UC-NRLF 
 
 B M MES M3T 
 
 LEPROSY 
 
 REPORT OR THE PRESIDENT 
 
 * OF THE 
 
 BOARD OF HEALTH 
 
 /;^^0 THE 
 
 Legislative Assembly 
 
 OF 1886. 
 
 HONOLULU, H. I. 
 
 DAir.T BULLETI oTEAM PRINTING OFFICE. 
 
 ' '1886. 
 
REIGN OF HIS MAJESTY KALAKAUA, 13th YEAR. 
 
 REPORT OF THE PRESIDENT 
 
 OF THE 
 
 BOARD OF HEALTH 
 
 TO THE 
 
 Legislative Assembly 
 
 OF 1886, 
 
 ON LEPROSY. 
 
 HONOLULU, H. 1. 
 
 DAILY BULLETIN STEAM PRINTING OFFICE. 
 188G. 
 

REPORT OF THE PRESIDENT 
 
 OF TTTE 
 
 BOARD OF HEALTH 
 
 TO THE 
 
 Legislative Assembly of 
 
 ON LEPROSY. 
 
 Office of Boakd of Health, 
 
 HoxoLULF, April :>()tlL 18S(). 
 
 NoUes and Eepresentatives: 
 
 When, twenty-one yeai-s ago, (January 3, 1865,) tlie 
 Legislature of this Kingdom enacted the law '*to pre- 
 yent the spread of Leprosy,'' it was provided that the 
 Board of Health, — the Dejjartment authorized to carry 
 out its provisions, —should report to the Legislature at 
 each of its regular sessions, the expenditures in detail, 
 together ivith such information regarding the disease of leprosy^ 
 as well as the public health generally, as it may deem of 
 interest to tlie pMie. 
 
 During the twenty years and oyer that haye elapsed 
 since the ])assage of the Act referred to, and the com- 
 pilation of the now famous Report of the College of 
 Physicians of England on leprosy, obtained at the in- 
 stance of Her Britannic Majesty's Goyernment, the stu- 
 dy of the disease, that has prevailed, and to a great ex- 
 tent, still prevails so virulently in this Khigdom, has 
 been pressed with unremitting zeal aud perseverance in 
 nearly every country by men of medical and scientific 
 attainments. By degrees, through unceasing and 
 Avatchful labor, by comparison of inforjnation and in- 
 
 "m185908 
 
terchaiige of experiences, experiments and thought, 
 and to no small extent perhaps, also, l)y uplifting the 
 heavy curtains of past centuries and unrolling the sci-oUs 
 penned by those familiar with this disease, thousands 
 of years before the birth of the Saviour of Man, and by 
 the material aid of practical common sense joining its 
 forces to those of medical science, the latter prone, alas, 
 at times to be blindly self-assertive, dogmatic and 
 tyrannical as much so to day as in the day of Hervey, 
 Jenner, and other great pioneers in medical thought 
 — the world has learned much, and the indications are 
 that knowledge is increasing so steadiU^ and favorably 
 that we are almost half justified in hoping that, at the 
 end of the next quarter of a century, the time will 
 then be not far distant that a controlling power shall 
 be found for that disease of which one Atreya, who 
 wrote, in India, probably more than 4000 years ago, 
 said "The man who neglects the disease at its commencement 
 is sure to die, for it becomes incurable.'' 
 
 With these facts and thoughts present in my mind, 
 I have deemed it a duty I owe, as the President of the 
 Board of Health, to the Hawaiian nation, and in that 
 spirit of benevoJence to the sufferer, be he Hawaiian 
 or foreigner, which has been one of the marked 
 features of the Hawaiian race and its rulers, and espe- 
 cially so during the present reign, to make a more ex- 
 tended Report to your Honorable Body than has hith- 
 erto been customary. I have done so in the fervent 
 hope, that under the Divine Will, good will result not 
 only to this nation but to other parts of the world at 
 large, suffering alike with Hawaii. 
 
 I have endeavored to present to you, in so far as a 
 pressure of duties and limited opportunities permitted, 
 the knowledge and information, in regard to leprosy 
 possessed by many other countries, compiled and 
 collected by the Governments of those countries ex- 
 pressly for His Hawaiian Majesty's Government, at my 
 invitation, and, in some instances, bearing date as re- 
 cently as the present year. To these governments the 
 Hawaiian people should be grateful. 
 
In this Report, taken in connection with the Snpple- 
 ment, I aim to lay before you the history of the disease 
 in these Islands so far as it is to be found in the official 
 records of the Board of Health and other sources, and 
 60 far as my researches and my experience as a resi- 
 dent of a quarter of a century in the Kingdom permit. 
 In the Appendix you will find the results of the la])ors, 
 and the opinions and suggestions of the medical men 
 and others, who are, or have been, engaged on these Is- 
 lands since the presentation of m}^ last report, in com- 
 bating the disease, attending to the sick, amehorating 
 their sad condition or soothing their dying hours. 
 I am convinced that a careful study of the material 
 presented to you will not only aid your deliberations 
 on behalf of the suffering and sick among the 
 Hawaiian people, and encourage hope in your 
 breasts and theirs, but it will also show you 
 that the Hawaiian nation, acting through those who 
 have been entrusted, from time to time, with the ad- 
 ministration of its affairs has done nobly,, and gene- 
 rously in the front of a great calamity, and has dared 
 more, and expended more money in ^^I'oportion to 
 the size and wealth of the country in the attempted 
 suppression of this most lamentable malady than great- 
 er, more powerful and wealthier countries have yet at- 
 tempted. It will, I trust, tend to preserve in you that 
 true kindliness of heart, and that spirit of compassion 
 towards the poor and suffering, that were the pride of 
 your ancestors, and which — bloody and cruel though 
 they may have been in battle-led them more rapidly 
 on the pathway of enlightenment, civilization and 
 patriotism than any other race similarly constituted and 
 situated as was the Hawaiian when the foreigner first 
 reached these shores. 
 
 A wise and eloquent writer has said; ''that no na- 
 tion can go forwai-d that has no past at its back.- ' Ha- 
 waii has both a past and a histor}^ in which may not 
 only be traced the germs and causes of its progress, but 
 possibly also the source of the disease, so far as this 
 
() 
 
 country is ooiicoi'iiorl, which forms the sad subject of 
 this Report. Tlie Khigdom of Hawaii in its political, 
 social and religious life in the transition ''fi'oni feudal 
 anarchy and general lawlessness to personal despotism 
 and strhigent i-epression, and from that to a constitu- 
 tional monarchy ; from social barbarism to a degree of 
 civilization that is unexampled m the histoiy of man- 
 kind, considermg the time that has elapsed ; from the 
 most cruel and oppressive idolatry to thQ spontaneous 
 repudiation of the idols and the ado})tion of Chiistianity'' 
 owes its initial movement on the road of national pro- 
 gress to Kamehameha the Conqueror. It is true 
 as Fornander says : '" The dark shadoAvs wdiich 
 flit across its pages are dark indeed, but the^^ are no 
 darker than those which, under even more fa^'orabie 
 circumstances, have stained the annals of many a proud 
 nation that formerly stood, or now stands, in the fore- 
 most rank of civilization.'' That during this extra- 
 ordinary political and social revolution the shadows 
 were not darker is due to the warrior-king. There 
 would seem to have been a marked dispensation of 
 Providence in the selection of Kamehameha the First 
 to direct the chain of events during this marvelous 
 transition period which succeeded the union of the is- 
 lands imder one s])ear and sceptre and the coming of the 
 Avhite i-ace. The Kingdom had the advantage of a 
 i-uler of marked and hei'oic character as its founder; a 
 man of vigorous and active intelligent thought, endow- 
 ed with a strength of purpose and [)ower which, had it 
 been directed merely to personal aggrandizement and 
 to sensual and sensuous existence, would have made 
 him a cruel and selfish tyrant, and have placed these 
 islands either in a state of contimial insuri-ection, or of 
 servile debase-ment and degradation, to fall an eas}^ W^J 
 to the foreign conqueror or as])iring adventurer, as we 
 see to day is the condition of other islands in the great 
 ocean that surrounds us. Fortiuiately he was destined 
 to set an example to his successors as favoring the 
 establishment and deAxdopment of this Kingdom as an 
 
Indcpc'iidejit State. He appivciatccK and lieivin may 
 hv found one of the marked reasons of his special sne- 
 eess and the proof of his enhghtened spirit, the vahie 
 of recognizing and acting upon the proffers of friendly 
 reciprocation and association Avith tlie C.'aucasian I'ace 
 and of learning from them the arts of peace rather than 
 the ])ractice of war. lie accepted then* teachers and 
 traders as his tutors ajid councillors, and amity and ad- 
 vice hegat knowledge throughout the land. Hence it 
 is that since he ascended the throne of United Hawaii, 
 AVe have no l^loody record of internecine Avars, of strug- 
 gles betAveen race and race : of hatred, open or coA-ei't ; 
 of jdots and counterplots hetween the luitiA^e population 
 and the strangei's ; l)ut^ on the other hand, calm con- 
 sultations, friendly co-operation, and active associations 
 intimately connected Avith the advancement of the 
 country. Hence also, to-day, the HaAvaiian State 
 stands solid and independent before the Avorld, so estab- 
 lished by the wisdom of its native chiefs, aided in its 
 oi-ganization and progressiAX^ dcA^elopment l^y a loyal 
 and zealous white element Avho Iuia'c l)ecome heartily 
 and honestly HaAvaiian in disposition, interest and so- 
 cial kinship, and as closely identified Avith the Avelfare 
 of the land as though it Avere the birthplace of them- 
 selves and ancestors, rathei- than a land of adoption. 
 
 The spirit of Kamehameha and his advisers develop- 
 ing and becoming enriched by ciAilization and intelli- 
 gence descended to his royal successors until, under 
 our present Sovereign Kahikana, the second transition 
 era may be said to have arri\'ed, since, from the King 
 downAvards, the generations of to-day have been edu- 
 cated — not under the old HaAvaiian system, but under 
 the intluence of Christian and Caucasian methods and 
 ideas. The puny neglected islands of the Pacific 
 hailed, scarcely a centur}^ ago, as mei'cly a new acqui- 
 sition for a missionary station, oi* a half-way inn for 
 sailors, are ra])idly gaining recognition as Avoithy to be 
 ranked and receiAX'd among the most powerful and en- 
 lightened Sovereig]) States r)f the world, as behig fniit- 
 ful of good deed^ in prate ^ though powerlea^ in war. 
 
s 
 
 III this half-won struggle for advancement, Hawaii 
 has undergone, and is still undergoing, the stern trials 
 attaching to all rising nations. She has been heavily 
 handicapped in being stricken with the terrible and 
 deadly disease of leprosy and with other maladies that* 
 have carried off her people l^y the hnndreds of thou- 
 sands. Elsewhere T shall speak of the lives we have 
 lost and the treasure we have expended on account of 
 these visitations. 
 
 But why should these Islands have been so signally af- 
 flicted? There must be a cause for it. In these days 
 we cannot be content with the explanation of the mid- 
 dle ages that it is the wTath of God. 
 
 In view, then, of the great and bcAvildenng masses of 
 information gathered by medical men as to the causes 
 of leprosy, and in view also of the many published er- 
 rors in regard to leprosy in this Kingdom, let us search 
 for a sensible cause practically, and not as professionals 
 pledged to individual schools of thought or line of ex- 
 })eriments. Let us do it in a fiiendly attempt to aid 
 science and not to baffle it or ourselves, and not in an 
 assertive but in an enquiring mood, having for our 
 main object the elucidation of facts and the alleviation 
 of the misery of our suffering countrymen. 
 
 Whoever will studiously peruse the very numerous 
 medical statements wdiich accompany this report, will 
 observe that each of the piopositions I am about to 
 place before you can be ansAvered as readily in the af- 
 flrmative as in the negative, and with probably an equal 
 array of argument on either side. Let us make these 
 propositions then, thus: 
 
 It is impossil)le to attach to this Hawaiian race and to 
 these Islands any distinctive feature as a character or 
 cause of the disease. 
 
 It will not do to say that it is owing to an admixture 
 of foreign races predis])osed to the disease, or to ui- 
 breeding producing scrofulous races, or that the race 
 is iu itself predisposed to scrofula, malaria and many 
 other assistant diseases. 
 
9 
 
 It will not do to say that it proceeds from climate, 
 from the diet of the country or from want of cleanliness. 
 
 It will not do to attribute it to any of these causes, 
 solely or conjunctively, for the unfortunately baffled 
 medical world i-epeatedly points out to us that all these 
 conditions exist m non-leprous countries and races. I 
 will, however, presently review all these conditions as 
 they are found amongst us, and see whether or not they 
 can be made actually applicable to us wholly or in a 
 degree. 
 
 A])out the great hold that leprosy has taken upon 
 this nation, there is no doubt; but as to when it first 
 began its ravages here there is very grave doubt, and 
 in the ascei'taining of the era of misfortune may be 
 found a solution of one portion of the perplexing prob- 
 lem. Although it has been stated by our best medical 
 observers that the disease is but a recent comer among 
 us, and dating back not more than 40 or 50 years ago, 
 I am strongly disposed to join issue with them. 
 
 THE IXTRODUCTIOX OF THE DISEASE. 
 
 It has been asserted l)y the early authorities that 
 leprosy was introduced by a Chinaman, and conse- 
 quently was called the 3Iai PaJce^ or Chinese sickness, as 
 native Hawaiian s could find no better name for the 
 disease in their vocabulary. I do not believe it was 
 introduced by a Chinaman, any more than I believe it 
 was imported from China by the warrior chief Keawe 
 Kaiana-a-Ahuula when he made his voyage with Cap- 
 tain Meares in 1787. I might, en passant, enquire how 
 it is that if one Chinanian caused such an alarming 
 spread of the disease thirty or forty years ago, there 
 are now, comparatively speaking, so very few cases of 
 leprosy among the seventeen or eighteen thousand 
 Chinamen on these islands, and no recorded cases, that 
 I am aware of, of an imported Chinese leper since the 
 enactment of the anti-leprosy law. Again, if the disease 
 had been inti'oduced by the Chinese, and propagated 
 by them in propoition to their intimate connection and 
 2 
 
10 
 
 association with tho females, especially young children, 
 of the native race, I should expect to find a nuich larger 
 proportion of females than males affected with this 
 loathsome malady, and yet we all know that the con- 
 trary is the fact, in spite of the census of 1884 giving 
 only 18,220 females over 15 years of age to 17,000 
 male Chinese of all ages. 
 
 To those, who are intimately acquainted with the Ha- 
 waiian language, the mere fact that thei-e is not a dis- 
 tinctive word in the language argues nothing, inasmuch 
 as the idiom is remarkably deficient in medical nomen- 
 clature, consequent upon the absenoe of any regular 
 study of the human system or ailments. The Hawaiians 
 possess generic words for the pains or sensations attach- 
 ing to the several classes of sickness to which they are 
 most prone, such as: Mai tvela^ hot sickness; mat 
 anuu. cold sickness ; mai puupim^ lumpy sickness ; 
 mai ulalii, sickness of small red spots (measles), and 
 so on. I believe that there is enough of assurance in 
 the general opinions of mtelligent Hawaiians that the 
 disease has existed here for a much longer jjeriod than 
 usually accredited. Old natives speak of a disease in the 
 past, attended with swellings, disfigurations, insensibility 
 and nlcerations, and wdiich diseases correspond with 
 what mcHlical science calls Ehphantiasls Arahurn^ and not 
 true leprosy ; but thei'e is, nevertheless, some ground 
 for the presumption that the Elephantiasis Grcecorum^ or 
 true leprosy, existed since ancient times. However, hi 
 the absence of fact this is only siu-mise. But in this 
 connection an interesting extract from the diary of 
 Kev. C. 8. Stewart, 1823, will be found hi the report 
 of Dr. Moui'itz, on page LXXIY, Appendix K. On P. 
 XXA Til of Appendix E, a well defined case of leprosy 
 in 1845 is mentioned, and cases might be given dating 
 back into the l^hirties. I am inclined to think that 
 the disease escaped the notice of the early missionary 
 nK^lieal writers owing to the fact that their want of 
 knowledge of its true s}'mptoms and correct diagnosis 
 led them to place it within the definitions of venereal 
 
11 
 
 and scrofulous ailments. Their writings and opinions 
 are, however, to a certain extent vahiahle, and it is 
 only fair that we should consult them in our desire to 
 learn all Ave can in regard to the various causes as- 
 signed luid the circumstances attendant upon the upris- 
 ing of this disease hi its peculiai- virulence. Let us 
 then turn to these, the earhest of our foreign ohservers, 
 and see what they had to say in regard to the inhahi- 
 tants of these islands within ten and twenty years of 
 the date of the landing of the first American mission- 
 aries in TS20. They write fi'cely a])out the diseases 
 and condition of t\n^^ i)eople, of their- food, their cus- 
 toms and their morals in the ei-a hefore which, modern 
 writers would have us heiieve, leprosy Ix^gan its ravages 
 among our peojjle. 
 
 THE XATl RAL PHEXOMP:XA OF THE TSLAXDS. 
 
 But first, as regards climate, which some writers 
 think is a potent factor in the disease, I cannot do bet- 
 ter than quote from Dr. Alonzo Chapin's description 
 repubhshed from the ''American Journal of Medical 
 Sciences " in the '' Hawaiian Spectator," of July, 1838. 
 Dr. Chapin says: ''Situated in the very midst of the 
 vast Pacific, without au}^ extensive inland causes to af- 
 fect 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 atmos])hei'ic temperature. Cool Ijreezi^s, by day 
 from the sea, and by night from the mountains, serve to 
 mitigate the ])urning heat produced by a vertical sun, 
 and to render the climate pleasant. The thermometer 
 varies but little from day to da}^, and even from month 
 to month ; and what is pai'ticularly to be remarked, all 
 portions of the ishnids, along the shores, are alike in 
 this respect. Districts most parched by heat and 
 drought do not differ essentially in temperature from 
 those sections where almost daily showers and perpetual 
 trade winds prevail. As we recede, however, from the 
 low lands along the sea and ascend the mountains, a 
 
12 
 
 change is immediately perceived, and along their ex- 
 tended sides we may procure almost any degree of tem- 
 perature. The greatest heat marked by the thermom- 
 eter at Honolulu was 88 ^ , lowest 59 ^ , and range 
 
 In dealing with the telluric agencies and physical 
 conformations of the islands I prefer to agahi quote 
 from the same distinguished medical authoi-ity who says : 
 "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 ori- 
 gin. Xumerous extinct craters of different periods and 
 dimensions are scattered over the surface, and two 
 large volcanoes 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 im- 
 petuous mountain streams. Plains of different dimen- 
 sions, varying from a few rods to many miles in extent, 
 are fi'equent. More commonly, however, the moun- 
 tains extend with a gradual slope entirely to the beach, 
 and here and there present bold and black lofty preci- 
 pices to the dashing of the wave. The sides of the 
 mountains, if we except the loftiest, are verdant entire- 
 ly to their summits, and present immense tracts of ex- 
 ceedingly fertile soil. The leeward shores have gene- 
 rally an arid and even sterile aspect, owing to the infre- 
 quency of rain. Vegetation is there promoted mostly 
 from h-rigation from the streams, and it is only the 
 tracts immediately contiguous to these which possess 
 much verdure, or will admit of cultivation. The con- 
 densation of the vapor, from the damp trades in their 
 passage over the mountains, produces continual rains 
 on their summits, which, extending backwards towards 
 the sea, keep the earth wet much of the time, and give 
 rise to a luxuriant growth of vegetation. Hence the 
 windward sides of all the islands are, unlike their lee- 
 
13 
 
 ward shores, extremely fruitful aud productive. "^ * * 
 The streams originate from spiings and rahis 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 hody of water emitting suf- 
 ficient miasma to create sickness along its horders. I 
 have occasionally met with stagnant ponds, which emit 
 a foul and offensive odor, and could in no w^ay satisfy 
 myself of the reason for the exemption of tlie inhahi- 
 tants along their horders from fevers, hut hy supposing 
 the effluvia to be diluted and i-endered inert hj the con- 
 tinual currents of winds. Small marshes abound but 
 are fed by springs, and the pure mountain streams, and 
 are thus prevented 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 ix. fever-generating 
 miasma. If any one variety of soil has a specific power 
 to produce malaria it does not appear to exist at those 
 islands. , The upland soil is there formed of decom- 
 posed lava, the lowland plains along the sea are consti- 
 tuted of a mixture of alluvion washed from the moun- 
 tains, and decomposed coral. Its immunity from nox- 
 ious exhalations is the same, whether parched with 
 drought, or n.ierely moist, as when the evapoi*ation is 
 most abundant after the rains." 
 
 The native food next claims our attention. The 
 staple article of diet as descril^ed by Chapin was poi, 
 ''The Arum Fscukntum, which is more generally eaten 
 l)y the inhabitants than any other vegetafele, grows like 
 the Armn triphjjlhnn, in wet or damp situations only, and 
 Avhen uncooked, is, like that, exceedingly styptic and ac- 
 rimonious. These qualities are destroyed by heat. The 
 natives prepare it for. use by cooking it thoroughly, 
 pounding it to a pulp, and adding water sufficient to 
 
u 
 
 make a thick paste, In which state it is called ^;oz; and thus 
 prepared, it is eaten with one or two lingers, accord- 
 ing to its consistency. As an article of diet it is simple 
 and Jiutritions ; and after the fermentative process has 
 commenced it is preferred by the people." 
 
 The sweet potato, the pala, a fern root, the tops of 
 the pulu fern, the l)i"ead fruit, the cocoanut, the candle 
 nut, the banana, many varieties of sea weed, along with 
 a great variety of fish and Crustacea, eaten raw, and the 
 meat of the hog and dog, baked in the earth, consti- 
 tuted the chief articles of ancient Hawaiian diet. 
 
 EAllLY DISEASES OF THE IIAWATIAXS. 
 
 Having thus touched upon three ' ' influential factors ' ' 
 let mt? pass on to what these writei-s say in regard to 
 the diseases which, according to their information and 
 opinions, afflicted the Hawaiians in those days. Dr. 
 Chapin says: ''The equableness of the climate, and 
 the simplicity of the natives in their regimen and most 
 of their habits of life, are, compared with civilked countries, 
 feuch that the variety of their diseases is neither numerous 
 nor complex. Their remoteness from other lands is so 
 great that but few contagious diseases are imported 
 among them. ^ ^ ^ Xhe diseases most connnon 
 within my circle of ol^servation, were fevers, ophthalmia, 
 catarrhs and asthma, rheumatism, venereal diseases, 
 diarrhoea, dysentery, cutaneous diseases, scrofula, 
 dropsy, etc., and they occurred in frequency and in 
 about the order in wdiich I have mentioned them. Dis- 
 eases sometimes occur epidemically, as was the case 
 wdth catarrh repeatedly, and croup once during my resi- 
 dence at the islands. Many other diseases, not speci- 
 fied, 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 predisi:)oses 
 
15 
 
 so strongly to febrile attaeks is not couiinon to these 
 islands. The continued and oppressive heat is there not stif- 
 ficient of itself to produce it^ and the universal custom of 
 the [)eoi)le, to repose during the hottest ])art of the day, 
 aids in counteracting other unfavoral^le influences. 
 The siniplicit}^, too, of their diet and habits of life is not 
 calculated to promote a state of excitability. Their 
 food is mostly vegetable, Avith but a scanty and irregu- 
 lar supply of meat. Until of late they have made use 
 of none of the stimulating condiments so profusely eni- 
 plo}'ed in civilized countries, their only drink is water. 
 In their movements the natives are extremely moderate. 
 They walk with a slow step, rest long, and often when 
 tired, and placing no value on time, they do everything 
 leisurely and to suit their convenience. "^ ^ With so 
 entire an exemption from the existence of miasmata, 
 there is also an entire exemption from those affections 
 induced by it. Malignant ])iliou8 fevers do not occur, 
 ■^ '^'' ^ derangements of the liver and biliary or- 
 gans do not prevail, neither are the stomach and intestinal 
 canal, and other organs of the al)dominal viscera sub- 
 ject to the numerous and complicated affections so com- 
 mon in every miasmatic region." 
 
 Dr. Chapin then discusses, and the point may have an 
 important bearing upon the disease I am considering, 
 ''some particulars of a cause (colds) which operates 
 more extensively than any other morbific agent, and 
 produces pi'obably more than one half of all the diseases 
 which exist, and more than three-quarters of all the idio- 
 pathic fevers on the islands." ''The habitations of the 
 natives," says the Doctor, ' ' are for the most part consid- 
 erably scattered, l)ut in a few instances crowded to- 
 gether in such numbers as to exhibit the dense appear- 
 ance of large towns and villages. There is, however, 
 throughout an entii'e exemption from those pestiferous 
 exhahitions which so extensively poison the atmosphere 
 of populous places in hot climates. All animal and veg- 
 etable substances throwii away by the people, or cast 
 up by the sea, are quickly devoured by the number of 
 
IG 
 
 starving dogs and swine, so that no detriment is expe- 
 rienced from their pntref action," but " the dwellings of 
 the native population are merely slender frames of posts 
 and poles tied together with strings and covei'cd 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 
 wmd 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 con- 
 dition, the almost naked state of the inhabitants, their 
 common i)ractice of sleeping at night on the bare earth, 
 outside of their houses, and their habit of continuing 
 long in the water and exposing their bare bodies to 
 strong currents of wind, when overcome Avith heat and 
 perspiration, and it will not be surprising that diseases 
 incident to such causes should abound. Fevers, in- 
 duced thereby, are numerous." 
 
 COXSTKUCTION OF NATIVE HOUSES. 
 
 Xow let me turn to the '•^Answ^ers to Questions," pro- 
 posed by the late Eobert Criehton Wyllie, the faithful 
 Minister of Hawaiian Kings, and addressed to all the 
 missionaries on the Hawaiian Islands, May, 1846," and 
 presented to the Hawaiian Legislature of 1848, and see 
 what these gentlemen said in regard to the same sub- 
 ject. My reason for quoting so largely from these 
 writers of forty years ago will be apparent later on. 
 
 Kev. T. Coan says: ^'jSTative houses are usually too 
 small, too low, too dark, not well ventilated, too filthy 
 and too perishable in their materials and construction." 
 Eev. J. S. Green says: '^The native houses are cer- 
 tainly defective, exceedingly so. Most of them are 
 without partitions. "'• * ^ Still nearly all could 
 ]nake improvements in their style of l)uilding did they 
 i-ealize the importance to their physical and moral health 
 of having comfortable dwellings." Rev. E. W. Clark 
 says: ''The houses gene t-ally are grass huts, many of 
 
Pf 
 
 them miserable. Some have permanent partitions, but 
 not the majorit3^ Less improvements have been made 
 in houses and in dress and furniture. ^ * -h- ^^_ 
 tives accustomed so long to a mere shelter, do not feel 
 the inconvenience of their houses." Kev. R. Arm- 
 strong says: ''The houses ai'e 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 
 says: ''The native houses are almost invariably small, 
 poor and uncleanly." Rev. A. Bishop says: ''The 
 houses of the common people are defective in almost 
 everything which constitutes civilization." Rev. J. S. 
 Emerson says: "The native grass houses when well 
 built, are probably more healthy than any others, if they 
 are not suffei*ed to be damp by having no flooor. The 
 convenience of wdndows would 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." The Rev. 
 Mr. Green says: "The method of living in small 
 houses, having no partitions, and crowded with men, 
 w^omen and children is exceedingly unfavorable to the 
 formation and strengthening of virtuous habits, but ex- 
 ceedingly favorable to the vicious propensities." Mr. 
 Armstrong, in speaking of the licentiousness of the 
 natives, observes, "The causes which lead to it are such 
 as idleness, living in small and miserable houses, without 
 pai'titions, a debased state of the moral feelings and the 
 licentious conduct of many foreigners." 
 
 Let me again return to Dr. Chapin, and see what he 
 has to say in regard to certain ailments of the native 
 race which were also, probably, factors in the problem 
 I am endeavoring to solve. On the subject of venereal 
 diseases the Doctor says, (and in the absence of 
 proof to the contrary I accept the statement wdth reser- 
 vation and subject to the remarks I shall hereafter 
 make. ) ' ' If it be a fact, that the aborigines of America 
 were affected by syphilis and gonorrhoea before Europe- 
 o 
 
18 
 
 aiis visited them, or if, as is presumed by Dr. Thomp- 
 son, 'syphilis has been thousands of times generated 
 de novo, by impure intereourses,' it is certain neither dis- 
 ease existed, or was known at the Sandwich Islands be- 
 fore the visit of Captain Cook, in 1779. The natives 
 had ever lived in the practice of ])romiscuous and almost 
 unrestrained iiitercourse, so that the women were often 
 unable to designate the father of tlieir children ; still 
 their practises were not attended with those conse- 
 quences which follow the licentious m all civilized 
 countries. Those who have the credit of the discovery 
 of the islands, and of exhibiting first to the astonished 
 gaze of the simple and ignoi-ant natives, some of the 
 ingenious and useful implements of enlightened lands, 
 •H- ^ 4c- xnust also receive the credit of having intro- 
 duced among these islanders two of the vilest and most 
 loathsome diseases evei' sent as a punishment for trans- 
 gression. And upon the same page on Avhich is re- 
 corded the benevolent efforts made to improve their 
 condition and circumstances, "^ ^ let it also be re- 
 corded that they entailed upon their beneficiaries, a dis- 
 ease wdiich has 'grown with its grow^th and strength- 
 ened with its strength,' which has extended its coui-se 
 with destruction and death, till all portions of the group 
 have become infected, and countless multitudes have 
 fallen victims to its power. With such an introduction, 
 the venereal disease has foi^ the past fifty-seven years 
 continued to spread and increase ; perpetuated and ex- 
 tended too by almost every vessel Avhich touched at the 
 islandSj till words Avould fail to express the wretched- 
 ness and woe which have been the result. Foul ulcers, 
 of mani) years standing^ both indolent and phagedenic, everg- 
 iuhere ahound^ and visages horrihlg deformed — eyes rendered 
 hlind, noses entirely destroyed, months monstrously draivn aside 
 from their natural ijosition, ulcerating joalates, and almost use- 
 less arms and legs, mark most clearly the state ami pro- 
 gress of the disease among that injured and helpless 
 people. I have seen more than one case of marasmus 
 iu(Jueed by the difficulty- of mastication and dc^luti- 
 
19 
 
 tion. The mouths of these patients were ahnost closed 
 in the process of cicatrization, and the gums and fauces 
 were destroyed by ulceration. In one of my ])atients 
 suffering with the secondary symptoms of the disease, 
 in which I Avas successful in stopping its progress by a 
 mercurial course, the external nose had entirely disap- 
 ]jeared, and its place w^as occupied l^y a concavity and a 
 foramen of an irregulai'ly oblong form. The left eye 
 Avas totally blind, and ])oth disfigured l)y ulceration as 
 almost to lose their identity. The mouth was shock- 
 ingly deformed ; the lips and alveolar processes mostly 
 removed l)y absorption, and the teeth having theii' necks 
 and a portion of their roots divested of integuments, 
 Avere irregular in their distances and positions, pointed 
 in every direction, and but slendeiiy adapted to the 
 purposes of utility. The Avhole countenance Avas dis- 
 ligured l)y deep eschars, and the body greatly emaciated ; 
 no food could be masticated by him, so bad was the 
 condition of his mouth.'' 
 
 In regard to cutaneous diseases and scrofula, the 
 Doctor says: ''Though the Saurhvich Islanders are re- 
 markably fond of the Avater and are fastidiously particu- 
 lar in their practices of Avashing and bathing, they are, 
 nevertheless, extremely filthy and sqiudid in many of 
 their habits of life. With their beasts and foAvls in the 
 same habitation, and not unfrequently on the same mats 
 with themselv^es, their often repeated ablutions Avill l)e 
 regarded as timely. The kapa, or native cloth, used 
 bA^ the inhabitants is Avorn without cleansing till haA^ng 
 become foul Avith dirt and vermin, and too i*agged to 
 serv^e longer the pui-poses of covering or protection, it 
 is lain aside. Hence diseases induced or exacerbated 
 by such causes have at those islands a fruitful soil and 
 flourish luxuriantly. The itch is extremely prevalent, 
 and often assumes a virulence unseen i;i this countrA^ 
 the pustules sometimes becoming confluent are con- 
 verted into large and troublesome ulcers. Other scabi- 
 ous affections exist. Scrofula is not only frequent but 
 extremely malignant . ' ' 
 
20 
 
 Now let me turn again to Mr. Wyllie's report in this 
 connection, and examine the replies to the question re- 
 garding diseases prevailing, contagious or epidemic, but be- 
 fore so doing I desire to say a few words parenthetically 
 to the foreign readers of this report. For many years 
 the Hawaiians have been presented to the world as be- 
 ing inordinately licentious, utterly profligate, absolute- 
 ly abandoned and worthless in character and wholly 
 deficient in moral principles. The responsibility 
 for this gross defamation of character, by care- 
 less exaggeration, must rest, in a large measure, 
 upon those from whom I quote and their associates, 
 friends and correspondents. It must be remembered 
 that they were men of a strictly religious turn of mind, 
 more adamantine in pulpit and print against every in- 
 fraction of the divine or moral law than the God-man 
 Himself whose teachings they came to impart. They 
 judged an indigenous aboriginal race sinning in ignorance, 
 and learning the sin of sinning from white sailors, whom 
 they at first regarded as equals, if not superiors, in 
 power and knowledge to their would-be spiritual bene- 
 factors, as if these poor, generous, hospitable, loving 
 and ignorant natives had had opportunities of learning 
 to be immaculate and holy. The hardworking mission- 
 aries were few, and the libidinous foreign sailors num- 
 bered by the thousands, and while the one aimed to 
 teach an entire change of life, manners, dress and cus- 
 toms ^\it\\ a somewhat severe and repressive hand, the 
 other offei'ed pleasure and profit unrestrained by 
 thoughts of future pain and punishment. No more 
 should the blame of sin, disease and defects in charac- 
 ter be thrown upon the native race than the Ci*edit of 
 their present high degree of intelligence and advance- 
 ment should be entirely given to their spiritual teachers. 
 The intellectual and material progress and the disease, 
 and such debasement as may exist, must be accredited to 
 foreign influence, to the teachers on the one hand and 
 to the licentious white men on the other. Nor does 
 this latter class include sailors alone, but even at the 
 
21 
 
 present day it is largely made up of young white men 
 whose family antecedents and position in life should 
 make them defenders instead of destroyers of the native 
 race . 
 
 But to resume, Mr. Coan says: ''the principal dis- 
 eases are of the venereal, scrofulous and cutaneous 
 character. The climate, however, is remarkably 
 healthy." Mr. Green says that no diseases prevail 
 contagiously or epidemic in his district (Makawao). 
 '" Occasionally the influenza prevails ; bu^" on the whole, 
 since I have resided among these people, they have 
 been exempted from diseases to a remarkable extent." 
 Mr. Bishop says : '^'No contagious diseases except cutan- 
 eous eruptions which are very prevalent and distressing. 
 * ^ * But the most prevailing and mortal diseases 
 are consequent upon the venereal corruption of the 
 blood." Mr. Emerson says, "the itch and venereal 
 diseases are destructively contagious.-' 
 
 It may not be amiss to say here, that the opinions I 
 have quoted were written when the native race num- 
 bered three or four times more than the present popula- 
 tion of 40,000, and that sixty years before they were 
 computed at ten times as many. 
 
 But there is anothei' dark chapter to be written before 
 I pass on to the next chain in the link of tracing cause 
 and effect, and again I quote from Mr. Wyllie's report. 
 The question asked is : " How far is it (physical health) 
 affected by the enervating effects of indolence and in- 
 difference, as to anything beyond the mere wants of 
 animal existence?" Mr. Coan replies: "Physical, 
 mental, and moral imbecility ; disease and vice are ex- 
 tensively engendered, and sadly perpetuated by indo- 
 lence and indifference to anything beyond the mere 
 wants of animal existence." Mr. Green says : "Great- 
 ly affected. ^LSTothing 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 says ; "Indolence here, as 
 everywhere, has a debasing influence on the moral and 
 
22 
 
 )3hysical condition of the pepple. It is the mother of 
 vice and disease. As artificial wants increase, the 
 character of the people is generallj^ elevated.-' Mr. 
 Parker says, "Both the moral and physical health of 
 the natives is mast serionsly affected (injured) hj' their 
 indiffei'ence and improvidence.'' Mr. Bishop says: 
 "'Indolence is attended with enervating effects on the 
 constitution. This is evinced in the females Avho have 
 little to do, and yet they are more subject to sickness 
 than the men. Perhaps there are other causes pro- 
 ductive of sickness in many females ; the consequences 
 of vicious idleness.'' Mr. Emerson says : ''This peo- 
 ple are indolent, and many of them improvident ; and 
 sickness and death are often the result of this improvi- 
 dence. 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 cii'cumstances would allow of their 
 use. But whether this indolence and improvidence are 
 peculiarly inherent in the Sandwich Islands, or the re- 
 sult of a system of oppression long practised, in con- 
 nection with the al)sence of that stimulus produced by 
 the artificial and imaginary wants connected with civili- 
 zation is yet to be proved." Mr. Gulick says : ''Very 
 injurious, and to a considerable extent. Yet this in- 
 difference 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 bettering their condition." Mr. Johnson 
 only says : " I think the moral and physical health of 
 this people is, in some degree, injured by indolence and 
 indifference to the wants of both bodv and soul." 
 
23 
 
 WHENCE THE DISEASE AVAS DETilVED. 
 
 In my report to your Plonorable Body, in 1881, I 
 said : "I beg to lu-ge that Hawaii take a larger pai't in 
 pursuit of such researches. She is attacked by a terri- 
 ble enemy. Let her study everything pertaining to its 
 origin, resources, and favorable conditions. Lej)rosy 
 has, at times, attacked every race in the world; but its 
 chief abiding places have been parts of Asia. Some of 
 the islands of ^falaysia have also been fecund hot-beds 
 of the fell disease. In Java, and other islands of the 
 great Archipelago, where the natives present most 
 striking affinities with the Hawaiian race, the diseases 
 that affiict them also afflict the Hawaiians. The Ja vans 
 treat as outcasts all Avho are suffering with the huUg. oi* 
 leprosy, and the unfortunate ones have voluntarily seg- 
 regated themselves upon small islands, where they are 
 supphed with the means of subsistence by their friends.'' 
 I added, and I am still of the same ophiion, that, ''I 
 think it would be well that the disease wdiich commands 
 so large a share of public attention, and calls for so 
 large an appropriation of the public revenue should be 
 studied by competent authorities under Hawaiian aus- 
 pices in various parts of Malaysia and Polynesia, where 
 it is to be found." 
 
 I do not purpose to enter into a long ethnological dis- 
 cussion to trace the orio-in of the disease in this country, 
 or if not its origin, a possible source for it, but I cannot 
 refrain from touching upon the subject in partial con- 
 nection with the origin of the Hawaiian race and the 
 existence of leprosy in India from the most ancient 
 times, as presented by the very valuable series of re- 
 ports furnished by Her Imperial Majesty's Govern- 
 ment of British India to His Majesty's Govei'nment. 
 
 My views on the origin of the Hawaiian and ^ialay- 
 
 sian races have been published and are known to those 
 
 who take an interest in such subjects. While they may 
 
 "l differ in a degree they coincide in the matei-ial point of 
 
 origin with those of Judge Foniandcrj who in his Avorli 
 
24 
 
 on the Polynesian race, says : ^' I believe I can show that 
 the Polynesian family can be traced directly as having 
 occnpied the Asiatic Archipelago from Samatra to 
 Timor, Gilolo, and the Philippines, previous to the oc- 
 cupation of that Ai-chipel by the present Malay family ; 
 that traces, thought faint and few, lead up through 
 Deccan to the northwest pai't of India and the shores 
 of the Persian Gulf; that, when other traces here fail, 
 yet the language points farther north, to the Aryan 
 stock hi its earlier daj^s, long before the Vedic irruption 
 in India ; and that for long ages the Polynesian family 
 was the recipient of a Cushite civihzation, and to such 
 an extent as almost entirely to obscure its own con- 
 sciousness of parentage and kindred to the Aryan 
 stock.-' And again, ''I hope to be enabled to show 
 that the Polynesian family formerly occupied, as their 
 places of residence the Asiatic Archipelago, and were 
 at one time in the world's history closely connected by 
 kindred, commerce, or by conquest with lands beyond, 
 in Hindustan, the shores of the Persian Gulf, and even 
 in Southern Arabia.'' 
 
 The Secretary to the Government of India states 
 that at the present day ''there appears to be at least 
 three centers of comparatively intense prevalence, viz : 
 
 {a) The Beei'bhoom and Bancoora districts hi the 
 districts in the lower provinces of Bengal ; 
 
 (h) The Kumauii district in the Northwestern 
 provinces ; 
 
 (c) The Deccan and Konkan in the Bombay and 
 Madras Presidency, respectively." 
 
 In other words that in, and surrounduig the cradle, 
 from which the great and ancient races from whose 
 loins were dei'ived the Hawaiian s, the disease still pre- 
 vails in the strongest form. Turning to page 80 of the 
 Indian Peport, I find a statement by Messrs. Lewis 
 and Cunningham, Assistants to the Sanitary Commis- 
 sioner of India, that '' the disease has been known to 
 exist in India for at least 3,000 years,'' but " with re- 
 gard to our definite Ivuowledgc of its actual causation, 
 
25 
 
 it is to be feared that we have not, except phraseologi- 
 cally, advanced very much on the etiological views re- 
 coi'ded 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 gf 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 re- 
 spectively of the seven varieties of knshta (leprosy) — 
 the kiidig of the Japanese. This Atreya lived at least 
 2000 years before the Christian era, and wrote the 
 " Charaka Sanpita on the pathology of the disease," 
 extracts fi-oin which will be found on the pages above 
 quoted. In these extracts he describes the various 
 kinds of leprosy, the descriptions of which are already 
 recognizable as forms of disease existing at the present 
 day. He says : '' the kiishta thus produced cause much 
 pain and suffering. None of these varieties result, 
 however, from the vitiation of a single humour. Kush- 
 tas are of seven, of eleven, or a larger number of a 
 kind : and these constantly irritating the system be- 
 come incurable. "^ ^ ^ The wind, the bile, and the 
 phlegm, being vitiated, re-act on the skin, &c. When 
 the wind is most vitiated it produces the kadala kiishta^ 
 the bile, the aiidumbara, the phlegm the mandala^ the 
 wind and the bile the rishyajihva, the bile and the 
 phlegm, and the wind the sidhma^ and the three to- 
 gether the kakanaka,^- The causes of the disease At- 
 reya gives as being : ' ' Excessive physical exercise 
 after exposure to too much heat or too much cold ; 
 taking food after surfeit; eating of fish with milk; 
 using barley with several other grains, such as ' haya- 
 naka,' ' dalaka,' ^ karsdusa,' &c., along with venison, 
 milk, curdled milk and butter milk ; excessive sexual 
 intercourse ; long protracted excessive fear or labor ; 
 fatigue, interruption of catarrah, &c., vitiate the 
 phlegm, the bile, and the wind ; hence the skin and 
 the three others become slackened. Thus iriitated, 
 the thre« elemeatft corrupt the skin and others, and 
 4 
 
26 
 
 produce ' kushta/ The premonitory symptoms of 
 ' kuslita ' are as follows : Want or excess of perspira- 
 tion, I'oughness, di>scoloi*ation, itching and insensi- 
 hility of the skin, [)ain, honipitation, eruption, and ex- 
 cessive pain on tlie pails that are a]:>out to fall off.'' 
 '' The worms that form in leprous eruptions destroy the 
 jiesh, skin, veins, muscles, and bones. When affected 
 by them, the patient snffers from spontaneous dis- 
 charges of blood, insensibihty, loss of sensibility of the 
 skin, mortification, thirst, fever, dysentery, burning, 
 weakness, disrelish and indigestion. The H^ushta ' 
 becomes incurable." 
 
 THE LEPKOSY OF THE I3IBLE. 
 
 As regai'ds the Biblical leprosy as defined by Moses 
 in Leviticus, this might have been deiived from the 
 same original source. The book of Leviticus, accord- 
 ing to accepted dates, w^as written snbsequent even to 
 that of Atreya by several centui'ies, and fi'om quota- 
 tions in the latter' s writings it is certain that he w^as 
 the earliest writer on the subject. The disease might 
 have been introduced by the great migratory race 
 founders into Arabia and thence into I'^gypt, and pro- 
 pagated among the Israelites during their bondage to 
 the Egyptians, since we find in Deuteronomy, chapter 
 28, V. 27, the threat implying the fear and knowledge 
 of the disease, " the Lord will smite thee with the botch 
 of Egypt, and with the emerods, and wiHi the scab, 
 and with the itch, tvhereof thou canst not he healed.'^'' It is 
 not easy to decide from the Mosaical description of the 
 disease whether the leprosy referred to was the 'kushta,' 
 or some of the other varieties such as leucoderma, or 
 white skin, but from the verse just quoted I am in- 
 clined to think that it existed even in its most deadly 
 form. It will be noticed throughout the Bible, that it 
 was invariably treated as an unclean disease, and one 
 for which, in addition to obedience to the sanitary com- 
 mands of the Pnest, sacrificial atonement had to be 
 made, as if for a violation of the moi'al an well a>^ phy- 
 
27 
 
 sical sanitary laws. 1 am also inclined to believe that 
 it was more than a common cutaneons affection and 
 was considered to be both contagious and infectious, for 
 not onh' were the lepers set apart from the clean, but 
 their clothing and even their homes were destroyed. 
 That the Jews, as the world grew older, gradually be- 
 came freer from the loathsome malady is probably due 
 to their hygienic laws being far stricter than those of 
 the other nations with whom they were bi'ought into 
 contact in their wanderings, either as a nation, sections ■' 
 of a nation, or as individuals. It is more than probable 
 I think, that the germs of the disease, too, were being ^ 
 insidiously spread through Europe by the adventurers, 
 navigators, discoverers and conqueroi's, developed by 
 these ancient races long before the Crusades, the ac- 
 cepted modern date of its inti^oduction into Europe. 
 
 HEEEDITAF.Y TIIAXSMISSIOX OF TIIK DISEASE. 
 
 Messrs. Lewis and Cunningham state ''that the 
 inhabitants of the Kumaun districts virtually consist of 
 two classes only — Rajputs and Domes, the former 
 representing an Aryan population, the latter an abori- 
 ginal people — whilst. other classes are only very spar- 
 ingly represented,'' and that in their cases, ''the 
 evidence, such as it is, is in favour of impartial distribu- 
 tion of the disease,'' but on the question of the heredity 
 of the disease they say the evidence they produce from 
 the Almorah Asyliun, "allowing the fullest play to the 
 possible influence of similarity of external conditions, 
 points to the distribution of the disease by families and 
 therefore to heriditary predisposition." They support 
 their position by statistics which ver}' strongly endorse 
 similai- view^s of other writers. 
 
 In view of the inunense mass of testimony pro and eon 
 in regard to the hereditary transmission of the. disease 
 Avhich forms part of my repoi't, and yet which I think, 
 in the main, will support to no little extent the view of 
 a latent race j^redisposition in individuals of that race 
 capable of being developed under conditions favorable 
 
28 
 
 to the germinating of the disease germs I will pass on 
 to the consideration of what has been observed in the 
 descendants of the more ancients races, and of the 
 more direct cognate races of the Hawaiians, not the 
 modern Malays wdio are scarcely older in Malaysia than 
 the Normans of the English conquest in England, but 
 to the more ancient stock such as the Sundees, the 
 Timorese and the ancient people of the Moluccas. 
 These were recognized as the aborigines of the 
 Country, whose language, religion, habits and ideas 
 bear a stronger resemblance to those of Polynesia than 
 any others of insular Asia, and among them to this day 
 we find the same disease, as the Hawaiians are, and 
 have been, subject to. Here leprosy has been 
 known for generations and a sj^stem of voluntary seg- 
 regation carried out. That is to say, lepers resorted to 
 certain islands Avhere they were occasionally visited by 
 their friends who brought them their means of subsist- 
 ence. In Tahiti, also, to judge from the description of 
 travelers, a form of leprosy, or of elephantiasis, was 
 known at least a hundred years ago. 
 
 Thus far I have endeavored to show that should 
 leprosy be a disease upon which the influence of race 
 has any effect, that influence must necessarily have its 
 effect upon the Hawaiian race as the descendants and 
 conquerors of those in whom the earliest seeds of that 
 disease were implanted, and through Avhom, for gene- 
 rations after generations, the seed I'ipened and was re- 
 implanted. In supporting this theory it is not neces- 
 sary to hold that the sequence would be that the whole 
 race should be diseased or even pre-disposed to disease, 
 for we find that there is evidence from all parts of the 
 world that, owing to circumstances, or perhaps in the 
 absence of the necessaiy infiuences to nourish disease, 
 the non-resistants are in a lai-ge majority. As a rule, 
 too, the evidence shows that while the chiefs, and the 
 '^ better classes" are occasionally attacked, the poorer, 
 and practically servile classes, badlj^ educated, sparsely 
 clothed, ill-fed, and wretchedly housed, form the im- 
 mense majority of the victims* 
 
29 
 
 WHAT, THEN, IS LEPROSY ? 
 
 If aslved my opinion of leprosy and how it originated, | 
 I will reply with the pi'oper modesty of a layman, — not 
 altogether mifamiliar with medical works on the subject, 
 nor altogether miexperienced with the disease in this 
 and other countries — in the presence of learned pro- 
 fessional and scientific observers and writers, I do not 
 know, nor appai-ently does any one, but I think that in 
 all probability it is a disease caused in its earliest inci- 
 piency by a demoralization of the system by uncleanli- 
 ness, not merely of the surface of the body, — for w^e 
 find in India, especially, that some races that never 
 wash enjoy an immunity from the disease — but of the 
 blood, poisoned, perhaps, to a very great extent by a 
 degraded condition of living, or by excessive indul- 
 gence of the animal nature in a tropical climate ; for, 
 so far as my reading extends, I may be permitted to 
 say that the disease was not only originated in but has 
 thriven better in hot than in cold climates; the excep- 
 tions of Xorway and TsTew Brunswick are comparatively 
 minor ones in proportion to the leper populations of the 
 tropical Avorld. 
 
 While I am not prepared to consider the medical 
 question of the relation of leprosy to syphilis, I am in- 
 clined to believe, and to say, that syphilitic blood pois- 
 oning has played no small part in the development of 
 the disease in these Islands, in connection with the m- 
 herited disease and "constitutional taints'' of the Isl- 
 anders, such as are mentioned in the earlier portion of 
 my report. I think that the mind, also, is no unimpor- 
 tant factor in aiding the propagation of the disease. I 
 see no reason why, in the scheme of the Great Creator, 
 the human body should not be placed on the same 
 plane as the members of the animal and vegetable 
 world in its relation to health and disease. Any gar- 
 dener knows that by cultivation he can improve his 
 flower and fruit, and by care and grafting and selection 
 of seedlings create ne^v varieties, and from a sorry crab 
 
30 
 
 apple grow a Blenheim orange, or by the reverse pro- 
 cess, by mipoverished soil, thriftless untidmess and 
 nncleanliness deteriorate the plant or tree, poison not 
 only its flowers and leaves through the sap but allow 
 its bark to become the refuge and home of insects and 
 fungi. The nnhealthy plant not only produces no 
 frnit but dies the lingering death of a leprons human 
 being. And so it is with animals, inbreeding, or breed- 
 ing with inferior stock deteriorates the original stock 
 and the weak puny animals succnmb to influences 
 which the stronger resist. 
 
 But with this inscrutable malad}^ of leprosy, as Dr. 
 Tache, of Tracadie, says :^ *' There are some instances 
 of such a slovj proc/ress and such an attenuated malignity of 
 the ailment that life and even fair health are enjoyed 
 for many years,'' and as Dr. Vandyke Carter,' in speak- 
 ing of the Xorwegian lepers, says if ''But, while the 
 coast-dwelling peasantry of Xorway, in comparison 
 with other (not all) countries of Europe, have admittedly 
 long dwelt in a backward hygienic condition, living 
 much on fish and potatoes, intermingling freely and 
 being subject to overcrow^hng dui'ing their long win- 
 ters ; still, on the other hand, it is notorious that they 
 are an unusually well developed and long-lived race ; 
 and besides, individual lepers are, as often as others, 
 even robust people," and yet, to quote Dr. Moore, the 
 leper must be in "a state of human system below par," 
 and therein in spite of the apparent strongly built phy- 
 sical frame lies the wdiole secret of the disease, and its 
 remedy, — a remedy not for the generation inheriting it, 
 but for the survivors, not only for the absolutely healthy 
 ones but also for those, even, in whom the disease germs 
 may be l3nng dormant, only waiting to be destroyed by 
 wise and sanitar}^ culture or to be nourished into viru- 
 lent life by baleful encouragement. 
 
 *Page 137, Foreign Reports. 
 fPage 91, Foreign Reports. 
 
:r\ 
 
 A PROBABLE CAUSE FOR JTS SUDDEN DEVELOPMENT. 
 
 Having thus far endeav^ored to show that the disease 
 has been possibly dormant in the Hawaiian blood for 
 many centuiies, appearing-, probably, in individual cases 
 to a greater or less degree before Ave, of a foreign race, 
 w^ere brought into contact with them, let me now pro- 
 ceed to give my reasons for its apparently unexpected 
 outbreak twenty or thirty years ago, or at the era when 
 it was first brought to the cognizance of the Hawaiian 
 Cxovernment. 
 
 Accepting Fornander's views that 'Hhat branch of 
 the Polynesian family, from which the oldest ruling line 
 of HaAvaiian chiefs claim descent, arrived at the Hawaii- 
 an group during the sixth centurj^ of the Christian era," 
 Ave have a history of nearly eleven centuries of a race 
 living in practical non-contact w^ith a white population. 
 And furthermore of a i*ace Avhich was in earlier times 
 according to Mr. Horatio Hale so prolific that it threw 
 off its ''too-i*edundant population by migratory expedi- 
 tions"' to various islands of the Pacific, to Easter island 
 and the HaAvaiian group for instance, and occupied 
 ' ' ovei' three thousand years for this gradual process of 
 redundancy and relief." 
 
 Cook and the earher Avriters estimated the population 
 of the Hawaiian group, onl}^ a little more than a cen- 
 tury ago, at nearly half a million inhabitants. These 
 people Avere practically gOA^erned as Avere Eui'opeans in 
 the earliest and most tyrannical days of early feudalism. 
 Their lives, a irtue and property, such as a semi-servile 
 feudal class might possess, were at the mercy and will 
 of the chiefs from the highest to the loAvest in turn. 
 Their food must necessarily have consisted principally 
 of a vegetable and fish diet, Avith swine and dogs, or 
 some small animals for — since cattle were unknow^n be- 
 fore the adA^ent of foreigners — animal food, and for a 
 beverage, Av-ater or products of roots, bark, etc. They 
 were, how^ever, in their primitive style of living, strong, 
 robust and he^jiJthy, living and loving as sons and 
 
32 
 
 dauo'htei's of the sun and Bea, but intermarrying and 
 inbi'eeding, as passion, or caprice, dictated. Of theii- 
 diseases we have no rehabie record at hand, but it is 
 not unreasonable to presume that they possessed the 
 morbific taints of their ancestors, and their ills were 
 treated much in the same way as in the earlier days of 
 the transition period by the native kahunas^ or doctors 
 and soi'cerers ; a treatment which apparently was a trust 
 in the native Gods and the resistant powers of the 
 patient, assisted by a rude knowledge of the medicinal 
 power of herbs, roots and earths. 
 
 THE LATEXT FLAME BURSTS FORTH. 
 
 The first spark that ignited the latent flame of disease 
 and death was undoubtedly the arrival of the first for- 
 eign ship — be it Capt. Cook's or another's. It is un- 
 necessary to repeat the statements of early writers as to 
 the rapidity with which the poor, ignorant, simple and 
 innocent minded natives were impregnated with one of 
 the most foul and loathsome diseases that nature has 
 inflicted upon man for outraging her laws. The dis- 
 ease was sown, and being neglected it increased in ma- 
 lignity and virulence, as it was passed around promis- 
 cuously from body to body. ]S^o merc}^ was shown to 
 any, the women flocked to the sea ports, the wdiite 
 Gods, so regarded by these unhappy creatures, passion- 
 ate, reckless and unscrupulous, after their long voy- 
 ages and abstinence, sacrificed them by the hundreds to 
 the bloody Moloch of their lusts. Inbred by genera- 
 tions, reinvigoi-ated by the pestiferous embraces of 
 thousands of white men it became perpetuated in the 
 blood of those who yielded to temptation. When I re- 
 member that in the last 75 years at least a quarter of a 
 miUion of men, of the white race principally sailors, in 
 visiting the shores of these islands have indulged in un- 
 resti-ained intercourse with the poor women of 
 these islands, I am not surprised at the reduction of the 
 po])ulation so much as the fact that so many remain, 
 Bear in mind, tocN thai ^vith th-e bold disorderly life o^ 
 
33 
 
 white men, came the white man's poisonous narcoticB 
 and intoxicants to a^'ain change and enfeeble the blood 
 of the race. Mentally, too, the lower classes were 
 probably debilitated by the oppression of their chiefs 
 and the hard and unusual labors imposed upon them by 
 their task masteivs. In the ruins and remnants of the 
 hciaus or temples may we not r^ad a record of lives lost 
 and bodily constitutions wrecked. All this time the 
 diseased and blood impoverish id natives were living in 
 their primitive manner in theii* grass huts, the general 
 condition of which I have ali'eady described, and sleep- 
 hig, the diseased wiUi the healthy, upon one mat and 
 under one tapa^ or bark woven covering. A whole fam- 
 ily, irrespective of age or sex, receiving from each 
 other's heated bodies the disease-laden or disease-creat- 
 ing exudations. Purely I might almost stop here and 
 claim that the diseased of the nation almost courted 
 death by the conditions they had at first so unwittingly 
 accepted and subsequeiitly so unhappily carried out. 
 
 THE EFFECT OF THE TRANSITION PERIOD. 
 
 The next stage is the one that marks the unprece- 
 dentedly rapid trandtion of the Hawaiian race from so- 
 called barbaiism to Chiistianity and civilization, from 
 the darkness of heathenism to intellectual life and 
 pliysical death, — for the change has cost the lives of 
 hundreds of thousands of souls. Let me say that I am 
 aware that in presenting my views upon the source and 
 ])artial cause of leprosy in the Hawaiian Islands, I am 
 ti'eading on dangerous ground from a medical and 
 scientific standpoint, and am falling counter to accepted 
 liuthorities, and furthermore am pai-tially upholding the 
 theoiy of spontaneity and syphilitic cachexia in con- 
 nection w^ith race-hereditariiiess and predisposition. I 
 am willing to accept the responsibilty in a degree, for I 
 think the facts justify me in believing that each has 
 had a marked influence on the disease on these Islands, 
 and that the al)atement of the disease depends to some 
 extent upoa their coasideratioa. 
 5 
 
34 
 
 ....k that the aclveiit of tiic foreign missionaries 
 he. about the year 1820, may be conveniently ac- 
 cept a as the practical iiianguration of the transition 
 pericJ. It is not within the })rovince of this report to 
 describe the noljle works which they, and their suc- 
 cessors of other civeds, liave done m the way of edu- 
 cating our people. Their work, in this regard, justifies 
 tliem. In promoting the health of the ])eople by educa- 
 tion in sanitary and moral laws and enlightening the 
 mind of the HaAvaiian generally, they have righteously 
 foUo^ved the precepts of their Mastei*. If, by the light of 
 subs ^juent events, faults were made they must be at- 
 tribii. ?d to an error of judgment, to the error of dealing 
 witJ^ he Hawaiian race, in ignorance of the character- 
 istics and history of the I'ace, Avith too firm a hand, and 
 too high a pressure propelling them on the road to ad- 
 vancement. In a word the should-have-lDcen labor of a 
 century Avas condensed into less than a generation of 
 tinK\ In so I'apid a change in the life and character 
 of an aboriginal race both mind and body must neces- 
 sarily suffer. To partially clothe a naked race Avith uu- 
 congejiial garments, AA^orn in heated rooms and discarded 
 as soon as })ossible, entailed u])on the natiA^e race, 
 a 'arge number of constitution-weakening diseases^ 
 and more especially in cutaneous forms. Strictness of 
 life in public gav^e AA^ay to hidden sin and deceit, and 
 reticence of disease ensued for fear of disfaAor or pun- 
 ishment. In lieu of the oppression of the chiefs came 
 the more dreadful — to an aborighial race — oppression 
 of civilization. Foreign intercourse brought new and 
 foreign diseases, and the pernicious body Aveakening 
 customs and hal)its of foreigners. And all this time, 
 too, fresh hoi-des of diseased men Avere propagating 
 afresh Avith unhealthy Avomen old diseases. The na- 
 tion's strength had l)een jn'eA'ioiisly sorely tested by epi- 
 demics Avhich had SAvept away theii' tens of thousands 
 ill great swaths, showing tliat tlie once strong bodies 
 had become debilitated. Small pox liad been intro- 
 duced into the land ujkI claimed its nctims by the legion. 
 
35 
 
 measles and other fevers followed, and diseases which, 
 under other conditions, would have lightly passed 
 through the- ranks counted then* dead ))y the scores. 
 The once prolific race had heconie sterile. Even the 
 population of 142,000 in 1823 had in thirty years (1853) 
 l)een reduced to 73,1)00, and in twenty years more (1873) 
 to ^(KOOO, or a loss of 86,000 — or more tlian douhle the 
 present i)opulatioji — in fift\' > ears, and so they steadily 
 died off. Is it a wonder that as the living think of 
 theii* man}^ lost friends they feel heart despondent and 
 hopeless, and jjcrhaps too regardless of the health of 
 themselves and families? Is it to he Avondered at that 
 only the l)ravest and strongest did not hecome discour- 
 aged, and are not now as much weakened in mind as in 
 hody? 
 
 But there are two more causes which, hi my judg- 
 ment, have had a great effect in the propagation of 
 leprosy, or diseases closely allied to it, although medi- 
 cally it he a disease siu-cjoicris. The first was the ignor- 
 ance of some of the early and unqualified medical prac- 
 titioners who were permitted to spread disease hroad- 
 cast, and to do irretrieva])le injmy Ijcfore retrihution 
 overtook them, hut the second and chief cause was 
 the indiscriminate, and to my mind careless vaccin- 
 ation that ])egan ahout 1868. It is stated in the 
 records of the Board of Health that a respected 
 |)hysician, now resident on the Islands was informed 
 that ''the usual ])rice of 25 cents for each success- 
 ful vaccination was to he reduced to 12 J cents, as some 
 ])hysicians, here in Honolulu, had vaccinated j^ersons, 
 and one of them 2,500 for a stipulated sum of $75, — or 
 3 cents a]>iece and providhig the vaccine virus appar- 
 ently. Dr. A ruing on page XLIV says in regard to 
 this suhject: 'VYou are doubtlessly aware of the very 
 ]n-evalent opinion among medical men that the unusually 
 rapid spread of the disease may possibly be attributed 
 to the great amount of indiscriminate vaccination which 
 has been carried on in these islands. There have, if my 
 information is con-ect, unquestionably new centres of 
 
36 
 
 leprosy developed after vaccination was practiced and 
 several old inhabitants have told nie, how they them- 
 selves used no precautions whatever in vaccinating dur- 
 ing a small-pox scare, but brought the lymph directly 
 from one arm to another without even wiping either 
 points or lancet." As we have not yet discovered 
 Avhether the disease can be conveyed by hioculation,'^''' 
 nor how long the germs thus implanted into the body 
 may be dormant before becoming productive or de- 
 stroyed, I can only state that the impression is strong 
 in the minds of many that a numltcr of cases have thus 
 been inoculated with leprosy. As regards the experi- 
 mental hioculation of Keanu, the condemned convict, 
 a report as to his pi'csent condition will be found in the 
 Appendix. 
 
 I wall now consider the question of contagion in so far 
 as, in my opinion, it bears upon the spread of the dis- 
 ease on these Islands. 
 
 THE CONTAGION OF LEPROSY. 
 
 I think that the evidence presented to you in the 
 several reports of the Board of Hen 1th, and of the med- 
 ical staff of the Government since the medical administra- 
 tion of Drs. Hoffmann, Hillebi'and and Hutchison to 
 that of Drs. Mouritz, Arning and others, and the, 
 hitherto unpublished, cases to be found in the Supple- 
 ment to this report, justifies thi stand the Hawaiian 
 Government has taken in believing that th? disease, as 
 it appears in this Archipelago, is to a limited degree 
 contagions among the Hawaiian race provided there are 
 strong predisposing and favorable conditions which 
 create ^'a certain weakness to resist its attacks." That 
 it is only mildly contagions, and then only under the 
 most favoring circumstances, among the white races, is 
 to my mind, absolutely proven by the fact that the 
 cases of leprosy among the white population are so few 
 in proportion to tlie number who have baen brought into 
 
 * Vide Tracadie Report, page 142. 
 
37 
 
 the closest contaet with the disease, and 1 will repeat 
 here views exj)ress'jd on the (Ivdicatioii of the Kapiolani 
 Home: ''1 have no hesitation in saying that the ques- 
 tion (of contagion) is one that has a remoter interest 
 than what is popularly entertained, especially abroad, 
 inasmuch as while admitting that the malady is conta- 
 gious undei* the most favorable conditions, yet it does 
 not seem to be more si) than many common diseases, 
 the result of an impaired condi Jon of blood, which are 
 generally accepted as being non-cortagious, and onh^ 
 become so through pe^uliu'ly favorable and strongly 
 coiresponding cii'cumstances. Certainly there is no- 
 thing in the history of the disease, or attaclung to it, to 
 cause the foreigners visiting our she res, to be in the 
 slightest degree a})prehen.'.ive of danger.'- I think it 
 can be asserted without fear of conti-adi:'tio:i that there 
 has not been a single case of leprosy among the white 
 or foreign population that was not connected with long 
 and intimate association with those of the native race 
 either having, or predisposed to, the disease. The case of 
 Rev. Father Damien, referred to in the ivports ( f Drs. 
 Mouritz and Arr.i ig, is the most int M-es'.ing and valua- 
 ble one in connection with the question of contagion. 
 As far baclv as Dec( nJxr, L^'TT, this faithful servant of 
 Chiist wrote to ilis Excellency J. Mott Smith, then 
 President of the Board of Health, '*! diall endeavor to 
 do all I can for the benefit of the Board, and also of the 
 sick people here. '" ^ - You are aware t/nd for the 
 general welfare (f the lepers 1 have sucr'jiccd nifj henltli and all 
 I have in the ivorld, and in consequejice you may trust 
 me." 
 
 To those rx-quainted with the strictness and pur- 
 itv of life of such men as enroll themselva'S in the ranks 
 of the Christian Arn:}^ as true soldiers, and especially 
 the men cf the 8tr.n j) aid mould of mind of Father 
 Damien, it is ni.necc e^aiy to say th:it th^ i Klucements 
 to the disease, too frequently m ^" with auDi >- laym 'ii, 
 are wanting, and const queritly tlie t\\\^ c )nL:igion^ and 
 infectious elements of ihe Uialady ma/ be nure correct- 
 
38 
 
 ly analyzed from his ca^^e than from any othei*. In his 
 report the Eev. Father gives us hut a modest and par- 
 tial insight into the terribly trying life of 13 years 
 among the lepers. Thirteen years in the elosest eon- 
 tact with ''a distemper so noisome, that it might pass 
 for the utmost corruption of the human body on this 
 side of the grave.'' Inhaling fetid breaths, cleansing 
 the horrible ulcers, watching over the dying and hand- 
 ling the semi-putrid cadavers, living, eating, sleeping 
 in an atmosphere polluted with disease, having his food 
 cooked by a leper, and surrounded by such an aggrega- 
 tion of foulness, an escape from contracting the disease 
 would have been regarded as miraculous. I think that 
 this case taken in conjunction with the fact that the 
 foreign portion of the community have been practically 
 free from the disease is sufflciently conclusive to enable 
 me to reiterate my belief that there is no ground for 
 alarm for white people from the disease. The very val- 
 uable tables, prepared by Dr. Mouritz and others, 
 which I elsewhere present to you, will I think convince 
 you that we may at length hope that not only has this 
 dread malady been checked and to a great extent con- 
 trolled 1)ut that it is less virulent and malignant in char- 
 acter. I think we are justified in taking, in respect to 
 the disease, a hopeful view of the future. Our duty 
 though must be to closely watch the rising generation 
 while we endeavor to ameliorate the condition of the 
 sufferers. In dealing with this question let us, as Ha- 
 waiians, remember that we set an example to the world 
 in the spirit with which we have treated the leper. The 
 unfortunate has not been, and should not be, regarded as 
 a mere outcast, as in other countries, Avhose life was an 
 eyesore and a burden to the community, and whose 
 death was desired. Even admitting that all attempts to 
 cure this dread disease which has baffled the medical skill 
 of ages have failed, yet we should not abandon our 
 leprous brethren in despair ; but we should continue to 
 treat them and to care for them in a spuit of love and 
 hope. Above all we should try to make the sufferers 
 
:^9 
 
 as coil ten t«d and comfortable as wc can. If wc cannot 
 cure the disease we can at any rate alleviate the condi- 
 tion and [)ains of our lepers. I feel satisfied that in the 
 iin[)roved condition of the lepers at the branch hospital 
 since the Sisters of Charity were placed in charge may 
 be found, a suggestion upon Avhich we may act hi deal- 
 hig with the disease on Molokai. With a ])etter supply 
 of water now assured, the course of treatment and the 
 line of conduct which is apparently tending towards 
 satisfactory results at Kakaako might be attempted on 
 a larger scale at the leper settlement. 
 
 You will notice by the accompanying reports that I 
 have furnished you with all the information I was per- 
 mitted to obtain in regard to this disease and to its 
 treatment in this and other countries. You will find 
 the opinions of professional men frequently in conliict, 
 but even in this divei'gence of ideas you may find much 
 of value. 
 
 rRACTICAL WORK OR SCIEXTIFlCi IXVESTlGATIO.\ . 
 
 After the somewhat costly experience, with practically 
 iiiade(j[uate results, in thcv])urely scientific investigation 
 of leprosy, I feel inclined, though with some reluctance, 
 to urge the more practical method rather than the 
 merely scientific. No one appi'eciates more highly than 
 myself the interest and beauty of microscopical and 
 technical research, and more especially when combuied 
 with possible [)ractical results of vast importance to the 
 health of the community, but on the other hand stand- 
 ing, with my colleagues, as a trustee of this Xation I 
 feel it my duty to urge that expenditures for purely 
 scientific research shall not be of the unknown and 
 never-ending quantity, but in propoi'tion to the value 
 received by the Government and people and not merely 
 to the individual making them. Leprosy has so far 
 baffled science even among nations who can conduct 
 their special examinations upon a grander scale than we 
 can. yet there are results from these investigations 
 of which "\vc may make practical use with present, 
 
40 
 
 if only temporary, profit and improvement to the suffer- 
 ing patients. It should be our aim therefor to devote 
 our actions and legislation in tiiis nioi-e praelical direc- 
 tion. But we shall never do vei*y much good as long- 
 as certain political elenic^n^s regard this- question of lep- 
 rosy as a political factor in the coiatrol of service to the 
 counti-y. It must be regarded from a humanitarian 
 and benevolent, and not tVom a political stand point. 
 The health and welfare of the people is our paramount 
 duty and I fe-l assured it will be your greatest pride to 
 promote. In ages past, when Lepers were regarded with 
 the greatest sternness and held in the greatest dread 
 and abhorrence, the nobh^st examiples of public and pri- 
 vate benevolence hiive be mi ]3rovi.led for us. In the 
 seventh centuiy, merchants established in Jerusalem the 
 Hospital of St. John where the Johannites attended 
 upon the sick lepers, and a 'Mittle later," as Dr. Live- 
 hig informs us, " the remarkable society of tliL^ Knights 
 of 8t. Lazarus was founded. i:i order that the lepers of 
 higher classes might not be deprived of their knightly 
 honors and fame. These knights, were employed in 
 superintending the leper hospitals and providing for the 
 wants of the inmatco." And still later on under the in- 
 fluence of reli,:>ious ordei's, '' kind and considerate treat- 
 ment forth 3 unfi)i'tunate lepers was strongly inculcated 
 and consolations were frequently given ; by some indeed 
 they wei'e looked upon as miirtyi's, and were treated with 
 far more kindness and compiision than they now meet 
 with in Eastern or even Eur. ptan countries." 
 
 The old histoi'ian Matthew Paris relates the following 
 interestino- story : — 
 
 "David, King of Scotland, the brother of JNIatilda, 
 Queen of the English, came to England to visit his sis- 
 ter (in the year IlOo), and when on a certain evening 
 he caine by inv'itatijn to her chamber, he found the 
 house filled with lepers, and the Queen standing in the 
 midst; having laid aside h^r cloak she with bjth her 
 hands girded herself with a towel, and water being 
 placed m i-eadiuess, she begau to wash tlitir feet aad 
 
41 
 
 wipe them with the towel, and taking their feet in her 
 hands, kissed them with the ntmost devotion. Upon 
 which her brother addressed her thus : ' What is this 
 which you are doing, my Lady? In truth if the King 
 knew this, he would never deign to kiss with his lips 
 your mouth, contaminated by the pollution of the lepers' 
 feet.' And she, smihng, replied, 'Who knows not that 
 the feet of an eternal King are to be preferred to the 
 lips of an earthly one? Behold, it was for this that I 
 uivited you, dearest brother, that you might learn, by 
 my example, to perform similar actions. Do, I be- 
 seech, that which you see me doing.' " 
 
 King Kobert Bruce of Scotland, who was suspected 
 of being a leper, founded near the town of Air a hospi- 
 tal for lepers. Then, too, let us bear in mind that Christ 
 ''moved with compassion, put forth his hand, and 
 touched a leper, and said unto him, ' I will : be thou 
 clean,' " and immediately the leprosy departed from 
 the man and he was cleansed. 
 
 OPPORTUNITIES FOR CHRISTIAN BENEVOLENCE. 
 
 In modern times true Christian benevolence plays an 
 important part in the treatment of the lepers. Out of 
 the sixteen leper asylums in the great empire of British 
 India two are wholly supported by private charity and 
 five partially so. Here, in Hawaii, also, we are not be- 
 hind hand, for in the noble devotion of the Sisters at 
 Kakaako, Father Damien's self-sacrifice at Molokai, 
 the Queen's Hospital and Kapiolani Home we have a 
 good nucleus of charitable work from which piivate 
 benevolence may expand. In tending the sick, cloth- 
 ing the poor, and cheering up the downhearted, in pro- 
 viding for them little luxuries and making them more 
 comfortable and contented, is afield open to all who un- 
 derstand their duties and have warm and courageous 
 hearts. In this field experience shows that ladies in- 
 spired by Christian love are more courageous, or moved 
 by a stronger faith than men, for they do not touch the 
 sufferer with a hesitating finger btit in the spirit of the 
 6 
 
4:^ 
 
 }nost devoted Christian charity, such as animated a 
 Queen Matilda of England, or a Queen Elizabeth of 
 Hungary, lay hands upon the outcasts to help them, and 
 lighten their sad lot in life. The Sisters of Chaiity at 
 Kakaako have completely, with their quiet but firm 
 methods, revolutionized the condition of the lepers 
 and in a few short months turned an abode of despair 
 into almost a comfortable home ; so that in the interest 
 of the sufferers of this nation I pray that their noble 
 example may be supplemented ])y a sympathizing co- 
 operation from private sources. 
 
 Anothei- matter that is within the scope of private 
 benevolence, and a proposal in regard to which I re- 
 cently made to a committee of gentlemen — appointed in 
 Dr. Arning's interest — in the hope and desire that it 
 would be accepted, is a more thorough study of the dis- 
 ease in the great foqi of Molokai, wherein can be found 
 every type and condition of the malady. What can 
 be accomplished by a willing and conscientious 
 man in a comparatively short time is patent to all 
 who will study the reports and tables of Dr. Mouritz, 
 the most complete ever furnished to this Govern- 
 ment. The trouble hitherto experienced by the 
 Goverinnent has j^een in obtaining a true resident phy- 
 sician at the settlement. ^AHiile pi'ofessedl}^ zealous hi 
 the cause of true science and jealous of the claimed 
 reputation of humanity, charity and love for the suffer- 
 ing, attractions of the capital have apparently been 
 greater, among some of these professors, than the op- 
 portunity of enlightening the world and benefitting 
 mankmd. The true scientific student, like the Father 
 Damien of rehgion, mil go Avhere he can learn the 
 most and do the most good, and I feel assured that this 
 honorable body will iiever be averse to assisting private 
 benevolence in encouraging such men. Such men take 
 their chances of loss of friends, and somet'nnes even of 
 loss of health and life, but their fame and the beneficial 
 results they liequeath to humanity are substantial re- 
 wards enough for them. The country wants for it^s 
 
43 
 
 suffering lepers more noble men and women to attend 
 to their needs, nurse and help them. It wants a cordial 
 and charitable co-operation between people and Govern- 
 ment. Their gracious Majesties and other members of 
 the v&ya\ family have furnished bright examples of their 
 love for these poor people and I trust there are many 
 to be found to support them b}^ good deeds. The sym- 
 pathetic human heart, moving a soft and gentle hand, 
 and a kindly eye ever bright and ready to cheer will go 
 farther in the treatment of our decaying people than 
 subtle scientific investigations carried on in a spirit of 
 self-heartedness. The Hawaiian race is mentally de- 
 ])ressed as well as physically ill and it is encouragement 
 to the mind and heart that is required. It must be 
 aided in the spirit of the Divine love which actuates the 
 Sisters of Charity and their associates in charity all over 
 the world, and not in the stern scientific methods of 
 Faculties, whether of London, Paris, Berlin, ^NTew 
 York or elsewhere. Hope and confidence must be in- 
 spired into the drooping hearts of our suffering people, 
 and they must be nursed with \o\e and kindly advice, 
 as well as administered to scientifically or experiment- 
 ally. 
 
 THE .JAPANESE HOSPITAL TREATMENT. 
 
 In my general Health Report to the Legislature, I 
 have called attention to the recent improvements made 
 at the Branch Hospital, at Kakaako, in connection 
 with the system of treatment adopted by Dr. M. Goto, 
 but I deem it necessary, also, to refer to the subject 
 here, as being one of more than ordinar}^ interest. 
 
 Dr. M. Goto, after some experience with his father, 
 Dr. Shobun Goto, of the Kihai Hospital, Tokio, Japan, 
 in the treatment of leprosy, was invited to come to this 
 country to give a fair trial to the Japanese hospital 
 method of cure. This method had particularly at- 
 tracted the notice of His Majesty the King during his 
 visit to the Japanese Empire, and, through His Majes- 
 ty's love for his suffering subjects, resulted in the invi- 
 tation to Dr. M. Goto to paiy his Kingdom a visit. 
 
44 
 
 This treatment had ah-eady been satisfactorily tested 
 by a gentleman, declared by medical men to be 
 afflicted mth leprosy, but who after a twelve month's 
 stay at the Kihai Hospital as a patient, returned to this 
 country in perfect health. The method may, in biief , 
 be stated to be medicated Avarm baths accompanied 
 with regular therapeutic and dietetic treatment, the de- 
 tails of which will be found to some extent in Dr. 
 Goto's own report. 
 
 That the Doctor has, so far, met Avith marked suc- 
 cess with the patients at Kakaako placed in his care is 
 indisputable. I am enabled to state, from my OAvn ob- 
 servation, that men and Avomen, Avho were placed in his 
 hands, AAath dead looking and badly marked skins, 
 numbed and incapable of performing a healthy perspira- 
 tory function, have been restored to normal healthmess 
 and action, accompanied Avith a ncAV groAA^th of hair 
 upon parts formerly affected, Avith the texture of the 
 skin made soft and smooth, eyes bright and clear, a 
 lively sensibility promoted in the former numb parts 
 and general health correspondingly improved. Foul 
 ulcers have been cleansed and closed and helpless 
 ati^ophied members again made actiA^e. After former 
 experience in this direction of curative or palKative 
 measures, I do not desire to speak too sanguinely, but 
 it is, undoubtedly, the unanimous opinion of all those 
 most interested — the patients themselves — that Dr. 
 Goto's treatment has been attended AA^th an apparent 
 marked success ncA^er before obserA^ed on these Islands. 
 There is evidently nothing occult or mysterious about 
 the treatment, which is simply a combination of clean- 
 liness, comfort, good nourishing food, and medical 
 treatment with drugs, tonics and barks Avell knoAvn, but 
 perhaps not sufficiently iuA^estigated and tested as to 
 their merits, by the average medical practitioners. Per- 
 haps in the stimulative bark of the (Escidus Turlinata^ 
 knoAvn to the Japanese as Hichyo and Tochi, there may 
 be greater virtues than in any medicine hitherto used. 
 It is no longer a professional secret, as a leading medical 
 
45 
 
 journal tells us, that, many of the most valuable formu- 
 las of the modern Materia Medica are derived from ' ' old 
 women's remedies," and others from, onee-ealled, em- 
 pirical nostrums. But, in no case should the successful 
 result be attributed to medicine alone, for whatevei* 
 may oe the virtues of the remedies used, it is to the 
 kindly and attentive physician, and the patient, watch- 
 ful nurse that the true credit of healing mainly belongs. 
 
 The medicinal \drtues of Dr. Goto's treatment are 
 aided b}' his faithful and assiduous attention to the re- 
 quirements of his patients. He is fortunate, too, in 
 having to assist him the Sisters of the Hospital who 
 carry out the physician's instructions with unremittmg 
 care and a kind attention. It is only a reasonable pre- 
 sumption that, under such circumstances, a system of 
 treatment so patiently and thoroughly adhered to must 
 result beneficially to the sick. 
 
 Is it not worth while even if we do not, for the 
 present, dare to hope for an absolute cure — to strive to 
 do as much as we can for our suffering countrymen ; 
 to restore the apparent bloom of health to the cheek ; 
 to brighten the eyes ; to release the contracted muscles ; 
 to give back life and sensibility to the numbed flesh and 
 limbs and enable the patient to feel more cheerful and 
 hopeful? I am sure this Honorable Body will agree 
 with me that it is, and, furthermore, that, in spite of 
 the opposition of those who disagree with this special 
 treatment, the success of Dr. Goto, so far, has raised 
 m us the highest hope of greater beneficial results for 
 our suffering people. But the result is only made pos- 
 sible by having faithful nurses to carry out the method 
 of treatment. 
 
 THE QUESTION OF SEaREGATION. 
 
 This is a measure fraught with the deepest interest 
 to a very large portion of the Hawaiian people. It is a 
 question involving loss of liberty and separation from 
 home and friends, to hundreds, nay, thousands, who have 
 committed no offense against the laws of the country. 
 
 / 
 
46 
 
 While recognizing the contagiousness of this dread 
 malady under certain favorable conditions, and the 
 fact that its first indications are hardly recognizable 
 to the most observant eye, there can, I think, be no 
 question that it is not contagious under casual circum- 
 stances. 'No contagion can arise from passing a leper 
 on the street, sitting in the same room with hhn 
 occasionally, or shaking hands, except, perhaps, that a 
 In-oken skin might afford an opportunity^ for doubtful 
 inoculation: — doubtful, as it has not yet been satisfac- 
 torily decided that the disease is inpculable. I feel in- 
 clmed to believe that greater danger ma}^ arise 
 from inhalation than fi'om inoculation, and in this 
 view I think I am sustained by some of the leading- 
 medical minds. But it is always wise to separate 
 the diseased from the healthy and, especially, to 
 break up that too close intimacy, — whether of family 
 or otherwise, — which unfortunately, througTi want 
 of knowledge on the part of Hawaiians, too often 
 exists between the sick and the healthy. Hawaii- 
 ans certainly are beginning to appreciate more and 
 more the fact that it is wise that well developed 
 cases of leprosy should not live with the clean and 
 healthy, but they also feel, as I do, that the practice of 
 herding all the sick in one place of exile is a hardship 
 with doubtful results. If segregation can be car- 
 ried out in ways, equally beneficial, but, more in har- 
 mony with the wishes of the people it should be done. 
 While it is well for the community that a sufferer from 
 any form of contagious disease should leave his home, 
 it is hardly necessary to compel him to leave his native 
 island. There would seem to be no valid reason why 
 an experiment of local segregation should not be made 
 in this regard on Kauai, as has been proposed, where a 
 retreat has been selected and where families having a 
 diseased member might there place their suffering i-elative 
 and attend to his wants, and be nearer -to him than if 
 doomed to Molokai. The Government would be willing 
 to provide any reasonable measures of relief as well as 
 
47 
 
 to furnish medicines. Wiiere a comminiity is found 
 willing to voluntarily segregate its own sick and care 
 for them, why should a government be called upon to 
 expend large sums for a plan of segregation which can 
 never be thoi'oughly carried out, bearing in mind the 
 occult and mysterious nature of the disease in its long 
 term of incubation and development? 
 
 And now in conclusion I beg to say that while I have 
 endeavored to place clearly before you the very valua- 
 ble information I have received, on behalf of His Majes- 
 ty's Government, from foreign authorities on the sub- 
 ject of leprosy, I have endeavored to reciprocate on be- 
 half of His Majesty the courtesies of other nations, 
 to whom the Kingdom must, I am sure, feel grate- 
 ful, by showing them the work that has been done 
 in the past, and is now being done here. I am very 
 well satisfied that where public spirit and benevolence has 
 accomplished so much in our country, we shall not 
 stand still but march on with redoubled effort, and with 
 a hope and a trust that it may be Haw^aii's glory to 
 achieve such a control of this- dread malady, the curse 
 of all ages, that her name shall be honored among the 
 nations, as a conqueror under the leadership of Love 
 for all, Charity for the sick, and Hospitality to the 
 stranger, the three great Marshals of the Grand Army 
 of Peace. 
 
 GOD SAVE THE Ki:>f G ! 
 
 WALTEE M. GIBSON, 
 
 President of the Board of Health. 
 

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