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.