By Jackie Ng-Osorio, DrPH
The Efforts of Our Ali‘i to Mitigate Foreign Diseases
“A subject of deeper importance, in my opinion, than any I have hitherto mentioned, is that of the decrease of our population. It is a subject, in comparison with which all other sink into insignificance; for, our first and great duty is that of self-preservation. Our acts are in vain unless we can stay the wasting hand that is destroying our people.” As Alexander Liholiho spoke these words at the opening legislature on April 7, 1855, he was stating what other ali‘i before him had witnessed: his people were dying.
By the middle of the 19th century, the population of Native Hawaiians had been decimated by almost 95%. During the reign of Kamehameha III, the number of Kānaka Maoli had dropped from a peak of 800,000 in 1778 when Captain Cook arrived on Hawaiian shores, to fewer than 40,000 in less than 100 years. With deaths outnumbering births, Hawaiians faced the real possibility of disappearing completely. A once physically strong and vibrant people had been overwhelmed by introduced diseases against which they had little to no immunity. Venereal diseases such as syphilis and gonorrhea came with the first ships of Captain Cook; diseases such as tuberculosis, influenza, measles, mumps, typhoid, smallpox and leprosy arrived later (Pukui, Haertig, & Lee, 1979; Stannard, 1988).
The highly organized system of traditional healing was threatened by the fatal impact of epidemics of contagious foreign infections. Neither traditional lapa‘au nor Western medicine were effective against these diseases, as some presented differently for Kānaka Maoli. Hawaiian ali‘i were not spared the onslaught of Western diseases. Queen Kīna‘u, King Kamehameha II and his consort, Kamāmalu, were early victims of mumps and measles outbreaks.
In response to the clear threat to his people, Kauikeaouli, Kamehameha III, established the first Board of Health in Hawai‘i on December 13, 1850. The goal was to create a structure to address the decline in population by enforcing public health measures that would prevent epidemics of introduced diseases. Prior to the Board of Health, the Hawaiian Kingdom had quarantine rules in place from 1839 intended to manage the ports and the ships entering the islands. The quarantine system was soon overwhelmed by the sheer number of foreign ships seeking to land in Hawai‘i and by the 1840s it was largely ineffective.
After his death in 1854, Kamehameha III was succeeded by his adopted son and nephew, Alexander Liholiho, Kamehameha IV. By this time, Hawai‘i had undergone major political changes. The country was now a constitutional monarchy and changes to land tenure brought about by the Great Mahele were significant. The number of foreigners in Hawai‘i continued to grow and, as those numbers increased, the plight of Native Hawaiians grew dire. Introduced diseases were indiscriminate, taking kāne, wāhine and keiki. Kamehameha IV’s opening legislative speech calling for measure to “stay the wasting hand that is destroying our people” was a rallying cry (Speeches of His Majesty, 1861). During the first few months of his reign he enacted the Act to Institute Hospitals for Sick Poor and the Act Relating to Public Health (Laws of His Majesty, 1853). Both Acts were intended to implement guidelines for hospital and preventative care. As a result, the legislature appropriated $5,000 for hospitals that were to be established to care for sick and poor Native Hawaiians, one in Honolulu and the other in Lahaina. But the money was not spent.
In 1859, four years after his initial ask of the legislature, Kamehameha IV signed into law a bill that would allow for a Honolulu hospital for sick and needy Hawaiians. Kamehameha IV felt that this was the most important action taken that legislative session. Both he and his Queen, Emma, went door to door and ship to ship to raise the $13,530 needed to begin construction of the hospital. In 1860 the cornerstone of the hospital was placed in it’s current location at the foot of Punchbowl Crater. Today, The Queen’s Medical Center’s mission remains “To fulfill the intent of Queen Emma and King Kamehameha IV to provide in perpetuity quality health care services to improve the well-being of Native Hawaiians and all of the people of Hawai‘i.”
Royals outside the Kamehameha line who also made significant contributions to the health of their people were Queen Kapi‘olani, consort of King David Kalākaua, and King William Charles Lunalilo. Being childless, Kapi‘olani felt a special affinity for women and children and in 1885 established the Kapi‘olani Home for girls orphaned by parents with Hansen’s Disease (leprosy). She followed with a maternity home (known today as Kapi‘olani Medical Center) for Hawaiian mothers five years later. King William Charles Lunalilo, known for his sense of justice, compassion and kindness for others wrote a will in 1871 establishing the Lunalilo Home. His goal was to “build a home to accomodate the poor, destitute, and infirmed people of Hawaiian (aboriginal) blood or extraction giving preference to old people.” These institutions still exist, providing healthcare for kūpuna, women and children.
Unforeseen to our ali‘i, the arrival of foreigners to Hawai‘i brought opportunity coupled with disease and population decline. In response, our ali‘i strove to strengthen the lāhui through infrastructure, policies, public health and healthcare institutions that continue to serve our people today. All of these things are still important today, especially as we face another pandemic. We can look to our ali‘i and their determination to do what was right with the resources that were available and continue to strive to strengthen and uplift the lāhui. May we look to the strength of our kūpuna, knowing that we have survived before, and we can survive now, for this generation and future generations.
Jackie Ng-Osorio has been committed to the health and wellbeing of Native Hawaiians for over 20 years. She is currently the Native Hawaiian Culture Case Study Manager at the Department of Psychiatry at John A. Burns School of Medicine. She resides in Kalama Valley with her husband, Kāne, and their two keiki, Petra and Tobias.