The third physician on the Honolulu Board of Health in December 1899 was Day's medical partner and longtime friend, Clifford B. Wood. Wood's mother and father had been living in Cincinnati when he was born in 1859, but his father died when he was only a few months old, and his widowed mother returned to her own family in Chicago. From early childhood, Clifford's closest boyhood pal was his neighbor, Francis Day. Just four months apart in age, the two went in tandem through Chicago's public schools, the University of Michigan, and the Chicago College of Physicians and Surgeons. Following completion of medical school, they spent eighteen months interning together at Cook County Hospital before Day left for warmer climates.
Wood was doing staff work at Cook County and trying to build a private practice of his own when he began to receive letters from his old friend. Day extolled the tropical glories and professional opportunities he was finding in Honolulu, and he urged Wood to join him. Medicine was an extremely competitive business for a young doctor in Chicago at that time, another winter was coming on, and each one of Day's letters made Hawaii sound more appealing than the last. So Wood decided in the fall of 18 8 6 to follow his friend to Honolulu. As persuasive as he was resolute, Wood convinced a young nurse at Cook County-"over the strenuous objections of her parents"-to come with him. The two were formally married in a ceremony at the Days' house in Honolulu the following year.
Once in Hawaii, Wood joined Day's circle of influential Americans. He too became an active member of the Sons of the American Revolution and of the camera club. Those ties, in turn, helped him secure a series of public health appointments. Following a short stint as a district physician outside the city, Wood returned to Honolulu as official city physician. The $2,400 salary for that job was too low to support the lifestyle he wanted, so he resigned to concentrate on his private practice. Even so, Wood had remained active in public health affairs through the early i 89os, serving variously as director of the public dispensary that Emerson once ran, surgeon to the Kakaako Hospital for quarantined immigrants, police department doctor, and physician to the Lunalilo home, which cared for indigent Hawaiians. He also inspected and vaccinated children in the public schools and became what would now be called chief of surgery at Queens Hospital.
Dr. Clifford B. Wood, Honolulu Board of Health. Mamiya Medical Heritage Center. Hawaii Medical Library
Like his colleagues, Wood became an avid proponent of American annexation during the late 188os. When the coup against Liliuokalani took place in 1893, Wood served prominently in the Citizens' Guard, the annexationists' paramilitary arm. From the leg of a Hawaiian policeman, Wood extracted the only bullet that hit anyone during the coup and kept it on his desk as a souvenir of what he considered a glorious event. Shortly after proclaiming the Republic of Hawaii, President Dole appointed Wood to join his friend Day on the Board of Health. In 1895 Wood was also elected to a term on the Council of State, which made him simultaneously a member of the government's highest decisionmaking body, a ranking officer in that government's military organization, and a member of the government's Board of Health. Wood's many over lapping posts clearly illustrated the interlocking roles played by the American elites in Hawaii during the late i 89os, and lent credibility to the opinion of Chinatown residents that the Board of Health was simply the not-to-be-trusted Dole regime in another guise.
Like Day, Wood had also visited China and Japan at government expense to investigate health matters for himself. During a three-month tour in 1896, he gathered what information he could, especially about the plague epidemic, then returned and presented a paper before the Hawaiian Medical Association summarizing what he had learned. After seeing health conditions in Asia, he was even more convinced that Hawaii should cast its lot with the United States. "The only politics I have is annexation," he declared famously at that time, and he repeated that statement often in the ensuing three years. When Wood's wife gave birth to their third child in September 1899, the couple named the boy Sanford Ballard Dole Wood.'
In the spring of 1899, Day and Wood had merged their separate private practices into a single professional partnership, which they were operating from an office in Beretania Street when the outbreak of plague in Chinatown propelled them to positions of unprecedented power. Along with their senior colleague on the Board of Health, they found themselves part of a triumvirate running America's most recent acquisition. In additional to their personal friendships and associations, the three physicians on the Board of Health in 1899 had two other overriding things in common that bound them together: their commitment to bacteriology in the service of public health and their commitment to the goals of the administration that appointed them. Particularly in the latter, they were truly the government's plague fighters.
Three laymen also served formally on the republic's Board of Health. One was Henry E. Cooper, then Hawaii's attorney general and the elected officer to whom the Board officially reported. He was on the Board because the constitution of the republic stipulated that the attorney general would function automatically as titular president of the Board of Health. The other two were George W. Smith and L. D. Keliipio. Smith, a prominent representative of the American commercial elites, had been appointed earlier in 1899; Keliipio had served for three years, but he had seldom been active in the Board's affairs, and little is known about him. As a practical matter, the three civilians attended the Board's daily meetings only sporadically and deferred to the three physicians on all matters of public policy."'
Though not formally appointed to the Board, a fourth physician, Duncan A. Carmichael, acted as an ex-officio advisor to the medical triumvirate of Emerson, Day, and Wood. Carmichael had been born in Montreal, Canada, in 1851 and received his MD degree from McGill University in 1873, before emigrating to the United States. In 1881 he joined the United States Marine Hospital Service, the rapidly expanding nineteenth-century predecessor of the United States Public Health Service. Well regarded inside the Marine Hospital Service, the expatriate Canadian doctor had steadily advanced from post to post; he was now at midcareer and appeared to be on the fast track.
When the Hawaiian annexation resolution passed Congress in 1898, the Marine Hospital Service sent Carmichael to Honolulu as their first superintendent of operations there. The assignment represented a significant boost for Carmichael, since the newly created Pacific post was located in an attractive place and was a highly visible job under the circumstances. Carmichael had primary responsibility for insuring that American soldiers and sailors fighting in the Philippines could count on healthful conditions when passing back and forth through Hawaii. In his first year, Carmichael successfully persuaded his federal agency to pay for two additional hospitals in America's newest possession, and they were promptly built under his direction, one in Honolulu and one in Hilo.
Dr. Duncan A. Carmichael in his Public Health Service uniform. National Library of Medicine
Carmichael and the three physicians on the Honolulu Board of Health became trusted friends and like-minded, science-oriented colleagues almost immediately. This was fortunate, since their formal lines of authority were hopelessly blurred under the "existing government" rules and they might easily have become professional rivals instead. Who could say, for example, where the continuing health responsibilities of the Dole regime ended and the legitimate health concerns of the United States government with regard to its military personnel and its newly acquired subjects began? But Carmichael and the three Board physicians had the same goal-to keep the islands safe from disease-and they made the same basic bacteriological assumption about contagious epidemics-that the health of every resident impacted that of everyone else. Consequently, Carmichael allowed his friends on the Honolulu Board direct access to the latest medical communications available through the Marine Hospital Service, and he shared federal medical supplies with the Board's physicians, on the rationale of keeping Honolulu safe for American military personnel."
Carmichael and the Board's three medical members also shared a st
rong belief that the future of public health lay with bacteriology. So did Carmichael's federal agency back in Washington, D.C. During the late summer and early fall of 1899, shortly before plague appeared in Chinatown, the Marine Hospital Service had moved beyond drawings of pestis and distributed actual slides of the bacterium to U.S. government physicians stationed around the world, including Carmichael in Honolulu. Carmichael shared the slides with his friends on Dole's Board of Health. Those slides became the norm against which Hoffman, the city bacteriologist, would test for plague.'
On a personal level, Carmichael had found his new assignment thoroughly delightful. He liked to hike in the islands, he rediscovered ancient Hawaiian caves near Koko Head, and he brought to light a number of lost petroglyphs. Honolulu's white elites made the physician from the Marine Hospital Service feel at home-no wonder, since he was the first civilian representative of the government they had been so eager to welcome into the islands. In the summer of 1899, the forty-eight-year-old widower married Alice McKee Hastings, a wealthy Honolulu widow, following a whirlwind, high-society courtship. If the new Mrs. Carmichael's reputation as a tempestuous and difficult personality cast any shadows into the future, Carmichael himself did not see them. Until the winter of 1899, his life in Honolulu could hardly have been more congenial, either professionally or personally. With the appearance of bubonic plague, however, his responsibilities increased sharply, and in his capacity as unofficial counselor to the three physicians in charge, he would find himself working under intensely strained conditions for the next five months."
The events of December 12 also propelled a fifth physician from relative obscurity into the public spotlight. That man was the city's bacteriologist, Walter Hoffman, whom Herbert summoned to help with the first autopsy at the Wing Wo Tai Company. Just twenty-seven years old, Hoffman had graduated from medical school in his native Germany less than two years earlier. Landing in Honolulu as ship's doctor for a boatload of Austrian immigrants, Hoffman liked the city so much that he applied for a license to practice medicine there. In the course of examining his application, the three physicians on the Board of Health noticed that Hoffman had taken advanced training in the latest bacteriological techniques, first in Berlin and then briefly at the Johns Hopkins Medical School. They granted him a license at the end of i 898 and kept their eyes on the young newcomer. 14
Hoffman had grown up amid the intellectual aristocracy of Berlin, where his father was a professor. Socially adept and fully at home in the worlds of art and music, the well-bred young German with the flashing red whiskers and the gilt-edged credentials quickly made an impression among Honolulu's white elites. For Emerson, Day, and Wood, that impression was altogether positive. They marveled at Hoffman's skills with a microscope, all the more remarkable since a collegiate fencing accident had blinded him in one eye. Remembering the flap that had forced their predecessors in 1895 to send cholera samples to mainland laboratories, the Board's three physicians determined to take advantage of Hoffman's fortuitous appearance in Honolulu. In August 1899 they created the new post of city bacteriologist and persuaded Hoffman to accept the job.
Dr. Walter Hoffman, Honolulu city bacteriologist. Mamiya Medical Heritage Center. Hawaii Medical Library
Hoffman made a less positive impression on some of the city's other white physicians. Most of the skeptics were older doctors who had practiced pre-bacteriological medicine for many years in the islands. They resented this continental aristocrat as an upstart competitor putting on airs, a come-lately neophyte who was a bit too up-todate for his own good. In their view, the new city bacteriologist knew little or nothing about health matters in Hawaii, and they thought of him in the same way they thought of the bacteriology he practiced: as untried and untested. They said little while Hoffman spent his time examining the Honolulu water supply, but they would eventually bring heavy pressure on the young outsider when the arrival of plague suddenly and dramatically changed the face of medical politics.
In many ways, the medical team directing the battle against plague and running the Hawaiian Islands looked impressive. In command was a tri umvirate that included a skillful veteran (Emerson) and two capable physicians in their professional prime, one of whom was unusually well regarded (Day), while the other was decisive, persuasive, and administratively able (Wood). Those three were supported, in turn, by a fully cooperative United States public health officer tagged for the fast track (Carmichael), and a medical bacteriologist splendidly trained in the latest techniques of that new science (Hoffman). From other perspectives, however, the same team could look quite different. The ruling triumvirate could be characterized as a battle-weary physician with plenty of public scars (Emerson), plus two boyhood pals from Chicago (Day and Wood), who had somehow gotten each other in over their heads after being appointed by political cronies. Those three were supported, in turn, by a United States public health officer who was unsure about his own authority under the "existing government" (Carmichael), and a recently arrived outsider whose oneeyed bacteriological investigations were resented by many of Honolulu's longtime practitioners. Both views were freely expressed on the streets of the city.
LAGUE IS IN THE crrY" announced the headlines of Honolulu's Englishlanguage newspapers on December 13, the morning after Dole's "existing government" turned the Hawaiian Islands over to the Honolulu Board of Health. Hawaiian, Japanese, and Chinese publications did the same in their own languages. "BOARD OF HEALTH IN CHARGE," confirmed other front-page stories. And along with pleas for calm came requests for citizen involvement in the emergency efforts already planned for the days ahead: "VOLUNTEER HEALTH INSPECTORS PLEASE REPORT AT THE BOARD OF HEALTH IMMEDIATELY." Though held at bay for five years, the world pandemic had finally breached the city's defenses. Honolulu mobilized a counterattack in less than forty-eight hours.
Despite repeated reminders that this epidemic had rarely attacked Caucasians elsewhere in the world, observers immediately noticed that the headlines of December 13 were generating more intense anxieties among Honolulu's white residents than any previous health threat ever had. "On every hand were signs of extreme public tension," reported the Pacific Commercial Advertiser that morning, "and these were increased by the characteristic Honolulu rumors." One editor even hypothesized that people of European descent might have inherited an abnormally intense fear of plague from their ancestors' catastrophic experiences in the Middle Ages.'
More likely sources of distress among Honolulu's whites were their deeply held cultural assumptions that linked the presence of plague to "diseased" social and political ways of life. Plague had long been among the most powerful metaphors in Western consciousness, a negative marker that went back even further than Biblical imagery. Consequently, while the city's whites did not anticipate sudden waves of widespread death among themselves, they were terrified, as the press recognized plainly, that observers around the world might begin to associate their city not with plague-free northern Europe and the New World, but with such debased urban centers as Bombay, where plague was still "slaughtering three hundred victims per diem," or Hong Kong, where plague had lingered continuously for the "past two hundred years." Where order and hygiene prevailed, plague could be resisted; where chaos and filth reigned, plague could establish itself. So if the epidemic now gained a foothold in the city, Honolulu faced the prospect of appearing to be, or perhaps even becoming, "Asian."'
Sensing the dismay of whites-not to mention a genuine fear for their lives among Asian residents-all of the English-language dailies cautioned against panic and urged full support for the Board of Health. "Encouragement may be drawn from our experience in the cholera epidemic," stated the Hawaiian Gazette. "So brethren, be of good cheer. The bubonic plague, though undeniably with us, is not likely to plague us long ... and it is but a matter of a few days before the active and intelligent labors of the Board of Health ought to bring the city out of its trouble and permit the inhabitants, white, yellow and brown, to resume their unruffled courses." The Adv
ertiser repeated the same admonitions. "Stand by the leaders," urged the Evening Bulletin, because "next to the plague itself a general stampede caused by fear" now posed the city's greatest danger. Even the Independent, which for years had bluntly castigated virtually every policy initiated by what it alternately called the "the Dole gang" or "Hawaii's puppet regime," now rallied strongly behind the government's resolve to contain and destroy the invading epidemic.;
Responding to the intense medical and sociopolitical pressures on them, Emerson, Day, and Wood quickly implemented the policies they had hastily agreed upon the day after You Chong and the four others perished. Hoping to prevent the disease from spreading beyond Oahu, the physicians ordered an immediate halt to all inter-island shipping in the Hawaiian archipelago. Should plague reach the other islands, they feared widespread death among Asian plantation workers and a probable collapse of Hawaii's economy. Despite a mad rush of captains to weigh an chor before the order went into effect, only one boat managed to get out of the harbor.4
On Oahu itself, the Board members imposed travel restrictions in and out of Honolulu. They were quite rightly afraid that people might try to escape the threat of plague in the city, as urban populations had done elsewhere for centuries and as some residents were already doing in Honolulu, and thereby inadvertently spread the disease to neighboring plantations on their own island. Reflecting the internationally held opinion that Asian races were more susceptible to bubonic plague than other races, and hence more likely to be its carriers, both the inter-island ban and the Honolulu city ban were absolute for Chinese and Japanese residents. NonAsians could apply for special travel exceptions if they were willing to submit to medical examinations by Board-appointed physicians. The U.S. Army physician at Camp McKinley, which had recently been established several miles from downtown Honolulu on the leeward slope of Diamond Head, expressed "little doubt about the diagnosis" of plague and forbade American troops from entering the city.'
Plague and Fire Page 7
