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

The oft-told story of the leprosy settlement on Molokai¹ has tended to emphasize Hawaiian victims and haole heroes, with a prominent role given to the recently canonized Saint Damien de Veuster. More recent scholarship—led by anthropologist Pennie Moblo—has challenged this narrow interpretation, both complicating the supposedly benevolent impact of Western medicine and recognizing the agency of previously passive Hawaiian actors. Kerri A. Inglis ably builds on this work, providing a rich history of Hawaiian experiences of leprosy that firmly situates the disease within the broader environmental, political, and cultural context of nineteenth-century Hawai‘i. Scholars of Hawai‘i, disease, and colonialism will find this a valuable work.

Using the methodology of ethnographic history, Inglis breathes life into such varied sources as Board of Health minutes; patient manuscripts and letters; Hawaiian proverbs, chants, and song; and—most notably and originally—nineteenth-century Hawaiian language newspapers. She draws meaning from specific events, encounters, and stories involving leprosy, purportedly to focus on the experience of those who contracted the disease, but her history is actually much larger in scope. By detailing the centrality of ‘āina (land) and ‘ohana (family) to Hawaiian identity, she reveals how health policies that separated those with leprosy from both their places of birth and their loved ones altered not just the lives of patients, but those of their community, their caregivers, their rulers, and—ultimately—their colonizers.

Inglis introduces each chapter with a brief vignette about the general history of the Hawaiian Kingdom that situates leprosy within the broader context of social and cultural changes unfolding in the face of foreign encounters. This approach provides a useful context for those unfamiliar with Hawaiian history, while linking leprosy to significant Native Hawaiian concerns over depopulation, land use, and struggles to retain autonomy. Describing ma‘i lepera as a disease “set apart,” Inglis nevertheless demonstrates that it should not be relegated to the margins of Hawaiian history. In the same vein, she shows how the 1865 Act to Prevent the Spread of Leprosy attempted to “set apart” people who contracted the disease, but they still found ways to remain connected to their communities. Chapters examining the criminalization of leprosy and Native Hawaiian responses to health policies provide accounts of Hawaiians evading arrest, attacking authorities, and questioning their diagnoses. Native Hawaiians also challenged the segregation mandate by holding meetings, writing petitions, and even introducing a bill in 1876 that sought to mandate the return of those with leprosy to their homes (pp. 101–102).

The most powerful discussions of Hawaiian experiences with leprosy emerge in the second half of the book, where Inglis focuses on the lives of those who found themselves involuntarily confined to the leprosy settlement on Molokai’s Makanalua peninsula. She contrasts Westerners’ favorable accounts of government officials caring for those with leprosy with residents’ descriptions of limited food and water, unfavorable environmental conditions, inadequate shelter, and rudimentary medical care. Patient letters to Hawaiian newspapers detailed deprivation and incompetent management, but they also revealed active agents communicating their concerns to people beyond the peninsula. Not only did those with leprosy advocate for changes within the settlement (including improved food and supplies, the establishment of places of worship, access to better caregivers and medical treatment, rights to their children, and competent superintendents), they also engaged in outside political action such as issuing a formal protest against U.S. annexation.

Inglis might have offered a more nuanced discussion of the etiology and treatment of leprosy in her account of competing nineteenth century medical understandings of the cause and care of the disease. At several points, she refers to quarantine as the only known form of treatment available for leprosy, conflating methods of therapy with those of disease containment and prevention. In describing debates over the transmission of leprosy, she contends that Western theories were “infused...