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segregation law established a receiving leprosy hospital in Honolulu and isolation of lepers on the Kalaupapa peninsula of the island of Molokai. 55/ One out of every 39 (2.6 percent) of native Hawaiians was affected, whereas the occurrence in non-Hawaiians was one in 1,847. 56/ A peak of 1,310 active cases was reached at the end of the century, and over the 40 years since the start of segregation, an estimated 4,000 natives died of this affliction. 57/

  • In 1853, 1861, 1873, and again in 1882, smallpox took over 7,000 lives, in spite of compulsory smallpox vaccination in 1854. 58/
  • In 1857, an epidemic of colds, headache, sore throat, and deafness (influenza?) raged. 59/
  • In 1866, cough, chills, fever, vomiting, nose bleeding, and disability (dengue?) affected


  • In 1878-1880, whooping cough brought death to 68 in Honolulu. 60/
  • In 1888, whooping cough struck again with 104 lives, and in 1890 diphtheria. 61/
  • In 1889-1890, measles and dysentery killed 26. 62/
  • By the time of the overthrow of the monarchy in 1893, the native Hawaiian population was

reduced by 87 percent to about 40,000. 63/

Lack of Immunity, Genetic and Other Factors: Multiple factors probably accounted for the steep logarithmic decline in the population of the pure Hawaiian. 64/ Introduced infections, as cited above, in a people who lacked immunity because of their long isolation, not only explained high and irregular direct mortality, but could also explain the decreased birth rate. Local, genital, venereal, and other infections, and general, systemic infections probably impaired fertility in both men and women, increased early and late fetal deaths in utero, and contributed to neonatal and infant mortality, through indirect general debility and malnutrition. 65/

Latent genetic defects could have predisposed to reduced birth rates, 66/ and probably account for the natives' hypersusceptibility to chronic infections, aside from impaired immune mechanisms, such as in leprosy and tuberculosis. 67/

Other chronic metabolic illnesses, not readily or specifically diagnosable, especially among the maka'ainana, but related largely to conflicting life-styles, were probably also taking their toll. These disorders include arterial hypertension, atherosclerosis, heart, kidney, and lung failure, stroke, and diabetes, so prevalent among modern Hawaiians. 68/

Among the ali' i, these terminal illnesses were identified as follows: in 1854 Kamehameha III died at age 42 of convulsions and delirium that could have been a stroke; in 1863 Kamehameha IV died with asthma at the age of 29; in 1872, at the age of 42, Kamehameha V succumbed of "buttock abscess, dropsy and asphyxia;" in 1883, Princess Ke'elikolani died at age 57 of heart failure; in 1884, Queen Emma died of stroke at the age of 49; and in 1891, King Kalakaua died at the age of 54 of "Bright1s disease" (kidney failure). 69/


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