CHAPTER VII.
THE LEPER ASYLUM ON MOLOKAI.
So much has been said and written of late about the disease called leprosy and its ravages in the Sandwich Islands that I had the curiosity to visit the asylum for lepers at Molokai, where now very nearly all the people suffering from this disease have been collected, under a law which directs this seclusion.
The steamer Kilauea left Honolulu one evening at half-past five o'clock, and dropped several of us about two o'clock at night into a whale-boat near a point on the lee side of Molokai. Here we were landed, and presently mounted horses and rode seven or eight miles to the house of a German, Mr. Meyer, who is the superintendent of the leper settlement, and also, I believe, of a cattle farm which belongs to the heirs of the late king.
Mr. Meyer has lived on Molokai since 1853. He is married to a Hawaiian, and has a large family of sons and daughters who have been carefully and excellently brought up, I was told. Mrs. Meyer, who presided at breakfast, is one of those tall and grandly proportioned women whom you meet among the native population not infrequently, who enable you to realize how it was that in the old times the women exercised great influence in Hawaiian politics. She seemed born to command, and yet her benevolent countenance and friendly smile of welcome showed that she would probably rule gently.
From Mr. Meyer's we rode some miles again, until at last we dismounted at the top or edge of the great precipice, at the foot of which, two thousand feet below, lies the plain of Kalawao, occupied by the lepers. At the top we four dismounted, for the trail to the bottom, though not generally worse than the trail into the Yosemite Valley, has some places which would be difficult and, perhaps, dangerous for horses.
From the edge of the Pali or precipice the plain below, which contains about 16,000 acres, looks like an absolute flat, bounded on three sides by the blue Pacific. Horses awaited us at the bottom, and we soon discovered that the plain possessed some considerable elevations and depressions. It is believed to have been once the bottom of a vast crater, of which the Pali we clambered down formed one of the sides, the others having sunk beneath the ocean, leaving a few traces on one side. It has yet one considerable cone, a hill two hundred feet high, a well-preserved subsidiary crater, on whose bottom grass is now growing, while a little pool of salt water, which rises and falls with the tide, shows a connection with the ocean. A ride along the shore showed me also several other and smaller cones.
The whole great plain is composed of lava stones, and to one unfamiliar with the habits of these islanders would seem to be an absolutely sterile desert. Yet here lived, not very many years ago, a considerable population, who have left the marks of an almost incredible industry in numerous fields inclosed between walls of lava rock well laid up; and in what is yet stranger, long rows of stones, like the windrows of hay in a grass field at home, evidently piled there in order to secure room in the long, narrow beds thus partly cleared of lava which lay between, to plant sweet-potatoes. As I rode over the trails worn in the lava by the horses of the old inhabitants, I thought this plain realized the Vermonter's saying about a piece of particularly stony ground, that there was not room in the field to pile up the rocks it contained.
Yet on this apparently desert space, within a quarter of a century more than a thousand people lived contentedly and prosperously, after their fashion; and this though fresh water is so scarce that many of them must have carried their drinking water at least two or even three miles. And here now live, among the lepers, or rather a little apart from them at one side of the plain, about a hundred people, the remnant of the former population, who were too much attached to their homes to leave them, and accepted sentence of perpetual seclusion here, in common with the lepers, rather than exile to a less sterile part of the island.
When we had descended the cliff, a short ride brought us to the house of a luna, or local overseer, a native who is not a leper; and of this house, being uncontaminated, we took possession.
By a law of the kingdom it is made the duty of the Minister of the Interior, and under him of the Board of Health, to arrest every one suspected of leprosy; and if a medical examination shows that he has the disease, to seclude the leper upon this part of Molokai.
Leprosy, when it is beyond its very earliest stage, is held to be incurable. He who is sent to Molokai is therefore adjudged civilly dead. His wife, upon application to the proper court, is granted a decree of absolute divorce, and may marry again; his estate is administered upon as though he were dead. He is incapable of suing or being sued; and his dealings with the world thereafter are through and with the Board of Health alone.
In order that no doubtful cases may be sent to Molokai there is a hospital at Kalihi, near Honolulu, where the preliminary examinations are made, and where Dr. Trousseau, the skillful physician of the Board of Health, son of the famous Paris physician of the same name, retains people about whom he is uncertain.
The leper settlement at Molokai was begun so long ago as 1865; but the law requiring the seclusion of lepers was not enforced under the late king, who is believed to have been himself a sufferer from this disease, and who, at any rate, by constantly granting exemptions, discouraged the officers of the law. Since the accession of the present king, however, it has been rigidly enforced, and it is this which has caused the sudden and great outcry about leprosy, which has reached even to the United States, and has caused many people, it seems, to fear to come to the Islands, as though a foreigner would be liable to catch the disease.
You must understand that the native people have no fear of the disease. Until the accession of the present king lepers were commonly kept in the houses of their families, ate, drank, smoked, and slept with their own people, and had their wounds dressed at home. If the disease were quickly or readily contagious, it must have spread very rapidly in such conditions; and that it did not spread greatly or rapidly is one of the best proofs that it is not easily transmitted. When I remember how commonly, among the native people, a whole family smokes out of the same pipe, and sleeps together under the same tapa, I am surprised that so few have the disease.
There are at this time eight hundred and four persons, lepers, in the settlement, besides about one hundred non-lepers, who prefer to remain there in their ancient homes. Since January, 1865, when the first leper was sent here, one thousand one hundred and eighty have been received, of whom seven hundred and fifty-eight were males and four hundred and twenty-two females. Of this number three hundred and seventy-three have died, namely, two hundred and forty-six males and one hundred and twenty-seven females. Forty-two died between April 1 and August 13 of the present year. The proportion of women to men is smaller than I thought; and there are about fifty leper children, between the ages of six and thirteen. Lepers are sterile, and no children have been born at the asylum.
So great has been the energy and the vigilance of the Board of Health and its physician, Dr. Trousseau, that there are not now probably fifty lepers at large on all the islands, and these are persons who have been hidden away in the mountains by their relatives. In fact if there was ever any risk to foreign visitors from leprosy, this is now reduced to the minimum; and as the disease is not caused by the climate, and can be got, as the widest experience and the best authorities agree, only by intimate contact, united with peculiar predisposition of the blood, there is not the least ground for any foreign visitor to dread it.
When a leper is sent to Molokai, the Government provides him a house, and he receives, if an adult, three pounds of paiai or unmixed poi, per day, and three pounds of salt salmon, or five pounds of fresh beef, per week. Beef is generally preferred.
They are allowed and encouraged to cultivate land, and their products are bought by the Health Board; but the disease quickly attacks the feet and hands, and disables the sufferers from labor.
There are two churches in the settlement, one Protestant, with a native pastor, and one Catholic, with a white priest, a young Frenchman, who has had the courage to devote himself to his co-religionists.
There is a store, kept by the Board of Health, the articles in which are sold for cost and expenses. The people receive a good deal of money from their relatives at home, which they spend in this store. The Government also supplies all the lepers with clothing; and there is a post-office. The little schooner which carried me back to Honolulu bore over two hundred letters, the weekly mail from the leper settlement.
For the bad cases there is a hospital, an extensive range of buildings, where one hundred patients lay when I visited it. These, being helpless, are attended by other lepers, and receive extra rations of tea, sugar, bread, rice, and other food.
Almost every one strong enough to ride has a horse; for the Hawaiians can not well live without horses. Some of the people live on the shore and make salt, which you see stored up in pandanus bags under the shelter of lava bubbles. When I was there a number were engaged in digging a ditch in which to lay an iron pipe, intended to convey fresh water to the denser part of the settlement.
Such is the life on the leper settlement of Molokai; a precipitous cliff at its back two thousand feet high; the ocean, looking here bluer and lovelier than ever I saw it look elsewhere on three sides of it; the soft trade-wind blowing across the lava-covered plain; eternal sunshine; a mild air; horses; and the weekly excitement of the arrival of the schooner from Honolulu with letters. There is sufficient employment for those who can and like to work—and the Hawaiian is not an idle creature; and altogether it is a very contented and happy community. The Islander has strong feelings and affections, but they do not last long, and the people here seemed to me to have made themselves quickly at home. I saw very few sad faces, and there were mirth and laughter, and ready service and pleasant looks all around us, as we rode or walked over the settlement.
And now, you will ask, what does a leper look like? Well, in the first place, he is not the leper of the Scriptures; nor, I am assured, is the disease at all like that which is said to occur in China. Indeed, the poor Chinese have been unjustly accused of bringing this disease to the Islands. With the first shipload of Chinese brought to these Islands came two lepers "white as snow," having, that is to say, a disease very different from that which now is called leprosy here. They were not allowed to land, but were sent back in the ship which brought them out.
The Hawaiian leprosy, on the other hand, has been known here for a quarter of a century, and men died of it before the first Chinese were brought hither. The name Mai-Pakeh was given it by an accident, a foreigner saying to a native that he had a disease such as they had in China. There are but six Chinese in the Molokai leper settlement, and there are three white men there.
The leprosy of the Islands is a disease of the blood, and not a skin disease. It can be caught only, I am told, by contact of an abraded surface with the matter of the leprous sore; and doubtless the familiar habit of the people, of many smoking the same pipe, has done much to disseminate it.
Its first noticeable signs are a slight puffiness under the eyes, and a swelling of the lobes of the ears. To the practiced eyes of Dr. Trousseau these signs were apparent where I could not perceive them until he laid his finger on them. Next follow symptoms which vary greatly in different individuals; but a marked sign is the retraction of the fingers, so that the hand comes to resemble a bird's claw. In some cases the face swells in ridges, leaving deep furrows between; and these ridges are shiny and without feeling, so that a pin may be stuck into one without giving pain to the person. The features are thus horribly deformed in many instances; I saw two or three young boys of twelve who looked like old men of sixty. In some older men and women, the face was at first sight revolting and baboon-like; I say at first sight, for on a second look the mild sad eye redeemed the distorted features; it was as though the man were looking out of a horrible mask.
At a later stage of the disease these rugous swellings break open into festering sores; the nose and even the eyes are blotted out, and the body becomes putrid.
In other cases the extremities are most severely attacked. The fingers, after being drawn in like claws, begin to fester. They do not drop off, but seem rather to be absorbed, the nails following the stumps down; and I actually saw finger-nails on a hand that had no fingers. The nails were on the knuckles; the fingers had all rotted away.
The same process of decay goes on with the toes; in some cases the whole foot had dropped away; and in many the hands and feet were healed over, the fingers and toes having first dropped off. But the healing of the sore is but temporary, for the disease presently breaks out again.
Emaciation does not seem to follow. I saw very few wasted forms, and those only in the hospitals and among the worst cases. There appears to be an astonishing tenacity of life, and I was told they mostly choke to death, or fall into a fever caused by swallowing the poison of their sores when these attack the nose and throat.
Those diseased give out soon a very sickening odor, and I was much obliged to a thoughtful man in the settlement, who commanded the lepers who had gathered together to hear an address from the doctor to form to leeward of us. I expected to be sickened by the hospitals; but these are so well kept, and are so easily ventilated by the help of the constantly blowing trade-wind, that the odor was scarcely perceptible in them.
You will, perhaps, ask how the disease is contracted. I doubt if any one knows definitely. But from all I heard, I judge that there must be some degree of predisposition toward it in the person to be contaminated. I believe I have Dr. Trousseau's leave to say that the contact of a wounded or abraded surface with the matter of a leprous sore will convey the disease; this is, of course, inoculation; and he seemed to think no other method of contamination probable. I was careful to provide myself with a pair of gloves when I visited the settlement, to protect myself in case I should be invited to shake hands; but I noticed that the doctor fearlessly shook hands with some of the worst cases, even where the fingers were suppurating and wrapped in rags.
There are several women on the Islands, confirmed lepers, whose husbands are at home and sound; one, notably, where the husband is a white man. On the other hand, a woman was pointed out to me who had had three husbands, each of whom in a short time after marrying her became a leper. There are children lepers, whose parents are not lepers; and there are parents lepers, whose children are at home and healthy.
There are three white men on the island, lepers, two of them in a very bad state. So far as I could learn the particulars of their previous history, they had lived flagitiously loose lives; such as must have corrupted their blood long before they became lepers. In some other cases of native lepers I came upon similar histories; and while I do not believe that every case, or indeed perhaps a majority of cases, involves such a previous career of vice, I should say that this is certainly a strongly predisposing cause.
As to the danger of infection to a foreign visitor, there is absolutely none, unless he should undertake to live in native fashion among the natives, smoking out of their pipes, sleeping under their tapas, and eating their food with them; and even in such an extreme case his risk would be very slight now, so thoroughly has the disease been "stamped out" by the energetic action of Mr. Hall, the Minister of the Interior, Mr. Samuel G. Wilder, the head of the Board of Health, and Dr. Trousseau, its physician. In short, there is no more risk of a white resident or traveler catching leprosy in the Hawaiian Islands than in the city or State of New York.
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I have heard one reason given why this disease has been more frequent in the last ten years. Ten or twelve years ago the Islands were visited by smallpox. This disease made terrible ravages, and the Government at once ordered the people to be vaccinated. There seems to be no doubt that the vaccine matter used was often taken from persons not previously in sound health; this was perhaps unavoidable; but intelligent men, long resident in the Islands, believe that vaccination thus performed with impure matter had a bad effect upon the people, leaving traces of a resulting corruption of their blood.
The choice of the plain of Kalawao as the spot on which to seclude the lepers from all the Islands was very happy. It can not be said that to an agile native the place is inaccessible, for there are, no doubt, several points in the great precipice where men and women could make their way down or up; and there are instances of women swimming around the precipitous and surf-beaten shore, seven or eight miles, to reach husbands or friends in the settlement to whom they were devotedly attached. But it is easily guarded, and, for all practical purposes, the seclusion is perfect.
A singular tradition, related to me on the island, points to its use for such a purpose and gives a sad significance to the leper settlement. It is said that in the time of the first Kamehameha, the conqueror and hero of his race, upon an occasion when he visited Molokai, an old sorceress or priestess sent him word that she had made a garment for him—a robe of honor—which she desired him to come and get. He returned for answer a command that she should bring it to him; and when the old hag appeared, the king desired her to tell him something of the future. She replied that he would conquer all the Islands, and rule over them but a brief time; that his own posterity would die out; and that finally all his race would be gathered together on Molokai; and that this small island would be large enough to hold them all.
It is probable, of course, that this tale is of recent origin, and that no priestess of Kamehameha the First possessed so fatal and accurate a gift of prophecy; but the tale, told me in the midst of the leper asylum, pointed to the gloomy end of the race with but too plain a finger. The Hawaiians, once so numerous as to occupy almost all the habitable parts of all the Islands, have so greatly decreased that they might almost find their support on the little island of Molokai alone. Happily the decrease has now ceased.
The great Pali of Molokai, one of the most remarkable and picturesque sights of the Islands, stretches for a dozen miles along its windward coast. It is a sheer precipice, in most parts from a thousand to two thousand feet high, washed by the sea at its base, and having, in most parts, not a trace of beach. This vast wall of rock is an impressive sight; here the shipwrecked mariner would be utterly helpless; but would drown, not merely in sight of land, but with his hands vainly grasping for even a bush, or root, or a projecting rock.