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During his short 9yr reign, he dealt with the alarming spread of leprosy. The Kingdom's Board of Health established a segregated settlement for housing and treatment of lepers at Makanalua Peninsula on Moloka'i. He commanded the construction of Hawaii's first hospital (Queen's Hospital). Kamehameha IV's son, 4-year old Prince Albert, died from an undiagnosed fever - which greatly depressed the King. A little more than a year later, Alexander Liholiho died at the age of 29.
The late King's brother, Lot Kamehameha, became Kamehameha V. Having served his brother as Minister of the Interior, he knew the political ambitions of non-native subjects and expatriates. Despised by court Christians, he was a "nativist" who did all he could to revive native traditions - such as hula and kahuna practices. Kamehameha V abrogated the Constitution of 1852, which weakened the powers of the monarchy, and declared a new constitution. This act was a bloodless and effective coup d'etat.
He established a Bureau of Immigration and constructed many public buildings such as the Central Post Office, the government building (Ali'iolani Hale), the Royal Household Troops housing ('Iolani Barracks) and a new Hotel (Hotel & Richards St.). He also negotiated the first friendship treaty with the Imperial Court of Japan. Kamehameha V never married or designated a successor. When he died in 1872, the 77 year Kamehameha Dynasty came to an end.
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