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leper settlement. The biennial report of the president of the board of health for 1890 states that "the work of collecting and segregating lepers had been carried on with firmness and impartiality, and that the number of lepers collected and sent to Molokai for the biennial period closing March 31, 1890, was 798. Of these 2 were of British and 2 were of American birth." The report shows that $331,057.80 was expended by the board of health during the biennial period, and it is asserted "that the maintenance of the leper establishment is the almost bottomless pit into which more than three-fourths of the money appropriated is cast."
It is hopefully claimed, however, "that its requirements are on the wane, and judging from the most reliable information obtainable there are but very few undoubted cases of leprosy now at large in the country, and they will come under the care of the board as rapidly as it is possible to get control of them." In proof of this it is stated that on the 31st of March, 1888, it was estimated that there were then at large throughout the Kingdom 644 lepers, while at the date of the report under consideration, March 31,1890, "according to the best information obtainable, there are ٭ ٭ ٭ about 100 persons supposed to be affected by the disease still at large who have not been before the examining board." The reasons why these suspected lepers have not been examined are stated to be that some very bad and unmistakable cases are hiding in fastnesses of the mountains, while some mild cases change their residence so often as to baffle the efforts of the officers of the law for their arrest.
In regard to the contagious character of the disease and the precautions necessary to be taken it is claimed by Surg. Tyron, 17. S. Navy,* that the spread of the disease in the Hawaiian Islands is due, or was due at that time, 1883, to the general belief that "the disease is only slightly contagious, and its treatment as such from the beginning, allowing free individual intercourse, with weak enforcement of the laws for its suppression."
That leprosy has not always been regarded by the authorities of the Hawaiian Islands as eminently contagious is shown by the following extracts from the report of the president of the board of health to the legislative assembly of 1884. He says: "Such a characterization is entirely uncalled for, is not warranted by experienced medical opinion, and the violent and hasty segregation which it would inspire is a wrong to a suffering community." "The confirmed leper should be separated from the community, but there should be no alarm in consequence of the temporary presence in the street of a leper, or on account of any ordinary intercourse with a sufferer from the disease."
On the other hand the report of the board of health for 1890 declares in the most emphatic manner that " complete, thorough, and absolute segregation offers the only safeguard" against the ravages of leprosy. The same report asserts that if, from the time when leprosy was first recognized as an established fact in the islands, the policy of absolute segregation had been firmly decided upon and unflinchingly pursued, ٭ ٭ ٭ Hawaii would be as free from leprosy to-day as any civilized nation." The report concludes with the hopeful words: "It is safe to say that if we do not relax our efforts we have seen the worst of leprosy in this country." The average leper population of the leper settlements in Molokai for the two years ending March 31, 1890, was 1,035.
*American Journal Medical Science, April, 1883.
A. Lutz, M. D., a specialist employed by the Hawaiian Government as "government physician for the study and treatment of leprosy," reports, under date of April 1,1890, as follows: "The infection from one person to the other furnishes probably the largest number of patients; heredity, if it really exists at all, is quite secondary, being perhaps only simulated by family infection. The influence of vaccination appears most doubtful."
From the Sanitary Instructions for Hawaiians, by the chairman of the sanitary committee of the Hawaiian legislature, the following statement of predisposing causes of leprosy and rules to be observed is made up:
"Be careful that where the operation of vaccination is performed pure vaccine is used."
"Avoid a leprous bedfellow as you would a pit of fire."
"Eat regularly and of the best obtainable food."
"Avoid dark, damp, badly-ventilated rooms."
"Never lie down to repose in damp or dirty clothing, and keep the body clean."
"Nearly all the lepers come from among the poor, who have fared badly and have lodged in damp and ill ventilated huts."
"Take care of the first symptoms of leprosy. The moment numbness of feeling, or any marks or swellings that indicate leprosy are observed, a physician should be consulted."
Venereal diseases favor the attack of leprosy. "If two men, one perfectly well and clean in body and the other diseased with venereal virus, were each brought into intimate contact with a leprous individual, the diseased man would be affected and become a leper far sooner than the sound man."
Dr. Lutz, Hawaiian Government physician for the treatment and study of leprosy, was encouraged to declare, under date of April, 1890, that he believes "we shall ٭ ٭ ٭ see cures, which may be attributed, not to extraordinary chance, but to our methods of treatment." It appears, however, from later reports, that the study of leprosy by specialists employed by the Government was soon abandoned. Dr. Lutz resigned September, 1890, without having effected a permanent cure.
The president of the board of health reports to the legislative assembly, session of 1892, on the subject of the study of leprosy by Government specialists, as follows: "In deference to the oft-repeated requests, ٭ ٭ ٭ the board of health opened correspondence with the leprosy commission of England and with Dr. E. Arning, of Hamburg, Germany, with a view of ٭ ٭ ٭ continuing the study and treatment of leprosy." The substance of Dr. Arning's reply is: "That the scientific work connected with the etiology and pathology of leprosy can, with surer prospects of success, be carried on here in its European centers, and this is actually being done; there are a number of bacteriologists ٭ ٭ ٭ at work on this intricate question and slowly unraveling knot on knot towards its solution."
The report of the board of health for 1892 states that on "December 31,1890, there were 1,213 lepers in the custody of the board, that being the highest number ever reached, and on March 31, 1892, there were only 1,115, a decrease of 98 during the period." In regard to the segregation of lepers the report affirms that at this date, March 31, 1892, "there are very few known lepers at large, with the exception of perhaps 17 at Kalalau, Kaui, but there are about 60 suspects at liberty in
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