Plague and Fire

by James C. Mohr

  Though a few of the doctors present at the emergency session thought that Emerson, Day, and Wood should wait for the report of their own bacteriologist, they themselves had already seen and heard enough. By unanimous vote, the three Board physicians formally declared their city under attack from bubonic plague. They then quickly and unanimously agreed upon a series of policies designed to address the mortal threat now confronting the people of Honolulu. The entire meeting lasted just fortyfive minutes."

  Under the republic's constitution, the Board's declaration would have created a state of emergency and permitted them to do whatever they deemed necessary during the emergency to protect the public health. But that constitution had been legally suspended in order to facilitate the joint resolution of annexation, so the Board's members were uncertain about the limits of their authority under the "existing government" rules promulgated by the United States Congress. Consequently, they reassembled at three o'clock to confer with the Council of State, which had been Hawaii's highest governmental body under the Dole republic.

  The Board's members asked the council to formally confirm their emergency powers and to ratify the policies they had hastily outlined just two hours earlier. Within minutes, the full council not only unanimously confirmed the Board's emergency medical powers but also unanimously ceded absolute control over the entire Hawaiian archipelago to the Honolulu Board of Health for the duration of the plague crisis. Fully convinced that the outbreak of bubonic plague necessitated extraordinary measures, and clearly relieved that an appropriate arm of government had come forward to deal with the situation despite the confusing constitutional circumstances they faced, President Dole and Attorney General Henry E. Cooper agreed that nothing should be allowed to impede the Board of Health's battle against "the dread disease." In a single brief meeting, the civilian government of Hawaii essentially suspended itself.'-"

  Thus three physicians found themselves holding absolute dictatorial authority over all aspects of everyday life in Hawaii. They were in command of the armed forces and had unrestricted access to the treasury. They could arbitrarily impose any rules on any subject whatsoever. As one local editor correctly observed, "In this crisis the Board of Health has a greater power than even Congress." And the physicians were clearly expected to exercise their power, since everyone was depending upon them to save the islands, stranded as they were in the middle of the Pacific Ocean, from the nightmare of decimation by plague. Consequently, the newly empowered rulers of Hawaii went immediately from their meeting with the council back across the street to the Board of Health office, where they had recently installed telephones. There they began to implement the policies they had hastily agreed upon just a few hours earlier, policies that would profoundly affect the city for the next several months and beyond.21

  he events of December 12, 1899, abruptly catapulted three physicians to unprecedented positions of absolute power in the Hawaiian Islands. All three had earned their MDs at American medical schools, all three had practiced in the islands for over a decade, and all three had considerable experience as public health officers in Hawaii. But none of them could have imagined becoming rulers of the archipelago-not just in matters of health but in economic, social, and all other matters as well. In a literal sense, and almost literally overnight, their collective word had become law.

  The oldest and most experienced of the three-both medically and politically-was sixty-year-old Nathaniel B. Emerson, who had been serving on the republic's Board of Health since his appointment by President Dole in 1896. The son of missionaries from New England, Emerson had been born on Oahu, where he grew up speaking Hawaiian among children in the village where his father served as pastor. He epitomized a rather amorphous group of second-generation whites known colloquially during the i88os and 189os as the "mission boys"-Americans who rose to positions of power and influence among the people their parents had come to convert to Christianity and capitalism.'

  After Emerson completed school on Oahu with his Hawaiian friends, his parents sent him to Williams College in their native Massachusetts. While he was a student, the Civil War broke out, and Emerson enlisted, along with many of his classmates, in a Massachusetts infantry regiment. Shrapnel from Confederate artillery fire tore his cap off during the Battle of Gettysburg in 1863, and he was wounded three times in the bloody spring offensive of i 864. Yet Emerson continued to fight with his regiment right through the surrender of Richmond in the spring of 1865. No one ever doubted either his mental determination or his physical courage.

  Following discharge from the army, Emerson completed his baccalaureate at Williams and entered Harvard Medical School. After finishing his basic medical training in Boston, he transferred to the College of Physicians and Surgeons of New York City, in order to study surgery under Willard Parker. While in New York, Emerson also served as clinical assistant to 0. Edouard Seguin, a national leader in the treatment of insanity. By the standards of that era, Emerson was thus working with individuals at the forefront of the medical profession. He received his MD degree in 1869 and developed a successful practice in New York City over the next decade. Interacting with the city's top physicians, he kept up to date on major medical developments throughout the United States and Europe, including the revolutionary field of bacteriology, which he enthusiastically embraced.

  In 1878, S. G. Wilder, one of Emerson's boyhood friends from Oahu, became interior minister of the Kingdom of Hawaii. Wilder promptly wrote to Emerson, pleading with him to come back to the islands and help the government get leprosy under control. Emerson recognized that his old friend's plea was both medically and politically motivated, since the disfiguring disease not only ruined the lives of those afflicted but also threatened to tarnish Hawaii's reputation in the eyes of the rest of the world. Both white elites and Hawaiian aristocrats feared that no one would want to do business with them-much less voluntarily visit them-if their homeland was perceived as a dangerous string of leprous islands. The loyal mission boy agreed to tackle the task, closed his practice in New York City, and returned to the island of his birth as "general inspector of lepers and leper colonies." For the next twenty years, Emerson would remain more or less continuously active on the tumultuous and often perilous frontier between medicine and politics in Hawaii.'

  As general inspector of lepers, Emerson toured the archipelago in search of concealed cases. The task of hunting down afflicted indigenous folk and wresting them from their families made him extremely unpopular with many ordinary Hawaiians and turned him into a symbol of medical imperialism. More than one family drew their guns on the doctor, but the Civil War veteran unflinchingly worked to identify and remove everyone with an active case of leprosy to the leper colony at Kalaupapa, on a remote peninsula jutting out from the base of inaccessible cliffs on the island of Molokai. There, at least in theory, the afflicted could be treated by medical experts not available elsewhere; and whether their lives were improved or not, the lepers would at least be removed and isolated from the rest of the islands. Following his tour, Emerson went to the controversial Kalaupapa colony, which badly needed reorganization and upgrading. There he devoted himself so thoroughly to the well-being of his patientssome of whose relatives had previously threatened to shoot him-that they petitioned the government to keep him on as permanent supervisor.

  With leprosy safely isolated on Molokai, Emerson moved in i 88o to Hawaii's next most sensitive medical post. He became "vaccinating officer" in Honolulu, where he was responsible for examining the health of incoming immigrants. The vast majority of the immigrants were Chinese and Japanese laborers, who were entering the islands from areas of the world that both white elites and Hawaiian aristocrats considered-even before the outbreak of bubonic plague-fonts of epidemic disease. Emerson served as medical gatekeeper, holding in quarantine anyone who appeared to be carrying a dangerous disease. He also routinely immunized all of the immigrants against smallpox, the one contagion against which medical doctors could then protect. For indigent p
eople already in the city, Emerson opened and directed a new public dispensary, where health care was provided free of charge.

  Dr. Nathaniel B. Emerson, senior member of the Honolulu Board of Health. Mamiya Medical Heritage Center. Hawaii Medical Library

  While working in Honolulu, Emerson met Dr. Sarah Eliza Peirce, who was practicing obstetrics and gynecology in the city. Like Emerson, Peirce had attended elementary school in Hawaii before going to New England in 1875 to study medicine. Since few regular medical schools in the United States at that time admitted women, Peirce enrolled at the Boston Homeopathic College, where she completed her medical degree in 1877. Also like Emerson, Peirce believed that the future of medicine lay not with homeopathy but with the new bacteriological sciences, so she went to Germany and France to learn about them before returning to Hawaii. Notwithstanding the thirteen-year gap in their ages, the two like-minded physicians married in 1885 and moved into a comfortable Victorian home on School Street, where they also maintained their medical offices.'

  In 1887 Emerson found himself at the center of an especially nasty incident in the perennially tangled politics of public health in Hawaii. King David Kalakaua, who was often at odds with Hawaii's white elites during his tumultuous rule in the late 18 8os, realized that many Hawaiians had long regarded European and American medical professionals like Emerson as agents of a way of life they disliked and distrusted. The king also understood that the officials responsible for the health of a society necessarily possessed-in addition to their legal authority-a great deal of cultural influence. Consequently, Kalakaua decided to try to override the Western-dominated Honolulu Board of Health, which determined medical policy throughout the kingdom. He proposed a new Hawaiian Board of Health, whose members the king intended to appoint himself. All members of the new board would be kahunas, or traditional Hawaiian healers, who would be granted an exclusive right to determine who could practice medicine in the islands. For Kalakaua, this was a symbolic effort to reassert indigenous authority over a society increasingly under the political influence and economic control of outsiders. To Western-trained doctors, the king's ploy seemed retrogressive and perverse. Christian missionaries, like Emerson's parents, saw the kahuna plan as an effort to revive pagan customs.4

  Whites inside Kalakaua's badly fractured government blocked the king's efforts to shift legal licensing power to his kahunas and persuaded Emerson to take over as president of the original Honolulu Board of Health. After a two-month struggle that culminated in a showdown over keys to the agency's downtown office, the politically effective Emerson restored the supremacy of the Western-dominated board. In retaliation, an irate Hawaiian legislator introduced a bill to ban Emerson from practicing medicine in the islands. Though the bill was eventually defeated, Hawaiian members of the legislature managed to pass another law that banned the doctor from continuing in private practice while holding public medical posts.'

  Following this confrontation in 1887, Emerson decided that the monarchical government he was theoretically serving could no longer be trusted with the long-term future of the islands. Like many of his friends, he convinced himself that the best future for Hawaii and Hawaiians lay under the protective custody of the United States, the nation he had once fought to preserve. In that conviction, he was hardly alone among the Western-trained doctors then practicing in Hawaii. Outraged and insulted that the king would seriously try to make them subservient to people they regarded as witch doctors, Honolulu's Western-trained physicians united in nearly unanimous and implacable opposition to indigenous rule. By attacking their professional status, Kalakaua had hit a sensitive spot. When the alliance of American planters and American merchants overthrew the Hawaiian monarchy in 1893, Hawaii's Western physicians were among the most ardent supporters of the coup.

  Although his political experiences persuaded Emerson that the monarchy had become dysfunctional and dangerous, the mission-boy physician nonetheless retained his admiration for many aspects of the traditional Hawaiian culture. In 1893, even as he joined those Americans bent upon delivering the Hawaiian Islands to the United States, he presented a pioneering paper before the Hawaiian Historical Society that championed the extraordinary navigational prowess of the ancient Polynesians. At a time when few people were doing so, he continuously collected, translated, and preserved Hawaiian-language songs, chants, histories, legends, and epic tales. His collections were later given to the United States Bureau of American Ethnography and to the Huntington Library, where they remain among the most significant repositories of nineteenth-century Hawaiian-language works.'

  Provided bacteriology retained its place of primacy, Emerson also remained reasonably tolerant of alternative methods of healing. Following their victory in the showdown with Kalakaua, for example, a group of Honolulu's Western-trained physicians approached the reempowered Board of Health with a demand to ban the importation of Japanese herbals. In its way, this proposal was as much an assertion of symbolic dominance as the king's kahuna scheme had been; in both cases the parties were trying to use control over public health care as a key component in the assertion of cultural authority. But Emerson bravely opposed the idea. "[I] am inclined to believe that [the herbals] had been of some benefit," the Board president told his colleagues, "and that certain of the patients seemed wedded to them." His arguments prevailed and importation continued.'

  In sum, the senior member of the Board of Health was a complicated and somewhat paradoxical person. On the one hand, he was a scientifically progressive physician, trained by top figures in Western medicine and fully committed to the promise of bacteriology; on the other, he was realistic about what Western medicine could and could not do, and he remained tolerant of other approaches to healing. As a personal symbol of professional imperialism, Emerson had been targeted-literally and legislatively-by Hawaiians who hoped to reduce the power of outside whites; yet he nonetheless revered and preserved the Hawaiian traditions and Hawaiian language of his upbringing and became arguably the most important conservator of Hawaiian culture in his generation. Emerson's scholarly and religious mind-set coexisted somewhat incongruously but comfortably with an impressive record as a political infighter. No other physician in the islands had won more major victories on the battleground of Hawaiian public health than the battle-scarred war veteran Nathaniel Emerson.

  Serving on the Board of Health with Emerson in the final years of the nineteenth century were a pair of longtime friends and medical partners, Francis R. Day and Clifford B. Wood. Forty-year-old Francis Day had been born in Missouri in 1859, then taken as an infant to Chicago when the Civil War broke out. His strongly pro-Union parents, upset with the political waffling of their border slave state and afraid for their own safety as ardent Free-Soilers, wanted to relocate to a securely pro-Union area. The family remained permanently in Chicago after the war, and Day went through public schools there before taking pre-medical training at the University of Michigan. In 1882 he graduated from the Chicago College of Physicians and Surgeons, then did an eighteenmonth internship at Cook County Hospital, and headed to Europe for eight months of additional study. In Europe, he too embraced the new bacteriology.'

  Dr. Francis R. Day, Honolulu Board of Health. Mamiya Medical Heritage Center. Hawaii Medical Library

  Day returned to Chicago, married the daughter of an older doctor in 1885, and was trying to establish a medical practice when his own health began to fail. Hoping to benefit from warmer climates and sea air, he signed on as a sort of circuit-riding ship's doctor for the Oceanic Steamship Company. When Day was only twenty-five, he and his bride headed for the South Pacific. On one of their voyages in 1886, the Days stopped at Honolulu, found the place enthralling, and decided to stay.

  Affable, outgoing, and erudite, Day quickly built a large practice among the white elites of his new city. Impressed with his solid scientific training and European polish, people found his medical manner immensely comforting and his personality unusually charming. He read both German and French
fluently; he avidly practiced the rapidly advancing art of photography; and "a violin in his hands responded feelingly to the touch of a true musician," according to those who knew him. By all accounts, Day was the sort of man everyone in genteel Victorian society genuinely admired.

  In accord with his most prominent patients and almost all of his professional colleagues, Day too came to strongly favor the annexation of Hawaii to his native United States. He was a leading member of the Hawaiian Society of the Sons of the American Revolution and an active participant in the secret Annexationist Club, which engineered the overthrow of Queen Liliuokalani. When the Honolulu Board of Health was reconstituted under the aegis of the new republic in 1894, President Dole's first appointment went to Day, his trusted medical confidant from the Annexationist Club. Day had been serving on the Board ever since, though he took a year off to return to Chicago and obtain another MD degree-from Rush Medical College, a more scientifically oriented and prestigious institution than the one he had graduated from ten years earlier. Day also doubled as chief port physician following the outbreak of the world plague epidemic. In that capacity his colleagues on the Honolulu Board of Health had sent him, at government expense, to China and Japan in 1897, to see firsthand how Asian ports were dealing with plague security.