The Hawaiian royal family of Damien's time at Kalawao took more than a formal interest in the question of leprosy. King David Kalakaua had come to the throne in 1874 determined to see the chronic depopulation of his realm reversed. "The increase of the people" was Ins slogan; and, leprosy being the great decreaser, Kalakaua made an official visit to the settlement not long after his accession. Touring the world in 188r, he asked in Japan about treatments used there. And, good Western-educated Hawaiian nationalist that he was, he tried personally, at home in Honolulu, to put native medical tradition to work, more or less as the kahuna did, practicing what he called "physchological medicine" on one leprosy sufferer with results that seemed to him encouraging.
Kalakaua's sister Liliuokalani, having arranged for Damien to be decorated after her visit to Kalawao in 1881, went to the settlement again in 1884 with the king's wife, Queen Kapiolani. Later, Kapiolani corresponded at length with Damien about charity, and about the best way to distribute royal gifts. (Damien went to great pains to see that each man, woman, and child at the settlement got a gift bundle addressed individually.) The queen also lent her name and her active patronage to the establishment of a home in Honolulu for girls born free of the disease at the settlement.
Leprosy was a royal question because it was a national question. Inevitably, it was political as well. Kalakaua's premier from 1882 to 1887 was a consummate politician, an accumulator and juggler
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of offices, part visionary, part opportunist, part statesman, part demagogue, named Walter Murray Gibson—"Minister of Everything," his opponents called him—an American, a Southerner of obscure origins, who had made his way up in the public life of the kingdom as the natural enemy of the white Protestant business and moral élite, and as the somewhat ambiguous champion of the native Hawaiians. Gibson was never reluctant to use tax money for the combined purposes of the social good of the Hawaiians and his own political advancement. It had been his "respectful suggestion" as editor of the Nation in /873 that the then king, Lunalilo, ought to visit Kalawao, and that a priest was needed there. Leprosy later became one of Gibson's favorite areas of political operation: there was the chance to take the part of the Hawaiian, make speeches about what he was doing, and win votes for himself among the kanaka.
In /865-1866, the first years of Kalawao's existence, the Board of Health, with a total appropriation of thirty thousand dollars, allowed sixteen thousand dollars for leprosy—more than half its budget. This was as much as the kingdom seemed able to afford just then; and yet it was nothing like enough, as the squalor and hopelessness of Kalawao in the early days showed. By the time Damien went to the settlement in 1873, the budget for leprosy had more than doubled. By 1875-1876, it had risen again, to more than fifty thousand dollars for the biennium. During Gibson's regime, from 1882 to 1887, the biennial figure was one hundred thousand dollars.
This great increase came about because the kingdom had found a new and lucrative source of wealth. The sugar industry of the islands had taken firm hold, A commercial treaty with the United States in the mid-seventies guaranteed the crop a market; haole plantation owners were amassing fortunes; and the government was taking its share of the wealth in taxes. The Board of Health generally got something like io percent of government revenues, and devoted between one-half and two-thirds of its appropriation to leprosy. This kind of allocation-5 percent or more of a nation's
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resources to treat a single disease—had no equal in the world, as Gibson was always pleased to point out.
And yet the combination of national necessity and governmental generosity by no means brought luxury to the leprosy settlement. Food supplies, after the first unplanned and dismal years, were generally adequate; perhaps even better than in the population at large. But clothes were budgeted for a long time at only six dollars a year for each person, which in Kalawao's changeable climate was not enough; and at the beginning of the 188os, the drug budget amounted to no more than one cent per month per person. In 1872, each leprosy sufferer cost the government only 10 cents a day; in 1886, under Gibson the benefactor, still no more than 211/13 cents per day.
However high the government appropriation was set and reset, the kingdom could not keep up with the disease. There were now usually between seven and eight hundred people confined at Kalawao (a figure that represented something like 2 percent of the native Hawaiian and part-Hawaiian population). And, as Damien observed, the only reason there were not more was that the government could not afford to have the islands combed regularly for suspects.
There was also, in this regard, the recurrent suspicion that Walter Murray Gibson was not "sincere" about leprosy—that he was not a convinced and rigorous segregationist. Segregation, especially among the white Protestants of Honolulu, was an article of faith. But for all Gibson's oratory on the floor of the legislature, his editorializing in the newspapers he owned and ran from time to time, his endless soliciting of professional medical opinion, his publishing of elaborate "sanitary regulations"' for Hawaiians—for all this, Gibson's political enemies thought they could see him manipulating the issue for votes.
Certainly, Gibson had taken to heart the Hawaiians' deep aversion to the idea of isolation. He said repeatedly that Kalawao need not be the only place for restraining leprosy sufferers. He suggested instead local centers of detention, perhaps one—or
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more than one—on each island. Ultimately, he supported strongly a branch hospital in Honolulu, on the waterfront at a place called Kakaako. Gibson, a considerable word spinner, could make Kakaako sound like a patient's paradise: a place of neat, spotless rooms adorned with "pleasing pictures and knick-knacks," and gardens a riot of color with hibiscus and geraniums, where little boys flew kites or played marbles, little girls dressed their dolls, and women sewed and stitched quilts, all to the accompaniment of song, so that "lovers of music can go to our lepers of Kakaako and have their ears gratified with a pleasant concert of melodies."
Others did not see Kakaako in quite the same mellow light. The hospital was built close to the water, between a "salt marsh" and an "offensive foreshore"; in a severe storm with onshore winds, the yard was likely to be flooded to a considerable depth. The place was overcrowded, beyond the possibility of good hygiene. And segregation there was a mockery. Visitors' permits were given out on a "very liberal scale." The fence was easily climbed in either direction; there was traffic between the men's and women's wards. Outside, "at the gate of the hospital, a crowd assembles daily; and seats have been provided on both sides of the fence, where patients and friends are in close communication. Stalls for the sale of various luxuries, tobacco, &c., have been frequently erected, and many articles are passed in and out without difficulty." While Gibson and his Board of Health kept on asserting that Kakaako was fulfilling its function superbly, his enemies—and they were many, enough eventually to bring him down by revolution—claimed that the place was not being used as a way station for Kalawao, but as a substitute. This might be more congenial to Hawaiians, but it was regarded by many haole as a bane, and a fearsome source of potential contagion at the heart of the political and commercial capital of the kingdom. Gibson, in that light, appeared to be playing off leprosy against liberty, all for the Hawaiian vote.
If Gibson had made leprosy political, then the Catholic Church was in politics. Damien, a Sacred Hearts Father, was the singular
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priest of Kalawao; and the branch hospital at Kakaako was run, after November, 1883, by Sisters of Charity of the Third Order of St. Francis, from the Convent of St. Anthony in Syracuse, New York, recruited by Father Léonor Fouesnel with the blessing of the Gibson administration. The extremists among the Protestants of Honolulu did not like this new accession of charitable power to the Catholics, any more than they had liked Damien's original emergence as the indisputable exemplar of Christian generosity.
Neither did most haole Protestants like Gibson. And if for the moment they did not have political power, they had great economic power: the power of the plantations and their revenues, the power of lucrative business in Honolulu. Gibson's powers of office rested on his control of the Hawaiian vote; but the taxes of planters and businessmen paid for the running of the kingdom, including the leprosy programs of the Board of Health. So things political were more than a little precariously balanced, and the Catholic mission and its works were in the balance along with everything else.
Gibson, in his private life a somewhat disturbed seeker after religious truth, was flirting with Catholicism. The public and political expression of this interest was a willingness—most unusual in the history of Hawaiian politics—to make generous appropriations for Catholic schools, and a readiness to have the Hawaiian monarchy and the Vatican mutually bestow honorific titles upon deserving people. There was Damien's medal to begin with. Then Father Léonor Fouesnel, having arranged for the Franciscan Sisters of Charity to come to the islands, was made an officer of the Royal Order of the Crown of Hawaii. And the mother superior of the Sisters, Marianne Kopp, Gibson's special favorite, for whom he had a liking that amounted almost to elderly infatuation, was decorated as well, with the Boyal Order of Kapiolani. On the other side, Gibson himself, King Kalakaua, and Governor of Oahu John Do- minis (husband of Kalakaua's sister Liliuokalani), became, without fanfare—a precaution against Protestant agitation—members of the Order of Pope Pius IX. In all this, there was a certain amount
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of political expediency. Gibson might have been ready to embrace the Church. But Kalakaua and Dorninis were no Catholics, even by inclination: both, in fact, were Episcopalians, and Freemasons as well.
Amid it all, the superiors of the Sacred Hearts mission had to tread carefully. They regarded themselves always as very much in enemy territory, with Protestant hostility always possible and often actual. To be sure, Gibson in power was better than Protestants in power; and the bishop and the provincial could see the usefulness of his professed friendship. But they were never wholehearted in their acceptance of the sincerity and integrity of the Minister of Everything—"the old fox," as Bishop Koeckemann called him—and they understood very well that, however much Gibson might have wanted the support and friendship of the Catholics, he feared still more the displeasure of his "numerous and powerful adversaries." So the Catholic superiors watched and waited, with each year in the 188os appearing to them more perilous than the last.
This was leprosy as politics; there was also, of course, leprosy as leprosy. The disease persisted, remorselessly. The easy optimism of the Board of Health about the speed with which the scourge would be put down had evaporated with the 186os—that is to say, with experience. The rigorous enforcement of the segregation laws under King Lunalilo in 1873, intended to bring the epidemic to a halt, showed only that no end was in sight. And nothing that happened in the reign of Lunalilo's successor, Kalakaua, suggested even remotely that the leprosy settlement might one day no longer be needed, that Damien's vocation might one day have no imperative usefulness in the Hawaiian Islands. Leprosy continued to be, as the Board of Health said, "the most burdensome tax that Hawaii has to bear with." Kalawao earned the epithet of "an
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almost bottomless pit" into which the money "appropriated by the Board of Health is cast." The disease, in the Board's words, was "everywhere among us, members of the police, the soldiers, the band boys, pastors of churches, teachers, students, are all among the sufferers." Throughout the 187os, into the '8os—and on into the '9os—the Hawaiian Islands remained "full of leprosy."
The kingdom's physicians had every chance to become well acquainted with the disease, and they learned a great deal about it; but most of what they learned merely added to their puzzlement. Leprosy continued to strike Hawaiians far more frequently than haole, and Hawaiian men rather than Hawaiian women— something like two to one. Between the mid-186os and the midz88os, the life expectancy of a diagnosed sufferer seemed to lengthen considerably, from between three and five years to between ten and fifteen years. But perhaps this was only because in the early years of the segregation laws only the most severe and advanced cases were recognized and isolated, and they died off quickly. As the disease became more familiar to the inspecting eye, the signs could be picked up sooner, the segregation made sooner, and the period of survival "lengthened," though in an administrative sense only.
Beyond such simple assertions, nothing seemed really sure. Indeed, one of the perplexing things about leprosy was the apparent randomness of its incidence. In the matter of the transmission of the disease, some sufferers could trace it back to a personal contact; some could not. This was particularly true of the handful of "respectable" haole who came down with leprosy. One haole couple, for instance, a Honolulu merchant and his wife, evidently quite healthy, had three children who caught leprosy one after the other. Among Hawaiians, there were well-authenticated stories of women, attractive and with no sign of the disease, who married, lost a husband to leprosy, married again, and lost this husband in the same way. One kdkua woman at Kalawao married five times; all five husbands died with leprosy. Then there were cases of another kind, severe enough to lead to segregation at Kalawao,
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which seemed to burn themselves out there. Ambrose Hutchison, for example, was exiled as a youth in 1879, but survived to become assistant superintendent in 1885 (and an admirer of Damien's work); he lived on—and on—into the 193os, fifty-three years and six months at the settlement, sole remnant of several of Kalawao's truncated generations.
Whoever tried to go beyond noting the symptoms and stages of leprosy, to get at its causes, to understand how and why and where individual cases of the disease originated, and how it became epidemic, was hampered as always by noncooperation. Hawaiians— and for that matter haole—who suspected that they had the disease still tried to evade the authorities. Until the end of the nineteenth century, a haole could often buy his way out of the hands of the examining physician, and leave the islands. (One government doctor even suggested an official fund to pay the fares of diseased white men, on the grounds that this would spare them the horror of life and death among Hawaiians at Kalawao, and spare the government expense.) Hawaiians, with nowhere to go in the outside world, continued to hide for months or years in remote valleys, caves, and lava tubes; or—more riskily—to take to the canefields when the government physician and the sheriff, the instruments of examination and exile, made their rounds.
In the absence of sound clinical evidence, all theories about the origin and transmission of leprosy remained no more than theories. One body of opinion could attach itself to another for reasons which had not much to do with the rules of strict medical investigation. Thus, George Fitch, a government physician of the 188os, was able to develop a theory of leprosy as a fourth stage of syphilis. "Syphilis," he argued, "was introduced here about one hundred years ago. Sixty years afterward leprosy appeared, or as soon as syphilis had a chance to fairly permeate the community, which among a people as licentious as these, was shortly accomplished. A person with syphilis presents a most favorable field for leprosy to work upon.... I defy anyone to produce a single case of leprosy in which Syphilis inherited or acquired has not been antecedent."
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The white man, the huele, according to Fitch, had acquired a kind of hereditary immunity to leprosy as a result of centuries of exposure in Europe; and so, in the Hawaiian Islands, even those bad huele who gave way to "licentiousness" and contracted syphilis were largely protected from the fourth stage of its consequences, leprosy.
Eitch had next to no support for his ideas in the medical profession itself, even from doctors such as Nathaniel Emerson, who would have agreed with his reading of the medical and social record on syphilis among Hawaiians. But among good Christians Fitch's ideas acquired a sort of moral persuasiveness. To the rigorous Christian mind, Hawaiians were immoral because sexually promiscuous. Promiscuity among the kanaka seemed impossible to stamp out. It was a form of contagion, epidemic in its incidence, awful in its consequences. So was leprosy. The Christian mind readily linked one with the other, and Christians talked in the same breath of the contagion of the soul and of the body, of moral and physical leprosy.
Damien himself, with as much practical experience of the disease among Hawaiians as anyone, was a believer in this connection between promiscuity, syphilis, and leprosy. He did not see it as an exclusive connection. In perhaps one-tenth of the cases, Damien thought, a faulty vaccination for smallpox, or inhalation of the "foul air" surrounding a leprosy sufferer, or physical contact of a nonsexual kind could bring on leprosy. But in nine-tenths of the cases syphilis was there, hereditary or acquired. Untreated—or inadequately treated by Hawaiian kahuna—it became leprosy. "It is admitted fact," Damien wrote, ''that the great majority, if not the total number of all pure natives, have the syphilitic blood, very well developed in their system. This poisonous root has shot into different ramifications, and as we are now, at least at the third generation, it developed it self in some instance in the way of what we called leprosy."
Damien's exceptional vocation led him to find ways to tolerate physical closeness to diseased Hawaiians, despite their physical
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repulsiveness, and despite the moral leprosy that he took to be part of their condition. Most white Protestants could not bring themselves to do what Damien did. Indeed, they were moving as a group in another direction, to almost total moral self-isolation from the contagion of Hawaiian culture. Increasingly, during Kalakaua's reign, as the 187os became the 188os, respectable haole Protestant opinion was coming to regard Hawaiian culture as corrupt and diseased, not only in its syphilitic and leprous manifestations, but in its very nature, at its very source.
Whether or not they could bring themselves—as representatives of the West, of course, not as individuals—to accept responsibility for having introduced syphilis and leprosy to the islands in the first place, they insisted that the root of the Hawaiians' disastrous condition was indigenous. This root they identified as the endless and endlessly renewed sexuality of the culture. The Hawaiian view of life was permeated by the generative principle. Sex was the expression, the ultimate incarnation, of the beauty and power of the forces of existence, something to be celebrated— privately, publicly, ritually. This perception was essentially what had reduced Damien himself in his days at Kohala to "black thoughts" of "insupportable melancholy." So with the convinced haole Protestants of Honolulu. Even where disease was not directly concerned, they discovered among the Hawaiians the presence of another deadly infection: sex.
When King Kalakaua, having returned from his tour of the world, held a greatly belated but elaborate coronation ceremony for himself in 1883, his royal hula dancers publicly extolled the vastness of his inherent mane: his procreative powers and his sexual potency. The English-language Hawaiian Gazette was deeply shocked: "No cleanly wantonness this, but a deliberate attempt to exalt and glorify that which every pure mind must hold as the type of what is to be kept out of sight, and out of mind as the representative of all that is animal and gross, the very apotheosis of grossness."
Only one word could convey the awfulness of it all—phallic
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worship at the royal level, the monstrous incarnation of brutishness—and that word was "leprosy." In the highest and most elaborate public expression of Hawaiian culture, the coronation ceremonies of King Kalakaua, the Protestants saw only revolting sickness. They conceived of themselves as being thrust "face to face" with a "leprous visage."
For the Reverend Doctor Charles McEwen Hyde, this "leprous visage" was very real. Arriving at Honolulu in 1877 to take up the directorship of a theological institute for the training of young Hawaiians in the Protestant ministry, he was appalled. "Accustomed as I was to the purity of a New England home, there yawned before me, in Hawaiian social and family life, an abysmal depth of heathen degradation, unutterable in its loathesomeness. Obscenity takes the place, among Hawaiians and other heathen nations, of the profaneness that pollutes our Christian civilization. Hawaiian home life, apart from Christian home life, is abominably filthy." Experience did not change Hyde's mind. Those words were written for publication after thirteen years in the Hawaiian Islands; they represented his considered judgment.
In such matters, Hyde could see no essential difference between the Hawaiian commoner and the Hawaiian monarch. King Kalakaua, in cultivating Hawaiian tradition, was cultivating obscenity; and the royal household was a sink of iniquity. Hyde stopped just short of calling the palace a "commercial brothel"—he actually used the words, but then qualified them by saying that he did not think the exchange of sexual favors there involved money.
So much for Hawaiian culture's leprous visage. As for literal leprosy, Hyde looked for and saw it everywhere among the Hawaiians who surrounded him: reddish spots on the faces of students at his theological institute; ghastly matter oozing through the clothes of a patient in a doctor's office; a clot of blood on the
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ground at the wharf where the condemned embarked for Molokai. Hyde had to ask himself a crucial question: "Could I safely hold intercourse with such a set?" There was only one way to find out. "I investigated the question for myself." His exhaustive inquiries showed that doctors contradicted each other on whether leprosy was hereditary or contagious, and whether it represented a late stage of syphilis. But "by all that I saw and heard and read, I was soon convinced of this one fact, that leprosy is one of the results of licentiousness." And, of course, it was overwhelmingly a disease of Hawaiians rather than haole. The connections were clear. Hyde was one of those who could hardly help thinking that the Hawaiians deserved their fate. When even the best of them—his theological students—came down with the disease, there was not much to be said in favor of the rest of the population.
And yet Hyde felt himself constrained to do his best for them, to meet foulness face to face. No one was more active than he in arranging benefits for Hawaiians who would accept gifts from Protestants. Hyde prided himself especially on being active in charity toward the victims of leprosy; and he made it a point to include in his pastoral visits the branch hospital at Kakaako.
So, if Hyde was no Damien--and there was only one Damien —he was by no means negligent of leprosy, not blind to what it might demand of a Christian minister. And yet, unable to pass by on the other side, having in fact come to the middle of the road, he would not cross all the way over as Damien had done. Indeed, Hyde was capable of halting his pastoral visits to Kakaako when a doctor friend of his—George Fitch, the strong believer in the connection between leprosy and syphilis—was removed from the staff. And he was capable of ceasing to help raise money for the Kapiolani Home for Girls when Walter Murray Gibson expressed an interest in the project. "If you take hold of it," Hyde told Gibson, "I shall drop it." Hyde, like a good many other haole Protestants, saw Gibson as "making of this national calamity a lever to hoist himself to place and
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power," and Ilyde would have none of it: he would "keep aloof."
This was Hyde's practice of the politics of leprosy: a kind of public moral isolation. What he never revealed in public was that for one terrible moment he was all but convinced that the objects of his own charity had infected him: that he, who knew the unholiness of dirt and kept himself clean so as to make certain of keeping himself godly, had leprosy. "I have been warned," he wrote home in confidence to New England in 1884, "of the risks of working for such a people. For economy's sake we have our washing done at one of the Chinese laundries. Six weeks ago in putting on my stockings fresh from the wash, with a new pair of shoes fresh from Boston, I noticed an irritation which I attributed to the tightness of new shoes. The next week a rash came out. That disappeared leaving some pimples on the ankles, which I took to be flea bites, such as I had before. These disappeared but left a discolored spot. Last week in shaving I found that my skin was easily cut by the razor and that the blotches were spreading." Hyde put himself at once in the care of his family physician, who "cannot tell how it will result."
For a man who had convinced himself of the connection between leprosy and licentiousness, this was a horrifying situation, even though licentiousness, however much it was on Hyde's mind, could only have touched his body at second hand. And for a man who saw Hawaiians failing to live up to his version of the moral cure of souls and becoming diseased in consequence, to be infected by the same disease would have been catastrophic. For Hyde, or anyone like him, to have died in the service of Hawaiians, and of their affliction, would have been to fly in the face of respectability and all that was holy in it.
Hyde did not die of leprosy. The blotches and skin irritations and ominous razor cuts which had so disconcerted him turned out to be, blessedly, a false alarm; and he was able to go back to his good works in good conscience.
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The Christian view, and especially the Protestant view—the comprehensive moral diagnosis of Hawaiian culture—began and ended with what Dr- Nathaniel Emerson called the "ultimate, frigid fact that leprosy is contagious." There were certain ruthless corollaries. If the Hawaiian race was ever to be "rescued from the slough into which it is sinking, the fatal lethargy that stupefies them must be dispelled, the instinct of self-preservation must be awakened, and it must be written upon their hearts, as with the point of a diamond, that to voluntarily contaminate oneself with leprosy is a crime." Segregation, "complete, thorough, and absolute," was the only safeguard. Frigid facts, diamond-hard insistences, absolute judgments about crime and punishment: this was the moral diagnosis in all its rigor. And yet it offered no cure for leprosy.
Indeed, the medical treatments for leprosy applied in the context of this moral diagnosis were wildly heterogeneous, hopeful perhaps, but feeble—palliatives at best. There were various kinds of patent medicines in bottles, pills, poultices, dietary recommendations (farinaceous foods, cod-liver oil, measured doses of strychnine), and an extraordinary number of things, soothing and stinging, to rub on the skin: beeswax and lard; salicylic acid followed by a solution of arsenite of potash; a mixture of tobacco juice and papaya juice; the lotion of corrosive sublimate that Damien used on his problematical yellowish spots in 1876; a blend of dog manure and molasses. These were haole decoctions. The Hawaiian kahuna had their own applications: wild ginger, turmeric, mountain apple, and on, and on, another endless list. The line between practical folk medicine and folk magic ran erratically back and forth between the two cultures.
The best thinking in the hack medical profession insisted, of course, that magic would not do: that it was foolish to "expect to find an arcanum, an oil or extract with very nearly supernatural qualities, as has only too long been done in connection with this
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most intractable disease." Neither was it sufficient, or even warrantable, simply to call leprosy incurable, and to "remove the afflicted out of sight," as the implacable—and dismissive—moral diagnosticians were concerned to do. "This is a remnant of medieval barbarism which every professional man ought to oppose," on a scientific basis, but on moral grounds as well, "in our relation to a race which has had our civilization forced upon it, and which is accustomed to look up to us for help and support." Conscientious representatives of a superior civilization, practitioners of its advanced medicine, "ought never, for a moment, to accept the saying of the incurability of leprosy as true; but ought to go on fighting against it. Perhaps we have been on the wrong track of treatment, and there is yet a solution of the problem to be found." In particular, "the recent experiences concerning the germ nature of disease may be the means of showing us the path of rational treatment; and they must and do give a new impulse and new encouragement to us to persevere in trying and experimenting."
This was clearly the voice of modern nineteenth-century scientific medical thought, as rigorous in its own way as the voice of moral diagnosis. The speaker was a highly talented and hardworking young German bacteriologist, Eduard Christian Arning, a student of the well-known Albert Neisser, who had in turn studied the techniques and findings of Gerhard Armauer Hansen, discoverer of Bacillus leprae. Arning's reference to the germ theory of disease, and the impetus it gave to experimentation, was made early in 1884; and remarkably enough, he spoke from Honolulu, a center of leprosy, but hardly, in world terms, a center of scientific research.
Arning had come to the Hawaiian Islands in November, 1883, at the invitation and the expense of the Board of Health and its president Walter Murray Gibson. In the matter of leprosy, as with most other affairs of politics, Gibson took the broad view. He did not see the islands as isolated from the rest of the world. If there was something to be learned from outside about control of the disease, then the Hawaiian kingdom ought to have access to the
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new learning. If the kingdom could sponsor research leading to the eradication of leprosy, then the Board of Health should make the arrangements, and reap the simultaneous rewards of local well-being and world glory.Gibson saw the appointment of Arning as another way for the Minister of Everything to do good, and to be seen doing good. "Let Hawaii," he wrote, "continue to maintain her honorable and enlightened position in Oceanica by her advanced philanthropic enterprise."
Arning was quick to discredit one part of the moral diagnosis of leprosy: the idea that it sprang from syphilis. "I avow that this hypothesis, which, if true, would entirely overthrow our hitherto accepted ideas not only of leprosy, but still more so of syphilis, seems to me to be so extraordinary and self-condemning that it would scarcely necessitate my entering on the subject .. but, on the other hand, the theory has been most energetically brought before the public and found believers, so that I consider it my duty to support with the full force of my opinion the endeavors of the other members of the medical profession who have already some time ago refuted this idea.
"The theory," Arning went on, "is, perhaps, not quite as harmless as many would believe, as it has led, and may still further lead, the public to consider leprosy as one outcome of licentiousness, which term certain classes of society unhappily seem to use as a synonym of syphilis, and to look upon the unfortunate lepers as the victims of their own or their parents' transgressions." Dryly, Arning pointed out that if leprosy was an extension, a fourth stage, of syphilis, then surely the thing to do was to halt syphilis before it turned into leprosy--to have syphilis settlements instead of leprosy settlements. "Singularly enough," this logic seemed never to have struck the moral diagnosticians. But then, in truth, leprosy was not really an extension of syphilis. "I wish it to be understood that neither clinically nor pathologically does the leprosy of these Islands present any peculiar feature or combination of symptoms which any physician accustomed to see and treat syphilis would recognize as belonging to the latter." For another thing, again
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connected with the moral diagnosis of Hawaiians, Arning simply did not find syphilis everywhere in the islands, as others seemed to do; and he suggested that "an inquiry on this subject, issued by the Board of Health, would ... very likely lead to a correction of the general opinion in this matter."
With this much misconception out of the way, Arning proceeded to explain what he was doing, and what he would be doing, by way of experimentation in the Hawaiian Islands. He had already found the bacillus of leprosy in the bodies of victims of the disease, in the living by "excision of tubercles," in the dead through post-mortem examination. The bacillus in the Hawaiian Islands was the same as elsewhere in the world—the Bacillus leprae of Hansen. Now, said Arning, he would go on "firstly, to gain knowledge of the paths the germ follows in the organism, and the changes it brings about in the tissues of the body; then to gather information as to the life history of the germ itself; and last but not least, to see to what extent the presence of the bacillus can be used as a practical test for leprosy."
He proposed to devote several months to "cultivation experiments—i.e. to try and grow the Bacillus leprae on specially prepared substances outside of the human body. This work is of the most tedious and delicate nature, and always associated with many discouraging failures; but, nevertheless, it has to be undertaken, forming an essential part of the modern methods of investigating disease."
Arning also proposed to carry out "inoculation experiments," trying to implant the disease in living tissue, a technique "of late perseveringly tried by quite a number of authorities, so far without result as regards general infection." He had, he reported early in 1884, "procured a monkey for these experiments."
Another subject for experimentation soon presented itself—this time a human being. Dr. George Fitch had already made the suggestion that, in the spirit of science, "condemned criminals should be given the choice of inoculation with the blood and matter from leprous patients or execution as preferred by them."
In 1884, a Hawaiian named Keanu committed murder, bludgeoning to death the husband of his lover. He was tried for the crime, convicted, and sentenced to be hanged. Arning applied to the Privy Council for permission to "perform some inoculation experiments" on Keanu. The Privy Council agreed; Keanu agreed; his sentence was commuted to life imprisonment. On September 30, 1884, Arning cut a leproma about the size of a hen's egg from the neck of a diseased girl, made an incision in Keanu's right forearm, and sutured the leproma into position.
Keanu was a man in his forties, vigorous, powerfully built. Arning, noting this, pointed out that physical strength did not necessarily exempt a man from leprosy. The leprosy bacillus apparently required "a certain disposition of the human soil to strike and thrive." What that disposition might be, "we are at present unable to define. It is evidently a disposition which may co-exist with apparent good health, as many examples of strong robust men, developing leprosy, show us." Arning thought there might be some hereditary factor involved. He did not believe there was such a thing as congenital leprosy, that a person could be born with the disease; "but I do believe that a certain weakness to resist its attacks may be transmitted."
For the four weeks following the implantation of the leproma, Arning saw Keanu every day, "and after that once a week for several months, a microscopic examination of the inoculation spot being made every time." While a scar was forming on Keanu's stitched-tip arm, Arning went about the rest of his research at Kakaako hospital and Kalawao settlement, gathering specimens of leprous tissue from every part of the bodies of patients, examining them microscopically, trying in hundreds of ways, unsuccessfully, to culture them. Once, doing a post-mortem on a diseased cadaver, he neglected to cover a cut on his own finger, and watched for weeks afterward while his arm swelled up and then subsided to normality.
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Arning, waiting for the vigorous body of a murderer to tell him what he wanted to know, found leprosy in the vigorous body of a priest. Between early 1884 and early 1885, it became clear that Damien was another of those "strong, robust men" in whom good health coexisted with the disposition to develop leprosy.
In the early 188os, Damien had begun to be bothered by pain in his left leg. Then, about the end of 1882 or the beginning of 1883, the outside of his left foot lost feeling, and became unresponsive to the touch. He could draw a line along the flesh where pain gave way to insensibility. By the early part of 1884, the condition was bad enough to give him pause about climbing the pali. At some point during the next several months, he was examined by a doctor, very likely Eduard Arning, and the result was ominous. By mid-September, Bishop Koeckemann was writing that he had been told, on medical authority, that Damien had leprosy.
The news was kept secret within the mission. In October, Charles Warren Stoddard visited Kalawao and spent several clays in Damien's company. Two doctors knowledgeable about leprosy were there at the same time: George Fitch, the Board of Health physician, making an official visit, and Arthur Mouritz, about to take up the post of resident physician. Stoddard heard nothing from them about Damien's condition, and nothing from Damien either, except for one oblique reference. Damien gave Stoddard a photograph of himself, not a very recent one: it showed Damien clean-shaven and without glasses, whereas the Damien that Stoddard saw was bearded and wore wire-rimmed spectacles all the time. Damien remarked of the photograph that it "looks like a leper," and Stoddard noted in his diary: "And so it does."
Eduard Arning prescribed some medicine for Damien. "I have taken the arcenica pill as by your advise," Damien wrote to him at the end of October, "but on account of the redness—appearing at my afflicted foot—y thought best to suspend there use a few weeks—I have resumed again—as they do not alter at all my good
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health, and intend to continue." Arning had also made some new medical equipment available to Kalawao. "I am anxious," wrote Damien, "to apply electricity every day, as soon as our machine has been put in order."
Damien was by no means ready at that point to give himself up passively to leprosy. "Dr. Mouritz—y hope will assist me in trying to stop—the progress of this incurable disease," he wrote to Arning, "... and with the help of the Allmight. your sery ... may be use full for many years to our people." Damien was not, in fact, ready to concede until the last moment that his disease really was leprosy, despite the scarcely veiled remark he had made to Stoddard early in October. Apologizing to Arning for "not having fulfiled my promis to send you a description of my own case," he went on: "I thought it is better to wait a little and see the progress of the disease—and if new indices appear to corroborate the verdict of true genuine leprosy. than it will be use full for science to take a detailed statement of all the circumstances."
The indices appeared in due course. Late in November, Arning probed Damien's foot and leg with an electrically-charged platinum needle, and found `the typical analgesia, with atrophy of the skin on the outer side of the left foot, accompanied by a swelling of the superficial peroneal nerve." Arning "did not conceal" from Damien his diagnosis, "which amounted to leprosy." Then, at the turn of 1885, Damien, in the course of a short visit to the mission at Honolulu, scalded his foot. Father Léonor Fouesnel telephoned for his own physician, Dr. George Trousseau, and Trousseau, not liking what he saw, telephoned Arning in turn, to have the finding confirmed.
Arning made one of his occasional visits to Kalawao in the spring of 1885. Early in May, he and Arthur Mouritz examined Damien thoroughly at the hospital dispensary, for leprosy, as well as for any "evidence of other diseases." There was no trace of other disease. In its own way, this was most important. It meant that, however Damien had contracted leprosy, it had not been by first contracting syphilis. That in turn meant that the moral diagnosis could not
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scientifically be applied to him. It was good to have this information, to be attested to if necessary, in view of the "syphilis-leprosytheory, which, as Mouritz said, was then "hypnotizing a certain part of the popular mind," and which he thought "might be invoked" in Damien's case.
As for leprosy itself, it was clearly there. No "striking changes" had occurred since Damien had last been examined, but the identifying marks had become visible on his forehead. Over the next few months, up to the fall of 1885, "a small leprous tubercle manifested itself on the lobe of the right ear," and the steady invasion of Damien's face began: "infiltration of the integument over the forehead and cheeks," "diminution and loss of eyebrows."
It was a year since Mouritz had first set eyes on Damien. The doctor had come ashore at Kalawao to take up his job as resident physician in the fall of 1884, and, like everyone else who saw Damien in those years, had been struck by his presence.
He was active and vigorous, of good physique, upright in his carriage, measured g feet and 8 inches in height, weighed zoo pounds, his chest was 41 inches in circumference, his hands and feet were shapely, although his fingers were stubbed and calloused from toil. ... His features were regular, his face fleshy, round, and of good dimensions; the color of his eyes brown, his hair black and abundant; his forehead of average breadth and height. He had a clear ringing voice, possessed a powerful barytone, and was a good singer.... The view of his full face gave the onlooker the idea of force, harshness and sternness, due in part to the squareness of his chin and lower jaw. His profile was handsome, was softer and more in harmony with the entire cast of his features than the view his full face presented. ... Having a wealth of hair, he roamed about bareheaded, resulting in his face becoming bronzed by exposure to the wind and sun's rays.
Now Damien, in all his strength, had leprosy. Leaving Europe for the islands in 1863, he had asked Our Lady of Montaigu for the privilege of twelve years in the missionary vineyards. Since then, he had been more than twenty years in the field; but in the special vineyard of Kalawao, it was twelve years and some months when the harvester of souls became part of death's certain harvest.
To a man such as Eduard Arning, Damien's leprosy was of clinical interest only another case, of undetermined origin. The bacteriologist was more interested in seeing if leprosy would declare itself in the powerful frame of his experimental subject, Keanu. And while he waited for this to happen, if it was ever to happen, Arning pored endlessly over the bodies of those in whom the disease was far advanced, photographing them for the sake of science; making casts of their deformed hands and feet; pressing the wet, white plaster down over their collapsing faces, to preserve disintegrating features in unchanging identity after leprosy had robbed them of the human look they were born with and grew into. Arning was only one step ahead of the disease. Leprosy in its severest form took away the senses one by one—taste and smell and touch and sight—leaving the victim at last only his hearing, so that he could do not much more than listen to his own breathing, until death pressed that out of him too.
Damien's leprosy was known to his priestly family in the islands; it was apparent to his family of Hawaiian parishioners at the settlement; how long it could be kept out of the newspapers was questionable. Somehow his first family, the De Veusters, would have to be told. But for the moment Damien could not bring himself to break the news to his aging mother.
He wrote home to Tremeloo in February, r885, after Arning and his platinum needle had confirmed the diagnosis, but before the marks on his forehead made the disease obvious to anyone who looked at him. The letter was addressed to his mother, his brothers, and his relatives. He spoke, in French, about why he was not writing in Flemish: "because without having forgotten our beautiful mother tongue, the expressions no longer come to mind." That
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in itself, he said, was one of the reasons why he did not write home often. Then, too, he said—rehearsing once more the passage he had made more than twenty years before from one family to another—"with the advance of age my ideas become more concentrated in the occupations of the Holy Ministry."
His own health, he said, was passably good, thanks to God. He was almost the same as usual; sometimes he let his beard grow; it was turning white. He talked about being caught in the rain one day, and having to cross "two torrents" to get home, and being bothered with a cold since then. And he spoke of another accident, of having scalded his foot with boiling water. For two weeks it was hard for him to say Mass; he had to preach sitting down. For a month, indeed, he could scarcely walk; and he used his carriage to get about. "Thus amid my sick people I play the sick man myself." But in a little while, he said, he would be cured: the injury was healing, the inflammation beginning to disappear, and new skin was forming. He made it sound like nothing very much, hardly anything at all; but then he spoke of trying to "bear his cross with joy—like Our Lord Jesus Christ," which would have been, for nothing but a scalded foot, an overblown comparison, especially coming from a man who all his life had exposed his body to extraordinary stress without complaint.
He spoke of health and sickness, aging and death, referring ostensibly' to his congregation, but in words that chose themselves because his own body was now fatefully involved. The phrase he used for his parishioners was ''Mies rneanbres maludes"—"my sick members"—hut the word "membrrs'' had also the meaning of "limbs": Damien was concerned, beneath the surface of the language, about "my sick limbs." He had, he said, already filled a cemetery with the dead. "Soon we will have to push the coffins down so as to bury others." And the word he used to describe the pushing down—"enfoncer"—was the same word he used to describe how he had accidentally plunged his foot into the boiling water.
He talked about death in the De Veuster family—Eugénie,
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Pauline, his father, all in heaven—and how he himself, for the glory of God and the salvation of souls, hoped to stay on at his post "until death." A doctor had advised him to go home for his health, and breathe the air of his native land; but then what would happen to his parishioners? He would stay with them, happy, content, "doing some little good." For that reason, he said, his family should not look forward too much to seeing him again in "this low world." He made his mother a joking invitation, writing a few words in Flemish for her: she should come to the settlement and spend her old age with him. She could help him cook—good coffee and plenty of eggs at Kalawao. And his brother Léonce, who had stayed at home on the farm—he would do well to set aside one of his many children to take Damien's place when he was gone, He finished by urging—again in Flemish—daily prayers for the reunion of the family in heaven.
Nowhere in the long, musing letter did he use the word "leprosy" about himself. He spoke instead about time and eternity; about the work of a priest; and about separations and reunions, exacted and promised by the procession of the generations in a family broken apart and brought together anew under the stringent demands and manifold blessings of the Sacred Hearts.
To Pamphile, Damien wrote separately, partly in English, partly in French; and again, at least to begin with, he used veiled words about his condition. Pamphile, still the scholar, never the missionary, had for some reason been asking about the Hawaiian language. Damien could instruct him in that, as Pamphile had instructed him long ago in Latin. Hawaiian, said Damien, was "the clearest and most agreable language ever y have studied." He spoke of his work, and of how he needed help: "Being trouble with a kind of nerf disease in my left foot traveling become difficult for me." In the settlement, with its seven or eight hundred leprosy cases, as soon as the dead were buried the government sent fresh sufferers. All were incurable. And here Damien linked his own case—his difficulty in traveling—with death by leprosy: "The only way out of here is by the cemetery road."
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Damien had not wanted to frighten his mother with the terrible name of his incurable disease. But Pamphile could be told; indeed, finally, there were special fraternal reasons that made it essential to tell him. Illness and priestly accomplishment were linked in the brothers' lives. Pamphile's typhus in 1863 had made the careers of the two Father De Veusters what they were, Pamphile's in the religious academy, Damien's at Kalawao. Late in 1884, Pamphile had written about a new illness of his own, something that seemed serious; and now Damien, early in 1885, answered in kind—and more than in kind. He was concerned, he said, to hear that Pamphile was ill, "and as you seem to be hinting that it could turn into consumption, which I hope God will not allow, I can no longer hide from you that I also am threatened with a disease still more terrible than consumption. Here I am, soon to be twelve years among the lepers—leprosy is a contagious disease. I do not think I have reason to complain of the visible protection that God has given me, the Holy Virgin and St. Joseph also count for something, because really I am still today strong and robust as you saw me when I left in 1863, with the exception of my left foot which three years ago lost almost all feeling. It is a secret poison which threatens to poison the whole body." In every sense, Damien's leprosy was a matter between the two brothers. "Do not gossip about it too much," he wrote, "but let us pray for one another." And, having once more outdistanced Pamphile, this time on the road to the cemetery, he signed himself, "your younger brother, J. Damien De Veuster."
Within the religious family, the priesthood and sisterhood of the Sacred Hearts, Damien felt more secure and certain of his place than ever. He was able to write to others who had taken vows like his that his leprosy was "anticipated from my first arrival into this leper asylum ... and voluntarely accepted before hand, and y hope that, helped by the prayers of many, our Lord will grant me the necessary graces—to carry my cross—behind him on our peculiar Golgota of Kalawao."
Writing to the father-general, he recalled a letter he had sent
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to the mother house in Paris several years before, suspecting "even then' that "the first germs of the disease were in my body. That was the natural and recognized consequence of a long sojourn among the lepers. Do not be too afflicted that one of your children should be decorated not only with the royal Cross of Kalakaua but also with the heavier and less honorable cross of leprosy. Our Lord has willed that I be stigmatized with it."
He was at yet another clearly marked stage in his passage from life to death. A quarter-century before, taking his vows at the mother house of the Congregation, he had lain beneath the burial pall and caught a glimpse of eternity. Going ashore in 1873 at Kalawao, his chosen land of exile, he recalled the ceremony. And now, in 1885, writing to Bishop Koeckemann, he returned to that same part of the Rule of the Congregation, which had begun by making itself the ruling image of his life, and had then persisted, to become his ruling passion. "It is the memory of having lain beneath the mortuary drape twenty-five years ago—the day of my vows—that led me to brave the danger of contracting this terrible disease in doing my duty here and trying to die more and more to myself ... the more the disease advances, I find myself content and happy at Kalawao."
Damien, first among the Sacred Hearts priests in the Hawaiian Islands to put himself consciously and continuously in the way of leprosy, had finally caught the disease. The question was to what degree he himself was responsible: to what extent he brought his fate upon himself, not alone by going to Kalawao, but by what he did with himself there. A priest could—must—always speak of resignation to God's will. A physician might take account of human behavior in other terms, and Dr. Arthur Mouritz did. "I have never seen," he wrote, "any other priest, doctor, or other contact, assume the same careless and indifferent attitude towards infec
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