Ma’i Lepera: Disease and Displacement in Nineteenth-Century Hawai’i by Kerri A. Inglis (review)

The story of leprosy isolation on the island of Molokai is a familiar one for Hawaiian historians, although newly emerging sources and approaches to Hawaiian history make a reexamination of this story quite timely. Kerri Inglis’s recent book skillfully weaves together multiple lines of evidence in producing a worthy account of the historical, sociopolitical, and environmental context of the leprosy policy of the Kingdom of Hawai’i. The book is notable for integrating the voices of individual Native Hawaiian people who were exiled to the peninsula of Makanalua from 1866 through the early 1900s. Hawaiian-language sources have often been overlooked in accounts that privilege the dominant, foreign perceptions of this important place. In addition to being of regional interest for Pacific historians, the book is a significant contribution to broader conversations about the historical significance of disease for modern colonialism, the relationship between medical technology and social perceptions of illness, and the continuing role that social stigma play in constructing cross-cultural interactions with sick persons.

Inglis has chosen to work through the story of Makanalua thematically, self-consciously and explicitly adopting the form of a Hawaiian mo‘olelo (which can be roughly translated as “story”), “a term carefully chosen, as it is understood that mo‘olelo contain metaphors, lessons, and layers of meaning” (p. 1). Each of the main chapters begins with a short historical vignette, outlining the rise of the Kamehameha dynasty and the independent Hawaiian Kingdom, its subsequent undermining by increasingly aggressive foreign business interests, and finally the dissolution and illegal annexation of the nation by the United States. The chapters cover the criminalization of leprosy in both legal policies and cultural perception (chap. 2), accommodation as well as resistance to these policies (chap. 3), adaptation of exiled people to living (and dying) at Makanalua (chap. 4), the ways that life in Makanalua was experienced and negotiated by inside and outside individuals and groups (chap. 5), and finally the construction of leprosy in Hawaii as ma‘i ho‘oka ‘awale ‘ohana, the “disease that separates families” (chap. 6). Since these are thematic chapters, the dates and characters overlap from one to the next, with each one covering sources and events from early in the period of Hawaiian leprosy policy through changes associated with a transition to American control of the settlement in the early 1900s.

One of the crucial observations in the narrative is that Hawaiian leprosy policy is not simply a sidebar in the later colonial history of the islands. Rather, there is a mutually constitutive set of relationships between depopulation caused by foreign diseases, changing cultural beliefs, and political events that is part of the story of annexation. As the Hawaiian population declined because of foreign diseases, ancient links among families, pieces of land, and ruling elites were significantly eroded. Leprosy was actually one of the least devastating foreign illnesses in terms of sheer number of deaths. However, the social stigma attached to this disease, combined with fears about the “disappearance” of the Hawaiian race and racist notions of Hawaiian uncleanliness and lasciviousness, contributed to a decision to pursue a policy of quarantine and isolation, which resulted in the establishment of the settlement at Makanalua. Simultaneously, resistance to leprosy policy was largely motivated by the fact that Hawaiians were more horrified by the idea of separation from family and home than the disease itself.

Makanalua’s residents were not simply passive observers of historical events. In addition to documents that expressed specific concerns about conditions in the leprosy settlement written by its Hawaiian inhabitants, Inglis points to sources, notably letters published in Hawaiian-language newspapers, that show the engagement of Makanalua’s residents with colonial politics. Some leprosy sufferers saw their imprisonment as an act of “aloha,” as separation was seen as necessary for the continued existence of the Hawaiian people (p. 148). Others vehemently protested the proposed placement...