Family History as Disability History: Native Hawaiians Surviving Medical Incarceration Adria L. Imada University of California, Irvine

Keywords:

kinship, leprosy (Hansen's disease), incarceration, petitions, settler colonialism, Hawai'i

On February 28, 1907, the Hawai'i Board of Health took a nine-year old girl named Nailima Lishman into custody. 1 Lishman was suspected of having leprosy, a disease criminalized by law since 1865. According to this Hawai'i law, all people with leprosy were ordered removed from their communities by the Board of Health (BOH). 2 Nailima was brought to Kalihi Hospital and Receiving Station, a large detention compound in the port city of Honolulu. Family members with loved ones detained at Kalihi Station knew this was likely the beginning of lifelong incarceration and separation. If a medical examination confirmed a suspect as leprous, incurable, and contagious, the person would be exiled to a leprosy settlement on the island of Molokai for the rest of their lives, regardless of age or condition. 3 Nailima Lishman would spend four years confined at Kalihi Hospital until she was exiled to Molokai settlement in 1911. 4

Approximately 8,000 men, women, and children were exiled over a period of a century, with hundreds more of their children born into Board of Health custody. 5 Hawai'i's leprosy control was the longest and most severe practice of medical incarceration in modern history. The vast majority of exiled people were Kānaka 'Ōiwi (Native Hawaiians), with smaller numbers of immigrants from Asia and Portugal and their descendants incarcerated. 6 Outbreaks of mumps, smallpox, venereal disease, measles, and influenza since Western contact in 1778 had decimated Kānaka 'Ōiwi, but leprosy brought terrible suffering as an illness that separated family (ma'i ho'oka'awale 'ohana). 7

In the decades prior to formal colonization by the United States, settler occupation and imperial pressure subordinated Hawai'i law, trade, and land tenure to the West. 8 These processes secured the U.S.-backed overthrow of Hawai'i's monarchy in 1893, illegal annexation by the United States in 1898, and incorporation as a U.S. territory in 1900. Yet prior to and during these calamitous political events, a system that I call carceral medicine disrupted Kanaka 'Ōiwi life and relations. Enabled by and articulated through settler occupation, carceral medicine was a juridical-medical system that incarcerated people and produced knowledge about their bodies. 9 By the 1840s, white settlers occupied powerful leadership positions in the Hawaiian government, including the Papa Ola, the kingdom agency known in English as the Board of Health. Enmeshed in a broader settler occupation that upended Native institutions and disenfranchised Kānaka 'Ōiwi, the Papa Ola removed thousands of Kānaka from their natal homes in the name of health beginning in 1866.

Although leprosy had been endemic in parts of Western Europe and reappeared in England in the 1840s, it became racialized and stigmatized as an "imperial danger" and "tropical disease" emerging from the Pacific in the high age of empire. 10 Settlers in Hawai'i, as well as in other nineteenth-century colonial zones of contact, became preoccupied with the containment of leprosy, an illness that can cause disfiguring effects in the face, hands, feet, skin, and eyes. 11 In this swirling colonial imaginary, leprosy was interpreted as a menacing racial-sexual invasion moving from Native to white bodies.

Known today as "Hansen's disease," leprosy is a bacterial disease transmitted through respiratory droplets. It is not highly infectious and requires long-term exposure to untreated people. A cure was not discovered until the 1940s. While the etiology and transmission of leprosy confounded scientists, the colonial public health response was forceful and unrelenting. The state's strategy of leprosy control centered on the removal and incarceration of Indigenous people, despite leprosy having been far less lethal than contemporaneous epidemics of influenza and tuberculosis. 12

Thus, significantly, beyond its treatment as an illness or medical condition, leprosy was experienced and signified in settler colonial Hawai'i as a disability — a disabling social and cultural condition — attached to the bodies, kinship, and behavior of Kānaka 'Ōiwi. Leprous people were excluded from civil society less for their risk to public health, but because their non-normative bodyminds and putative social incompetence were considered intolerable forms of disability. Perceived by settlers as unchaste, unvirtuous, and uncivilized, Kānaka were treated as culpable for spreading the microbe through sexual contact and non-conjugal relations. 13 Those who contracted leprosy became civilly dead and were removed from public life. Kānaka 'Ōiwi experienced the highest rates of infection and medical incarceration, although leprosy afflicted Native Hawaiians, settlers, and immigrants of all economic and social backgrounds. 14

However, during medical detainment at Kalihi and removal to Molokai, Kānaka refused to abandon their loved ones. In this essay, I discuss the efforts of Native Hawaiians to maintain kinship and care across the fences, walls, and laws of Hawai'i's carceral medical institutions in the early twentieth century. Incarcerated people and their families sought visitation and treatments, protested medical decisions, and petitioned for re-examination, reunion, and release. In the everyday experience of empire, these deeds are not often visible or coherent, but they constitute a micropolitics of survival against the aggregate, coercive power of settler colonial institutions and the weight of Western biomedical knowledge. Following people through time and space as they negotiated with these institutions and practices, I argue that in seemingly discrete and heterogeneous acts of contesting medical and legal regulations, Native people and their collateral kin unmade settler colonial processes of ability and disability formation.

In doing so, this essay stakes a broader claim that family histories matter for disability histories, especially disability histories by and about Indigenous people. Why and how should disability histories pay attention to Indigenous kinship? Family histories, as historians and anthropologists have demonstrated, are not merely histories of families or kinship networks. Biological reproduction is attached to processes of social, cultural, and class reproduction, the allocation of labor and property, imperial expansion, and capital accumulation. Such studies can reveal state and institutional formations, as well as broader racial, gender, social, and economic hierarchies instantiated via the "family." 15

Historians of disability also have de-naturalized the unit of the family by usefully examining how state and institutional gatekeeping and ability-making worked through families, such as the encouraged breeding of racial "superiors" and the institutionalization and social exclusion of the "mad," "unfit," "deviant," and "queer." 16 In a parallel scholarly arena tracking the state's genocidal preoccupation with kinship, Indigenous histories analyze how settler colonial institutions forcibly assimilated, eradicated, and terminated Native peoples, often by targeting the family, kinship, and tribe. These were undertaken, particularly in Native North America, through blood quantum regulations that limited tribal rolls, federal termination policies that ended tribal land trusts, colonial health and medicine policies that starved and excluded, and boarding and residential schools that removed, institutionalized, and abused youth. Importantly, scholars in this field document assaults on kinship by the state, but also demonstrate that sovereignty and self-determination rest in tribal and family ties and practices of relationality. 17

My work on kinship practices and Indigenous survival in this essay aims to amplify connections between these scholarly approaches to kinship and ability-making. 18 Disability was often co-constituted with Native kinship in settler colonial contexts, whether with or without the explicit invocation of the term "disability." Put another way, living communally with collateral kin and distributing material and affective resources outside legible heteropatriarchal nuclear units and capitalist labor structures were interpreted as disabilities which justified diverse forms of institutionalized state violence. 19 In Hawai'i, Kanaka 'Ōiwi kinship was stigmatized as a disabling excess of kinship – an overabundance of sexuality, proximity, and intimate care that was considered unclean and disorderly. Within this paradigm, Hawaiians were interpreted as culpable for spreading contagion and unfit for self-governance. 20 Yet, as I highlight here through representative episodes of responses to carceral medicine, Hawaiians drew strength from kinship even as it was censured and waged against them as a disability. They refused to accept state-mandated definitions and expectations of normative families, ability, care, beauty, and love.

A grounding of Indigenous Disability History in kinship history here suggests not only an epistemological framework, but an ethical one. A central guiding principle is that the people I write about, while no longer living, are collateral kin: ancestors, elders, and family who continue to be claimed and loved. 21 While I am a descendant of immigrant settlers to Hawai'i, I hold abiding and accountable relationships with Hawaiian people, land, and mo'olelo (histories), past and present. My research and writing on Hansen's disease is informed by what I call an ethics of restraint—a deliberate attempt to refrain from overexposing and spectacularizing vulnerable people. These protocols about privacy, names, and narratives are informed by ongoing conversations with Kanaka 'Ōiwi scholars and interlocutors, including people who live and work in the present-day Kalaupapa, Molokai settlement. 22

Although a person's appearance as a medicalized subject in Board of Health records may be a starting point, I attempt to place and interpret a person and their kin in wider relational and genealogical contexts using other available sources. Describing where they were from, who they loved, and who claimed them, albeit in partial and provisional ways, before and after medical detention helps to convey lifeworlds and relationships beyond the experience and timeframe of illness and incarceration. Family members seeking to learn more about exiled relations may find more information and sources in the footnotes. In accordance with these principles, except when quoting directly from sources, I avoid the pejorative term "leper," which reduces a person to a stigmatized condition. 23

Everyday Contestations: Visitations

"In reviewing my tours among the people I can not but be painfully impressed with the recklessness which Hawaiian people exhibit in their intercourse with the victims of leprosy in their midst. They and their children do not hesitate to eat, drink from the same dishes, smoke the same pipe, lounge and sleep on the same mats as are used by the leper that live among them. The wife does not shun her leper husband, nor the lover his mistress who is a leper. This cannot be laid entirely to ignorance. They are keen observers and as a rule their diagnosis of leprosy is remarkably accurate.…[C]all it unselfish devotion, call it what you will it is a blindness that not less severely leads to death."

– Dr. Nathaniel B. Emerson, Report to President of the Board of Health, 1879 24

"Lacking knowledge of the diseases of civilization, or their control or remedies, this [Hawaiian] race has suffered accordingly, and become susceptible to certain infections to an infinitely greater degree than other races dwelling among them."

– Lucius E. Pinkham, President of the Board of Health, 1907 25

"…E hookuu, a hoihoi mai i kuu kaikamahine ia Miss Ane N Kekoa." ("Release and return my beloved daughter Miss Ane N. Kekoa.")

– Edward Kekoa to the Hawai'i Board of Health, October 28, 1905 26

As suggested by the first two excerpts from medical reports above, physicians racialized Hawaiians as spreaders of leprosy, arguing their inability to conform to Western norms of civilization made them susceptible to disease. Worse yet, the very devotion Hawaiian bestowed on loved ones with leprosy were cast as irresponsible. Able-bodied Hawaiians performing acts of care for leprous kin could themselves be interpreted as disabled, suffering from blindness or a kind of critical misperception or willful noncompliance. If disability was defined against the bodies, behavior, and kinship practices of Native people, how did they and their kin experience and respond to this colonial ableism? I answer this by connecting and interpreting written documents, letters, and petitions dispersed across the carceral medical archive, as well as reports published in Hawaiian-language newspapers from this early territorial period. 27 The third epigraph above, a letter from a Hawaiian father contesting his daughter's imprisonment, is but one direct response to settler health authorities.

Nailima Lishman, the child introduced at the beginning of this essay, was the only one of her immediate family and her seven siblings to be medically detained. The day after Nailima was admitted to Kalihi Receiving Station–on March 1, 1907–"Mr. and Mrs. Lishman," as her parents' names were recorded, went to visit her. Her mother Nellie Nailima Koli was Kanaka; her father, Thomas Lishman, a white Australian. Every person seeking to visit with someone at Kalihi Station required a formal visitation permit issued by the Board of Health and carried out by the Station keeper. The Lishmans' permits are recorded in the one extant keeper's log that was retained by the Board of Health, documenting visits to inmates between 1904 and 1908. 28

Thomas and Nellie Koli Lishman would have entered a compound surrounded by high wooden fences. After the keeper confirmed them as visitors, the Lishmans went into a bare visiting room. Mesh wire stretched from floor to ceiling, separating the room into two zones. On one side, Thomas and Nellie sat on a small bench. Ten feet away across the wire, nine-year-old Nailima sat in another chair. They were not allowed to touch each other. 29 The record cannot tell us how Nailima and her parents felt–perhaps hope, elation, anguish–when they saw each other in this room. However, week after week, from March 1907 through August 15, 1908, Thomas and Nellie came here to sit with their daughter. They applied for thirty visitation permits that covered themselves and their relations to see Nailima during two-week allotments. 30 After being detained for over four years at Kalihi, Nailima was sent to Molokai on September 27, 1911. She died there on July 1, 1916 at the age of eighteen.

On yellowing sheets of mimeographed paper in the Kalihi Station visitors' log, names and patterns emerge of women visiting their lovers, daughters their mothers, brothers their siblings, neighbors, and friends, as well as a score of other relationships that are unknown today. Captured Hawaiians came from heterogeneous class backgrounds and birthranks, including ali'i (chiefly) and maka'āinana (common people) lineages, but many were from households of modest means, if not cultural capital.

One Hawaiian child detained at this time was Samuel Meheula. His father held positions as a bilingual teacher, Democratic secretary of the territorial house, and police department secretary. 31 Samuel was admitted as a leprosy suspect in 1905 from Auwaiolimu, O'ahu at the age of ten. He had been a student at 'Iolani College, an Episcopal school for boys, where his father once taught. 32 According to the visitors' log, Samuel's parents applied for permits from December 1907 until April 1908. During this time, Meheula's parents visited him every week, usually on Sundays. Some weeks Samuel received two separate visits, with his mother applying to visit on a Friday or Saturday, and both parents coming on Sunday.

A typical typed letter, addressed to the Kalihi Receiving Station keeper and stamped with the signature of the BOH president reads, "Permit Mrs. Meheula to enter the Visitors' House today, January 31st, and on Sunday February 2nd, permit Mr. and Mrs. Meheula to enter the Visitors' House for the purpose of seeing their son, Samuel." During the months of April and May 1908, Samuel's parents were granted visitations every Sunday. The frequency of the permits conveys the Meheula family's determination to bridge separation. Other logs after 1908 were not retained, but families and friends made use of visitation policies until the Kalihi facility closed in 1949. 33

While Nailima Lishman and Samuel Meheula are notable for receiving the most visitors during this period, not all imprisoned people were fortunate to have family nearby. Some Hawaiians brought from neighboring islands did not have family on the island of O'ahu, and removal to Kalihi Hospital marked the beginning of lifelong separation. Yet some Kanaka families exerted strenuous efforts to remain in close proximity with detained patients, such as the 'ohana (family) of Lahela Kanewa.

Lahela Kanewa entered Kalihi Hospital as a suspect on November 10, 1907. She was forty years old at the time and had advanced symptoms of leprosy. Her neck was paralyzed, nodules appeared across much of her face, and her right eye was inflamed. Lahela Kanewa and her family lived in La'aloa in Kona, Hawai'i, the southern-most island. Hawai'i island lies over 150 miles of ocean south of O'ahu. However, her immediate kin accompanied Kanewa on this journey from Kona to the city of Honolulu.

The day after her detention at Kalihi, Lahela Kanewa's husband and seven children received a permit to visit her at Kalihi Station. At least two of her daughters, Ana (or Annie) and Malia Kanewa, remained in Honolulu that month, and they applied for three more visitation permits that November. 34 These family members may have relocated to Honolulu temporarily, perhaps until a final medical and legal decision about Kanewa was declared.

The Wittrock family also relocated from a neighboring island to accompany daughters Augusta and Ella, who were taken into custody at Kalihi in 1912. Frederick Wittrock, a Danish immigrant, and his Hawaiian wife Kukonaalaa (Susan) Kepano left rural Hāna, Maui to stay near the Kalihi pineapple cannery, not far from Kalihi Hospital. Wittrock wrote to the BOH president Dr. John Pratt, for news of their "dear children" who had been taken into medical custody six months ago. His daughters were worried they would be removed to Molokai settlement. Wittrock relayed that the family would "go down and see the children every day from outside the fence" at Kalihi Hospital. Wittrock concluded by asking Pratt, "If your time allows it, please be so kind and let me know something about them." Pratt replied that transportation to Molokai was only a rumor because the Kalaupapa landing was in poor condition. He went on to reassure the worried father, "As long as they show signs of improvement and there is hopes [sic] of doing something for them I do not think that the Board would be likely to send them to the Settlement." 35

Only two months after composing this letter, Frederick Wittrock died suddenly of a stroke in Honolulu. His incarcerated daughters would not have been able to attend the large funeral and burial held in Hāna. Within the next decade, Augusta, Ella, and two of their brothers would be exiled to Molokai. 36

Letters and Petitions

While some Hawaiians went to great lengths to visit family at Kalihi, they also reviewed laws and policies, wrote letters to officials, and petitioned the Board to re-examine their loved ones. Solomon Meheula wrote the BOH to request such a re-examination for his son Samuel on May 6, 1908. Samuel was re-examined that day, according to the reply addressed to the elder Meheula. 37 Although I could not find the outcome of this exam in BOH records, it is likely Samuel was found non-leprous and released from medical detention. 38 As of the 1910 U.S. census, Samuel was living with Solomon and other family members in the Pālolo neighborhood of Honolulu. 39

Another young person held at Kalihi Receiving Station during this period was nineteen-year-old Ane Kekoa from Hilo, Hawai'i. Ane had been ordered to report to BOH examination in September 1905 as a "leper suspect." 40 Some families surrendered to medical agents in their home districts, but Ane's father Edward refused to allow her to be taken to Honolulu for examination. 41 Edward Kekoa was a man of standing; he was pastor of Hilo Hawaiian Church and a lawyer active in Hawai'i's Democratic party. Edward and his wife Mary Pililua had at least seven other children.

According to Edward Kekoa's complaint in 1905, a health agent named D.S. Bowman dragged his daughter from the house, tearing her clothes. Kekoa claimed the leprosy law was unconstitutional and "denied the right of police to arrest his child." He wielded a hatchet and knife against the officers, but Annie was taken into custody and driven to Waiākea detention camp, then sent on to Kalihi Receiving Station in Honolulu. The BOH, however, argued the girl had been apprehended in a "very humane and courteous manner." 42

After Ane was taken from their Hilo home, Edward Kekoa continued to send protests from Hilo demanding that she be released from Kalihi detention. Two of his letters, written in 'ōlelo Hawai'i (Hawaiian language) and in elegant cursive, are retained in the Board of Health's correspondence file. In one written in 1905, Kekoa criticized the BOH for "he mau hana uahoa no ka oukou o ke ano lokaino, na kuu kaikamahine" (the severe actions of your merciless people towards my beloved daughter.") Edward concluded with a final ultimatum: "…[O] keia ka'u uwalo hope loa ia oukou ma ke ano mahiehie a iliwai hoi; a oia keia: E hookuu, a hoihoi mai i kuu kaikamahine ia Miss Ane N Kekoa." ("This is the last time I'm going to ask you nicely: release and return my beloved daughter Miss Ane N. Kekoa.")

Amidst his bitter censure of the Board, Kekoa signaled his deep fondness for his daughter, referring to Ane with the possessive pronoun "kuu" (my) that expresses affection toward intimates. On October 31, 1905, BOH president Lucius Pinkham acknowledged this letter and others sent by Kekoa, but confirmed that Ane had been declared a "leper." He encouraged Edward to accept Ane's fate. 43

Having been verified as leprous at Kalihi Receiving Station, Ane Kekoa was exiled to Kalaupapa, Molokai and spent about three years there. 44 Yet Edward continued to press for Ane's release. In 1908, Ane returned to Kalihi, possibly for additional treatment or because her condition had improved. Her sister Mary Rowland's visits to Ane between February 24 and March 3, 1908 were recorded in the Visitors' permit book. Her father Edward likely coordinated with Mary about Ane, as he sent another demand to President Pinkham on the last day of Mary's visit to the station on March 3, 1908. 45

Edward titled this second letter "Palapala Nonoi," or a petition. Edward cited both his birthrights of his native Hawai'i ("He Hawaii Ponoi ma ka hanau ana") and his rights of American citizenship ("he kupa Amerika"), and argued for Ane's re-examination. He contended Ane had greatly improved at Molokai, observing that only the fingers on her right hand showed slight contraction. Pinkham replied, however, that Ane had not sufficiently improved. Lodging a petition at the Board was neither coincidental nor rhetorical. As a lawyer who had recently experienced the tumultuous overthrow of the kingdom, takeover of the government by white setters, and a broad Hawaiian movement contesting U.S. annexation, Edward Kekoa would have been very familiar with the convention of written petitions and their power. Indeed, Edward had signed his name in beautiful script at the top of a Hilo, Hawai'i petition sheet opposing a 1897 U.S. Senate treaty of annexation. Called Papapala Hoopii Kue Hoohui Aina (Petition Protesting Annexation), this mass petition signed by citizens of all islands successfully defeated a treaty of U.S. annexation in 1897. 46

After the failure of the 1897 annexation treaty, U.S. annexation of Hawai'i was accomplished illegally by the Newlands Resolution, a joint resolution of U.S. Congress in 1898. This resolution required a simple majority, instead of the two-thirds vote in each house for treaty ratification. Yet Edward Kekoa, as Kanaka 'Ōiwi scholar Noenoe Silva has illuminated, continued to denounce the illegal annexation, along with many others who had collectively opposed the U.S. overthrow and takeover of the Hawaiian nation. Kekoa penned essays urging "ke kupaa no ke aloha i ka aina" ("steadfastness for the love of the land"). These were published in the Hawaiian nationalist newspaper Ke Aloha Aina in 1900. 47

Edward Kekoa's palapala nonoi (petitions) to the Board of Health were marked with flourishes reflecting his work as a minister and public intellectual. However, other protests and pleas to the Board took varied forms during this time. Hawaiians of diverse class and occupational statuses sent appeals on behalf of family and friends. For instance, on a simple sheet dated April 29, 1907, eight people signed their names to a short request as "We, the undersigned relatives of George Kakapu." Maram Kahaina, Angeline Kahau Kapu, Keliinui, Kaliko, Mrs. Kalua, John Kaapa, and Fred Hamilton signed in two columns, with women's names on the left and men's on the right. They asked that George "stay at the receiving station up Kalihi for 12 months under Dr. J.T. Wayson to be treated." In this case, Kakapu's relatives' request was validated and may have had some influence on the Board's decision to keep him at Kalihi for treatment. President Pinkham's handwritten notations on the letter confirmed that Dr. Wayson had agreed to keep treating George Kakapu at Kalihi Hospital. 48

News of Intimates from the Settlement

These family petitions exemplify acts of care and concern for incarcerated people inside, but those captive also reached toward their loved ones. 49 In 1909, patients and their families petitioned territorial legislators for re-examination by BOH physicians in hopes of being declared non-leprous and freed. Nineteen of these legislative resolutions passed. Eleven people held in leprosy institutions showed enough improvement to be ruled not leprous and were released from custody with clearance certificates. Ranging from ages six to seventy-nine years old, they had been institutionalized from three to twenty years. 50 Hearing of these releases in June 1909, over 170 people sought re-examinations at the Kalaupapa, Molokai settlement later that year. These exams were so numerous that physicians traveled to Molokai between August and October 1909 instead of patients coming to Kalihi Hospital in Honolulu. 51

These legislative events were covered dispassionately by the territory's English-language press. During the same time, however, an exiled patient sent letters to multiple Hawaiian-language newspapers in 1909 penned in the names of S.K.M. Nahauowaileia and S.K. Maialoha. He offered detailed, first-hand accounts of the re-examination efforts to a public sphere of Hawaiian readers. 52 Print culture in Hawaiian, especially in newspapers, continued for decades despite active efforts to suppress 'ōlelo Hawai'i (Hawaiian language) and promote Americanization in the territory. In 1909, for instance, when Nahauowaileia wrote his articles, there were ten Hawaiian-language newspapers in circulation. 53 In these pieces, Nahauowaileia publicized and humanized the individual and collective desires of exiled people to return to their beloved homelands and kin. 54

Nahauowaileia opened his reports with a customary greeting of aloha to the editor of the newspaper. He then presented his fellow residents not as a cohort of inmates, but as people recognizable by their relationships with "kini makamaka" (intimate friends) outside the settlement: "Eia mai ka mea aloha he kane wahine, keiki, moopuna, kaikamahine, kuakahi, kualua, a huli hoi aku no ka aina e ike a e honi hou i na ea hu'i hu'i o ka aina (ke huli hoi aku hoi)…" ("Here are your loved ones: a husband, wife, child, grandchild, daughter, child three generations removed [great grandchild], child four generations removed [great-great grandchild], they turn toward their homes, to see and to smell again the chilly air of the land (if they do return)… 55 He listed the names of 133 people, their gender, land of origin, and the number of years spent in the settlement. In three other articles from this period, he followed the same naming and biographical conventions. 56 Significantly, these kinship terms invited exiled people to be claimed by those on the outside reading their names. Through poetic and metaphoric language that evoked memories of shared sensory experiences, Nahauowaileia represented exiled children and elders alike yearning to return to their homelands. The prospect of return, then, was to both kin and place.

Two of those seeking re-examination in Nahauowaileia's letters were Ane Kekoa and her new husband Joseph Kauhane. Dedicated to her discharge, Ane's father Edward Kekoa would have been following these developments closely. Reunification with her Hilo kin brought another kind of separation, however. Ane had married fellow patient Joseph Iokewe Kauhane in the settlement in June 1909. That fall, after both Ane and Joseph were medically discharged, Ane returned to her birthplace and family in Hilo. 57 Joseph does not appear to have accompanied her. Ane worked as a telephone operator in Hilo, becoming a supervisor. Edward Kekoa died in 1915, and Ane remained in the Hilo district until her death in 1932.

Conclusion: Care After Exile

The release of Ane Kekoa and Samuel Meheula back to their homelands and families were exceptions within thousands of other instances, however. The majority of people declared leprous were exiled to Molokai settlement. What could families do once loved ones were exiled? Some petitioned to become kōkua, or unpaid caregivers, for disabled and ailing kin in exile. Kōkua means to help or assist in Hawaiian. "Mea kōkua" or "kōkua" were so-called "clean" (i.e., non-leprous) people permitted by the Board of Health to reside in the settlement in exchange for essential manual and domestic labor, including caregiving for sick friends and kin. These kōkua nursed, buried bodies, built structures, farmed, prepared food, fetched water, and washed clothes, ensuring the function of the settlement.

Five months after Lahela Kanewa entered Kalihi Hospital in an advanced stage of leprosy, the Board removed her to Molokai on April 17, 1908. Again, even within the Board's archive of routinized proceedings are opportunities to apprehend the great determination, deliberation, and sacrifice on the part of Hawaiian families. A week later, on April 24, 1908, Lahela sent a request for her husband Joseph to be allowed into the Molokai settlement as her kōkua. Their petition was considered at a BOH meeting; it was approved and a permit issued for Joseph Kanewa. Joseph joined Lahela at the settlement on May 21, 1908. They lived together until Joseph predeceased Lahela in 1911. 58

The Kanewa family was but one of many who took such actions. At the same meeting, the Board considered the petition of a Mrs. Mary Leialoha Kuokalani, who requested her husband Owen Kuokalani as her kōkua. Their petition was also granted. Owen appears to have lived in the settlement with Mary Leialoha until she died two years later in 1910. 59 During this period from 1908 through 1910, a significant portion of the Board's meetings was spent deliberating petitions, either for kōkua to join family members or to remain in the settlement. ⁠ Not all petitions were approved, however. The Board denied some without explanation.

Without the work of kōkua, the Board would not have been able to run the Molokai settlement. More importantly, the willingness of kōkua to accompany their loved ones challenged the mandates of carceral medicine that produced stark divisions of clean/dirty, disabled/able-bodied, diseased/healthy, competent/incompetent, and beautiful/unsightly. Although the precise number is unknown, many hundreds of these helpers, usually kin or friends of patients, volunteered to go into exile at the settlement. 60 Kōkua gave up occupations, property, and rights to care for their loved ones. These helpers, although legally and socially designated as "clean" and able-bodied, continued intimate ties with biological, conjugal, and non-biological kin through cohabitation, nursing, sex, feeding, marriage, and adoption. Family members continued to recognize a person beyond external manifestations of illness.

What might these individual and collective actions suggest about Indigenous people and caregiving? It would be wrong to essentialize Kānaka 'Ōiwi as more capable of love and care than settlers. Nor did they dispute contemporaneous Western science that leprosy was contagious. However, many challenged a settler system that removed them from the reach of loved ones: a system they saw as unfair and unjust. Their visits, petitions, letters, and coordinated movements constitute a micropolitics of survival. Responding to suffering, love, and grief, they rejected normative assessments of their bodies and kinship and made deliberate choices to stay connected. If they were to survive illness and the wider colonial practices that threatened to extinguish them, they needed each other.

Acknowledgments:

I wrote this essay fitfully during the vicissitudes of the COVID-19 pandemic, leaning on many near and far. DSQ special issue editors Ella Callow, Juliet Larkin-Gilmore, and Susan Burch provided exceptional stewardship and feedback, while reviewers offered informed and judicious queries. I also wish to thank Makanani Salā and Noah Dolim for lending insights to my translation and interpretation of letters here, as well as conversations about Hawaiian kinship. Finally, I mahalo my own extended relations, especially the Arakawas, Rae Yamanaka, Aunty Shari "Chame" Smith, Aunty Jeanette Yamanaka, and hoaloha Ka'ohulani McGuire, whose love, food, and care kept us closely tied as the pandemic unfolded.

Note on Language: I do not italicize words in 'ōlelo Hawai'i (Hawaiian language), in order to avoid marking an Indigenous language as foreign. As nineteenth-century and early-twentieth-century sources written in 'ōlelo Hawai'i did not employ diacritical marks, I have preserved the original spelling of names and words in these sources, with the exception of prominent places and names that follow contemporary spelling conventions.

NOTES

  1. Kalihi Hospital and Detention Station operated between 1865-1875 and 1889-1949. It was also called "Kalihi Receiving Station" until ca. 1908 and "halemai lepera" (leprosy hospital) in Hawaiian. Kalihi Hospital admitted, examined, and detained people suspected of having leprosy. Those deemed incurable were sent from Kalihi to Molokai settlement. Located in Kalihi Kai (the seaward area of Kalihi) at the makai (seaward) end of Pu'uhale Road, Kalihi Hospital expanded to a compound that included a receiving building, separate men's and women's quarters, infirmary, and a keeper's cottage by the early twentieth century. The Molokai Settlement (Illustrated), Territory of Hawaii (Honolulu: Board of Health of the Territory of Hawaii, Hawaiian Gazette Co., 1907). Medical officers offered some treatment there, and from about 1910, federal public health scientists also conducted experiments on patients. C.H. Binford, "The History and Study of Leprosy in Hawaii," Public Health Reports, 1896–1970 51, no. 15 (April 10, 1936), 419-421.
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  2. By the 1865 law, "any person alleged to be a leper" would be arrested and delivered to the Board, and "all leprous patients who shall be deemed capable of spreading the disease of Leprosy" would be "isolated and confined, in some place or places for that purpose provided." Laws of His Majesty Kamehameha V, King of the Hawaiian Islands. Passed by the Legislative Assembly at Its Session, 1864-65 (Honolulu: 1865), 63-64. The Board of Health was an agency created by the kingdom of Hawai'i in 1851, with foreign settlers and missionary descendants forming its primary leadership. After Hawai'i was annexed in 1898 and incorporated as a territory in 1900, the BOH became a territorial entity of the United States, but retained many aspects of its original structure and expansive mission to license physicians, control infectious disease, carry out quarantines, and maintain hospitals. Hawai'i was an incorporated U.S. territory from 1900 until statehood in 1959. The essay discusses the early territorial period.
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  3. Makanalua, the northern peninsula of the island of Molokai, was chosen for the settlement because its forbidding cliffs and limited landing shores created a natural prison and discouraged escape. Makanalua was the site of two leprosy settlements: the original Kalawao settlement on the east side of the peninsula from 1866, and Kalaupapa on the west side, where people began moving in the early 1900s for its more hospitable climate. As of ca. 1907, the BOH process for confirming leprosy was first a microscopic examination; if bacilli were found in tissue, the person was examined by the five-member Board of Examining Physicians. If four members declared this person leprous, the person would be sent to Molokai. The Molokai Settlement, 11, 13. For a rich account of the criminalization of Hansen's disease and the founding of the Molokai settlement, see Kerri A. Inglis, Ma'i Lepera: Disease and Displacement in Nineteenth-Century Hawai'i (Honolulu: University of Hawai'i Press, 2013). A social history of the diverse people imprisoned at Molokai is in Anwei Skinses Law, Kalaupapa: A Collective History (Honolulu: University of Hawai'i Press, 2012).
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  4. Nailima Lishman's record is case 368, Box 25 (Medical Examination Records 1907), Medical Examination Records, 1896-1910; Bureau of Leprosy, 1866-1930, Kakaako and Kalihi Receiving Stations and Kalihi Hospital; Records Relating to Hansen's Disease, 1866-1981, Series 260; Hawai'i State Archives (HSA). Hereafter, Medical Examination Records are "MER, HSA."
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  5. This official period of segregation was between 1866 and 1969. The first group of exiled people arrived at Kalawao, Molokai in 1866, and the law mandating segregation was not rescinded until 1969 by the state of Hawai'i. In the last two decades of the policy (1949-1969) as sulfone drugs became accepted as a cure, people newly diagnosed with leprosy were confined and treated at a new facility, Hale Mōhalu on O'ahu. By the 1969 rescindment, more people were treated as out-patients without confinement.
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  6. With increased racial mixing in nineteenth and twentieth century Hawai'i, the BOH categorized "Hawaiians" separately from so-called "Part Hawaiians" (i.e., those of mixed Native and non-Native backgrounds). However, following the practice of Kānaka 'Ōiwi, I use "Hawaiian" and "Native Hawaiian" to refer to anyone descended from the Indigenous people of the Hawaiian archipelago. Immigrants from Asia and Portugal and their descendants who were medically incarcerated were mostly Chinese, Portuguese, Japanese, Koreans, and Filipinos brought to Hawai'i as contract plantation laborers. As immigration and settlement increased in the early territorial period, they and their descendants were represented in greater numbers in leprosy institutions.
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  7. Kekuni Blaisdell, "Historical and Cultural Aspects of Native Hawaiian Health," Social Process in Hawaii 32 (1989): 8. By the time leprosy isolation was enacted in 1865, Hawai'i's Native population had declined from 300,000 in 1778 to an estimated 59,000. O.A. Bushnell, "Hawaii's First Medical School," in Hawaii Historical Review: Selected Readings, ed. Richard A. Greer (Honolulu: Hawaiian Historical Society, 1969), 109. Hawaiians referred to the Molokai settlement by many names that capture the suffering of their people, including "luahi o ka make mau loa" (fiery pit of endless death) and "lahui i hoehaeha" (nation of great agony). These descriptive phrases are among those notated and translated from Hawaiian-language newspapers in John R.K. Clark, Kalaupapa Place Names: Waikolu to Nihoa (Honolulu: University of Hawai'i Press, 2018), 141. I extend gratitude to Noelani Arista for conversations about the nuanced reinterpretation of these Hawaiian-language descriptions and others.
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  8. Jonathan Kay Kamakawiwo'ole Osorio, Dismembering Lāhui: A History of the Hawaiian Nation to 1887 (Honolulu: University of Hawai'i Press, 2002), 224; Sally Merry, Colonizing Hawaii: The Cultural Power of the Law (Princeton: Princeton University Press, 2000), 89; Mark Rifkin, "Debt and the Transnationalization of Hawai'i," American Quarterly 60, no. 1 (2008): 43-66.
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  9. I elaborate on this control, subordination, and sanitizing of disabled Native Hawaiians and non-white immigrant descendants in my forthcoming book, An Archive of Skin, An Archive of Kin: Disability and Life-Making during Medical Incarceration (Berkeley: University of California Press, 2022). For more on the relationship between settler colonialism and carcerality, see Kelly Lytle Hernández, City of Inmates: Conquest, Rebellion, and the Rise of Human Caging in Los Angeles, 1771-1965 (Chapel Hill: University of North Carolina Press, 2017), 10-44 and Disability Incarcerated: Imprisonment and Disability in the United States and Canada, ed. Liat Ben-Moshe, Chris Chapman, and Allison C. Carey (New York: Palgrave MacMillan, 2014), 16-17, 35-36; 165-167. These works outline, respectively, how settler colonial invasions displaced and confined Indigenous people, while accounting for the disproportionate over-incarceration of Indigenous people.
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  10. On the persistence of leprosy in Europe and its resignification during imperial expansion, Rod Edmond, Leprosy and Empire: A Medical and Cultural History (Cambridge: Cambridge University Press, 2006), 7-8; 44-45. The relationship between colonial expansion and racialized phobia of leprosy, particularly in the Pacific, has been established by Zachary Gussow and George S. Tracy, "Stigma and the Leprosy Phenomenon: The Social History of the Disease in the Nineteenth and Twentieth Centuries," Bulletin of the History of Medicine 44, no. 5 (Sept.–Oct. 1970): 425-429; Zachary Gussow, Leprosy, Racism, and Public Health: Social Policy in Chronic Disease Control (Boulder: Westview Press, 1989), 85; 125-126; and Alison Bashford, Imperial Hygiene: A Critical History of Colonialism, Nationalism and Public Health (New York: Palgrave MacMillan, 2004), 81, 83-89. David Arnold has emphasized that it "would not be hard to construct" a "definitive colonial history of leprosy," noting how leprosy "rapidly became in a perceptual, if not in an epidemiological, sense naturalized in the Pacific, reinforcing the perception that it was, or had become, a largely 'tropical' disease." Arnold, "Leprosy: From 'Imperial Danger' to Postcolonial History–An Afterword," The Journal of Pacific History 52, no. 3 (2017): 407, 411.
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  11. About ninety-five percent of people exposed to the leprosy bacilli will not develop the disease because their immune system will fight the infection. It is a common myth that fingers of leprosy patients fall off. When fingers and toes suffer nerve damage, people may lose feeling and injure these areas, developing infections that result in tissue loss and cartilage absorption. Hence, some experience shortened bones and fingers. Nostrils and facial tissue can become deformed, and people also may experience loss of fingers and extremities, paralysis of eyelids, blindness, and chronic pain. S. Kalani Brady, M.D., interview, December 18, 2013; https://www.cdc.gov/leprosy/world-leprosy-day/index.html
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  12. By 1915, pneumonia and tuberculosis were the top two causes of deaths in Hawai'i, while leprosy ranked a distant tenth. Pennie Moblo, "Blessed Damien of Moloka'i: The Critical Analysis of Contemporary Myth," Ethnohistory 44, no. 4 (Autumn 1997): 697.
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  13. For discussion of disability as a historical colonial condition and the weaponizing of disability against colonial subjects, see Adria L. Imada, "A Decolonial Disability Studies?" Disability Studies Quarterly 37, no. 3 (2017). https://doi.org/10.18061/dsq.v37i3.5984
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  14. Between 1901 and 1920, for example, between 79 and 94 percent of those exiled were Kānaka 'Ōiwi, with the largest foreign, immigrant, and non-Indigenous populations usually represented by Portuguese, Chinese, Japanese, Koreans, and Filipinos. For a sample of these racialized national statistics, see Report of the President of the Board of Health of the Territory of Hawaii for the Eighteen Months Ending December 31, 1902 (Honolulu: The Bulletin Publishing Co., 1903), 268; Report of the President of the Board of Health of the Territory of Hawaii for the Twelve Months Ended June 30, 1915 (Honolulu: Hawaiian Gazette Co., 1915), 42.
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  15. For example, Sylvia Junko Yanagisako, Producing Culture and Capital: Family Firms in Italy (Princeton: Princeton University Press, 2002); Ann Laura Stoler, Carnal Knowledge and Imperial Power: Race and the Intimate in Colonial Rule (Berkeley: University of California Press, 2010); Evelyn Nakano Glenn, Issei, Nisei, War Bride: Three Generations of Japanese American Women in Domestic Service (Philadelphia: Temple University Press); Vicki L. Ruiz, Cannery Women, Cannery Lives: Mexican Women, Unionization, and the California Food Processing Industry, 1930-1950 (Albuquerque: University of New Mexico Press, 1987); and Laura Wexler, "The State of the Album," Photography and Culture 10, no. 2 (July 2017): 99-103. https://doi.org/10.1080/17514517.2017.1331561
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  16. For example, Alexandra Minna Stern, Eugenic Nation: Faults and Frontiers of Better Breeding in Modern America (Berkeley: University of California Press, 2015); Jay Dolmage, Disabled Upon Arrival: Eugenics, Immigration, and the Construction of Race and Disability (Columbus: The Ohio State University Press, 2018); Regina Kunzel, "Queer History, Mad History, and the Politics of Health," American Quarterly 69, no. 2 (June 2017): 315- 319. https://doi.org/10.1353/aq.2017.0026; and Susan Burch, Committed: Remembering Native Kinship in and beyond Institutions (Chapel Hill: University of North Carolina Press, 2021).
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  17. For instance, Brenda J. Child, Boarding School Seasons: American Indian Families, 1900-1940 (Lincoln: University of Nebraska Press, 1998); K. Tsianina Lomawaima, They Called it Prairie Light: The Story of the Chilocco Indian School (Lincoln: University of Nebraska Press, 1994); Mary Jane Logan McCallum, "Starvation, Experimentation, Segregation, and Trauma: Words for Reading Indigenous Health History," The Canadian Historical Review 98, no. 1 (2017): 96–113. https://doi.org/10.3138/chr.98.1.McCallum; Lisa Brooks, Our Beloved Kin: A New History of King Philip's War (New Haven: Yale University Press, 2018); Malinda Maynor Lowery, Lumbee Indians in the Jim Crow South: Race, Identity, and the Making of a Nation (Chapel Hill: University of North Carolina Press, 2010); and Joshua L. Reid, The Sea is My Country: The Maritime World of the Makahs (New Haven: Yale University Press, 2015).
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  18. To date, histories making explicit connections between constitution of Indigeneity, ableism, and disability have been uncommon. However, recent work pursues these questions in productive directions. See Burch, Committed; Jess L. Cowing, "Occupied Land is an Access Issue: Interventions in Feminist Disability Studies and Narratives of Indigenous Activism," Journal of Feminist Scholarship 17 (Fall 2020): 9-25. https://doi.org/10.23860/jfs.2020.17.02; and Juliet Larkin-Gilmore, "On the Borders: Towns, Mobility, and Public Health in Mojave History," Journal of Arizona History 61, no. 3 (2020): 511-534. muse.jhu.edu/article/775436
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  19. Scholar Patrick Wolfe did not rely on disability as an analytic. However, as settler colonial projects rely on the "elimination of native societies," I observe the weaponizing of ability as critical in marking Native people as unfit, thereby allowing for their incarceration, elimination, and removal. Patrick Wolfe, "Settler Colonialism and the Elimination of the Native," Journal of Genocide Research 8 (2006): 391. https://doi.org/10.1080/14623520601056240 See also Imada, "A Decolonial Disability Studies?"
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  20. In Hawai'i, Kanaka 'Ōiwi kinship was explicitly indicted as a disability that weakened Hawaiian people, as in Rev. S.E. Bishop, Why are the Hawaiians Dying Out, Or Elements of Disability for the Survival Among the Hawaiian People, s.n., 1888. Settler colonial occupation transformed Hawaiian governance and land use to a capitalist economy, Christianity, Western land tenure, laws, and coverture. Accompanying this shift, institutions captured and disciplined "wayward" Hawaiians through jails, insane asylums, juvenile reform schools, and leprosy institutions.
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  21. While settler colonial authorities and physicians in Hawai'i viewed family as hereditary, biological, and "blood related" heteropatriarchal nuclear families, Hawaiian social relations recognized more expansive practices of 'ohana (kinship) that included both lineal and collateral descent, as well as non-heterosexual, polyandrous, and polygamous unions and other forms of non-biological kinship and informal adoption. For more on the "deeply felt, unifying force" of 'ohana as offshoots deriving from the same ancestral kalo (taro) root, see Mary Kawena Pukui, E.W. Haertig, and Catherine A. Lee, Nānā i Ke Kumu (Look to the Source), Vol I. 1979 (1972; Honolulu: Hui Hānai, 2001), 166-171. The kin relations discussed in this essay are primarily legible as conjugal and biological, but diverse, non-biological kinship flourished in leprosy institutions; see Adria L. Imada, "Lonely Together: Subaltern Family Albums and Kinship during Medical Incarceration," Photography and Culture 11, No. 3 (2018): 297-321. https://doi.org/10.1080/17514517.2018.1465651
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  22. Further elaboration on the ethics of restraint is in Imada, An Archive of Skin, An Archive of Kin. My decision to use people's real names instead of pseudonyms is influenced by early twentieth-century newspaper articles that named survivors and their birthlands. I discuss examples of these later in this essay.
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  23. "Hansen's disease" became the term for leprosy adopted by patients, their advocates, and some doctors in the 1960s to destigmatize the illness.
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  24. Nathaniel B. Emerson, Report to President of the Board of Health (1879); EMR 188; Box 5, Medical Papers; Series One: Emerson's Research Material; Nathaniel Bright Emerson Papers, 1766-1944; The Huntington Library, San Marino, California. Emerson was a missionary son appointed as the first resident physician at the Kalawao, Molokai settlement from 1878 to 1880. He later served as president of the BOH from October 1887 to January 1, 1890.
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  25. The Molokai Settlement, 6-7. Lucius E. Pinkham would go on to become the fourth territorial governor of Hawai'i in 1913, a non-elected position appointed by the president of the United States.
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  26. Letter from Edward Kekoa, October 28, 1905, Folder, Kalihi Hospital, 1905-1909; Box 335-13; Correspondence of the Board of Health, 1905-1917, Series 335; HSA.
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  27. While this essay interprets textual sources, my other research on carceral medicine focuses on the visual culture of leprosy and disability produced by institutions and the people within. Adria L. Imada, "Promiscuous Signification: Leprosy Suspects in an Archive of Skin," Representations 138, no. 1 (Spring 2017): 1-36. https://doi.org/10.1525/rep.2017.138.1.1; Imada, "Lonely Together"; and Imada, An Archive of Skin, An Archive of Kin.
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  28. Covering a discrete period between 1904 and 1917, with the bulk of visits in the years between 1904 and 1908, this Kalihi Hospital Keeper's log is leather bound and labeled with a calligraphed title: "Visits to Kalihi Station." The volume was possibly created by Richard Burns, keeper of the station from ca. 1904, to catalogue permit authorizations he received from the BOH President's office. 331 Volume 115 (Visits to Kalihi Station, November 23, 1904–September 17, 1917); Board of Health Letterbooks (Other Agents and Officers); Outgoing Letters of the Board of Health, 1865-1961, Series 331; HSA. (Hereafter 331 Vol. 115 Letterbooks, HSA ). All subsequent references to Station visits are from this letterbook.
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  29. This description of Kalihi Hospital is based on one by a "part-Hawaiian" man who was incarcerated at age 13, ca. 1921. Ted Guglyk and Milton Bloombaum, Ma'i Ho'oka'awale (Honolulu: Social Science Research Institute, University of Hawaii, 1979), 81. According to published BOH reports, about 20 to 30 detainees were living at Kalihi Hospital in 1909 and 1910. Between July 1909 and June 1910, for example, 55 people were received, 33 sent to Molokai, 3 died, and 7 discharged, leaving 31 people in custody as of June 30, 1910. In comparison, 614 people were inmate-patients at the Molokai settlement as of the same date. Report of the President of the Board of Health of the Territory of Hawaii for the Twelve Months Ended June 30, 1910 (Honolulu: Bulletin Publishing Co., 1910), 124, 127. By the 1930s, the Kalihi facility had adopted more carceral architecture, replacing its high boards around the compound with an eight foot-high chain-link fence and barbed wire. Henry Kalalahilimoku Nalaielua, No Footprints in the Sand: A Memoir of Kalaupapa (Honolulu: Watermark Publishing, 2006), 20.
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  30. The BOH ordered Nailima Lishman to be transported to Molokai on April 16, 1908; this was recorded in Volume 15 (January 16, 1907 - June 17, 1908); Minutes of the Board of Health, 1858-1983, Series 259; HSA; pp. 221-222. (Hereafter, Vol. 15 Minutes, HSA.) The discrepancy between the 1908 order date and her actual arrival in Molokai in 1911 is because she was detained for a longer period in Kalihi. Per the U.S. census in 1910, Lishman was an inmate at the Kalihi Receiving Station. Nailima Lishman's death in 1916 is in Volume HD-3 (Records of Deaths in Leper Settlement [Monthly], 1889 -1923); Patient Registers and Indexes; Bureau of Leprosy, 1866-1930, Kalaupapa Leprosarium; Records Relating to Hansen's Disease, 1866-1981, Series 260; HSA (Hereafter, HD-3, HSA).
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  31. Solomon Meheula was likely either Samuel's father or uncle who functioned as his guardian; see notes 21 and 39 about the flexibility of Hawaiian parenting. "Ua Pauaho Mai o Solomon Meheula i Keia Ola Ana," Ka Nupepa Kuokoa, November 30, 1922; Journal of the Proceedings of the House of Representatives of the Second Legislature of the Territory of Hawaii in Regular Session, February 18 - April 28, 1903 (Honolulu: Bulletin Publishing Co., 1903), 5-6.
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  32. Sam Meheula, as his name was listed on the clinical record, was admitted and examined at Kalihi Hospital on May 19, 1905. His record is case 508, Box 22 (Medical Examination Records 1905); MER, HSA.
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  33. As of 1936, patients' friends and families visited frequently. C.H. Binford, "The History and Study of Leprosy in Hawaii," Public Health Reports 1896-1970 51, no. 15 (April 10, 1936): 415-423. Although beyond the scope of this essay, detained people extended care to one another within the detention facility to survive and make life bearable. Family members may have brought lei (garlands) to adorn imprisoned loved ones, or patients may have woven lei from flowers growing in the compound. These lei are visible in medical photographs taken at Kalihi Hospital. Imada, "Promiscuous Signification," 24-27. In the 1930s, younger patients escaped through the Kalihi compound's fence for jaunts into the surrounding working-class Kalihi neighborhood. Nalaielua, No Footprints in the Sand, 28.
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  34. Lahela Kanewa's record is case 737, Box 26 (Medical Examination Records, 1907-1908), Series 260, HSA. The Kanewa family's numerous visitation permits are recorded in 331 Vol. 115 Letterbooks, HSA.
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  35. Letter from F. Wittrock to Dr. John Pratt, February 21, 1913; and Letter from Dr. John Pratt to F. Wittrock, February 24, 1913; Folder, Kalihi Hospital, 1905-1909; Box 335-13; Correspondence of the Board of Health, 1905-1917, Series 335; HSA. Although Frederick Wittrock does not name them in this letter, the children to whom he refers were likely Augusta and Ella. Augusta would have been nineteen years old; she had married in Honolulu in 1911. Her sister Ella was about nine years old. Later, two of their brothers, George and Walter Wittrock, also would be exiled to Molokai. Ella married another patient named Manuel Borge (also spelled Borges) at Kalaupapa settlement in July 1921. This biographical information has been reconstructed by cross-referencing U.S. census records with BOH records and newspapers.
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  36. Frederick Wittrock was deputy sheriff of Maui at the time of his death on April 25, 1913. Although he and Kukonaalaa had seven children, an obituary in a Honolulu newspaper notes he was survived by "a widow and five children," suggesting his daughters with leprosy may have been considered socially dead. "Two Pioneer Citizens of Hawaii Pass to Beyond," Honolulu Advertiser April 27, 1913.
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  37. Letter from Solomon Meheula to L.E. Cofer, May 6, 1908; Letter to Solomon Meheula, May 6, 1908; Folder, Kalaupapa Settlement, 1908; Box 335-12; Correspondence of the Board of Health, 1905-1917, Series 335; HSA. Brenda J. Child (Ojibwe) discusses how American Indian family members wrote and sent concerned letters about their children to boarding school superintendents, including that of the Flandreau School in South Dakota, during a contemporaneous period. Child, Boarding School Seasons.
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  38. There do not appear to have been consistent re-examination procedures at Kalihi Hospital in BOH rules ca. 1907. However, the BOH stated that any person at Molokai settlement who warranted re-examination could receive one and be released if no bacilli were found. Molokai Settlement, 10. In 1909, territorial law formally revised these procedures. Patients had the right to name a licensed physician as their examiner, with the BOH selecting its own licensed physician. A third examining physician was to be selected either by the two physicians or by a circuit court judge. L 1909, c 81, § 4 (April 14, 1909).
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  39. In the 1910 U.S. census, Solomon Meheula's occupation was listed as a clerk. Samuel, who was identified as Solomon's nephew, had no occupation recorded. In 1920, they were living in the same household, with Solomon employed as deputy jailer at county jail and his "foster son" Samuel working as an "express wagon" chauffeur. Solomon may have been either Samuel's father or uncle. However, in Hawaiian kinship terms, a father and uncle or a mother and aunt are "makua" (a parent-generation) to a child. Thus, it would not have been unusual for Solomon and Samuel to live as parent (makua) and child (keiki), although U.S. and territorial agencies struggled to define these kin relationships. Pukui, Haertig, and Lee, Nānā i Ke Kumu (Look to the Source), Vol I., 167.
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  40. The BOH used the medical-juridical categories of "not a leper," "leper," and "suspect." A "leper" was someone who was "incurable or capable of spreading the disease of leprosy." These people were exiled to Molokai for life. A suspect was monitored while detained. Molokai Settlement, 13. Ane Kekoa's record is case 545, Box 22 (Medical Examination Records 1905); MER, HSA. In this record, she is identified as Anna Kekoa, age 19, "part-Hawaiian." She was admitted to Kalihi Hospital on September 29, 1905.
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  41. Some Hawaiians suspected of having leprosy became fugitives rather than be removed from their families. One celebrated mo'olelo (history) relayed the armed resistance of Kaluaiko'olau and his family on Kaua'i. Around 1892 Kaluaiko'olau and his young son Kaleimanu contracted leprosy. Kaluaiko'olau was ordered to report to a government physician; he agreed to go to Kalawao, Molokai if Piilani could go as their mea kōkua (helper), but the BOH refused. The family vowed not to be separated and fled below the steep Kalalau cliffs. In 1893, the Provisional Government (the pro-U.S. entity that overthrew the Hawaiian kingdom) sent soldiers into the valley to capture a group of Hawaiians hiding from health agents. Kaluaiko'olau, a cowboy and marksman, shot and killed a sheriff and wounded two soldiers. After her beloved husband and son died of leprosy, Piilani emerged from the valley in 1897. A book about Kaluaiko'olau was written and published in Hawaiian by Kahikina Kelekona (John Sheldon) in 1906, based on Piilani's oral account. "The True Story of Kaluaiko'olau, or Ko'olau the Leper," [original by Kahihina Kelekona], Translated by Francis N. Frazier, The Hawaiian Journal of History 21 (1987): 1-41. Jack London subsequently embellished the story and published it as "Koolau the Leper," in The House of Pride and Other Tales of Hawaii (New York: MacMillan, 1912). Other Kānaka and Asian immigrants evaded government agents in less spectacular fashion by running away or by hiding with the help of family members. Kalihi Hospital records offer a glimpse of these experiences. A husband and wife, Haumea and Makanui Kanehe, entered Kalihi Hospital in December 1902 from Wainiha, Kaua'i. Haumea Kanehe conveyed that they had "been hiding in the bush for two years past." After their exile in February 1903, they petitioned the BOH to allow their daughter in Waimea, Kaua'i to join them at Molokai, but this was denied. The daughter was sent to Kapi'olani Home for Girls, a Honolulu institution for non-leprous children of leprosy patients. Their records are case 240 and 241, Box 16 (Medical Examination Records 1902-1903); MER, HSA. Hawaiian Gazette, June 5, 1903. Three years later, Haumea Kanehe died at the settlement at age 29. Makanui Kanehe appears to have been discharged in November 1909.
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  42. "No Cruel Treatment of Lepers," Hilo Tribune, October 10, 1905. This article also was reprinted in Pacific Commercial Advertiser, October 12, 1905.
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  43. Letter from Edward Kekoa, October 28, 1905, and Letter from L.E. Pinkham to Edward Kekoa, October 31, 1905; Folder, Kalihi Hospital, 1905-1909; Box 335-13; Correspondence of the Board of Health, 1905-1917, Series 335; HSA.
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  44. Ane Kekoa was one of the residents whom Charmain London described during a 1907 visit to Molokai settlement with her husband, the writer Jack London. Charmian Kittredge London, Our Hawaii (Honolulu: Patten Company, 1917), 128.
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  45. Letter from Edward Kekoa, March 3, 1908, Folder, Kalaupapa Settlement 1908; Box 335-12; Correspondence of the Board of Health, 1905-1917, Series 335; HSA.
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  46. Edward Kekoa was age 60 when he signed the men's Apana o Hilo, Mokupuni o Hawaii (Hilo district, island of Hawai'i) petition. This sheet and the rest of the September 11, 1897 petitions have been digitized and can be viewed at http://libweb.hawaii.edu/digicoll/annexation/petition.php These signatures were collected by the Hui Aloha 'Āina, one of three Kānaka-led organizations opposing U.S. annexation. The Hui Aloha 'Āina petitions are over 556 pages, with over 20,000 names of men and women. Signatures from the three organizations totaled 38,000 out of the Native populace of 40,000. Even if some signatures were duplicates, the petitions represent extraordinary opposition to the U.S. takeover. People incarcerated at the Molokai settlement also signed. Delegates from the organizations brought the petitions to Washington in late 1897 and persuaded U.S. senators not to sign this second treaty of annexation. Ultimately, the Senate failed to ratify the treaty. Noenoe K. Silva, Aloha Betrayed: Native Hawaiian Resistance to American Colonialism (Durham: Duke University Press, 2004), 146, 151, 159, 160.
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  47. Silva discusses Kekoa's writings that denounced the legitimacy of the Newlands Resolution and urged people to persist in Aloha Betrayed, 161 and Noenoe Silva, "Translations of Articles from the Hawaiian Nationalist Newspaper Ke Aloha Aina," 'Ōiwi 2 (2002): 120-124. Edward Kekoa, "E Hoomau i ke Kupaa i ke Aloha i ke Aina," Ke Aloha Aina, January 20, March 3, April 28, 1900.
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  48. Pinkham relayed this update to Fred Hamilton, one of the signatories. Letter to L.E. Pinkham regarding George Kakapu, April 29, 1907, Folder, Kalihi Hospital, 1905-1909; Box 335-13; Correspondence of the Board of Health, 1905-1917, Series 335; HSA.
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  49. While beyond the scope of this essay, people with leprosy also challenged the authority of the territorial Board of Health in court. In one notable case, the lawyer representing Emma L. Kaipu filed a writ of habeas corpus on behalf of Emma's mother Mikala Kaipu in 1904. The writ argued that Mikala had demonstrated enough improvement to be released from Kalihi Hospital. After the writ's denial by the U.S. District Court in Hawai'i in 1905, Emma Kaipu appealed to the U.S. Supreme Court. However, due to Mikala Kaipu's death, the case was dismissed on May 13, 1907. Another Kalihi inmate Anamalia Maunakea, however, was discharged after filing a successful writ of habeas corpus with the First Circuit Court of Hawai'i. The BOH appealed the decision to the Supreme Court of Hawai'i, but the original order was affirmed in 1908. In the wake of this legal defeat, the BOH noted in 1909 that no active work to apprehend leprosy suspects had been pursued as it could not enforce the law. It only took suspects who had turned themselves in voluntarily. Both petitioners, Kaipu and Maunakea, were represented by former Kingdom of Hawai'i attorney general Clarence W. Ashford. Mikala Kaipu was admitted to Kalihi Hospital on September 23, 1904 from Kaua'i. She was 47 years old. Her record is case 450, Box 20 (Medical Examination Records 1904); MER, HSA. Anamalia Maunakea was admitted on November 10, 1907 from Kuamo'o, North Kona, Hawai'i island; she was 39 years old. Her record is case 740, Box 26 (Medical Examination Records 1907-1908); MER, HSA. In the Matter of Kaipu, 2 D. Haw. 215 (1904); Kaipu v. Pinkham, 51 U.S. 1191 (1907). In re: Maunakea, 19 Haw. 218 (1908). Report of the President of the Board of Health of the Territory of Hawaii for the Twelve Months ended June 30, 1909 (Honolulu: Bulletin Publishing Co., 1909), 10.
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  50. A Hawai'i daily newspaper opined that these people were "victims of a terrible mistake." One of the eleven people released was a seventy-nine-year-old Hawaiian man named Naiwi from Pālama, O'ahu, who had been apprehended and examined in 1906 showing "deformed" hands and "very few" bacilli. In all likelihood, Naiwi and the other ten patients had not been cured, but their bacterial counts had waned as leprosy is now understood to do, presenting as remission. These articles are respectively "Discharged from Kalihi Station," Hawaiian Gazette, June 4, 1909 and "Victims of a Terrible Mistake," Evening Bulletin, June 3, 1909 in 334-37, HSA. Two boys had been at the Kalihi Boys' Home (a Honolulu facility for non-leprous male children of Molokai patients) and nine were at Molokai settlement. Charles Wainui, O. Kaimu, J. W. Puiehaka, J.K. Alapai, John Kaapuni, Kahele Kana, Kealiiahonui, Naiwi, and Augusta Freitas were released from Molokai. All were issued certificates clearing them of leprosy. The petitioners' accounts are not in the BOH records, but territorial resolutions supporting individual petitions are in Folder: House of Representatives re: Lepers 1907-11; Box 335-11; Correspondence of the Board of Health, 1905-1917, Series 335; HSA.
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  51. "Now 171 Lepers Knocking at the Door of Hope," Hawaiian Star, August 24, 1909. Some exiled people declined to be examined; they may not have had homes or employment prospects to which to return.
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  52. Nahauowaileia (the dews of Waileia) and Waikakulu (a freshwater pool) were two of S.K. Maialoha's poetic pen names. Marriage, 1910 U.S. census, and HSA BOH records indicate Maialoha was a man, possibly with the full name S. Maialoha Kapela. See also Clark, Kalaupapa Place Names, 297-298, 309. Nahauowaileia's testimonials represent part of a much larger written archive of patient-centered accounts. In a survey of Hawaiian-language newspapers from 1865-1897, Noenoe K. Silva and Pualeilani Fernandez argue that patients who were mostly maka'āinana (non-chiefly, common people) used newspapers to protest government policies and ask fellow citizens to take responsibility for wrongs. These consist over 350 letters and editorials in six different newspapers. Noenoe K. Silva and Pualeilani Fernandez, "Mai Ka 'Āina O Ka 'Eha'eha Mai: Testimonies of Hansen's Disease Patients in Hawai'i, 1866-1897," The Hawaiian Journal of History 40 (2006): 76. A sampling of letters sent from Kalaupapa and Kalawao and published in nūpepa (Hawaiian-language newspapers) further shows Hawaiians using print culture after 1900 to mourn the deaths of loved ones, report on settlement activities, and raise objections to BOH practices. Some of these letters are in Clark, Kalaupapa Place Names.
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  53. Hawaiians were highly literate in their Native language, 'ōlelo Hawai'i, with an estimated three-quarters of Hawaiians who could read and write in Hawaiian in 1853. Robert C. Schmitt, Historical Statistics of Hawaii (Honolulu: University Press of Hawaii, 1977), 209. Three years after the U.S.-backed overthrow of the Kingdom, 'ōlelo Hawai'i (Hawaiian language) was suppressed in all public and private schools in 1896, and English designated the official language of instruction. Paul F. Nahoa Lucas, "E Ola Mau Kākou I Ka 'Ōlelo Makuahine," The Hawaiian Journal of History 34 (2000): 8. On the circulation and longevity of Hawaiian newspapers, see Esther K. Mookini, The Hawaiian Newspapers (Honolulu: Topgallant, 1974), 44.
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  54. S.K. Maialoha, "Na Mea Hou o ke Kahua Ma'i," Ke Aloha Aina, September 4, 1909; S.K.M. Nahauowaileia, "Na Mea Hou o Kalaupapa," Kuokoa Home Rula, September 3, 1909; S.K.M. Nahauowaileia, "Papa Inoa o Na Ma'i Lepera," Ka Nupepa Kuokoa, September 3, 1909; S.K.M. Nahauowaileia, "Nanaia Na Ma'i o Molokai, " Ka Nupepa Kuokoa, October 29, 1909. I credit Sahoa Fukushima's nupepa-hawaii.com for highlighting the importance of these articles, as well as Clark's Kalaupapa Place Names.
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  55. Nahauowaileia, "Nanaia Na Ma'i o Molokai," Ka Nupepa Kuokoa, October 29, 1909.
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  56. Nahauowaileia lists 55 names out of total of 108 in "Papa Inoa o Na Ma'i Lepera," Nupepa Kuokoa, September 3, 1909. "Na Mea Hou o ke Kahua Ma'i" and "Na Mea Hou o Kalaupapa" each list 52 names. Ane Kekoa, for instance, is named as "Annie Kekoa (w[wahine]) 3, Hilo."
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  57. By 1915, Ane Kekoa was no longer living in the settlement; Charmain and Jack London made a second visit to Kalaupapa that year. Asking after her, Charmain learned that Kekoa "had been discharged years before, all tests having failed to locate further evidence in her of the bacillys [sic] leprae … She was now married and living in Hilo." London, Our Hawaii, 303. Kekoa married a Russian-born man named Samuel Siegel in 1919; he was employed as a saddle-maker. She may have separated from him or been widowed, for she appears to be living by herself as of the 1930 U.S. census. In 1925, Kekoa was awarded a Hawaiian homestead in Keaukaha, Hawai'i island. When she died in 1932, her community remembered her as "Mrs. Annie Kekoa Siegel." "Ua Hala o Mrs. Annie Kekoa Siegel," Ka Hoku o Hawaii, May 17, 1932.
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  58. English translation, Letter from Lahela Kanewa to L.E. Cofer, April 24, 1908; Folder, Kalaupapa Settlement, 1908; Box 335-12; Correspondence of the Board of Health, 1905-1917, Series 335; HSA. Kanewa's original letter to Cofer, written in Hawaiian, is not in this file. Lahela Kanewa's kōkua petition is recorded in Vol. 15 Minutes, HSA, p. 231. Two years later in May 1910, one of their children, George, was exiled to Molokai. Joseph Kanewa predeceased Lahela in the settlement in 1911. Lahela Kanewa died there on March 18, 1916 at the age of 48. Their son George died in May 1918 at age 22.
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  59. Mary Leialoha Kuokalani's record is case 735, Box 26 (Medical Examination Records 1907-1908); MER, HSA. Identified as Leialoha Kuokalani in her medical record, she was born in Hāna, Maui and had been living in Wailuku, Maui when she entered Kalihi Hospital. She was sent to Kalaupapa settlement on April 17, 1908 and died August 10, 1910. Owen and Leialoha Kuokalani's kōkua petition is Vol. 15 Minutes, HSA, p. 231. Owen survived Leialoha and returned home to Maui. He worked in Hāna as a laborer, but in 1930, he was living in Lunalilo Home, a home for aged, indigent, and disabled Hawaiians in Mākiki, Honolulu.
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  60. There are no clear statistics on how many mea kōkua lived in the settlement during the formal period of leprosy segregation from 1866-1969. Historian Kerri Inglis estimates that by 1900 there may have been approximately four to five hundred mea kōkua who had settled on the peninsula. Inglis, Ma'i Lepera, 86.
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