This exhibition is made possible with the support of Hawaii State Archivist Dr. Ronald Williams, Jr. and his essay written for the Judiciary History Center’s museum renovation project. Images courtesy of the Hawaii State Archives Photograph Collection.
Ka Imi Pono: Threats to the Native Populace
Hawaii’s documented history with infectious disease dates to the 18th century. Contact with foreign explorers, tradesmen, laborers, and missionaries introduced viruses and diseases for which Native Hawaiians had no immunities. Scholars estimate the native population ranged from 250,000 to one million when British Captain James Cook first arrived in 1778. Following the overthrow of the Hawaiian Kingdom, the Republic of Hawaii’s census of 1896 reported 39,504 Native Hawaiians within a total population of 109,020. Since the early 19th century, the government has looked to law and public policy to foster greater health protections for its native community. Today, the group has grown to over 290,000 people, about 21% of the population statewide, and over 560,000 nationwide.
One of the first foreign ailments noted by Captain Cook’s crew was venereal disease, which often left survivors sterile. Shortly after, cholera and influenza arrived in the islands. In 1820, the American Board of Commissioners for Foreign Missions sent its first group of American missionaries to Hawaii. In their 1832 census covering a few districts, they recorded a native population of 134,750, a reduction in about half of the most conservative population estimate from the time of Cook’s arrival.
Hawaii’s rulers quickly used the law to stem the spread of disease and curb population decline. In 1827, Queen Kaahumanu and the Council of Chiefs issued “He Olelo No Ke Kanawai” (Proclamation of the Law), which included a provision outlawing adultery. King Kamehameha III followed suit in “No Ka Moe Kolohe” (Concerning Mischievous Sleeping), which declared adultery and fornication “violations against the laws of the Kingdom.”
The Hawaiian Monarchy also introduced measures targeting transportation and trade to block the transmission of new illnesses. In 1836, Princess Kinau ordered a screening of all ships and crew for smallpox and cholera. Ships were to hoist a yellow flag to inform harbor authorities of a contagion’s presence onboard. Kamehameha III created the Kingdom’s Board of Health and issued its first quarantine laws. These laws outlined protocols for ships exposed to infectious disease, as well as the responsibilities of local representatives, harbor officials, physicians, and ships’ captains. In 1839, “He Kanawai No Ka Mai Puupuu” (A Law Regarding Smallpox) was passed. Vessels originating from places with active epidemics like smallpox or measles were restricted from entering Honolulu Harbor. Ships were required to remain at sea for 42 days without crew disembarking.
Over the next decade, cases of measles, whooping cough, dysentery, and influenza spread quickly via the harbors at Honolulu and Hilo. Death toll estimates range between ten and thirty thousand people. Nineteenth-century Native Hawaiian historian Samuel Kamakau wrote, “One-third of the entire nation was killed in this massacre.” The problem escalated by the late 1840s with the opening of the Central Wharf in San Francisco. Ships from New England arrived in Hawaii in approximately six months, leaving ample time for a disease to run its course among the crew and be passed to the local community onshore. In 1850, the government census revealed that the native population had fallen to 82,593.
Conscious of the tragic deaths of his people, King Kamehameha IV requested funds be set aside for a modern hospital to serve Native Hawaiians. The Legislature appropriated $5,000, but later refused to release the funds. In 1859, Kamehameha IV and Queen Emma set out to raise the money on their own, collecting over $13,000. By the following summer, the cornerstone for Halemai Moiwahine (Queen’s Hospital) on Oahu was laid.
Queen’s Hospital’s annual report of 1863 notes one of the first outbreaks of “mai Pake” (Chinese disease) or Hansen’s disease (leprosy). Leprosy was present on the islands since the 1830s, and physicians stressed the responsibility of the Legislature to establish a quarantine facility for patients. Within two years, King Kamehameha V and the Legislature passed “An Act to Prevent the Spread of Leprosy.” This law implemented forced segregation of those afflicted with leprosy to Kalaupapa Peninsula on Molokai. Forced relocation stigmatized patients and devastated many families. Although the number of leprosy cases was fewer than other epidemics, it was viewed harshly due to its physical effects and incurability. From 1866 and 1867, more than half of the Board of Health’s annual budget was appropriated to the disease’s prevention.
By 1866, the death rate of Native Hawaiians continued to outpace live births. Census numbers recorded a native community of 58,765. In 1869, King Kamehameha V designated the sand islet Kamokuakulikuli off the coast of Honolulu Harbor as a quarantine station for ships exposed to infectious disease. It became known as Quarantine Island or Mauliola and was used for this purpose into the early 20th century.
In January 1881, King Kalakaua left Hawaii to embark on a diplomatic world tour. One month into his trip, smallpox arrived to Honolulu Harbor. On February 23, 1881, Princess Liliuokalani, acting as regent, and the Board of Health ordered the steamship en route from China to isolate its 711 passengers on Quarantine Island. Liliuokalani also ordered inter-island freight travel to stop and prohibited vessels from taking passengers.
When the ship first arrived in Honolulu ten days prior, two of its passengers were removed and given medical care for smallpox. The Board of Health determined that the ship needed to be disinfected and cargo intended for Honolulu removed, but it did not want to expose people onshore. Temporary lodging was set up on Quarantine Island for the ship’s crew and passengers.
After their time in quarantine, the ship’s passengers were refused entry and customs clearance into the Kingdom until the captain secured a bond to reimburse the board for all expenses incurred since its arrival. The captain refused responsibility for costs other than the board’s care of the two sick passengers. The issue was heard before the Supreme Court in March 1881, in the case Peterson v. Carter. Chief Justice Charles Harris ruled in favor of the Board of Health citing sections 296 and 298 of the Civil Code, which placed all liability for quarantine expenses with the vessel’s owner.
The growing plantation industry stimulated immigration of thousands of Chinese, Japanese, Filipino, Portuguese, and other groups to the islands. This exposed natives to more disease. By 1884, the government census recorded 44,232 Native Hawaiians, roughly 55% of the total population.
On December 12, 1899, the bubonic plague broke out in Honolulu’s Chinatown. It is believed that flea-infested rats from a freight ship docked in Honolulu Harbor carried the infectious disease onshore. After five days and five deaths, the Board of Health, Council of State, and Board of Education took action. Initially, a quarantine was implemented along with military supervision over Chinatown, which was divided into 15 districts. Widespread cleaning of city streets, businesses, and homes was undertaken. Public schools were shut down, inter-island steamers as well as cargo and passenger ships from Asia were prohibited from leaving Honolulu’s port. Volunteer doctors were asked to stay on call to monitor the development of positive cases.
The Board of Health relaxed quarantine measures for holiday business to resume, but new cases were discovered on December 24, 1899 through the end of the year. On December 31, 1899, the Board of Health condemned the area between Mauna Kea Street and Pauahi Street, issuing the first controlled fire in Chinatown to be set. A building was condemned to burn not only if a plague-induced death had occurred there, or if its condition was so unsanitary that it could not be disinfected, but also if it was determined that a rat could easily pass through the structure to another.
A quarantine camp was set up in Kalihi to relocate those who had been exposed to the infectious disease, and the entire district of Honolulu went under lockdown. On January 11, 1900, the Council of State passed a bill allocating $20,000 for the designation of relief camps for dislocated persons and the maintenance of patients under quarantine. By this time, only freight carrying canned goods that had been fumigated were allowed to leave Honolulu’s port to uninfected parts of other islands.
On January 16, 1900, the Board of Health created and appointed members to the Citizens’ Sanitary Committee, led by Lorrin A. Thurston. This group appointed inspectors from a pool of citizen volunteers throughout the newly defined districts across the Hawaiian islands. Each held the power to enter into any premise to conduct a sanitation inspection of the buildings and its occupants. The committee regulated businesses’ hours of operation to conduct inspections. They also instituted a rat extermination campaign, referred to as the “rat crusade” in local newspapers.
On January 20, 1900, the burning of Chinatown’s block 15 was blown off course by strong winds, carrying embers that ignited Kaumakapili Church. The fire raged out of control and displaced several thousand Native Hawaiians and Asian immigrants from their homes. This devastation did not prevent the Board of Health from continuing to use fire as a plague eradication measure.
Claims were filed by residents who lost their homes and businesses to the devastating Chinatown fire. Three notable civil cases in 1900, Yee Wo Chan Company v the Transatlantic Company, Hawaii Land Company v The Lion Insurance Company, and Yee Wo Chan v the Magdeburg Insurance Company, were all heard before the Hawaii Supreme Court. In Yee Wo Chan Company v the Transatlantic Company, the decision of a $5,000 judgment to the plaintiffs was upheld. In the latter two suits, the defendants’ judgements were affirmed on account of specific wording in the insurance companies’ policies. The verbiage prevented the aggrieved parties from securing compensation for loss or damage caused by order of civil authority. L.A. Thurston, leader of the Citizens’ Sanitary Committee, was the attorney for the Magdeburg and Transatlantic insurance companies.
Over the course of a few months, the Honolulu plague killed 61 people. Small outbreaks occurred in Kahului, Maui (2 of the 61 deaths) and Hilo, Hawaii (no deaths). During the height of the four-month quarantine, death as a result of pneumonia and tuberculosis both separately outnumbered the plague’s total casualties. Tuberculosis was a leading cause of disease-related death in Hawaii for over a century until its downturn in 1957. It was the cause of King Lunalilo’s death in 1874. The plague came back periodically in urban and rural locations across the islands into the 1950s. It killed more than 400 people in total.
Attention to the severity and lack of resources for patients suffering other ailments led to the opening of Leahi Hospital in 1901, referred to then as the Victoria Hospital for Incurables. The Board of Health also recommended new water filtration, sewage, and garbage disposal systems be developed in Honolulu. From December through March the Council of State passed bills allocating over $345,000 for a new sewer system, $20,000 for a garbage crematory, and around $625,000 for the suppression of the epidemic.
The bubonic plague brought to light issues of poor sanitation and infrastructure endured by the community in Chinatown. Public commentary in local English language newspapers also revealed racist attitudes held by some of Hawaii’s white population towards the non-white community living there. Some newspapers called for regular monitoring of Asian communities after the plague’s passing to ensure higher standards of sanitation were adhered to.
Census records show that the decline of the Native Hawaiian population slowed and stabilized by 1890. However, talk of the group’s extinction continued in popular discourse into the early 20th century. Hawaiian leaders and their allies searched for answers to aid the native community, while others called the crisis an issue of “survival of the fittest.”
In 1918, the modern world faced two unprecedented tragedies: World War I and the Spanish influenza. Scholars estimate the total casualties in WWI were around 40 million, and for the flu pandemic, 20 to 50 million. The virus killed over 2,300 people in Hawaii, almost 20% of all deaths recorded by the Bureau of Vital Statistics between 1918 and 1920. Pneumonia and tuberculosis followed as the next leading causes of death.
The first incidences of the flu were reported on Oahu’s military bases in the summer of 1918. The virus had spread heavily throughout plantations by December. Despite the threat, English language newspapers focused headlines on the progress of the war instead of the pandemic. Scholars suggest this was to keep morale high while the Territorial Government focused on the war effort.
The Board of Health’s annual reports of 1919 and 1920 note that isolation wards were prepared for influenza cases and temporary buildings were erected in areas lacking medical infrastructure. The US Army Medical Department was also called to assist hospitals. The most notable of facilities managing the pandemic were Queen’s Hospital, Lihue Armory on Kauai, and Pa Ola Day Camp (referred to as Pa Ola Influenza Camp) and the Insane Asylum on Oahu. Nurses and district sanitary inspectors conducted regular inspections of public schools in high incidence areas until the epidemic was over. While it was noted that some businesses like theaters closed, public schools remained open due to the observations that children were less vulnerable, and would remain less susceptible and better supervised at school.
The annual report of 1920 notes the flu pandemic’s peak that year corresponded with a large strike by Japanese and Filipino plantation workers on Oahu. They and their families left the poor conditions on farms and relocated, but did not escape the virus. The Japanese Federation of Labor set up temporary camps to house the groups in Honolulu. Other camps were built at Waipahu, Waialua, Kahuku, and Kailua. The flu pandemic was perceived to have passed by 1921 with 64 deaths attributed to it that year. Subsequent pandemics occurred in 1957 and 1968. The flu continues to kill tens of thousands of people across the United States each year.
Epidemics and Public Policy in Hawaii
Hawaii’s remoteness no longer lends it protection from foreign disease. The 2019–2020 novel coronavirus pandemic continues the influx of introduced illnesses and the socio-economic, medical, and cultural challenges they bring. As in the past, local government is employing law to stem the epidemic’s impact. Hawaii’s Executive Branch officials have issued orders mandating closure of public schools and public gathering places, suspension of nonessential business services, stay-at-home and curfew orders, and a 14-day self-quarantine for people who travel to or from the islands, excluding essential workers. The Judiciary has adopted new rules extending filing deadlines, postponing certain types of court cases, and assessing which cases can resume through online platforms. The Legislature has also crafted bills and resolutions addressing financial appropriations, sick leave, travel, and precautionary measures.
Around 10 million people visit Hawaii every year. Hawaii’s working force and economy are suffering from global travel restrictions and local business shutdowns. More than 220,000 residents filed for unemployment in the spring months of 2020, and the Department of Labor and Industrial Relations has paid over $204 million in unemployment insurance benefits. The total impact of COVID-19 on the State and its community remains unclear. Economists suggest it will continue to disrupt lives and the economy for the next few years.