A Land and a Disease Set Apart
A Land and a Disease Set Apart
Abstract and Keywords
This chapter sets the historical context for this work in terms of the environment and landscape of the Hawaiian Islands in general and the island of Molokai and the Makanalua (Kalaupapa peninsula) in particular. Here the theme of Makanalua and maʻi lepera standing alone, or being socially, culturally, and historically set apart, is established. It also includes a general look at the disease of leprosy, placing it in the larger context of foreign diseases introduced to the Hawaiian Islands in the nineteenth century. A biomedical explanation of Hansen's disease, along with its cultural history, is offered. A general history of leprosy in Hawaiʻi is also outlined.
Nānā no a ka lā‘au ku ho‘okahi
“Look for the plant that stands alone.”
The Hawaiian Islands began to form several million years ago, and they lie some three thousand kilometers from the nearest continent.1 They are the most geographically isolated archipelago in the world, and, as one writer has noted, “more than any other factor, it is the isolation of these islands … that has shaped Hawai‘i’s natural history.”2 Indeed, it might also be said that more than any other factor, the remoteness of these islands has shaped Hawai‘i’s cultural and social history as well.
All plant and animal life had to come from somewhere else, blown by the wind or brought by the ocean currents. Likewise was the arrival of Hawai‘i’s first human inhabitants. Further, because of the islands’ isolation, its plant and animal life, and human culture, would each evolve in its own respective way. Through growth and erosion, evolution and decay, all life forms that came to the shores of Hawai‘i would shape, and be shaped by, its variety of environments.3 Just as Hawai‘i’s native plants and animals are unique to these islands “as a result of its isolation and speciation,” so was the development of the Hawaiian population and culture unique because of its isolation.4
It is thought that the first Polynesians migrated to the Hawaiian Islands sometime between 200 BCE and 400 CE. These early voyagers would have survived by gathering, lowland agriculture, and fishing. The cultivation of kalo (taro) would set many basic patterns for Hawaiian culture. For instance, the regulation of water, the location of houses, festivals and rituals honoring the gods, and daily eating habits were all influenced by this food staple. The Kānaka Maoli were exceptional engineers (p.18) and cultivators as they developed intricate networks of irrigation canals, built terracing walls and fishponds, and cultivated as many as three hundred types of kalo, as well as numerous varieties of ‘uala (sweet potatoes) and ipu (gourds).5
The ‘āina was not only essential to the survival of the Hawaiians, but it was also the basis of their cultural and social structure. The ‘āina was regulated by the ali‘i (chiefs) and home to the maka‘āinana (commoners, those who attend the land), who considered themselves kama‘āina (native born, born of the land). The land had personal status as an ancestor or progenitor, it was the place where the graves of ancestors, kulā iwi (the plain of one’s bones), were found, and it nurtured the people (the kama‘āina).6
Perhaps most important, Native Hawaiians viewed their ‘āina as a precious and limited resource, one that was to be used, but also one that required continual care. Certainly the early Hawaiians altered their environment, but they also held it in great respect.7 The environment was protected largely by the kapu system, which helped to regulate the use of the ‘āina. The kapu system, which distinguished what was sacred from what was not, in accordance with the Hawaiian gods, not only controlled but preserved all the resources available to Hawaiians, including the ‘āina.
It is evident in the oral traditions of Hawai‘i and the Pacific that two-way voyaging continued between Kahiki (beyond the horizon) and the Hawaiian Islands at least until the 1300s.8
Within that time period a significant wave of migration and settlement brought a more structured hierarchy to the islands. Thought to be introduced through the Tahitian kahuna (priest) Pā‘ao, the kapu system was established to regulate the relationships between the ‘akua and the ali‘i, the ali‘i and the ‘āina, and the ali‘i and the maka‘āinana.
Ruling chiefs competed for resources and challenged for power, and many strove not only for interisland kingdoms, but also to unite all of the islands under one. As the power of the ali‘i grew, four main island kingdoms emerged. While their specific parameters would increase or decrease with different ruling chiefs, they were essentially the kingdoms of Kaua‘i, O‘ahu, Maui, and Hawai‘i. Pi‘ilani of Maui was the first to establish an interisland kingdom. The great ali‘i Kahekili, also of Maui, in his wars against Kalani‘iopu‘u during the eighteenth century, was on the verge of uniting all the kingdoms. But unification of all the islands under one ruler would wait for another.
The nineteenth-century scholar Samuel Mānaiakalani Kamakau tells (p.19) us that many visitors came to the shores of the Hawaiian Islands. His historical writings speak of many travelers from “Kahiki” as well as of those foreigners who arrived during the days of Kahekili and Kalani‘ōpu‘u.9 Welcomed by the Kānaka Maoli, these foreigners first landed at Waimea on the island of Kaua‘i in 1778. They were the British crews of the Discovery and Resolution, led by Captain James Cook. They replenished their ships’ stores with fresh food and water, exchanged goods with the people of Kaua‘i, became involved in at least one violent encounter, and introduced the foreign diseases of syphilis, gonorrhea, and likely tuberculosis before continuing to head north to the western coastline of North America.10
Returning in November of that same year, the ships’ crews sighted O‘ahu, met with Kānaka Maoli off the shores of Maui, and then eventually looked to the island of Hawai‘i to find a safe harbor for the winter months. Kealakekua Bay provided the “refreshment” desired by these British voyagers; the encounter with these haole (strangers, non-Hawaiians)11 provided the Kānaka Maoli with both known and unknown exchanges—cultural, commercial, and biological. After leaving peacefully, Captain Cook returned a few days later because of a broken ship’s mast. His second visit to Kealakekua Bay culminated in his attempt to take Kalani‘ōpu‘u hostage and Cook’s subsequent death on February 14, 1779.12
In the midst of this encounter between Native Hawaiians and the British stood a young warrior by the name of Kamehameha Pai‘ea. Upon Kalani‘ōpu‘u’s death a few years later, his kingdom was inherited by his son, Kīwala‘ō. But as was common in preceding generations of Hawai‘i’s ruling chiefs, guardianship of Kūkailimoku (the island snatching/war god) was given to another—in this case Kamehameha.13 Thus, while Kīwala‘ō had been given the responsibility to govern, Kamehameha was given military responsibilities and the right to challenge Kīwala‘ō’s rule. After Kīwala‘ō was defeated at the battle of Moku‘ohai, Kamehameha continued to consolidate his power, first over the island of Hawai‘i. Then, one by one, he conquered the islands of the archipelago—with the exception of Kaua‘i. Kamehameha was thwarted first by storms in 1796 and then by the ma‘i oku‘u (squatting sickness) in 1804, but in 1810 Kaua‘i was ceded to Kamehameha by Kaumuali‘i, thereby completing Kamehameha I’s unification of the islands. The new Mō‘ī (Hawaiian monarch) had gained control over all the islands and was able to centralize not only his power, but also cultural systems, a tribute system, and the kingdom’s economy.
(p.20) Following the arrival of the British in 1778, the Hawaiian Islands were subsequently charted on European maps. In due course, many foreigners came to the islands during the days of Kamehameha I. Seen as a convenient stop, Hawai‘i became a crossroads of sorts for other explorers and for those engaged in the many facets of maritime trade throughout the Pacific. Merchants, traders, whalers, and settlers increasingly arrived on Hawai‘i’s shores. Their presence brought both subtle and dramatic changes to Hawaiian society. Most notable was the continued introduction of foreign infectious diseases. By the time of Kamehameha’s death in 1819, Hawai‘i’s population was already in serious decline (a 50 percent depopulation since 1778 by even conservative estimates).
Since 1989, debate concerning the pre-1778 population of the Hawaiian Islands has increased, reignited largely due to the efforts of David Stannard. In his work Before the Horror, Stannard challenged the prevailing estimates of Hawai‘i’s population prior to the arrival of Cook and others. Leading demographers, including Nordyke and Schmitt, have maintained that the Hawaiian population in 1778 should be estimated in the 200,000 to 300,000 range, 400,000 at the very most.14 Using conjecture, constructed population models, population growth rates, and depopulation ratios, Stannard not only deconstructed past estimates but provided a model that set the figure, conservatively, at 800,000 to 1 million in Hawai‘i in 1778.15 Most recently, however, archaeologists Patrick V. Kirch and Ross Cordy have convincingly argued that Hawai‘i’s population at the time of Captain Cook’s arrival was in the range of 300,000 to 400,000. Using methodologies in paleodemography as well as relying upon post-European contact records, their work challenges Stannard’s assertions while acknowledging that there are yet many unanswered questions.16
Even with the lowest estimates of the population at the time of Cook’s arrival, the subsequent rapid depopulation of the Hawaiian people (to fewer than 40,000 in 1896) is almost incomprehensible. As microbiologist and medical historian O. A. Bushnell explained in The Gifts of Civilization, “since 1778, infectious diseases introduced by foreigners have claimed more Hawaiian lives than all other causes of death combined.”17 Bushnell went on to suggest that it was the isolation of the Hawaiian Islands that produced such a cruel irony in terms of the health of the Hawaiian population. First of all, being so isolated from other populations, Native Hawaiians were spared the disease experience that so many other areas of the world contended with, and as a result of that lack of experience, Hawaiians did not develop the protective (p.21) antibodies that would have fought against the incoming disease pathogens.18 Simply put, Kānaka Maoli were vulnerable to the foreign diseases because they had never encountered them before. Secondly, the isolation and relatively comfortable environment of the Hawaiian Islands (one without overcrowding and pollution and without the presence of infectious disease) helped to produce a population in which both the weak and the strong (in immunological terms) would survive, and the islander was thus poised to become the victim of all foreign germs and diseases.19
After four decades of interaction with foreign explorers, merchants, traders, and settlers, Kānaka Maoli had experienced a great deal of change. Through conflict, foreign infectious diseases, out-migration, and exploitation of the sandalwood trade, the population had been severely reduced. Social, economic, and cultural facets of Hawaiian society were all significantly influenced. The island chain had gone from a competing sphere of kingdoms to one, unified by Kamehameha Nui (Kamehameha the Great). Encounters with foreigners challenged Hawai‘i’s land tenure system and social organization. Urban areas were expanding, and the introduction of capitalism disrupted traditional systems of subsistence.
With the arrival of more and more haole, foreign diseases, and new plants and animals, the isolation that had “at once created and protected these unique islands was forever lost.”20 Another factor in the spread of disease were the cultural changes taking place in the islands after the arrival of foreigners shattered their isolated existence. The kapu system had “maintained strict public sanitation and environmental protection,” and it provided an explanation for health and illness, leading some researchers to maintain that when the kapu system was no longer in effect (by 1819), the laws that governed personal hygiene and public sanitation were also abolished, promoting the pollution of person, home, land, and water and thereby inviting the spread of disease.21
Upon Kamehameha’s death, his son Liholiho was heir to the kingdom. Guardianship of the war god Kūkailimoku was given to Liholiho’s cousin, Kekuaokalani. Official dismantling of the kapu system took place in November 1819, when the ‘ai kapu (eating restriction) and its complex system was not reinstated by the young Mō‘ī. Liholiho’s reasons for not reinstating the kapu are thought to be complex, and they continue to be a source of debate. Whether it was to allow Ka‘ahumanu to consolidate her power, or to protect Liholiho’s (and thereby the Kamehameha line’s) kingdom from those who might challenge the new Mō‘ī, or a (p.22) necessity in dealing with the challenges of depopulation, not everyone agreed with the decision. Kekuaokalani challenged these actions, which metaphorically severed the connection between the ali‘i and akua,22 but this challenge came to an end with his death at the battle of Kuamo‘o. Thus Liholiho’s rule (i.e., house of Kamehameha rule) could never be challenged again, at least in the traditional sense. Both literally and metaphorically, Kūkailimoku was defeated, and the kingdom would there-after be inherited through lineage.
In the midst of this dramatic change of kingdom rule, Calvinist missionaries from the American Board of Commissioners for Foreign Missions (ABCFM) arrived from New England in March of 1820. The missionaries viewed the timing of their arrival as providential. They believed their purpose was to fill a spiritual vacuum, even though not all Kānaka Maoli had abandoned the ancient religion despite “official” proclamations and actions to that end. Yet, having been granted permission by the Mō‘ī to stay in Hawai‘i, the missionaries soon made their mark in the islands. They established schools in which they taught the English language, heluhelu (reading), and palapala (writing). The Roman alphabet was applied to the Hawaiian language and soon the Bible was translated into Hawaiian. Keōpūolani was the first of the ali‘i to convert to the Protestant faith; Ka‘ahumanu’s conversion came later but would hold a greater sway. As missionary influence spread, Liholiho wished to solidify his kingdom’s relationship with the British crown. To meet these ends, and he and his wife Kamāmalu sailed for England in 1823.
While visiting in London in 1824, Liholiho and Kamāmalu succumbed to measles. Before leaving the islands, the king had designated his younger brother Kauikeaouli to be Mō‘ī while he was gone. Kauikeaouli was only nine years old at the time, so Ka‘ahumanu, as Kuhina Nui, controlled the kingdom with the assistance of Kalanimoku. Following Liholiho’s death, Kauikeaouli was confirmed as Mō‘ī (as Kamehameha III) in 1825.
Molokai and Makanalua Peninsula
Formed by two large shield volcanoes, the island of Molokai is situated southeast of the island of O‘ahu.23 Traditionally, Molokai was known for its spiritual power and sorcery. It is said that the people of other islands stayed away from Molokai for fear that some evil might be cast upon them by the island’s kāhuna (priests). These kāhuna of Molokai (p.23) had a formidable reputation and were known to be the “most powerful in all the Hawaiian Islands.”24
Most of the inhabitants of Molokai lived along the southeastern coast of the island. Known for its fishponds, this coastland also had alluvial lowlands, gentle slopes, fertile soil, and adequate water resources such that the residents there also practiced wet-taro cultivation.25 While not as large as along the southeastern coast, a concentrated population also resided in the valleys along the northeastern coast of Molokai and at Makanalua. These populations were “politically distinct from the rest of the island,” and the resources available to them were not like those of the southeastern coast.26 Thus, prior to recorded encounters with foreigners in Hawai‘i, Molokai was developing in its own unique way apart from the other islands, and Makanalua was distinct from the rest of the island as well.
Kamehameha I conquered Molokai in 1795. The result of his conquest left Molokai “desolated and the population severely decreased,”27 and an epidemic in 1803 caused the population of the island to further decrease. It is thought that at the turn of the nineteenth century, the population of Molokai ranged from twenty to twenty-five thousand.28 Encounters with foreigners had introduced new diseases to the Hawaiian Islands, and in this regard Molokai would be no different from the other islands. By 1836, the island’s population had diminished to approximately six thousand, twenty-seven hundred of whom were said to reside in Makanalua and its neighboring valleys (e.g., Waikolu) to the east of the peninsula.29
Many factors contributed to the decrease in Molokai’s population. Certainly many were lost in the conflict when Kamehameha I took over the island, and foreign diseases further reduced the population. The sandalwood trade also forced many to leave their fields and go into the forests without proper provisions, weakening these people’s stamina and often leading to illness and death. Many of Molokai’s residents also migrated to Honolulu and Lahaina to participate in the whaling and trading economy. Whaling and trading ships rarely stopped at Molokai, which had only a few small harbors on the south shore, a lack of provisional supplies, and a lack of fresh water for the vessels. Together, these factors contributed to Molokai’s isolation. As a result, in the early 1800s Molokai gained the reputation as being the “Lonely Isle.”30
It has been speculated that the pali (cliffs) of the north side of eastern Molokai were formed by faulting that supposedly dropped the northern (p.24) portion of the shield below sea level. The only evidence that might support this hypothesis is the presence of the Makanalua volcano. Geologists admit that it is possible that the magma of the Makanalua volcano was brought to the surface by a fault. However, this theory is not generally accepted. Instead, it is believed that the pali that stands above Makanalua is a sea cliff, formed by the impressive “power of the waves driven by the trade winds across the open sweep of the North Pacific.”31 Further, it is believed that it took approximately one million years for erosion to form these spectacular cliffs.32
All those years ago, a small shield volcano, resting against the pali, formed the Makanalua peninsula.33 Today the volcano of Makanalua is indented at the top by Kauhako Crater. During the last eruptions that built the peninsula, lava rose almost to the top of the crater and then drained northward through a large lava tube, which later collapsed.34 The course of the collapsed tube is still visible today. Hardly touched by erosion, the Makanalua peninsula is fairly young (in geological terms) and is thought to have been formed some 345,000 to 570,000 years ago.35
This prominent peninsula stands out along the north shore of the island (see Fig. 1). Separated from “topside” Molokai by the ominous pali and surrounded by often rough ocean waters, it has been physically and symbolically set apart from the rest of the island since its formation.36 The remoteness of the islands in the vast Pacific Ocean and the apparent separation of Makanalua from the rest of Molokai had significant consequences in the history of disease in Hawai‘i. Remoteness of the islands rendered Kānaka Maoli susceptible to many foreign diseases in general, and the geographical and social setting apart of Makanalua would in particular dominate the history of leprosy in Hawai‘i.
Makanalua, the “double-gift,” is a peninsula with a rich history. A promontory with three districts, it is a land of cultural, historical, economic, and geographical importance. The ahupua‘a of Makanalua peninsula are particularly significant because, as Native Hawaiian historian, Lilikalā Kame‘eleihiwa explains:
Ideally, an ahupua‘a would include within its borders all the materials required for sustenance—timber, thatching, and rope from the mountains, various crops from the uplands, kalo from the lowlands, and fish from the sea. All members of the society shared access to these life-giving necessities.37
(p.25) Knowing that the Makanalua peninsula was divided into three ahupua‘a tells us that the resources available to the peninsula must have been plentiful enough to be able to support a large population.
Most of the lands of Makanalua are plains or sloping grounds between the mountains and the sea, known as kula lands. Makanalua’s plains are dry and need irrigation to cultivate crops.38 There are three valleys that lead down to the Makanalua peninsula or its shores, Waihanau, Wai‘ale‘ia, and Waikolu. Waikolu was a prime area for the cultivation of wetland kalo, and Waihanau and Wai‘ale‘ia were used seasonally for kalo cultivation as well.39 The kula lands of Makanalua were used primarily for growing ‘uala.40
The natural environment of Makanalua would have supported a large human population prior to the arrival of foreigners to the Hawaiian Islands. Such a population could have been sustained by the rich marine resources and the cultivation of kalo and ‘uala.41 Considerable historical evidence suggests the significance of the Makanalua peninsula in Hawai‘i’s history, as well as of extensive human settlement at Makanalua.
For instance, Hawaiian traditions tell us of a Mō‘ī of the island of Hawai‘i, Lonoikamakahiki, seeking shelter from a storm as he passed by Molokai in the late 1500s. On the northwest side of the island he “hauled up his canoes, and remained the guest of the Kalaupapa chiefs until better weather should permit him to leave.”42 This great chief was welcomed at Kalaupapa, and the resources available to him were more than sufficient.
Another tradition, from the 1700s, tells of a Mō‘ī of O‘ahu, Kuali‘i who became involved in a dispute between the Kona and Ko‘olau chiefs of the island of Molokai. The Ko‘olau chiefs had invaded the fishing grounds of the Kona side. Kuali‘i’s fleet, along with the Kona forces, “made their descent on Kalaupapa, where the Ko‘olau chiefs had collected. A well-contested battle was fought, the Ko‘olau chiefs were beaten, and … Kuali‘i returned to O‘ahu.”43 A close reading of these traditions suggests that the resources of Makanalua were both sufficient to feed the armies and were worth fighting over.
The archaeological remains found at Makanalua, including stone walls, terracing, and heiau (sacred spaces/temples) attest to the sizeable population that once lived upon the peninsula. Additional supportive evidence is derived from the accounts of visitors to the Kalawao and Kalaupapa settlements in the middle to late 1800s. A French botanist, Jules Remy, visited the hamlet of Kalawao and the large village of Kalaupapa (p.26) in 1854. He spoke of the cultivated land and of riding “through one village surrounded by fields of potatoes.”44
In the speeches that were given at the 1885 dedication of the Kapiolani Home for Girls in Honolulu (for girls who were born to leprous parents or who were suspected of having leprosy), many descriptions of the leprosy settlement at Makanalua were included. Robert J. Creighton stated that the Kalawao ahupua‘a “was evidently the seat of a dense population, and the old natives speak of it as being famous for its production of sweet potatoes and hogs.”45 He described the existence of a formerly large population as evidenced by “numerous stone walls, stone fences and break-winds; there being certainly not less than thirty to forty miles of such fences. Every little holding or kuleana was securely fenced off with stones gathered from the surface of the ground.”46 He spoke also of the cultivation of sweet potatoes and the “dense” population that lived upon this “precious” land.
In the early 1870s, the traveler Charles Nordhoff visited the Makanalua peninsula and later published his observations and experiences. He, like many others, would identify the entire island of Molokai as the place where those with leprosy would be sent, even though those with the disease were confined to the natural boundaries of the peninsula. Looking down at the peninsula from topside, he described Makanalua as “an absolute flat, bounded on three sides by the blue Pacific,”47 but once he had descended the pali he found it to have a much more rugged terrain. And while Nordhoff supposed that some (in 1873) might view the peninsula as “an absolutely sterile desert,” he explained that “here lived, not very many years ago, a considerable population, who have left the marks of an almost incredible industry in numerous fields enclosed between walls of lava rock well laid up.”48 He acknowledged the prevalence of ‘uala that had once been cultivated there, and he remarked that “within a quarter of a century more than a thousand people lived contentedly and prosperously, after their fashion.”49 By 1873, what remained of this formidable population was “about a hundred people, the remnant of the former population,”50 who preferred to remain “in their ancient homes”51 despite living among people who suffered from leprosy.
Another report about the population of Makanalua prior to its distinction as a settlement for those suffering from leprosy came from Jonathan W. Nakuino, a young Kanaka Maoli who was sent to the peninsula in 1878. In a letter he wrote to a friend in Honolulu, he claimed that Kalaupapa “looks as though it had been thikly [sic] inhabited a good (p.27) while ago. You may see numerous places where the land was formerly cultivated, and old foundations for houses.”52
It is thought that one of the reasons for the large population that resided on the peninsula in the mid-1800s was their success in producing ‘uala. Certainly, ‘uala and its cultivation played a significant role in the history of Makanalua prior to the peninsula’s being set apart as a leprosy settlement. Remy explained:
Not having seen in the fields of Kalaupapa coconut trees, pandanus, taro, I asked these people why these were not planted. They replied that it was not their custom, and as regards the taro, the ground was not suitable for its cultivation; it produced potatoes in any amount at will and these could be readily exchanged for products cultivated in Waikolu.53
Actually, ‘uala was exchanged far beyond Waikolu valley. In 1849, the influx of gold seekers to California, along with a growing neglect of agriculture there, created a demand in California for potatoes and other vegetables from places such as Hawai‘i. By the fall of 1849, California’s need would have a profound affect on agriculture in Hawai‘i. In 1849 Hawai‘i exported 306 barrels of sweet potatoes, but by 1850 that number had increased to 9,631 barrels, and in 1851, that number jumped to 56,717 barrels.54
The boom would end by the fall of 1851, but ‘uala would continue to be exported, albeit in smaller quantities. Nonetheless, Makanalua residents enjoyed a degree of prosperity cultivating ‘uala for the California market until the leprosy settlement was established in 1866. Indeed, researchers found that sometimes “ships from California would come directly from the mainland to Kalaupapa.”55 The peninsula’s fame as an exporter of ‘uala is further supported by the following quotation from Ka Hae Hawaii (The Hawaiian Flag, a Hawaiian-language newspaper) in 1857:
These are sweet potatoes from ancient times. Most of mine seen here in Kalaupapa are of these kinds…. These three mentioned above are much sold at Kalaupapa with the addition of some white and dark sweet potatoes…. Kalaupapa is a good land because the crops planted are successful and the gain is large. They are not eaten by caterpillars and cut worms. The number of animals from Kalaupapa to Waikolu are over a hundred, cattle, (p.28) horses, donkeys, and mules. They do not swallow these things because there is much grass…. Many sweet potatoes are being planted now, four or five patches to each man…. Kalaupapa is the best in all the islands for good prices and fast work. All the California ships come to Kalaupapa.56
But the ships that came to Kalawao and Kalaupapa from the mid-1860s onward would not be coming for ‘uala, but rather to bring patients to the peninsula. These new residents would leave an even greater mark upon Makanalua and its history than did the ‘uala that terraced its landscape.
Foreign Diseases in Hawai‘i
The Mo‘olelo of Lonopūhā
There is a Hawaiian mo‘olelo that tells of the arrival of some strangers from Kahiki in a time long before a written history was kept in these islands. It was said that the strangers traveled the length of the archipelago, from Niihau to the island of Hawai‘i. It was also said that wherever the strangers went, ali‘i and maka‘āinana alike suffered from diseases that included chills, fevers, and headaches. As the newcomers went from place to place, they were also followed by one who provided healing to those who were ill. His name was Kamakanui‘aha‘ilono, and he followed the men and women from Kahiki until they arrived in the district of Ka‘ū on the island of Hawai‘i.
While in Ka‘ū, Kamakanui‘aha‘ilono was welcomed with gifts of food and ‘awa. As he rested on a hillside, he watched a man with red skin who was working in the lo‘i ‘ai (taro patch) below. When Kamakanui‘aha‘ilono asked the people who the man was, they answered proudly, “He is Lono, our chief.”
As Kamakanui‘aha‘ilono was leaving, he told the people that their chief was sick, as was evidenced by his red skin, and that they should take care of him. The people protested that their chief was most healthy, but they still ran to tell Lono what the stranger had said. Angry that Kamakanui‘aha‘ilono had said such a thing, Lono lifted his digging stick, slammed it down, and accidentally drove the stick into his foot. Blood gushed from his wound, and Lono fell to the ground. His people were stunned and confused and did not know what to do. One grabbed a pig as an offering and ran after Kamakanui‘aha‘ilono, who eventually turned to see what all the ruckus was about. After hearing what had (p.29) happened, Kamakanui‘aha‘ilono agreed to help and hurried back to the kalo patch, gathering leaves and seeds on his way.
When he arrived at Lono’s side, “he pounded salt together with the popolo leaves and seed and placed the mixture on the wound with a covering of coconut cloth” to stop the bleeding. He then stayed with Lono until the wound from the digging stick had healed. Kamakanui‘aha‘ilono left once more and headed toward the district of Puna, where the visitors from Kahiki had gone. He soon heard someone following after him. It was Lono.
Kamakanui‘aha‘ilono asked Lono why he was following him. “I want to learn your art of healing. I have turned the village over to my heirs and want to follow you so that you may teach me,” was his answer.
Kamakanui‘aha‘ilono then said “Lono, open your mouth.”
Lono opened his mouth, and the kahuna spat into it as a sign of the knowledge the teacher would be giving to his student. Afterward, Kamakanui‘aha‘ilono added pūhā (sore) to Lono’s name, and he was thenceforth known as Lonopūhā. Kamakanui‘aha‘ilono and Lonopūhā followed the strangers from Kahiki through the districts of Ka‘ū, Puna, Hilo, and Hamakua. As they traveled, Lonopūhā learned to recognize and treat the diseases left by the foreigners.
When they neared Waipi‘o, the two parted so that Lonopūhā might further develop his own skills. He settled in Waimanu and treated those who were ill. With each new disease, Lonopūhā called upon his ‘aumakua (family guardians) for assistance, and he was given more and more knowledge. Soon, as his reputation for healing grew, others came to him to learn of these skills, and they in turn passed on their knowledge to future generations. Thus “Lonopuha became known as ka po‘o kahuna lapa‘au mua (the first head medical doctor) and the first ‘aumakua of the kahuna haha.”57
While there are various instructive elements to this mo‘olelo of Lonopūhā, the one most pertinent to this work is the reaction of the Kānaka Maoli to the foreigners and to the diseases they brought with them. Kānaka Maoli have a natural propensity to look to the past for direction on how to deal with the challenges of the present. Therefore, it is not surprising that with the great influx of foreign infectious diseases in the nineteenth century, both ali‘i and maka‘āinana often looked to foreigners for knowledge on how to treat the diseases these strangers had brought with them—just as the people of old had looked to (p.30) Kamakanui‘aha‘ilono for instruction on how to treat the diseases brought by the strangers from Kahiki. Unfortunately, the medical practitioners of the nineteenth century were less successful than Kamakanui‘aha‘ilono and Lonopūhā had been in their endeavors.
In his political history of Hawai‘i, the Hawaiian scholar Samuel Mānaiakalani Kamakau described one of the consequences of foreigners arriving on Hawai‘i’s shores:
[W]ith the coming of strangers, there came contagious diseases which destroyed the native sons of the land. No longer is the sound of the old man’s cane heard on the long road, no longer do the aged crouch about the fireplace, no longer do those helpless with age stretch themselves on their beds, no longer do they remain withering in the house like the cane-blossom stalks plucked and dried for the dart-throwing game. We are praying to God that we may reach the length of life of our forbears. We build churches, labor day and night, give offerings to charity and the Sabbath dues, but the land is become empty; the old villages lie silent in a tangle of bushes and vines, haunted by ghosts.58
This loss felt by many generations was largely the result of foreign diseases—their introduction to the Hawaiian population and the depopulation these diseases caused. The impact of this encounter (physical, social, cultural, economic, political) would be overwhelming, with far-reaching consequences still evident in contemporary Hawai‘i.
By 1865, when leprosy was of great concern to the Kingdom of Hawai‘i and to the Board of Health, Kānaka Maoli had already suffered greatly at the hands of many diseases brought by foreigners—explorers, traders, whalers, and settlers—to the Hawaiian Islands. Captain Cook and his men introduced venereal diseases and tuberculosis to Hawai‘i in 1778, and from that moment onward, Native Hawaiians would be assaulted again and again by a myriad of epidemics. There were three “[great] epidemics in Hawaiian history,” namely the ma‘i ‘okuu of 1804, the epidemics of 1848–1849 (which included measles, whooping cough, dysentery, and influenza), and the smallpox epidemics of 1853.59 These epidemics all contributed to the dramatic decline of the Hawaiian population, and many of them seriously challenged the economy and social fabric of the Hawaiian Kingdom as the population continued to decline with each invading disease.
Ma‘i ‘okuu was said to have “destroyed a great number of men, (p.31) women and children, and took off the majority (hapa nui) of the population” during the time of Kamehameha I.60 Yet while many scholars (physicians and historians) have analyzed the available secondhand accounts and popular traditions of the outbreak (along with suggested population demographics for the time it is thought to have struck), there is no clear consensus as to the Hawaiian name for the disease, where the disease originated, the range of its spread, how long it lasted, nor its final death toll.61 Indeed, it seems to have been called by many different names by Hawaiians, ‘okuu being the most common, because “the people ‘okuu wale aku no i ka uhane,’ i.e., dismissed cruely [sic] their souls and died.”62 Further, few are in agreement as to what the sickness truly was, although Asiatic cholera seems the most probable, and the death toll from the outbreak is estimated anywhere between five and fifteen thousand.63
The epidemics of 1848–1849 were some “of the most devastating in Island history,” claiming an estimated ten thousand lives (more than one-tenth of the population at that time).64 Measles and whooping cough struck first and simultaneously, followed by outbreaks of dysentery and influenza. Even though these diseases did not always cause death themselves, fatal complications often arose from the secondary effects of the infections.65
The smallpox epidemic of 1853 claimed the lives of five to six thousand people.66 In February of that year a ship, the Charles Mallory, arrived in Honolulu, “carrying at least one person still showing symptoms of smallpox.”67 That person was isolated on shore. The remaining six vaccinated passengers were also allowed to disembark after the mail and all baggage had been fumigated. The passengers all “took salt-water baths, had an entire change of clothes, and went into quarantine for two weeks.”68 The Board of Health took measures to confine the disease, and for the general good, they vaccinated the people in hopes of preventing the spread of the disease.69 Despite these efforts, smallpox still spread. By May, the disease raged in epidemic form that lasted until January 1854. In retrospect, this has become known as “ka wa hepela”—the smallpox time.
Smallpox came to Honolulu again in 1881, whereupon the “Board of Health sought by prompt action, a vigorous quarantine and restriction on inter-island travel to confine its ravages,” and fortunately the disease did not spread beyond the island of O‘ahu.70 This time the epidemic lasted approximately five months and resulted in 282 deaths.
Table 1 Epidemics and Depopulation in Nineteenth Century Hawai‘i
Native Hawaiian population
ma‘i oku‘u (the squatting sickness)
“cough, congested lungs, sore throat”
(*) The 1778 Hawaiian population of 800,000 is based on the work of David Stannard in Before the Horror: The Population of Hawai‘i on the Eve of Western Contact. Subsequent population numbers are based on census records of the Kingdom and Republic of Hawai‘i.
(p.33) introduction of many other diseases as well. Most simply carried away their victims, adding to the rapid and disturbing decline of the Native Hawaiian population. Yet one disease that reached epidemic proportion granted its victims a slow death. Despite its slow progression, its impact on the social and cultural foundation of the islands made it one of the most significant in Hawaiian history.
Leprosy in Hawai‘i
It is thought that leprosy (known as ma‘i lepera, ma‘i pake, ma‘i ali‘i, and later ma‘i ho‘oka‘awale ‘ohana) came early to the Hawaiian Islands, but it did not attain levels of great concern until the 1850s and 1860s. Thousands of victims of leprosy (90 percent being Native Hawaiians) would suffer in confinement on the Makanalua peninsula.71 While many diseases, such as cholera, influenza, and tuberculosis, were responsible for Hawaiian depopulation, and many others, such as smallpox, measles, and venereal disease, attacked the surface of the body, it was leprosy that was visually the most disturbing and lingered the longest.
Although new to Hawai‘i, leprosy itself had a long history. Leprosy was set apart from other diseases because of the way it affected the human form and because of the stigma that had been attached to the name in the Judeo-Christian tradition.72 The other diseases either took one’s life quickly or one recovered from them with few lasting visible signs. But leprosy lingered and disfigured, its cause was unknown, and it was commonly believed to be highly contagious.
Leprosy’s origins in the islands are said to be traceable back to the 1830s. A persistent myth described it as having been introduced to the islands by Chinese immigrants; thus the disease came to be known as ma‘i pake (the Chinese sickness). Its incidence among, and association with, Hawaiian royalty also earned it the name ma‘i ali‘i (the royal sickness).
Ambrose Kanoeali‘i Hutchison, a Hawaiian patient, was sent to Makanalua in 1879, and he remained there until his death in 1932. Hutchison wrote a memoir of his experiences at the leprosy settlement, and in it he connects the two names for the disease. According to Hutchison, the disease was introduced to Hawai‘i by a Chinese man (thus ma‘i pake) who had come to the islands during the sandalwood trade era (1812–1830) and later became a cook for the ali‘i, Naea (a member of the council of chiefs of nobles), in the days of Kauikeauoli (Kamehameha III).73 Soon after the Chinese cook died of the disease, Naea was (p.34) diagnosed by Dr. Hillebrand of the Board of Health as having contracted it as well (thus ma‘i ali‘i). According to Hutchison, Dr. Hillebrand was called to the council of nobles, and he informed the king and chiefs that this was “a disease prevalent among the different races of people on the Asiatic continent. An incurable, contagiuous [sic] disease, and the only remedy known to prevent the spread of the disease is isolation of the afflicted from the well.”74 Naea was isolated in Wailuku, Maui, with his attendants, where he lived as “the first known leper,”75 and where he died in 1854. As Hutchison interprets it, Naea’s attendants then scattered throughout the islands after his death, spreading the disease and creating the epidemic.
Aside from Hutchison’s mo‘olelo, another rumored case of leprosy occurred in 1835, attributed to a Hawaiian woman, Kamuli, from Koolau, Kaua‘i.76 As early as 1823, missionaries noted medical cases that may have involved some aspects of leprosy, though its confusion with early stages of syphilis tend to discount their accuracy. Although it may never be certain how or when leprosy was brought to the islands, its early incidence in Hawai‘i has most often been associated with Chinese immigrants. Two reasons support this association: Chinese persons were counted among those who had the disease, and Chinese immigrants were more familiar with the disease because it was endemic in their homelands. Some believed that leprosy was imported by Chinese workers who were brought to the islands, but many individuals arrived from other lands where leprosy was also endemic, thus it could feasibly have come from any number of sources (including the Azores, Africa, India, Malaysia, or Norway).77 It should also be noted that many Hawaiians were traveling abroad by this time, often as crew members on whaling ships, and could have brought the disease back to the islands upon their return.78
A Board of Health was organized by Kauikeaouli in 1850 and charged with the prevention and cure of epidemic diseases. Although leprosy had been present in the islands from the beginnings of his reign, no mention of the disease appears in official records prior to his death in 1854. During the reign of Alexander Liholiho (Kamehameha IV), leprosy was not mentioned until April 1863. At that time, William Hillebrand, medical director of Queen’s Clinic in Honolulu, reported that he was encountering many cases of leprosy at the hospital, and he admonished the next legislature to “devise and carry out some efficient, and at the same time, humane measure, by which the isolation of those affected with this disease can be accomplished.”79
(p.35) Lot Kapuāiwa (Kamehameha V) ascended the throne November 30, 1863. At the next Board of Health meeting, December 28, 1863, concern over ma‘i pake was raised, and by February 10, 1864, it was noted that the disease was spreading to the other islands. Questions as to the origin and inheritable nature of the disease were growing.80 It is within this context of alarm and concern for prevention of leprosy that a policy for quarantine and isolation of those with the disease was approved.
On January 3, 1865, the Mō‘ī signed An Act to Prevent the Spread of Leprosy, determining that a hospital for the treatment of mild cases would be established at an isolated peninsula on the island of Molokai. Isolation, or quarantine, was the only proven method of disease prevention at the time, and by the end of the nineteenth century the disease became generally known as ma‘i ho‘oka‘awale ‘ohana, or the disease that separates family. Significantly, Native Hawaiians did not name the disease for what it physically did to their bodies, but rather for what it did to their ‘ohana. Moreover, as it separated them from their families, it was a disease that set those who suffered from it apart from the rest of society for the remainder of their lives.
In the Makanalua peninsula’s more than one-hundred-year history as a leprosy settlement, some seven to eight thousand people were taken from their homes and families and exiled there, first to the settlement at Kalawao and later Kalaupapa, 90 percent of these exiles being Native Hawaiians.81 Surrounded by steep cliffs and treacherous ocean, the peninsula served as a “natural prison” and soon gained the reputation of serving as a “living tomb.”
Secondary historical writings that reflect upon this period in Hawaiian history state that Kānaka Maoli had no fear or disgust of leprosy, nor of those who had it. What they did fear, however, was the compulsory banishment to Kalawao and Kalaupapa, the public health officials who sought to send them to Makanalua, and the often negative treatment by a fearful non-Hawaiian community that often shared power with, and greatly influenced, the Board of Health and the Hawaiian monarchs.
A Land and a Disease “Set Apart”
The Act to Prevent the Spread of Leprosy gave the president of the Board of Health the authority “to reserve and set apart any land or portion of land … to secure the isolation and seclusion of such leprous persons as in the opinion of the Board of Health or its agents, may, by being (p.36)
(p.37) at large, cause the spread of leprosy.”82 While Palolo valley and Makiki, on the island of O‘ahu, were both considered as possible locations for this place of “isolation and seclusion,” it was ultimately the peninsula on the northern side of the island of Molokai that was chosen as the place to send those who were suffering from the disease. That peninsula, traditionally known as Makanalua, had a history of being set apart: geologically, culturally, politically, and economically, and as of 1865 it was socially set apart as well. The seclusion of the peninsula would be a key factor in its history, both before 1865 and after.
Most histories of Makanalua begin with the history of leprosy in the islands of Hawai‘i. However, a history of the peninsula, and indeed the history of leprosy in Hawai‘i, should begin long before the 1860s. According to Hawaiian mo‘olelo, the Hawaiian Islands were created by Wākea (sky father) and Papahānaumoku (she who births the islands). Some versions of the mo‘olelo claim that the island of Molokai was created by Wākea and Hina.83 Other legends speak of all the islands being fished from the ocean by the demigod Maui. Still others, particularly concerning the creation of Molokai, involve Hina but not Wākea. And there is one legend that speaks of Pele’s involvement in the creation of the Kauhako Crater found at Makanalua, Molokai. Regardless of which mo‘olelo is applied, it is clear that from the Hawaiian worldview, the Hawaiian gods are connected to the creation of the islands, including Molokai, and even to specifics found at Makanalua; thus kama‘āina connections to these lands would have been significant.
The Makanalua peninsula is divided into three ahupua‘a (districts). Kalawao to the east can be interpreted to mean “announce mountain area.” In the center of the peninsula is Makanalua district, which can be translated as “double gift.”84 It has also been said, however, that the name means “given grave” or “pit.” The connotation of “given grave” or “pit” is explained as a reference to the use of the lake in Kauhako Crater as a burial site.85 The third ahupua‘a, Kalaupapa, translates as “the flat leaf” and is the name by which most refer to the peninsula and settlement found there today. It is understood that each of these placenames is significant and may have more than one meaning.
The history of the Hawaiian Islands and of the Hawaiian people is one that echoes a theme of being set apart throughout its existence: set apart in its creation, in its geographical remoteness,86 in the development of its unique culture, and through its encounters with foreigners and all they brought with them. This theme continued into the history of the Makanalua peninsula on Molokai, its creation and geographical isolation, (p.38)
When the Makanalua peninsula was chosen as the location to send those with leprosy, the patients first lived at Waikolu valley, and then Kalawao.87 Located on the east side of the peninsula, Kalawao receives a lot of rain, but the high pali above blocks it from the sun’s rising and setting. By 1866, when the first patients arrived, there were few kama‘āina living at Kalawao. Some were living in Waikolu, and those who had remained on the peninsula were mainly living at Kalaupapa, on the western side of the peninsula. The Hawaiian Board of Health expected the first patients to remain at Kalawao and to fend for themselves. But they were the most advanced cases and had little strength to be caring for themselves or those around them.
In the 1860s Kalaupapa was primarily known as a fishing village. Those Kānaka Maoli who still lived in Waikolu were cultivating kalo for their subsistence, whereas those at Kalaupapa also grew kalo and ‘uala. They lived on their kuleana (piece of land) and were reluctant to leave simply because the government was sending leprosy patients to the Kalawao side of Makanalua. Many of the kama‘āina of Makanalua remained there until the 1890s, when the government forced them to leave and resettle on the southeastern shore of Molokai.
Whether first at Waikolu and Kalawao, or later at Kalaupapa, these settlements soon became synonymous with leprosy. The Native Hawaiian population of the peninsula had already declined considerably because of disease and economic and political changes, and their native residents became displaced even further as yet another foreign disease began to ravage the Hawaiian population on all the islands. The new residents, sufferers of leprosy, were given a place to live and die—at Makanalua—out of sight from the healthy segment of the population.
Even in the leprosy settlements at Kalawao and Kalaupapa, rules of separation evolved. Mea kōkua (helpers) were set apart from those they came to care for, both physically and socially. Later policies separated children from their parents. Doctors, priests, and nuns also kept physical barriers between themselves and those for whom they provided care.88 Although they were regarded as an integral part of the community, authorities viewed them as being apart from it.
Even the sufferers of leprosy developed degrees of separation among themselves. Those who could no longer care for themselves were put into the hospital (in the beginning, a crude building without beds). Those deemed beyond care were set apart and taken to the ho‘opau (p.40) keaho, otherwise known as the “dying hut.”89 In Kalawao, next to St. Philomena’s (the Catholic church), those who died were also set apart in burial; the “clean” with marked graves within the graveyard, most leprosy patients (considered as “unclean”), were laid in unmarked graves outside the cemetery walls.90
By the nineteenth century, Westerners concerned with the “imperial dangers” of diseases such as leprosy in places like India and Hawai‘i had accepted a socially constructed understanding of leprosy and acted upon that understanding. As they perceived it, leprosy was “God’s punishment for dark, hidden thoughts, words and deed, usually involving disgusting forms of sex.”91 Moreover, they viewed those with leprosy as more in need of moral cleansing than of medical care, thus most of the work among the diseased was done by missionaries, missionary doctors, and religiously motivated volunteers. During this time of “imperial danger,” leprosy seemed to be found most commonly in the tropics and among certain ethnic groups that were particularly susceptible. Given this pattern of disease, debates erupted concerning the hereditary nature of the disease and whether or not confinement of those afflicted was necessary.
In 1862–1863, arguments against confinement of leprosy patients included “a committee of the Royal College of Physicians [who] decided that leprosy, historically amongst the most feared contagions, was a hereditary disease and recommended that ancient leper statutes be repealed.”92 The British committee was responding to a request from colonial officials in the West Indies as to whether confining those with the disease was justified. Throughout the world of Western influence, the debate as to the hereditary or contagious nature of the disease continued, infused as much with medical understandings as with the socially constructed views of the disease.
When leprosy became prominent in Hawai‘i in the mid-1860s, disease theories and medical practices were quite diverse. Both conflicting as well as shared ideas existed in the world of medicine, but what most Western medical practitioners agreed upon was that empiricism should be relied upon more heavily than theory. In other words, physicians were relying upon experience and observation to build up their medical knowledge and evidence-based practice, often avoiding “theory.”93 When theory prevailed, the most popular ones concerning disease and germs supposed that contaminants arose within the body.94 But just as significant, according to medical historian Michael Worboys, “doctors saw the external environment as an important factor in the origin and (p.41) development of all manner of internal diseases, acting directly on tissues, as with the effects of colds and chills, or indirectly, as when predisposing the body to particular conditions, as with dampness.”95
While most physicians would have been aware of developments in the field of medicine, probably through contact with their colleagues or through widely distributed medical publications, few would have had the opportunity to make their own investigations. The modern concept of the “germ theory of disease” therefore did not begin to take hold until the 1870s. It should be noted, however, that during this era, several germ theories of disease existed. Further, many “existing medical and sanitary procedures, such as disinfection, isolation, antisepsis, anti-inflammatory remedies and vaccination” that would be specified as germ theories were further redefined and elaborated after 1865.96
In the mid-1800s, a dominant metaphor in germ theories of disease and health was “the botanical one of ‘seed and soil.’”97 That is, some speculated that disease-causing germs would plant themselves in soil that was conducive to their growth. The implications of such metaphors on the understandings and representations of a population such as the Native Hawaiians would be far-reaching. Essentially, the Euro-American contingent tended to view Native Hawaiians as poor, unsanitary, uncivilized, and unclean—a “soil” in which the “seeds” of disease could grow quite readily. The continual onslaught of epidemic disease was proof of that theory for many of the foreigners, and the Euro-Americans justified their presence in the islands by implementing Western ways of dealing with disease, that the “dying race” might be “saved.”98 For many, leprosy was the prime example of a disease finding a rich “soil” in which to grow, and it provided Euro-American residents with an opportunity to exercise their understandings of the disease and how it should be treated.
The stigma leprosy derived from the Western/Judeo-Christian tradition is a strong and negative one. Adding to this stigma were foreign perceptions that Hawaiian culture was uncivilized, immoral, and lascivious. Euro-American writers often considered Native Hawaiians to be in “want of cleanliness” and having insufficient or poor diets.99 Further, its early association with syphilis led many to perceive leprosy as a sexually transmitted disease, and a fit punishment for the “promiscuous” Hawaiians.100
Throughout its history, there has been serious disagreement with respect to how leprosy was transmitted from one person to another, whether it was hereditary or contagious, and, if contagious, just how (p.42) infectious it was or was not. In the late nineteenth century, leprosy was increasingly moralized as a just punishment for a corrupt and diseased society. Many in Hawai‘i discussed how the disease was caused by divine wrath or that it was due to sexual intercourse with an infected woman.101 This perception of its etiology came to be seen as indigenous and was situated in the promiscuous sexuality of the culture. In a paper read to the Honolulu Social Science Association in 1888, Rev. S. E. Bishop’s discourse was typical of foreign judgments of the time. In answer to the question, “Why are the Hawaiians Dying Out?” Bishop reasoned the causes in the following order: unchastity (among females as well as males), drunkenness, oppression by the chiefs, infectious and epidemic diseases, kāhuna and sorcery, idolatry, and wifeless Chinese. He refers to Hawaiians mingling “freely with lepers” and their regarding the “segregation of their leprous relatives as a cruel and uncalled for severity,” yet, he notes, this is “only one illustration of the habitual indifference of this people to sanitation, whether in physics or in morals.”102 To most haole, Hawaiians’ social relationships, sexual mores, religion, diseases, medicines, and kāhuna were subjects for disapproval if not outright condemnation.103 Because Native Hawaiians were more apt to contract leprosy than were the foreigners in Hawai‘i, some deemed that the Hawaiian diet was to blame. The native food staple, poi (the food, not just the act of eating it), was suspected by some to be the very root of spreading the disease.104
Relatively slow in its progress, leprosy is a severe disease, devastating in its pathology, disfiguring in its attack. While it usually does not precipitate death itself, leprosy brings death with it. At first attacking the cooler parts of the body (i.e., hands, feet, fingers, face, earlobes), the bacteria damages the peripheral nerve tissue, often destroying skin and mucous membranes. Because of this, leprosy sufferers are prone to ulcerations as well as to wounds that often lead to infection. As the disease progresses, the inability to move the hands or feet, the unceasing deformity of the feet, exacerbated difficulty in breathing (the bacteria attacks the larynx), and progressive blindness may result. The combination of nerve damage and diminished immune response often lead to the visible disfigurement to which others in society often react—collapse of the nose, thickening of the skin, loss of eyebrows. Further, the immune system of the leprosy victim is also compromised, leaving the sufferer susceptible to other infectious diseases, including tuberculosis, influenza, pneumonia, and measles.
Those with leprosy in nineteenth-century Hawai‘i (90 percent of (p.43) whom were Native Hawaiian) would ultimately suffer the loss of life; however, because of the social and cultural construction of the disease during this time, a much greater loss was often experienced long before the finality of physical death. Indeed, the very act of sending Kānaka Maoli with leprosy to the Makanalua peninsula not only resulted in the separation of ‘ohana, but it also contributed to challenging, and some-times severing, the connections between the maka‘āinana, ‘āina, and ali‘i that were part of a larger cultural imperialism at work in nineteenth-century Hawai‘i.
Disease, Displacement, and Death
When the Act to Prevent the Spread of Leprosy was signed by the Mō‘ī, Kamehameha V, in 1865, and implemented by the Board of Health in the Hawaiian Kingdom, little was truly understood about leprosy and its transmission. It was not until 1873 that Gerhard Henrik Armauer Hansen, a Norwegian bacteriologist, discovered the leprosy bacillus. His discovery began to disprove the theory that leprosy was hereditary and focused future research on its nature as an infectious disease as well as on a potential antibacterial cure.105
Again, because of Hawai‘i’s history of isolation, infectious diseases introduced into the Hawaiian Islands after 1778 contributed to the rapid depopulation of Kānaka Maoli. This loss of the aboriginal population allowed foreigners to gradually displace the Hawaiians—economically, politically, socially, and culturally—in what scholars term “settler colonialism.”106 In various ways, the Act to Prevent the Spread of Leprosy assisted in that displacement of Native Hawaiians. Both the disease, and the law that was instituted to stop it, left their marks on the bodies of Kānaka Maoli and on the ‘āina from which they were taken and to which they were sent. Leprosy forced the removal of the original inhabitants from the Makanalua peninsula, and it forced the removal of those suffering from leprosy from their homes in the various islands to the isolated peninsula on Molokai’s north shore.
Leprosy caused physical, social, and cultural disruption. It was devastating from many perspectives. Thus when Ka‘ehu the chanter asked,
- E aha ‘ia ana o Hawai‘i
- I ne ma‘i o ka lēpela,
- Ma‘i ho‘okae a ka lehulehu
- A ka ‘ili ‘ula‘ula ‘ili ke ‘oke‘o?
- (p.44) …
- Ha ‘ina mai ka puana
- Nō nei ma‘i o ka lēpela
- What will become of Hawai‘i?
- What will leprosy do to us/our land—
- Disease of the multitudes; despised, dreaded alike
- By white or brown or darker-skinned?
- So ends my song and this refrain.
- What will leprosy do to my people?
- What will leprosy do to our Land?107
he was crying out not only against the disease itself, but also against the displacement it has caused and its subsequent devastating effects, to bodies and to families and to the future of Hawaiians.
As a result of the depopulation and displacement of its residents, Makanalua suffered as well. Being set apart physically and culturally, the peninsula challenged its new residents as they struggled to manage its resources and survive in apparent isolation. Ma‘i lepera was a
Faced with the most challenging of circumstances—separated from family and taken from their homes to begin anew on the peninsula known as “a natural prison”—Native Hawaiians and others who contracted the disease demonstrated their resilience as they found ways to remain connected to the larger community from which they had been separated, formed a new community, maintained their values, and survived as best they could until death did take them. In these ways, the patients of the Kalawao leprosy settlement set themselves apart in ways that we are only beginning to understand.
(1.) Gordon A. Macdonald, Agatin T. Abbott, and Frank L. Peterson, Volcanoes in the Sea: The Geology of Hawaii, 2nd ed. (Honolulu: University of Hawai‘i Press, 1983), 1.
(2.) David L. Eyre, By Wind, By Wave: An Introduction to Hawai‘i’s Natural History (Honolulu: The Bess Press, Inc., 2000), 6.
(6.) Patrick V. Kirch and Marshall Sahlins, Anahulu: The Anthropology of History in the Kingdom of Hawaii, 2 vols., vol. 1 (Chicago: The University of Chicago Press, 1992), 31.
(8.) Teuira Henry and others, Voyaging Chiefs of Havai‘i (Honolulu: Kalamakū Press, 1995); “Kahiki” has many interpretations including “homeland” or a place beyond the horizon, and for many denotes Tahiti or the Marquesas.
(11.) Haole is a term that formerly referred to any foreigner, but today it is most often used in connection with non-Hawaiians of Euro-American descent. My use of the term is in reference to foreigners of Euro-American descent who came to the islands with prevailing Western attitudes and perspectives, and is not meant to be derogatory. See Pukui and Elbert, Hawaiian Dictionary, 58.
(12.) George Gilbert, Captain Cook’s Final Voyage: The Journal of Midshipman George Gilbert, ed. Christine Holmes (Honolulu: University Press of Hawai‘i, 1982). Kalani‘ (p.213) opu‘u was the highest ranking ali‘i on the island, and Captain Cook’s attempt to take the revered chief hostage in an effort to retrieve a missing longboat was perceived as an act of aggression.
(13.) Kamakau, “The Story of ‘Umi,” in Ruling Chiefs of Hawaii, 1–21.
(14.) Eleanor C. Nordyke, The Peopling of Hawai‘i (Honolulu: The University Press of Hawai‘i, 1989); Robert C. Schmitt, Demographic Statistics of Hawaii: 1778–1965 (Honolulu: University of Hawai‘i Press, 1968).
(16.) Patrick V. Kirch and Jean-Louis Rallu, “Long-Term Demographic Evolution in the Pacific Islands: Issues, Debates, and Challenges”; Patrick V. Kirch, “Like Shoals of Fish: Archaeology and Population in Pre-Contact Hawai‘i”; Ross Cordy, “Reconstructing Hawaiian Population at European Contact: Three Regional Case Studies,” all in Patrick V. Kirch and Jean-Louis Rallu, eds., The Growth and Collapse of Pacific Island Societies: Archaeological and Demographic Perspectives (Honolulu: University of Hawai‘i Press, 2007).
(21.) Richard Kekuni Blaisdell, “Historical and Cultural Aspects of Native Hawaiian Health,” in Social Process in Hawai‘i: A Reader, ed. Peter Manicas, 40–41, 46 (New York: McGraw-Hill, 1993).
(24.) Lucille DeLoach, “Molokai: An Historical Overview,” in Molokai Studies: Preliminary Research in Human Ecology, ed. Henry T. Lewis, 123 (Honolulu: Department of Anthropology, University of Hawai‘i, 1970).
(28.) Schmitt, Demographic Statistics of Hawaii: 1778–1965, 42. However, DeLoach’s research places the population as low as eight to nine thousand at that time. DeLoach, “Molokai: An Historical Overview,” 125.
(32.) David A. Clague et al., “Age and Petrology of the Kalaupapa Basalt, Molokai, Hawaii,” Pacific Science 36, no. 4 (1982): 417.
(p.214) (36.) Since 1980, the peninsula has continued to be set apart, now as a National Historical Park.
(38.) E. S. Craighill Handy and Elizabeth G. Handy, Native Planters in Old Hawaii: Their Life, Lore, and Environment (Honolulu: Bishop Museum Press, 1972), 55.
(39.) Gary F. Somers, Kalaupapa, More Than a Leprosy Settlement: Archeology at Kalaupapa National Historical Park (Western Archeological and Conservation Center Publications in Anthropology No. 30, 1985), 12.
(44.) M. Jules Remy, Journal De M. Jules Remy, Naturaliste-Voyageur De Museum, trans. Mildred M. Knowlton (Arcis-sur-aube, France: Imprimerie Leon Fremont, 1893), 20, 22.
(45.) Robert J. Creighton, “Molokai: Description of the Leper Colony on This Island,” in Dedication of the Kapiolani Home (Honolulu: Advertiser Steam Print, 1885), 35.
(47.) Charles Nordhoff, Northern California, Oregon, and the Sandwich Islands (Berkeley, Calif.: Ten Speed Press, 1974), 100.
(49.) Ibid. In 1853, the population of the entire island of Molokai was estimated at 3,607, thus a population of 1,000 on the peninsula itself would have appeared quite formidable to a visitor in the early 1870s. DeLoach, “Molokai: An Historical Overview,” 130.
(52.) Jno W. Nakuino, “A Leper Writes a Letter from Kalawao,” The Pacific Commercial Advertiser, October 5, 1878.
(54.) Somers, Kalaupapa, More Than a Leprosy Settlement, 21. The number of Irish potatoes grown in and exported from Hawai‘i would also increase in numbers similar to those of the sweet potato.
(56.) Quoted in Handy and Handy, Native Planters in Old Hawaii, 518.
(57.) The mo‘olelo of Lonopūhā is taken from the reconstruction of the story offered in June Gutmanis’ Hawaiian Herbal Medicine: Kahuna La‘au Lapa‘au (Honolulu: Island Heritage Publishing, 1976), 11, based on versions of the story by Kamakau, Malo, and ‘Ī‘ī.
(59.) Robert C. Schmitt, “The Okuu—Hawaii’s Greatest Epidemic,” Hawaii Medical Journal 29, no. 5 (1970), 363.
(60.) “Ma‘i Oku‘u,” Ka Nupepa Kuokoa, February 28, 1863.
(62.) Thomas G. Thrum, “Hawaiian Epidemics,” Hawaiian Annual (1897), 95.
(64.) Robert C. Schmitt and Eleanor C. Nordyke, “Death in Hawai‘i: The Epidemics of 1848–1849,” The Hawaiian Journal of History 35 (2001), 1. Schmitt and Nordyke provide the most recent and complete evaluation of these epidemics.
(65.) For instance, the most common complication of influenza is secondary bacterial infections, such as purulent bronchitis and pneumococcal or staphylococcal pneumonia; heart disease could also be a secondary effect. Schmitt and Nordyke, “Death in Hawai‘i,” 4.
(68.) Richard A. Greer, “Oahu’s Ordeal—the Smallpox Epidemic of 1853, Part I,” Hawaii Historical Review 1, no. 12 (1965), 222.
(71.) Between 1866 and 1915, the number of those in Hawai‘i who suffered from leprosy (including those who were segregated and those who, according to Dr. Mouritz, were known to have the disease but were not segregated) totaled 9,696. A. A. St. M. Mouritz, The Path of the Destroyer: A History of Leprosy in the Hawaiian Islands and Thirty Years Research into the Means by Which It Has Been Spread (Honolulu: Honolulu Star-Bulletin, Ltd., 1916), 165.
(72.) In other regions of the world where leprosy has been experienced (Africa, India, China, Japan, Oceania, the Americas) outside of a predominantly Western/Christian worldview, there seems to be a common connotation of leprosy as some form of divine punishment. However, since that stigma is amplified in the Judeo-Christian tradition and is the perspective that came with many foreigners to the Hawaiian Islands, it is the focus of my attention.
(73.) Naea was also the biological father of Queen Emma, the wife of Alexander Liholiho (Kamehameha IV).
(74.) Ambrose Kanoeali‘i Hutchison, “In Memory of Reverend Father Damien J. De Veuster and Other Priests Who Have Labored in the Leper Settlement of Kalawao, Moloka‘i,” unpublished manuscript (Sacred Hearts Archives, Leuven, Belgium: 1931), 6.
(76.) Mouritz, The Path of the Destroyer, 36–37. The first “known” cases (five plus maybe a few others) were spread over almost twenty years: In 1823 it (p.216) was reported that there were possible cases in Honolulu, but it is not clear just how many; Kamuli’s case became known in 1835, she died in 1848 at Waiohinu, Kā‘u, Hawai‘i; in 1838 Naea contracted the disease; in 1839 a man in Nu‘uanu valley, O‘ahu, had leprosy and died in 1860 (that Mouritz does not identify him as any specific ethnicity, as he does with the others, implies that he was likely non-Hawaiian); and in 1840 an ali‘i in Kamehameha III’s court is said to have had the disease.
(77.) Walter M. Gibson, Sanitary Instructions for Hawaiians (Honolulu: E.R. Grieve, 1880), 146; Watts, Epidemics and History, 66; Buckingham, Leprosy in Colonial South India, 8–9. Gibson’s Instructions were originally published in newspaper articles in the Hawaiian language in 1879, and then in book form in both Hawaiian and English the following year.
(78.) In an article in The Hawaiian Gazette (August 24, 1881), remarks are made on how widespread leprosy was throughout the world by that time—listing more than twenty nations or regions and supporting the theory that it could have been introduced to Hawai‘i from any number of sources.
(79.) “Report of Dr. Hillebrand,” in Supplement. By Authority. Leprosy in Hawaii, Extracts from Reports of Presidents of the Board of Health, Government Physicians and Others, and from Official Records, in Regard to Leprosy before and after the Passage of the “Act to Prevent the Spread of Leprosy,” Approved January 3rd, 1865. The Laws and Regulations in Regard to Leprosy in the Hawaiian Kingdom. In MMHC, Box 27: Leprosy. File 289 (1) (Honolulu: Daily Bulletin Steam Printing Office, 1886), 4.
(80.) “An Act to Prevent the Spread of Leprosy, 1865,” in Supplement, 5–6. It should also be noted that elsewhere theories surrounding the hereditary predisposition of the disease were also being discussed and were gaining support. See Philip K. Wilson, “Hereditary Factors Underlying the ‘Destructive Trinity of Diseases’: Syphilis, Leprosy, and Tuberculosis in 19th Century Hawai‘i” Medicina & Storia 14 (2007): 37–64.
(81.) Richard Kekuni Blaisdell, “Leprosy: The Separating Sickness,” in Simple Courage (Honolulu: ‘Olena Productions, 1992), 13; Linda W. Greene, Exile in Paradise: The Isolation of Hawai‘i’s Leprosy Victims and Development of Kalaupapa Settlement, 1865 to the Present (Denver Service Center: U.S. Department of the Interior, National Park Service, 1985).
(82.) “An Act to Prevent the Spread of Leprosy, 1865,” in Supplement, 8. See also “Appendix E; Report of Dr. G. L. Fitch to the Board of Health,” in Appendix to the Report on Leprosy of the President of the Board of Health to the Legislative Assembly of 1886, MMHC, Box 27: Leprosy. File 289 (1) (Honolulu: P. C. Advertiser Steam Printing Office, 1886), in which he states that “the point of land projecting out into the sea from the base of the cliff, on the northern side of Molokai, was duly set apart for a residence for persons afflicted with leprosy.”
(83.) It is also understood that all the female akua are daughters (or manifestations) (p.217) of Haumea; see Lilikalā Kame‘eleihiwa, Nā Wāhine Kapu: Divine Hawaiian Women (Honolulu: ‘Ai Pōhaku Press, 1999), 3, 7. As one Hawaiian phrase explains, “Molokai nui a Hina,” meaning “great Molokai, child of Hina.”
(84.) Mary Kawena Pukui and Samuel H. Elbert, Place Names of Hawaii (Honolulu: University of Hawai‘i Press, 1966).
(86.) Although remoteness does not necessarily equate to isolation. Indeed, most would concur that the Hawaiian Islands remained connected to Kahiki well into the fourteenth century, and that even after two-way voyaging declined Kānaka Maoli continued to view the ocean as a source of connection to (not separation from) other peoples and other lands.
(87.) As will be seen in later chapters, calling those who contracted leprosy “patients” is problematic, as appropriate medical care was often lacking in this pre-1900 era, and it could be argued that they were just as often treated as prisoners. Despite my reluctance to use this problematic term, “patients” is the label by which I will most often refer to those with the disease and who were sent to Makanalua as a result of the 1865 Act to Prevent the Spread of Leprosy. Other terms are just as problematic, and those who were sent to the settlement were in essence “diagnosed” with the disease, even if they did not always receive what we would consider medical care. Further, those who remained in Honolulu (at the Kakaako Hospital and Kalihi Receiving Station) did receive some consistent medical attention.
(88.) Father Damien was a notable exception to that policy.
(89.) Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 3–4, 39. It should also be recognized that this separation of those who were close to death, to a hut separate from the living quarters of the others, may have been in keeping with traditional practices.
(90.) A significant exception to this was Father Damien, the only leprosy patient to be buried within the wall closest to the church.
(92.) Michael Worboys, Spreading Germs: Disease Theories and Medical Practice in Britain, 1865–1900 (New York: Cambridge University Press, 2000), 42.
(98.) See David Arnold, Colonizing the Body (Berkeley: University of California Press, 1993).
(99.) J. R. Tryon, “Leprosy in the Hawaiian Islands,” American Journal of the Medical Sciences (1883), 444.
(p.218) (100.) One of the prevailing theories among some physicians in the late 1800s in Hawai‘i was that leprosy was actually the fourth stage of syphilis. In opposition to the theory, Dr. Edward Arning, a bacteriologist conducting research in Hawai‘i in the 1880s, thought the theory ridiculous and suggested that if those in power truly believed that it was true, then the logical thing to do would be to stop syphilis before it became leprosy, and that the Board of Health should really be establishing syphilis settlements rather than leprosy settlements. “Report of Dr. Edward Arning,” in Supplement, 148.
(101.) Walter M. Gibson, “Address by the President of the Board of Health,” in Dedication of the Kapiolani Home for Girls, the Offspring of Leper parents, at Kakaako, Oahu, by their Majesties King Kalakaua and Queen Kapiolani (Honolulu: Advertiser Steam Print, 1885), 18.
(102.) Rev. S. E. Bishop, “Why Are the Hawaiians Dying Out? Or Elements of Disability for Survival Among the Hawaiian People” (Honolulu Social Science Association, November, 1888), 10. For more on the cause of leprosy, as perceived and understood by Bishop’s contemporaries, see also M. Hagan, “Leprosy on the Hawaiian Islands,” Southern California Practitioner 1, no. 3 (March 1886): 85–91; Tryon, “Leprosy in the Hawaiian Islands,” 443–450; Phineas S. Abraham, “Leprosy and Its Causes,” in Edward Clifford, Father Damien and Leprosy in India (St. Louis, 1889); Prince A. Morrow, MD, “Leprosy and Hawaiian Annexation,” The North American Review (1897): 582–590.
(104.) Ronald F. Chapman, “Leprosy in Hawaii: Scare Advertising at the Turn of the Century,” Hawaiian Journal of History 13 (1979): 124. Dr. Mouritz also discusses at great length the possibilities of transmission through the Hawaiian practice of eating poi (all dipping and licking their fingers as they share the poi from the same bowl), but he does not condemn the practice; he merely points out how the bacillus could be transferred as a result. Mouritz, The Path of the Destroyer, 125.
(105.) Three decades passed before a possible remedy, chaulmoogra oil, was found, and it was not until the 1940s that an effective treatment, sulfone drugs, would be discovered. In 1949, leprosy became legally designated in Hawai‘i as “Hansen’s disease” rather than “leprosy.” Still, despite a known treatment and a name change, the stigma and public fear remained prominent. Even with this “cure,” the rules and regulations of segregation persisted, reminding the people of Makanalua that not only were they still patients but social outcasts as well. It was not until 1969 that the isolation policies were rendered obsolete and the segregation law was ended.
(106.) See Patrick Wolfe, Settler Colonialism and the Transformation of Anthropology (London: Wellington House, 1999); Candace Fujikane and Jonathan Y. Okamura, eds., Asian Settler Colonialism: From Local Governance to the Habits of Everyday Life in Hawai‘i (Honolulu: University of Hawai‘i Press, 2008).
(p.219) (107.) Ka‘ehu, “Song of the Chanter, Ka‘ehu,” in The Echo of Our Song, trans. Mary Kawena Pukui (Honolulu: University of Hawai‘i Press, 1973), 126–129. Variations of this translation can of course be made; I have chosen to stay with Mary Kawena Pukui’s published translation for the purposes of this work.