Volume 97 1988 > Volume 97, No. 2 > Leprosy in New Zealand, by J. Z. Montgomerie, p 115-152
LEPROSY IN NEW ZEALAND
One of the most curious stories in the history of medicine in New Zealand is that of the disease ngerengere — “a sort of leprosy”. The available evidence for this disease has been reviewed by a number of writers (Begg & Begg 1979:182; Best 1905a:11-13, 1924:49, Gluckman 1962, 1976; Goldie 1899; Hiroa 1910:74-6, 1949:408-9; Lange 1972; Wilson 1934:209-11). The story is curious because leprosy was said to have existed among the Maoris in pre-European times when the disease was probably not present in other Polynesian groups. A quotation from Elsdon Best (1924:49) summarises a widely accepted view of this disease which was often called “a sort of leprosy”:
He [the Maori] assuredly had a form of leprosy, termed ngerengere, tūhawaiki and tūwhenua, in olden times; it was introduced from Polynesia by a canoe since known as te waka tūwhenua — the leprosy vessel. This disease was spoken of as a malignant atua .... The distressing ngerengere caused the extremities to drop off joint by joint. The Maori had a curious belief that certain sorcerers possessed the power of inflicting this disease on others, the act of doing so being known as wero ngerengere.
This statement was not supported by any evidence and is not untypical of the sweeping statements made by early New Zealand writers.
Leprosy has at one time or another been a world-wide disease. Historically it probably originated in China and India, where clinical descriptions of the disease have been dated 600 B.C. (Cochrane 1964). The army of Alexander the Great may have introduced it into the Mediterranean area when they returned from India 327-26 B.C. (Anderson 1969). The disease may have spread locally from China to the Pacific as far as Melanesia, but general accounts of leprosy do not mention Polynesia as a site of leprosy before the latter half of the 19th century.
Although the occurrence of a sort of leprosy among the Maoris in pre-European times has been accepted by a number of writers, the lack of adequate clinical descriptions or physical evidence has made many persons skeptical of the story.- 116
I have reviewed the evidence that leprosy did or did not exist among the Maoris before European contact by examining: (1) the terms used to describe the disease which includes narrations, waiata (songs) and legends; (2) the oral traditions of the Maoris; (3) the descriptions by early physicians and visitors to New Zealand; and (4) the history of leprosy in the Pacific and Polynesia.
THE TERMS USED TO DESCRIBE LEPROSY
The terms used to describe leprosy in early New Zealand dictionaries and word-lists are shown in Table 1. Kendall's dictionary (Kendall and Lee 1820) does not contain any terms relating to leprosy, and has not been included.
This is the term used most frequently in the literature to describe leprosy. Taylor's list of terms in 1848 contains ngerengere meaning leprosy. He also lists mutumutu, ringamutu, tūwenua and tūhawaiki as leprosy or a sort of leprosy.
The Rev. Richard Taylor was a well-educated man who gained an M.A. degree at Cambridge University before entering the church. From 1843 to 1855 he lived in Wanganui, the district where the medical description of ngerengere was first made. As a missionary, Taylor had close contact with the Maoris. He visited all the villages in the district, often travelling great distances; in 1843, for example, he walked to Rotorua. From 1825 he kept a journal of his daily life. He was an accurate observer and a prolific writer about Maori culture and is considered to be an important source of information about Maori culture.
Taylor's inclusion of ngerengere and a number of other terms relating to leprosy in a dictionary in 1848 might seem surprising because of the limited descriptions of leprosy available at that time. However, Taylor recorded in his diary meetings with all the persons who provided descriptions of leprosy or “a sort of leprosy” at that time. Dr Shortland stayed at Taylor's home in Wanganui. Taylor and Dr Johnson seem to have been close friends and their association in Auckland is recorded. Taylor also had close contact with Dr Rees who provided the first clear description of leprosy.
The earliest use of the term ngerengere that I could find was in 1851 by George Rees, M.D., Colonial Surgeon at Wanganui. In a report to Sir George Grey, Rees (1854:31-2) used the term to describe a disease with- 117
Terms used to Describe Leprosy in New Zealand Dictionaries and Word-lists
nf = not found- 118
skin lesions, loss of sensation and loss of digits, features that were consistent with leprosy. He stated that the disease was called ngerengere by the Maoris. The first written use of this term by a Maori that I could find was in Grey's Collection of Maori Manuscripts (MS nd.), probably written before 1854. The term was used to describe the disease of Te Rohu, a Maori chieftainess, but there was no clinical description. Ngerengere was also used in a legend to describe the persons with the disease rather than the disease itself (Grace 1917). Ngerengere was used in this sense by Dr Ginders (1890:2). On June 23, 1846, at Taikawakawa, William Williams noted in his Journal to the Church Missionary Society (Porter 1974:386):
Went in the afternoon to see Ruitene Ngerengere a poor man who was almost at the last gasp from the want of proper food.
No description of the man's physical state was included. We can only guess that this man got his name because of his illness. One variation of the term, wero ngerengere, was used to describe a spell that caused a person to be afflicted with ngerengere. According to Gluckman (1976:197), mata ngerengere was leprosy involving the face (mata). Matangerengere as a single word, meaning benumbed or cramped, can be found in dictionaries as early as Williams' (1844). Shortland (MS 1854-5) included matangerengere” in his word-list as “limb that is asleep ... [illegible] ngerengere”. This possibly suggests a link to leprosy, since anaesthesia in the limbs may be a symptom in leprosy. Gluckman (1976:197) stated that ngere means ‘gloomy’ and the duplication is for emphasis. Ngerengere has not been described in other Polynesian languages except for nele, which is a term from Hawaii (Pukui and Elbert 1971). Ngerengere may also mean ‘property’ or ‘goods’ as well as part of a fortifications for a pā (Williams 1971). As an adjective, Ngere may have three meanings: (1) pass over, not served; (2) disappointed, having failed in one's object; (3) ceremonially sequestered or tapu (Williams 1971).
The first written use of this term was in Taylor's dictionary of 1848. He defined tūwhenua as ‘a sort of leprosy’. Taylor also used the term tūwhenua for ‘a kind of leper’ in 1849 when he was in the Rotorua area. Tūwhenua was used to describe a sort of leprosy in the story of one of the early canoes that arrived in New Zealand. The people in the canoe had a disease which was called tūwhenua and some of them died from this disease. This story was obtained from the Maoris in Northland in the - 119 1840s or 50s and is part of the collection of John White (MS nd.). For many years John White lived in Bethells Beach where the Kawerau tribe resided, and may have become familiar with the term at that time. Tūwhenua also means ‘covered with sores’, ‘land breeze’ and ‘mainland’ (Williams 1971).
This term seems to have been used in the South Island. Dr Shortland (1851) first used the term in 1843 to describe a woman with a disease that looked like frostbite. He implied that the disease was called tūhawaiki by the Maoris in the area. John White (1887-90b:59) translated tūhawaiki as ‘leprosy’ in a Maori legend. Some writers have used this term in the sense that the disease came from Hawaiki (Gluckman 1976:197; Hiroa 1949:408). Tū Hawaiki was also the name of a prominent chief in the South Island, but there is no evidence that he had leprosy. It is possible that tūhawaiki may have also had the meaning of ‘deformed’ because the chief and his family were noted as having six toes (Ian Church — personal communication).
Mumutu, mutumutu, ringamutu
These terms have been derived from mutu meaning to ‘cut off’ or ‘truncate’. Mutumutu is included in Taylor's dictionary of 1848 as ‘a sort of leprosy when the first joints of the fingers and toes fall off’. Mumutu is defined in Williams' dictionary (1971) as leprosy which caused fingers and toes to drop off. Ngerengeremumutu (a combination of ngerengere and mumutu) is an intriguing entry in Taylor's 1848 dictionary, meaning a swelling of the head from the heat of the sun which causes blood to flow from the nose. This seems to be unrelated to leprosy. Ringamutu means ‘loss of a hand’ and, as a variation on this, Ringaringa Beach on Stewart Island was supposedly named after a man whose hands had rotted away to stumps through the ravages of a disease called tū Hawaiki (Beattie MS nd.). ‘Lament for Pare-ringamutu’ is a waiata in Ngā Moteatea (Ngata 1959b:124-5). There is no explanation for this name and nothing to suggest the subject had had any illness.
This is a modified English term formerly used in Maori Bibles (Anon 1837; Anon 1845; Anon 1868) as a translation of “leprosy”. Repera was also used in the Te Rohu waiata (Ngata 1959a:142-5).- 120
This term is in Tregear's Dictionary (1891) as a sort of leprosy. Tregear referred to the translation of the legend “The Deluge” by John White (1887-90a:152, 169) in which the term tāiko was translated as tūwhenua. The stated source of the story was the Ngai Tahu, a South Island tribe. Apart from this, I was unable to find this term linked to leprosy in the literature. Tāiko also means ‘black petrel’ (Williams 1971), and this meaning will be discussed later under Motutaiko. The term is also the South Island dialect variation of taaingo ‘spotted, mottled’ (Bruce Biggs — personal communication).
This nonsourced term was included by Goldie (1899) as a Maori term in a thesis about Polynesian medicine. I could not find this word with any meaning related to leprosy elsewhere in the literature. Putuputu is included in Williams' dictionary (1971) as ‘close together’, ‘frequent’, ‘closely woven’ or ‘fern root’.
This was a term used by a sailor (Boultbee MS 1840) (written c.1827) to describe the illness of Chief Te Wera in Foveaux Strait. Some authors have considered the illness to be leprosy, although it was not described sufficiently for positive identification. The term does not seem to have been used elsewhere for leprosy. Boultbee was probably using the term whēwhē (wh = f) which means ‘boils’ or ‘abscesses’ (Williams 1971).
THE ORAL TRADITIONS OF THE MAORIS
If leprosy occurred in the pre-European Maori, the most important source of evidence might well be descriptions of the disease obtained directly or indirectly from the Maoris in oral traditions, narrations, waiata and legends.
Te Waka Tūwhenua (‘Leprosy Canoe’)
John White's papers (MS nd.) contain a story from a Maori source (Akitai) translated by Simmons (1976:232) as follows:
That canoe, Te Wakatūwhenua landed at Te Wakatūwhenua on the coast above Te Arai. From it come the men of Ngai-Tahuhu. From Nai-Tahuhu come the hapū [subtribe] who lived at Te Arai — and who were lost with illness in the village, the very bad illness of leprosy (tū whenua). - 121 From them come descendants and this is the origin of Te Kawerau and Te Waiohua and many other hapū who come from those canoes.
Simmons (1976:232) also translated some definitions of terms found in the same manuscript, including wakatūwhenua:
That canoe landed off the headland on the other side of Tū Whenua at Te Kareu [? Te Kawau]. They were a people sick with leprosy (tūwhenua) and that is that origin of the name of the place which was given to the headland where that canoe landed from their sickness tūwhenua (leprosy), a name also for that canoe is Te Riu Hakara. Te Kawerau are relatives of that people and some of Te Kawerau died with that illness. In the sand at the mouth of the Waitakere those bodies are still and those bodies are not approached by men lest any man using those lands be struck with that illness.
These people had a disease that killed them but, in the absence of clinical features, it is not possible to link the disease (tūwhenua) with leprosy in this quotation. The information seems to have been obtained from Maori sources, and the tūwhenua canoe was recorded from other tribes (Best 1925; Stafford 1967) without mention of a disease resembling leprosy.
He waiata mo te mate ngere-ngere (‘A song for a leprous malady’)
A description of ngerengere is contained in this waiata from Ngāti Tūwharetoa about the chieftainess Te Rohu (Ngata 1959a:142-5):
This was translated as follows by Pei Te Hurinui Jones:
Come quickly, thou infant morn, hasten hither;
For 'tis a wakeful vigil I alone do keep.
The fever within, O Sire, is like the flaming tussock!
Brought (was I) from O'er the range, so that I might feel
The (healing) gold plates unscale entirely
The unsightliness from my body, now covered with sores.
See now what leprosy has done (to me), O people.
If true your claim, give me the proof now,
And I will ask, who is your name?
Methinks 'tis Te Ana-i-Ōremu. Yours the weapon.
Sharp as a needle point as it penetrates deeply within.
Ah me! The pain of it!
With the sun aglow I have my pensive moods.
O friends, what purpose is there (in living)?
O ye hundreds assembled, look here and observe
My eyebrows once so neat are now upthrust
Like the crested waves that flow on Taupo.
My skin is like the heavens aflame.
My treasures have been taken by Te Hanamai,
Tho' distant he, yet came close [he], of Ngāti-Whātua.
Listen to me, O sire, at Tongariro,
At Pukeronaki is your head-rest on this earth;
Hapless were we in missing the dragon's retinue of thee,
If I too had been O'erwhelmed, sound would be my sleep
In the exalted company of my sire.
The following explanation by Te Taite Te Tomo was included with the waiata in Nga Moteatea (Ngata 1959a:143): - 123
Te Rohu was a daughter of Te Heuheu Tukino, by his senior wife Nohopapa. This song was composed on account of her being afflicted with leprosy.
In 1846 a landslide killed Te Heuheu Tukino, the father of Te Rohu. Te Rohu was thus a chieftainess of high rank in the Ngāti Tūwharetoa with family ties to the Ngāti Kahungunu. The story of her negotiating peace between Paraihe and her father was outlined by Grace (1959:341). She lived and died in the Taupo area. The use of the term ngerengere rather than repera in the title of the waiata is unexplained. In Grey's Maori Manuscript Collection (MS nd.), a Maori version used repera in the waiata while the accompanying description used ngerengere. On the basis of the handwriting, the author is considered to be Hami Ropiha (Samuel Hobbs) of the Ngāti Kahungunu (Rae Fletcher-Cole — personal communication).
It is not clear exactly when the waiata was composed. Te Taite Te Tomo noted that there are a number of English words — gold, leprosy (repera) and needle — in the waiata. These terms place the composition in the post-European period. Te Rohu probably composed the song some time between 1830 and 1850. The waiata of Te Rohu has six or seven recorded sources in Nga Moteatea (Ngata 1959a:142), one of which was probably obtained before 1854 (Grey MS nd). Presumably Te Rohu composed the waiata because she was afflicted with the ngerengere. From the translation we learn that the chieftainess had a fever, was covered with sores and that her skin was red. Her eyebrows were distorted by the disease and she may have been in physical pain. The translation may, however, not be accurate and “the unsightliness of my body” may more accurately be “the evil of my body” (Biggs, personal communication). This discription falls short of an adequate clinical description of leprosy.
The notes with the waiata also said that the disease was communicated to Te Rohu by a man of the Ngāti Whātua tribe called Te Whetu, who touched her. Supposedly he was a seer who had the power to communicate leprosy and wanted Te Rohu to be his wife. Best (1905a) stated that some persons asserted that Te Whetu of Taupo still possessed the power to transmit ngerengere. Obviously the two Te Whetus were not the same person. In the waiata there is mention of Te Hanamai, an ancestor of the Ngāti Whātua who was said to have been the repository of leprosy. The notes with the waiata state that the first man who died of leprosy was put away in Te Ana-i-Ōremu (lit., ‘the Cave at Ōremu’), which is a burial site between Waihi and Tokaanu, at Lake Taupo.- 124
Pio was an important Maori informant used by Best and others. Best (1905a:11-12) collected the following information from Pio some time between 1885 and 1905:
Another atua [‘god’, ‘demon’, ‘affliction’] of the Maori people is the ngerengere. No one recovers from that disease. The persons who destroy the Maori people by that complaint are the fish of the ocean and the birds of the land. I say that the ngerengere is a plebian complaint, unlike the whēwhē [boils] and hakihaki [cutaneous diseases], which are aristocratic complaints. If a person appears to be recovering from the ngerengere, that means that the cause of the disease has fled to the ocean, but ere long they will return and again assail the person. Then he will die. This disease was first introduced by the Ngāti Whātua tribe. It appeared at Taupo a long time ago, and the first person afflicted by it there was cast into a cave called Ōremu.
Te Rangi Hiroa (Sir Peter Buck)
In his M.D. thesis ‘Medicine amongst the Maoris in ancient and modern times’ (MS 1910), Te Rangi Hiroa included much information that I believe he obtained directly from the Maoris. I suggest this since he did not detail his sources. He stated that the Maoris considered that leprosy was caused in three ways: (1) By heredity. The disease occurred in families and (2) By infection. The disease appeared to be communicable. Persons with leprosy were isolated and were avoided. The urine was considered to be contagious and it was particularly dangerous to walk over places where persons with leprosy had mictulrated. Te Rangi Hiroa related the following story:
Near Maungatautari is a spot which has been an ancient leper colony. It passed into the hands of Europeans who employed a Maori to burn the farm. He returned to his village ill. On being questioned he told where he had been working. It was recognized as a leprosy place. The man developed leprosy. The burn of fern or rubbish over these sites were held to be very dangerous, either when the smoke is about or when the dust or ashes are liable to be inhaled.
Hiroa stated that the Ōremu cave at Taupo was used for isolating lepers. In the north, amongst the Rarawa tribe, there is a district named Herekino, just south of Kaitaia, where leprosy was so prevalent that people feared to pass through the district. There was a saying, E kore koe - 125 e puta i te taru Herekino. This was translated as ‘You will not escape from the evil weed of Herekino’. The place-name Herekino means ‘evil bond’ or ‘evil captivity’ and Biggs (personal communication) has translated the saying as ‘You will not escape from the Herekino thing’. (3) By mākutu or witchcraft. This was a power wielded by some members of the Ngāti Whātua tribe living near Helensville. Hiroa learned that one of the last persons to use the power was the aged chieftainess Te Ngau-toka whose god was Tu-hope-tiki. Te Ngau-toka's descendants discussed this power with Hiroa. They said that on one occasion she punished a European who had insulted her and that he died of leprosy, and such was the fear of the Ngāti Whātua that Paora Tuhaere (born 1835), chief of Te Taou hapū at Orakei, used this fear to recover a large sum of money that had been stolen from one of his tribesmen at Waikato. Paora announced that if the money was not returned in 12 hours he would afflict the thief with leprosy. Needless to say, the money found its way back to the owner in a few minutes. Hiroa also described a patient with leprosy whom he saw at Wanganui, probably between 1900 and 1910.
Tikao Talks, published in 1939, contains traditions and tales told by Teone Taare Tikao to Herries Beattie about the beliefs of the South Island Maoris. In a discussion of mākutu he stated that a curse could be projected a considerable distance and that leprosy could be produced by incantations against an enemy or someone who had wronged you.
Unofficial Maori minutes of the Land Court indicate that Chief Wi Maniapoto in March, 1869, gave evidence that persons with leprosy were buried on Motutahae Island (Cherry Island, Taupo) and, as a result, the area was tapu. (This was confirmed in recent years by Kapi of Rotorua, who stated that 15 people were buried on the island (personal communication — Trevor Hoskings). This evidence could not be found in the official Maori Land Court Minutes (Taupo Minutes, Vol.1, Judges White and Smith) and was only in the unofficial records.
One person who had lived many years at Taupo said that he had been told that persons with leprosy were placed on Motutaiko Island in Lake Taupo. Supposedly, the people who were left there lived in a hamlet on the southern side of the island and survived by eating birds' eggs. The - 126 island is very small at present, but was probably much larger before the water in the lake was raised by the dam at the outlet to Waikato River. In the early 19th century this island was a refuge for Te Heuheu when pursued by his enemies. It is unlikely he would have stayed in an area made tapu by ngerengere or any illness. The derivation of the name Motutaiko is intriguing since motu means ‘island’ and tāiko was one of the terms linked with leprosy, but, as discussed earlier, this linkage is very tenuous. Tāiko also means ‘black petrel’, a seabird which may nest inland in the Taupo area. There are two areas in New Zealand where Taiko is used as a place-name.
Maori Legends of Leprosy
There are five Maori legends with references to leprosy, none of which seem to be related. Four of these can be found in The Ancient History of the Maori by John White (1887-90). White (1826-91), a Maori scholar who spent his early life in Hokianga, was closely associated with the Maoris and learned their language and customs from the tohungas. In 1852 he moved to Auckland as a Government Interpreter and later became Resident Magistrate for the central Wanganui district. He returned to Auckland in 1867 to handle claims for the newly established Native Land Court. In 1876 the New Zealand Government commissioned him to prepare a compilation of the traditional history and tribal lore of the Maoris. White was selected because he had had a close association with the Maoris and was considered to be an authority on them. Although The Ancient History of the Maori was planned to be in 12 volumes, only six volumes were published and four more were drafted. White has been severely criticised for rewriting Maori text (Johanson 1956), and it is difficult to be sure about the factual content of his writing.
1. Te Whaipo. The deluge legends (legends of a deluge of water that destroys persons and places) were quite extensive in the Pacific and appear to be Polynesian in origin. The story of the deluge that contains this passage (White 1887-90:1:152, 169) was stated to be from the Ngai Tahu (a South Island tribe) and was obtained from Wohlers (MS nd(a).). Best noted that it was biblical and this version may not be authentic. After the recounting of the legend, a list of gods and characters includes the name Te Whaipo and a passage:
Te-Whai-pō, Ko te tangata i tuātia (tohia, iriiria) Ki te wai e ōna tipuna- 127
(tupuna) a kaua (ngaua) ana tāua tangata e te tāiko, (tūwhenua) kāhore hoki i kitea he kiri tangata, pau katoa aia i te tāiko.
This was translated by White as:
Te-Whai-po (incantations chanted at night). He who was baptised in the water by his grandparents, and smitten with leprosy. His skin was not like that of other men, but all white and leprous.
Goldie (1899) used this legend as evidence of the antiquity of leprosy because Te Whaipo was born before the flood, but this is not a clinical description of leprosy. White translated tāiko as ‘leprosy’ and ‘leprous’ (or tūwhenua). Biggs (personal communication) translated this passage:
Te Whai-po, the man who was dedicated with water by his grandparents, and was smitten by tāiko. No ‘human skin’ (i.e., normal skin)...it was all consumed by tāiko.
Biggs felt there was no justification for the use of the term ‘all white’ and that the dialectal kaua and tāiko for ngaua, ‘bitten’ and tāingo, ‘spotted, mottled’ marked the passage as being from the South Island. This is the only link of tāiko with leprosy and seems to be a translation by White without justification so far as I could determine.
2. The Legend of Paowa (White 1887-90:2:59). Two lines at the end of the legend mention leprosy:
Na wata te whēwhē. He hiakaitanga na Ue-nuku ki a Wata te tūhawaiki
This was translated, “Wata was the cause of boils and leprosy, which he produced when Ue-nuku was hungry and wished to eat him”. This might be more accurately translated as “Wata was the source of boils. Tūhawaiki is Ue-nuku hungering for Wata” (Biggs — personal communication). This is probably an addition to the original text by White, as he was prone to do so, but it is not known where White obtained these lines. Uenuku was a prominent figure in history and was also a god, but I could not find any reference to Wata in Maori legends elsewhere. Orbell (1968) reviewed the changes made by White, changes which were traceable because the material had been given to White by the Rev. J. F. - 128 H. Wohlers. These lines are not present in the original manuscript that White obtained from Wohlers (MS. nd(b).) or in Wohlers' version, submitted for publication in Transactions of the New Zealand Institute (Wohlers MS nd(c).).
3. Mai-waho or Tama-i-waha. White (1887-90:1:112,126) obtained the following information from the Ngā-Rauru:
This was translated by White as:
Te-mai-waho (coming from afar) was a most eminent man, and of great healing power and influence. To him all offerings were made, ceremonies performed, and incantations chanted for the afflicted and leprous. It was he who taught Ta-whaki the various powerful incantations and songs.
This might be translated as “Te Mai-waho is an important man of very great mana. He has the spells called waitiri, ‘thunder’, and Tūhawaiki, [?leprosy]. Mai-waho taught Tawhaki many spells” (Biggs — personal communication). This legend has not been obtained from elsewhere and is not dated.
4. Leprosy omens. One passage in White's work (1887-90:3:3,5-6) was interpreted by Goldie to indicate the faith of the Maori in omens, including an omen of leprosy. Biggs (personal communication) translated this passage “If it twitched below the ear, it was a mate, if under or at the side of the eyebrow, it was a mate. If the upper lip twitched, it was a [sign of] scandal, or back-biting. If it twitched above the eyebrow it was a tūhawaiki [?leprosy], misfortune, a peepeke”. Mate can mean ‘death’, but it is also the usual word for illness, misfortune or bad luck. Peepeke refers to doubling up of the limbs in the foetal position. The meaning of tūhawaiki is unclear but was translated by White as ‘leprosy’. White obtained this material from the Ngāti-Ruanui (Taranaki).
5. Putawai and Manoa seek the help of the lepers in the underworld (Grace 1917:53). While fleeing from Hiri-toto in the underworld, Putawai and Manoa finished up in the home of the ngerengere: - 129
They alighted at the terrible underworld home of the ngerengere (those who were afflicted with leprosy). In spite of their repulsive appearance they sheltered amongst them. Soon Hiri-toto and his friends, angry at the loss of their prey, came flying through the air and tried to reach the fugitives. The ngerengere did their best to hinder them, but they were feeble and could do little to stop them. Manoa gathered Putawai up in his arms and flew on until they came to the region where blind wairua [‘spirits’] were gathered. Hiri-toto caught up with them again, and Manoa came to his own pā. His people rallied to his aid, and were so successful in repelling Hiri-toto and his followers that it is difficult to understand why Manoa ever enlisted the aid of the lepers and the blind.
In a footnote Grace stated that, “It is my opinion that ... the story is in reality very old”. It is interesting that “ngerengere” is used to describe the people with the disease rather than the disease itself. There is no clinical description of leprosy and the legend may establish that the term is an “old” term. The possible link between leprosy and blindness is of interest, as clinical blindness was a common sequence of untreated leprosy.
I have examined Maori descriptions of leprosy to find a clinical description of leprosy. The use of descriptive terms such as ringamutu (‘loss of a hand’) indicates that this sign was recognised, but it may not be reasonable to expect a clinical description of such a complex disease as leprosy. Te Rangi Hiroa (1949) indicated that most Maori sickness was considered to be the result of a supernatural power. The malignant powers that caused disease were of two classes: the cacodemons and the familiar spirits. The cacodemons usually had some form of animal incarnation, such as a fish, bird, or lizard. Spirits were conjured up from the dead or the underworld by sorcerers. The factor which precipitated an attack of cacodemons was some infringement against the restrictions of tapu. The cacodemon took possession of the patient and produced the symptoms — pain, weakness, fever, etc. The tohunga was called in first to find out the error committed and to locate the cacodemon; this was equivalent to diagnosing the disease. The case history involved the determination of the patient's movements before the illness started so that it could be determined where and when the tapu was broken. The symptoms of the disease were not relevant — that is, unless the patient were delirious, when he might provide important clues. Dreams were also important sources of information. Various methods were used to remove the offending spirit (Hiroa 1949). It is unlikely that a complex of - 130 symptoms and signs, loss of fingers and toes, anaesthesia and skin lesions would be recognised as anything more than the loss of limbs alone.
DESCRIPTIONS OF LEPROSY BY EARLY PHYSICIANS AND VISITORS TO NEW ZEALAND BEFORE 1906
Visitors to New Zealand early in the 19th century described some of the diseases they found among the Maoris. Leprosy may result in a wide range of symptoms and signs, and, in some forms of the disease, may be difficult to diagnose. On the other hand, the features of severe leprosy may be dramatic with deforming skin lesions of the face and limbs associated with the loss of fingers and toes over a period of months and years. The changes can be recognised by untrained persons and it would be surprising not to find more descriptions of the disease, particularly if it was prevalent.
There are other diseases that produce deformed limbs, and, unless some other criteria are fulfilled, the diagnosis of leprosy cannot be made with certainty. Skin lesions, neurological deficit, and the presence of acid fast bacilli in characteristic pathology are the medical criteria used to establish the diagnosis today. It was 1870 before Hansen described the bacteria causing the disease. Medical knowledge of leprosy was limited and the features of the disease that we might expect in descriptions of leprosy at the beginning of last century would be the presence of skin lesions, evidence of nerve damage and loss of digits. These are the features that have been sought in the descriptions of leprosy or possible leprosy in approximately 50 persons listed in Table 2.
In 1817 John Liddiard Nicholas, who accompanied Marsden to New Zealand, described a boy who he said was born with leprosy (1871:253). Although others have accepted this as leprosy, the description provided seems to be clearly that of an albino with no indication that the boy had leprosy.
Captain Edwardson traded flax in Foveaux Strait and provided an interesting account of the Maoris in the south of New Zealand (McNab 1909). In an essay, he described the Maoris in Foveaux Strait in 1823 and stated that “Natives can be seen who have lost their feet and hands; their bodies are frightfully thin and their extremities rot away”. Edwardson thought they might have had yaws or elephantiasis but these diseases were unknown in New Zealand. The description is very limited, but the author may have been describing leprosy.
John Boultbee was a sailor who wrote about his experiences in the- 131
Patients Described with Leprosy or Possible Leprosy
South Island. In Journal of a Rambler (1840) he described an old chief with a disease that some have considered to be leprosy:
The old chief Toowaro was, and had long been, in a most dreadful state owing to the fafa, a disease common to these people — I was told that the first symptoms of it was a wryness of the mouth, and a discharge from the eyes. The ravages it makes on the face, eyes, nose, mouth and at last on the feet and hands, is terrible. The victim of this disease generally dies in a half putrid state — the face of Toowaro was scarcely human, and I turned away, with mingled feelings of pity and disgust from an object so forbidding.
This was probably written about January 1827. As discussed earlier, “fafa” was probably a variation of “whewhe” (wh =f), which means ‘boils’ or ‘abscesses’.
Te Wera (correct spelling of “Toowara”) had been described earlier by another visitor to New Zealand, Thomas Shepherd, who wrote on March 23, 1826 (Begg and Begg 1979):
Te Wera is about 6 feet High very stout made is about 30 years of age Tatooed has very large full cheeks lips near an inch thick and a large mouth and a downcast look the ugliest man I ever saw.
These descriptions by Boultbee and Shepherd are insufficient to make a diagnosis of leprosy, but are, none the less, consistent with the disease.
William Woon (MS nd.), a missionary in Wanganui for the Wesleyan Methodist Missionary Society, noted in his diary on May 9, 1842:
I conducted the evening native service and improved ‘Na'aman's Leprosy’, which was new to the people. May 16. My mind was fully employed during the whole of yesterday Lord's day, and conducted all the services on the station. I improved ‘Na'aman's Leprosy’ again in the morning and urged the natives to an immediate application to the friend of sinners to be healed of the leprosy of sin which I showed was an universal disease, and which the blood of Christ alone can cure.
My own interpretation of this direct reference to leprosy of sin is that the author was using the term “leprosy” in a biblical and figurative sense and did not indicate a physical disease. At that time, however, the disease of leprosy was interpreted as a physical manifestation of sin (Olaf Skinsnes — personal communication) and it is interesting that the - 133 first medical descriptions of leprosy came from Wanganui.
While in the South Island in 1843, Dr Shortland (1851) saw a disease which has been considered to be possible leprosy:
At Otakou, I saw, for the first time, the effect of a singular but dreadful disease, called Tūhawaiki, by which a woman had lost her hands and toes, as though they had been frost-bitten. She was not more than thirty years of age, and appeared to be at present healthy. The mutilated stumps had healed, but the limbs had a shrivelled appearance, and were of a darker colour than other parts of her body. This disease must now be of rare occurrence, as I have never seen a case of it in the Northern Island, nor to the south of Hakaroa [Akaroa], more than two or three old cases of mutilations of the extremities, said to have been caused by it.
The disease reminded Dr Shortland of ergotism. Although he did not raise the possibility, he may have been describing leprosy, a disease that may still not be recognised by even well-trained physicians unless they have had experience with the disease elsewhere. Shortland did not mention neurological deficit or skin disease, but in some cases these findings can be missed without careful examination. Shortland, a keen scholar of Maori customs and language, wrote extensively about New Zealand. He was private secretary to Captain William Hobson, Lieutenant-Governor of New Zealand, and as a result probably had frequent contact with other physicians in New Zealand. Shortland almost certainly discussed the patient he saw with Dr John Johnson, who wrote an account of a disease resembling leprosy.
Johnson, New Zealand's first colonial surgeon, was appointed in 1840. On a journey to Rotorua at the Ruakareo Pā in 1847, he was shown a man and a boy with a disease consistent with leprosy (Taylor 1959). The man had lost the first two joints of all his fingers, and the boy's fingers were so contracted as to be completely bent inwards, and Johnson indicated that the digits dropped off by “dry gangrene”. He noted that the Maoris linked the disease to evil spirits. Johnson did not mention leprosy or ngerengere and said someone had suggested that it might result from eating raw karaka berries. Like Shortland, Johnson believed that the disease process was similar to ergotism.
Two patients with leprosy were treated in the Wellington Colonial Hospital in November and December 1847 (Grey 1848), although no clinical information was provided in this report to allow us to confirm that the diagnosis was correct. One patient was a 20-year-old man from Wainui, the other patient a 30-year-old male from Ohau.- 134
The Rev. R. Taylor (1850:46-9) visited a village at Roto-Mahana (Rotorua) in March, 1849, and found that the teacher of the village was a tūwhenua — a kind of leper, whose fingers and toes seemed to be wearing away with dry ulcerous looking sores, the skin being quite horny. Taylor noticed two “lepers” in that place and stated that this was remarkable because the disease was so rare. Taylor's selection of the term “tūwhenua” to describe these patients is curious because “ngerengere” is probably the term used most frequently in Wanganui, where Taylor lived, and also in Rotorua, where he saw the patient.
The first unequivocal description of leprosy was provided by Dr George Rees, Colonial Surgeon at Wanganui. Rees wrote a report to the Governor, Sir George Grey, on July 29, 1851, that was subsequently published in the British Parliamentary Papers relating to the affairs of New Zealand in 1854. This description of ngerengere was included in a section on the medical topography of Wanganui:
There is a disease called in the native language, ‘Ngerengere’, seen occasionally in Wanganui, the subjects being from Taupo, a district in the immediate neighbourhood of Tongariro; it is said to be endemical to that place; but I have met with those who affirm its existence in the South Island. The first symptoms are said to be a degree of constriction in the skin of the affected parts, which are generally the loins, extremities and face; a degree of puffiness and heat follows, the skin becomes of dusky red, the eyeball prominent, and the lachrymal secretion flowing down the cheeks; after a lapse of time varying from one to three or more years, the puffiness increases to a considerable swelling, the face attaining to a large size; the cellulae substance and skin, the former of which is infiltrated with a serous fluid, ulcerate, and death soon ensues. During the early stage, the skin loses its sensibility, and may be severely pinched without the sensation of pain; the flexor muscles of the upper extremity often become paralyzed, and the fingers occasionally drop off; whether or not the alimentary canal suffers, I have not been able to ascertain. It will be remarked that many of these symptoms are similar to those which exist in lepra-tuberculosa; the natives consider it contagious, and their treatment of it is by incisions into the swelling, and fomentation, the ingredients of which are a variety of barks and leaves, without reference to their individual property. Having met with but one case, and that in its earlier stage, I am unable to give the result of my own opinion.
Rees seems to have provided the first clear clinical description of leprosy that includes skin disease, neurological deficit and loss of fingers. In - 135 addition, he thought the symptoms were similar to those of leprosy. Rees qualified LSA in 1830 and arrived in New Zealand in 1841 (Rex Wright-St. Clair — personal communication). It would be interesting to know if he had had prior experience with leprosy as had Thomson (1854:496-502), who provided an early medical description of ngerengere.
Thomson has been recognised as an outstanding physician and scientist (Wright-St. Clair 1976). The description by Thomson included all the essential features of leprosy, i.e., the skin lesions, the swelling of the face, nose, lips, forehead and the eyebrows, the loss of fingers and toes without pain, and the contraction of other joints. The disease continued over months and years and usually resulted in the death of the patient. The unusual feature of Thomson's description is that he carefully stated that the patients had normal sensation. “The least pinch or puncture on the skin is immediately felt” (1854:497). He discussed this fully and considered that the disease was not lepra anaesthetica of India, in which the skin is described to be “so insensible that you may with hot irons burn to the muscle before the patient feels the pain, the whole body becomes devoid of sense” (1854:499). Thomson thought the disease looked like cacubay, a disease described by Dr John Hunter in Jamaica. This disease is now considered to have been leprosy. In his description of ngerengere, Thomson does give some evidence that there may indeed have been considerable anaesthesia present, which may have been less marked than that described above. When he described the loss of fingers and toes, he stated, “Nature carries on her amputations without pain” (1854:497). He also noted that, “It might be expected that men beholding their bodies dying by inches and not knowing whether they might not live to contemplate themselves a living trunk, should be miserable; but all the sufferers I have seen were cheerful and happy”. In addition, Thomson (1854:497) almost certainly described enlargement of nerves that he thought were lymphatics. “In the skin of the right arm below the elbow, there are several flat thickened cords in the skin, as if the lymphatics were enlarged. The cutaneous eruption covers, in some places, these swellings, which to the hand and eye are perceived and felt to be elevated above the skin” (1854:500). Thomson confirmed Shortland's impression that this was a disease of the Maoris.
From 1854 until the 1890s accounts of leprosy in New Zealand were very limited. Tuke (1863-4:722-3) described two cases of leprosy, which he said the Maoris called “ngerengere”. Dr Samuel Walker (1878), Surgeon to the Armed Constabulary and Medical Attendant to the Natives, reported to the Native Minister that he had treated three cases - 136 of ngerengere. He also reported that he had seen one white man with the disease. This was the only 19th century mention of leprosy in a non-Maori that I have found. Scannell (1885), the Resident Magistrate at Taupo, reported a kind of leprous disease called “ngeri ngeri”, which he believed to be peculiar to Taupo, and there only at Tokaanu. He knew of six cases, but gave no details.
In the 1890s accounts of leprosy were recorded by the medical officers in various regions of New Zealand (Bishop 1891; Bush 1891; Ginders 1890; Martin 1892; Pairman 1890-1). Dr Ginders (1890:1-3), for example, provided clinical descriptions of Maori patients with leprosy at Taupo and Rotorua. Ereatera from Rotorua was a 60-year-old man who belonged to the Ngāti Rangiwewehi tribe of Awaho on Lake Rotorua. He developed his first symptoms of leprosy in 1879 and was isolated by his tribe at Kaimoa on the edge of Oropi Forest. Although he had known other cases of leprosy, he had not had direct contact with them and there was no leprosy among his close relatives. In another account, the father of four of Cinders' patients made the following statement (Ginders 1890:2):
I never had any symptoms of ngerengere. My wife Huia, the mother of these children, when she was young, had a white patch on her right side; it was not anaesthetic. The tohungas told me it was caused by her gathering fern on a spot where a ngerengere had once lived. This was cured by a tohunga, and she never had any other symptoms of the disease. Ngerengere was much more prevalent in the Taupo district when I was a boy than it is now. It was first brought into the district three generations ago by a man whose name was Te Oro [three generations before 1890 would place the introduction about 60-75 years before, i.e., 1815-30]. Te Oro belonged to the Ngātipaki Hapu of the Ngātituwharetoa tribe and lived at Oruanui. His grandson is still living. His genealogy is thus: Te Oro begat Taman Pahiroa, who begat Hame Pahiroa, now about 40 years of age. Te Oro wished to be avenged on certain members of his tribe who had offended him, and, hearing of the terrible ravages of the disease among the Ngātimaru at Hauraki, he went there and learnt the art of communicating the disease (wero ngerengere). On his return, the disease broke out and we have never been free from it since. I do not think ngerengere is contagious. With regard to my son, Te Rangi, I believe his disease was the same as that his brothers are suffering from but I never knew or heard of a case so rapidly fatal.
The chief at Tokaanu and the chief at Awaho were both of the opinion that ngerengere was far more prevalent in former times (Ginders - 137 1890:2). Wi Maihi, a chief of the Ngāti Rangiwewehi, said he had known it carry off whole hapūs. He attributed the reduction in the disease to the fact that all the old men who knew how to communicate the disease had died out, and he said the disease could be transmitted to enemies by giving a present of a mat or other piece of clothing worn by a person with ngerengere. Ginders must have been confused by some of this information, which does not conform with what was known of the natural history of leprosy. He wrote that the general consensus of opinion among the Maoris was that the disease first appeared in the North Island at Hauraki some time during the latter half of the 17th century (he must have meant the 18th century), and was probably introduced by the marooning of a leper from a ship (possibly a whaler) at or near Hauraki. Ginders also seemed to believe the story about Te Ora that the disease was recently introduced into the Taupo district.
In 1902, Mason, the Chief Health Officer, investigated some 40 or 50 cases of alleged leprosy among the Maoris (Mason 1902). He was able to confirm only two of the cases as leprosy: one a Chinese man at Macrae's Flat, and the other in Raglan County.
By 1904, Pomare, who was the Native Health Officer, had investigated about 30 cases of alleged leprosy, and stated that only three genuine sufferers could be found (Pomare 1904). The other leprosy cases were found to be mainly syphilis or tuberculosis.
POSSIBLE ORIGINS OF LEPROSY IN THE PACIFIC
The Maoris probably travelled to New Zealand from the eastern Polynesian Islands some time in the period A.D. 800-1200. If leprosy was present among the Maoris in pre-European times, it is important to examine the Pacific Islands and particularly Eastern Polynesia as a potential source of the disease.
History of Leprosy in the Pacific and Polynesia
Migrant Chinese were thought to have been responsible for bringing leprosy to the Melanesian islands and perhaps to the Australian Aborigines (Browne 1970:13). Leprosy may also have been endemic in south-east Asia, particularly Malaysia. Although the disease is prevalent in Polynesia at the present time, it is thought to have developed in the latter part of the 19th century (Lonie 1959), and most authors have accepted the view of Cantlie (1897), who stressed the importance of Chinese immigrant labour in introducing leprosy. In Hawaii, Western Samoa, and French Polynesia, and possibly in New Caledonia also, the - 138 introduction of leprosy apparently occurred in this way, and, in each case, leprosy was probably introduced between 1850 and 1890 (Genevray 1925; Sasportas 1924). Lonie (1959), however, considered that the most important factor in the introduction of leprosy to most of the islands was the spread of the disease by infected Islanders moving to other islands or by travellers who had contracted the disease in other countries and then returned to their own islands. In Nauru and American Samoa the disease was introduced between 1850 and 1900 by visitors from neighbouring islands (Dempster 1959; Wade and Ladowsky 1952). In the Cook Islands and Niue leprosy was introduced in the latter part of the 19th century by individuals who had contracted the disease elsewhere and returned to their own islands (Numa 1953). Ships ordered to repatriate pressed labour to their home islands deposited the passengers on any convenient island (McCarthy and Numa 1962). In many islands, however, the method of introduction remains unknown.
Some areas in the Pacific have oral traditions of leprosy having been present at an earlier time.
The early history of leprosy in Fiji has been reviewed by Austin (1936, 1949). Lyth, the first doctor to settle in Fiji, recorded that he treated leprosy at the Methodist mission in 1837, but no clinical details of the disease were provided. The Fijian language has at least two names for leprosy: sakuku (Western dialect) and vukavuka (Bauan dialect); neither word has another meaning. Vuka by itself means ‘to fly’ and may be related to the way in which Fijians considered that the disease spread. In the 19th century there were still leprosy stones (vatu ni sakuku) in Viti Levu. The stones were the property of certain mataqali (‘families’), some of whom suffered from the disease. The leaders of the mataqali transmitted the disease in return for payment (Corney 1896). Few cases were seen in the Indian population who migrated to Fiji last century and who were carefully screened both before leaving India and after arrival in Fiji. A frightful form of treatment for a disease thought to have been leprosy was recorded in 1859 (Seemann 1862:337): a young Fijian was smoked over burning sinu qaqa wood, considered to be very poisonous.
In his journals of 1830 and 1832 the Rev. John Williams described oovi, a chronic disease associated with loss of extremities, including toes, fingers, noses and ears. He stated that it was prevalent in the South Sea Islands (Moyle 1984:234). Another missionary, the Rev. George Turner - 139 (1861:220), who lived in Samoa from 1841 to 1861, stated that there was a “species of leprosy” in Samoa, but that it had greatly abated. Many suffered from ulcerous sores until all the fingers of a hand or the toes dropped off. The Rev. George Brown, who lived in Samoa from 1860 to 1874, said he knew of one very bad case of leprosy (Armstrong 1924:7). The history of leprosy in Western Samoa was reviewed by Dr Armstrong (1924:7), who concluded that, since even medical men at that time were inclined to confuse tertiary yaws with leprosy, the evidence of these missionaries was questionable. The evidence that leprosy was introduced into Samoa in the late 19th century was reviewed by Cantlie (1897:391). The first medical evidence of leprosy in Samoa was given in 1892 by Dr F. H. Davies, who believed that it had been introduced by the Chinese. Leprosy was probably introduced into American Samoa from Western Samoa.
There is no reliable record of the introduction of leprosy into the Solomon Islands. Innes (1938) found in many places well-formed superstitions about the disease, and said that leprosy appeared to have been indigenous in Malaita for several hundred years, but provided no supporting evidence.
Bougainville, the French explorer, named Aoba Island in 1768 the “Isle of Lepers” in 1786 (Dunmore 1965:92). The people of this island suffered from a skin disease and were shunned by the other natives, but it is doubtful that this was leprosy. Ratard and Bravo (1978), who reviewed the epidemiology of leprosy, considered that yaws and other skin diseases could have been mistaken for leprosy. Ragusin (1951:413) stated that the first cases of leprosy in Vanuatu occurred in 1883. On the other hand, missionaries said there was no leprosy in the Vanuatu islands of Tongoa and Epi in 1894 (Cantlie 1897:388).
These stories of possible leprosy in some areas are not convincing. No physical evidence of leprosy in pre-European times has been found in Polynesia. No leprosy, for example, was found among skeletons in 868 pre-European burials in Hawaii (Bowers 1966:208). This sample, however, is very small when the possible prevalence of leprosy is considered.
Comparison of the Maori terms for leprosy with other Polynesian languages (Table 3) has shown no words in Polynesia comparable with - 140 the Maori tūwhenua, tuhāwaiki, or tāliko. In Milner's Samoan Dictionary (1966) ma'i mutumutu is included under ‘leprosy’. This can be translated ‘the illness with many cut-off appendages’ and may be equated with mutumutu in Maori, first recorded in Taylor's word-list in 1848 as a sort of leprosy. An earlier Samoan dictionary by Pratt (1878) does not include mutumutu. This accords with Cantlie's view (1897:390) that leprosy was introduced into Samoa in the late 19th century. Williams' Maori dictionary (1971) defines mumutu as ‘leprosy which causes fingers and toes to drop off’. In a study of Proto-Polynesian words, Walsh and Biggs (1966:68) noted that mutu was a term common to many Polynesians (Table 4). They also examined ngere, but did not mention any linkage to leprosy elsewhere in Polynesia. This absence of Polynesian terms in the Eastern Polynesian area tends to confirm historical evidence that leprosy was not present in pre-European times.
Comparison of Terms from Different Polynesian and Melanesian Islands
From Walsh and Biggs 1966.- 141
In addition to the Maori legends, there are a limited number of legends of leprosy from Polynesia. From Tonga there is the story of a child disguised as a leper to avoid discovery by albino twins who were possessed by spirits. This story, in English, was told by Abraham of Lifuka Island, Ha'apai, and published by Gifford in Tongan Myths and Tales (1924:193). There are also tales from the Tuamotus and Tuvalu about a leper hero.
Rees in 1851 and Thomson in 1854 described clinical leprosy, which the Maoris called ngerengere. The authors described a chronic disease lasting months or years with skin lesions, sensation loss, contractures and loss of fingers and toes. The disease was known to other individuals in localised areas. The descriptions by Shortland, Johnson and Taylor in the 1840s were consistent with, but not diagnostic of, leprosy.
Despite a considerable amount of material in the literature dealing with leprosy among the Maoris before European contact, it is not possible to find a convincing oral tradition providing a clinical description of leprosy before 1850. European contact in New Zealand began 50-60 years earlier and this delay before there was an unequivocal description of clinical leprosy itself suggests an absence of the disease. Other evidence against the presence of the disease includes the lack of convincing oral tradition, the absence of descriptions of leprosy by a number of visiting physicians, the absence of descriptions of leprosy in Polynesia before the mid-19th century, the lack of common Maori and other Polynesian terms for leprosy, and the absence of physical evidence of leprosy in New Zealand or Polynesia before the mid-19th century.
A review of orally-derived material for evidence of leprosy in pre-European times is inconclusive. Many Maoris provided information (in Maori) to a recorder and some Maoris wrote what had previously been oral tradition. Recorders sometimes stated that the information had been obtained from a Maori or unnamed person belonging to a particular group. The dangers in using this type of work have been well outlined (Simmons 1976:8). To determine that a source was indigenous, a tradition ideally should have been present in a number of printed sources as well as in songs and chants. The information should have been found in early printed works and should have persisted to the present. These criteria cannot be fulfilled for the story of the leprosy. Maori oral tradition includes the story of a canoe arriving in New Zealand with the - 142 occupants suffering from leprosy, and also the waiata of Te Rohu. The canoe story was obtained from only one source. The occupants of the canoe had a disease that killed many of them, but there was no description of leprosy. The Te Rohu waiata is an account from many sources and is reliable, but it contains an inadequate clinical description of leprosy and is itself post-European. Although the leprosy described by Rees and Thomson was called “ngerengere” by the Maoris, it is far from clear that all ngerengere was leprosy. The Maoris considered that disease had a spiritual source, and ngerengere was unlikely to have been considered as a symptom complex.
Evidence that leprosy was referred to in Maori legend depends on the interpretation of the translator. Most of the material in the legends dealing with leprosy was obtained by John White, who was an unreliable translator. The legends could not be dated, and need further study. Shortland, Johnson, Rees and Thomson refer to the Maori belief that the disease had been present for some time. It is possible that other diseases were confused with leprosy. Infections with skin lesions that may be confused with leprosy include yaws, pinta, nonvenereal syphilis and leishmaniasis. These diseases have not been described in the Maori. Yaws has been present in Polynesia but not in New Zealand. Other diseases which may have been confused with leprosy include rodent ulcer, neurofibromatosis, raised lesions seen with psoriasis, sarcoidosis, granulomatous lesions such as histoplasmosis, diseases with peripheral nerve lesions, such as syringomyelia, diabetic neuropathy, amyloidosis and congenital indifference to pain (Browne 1970). Only in exceptional circumstances, however, would they produce the classical signs of leprosy. Some of the early authors pointed to similarities of the disease to frostbite and ergotism, but these are acute diseases and not associated with sensory loss or skin lesions, and should not normally be confused with leprosy, which is a chronic disease.
The possibility that ngerengere might have resulted from eating the karaka berry (or karaka nuts) was raised by Johnson (Taylor 1959:168). This berry, which is very poisonous in its uncooked form, was part of the Maori staple diet in most parts of New Zealand (Bell 1974). To remove the poison, the fruit was baked in earth ovens for several hours and then washed for days or weeks. The flesh was removed and the kernels dried in the sun. Poisoning resulted in convulsions and was often fatal. Colenso described a boy with distorted immovable limbs, which he attributed to poisoning with karaka berry (Skey 1871:316). Paralysis of hind limbs was seen in pigs fed karaka fruit (Bell 1974) and guinea-pigs dosed with nectar from karaka flowers (Palmer-Jones and Line 1962:433-6), but - 143 the clinical picture of karaka-poisoning would seem to be quite different from that of leprosy.
In the absence of better evidence it is likely that leprosy was introduced into New Zealand in the late 18th or early 19th century by a number of possible means. Ginders noted in 1890 that the Maoris at Taupo at that time believed the disease was introduced by the marooning of a sailor with leprosy; I can find no supporting evidence for this. It is also possible that Maori travellers acquired the disease in other countries. Maoris frequently worked in ships as members of the crew and in all areas of the Pacific. In the early 19th century they travelled as far as Boston and London (Howe 1984:101-2). Early trade with China and India provided a potential link of Maori crew members with leprosy. The introduction of leprosy into Hawaii in the 1840s was considered to be by Chinese trade, by Hawaiian crew working in trading ships, or by Chinese workers in Hawaii (Cantlie 1897). The difficulty with the proposal that leprosy was introduced into New Zealand in the late 18th or early 19th centuries is the geographic distribution of the disease in a number of relatively remote areas (where it was first reported), but it is possible that the disease was introduced by this means at two or three locations.
As mentioned earlier, many early descriptions of New Zealand and the Maori race by visitors, including physicians, did not mention leprosy. The works I examined included Monkhouse's Journal (Beaglehole 1962), the writings of Crozet (1891), Dumont (1830), the surgeon John Savage (1807), Markham (1963), and Yate (1835). Perhaps more significantly, G. Bennett, in a review article of medicine in New Zealand and Polynesia in 1831 and also in later publications (1860, 1883-4), did not mention ngerengere or leprosy. This man had practised medicine throughout the Pacific, but particularly in New Zealand and Polynesia, including Hawaii. Dr E. Dieffenbach wrote Travels in New Zealand in 1843 with a chapter on diseases of the natives and did not mention ngerengere or leprosy. In reviewing diseases in New Zealand, two surgeons, Watkins and Tawell, gave no evidence of leprosy to the Select Committee of the House of Lords, “Appointed to Inquire into the Present State of New Zealand in 1837” (British Parliamentary Papers 1837-8).
A feature common to all the accounts of leprosy in New Zealand was that the authors did not consider the source of the leprosy, even though most of them accepted that the disease had been present in pre-European times. They may have assumed that leprosy was also present in the Pacific in pre-European times. However, there seems to be no evidence that leprosy was in eastern Polynesia, which is the likely “Hawaiki” or - 144 home of the Maoris. The strongest evidence against the introduction of leprosy from eastern Polynesia is the lack of common terms for leprosy anywhere in the Pacific. The bulk of the historical evidence suggests that leprosy was introduced into Polynesia at the end of the 19th century, and there appears to be no physical evidence of leprosy in Polynesia before that time.
Included in writings about the western Pacific (especially Fiji) are occasional statements that leprosy had been present for some centuries. Best (1905b), for example, speculated about migration from Melanesia to New Zealand:
Horouta seems to have arrived here some five or six generations before the fleet. Their descendants may be found among the Ngatiporou, Tuhoe, Ngatihau and other tribes. On this canoe came a number of black-skinned men who spake a different language from that of the Maori people. These people were probably Melanesians of Fiji.
There is no evidence to support these stories, and they are not generally accepted. The “fleet” was a fleet of canoes considered by Best and others to have carried the Maoris to New Zealand. This view of the early migrations of the Maoris has been largely discredited.
Robyn Jenkin's Was Tasman the First (1970:15-20) centres on the Portuguese or Spanish who may have visited or been shipwrecked in New Zealand. The Maoris do indeed have some stories of light-coloured people, but these possibilities are speculative.
A number of questions remain unanswered. If leprosy was introduced or if indeed leprosy had been present among the Maori in pre-European times, why did the disease decrease at a time when living conditions were very poor? Many early authors (e.g., Ginders 1890:2; Newman 1881:470; Thomson 1854:499; Tuke 1863-4;722) accepted that leprosy had been widespread in the Maoris in earlier times and that it began disappearing in the 19th century. Goldie (1905:65) was probably correct in suggesting that the few sporadic cases of leprosy observed among the Maoris had been referred to by so many authors that undue importance had been attached to them, and the prevalence of the disease was overestimated. The ethnic distribution of leprosy is curious in that I could only find a single report of a case of leprosy in a European in New Zealand.
The Maoris in the 19th century were fearful of ngerengere, and patients with the disease were often isolated. Although the segregation of patients has been used as evidence that the disease was leprosy, the - 145 isolation of persons with ngerengere was not unique to this illness. When persons were ill, the patient would often be moved to a separate hut erected for the purpose. In the event of death, the hut was usually burnt (Bennett 1831:628).
Most Maoris with whom I had contact did not know the story of ngerengere. One Maori physician had no knowledge of the disease, and I suspect most physicians in New Zealand are unaware of the history of leprosy in New Zealand. In Taupo and Rotorua, where leprosy has been described, some individuals were familiar with the term “ngerengere” and were still concerned about the disease. Those who knew anything about ngerengere had heard about it from old relatives or old people who remained fearful. One Maori contact said that he had been told of a victim of ngerengere who was burnt at the site where he died. As mentioned above, this practice does not seem to have been unique to ngerengere. Another person who described an incident with an unknown victim of ngerengere did not want me to share the details of this information with others. Some fear of a disease like leprosy might be expected to remain for many years.
A review of all the available evidence does not support the existence of leprosy in New Zealand in pre-European times, for want of adequate clinical description or skeletal evidence. Limited examinations of skeletal material from New Zealand in pre-European times have been made (Phillip Houghton — personal communication). In another study of the variation of approximately 1,000 skulls, no pathology consistent with leprosy was seen (Robin Watt — personal communication). These two studies of available skeletal material of New Zealanders have not noted pathology consistent with leprosy, but minor changes of leprosy are not readily detected and additional skeletal material would have to be examined to rule out leprosy. Because of the lack of other evidence, it would be possible to establish the presence of leprosy in New Zealand in pre-European times only by demonstrating its physical evidence.
An extensive literature has described the existence of leprosy in the Maoris before European contact. The available evidence does not support this view. The main points against the existence of the disease are the lack of convincing oral tradition, the delay in time after European contact before unequivocal clinical leprosy was described in New Zealand (50-60 years), the absence of records of leprosy by a number of visiting physicians who studied diseases among the Maoris before 1850, - 146 the absence of descriptions of leprosy in the Pacific before the mid-19th century, the absence of common terms for leprosy in Maoris and other Polynesian languages, and the absence of physical evidence of leprosy in New Zealand or Polynesia before the mid-19th century.
The first clear descriptions of leprosy in New Zealand were in the 1850s. The means of introduction of this leprosy into New Zealand are unclear, but it may have been introduced by travellers from other countries, particularly China or India, where the disease was prevalent at that time.
The preliminary findings of this study were published in the Proceedings of the first New Zealand Conference on the History of New Zealand and Australian Medicine, held at Hamilton, New Zealand, April 20-30, 1987.
Support for this study was provided by the University of Southern California Faculty Research and Innovation Fund, and the Department of Medicine, Auckland University Medical School.
I gratefully acknowledge the support of Professor Gordon Parsonson, whom I consulted on New Zealand and Polynesian history, and who reviewed a large amount of material and extensively edited the article. I also thank Professor Bruce Biggs, who reviewed Maori translations and translated additional work.
I acknowledge the help of the staff of the Auckland University, Auckland Museum, Auckland Public, Alexander Turnbull and Hocken Libraries. I also gratefully acknowledge the help of many persons who provided information and discussed aspects of this work: Ian Church, Darkie Downs, Sharon Dell, Rae Fletcher-Cole, Dr L Gluckman, the late Sir John Grace, Trevor Hosking, Dr Philip Houghton, Raeburn Lange, Dr Margaret Orbell, Steven Oregan, Dr J. M. F. Owens, Rakato Te Rangiita, Dr Thomas T. Rea, Murdoch Riley, David Simmons, Dr Olaf K. Skinsnes, Dr Douglas G. Sutton, Agatha Thornton, Christine Tremewan, Wāka Vercoe, Robin Watt and Dr Rex Wright-St. Clair.
For her help in the preparation of the manuscript, I thank Jean Lloyd.
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