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.