Jack London - The Cruise of the Snark

In Molokai the people are happy. I shall never forget the celebration of the Fourth of July I witnessed there. At six o'clock in the morning the "horribles" were out, dressed fantastically, astride horses, mules, and donkeys (their own property), and cutting capers all over the Settlement. Two brass bands were out as well. Then there were the pa-u riders, thirty or forty of them, Hawaiian women all, superb horsewomen dressed gorgeously in the old, native riding costume, and dashing about in twos and threes and groups. In the afternoon Charmian and I stood in the judge's stand and awarded the prizes for horsemanship and costume to the pa-u riders. All about were the hundreds of lepers, with wreaths of flowers on heads and necks and shoulders, looking on and making merry. And always, over the brows of hills and across the grassy level stretches, appearing and disappearing, were the groups of men and women, gaily dressed, on galloping horses, horses and riders flower-bedecked and flower-garlanded, singing, and laughing, and riding like the wind. And as I stood in the judge's stand and looked at all this, there came to my recollection the lazar house of Havana, where I had once beheld some two hundred lepers, prisoners inside four restricted walls until they died. No, there are a few thousand places I wot of in this world over which I would select Molokai as a place of permanent residence. In the evening we went to one of the leper assembly halls, where, before a crowded audience, the singing societies contested for prizes, and where the night wound up with a dance. I have seen the Hawaiians living in the slums of Honolulu, and, having seen them, I can readily understand why the lepers, brought up from the Settlement for re-examination, shouted one and all, "Back to Molokai!"

One thing is certain. The leper in the Settlement is far better off than the leper who lies in hiding outside. Such a leper is a lonely outcast, living in constant fear of discovery and slowly and surely rotting away. The action of leprosy is not steady. It lays hold of its victim, commits a ravage, and then lies dormant for an indeterminate period. It may not commit another ravage for five years, or ten years, or forty years, and the patient may enjoy uninterrupted good health. Rarely, however, do these first ravages cease of themselves. The skilled surgeon is required, and the skilled surgeon cannot be called in for the leper who is in hiding. For instance, the first ravage may take the form of a perforating ulcer in the sole of the foot. When the bone is reached, necrosis sets in. If the leper is in hiding, he cannot be operated upon, the necrosis will continue to eat its way up the bone of the leg, and in a brief and horrible time that leper will die of gangrene or some other terrible complication. On the other hand, if that same leper is in Molokai, the surgeon will operate upon the foot, remove the ulcer, cleanse the bone, and put a complete stop to that particular ravage of the disease. A month after the operation the leper will be out riding horseback, running foot races, swimming in the breakers, or climbing the giddy sides of the valleys for mountain apples. And as has been stated before, the disease, lying dormant, may not again attack him for five, ten, or forty years.

The old horrors of leprosy go back to the conditions that obtained before the days of antiseptic surgery, and before the time when physicians like Dr. Goodhue and Dr. Hollmann went to live at the Settlement. Dr. Goodhue is the pioneer surgeon there, and too much praise cannot be given him for the noble work he has done. I spent one morning in the operating room with him and of the three operations he performed, two were on men, newcomers, who had arrived on the same steamer with me. In each case, the disease had attacked in one spot only. One had a perforating ulcer in the ankle, well advanced, and the other man was suffering from a similar affliction, well advanced, under his arm. Both cases were well advanced because the man had been on the outside and had not been treated. In each case. Dr. Goodhue put an immediate and complete stop to the ravage, and in four weeks those two men will be as well and able-bodied as they ever were in their lives. The only difference between them and you or me is that the disease is lying dormant in their bodies and may at any future time commit another ravage.

Leprosy is as old as history. References to it are found in the earliest written records. And yet to-day practically nothing more is known about it than was known then. This much was known then, namely, that it was contagious and that those afflicted by it should be segregated. The difference between then and now is that to-day the leper is more rigidly segregated and more humanely treated. But leprosy itself still remains the same awful and profound mystery. A reading of the reports of the physicians and specialists of all countries reveals the baffling nature of the disease. These leprosy specialists are unanimous on no one phase of the disease. They do not know. In the past they rashly and dogmatically generalized. They generalize no longer. The one possible generalization that can be drawn from all the investigation that has been made is that leprosy is FEEBLY CONTAGIOUS. But in what manner it is feebly contagious is not known. They have isolated the bacillus of leprosy. They can determine by bacteriological examination whether or not a person is a leper; but they are as far away as ever from knowing how that bacillus finds its entrance into the body of a non- leper. They do not know the length of time of incubation. They have tried to inoculate all sorts of animals with leprosy, and have failed.

They are baffled in the discovery of a serum wherewith to fight the disease. And in all their work, as yet, they have found no clue, no cure. Sometimes there have been blazes of hope, theories of causation and much heralded cures, but every time the darkness of failure quenched the flame. A doctor insists that the cause of leprosy is a long-continued fish diet, and he proves his theory voluminously till a physician from the highlands of India demands why the natives of that district should therefore be afflicted by leprosy when they have never eaten fish, nor all the generations of their fathers before them. A man treats a leper with a certain kind of oil or drug, announces a cure, and five, ten, or forty years afterwards the disease breaks out again. It is this trick of leprosy lying dormant in the body for indeterminate periods that is responsible for many alleged cures. But this much is certain: AS YET THERE HAS BEEN NO AUTHENTIC CASE OF A CURE.

Leprosy is FEEBLY CONTAGIOUS, but how is it contagious? An Austrian physician has inoculated himself and his assistants with leprosy and failed to catch it. But this is not conclusive, for there is the famous case of the Hawaiian murderer who had his sentence of death commuted to life imprisonment on his agreeing to be inoculated with the bacillus leprae. Some time after inoculation, leprosy made its appearance, and the man died a leper on Molokai. Nor was this conclusive, for it was discovered that at the time he was inoculated several members of his family were already suffering from the disease on Molokai. He may have contracted the disease from them, and it may have been well along in its mysterious period of incubation at the time he was officially inoculated. Then there is the case of that hero of the Church, Father Damien, who went to Molokai a clean man and died a leper. There have been many theories as to how he contracted leprosy, but nobody knows. He never knew himself. But every chance that he ran has certainly been run by a woman at present living in the Settlement; who has lived there many years; who has had five leper husbands, and had children by them; and who is to-day, as she always has been, free of the disease.

As yet no light has been shed upon the mystery of leprosy. When more is learned about the disease, a cure for it may be expected. Once an efficacious serum is discovered, and leprosy, because it is so feebly contagious, will pass away swiftly from the earth. The battle waged with it will be short and sharp. In the meantime, how to discover that serum, or some other unguessed weapon? In the present it is a serious matter. It is estimated that there are half a million lepers, not segregated, in India alone. Carnegie libraries, Rockefeller universities, and many similar benefactions are all very well; but one cannot help thinking how far a few thousands of dollars would go, say in the leper Settlement of Molokai. The residents there are accidents of fate, scapegoats to some mysterious natural law of which man knows nothing, isolated for the welfare of their fellows who else might catch the dread disease, even as they have caught it, nobody knows how. Not for their sakes merely, but for the sake of future generations, a few thousands of dollars would go far in a legitimate and scientific search after a cure for leprosy, for a serum, or for some undreamed discovery that will enable the medical world to exterminate the bacillus leprae. There's the place for your money, you philanthropists.