The Public Health Service Leprosy Investigation Station on Molokai, , 1909-13-an Opportunity Lost

JERROLD M. MICHAEL

LEPROSY HAS BEEN DESCRIBED in its inhabitants are no longer under various writings since ancient times. 14- . Nearly 2,000 years ago, Chinese ob- Walter Wyman, who served as servers discussed clinical states that .I Surgeon General of the Public fit the picture of lepromatous lep- Health and Marine-Hospital Serv- rosy so precisely that they could ice from 1891 to 1911, determined scarcely have been describing any to make a concerted and scientific other condition. Other ancient writ- attack on leprosy. He commissioned ings from the Far East would con- three highly competent Public firm the fact that leprosy has al- Health Service medical officers, Dr. ways been endemic to that part of Joseph H. White, Dr. George T. the world. Vaughan, and Dr. Milton J. Questions arise, however, as to Rosenau to make the first nation- the extent of leprosy in the Middle wide study of its prevalence in 1901 East in biblical times. Although it (1). A total of 278 known cases of is entirely possible that sporadically leprosy were tallied. Only 72 of the persons with leprosy migrated there patients were isolated. At that same from Africa, archeological studies time, more than 850 cases existed would suggest that the leprosy of in the Territory of Hawaii. Leviticus encompassed a horde of As evidence of the persistence of rather mundane conditions such as the social stigma that has compli- fungal infections, psoriasis, and Surgeon General Walter Wyman cated control of the disease until acne. today, the medical officers reported During the Middle Ages, Europe origin is uncertain, but it is gen- that there was an inclination on was ravaged by an epidemic of erally believed that the disease be- the part of the patient as well as leprosy that lasted for several cen- gan its spread from infected the patient's family and friends to turies. It ultimately died out except Chinese laborers imported to work conceal the affliction. for small endemic foci in Spain, on the planatations. Because of a The report highlighted a high Portugal, and Greece which persist high degree of susceptibility among incidence of leprosy among immi- to this day. the people of Hawaii, an epidemic grants to Minnesota from Sweden Leprosy was introduced to developed which finally resulted in and Norway. Dr. Gerhard A. Hawaii about 140 years ago. Its a decree by King Kamehameha V Hansen of Norway, who had dis- that called for the isolation of all covered Mycobacterium leprae 25 Professor Michael, a former Assistant victims of the disease. An inaccessi- years previously-giving the old Surgeon General of the Public Health ble peninsula jutting out from the malady the new name of Hansen's Service, is Dean and Professor of Public as Health, University of Hawaii School of north side of the island of Molokai disease-was quoted urging legal Public Health. Tearsheet requests to was selected, and the first patients isolation as the best means of keep- Prof. Jerrold M. Michael, University of were sent there in 1866. A settle- ing the disease from spreading. This Hawaii School of Public Health, 1960 was to have East-West Road, Honolulu, Hawaii ment for leprosy patients still exists comment far-reaching 96822. on the Kalaupapa Peninsula, but effects on the treatment of patients.

May-June 1980, Vol. 95, No. 3 203 Dr. Leland Cofer, officer in charge of Pharmacist Frank Gibson (left) and Dr. Walter R. Brinckerhoff, the director, the Honolulu Quarantine Station planning the Leprosy Investigation Station

Louisiana for 6 years had main- Hawaii Territorial Board of Health, went to Hawaii in June 1905 to tained a leprosarium in Iberville Dr. Charles Cooper, set out a pro- choose the site. An account of his Parish, at Carville, and had on its posal to assist in handling the care visit there is contained in Dr. statute books a law requiring the of 856 lepers in a population of Cofer's handwritten Quarantine commitment of lepers there. Re- 154,000 in the Hawaiian Islands. Station Log. search at that facility was later to He obtained the support of Gov- The Surgeon General arrived in have dramatic implications for lep- ernor E. Carter and the Congres- Honolulu June 7, 1905, took up rosy treatment. sional Delegate, Hawaiian Prince headquarters at the Alexander At about the same time that he Kuhio Kalanianaole, to request Young Hotel, and called on the commissioned a report on leprosy support for a facility to study the Territorial Governor. Arrangements in the , Surgeon Gen- cause and cure of leprosy. were made for the Wilder Com- eral Wyman sent Dr. D. A. Car- President , in pany's steamer, Likelike, to take his michael to the Hawaiian Islands his Message to Congress on Novem- party to Molokai on June 9, and to make a complete report on lep- ber 4, 1904, recommended that a return to Honolulu on June 11. rosy there. Dr. Carmichael de- hospital and laboratory be con- According to Dr. Cofer's log scribed how this disease, imported structed in the Hawaiian Islands (2): into Hawaii, had spread through for the study of leprosy. Congress This trip is the official beginning of the islands, crippling and killing on March 3, 1905, passed a law the scientific study of leprosy by the the susceptible islanders. He re- appropriating $100,000 for con- United States, through Surgeon Gen- ported on the 1865 law which de- struction of these facilities and eral Wyman and his Corps, the U.S. creed that those with incurable $50,000 for their maintenance dur- Public Health and Marine Hospital cases must be segregated and how ing the first year. Service. It marks a new era in the this was done on a particularly Dr. Cofer followed up on the medical history of leprosy, and will isolated small peninsula of Molokai. congressional action and was soon become a part of the important history of the United States. His successor, Dr. Leland E. Cofer, able to advise the Surgeon General the Honolulu Quarantine Officer, that the Hawaiian Legislature The Surgeon General's party in- described the scenically beautiful agreed to give the Public Health cluded Congressman W. P. Hep- colony that had grown up on a and Marine-Hospital Service 1 burn of Iowa; Dr. Cofer, who had spit of land jutting out into the sea square mile of its leprosy reserva- been instrumental in getting the bill below the high, steep cliffs of tion on Molokai for the construc- for the leprosy investigation station Molokai. tion of the Federal investigation passed; Governor Carter; W. 0. In 1904, the President of the station. Surgeon General Wyman Smith of Honolulu; R. E. Pinkham,

204 Public Health Reports President of the Territorial Board of Health; four surveyors; and a number of military officials. The leprosy patients got out their brass band to greet the Surgeon General at the early hour of 7:30 a.m. Saturday, June 10. Then Dr. Wyman traveled the length and width of the Molokai colony. On its western shore close to the cliffs lay the town of Kalaupapa, with white cottages and churches surrounded by stone or lava fences. The yards were planted with tropical fruits and flowers. On the eastern shore was the village of Kalawao, exposed

to the full force of the usually pre- Pr.,{ ^;,w-, -1_* ---_------vailing trade winds, but with a wild, weird beauty of its own. Surgeon General Walter Wyman with Brother Joseph Dutton, who had cared for the dying Father Damien, at Father Damien's tomb He selected a site at Kalawao, close to the foot of the cliffs. In and the Bishop Home for leper girls teristic of his nature. Next to myself, describing this site in his journal, were visited. he is the most modest man I know Cofer noted that it was "to the Surgeon General Wyman and of-(laughter)-and when he at- me credit east of the Baldwin Home and party all mountain climbed to the tempts to give for carry- ing out this idea, it is simply because the Romanish church but removed summit of the extinct volcano Kauhako, and from this point, the of his kindness. I have known the about 50 feet more or less from whole peninsula was viewed and the doctor a long time. I have been per- these places" (2). relation of the selected site to the mitted to preside over the committee The famed missionary Father surrounding country noted. on interstate and foreign commerce Damien had added a wing to this After a day of much activity and for about 10 years. It is the com- which has the incentive with after he came to Molokai thoughtful work, the party boarded mittee church and re- reference to all matters appertaining 1873. He was buried there in the Likelike at 5:30 p.m. in turned to Honolulu, arriving at to his bureau. I might say here that 1889, having died of leprosy which 10:20 p.m. the General never came to us with he had developed years earlier after any proposition, personal to himself, ministering to the patients in the On June 12, a banquet was held his rank or his pay, all of that he colony. Later his body was re- for the visiting dignitaries. Con- has left to others. The subjects that moved to his native Belgium. (The gressman Hepburn arrived late be- have engaged his attention have been church is still standing today.) cause he and his wife were enjoying for the public weal. I know some- married thing of the persistency with which At the time of Dr. Wyman's visit, the hospitality of their of Honolulu he adheres to every purpose looking the body of Father Damien was in daughter, a resident to the common benefit. If the doctor the churchyard tomb, and Brother living on Lunalilo Street. She was ever came to us with the same per- Joseph Dutton, who had cared for happily married to Roy Chamber- sistency in personal matters that he mis- him as he lay dying, had charge lain, a member of a prominent does with matters for the public, I of the nearby Baldwin Home for sionary family in Hawaii. This, in would say he would be a d-----d bore. boys who were patients. part at least, accounts for Congress- (laughter). When he came to see me According to the log (2): man Hepburn's remarkable interest with his bill, and told me it was in Hawaii and leprosy. for the public welfare, I did every- Surgeon General Wyman personally The Congressman's remarks at thing I could to get rid of the bill. covered the ground (stepped off the the were printed in the That is the secret history of the banquet and laughter). boundary lines) of the selected site Pacific Commercial Advertiser (3): measure. (applause and gave some consideration to the I am glad of the opportunity the location of the various groups of When you get to know Wyman as doctor has. Everything he has done buildings. In the course of the day, well as I do, you will recognize the in the past dozen years I have known the Baldwin Home for leper boys fact that modesty is a great charac- him has been for the public interests

May-June 1980, Vol. 95, No. 3 205 and has been well done. When he tion Station to be constructed at pathy. Humor gave way to sourness, takes hold of a matter there is assur- Kalawao. In March of 1906, he grim determination to impatience. ance of success. I anticipate that went to Hawaii, stopping at the And, perhaps worse of all, he was infinite good will come from this Public Health and Marine-Hospital so germ-conscious, so full of respect movement and those thousand and Service inpatient facility in San (if not of subconscious' fear) for the more unfortunates on Molokai, be- Francisco for discussions with horrors of leprosy and for the germ yond the power of destruction by which causes the disease, that he me, for when a man loses hope, and Pharmacist Frank Leighton Gibson, who was to take imposed extremely rigorous precau- when all the good he can think lies slated charge of tions upon himself and his colleagues behind him, he is deplorable indeed, the Leprosy Investigation Station in order to protect them from in- and if there is any way to lift this building and equipment, as ad- fection. He was not necessarily ter- cloud, it will indeed be a benefit to ministrative officer. rified by leprosy, but certainly he mankind. I hope for those thousand Later in the year, Pharmacist allowed his good sense to be over- people, there will be a future for Gibson and his young wife Emma whelmed to the point where his pre- them and that hope will illumine joined Dr. Brinckerhoff, and to- cautions became offensive, as well as them. gether they set out to make this the ridiculous. I want to say to you all how most modern leprosy research More than likely, his habit of grateful I am for courtesies received. laboratory in existence. Mrs. Gib- respect for germs was exacerbated Every moment I have been on this son's book "Under the Cliffs of by the company he kept. Being an beautiful island has been a pleasur- Molokai" gives us a glimpse of eminent and eligible bachelor, he was able one. I have but one single drawn immediately into Honolulu's thought that gives me discomfort- the Leprosy Investigation Station social life. At one of its elegant oc- my absolute inability to get along from 1906 to 1913. casions, he became engaged to Miss with a language that has only eleven "My husband," she wrote, "was Nellie White, sister of Mrs. James or twelve letters in it. to have charge of the building and Castle, one of the dominant per- You have a beautiful city, and equipment, the finances, and, in sonages in local society. On August 21, 1906, Dr. and Miss what pleases me most is that it is an fact, all the executive part of the Brinckerhoff American city. You will still find enterprise" (4). Pharmacist Gibson White were married. many cities in , New achieved a minor miracle-he got Upon the announcement of her Mexico, Arizona, Colorado, Florida the station built. engagement, Miss White, a forthright, and Louisiana that are not as A meri- Dr. Brinckerhoff, as Mrs. Gibson not very adaptable young lady, is canized as this little city here and describes him, was "a humor- reputed to have said that she would tall, 'never never set foot upon that I am glad to know it. There is a ous man, full of ideals and a grim great chance of this American na- island' where her finance's duties determination to succeed if pos- were supposed to take him-and in- tion of ours being a great people if sible in this mission" (4). we can only have time, and there deed where the federal government is a great possibility ahead for these One of Hawaii's most distin- was planning to build him (as well little islands. No other spot that my guished historians in this general as the Gibsons) a large and com- eye has ever rested on has more area, 0. A. Bushnell, also described fortable residence. beauty than the scene from the top Brinckerhoff (5): of your mountain behind us (Tanta- Regardless of Mrs. Brinckerhoff's lus). The view is incomparable but Humorous and idealistic he may resolve, the homes for her and the that landscape is no more beautiful have been but Brinckerhofj seems to Gibsons as well as the investigation than your climate or the spirit of have been afflicted with at least three station were being built and Americanism. serious faults, which made him the equipped. Mrs. Gibson described wrong choice for the difficult job he the difficulties and the joys (4): Representative Hepburn's flip- was appointed to perform. He was a pant tone, his derision of the typical laboratory man, happier with Every stick of lumber and bit of Hawaiian language, and his sense a pathologist's specimens than with equipment had to be either floated of the "Americanization" of Hawaii living people from whom those speci- ashore or loaded into small boats was not lost on the Hawaiians and mens were taken; and he was a typi- from the deck of the Mikahala or the patients at Kalaupapa, who cal unbending Yankee haole (Cau- Iwalani, the interisland steamers. It could also read the speech in the casian) who simply could not under- was some enterprise to buy and paper. stand either native Hawaiians or those check every piece of equipment, haoles who were members of the from heavy block and tackle to Dr. Walter R. Brinckerhoff of Territory's bureaucracy. In the jargon handling the heavy pieces of ma- Harvard University was named of today, he could not relate to pa- chinery for the ice machine and director of the Leprosy Investiga- tients or colleagues, he had no em- electric dynamo, down through lists

206 Public Health Reports Survey and construction crew that helped to build the station Staff quarters and the Gibson home under construction. Every stick of lumber and bit of equipment had to be brought to Kalawao by interisland steamer

Completed Gibson home with stone storage house at right, Leprosy Investigation Station with its three compounds- on July 6, 1909, the day the house was occupied. Wrote residence, executive, and hospital. The station was opened Mrs. Gibson, "we felt like Adam and Eve in Paradise with all officially on December 23, 1909. the conveniences of civilization." of linen, dishes, mules, garden seeds so to soften the glare of the reflec- The architects in Washington, and all the delicate laboratory equip- tion from the ocean. . . . We were stinting nothing, had produced plans ment. The U.S. Leprosy Investigation very comfortable indeed; the upstairs for a great institution-by far the Station at Kalawao had one of the lanai was furnished with hammocks, biggest complex yet erected in most complete laboratory outfits in chairs, and couches; French doors Hawaii. The buildings themselves, world. the opened from each room into a lanai; designed in the prevailing bureau- Uncle Sam furnished us with the cratic-baroque style of the day, were best of everything: fine linen, good electric fans were supplied but sel- huge, airy, high-ceilinged edifices, furniture, Haviland dishes, silver, dom used because of the fresh encircled by wide verandahs held electric lights, ice, our own water breezes wafting from the ocean.... in place by numerous slender pillars system and even a Jersey dairy cow Indeed, we felt like Adam and Eve -a mainlander's idea of a southern and a flock of chickens. The 32 in Paradise with all the conveniences planter's mansion transplanted to the Chinese were detailed to help us at of civilization, besides a private post sunny, languid tropics. Identical first, but by and by we did not need office. structures were built by the Ameri- so many. . . . Everything had been can government in , Puerto thought of. The floor of our house Dr. Bushnell described the con- Rico, the Canal Zone, the Philippines was painted black, like a piano top, struction in another way (5): -and in Honolulu, at Fort Shafter,

May-June 1980, Vol. 95, No. 3 207 where some of them (now much modified) still survive. The old Tripler General Hospital at Fort Shafter, destroyed about 1955, was a splendid example of this rather grand, very romantic, and yet indubitably family- style architecture of that imperial age. The station was divided into three compounds: residence, execu- tive, and hospital. The residence section included individual homes for the staff and was separated from the patients by a double row of fencing. No patients were ever to cross that barrier. The administra- tive compound had office space and laboratories, storehouses, icehouses, barns, and accommodations for the animals to be used in experiments. The hospital had individual rooms for 40 patients-unfortunately, few would ever be used. Fed from the watershed of upper Molokai beyond them, the high cliffs above the station furnished an ample supply of water under grav- Kalihi Leprosy Hospital on Oahu where Dr. Brinckerhoff worked ity pressure. The laboratory even had an elaborate electric system In the meantime, the Gibsons caring to take the treatments and which turned out artificial ice. moved into their newly built pri- preferring a freer life in Kalaupapa. Before the station was ready for vate home on Molokai on July 6, When the last one departed, the au- occupancy, Dr. Brinckerhoff made 1909. While they lived there a son, thorities in Washington decided to his decision to "do his work" at the Alfred, was born. Alfred Gibson, a close the station. Kalihi Hospital or Leprosy Receiv- retired lawyer and judge, lives in On October 23, 1911, Dr. George He and ing Station near Honolulu. California. He is married to Edith W. later to bring the Na- their iMcCoy, his wife never moved into Foster, the daughter of another tional Institute of Health to prom- when their quarters on Molokai, for Public Health Service officer, Dr. inence, took over as director of the son Nelson was born in 1909, Nellie Albert A. Foster. Leprosy Investigation Station on died. Dr. Brinckerhoff was never the Only nine of the hundreds of Molokai from Dr. Currie. It was same. He continued to work on patients on Molokai volunteered as McCoy who closed the station along Honolulu until April 15, leprosy in hospital patients when the station with Mr. Gibson on August 7, 1910, when he resigned from the was formally opened by Dr. Currie 1913. Service and moved to the main- No others on December 23, 1909. and land, where he died (6). ever came. Mrs. Gibson explained The buildings lay empty Dr. Donald H. Currie, who had what happened to the nine (4): unused and, as Dr. Bushnell put it, been for 2 years on special duty in that may have been another great Honolulu, was assigned on May Unused as they were to the re- tragedy (5). strictions of hospital life, they had 31, 1909, as director of the Molokai little liking for it and proved un- Meanwhile, ironically, the pas- Leprosy Investigation Station. The cooperative. They rebelled against sage of time and changes in person- big new station still was not ready the rigor of the treatments and the nel, and therefore in personalities for occupancy, and Dr. Currie con- confinement of living within the among both lepers and Territorial tinued Dr. Brinckerhoff's studies grounds after the unlimited freedom physicians, were diminishing the old on the people being treated at the oJyered by the settlement.... One by prejudices of lepers against segrega- Kalihi Receiving Station on Oahu. one the volunteer patients left, not tion and treatment by federal scien-

208 Public Health Reports there were four reasons for the from Carville was made available failure: to Hawaii, and it was used on those 7~~~~ 1. The lack of communication patients who were deteriorating between the white scientists and the rapidly, particularly those who were residents of Kalaupapa-a gulf so going blind. After about a year, wide that neither patient nor health the results were so encouraging professional could bridge it. that the drug was offered to all 2. The native Hawaiians' resent- patients. ment of their incarceration and Was this truly an opportunity lost their lack of fear of leprosy ob- in those years from 1909 to 1946? viously were not shared by the Many would say "yes." An all too health professionals attending them. common emphasis on technology 3. without a concomitant emphasis on Only the chimney and some concrete The overlay of resentment by foundations remain. Station was many islanders of the high-handed the important human dynamics of closed in 1913, and the buildings annexation of Hawaii and the take- communication, patient education, taken down in 1929 over of land at Kalawao by the and behavior change led to wasted resources and inadequate treat- tists. Or so thought Dr. J. T. Mc- Public Health and Marine-Hospital Service. ment. Donald, one of the physicians at What Kalihi: 4. An irrational but understand- is past should be prolog to the future. We must be careful . . . The old fear of the 'federal able concern, which exists today, doctors' when the work of the Lep- that patients were being used as not to repeat history because of an rosy Investigation Station began experimental animals to learn more undue preoccupation with technol- gradually gave way to the kind and about leprosy to help people some- ogy that could delay solutions to tactful administrations of the suc- place else-not in Hawaii. current problems in cancer, heart cessive medical officers of the Public disease, accidents, and mental dis- Health Service in the past, until to- At least one result was the possible orders. Let us not lose our concern day the medical attendant flatters delay in the discovery of an effec- for humanity in our striving for himself that he enjoys the most im- tive treatment for leprosy. knowledge. plicit confidence and heartiest co- In 1946, Surgeon General operation of his patients . . . Thomas Parran was enabled, by a References Perhaps even then the station at curious combination of circum- 1. White, J. H., Vaughan, G. T., and Kalawao might have been reopened stances, to announce a truly new Rosenau, M. J.: Report of the Sani- and put to proper use by the Board era in the treatment of leprosy. The tary Board on the prevalence of of Health if not by the USPHS men. experiments started in 1941 by Dr. leprosy in the United States. Senate But by that time no one in either Guy Faget in the leprosarium at Document No. 269, 57th Cong., 1st group thought to suggest such a Carville were remarkable Sess., Nov. 30, 1901. course of action. showing 2. Honolulu medical officer's journal, results. The 1946 annual report of June 1900 to June 30, 1910. (Hand- In September 1922, the Congress the Surgeon General stated that written document in the archives of deeded the land back to the Ter- 37 patients were discharged from the National Library of Medicine, ritory of Hawaii. A year later, the Carville because of arrested dis- Bethesda, Md.) ease-about twice as many as in 3. Banquet given to Wyman and Hep- Territorial Legislature appropriated burn. Pacific Commercial Advertiser $12,000 to take down the station several proximal years. Dr. Parran (Honolulu, Hawaii), Vol. 41, No. and finally in 1929, 20 years after hailed this statistic as the good re- 7128, June 13, 1905. it was opened and 16 years after sults of sulfone therapy for leprosy 4. Gibson, E. W.: Under the cliffs of it was closed, the building materials and noted, "For the first time in Molokai. Academy Library Guild, were "liberated" and can now be the history of leprosy, it is now Fresno, Calif., 1957. 5. Bushnell, 0. A.: The United States found as part of the homes of possible to bring hope to its victims. Leprosy Investigation Station at Kalaupapa. All that remains are There is now hope, furthermore, Kalawao. Hawaiian Journal of His- the concrete piers upon which the that by diagnosis at an early stage tory 2:76-94 (1968). buildings once stood. and immediate treatment with the 6. Furman, B.; A profile of the United What caused this mrisuse of re- sulfones, it will be possible to arrest States Public Health Service 1798- 1948. DHEW Publication No. sources, what was the result, and the disease within a comparatively (NIH) 73:369, U.S. Government is there a useful lesson? short time" (6). Printing Office, Washington, D.C., Many people now believe that In 1947 a small supply of sulfone 1973.

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