A FEW 
CASES of LEPROSY, 
BY 
J. H. BEMISS, M. D„ 
LAHAINA, MAUI, H. I. 
| Reprinted from the April Number of the New Orleans Medical and Surgical Journal.] 
NEW ORLEANS: 
L. Graham. Steam Book Printer, 127 Gkavikk Street. 
1 8 8 0. A FEW 
CASES OF LEPROSY. 
BY 
J. H. BEMISS, M.D., 
Lahaina, Maui, 2Z. J. 
u Leprosy in the Hawaiian Islands ” has been the title of 
several papers published from time to time in the United 
States. That of my friend and associate in practice, Dr. F. H. 
Enders, deals with the most interesting questions, and will be 
of value to those who may be able to read it in the Trans- 
actions of the International Medical Congress of 1876. My 
purpose is to present a few cases whose histories were either 
taken by myself, or obtained from Dr. Enders, or elsewhere, 
calling attention to some points which may serve to add inter- 
est to this paper. 
Statistics as to the time and manner of introduction of lep- 
rosy into these Islands, are wanting. The period between 
1825 and 1830 is supposed to approximate to the correct time 
of importation, though the evidence to that effect is very 
indefinite. Rev. W. P. Alexander who came here in 1833, 
says, the first case he met with personally was that of a native 
Hawaiian in about 1838, living in a very isolated locality on 
this island (Maui), but he had heard several years before that 
a chiefess in Lahaina—also on Maui—was affected with the 2 
disease. The first case on the islands was said to have been 
that of a cliinaman on Oahu, the island upon which Honolulu 
is situated. 
Of course the manner of introduction is just as uncertain as 
the time. The means for importing it, however, have been 
unlimited. During the height of the whale hunting business, 
that is, during the first half of the present century, these 
islands were the great resort for the whaling fleets of the 
Pacific, as many as a hundred sail often being in the harbors 
of Honolulu, Oahu; or Lahaina, Maui; at one time. These ves- 
sels in addition to bringing sailors from all parts of the world, 
frequently shipped native crews, who in their cruises were 
brought into contact with all nations along the Pacific, and 
afterwards returned here to spread such diseases as they might 
have contracted. But before whalers ever touched at these 
islands, the uatives are said to have occasionally gone from 
island to island in the Pacific exchanging their diseases, as 
well as their commodities, which latter, however, were proba- 
bly very limited. It may be then that the disease was present 
here in a dormant state long before it became generally known 
—at least to foreigners. The old disease, “ mai alii—chief’s dis- 
ease ”—is generally supposed to have been Elephantiasis Ara- 
bum, or else the result of the high liviug, in w'hicli the chiefs 
indulged. Some, however, have thought it not too much to 
suppose some of the cases to have been leprosy. 
The natives call leprosy “mai pake,” “Chinese disease,” the 
tradition among them being that the “ heathen Chinee” brought 
it with them. But the first lot of Chinamen did not come here 
until quite a number of years after leprosy became kuowu, and 
this charge seems the more unwarrantable when we consider 
that of the whole population at the leper asylum there are 
not over six Chinamen. 
After its introduction it seems to have spread quite slowly 
until the latter part of the ten years, 1850-1860. It then 
became so plentiful that the government took alarm and began 
to institute measures looking toward the prevention of its 
spread; one of its acts being the establishment of the Leper 
Asylum on Molokai, and the forcible transfer of prououuced 3 
cases to that place. The census of 1878 (December 21st), 
showed the number of lepers at the Asylum Kalawao, at that 
date to have been 806; since then quite a number have been 
added, though there are still many at large. There have been 
admitted to Kalawao certainly not less than 2000 persons from 
1866 to date; of which number upwards of 750 are still alive. 
The total native population, excluding all foreigners and those 
born of foreign parents, is 44,088 (census of 1878), quite a 
small number to furnish so much leprosy. The large majority 
of these are full blood natives or half breeds, there being 
two whites,—one American, the other English, and less 
than a halt dozen Chinamen. 
There are present here, the two forms, tubercular and 
anaesthetic. This division is based upon the predominance of 
one or the other of the two most important symptoms. In 
actual observation the disease does not always admit of such 
strict classification, but generally shows the two forms combined 
iu greater or less pathologic preponderance. It may start as 
purely tubercular or purely anaesthetic, but does not often 
preserve a single type throughout its course; iu the one case 
anaesthesia, in the other tubercles making their appearance in 
due time. As to a third variety, macular, my observation does 
not warrant my stating any such class. True, maculae of one 
sore or another are common enough, but these cases already 
present one or the other of the two forms generally recognized. 
I have seen but one case in which I was not easily able to 
observe tubercles or anaesthesia well marked. 
This man had several large, light and slightly raised 
maculae upon his body, as the only main symptom of the disease, 
but these were anaesthetic, and there was a slight enlargement 
of the alae nasi due to infiltration, one of the phenomena of 
incipient tubercular leprosy.* 
The tubercular variety is characterized by infiltration and 
*After Having prepared this for the mail, I was upon Molokai on professional business, 
and there saw a case more purely macular than the above. The child a girl ten years 
old, presented upon her face especially, but also elsewhere upon her body, large black 
maculae, slightly raised above the surface and producing a very disastrous effect upon her 
appearance. She was so young, that it. may he she did not understand my questions; at »11 
events, neither by questions nor close examination could I obtain any evidence of 
anaesthesia. Scattered from her left eye brow to her hand were not less than six small 
tubercles, on her right hand there were about half as many. 4 
subsequent hypertrophy of the skin, especially where there is 
much loose tissue, such as the lobes of the ears, alae nasi and 
face generally. Later on there is deposited in the skin of the 
face, hands, arms, &c., cheesy masses of the size of a pea or a 
little larger. These tubercles are prone to break down and 
leave deep indolent sores, which heal, however, after a time, 
but with strongly marked cicatrices. Mucous membranes, just 
as the external skin, are liable to the above morbid changes. 
They may become infiltrated and hypertrophied, or tubercles 
may appear in their substance and undergo ulceration. When 
such changes occur in the larynx an alteration of the voice is 
the result. In breaking down, they produce a most offensive 
fetor of the breath. The same changes occurring in the 
mucous membrane of the intestines are in a certain proportion 
of cases the cause of the diarrhcea which is so common, and so 
often fatal. But in many instances diarrhcea is only one of the 
many intercurrent affections due to a vitiated state of the 
system. In cases primarily anaesthetic, I have on several 
occasions first observed tubercles upon the mucous membrane 
of the posterior part of the tongue aud pharynx, as the only 
localities where they may be seen at that stage. 
The anaesthetic form is marked by all those phenomena 
which are the result of degenerative chauges in the nerves. 
These are anaesthesia, paralysis, contractions and distortion, 
especially extreme flexion or extension of the fingers and 
toes, also ectropiou, loss of smell and taste, wasting of muscles, 
vesicles, sloughing of fingers and toes, &c. The ulnar aud 
facial nerves are especially frequently affected, but all are 
liable. 
It is with difficulty that any history of a prodromic stage can 
be obtained from a native. They are by no means observant 
of such matters, but occasionally one may be found who will 
complain of a general indisposition extending over a period of 
several months or even longer. 
When anaesthesia plays an important part from the first, the 
patients very frequently speak of formications, over the entire 
body sometimes, but especially over the nerves which after- 
wards become anaesthetic. 5 
The following case was among the first that came to the 
office after my arrival. It is quite a typical case aud as will be 
noticed combines the two forms : 
Case I. Labels, female, aged 30, pure-blooded native; 
residence, Waihee, Maui. Lahela admits no history of any 
syphilitic cachexia. Can say nothing as to the health of her 
parents or what caused their deaths. She has a child 0 years 
old now affected with leprosy. (It was examined by us.) The 
child was quite sickly when a baby, but seems to be healthy, 
generally, now. L. first noticed the disease in herself two years 
ago, when she suffered much from chills and fever and general 
ill health ; “ she enjoys better health now.” 
Skin of face and lobes of her ears infiltrated and more 
or less hypertrophied: that of hands, arms and feet tubercu- 
lated and shows scars in abundance. Skin of left forearm and 
left hand anaesthetic, also little and ring fingers of the right 
hand, and ulnar side of right hand and forearm. The fingers 
of left hand are considerably distorted, the two terminal pha- 
langes fixe i, which first are slightly extended. Those of the 
right hand are also affected slightly in same way. Voice 
coarse, tubercles on posterior part of tongue and pharynx. 
Smell affected. She was vaccinated when young by a foreigner. 
She was put upon one-tenth of a grain (gr. 1-10) of nitrate 
of silver three times daily, salt being interdicted. An addi- 
tional note taken one month after first appearance r eads: 
Amestliesia apparently less, but pruritus of skin where eruption 
existed much greater than before—eruption desquamating; 
says she is u oluolu loa ” much better; appetite improved and 
says she longs for salt food, which I am inclined to think she 
uses freely though positively prohibited. 
Salt was positively prohibited, because in addition to the 
danger of neutralizing the effects of the nitrate of silver, it is 
thought to have a deleterious effect in itself upon the disease. 
The food of the native consists principally of “ poi ” (a thick 
paste made from the baked or powdered root of the tarum 
esculentum) and fish, either salt or fresh, and much salt meat. 
Some foreigners, not physicians I am careful to add, have a 6 
prejudice against Ash and much salt food, on the ground that 
leprosy is caused by such articles. 
We were Armly convinced that great improvement had re- 
sulted from the treatment adopted in L.’s case. Unfortuna ely 
we lost sight of her, she being afraid we would inform the au- 
thorities and have her arrested and removed to Molokai. I 
heard afterwards she had been removed. 
Case II. Poupouka, female, aged 14, full-blooded native, 
residence, Waihee, Maui, came to the office August 27tli, 1878. 
She gives no history of any syphilitic taint. Her mother has 
been affected as P. for the last three years. The man who 
brought P. is the father by P.’s mother of a now healthy boy 
two years old ; the man himself gives no indication of the 
disease. 
P. is rather deficient in intellect and can give no history of 
her case. Examination shows the skin of hands, arms, legs 
and feet tuberculated and infiltrated. Skin of face hyper- 
trophied and shows two immense irregular black macula) on 
each cheek ; right hand and entire right forearm anaesthetic ; 
little and index Angers and thumb of left hand anaesthetic: 
also back ulnar side of left forearm. She had been vaccinated 
six years ago. 
The treatment instituted was similar to that in L.’s case, 
with the addition that she was to wash the diseased surfaces 
daily with carbolic tar soap and anoint the same with solution 
of iodide of sulphur in glycerine. 
The points of note in this ease are, 1st. The combination of 
the two forms; 2d. the partial or irregular affection of the 
nerves; 3d. P.’s mother, though a leper, was not sterile, leprosy 
according to some, causing sterility ; this, however, is further 
contradicted by the fact that children have been born to lep- 
rous parents at the asylum itself; 4th. the maculae are also of 
interest, but they occur associated with the disease otherwise 
well uiarked. 
We were unable to take any notes upon the result of the 
treatment, for both Poupouka and Lahela were removed to 7 
Molokai, about the middle of September. I might also add 
that P. and L. lived in the same house at Waihee. 
Case III. Keahi, male*, aged 40; residence, Wailuku, 
Maui. He gives a history of buboes on two occasions, or as he 
expressed it “ syphilis twice.” Can’t speak as to venereal or 
other diseases in his parents. Brother died with u sores on his 
body and lumps in his skin similar to patient’s.” Says he has 
been unwell about four years, but he first noticed these tubercles 
about half a year ago. His general appearance is that of a 
strong, healthy man. The skiu of bis face and lobes of his 
ears greatly infiltrated and hypertrophied. That of hands, 
forearms and legs hypertrophied, and excessively tuberculated, 
the same are covered with numerous scars—the seats of former 
tubercles that have ulcerated. Mucous membrane of mouth 
and pharynx thickened and tuberculated; voice coarse. Was 
vaccinated six years ago by a physician. 
We note here the absence of anaesthesia; he gave no indica- 
tion or evidence whatsoever of it. He remembers having had 
chancroids, but as is often the case everywhere, can’t recall 
anything like chancre. 
Case IV. Kalepua, male, age 30, full-blooded native, came 
to the office with the left side of face swollen, painful and pre- 
senting all the characteristics of phlegmonous erysipelas, for 
which he was treated. It proved very obstinate, gradually 
becoming chronic with diminution of pain but not of the 
swollen condition. It finally improved somewhat under iodide 
of mercury internally and external applications of opium and 
acetate ot lead; but he had been taking at different times 
tincture of the chloride of iron, iodide of potassium, etc., for 
upwards of a month. So unusual was -the case that leprosy 
was not suspected. Prolonged observation however led to a 
belief that it existed, and subsequent phenomena one by one 
confirmed the diagnosis. 
When a child he had an eruption upon his body which was 
probably secondary syphilis; since grown has had buboes; his 
mother died in child-birth ; father still living but complains of 
“ heaviness and weight ” in his legs and feet. 8 
The skin of the left side of the face and forehead was anaesthe- 
tic and expressionless, still thickened, evidently hypertrophied, 
there being no pain, heat, or redness. Muscles of left side of 
face paralysed, causing drawing of corners of mouth and face 
generally to right side, exactly as in hemiplegia. Paralysis 
of left orbicularis muscle causing dropping of lower eyelid 
(ectropion) and inability to move but slightly the upper lid. 
Tubercles upon pharynx and posterior part of tongue. Slight 
anaesthesia of two fingers (little and ring) of right hand. Was 
vaccinated 9 years ago by a foreigner, not a physician 
After leprosy was suspected he was put upon nitrate of silver, 
resulting in marked improvement in all his symptoms, especially 
the anaesthesia, that of his hand disappearing entirely. 
This case was unique in its commencement, looking so like 
erysipelas and resisting every variety of treatment for over a 
month, then gradually settling into a chronic form, finally 
leprosy suspected, The diagnosis was gradually confirmed and 
improvement occurred under nitrate of silver. 
The preceding four cases are from those collected by Dr. 
Enders and myself and probably illustrated the most perma- 
nent symptoms. They are, however, the histories of patients 
rather in the incipient stages, and the photographs which we 
had taken of the two first, would probably not show sufficient 
of the disease to warrant their publication. 
Those which follow are the histories of lepers already at the 
asylum, and whose photographs were taken under the direc- 
tion of the Legislative Sanitary Committee appointed by the 
last legislature to go to Kalawao and examine into the needs of 
the lepers. 
The statements accompanying the photographs were not 
taken by us, but at Dr. Erider’s request by Father Damien* 
resident catholic priest at K ilawao. Though uot possessed of 
medical authority they will aid materially in explaining the 
photographs. 
The following letter from the father is especially interesting: 
Kalawao, Sept. 2, 1879. 
Dr. F. H. Enders : 
Dear Sir.—Your honorable note of the 25th July has been 
lately received. I have taken the statements desired concern. Case V. (Photograph 1.) 9 
ing the lepers who were photographed in 1878. Two of them 
are gone, eight still live; each one’s history shown iu the 
blanks the best I could. A very few children are born here of 
leprous parents and most of those have died; there are a few 
now from four to six years old,and nearly the half of them already 
have signs of leprosy. May last, I received from Hong Kong, 
China, a new medicine for the amelioration of leprosy—“ Hoang 
NanThose who take it and can abstain themselves from fish 
and pork feel a general amelioration. It is a beautiful tonic 
and shouldbe introduced in this archipelago to keep down the 
spread of this disease. 
My own health continues to be the same as before; perhaps 
I have the germs of leprosy in my system, I am not sure. 
Very respectfully yours, 
J. DAMIEN, 
Catholic Priest. 
Case V. (Photograph 1.) Opu, female, age 38 years, native 
of Kauai. Parents dead, not certain of what disease. Opu, 
before she was married was paralyzed. In 1870 disease made its 
first appearance, was afterwards put in hospital in Honolulu, and 
from there sent to Kalawao. Her appetite is good but she is 
unable to move around much. Her face, hands and feet, covered 
with scars. Skin covered with dark dry cracking spots. Was 
vaccinated by a physician on Kauai, result a good scar; two 
years afterwards taken with a paralytic stroke in the legs. 
Since she was photographed the disease has made fearful 
progress. 
The report of the Legislative Committee says : 
Opu, woman, 49 years of age, and three years at the settle- 
ments, did not show much indication of leprosy on first arrival, 
but the symptoms of the disease developed very rapidly after 
her arrival at Kalawao. Neither of her parents nor any of her 
relatives had contracted the disease. 
The photograph illustrates very finely the hypertrophied and 
infiltrated conditio* of the skin of face and lobes of ears. It 
is well to note also the absence of disease in her family, and 10 
the fact that she became affected at least with a nervous 
disorder of an uncertain character, subsequent to having been 
vaccinated. 
Case VI. (Photograph 2.) Pilaui, female, age 41, na- 
ture of Kauai. Father still ali\re, mother died in child-bed . 
both Arery healthy. Married in 1851; had three children. She 
says she caught the leprosy from another native in 1872 by living 
in same house. In 1874 had first appearance of leprosy with red 
spots upon the body. In the same year was sent to Molokai 
Does not remember ha\ring had syphilis. Legs affected as 
hands and face, Skin of body dry and cracking. Eats well 
and is able to be about. Was \raccinated by two foreigners, one 
a physician, both times with good result. 
Extract from legislative report. 
Pilani, a Avomau,33 years of age, and three and-a half .a ears 
at the settlement, says that her person showed very slight 
indications of leprosy Avheu she came here, but since her stay, 
the disease has deAreloped rapidly. She has a child, a boy, five 
years of age, hoav living at Waimea, Kauai, not a leper and in 
the enjoyment of good health. 
The photograph shows the tubercles scattered in the hyper- 
trophied skin of the face. The ugly looking ulcers on her 
hands are well shoAvn. 
Case VII. (Photograph 3.) Kahuna, male, 45 years old, 
of Honolulu, four years at Molokai; being deaf, can not find 
out his history ; he had syphilis when young; is deaf, has sore 
eyes, and asthma. 
The committee report says : 
Kahuna, 40 years of age, two and-a-half years at Kalawao 
His body indicating peculiar leprous blotches and marks, and 
notable swellings in the groins Avas photographed as Ko. 3, but 
owing to a defect in the focus the blotches do not appear. 
Case VIII. (Photograph 4.) Kaluhi, age 15, male, of 
South Kona, Hawaii. 
His mother is au old leper; never saw his father. Was Case VI. (Photograph 2.) Case VII. (Photograph 3 ) Case VIII. (Photograph 4.) Case IX. (Photograph 5.) Case IX. (Photograph 6.) Case X. (Photograph 7.) 11 
brought up by a guardian. Leprosy appeared in him ac the 
age of 5 or 6 years—he is now four years at the settlements. 
Is strong and has good appetite. General appearance same as 
in photograph. Respiration as an asthmatic. Vaccinated 
twice when very young. Apparently a case of inherited 
leprosy, and in this connection, I copy from the legislative 
report the following: 
It is stated by Dr. Hoffman, who for some time had charge 
of the leper patients in Honolulu, that in no instance had 
he seen any symptoms of leprosy manifested earlier than 
five years of age. Thus it may be that leprosy, like syphilis 
requires a certain degree of growth before it begins to make 
manifest its ravages upon the system. It makes it thus a sad 
reflection, that perhaps the twenty-eight healthy looking 
children of the leper settlement at Kalawao are, after all, only 
doomed lepers. 
Case IX. (Photograph 5 and 6.) Kalamau, female, 60 
years old. Mother died of leprosy—father died of nervous 
shakes. Kalamau enjoyed good health after marriage. She 
had two children. She was infected with svphilis in 1845, by 
her husband. She used native medicine which dried up the 
sores. In 1852 leprosy broke out in red spots all over her body. 
In 1856 commenced to lose fingers and toes. Still able to get 
about. Now both feet half gone, hands have no fingers, almost 
blind, mouth on one side, eyes always open, flesh wasted away, 
skin dry. Was vaccinated after contracting leprosy. 
The report says: 
Kalamau, a woman, 50 years of age, from Honolulu, and at 
Kalawao five years; a poor, helpless creature, whose palsied 
and fingerless hands had to be held to enable the photographer 
to take an impression—No. 6. The feet of this case without 
toes—all destroyed by the erosions of leprosy. 
Case X. (Photograph 7.) No history by Father Damien, 
Nuluaai being dead. Committee report says : Nuluaai, male, 
56 years old; at Kalawao five years. 12 
Case XI. (Photographs 8 and 9.) David Ostrom, a white 
man, age 60 years. Father and mother Americans, both 
healthy. He contracted this disease on the Island of Maui; 
had had syphilis in 1850 in Xew York. In 1871, first felt 
tenderness in bottom of feet. In 1872 first noticed yellow spots 
on breast; made their appearance after the use of cold water. 
Body covered with salmon-covered spots; hands and feet 
insensible to feeling; skin dry and shrivelled. Good appetite 
and able to be about. Vaccinated without effect in the States. 
Cominittee report says: 
Tom Ostrom, a native of the State of New York, American, 
55 years of age, 3 years and six months at the settle- 
ment. No symptoms of the disease until about six months 
before coming here. Went himself to be examined by 
Hr. Enders and, when satisfied he had the disease, volun- 
tarily came to the settlement. He feels satisfied his case 
is incurable. Would be willing to surrender his body to 
be vivisected, if necessary for the benefit of medical science. 
Wants to die. His feelings are terrible. Voluntarily offered 
his person to be photographed. His case is a marked illustra- 
tion of leprosy. Large swellings in groins, which often 
suppurate. According to outside information, he was an 
assistant for some years in the hospital at Lahaina. He took 
some leper patieuts to live with him, in order to treat them for 
cure, and the disease appeared after this association. Photo- 
graph 8 represents a front view of Ostrom; photograph 9, a 
back view. 
Case XII. (Photograph 10.) Xo history by Father 
Damien, Kaapu being dead.) 
Committee report says: 
Kaapu, a man from Waimaualo, the witness who testified 
to the digging of the graves. That testimony is—Kaapu, 32 
years of age, and nine years at the settlement, says that he 
has been obliged to dig graves ever since he has come here. 
His hands are in a very bad condition. Has lost several 
joints of his fingers, and all are in an excoriated and suppura- Case XT. (Photograph 8.) Case XI. (Photograph 9.) Case XII. (Photograph 10.) Case XIII. (Photograph 11.) Case XIV. (Photograph 12.) 13 
ting condition. He is one of seven children and neither of his 
parents, nor any of his brothers or sisters have contracted the 
disease. 
Case XIII. (Photograph 11.) Eph. Kanoe, male, aged 
30, native of Hawaii. His father is now seventy years old, and 
strong ; his mother, 46 years of age; she is supposed to have 
had syphilis; she had nine children, Eph. being the oldest. 
When young he had sores upon his body. At 16 or 18 he had 
syphilis (buboes are meant probably). In 1871 he had for 
several months discharge of bloody excrement—(dysentery), 
and bad a red spot on his right arm which was ansesthetic. 
In 1873 all the arm was red. In 1874 this was cold and hot by 
turns. Soon covered with bad sores. Iu 1876 redness 
apx>eared on his face ; at the end of same year all his body was 
• black colored, and in 1877 he was sent to Kalawao. His present 
condition is the same as when photographed, a little weaker, 
but he continues to move about. Whole skin leper-colored, 
but clean. Vaccinated in 1853 by a physician. 
“ Kanoe Eparaima, a man, 30 years of age, and about two 
years at Kalawao. A case to illustrate the loss of the eyebrows 
as one of the effects of leprosy. v 
Committee report contains following : 
Case XIV. (Photograph 12). Win. Crouningberg, aged 
46, male, nativity Lahaina; mother Hawaiian, father Ameri- 
can, both were healthy. C. healthy from youth up. In 1869 
had an anaesthetic spot on right foot. In 1873 one appeared 
upon face. Went to Honolulu for examination. In 1874 sent to 
Kalawao. He is covered with salmon-colored spots. Hands 
affected, fingers off one hand. Skin dry, shrivelled, crack- 
ing. Vaccinated a very long time before leprosy appeared. 
During 4 months used Hoang Xan pills with wonderful effect 
for amelioration. Looks somewhat different from his appearance 
when his photograph was taken; now covered with scales, 
longest finger of right hand gone, both hands sore. 
The above cases I hope will prove of interest to such of the pro- 
fession as are giving some attention to this rapidly increasing 14 
disease. They are necessarily more meagre than I could wish 
to have them, but even those whose histories were taken by a 
non-professional gentleman, illustrate many of the most interest- 
ing symptoms of leprosy, and every little helps to swell 
the total amount of knowledge possessed of a disease. 
It will be noted that syphilis or any syphilitic cachexiae 
were in every case diligently sought for, for there are some on 
these islands, as well as in India and elsewhere, who hold to 
an intimate connection between syphilis and leprosy. If there 
is any such relation as they claim, then is it unnecessary to 
speculate as to the manner of introduction of leprosy into this 
kingdom, for though my experience in foreign lands is confined 
to these Islands, I am not prepared to read of a country where 
syphilis is so prevalent, so grounded into the whole native 
population as here. The problem, then, would be, how long the 
disease—syphilis—left to itself, would require to become elab- 
orated into leprosy. But I am not willing yet to adopt such 
an hypothesis, for then should leprosy be more general in the 
families of those affected, as well as more common in other 
countries, where there is a certain proportion of families 
thoroughly imbued with syphilis, and from which they have 
not been exempt for several generations. Again, anti-syphilitic 
treatment should give some good results, which is not the case, 
save when syphilis is added to the disease. Moreover, the 
symptoms of the two diseases do not coincide in a way to 
warrant such an opinion. 
Vacciuatiou was also inquired into. Alarmed by an invasion 
of small-pox in 1853, a general vaccination of the whole popu- 
lation was ordered, and physicians being at that time very few 
on the islands, non-professionals aided in the work. It is 
charged by some that, as a natural result of the labors of the 
heterogeneous force so appointed, not only syphilis but also 
leprosy was greatly increased. In my last circuit trip in my 
district, I found very few adults who had never been vac- 
cinated. 
This involves the question of inoculability, in my opinion 
the main, if not the only means of propagation, other than in- 
heritance. That is, like syphilis it depends for its propagation 15 
upon the direct introduction of its virus into the blood. The 
general immunity of those coming in constant contact with 
lepers points to the abseuce of any direct contagious quality. 
These statements are illustrated in the cases given above, and 
it is not necessary to lengthen this paper by explaining them. 
I will only quote the followiug from the committee report, as 
one of many instances of similar nature coming under my 
knowledge: 
“ The committee observed in a hut a leprous woman, named 
Makahiki, who presented all the appearauces of a badly dis- 
eased incurable case, and yet had her fine, healthy child, living 
with her, a bright looking little boy, about 2 years of age. Her 
husband, Kioni Kahiapo, a healthy, intelligent looking man, 
with no appearance of any taint of leprosy about his person.” 
“ Had been with her in settlement about five years, and would 
remain with her as long as she had breath.” 
The duration of life is on an average within a decade of the 
undoubted establishment of the disease. With more strict 
hygienic measures than seem possible at Kalawao, this might 
be increased materially. The disease in itself would probably 
be long in producing death, but it causes a vitiated condition 
of the system favorable to pulmonary, hepatic and intestinal 
troubles which prove rapidly fatal. 
Treatmeut has been directed to only two points : 1, preven- 
tion of spread, and 2, palliative treatment, including the relief 
of iutercurrent troubles. In fulfillment of the first indication, 
the government has set apart a very favored quarter on 
Molokai. It is open to the trade winds on one side, and on the 
others is shut off from the rest of the island by almost impreg- 
nable mountains. To this place the lepers are carried and sup- 
ported by legislative appropriations 5 and here also is a hospi- 
tal where the helpless are provided for. Under the second in- 
dication, such as was possible has been done at the settlement 
itself. 
As directed against the disease itself, I hope nitrate of silver 
will be more thoroughly tried. It certainly gave some good 
results in several cases under Dr. Enders’ supervision, so far 
as the affection of the nerves was concerned—a result intelligi- 16 
ble in the light of its alterative affects upon the nerves. Un- 
fortunately it is impossible to keep a patient under observation 
sufficiently long to carry out a line of treatment thoroughly. 
Cliarelmoogra oil has been used in India with good results, so 
it is claimed. We lately received from a prominent druggist 
in New York a sample, but have not yet been able to report 
any cases under its use. 
Lahaina, Maui, Hawaian Islands, 
December 15, 1879.