Ka Wai Ola - Office of Hawaiian Affairs, Volume 2, Number 10, 1 October 1985 — He Mau Ninau Ola [ARTICLE+ILLUSTRATION]

He Mau Ninau Ola

Some Health Questior\s by Kekuni Blaisdell, M.D.

Q: E Kauka, I heard you say that Kamehameha died from a coronary. How do you know this? A: A'ole au 'ike keia (I do not know this). I do not believe anyone knows with certainty what the great chief's terminal illness was in modern terms. But we kauka like to soeculate based on

the fragments of available evidence. Such guessing helps us picture what life, sickness and medical care might have been i ka wa kahiko (long ago). The Journal of Nanini (Don Francisco de Paula Marin), the versatile Spanish expatriate who attended the king in 1819 at Kamakahonu, Kailua-Kona, tells us that on "8 May. This day the King T ameamea died at 3 in the morning age 60 yeārs and six months."

We know from a ki'i (portrait) of the conqueror by the visiting Russian artist Tikhanov in October 1818, seven months before his demise, that Kamehameha had already lost considerable body flesh [from?] but he was still agile [see accompanying illustration]. Sometime later, however, at least three weeks before his passing, he was overtly ailing, for on 15 April, Manini was summoned from O'ahu by brig to treat the sick king on the island of Hawai'i. On 20 April, the Spaniard found both Kamehameha and Ka'ahumanu, the king's favored wahine, to be ill [with what syptoms?], so he gave them medicine [what kind?]. The queen improved, but the king worsened. On 27 April, the monarch was given enemas [for?]. Then on 29 April, Liholiho, the king's 22-year son and heir, was "a little sick" [symptoms?]. On 1 May for the first time, Manini recorded the on!y specific symptom of the king — diarrhea. Was this perhaps an infectious diarrhea, whieh earlier affected the queen and the prince? Or were Kamehameha's watery stools merely a late eomplieahon, perhaps a result of enemas? Thereafter, the.king was so weak, he had to be carried to the hale mua (menVeating and worship house) to be fed, and then carried back to the hale nōa (free house) for rest or to confer with Ka'ahumanu who had already begun to seize ruling power. Up to the last, the old warrior was able to speak and he remained mentally clear. As already suggested, diagnostic probabilities include a bowel disorder, although apparently the king's diarrhea did not occur until the last week of his more than three-week illness. If it were infectious enteritis (inflammation of the gut), Manini did not mention fever, and he did not apply the term "dysentery," although he did record it later on 29 May in reference to an epidemic on O'ahu. Samuel Kamakau, who was born in 1815 and who wrote mueh later in 1867 based on older informants' recollections,

stated that Kamehameha "was a long time ill." Thus, coronary thrombosis with myocardial infarction (heart attack) does not seem likely unless the king was chronically disabled by "silent infarction," angina (chest pain), heart fai!ure (swelling and breathlessness), and/or abnormal heart rhythm (palpitation). Ma'i 'a'ai (cancer) is a possibility since the ali'i nui had conspicuously lost body tissue as early as seven months previously, but a site of cancer origin must also remain conjecture. Stroke, with perhaps multiple lacunar infarctions of the brain may also have ravaged the ruler, causing selective paralysis, but sparing his mental faculties. Kokopi'i (high blood pressure) could have contributed to a stroke. The foregoing diagnostic hypotheses are proposed because they are eommon and they occur with highest frequencies among po'e Hawai'i today. Modern diagnostic methods, of course, were not available in Kamehameha's time more than 166 years ago, and whether any of these diagnostic inferences apply to the kindgom's founder will remain as huna (secret) as the burial plaee of his sacred 'iwi (bones). Next month, we will recount the great leader's death from a Hawaiian perspective.