the disease, as well as for those who have no friends, there are now fine build- ings, called hospitals; they are w r ooden structures 46 feet long, by 20 feet wide, and 9 feet high, and for the better ventilation these houses are unceiled and have short chimnies to promote a current of air. There are two rows of bedsteads in these houses at a dis- tance of about 4 feet between each ; they are whitewashed at least twice a year, inside and outside, and are kept as clean as it can possibly be expected with the means at hand. There the lepers are cared for, their food is prepared for them, they receive tea or coffee with sugar or milk, and some extras when the case demands it. These hospitals are at Kalauwao, about 2 miles distant from the landing at Kalaupapa, and surrounded with a picket fence enclosing an area of about one and a half acres. The ground in front of the hospital buildings within this enclosure has latterly been converted into a garden, where the inmates, or those who take an interest in it, plant flowers and some vegetables, making the place look cheerful. The hospitals are in charge of a native steward, who, I am happy to say, takes considerable pride in doing his duty well, and to have all the buildings clean, and the wants of the sick attended to. A new cook-house has been built, probably eighteen months ago, and whenever I have seen it, it always w T as clean and tidy, very different from what it used to be. These hospitals are also regularly washed, and there is really now but very little bad odor compared with former years, when the means of obtaining a sufficiency of water were difficult. The clothing of the inmates is washed by people employed for that purpose. But 276 THE PATH OF THE DESTROY ER in spite of the care taken to make these people comfortable, very few care to go into the hospitals, they do not seem to feel at home there, and the buildings are seldom more than very partially filled; at present there are only 43 inmates; 36 of them are males, and 7 females. Besides these hospitals there are two other buildings, one for boys and another for girls, which are in charge of Father Damien, and on this account they are in the immediate proximity of his own dwelling-house. These houses are intended for the reception of orphans or children who have neither parents nor friends at the Settlement. Other children at the Settlement, live with their parents or relatives, in the same manner as they do in other places. There are two schools for them, one at Kalaupapa, the other at Kalauwao; the former has a kokua, not a leper, for a teacher; the latter a leper. The leprous and non-leprous children go into the same school, but are kept in separate places in each of these schools. The number of scholars in all are 50, of whom 36 are boys and 14 are girls. Segregation of sexes has only been attempted with the hospital yard, where the women occupy separate houses from the men ; and with the children, living in the two houses in charge of Father Damien. The condition and behavior of married people at the Settle- ment appear to me to compare very favorably with other places, and I do not believe that their standard of morality falls below, if any, that of people living in other settlements. Everything is done to provide for married people either separate houses or rooms, as far as the means at hand allow this to be done. The lepers do not directly receive clothing from the Board, but they receive an order to the value of six dollars annually, for which they receive at the store whatever articles they stand in need of; but I must say that, as they now have no means of earn- ing any money, that those who have no friends to assist them can- not clothe themselves sufficiently for six dollars per annum; and there would be more or less suffering were it not that charitably disposed people, especially the people of Honolulu have occasionally sent such contributions of clothing, etc. ; collected by Her Majesty the Queen, which supplied the wants of the needy ones. Friends and relatives of lepers living on the other islands are permitted to visit the Settlement, and live with the lepers for a shorter or longer time, from one week to a ?nonth or more, pro- vided they produce a permit. (Very lax segregation. — Author.) For the preservation of law and order, a magistrate has been appointed, who, although vested with the authority of a district THE PATH OF THE DESTROYER 277 judge, uses his office chiefly as a judge of peace, or peace arbi- trator. All difficulties and disputes arising between the lepers are settled in a friendly manner, without expense to either party, and apparently to the satisfaction of all. With the exception of the one unfortunate case of man- slaughter, committed at the Settlement in November last, crimes have been of rare occurrence. Since 1882 there has been but one case of burglary, and during the last two years only one case of attempted burglary. For such crimes, of course, the offenders are punished with imprisonment; but, being sick, the time of imprison- ment is made very much shorter than the law really prescribes. As laws and rules which cannot be enforced had better not be made, it has ever been the endeavor of those having had charge of the affairs of the Settlement to establish as few of them as possible, and only such which years of observation and public opinion at the Settlement made and approved. These rules, there- fore, are few, but the following of them have been the means of preserving the peace. Each leper has the right to select a building spot wherever he pleases, provided the place is not essential for purposes of the Board of Health, and he is therefore required to notify the super- intendent. Each leper on arrival at the Settlement has also the right to select the family or company he desires to live with, pro- vided, however, they do not object to it. If they object, he is given a place with others who are not adverse to it. Lepers building houses at their own expense, have the right to sell those houses again to other lepers, for lepers to live in. All houses built by lepers at their own expense, therefore owned by them, are, nevertheless, considered to be under the control of the Board, if to assert such a control, for good reasons, should become necessary. Lepers trusting one another with money or other things must do so at their own risk, nothing is done for them, officially, by any officer of the Board. Claims against deceased lepers for services rendered during their last illness are respected, if testified to by the leper before death and in presence of the chief officer of the Settlement; and if his heirs do not pay the disputed amount, his property, if he leaves any, is sold and sufficient of the proceeds is paid for such services. The property of a leper who dies without heirs at the Settle- ment or assigns, is sold by the sheriff of the Board and the pro- ceeds are forwarded to the president of the Board of Health, and the death of the leper is advertised in the papers that his heirs 278 THE PATH OF THE DESTROYER may come forward and claim what he left. Wills left by lepers are also carried out by the Board, provided they are satisfactorily made out and properly witnessed. Drinking intoxicating beverages is forbidden, and persons found drunk are punished with twenty-four hours' imprisonment. Making intoxicating drink from potatoes or ti root is likewise prohibited and punished, and all material used in making the same is confiscated and destroyed. Liquor for the use of lepers and kokuas is not allowed to enter the Settlement, and suspicious looking packages when they come ashore are opened. If liquor is found, it is confiscated and des- troyed or sent to Honolulu to the marshal, to whom opium, if found, is also sent. Gambling is also forbidden at the Settlement, and guilty persons are punished. For the kokuas, the same rules are applied with some addi- tional ones. Every able-bodied male kokua gives one day's labor to the Board per week, for which he enjoys all the privileges and benefits of the place. Kokuas deserting their leprous wives or husbands, on whose account they were permitted to live at the Settlement, are told to leave. Kokuas repeatedly guilty of disorderly conduct or gross im- morality are likewise ordered to go. Every kokua can leave the Settlement when he pleases, but he cannot return without a special permit from the president of the Board of Health. Kokuas guilty of crimes or misdemeanors, are tried according to the laws of the Kingdom. These are, substantially, all the rules which have thus far been observed at the Settlement, and, with the exception of the unfortunate occurrence last November, already mentioned, affairs have gone very smoothly during the past period. During the past twelve or fifteen months the lepers have had a much better opportunity to avail themselves of medical attendance, than they have ever had before, having had the services of a resi- dent physician during the greater portion of this time. The live stock now running on the pastures belonging to the Leper Settlement consists in 235 horses, 288 mares, and 74 colts — in all, 579 horses; 40 cows, 18 steers, 25 heifers, 10 working oxen, 1 bull and 25 calves — in all, 119 cattle; 20 jackasses and 3 mules — THE PATH OF THE DESTROYER 279 in all, 23 ; making a total of animals of 739 head now running on the land. Suggestions for further improvement of the condition of the lepers and additional comforts, I have but few to make. Since the discontinuance of allowing lepers the choice of re- ceiving the cash value, in lieu of their weekly food rations, many of them have become rather poor; they do not plant as much as they used to, as they cannot sell their produce ; it ceases, with them, to be an object to raise it. I beg, therefore, to recommend the re-establishment of the system of giving them the choice to receive either the food itself or cash in lieu thereof, besides providing means as much as possi- ble to enable them to earn a little money, such as by raising po- tatoes and purchashing them again, as used to be done for the supply of the hospital, and others who very often prefer them to paiai, rice or bread. They will then be able to supply themselves with some additional clothing and other necessities, for, as already said, "six dollars per annum" is insufficient to clothe anybody. It does not cost any more to give them cash in lieu of. food, rather the contrary, and were it only practicable to adopt the plan of giving them all cash in lieu of food and meat, it would very much simplify the management of the place and be less expensive. Whilst I do not wish to deny the desirability of laying a larger water pipe, and extending the same to Kalaupapa, I must say that no absolute necessity for it exists, but should means be at hand and permit it to be done, I would recommend that it be done. And in that case, I would still advise obtaining the water from an abundant and unfailing source, by which Kalauwao, Makanalua and Kalaupapa and the entire Settlement can be supplied at once, for almost any desired purpose, than to obtain the supply from springs which are too much dependent on our irregular and un- certain rainy season, even should it cost a little more. I would also recommend the erection of a new slaughter- house, the present one is getting old and in a place where it is difficult to be kept clean, and put in a place where it can be sup- plied with water from the pipes, and save the expense of carting the same. Furthermore, I consider it an advantage, when providing the Settlement with beef-cattle, to obtain a larger number at once; (orders to send cattle to the Settlement to fatten on the pastures, have repeatedly been sent to Meyer. — Secretary Board of Health), 280 THE PATH OF THE DESTROYER sufficient, perhaps, to last three months, that they may derive some benefit from the extensive pastures. As a rule, cattle lose in weight for the first two weeks after being landed, owing to change of place and pasture, but will soon regain what they have lost, and probably add considerably to their weight. To the request, what my experience and observations during these years of intercourse wkh lepers and others have taught me, relating to the contagiousness or uncontagiousness, heredity and causation of leprosy, I will give the result, which may be taken for what it is worth. "In the face of so much evidence of its spreading in so short a time as it has done on these islands, it is hard to conceive how anybody, professional or non-professional, can doubt the communica- bility of leprosy. It is simply the extreme slowness of its action and development, the apparent immunity from it, which so many seem to possess, and the imperceptible manner of its communica- tion, which could have led to the conclusion that the disease is not contagious." — Dr. Mouritz. I arrived on these islands in 1850, and very little, if anything was then known of leprosy. About the year 1857, I first heard of its appearance amongst natives, under the name of Chinese disease, or in Hawaiian, "Mai Pake." It was recognized by the few Chinese then on the islands, and this has given it the name of "Mai Pake" here, and not because it has been introduced here by the Chinese. It is much more likely that it came to these islands through the mixed crews of whale ships, which had negroes, black and white Portuguese, and men of other races, coming from countries where leprosy was, and still is, prevalent. In about 1859 or 1860, I saw on this island the first case of leprosy; it was a young man, he died with it in less than three years. The young man's mother took care of him, probably, and in 1868, she showed signs of leprosy, and died a leper at the Leper Settlement. I have known these people well, for they lived in my neighborhood. I only mention this one case, although I have account of others. And at the Leper Settlement, whilst there are many cases where people have lived together for many years with- out showing visible signs of leprosy at present, there are enough who do, and, as I reported before, fifty-two kokuas alone, have be- come lepers during the past two years, or declared to be lepers, by the physicians attending. Again, a number of foreigners of THE PATH OF THE DESTROYER 281 various nations — American, English and German — have become lepers. Is it reasonable to suppose that all these men would have become lepers had they remained at home where they were born? They became lepers, because they came here, to a place where leprosy was prevalent, and exposed themselves to it. Leprosy attacks the robust as well as the delicate, but it appears that people with syphilitic and broken-down constitutions are more apt to become its victims. That no more foreigners have contracted the disease than they have, is simply owing to their better mode of living and care they take to avoid coming in con- tact with leprosy, and it may be that they possess a great degree of immunity. The disease appears to me also to be hereditary, and I will give a short history of a couple, a man and his wife, living also in my vicinity. Both man and wife are strong and hearty look- ing people, they show no outward signs of the disease, yet their children at the age of six or seven years became lepers one after the other, several of them were taken to the Settlement years ago, and there died lepers, and they have now with them another child, also a leper. How did these children become lepers? The husband's mother died a leper, the wife's father likewise. Is here not reasonable belief that these children were born with the germ of the disease in them, and that it was transmitted to them through their grandparents? Similar cases exist or have existed at the Leper Settlement. Another significant fact is the great number of cases of leprosy existing, where other and older members of the family of such cases are lepers or have died with it. The cause of the disease appears to me to be more or less speculative, by taking a general view and comparing the same with other diseases, it is not improbable that leprosy is caused very much in the same manner as they are. If it be true that like causes, under like circumstances or conditions, always produce the same effect, or similar effect, it must be evident that all diseases, running a known course, from that visible beginning to the end, must have had always the same origin, each disease peculiar to its kind, very much like the sprouting and growing of seeds of dif- ferent plants. What this origin of leprosy or other disease consists in I do not pretend to know; it may be a parasite or organism of an in- conceivably small size, which enters the body, and under unknown 282 THE PATH OF THE DESTROY ER conditions develops and reproduces itself until it has taken pos- session of every part of the body, including the organs of re- production. Until the true cause of the origin of leprosy has been dis- covered, there does not appear to me to be much hope of arresting the progress of the disease or effecting a cure, and no other means can be expected to stem the spread of this scourge than the most merciless and rigid enforcement of the law of segregation. It would prove to be the most merciful in the end. Twenty years of segregation have now been practiced. What is the result? There are as many lepers as ever, more than in the commencements Halfway measures are here of no avail, they simply amount to a constant repetition of those heart-rending scenes, experienced by so many, of separating husbands from wives, parents from chil- dren, brothers from sisters, and without accomplishing the impor- tant purpose of saving the rest of their fellow-men, and for which they were required to suffer, and willingly gave up their liberty. I am fully aware of the insuperable difficulties encountered in carrying out the law of segregation on these islands, and there- fore doubt the possibility of having it carried out to the extent it ought to be. There is, however, one hopeful sign, the disease appears to assume a milder form, and the number of the very bad cases, of which there were so many in former years, is very much smaller and the disease appears to progress slower. I have the honor to be, sir, Your obedient servant, R. W. MEYER, Agent Board of Health. BROTHER JOSEPH DUTTON Soldier, Trappist Monk, Soldier of the Cross. Brother Joseph Dutton, of Kalawao, Molokai, the indefatigable worker amongst the lepers during the past, thirty years, is a veteran of the Civil War. He was an officer connected with the Army of the Cumberland, and was then known as Lieut. Ira B. Dutton, of Co. "B," 13th Wisconsin Volunteer Infantry, and had a splendid record as a soldier. He was born on April 27, 1843; his boyhood was passed at Janesville, Wisconsin, and in his youth he displayed the same ex- cellent qualities as he did in the Army, and has done during the past thirty years at the Leper Settlement, Molokai, Hawaii. In the summer of the year 1861, Dutton enlisted in the then recently formed Co. "B," 13th Wis. Vol. Inf. He served the length of the war, some four and a half years. The record of his army service is as follows: Quartermaster sergeant, 13th Wis. Inf. to February 10, 1863; Second Lieut., 13th Wis. Inf., Co. "I," February 10, 1863; First Lieut., 13th Wis. Inf., Co. "I," February 15, 1865; First Lieut, and regimental quartermaster, March 24, 1865. He was strongly recommended for appointment as captain and H. Q. M., U. S. Vols., by Major-General Geo. H. Thomas, Major- Generai J. L. Donaldson, Major-General L. H. Rosseau, Major- General Robert S. Granger. Lieut. Dutton was on the staff of the last named officer from June, 1864, to October, 1865, the end of the war. Col. A. Wills' testimony of Lieut. Dutton's value as a soldier is herewith given : "We were in the Army of the Cumberland together as officers. Dutton was a handsome fellow, and one of the best and bravest officers in the army. He was complimented in official orders for bravery. At the close of the war in 1865, Dutton was mustered out of the service, and I then engaged him as one of my superin- tendents in the locating and purchasing of National Cemetery lands in the Southwest. He was later engaged in caring for and trans- porting the bodies of the heroic dead of the battlefields, now in- terred in the cemeteries at Corinth, Mississippi, and Pittsburg Landing, Tennessee. After leaving the Government service, Dutton was employed by the Louisville and Nashville Railroad Company at Memphis, Tennessee; upon leaving the service of the company he engaged in religious work, became a convert to Catholicism, and soon after entered the Trappist Monastery at Gethsemane, Ken- tucky." Brother Joseph Dutton came to Hawaii in the year 1886, and Upper, Lieut. Ira B. Dutton, A. D. 1863. Middle, Lieut. Ira B. Dutton, A. D. 1877. Lower, Brother Joseph Dutton, A. D. 1907. THE PATH OF THE DESTROY ER 285 in the early afternoon of Thursday, July 29th, of that year he arrived at Kalawao, calling at my house on his way to the Catholic Mission premises. He took up his residence with Fr. Damien, later occupying a small house near the residence of the priest. Since his arrival, now nearly thirty years ago, Brother Dutton has never once set his foot outside the boundaries of the Leper Settlement; but he could leave, if he so desired — he is not a leper. The Leper Settlement is under the control of the Board of Health of the Ter- ritory of Hawaii, and there is no law or statute on its books that can compel a non-leper to remain at the Leper Settlement, if said person desires to leave, move, or reside elsewhere. Any nurse, kokua, brother, sister, or other employee who is not a leper, is a free person. There is no such condition as involuntary confinement for a well person, but such statements find frequent place in certain newspapers. The day of his arrival Br. Dutton took luncheon with me, and I scanned him carefully. He had come afoot from Kaunakakai, a port on the south side of Molokai, about nine miles from Kalawao. It is a hot, dusty, fatiguing trip, even on horseback, yet Dutton showed no fatigue nor travel-stained clothes. He wore a blue denim suit, which fitted his well-knit, slim, lithe, muscular figure. He stood about five feet seven inches tall, had dark brown hair and grayish-blue eyes, low voice, placid features, and pleasant smile ; he was reserved and thoughtful, had nothing to say about his past life nor the reason for his seeking seclusion and work at Molokai, and turning his back on the world forever. Brother Dutton soon demonstrated that leprosy had no power to instil fear in his mind. For many months after his arrival, his daily routine, from daybreak to dark, was cleaning and dressing the sores, ulcers, and other skin troubles; removing carious and necrosed bone — all of the type that leprosy inflicts on mankind. He was methodical and accurate in his work, and quick to learn the rudi- ments of medicine and surgery. I started him dressing the wounds and sores of the leper proteges of Fr. Damien, and showed him (Dutton) the method of affixing dressings by properly applied bandages and other appliances. Within a very short period he he'd become so apt that he surpassed his teacher; in brief, "whatever Br. Dutton undertook to do he did it well." He always seemed to find time to attend to the numerous duties that fell to his lot, the more his work expanded the bettei he seemed to like it. He possessed a DIVINE temper, nothing could ruffle it, no vulgar or angry speech ever emanated from his lips; although his clothes were cheap, rough, and uncouth, he was always dignified and commanded respect. He never ceased to be neat and clean, and I have always believed this was his salvation 286 THE PATH OF THE DESTROY ER and protection from leprosy. I enumerate some of Br. Dutton's manifold duties performed daily: Fr. Damien's companion, secre- tary, servant, nurse, and other menial work, sexton, sacristan, ver- ger, purveyor for Fr. Damien's Homes and his household, hospital steward, dresser, clinical clerk, later manager of the Baldwin Home, sanitary engineer, architect, landscape gardener — the site of the Baldwin Home was formerly an unsightly pile of rocks, note the transformation, as shown in the picture. Br. Dutton was also post- master. For years, single-handed and alone, he filled well all of the above offices. Br. Dutton will be seventy-three years of age on April 27, 1916. His services have been invaluable to the Board of Health and all the lepers; his earthly reward has been board, lodging, and a few dollars a month, but his greatest and most cherished recompense has been the love and esteem of those afflicted persons he has had charge of, who number at the Baldwin Home alone 1,148 to July, 1915. This Home opened in the year 1894, for single men and friendless boys, comprises forty-five houses, and has an excellent sewerage sys- tem. The grounds are well kept — have a forest of 5,000 eucalyp- tus trees, a large number of Samoan cocoanut trees, all planted under the supervision of Br. Dutton. During his thirty years of residence, great changes have taken place; grass houses, lean-tos and shacks have given place to com- fortable cottages with neat gardens; the meagre water supply has been supplanted with an abundant and never-failing source, suffi- cient for a modern city. These improvements, begun in the year 1887 (due in the main to the energy and forcible personality of the then Minister of the Interior, Lorrin A. Thurston, ex-officio member of the Board of Health, and in later years — the nineties — to William O. Smith, many years president of the Board of Health), are still in progress, until the Leper Settlement has reached a degree of efficiency, that, it is unquestionably the foremost insti- tution caring for lepers in the whole world. I add, in concluding Br. Dutton's life history, he has always been careful, cleanly, and prudent whilst in contact with leprosy; and after thirty years of intimate association with the disease he re- mains unscathed. THE CHARLES R. BISHOP HOME, KALAUPAPA The noble, devoted, and priceless work carried on at this Home fcr leper girls and single women, is beyond all earthly praise and approval. The venerable and saintly Mother Superior Mary Anne, and her Sister companions, are prototypes of Martha and Mary and other holy women of the Biblical times. The Catholic Sisters dread publicity, hence the history of their lives, devoted to the service of God, cannot be written or printed. REV. CHARLES M. HYDE, D. D. 1884 A. D. REV. CHARLES M. HYDE, D. D. Dr. Charles M. Hyde arrived in the islands May 31, 1877, and died in Honolulu, October 13, 1899, aged sixty-seven years. Extract from "The Friend,'' November, 1899: "Dr. Hyde's executive ability and intelligence made him a trustee in many educational and other institutions — notably Oahu College, Kame- hameha Schools, and the Bishop Museum. In each of these he has occupied a leading position ; in the organization and development of the Kamehameha Schools, his has been the leading hand in the work * * *" (For the above information, I am indebted to Mr. Thos. G. Thrum, eminent statistician, and foremost in knowledge of all matters pertaining to the Hawaiian Islands.) Glancing over the dates of Dr. Hyde's arrival and death, it will be seen that the doctor had resided in Hawaii well over twenty-two years. I will add the following supplemental facts showing the wide scope of the doctor's life work and activities. "Prominent church worker, recording secretary of the Ha- waiian Evangelical Association, trustee on the Board of the Public Library, and head of the North Pacific Institute, a theological training school for young men of Hawaiian, Caucasian-Hawaiian and Chinese-Hawaiian descent, to ultimately fit them for ordi- nation to the priesthood." The doctor was scholarly, polished, and refined; belonged to to the best class of Americans, he came from New England. He rather reminded me of a college proctor or don, such as we have in European universities, or even the rector of the same institution. The doctor's disposition was placid and calm, his voice low, his features were handsome and refined, his eyes and the general expression of his features tended to sadness and thoughtfulness combined, his personal appearance was good. He did not amass wealth ; he was in no position to do so, he worked amongst the poor, opened his purse to them and gave them freely of his means. He once authorized me to make a certain purchase; I thought the limit price was 50% too low, and asked the doctor to allow me to use my discretion and give more, rather than lose the pur- chase. He answered, "I cannot afford it, my purse is strained to the utmost ; if you cannot obtain it at the price named I must go without it." This is pretty good proof the doctor was not wealthy. My first meeting with Dr. Hyde occurred in September, 1884, THE PATH OF THE DESTROYER 289 at Waialua, Oahu, at the supper table in the home of the vener- able and motherly lady, Mrs. Ursula Emerson, of original mis- sionary stock. The doctor and I spoke not, no introduction being made. VISIT TO THE LEPER SETTLEMENT My second meeting with Dr. Hyde took place on the after- noon of Wednesday, September 2, 1885, at Kalawao, Molokai. The doctor had landed at Kalaupapa from the palatial steamer "Mokolii," alias "Mud Hopper," of ninety-six tons burden. It was his first visit to the Leper Settlement, his business was to look after "church matters'' and also consecrate the newly erected Protestant church at Kalaupapa. He accepted such hos- pitality as I could extend to him, and remained in the Settlement some weeks. During the following days Dr. Hyde was busy with church affairs; later on he made a careful examination, investigating fully the schools and homes which Father Damien had founded for the orphan and friendless children. The doctor marveled greatly at the vast amount of work undertaken by Father Damien, and the promising results obtained with such a paucity of material. Dr. Hyde emphasized the benefits that would accrue in having more commodious and up-to-date buildings in every respect, for girls and single women, for boys and single men ; nursing was also debated and the conclusion reached that paid, trained foreign nurses were out of the question, Sisters and Brothers of Catholic organizations being alone available and promising success. Father Damien only too eagerly acquiesced and hoped ultimately to see those changes carried out. RESULTS OF DR. HYDE'S VISIT Dr. Hyde's visit was directly and indirectly of untold benefit to the lepers. The doctor had the ear and confidence of wealthy men connected with the then Fort Street Church, now Central Union, both Mr. Charles R. Bishop, and Mr. Henry P. Baldwin of Maui, were connected with this church. The congregation and membership of Fort Street Church was then the wealthiest and largest in the islands, and Dr. Hyde's visit to the Leper Settlement ultimately brought about, the de- sired result. A few years afterwards, excellent and commodious homes were built by Mr. Charles R. Bishop at Kalaupapa for FORT STREET CHURCH, CORNER OF BERETANIA, HONOLULU. In the year 1892, this building was dismantled; the congregation moved to their handsome new church at the corner of Beretania and Richards streets, called "Central Union." After the destruction of the "Bethel Church," its congregation amalga- mated with the Fort Street Church, and subsequently with "Central Union." THE PATH OF THE DESTROY ER 291 girls and single women, and by Mr. Henry P. Baldwin at Kala- wao, for boys and men. Both these donors are dead. Mr. Joseph Dutton was put in charge of the Baldwin Home and Mother Superior Marianne in charge of the Bishop Home, and both these parties still survive, and still are active in dis- charge of their duties. These homes built by Protestant dollars are in charge of and administered by Catholic Sisters and Brothers. If Hawaii nei is the "Melting Pot" of the numerous races which inhabit its islands, it can also be truly said that Hawaii is also the "Melting Pot" of religions and sects, where all dwell to- gether in peace and amity. In no other country has the Brother- hood of Man and the Sisterhood of Woman reached such an advanced stage as in Hawaii. We have no beggars! We have no poor houses! How many other countries can assert the same. PARTIAL AND IMPARTIAL DONORS In former years only four denominations existed in Hawaii — Protestants, comprised of (1) American Congregationalists, and (2) Episcopalians, chiefly British, (3) Catholics, (4) Mormons. The chief wealth and power (as I have before stated) was in the hands of the American Protestant church (original mis- sionary church.) Today the missionary children and grandchildren, are the chief supporters and voluntary benefactors of the Leper Settle- ment; the Catholics coming next. The Episcopalians had no place of worship at Kalawao, the zeal and activity of Father Damien took most of them into his fold. When I was at the Settlement, the Catholics, Calvanists (Missionary Congregationalists), and the Mormons all had their own church buildings. There also existed certain adherents of the royal families of Hawaii with strict dividing lines; the followers of Mrs. Bernice Pauahi Bishop, the most numerous, haughty and distingue, then the followers of Queen Emma, and lastly the followers of the reign- ing Kalakaua dynasty. Quite naturally gifts and donations from each of these royal sources were distributed to their partisans. In marked contrast was the distribution of gifts and dona- tions to the lepers for Christmas, furnished by the members of the various churches in Honolulu; especially impartial were the do- nations from the missionary children, they were for all, irre- spective of church or creed. 292 THE PATH OF THE DESTROYER Money and other gifts were placed in my hands with no re- strictions whatever — "Give to the most needy" was the injunc- tion. All of which goes to show that the people of Hawaii are remarkably liberal and progressive in their ideals, and set a shining example to other countries to follow. During the term I held office as physician to the Leper Reser- vation, the pastor in charge of the Protestant religious work was the Rev. J. Hanaloa; he was past sixty years of age, semi-blind and enfeebled; he was burdened with a sick wife, a victim of the nodular form of leprosy. This condition of his household naturally hindered him in his work. He was the type of old Hawaiian, who is rapidly passing away; minded his own business, frowned down upon drunkenness, card playing, and other occupations that lead to nocturnal orgies; his rebukes were given in such a mild manner that the sinners could take no offense. The Rev. Hanaloa had been brought up under the tutelage of the Rev. J. S. Emerson and his wife Ursula, and his (Hana- loa's) religious and other pastoral work did them much credit at the Leper Settlement. Oliver Goldsmith has informed us in his beautiful and soul- stirring poem, the "Deserted Village," of the village pastor, who passed rich at £40 a year — $200. The incumbent of the pastorate at Kalawao, Molokai, received a salary somewhat less, but it was materially added to by Mrs. Rice (Mother Rice) of Kauai, who always had a kind word and money for the poor and needy. Another worthy, generous, unassuming gentleman also contrib- uted to the stipend of the Rev. J. Hanaloa — the late James B. Atherton, who deceased April 7, 1903. PART IV. REPUBLISHED BY REQUEST REPORTS ON LEPROSY AND THE LEPER SETTLEMENT Thirty Years Ago REPORT OF HER MAJESTY QUEEN KAPIO- LANI'S VISIT TO MOLOKAI, BY H. R. H. PRINCESS LILIUOKALANI, JULY, 1884. To His Majesty the King: Sir: I have the honor to submit the particulars of Her Majesty's visit to the Leper Asylum on Molokai, whom, in obedience to Your Majesty's wishes, I accompanied thither. The steamer "Waimanalo" having been placed at the disposal of Her Majesty by Hon. J. A. Cummins, the party embarked early on Saturday, the 19th of July, 1884, leaving Honolulu at 3 a. m. and arriving at Waimanalo at 8 a. m. that morning. The weather proving favorable on Monday morning, we left that port for Kalaupapa, reaching our destination in the after- noon. At 4 p. m. the party consisting of Her Majesty the Queen, Hon. J. A. Cummins and lady, who were in attendance upon Her Majesty, Dr. Edward Arning, and Mr. C. B. Wilson, comptroller to my household, landed and were received by Ambrose Hutchi- son, the assistant superintendent, Rev. Father Damien, and Rev. Father Albert, who escorted the party to a house where a large number of the patients were assembled. The Hon. J. A. Cummins addressed the people and stated the object of the queen's mission among them. Her Majesty then arose and with the usual salutation of "Aloha Oukou," briefly addressed them as follows: "With love I greet you all. My heart-felt sympathy and that of His Majesty the King, your Father, is with you in your affliction. The King has sent His Sister, the heir apparent, to accompany me in this mission, to show his love to you. I also bring to you the love of the people of Honolulu, the ladies and gentlemen, natives and foreigners, and those of the other islands who have assisted me in raising the necessary funds and contribu- tions for your relief. I have been made familiar with your letters to me, and pe- titions to the Legislature, and whatever remarks you may have to make we will be pleased to hear them while we are with you. The principal object of this mission to your asylum is to 296 THE PATH OF THE DESTROY ER know your condition, and to render such assistance as may be neces- sary for your comfort." The people were much moved with the queen's remarks. The assembly standing during the address. At the conclusion of Her Majesty's remarks, Kailikapu made the following address: "Your Majesty, Your Royal Highness, and gentlemen, I must, first, on behalf of my fellow sufferers, express to you our warm and heart-felt feeling and thanks for this exhibition of your tender love and affection towards us, your afflicted people. I have been an old inmate of this asylum, and this is the second time I have been removed from Honolulu to this place, where I suppose I must remain like my afflicted fellows to linger out a miserable existence without a hope of cure; away from the comforts of home and the society of family and friends. Since my last re- moval to this place, by a close observation of the workings of the disease here, I have become thoroughly convinced of the non- contagious nature of the disease. Instances are numerous here where men afflicted with the disease have been accompanied by healthy wives, who have lived with them, and nursed them for years until death, without the wife becoming afflicted by the dis- ease, or in the other case, the husband. Children, too, have been born of diseased parents and reared among the lepers, without contracting the disease; several such cases are among us now. Such being the case, I cannot see how the disease can be called con- tagious or why we are segregated in an isolated place, where our most urgent wants are but poorly supplied. Poor food, insuffi- cient as regards quantity, and want of proper care and nursing, are prominent among the ills of which we have to complain, and if the government cannot supply these as they are supplied to us when at home, they should return us whence we came. Our rations consist of 21 lbs. of paiai, 7 lbs. of beef, and 1 lb. of sugar per week. Of this 7 lbs. of beef, 5 are often made up of bone. This is sufficient for one person only for three days, and the remaining part of the week he has to go without food. Those living at Kalaupapa have to travel five miles to get their rations, and there being no means of conveyance supplied, such as are too feeble to travel that distance, and have neither horses of their own to travel on, or friends to assist them, are often de- prived of food. Many poor, disabled people, too, are unable, in their feeble and mutilated condition, to prepare their own food THE PATH OF THE DESTROYER 297 after they have got it. When the rainy season sets in the streams would be swollen, and these feeble ones would sometimes be so •exhausted that they were unable to cross the stream on their way home, and therefore had to wait until the storm and freshet subsided before they were able to cross. From this cause many have taken cold, and died in consequence. An order for six dollars' worth of clothing is allowed per year to each patient, which they get filled at the store of the Board of Health. This is altogether insufficient. One woolen shirt and a blanket is all it will buy. On account of being thus poorly supplied with clothing, some died of cold, especially in the winter months. One great need also is wholesome water to drink and use for preparing food. Now we have to go three miles for water and pack it ourselves, and very often we are compelled to use the brackish water from a well near the beach. I will also speak of another matter — that is, of the healthy children amongst us. Why are such children (many of whom are well grown, and without any sign of the disease about them), allowed to remain here and become patients through contagion? Why are they not taken elsewhere and properly cared for?" The second speaker, Mr. Kahanapule, said: "Greeting to you our Queen, and to your Royal Highness and gentlemen: By the request of the patients now residing at Kalaupapa and Kalawao, I was selected from among their number to draft a petition in their behalf to be presented to the Legislature, now in session, in which was made a statement of our needs and a prayer for re- lief — a duty I was glad to perform. The confidence they have placed in me to act in their behalf, I now avail myself of on this occasion to make known to you what I believe to be our sorest needs; I speak in the interest of those people you now see around you, and more especially of those in crippled condition, unable to be present to meet you upon this occasion, and of those who have joined with us in showing our appreciation of the great love you have shown to us in the willingness with which you have crossed the dangerous ocean to meet us, and hear our appeals and relieve our necessities. Our needs are many. Foremost among them is the necessity of clothing, someone with authority to settle our difficulties, and satisfactorily dispose of them. At present we have to submit without appeal to the arbitrary ruling of Agent Meyer of the Board of Health, and are often incarcer- 298 THE PATH OF THE DESTROYER ated for alleged offenses in a summary manner, and without a hearing of the case. It is the desire of many of us that a resident judge should be appointed, who will always be present to hear and determine in a proper manner many of the little grievances between the members of our colony, and also be empowered to punish justly any offence against the peace and good order of our community. Our general superintendent visits us only once during each quar- ter of the year, and remains altogether too short a time to make such investigations as are necessary to the end of justice. Es- pecially frequent are desertions in married life, and the annoyance suffered on this account is great. Many, today, amongst us are living in adultery, because they feel secure in their removal from the reach of the law. With the general government I have no fault to find, as every endeavor is being made to provide for our wants; but I do blame the Board of Health for its laxness in carrying out a proper system of supplying those wants which have been liberally provided for by the government. Our paiai, for instance, is landed at Waikolu Gulch, about five miles distant from Kalaupapa, and the patients of that part are necessitated to pack it themselves all that distance. This is a grievous task to many, while to those who are weak it is an impossibility. The place of landing, too, is so situated, and the road to it impassible, that in stormy weather travel there becomes actually dangerous, and at times pack-horses, together with their burdens, have been washed away and drowned, and men too have barely escaped with their lives. In such an event, those to whom the food be- longs are necessitated to go without their supply until a new lot has been received. After the paiai is obtained many of the more crippled are unable to prepare it themselves, and can have no water to mix it with unless they are willing to use the brackish water near the beach, which is entirely unfit for any such purpose. "Those who prefer it may, in lieu of paiai, have nine pounds of rice and seven pounds of hard bread per week. They are compelled to make the change when the poi supply is short, or when they are unable to go that long distance for paiai. But such food is not satisfying, even when we have eaten our fill with other kinds of food we are not satisfied. Poi is our natural food, and nothing could take its place. Kokuas who help the patients have to be fed out of their rations, and when this is the case the weekly supply of food is not more than sufficient for three days, and the unfortunate one goes part of the time hungry. QUEEN KAPIOLANI. Wife of King Kalakaua. 300 THE PATH OF THE DESTROY ER Many of the patients have kokuas to prepare their food for them, otherwise they would go without food, and sometimes do, and die of starvation. What the previous speaker has said in regard to the insufficiency of warm clothing and the number of consequent deaths is perfectly true. If the government intends to keep us here, let the Board of Health be instructed to exercise a better care over our wants. Each of us has an allowance of six dollars a year." Mr. Ambrose Hutchison, who is under-superintendent of the entire Settlement, said: "Being myself an employee of the Board of Health, I feel it my duty to uphold the actions of the Board where they are defensible, but at the same time I feel it my duty to my fellow sufferers here that I should speak plainly of matters as they are. I concur in the statements made by the previous speakers with reference to the food supply, and the mode of de- livery. Their statements are not exaggerated. For those who are so crippled as to be unable to attend to their own wants a hospi- tal is provided; but their prejudices against the institution prevent many of them from availing themselves of the comfort there af- forded. Their dread of the place may be easily explained, when we take into consideration the fact that it was formerly a practice to send along with each patient, by the same conveyance, a coffin he was soon to occupy. Add to these things the fact that no proper care or nursing is provided, and the horror of the place so generally entertained by the patients is easily explained. The great, want here is the institution of more approved nursing facili- ties. The hospital patients should be also supplied with better accommodation generally, and be provided with a more appropriate place in which to take their meals. If to such provisions were added that of a resident physician and an efficient staff of nurses, the main source of objection would be removed, and then they might enter the hospital willing instead of avoiding the place as they do now. Could some Sisters of Mercy be induced to come up and remain among us, as is now the case at Kakaako, it would certainly be a great blessing. The nursing is now performed by kokuas, who receive no pay, and whose hearts are not in their work, and amounts to nothing so long as they attend to the wants of their own people. They go and come as they please, and pa- tients suffer much from their neglect. One thing I would like especially to call your Majesty's attention to, and that is among us are a number of children born of diseased parents, who them- selves are entirely free from all symptoms of the disease." THE PATH OF THE DESTROYER 301 Taking in his arms a little girl about ten years old from the crowd, the speaker said: "Here is one of them, and there are here between fifty and sixty just such cases as this, and at various ages. These should be kept aloof from the diseased and properly cared for in a separate asylum, and not be allowed to remain where the chances are of so many of them becoming patients by contagion. I would urge upon the Queen and the Heir Apparent to have this matter attended to, and to allow the weight of their elevated positions and the great influence they possess to bear upon the Board of Health, in order to bring about the realization of so worthy an object. In conclusion I can only express my hope that this royal visit may be pregnant of future good, and may prove the harbinger of an improved moral and social condition among us." Two other speakers followed in substantially the same strain as the two first speakers; one of them, a young man of the age of thirty years, spoke at length upon the proposition for the appoint- ment of a resident judge, and told a piteous tale of the infidelity of his own wife, and his want of means of redress. He had no other complaints to make against the Board of Health. What was done for them was perfectly satisfactory, and they were all well provided for. A murmur of disapproval was at. once raised, and interfered with the continuation of his remarks. After making such visits as time would allow among the tenements of Kalaupapa, Her Majesty and company proceeded on horseback to the main settlement, arriving at about 7 :30 o'clock p. m. There quarters were provided for the royal party by Mr. Van Geisen in a new house lately built for the special accommo- dation of visiting physicians. At supper, the Rev. Father Damien was a guest. After breakfasting on the morning of the 22d, the party consisting of Her Majesty, attended by Hon. J. A. Cummins, Dr. Arning, Mr. C. B. Wilson, Mr. J. H. Van Geisen, and the undersuperintendent, Mr. Ambrose Hutchison, began to inspect the houses of the patients. In the first place visited there were nine patients, one of which was a very bad case. He had been twelve years at the Settle- ment and nine years in the Hospital ; his age being about sixty years. Three were about the age of thirty years, and the re- mainder boys between fifteen and seven years of age. To questions put by Her Majesty, they complained that their bedding (only mats), was too hard, their covering insufficient to keep them warm at night, and their food neither properly pre- 302 THE PATH OF THE DESTROYER pared nor always sufficient in quantity. They complained also of neglect at the hands of the kokuas, to whom were detailed the work of administering their medicine and dressing their sores. They also expressed their desire for the attendance of a resident physician, who could prescribe for them in the many cases of inter-current diseases, such as bowel complaints and other troubles which were frequent among them. When questioned as to the conduct of the visiting physician, they said that his visits were so short, and his work so hurried, that no practical advan- tage was to be derived from them. In the second ward were ten patients, ranging in age from twenty-five years to seventy. Most of these cases seemed to be of the anaesthetic form of the disease, there being but comparatively little distortion of features. In the majority of these cases ringers and toes were either entirely wanting or in process of amputation, rendering the victims almost entirely dependent upon the help of others. Some had bound up their own ulcerated extremities them- selves after a primitive fashion. To the question asked whether or not such ulceration could be healed by the appropriate treat- ment, Doctor Arning answered in the affirmative, qualifying the statement, however, by saying that in some cases the healed sur- faces might again take on ulcerative action, that being the natural tendency of the disease. These patients uttered the same complaint as those previously visited; but complained especially of the neg- lect of the kokuas, and the difficulty they often experienced of getting a sufficiency of water regularly supplied them, notwith- standing the fact that there was an abundance of water on the premises. The third ward contained eleven patients, five of whom were sixty and seventy years old, three about thirty-five years of age, and the remainder between seventeen and twenty. One aged twenty-five years had totally lost his sight, and all his ringers and toes. This result of the disease required him to be fed by another patient of the ward. Among those was the old man Nakahuna, well known to all old residents of Honolulu as the vendor of Hawaiian curios there a few years since. He has had the disease about four years, and has been an inmate of the hospital at Kalawao for three years. Worthy of remark is the case of a woman named Kealahua, whom we met in this ward. She came to the Settlement about fourteen years (1869) since with her leper husband, who died there about seven years ago of the disease. She herself is robust 2 a o o rv C on ^C 53 ~ si ■a §.* ti 3 o bo q « ^~ "5 r3 hh o o SgS bfl o <" 3 G ■3.5 s •as .5 § 2 2 — G ° 2 X =1 h 304 THE PATH OF THE DESTROYER and to all appearance without any symptoms of the disease about her, and is engaged by the Board to do the entire washing for the patients at the hospital, at a salary of $10 per month. She has been the mother of four children, one of whom died of acute disease without having developed leprosy, another of leprosy, the remaining two now living being lepers. (In the year 1888 this woman developed leprosy. — Author. ) The fourth ward contained ten patients, all of whom were women. Of these eight were between nineteen and thirty years of age, and two about sixty-five years. Among them was a young girl of about ten years who had accompanied her leper grand- mother there. This girl, after a careful examination by Doctor Arning, was pronounced to be free of leprous symptoms, and her removal recommended. The great complaint here seemed to be of the insufficiency of warm clothing and comfortable bedding. The fifth ward contains two rooms, in one of which were six young men between 16 and 20 years, all of whom were inveterate cases. In the other room were two native boys and two Chinamen. One of the boys was threatened with blindness from the disease. Insufficiency of warm clothing was also their complaint. The sixth ward was occupied by one patient only, who was in the last stage of the disease. He was horribly deformed in features and his eyes totally blind. He seemed to be undergoing intense suffering, and was muttering, throwing himself about in the wildest manner. Doctor Arning was called in and gave him a draught which seemed to give speedy relief ; and at the end of half an hour he was sleeping quietly. Such cases as this prove the value a resi- dent physician might often be. In the seventh ward were four very bad cases. One in par- ticular was noticed, where, though the face showed little disfigure- ment, the whole trunk was a mass of inflamed or suppurated tuber- cles which emitted an offensive smell unbearable to stand. In noticing this patient the doctor observed that with proper medical treatment, such cases as these might be greatly alleviated and a great deal of unnecessary suffering be prevented. In the eighth ward were three boys, between the ages of fourteen and seventeen years, all bad cases. They seemed diffident, had no complaints and nothing otherwise to say. The lock-up was next visited. The building is about 10 by 15 feet is dimension, and contains two rooms about 6 feet long and 9 feet wide respectively. These are poorly ventilated by small iron gratings situated on the leeward side of the building. In* THE PATH OF THE DESTROY ER 305 one were two Chinamen, both sentenced to one months' con- finement on a charge of assault with a deadly weapon upon one of their countrymen. In the other was confined a native named Makahui, sentenced for burglary in the store of the Board of Health, and abstracting therefrom money to the amount of $240, his partner in the crime, one Naai by name, had terminated his own life shortly after sentence, by suspended himself from the grating of his cell. The cooking arrangements are commodious, cleanly kept, and convenient; a cooking range being supplied sufficiently large to do the cooking for 150 persons. The poi room is also spacious and clean. As numerous descriptions of the Settlement generally, and of the hospital in particular, have heretofore been published, it will be unnecessary to give a further description. But here I may say that great credit is due to those in charge for the very neat and cleanly manner in which everything connected with the premises is kept. After leaving the hospital premises, the party next visited the storehouse, situated not far distast from the hospital and im- mediately across the road. Upon a close observation of the stores, all the articles provided appeared good, with the exception of the sugar, bread and salmon, the last mentioned article being so mouldy and soft as to be unfit for use; the sugar dark and dirty, of about No. 3 or No. 4 quality; and the bread tolerably good for medium bread, though inferior to that supplied to the Oahu jail. There are about 14 head of cattle butchered per week. Allow- ing (which, according to the statement of some butchers, is a large average) that each bullock weighed dressed, 350 lbs., and seven pounds per week of beef to an individual, the amount of beef slaughtered would supply only about 700 people ; whereas, there are at the Settlement, including the kokuas, a population averaging between 850 and 950 souls. The arrangements for slaughtering are most primitive; and the water supply insufficient for the cleansing of the meat. Ar- rangements, however, are now being made, whereby this defect will soon be remedied. A new reservoir is now in process of construc- tion near to the place of slaughtering, and designed to be filled from pipes connecting with the valley supply. The next subject which engaged the attention of the party was an inspection of schools under the charge of Rev. Father 306 THE PATH OF THE DESTROYER Damien. The buildings occupied for this purpose are supplied by the Board of Health, one of which is used for a boys' school and the other for girls, being situated in near proximity, and on the opposite sides of the road. Both are within the vicinity of the mission church. In the girls' school are sixteen pupils in all, ranging in age from nine to seventeen years. Among these was the young girl Luahiwa, of whom mention was made by Dr. Fitch in his late biennial report. Of all these scholars she bore the worst marks of disease. Out of these children there were four between nine and eleven years of age who exhibited no external signs of the disease; but one, upon careful inspection by Dr. Arning, was de- clared to be in the incipient stage of disease. In the boys' school were twenty-six pupils, all of whom were well marked with the disease. The pupils of each school are separately lodged and fed. They are all either orphans or friendless, and under the immediate care of Father Damien and a native woman named Kuilia, not her- self a leper. After leaving the school the party proceeded on horseback, for the purpose of inspecting the old and the newly proposed sources of the water supply of the Settlement. The system now in use, and which has been so almost since the establishment of the Set- tlement, has its source in the valley of Waileia. It is now recognized by the Board as inadequate to the needs of the place, and a proposition has been made to bring the water from Waikolu Valley — about two miles further on. Waikolu is the place where the paiai supply of the Settlement is landed and dealt out to the patients, being about three and a half miles from Kalawao, and five and a half from Kalaupapa. After traveling the road to this valley, one is forcibly struck with the force of the universal ob- jection made by the patients, to the great distance they have to travel for their food. The water supply here is abundant and never-failing, and capable of supplying the needs of a town larger than Honolulu. The scenery of this valley is grand. The numerous cascades dart- ing out in all directions from over the lofty precipices, the spray gracefully falling among the dense shrubbery and covering the green foliage as with gems of pearls. A sight seldom seen or surpassed in magnificence and beauty. In the valley are several acres of land now lying idle, which might be utilized at a small outlay, in the cultivation of taro and THE PATH OF THE DESTROYER 307 other products for the use of the Settlement. The landing of two boat-loads of paiai during the sojourn of the party there afforded an opportunity of realizing the fact that a number of complaints, already enumerated, were not without foundation. The stream was so swollen by the rains which had been unceasing during our visit, that after a difficult landing had been effected, it was still more hazardous for the animals with their heavy packs, and they had to be forced to cross over the stream. After staying in the valley for half an hour, the party took the opportunity of inspecting a proposed new landing about half a mile from the hospital, thence returning to Kalawao and visiting on the way every house to be seen. Most noted among the houses visited were the dwelling of Kaulamealani, Napua, Kuanea and Kii. The two last named individuals were pitable objects indeed and entirely dependent upon the friendly assistance of their neighbors for what help they received. Their fingers and toes were almost entirely gone with the disease. With suppurated hands and stumpy fingers they had improvised rude bandages for relief. Hospital accommodations and aid were clearly needed, but in reply to the question put to them, they said that they had a horror of entering the hospital. Her Majesty, as well as others of the party, was much affec- ted at the touching sight of these two old women, utterly unable to help themselves, and promised every exertion on her part toward the removal of any objection that might really exist in the hospital, and that efforts hereafter should be used to render the place attrac- tive and not repulsive. As there was little time to spare, and as Her Majesty had promised to address the people of Kalawao be- fore leaving, she bade the sufferers a kind adieu, and the company wended their way toward the Settlement, arriving at the store where the address was to be given at three o'clock that afternoon. A large number of patients had gathered. Her Majesty proceeded to address them similarly as upon the previous occasion at Kalau- papa. At the conclusion of her address she was heartily cheered by the people. A few among them responded to Her Majesty's remarks, but as they were of similar tenor to those previously given, it will be unnecessary to quote them here. Upon our final parting, three cheers were given for their Majesties the King and Queen. Before leaving the house at Kalawao, the party engaged itself in planting several seeds of alligator pears and mangoes, taken 308 THE PATH OF THE DESTROY ER from a large supply of such fruit seeds that had been brought by Her Majesty for distribution among the people. The landing was finally reached at about half-past seven o'clock p. m., after Her Majesty had made a slight detour in order to visit an extinct crater, Kauhako, whose basin is partially filled with sea water by a subterranean connection with the ocean. Before leaving the place, however, Her Majesty again visited every tenement in the neighborhood. Incidentally I would mention an interview which took place at the landing between one of the party and Keliikapu, one of the former speakers, several others being in the company. This man claims to have contracted the disease from vaccination, it having appeared about four years after. He asserted that through the same agency all of his schoolmates had died of the disease. In speaking of other matters he said that a great deal of bad management existed, rendering a loss to the government of about one-third of the cattle driven to slaughter over the precipitous road from Kalae, and thought it would be far less expensive on this account to land them from vessels at Kalaupapa. He said there was ample pasture in the district for several hundred cattle. He disapproved of the appointment of a resident judge, saying that such an office was unnecessary, and that such an idea had only originated in the brain of one who was looking forward to his own appointment. A foreigner, he said, would never suit as under- superintendent of the Settlement, as, owing to prejudice, his actions would often be misjudged, and trouble of a serious nature might ensue. Natives would be more likely to overlook or con- done the fault of one of their own race, than would be the case if the offender were a foreigner. He said that the present over- seer, Mr. Hutchison, was in every respect a good man for the position and universally esteemed in the Settlement. He thought there was urgent need of more hospital accommodation, and medical attendance and nursing. He said that not the least among their difficulties was that of obtaining wood for fuel. As it was now the patients had to travel far and climb the mountain themselves to get it. Upon a careful review of all the facts elicited by our visit and observation of the existing state of affairs, the following propositions have suggested themselves: 1st. As the supply of water is manifestly inadequate to the needs of the population, it would be advisable to put into operation the proposed plan of bringing the water from the valley of Waiko- lu, where an abundant and never-failing source could be obtained, QUEEN LILIUOKALANI. Sister of King Kalakaua. 310 THE PATH OF THE DESTROY ER and the supply so created should also be extended to Kalaupapa, where brackish and unwholesome water is now only obtainable. Here the water is often rendered absolutely unfit for use by an overflow of the tide into the well from which the supply is de- rived. 2d. A resident physician and an assistant are needed, whose dwelling place should be in near proximity to the hospital, that being a central locality. The patients die in many cases from maladies, such as diarrhoea, dysentery and other complaints that can be treated, if proper medical aid was at hand. 3rd. The hospital accommodation should be increased so that at least two hundred patients could be admitted. 4th. If possible, Sisters of Mercy should be induced to lend their aid in carrying out the nursing part, and care of the hospital. 5th. There should be an ambulance provided for the trans- portation of crippled patients, also two spring wagons for the more convenient delivery of beef and paiai to the lepers, at or near their dwellings. 6th. It would be good to subsidise a small steamer, from 80 to 100 tons, able to carry 20 or 30 head of cattle, 50 cords fire wood and the poi. This steamer should also be used for the transportation of patients from Honolulu to Kalawao. 7th. Lepers who are unable to help themselves should be compelled to take shelter in the hospital. 8th. For the treatment of children in the incipient stage of the disease, with a view to their cure, and also as an asylum for the otherwise healthy children where they could be kept apart for a reasonable time there should be two proper buildings provided in or near Honolulu, to be attended by a competent physician and an efficient nursing staff. 9th. As so much complaint is made about an insufficiency of food and clothing, it might be advisable to increase the supply of the same, and to have the rations altered as follows: 4 lbs. of beef delivered twice a week; 15 lbs. of paiai delivered twice a week; 1 lb. of salmon (for variety sake) per week; 4 lbs. of mutton occasionally, in place of beef; 2 lbs. of sugar, not darker than No. 2; 5 lbs. of salt per month ; 1 bar, 2 lbs., soap per month; y 2 gallon illuminating oil per week. THE PATH OF THE DESTROY ER 311 I would suggest also a trial of canned meats, such as are put up in Australia for army and navy use, by way of variety as a substitute for beef, it might be found useful and economical. In regard to clothing, it would be advisable to supply each person with a certain amount for day and night wear, in place of an allowance in money for that purpose, as at present. Many misuse their money, and suffer in consequence. It would be far better to allow each person two suits of woolen clothes a year and two blankets, the same as is done at the Oahu jail. There is no reason why a moderately large herd of beef cattle, and milk cows could not be raised on the pasture lands of the Settlement. The beef cattle could be kept for cases of emergency, when weather might interfere with the regular supply, and the cows might be milked, more especially for the benefit of children and the sick. In the two valleys of Waikolu and Waileia, there is much land uncultivated which would be suitable for the growth of taro, if it could only be utilized, which I believe is possible, if proper inducements were offered to cultivators. It would be advisable that Waikolu should be abandoned as a place of landing, on account of the dangerous nature of the only road thereto; and that a boat landing be constructed near Kalawao. Such a plan is perfectly practicable and could be perfected with but little outlay. The road to the present landing place is for two miles of its length over lava rock, and overhung by craggy precipices from which frequent showers of stones are precipitated upon the road below, rendering travel dangerous to man and beast. A greater danger still exists in the frequent washing out of the road by the sea, making it on this account, in stormy weather, highly unsafe to travel. There should be a better system adopted in regard to the kokuas than at present exists. So far as efficiency and reliability are concerned, the present plan of giving the work of the place to kokuas is a failure. It is not to be expected of persons going there as they do, merely to serve their own immediate friends or relations, that gratuitous work could be voluntarily performed by them for others, and any compulsion in this matter is altogether out of the question; and yet it is upon their general help that reliance has, under the present system, to be mainly placed. The support of every kokua means so much less in the way of food, rations and other necessaries to every patient that needs their help, and the question of the propriety in allowing so many healthy 312 THE PATH OF THE DESTROY ER people to place themselves without restriction in the way of con- tagion, is one to be taken into consideration. In closing these suggestions, I cannot help stating that the Settlement as an asylum for these poor unfortunate creatures is decidedly the best place for them for a place of strict isolation, and the condition of things is so much better than that at my for- mer visit in 1881. The party slept on board the steamer, which lay at anchor that night, and at 4:45 a. m. on the morning of the following day, left Kalaupapa for Honolulu, arriving at the wharf at 12 o'clock m., after a smooth and pleasant passage across the channel. LILIUOKALANI. DR. STALLARD'S REPORT Honolulu, March 12, 1884. To Honorable A. S. Cleghorn, Member of the Board of Health. Dear Sir: In accordance with your suggestion, I have the honor to submit the results of my inquiries into the condition or the lepers, and into the administration of the sanitary arrange- ments intended for their benefit. My first visit was made to the branch hospital at Kakaako. I went through the establishment with Dr. Fitch; and at a more recent visit, I have had the oppor- tunity of conversing with one of the nursing Sisters. I was in- formed that this hospital was originally established for the purpose of segregating the recent and doubtful cases of leprosy which were to be submitted to careful medical treatment ; and in case of cure, discharged. It was also intended that those on whom the disease became fully manifest, should be transferred to Molokai. In every one of these objects the hospital has proved a failure. The segregation has never been complete. The granting of permits to visitors has always been exercised on a very liberal scale. The light palisading which surrounds the hospital, accords every facility for verbal intercourse with the inmates. It may readily be scaled from either side. It is notorious that men have obtained access to the female wards, and that inmates have paid visits to their city friends without the knowledge of the superintendent. At the gate of the hospital a crowd assembles daily ; and seats have been provided on both sides of the fence, where patients and friends sit in close communication. Stalls for the sale of various luxuries, tobacco, etc., have been frequently erected, and many articles are passed in and out without difficulty. This intercourse with the outside population has been freely carried on ; and there is, in fact, no real isolation. Furthermore, the proximity of the hospital to the city presents the strongest temptation, both to patients and their friends, to carry on for- bidden intercourse. This is prevented with difficulty, in case of criminals, by the erection of high walls, a method of isolation quite inapplicable to the case of lepers. If, however, by this or any other means the isolation of the lepers were made complete, the hospital would be converted into a prison ; the feelings of the patients and their friends would certainly be wounded deeply, and a revolt might be expected on either side. 314 THE PATH OF THE DESTROYER Nor would complete confinement to so limited an area as that enclosed at Kakaako be justifiable in the treatment of a disease which is eminently characterized by weakness. For leprosy space, air, good food, abundant exercise and occupation are absolutely essential, and without them it is hopeless to look for improvement, and more hopeless still for cure. In Kakaako there was, at the time of my visit, great over-crowding; there were 200 inmates, but recently 39 have been removed; nevertheless the hospital is crowded to its full capacity. Nor is the surrounding air always pure. On one side is a salt marsh, and on the other an offensive foreshore; but if it were still possible to prevent personal communi- cation with outsiders, there is no guarantee of public safety, since no one has yet determined the exact manner in which the germs of leprosy are diffused and communicated. It is not long since it was believed that the contagion of smallpox would not pass the barrier of a few feet of air; but recent experience has shown that the erection of a smallpox hospital in a populous locality becomes a focus of contagion, over-leaping all barriers and spreading its deadly influence to the distance of a quarter of a mile. It is not impossible therefore that the germs of leprosy may be conveyed by mosquitoes, flies, and other insects over the short space which separates the hospital from the city. It is lastly a great objection to the position of suburban hospitals that they depreciate the value of surrounding property, and in case of Kakaako the position in front of the sea makes it a standing advertisement of the existence of leprosy, and a menace to all who dare risk danger of contagion by entering the port. But the most objectionable feature of Kakaako is the complete absence of any classification of the inmates; the practice of sending away the confirmed lepers has long since ceased. Apparently friends amongst persons high in authority are per- mitted to remain in spite of their condition, while those who have no friends are sent to Molokai, even before the hope of suc- cessful medical treatment has entirely passed away. The hospital has, in this way, lost its special character. New cases and old cases, those with but slight traces of disease, and others at the point of death, those with running sores and those without, are all mixed up, young and old, without any attempt at classification. Even males and females are not really separate; until recently the more able-bodied were placed, by necessity, with the permanent invalids for whom they were the only nurses and attendants. It seems to me a perfect outrage that any recent or doubtful case THE PATH OF THE DESTROYER 315 should be sent to Kakaako. In this city I have seen cases of young men and women with some symptoms which indicate the probability of their being eventually lepers. Many of these young persons are well educated and have refined sensibilities. Until the exact mode of propagation is made out, such persons are unfit to remain in public schools or to mix with the children of private families. They belong to the class of suspected, and they pre- sent the hope of possible amendment and of cure. To admit such persons to this hospital is to force them into contact with the most contagious forms of the disease. This exposure frustrates every effort of the physician to determine the period of incubation, the early history of the disease and the possibilities of cure; for it is obvious that such persons may be re-infected just as fast as they are cured. The food supply at Kakaako is both abundant and regular ; but it is scarcely expected that whites and foreigners will be satisfied with poi. There is, however, no provision for the prepara- tion of medical comforts, which are now supplied by nursing Sis- ters from their own kitchen, and at their own expense. It is extraordinary to notice the absence of proper surgical instruments and appliances. On the occasion of my visit it w^as found neces- sary that a large abcess should be opened, and it was painful to observe that the instrument used by Dr. Fitch was taken from a post-mortem case, and that it cut through the tissues with great difficulty. The nursing Sisters bear thrilling testimony to the amiable characteristics of the patients, by whom their services are highly appreciated. They althogether refute the opinion that the natives universally prefer the native kahuna, or that they neglect or refuse to take the medicines prescribed for them. They state emphatically that the natives appreciate the services of kind and attentive doctors and nurses; that they take their medicines willingly, and even ask for them when, by accident, they have been omitted. In conclusion, I am of opinion that the hospital at Kakaako is totally unfit for the treatment of lepers. Under no circum- stances does it seem possible to secure complete isolation ; the loca- tion is too near the city. The area is too small for the detention of many patients, and there is no possibility of instituting any classifi- cation of disease. MOLOKAI. I arrived at Molokai on Tuesday, March 5th, in company with Dr. Fitch and Dr. Arning. From information received from 316 THE PATH OF THE DESTROY ER Mr. Meyer, there were 445 males and 300 females, resident on the Settlement; of these 62 were in the hospital. With the kokuas and their children, the total population of the settlement numbers about 1000 persons. In company with Dr. Fitch, who evinced the strongest desire to afford the fullest information, and under the guidance of the Rev. Damien, we visited many of the cottages occupied by the ko- kuas and kamaainas, I was most gratified at. the cheerful and con- tented population, the entire absence of grumbling or complaint, the cleanliness of their persons and the comfort and tidiness of all their dwellings, the many neat little plots of onions, sweet potatoes, tobacco and flowers in front of many of their houses and above all, the general possession of a horse and little articles of personal adornment ; everywhere we saw the appearance of hap- piness and freedom. All this contrasted most favorably with the confinement at Kakaako, and it is impossible to doubt that the loca- tion is admirably adapted to rob isolation of its greatest terrors. The natural beauty of the scenery; the luxuriance of the vegeta- tion ; the richness of the soil ; the necessity of riding to the store for beef, poi, oil and other necessaries, encourages movement in the open air; and there is no doubt that the lives of many lepers have been prolonged, and their sufferings lessened, by the favorable conditions under which they live. Nor can it be ignored that the government has done much towards this result. In the place of the wretched grass huts, resting on the damp ground, they have erected many comfortable dwellings of wood. They have brought in water from a neighbor- ing stream; they have erected a hospital and the residence for a physician. They have encouraged those who have the means to build dwellings of a better class, and by allowing kokuas they have greatly reduced the immorality which naturally resulted from separating 200 women from their husbands and forcing them to live in the same settlement with 300 men, also separated from their wives, neither being in any way deprived of their natural desires, and none imbued with any exalted notions of morality. But here my commendations end, all the natural advantages of Molokai have been destroyed by defective and incomplete ad- ministration. The excessive mortality alone condemns the manage- ment. During the year 1883, there were no less than 150 deaths, a mortality of 150 per thousand annually and during the present year, the death rate has risen to 25 per cent, per annum or more than ten times that of any ordinary community of an unhealthy THE PATH OF THE DESTROYER 317 type. This high mortality has not been caused by leprosy, but by dysentery, a disease not caused by any local insanitary conditions, but by gross neglect. The leper cannot stand up against starvation. He requires generous food, and he dies without it is supplied. On paper and by the regulations he is allowed one pound of beef daily. How much does he get? It is not difficult to know. To supply those who are entitled to beef rations takes 5,600 lbs. per week, and from the beginning of the year the following figures show what they really got: Pounds Deficiency January 2 to January 9, 1523 pounds 4077 January 9 to January 16, 5811 pounds January 16 to January 23, 5600 January 23 to January 30, 4931 pounds 669 January 30 to February 6, 5600 February 6 to February 13, 5600 February 13 to February 20, 5720 pounds February 20 to February 27, 620 pounds 4980 February 27 to March 6, 5890 pounds Deficiency in nine w T eeks 26,526 So for three w T eeks out of nine there was no beef at all, and for two other weeks there was only a very partial supply, and that probably consumed by officials, whilst for three weeks only was the supply sufficient. During these times, the lepers were given salt salmon in lieu of beef, a food which has been universally con- demned by the best medical authorities as entirely unfit for the use of lepers. Nor was the supply of poi much better. The only complaint made to me by any leper on the Settlement was on this account. For some time past, the supply of paiai has been irregular and much had to be baked over again to make it eatable. At the time of our visit to the hospital no fresh paiai had been received for a week, and none had arrived before our departure, two days afterwards. It was said the persons who supply the Settlement had not been paid, and that thev refused to supply more until accounts were set- tled. I inspected many bundles of paiai which had been submitted to the oven in order to make them eatable, and I cannot doubt that the dietary of spoiled poi and salmon is the cause of the dysentery which so generally prevails. It was my fortune to see the arrival of a cargo of lepers, and 318 THE PATH OF THE DESTROY ER here also there was the same absence of proper management; no preparations had been made for their reception. They were simply "dumped" upon the "shore," and left to "shift" for themselves. Some of the young had happily been provided by the Sisters at Kakaako with a letter to Father Damien, soliciting his interest in their welfare. But the rest, if not too feeble to Walk, were left to shift for themselves, while a few of the most feeble were con- veyed to the hospital. Only that the natives are a kindly and hospitable and a long-suffering race, this total absence of prepara- tion would be an intolerable evil. It is impossible to avoid the comparison between the care be- stowed upon Kakaako, and the neglect of Molokai. Whilst the former is regularly supplied with food, the latter is starved for want of the money which has been appropriated, but is not forth- coming for the first necessaries of life. At Kakaako the leper is allowed the society of friends and relatives, and isolation is a sham. Indeed, it is no wonder that the patients prefer the city life to the den of death which has been made for them at Molokai. It is evident that if the principle of segregation is to be equally, justly, and kindly carried out, and the public properly protected against the contagion of leprosy, Molokai is the most fitting lo- cality where alone such segregation can be made effectual, and where the necessary terrors of confinement might be reduced to a minimum. If the money spent at Kakaako, and the care bestowed upon its management had been spent at Molokai — if the patients at Kakaako had been starved to death, imprisoned, and neglected, like those at Molokai — it is possible that the inmates, instead of resisting removal, would have prayed to go away. But the absence of proper administration appears at other points. I saw two men accused of robbery who have been confined in prison for upwards of three months without being brought to trial. They were con- fined in one cell eight feet by five feet in size, and about ten feet high. Their cell is ventilated by a barred opening over the door twenty inches by ten inches. Both men are lepers, and as the door opened the foulness of the air was evident. These men have been advised to confess, and restore the stolen property, when they will be given liberty. After our visit, they endeavored to impli- cate another party. But this sort of trial by fortune merely indi- cates the necessity of police and the appointment of some person competent to act as a justice of the peace. To conclude, it is to be observed that this same neglect hangs over improvements admitted to be essential to the well-being of THE PATH OF THE DESTROYER 319 the Settlement. A further water supply is necessary; $10,000 was appropriated for the purpose, and nothing has been done. The landing places are always dangerous, and sometimes useless. Steam- ers conveying passengers and supplies have remained at anchor, and have been obliged to return to Honolulu without discharging cargo. This might happen whilst the lepers were absolutely in want of necessaries, and yet appropriations have been made without result. The approach by the pali is also in a shameful state; cattle are continually killed upon it. No such difficult pass is necessary to confine the leper, and to prevent communication; and it seems monstrous that this dangerous path is not improved. It is by good sanitary organization, and better sanitary ad- ministration, that we raise the standard of public health, and en- able the people to resist and throw off the beginnings of disease. Then by such means we may hope that the germs of leprosy will fall harmless in our midst, and the necessity for leper settlements shall cease. Your very obedient servant, (Signed) J. H. STALLARD, M. B. L. Member of the College of Physicians, England, et£. REPORT OF DR. EDWARD ARNING Honolulu, H. L, November 14th, 1885. To His Excellency W. M. Gibson, President, and Members of the Board of Health. Sirs: — At the request of the president of the Board, I furnish you with a report as to the course of investigation carried on by me with regard to leprosy. The general headings, under which the work is being con- ducted, may be classified thus: I. Clinical. II. Morbid — Anatomical. III. Special Bacterial Research. IV. Therapeutic. V. Hygienic. All these different classes of work have had an even amount of attention bestowed on them, which I will try to outline in the following, without of course going into details, which have found, and will find, their place in medical publications. I. The clinical work embraces : Inquiry into the general historical features of the disease, and into the history of the disease in the individual. I have here encountered great difficulties, and am afraid have wasted time and patience in trying to derive re- liable information from the Hawaiians. Lack of observation of their personal health and wilful deceit are so mingled with truth in their statements, that I defy anybody to collect reliable statistics, such on which it might be possible to base proofs for hereditary or congenital transmission of leprosy on these islands. Of course, I do not deny that good anamneses may be obtained in some cases, but to base theories on this kind of evidence alone must assuredly lead to fallacy. The second part of the clinical work pertains to the symptoms of leprosy, as we find them on these islands, and their similarity, or dissimilarity, to the symptoms described in the accounts of observers at other times, and in other localities. The practical drift of this comparative symptomology, as I may term it, is perhaps, not quite obvious, although none the less important. All endemic and epidemic diseases are apt to modify their character and appearance with time and circumstance. General experience THE PATH OF THE DESTROYER 32 J goes to show that milder forms follow the more malignant type, and may be welcomed as indications that the disease has reached its acme. Certainly this applies more strictly to epidemics of acute character, but due allowance being given for time, it holds good also for the chronic infectious type of disease. Now, there seems to me to be no doubt that a great number of cases are to be found on these islands which present, and often have presented for years, one or two symptoms of leprosy, mostly belonging to the group of leprous nerve lesions. I style these cases abortive leprosy, and I venture to hope that they may be hailed as signs of a decrease of virulence of the disease in general. I have bestowed particular attention on the symptoms of these initial and abortive cases, as the diagnosis of leprosy is, of course, a terribly severe one, and more liable to be disputed in these cases than in the advanced stages. Full notes have been taken of all these cases, and will be of importance in a number of years hence, when I shall try to gain new information about them, and see whether the leprous virus was only dormant in them, or actually exhausted. Of the value of these cases for therapeutic action, 1 shall have to say more hereafter. A great number of lepers were examined as to the presence or absence of the bacillus leprae. The results I summarize as follows : 1. The bacillus is found plentifully in all nodules of the tubercular cases, and likewise in the diffused swellings of the skin in the tubercular cases. 2. It is found in similar quantity in the nodules and diffused infiltrations of the mucous membranes of the mouth, throat, nose, rectum and large intestine. 3. In case of softening and breaking down of these nodules, the bacillus is mixed with the discharge in great quantities. The presence of sores in the mouth, throat, and nose causes large num- bers of bacilli to be contained in the saliva, and the mucous dis- charge from the nose. In leprous diarrhoea which closely simulates dysentery, but which I have been able to trace to leprous, not dysenteric ulcerations of the bowels, I have been able to detect the bacillus in the faeces. 4. In the so-called anaesthetic cases, the bacillus is not found in the anaesthetic patches, nor in the chronic sores of necrotic parts of skin, tissue, and bone; but as nerve excisions have proved to me, in the nerves supplying these multilated parts with vitality. 5. The bacillus cannot be found in the bright red patches, so frequently ushering in the first formidable attack of the disease 322 THE PATH OF THE DESTROY ER and mostly occurring on the face. These patches are always located in the distribution of some larger nerve and are seats of local vasomotoric congestion, based on leprous disease of this nerve. 6. The bacillus cannot be found in the urine of lepers, which is accredited by the Chinese to be the infection-carrier "par ex- cellence." 7. The bacillus as such cannot be found in the blood, not even during the febrile attacks marking the progress of the disease. As it has of late been asserted by different observers that the blood contains the germ, particular care has been bestowed on this point. Their statement must be due to the fact that in obtaining a drop of blood for examination, the bacilli have got into the blood by not carefully selecting a healthy spot of the skin in pricking for blood, but going through diseased tissue and getting some of the bacilli contained in this tissue mixed with the blood. For all that, the germ may be contained in the blood, more especially during the febrile attacks, possibly in some hitherto un- known, but suspected form of spore-condition, a stage of the life of a bacillus. These suspected spores may not be visible either on account of their minuteness or which is more likely, on account of our inability to make them visible by the staining methods we use in searching for bacteria. As this is a most important point for the whole question of the spread of the germ, I have applied myself most assiduously to its investigation by devising new staining methods and employing the highest magnifying powers at our command, also by culture experments with blood taken from lepers during their febrile at- tacks, with the idea of making the spores which I consider it likely to contain, grow into fully developed bacilli and become visible as such. At present I must confine myself to the statement that the blood of lepers, if taken with all due precautions, does not contain the bacillus. It has been noted before by Danielssen and Boeck, the Nor- wegian observers, that leprous ulcerations of the nose occur in anaesthetic cases, which otherwise present no ulcerations. I have met with this peculiar condition in two cases. One that of a Portuguese who had brought the disease with him from the Azores, and the other that of a young Hawaiian girl. These cases being otherwise not very advanced, and decidedly not repulsive looking, were discharged from the branch hospital. But I must consider these cases a great deal more dangerous than their general appear- THE PATH OF THE DESTROYER 323 ance would lead to believe. I was surprised to find in both cases the discharge from the nasal sores full of the bacillus. Next to this microscopical work in relation to the clinical aspect of leprosy, my attention was directed to the peculiar features of leprous anaesthesia and paralysis. They have been examined under the heads of distribution, intensity, and mode of progress, and as to their spinal or peripheral origin. For these particulars we have to rely mainly on the modern teachings of electro-diagnosis. Let it suffice to say here, that I consider all these troubles due to leprous disease of peripheral nerves, and that I believe the dis- tinctions found in this respect between leprosy and the great num- ber of other diseases of the nerves, spinal cord and brain, will enable us to pronounce with more confidence on the nature of what it is here customary to call suspicious cases. The different appearances of muscular wasting and contraction have been studied in comparison to similar symptoms of other neurotic diseases. The advanced, or I may say, completed stage of this muscular derangement is not so very far different from similar troubles due to other nervous lesions, such as rheumatic, diptheritic, traumatic, etc., whereas the beginning presents more salient features, which will with due regard to accompanying symptoms enable us to specify the particular disease as leprous or not. But this muscular crippling being largely due to mechanical causes, is decidedly not as characteristic as the bone disease of leprous origin. The mode of attack, the privileged seats of caries and necrosis, and the resulting crippling, are decidedly one of the most peculiar features of leprosy, and most strikingly different from bone disease, due to osteomyelitis of syphilis and tuberculosis. As such, they claim a particular share of our attention, more than they have hitherto found. A large number of photographs and plaster casts have been taken of cases, selected at Kakaako and the Molokai Settlement to substantiate these experiences, and to serve as illustrations for future publications. A certain amount of attention and study have, furthermore, been accorded to diseases of more external nature, presenting any re- semblance to leprous lesions, and occurring both independently and in company with leprosy. As such, I mention pigmentary and parasitic skin diseases. A very troublesome affliction of this nature, unknown to the Hawaiians, has been introduced by the Gilbert Islanders, among whom it is quite common. I have seen a pure 324 THE PATH OF THE DESTROYER Hawaiian, who is married to a Gilbert Island woman suffering with it. He had been subject to it for years, and was looked upon by some as a suspicious case of leprosy, but I have since been able to cure him entirely with simple applications of chrysophanic acid. The true scabies, or itch, due to the insect "Scarcoptes Hominis,'' is exceedingly prevalent at Molokai, and will be hard to eradicate there under existing conditions, just, as we are not table to eradi- cate it in large cities. I have successfully stamped out a small epi- demic of it at Kakaako, and great watchfulness will be further needed. Only quite recently a hideous looking case of tubercular leprosy, in a seven-year-old boy, was brought to the branch hospital. A great part of his hideousness was due to inveterate itch, and this trouble caused him a great deal more pain and discomfiture than his leprosy. It was, of course, easily cured, and had to be done at once on account of its eminent, contagiousness. In the foregoing I have attempted to outline the clinical part of my work. In case the Board desires it, I will condense the results into the form of a schedule, which may serve as a guide for examination of doubtful cases. II. Morbid — Anatomical Work. Here I can confine myself to closer limits. I have been able to make seventeen post-mortems of lepers, which have given me much vaulable opportunity to study the anatomy of the disease, and have enabled me to make some important discoveries regarding the diffusion of leprosy through the internal organs. For this reason I deeply deplore that lack of support by the Board has put a stop to this most intrinsic part of my work since last spring. In all advanced tubercular cases, I was struck with the ex- treme frequency of grave changes in the larger viscera, more es- pecially the lungs, liver, spleen, and bowels. These organs pre- sented an aspect quite new to me, and closer examination of their tissues has enabled me to prove that we have been mistaken in attributing deaths to lepers to inter-current pneumonia, tubercular phthisis and dysentery, which were stimulated by the clinical symp- toms. The ulcerations of the bowels and the breaking down of lung tissue are due to leprous infiltrations, and we shall have to modify our opinions of leprosy, being mainly, a disease of the cutis and peripheral nerves and introduce terms such as phthisis leprosa and enteritis leprosa, etc. As far as the brain or spinal cord were examined, I found them unaffected, but they will yet have to find a very close and searching microscopical scrutiny. This applies generally to all the THE PATH OF THE DESTROYER 325 material collected from the post-mortems and preserved in different ways. III. The bacterial research, i. e., the question of etiology of leprosy, is another essential part of my investigation, and at the same time the most subtle and delicate. No one who has not tried himself at this particular kind of modern research is able to judge of its many disappointments, its dependency upon apparently insig- nificant particulars, and the difficulties which crowd upon you when you are working outside of the accustomed laboratory with its always handy intelligent help and never-failing supply of requisites. The outline of experiments embraces: 1. Search for the germ of leprosy in the air, water, and food. 2. Attempts to breed it outside of the living organism on artificial soils, employing the greatest variety of composition of soil and different, grades of constant temperature. Of soils I have used : 1. Koch's meat-peptone-gelatines of varying strengths. 2. Gelatines made of seaweed and meat. 3. Gelatines made of seaweed and fish. 4. Bouillons of meat and fish. 5. Sterilized and solidified serum of blood taken direct from the carotid artery of bullocks and sheep. 6. Vegetables, solid and in decoctions. 7. Poi. After being sterilized, i. e., freed by high temperature (steam and dry heat), from any germs they may accidentally contain, these soils are implanted in sterilized containers with the leprous germ and kept for weeks together at constant temperature in the incu- bator, and carefully watched day by day. Until now, the results of this work are altogether negative. Under all the varied conditions, I have not once succeeded in ob- taining an independent and pure growth of the bacillus leprae. Parallel with these culture experiments on artificial soils, a large number of experiments were conducted to grow the germ in living tissue. For this purpose I have procured and inoculated a variety of animals at ages ranging from a few days old to grown- up beasts, rabbits, guinea-pigs, rats, hogs, pigeons, and a monkey. They were inoculated in and under the skin, in the cavity of the abdomen, under the conjunctiva of the eye, in the anterior chamber of the eye, and in the ulnar nerve, mostly with small pieces of leprous tubercule excised under antiseptic precautions. 326 THE PATH OF THE DESTROYER I have been able to follow up, microscopically, the presence of the bacillus leprae at the spot of inoculation for months after the inoculation, but have not in a single instance been able to observe any general symptom of leprosy. The negative results of all this work are not valueless and discouraging. On the contrary, they act as a stimulus for further research. I am not in the habit of drawing hasty conclusions, es- pecially from negative evidence, but as from well proven analogy with kindred diseases we know that the bacillus leprae is the etiological factor of the malady, and as we find it impossible to discover or grow this bacillus outside of the human body, but find it in immense numbers and rapidly increasing in the human body, we are naturally driven to the following conclusions: 1. The bacillus leprae is a parasite limited to the human race. 2. It must be transmitted either directly from individual to individual; or 3. Run through a stage of intermediate life (spore condition) which we are at present unable to detect, for reasons given above, but which may be present in the soil, water or food, but can only get into them from the diseased tissues of a leper. 4. Accepting either theory, the direct or indirect transmission, we must look upon every individual leper, whether in the incipient or advanced stage of the disease, as a dangerous focus of the mal- ady; he multiplying and nursing the germ in his tissues. 5. As every seed requires its peculiar conditions of soil, at- mosphere, etc., to allow it to strike, and, when struck, to grow up to be itself a seed-bearing plant, so does the leprous germ re- quire a certain disposition of the human soil to strike and thrive. What this peculiar disposition may be, we are at present unable to say. It is evidently a disposition which may coexist with appar- ent good health, as many examples of strong, rubust men, develop- ing leprosy, show us. This disposition may possibly be transmitted by heredity. I desire not to be misunderstood on this particular point. I do not believe that leprosy itself is in any case con- genital ; but I do believe that a certain weakness to resist its attacks may be transmitted. I have hinted at. similar ideas in the motives accompanying my application to His Majesty's privy council, to be allowed to perform some inoculation experiments on the condemned convict Keanu. The application I made resulted in the sentence of death passed on the murderer, being commuted to penal servitude for life. With the prisoner's written permission, I commenced operations on THE PATH OF THE DESTROYER 327 the last day of September, 1884, after having previously made a most searching inquiry as to any leprous taint in his family, and a close examination of his own body. This examination satisfied me that, as far as I am able to judge, no trace of the disease could be found in him at the time. A further step was to insure that the prisoner would not be employed at work outside of the prison walls. As stated above, I inoculated Keanu on the 30th day of September, 1884, and for the four weeks following, I saw him daily, and after that once a week for several months, a microscopic examination of the inoculation spot being made every time. After that period the convict has been examined by me regularly once or twice a month. The microscope revealed the presence of the bacillus leprae in large numbers until the middle of March, 1885. They have since gradually diminished in number, but a recent excision of a small part of the scar shows them present even yet, i. e., nearly fourteen months after the inoculation. At the same time there is nothing in the general appearance of the convict which would denote any development of leprosy. Pains in the joints of the inoculated arm, from which Keanu suf- fered in January and February last, have since disappeared. To the foregoing I wish to add the following remarks: 1. I do not consider my experiment with Keanu concluded, or mature for scientific publication. 2. Even if future observation should show us no trace of leprosy developing, we should not be able to infer more from the experiment than that in this case inoculation proved ineffectual. 3. I have given this account of the experiment to Your Excel- lency and the members of the Board, to allow you to judge of the spirit in which it is being conducted. 4. Moreover, I have been induced to do so by recent per- fectly unauthorized publications of Dr. Fitch, in a California medical journal, as a protest against the thoroughly unprofessional conduct with which this author, who could only gain knowledge of my doings in an under-hand manner, has brought my name and work forward in support of his own unproven assertions. I take the same opportunity to protest against the narrow arguments used by the same author, as far as this subject of in- oculation goes. He cites my name, and an ordinary post-mortem blood poisoning which I acquired at the autopsy of a leper as a proof of the non-possibility of inoculation of leprosy. It would be a very bad thing, indeed, if all the cases of common, local, or CHARLES R. BISHOP. Banker, capitalist, philanthropist. * Ninety-three years old January 25, 1915. Founder of the Bishop Home for leper girls at Kalaupapa, Molokai, and good friend and generous benefactor to the Hawaiian race. Husband of the late Chiefess Bernice Pauahi, the foundress of the Kamehameha Schools for Hawaiian boys and girls — the foremost and best educational institutions in the Pacific Ocean. The contiguous Bishop Museum, with its masterly arranged exhibits, affords unrivalled facilities for study amongst its unique and splendid collection of Polynesian antiquities, etc. * Died at San Francisco, California, June 7, 1915. THE PATH OF THE DESTROYER 329 general septic poisoning at a post-mortem should result in our ac- quiring the disease the patient was subject to. Vague statements of this nature do not deserve, and would not find an answer from me in a scientific publication, but as they are put forward with the intention of captivating the mind of the general public, and are, as bold and positive assertions, more apt to do so than the often restricted and guarded utterances of calm independent observation, I have given them this brief consideration in my report. Closely allied to the inoculation question is the subject of vaccination. Your are doubtlessly aware of the very prevalent opinion among medical men, that the unusually rapid spread of the disease may possibly be attributed to the great amount of indis- criminate vaccination which has been carried on in these islands. There have, if my information is correct, unquestionably new cen- ters of leprosy developed after vaccination was practiced, and several old inhabitants have told me how they themselves used no precautions whatever in vaccinating during a small-pox scare, but brought the lymph directly from one arm to another, without even wiping either points or lancet. To bring some light on this moot point, I vaccinated a num- ber of lepers. The vaccination only took in three cases, one tuber- cular and two anaesthetic. Both the lymph and crust of the tubercular case contained the bacillus leprae ; in the anaesthetic cases I could not detect it. As the vaccinations are now conducted by medical men and with bovine virus, it may seem to be per- fectly superfluous to dwell any further on this point, it apparently presenting only historical interest. But recent experience causes me to advise the Board not only to supply its medical officers with animal vaccine and points, but also to issue strict regulations as to the manner how this virus is to be used. If the lancet is dipped into the virus, then into the arm, then again into the virus and the next arm, or if points used for one vaccination are re-coated for further use, as physicians of the other islands have, at my special inquiry, owned to doing, then the use of bovine virus gives us no safeguard whatever against the propagation of constitutional dis- ease by vaccination. The main point is the thorough disinfection of the lancet after making one vaccination, and before dipping it into the lymph for the next arm. This is easily obtained by heat- the point of the lancet in a spirit flame to a dull red heat, and it forms a main part of the instructions issued to the government physicians in Germany. 330 THE PATH OF THE DESTROY ER Another point which has been raised is the possibility of the leprous virus being conveyed by mosquitoes. I am at present oc- cupied with investigating this subject. The endemic elephantiasis of the tropics, a disease which is happily unknown here, has lately been traced to propagation by mosquitoes, and by these solely. IV. The next of my headings is that relating to therapeutics. As this is one of the practical sides of the question, and one in which the general public naturally takes the greatest, interest, as it considers it more within its scope than the rather distant etiological and pathological studies relating to leprosy, I beg to be permitted to begin with some general remarks on this subject. All our therapeutic action may be classed either as specific or symptomatic. Looking upon disease as a weed which grows in the fertile soil of the body, we may say that with the former we aim to strike at the root of the weed, whilst with the latter we only lop its branches and keep its growth in check. There are very few diseases where we can rely entirely on specific treatment, the most notable being syphilis, malaria and acute rheumatic fever. For these three diseases we possess in mercury and iodine, quinine and salicylic acid respectively, real specific medicines; and if by their aid we have been able to restore a patient suffering from any of these troubles, we may say he has been cured by these medicines. On the other hand, we have a vast number of diseases where we have to rely on symptomatic treatment, i. e., mainly alleviate pain, ward off external danger and keep up the power of the body, so that it may rally to healthy re- action and cast off the disease by its own efforts. This applies to all our acute zymotic diseases, the eruptive fevers, small-pox, scarlatina, measles, etc., to the various typhus fevers, to cholera, dysentery, etc., and very nearly to all chronic diseases, foremost to consumption, the scourge of our age, and as yet to leprosy. We have no specific for leprosy, nor has any man of any other country or nationality. Scientific medical information reaches too far now-a-days to permit of any agent of this kind being known by an individual and kept as a secret. Anything put forward in that way without being published through the regular channels must be regarded as quackery and nothing else. Anybody who is read on the subject of leprosy, in fact, any remoter medical literature, will be struck with the amount of at- tention bestowed on the therapeutic portion in those writings. The tendency of our age is to simplify therapeutic action as much as possible, and not experiment empirically, but bring therapeutics THE PATH OF THE DESTROY ER 331 within the rational limits of physiology, etiology and pathology. There is scarcely a drug in the pharmocopeia, at least scarcely a class of drugs, that has not been most systematically tried in the treatment of leprosy. Over and over again men of sanguine views have found what they called a specific cure, but in every instance calm and unbiased judgment has afterwards pronounced a verdict of uselessness. How is it that these facts are not accepted, and a different line of therapeutic attack inaugurated? Let us pay more attention to careful symptomatic treatment of leprosy. Even the advanced cases we can help and benefit a great deal more than is generally believed. The great number of incipient cases will furnish us opportunities enough to try new lines of specific treatment. Let the scourge this nation is subject to be turned into as much good as possible, and let arrangements be made (for it is not feasible, under the present circumstances) to let at least a limited number of advanced patients be benefited by modern medi- cal and surgical progress. On the other side, let the incipient cases be divided into classes, and treated systematically on different prin- ciples, but under one general management and observation. I beg to refer you to my first report, written for the session of the Legislature of 1884. I have already then dwelt on this point, and, I am happy to say, not without results. My sugges- tions of a home for suspected and incipient cases, and of regular medical school examinations, have been carried out, and order and cleanliness prevails, where there was an acknowledged bad state of affairs before 1884. But if you ask me whether enough has been done to be able to say to the world that all is being done for the lepers that can be expected, and in a model w T ay for other nations, looking with fervent interest to Hawaii's fight with lep- rosy, I must say no. The therapeutic side, the treatment is neg- lected. I have been told that my views are too advanced. I answer that I am proud of it, and that I consider nothing can be too advanced in the treatment of a question, which has been grappled with for centuries in the old style of isolation and feeding. What I have repeatedly applied for is a small hospital-ward within the Kakaako enclosure, with, say, no more than six or ten beds, but managed separately from the general Settlement. This hospital should have a nurse and a servant attached to it, and to it exclusively; have arrangements for hot and cold and permanent baths, steam baths, gas baths, etc., and ought to be fitted with all 332 THE PATH OF THE DESTROYER the necessaries of clinical research, and medical, surgical and electri- cal treatment. The patients .would be selected from the general flock, according to the wishes of the physician put in charge of this trial station. Then the journals, which would have to be strictly kept of every case, would be able to contain all that accurate information, without which modern clinical work is considered in- complete, and which it is impossible to gain under existing cir- cumstances. Then electrical treatment, which is undoubtedly of great, even surprising benefit, could be carried on; and surgical operations, such as removal of necrosed bone, stretching of nerves, cutting and stretching of contracted muscles and sinews, and oper- ations on the eye and other important organs, be attempted with more view to success than is possible at present, where no arrange- ments of any kind are made for all this at the branch hospital. The therapeutic results I have achieved, under less favorable circumstances than those enumerated did offer, urge me to renew this request. After these general remarks I will, in a cursory way, state the methods of treatment I have adopted for different classes of lepers, native and foreign, some treated at Kakaako, some as outside patients. Some sixty cases I find in my private books, which I look upon as either fully developed and progressive, or abortive, or incipient, or suspicious cases of leprosy. A number of them have since been received at the branch hospital, a number of foreigners have left the country, others I have lost sight of, and some few I consider so far benefited by continuous treatment, that I might doubt their being afflicted, if I did not. find the record of their previous state in my books. Since about a year, I have found in the external use of sal- icylic and pyrogallic acid agents of undoubted value for symptomatic local treatment. With them it is possible to destroy leprous tuber- cules and soften diffused leprous infiltrations, sometimes even to restore a portion of the feeling lost over these infiltrated patches. Especially the conspicuous red patches, which usher in the com- mencement of tubercular leprosy, and often stand for years with- out fading, subside readily under local treatment with an ointment or paste containing ten per cent of salicylic acid. Isolated tubercles and serpiginous leprous papules have been entirely removed with a strong solution of pyrogallic acid in traumaticine, or with a ten per cent pyrogallic acid ointment. For the diffused leprous in- filtrations I use a ten per cent solution of salicylic acid in oleic acid. Internally I have used either nothing, so as to be sure that the THE PATH OF THE DESTROY ER 333 disappearance of the symptoms was due to the local applications alone, or salicylic acid in large continued doses. I have certainly seen fresh febrile eruptions occurring during this treatment, but in several cases a decided improvement, even when used without any local treatment. Special reasons induced me to try a very active sulphur treat- ment in one case. Sulphur was administered internally as hypo- sulphate of soda, and the patient was subjected to a sulphurous acid gas bath every day for one hour. The more pronounced tubercles of the face were at the same time treated with compression and deep local injections of absolute alcohol, which caused prompt break- ing down and cicatrization of the tubercles. This method I have since discarded for the more efficient and less painful pyrogallic acid treatment. I am sorry to say that this patient, whom I had under this treatment for a full year, and who was one of those put under my special charge by the Board, was, like two other patients of this particular lot, removed from the branch hospital without my knowledge. Such steps are naturally not inclined to promote scientific work. In deciding the advisability of their re- moval I might at least have been asked, and my reasons for re- taining them weighed with those which prompted the action of the Board. The much-abused mercurial treatment has been used both as a general and local application. For the general treatment I have relied chiefly on hypodermic injections of corrosive sublimate, a centigramme of the drug being injected daily. In one case of a well-educated native man, who has been under my treatment for nearly two years, I have given two courses of these injections — one of a hundred, and the next of sixty — without any trouble, al- though the injections are a little painful. His enlarged ears were treated with excisions and deep scarifications, and an anaesthetic spot on the back and the anaesthetic big toe of his left foot were successfully treated with electricity. The patient now feels that he has regained his lost strength and mental activity, looks hale and hearty, and would pass very close scrutiny without being con- sidered in any way suspicious. For all that I do not for a mo- ment pretent to have effected a lasting cure — that remains for time to prove — nor do I feel inclined to let the patient go without further treatment, though he is apparently in vigorous health. He is at regular periods taking small doses of mercurials, and should go on with this for a number of years. In another case of rapidly progressing mixed form the quick 334 THE PATH OF THE DESTROYER course of the disease has changed to a slow progress after eighty hypodermic injections of corrosive sublimate. I am sorry to say that this is one of the cases taken out of my observation at the branch hospital. The anaesthetic and contracted hand was steadily improving when I was treating it electrically at my office. This had to be discontinued when the patient was removed to the branch hospital, no appliances for this purpose being provided for there. Since her dismissal she is under no treatment whatever, but, as I hear, in the family-way, and losing the improvement she had gained in her hand. In other outside cases I have used creosote and carbolic acid treatment, the former in pills of which Dr. Hillebrand speaks very highly, the latter as hypodermic. Only in one case did I see marked effects. In this, local injections of a five per cent carbolic acid solution were used, and restored color and feeling in a white an- aesthetic spot on the cheek. Iodide of potassium failed entirely at my hands. Electrical treatment was used in quite a number of anaesthetic cases, and when persevered in long enough proved very efficient. One patient especially, a white man, who had several anaesthetic patches on the arms, has recovered entirely. He has at the same time been taking from \y 2 to 3 grammes of salicylate of soda daily for a whole year. Another patient, a native woman, who had, be- sides other symptoms, a nearly complete anaesthesia of the left arm and contracted useless hand for over ten years, is now enabled to stretch her fingers and use them for needle work, the feeling being completely restored in two of the fingers. The treatment in her case has extended over very nearly eighteen months, and very high doses of arsenious acid, up to nine centigrammes daily, have been taken internally, the patient standing this drug extremely well, whilst from some other experiences I have learned to be extremely cautions with this drug in the treatment of leprosy. The very distressing symptoms of the nose, mouth and throat, which are in the general run of the treatment of leprosy all helped to a gargle and nothing more, deserve especial attention for several reasons : 1. There is nothing so apt to run down the appetite, and with it the general health of the patients, as the continual swallow- ing of putrid matter from festering sores of these parts. 2. The discharge from these sores containing the bacillus in great numbers, as stated above, there is sufficient ground to believe that like in similar cases of tuberculosis, the leprous ulcerations of THE PATH OF THE DESTP OYER 335 the bowels are caused by self-infection from swallowing the pus secreted from these sores. 3. The heavy breathing and hoarseness, the disgusting smell and the ever-abundant secretion makes these patients doubly loath- some and dangerous. My experience teaches me that these ulcerations are especially amenable to local treatment. The daily application of antiseptics, caustics, and astringents, as the case may require, the fixing of oint- ment tampons, the use of medicated sprays and steam inhalations, all this can be used with much success, and ought to be used in a hospital for lepers. Similar arguments relate to the treatment of the disease of the eye so common in leprosy. I firmly believe that early operation for leprous nodules on the conjuctiva, and for leprous iritis will rescue a large number of the unfortunates from irretrievable blind- ness, and the paralytic drooping of the lower eyelid, which so commonly leads to loss of vision in leprosy, may just as well be benefited by plastic operation as it is in facial paralysis from other causes. But to effect all this, and a great deal more which I will not detail, there is required good-will on all sides. On part of the physician it must be brought, and on part of the patients it wall have to be courted and enforced by more vigorous support of the medical work by the Hospital Board, working in concord, and with the advice of the hospital physician. I now draw to the close of this report with a few remarks as to V. Hygienic Measures. I will skip the commonplace, but nevertheless all-important subject of general sanitation and im- proving the social habits of the people, but try to give some more definite points. Traveling around the islands to gain information on these subjects, I found in some parts, especially so in parts of Kauai and Maui, more lepers at large and in unconstrained intercourse with the healthy population than ought to be under the present laws. Now, I do not think it possible for the government to take charge of all lepers, but as long as the powerful law of segregation is in force, let it be brought to bear on such cases which are really com- plained of as public nuisances. I have intentionally visited the remot- est gulches and corners where few white men penetrate, and have found more bad cases of leprosy than I expected. Perhaps it may te just as well to leave these poor wretches in their homes, where they are just as much or more out of the way than at Kakaako or 336 THE PATH OF THE DESTROYER Kalaupapa; but there is an important point to consider. Pent up with these bad cases in their squalid huts and houses are apparently healthy children. These ought to be removed, for they are the future and hope of the nation. And not alone the girls, but also the boys should be removed, especially so as old and new statistics point to a prevalence of leprosy among the male sex. But one thing must be avoided if we accept the theory of disposition in children of leprous parents. We must keep these out of harm's way even more carefully than other children whose families are free of the taint. I know that it is acknowledged by Your Excellency and the members of the Board that the present Kapiolani Home is not in its proper position, and that only the most pressing circumstances have necessitated the selection of the present site. From my point of view I must stand by my original proposal to have the Home out of sight and reach of the leper asylum. If we want to keep the possibly disposed systems of the children free from the disease, the first step should be to remove them as far as possible from it, and not to tabu them within the walls of a lazaretto. The next point touches the vaccination question, with which I have dealt at length under the heading of experimental work. I would further urge that the medical examinations of school chil- dren, which has led to the elimination of quite a number of cases, should be kept up regularly and carefully. As an instance of their necessity, I may quote a case which has quite recently come under my observation. A little girl (native) belonging to one of our large schools passed my close examination a year and a half ago as healthy, but now presents initial symptoms of leprosy. We must not rely on general healthy appearance in these examinations, and on a furtive glance at hands and arms. I have found unmistakable marks of leprosy on the back of a child that held a recent health certificate. Moreover, we shall have to extend our examinations even to very young children in spite of Dr. Fitch's assertion that leprosy does not make its appearance before the period of second dentition. I have seen a child with clear signs of leprosy at. 3>]/ 2 year of age, and know of another boy who was a marked case at four years old. As this country has to rely on immigration mainly coming from countries where leprosy is endemic, i. e., China, the Azores, and Japan, considerable care ought to be exercised m guarding against new cases of the disease being imported from there. I know BERNICE PAUAHI BISHOP. High Chiefess or Alii, wife of Charles R. Bishop. Born December 19, 1831. Died October 16, 1884. FOUNDRESS OF THE KAMEHAMEHA SCHOOLS 338 THE PATH OF THE DESTROYER of two unquestionable cases of leprosy having come here from the Azores — the one was the Portuguese man mentioned above, the other a young Portuguese girl who, immediately after her arrival, half a year before I was asked to examine her, obtained a position as nurse in one of our best families. Altogether it is deplorable, though perhaps inevitable, that these islands with their terrible abundance of leprosy should be repopulated by the very nationalities, who seem to have not yet overcome a disposition to the disease as much as other races. There are two more points I wish to bring again before you, one of more local, the other of general and scientific importance. Both have been subjects of previous memoranda to the president of the Board. The first applies to the necessity of furnishing a wash-house at the Kakaako hospital to obviate the certainly unpermissible prac- tice of some of the lepers sending their soiled clothing out to be washed. The other relates to the disposal of the dead bodies of lepers. To make this report complete, I shall here insert the text of my previous communication, sent to the president of the Board in June last: To His Excellency W. M. Gibson, President of the Board of Health. Sir: I beg to submit to Your Excellency's consideration the following facts, which I have recently discovered with regard to the power of resistance of the germs of leprosy to putrefaction. I communicate this result of my work immediately to you, because it seems to me to have a direct practical bearing towards public sanitation. A series of experiments in this line were commenced in Oc- tober, 1884. Leprous tissue and matter was set aside under con- ditions of temperature and moisture most conducive to slow and thorough putrefaction, whilst the growth of the larger fungi was at the same time carefully excluded. From time to time a micro- scopical examination was made, and the characteristic bacillus leprae was not only found to hold its own against the germs of dissolution and putrefaction of albuminous matter, but met with so abun- dantly and laden with spores that the idea suggested itself there might be actual increase. An examination made a few days ago of the remains of this leprous tissue, set aside fully eight months ago, shows it to consist nearly entirely of swarms of the bacillus leprae. THE PATH OF THE DESTROYER 339 closely packed. Every vestige of the cellular and fibrous structure of the tissue has disappeared, even the bacteria of putrefaction have crumbled up into a mass of detritus, but the bacillus leprae is there with all its peculiar microchemical reactions. The discovery prompted me to examine dead bodies of lepers under the ordinary and natural influence of decomposition. Not being able to acquire the desired corpse here, I went to Molokai, and succeeded in procuring parts of the body of a tubercular case, which had been buried for nearly three months, and was in the most active state of putrefaction. After what I had learned from my experiments, I was not surprised to find the leprous germ pres- ent in large numbers. I candidly admit that I am not yet able to give a decisive answer to the question, whether these germs are alive and capable of reproducing the disease. This final question will not be solved until we have been successful in artificially cultivating and in- oculating the germ, a result which none of us who are engaged in this question, have as yet achieved. However, I feel personally confident, from the microscopical evidence alone, that they have not lost their power of germinating under the above named con- ditions. At any rate, it seems to me desirable to effectually bar even the possibility of a spread of the disease, through the slow decomposition of the dead bodies of the lepers in the graveyards surrounding the town. Cremation would certainly be the surest safeguard, but, as that can hardly be achieved, I suggest the com- pulsory filling up of the coffins containing the corpses of lepers with quicklime. To secure this end, I deem it necessary to stop the practice of letting friends and relations take away the dying lepers to their homes, as has recently been done in several cases. * * * Thus far goes my previous communication on this subject. Let me close these observations and suggestions relative to the hygienic side of the question with the following general appeal. Increasing familiarity with a signal danger lessens our fear of it, but not the danger. This applies most pointedly to our relations with leprosy. We live amongst it, and there are many of us, not only Hawaiians but also foreigners, who have grown so accustomed to it that they not only do not heed it themselves, but by word and deed try to dispel the fears of others. This is all very well, and has its good side when it becomes necessary to dissipate a scare. But as long as this is absent it will be a good thing to sound a warning note from time to time, so that carelessness on 340 THE PATH OF THE DESTROY ER part of the population may not be the outcome of assurances of safety. Examples like those of Father Damien, who has now him- self become a leper, and as such a veritable martyr to his cause, and of other worthy and pure members of the community whose names I am not authorized to mention, should teach us a lesson, and cause us all to work harmoniously and united for the one good end, to confine the dreaded leprosy to its closest limits, and to help and support the poor afflicted ones with the best of our will and skill. I have the honor to remain, Yours most respectfully, (Signed) ED. ARNING, M. D. COPY OF CORRESPONDENCE BETWEEN THE BOARD OF HEALTH AND DR. EDWARD ARNING. Office of the Board of Health, Honolulu, Nov. 30, 1885. Ed. Arning, M. D. Sir: By instruction of His Excellency Mr. Gibson, the presi- dent of the Board of Health, I have the honor to acknowledge re- ceipt of your report as to the course of investigation carried on by you with regard to leprosy, dated Nov. 14, 1885, addressed to him and to the members of the Board of Health, and am furthermore instructed to make the following remarks for your consideration and attention. In the month of February of the present year, His Majesty's government, through the foreign office, addressed His Majesty's accredited representatives abroad, a series of questions somewhat similar to those propounded by the Royal College of Physicians of London in 1862, to medical representatives of foreign powers in whose borders leprosy exists, or is suspected of existing. To these questions His Majesty's government has received interesting and valuable replies in many instances. It is proposed to print these reports in conjunction with your report and other material of value in the study of leprosy. His Majesty's government deeply appreciating the good-will shown by other nations in collecting and forwarding, at no little cost of time, labor and money, the infor- mation required, is naturally anxious to reciprocate to the best of its ability by furnishing to such foreign powers all the information the Board of Health can obtain in regard to leprosy as it exists on the Hawaiian Islands. It is reasonaly considered that after the two years you have spent on these islands in the service of the Board of Health with liberal emolument, combined with your high recommendations to the Board as an honorable scientist and close and faithful student, and the facilities and opportunities it has placed at your disposal for experiment and observation, you have been enabled to acquire knowledge and information in regard to leprosy of great value and importance to the health authorities of the kingdom, and to all interested in the study of the disease. The impression is therefore felt that it is within your power to present a report of value and benefit to those engaged in battling with the disease abroad ; credi- 342 THE PATH OF THE DESTROYER table to this State and honorable to your talent and your position as the government's special medical representative. I am not instructed to make any comments upon the report of Nov. 14th, further than this, that in the opinion of His Ex- cellency the president of the Board, it is incomplete and incon- clusive, and not such a one as might be anticipated after two years of special labor, with considerable outlay of public funds. I am instructed to speak of the report as incomplete by reason of references in it to notes and data not presented to this honorable Board with the report, but mentioned as being retained or intended for "future publications;'' and, furthermore, to request that, you furnish to the Board by way of schedule or appendix, the schedule referred to on page 12 of the report to "serve as a guide for ex- amination of doubtful cases." It. is also deemed proper that the "full notes," referred to on page 4, should be presented to the Board. On page 10 reference is made to photographs and casts of cases selected at Kakaako and Molokai, the president expects that duplicates of these be placed in possession of the Board — allowance being made for any extra expenditure on your part — and, also, the notes of autopsies made by you on hospital cases should be given for future medical reference. On page 32 occurs this: "I will, in a cursory way, state the methods of treatment I have adopted for different classes of lepers, native and foreign, some treated at Kakaako and some as outside patients." The president is of opinion that the notes of such cases or some of them would materially add to the scientific value of your report abroad, and should be furnished. On page 40 reference is made to your "traveling round the islands," in search of information, and also to the large numbers of lepers on Kauai and Maui, "in unconstrained intercouse with the healthy population." The president will be pleased to receive more definite infor- mation on these matters, for the consideration of the Board. A more extended notice of the large body of leper patients whom you have visited on Molokai could not fail to be of interest. Having outlined the views of His Excellency the president for your consideration, I have the honor to be, sir, your most obedient servant, FRED H. HAYSELDEN, Secretary Board of Health. THE PATH OF THE DESTROYER 343 Honolulu, Dec. 15, 1885. To His Excellency W. M. Gibson, President of the Board of Health. Dear Sir: I am in receipt of the letter of the secretary of the Board of Health, dated Nov. 30th, and regret that my report on the progress of my investigation of leprosy is unsatisfactory to Your Excellency. I will beg to state, that after due consideration, and after having submitted my report to some of my medical friends, viz., Doctors Trousseau, McKibbin and Brodie, I cannot modify it or make a more extensive one. My friends and myself are of opinion that as information for "a lay Board of Health," it is as complete and conclusive as necessary. It is far from my desire to have, for the present, a full sci- entific report published, as my investigations are not nearly com- pleted, and will probably take many more years to allow me to come to positive conclusions. Footing on the preliminary correspondence between Your Ex- cellency and Dr. Hillebrand, and our own conversation after my arrival, I could not look upon the moderate salary allowed me by the Board otherwise than as an assistance and encouragement to purely scientific work; but never for a moment understood that either my work or notes, or specimens, etc., could be claimed by the Board for its own purposes. The above were mostly obtained at my private expense and for my private use, and, therefore, I must decline to furnish duplicates or put at the disposal of the Board my private notes of cases and post-mortems, these being collected for future scientific information and publication. It is unnecessary to say that in these latter due credit will be given to the Hawaiian government for all assistance rendered to me. I have, however, keenly felt that this assistance was not such as I was led to expect from the above-mentioned correspondence, es- pecially as far as moral support was concerned. I further beg to state that. I did not visit the lepers on the other islands with the intention of gathering information for the Board of their whereabouts, but for my own private knowledge, to be able to judge of the causes of the continued spread of leprosy, in spite of segregation. The finding and segregating of these cases is a duty devolving on the police and local government physicians. I have the honor to remain, yours respectfully, ED. ARNING, M. D. 344 THE PATH OF THE DESTROYER Office of the Board of Health, Honolulu, Dec. 22, 1885. Ed. Arning, M. D., Honolulu. Sir: By the instructions of His Excellency the president of the Board of Health, I have the honor to inform you, that by a recent resolution of the Board, a special committee was appointed to make such reduction in the medical staff of the government as they deemed advisable; and, acting under this authority, it has been decided to discontinue your services on the staff. Your statement to the president, in your letter of the 15th instant, that it will take you many years to come to positive con- clusions in your medical investigations; that you never understood that your work, or notes, or specimens could be claimed by the Board, and as you decline to furnish duplicates, or place at the disposal of the Board any notes of cases or of autopsies — all these being collected, as you state, for future scientific information and publication — satisfies the Board, after the expenditures made on your account, of the propriety of their action in this matter. Your appointment as a physician, in the employment of the Board, will cease on the 31st instant; and between now and that date you will vacate the offices situated in the Kakaako hospital enclosure, now used by you, leaving therein such articles as have been supplied to you by the Board. I have the honor to remain, sir, your most obedient servant, FRED H. HAYSELDEN, Secretary of the Board of Health. * * * Honolulu, Dec. 28, 1885. Fred H. Hayselden, Esqr., Secretary of the Board of Health. Sir: I have the honor to acknowledge receipt of your letter dated December 22, 1885, informing me of the decision of a special committee of the Board of Health to withdraw my appointment as a physician in the employment of the Board, by the end of the month. The premises I have used for my work at Kakaako will be vacated by the 31st inst. I shall leave therein such articles as have been supplied to me by the Board. E.c o *- CO o a. -a *- o c <" § §.s . -5 a J3 c a. o aj > si c o IU — <+* «« » « o ^ -5 <3 c <+h e oobll.. S c « — a< u Kj (fl CJ r- « 2 £ ° U 03 C en (h ra £ w -3 ^ eg- -a £ pj he Q - w O ■sfa £ S £~o fe s -£ ,e T3 rt p « £S a ■a -s £ Q S^g o bo O C g cd mh °° £ 3 > & « 3 1) Cd 4-1 ,3 1 to 23 i 1 Kona 1 Niihau r i Oahu j J i i Honolulu Ewa Waianae Waialua >- 1 to 23 I i Koolauloa 1 i r Koolaupoko Kona Wailuku 1 j 1 1 IVIaui ! Makawao Hamakua Hana i I > 1 to 17 i r i Kahikinui J 1 Kohala Hamakua . Hilo 1 Puna y 1 to 24 ! Kau i 1 Kona 1 J 1 to * Koolau Molokai . j Kona 1 to 29 Lanai Lanai 1 to 50 1,812 * ( 1 ) Formerly kokuas, now lepers at Kalawao. 370 THE PATH OF THE DESTROY ER CONTAGION.— The whole history of leprosy in the Ha- waiian Islands from its introduction to its present rapid spread and development, verily proves that it can only be accounted for by re- garding it as a contagious disease, and that it spreads from indi- vidual to individual. Whatever else may be said of its being non- contagious in other ancient countries, where the disease exists en- demically, these statements do not apply, or should not apply, to the disease in the Hawaiian Islands. Even in other countries where the disease has existed for centuries, the question of contagion or non-contagion is not definitely settled, the evidence tending in many cases to affirm contagion; in many others to negative this conclusion. How any competent observer concludes that leprosy is non- contagious in these islands is to me only accountable by presuming that previous views from extraneous sources have clouded his powers of observation. That leprosy did not prevail on these islands until many years after they were open to foreign intercourse, receives great confirma- tion in the fact that no true aboriginal word is in use for the name of the disease. I consider this a most significant illustration of the rapid spread of leprosy within a comparatively short era. I believe it perfectly safe to affirm that did leprosy exist amongst the ancient Hawaiians they would not call it, as the present race do, "Chinese sickness." Whatever defects the Hawaiian language may have, a very casual observation shows that it was in the highest degree, and is a language of minuteness and exactitude; for example, take the verb "to break," in the Hawaiian language it is exquisitely definite — to break, as glass, "naha;" to break, as rope, "moku;'' to break, as bone or stick, "haki ;" and it can scarcely be imagined that naming a slow progressive disease like leprosy was beyond the power of their intellect, and yet this is really what those who claim to trace a hereditary development of the disease ask us to do. The name "mai pake" may, no doubt, have originated on the interrogation by a na- tive of a Chinaman, "What is this disease?" The Chinaman would probably answer, "I do not know the Hawaiian word, but there are plenty of people sick with the disease in my country." Chinese with leprosy do not generally emigrate, though the disease may ap- pear after their arrival in the islands. As I have before mentioned, Mr. Stewart states the disease prevailed in the year 1823. What significance the absence of a true Hawaiian word for leprosy bears, rs such, that this very absence in itself is almost sufficient evidence to prove that leprosy has not reached its present development by hereditary influence only, and that a very strong, helping hand has CHINESE MOTHER AND BABE. Type of people who miss and lament the late Francis W. Damon; he spoke their language, and was their monitor and friend in need. 372 THE PATH OF THE DESTROYER been offered by contagion, the period being too short for the in- fluence of heredity to show itself, if it is hereditary at all. I repeat, on no other grounds can the spread of leprosy be ex- plained in the Hawaiian Islands, than by regarding the disease as contagious. Were the habits of the people different to what they are, one might have some diffidence in arriving at this conclusion; here we have the best field of observation. In the carelessness of of the natives, in disease generally, their hospitality to the leper, and contempt of the disease, there is also present here in these islands a typical illustration of the ominous remark of Dr. Tilbury Fox — such remark generally being accepted as correct — "that it is in those places where leprosy is on the increase that the freest intermingling of the leprous and non-leprous parts of the community takes place." Could the opposite conclusion be arrived at, "that although in Hawaii free intercourse exists between the leprous and non-leprous," the disease does not spread? I say no. Any calm impartial observer must arrive, sooner or later, at the conclusion that the type of leprosy prevalent in these islands is contagious, whatever else may be related of it in other countries. Many cases, undoubtedly, present some striking pecularities, giving some credence to the view that the disease is non-contagious; but on a more minute scrutiny such cases can be explained on the principles of analogy, in certain respects like and similar, in other respects dif- ferent and dissimilar, and did such instances arise in the prevalence of a disease we have more accurate knowledge of, they would present but slight difficulties, these being one of the many peculiar traits of a specific disease like leprosy. I now wish to state, because I conclude leprosy is contagious, I think I am carrying conviction to the mind of any person, who may happen to read this report; my object is to state facts, and hence the truth must result. Did I wish to write a paper on the non-contagious nature of leprosy, I could do so at the expense of concealing prominent facts bearing on the view that it is contagious; on the other hand, did I wish to prove leprosy contagious, I might conceal many facts proving it non-contagious. To avoid any pros- pect of being charged with wholly treating leprosy in its con- tagious aspect, whatever cases bear on the non-contagious view, I will give as great prominence to, and assign to them their relative degree of importance. I now state my reasons for believing that leprosy is contagious. 1. Heredity, as the sole agent in the propagation of the dis- ease, will not account for its rapid increase in these islands for the following reasons: THE PATH OF THE DESTROY ER 373 (a) Sterility amongst the leprous is much more frequent than fertility. (Years 1884-87.) (b) The majority of the offspring of leper parents, or parent, are still-born, or die within a short period after birth. The chil- dren born at the Settlement, during the past fifteen months, amount to five, and two out of these alone are now alive. And again, it it doubtful if these two remaining infants will reach adolescence, and even then if they do, there is only a bare possibility of their developing leprosy. (c) Even allowing lepers to be fertile, is not the Hawaiian race notoriously unprolific? and shall I ask the question, whether a healthy parent is more likely to be fertile than the leper? If fertil- ity in a marked degree does not exist amongst the healthy, then it is hardly reasonable to conclude that it will exist to a greater degree amongst the leprous. Numerous children, the offspring of known lepers, have not developed the disease in their lives, although most probably alleged hereditary predisposition was present, but they never developed leprosy. That the influence of heredity might play an important role as the sole factor in the propagation of the disease, did the lepers in these islands only aggregate a few hundred since the disease was first definitely known, I quite admit; but when the number of lepers reaches into thousands, I certainly think that another source for its spread must be sought than in the influence of heredity. 2. That, almost invariably, when no (?) hereditary history of the disease is obtainable, I can always elicit the facts "that contact with a leper for long or short periods had existed.'' I do not think the importance of this evidence can be sufficiently overrated, and it tends to difinitely prove leprosy spreads by direct contact, from in- dividual to individual. 3. The evidence obtained from foreigners — victims of the dis- ease — and from the history of their own cases, lends strong support to the view that the disease is contagious. It is not rational, but absurd, to conclude that the foreigners who now have the disease, and those who have had the disease (now deceased) acquired it in their respective countries. How does the hereditary theory affect them? 4. The history of Father Damien, who came here (Leper Settle- ment) in the year 1873, to exercise his calling as Catholic priest, and who has, within the past two years, been afflicted with symptoms suspeciously resembling those of leprosy — (since August, 1885, out- 374 THE PATH OF THE DESTROYER ward manifestations of tubercular leprosy have appeared, placing the diagnosis beyond all doubt). His case will be discussed further on when dealing with the manner the "contagium" of leprosy enters the system. I may add, also, that Father Damien has always maintained that the disease was contagious; his continuous residence or thirteen years has afforded him plenty of facilities for giving this opinion on the matter. 5. My own observations, from a physician's standpoint, will be stated hereafter. 6. The opinions of experienced and reliable physicians in these islands. 7. The failure to explain its appearance amongst clean families (foreign), known to have no tendency to the disease, otherwise than by regarding the disease in a contagious light. 8. The contagious character of leprosy can be borne out in every particular by the attitude the Hawaiians adopt towards lepers. To> state briefly, "The lepers are welcomed in their midst with open arms." Were these conditions reversed, the state of affairs, socially fulfilling rigid seclusion and ostracism, then leprosy spreading to any extent, it would be necessary to seek other sources of spread than contagion supplies. Under these latter conditions, I do not deny that leprosy would exist, and there would also be strong evidence in favor of the disease being non-contagious. It is from this evidence also that we receive alleged facts applying to those countries where we have reports of the disease being non-contagious. I now wish to offer a few remarks to illustrate the progress of disease at Kalawao and Kalaupapa amongst the kokuas, both male and female ; these are cases that have been under my own observation, and have developed leprosy since my residence at the Settlement. In the month of January, 1885, I made a thorough medical inspection of all the kokuas residing at the Settlement ; the result was as follows: Total number male kokuas 91 Total number female kokuas 87 Total 178 The male kokuas had mostly accompanied their wives, and the female their husbands. There were one or two cases where the father accompanied his son, and a mother her son or daughter, or aunt, nephew and niece. Be the relation what it may, all these healthy people were in contact with lepers continuously. THE PATH OF THE DESTROY ER 375 In the month of August, 1885, I made another inspection. At the date of my writing this report (January 1, 1886), some twelve months after my first systematic inspection of the kokuas, the state of affairs is as follows: Number of male kokuas who have become lepers in the twelve months, February, 1885, to February, 1886, 5. Female kokuas who have become lepers during the same period, 12 — male 5, female 12; total 17. Total number male and female kokuas, therefore, are 17. Excess of female over male, 7. So that out of a total of 178 healthy people, in twelve months 9.5 per cent have developed leprosy. Then, at the same rate of progress, in twenty years all these people will be lepers. But this is not borne out absolutely, for many Hawaiians live here year after year, marry lepers again and again, and show no manifestations of the disease. Whatever may be said to the con- trary, I assert that a large majority of the Hawaiian race are posi- tively exempt from the disease under the greatest degree of exposure to infection — they are non-receptive or immune. NON-CONTAGION.— From what I have just written it is evident, I hold the opinion that, leprosy is not contagious to every- body. This is the case, and there is nothing remarkable in the state- ment. Did everybody who comes in contact with our well-known contagious and infectious diseases — small-pox, scarlet fever, measles, typhus, etc. — get each of them respectively, it would be a very dis- mal prospect for nurses and physicians, and other attendants. I simply assert that many persons have an immunity conferred on them. What confers this special immunity is now foreign to my purpose to enter upon, but the cases which go to prove leprosy non-conta- gious fall within this special sphere of immunity or non-receptivity. Wlien I see daily and hourly before my eyes a man who tells me he is perfectly well, looks well, and I conclude he is, after a medical inspection, and after these preliminaries I come to inquire into his history, and he states as follows: "I have had one, two, frequently three, and sometimes four leper wives, and my children have died from leprosy, and I have lived here ten years in contact with all the lepers" — after such a story as this it would be quite reasonable to conclude that leprosy is certainly not contagious to everybody — it is not a question of degree of contagion, but non- contagion and immunity. Again, w T hen a woman repeats in substance such a story as the following, and after all this contact and exposure, is to outward ap- pearance healthy, one would be justified in concluding that the dis- ease was non-contagious, certainly to this individual woman. To illustrate. — The washer-woman for the hospital at Kalawao 376 THE PATH OF THE DESTROY ER has washed the soiled clothes of the worst cases, certainly many of them so, in the Settlement for the past seventeen years. Any one who has seen advanced cases of tubercular leprosy knows the con- dition this soiled linen will present ; nor is this her only contact with the disease; she has lepers living in her house, and, to crown all, her husbands, two in number, were lepers for years before they died ; and yet, in spite of all this contact, this said woman today is hale, hearty and plump, and as fine a specimen of womanhood as any in the islands; her age is now forty-six years. (This woman Kalehua later developed leprosy, in 1888.) But are these cases the rule? Certainly not. These cases number, at the Settlement: Males .: 26 Females 22 Total 48 These forty-eight cases give an average of fifteen years each of close and intimate contact. That some will become lepers I am certain; that others will resist all infection I am also positively cer- tain. These are the accumulated Immunists. One woman has lived here nineteen years. I have already shown the number of kokuas who did develop leprosy last year, viz., seventeen. If the disease develops at the same rate, in three years time the contagious cases will have passed the non-contagious, taking the same figures; and yet these forty-eight are the accumulated veterans of the Settlement. ALLEGED, HEREDITARY PREDISPOSITION.— As an agent in causing the spread and perpetuation of leprosy, occupies no important position. In these islands, I will place its relative rank next to contagion, giving the latter the position of chief factor at work spreading the disease in this country. Having before stated, "that, in my opinion, leprosy was intro- duced here only since the advent of the foreigners," (?) hereditary predisposition has not had opportunity to prove sufficiently the extent of its power; that it can approach its ally, contagion, is not to be thought of, owing to the unproceativeness of the present Hawaiian race, and how hereditariness in leprosy should or could have been elevated to the first rank of propagator of the disease in these islands I am at a loss to understand. (Read Dr. Fitch's report.) Predisposition is a name applicable to very few diseases, the least exponent being found in leprosy, syphilis is quite erroneously placed under this heading. Tuberculosis somewhat falls under this heading. 'GENUINE CHINA. 378 THE PATH OF THE DESTROY ER I may here remark that no child born at. the Settlement since my period of residence has had manifestations outwardly of leprosy at birth. The causes, so far, that I have mentioned in connection with the spread of leprosy in the Hawaiian Islands are: First, con- tagion; second, possibly hereditary predisposition. The third cause to which I attach some importance, and which has (?) doubtfully spread the disease, is vaccination. I can bring forward no case personally, but I have hearsay evi- dence that after the operation of vaccination had been performed on several white children they manifested signs of leprosy, and finally developed the disease (but the evidence of so acquiring leprosy is far from conclusive). Evidence on this same point is put forward by Sir Ronald Martin, in India, and by Professor H. G. Piffard, of New York. The possibility of such an occurrence again taking place, "now that bovine virus only is used in the operation" by the medical officers of the Hawaiian government, is most improbable. The extent to which each of the following factors is responsible for spreading leprosy, these factors being contagion, heredity, and vaccination, are approximately as follows: Contagion, estimated at 90 per cent. ? Heredity, estimated at 9 per cent. ? Vaccination, estimated at 1 per cent. I have personal knowledge of the two first, which account for almost all cases. Some few cases not coming under either heading, I have placed under vaccination, as being the most feasible situation for them, as in the Hawaiian Islands I recognize no other agents at work, such as we hear of in Norway, India, etc. In these islands no such origin need be sought for, the disease being introduced. CONTAGIUM. — It is not my intention to enter at length on this subject, except in so far as it trenches on the domain of leprosy. By the "Contagium of Leprosy," I wish to convey "that sup- posed specific material in which the infective power ultimately resides." I believe that the "contagium" of leprosy enters the system by: 1. Inoculation. (?) (a) At broken surfaces of the skin. (b) At broken surfaces, fissures or chaps, on external mucous surfaces. (c) Possibly by puncture of insects, or the presence of parasites, scabies, etc. (I held these crude ideas in the days of my youth. — Author.) THE PATH OF THE DESTROYER 379 DIVISION II— INHALATION AND ALIMENTATION. — An act comparable to inoculation on an external surface takes place on an internal surface. 1. Contagium particles or bacilli conveyed in the sputum and exhalations of the leper (especially in the advanced tubercular cases attended with severe ulceration), enter the mouth, are caught on the tonsils, or are carried into the bronchi and air cells. 2. From eating with soiled fingers, bacilli may be swallowed, reach the stomach and the intestines, and later penetrate the texture of the intestinal mucous membrane, and thus effect as genuine an inoculation, with regard to the blood, as that which art or accident provides in other cases through the punctured skin. By the first means (inoculation) a few cases of leprosy are (?) propagated, but I do not think it is nearly so frequent as by alimen- tation. Under this latter heading I would place the case of Father Damien, whose history I briefly relate. Father Damien arrived at the Settlement in the year 1873, and has lived there continuously ever since. He is a Belgian, of good physique, and when he arrived, was thirty-three years of age. During all the period of his residence he has been daily and hourly in con- tact with lepers of various grades, many very severe. Until 1884 he felt, fairly well. In that year pains in the left foot troubled him ; these continued to get worse, and, in the absence of any other signs, were attributed to rheumatism. Towards the end of the year 1884 he consulted Dr. Arning (a physician who is making leprosy a special study), and to this gentleman must be given the credit of diagnosing the disease in its very early stage, as certainly not until six months afterwards did external manifestations of leprosy develop; the symp- toms pointing to deposit of leprous matter in the structures connected with the peroneal nerve in the flexure of the knee. In May, 1885, there were no striking changes in his face, except the forehead, when examined by Dr. Arning and myself. In August, 1885, a small leprous tubercle manifested itself on the lobe of the right ear, and from that date to the present, diminution and loss of eyebrows, in- filtration of the integument over the forehead and cheeks is slowly, but certainly, going on, so that the case of Father Damien is a con- firmed tubercular one, the symptoms and signs now present placing it in that class ; the Father is careless, has eaten repeatedly with lepers, has a leper cook also. I believe the majority of cases of leprosy at the Settlement, had they been rigidly watched, would fall in the same category as Father Damien's. Most cases of leprosy are recorded between the ages of twenty-five to forty years, so heredity is scarcely possible. 380 THE PATH OF THE DESTROY ER I am also clearly of opinion that nodular leprosy is contagious at the beginning, and all through its course. Women are less liable than men to the disease, I believe, owing to ( ?) physiological causes peculiar to the sex; and, I explain, (the many cases related of certain women having two or three husbands, and although previously clean, falling victims to leprosy, the woman herself remaining unscathed) on these physiological grounds, which, when a certain age is reached and changes occur in the system — re- sulting in the cessation of menstruation — leprosy, which has been dormant, proceeds to show itself. The female may also possess, however, greater Immunity than the male, this may account for the disparity of prevalence in the sexes. One other point I wish to allude to, and that is, that I have not met with an intermixing of cases of tubercular and anaesthetic lep- rosy in the same family. The variety is tubercular alone, or it is anaesthetic alone. My opinion as to whether I think leprosy and syphilis are homo- logous is asked, and whether one disease has any connection with the other, or with tuberculosis. There is no homology between leprosy, tuberculosis and syphilis in my opinion, but there is an analogy. No other constitutional dis- eases are allied so closely as leprosy, tuberculosis and syphilis; but they are distinct diseases. Leprosy is sui generis, tuberculosis and syphilis are each sui generis. I affirm that any observer or physician who has studied syphilis carefully, will speedily see where the diseases agree, and where they no not. This report is very incomplete. I have written it, much against my own will, in the brief periods I could snatch from the busy hours of my professional work. To cover the vast field of leprosy requires more time and experience than I have had at my disposal. TREATMENT. — There are legions of alleged cures for lep- rosy, but most are of no value and cannot be relied on in any given case. In a few instances, in the early stages of the disease, it is possible to check the progress of leprosy by the persistent use of the following drugs: Calcium sulphide, sodium salicylate, quinine, and guaiacol carbonate. ARTHUR MOURITZ, Kalawao, Jan. 1, 1886. Physician. L 'GENUINE CHINA." NONCONTAGIOUS REPORT OF DR. G. L. FITCH, 1884. To the Honorable the President and Members of the Board of Health: Gentlemen: In this, my quarterly report as medical officer in charge of the Leper Settlement, for the quarter ending September 30th, 1884, I propose to thoroughly discuss the question of the con- tagious nature of leprosy, and its etiology. Before expressing any opinion of my own, it will be proper to give the views held by others who have made the study of the dis- ease elsewhere, and so I quote as follows from the "Report on Leprosy by the Royal College of Physicians." "The Committee having carefully considered the replies already received are of opinion that the weight and value of the evidence they furnish is very greatly in favor of the non-contagiousness of leprosy. "The Committee can only repeat the statement made in their former report to the College, that the replies already received con- tained no evidence which, in their opinion, justified any measure for the compulsory segregation of lepers." Acting on the advices already obtained, the Duke of Newcastle forthwith issued a circular to the governors of the Colonies express- ing his opinion "that any laws affecting the personal liberty of lepers ought to be repealed, and that in the meantime, if they shall not be repealed, any action of the executive government in enforcement of them, which is merely authorized, and not subjoined by the law, ought to cease." — Handbook of Treatment, Aitken. Doctors Danielssen and Boeck state, "that among the hundreds of lepers who we have seen daily, not a single instance has occurred of the disease spreading by contagion. We know many married persons, one of whom is leprous, cohabitating for years without the other becoming affected. At St. George's Hospital many of the at- tendants of the inmates have lived there for more than thirty years, and are quite free from any trace of the disease. As the result of our observations we have only to denv the contagiousness of leprosy." — Coll. Phys., Report, p. 4, XIX. ' Jamaica — "I am certain that it is in no way contagious, and that it is L THE PATH OF THE DESTROYER 383 not transmissible by sexual intercourse. The evidence against the contagion of leprosy in all its forms is irrefragable." — Dr. Fiddes. Barb ado es — "I have noti met with any cases of contagion; none of those in attendance during the last nine years upon the inmates of the laz- aretto have contracted the disease, and I, after receiving a wound from a knife moistened with the fluids of an inmate, have escaped, although the wound was followed by great constitutional irritation and loss of the ringer. From what I have heard I do not believe it communicable by sexual intercourse." — Dr. Browne. Mytilene — "It is demonstrably not contagious. Dr. Bargilli practiced in- oculation in two instances, but without results." — Dr. Brunelli. Mauritius — "I know two instances where medical men have wounded them- selves in dissection, but without any bad results." — Dr. Powell. Crete — "There are 127 persons who have all lived together healthy among lepers for many years." — Dr. Brunelli. Benaveo — "All the reporters agree in stating that leprosy is not contagious, nor transmissible by sexual intercourse." — Dr. Dunbar. Nag pore — "During the nine years I have held charge of the Nagpore goal, with the daily average of 500 prisoners, all of whom freely inter- mingled, and some of whom when imprisoned were lepers, I have never known an instance of contagion. As far I could ascertain the disease does not seem transmissible by sexual intercourse." — Dr. Hende. New Brunswick— -Coll Phys. Report, pp. XLIII, XLIV, XLV. "I am thoroughly convinced that the disease in Tracadie is not contagious, and that it is not transmissible by sexual intercourse. All the cases I have reported prove its noncontagiousness. Leprous hus- bands have lived many years with their wives, and vice versa, with- out infecting each other. Children have been born of leprous moth- ers, and have been nursed and handled by patients in the Lazaretto in all stages of the disease, without manifesting any symptoms of the disease." — Dr. Bayard. "It does not seem to be transmissible by sexual intercourse." — Dr. Gordon. "I have never met with an instance of leprosy being communi- cated to a healthy person by contagion. On the contrary we have 384 THE PATH OF THE DESTROYER a female, who, for the last six years has scrubbed the floors of the hospital, washed their clothes, ate, drank and slept with those affec- ted, and who, notwithstanding, exhibits no trace of malady, and at present enjoys good health. "Leprous husbands have, for many years, slept with their wives and families, and wives with their husbands, without contracting it. Children have been born of leprous mothers in the last stages of the disease and have been nursed by lepers, and have now attained adult ages without manifesting any symptoms of the disease. All of which proves it not to be transmissible by sexual intercourse." — Dr. Nicholson. "Several lepers have cohabited with their wives for years and no infection was communicated to them. In the case of a leprous man now in the hospital, the wife has continued free, although two of seven children which she has borne to him are afflicted with the disease." — Dr. Benson, Coll. Phys. Report, p. 4. William Aitken, M. D., etc., says in his recently issued "Hand- book of Treatment," p. 238, A.D. 1882: "LEPROSY; TRUE DEFINITION." "A constitutional noncontagious hereditary affection. There appears no more need (or just about the same) for restricting the liberty of lepers as for restricting the liberty of those afflicted with the gout." Under the heading: "A CASE OF INDIGENOUS LEPROSY," in the Medical Record of August 16th, 1884, W. H. Greddings, M. D., of Aiken, South Carolina, U. S. A., says: "Isolated cases of leprosy have been observed in Charlestown and its vicinity for many years, the present being the latest of a series of twenty that have been brought to my notice during the last twenty-five years. In none of these cases was the disease hereditary, although in one instance a mother and daughter were affected at the same time. In all these cases except the one just mentioned there was not the slightest evidence of contagion, nor has it ever been deemed necessary to isolate those affected with the disease. When well enough they walked about the streets of the city, attracting but little attention, as the people know from experience that in this country they run no risk of contracting the disease by coming in contact with those affected with it. L CHINESE-HAWAIIAN. 386 THE PATH OF THE DESTROY ER "As isolated cases of leprosy have been observed on the coast of South Carolina for nearly forty years, without any apparent increase in the number of cases, it may be safely inferred that there is but little danger that the disease will ever become endemic in this section." A. Balmanno Squire, M. D., of London, says: "Greek Elephan- tiasis was formerly thought to be contagious. It has, however, long been satisfactorily ascertained that it is not so." — Reynold's System of Medicine, Vol. 3, p. 948, A.D. 1880. Thomas Hawkes Tanner, M. D., F.L.S., of London, says: "Elephantiasis Graecorum, or Elephantiasis Anaesthetica, or the East- ern Leprosy, is a terrible and dangerous constitutional disease, being endemic and affecting the poor and badly nourished in preference to the well-fed, while it is noncontagious, hereditary, and generally incurable." — Practice of Medicines, Tanner, p. 671. "That leprosy in Japan is not in the slightest degree contagious or infectious; that the idea to isolate lepers from other patients does not occur to anybody. In my own wards I have always had lepers between other patients, everybody knowing the nature of the dis- ease, but no one objects to the sleeping in the bed next to theirs. No disinfection is ever used. There is a native doctor in Tokio, in whose family the treatment of leprosy has been carried on as a specialty for at least three generations, he and his whole family live in the same house with his leper patients. For a hundred years, many, many thousands have been treated in that very same house in the center of the capital, inhabited by more than a million of people and never one case of contagion has happened." — Dr. Baelz, Prof, of Chemical Medicine at the University of Tokio, Japan (on board the steamer "City of Tokio, Pacific Ocean, September, 1884.) Dr. Baelz is one of the best and most favorably known physicians of the Orient. The above quotation is an extract of a letter from Dr. Baelz to Rev. S. C. Damon. A recent visitor at the Lazaretto in Tracadie found the Mother Superior of the Sisters of Charity, who have charge of the Lazaret- to, with her hands in the same basin of water with those of a leper, whose hands were covered with leprous ulcers. She, the Mother Superior, was cleansing the ulcers preparatory to dressing them. There are nine Sisters of Charity at that Lazaretto who have lived there for fifteen years, engaged as nurses and caring for lepers; none of the Sisters have contracted the disease. My authority for this statement is Rev. Father Leonor, Provin- cial of the Catholic Mission in these Islands. (Verbal communica- tion.) THE PATH OF THE DESTROYER 387 The following quotation is from a recent newspaper article which, from other sources of information, (on the Etiology of Lep- rosy, by G. Armauer Hansen, Assistant Physician to the Leper Hos- pital at Bergen, Norway), I believe to be a true statement: "In a report given a few T days ago by the head physician of Norway it is shown that at the end of 1856 there were known in Norway 2,863 cases of leprosy, of whom then but 235 were treated in hospitals, and 2,628 in their houses. Since then there has been steadily more isolation, and thereby a steady diminishing of new cases, so that by the end of 1866 there were 2,704 cases, and of these 795 were in hospitals, and 1,909 in their houses; a decrease of 159 cases. By the end of 1876 there were 2,008 cases, showing a decrease of 696 cases. Since the decrease has been regular ; thus there were known in 1877, 1,923 cases; in 1878, 1,835 cases; in 1880, 1,582 cases; of whom 617 were in hospitals, and 965 in their houses. Thus the decrease of this disease is from 2,863 cases in 1856 to 1,582 in 1880; in all 1,281, or 45 per cent." — Hawaiian Gazette, March 10th, 1883. Summing up this statement it will be seen that, beginning with 1856, we find one case in twelve, or a little over, segregated, and 2,628 different foci of contagion — according to those who believe in contagion — engaged in spreading the disease, and yet the disease be- gins to decrease, so that with a gradually increasing number of cases segregated — or rather varying in number, for in 1866 seven hundred and ninety-five were segregated, and in 1880 only six hundred and seventeen — by 1880 45 per cent of the disease disappears, but still about three-fifths of the cases are at large. It has been asserted, how- ever, that those who were living in their homes were carefully seg- regated. How to make these facts agree with the assertion of the advo- cates of contagion, in Hawaii, who so eagerly assure us that all the cases here originated from one imported case — a Chinaman, many years ago — and that the disease has spread from that one case, is a matter entirely beyond my comprehension. As we shall see further on, there is no evidence in favor of such a statement whatever. As is well seen, the evidence of observers in other lands, who have been brought into intimate contact with the disease, and have really investigated the matter, seems generally opposed to the doc- trine of contagion. Those like Dr. J. C. White, of Harvard Uni- versity, who has seen one case (Am. Journal Med. Sciences, p. 447, 1882) or Dr. J. R. Tryon, of the U. S. Navy, who, during a visit of some weeks' duration here in Honolulu, visited the Kakaako leper 388 THE PATH OF THE DESTROYER hospital three times — and in the American Journal Med. Sciences, April, 1883, is very sure of the contagious nature of the disease; and various observers elsewhere, who have examined the disease at a secure distance, are equally certain of it; but real, practical, earnest workers in the field, like Drs. Danielssen and Boeck of Norway, with their forty or more years of experience, say: "Among the hun- dreds of lepers whom we have seen daily, not a single instance has occurred of the disease spreading by contagion." "As the result of our observations we have only to deny the contagiousness of leprosy." And now let us turn to what we can find here in Hawaii to help us form a conclusion on the subject. In the March number, A. D. 1883, of the "Medical Bulletin," published in Philadelphia, I find this statement, by J. V. Shoemaker, A. M.,'M. D. "I am indebted to Professor Samuel D. Gross for a recent op- portunity of seeing and examining a young man suffering from lep- rosy. The patient was sent from Honolulu to Professor Gross by Drs. Hagan and Trousseau, gentlemen who are well known in the Sandwich Islands as expert practitioners of medicine. "The letter of introduction, and the description of the patient's condition, stated that they believed the case in question to be one of leprosy; and, as they regarded it noncontagious, they advised a trip to the States for a change and benefit to his general health, and wished him at the same time to have the best medical advice that this country could give." That Drs. Hagan and Trousseau did, at that time, believe that leprosy was noncontagious must have been the case, for it is entirely inconceivable that any man, and certainly any medical man, would send a person suffering with a disease that they believed contagious, to infect a healthy community ; yet how to reconcile this matter with the statement in the following card, published in the "Hawaiian Gazette," under date of May the 23rd, same year, is beyond my ability. "DOCTOR MATHES ENDORSED." "Editor Gazette: We have read with pleasure the article of Dr. G. L. Mathes in the Saturday press of May 15th, in which he ably sets forth the difference between syphilis and leprosy, and in which he gives the views of the great pathologists and eminent medi- cal investigators of the present day." "We cheerfully express our high appreciation of the article, and THE PATH OF THE DESTROY ER 389 fully endorse the writer's views in regard to the non-identity of the two diseases. Moreover, with a knoweldge of the introduction and spread of leprosy among the people of these islands, we believe the disease to be eminently contagious/' "As to cure, we regret to say, that nothing is yet satisfactorily established, although modern scientific investigation in different coun- tries is tending to establish greater hopes in that direction." "Such being the case, we recognize segregation as the only means left us to rid the country of the disease. While we realize the se- verity of such a measure, and do most heartily regret the necessity of its enforcement, we cannot but feel that it is the only thing left us." "Better to amputate a diseased limb, than through a false sense of tenderness to allow it to remain and gangrene the whole body." "G. TROUSSEAU, M. D. "J. S. McGREW, M. D. "J. BRODIE, M. D. "N. B. EMERSON, M. D. "M. HAGAN, M. D." Many instances where foreigners, exclusive of Chinese, have lived with lepers I have seen personally. I have heard of a large number of other cases, and the result is the same. Not a single in- stance of contagion, or the development of the disease, has occurred among these cases, or in any of the cases that I have only heard of and not seen, among those who have been known to cohabit with lepers, except those which are doubtful. A white leper at the Settlement said he had had a multitude of native mistresses, and probably some ol them may have been lepers. Another white man at the Settlement said he had a native wife many years ago who had red spots on her, and large sores. This may or may not have been leprosy. Count- ing these two lepers just mentioned, I have had nineteen white people under my care who had leprosy. I have carefully questioned all but two of them as to whether they had lived or been on terms of in- timacy with lepers; all except the two whom I did not question, and the two whose statements I have already given, "denied any re- lations with lepers, and most of them deny ever seeing a case until they were declared lepers themselves/' The two whom I did not question were these: An aged Portuguese, with whom I could not converse, through inability to understand each other's language, and the first case I saw, which was shortly after I arrived in the king- dom, and before my attention was called to this matter. Of course, the entire nineteen may have been exposed many times to the dis- KING LUNALILO. Born January 31, 1835. Died February 3, 1874. Bequeathed the bulk of his fortune to found a home for his poor and needy subjects (see page 394). The benevolent and praiseworthy act of this Hawaiian king (only a brief period removed from so-called barbarism) ; is in striking contrast with the deeds of the dissolute, torture-loving, assassinat- ing and head-chopping specimens of kings, who have occupied European thrones in the not very remote past. L THE PATH OF THE DESTROY ER 391 ease ; for I doubt much if one out of fifty among all the physicians of the world would recognize the first case of leprosy they should see unless it was a pronounced case. It is frequently a difficult matter to decide positively whether a person is a leper or not. There have been several cases here lately in which physicians, thoroughly familiar with the disease, were unable to agree or come to a definite con- clusion. Turning back to instances, on June 24th, A.D. 1882, while engaged in making a post-mortem examination of a boy who had died with leprosy the day previous, I scratched my wrist on my sleeve button, and did not discover the wound until it had been covered with blood from the boy's body for a full half hour. I have never experienced the slightest bodily inconvenience from the wound. Some months ago, I regret I cannot give the exact date, Dr. E. Arn- ing inoculated his finger while making a post-mortem examination of a leprous cadaver. I called his attention to a scratch on his finger, just as he was about to begin the operation, but he took no pre- cautions, and as a consequence his arm shortly afterwards swelled clear to his body, and he suffered severe constitutional disturbance, but he has not developed leprosy. Turning now to native cases. Kauuku, a mail-carrier on Molo- kai, had the palmer surface of the third finger of his left hand bitten out by a leper six years ago. He is not a leper. It is a well-known fact that leprosy exists in a large percentage of the native race. Estimating the entire native population of pure blood at something over 40,000 and total number of lepers at 1,800 would give us four and a half per cent at any one time. I base this estimate on the fact that on October 9th, there were 723 lepers at Kalawao Settlement and 180 at Kakaako leper hospital, and from information from different portions of the kingdom, in answer to inquiries I have made. Drs. Danielssen and Boeck state : ''That the average duration of the tubercular form among the patients in the hospital at Bergen, from 1840 to 1847, was between nine and ten years, and of the anaesthetic form, among the same, was between eighteen and nineteen years."— Coll. Phys. Rep., p. LXV. September 30th, 1884, we had at Kakaako hospital 67 married males and 36 married females — that is, where either sex were, or had been married. One married couple were in the hospital, and of the rest, three of the males had had leprous wives, and one woman a leprous husband. No larger number of persons became lepers from inter-marriage 392 THE PATH OF THE DESTROY ER with lepers, than in the community at large, as these figures plainly show. Presenting the evidence in another form. The Leper Settlement at Kalawao was inaugurated A. D. 1866. Since which time up to the 1st of April this year, 2,864 persons have been consigned there as lepers. October 9th I made a careful census of the number of the children alive who were born at the Settlement, and where either or both parents were lepers before the birth of the child. The total number was twenty-six/ as follows: MALES Name Age Kalani 8 years Mahai (is a leper) 14 years Keoloewa (brother of Mahai) 11 years Kukelaile 4 years Kalaniuli 2 years Samuela 21 months Joe Kanaana 4 years Kunihi 3 years Kahema 2 months Keoni 9 years Damiana 9 years Keahimu 9 years Opupeli 10 years Joe 8 years Total, 14 boys. FEMALES Name Age Keneki 2 years Kahua 8 years Kamaka 4 years Likapeka 1 year Lilia - 13 years *Abikaila 9 years *Elikapeka 7 years Keoho 3 years Parents Mother Father Father Mother Both Mother Both Father Mother Father Mother Both Father Both Leper Leper Leper Leper Lepers Leper Lepers Leper Leper Leper Leper Lepers Leper Lepers Parents Mother Leper Mother Leper Both Lepers Father Leper Father Leper Father Leper Father Leper Both Lepers *Sisters of Mahai and Keoloewa. THE PATH OF THE DESTROYER 393 Hoomanawanui 11 years Both Lepers Kalua \0y 2 years Both Lepers Leialoha (this girl is a leper) 9 years Both Lepers Mary 3 years Mother Leper Total, 12 girls. Of the total number, it will be seen that fourteen are above the age cf six years, or at or above the age when the permanent teeth begin to erupt, the earliest period of life when I have seen a case of leprosy developed, and before which I do not believe it ever appears; at least it must be seldom, as I have not seen a case younger among over two thousand lepers who have been under my charge. Two of the fourteen only are lepers, although, in addition to being born of leper parents, they have lived in the houses of lepers all their lives. In 1866 the easterly side of the point of land projecting out into the sea from the base of the cliff, on the northern side of Molokai, was duly set apart for a residence for persons afflicted with leprosy; and the disease having been by law declared contagious, all lepers were required to remove, or be removed, to this settlement. In 1873 the westerly side of the promontory was annexed to the settlement, but there remained several kuleanas, or homesteads, which were not purchased by the government, and the owners of these kuleanas remain on their lands to this day. With a number, at least, of these kuleanas, or owners, it has been the custom to take lepers into their families to reside, so as to share the rations of food provided by the government for the sick; and, where this has not been the custom, they have freely com- mingled with their leprous neighbors, and, in two instances, have intermarried with lepers. The total number originally of these kamaainas was thirty- eight. One of them developed leprosy before the place was annexed to the settlement, but none of the rest have become so since the annexation, a period of eleven years. Now let us proceed to sum up the evidence. First — The Royal College of Physicians, a body of medical men representing the highest medical intelligence of the age, deny the contagious nature of the disease, after a study of it lasting through a period of several years. Second — Acting on the advice of this body of medical men, the secretary for the English colonies instructs the governors of the colo- nies "that any laws affecting the personal liberty of lepers ought to THE LUNALILO HOME. King Lunalilo's token of love for his aged, infirm and homeless subjects. Opened March 31, 1883. THE PATH OF THE DESTROYER 3Q5 be repealed; and that, in the meantime, if they shall not be repealed, any action of the executive government in the enforcement of them, which is merely authorized, and not enjoined by the law, ought to cease." The results of such action, if the disease were contagious, would seem most certainly to be a vast increase of the malady. Let us see whether this be so or not. In the Chronicle of the London Missionary Society, March, 1884, I find the following, by Rev. James Kennedy, M. A.: "Lepers are found in all parts of India, not in such numbers as to be an appreciative portion of the population, but in such numbers as to be well known. They are regarded by the Hindoos as objects of divine displeasure, not on account of wickedness in the present life, but on account of wickedness committed by them in a former birth. While thus regarded, they are not excluded from society, as was the case with the Jews, and is still the rule in some parts of the world. They are allowed to move about, and to ask alms of those they meet. At Benares I have sometimes seen them sitting on a native bedstead with persons who, if they did not touch them, showed at least no dread of their immediate neighborhood." * * * "While Ku- maun was under native rule lepers were buried alive, their nearest relatives heaping earth on them ; but since the establishment of British rule, in 1815, this atrocious custom, as well as other customs equally inhuman, has been suppressed." P. 89. Rev. J. H. Bruce, of Satara, India, writes: "I cannot find that there are any government laws whatever on the subject of leprosy. There are certainly no laws of segregation, and lepers are found everywhere in their homes and villages. There are no restrictions in regard to their marriage — there could hardly be any in this land of infant marriages. In the case of adults, "the non-leprous party would shrink from marrying a leper." When, however, one of the parties became a leper after marriage, there would not always, and perhaps not generally, be a separation of husband and wife. * * * We have had in our house for years a child nurse, who is the widow of a leper. * * * You ask how Vishompunt could preach and visit if he were a leper? The fact of his being a leper was well known, and never in any way concealed, yet he continued his pas- toral work until within a week of his death." Letter to Rev. C. M. Hyde, D. D., published in Hawaiian Gazette, May 14th, 1884. "I find, from the censuses of the following Provinces of 1871 and 1872, comprising nearly the whole of India, viz., Bengal, Madras, Bombav, the Central Provinces, the Northwest Provinces, 396 THE PATH OF THE DESTROYER Oudh, Coorg and Mysore, that the total number of lepers then enumerated was 99,639, or 1 in 1,864 of the population; but, as I have already stated about 1 in 1,500, or 120,000, would be, I believe, nearer the truth."— P. 42, "Leprosy." W. Munro, M. D., C. M. Manchester, 1879. Third — Segregation, except in so far as it prevents hereditary transmission of the disease, has absolutely no effect toward checking it. (a) In India, under native rule, up to 1815, lepers were buried alive, but still the disease persisted; while under English rule, with no compulsory segregation, we find, at the most, only one in 1,500 persons a leper. (b) In Norway it begins to decrease with only one in twelve and a fraction segregated; and by the time two in five are segre- gated, 45 per cent of the disease has disappeared in the short space of twenty-five years. (c) In South Carolina the disease does not increase in forty years without segregation. (d) In Hawaii, where a larger percentage of cases are segre- gated than Norway, the disease for many years increased. Although at no time within the last fifty years have less than one-half the cases of leprosy in this kingdom been segregated, and for the last two years a still larger proportion. (e) Heredity plays but little figure in the spread of the disease, because we find that after sending more than 2,800 lepers, during a period of eighteen years, to Kalawao Leper Settlement, there are only twenty-six children alive, and only two of these children are lepers. While, however, this disease is, as I believe, absolutely non- contagious, that fact does not do away, as far as these islands are concerned, with the need of strict segregation. * * * But carry- ing out the law to the letter presents almost insuperable obstacles, which no one who has not been in a position to know from personal experience can fully comprehend. Fourth — Leprosy is an absolutely non-contagious and non- communicable disease from a leper to any other person by any pos- sible combination of circumstances except by heredity. (a) We find that seven inoculations, namely, the two cases inoc- ulated by Dr. Bargillo, the two cases mentioned by Dr. Powell of medical men wounded in dissecting leprous cadavers, Dr. E. Arning, and myself, wounded in the same way, and also Dr. Browne, who lost his finger as the result of inoculation, and no leprosy results. These seven cases mentioned do not, as is seen, include Kauuku, the mail carrier on Molokai, who had his finger badly bitten by a leper. THE PATH OF THE DESTROYER 397 (b) Husbands who have leprous wives, and wives who have leprous husbands, as is seen in the 103 cases of married persons at Kakaako Hospital, do not contract the disease in a larger proportion of cases than among the community at large. (c) Women conceive and bear children by leprous husbands, and in some cases, first by a leper, and the children also develop lep- rosy, and yet the wife and mother escapes, and, as found afterward, capable of bearing healthy children by a healthy man. (d) Food cooked by lepers and eaten by non-lepers, the clotihng of non-lepers washed by lepers, and the blood and pus-saturated gar- ments of lepers laundered by non-lepers, eating, sleeping, drinking with lepers for years fails to reproduce it. Fifth — Those who are constantly exposed to the disease for years, as physicians, nurses and attendants on lepers, seem to invariably escape; certainly the proportion is not larger, if as large, as among the population of countries where leprosy is endemic. In fact, I can find only one case in medical history where a physician contracted it, and no nurses are mentioned as having it. For years it has been the custom here, among those advocating contagion, to offer what to them seemed apparently an unanswerable argument in favor of contagion. "Thirty or more years ago there were only a few cases here, and now there are hundreds; it must have spread from contagion. There is no other way to account for it." In A. D. 1856, when I first went to a mining camp in Cali- fornia, malarial troubles were a thing unknown, but in less than ten years "fever ague" was as common, or more so, there than leprosy is here now. Yet no one thought of contagion, although not infre- quently one after another would be taken down with the disease in the same place. Very frequently a man would be taken sick with the disease, and shortly after the wife, or vice versa, which, according to some acute observers who write on leprosy, is a sure proof of contagion ; but probably these people would not observe any sign of contagion under the same circumstances with malarial disease ; but I am utterly unable to see why it is not as much a sign of contagion in one case as in the other. As I have before stated, nineteen foreigners, exclusive of Chi- nese, have come under my care, having the disease, during my four years' residence in the kingdom. All these persons with one exception were adult males, with no history in any instance of hereditary taint. 398 THE PATH OF THE DESTROYER How have these parties contracted the disease? This brings up the question of etiology. GEO. L. FITCH, M. D. The late Dr. G. L. Fitch, subsequent to his leaving the service of the Board of Health, made some experiments on his Hawaiian patients. With blood and serum obtained from scarified leprous nodules he inoculated some thirty males and females on the upper arm, similar to the usual method pursued in vaccination. The Doctor claimed that all these cases had syphilis, and he pro- posed to demonstrate that leprosy could not be successfully inocu- lated, because it is or was modified syphilis in a fourth stage, hence not inoculable nor contagious. Whether this assumption is correct or not, it however furnished to my mind fresh evidence of the non- inoculability of leprosy, for no development of that disease took place in any of these inoculated people within the four years subsequent to the performance of the operation. On a previous page of this monograph I have stated, while Dr, Fitch in Hawaii apparently promulgated new and novel views regard- ing leprosy, they were really not new; for as far back as the year 1858 Dr. Danielssen of Norway had recorded his work and experi- ences on the syphilization of lepers, and its failure to alter or modify the general features of leprosy. What was old history, and well authenticated in Norway, was introduced and palmed off on Hawaii in the year 1881 as a new and previously unknown discovery. DR. RICHARD OLIVER. The late Dr. Richard Oliver held the office of resident physician at the leper settlement for ten years, 1892-1902. At the date of his death, August 12, 1902, the Doctor had lesided over thirty years in the Islands, and had had a very long and comprehensive experience with leprosy on the Island of Hawaii, some twenty years. The last ten years of his life, spent at the leper set- tlement, added largely to his knowledge of the disease. The copious notes, memoranda and other data on leprosy, which he had accumu- lated, he had intended to publish; but his last illness and subsequent death prevented this. Whatever books and papers the Doctor pos- sessed were speedily lost or destroyed soon after his death, which occurred three months after he had resigned his office at the Leper Settlement. Dr. Oliver's long contact with leprosy in Kona and Kau, and L THE PATH OF THE DESTROYER 399 later at Molokai, where he did some experimental work, had con- vinced him that the inoculability of leprosy had yet to be proven. He was, however, an advocate of non-contagion, but my persistent and insidious proselytising won him over to the fold of contagion. The Doctor had received his medical education at the medical school of Saint Bartholomew's Hospital, which is situated in the heart of the old or true City of London. It is one of the most ancient seats of hospital and monastic work; the resident monks were the hospitallers. This hospital was founded by Rayere, a physician and monk, in the year 1102 A. D., eight hundred and fourteen years ago. It enclosed a large and famous leper hospital within its bounda- ries, where some 37,000 lepers were cared for between the years 1150 and 1390, a period of two hundred and forty years. About the year 1347 six thousand cases of black death, or spotted typhus, died within the portals of the hospital proper; and again, in the year 1665, the bubonic plague filled the hospital with some 10,700 cases, and over 90 per cent of these victims died. J NODULAR LEPROSY (Mild Early Stage. The Eestrover at work. NODULAR LEPROSY (Medium). Advancing. Medicines and serums fail to check the Destroyer. i NODULAR LEPROSY (Severe), Very Advanced. The Destroyer actively at work. PIGMENT DEPOSIT IN SKIN OF FEMALE LEPER. LEPROUS MACULATION AND INFILTRATION OF THE DERMAL TISSUES OF THE DORSUM. ■>;? NODULAR LEPROSY. The Leper Ear. DUAL OR MIXED LEPROSY. 1 I DUAL OR MIXED LEPROSY. NEURAL LEPROSY OF THE HAND. The "Main en Griffe" or Claw-Hand. NEURAL LEPROSY OF FOOT. Pressure Ulcers Due to Trophic Nerve Lesions. h o o u* o CO o Oh W l-J < w B ^ -a > C C ^ t» rt cj (S *> 2 .22 £~."§ c 22 -^ ~ « S--3 D O O S u -w £ S c ^ 2.2