Monday, January 6, 2014

Maʻi Pākē

The common Hawaiian name for the disease was Maʻi Pākē, or Chinese sickness.

Its introduction to the Islands was but one of many new diseases; it was called maʻi pākē (Chinese sickness,) maʻi ali‘i (chiefly sickness) and eventually maʻi hoʻokaʻawale ʻohana (disease that separates family.) It is thought that it came to the islands in the early-1800s, but it did not attain levels of great concern until the 1850s and 1860s.  (Inglis)

One of the earliest descriptions of it in Hawaiʻi was written by the Reverend Charles Samuel Stewart, a missionary in the 2nd Company of American Protestant missionaries, who landed at Honolulu in 1823.

An entry in his journal dated May 21, 1823 notes “not to mention the frequent and hideous marks of scourge, which more clearly than any proclaims the curse, of a God of Purity, and which while it annually consigned hundreds of these people to the tomb, converts thousands while, living into walking sepulchres.  The inhabitants generally are subject to many disorders of the skin; the majority are more or less disfigured by eruptions and sores found many are as unsightly as lepers.”  (Schrodt)

The association of the disease with the Chinese people probably had to do either with the fact that an individual or individuals of that race were noted to have the disease or simply that the Chinese were familiar with it because they had often seen it in their own country.  (Greene)

The name "maʻi pākē" may, no doubt, have originated on the interrogation by a native of a Chinaman, "What is this disease?"  The Chinaman would probably answer, "I do not know the Hawaiian word, but there are plenty of people sick with the disease in my country."  ... It was recognized by the few Chinese, then on the islands, and this has given it the name of "Maʻi Pākē" here, and not because it has been introduced here by the Chinese." (Hawaii Board of Health 1886)

From Eastern writings there is good evidence that India, East Asia and China are among its most ancient homes. The earliest reference appears to be rather universally accepted was written in the Chou Dynasty in 6th century B.C.  In the Chinese medical classic entitled Nei Ching there are four passages which may allude to an afflicted patient. If this classic was written by one Huang Ti, it may have been recognized in China over five thousand years ago.  (Schrodt)

Early incidences in the Islands were most often associated with Chinese immigrants to Hawai‘i and thus the name maʻi pākē. Some believed that it came with Chinese plantation workers, but many individuals and groups also arrived from other regions of the world where leprosy was endemic. It could have come from any number of sources such as the Azores, Africa, Malaysia or Scandinavia.  (Inglis)

Further statements from the Board of Health report refute that the disease was started by the Chinese, "if one Chinaman caused such an alarming spread of the disease thirty or forty years ago, there are now, comparatively speaking, so very few cases of leprosy among the seventeen or eighteen thousand Chinamen on these islands."  (Hawaiʻi Board of Health, 1886)

"Again, if the disease had been introduced by the Chinese, and propagated by them ... I should expect to find a much larger proportion of (them) affected with this loathsome malady, and yet we all know that the contrary is the fact. ... It is much more likely that it came to these islands through the mixed crews of whale-ships, which had negroes, black and white Portuguese, and men of other races, coming from countries where leprosy was, and still is, prevalent."  (Hawaiʻi Board of Health, 1886)

It rapidly spread on Oʻahu.  In response, the Legislative Assembly of the Hawaiian Islands passed “An Act to Prevent the Spread of Leprosy” in 1865, which King Kamehameha V approved. This law provided for setting apart land for an establishment for the isolation and seclusion of leprous persons who were thought capable of spreading the disease.

On June 10, 1865, a suitable location for incurable cases of leprosy came up for discussion.  he peninsula on the northern shore of Moloka’i seemed the most suitable spot for a leprosy settlement.

Its southern side was bounded by a pali - vertical mountain wall of cliffs 1,800 to 2,000 feet high, and its north, west and east sides by the sea and precipitous shores. Landings were possible in only two places, at Kalaupapa on the west side and at Kalawao on the east side of the peninsula, weather permitting.

The first shipment of lepers landed at Kalaupapa January 6, 1866, the beginning of segregation and banishment of lepers to the leper settlement.

Receiving and detention centers were established on Oʻahu.  Kalihi Hospital was the first hospital for leprosy patients in Hawaiʻi opening in 1865. Kapiʻolani Home opened in Kalihi Kai in 1891 adjacent to the Kalihi Hospital and Receiving Station; Kalihi Plague Camp (1900-1912) and Meyers Street, Kalihi Uka (1912-1938.)

Two notable people in Hawaiʻi associated with the treatment of patients with leprosy are Father (now Saint) Damien and Mother (now Saint) Marianne.)

Damien (born as Jozef de Veuster,) arrived in Hawaiʻi on March 9, 1864.  He continued his studies here and Bishop Maigret ordained Father Damien at the Cathedral of Our Lady of Peace, on May 21, 1864; in 1873, Maigret assigned him to Molokaʻi.  Damien spent the rest of his life in Hawaiʻi; he died April 15, 1889 (aged 49) at Kalaupapa.

In 1877, Sister Marianne was elected Mother General of the Franciscan congregation and given the title “Mother” as was the custom of the time. In 1883, she received a letter from Father Leonor Fouesnel, a missionary in Hawaiʻi, to come to Hawaiʻi to help “procure the salvation of souls and to promote the glory of God.”

Of the 50 religious communities in the US contacted, only Mother Marianne's Order of Sisters agreed to come to Hawaiʻi to care for people with leprosy.  The Sisters arrived in Hawaii on November 8, 1883.

In the summer of 1886, the Sisters took care of Damien when he visited Honolulu during his bout with leprosy.  He asked the Sisters to take over for him when he died.  Mother Marianne led the first contingent of Sister-nurses to Kalaupapa, Molokaʻi, where more than a thousand people with leprosy had been exiled.

A third person in Hawaiʻi, Alice Ball, made notable contributions in the treatment of the disease. In the fall of 1914, she entered the College of Hawaiʻi (later called the University of Hawaiʻi) as a graduate student in chemistry.   The significant contribution Ball made to medicine was a successful injectable treatment for those suffering from Hansen’s disease.

Although not a full cure, Ball’s discovery was an extremely effective in relieving some of the symptoms of Hansen’s disease and was a significant victory in the fight against a disease that has plagued nations for thousands of years.

The discovery was coined, at least for the time being, the “Ball Method.”  During the four years between 1919 and 1923, no patients were sent to Kalaupapa – and, for the first time, some Kalaupapa patients were released.

Once known as leprosy, the disease was renamed after Dr. Gerharad Armauer Hansen, a Norwegian physician, when he discovered the causative microorganism in 1873, the same year that Damien volunteered to serve at Kalaupapa.

During the third quarter of the nineteenth century incidence of the disease occurred in more than 1% of the population in Hawai`i. In 1890 Kalawao’s patient population peaked at around 1,100. By 1900, the number of new patients in the islands began a slow decline, a trend that continued until the 1940s when it was determined that the disease was not spreading in the general population.  (NPS)

About 8,000 people have been exiled there since 1865.  The predominant group of patients were Hawaiian and part-Hawaiian; in addition there were whites, Japanese, Chinese, Portuguese, Filipino and other racial groups that sent to Kalaupapa.  The law remained in effect until 1969, when admissions to Kalaupapa ended.

The image shows a view of Kalaupapa, Kalawao.

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