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RE PORT
OF THE
Sanitary           Commission
(Created Under Act of the Legislature of 1911i


To His Excellency
The Honorable W. F. Frear,
Governor of Hawaii.
HONOLULU, T. H. 1912


Press of the Hawaiian Gazette Co., Ltd.




CONTENTS.
PAGE
Contents   by   parts..............................................  3
Letter  of  transmittal...5.............................  5
Sum m ary........................................................   7
Acknowledgm ents................................................  27
Introduction.................................................  29
PART I-General:
Sanitary   science............................................  30
Local necessity for sanitation............................... 33
M odern   developments......................................  37
Study   of  disease...........................................  45
O ur   defense...............................................  47
PART II —Descriptive:.. *.  *   Board of Health.......................................... 51,:   *.:.     W ater  supply..............................................  79
*  *4... Sewage       disposal............................................  88
D rainage................................................   96
G arbage...................................................  106
Regulation  of  foods......................................  115
Living   conditions...........................................  121
PART III-Recommendations:
General  betterm ents........................................  134
PART IV-Results:
Saving  in  waste.........................................  142
Possibilities................................................  144
A ct   28..........................................................  147
L ist  of  D airies...................................................  149
< t.,..




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CONTENTS BY PARTS.
ACKNOWLEDGMENTS.
INTRODUCTION.
PART    I.-GENERAL............................ CHAPTERS 1- 5
PART II.-DESCRIPTIVE........................CHAPTERS 6-12
PART III.-RECOMMENDATIONS................CHAPTER     13
PART IV.-RESULTS............................CHAPTERS 14-15
APPENDIX.
Copy of the Law.
List of Milk Dealers.
CONTENTS BY PARTS, CHAPTERS AND SECTIONS.
PART I.-GENERAL.


Chap. 1. SANITARY SCIENCE.
Chap. 2. LOCAL NECESSITY
FOR SANITATION.
Chap. 3. MODERN DEVELOPMENTS.


Sec. I.-Definition.
II.-Nature of Disease.
III.-General   Classification  of
Disease.
IV.-Germ Theory.
V.-Infection and Contagion.
Sec. I.-Geographical.
II.-Racial.
III.-Economic.
IV. —keaport.
Sec. I.-Prevention of Disease.
II.-Life Can Be Prolonged.
III.-Life Can Be Strengthened.
IV.-Ignorance and Education.
V.-Aspects 'of the Law.
Sec. I.-Essential Conditions.
II.-Cause and Classification.
Sec. L.-The Mouth.
II.-Contact.
III.-Insects.
IV.-Knowledge.
V.-Federal Quarantine.


Chap.
Chap.


4.
5.


STUDY OF DISEASE.
OUR DEFENSE.


PART II.-DESCRIPTIVE.
Chap. 6. BOARD OF HEALTH. Sec. T.-Early History.
II.-Great Epidemics.
III.-Leprosy.
IV.-Mortality Records.
V.-Present Board.
VI.-Work.
VII.-Need of Publicity.




4


Chap. 7. WATER SUPPLY.
Chap. 8. SEWAGE DISPOSAL
(MAP).
Chap. 9. DRAINAGE (MAP).
Chap. 1.0. GARBAGE.
Chap. 11. REGULATION OF
FOODS.
Chap. 12. LIVING CONDITIONS.


Sec. I. ---,Brief History.
11.-Artesian Water.
11I.-Size of System.
TV.-Lack of Protection.
V.-Waste.
Sec. I.-Early Reference.
T1.-Construction.
TIT-Present System.
IV.-Defects and Remedies.
Sec. 1.-Early Efforts.
11.-Rainf all.
111.-Natural.
IV.-Artificial.
V.-Swam~ps.
VI.-Need of Plans.
YII.-Wet Lands.
Sec. T.-Onr Past.
11.-Cost of Management.
111.-Present System.
IV.-Collection.
V.-Disposal.
VI.-Street Sweeping.
Sec. T.-Early Reference.
IT.-Inspection of Beef, Fish,
Milk.
111.-Sources of Control of Milk.
IV.-Protection.
V.-Vegetables.
Sec. 1.-The Past.
111.-Things to hbe Seen.
IV.-Sanitary Survey.
V.-Tenements.
VI.-Large Blocks.
VII.-New Streets.
VIII.-Mouth Hygiene.


PART 111.-RECOMMENDATIONS.
Chap. 13. GENERAL BETTER- Sec. 1.-Wet Agriculture,.
MENTS.                   11.-Reclaiming Swamps.
111.-Opening Streets.
TV.-Water Control.
V.-Mill- Qontrol.
VT.-Refuse Disposal.
VII.-Tenement House Comimission.
VTTI.-Publicity.
PART TV.-RESULTS.
Chap. 14. SAVING IN WASTE. Sec. 1.-Life and Its Value.
11.-Value of Preventahle LossChap. 15. POSSIBILITIES.          Sec. 1.-Economic Value.
11.-Selfish Gains.
TT1.-Influence.




Report of the Sanitary Commission.
To His Excellency,
The Holorable If'. F. Frear,
Gozvernor of Hawaii,
Hooluolut.
SIR:-We, the undersigned, have the honor to transmit herewith the report of the Sanitary Commission created by the Legislature in an Act approved March 20th, 1911, (see appendix).
This bill was introduced by Senator A. F. Judd, passed unanimously in the Senate and with but one dissenting vote in the
House.
Under this Act the following appointments, made by you, were
approved by the Senate:
Hon. G. R. Carter,
Dr. D. H. Currie,
Mr. A. R. Keller,
Mr. J. L. Young,
Mr. C. R. Hemenway.
The Commission met for the first time on May first.  Since
then their minutes show nine regular meetings. They have also
met for afternoon inspection tours on fifteen different occasions.
We divided the work into five parts:
Division I. Water Supply.
II. Sewerage.
III. Drainage.
IV. Building and Living Conditions.
V. Garbage and General Sanitation.
By early June it was evident to all members of the Commission
that no satisfactory study or report could be mnade without a
thorough survey.




6


After consulting with you, and your consent to the expenditure
of $2,000.00 for a Sanitary Survey, the work was begun in July.
The introduction of yellow fever delayed the work, and it proved
more difficult to obtain the data desired than was first supposed.
The work was carried to completion at a cost of $2,804.85.
We have compiled information never before gathered, and
which is certain to be of great benefit.
Our maps supplement those already in existence, giving not
only each building, but every cesspool, privy vault, and swamp,
all standing water, all rat-harbors, the density of population, and
where tenement conditions were found.
This data and these maps are filed with the Board of Health,
and should be of great value to the public for reference and as a
basis for future sanitary work.
Dr. Currie resigned on November 17th last, as he was about to
return to the mainland, and Dr. G. W. McCoy was appointed on
December 15th in his place.
Respectfully submitted,
G. R. CARTER,
GEORGE W. McCoY,
ARTHUR R. KELI ER,
JAS. L. YOUNG,
C. R. HEMENWAY.




SUMMARY.


PART I.-GENERAL.
CHAPTER I.-SANITARY SCIENCE.
Sec. I.-Dcfinition. The best usage in America makes "sanitary science" a term employed to cover knowledge which has to
do with health as affected by environment, while "hygiene" is a
word used to describe a condition of health related directly to the
human body.
For illustration, smallpox may be warded off by vaccination, a
process directly upon and in the body, therefore hygienic; on the
other hand, typhoid fever is prevented by the purification of water
and protection of food supply, a process applied to the environment and therefore sanitary.
Students of the latter are sanitary engineers and health officers,
while the science of hygiene is more directly in the hands of
physicians.  Sanitary problems deal directly with the surroundings and only indirectly with the individual.
Sec. II.-ATature of Disease. If we think of the human body
with all its parts in sound working order, moving in favorable
surroundings, we have the modern conception of health: but, if
we imagine parts or organs out of order or working in adverse
environment, we picture the condition from which disease results.
Health and disease are special states or conditions. The sources
of health are good material, good construction, and wise operation (hygiene) to which must be added favorable surroundings
(sanitation).
Sec. III.-General Classification of Disease.  Common usage
has adopted "constitutional" diseases as distinct from all others.
They are those which are due to defects of material or construction.
Sec. JV.-Germn Theory. Two discoveries created the modern




8


germ theory.  That some diseases of previously unknown origin
were due to the entrance into the body of certain micro organisms,
and second that micro parasites are capable of living outside the
body in the environment of man. Then it became easy to understand how certain diseases were caused and spread, also how they
may be controlled and obliterated.
Sec. V.-Inffection and Contagion.  If microscopic plants or
animals from living external agents find their way from person
to person indirectly through the surroundings, those diseases are
called infectious, or, if they pass directly, they are contagious.
Practical health work divides along two lines; first, an attempt
to reinforce the organism in its struggle with the microbe
(hygiene) and, second, efforts toward the exclusion and destruction in the environment (sanitation).  Therefore sanitation deals
with the control of the extrinsic environment rather than the intrinsic living organism.
CHAPTER 2.-LOCAL NECESSITY FOR SANITATION.
Sec. I.-Geographical. The Cross-roads of the Pacific will
always be a point exposed by commerce to every possible form of
contagion and infection.  Our best protection is therefore to deprive all germs of the means of growth and spread in Honolulu.
Sec. II.-Racial. We have invited to our shores people from
many lands and owe it to them that they be taught better standards of living, while they owe it to the land they live in to accept
its standards, customs and laws.
Sec. III.-Economiic. We cannot afford to be quarantined and
left out of the commerce of the Pacific.  Expenditures for sanitation will, like those in the Canal Zone, prove of great economic
value.
Sec. IV.-Seaports.   These are the gateways of commerce
through which pour the wealth of nations.  The importance of
their relation to the interior of a country is recognized among
the more intelligent nations.  The ideal seaport is said to be one
where the residence portion is distant and distinct from the conmmercial. In the latter only fire and rat-proof buildings are used.
People go there for a few hours each day, and in it little or no
food is allowed, thus contagion and infection find least chance
of lodgment. Disease, if it exists, will be found where people




9


live and, if this is separated some distance from the commercial
section, commerce will be endangered but little and the intercourse of nations will be promoted.
CHAPTER 3.-MODERN DEVELOPMENT.
Sec. I. —Prcv'etion of Disease. Preventable mortality or morbidity are terms used to denote the amount of death and sickness
that can be controlled and avoided. Prevention is not used in the
theoretical sense, but rather in that in which sickness and death
would not occur, if the present knowledge was understood and
applied.
If we all lived out of doors there would be no more tuberculosis.
It is theoretically preventable to the extent of 100 per cent., but its
preventability is figured at 85 per cent., the amount of reduction
that would occur if every one followed out the commonly accepted methods of treatment. Experts state that 42.3 per cent. of
deaths in America could be prevented.
Sec. II.-Life Cait Be Prololngcd. Formerly the law of life
was supposed to be fixed, and the circumstances surrounding people were supposed to have no influence on the average length of
life.  This is no longer accepted.  The average length of life is
definitely known to be increasing in proportion to the wholesomeness of the environment.  Life is lengthening in Germany and
England, while it is stationary in India.
Sec. II.-Life Cait Be Streltngthcicd. Life can be strengthened.  Length is only one phase of life-another is breadth or
usefulness; one is measured by death, the other by sickness. Few
realize how common sickness is and how rarely there is any one
over forty who is not in some way impaired in health.  Serious
illness is that which incapacitates for work, while minor ailments
are those which seriously affect our energy and capacity but do
not entirely prevent our working.  Preventable effort is taking
the place of curative.  The breadth of life is increasing.
Sec. IV.-Ignorance and Educatioin.  There are four great
wastes of today, lamentable because unnecessary: they are, preventable death, preventable sickness, preventable low energy and
preventable ignorance.  Of these preventable ignorance is the
greatest, because so largely the cause of the other wastes.  The
people of the United States are not so advanced in health matters




10


as those of European countries, our activities are not yet collective.  Kentucky advocates a combined Federal Department of
Health and Education.  In Hawaii we have spent money lavishly
for health in some directions, but little or none has been applied
to the education of our people in health matters.  We have attempted cure rather than prevention.
Sec. V.-Aspccts of the Laev. Most every one wants to ascertain two things before he obeys any law or health regulation;
first, can he be excused from its operation; second, are his neighbors going to obey.  It is rarely a law is accepted until tested
and enforced by the courts.   For this and other reasons the
operation of law is usually uneven.  Public sentiment, when
aroused, often strikes out recklessly and illogically, then subsides
into indifference.
The power of our Board of Health is sometimes ample for
steady, even operation, then again it finds its load beyond its
power.   Our predilection for litigation multiplies the cost of
health administration.  Fines and costs never repay for the loss
of time required for legal preparation or attendance on the courts.
The only way to correct this is to secure the active interest of all
classes in health matters.
CHAPTER 4.-STUDY OF DISEASE.
Sec. I.-Essential Conditionls. The germ theory has developed
the knowledge that those low forms of life, whether vegetable or
animal, require warmth, moisture and oxygen for their growth
with a certain amount of food from decaying animal or vegetable
materials, hence tropical regions have more germ diseases than
others and are liable to be unhealthy.
In order to develop germ diseases three essentials are necessary
in addition to the climatic and sanitary conditions:  1st, the cause
of the disease; 2nd, the proper transmitting agent; 3d, the susceptible individual: lacking any one of which the disease secures
no foothold.
We have already had plague, cholera, amoebic dysentery and
(lengue.
Diseases not yet introduced are malaria, blackwater fever, elephantiasis, yellow fever, while the other insect-borne diseases are
the relapsing fever of Europe supposed to be carried by the bed



11


bug. The Rocky Mountain fever is transmitted by a certain tick.
The sleeping sickness of tropical Africa is carried by the tsetse fly.
Parasitic diseases are those due to organisms which obtain their
nourishment at the expense of some other living thing.  These
may be either animal or vegetable.  They do not originate in our
bodies.
Sec. II.-Cause and Classification. For our purpose we desire
to classify diseases into three simple divisions:
1. Those obtained through the mouth.
2. Those received by contact.
3. Those spread by insects.
CHAPTER 5.-OUR DEFENSE.
Sec. I.-The Mouth. The mouth is the means by which certain
classes of diseases find access into our bodies, either through food
or drink or because of direct contact.  Typical of this class is
typhoid fever. The first defense is therefore the purity of all that
goes into our mouths.
Sec. II.-Contact. Of diseases by contact tuberculosis and
leprosy are examples.  Our defense lies in better living conditions, no over-crowding, and more knowledge spread broadcast as
to the probable mode of spread, and how, when affected, we can
keep others from contagion and infection.
Sec. III.-Insects. Diseases due to insects are plague, yellow
fever and dengue, and naturally our defense depends upon the extermination of the transmitting agent-rats and their fleas and
mosquitoes of all kinds.  Build out the rat with rat-proof buildings.  Remove standing water and all receptacles or places likely
to hold water.  Keep free of all kinds of insects that careless,
slovenly people permit to exist about them.
Sec. IV.-Knozcledge.    The surest defense is to know the
cause of disease and its mode of transmission.  When people
generally have learned these then that knowledge will bring with
it the public support that is necessary in order to protect ourselves from disease, and to confine and eliminate it.
Sec. V.-Federal Quarantinle.  The description of this great
bulwark of our defense is by Dr. D. H. Currie, and it is the clearest and most concise account of the service in Honolulu that can
be found.  It is notable that there are only six quarantinable dis



12


eases. A ship cannot be delayed for any other disease.  In fact,
splendid as the service is, its effectiveness can at best be only
about 60 to 70 per cent., for the only absolute (100 per cent.)
safety can be secured by prohibiting all intercourse with other
communities.  The aim is to facilitate commerce by preventing
the transmission of disease.  If there is no source or center of
distribution there can be no danger. When all the seaports with
which we have direct commercial relations are so advanced that
disease cannot gain a foothold in any of them, then we need only
guard against the danger from other ports, but first we must
"put our own house in order."
PART II.-DESCRIPTIVE.
CHAPTER 6.-BOARD OF HEALTH.
Sec. I.-Early History.  A perspective is needed for a mind
picture as well as one on canvas.  The lessons to be learned
from the history of our Board of Health are: first, that progress
in health matters has always been exceedingly slow; second, that
for many years the advance in health matters was led by intelligent volunteers and therefore no other public service has accomplished so much without pay; third, that in Hawaii as elsewhere
in the world the value of health work is only just beginning to be
appreciated and understood.
The background of our present sanitary situation accounts for
much that exists in the foreground.  The free distribution of
medicine began long before the Board of Health was created.
The practice of doing rather than directing has the force of long
usage.
Those connected with the work realize more than any others
the importance of it, and have been ever ready to assume responsibility rather than place it upon the individual.
Sec. II.-Grcat Epidemics. The past teaches us that the alarm
and consternation caused by large outbreaks of disease have occurred at ever lessening periods, but fortunately with less intensity as our knowledge increased.  There never again need be the
fear of number of deaths from smallpox, cholera or plague.




13


The power to prevent disease is vastly more important than the
power to cure. Our record of epidemics is probably as large, as
long, and as costly as that of any other community.
Sec. III.-Leprosy. The record of this disease in Hawaii appears to be one of constant claim and counter-claim of assumption
of successful results only to find disappointment, of efforts and
relaxation, until after 45 years our large expenditure of endeavor
and money leaves us with our best claim that of philanthropy.
We are no better able to intelligently advise as to the best mode to
pursue today than we were when the discussion of absolute or
partial segregation first began.
The cost of maintenance has increased in the last three years
more than 75 per cent. for each individual in the Settlement.
Sec. IV.-Mortality Records. What those who have struggled
for better health conditions have accomplished is clearly shown
by our mortality records.  In the 10 years from 1876 to 1886
there was an average of 40 deaths out of every 1,000 among those
living in Honolulu.  The next 10 years the average was 25.3;
while the 11 years since annexation shows a still further reduction
to 22. This means almost 50 per cent. improvement in 36 years.
There have been 26,144 deaths recorded in Honolulu from 1876
to 1911.
Sec. V.-Present Board.   The origin, the duties, the powers
of the Board of Health, as well as the duties of others, are not
often understood, and we have therefore given in the report a
brief synopsis of them.
Sec. VI.-Work. Our Board of Health has accomplished just
about what Honolulu has been ready to receive. In time the public will demand more; when they become dissatisfied with preventable death, poverty from illness and the cost of neglect, they will
demand more from the Legislature and the courts.  They will
come to the position of more enlightened communities and the
Board will be admitted as experts in health matters whose actions
are final.
Sec. VII.-Need of Publicity.  All of the work of the health
authorities is much aided by the press, but sometimes other news
crowds out important information which the press is under no
obligation to publish.
It is a serious defect, particularly in health work, for the public




14


representatives to do their work in silence.  The Legislature
should provide so that the public may receive constant and regular information in regard to its health work by weekly or monthly
bulletins.  Our school teachers should be helped in teaching the
citizens of tomorrow sanitation and hygiene. We need some one
to travel from island to island, school to school, village to village,
and preach the gospel of good health.
CHAPTER 7.-WATER SUPPLY.
Sec. I.-Brief History.  In 1855 the authorities of Honolulu
thought they were making ample provision in planning a water
system for 6,000 people.  In 50 years we have increased our
population tenfold and, if we are to profit by the experience of
the past, we ought now to plan for nearer 500,000 people than
simply to provide for the present needs.
The growth of the water system has been largely a struggle for
an ample supply.  Scarcity of water every summer was of regular occurrence until the artesian source was used and until the
completion of the big dam in Nuuann.
Sec. II.-A rtesiais. The earliest mention of the possibility of
a pure underground source of water was that of R. C. Wyllie in
1859. The first successful well was bored in 1880.  There are
now 117 wells in the district of Honolulu, and the level of the
water in the artesian basin has dropped 12 feet in 20 years. The
important question arises as to how long the supply will last, and
when will a stop be put to the waste of wells flowing constantly
for irrigation.
Scc. III.-Size of Systlem.  The water system furnishes from
four to six billion gallons of water each year. This is distributed
in 78.61 miles of pipe line, and is delivered through 4,992 connections (for area see map).  We have four pumping stations
with a daily capacity of 13,500,000 gallons.  All our water is
from the rain that falls on a small portion of the island and is
held by the forest and tundergrowth long enough to be absorbed.
We use about 18,000,000 gallons a (lay, but with the pumps and
surface supply we have control of about twice our present need.
Sec. IfrV.-Lack of Protectionl.  Epidemics arouse communities
to action as every day danger never does. The danger of infection of our storage reservoir in Nuuanu should not be left to an




15


epidemic of typhoid before it arouses us.  The storage basin
should be fenced, all stragglers kept out, and the drainage from
the road surface carried by concrete gutters to a point below the
catchbasins.
Sec. V.-Wastc. The unnecessary water supplied to the people
of Honolulu does no harm to health except that the cost deprives
us of funds that could be otherwise used, perhal)s, for health matters.  The excessive waste overtaxes the sewer system, and we
are spending now a large sum for an additional trunk line of
sewer along Queen Street, all of which could have been save(l, if
we checked the waste of water. A meter system should be put in
and water sold at a low rate, say 5 cents per 1,000 gallons, the
cheapest in the world.
CIHAPTER 8. —SIEWAGE(I DISPOSAL.
Sec. I.-Early Referenlcc.  Another illustration of persistent
effort crowned with final success is the sewerage systeim.  There
were miany who argued from 1880 on that Honolulu could not
afford the cost of a sewer system.  The cholera epidemic in 1895
brought it, and its success was due to careful planning in advance.
The cost of the expert was saved many times over.
Sec. II.-Constrltction. The system was built in 1899 and 1900
and largely added to in 1904.
Sec. III.-Preslent Systcln.  In September, 1911, there were
2,600 connections and 58 miles of sewers.
The sewerage system cost $512,796.51 to June 30, 1911, and the
cost of operating for the year previous was $21,146.00.
The sewer pumlps are handling daily from 6,000,000 to 9,000,C00
gallons of sewage, or about 200 gallons for each individual servel;
while, if the waste was checked, the normal ought to be 60 gallons.
The leak is caused in part at least by the washing away of two
sections of the pipe so that the whole city's sewa:ge is now (ischarged on the reef in 18 feet of water.
There are still in use 2,263 cesspools, every one of which may
contaminate our surface water, and there are 2,403 privy vaults,
or a total of 4,666 sources of danger.
Sec. IV.-Defcts and Remedies.    The volume of sewage depends on the consumption of water.  With about two-thirds of
our people served, the system is overtaxed.  We are ptumping




16


from two to three times the amount estimated for a city of our
present size.  We are indulging in one of the most extravagant
bits of municipal folly possible, paying for pumping water and
allowing it to be wasted, then paying for pumping it away as
sewage.
It is equally foolish to collect the sewage of our city and then
dump it on the reef in 18 feet of water for the tide to carry back
and forth or collect in banks of black muck, just as it did in the
estuary of the Thames due to London's sewage.  No seafood
taken in reach of this pollution is fit to eat, nor is it safe to wade
or bathe there, and time alone will tell how far it travels.
Hering said: "The best protection from sewer gas is to dilute
it with pure air until it is both harmless and inoffensive." This
advice we seem to ignore by stopping up the manholes and diminishing the ventilation.
The sewerage system was designed to have the sewage screened
so that there would be no floating matter to drift about on the
surface of the water.  Any fine particles passing through the
screens would be further commuted in passing through the pumps
and be discharged at the outfall in a condition to prevent them
rising in 100 feet of water to the surface.  Now handling so
large a quantity the advice given is ignored, the screens removed,
and everything pumped that can pass through the pipes out on the
reef.
CHAPTER 9.-DRAINAGE.
Sec. I.-Early Efforts. In 1876 an Act was passed to provide
for right of way for draining land, but not until 1882 did an agitation begin for the removal of standing water on low lying ground
in and around the city, and it has kept on gaining in force until
now it appears to have become a question which the people of
Honolulu are determined to settle.
Storm drains were not of importance until the town spread out
over the plains and the damage to street surface was recognized.
In 1890 large intercepting ditches were built which take the surface water from the top of Punchbowl and all of Makiki over
into Waikiki swamps at Pawaa instead of into the sea as formerly.
Sec. II.-Raillfall.  In building drains for surface water
proper consideration has not been given to the rainfall. In 1860




17


14 inches fell in 40 minutes, and provision has not yet been
made to keep this water out of the swamps.
Sec. III.-Natural. The district of Honolulu contains 44,000
acres out of a total acreage of 384,000 on the Island of Oahu, it is
therefore about one-eighth of the whole island. There is a heavy
rainfall and there are five main valleys that drain across the city
into the sea.  Kalihi and Nuuanu streams are fairly direct.
Palolo and Manoa spread out on the Waikiki flats, and Makiki has
been diverted into the same flats at Pawaa.
Sec. IV.-Artificial.  All the water on the front slopes of
Punchbowl around Prospect Street is carried to Pauoa stream.
There are a number of small culverts and drains diverting water
off the street.  One system starts at Luso Street, down Punchbowl, crossing King, down South through Kakaako.   Another
runs from the sea up Ward Avenue (see map), but in no case
has there been any general plan made.
Sec. V.-Swamps. The low lands along the sea front of six
miles are largely swamps.  Wherever profitable they are used
for wet agriculture, and the area of wet land has been enlarged
until it is difficult now to distinguish between them, nor can the
source of water in the swamps be determined except by survey;
much of it is water from irrigation. The total area of wet land
is 36 per cent. of the land below the foothills.
Sec. FI.-Need of Comprehensive Plans.   Heretofore drains
have been built only to satisfy an immediate need, a method that is
certain to cost a far greater sum than is necessary, requiring enlargements that could be avoided and saved if each storm drain
were built as a part of a definite plan.  There is wisdom and
economy in adopting a well-thought-out plan in advance.  It
gives an object to work for, a goal to reach.
Sec. VII.-Wet Lands. The increasing knowledge of the immense loss due to mosquitoes is now putting wet agriculture to a
severe test. We are beginning to inquire, if against the value of
crops should not be set the loss due to mosquitoes and the easy
spread of infection.
Another serious defect in the method of wet agriculture within
the city, is that dwellings are allowed to be used which are surrounded with standing water and without facilities for sewage
disposal, thus enhancing the danger of water infection and the




18


possibility of typhoid or cholera.  The danger from standing
water can best be avoided by making such land too valuable for
wet agriculture.  Money so expended has a double advantage,
it brings an improvement to the city and does away with a possible
nuisance.
CHAPTER IO. —GARBAGE.
Sec. I.-Our Past.  The credit for the first public attempt to
remove refuse and waste belongs to J. Mott-Smith, the father of
the present Secretary of the Territory.  In 1878 as President of
the Board of Health, he began a system of street cleaning, and his
successor, S. G. Wilder, extended it so as to include free collection
of refuse from residences.  Since then Honolulu has vacillated
between pay and free systems with the former usually unsatisfactory.  The habit of hiding or depositing garbage in vacant
lots rather than pay for its removal is deep-seated and extends
back over 30 years.
Sec. II.-Cost of Malnatgenmenlt.  Since 1905 the county has
operated a pay system of collecting city waste, which, measured
only by the net cost, has been successful, for its operation has been
reduced from $14,695.00 in 1906 to $2,084.25 in 1910.
Sec. III.-Prescnt System.  The area served is now approximately all the populated portion of Honolulu except Kaimuki.
(See map.)  The county service plans to carry away all refuse
set out by the regular subscribers and charges are from 35 cents
to $7.00 per month. They have 13 mules, 1 horse, 7 wagons and
1 buggy at work.
Sec. IlV.-Collection.  A pay garbage system is defective because it permits the shiftless citizen to avoid the responsibility of
disposing of his own waste.  He refuses to employ the service,
pleads poverty, cares nothing for the risk of disease, and so hides
as best he can his refuse and sets an example to others, until the
health authorities or some other civic organization arouses the
community to the necessity of a "clean-up day," and then at the
expense of others or at public expense the vacant lots and hidden
piles of waste are cleaned up.  Thus the man who is mean
enough to refuse to do his part, escapes.  He is neither taxed
for a free public service nor does he pay for the removal of his
part of the city refuse.




19


Garbage should be measured by weight rather than by bulk.
The average for all American cities is one-half a pound per citizen
per day, when the collection is constant and effective.  Honolulu
should therefore expect some 13 tons per day.
Sec. V.-Disposal.   No disposition of the city refuse has
proven satisfactory that does not destroy the germs of disease
which it is certain at times to carry, nor is the refuse in a city of
50,000 of sufficient value to pay for its disposal. The small quantity of ash in our refuse should enhance its value for fuel, and
some day it will probably be used in conjunction with other fuel
to furnish power.
The Meldrum Destructor is a furnace built for such purpose;
meanwhile it is wise to employ the Thackery Incinerator already
installed.
Sec. VI.-Street Swecping. As our population increases the
necessity for better street cleaning and sweeping will become more
important.  This is of great importance because the dust of our
streets causes certain diseases, among which are colds, pneumonia,
and tuberculosis.  The habit of spitting provides dried particles
containing the germs of disease; then, too, the discharge from
animals is ground into the dust and partially taken into our
systems.
Clean streets are evidence of high culture and of local pride.
Money spent economically for such purposes brings bountiful returns in health among those for whom the municipality is created.
CHAPTER II.-REGULATION OF FOODS.
Sec. I.-Early Reference.  The early attempts to protect the
helpless and innocent from the selfish greed of those who supply
our food and drink were unsuccessful. The first attempt to control the sale of milk was made in 1882.  In 1888 an attempt to
regulate the sale of poi was made. Fish inspection began in 1894.
Under the Republic of Hawaii the first pure food act was passed
and approved on May 18, 1898.  In 1907 began the demand for
the control of the environment of food in order to secure its
purity, and this is still to be developed.
Sec. II.-Inspection of Fish, Beef and Milk.  Since 1909 the
county has taken over the inspection of beef and fish. There are




20


two inspectors for each, and the milk inspectors assist the Federal Pure Food Commissioner.
Sec. III.-Sources and Control of Milk.  More than one-fifth
of all deaths last year in Honolulu were of children under one
year of age, and milk being so important a food for infants, the
Commission secured a special inspection of all sources of milk.
There were 50 dairies, milking 915 cows, and approximately
5,476 quarts of milk sold daily, or an average of 6 quarts to
the cow.   The special inspection made for this Commission
snowed 4 dairies using surface water subject to contamination.
Every dairy should be required to use the city's supply of water
unless specially excused by the Board of Health.
The conditions of our dairies should be more strictly regulated
by law, and the responsibility placed on those who desire to sell
milk to see that they are complied with.
The use of cows infected with tuberculosis is altogether too
common, and in justice to those who have destroyed cattle so infected, without compensation, there should be a heavy fine for any
person disposing of milk from a cow so infected.
Typhoid is so often carried in milk, that sickness among those
who handle milk should be reported and a fine imposed for failure
so to do.
Sec. IV.-Protection.  The officials endeavoring to protect the
public from adulteration of foods, from poi of poor quality, milk
that kills, meat that is flyblown and fish that is decomposed, are
not supported as they should be.
The habit of touching the fish and meat exposed for sale at the
market is bad. If permitted to one, it must be granted to all, and
some may, perhaps unknown to themselves, be the victims of disease. This may be one of the causes why tuberculosis has spread
among the class that uses the market most.
A large part of our fish now arrives on ice, it is exposed for
sale, allowed to rise in temperature, and then decomposes more
rapidly than if never cooled.
The remedy lies with the customers.   In time  they  will
learn to trade only with those who screen their meats, and who
keep their fish under glass on cooled tables.
Authorities can do little as their power does not sufficiently per



21


mit control over the environment. They can act legally  only
after the food is actually unfit, after the harm is done, and is
thereby subject to proof in the courts.
Sec. V.-Vegetablcs. The Oriental system of fertilizing vegetables with diluted human excreta is too often employed here in
Honolulu, nor is the necessity of pure water realized by the
truck gardener.  Health officers cannot stop the Oriental customs without active public support. When the same means are
devised for insuring the purity of our fish, vegetables and
strawberries, then the sales of these will be greatly enlarged.
At Hong Kong a special garden with direct delivery    has
solved the problem. Dr. Currie's report of the conditions he
found in Manoa Valley during the cholera of February, 1911, is
a severe indictment of the sanitary conditions tolerated.
CHAPTER I2.-LIVING CONDITIONS.
Sec. I.-The Past. Living conditions did not become an important question until parts of Honolulu became over-crowded.
In 1882, Captain Brown, health officer, called attention to the
necessity of cutting new streets to relieve congestion and provide better sanitary conditions.  The first fire limits were established in that year. The first regular sanitary inspection began
in 1890, and the first mosquito campaign in 1904.
The struggle to remove nuisances began with the first Board
of Health in 1850, and it has been constant ever since.  The
keeping of pigs, ducks, chickens, stables, wash-houses, and poi
factories have been and still are problems seriously affecting our
general health.
Market control has been for years a matter of regulation and
surveillance.  Unfit buildings are still a problem, while the
control of new buildings and plumbing is at last under way, and
that of proper location is yet to come.
Sec. II.-Population. The report contains a table showing
census of all islands and Honolulu since 1853, also estimates of
nationalities in Honolulu.
Sec. III.-Things to be Seeni. In an ordinary inspection of the
congested portions of Honolulu, one is surprised to find the
most ordinary sanitary precautions ignored. One sees buildings




22


that are a disgrace, and conditions that offer every opportunity
for the spread of disease.
Sec. IV.-Sanitary Survey. There are no legal limits to the
City of Honolulu as distinguished from the entire Island. It is
a district with 130 miles of roads and lanes covering 812 acres.
There are 18,381 buildings located within some 12,800 acres.
Household food waste is reported as taken by swill men from
4,060 places. There are 3,273 people keeping chickens, and 197
of them keep them under their houses.
Of all the 18,381 buildings only 3,273 offer free access under
them for the enemies of rats-that is 15,410 buildings are ideal
rat-harbors.
Our survey accounted for the sleeping accommodation of
49,145 people located in 7,941 dwellings, 12 boarding houses, 34
hotels, 193 lodging houses and 470 tenements, using 266 garages,
897 stables and 1,374 stores.
Sec. V.-Tenements. In 1880 an Act was passed that provided for the control of dwellings among other things.  Not
until 1880 was there any attempt to control tenements; at that
time a license was necessary, which required satisfactory sanitary
conditions to be maintained. In 1898 the authorities were given
power to prohibit tenements or lodging houses in locations
thought unsuitable or objectionable, but this power has not been
re-enacted since annexation.
Tenements are all supposed to be licensed and liable to a fine
of from $10 to $100 for violation of certain fixed conditions. The
responsibility rests between the Board of Health and the county.
The former had a record of 172 tenements but the county officials
reported only 72 licenses issued, while we found tenement conditions in 470 buildings.
The responsibility for the tenement evil is so divided that it is
lost. The worst conditions are not in the dwellings owned by the
poor, but are found in buildings which are held as investments.
Society permits the owner of no other property to offer it for
sale or use, when in a condition that makes it a menace to public
health.
Sec. VI.-Large Blocks. There is one small rectangle bounded
by four streets in which live 5,667 people.  All over Honolulu




23


there are thickly populated blocks without proper means of ingress
or egress.
The unwieldy size of so many blocks is a serious drawback.
The cause of them is due partly to complicated legal machinery
now necessary to be operated before a highway can be opened.
This makes the growth of the city slow and accustoms us to conditions that should not be tolerated.
Sec. VII.-Nezw Streets. If Honolulu is to progress it must
cease to expect the outside communities (the counties) to contribute to the cost of new streets. At present the whole Territory
pays a large proportion of these improvements. There is not revenue sufficient to meet the requirements and if we delay the progress that is being forced upon us by increased commerce and
population, we are not worthy of the opportunities vouchsafed to
us. Honolulu must pay its own bills, and furnish the capital outlay needed for new streets, with their water mains and sewers,
sidewalks, curbs and pavements and leave their maintenance for
current revenue. The gain in sanitary conditions will more
than offset the cost.  If the right of eminent domain is made
available to a majority of those owning property affected by a
proposed highway, then the more intelligent property owners can
secure immediate improvements, and the increased value of their
property will stimulate others to do likewise. Honolulu can then
become through her own efforts a city worthy of her surroundings.
Sec. VIII.-Mouth Hygieine. We do nothing collectively to
save the waste due to neglected mouths and teeth.
The Chicago Board of Health feels justified in announcing
that the seat of infection of pneumonia is the media around the
teeth and in their cavities, and that the proper care of the
mouth will control, if not obliterate that disease.
PART III.-RECOMMENDATIONS.
CHAPTER 13.-GENERAL BETTERMENTS.
The whole of Part III is devoted to the specific recommendations of this Commission and they deal with:




24


Sec. I.-Wet Agriculture.
Sec. II.-Reclaiming Swamps.
Sec. III. —Opening Streets.
Sec. IV.-Water Control.
Sec. V.-Milk Control.
Sec. VI.-Refuse Disposal.
Sec. VII.-Tenement House Commission.
Sec. VIII.-Publicity.
PART IV.-RESULTS.
CHAPTER 14.-SAVINGS IN WASTE.
Sec. I.-Life and Its Value. We show that it is possible with
better sanitation and hygiene to save 500 lives each year in Honolulu. This will in time modify the necessity for immigration,
and we estimate the capitalized value of the lives of our 52,183
people at $131,064,560, while the total taxable wealth of the
whole Territory is only about $151,000,000.
Therefore when providing for the sanitation of Honolulu, we
are considering the protection of that which is nearly as valuable as all the material wealth of Hawaii.
Sec. II.-Value of Preventable Loss. In order to measure the
waste due to preventable death and sickness we have assumed a
low earning capacity and taken the proportion conceded by experts to be preventable, reaching the astonishing result that sanitation offers an annual saving of $345,176.70, or 5 per cent. interest on $6,903,534; a sum of money which could, with wisdom, be
expended in bettering the health conditions of Honolulu.
England spent $40,000,000 a year during a considerable period
in improving her public health, with a result that in ten years she
regained in the value of the lives saved the expenditure of fifteen
years.
CHAPTER r5.-POSSIBILITIES.
Sec. I.-Ecolnomic Value. Of what value is our wealth, if we
are without the blessings of health? Health should bring with
it great power to work. It should also bring great happiness




25


and enjoyment to those who possess it. The world's work depends upon those who enjoy health.
We seldom find a strong, vigorous mind in a weak body. The
invalid is idle. He can do little to help others. The community
loses his labor and that of those who care for him. It is therefore not surprising that the world is awakening to the great
waste of time, of money, of work and happiness, and people are
contending that, if this waste can be checked, it is worth all the
time, study and cost necessary to bring it about.
Sec. II.-Selfish Gains. It is within our power to control our
environment and thereby postpone death, prevent disease, gain
more of the pleasures and enjoyment of life and render work a
delight rather than a burden.
Our isolation makes the task easier. Our death rate can be
reduced one-half.  We know our climate is ideal.  We have
only to take up the task in earnest and bend our united energies
to these ends, and the result will be greater even than anticipated.
Sec. III.-Infltuences. We can by the practical application of
the knowledge within our reach set an example which will influence the whole Pacific Basin. We can build here a city more
wonderful for its health than its natural beauty, and the health
of the community and the joy of living in Honolulu can be made
so great that it will become the Mecca for a large part of the
world.




0




ACKNOWLEDGMENTS.


In preparing this Report we have turned in many directions
for material.
Through the kindness of Governor W. F. Frear, the War
Department supplied a large assortment of valuable reports, covering a number of years and referring to the splendid sanitary
work accomplished by our officials in Cuba, Panama, and the
Philippines.
No modern work at our disposal contains more information,
or information more conveniently arranged than Prof. Irving
Fisher's valuable report on "National Vitality, its Waste and
Conservation." We have borrowed from it freely and used it as
a model.
We have turned repeatedly to the valuable collection of reports
and material of all kinds to be found in the Archives of the
Territory. The past of Hawaii cannot be intelligently examined
without the aid of Prof. W. D. Alexander's "Brief History of
the Hawaiian People," which has been freely consulted.
We owe our, thanks for courtesy and assistance to many, in
fact all, officials, both Territory and County.  The Superintendent of Public Works, Mr. Marston Campbell, and the City
Engineer, Mr. Guy Gere, have been of particular assistance.
Those who serve and compose the Board of Health, we have
used as if our own, while the U. S. Public Health and Marine
Hospital Service has furnished the intelligent and necessary
leadership of our Commission.
We owe much to the health reports of cities and to none
more than that of Chicago.
Among others the following works have been of great help
and to their authors we owe acknowledgment:
"Making Life Worth While"................Herbert Wescott Fisher.
"Checking the Waste".....................Mary Hunter Gregory.




28
"Clean Water and How to Get It"..........Allen Hazen.
"Sanitary Engineering "...................R. dolph Hering.
"Tuberculosis"........................... S. Adolphus Knoff, M. D.
"Prolongation of Life".....................Prof. E. Metchnikoff.
"Sanitary Science and Public Health"......Prof. Wm. T. Sedgwick.
"Typhoid Fever"........................... George C. Whipple
" Tropical Diseases and Health in the United
States".............................. J. M. Swan, M. D.
"Municipal Sanitation of Seaports" (Southern Medical Journal, Vol. 14, Number 6,
July,  1911)...........................R. H. Von  Ezdorf, M. D.
"History of Leprosy in Hawaii" (American
Journal of Dermatology, Vol 11, 1906)....E. S. Goodhue, M. D.




INTRODUCTION.


No subject is attracting greater public attention at this time
throughout the civilized world than public health and hygiene.
The great possibilities of preventive medicine appeal to the
imagination.
The fight against tuberculosis shows what can be done with
other diseases, encourages effort and gives hope.
The study of defects in school children is opening a wonderful
field of economic value, for in saving the child the state is saved,
The possibility of prolonging the average life is revolutionary
and upsets the actuary's theories of a fixed law of life.
Communities begin to realize that man is entitled to good
health, as well as life and liberty, and that it is within reason
to expect from the state protection of health as well as the enjoyment of property. Common health is perhaps more important
than common wealth.   The community's welfare is of greater
importance than any individual's interests. Liberty, as well as
property, which injures the health of others is not entitled to
judicial protection. Some communities are realizing that those
on whom the responsibility of our common health rests must
not be unnecessarily hampered by the technicalities of laws or
the delays of courts.
In the future, when our doctors become as active as our lawyers.
we may be taught to revere and respect "The Temple of Health"
as equally resplendent and important with that of "Justice," and
when a question of precedence arises, the greatest good to the
greatest number will show that as justice is least affected by
delay, health matters must lead and the authority of the courts
follow, undiminished, but only in review.




PART I.-GENERAL.


CHAPTER 1.-SANITARY SCIENCE.
SECTION I.-DEFINITION.
Some authorities define "Sanitary Science" as a term conveniently employed to cover knowledge which has to do with
health-either personal or public.  If this definition is adopted
the term is the equivalent of "Hygiene."  Formerly in Great
Britain the term "Sanitary Science" was used largely to the exclusion of the term "Hygiene," while in Germany the reverse was
and is still the case. In America both the terms "Sanitation"
and "Hygiene" are used rather indiscriminately.
Of late years there has come about a more practical difference
between "Hygiene" and "Sanitation," the former being largely
in the hands of physicians, and the latter largely in the hands
of sanitary engineers; the latter dealing directly with the environment of disease and only indirectly with the individual or person.
Some diseases may be warded off by increasing the vital resistance of the mechanism, while others may be prevented by an
adequate control of the environment. Smallpox, for example,
may be warded off by vaccination, a purely medical and therefore
"hygienic" process.  Typhoid fever on the other hand is best
prevented by proper control of the environment, purification of
the water, and protection of the food supply. These are "sanitary" problems dealing directly with the environment and only
indirectly with the individual.
"Hygienic" more particularly refers to the proceedings directly
affecting or dealing with the bodies of the people themselves,
and "sanitation" with the proceedings dealing directly with the
environment and only indirectly with the human mechanism.
There are, however, authorities who prefer to use the term
"hygiene" for the whole subject. Then, that which we term as




31


"sanitation" would fall under "public hygiene" as distinct from
"personal hygiene."'
SECTION II. —NATURE OF DISEASE (MODERN CONCEPTION).
It is important to be as clear and definite as possible in the
use of the terms "health" and "disease," which are not always
thoroughly understood.
Modern physiology regards the human body as a physical
mechanism, an intricate piece of machinery subject to all the conditions and limitations to which any machine is exposed.  If
around this mechanical view, we throw that other modern conception-environment-and picture to ourselves the human body
as a mechanism, not only deriving energy from its environment
and doing mechanical and other forms of work, but giving back
to the environment heat and waste products, we shall have a
more helpful conception of the human body from which to draw
clearer and more logical ideas of health and disease.
The condition of health is that of the body with all its parts
in sound working order, moving in a favorable environment.
On the other hand we may regard any condition of the
mechanism in which one or more parts (organs) are out of
order, or working under unfavorable environment, as a condition
from which disease results.
The essential bases for "health" are sound and proper construction and operation of the human mechanism under favorable conditions. This makes the sources of our health plain.
They are, good material, good construction, and wise operation
or management (hygiene) to which we must add favorable surroundings or environment (sanitation).
In so far as the mechanism is affected by hereditary circumstances, they are today for the most part beyond the control of
either sanitation or hygiene, and form a distinct branch of the
science of health, which is termed Eugenics. But so far as health
and disease are dependent upon good care, management or operation, and especially in so far as they are dependent upon favorable
environment, they are obviously subject to our influence and
control.




32


SECTION III.-GENERAL CLASSIFICATION OF DISEASES.
For general purposes disease may be roughly divided into two
classes; those due to defects of material or construction, which
hence may be described as "constitutional;" and those which proceed more directly from external sources and are due to mechanical injuries, poisons, parasites, or other external conditions. The
latter health experts are learning rapidly to control, while the
former, being largely hereditary, are at present not so easily
mastered.
It should not, however, be overlooked that both material and
construction of the mechanism may suffer damage from   the
action of slight external causes, or that some so-called constitutional diseases may take their origin in the environment.
SECTION IV.-GERM THEORY.
To the Nineteenth Century belongs the credit of the discovery
that certain diseases of previously unknown origin are due to the
entrance into the body of certain micro-organisms, or germs as
they are usually called.
In 1880 to this was added another discovery; i. e., that germs
are capable of living outside of the bodies of plants or animals in
the environment of man, and especially in material intimately
associated with human life. It then became easy to understand
how certain diseases are caused and spread, and also how they
may be controlled and even suppressed.
SECTION V.-INFECTION AND CONTAGION.
Once the principle has been clearly recognized that there exists
a large class of diseases, all of which are due to the entrance into
the human body of either microscopic plants or animals from
liinig cxternial agents together with the additional fact that these
germs or agents find their way from person to person, either
directly (contagion), or indirectly (infection) through environment; it becomes a fascinating study to detect and discover the
precise routes by which infection or contagion travels; the material vehicles by which these germs are conveyed; their resistance;
their endurance; their distribution from person to person, from
colmmunity to community, from nation to nation.




33


The search for agents of disease shows that the invasion of the
body by germs of whatever sort is to all intents and purposes an
attack upon it by parasites and once this is understood it is evident
that, as in other cases of parasitism, the process is a struggle between the invading parasite and the resisting organism. It is not
an attack on a passive subject, but a struggle between host and
parasite, or, for example, between man and microbe.
In the case of certain germs, the parasite excretes a poisonous
substance known as toxin; while the host, if strong and healthy,
develops what is known as anti-toxin-a substance capable of
neutralizing the toxin.
Practical hygiene and sanitation may proceed along either of
two lines (a) reinforcement of the organism in its struggle with
the infectious microbes (hygiene), or (b) exclusion of the microbes and their destruction in the environment (sanitation).
CHAPTER 2. L()CAL NECESSITY FOR SANITATION.
SECTION I.-(;IE()GRAPII ICAL.
Where else in the world is sanitation of more importance than
in Hawaii?   Probably no other community is so exposed, not
only from its geographical position, but because it is surrounded
by the ancient civilization of so many different races.
Three-fifths of the world's population borders on the Pacific
Ocean   ()nly a small percentage of that population realizes that
most diseases are preventable that filthy, dirty habits, and the
toleration of certain insects and rodents are fruitful sources of
infection. While among a large percentage of that population
are found all the favorable conditions for developing diseases.
We should not criticize nor condenln our neighbors, but rather
set them an example; show them that we belong to that part of
the civilized world which recognizes the fundamental truth  of
Pasteur's epoch-making statement: "That man has the power
to rid himself of every communicable disease."
Deaths from tuberculosis, leprosy, pneumonia, as well as cholera and plague, not only in Hawaii but throughout the world




34
are unnecessary. Most of the deaths from these diseases could
be prevented, if only that portion of the wo)rlds population living
in that environment applied the sanitary and hygienic knowledge
now available,
SECTION II-RtACIAL.
IUnder the strain of economic conditions our population has
increaseld by the impnrtation of numbers, not only from  our
neiglhors in the Pacific, but fronm half arotlnd the globe. We
JAW4A:su-sin    B-C-sseoo      (]CLOSET     D-DITCH
Closet not more than O fet from ditch.
have invitedl antl e tnlra cle those vwho have come fron the
IslantI in the Atl e Atlantic, fcroemt the,zore and fros Porto
Rico, as well as from the Pacifi  llTher efore, eposed as we are
from our geograhikcaI position-a the cross-roads of the Pacfie
-oulr it llic health probilem is tcopi ated 1by a great diversity
of racs
We   eit lnot here 1csils the trait of character of the various
races vit I to tIhese I slands  ihiie ll bits io not, when jutlged
by tior stanilard appeial to our reason rather 1ist we face the




35


situation and realize that our responsibilities are in proportion to
the prejudice and ignorance that exists among them.
There are, of course, other reasons for the careful study of our
environment than those caused by our geographical position, or
by the character of the races which form our population.
The Panama Canal will undoubtedly be opened in 1913, rather
than in 1915.  The proportion of increased commerce is now
almost daily commented upon by the press. We cannot afford to
be quarantined and left out of the commerce of the Pacific. The
loss in such case is both direct and indirect.
Unfortunately our harbor is such that we cannot erect wharves
at such distances as to keep contagion at arm's length. To enter
the Harbor of Honolulu is practically to enter the center of our
city, and make infection from mosquitoes, flies and refuse difficult to prevent.
SECTION III. —ECONOMIC.
To prevent infection of our city we must adopt modern methods
and modern laws.   Fortunately reciprocity in health matters is
universal.  We can, without cost, benefit by the experience of
every other community.
The world is amazed to find that science and money have made
the Panama Canal Zone a healthier place of residence than the
mainland.  The French company which undertook the canal did
not realize that the first cost of prevention for sanitary measures
would be economy.   Lavish, as our engineers appear to be in
their allotments for the sanitary work, it is now clear that time
and money have been saved because of this prompt and early
expenditure.  Had Congress failed to sustain the engineers in
this, it is doubtful if the canal could have been completed within
the original estimate of cost.
If local opinion and our Legislature do not sustain the large
expenditure necessary for our protection from contagion, it is
equally certain that the cost in the end will be infinitely greater.
SECTION IV.-SEAPORT.
Dr. Von Ezdorf in his article in the Southern Medical Journal
of July, 1911, on Municipal Sanitation of Seaports, gives the resolutions adopted at the Fourth International Conference of Ameri



36


can Republics, held in 19G9, among which the following are of
particular interest to us:
They recommend: first, all possible attention by American governments to the sanitation of seaports, so that the introduction of
plague, cholera, and yellow fever might be prevented; and, that
if either of these diseases reached a port, it be promptly isolated
and measures taken to prevent its spread.
Second, the proper construction of rat-proof buildings, especially those designed for the storage of foodstuffs, granaries,
abattoirs, and stables.
Third, the use of galvanized iron garbage cans with tight-fitting
covers, for the reception of refuse from houses, and the daily disposal of such refuse.
Fourth, that the crusade against mosquitoes be carried on vigorously.
Fifth, that every seaport should be provided with a proper
system of sewerage, adequate supply of pure water, and paved
streets.
Sixth, that in every port there should be a sanitary authority
clothed zwith ample power to vigorously enforce sanitary conditions.
Seventh; that it be made obligatory for the schools to furnish
instruction in the elementary principles of hygiene and sanitation.
That these conferences have had their effect and that outr
South American cities are making great progress in these lines
is indicated by the fact that at Buenos Ayres, Rio d(e Janeiro, and
Santos, the water front conditions are now said to be almost
ideal. These communities have spared no expense, for they have
recognized the importance of their commerce.
Dr. Von Ezdorf believes that the ideal seaport should clearly
distinguish between the residential section and the business section. The latter with its limited hours for work and where people
gather for the purpose of commerce and stay principally during
the lay, is no place for a sick person.  The business section
should have its buildings fire and rat proof; its wharves of iron
and concrete, containing no low dives, cheap saloons or lodging
houses-in which the sailor infected in some foreign port usually
begins the spread of disease, and in which the rat, mosquito, fly,




37


roach, and vermin of all kinds often find harbor.  In this manner the chances of infection are reduced to a minimum.
Disease usually prevails where people live, that is, in the domicile. Dr. Von Ezdorf points out that by such division the chances
of infection are greatly reduced, and in case it did occur it would
but slightly hamper the intercourse of nations, which modern
facilities for travel have made so extensive.  Great nations are
realizing more and more their dependence upon the seaport for
commerce and wealth, and the importance of keeping the ports
clean is perfectly obvious.
CHAPTER 3.-MODERN DEVELOPMENTS.
SECTION I. —PREVENTION OF DISEASE.
A "preventable mortality" and "preventable morbidity" are
terms used to denote the condition, when all deaths or diseases
that can be controlled are avoided.
"Preventable' is used to signify the proportion of deaths or
sickness that would not occur if the present knowledge of sanitation and hygiene was generally understood and applied by people
at large. We can illustrate by scurvy. At one time this disease
caused many deaths. It seriously hampered commerce as it
frequently occurred on ships. Now that its cause is universally
understood, its preventability is practically 100 per cent.
Smallpox can be avoided by vaccination-many still objectand its preventability is rated at 75 per cent.
Typhoid has lately been remarkably controlled by preventive inoculation. It is reported that when twenty-five thousand of our
troops assembled on the Mexican frontier, the only person to
develop typhoid fever during the summer was a man who refused
to be inoculated.  The proportion of death and sickness from
typhoid will be greatly reduced when this knowledge becomes
universal and inoculation general, but at present its preventability
is rated at 85 per cent.
Tuberculosis can be wiped out according to experts, but people
generally pay so little attention to its cause and spread that the
proportion of its preventability is still 75 per cent. When experts




38
state that 42.3 per cent is the present fraction of preventable
deaths in America, it means to 90 given calses of death there
has been alloted by experts a percentage of preventability based
upon the present knowledge of the cause of the disease and the
extent of the acceptance of that knowledge and its application;
that their percentages are averaged, and the result is the percentage of all deaths which would be avoided if the knowledge now
TENxai Ne NEAtt KLIntt  PstMPIetG STATION WHatREt (stESPOOtL liRAISS
INTO STREAM
existintg  as acttually appliehd in a reasonable way to a reasonable
extent.
Thlus for our deatlis iln Honotlulut we caI reasotably estimate
40 per cenit as preventable,
SECTI(R   tI.-tIFE; CAN BE PROLONGaED.
It is sbvious that as the ratio of prevettability increases, the
yaverage length of life tatlst increase. Amolng the first to pereive
this was Edwitt Chadwick, a yout3g law sttdent of En1gland. It
appears that before a arlliametttary tontiitteef the offielat actto
ary state in   f defending tihe Government Mortality Tables; based




39


upon the theory that there was a law of life, that "Though the
circumstances of the middle classes had improved the expectation
of life had not lengthened."  This the young lawyer did not
think reasonable or logical. He began to investigate, and in 1828
published in the "Westminster Review" an able article demonstrating that environment must have an influence on health; that
health must improve when the environment is bettered, and further that many of those circumstances, which were unfavorable
to the health of the lives of men, were under man's control and
capable of being removel. This was the foundation of modern
Sanitary Science, and Chadwick became England's original expert sanitarian.
The first steps taken in Paris toward better sanitary conlitions
were due to Chadwick. His reputation was such that in 1854
the Emperor, Louis Napoleon, granted him   an interview  in
which he was asked his opinion of Paris and stated, "All that
meets the eye is beautiful and much is worthy of imitation, but
---- -;" the Emperor interrupted the pause with, "all that meets
the nose is not so agreeable." Then followed the suggestion for
the drainage of Paris, and the interview closed with the suggestion that, as Augustus had boasted "he found Rome bricks and
left it marble," so Napoleon III. would find it a greater, wiser,
and prouder boast, if in time it could be said that "he found
Paris offensively odorous and left it sweet."
Pasteur did for hygiene what Chadwick did for sanitation,
when the famous Frenchman stated that "it is within the power
of man to rid himself of every parasitic disease."
That the average span of life can be prolonged is now universally admitted. Fisher states that "in Europe the span of life
is double that of India-the former is increasing, the latter is
stationary."
The figures Fisher gives show that at least fifteen years can
be added to human life by the partial elimination of preventable
diseases, according to the present stated ratios of preventability,
and this takes no account of future medical discoveries. Cancer
for instance is put down with zero as the ratio of preventability.
Likewise old age has been   assumed as unpreventable, yet
Metchnikoff, director of the Pasteur Institute, maintains with
reason that old age can be prevented and that one result of length



40


ening life will be a greater utilization of accumulated experience,
and we shall have less immature judgment. He states that "old
age" at present is practically a useless burden on the community,
but will become a period of valuable work.
SECTION III.-LIFE CAN BE STRENGTHENED.
The probable length of life is certain to increase with knowledge and the number that become centenarians greatly increase.
But the length of life is only a phase of the results of proper sanitary conditions, as Fisher aptly puts it, "let us conceive another
dimension, 'breadth' besides length, and consider 'breadth' as
related to the usefulness of life, its vigor, vitality-length
measured by death (mortality); breadth measured by sickness
(miorbidity)."
Investigation as to the amount of sickness shows that for every!eath in a community there is a little more than two years serio.s
illness; or, expressed in another way, for each death per annum
there are, on an average, two persons constantly sick during the
year. In addition there are those who are incapacitated for work,
but whose vitality is lowered and whose usefulness is lessened by
milder forms of ills not generally consi(lered, and again where
the individual is unaware of some functional impairment. The
so-called minor ailments will undoubtedly in the next few years
receive much more attention than at present.
We have been accustomed to have only acute diseases treated,
but as preventive medicine takes the place of curative, we shall
treat all the minor ailments.  Many of them are but first warnings that something is wrong with the machine. The first twinges
of rheumlatic pains warn us against gout and more serious conditions. There are, of course, no authentic statistics as to the
extent of the minor ailments. They have been estimated as an
average of three days' loss of time annually for each person in
the community.
SECTION IV.-IGNORANCE AND EDUCATION.
Prof. I. P. Norton, of Yale, has said that there are four great
wastes today, the more lamentable because they are unnecessary.
They are: Preventable death, preventable sickness, preventable




41


conditions of low physical and mental efficiency, and prevettable
i lntoranlCc.
Education has long been recognized by the American people
as essential to their mental progress but they have not yet realized
the loss in physical development and the waste clue to the lack
of knowledge and application of health matters. Our general
Government has as yet no health department. We were the only
civilized country not represented this summer at the wonderful
International Health Exhibition in Germany. Naturally under
such circumstances our press gave it scant notice.  Professor
Fisher, who visited the Exposition, stated that its most impressive feature was the surprise to find the excellence of the exhibits
of so many countries-not only of Europe but of South America
and Africa.
An example of the expensive results of failure to apply our
knowledge of communicable diseases is found in California in
relation to Bubonic Plague. When the disease first appeared in
San Francisco in 1900, the idea that this Oriental pestilence had
invaded the State was strenuously opposed by practically everybody. It is unnecessary to go into details of how the diagnosis
was combated and efforts ma(le to conceal the facts.  In the
meantime the disease gained a foothold among the groundsquirrels of the State, and California is now an endemic focus of
plague. It is encouraging, however, to note that the attitude of
the people is changing and that now the local authorities and the
people are making every effort to exterminate the infection among
the rodents.
Whereas, a moderate outlay would have resulted in the eradication of the disease had the people been alive to the importance
of the matter in the beginning, it is necessary now to expend
about $250,000 per year and in several years the expense has
reached nearly a million dollars.
Education has taught us here in Honolulu the value of publicity,
for our experience has shown that the phantoms of imagination
are always darker than the truth, and there is nothing to gain
and much to lose by false health reports.
The Japanese demonstrated in the Russian war that they are,
as a race, awake to the world-wide importance of Sanitation and
Hygiene. When the race pride and intelligence of the local




42


Japanese are appealed to, they will quickly respond. An example
was given of this at the time of the civic clean-up day. Inspection
prior to that day showed that the Japanese were the first to act
and their places were put in good shape.
Dr. McCormack, who visited us last summer as a representative of the American Medical Association, stated that education
is the key-note of modern sanitation, that many Boards of Health
issued regular bulletins, and Kentucky went so far as to advocate
a combined Federal Department of Health and Education.  In
that state, he said, they taught the school teacher that her salary
was not fully earned until the death rate fell in her district.
Virginia has published a "Primer of Sanitation and Hygiene,"
written by the Secretary of the Board of Health, and it is used
in all her schools.
One, the most effective, method of combating disease has been
illustrated in the tuberculosis campaigns, notably that of Newark, N. J., where the mortality was reduced one-half. The object
of the campaign was to interest every resident in the study of
tuberculosis. Signs, exhibits, picture shows, gramaphone music
and lectures were all effectively used to attract and educate.
The National Association for the Study and Prevention of
Tuberculosis finds that not only must it distribute information to
the masses, but it must also prepare matter exclusively for the
press-in every case the leaders of a community must be taught
first.
Money is spent lavishly in Hawaii on health measures. They
are recognized as a vital necessity. Sometimes it is spent to cure,
then again to prevent, but rarely to educate. We are buying our
sanitary education in chunks and paying for it in big hunks of
experience. We have with jolts and jerks overcome considerable
ignorance. Some day we will demand the distribution of a regular supply of health information, constantly spread throughout
the community and maintained under a normal pressure.  We
will then secure more health for all at less expense.
SECTION V.-ASPECTS OF THE LAW.
The Chicago Health Report for 1910 says that the American
people are termed a lawless people. A large portion hesitate to
obey any law until they have discovered one or both of two things;




43


first, whether they can be excused from its operation; second,
whether their neighbors are going to obey. This means that the
operation of the law is uneven. Too frequently those who are
charged with the duty of enforcing the law allow things to drift,
and they go from bad to worse until latent public sentiment is
aroused.
Public sentiment being accustomed to leniency and unaccustomed to power, strikes out recklessly, even revengefully, and
usually illogically. Laws are then enacted, or executive measures
taken, without due regard to normal conditions; as a result the
aroused public sentiment considers that the situation is cured
simply by the enactment of the law or by the promulgation of an
executive rule, and the public then failing to support action by its
officers the old conditions recur.
The difficulty usually encountered in enforcing health laws and
regulations is that so large a percentage of the people will not
obey their regulations without question; and the next difficulty is
too often inadequate power and a lack of support, if not hostility
from public opinion. Many of the more intelligent members of
the community by their silence, fail to add "power' when the
difficulties increase. The result of this is felt in several ways.
First, it multiplies inspection-instead of one visit either for
inspection, direction, or to deliver orders, many are required. In
some cases suits have to be started before men will do the simplest
things.  Before the courts such a man may be excused, when he
promises to do that which he should have done months before
with a minimum amount of trouble to himself and the health
authorities.
Second, the effect is the increased cost of administration.  A
dollar of expenditure in health work renders much less return
than if conditions were different. The amount an inspector can
do is cut far below what it should be; the detail of the records
increases and with it the office work develops. Litigation costs
the time of lawyers, inspectors, doctors, judges, witnesses and
court attaches. Iines and costs never remunerate for the loss of
time occasioned by reinspection, clerical services, supervision,
witness fees, legal and court services. Dollars in our community
are not so plentiful that they can be expended with such waste.




44


Third, it tends to inefficiency in the health service, because
standards are lowered and the service is discouraged.
Fourth, and the most important effect is, that progress in
improving the health of the community is checked.
There appears to be only one way to correct this condition and
that is to secure an active participating interest of all classes in
health conditions and an equal and prompt acceptance of health
regulations.
The Board of Health operates under what is called the police
power.   This is the right of the comnmunity to have that done
which is required to protect its health, its morals, and its safety.
It is a fundamental power for the protection of society. In extreme cases individuals, or groups, reassume the power of selfprotection and exercise it personally and public sentiment condones their acts.
It is now conceded that, if a man has smallpox, he can be deprived of his liberty without trial by jury, and property can be
destroyed sunmmarily, if that property is a public menace and
delay would be dangerous to the public.
The rights of the people along these lines are inalienable.
There is an old Roman adage: "That the health of the people
is the supreme law."  All laws or regulations based ion police
power must conform to two basic requirements:
1st. The situation to be met must be genuine and of sufficient
importance.
2d. The operation of the law must not unreasonably interfere
with liberty or rights of property, or work discriminatively.
To say that vaccination should only be done in time of epidemic
is no more an accepted opinion, than to say that laws requiring
buildings to be fire-proof should only be operative during a fire
-both logical but poor law. The difficulty too often is that we
do not see the community view-point, because our point of view,
our method of approach to any subject is so intensely individualistic.
The habit of looking on the community side is a growing one,
and we are just beginning to see that in health matters the liberty
of the individual to do as he pleases too often ignores the common welfare.




45
CL7APTER 4. -S.T UDY OF DIrSEAl    S
SECTI'ON 71.-ESSENTIAL (CONDITIONS.
In order that any tropical disease shoIul develop in a given
region three essentials, in addition to he climhatic conditions,
must be present; first, the cause of the disease; second, the proper
transmitting ageot; (tird, the susceptible indlividlttal.
Slo~WING )ISCAg PiE  PIPE m Ck{ESSPOOr, o0k TvENEMENmT xkuzA KALIHI
PU MPINs SATI
)tnr climatic conditions are favorable thre ase of the disease
omay be here. and we omay have the susceptilble individual; but, if
the trasmitting agent is absentt the disease till anot develop.
This is our situation in regaro m alaria. We lack tht  l   W e k  proper
tralsmtitting agentmthe Aopeles musqtito. If, hiweer, it is
intrioduced an elidemie is ertain to occur an perhas this costly
tllsease hbeet me endemitie. There are thirtydwto sImeeles of Anopheles mosqumitoes, seven of these have definitely been shown to
carry imalaria. l omth the traostmitltg aAgent atd the dmsease exists,




46


on one side of us in the Philippines, and on the other side of us
in Central America, Mexico and Texas.
Again the transmitting agent may be here, with the susceptible
individual, but the cause of the disease-the individual harboring
the parasite may be absent and the disease undeveloped. This is
our condition in regard to "yellow fever" and "elephantiasis,"
both mosquito borne; the former known to be transmitted by one
species of the Stegomyia, and the latter by our common variety
of the culex.  Yellow fever is bound to be introduced from the
various parts of South and Central America, if not Mexico, and
elephantiasis may make its appearance here at any time, as it is
already in Samoa.
SECTION II. —CAUSE AND CLASSIFICATION.
Turning now to the obviously external causes of disease, environmental, those with which sanitation chiefly deals, let us pass
over those caused plainly by external origin, which are chemical,
mechanical and physical, accidental or otherwise-such as being
crushed, drowned, suffocated, wounded or executed, and leaving
another group of obviously external causes of disease, those
from poisons due to external causes which may be grouped together under the head of living agents of disease or parasites, including not only the larger and more common parasites such as
tapeworm, fleas, ticks, lice and mosquitoes, but also those far
more elusive, the micro organisms, bacteria or germs.
Prof. Henry B. Ward, of the University of Nebraska, defines
"parasites" as any organisms which obtain their nourishment at
the expense of some other living thing. They may be plants or
animals. Parasites do not originate in vitiated organs nor are
they the result of temperament. They are introduced into or upon
the body by the host from without. Methods of cure, he states,
depend upon the removal of the parasite and prevention of further introduction.
For our purpose due to "the grave and increasing danger of
the introduction and spread of contagious and infectious diseases," we prefer to classify all such diseases in three simple divisions: 1st, those obtained through the mouth; 2d, those received
by contact; 3d, those spread by insects.




47
CHAIPTER 5.-OUR DEFENSE.
SECTION I.-THE MOUTH.
Diseases which reach us through the mouth, stlch as typhoid,
cholera, and dysentery, can be prevented by having pure water,
clean food and anl acdeqate sewerage sstem, and by extermlhating the housefly.
cALT P[>OiDS AT M1OcT11 OF 2KAmlRI STREAm INTOA l HvIIdICH 11H1 CONTAMINATqED
WXlE FROM    ESSPO A  ND MI S.AdNI3OTERIHOIISE  MusT lO o"  'Ts WAY
BIArTaE TlE SALu IS Sola
To 'ld and secure this defense it is essential to stldy the corn
ditions il regard to our sewiers the source of our water suptlly,
its purity and freedlom  from i  lfection; thIe proItection of the
catchmeit basins aid storage reservoirs: atd the avoidauce of
the comp.mon d.;riking cup 
Buy Io meat, fish, vegetables, frllit. milk or ice that is not certai to be fresh, clea, anIld tPe.
Patronze only those wlo scrkeen thleir foodstuffs from flies.




48
Investigate how the vegetables you use are cultivated, and
where they are washed.
Patronize restaurants where both the kitchens and dining
rooms are screened, and where only boiled or distilled drinking
water is served.
Insist that flies are an unnecessary nuisance, and remember
that their source is usually stable manure.
SECTION II.-CONTACT.
Diseases that we take by contact, such as tuberculosis, leprosy,
smallpox, and measles can best be guarded against by enforced
ventilation, better living conditions, avoidance of over-crowding
and school infection, with education of the masses as to the mode
of their spread.
This defense we can aid by living only where the light can
penetrate and where there is at least 400 cu. ft. of air space for
each person; by reporting landlords, who offer for rent dark,
damp, dirty rooms, and by studying our own living conditions, if
ill, to see how we can save others from contagion and infection.
SECTION III. —INSECTS.
In diseases spread by insects, such as plague, cholera, yellow
fever and (lengue, our defense depends on the extermination of
the transmitting agent-rats and their fleas, and mosquitoes of
all kinds.
To aid this defense each one can help the rat campaign "to
build the rat out of existence," to destroy and remove his breeding places, starve, poison and kill him. See that refuse and swill
neither protect nor feed him, that grain and feed are out of his
reach. Rat harbors are wooden sidewalks, attics, piles of brush
and kindling wood, old barrels and lumber. Boarded or closelylatticed places under houses offer a fine refuge.  We should see
that they are removed or so adjusted that under the house the rat
will not longer feel safe from his enemies.
We should help the mosquito campaign by destroying and removing all breeding places-first around and then at a distance
from habitations. Any standing water is apt to be a breeding
place, if the mosquito can reach it. The contents of ponds, water



49


tanks, flowerpots, water troughs for animals or chickens, spots
that are continually damp and muddy, water holding plants, defective drains and gutters, empty cans, bottles, hollow stumps and
trees or branches that hold water are all sources of danger in that
the mosquito will find water in them. Running water, when
crowded with grasses or water-plants, furnishes quiet places in
which mosquitoes can breed.  Streams that are intermittent in
their flow, leaving hollows and pools, should be paved.
SECTION IV.-KNOWLEDGE.
Finally the surest defense is knowledge.  When men know
the cause of disease and the reason for premature death, then
that knowledge will bring with it the public support that is essential to protect ourselves from an environment that causes suffering, loss and waste.
It is not sufficient for experts to know the cause of disease
and the methods of its spread, but the people at large must be
instructed so that disease appearing anywhere may be restricted
to its place of origin and there confined and exterminated.
SECTION V.-FEDERAL QUARANTINE.
One great bulwark of defense is the protection afforded by the
Public Health and Marine Hospital Service. The laws and regulations of this service, in so far as they relate to the Territory of
Hawaii, may be summarized as follows:
I. The service has medical officers in all foreign ports considered dangerous from the standpoint of health, and these officers enforce certain regulations to insure that every precaution is
taken at the point of departure against the introduction of quarantinable diseases. The same medical officers also inspect aliens
destined for the United States to ascertain if they are suffering
from certain "loathsome contagious diseases" or "dangerous contagious  diseases,"  other than  those  called  "quarantinable
diseases."  There are only six "quarantinable diseases" under
these regulations, viz., typhus, leprosy, cholera, plague, smallpox,
and yellow fever.
The diseases considered "loathsome contagious" are such as
excite abhorrence in others by reason of the knowledge of their




50


existence. The term "contagious" should be regarded as synonymous with "communicable."  Examples of "loathsome contagious" are:  Trachoma, filariasis, hookworm, and amoebic dysentery.
II. On arriving at an American port of destination vessels of
the following classes are subject to inspection by a medical officer of the service:
(a)  All vessels from foreign ports.
(b)  Any vessel with sickness on board.
(c)  Vessels from domestic ports where cholera, plague, or
yellow fever prevails, or where smallpox or typhus fever
prevails in epidemics.
If the officer making this inspection discovers a case of
"quarantinable disease" or a condition aboard the vessel which
he considers liable to convey "quarantinable disease," the vessel
and its personnel together, or the vessel alone, or certain parts
of its personnel, as the case may be, are placed in quarantine.
If on the other hand he finds none of the six "quarantinable
diseases," he only certifies to this fact and turns the certificate
over to the United States Immigration Service.  That service
either holds the infected individual until cured by treatment, or, if
this is not practical, deports the individual to his or her country.
In addition to the above, such diseases as scarlet fever, diphtheria, measles, whooping cough, etc., when discovered aboard are
required to be reported to the local authorities in order that the
latter may intercept the infected passenger and adopt such precautions as they may consider necessary.
III. When Honolulu suffers from an outbreak of a quarantinable disease, the officer here, in order to protect other American
ports, is required to put in force certain regulations commonly
known as "outgoing quarantine."
In addition to the foregoing duties prescribed by regulation,
the Service here, in conjunction with the Board of Health, makes
a bacteriological examination of all rats captured by trappers of
our Board, and reports weekly the results.
Efficient as this Service is, the protection at best can only be
partial, for absolute safety can only be had by prohibiting commerce.




51
The Service aims to facilitate commerce in every way compatiblIe with iits duty.
It mtst be evident that nmch remains to be done by local
autlhority when the Federal Service simply reports measles, scarlet fever, and wlhooping cough, andl oes not touch malaria.
PART 1III) LSCRIPTIVE.
CHAPTER 6.- i) ARD) O1 1 IEALTH.
SECTIO N I. -EARLRY HISTORY.
The earliest known record of any public action for the plrotection if health in these Islands is a little, single, printed sliest,
ewhich can he senin the archives, dated at 1Waikiki, Aus 1,
VPgIt} 11 VTAO. C  FgO}~ W t.    IS-e. A Id Sr; GET WTE(g;P s
1836, am|dl signd hy Kfian, Auhao, a    Il Paki
It is a  tice t  he Pilot f   nll, f     iddi  hito      ard




52


vessels until he has ascertained their condition of health. If infected with smallpox, the vessel is to anchor and fly a yellow
flag. The notice states that: "Any neglect of these regulations
will be severely dealt with, and vessels not conforming will be
driven from our shores."
On May 29, 1839, the King by proclamation provided for a
Board of Health of three persons for each harbor, to be appointed
by the respective Governors of the Islands, whose duty it was to
enforce quarantine regulations against smallpox then prevalent on
ships in the Pacific. This proclamation is also to be found in the
archives. It is a little pamphlet printed at Lahainaluna.
The first Constitution was promulgated October 8, 1840, and
the first Compilation of Laws was published in 1842. By them
the right to quarantine vessels and passengers was established,
and, for the purpose of carrying out these laws, a Board of Health
for each harbor was created, consisting of five health officers, including the port physician and the pilot. This Board was given
(lst) control of vessels in quarantine; (2d) power to establish
laws over all people in time of danger from sickness; and (3d)
the duty of devising plans to prevent the introduction of contagious and other diseases.
The laws organizing the Executive Departments, printed in
1846, do not mention health, except in relation to the quarantine
of vessels.
It was not until 1850 that aly official action was taken for the
internal regulation of health. On December 4th of that year, the
King empowered T. C. B. Rooke, George A. Lathrop, M. D.; B.
F. Hardy, G. W. Hunter, E. Hoffman, M. D.; R. H. Smith, and
V. Newcomb as a Ioard of Health, and asked them to prepare
suggestions as to laws and regulations. These were submitted to
the King in Privy Council on December 16th, and were accepted,
approved and enacted. This Board of seven was self-perpetuating. It had power to make regulations not contrary to law, to
examine and report nuisances, to appoint physicians for contagious epidemics, to quarantine, to move patients, and to dispense
relief.
In May, 1851, the Legislature approved the health laws as
passed by the Privy Council. This Act prohibited burials within




53


the city, required reports by householders of malignant disease
within twenty-four hours, and required the Board of Health in
times of pestilence to report each week for publication.  The
Board, however, had no funds, nor was there any other means of
enforcing the law.
The Constitution of June 4, 1852, does not mention 1)blic
health and it probably repealed the former law. The Legislature
of 1852 made the first appropriation, as far as can be ascertained,
for public health, granting to the Department of Education $500
per annum for the purchase of medicines to be distribute(l to poor
Hawaiians.
R. Armstrong, Minister of Public Instruction, in his report
(page 65) of April 6, 1853, states that "the Legislature seems to
connect health with education for it provides $500 for free medicine."  "This," he states, "was paid to the Agent of the Mission,
which had expended in 1852 about $1,000 for free medicines.
Owing to a change in their plans this will be discontinued, and
there will be much suffering and loss of life, if the natives are
left to their own remedies." Armstrong states that "a hospital
and (lispensary have been often strongly recommended by physicians, some of whom offer their time gratuitously, and no doubt
such a plan would work incalculable good."  He further says:
"Our quarantine laws need revision, as late experience with smallpox shows necessity for better sanitation. There should be some
provision for paupers, particularly those insane, (leaf, tumb and
blind."
(n May 16, 1853, the Legislature passed an Act relating to
public health. Its preamble stated that "smallpox is supposed to
exist." This provided for a Health Commission of three, without
pay, granted them all the powers contained in the Act of May,
1851, anld gave authority over all sick, and power to provide medical attendance, food, lodging and clothes at Government exlense.
It provided for publishing their regulations and enforcing them
by fines, and gave authority to draw necessary funds from  the
Public Treasury.
On the same day the King apl)ointed G. P. Judd, T. C. B.
Rooke, and W. C. Parke, members of the Health Commission.
Three months later, Dr. Judd, the Minister of Finance, resigned.
The report of the Health Commission, dated September 12,




54


1853, and signed by H. R. H. Liholiho, Rooke, and Parke, is the
first Health Report to be found. It is a manuscript on file in the
archives.
At the next Session of the Legislature in 1854, John Young,
Minister of the Interior, reported that "the Commission on Public
Health will present their report on smallpox, to combat which
they were appointed." "That the appropriation of $10,000 has
been exhausted and $20,000 additional expended."  He recommended careful revision of the law, "so as to make permanent
provision against pestilence."
On March 20, 1854, appeared the first printed Health Report
that can be found in the archives. It is signed by the same three
Commissioners of Health as the report of the September previous,
and is submitted to the Legislature with their resignations.
On August 10, 1854, an Act was passed making vaccination
compulsory.
December 15, 1854, the King died and on January 11, 1855,
Alexander Liholiho ascended the throne as Kamehameha IV.
February 25, 1855, H. R. H. Prince Lot Kamehameha, acting
Minister of the Interior for John Young, reported difficulty with
the virus obtained through the philanthropy of the British Consul,
and that compulsory vaccination had not had a fair trial. The
Minister of Finance reported $800 spent in vaccination on Hawaii
and Maui during 1854.
On May 25, 1855, an Act was passed providing for the establishment of hospitals for the care of indigent sick persons, and
for instruction in nursing, and $5,000 was appropriated for this
purpose, but nothing appears to have been done.
June 25, 1855, a new Act was passed relating to the Public
Health. This time a Board of three was created, who were
charged with the oversight and care of the public health. They
were for the first time required to keep a record of their proceedings, and were given very general powers, among which was that
of drawing the funds they needed by drafts on the Minister of
Finance to be accompanied by a statement of accounts and vouchers. They were also authorized to use the labor of prisoners.
This Legislature made a grant of money for vaccination on all
the Islands and for the first time provided $500 for coroner's inquests, but made no other provision for the Board of Health.




55


The Minister of the Interior's report to the Legislature of 1856
contains the report of the Board of Health which states that, beyond passing a few resolutions, the Board was unable to carry
on its work, for the Minister of Finance, Elisha H. Allen, refused
to advance money for its use.  Financial reports show there
was expended $2,733.65 in vaccination and $141.65 for coroners.
This Legislature made the first specific appropriation for the
general expenses of the Board-$1,000-but it could not be used
because of the law requiring vouchers in advance. Vaccination
and coroner's inquests were provi(led for by small appropriations.
Unfortunately the minutes of the Board of Health as organized
by the Act of June, 1855, are lost. The oldest record book now
in the possession of the Board begins with the minutes of a
meeting on January 1, 1858, which stated that the minutes of the
preceding year were read and approved.
The resignation of the Commission in 1854 had evidently been
ignored, for we find Messrs. Rooke andl Parke signing a health
report to the Legislature of 1858, addressed to H. R. H. Lot
Kamehameha, then Minister of the Interior as well as I'resident
of the Board of Health. This report was printed with that of the
Minister of the Interior in 1858. It stated that a few nuisances
were abated, where owners were willing, that there had been no
epidemics although some alarm had been felt over typhus fever;
that requests for labor and money had been refused, therefore the
Board recommended a revision of the law, "granting greater
power or permitting less supervision."  The Board stated that the
only asylum for the insane was the jail; that sick or disabled seamen had no care, and urged the establishment of a hospital.
At the same time the repoll of the Minister of the Interior
urged the appointment of a Sanitary Commission and a stricter
regard for the preservation of life by affording proper facilities
for the prevention of disease.
A new Civil Code was under preparation and on May 17, 1859,
it was finally passed to take effect August 1st. The chapter on
public health reenacted the former law, adding the prohibition of
the practice of medicine by foreigners, except after examination
and evidence of good moral character. It also provided a penalty
for the violation of any regulations by a fine of not to exceed $100.
The Code of 1859 gave the Board the regulation of nuisances




56


and filth; control of sickness on shore or on vessels; authority
over the interment of the dead and cemeteries, and power to
quarantine. It granted power to enter private property in order
to examine the same, to order the removal of nuisances in 48
hours, and to act, if the owners failed, charging the expense to
the owners. It provided another course of action through the
courts as to "common nuisances injurious to the public health,"
upon conviction, it being discretional with the court to order removal under the direction of the Board or to punish by fine. The
Code also required that "all regulations must be published" and
it was the duty of the police to report nuisances. Physicians were
then for the first time required to report dangerous diseases in
zcriting. The Code also granted the Minister of the Interior
power to establish hospitals on each Island, as had been done
by the Act of 1855. The Code also regulated the sale of opium
and other drugs by requiring licenses to import and sell the same.
This Session of the Legislature also enacted a law providing
for a hospital in Honolulu and granted land to the value of
$5,000, such grant becoming effective when the hospital should
have $5,000 in funds. This was approved April 20, 1859, and
on June 16, 1859, a charter was granted to the Queen's Hospital.
Another Act, that of May 13, 1859, prescribed a tax of $2.00
a head on all foreign passengers that might land in order to pay
the hospital expenses of sick and disabled Hawaiian seamen. The
first financial report for the year 1859 showed a payment in support of the Queen's Hospital of $2,000, with a continuation of
appropriations for vaccination and coroner's inquests.
The Legislature of 1860 received from the Minister of the
Interior the usual report included in which is Secretary McKibbin's report of the work of the Board of Health. The Minister
of Interior commented( on the Board's need of money, and recommended increasing the membership of the Board from three to
five by the alddition of two medical practitioners.
The health report of May, 1860, stated that regular meetings
had been held and medical examiners appointed, and that licenses
to practice me(licine had been issued by the Minister of the
Interior. Regulations were published in the "Polynesian" and
the "Hae Hawaii," and a new function taken up, to wit, the control of markets, curing hides, and slaughter houses, the latter re



57
moved from town, as well as the regulation of privies and cesspools. The keeping of pigs within the city had been forbidden
and densely crowded premises or filthy locations inspected.
On August 26, 1860, the Act to mitigate the evils of prostitution was passed and an appropriation of $4,000 was made for its
enforcement, and on August 28, 1860, an Act was passed increasing the Board from three to five, two to be medical men.
The Legislature of 1860 provided the usual biennial funds,
covering items heretofore mentioned, i. e., vaccination, free medicines and coroner's inquests, and new items of $4,000 for the support of the Queen's Hospital and of $300 for the general expense
of the Health Commission and the removal of nuisances.
This was the first appropriation made for the expenses of the
Board of Health-the result of ten years' constant effort on the
part of those who were serving without pay, wholly in the interests of their fellow citizens.  The total biennial appropriatiolis
for health measures were $7,400 out of the estimated receipts for
two years of $66,626, or slightly over 10 per cent.
Minutes of the meeting held January 23, 1861, show Lot Kamehameha, President, and the following four members:  W. C.
Parke, J. I. Dowsett, Dr. Willialm HEillebrand and Dr. R. McKibbin.
In 1862 the Legislature received the first report from  the
Queen's Hospital. The opium licenses were said to be satisfactory, and the Act to mitigate prostitution practicable.  Agents
for the free distribution of medicine had been appointed.  This
report shows that on December 20, 1860, the first epidemic of
measles appeared, causing an expenditure of $147.50.
On August 23, 1862, an Act was passed to establish an Insane
Asylum and provision was made for its execution by an appropriation of $7,000.
On August 23 in the same year, the first Sanitary Commission
in these Islands was created, consisting of five persons appointed
by joint resolution of the Legislature to investigate sanitary conditions and causes of' depopulation. The King in Privy Council,
September 16, appointed the following: Prince Lot Kamehameha and Dr. Wmn. Hillebrand, of Honolulu; Dr. F. W\. Hutchinson,
of Lahaina; Dr. J. W. Smith, of Kauai, and Judge Wight of
Kohala. (No report can be found.)




58


On November 30, 1863, Kamehameha IV. died and Prince Lot
was proclaimed King as Kamehameha V.
Late in December of that year the Board was reorganized,
under the new President, G. M. Robertson, Minister of the Interior, with the following members: Dr. William Hillebrand, Dr.
Stangenwald, T. C. Heuck, and the first Hawaiian to serve, A. M.
Kahalewai.
On January 7, 1864, the Board passed the first official regulations governing the burial of the dead.
At a meeting held February 10th, the minutes show the first
recordled discussion of leprosy.
On August 20, 1864, a new Constitution was proclaimed.
G. M. Robertson was succeeded as President on February 18,
1864, by C. G. Hopkins.
On January 23, 1865, an Act was passed to prevent the spread
of Leprosy. The passage of this Act so profoundly affected all
future health matters that we shall treat the subject of leprosy
under a special heading.  Seven days later another Act was
passed making the Minister of the Interior President of the
Board of Health, and requiring that two members at least be
from the Privy Council and two members at least be medical
practitioners. At a meeting held July 18, 1865, C. de Varigny was
acting as President, owing to the illness of the Minister of the
Interior, F. W. Hutchinson. In 1865 came the first law regarding mortality statistics. Heretofore certain statistics had been
gathered by the Department of Education.
In 1866 appeared the first regular, separate, printed report of
the BIoar(d of Health, and these have continued to appear ever
since. President F. W. Hutchinson gave a statement of expenditures for two years ending March 31, 1866, as follows:
Leprosy.......................................   $16,012.84
Sm allpox......................................  2,047.84
D ispensaries...................................  5,348.87
Coroner's  inquests...............................  51.50
T otal.......................................  $23,461.05
The Legislature in its Session of 1866 provided a single health
appropriation of $20,000 for the next two years.




59


The report for 1868 showed the appointment of physicians
wherever possible to look after the poor Hawaiians. Dr. Hutchinson stated that the steamers then established would increase the
danger of contagion and that there was need of both law and
equipment for quarantine.
The year 1868 saw the establishment of an exclusive Hawaiian
Board of Health in order to control the Kahunas and the passage
of the first law controlling the sale of poisons.
During 1870 concurrent jurisdiction was granted to both the
Supreme and Circuit Courts in the cases involving the abatement
of nuisances, and the same law provided that all orders in such
cases were to provide penalties, fix time for abatement, and
costs.  The appropriations for health included those for the support of the insane, leper settlement, traveling physicians, for free
medicine, and for aid to the Queen's Hospital, and they amounted
to about 7 per cent of all the appropriations made.
In 1872 it was found necessary to amen(d the Act of 1868 Regulating the Sale of Poisons to include the "wooden containers
used."
January 1, 1873, Lunalilo was elected King as provided by the
Constitution, but his reign was short, his death occurring January 18, 1874. During this period E. 0. Hall was President of
the Board of Health.
Lunalilo was succeeded by Kalakaua on February 14, 1874, who
appointed H. A. Widemann as President of the Board of Health,
and he was succeeded by S. G. Wilder, who in turn gave way to
J. Mott-Smith on December 5, 1876.
The session of 1876 changed the laws, likewise the membership
of the Board of Health, making a Board of five, one to be President and three were to be members of the King's Privy Council,
all to serve without pay.  This Act empowered the Board to
spend during times of pestilence moneys set aside for its use by
the Privy Council.
The report of 1876 shows expenditures for leprosy, the care of
the insane, to enforce the "Act to Mitigate," for traveling physicians, free medicines, quarantine against measles, and for general expenses.
The total appropriations for health were $55,000 per annum,
or about 10 per cent of the total of the Government expenditures.




60


In 1876 the vital statistics of Honolulu District were begun
and the cause of death first recorded.
President Mott-Smith started the Makiki Cemetery for Hawaiians in June of 1877.
The Health Report of 1880 signed by S. G. Wilder, President,
recommended a better water supply, a sewer system, and the
control of wash-houses. He gave no general statement of expenditures, although the appropriation for the year ending March
31, 1880, for health was $66,500, and covered the leper settlement,
traveling physicians, medical supplies, general expenses, quarantine building, care of the insane, aid to the Queen's Hospital, and
medical instruction for Hawaiians.
The Health Report of 1882 was made by W. N. Armstrong,
as President. J. H. Brown, Health Agent, desired authority to
drain the surface water and stagnant pools and to cut new
streets.
In 1884 W. M. Gibson became President, and after the new
Constitution of 1887 was promulgated was succeeded by Dr. G.
Trousseau, who in turn was succeeded by Dr. N. B. Emerson on
September 17, 1887. A special session of the Legislature in 1888
for the first time regulated the sale of alcohol. The free treatment of natives by Government physicians was begun in 1884
and abolished in 1888.
()n January 1, 1890, Dr. J. H. Kimball succeeded Dr. Emerson
as President. In his report the free dispensary established under
P'resident Wilder in 1880, the need of sewage disposal, and of
better water and less waste are colmmented upon.  In 1890 the
first sanitary inspection was undertaken. The expenditures for
the two years ending March 31, 1890, were:
Settlement....................................   $239,342.40
H ospitals.....................................  41,855.00
Free  Medicines.................................  9,408.26
Physicians.....................................  39,685.31
Quarantine...................................  3,997.59
General Expenses............................... 32,935.25
Total.......................................$367,223.81


The appropriations made in 1890 for health were $497,191.20




61


out of a total of $4,870,161.08 for two years, or slightly over 10
per cent.
In 1890 a law was passed placing the licensing of hotels and
victualing houses under the control of the Board of Health, while
another law provided that lodging and tenement houses should
secure licenses from the Board also.
In 1892 the enforcement of the Act to Mitigate the Evils of
Prostitution was turned over to the Board of Health by the Department of the Interior, and in order to suppress cholera, the
Minister of Finance, on request of the Board of Health, was
given power to close all ports except Honolulu.
January 17, 1893, brought the downfall of the Monarchy and
the establishment of the Provisional Government with its Executive Council to administer executive affairs, and its Advisory
Council to legislate. On February 23, 1893, the Board of Health
laws were again amended so as to make the Board consist of
seven members-three laymen, three physicians, and the Attorney
General-all to be appointed by the President with the approval
of the Executive Council, to be commissioned for two years, subject to removal by the Minister of the Interior with the consent
of the Executive Council, and all to serve without pay.  The
Board was to elect its own President, and in his absence might
select a presiding officer.
The Provisional Government in 1893 made appropriations for
two years ending March 31, 1896, of $2,097,246.67 out of which
nearly 17 per cent was for health-$360,452.40.
On July 3, 1894, the Constitution of the Republic of Hawaii
was proclaimed to take effect the following day. Under it the
Council of State could appropriate money between sessions of the
Legislature, during pestilence, or in case of great public necessity, and the President with the approval of the Cabinet was authorized to appoint the Board of Health.
In 1895 the first great epidemic of cholera occurred, which
we have treated elsewhere.
The Legislature of 1896 passed many laws improving health
conditions. The fire limits were extended, mortality statistics improved, the practice of medicine better defined, a law for unsanitary land passed, and laws requiring licenses for tenements, milk
and drugs renewed and changed.




62


The Legislature of 1898 passed the first pure food law providing a commissioner whose duty it was to enforce the law.
In June of 1900 annexation to the United States was completed. W. 0. Smith resigned as President of the Board of
Health and H. E. Cooper succeeded him both as Attorney General and the first President of the Board of Health of the Territory of Hawaii.
Not until 1903 were the health laws amended. Then on April
28, a law was passed again changing the make-up of the Board,
by reducing the necessary number of physicians from three to two,
so that the IBoard consisted of seven members, four of them laymen, two physicians, and the Attorney General, ex officio.
In 1905 an act was passed permitting the practice of osteopathy
and another requiring certain health regulations to be first approved by the Governor.
In 1907 the laws concerning the organization of the Board of
Health were not changed, but a number of laws relating to health
matters were passed.
The Legislature of 1909 passed an act making it legal for the
President of the IBoard of Health, with the approval of the Governor, to designate some other officer il the department to act
during his temporary absence or illness. All statutes attempting
the control of the manufacture of poi were repealed. The statute
respecting vaccination was amended so as to require the presence
of parents or their written consent before vaccination could be
made, and the law requiring school children to be vaccinated before attendance at school was repealed. The law regulating the
collection of vital statistics was also amended and improved.
The 1911 Legislature passed a new statute governing the conditions under which poi can be manufactured, and the first law
to check the spread of tuberculosis, as well as a statute requiring
a license for the manufacture of food products.
We touch elsewhere on the change of laws in regard to nuisances and causes of sickness, as well as those affecting leprosy
and the drainage of unsanitary lands.
Since annexation, in 1900, there has been more serious invasion
of disease than during any other period of the same length, but
thanks to the efficiency of both the Federal and local authorities,
contagion and infection have been held in check.




63
The health reports during this period make good reading for
those who believe that affictieon and pestilence are beyond control.
SECTIO)N It-GREAT E1PID iEsICiS.
The earliest recorded disease that becarae serious enoutgh to
note as a, great epidelmic was the pestilellee of 1805 known as
"mai okutu" which broke out at the tilme IKamnehamleha I gathered together his troops to invade Kauai. Professor Alexander
B     OAr IloUSE OVEu: )ITCH 'WniHER}E  nttiSPE)D2R AND  uiAMBEis AiE WASHED
AND Bo\tss PLAY
states that Kaiueluameha himself Was attacket butt recovered,"
All his chief couniselors perished except Kalanimoku. Many believeh this to be cholera.
The sialphAox of 1853 was severe.Out ofI a pofilati      of 
19,126 on the Island of Oahn there terre 9,082 cases and 5,748
deaths, Th   e sane proportion iw  wuvItld Mean 17,361 deaths on
Oahun durinrg nine tmonths time. The direct cost was $30,115.87
at a period when the total revenue of the whbole Kingdonm was
otly $:312,699.07. The mortality of the wIsnlands 109a 7 ter
1,000.




64


The health report for 1870 shows a serious epidemic of fever.
The population had been steadily decreasing and the death rate
increasing until in 1869 it was 58.9, jumping to 64.8 in the next
year.  Dr. Stover of Maui wrote on April 18, 1870:   "The
plague (?) which is decimating the natives on this Island is
'scarlatina anginosa' but there are other cases which I have denominated 'acute fever,' not contagious but extremely prevalent
and very many die of it. The mortality on the Island is shocking.
I never knew until now that people could die so easily or with so
much indifference.'
In 1880 there were 196 deaths from fever. Typhoid was so
prevalent that the Board of Health summoned all of the physicians
from the whole group to a conference. Measles was again very
prevalent, having first caused trouble in 1860.
Smallpox again became epidemic in 1881, complicated because
of the large number of infected Chinese immigrants constantly
arriving. More than 5,000 people were maintained in quarantine
and over 1,000 guards employed. There were 780 cases with 282
deaths. The net cost or direct loss was $98,698.36.
In 1888 measles again broke out, followed by dysentery. Dr.
Kimball reported that measles, in nearly all cases, was of a mild
type, but unfortunately it broke out just before the rainy season
which was remarkable for the heavy rainfall and the long continued prevalence of southerly winds. Dysentery prevailed as a
primary disease and also as a very marked sequel to measles.
Many deaths occurred, especially among the natives.
During August and September of 1895, Hawaii had its first
experience with cholera. The first case was reported by Dr. H.
V. Murray on August 20th. In all there were 87 cases and 64
deaths. It was undoubtedly brought here by the s. s. "Belgic"
which arrived on August 9th.  The direct cost of this epidemic
was $61,697.55, the population being 28,061. A volunteer citizens'
committee aided the health authorities by establishing complete
daily inspection and a special report was printed in 1896 showing
in (letail the work done in controlling and checking this scourge.
On December 12, 1899, occurred the first case of Asiatic plague,
which soon became epidemic and proved one of the most costly
experiences Honolulu has undergone. There has never been a
published report. The direct cost was $625,000. There were 71




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65


cases. Every house in which a case occurred was burned. Finally
by accident a great fire took place, due to which claims were
finally paid amounting to $1,315,000.
Since then plague has been sporadic.
SECTION III.-LEPROSY.
In April, 1863, Dr. Hillebrand, surgeon of the Queen's Hospital,
called attention to the spread of a new disease, called by the natives "Mai Pake," "Chinese disease."  Dr. Hillebrand claimed
that it was the "genuine Oriental leprosy."'
In December, 1863, the Board of Health met and discussed the
"Mai Pake" menace but took no action.   In February, 1864,
however, learning of the spread of the disease, a resolution was
adopted on the 10th whereby a census was taken of the cases
in and about Honolulu in order to later have them examined. In
the following May, the Board regretted that the census had not
been taken.
August 10, 1864, the subject of leprosy was again brought before the Board, and its spread among the people reported upon.
On January 3, 1865, the Legislature passed an Act to prevent
the spread of leprosy. There were seven sections. The first two
authorized acquiring suitable land for an "isolated settlement."
Section iii. gave the Board of Health authority to confine those
afflicted; Section iv. provided for a hospital to treat incipient
cases. Section v. made it possible to require labor of those confined and authorized rules and regulations to govern lepers. Section vi. made the property of lepers liable for the expenses of
their confinement.  Section vii. required the health authorities
to keep accounts of expenditures for leprosy separate from other
matters and report them in detail to the Legislature, with such
other information regarding leprosy as was deemed of public
interest.
In 1866, Dr. Hutchinson, President of the Board of Health,
under the foregoing law prepared a seven-page, printed report for
the Legislature. This shows that his predecessor had purchased'
land in Palolo Valley for $1,000.  Objection was made to this
location, and the selection turned to Kalihi, on the stream below'
the valley, at a cost of $665, for a Leprosy Hospital and Receiving Station. At the same time land on the north side of Molokai




66


was acquired by purchase and exchange for a large settlement
of incurables.
The best information indicated a total of 275 cases in the whole
group of Islands. On being summoned to present themselves for
examination, a much larger number appeared than was anticipated and many names were added to the list of those heretofore
known on this Island. At the time of this report, March of 1866,
the examination of Oahu was finished, Maui under way, and Hawaii expected to be completed in four or five months.
Cattle, sheep, and goats were sent to the isolated peninsula
with the idea of making it self-supporting. The new settlers expressed themselves satisfied and contented. Difficulty was found
in obtaining transportation facilities.
To March 31, 1866, the expenditures were $16,012.48; 151 persons had been sent to Molokai; of this number 36 had died, leaving 115.
On December 31, 1865, Dr. Hillebrand expressed his belief that
the disease was undoubtedly contagious, but this property did not
seem to him to be strongly developed. Dr. Hoffman, in charge
of the Kalihi Hospital, said:  "The disease is contagious only on
close and continued contact."
The report of 1868 shows unexpected trouble with the Settlement, apathy on the part of the public and press, as well as insufficient appropriations and lack of transportation facilities. According to Dr. Hutchinson, "lepers lose their moral sense." Certainly there was much disorder and lack of foresight. Two things
he found desirable, a hospital at the Settlement to care for the
worst cases, and a nurse, both of which were supplied. He recommends that "as the only justification for taking possession of
these people and depriving them of their liberty, is the attempt
to exterminate the disease, complete and absolute isolation should
be recognized as necessary."
On January 22, 1868, the King approved an Act by which
leprosy became ground for divorce.
Dr. Hutchinson again reports in 1870 that the "disease is contagious and inherited, but that as it is decreasing the efforts to
check it are presumed to be successful." The difficulties of complete segregation where no dread or fear exists were encountered




67


and a Bill was presented to the Legislature imposing a penalty on
all persons found in the Settlement without a written permit.
This became law on July 19, 1870, and under it the Board of
Health was "given power to make and promulgate such rules
and regulations as may be necessary for the government and control of lepers placed under their charge and these are to have the
force and effect of statute law, provided always they are approved
by the King, and are published."  There is still much trouble
occurring at the Settlement. This report deals with insurrection
and ration riots, the refusal to work, and the necessity of sending
provisions from Honolulu.
The difficulty in transportation resulted in an Act on July 18.
1870, by which all vessels engaged in coastwise trade were required to carry passengers placed on board by the health authorities, on payment of usual and reasonable passage money.
The report of 1872 (still by Dr. Hutchinson) states that the
previous flattering accounts of reduction in the number of lepers
are all wrong. Opposition has appeared and cases are found secreted in the valleys or in obscure hiding places. The natives are
indifferent to the disease. At the Settlement there is improvement. A church has been built by the Hawaiian Evangelical Association and the Catholics are erecting another. Some are cultivating the land, although they all claim rations equally, and there
appears no way out of the difficulty, for, if those who raise food
are deprived of equal rations, they at once cease to labor. Large
rations are granted, and experience shows the disease emphatically contagious.
In March of 1873, Dr. Trousseau, a very capable French physician, expresses the opinion: "That the only method at all likely
to be successful is immediate, energetic, and to a certain extent unsympathetic isolation of all who are suffering with the disease,"
and during the short reign of Lunalilo segregation was more
vigorously enforced; 415 cases were admitted as against 91 of the
previous year.
February 14, 1873, Kalakaua ascended the throne, and Hon.
H. A. Widemann becomes Minister of the Interior as well as
President of the Board of Health. He reports "that half-way
measures will cause enormous expense and bring no result; that
ignorance is great and exposure reckless. Owing to the inade



68


quate accommodations; more land has been purchased at the
Settlement, water pipe put down, and a store established. That
800 people are fed with large rations, still they clamor for more."
Mr. Widemann withdraws and Hon. W. L. Moehonua becomes
President in October, 1874, so that notwithstanding the report,
the figures show that the admissions dropped to only 78 for the
year 1874, and the total remaining December 31st dropped from
810 to 731.
During the Session of 1874 the Legislature by Act removed the
liability of costs from the property of lepers and appropriated a
large sum for the care of the Settlement.
The next report, that of 1876, is by Hon. S. G. Wilder, President of the Board of Health.  He states that Doctors Powell
and Akana, after being given every opportunity to show their
skill in curing leprosy and for whom the previous Legislature has;
awarded $6,000, utterly failed. Dr. Powell becomes insulting and
then leaves the country. The Chinese doctor tries without result.
Mr. Wilder reports the abolition of the Receiving Station and
Hospital at Kalihi because isolation was difficult and no cures
were obtained. A suitable building was erected adjacent to the
police station to care for all received until the physician made final
decision. He believes that the disease is under control and that
another two years of active segregation, like the past two years,.
will result in checking the spread of leprosy.
On September 15th, 1876, the law was changed so that the
Minister of the Interior was no longer President of the Board of
Health, but the King was to appoint this official.
The next report in 1878 is signed by Hon. J. Mott-Smith, this.
being the fifth year of the reign of Kalakaua. It notes the high
price of food, the necessity for a resident physician, and the death
of William P. Ragsdale, who has been an efficient superintendent.
This Legislature appoints a "special committee on the state of
the Leper Settlement," which makes a visit on May 27th. W. M.
Gibson is chairman. The Legislature again increases the appropriation for the Settlement, besides granting $10,000 for a medical
superintendent.
The 1880 report shows Hon. S. G. Wilder again President of
the Board of Health. He has secured a resident physician-Dr.
Emerson-as well as the introduction of Dr. Goto's medicines




69


from Japan. He has inaugurated free freight for the lepers and
he notes the arrival from China of Father Damien in April of
1879, with a large quantity of medicine known as "Hoang nan
pills." This medicine had been heralded as a cure for leprosy.
The report of 1882, signed by William Armstrong, shows that
his predecessor, H. A. P. Carter, has started a Receiving Station
at Kakaako under Doctor Fitch. Armstrong recommends the expenditure of $10,000 for a greater water supply at the Settlement.
He urges accommodations for visitors and the purchase of all
small remnants of land. This report contains a statement by Dr.
Fitch, which upbraids the past medical treatment of lepers.
In 1883 there is a sudden increase of admittance. Segregation
is enforced. On November 8, Dr. Edward Arning, recommended
by Dr. Hillebrand, arrives from Germany to study leprosy.
The report of 1884 is by President W. M. Gibson, who maintains that leprosy is not contagious. Such characterization, he
claims, is uncalled for and unwarranted by experienced medical
opinion. He asks the Legislature for $10,000 additional because
of increased numbers. He wants Sisters of Charity introduced.
In November, 1885, Dr. Arning is obliged to withdraw, and his
report is printed in 1886.
Mr. Gibson in his report of 1886 notes the opening ceremonies
of the Kapiolani Home for girls of leprous parents, and he requests more funds for the future. He presents to the Legislature
a special report on leprosy in which he now recognizes the disease
as contagious, but proposes local segregation.  He also presents
an appendix of 155 pages, reprinting much that has already appeared. To this a supplement was added of 192 pages, giving
extracts of early reports, records, regulations and laws. Gibson
also published this same year a summary of reports on leprosy,
secured from other countries, containing much valuable data.
The year 1887 saw the upheaval in the Government with a new
Constitution. On September 19th, Dr. Emerson is made President, and he signs the next health report to the Legislature on
July 7, 1888. In this report Dr. Emerson says: "Leprosy was
first clearly made out to exist here about the year 1840 in the person of one Naea. He was a messenger of a chief and died in
1852. His case was reported by Rev. Baldwin, M. D., of Lahaina,




70


in a communication of May 24, 1864." Dr. Emerson notes the
fearful strides leprosy has made, reports 644 suspected cases at
large, and begins segregation in earnest, obtaining the largest
number of admissions and running the number at Molokai to the
highest point yet obtained, 1,033. He points out that every means
must be employed to awaken and keep alive public sentiment that
shall stand behind the law. Emerson states "that as yet there is
no cure but great interest is being aroused and this brings hope."
The Legislature of 1888, as usual by special committee, visits
Molokai. Their published report, signed by Chairman W. A. Kinney, recommends among other things, "the complete removal
from Kakaako of the Receiving Station and the Kapiolani Home
for girls."
The report of 1890 is made by Dr. Kimball, President, and
states "that the branch hospital at Kakaako was abolished on July
24, 1888, but that it is temporarily used as a receiving station."
Several large buildings were taken down and moved to Molokai.
Dr. Lutz, of Brazil, arrived in November of 1887 to make a special
study and treatment of leprosy. He is installed at Kalihi, with
a number of special patients, assisted by Sister Rose Gertrude.
The number of lepers abroad is estimated at 644. There are 1,213
at the end of the year at Molokai, the maximum number reached.
The year 1892 finds Mr. David Dayton in charge of health matters. Dr. Lutz has resigned and correspondence is opened with
Dr. Arning, of Hamburg, for the purpose of obtaining another
expert.
A select committee of the Legislature visits Molokai and
praises the work of Brother Joseph Dutton and Mother Marianne.
Hon. W. O. Smith began his long and remarkable devotion to
the interests of the Settlement on February 24, 1893, following
the formation of the Provisional Government. The report of 1894
gives evidence of careful segregation, mentions the arrival in 1893
from Japan of Dr. Goto, the expert, and the beginning of the
Baldwin Home for boys at the Settlement.
After 1895 part of the quarters used in the cholera quarantine
were made into a Receiving Station, where treatment was under
the direction of Dr. Wayson.
These Islands were represented by a delegate at the Interna



71


tional Leprosy Congress held in Berlin in October, 1897. Dr.
Alvarez' report was published in 1898.
Following Annexation the Territory kept up the Settlement in
about the same manner, with constant slight improvements, until
1903, when Dr. C. B. Cooper, President of the Board of, Health,
began to agitate Federal study of leprosy. The local medical association finally sent Dr. Cooper as its representative to the American Medical Association meeting at Atlantic City. There the sole
representative of Hawaii urged and secured a vote of approval to
the plan for having Congress make a special appropriation for
the study of leprosy.
The Governor's report of 1904 shows that he too was in hearty
accord with the plan and recommended such an appropriation.
On March 3, 1905, Congress passed an Act to provide for the
investigation of leprosy with special reference to the care and
treatment of lepers in Hawaii, and provided $100,000 for a hospital with $50,000 for its maintenance, conditional on the Territory deeding a site at the Settlement.  This was consummated
under L. E. Pinkham, who became President of the Board of
Health April 13, 1904.
Meanwhile there were important changes in the law. A struggle begun in the session of 1905 culminated in the passage of a
new act and the sustaining of the Governor's veto of a bill which
had been introduced, providing for a citation to be issued for the
examination of suspects and yet permitting the court to cite only
those who were actually suffering from leprosy.  A new act
passed at the last session was hurriedly drawn and proved difficult of execution, and finally in a test case the Supreme Court so
ruled that segregation under the act was impracticable.
In the Session of 1909, a new Act, which is still in.operation,
was passed, making treatment of prime importance and segregation as incident to it. A hospital at Kalihi was provided.
April 20, 1911, an Act was passed allowing the Board of Health
to transfer patients from one place to another.
Some idea may be gained of the burden to the taxpayers by an
examination of the following table made from the last eight annual reports: 




72


Year.
1904
1905
1906
1907
1908
1909
1910
1911


Amount Spent.
$ 149,325.95
132,250.81
96,413.56
115,810.36
165,662.85
141,725.52
162,843.58
204,546.22
$1,168,578.85


Number of
Lepers.
994
858
828
798
791
723
614
592


Cost of
Each.
$150.22
152.11
116.39
145.12
209.43
196.02
265.21
345.52


For the purpose of comparison we give similar
ferent earlier periods taken from reports:


figures for dif

1870            $ 17,016.87         392           $ 44.68
1875              29,698.93         754             39.25
1880.         43,740.33         589             74.26
1885      -       54,131.00         663             81.65
1890:         169,671.20         1213           139.90
1895             116,447.46         1087           107.12
1900             118,880.03         983            120.93
As near as we can ascertain the total amount of public money
spent on leprosy must be about $3,887,724.90.
We believe that if the present plan of segregation fails to effect
the desired end, it would be well worth while to consider carefully
whether local segregation would not give better results than the
present system. This would undoubtedly be more expensive than
the plan in vogue at the present time, but it is possible that if
segregation could be effected in a place where patients would
not be so far removed from relatives and friends as at Molokai,
the result might be a disposition on the part of lepers to present
themselves in the earlier stages of the disease and a willingness
on the part of relatives to permit members of families to be
isolated.
SECTION 1V.-MORTALITY RECORDS.
From 1851 to 1863 the mortality records were kept by the Board
of Education. The records for 1864-1865 were not completed.
iyv




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73
From 1866 to 1876 the Board of Health kept the records of births
and deaths throughout the Islands, and from these figures the
mortality tables have been compiled. They show a total number
of 69,605 deaths, not including the years 1864 and 1865.
The death rate for these early years varies from 109.71 per
1,000 in 1853 due to smallpox; 64.8 in 1870 due to scarlet fever;
to a minimum of 21.2 in 1854.
Death Rate in Honolulu.
On April 7, 1876, the Board of Health began a record of the
deaths in Honolulu. The report of 1878, for the first time, shows
an attempt to give the cause of death.
During the first 10 years, 1876 to 1886, there were 6,516 deaths
in Honolulu. With the exception of the first year, in which perhaps there was an error, the highest death rate was that for the
year 1881 due to smallpox, when there were 46.3 deaths per
1,000. The lowest death rate was 24.4 in 1885, while the average
rate for the first 10 years was 40 out of every 1000.
During the next 10 years, 1886-1896, the total deaths in Honolulu were 6,153, or an average of 25.3 per 1,000; the highest death
rate being 27.7 per 1,000 in 1892 and the lowest being 21 per 1,000
in 1893.
The period from 1896 to 1900, covering 4 years, shows a total
of 3,411 deaths, with an average rate of 25.1 per 1,000; the highest being that of 1899, when the rate reached 31.1, due to plague.
Since annexation, taking the 11 years from 1900 to 1911, there
have been reported 10,377 deaths, with an average rate of 22.0
per 1,000; the highest rate being 32.8 for the year 1900, and the
lowest being 17.3 for 1905.
This makes a total of 26,144 recorded deaths in Honolulu from
1876 to 1911.
Death Rate in All Islands.
Year.       Population.     Deaths.    Rate.     Cause.
1851                        5,792
1852                        2,822
1853      73,138-Census     8,026      109.7     smallpox
1854      72,661            1,439       21.2
1855      72,184            1,685       23.3
0.',,.1




74


1856
1857
1859
1860
1861
1862
1863
1864
1865
1866
18670
1868
1870:1873
1874
1875


71,707
71,230
70,753
70,275
69,800-Census
68,660
67,520
66,520
65,240
64,100
62,959,-Census
61,900
60,900
59,900
'58,900
57,900
56,897-Census
57,077
57,257
57,437


1,479
2,017
2,104 
2,291
2,343
2,249
2,426
'2,657
2,941'
2,610
3,351
3,528
3,819
3,502
3,083
3,036
3,043
3,262


22.0
28.3
29.7
32.6
32.2
32.8
# 3 5.9
30.0


46.8
42.2
55.0
5-8.9
64.8
60.4
54.2
53.1
53.1
56.8


scarlet fever


Death Rate in Honolulu.


Year.
1872
1876
1877
1878
1879
1880
1881
1882
1883':
1884
~~ ~ 10~,:1886,


Population.
14,852-Census
14,384:
14,300
14,1 14-Census
15,174
16,234:17,294
18,354
18,414
20,47 —~Census
yeharss average


Deaths.     Rate.


981
624
555
638
607
818
542
633 
567
551
I6,515
5  73* 2  
593/ 


error? 67.7.42.6
390.5
42.0
37.4
47.3
32.8
27.6
24.4
40.0
I 26.8
27.3


Cause.
Measles and
typhoid
Smallpox


1 8 8 7   -  2 1,6 93




75


1888


22,099


555


25.1   Measles and
dysentery


1889      22,502             548
1890      22,907-Census       627
1891      24,076             652
1892      25,245              701
1893      26,414             555
1894      27,583             617
1895cal. yr.27,752            731
10 years' average........6,153
1896    29,920               673
1897      32,266             659
1898      34,612             926
1899      36,985            1,153
4 years' average........... 3,411


24.3
26.9
27.0
27.7
21.0
22.3
25.4
25.38
22.4
20.4
26.7
31.1
25.1


Diphtheria
La grippe
Cholera
Plague


Honolulu's Death Rate Since Annexation.


Year.       Population.     Deaths.
1900      39,306-Census. 1,290
1901      40,594            1,125
1902      41,881              971
1903      43,169              864
1904      44,456              925
1905      45,744              792
1906      47,319              964
1907      48,319              964
1908      49,607 —six months  503
1909      50,895              925
1910      52,182 —Census     1,030
Average.............. 10,377
Total deaths in Honolulu from 1876 to


Rate.
32.8
27.7
23.2
20.0
20.8
17.3
20.5
20.5
18.1
19.7
22.05
1911, 26,144.


Cause.
Plague


SECTION V.-PRESENT BOARD.
The Board of Health at present is composed of seven members:
Four laymen, two physicians, and the Attorney General, ex-officio.
They are appointed by the Governor with the approval of the
Senate. All serve withoutpay except the President.
The Board is required (1) to keep a regular report of its pro



76


ceedings; (2) to take general charge, oversight, and care of the
health and lives of the people of this Territory, and (3) to report
annually through its President to the Governor, showing all expenditures in detail and such other information as it deems of
public interest.
The powers granted the Board are general. It has power (1)
to appoint agents throughout the Territory; (2) to disburse all
money appropriated by the Legislature for the preservation of
public health; (3) to establish and regulate quarantine in the
Territory, or in any of its harbors; (4) to prevent any county
from issuing license for any of a number of specific things (*see
note) except upon examination and approval. Also to cancel
licenses; (5) to make with the approval of the Governor regulations respecting nuisances and other specific matters (** see note)
within the Territory, or in any vessel, as it deems necessary for
the public health and safety; also respecting articles capable of
containing infection or contagion, or creating sickness, when such
are brought into or conveyed from one district within the Territory, or into or from any vessel.
It is the duty of all Territorial and County officers and employees to report nuisances and to aid in the enforcement of the
health laws and rules and regulations of the Board of Health.
Physicians are required by the law to report all contagious and
infectious diseases. The power of the several counties respecting
health matters is concurrent with that of the Territorial Board of
Health.
* NOTE.-Those things specified are:  Erection, maintenance, use, or
operation of any (1) building, (2) bakery, (3) laundry, (4) poi shop,
(5) abattoir, (6) stable, (7) fish, meat or vegetable store or market,
(8) hotels, tenements or lodging houses, (9) or any place or building
where noisome and noxious trades or manufactures are carried on, or
intended to be carried on.
** NOTE.-The specific nuisances subject to regulation are:  (1) Foul
or noxious odors, gases or vapors, (2) water in which mosquito larvae
breed, (3) sources of filth, (4) causes of sickness or disease.  The power
also extends to (5) adulteration and false branding of foods, (6) drainage, (7) location, air space, ventilation and sanitation of buildings,
courts, areas, alleys, (8) privy vaults and cesspools, (9) fish and fishing,
(10) interment of dead bodies, (11) laundries, stables, bakeries, poi
shops, abattoirs, fish, meat and vegetable stores or markets, (12) hotels,
tenements and lodging houses, and (13) any place or building where
noisome or noxious trades or manufactures are carried on or likely to
be carried on, (14) milk, (15) poisonous drugs, (16) pig and duck
ranches.




77


The work of the Board of Health is based upon the principle
that there are many preventable conditions that contribute to the
lack of health.
Public health work is largely a matter of sanitary science, requiring special study, and certain states have accordingly inaugurated special schools for those who desire to take up such work.
A number of universities now provide courses in sanitation and
hygiene in order to meet the demand for trained men to act as
health officers for towns and cities or to take charge of communities where epidemics exist.
Methods change as time progresses, and a study of the development of our present Board of Health shows that its present methods are what Honolulu is ready to receive. Within a few years,
when people become dissatisfied with preventable death, poverty
from illness, and the cost of neglect, more will be required not
only from the Board of Health but from the Courts and from
the Legislature. Honolulu will then take the same attitude as
certain other communities where the Board of Health is admitted
to be the best authority on public health questions-the experts
to whom all such matters are confided.
SECTION VI.-WORK.
Ordinarily the public pays little attention to health work. Few
taxpayers know the cost of health measures. Citizens have no
idea of the volume of routine work that is necessary to carry on
the many branches of activities in which the Board of Health is
engaged.
These activities are: Leprosy, with 592 people at Molokai to
be cared for and fed, besides attending to their many wishes and
furnishing them with medical treatment; and the Kalihi Hospital,
where examinations are made and fifty or more cases under treatment, requiring attention to every detail; statistics and mortality
records to be kept, which are in health matters what bookkeeping
is to business, or surveying to land matters. They measure and
describe the ever varying conditions of health. The detailed vital
statistics are absolutely'essential and those of each of the five counties are kept in addition to those of Honolulu; reports of all dangerous diseases to be received and acted upon; free dispensary,
laboratory and bacteriological work, and the protection of certain




78


food standards; anti-tuberculosis bureau; medical superintendence
of the insane; continuous rat and mosquito campaigns; physicians,
maintained in twenty-three districts throughout the Territory; inspection and control, through licenses of buildings, bakeries, tenements, lodging houses, poi shops, the ke.eping of pigs, etc., etc.;
inspection and prompting of individuals in the ordinary conditions
about their kitchens, privies, stables, chicken yards, duck ponds,
plumbing and drainage; maintaining similar inspection in various
other districts; making appointments; directing and consulting
with all those employed; keeping accounts; watching appropriations; securing bids and awarding contracts; condemning nuisances; work on new and necessary legislation; recording proceedings and annually preparing a report.
Besides the foregoing work, there are special calls due to various outbreaks of disease from Kauai to Hawaii, and periodically
some severe epidemic, taxing all reserve forces.
This is the work of those, who patiently, conscientiously, and
earnestly aim to better all health conditions.
SECTION VII. —NEED OF PUBLICITY.
All the foregoing work to be done by the health authorities is
aided by the press, but sometimes other news crowds out most
important information.
Ignorance is admitted everywhere as the cause of waste, and
education is the keynote of successful health work. Therefore
much of the public money now expended would be more effective
if a small percent were spent in publicity. The people are entitled
to know what their officials are doing. The school teacher should
be helped in teaching our future citizens sanitation and hygiene.
It is a serious defect for public representatives to do their work
in silence. The Legislature should so provide that the public
shall receive constant and regular information of the work being
done by the health authorities properly prepared.




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79
ClAPTEL  R 7     -WATEFR SUPPLY.
SECTION I.-BRIII1EF IISTOIRY.
Mlarston Camlpbell has had compiled a Imost ihlterest i istorv
of iHonolulu's water works. 'iroot this and the general report we
learn that, for some time after the (discovery of 1Ionolult Hltarbor
by Captain Brown in 1794. the Ill     r I    y e ony  e sed ly t i ts
34 PLACE DIREcTLY t()ER A DITCH, WATERg FROM WHICH PASSES IlDEPl
JAPANESE HOUSE WkHERE VEGFTABLES ARE WASHFr
vas that of Nltlanu Stream. into wh1ch vessels seot tleir boats
for the iurpose of filling their casks
About 1820   tirface wells were dug ino   the coral, but some
th    eople seot for thleir drinkikg water to thle springs in the
foothillts.
After the reorgaizatio  n of the Government il 1840. and the
revase \of thie whaltig hindulsry. cate   a deloald for a more cooVeiet smpp y to the Shls. In 188 the Miiste of t the Iterior put
A tank in the tasernor t of the t)liot' offce at the toot of Nnallan
treet, froi  which thte shlps' boats could readity fillt their casks.




80


This, the first Government water works, was supplied through a
lead pipe from an old taro patch on Emma Street near the Central
Grammar School.
The system was even then a make-shift, for both pipe and supply were objected to by a number of the community. Although
at first confined solely to the use of ships, the enterprise was extremely profitable, and in 1850 a supply of four-inch pipe was
ordered for its extension and improvement as well as to provide
fire protection.
During 1851 a small reservoir was completed on the Waikiki
side of Nuuanu Street about opposite the end of Bates Street.
During 1852 four or five hydrants were placed in the village and
there was a constantly increasing demand for private and individual use, which caused the Minister of Interior in 1855 to submit to the Legislature the reports and plans of the expert, William
Webster, for an improved water system. The authorities estimated then, that a sufficient daily supply would consist of an average
of 60 gallons per capita for 6,000 people. This would require the
4-inch main to be replaced by a 6-inch iron pipe. Notwithstanding that the population in 1854 was 11,455, yet only a portion were
thought to be able to indulge in the luxury of a direct water system. In 1859 the Government borrowed $20,000 at 12 per cent
interest from James Robinson & Company and purchased iron
pipe.
In 1860 came an act to condemn the necessary land for the improvements previously suggested, but not until 1862 were they
finally executed. In that year a second and larger reservoir was
built. It was situated just above the old one near Nuuanu Stream
between Bates and Judd Streets and was used until 1895. This
reservoir was supplied from the same stream as the former smaller
one had been, but being inadequate, a pipe was laid from Kapena
Falls and additional water was taken out of Nuuanu Stream. The
fluctuation in the volume of water between seasons was very great
and the use of larger amounts of Nuuanu water brought the
Government in conflict with the private owners interested in
Paki's auwai and other irrigating ditches. Thus after fifteen
years the system was still a make-shift but profitable.
From 1862 to 1866 and thereafter there was a period of stagnation. Whaling had declined and no-complete substitute had




81


been found. The population in the meanwhile had only increased
to 13,251.
In 1870 came the purchase of Paki's auwai and other water
rights.
In 1876 the Reciprocity Treaty with America overcame the
period of stagnation.
The map of Honolulu in 1877 shows that the system had about
seven miles of pipe line, but no material change had taken place
save better protection for the source of supply and a gradual absorption of the individual water rights.
In 1879 came the first successful artesian well. In 1880 came
the Makiki Reservoir with its capacity of 725,000 gallons, and 10
miles of pipe up Nuuanu to the new reservoir on Queen Emma's
property. In this year an act was passed to protect certain lands
used as water sources from trespass of any domestic animals. The
lands were those lying at the source of all streams above (or
mauka) of Beretania Street between the western slope of Kalihi
and the eastern slope of Palolo.
In 1882 a filter was constructed just above the reservoir in
Nuuanu on J. H. Wood's property, Pawaa artesian well was sunk,
and those at the Palace and Mililani begun.
In 1884 five artesian wells, either bored or purchased, were
owned by the Government and a complete sectional map of the
water system shows that its supply for a population of 20,487
came from the streams in Nuuanu and Makiki Valleys and the
artesian wells. Pipe lines and fire hydrants were located over a
large area extending from the present fire station on King Street
in Palama through the town across the plains on King, Beretania
and Wilder Avenue to Punahou Street and out Waikiki as far as
Kapiolani Park.
In 1886 came the great Chinatown fire and Major Bender's
plans for improving the water system. Honolulu's population
was then about 21,293, and there was about 25 miles of pipe line
service. This resulted by 1888 in new and heavier mains up
Nuuanu Valley with two new reservoirs, as well as the installation of the electric plant, by which water power was first used
to furnish light.
In 1889 a severe drought caused a search for more water and
the beginning of careful measurement of the sources as well as




82


restricted regulations in the use of water. A fire engine for the
first time pumped water from Thomas Square artesian well.
In 1890 the population was 22,907 and the pipe lines had increased to 35 miles.
Another severe drought in 1891 renewed the demand for more
and better service.
From 1891 to 1894 much money was spent in renewing the pipe
lines, which had become entirely inadequate. In the summer of
1894 water was more scarce than usual and a contract was let for
two artesian wells and a pumping plant at Beretania and Alapai
Streets. This plant was completed in 1895, adding more than
2,500,000 gallons per day of the first water which could be relied
upon.
Then came the first epidemic of cholera, and artesian water was
used, when possible, throughout the city. By the end of 1897
extensive repairs and alterations of the pipe lines had taken place,
and the Punchbowl reservoir, capacity 500,000 gallons, was completed.
By 1899 the wells for Kalihi Pumping Station were sunk and
work on the installation begun. Diamond Head reservoir was
built with a capacity of 887,000 gallons.
Annexation to the United States took place in August, 1898.
Honolulu then had a population of 39,306.
On June 14, 1900, the Organic Act went into effect.
From 1901 to 1904 was a period of extension of the fire system and pipe lines. In the latter year the town had 333 hydrants.
The Kaimuki pumping plant and water system, built by private
enterprise, was purchased for $75,000 and the contract let for the
big Nuuanu Dam. It was then estimated that the people of
Honolulu consumed daily 7,850,000 gallons, or approximately 200
gallons per capita.
By 1906 Kalihi reservoir was completed and the Makiki Dam
providing another reservoir for 800,000 gallons was under way.
During that year, notwithstanding these improvements, it was
necessary to restrict the use of water and a system of careful
water inspection was under trial.
In 1909 the Legislature for the first time put the water works
on a self-supporting system. Revenues, after paying the expenses
of operation and the fixed charges incurred for interest on the




83


bonded debt used in the construction of the various works, can
now be applied towards the permanent improvement of the water
and sewer systems.
In 1910 two 12-inch artesian wells were sunk and a high-lift
pump installed at the Beretania Street station, and Nuuanu Reservoir Number 4 was completed with a capacity of 639,000,000 gallons at a cost of $298,563.89. Kaimuki Reservoir with an additional capacity of 750,000 gallons was under way and the pipe
line system partially extended,
SECTION II.-ARTESIAN WATER.
In 1859 R. C. Wyllie while in charge of the Bureau of Public
Works, states the following: "I am not sure that a large portion
of Honolulu might not be supplied with good water by artesian
wells. That there is a subterranean current of fresh water quite
close to town on the plains leading to Thomas Square, I know
to be a fact, because in 1854 I obtained an experienced leadman.............. who carefully sounded it............... When
I find leisure I contemplate boring at my own expense. There
is a boring apparatus in tolerable order left here by Commodore
Wilkes. I have written to obtain estimates of the price and cost
of working a modern apparatus for boring to the greatest
depths."
It is interesting to learn from the research work undertaken by
the Superintendent of Public Works, Mr. Marston Campbell, and
from other sources that the first bored well to flow outside of
Honolulu was at Honouliuli, and the first in Honolulu was that
of Dr. A. Marques in 1880 in the Punahou District. The artesian
level in the Honolulu basin was found to be 42 feet above sea
level.
The Legislature of 1880 appropriated $20,000 for artesian wells,
and in 1884 an Act was passed to prevent the waste of artesian
water on the Island of Oahu. It required all flowing wells to be
capped and prohibited all waste except for irrigation purposes.
By 1889, 47 wells had been bored in Honolulu. The artesian
level had fallen somewhat but regained the 42-foot mark that
year.
By 1910 there were 117 wells drawing from the supply and the
artesian level in the city is now 30 feet. If this can be depended




84
upon, we have only 50 years' upply. We are therefore consulming
our reserve and eating into our principal at about the rate of 7
inches each year.
A portion of the City of Denver, supplied by wells, suddenly
Ione morning fonnd every well dry. lnvestigation showed that
iad the source been regulatet d to its yearly increase, the ue could
SNr  WATER DRAINING INTO IITCHEg BACK O WASH-HOUSES IN PAILA MA
Eight ilch drails as the to pIreeding ill a (distanee f 500 ifeet
have been indefinite, but exhauste d it would take 60 years for its
retlurn.
Deep wells, if properly cased, furnisl the lprest ald safest
water.
SECTION iu.- SIZE OF SYSTEiM.
)tr rlesent upply of Water is taken l arely frou   artesian
sources. The estimated consunllptlon tfor the year endnll   June
30, 1911, was as follows:
Artesian                                Gallons.
K  i m  ki............................  8.606.




85


Beretania...........................  1,143,301,000
K alihi..............................  1,272,517,200
Total  Artesian.........................  3,300,424,300
M akiki.............................  125,925,000
Nuuanu  Sources..................... 2,007,361,000
5,433,710,300
This gives an average daily consumption of 14,887,000 gallons.
On the basis of a population of 52,000, this would give a daily
per capita consumption of 286 gallons.
There are 78.61 miles of pipe in the system. As there are 4,992
connections, the average length of pipe required for each connection is 83'2 feet.
The system now has four pumping plants, viz:


Location


Type


Beretania (high)   Horizontal crosscompound Blake end
Beretania (low)    Horizontal crosscompounl outside
packed plunger
Kalihi             Vertical triple
expansion
Kaimuki            Horizontal crosscompound outside
packed plunger
Makiki (seldom used) Gas triplex


Rated Daily
Lift      Capacity
Feet R.P.M. Gallons
300   50 3,000,000
160   21  2,500,000
180   36 5,000,000


300
125


50 3,000,000
600,000


Total........................................   14,100,000
In order to secure uniform static head on the system, the
pumps deliver the water to covered reservoirs, the capacity of
which are as follows:
Punchbowl...................... 1,500,000 gallons
Kalihi..........................  3,200,000  "




86


Diamond Head..................   887,000  "
Kaimuki........................  750,000  "
Total......................... 6,337,000  "
The surface water used is all taken from Nuuanu Valley. The
catchment of the big upper reservoir is some 1,250 acres. There
are in the valley four surface reservoirs of about the following
capacity:
No. 1 Electric.................. 21,000,000 gallons
No. 2 Luakaha................. 7,000,000   "
No. 3 Luakaha................. 10,000,000  "
No. 4 Dam...................639,000,000  "
Total........................677,000,000  "
The source of all the surface water that we use in Honolulu is
from the rain that falls on that portion of the Island of Oahu in
which are found the watersheds of Nuuanu, Palolo, Makiki, and
Pauoa Valleys. The artesian wells in Honolulu basin augment
the surface supply. The definite limits of the watershed for the
artesian basin are not so clearly defined.
SECTION IV.-LACK OF PROTECTION.
Mr. George C. Whipple in his admirable work on "Typhoid
Fever" says that "it is epidemics which arouse careless communities to the protection of their water, cause laws to be passed
for the prevention of infection, and awaken citizens to a sense of
their responsibilities in a way constant danger would never do.
They have enlightened the public as to the principles of sanitary
science and compelled officials to apply those principles for the
common good."
Honolulu will some day see the necessity of protecting the
catchment area used in Nuuanu Valley. A study of epidemics
elsewhere shows that storage water can be infected by pure mountain brooks which flow for several miles before they empty into
the reservoirs. Nor does the size or quantity of water obviate
the danger.
On last Labor Day in a trip to the Pali, twenty-six people were




87
counted who had evidently been wandering in and over the catchment area of our water supply.
Remedy. We should demand, first, that the Nuuanu Road,
passing through the catchment area of our present supply, be
fenced on each side and that these fences be continued so as to
keep out of the drainage area stragglers, and that the catchment
areas of the remaining reservoirs also be fenced, or the reservoirs condemned and the use of water from them prohibited.
Second, the construction of concrete gutters along both sides
of the Nuuanu Road so as to carry all drainage from the road
area to a point below the catchment area is necessary.
Third, the watersheds should be constantly patrolled so as to
rigidly enforce the requirements of Section 1.
SECTION V.-WASTE.
While waste is not detrimental to our health conditions, yet
excessive extravagance restricts the funds available for other improvements.
A tropical city needs an abundance of water, but the quantity
we now use is beyond reason and serves to show that our taxpayers are content with an unnecessary expenditure of their
funds. This enormous waste is either in the distributing system,
in the plumbing fixtures, or in the irrigation of lawns, vegetables
or perhaps taro patches and rice fields.
Control of waste by inspection has been tried, but it is impossible with 78 miles to cover and, say, 25,000 taps or fixtures to
look after. The only practical way to check waste and accurately
measure its extent, or to ascertain its source, is by meters. Waste
is not always due to the consumer. Other cities upon adoption
of the meter system have found the waste in the system itself
sufficient to pay more than the interest on the capital necessary
to relay and repair. The saving and economy is surprising.
One illustration is the City of Kalamazoo, Michigan, where
the sewer system was overtaxed and about to be replaced with
larger mains, when the suggestion of meters was adopted, with
the result that at the end of ten years, with double the population,
the city was pumping 77,000,000 gallons less than the year before
meters were installed, while the old sewers had proven ample and
were still in use.




88


Our water consumption far exceeds that of most other known
communities, and the waste is not only in the cost of the water
but it is overtaxing our trunk lines of sewers and increasing the
cost of pumping sewage.
Remedy.   Water from deep artesian sources through bored
wells tightly cased to bottom is so much safer than any surface
water, that the Nuuanu supply should be used to furnish power
with which to pump the better water and to give fire protection.
Thus we should demand, first, that the supply of artesian and
pure spring water be developed, and, second, the expense of delivering the supply be reduced.
A tropical city, without the beneficent effects of frost and
spring floods, needs an abundant quantity of water, therefore the
comparison of water charges in mainland cities offers no
satisfactory criterion. We should insist upon cheap water, but
demand that our present waste be checked or paid for.
CHAPTER 8.-SEWAGE DISPOSAL.
SECTION I.-EARLY REFERENCE.
The first official mention for the need of a sewerage system
was by S. G. Wilder, President of the Board of Health, in his
report of 1880.* After urging the necessity for action, he gives
the report of Robert Stirling, an engineer, who recommended the
dry earth system.
The Legislature responded with an Act authorizing the Privy
Council to adopt a scheme for sewage disposal and gave the Minister of the Interior power to cause surveys and maps to be
made to open trenches in any public or private street for the purpose, the cost to be borne by the Public Treasury, and the Privy
Council to determine what portion, if any, of the cost should be
borne by the property owners.
In 1884, W. M. Gibson, President of the Board, stated "that
the weight of public opinion is against the pipe system," and he
recommended night service; however, in 1886 he referred to a
(* Page 33, see Act on Sewerage.)




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special report made by Major Bender to C. T. Gulick, Minister
of the Interior, which stated that "the necessity for some system
has long been recognized. If any assurance could be given to
show that the ground would not become saturated in consequence
of clogging, it might not be unwise to continue the present absorption system." He stated that "sewage cannot be safely used
in agriculture, that a system of earth closets here would be impossible, and that the final disposal must be the sea," and recommended, owing to excessive rainfall, sewerage pipes without surface drainage in them.
In 1886, W. E. Rowell, Superintendent of Public Works, in
his report to the Minister of the Interior, called attention to the
failure of Major Bender's plans to provide any scheme for the
disposition of the sewage, and that the maps are not in conformity with the plans as reported, and it would seem desirable that
a properly prepared scheme be elaborated with plans, specifications, estimates, reservoir, pumping plant and outfall," and he
requested an appropriation of $1,200.00 for this object.
In 1890, Dr. J. H. Kimball, as President of the Board, reported at length on the necessity for a sewerage system and aptly
denoted sewage "as matter in the wrong place." The subject
had been agitated in other quarters, for L. A. Thurston, Minister
of the Interior, stated in his report as follows: "The sewerage
of Honolulu has often been discussed and an appropriation made
by the last Legislature for plans and estimates, resulted in the
employment of G. F. Allardt, whose report was presented separately to the Legislature. He recommended a pipe system for the
sewerage question. In other countries the expense of the mains
and plant is borne by the city, while the cost of the branches and
connections is paid for pro rata by abutting property owners. If
this is done the cost will not be great, but it will need an Act to
Secure the contribution of property owners." Allardt's report
was a pamphlet of 23 pages, in which he described Honolulu as
"a city with 25,000 people, with extensive flats, and a mean rise
and fall of tide of 1.7 feet, with a harbor of sluggish water." He
stated that "no advantage of soil or climate will counteract or
render harmless the evil effects of an accumulation of sewage,
that experience shows to have a marked effect in assisting the
ravages of disease and death." He recommended water carriage




90


by small sewers without surface drainage, and selected an outfall
location about where it is at present. He proposed it should be
pumped out 2,000 feet from the shore line, and recommended the
using of water-power from a reservoir to be located on the slopes
of Punchbowl. He estimated the ultimate cost of the system he
proposed at $263,541, but believed the immediate necessities required attention of only the area from the junction of Nuuanu
and Pauoa down through the town. He called attention to the
fact that in California, the cost of sewers, except the mains, intercepting sewers and outfall "is assessed to the abutting property
owners and the street crossings adjusted to the adjacent quarter
blocks. Thus public money is required only for the frontage of
public property. The cost of the mains, etc., is easily raised by
special taxes on either the whole city or the drained area."
In 1892, T. H. Davies & Co. published a description of the
Shone System, which used compressed air and patent ejectorsan excellent system for low areas.
In 1895 came the first epidemic of cholera, with its 87 cases
and 64 deaths in two months. During this year a pamphlet appeared by "Pro Bono Publico" on "The Sewerage Question in
Honolulu." The author stated that "after our cholera experience, the sewage must not go into the sea, for in this case the
fish become polluted and black mudbanks will form along the
shore." He drew attention to the effects of the sewage of London emptied into the estuary of the Thames and being washed
up and down with the tides, and stated that "to empty the sewage
of Honolulu in this way is to bequeath to posterity a hotbed of
disease." He pointed out the imperative need of the speedy removal of sewage and suggested that "as dry earth absorbs and
prevents decomposition" therefore he recommended "dry pits
filled daily with dry dirt-nature's way."
In 1896, W. O. Smith, President of the Board, stated "that
there is as yet no sewerage system, but that F. S. Dodge has been
sent to America and Europe to study the subject and report."
This report was printed in the same year and in it Mr. Dodge
stated that "the sewage of Honolulu is no longer a question of
need but rather which system to adopt." He described many of
the systems in the cities visited by him and his conferences with
expert sanitary engineers. He recommended a separate system




91


discharging into the sea and stated that "it is the part of wisdom
to secure the best experts to draw plans and give estimates of
cost."  His suggestion was adopted, and Rudolph Hering, of
New York, a former associate of Col. Waring, was employed.
In 1897, Mr. Hering's plans were submitted with the printed
report. He estimated for a city of 50,000 people, with a density
of 80 per acre in the down town business portion, and 30 per acre
in the area extending to School Street and Kalakaua Avenue,
with about two-thirds of the remaining area at 30 per acre. He
believed that there was no question as to the advisability of a
separate system and quoted from A. B. Lyons some interesting
figures as to excessive rainfall.
Hering pointed out that our ships discharged into our harbor
all the sewage it could stand and contended that the best outfall
was east of the harbor at a depth of 100 feet. There the sewage
would never be noticed and the prevailing currents would take it
away from the Island, if as he pointed out it was screened at the
pumping station. He stated that "the amount of sewage is proportionate with the water supply" and he figured 60 gallons per
head per day and planned to have the pipes run half full and he
insisted that the work of construction must be carefully done, as
"it is imperative that the system be absolutely water-tight."  His
plans did not cover the swamp lands or certain low areas, which
he said "will need a separate system."
In 1898, W. O. Smith, President of the Board, reported that
"the great need of sewerage is being met and that the plans have
already arrived from New York and an appropriation has been
secured from the loan fund of $257,000."
In 1899, President Smith reported further that "the construction of sewers was commenced in April and is progressing rapidly."
SECTION II.-CONSTRUCTION.
The following table gives the lineal feet of sewers constructed
each year, including that done by private enterprise:
Year.                         No. of Feet Built.
1899                               61,023.5
1900                               75,627.9
1901                                4,582.8




92


1902                              12,735.2
1903                               2,316.5
1904                             46,796.8
1905........
1906                              6,874.9
1907                              7,911.0
1908                              4,589.0
1909                               2,501.0
1910                              7,192.6
Total..........................232,151.2
SECTION III.-PRESENT SYSTEM (MAP).
On September 9, 1911, our city sewage was collected from 2600
connections into 58 miles of pipe line, extending from Bingham
Street out on the plains along the foothills, across Nuuanu Valley
at Judd Street, along Asylum Road to King Street, and back
along King Street including the waterfront and business portion.
(See map.)
In this area there are, however, a few places too low for the
gravity service, such as Waikahalulu, part of Palama below Kukui
Street and at the junction of King and Liliha Streets, but all can
be connected to the new extension now being constructed, known
as the Waipilopilo extension, and should be forced to do so.
The cost of the system up to June 30, 1911, has been *$512,796.51, which does not include the amount contributed by firms
or individuals in extending the system.
The cost of operation for the year ending June 30, 1910, was
**$21,146.00.
The pumps are doing a service of from two to three times their
normal duty; in other words, the system is handling from 6,000,000 to 9,000,000 gallons of sewage a day. This is from about twothirds of our population, as the service does not extend to Waikiki, Kaimuki, Palolo, Manoa, the slopes of Punchbowl, Liliha extension, Alewa, upper Nuuanu, a part of Kapalama, and Kalihi
NOTE.-* Auditor's letter of December 14, 1911.
NOTE.-** Public Works Report for 1911, page 173.




93


flats, so that instead of 60 gallons daily for 50,000 people, as figured by Rudolph Hering, the amount is nearer 200 gallons for
each individual, and if meters were put in it would easily be cut
in half.
The outfall leak is caused by the washing away in some storm
of two sections of the pipe shortly after construction.
This occurred in about 18 feet of water and the sections can
be seen lying near by on the bottom. Thus the whole city's sewage rises just where the rollers break and it is easily located by
its color and the swarms of jumping fish that surround the spot.
More need not be said.
As a result of our survey we find there are over 2,263 cesspools
still being used, the contents of which are seeping into and contaminating the surface water and soil, and there are in addition
over 2,403 privy vaults, or a total of 4,666 sources of danger, the
contents of which should be disposed of in some better way, if we
are to keep the ground under us free from danger.
The way these are grouped proves interesting. Take the flat,
usually wet, area beginning at the sea, up Sheridan Street to
King, out King to beyond Alexander, up to Beretania and out to
the Moiliili Church, thence across the rice fields to the Seaside
Hotel, and we find 304 cesspools with 259 privy vaults.
In addition to the area above, from Piikoi Street along the
foothills, across Oahu College pastures, intersecting Metcalf,
thence down to King and back to Piikoi, an area including our
best residences, we find 151 cesspools, also 65 privy vaults.
Districts not yet completely sewered can be excused, but right
in the city's heart, that is from the sea up to Punchbowl Street
to Vineyard, thence to Liliha down and along King Street to the
sea at the River Street bridge, there are still in use 17 cesspools,
and 22 privy vaults; of these 13 cesspools and 14 privy vaults are
found to be in the low level rectangle bounded by Fort, Liliha,
Vineyard and Beretania Streets.
Down in Kakaako, below Queen Street, there are 51 cesspools
and 38 privy vaults.
SECTION IV.-DEFECTS AND REMEDIES.
Rudolph Hering in his report stated that the "volume of sewage depended upon the consumption of water" and warned us that




94


it was essential to have our system built water-tight, which it is
thought was done.
It appears, however, with only about two-thirds of our people
served, the system is over-taxed. In rainy weather, it is reported
that the pumps show a daily discharge as high as 9,000,000 gallons
a day in place of 3,000,000, or a slight error in computation of
6,000,000 gallons by the designer.
The King Street main is on occasion so overloaded that to prevent its overflowing fixtures in private houses there has been an
opening made so that when over-taxed the surplus sewage empties
into Nuuanu Stream at River Street. The King Street trunk
was a mistake and exhibited an utter disregard for the contours
of the city.
In the expenditure of the present Loan Fund Appropriation, it
has been found necessary to build another large trunk sewer along
the waterfront from King and River to Queen and Nuuanu; this,
however, will take care of all that district north of King Street
between Liliha Street and Houghtailing Road, and between Liliha,
River and Judd Streets and all the districts south of King Street
between the Kamehameha Girls School and the Prison road, including the Canneries and Iwilei.
If the present waste of water can be stopped and property owners are forced to comply with the law regarding sewer connections, the sewage flow will probably not be over 50 per cent of that
shown at present. If additional and sufficient surface drainage is
provided, there will be no overloading during rainy weather, as
it is thought that the only surface water that enters the sewers
goes through manholes when the streets are flooded.
The conduit system, as far as it has been constructed (including
that now under construction) is adequate for all present or probable demands for the next twenty-five years, except the Kalihi outfall, which is undoubtedly a greater danger than the pump outfall,
as this accumulation has no waves to break it up and no current
to carry it away, and should be extended across the Kalihi Bay
to deep sea water. The pumping plant has been added to, and
kept going from scanty appropriations. The original design was
faulty and inadequate if we require the extensive plant now in use.
The station should be extended and proper and sufficient plant
installed to take care of the present flow, mechanical screens




95


should be installed with proper appliances for their control; with
this, some mechanical method of removing the materials retained
on the screens.
If this is done and the water meters installed, it is believed the
area intended to be accommodated by the present trunks will prove
sufficient for the next twenty-five years, but the laterals should
be extended to take in every piece of property in the district included for these trunk lines. The Manoa, Palolo and Kaimuki
sections should be sewered at once and connected to a pumping
station near Fort De Russy.
A pumping station should also be built at Kalihi, the main extended across the bay and the system extended to take in every
lot in the district.
It is difficult to imagine greater folly than to collect all the
sewage, excrementitious, or human refuse, and other waste matter necessary to human habitation of this city and dump it on the
reef in close proximity to the harbor entrance. The discharge
sewer from the pumps has been broken and rolled out of position
and all of the sewage is discharged on the reef in approximately
18 feet of water, where the waves break and drive it back towards the harbor entrance and along the shore to Waikiki; and
where it undoubtedly infects the harbor and shore line and will
eventually form banks of black, infected mud, as was the case in
the estuary of the Thames due to London's sewage thus neglected.
It is not possible to state when this break occurred, but it was
undoubtedly shortly after its construction. No sea food taken
within reach of this pollution can be used for food without great
danger, nor is it safe to wade or bathe in its pollution, and the
distance it travels is indeterminate.
Perhaps some one can explain why this condition has been permitted to continue. We are unable to ascertain. The only possible excuse for its existence and continuation is probably lack
of information as to the danger therein, and brands the community as one willing to tolerate such nuisances and content to permit false impressions.
The manhole covers were perforated and dust pans provided
according to the very best practice and in no case should covers
be plugged. The pans should be inspected and emptied at regular
intervals, and after each rain they should be emptied of water and.




96


if oiled, it should be done with a light petroleum and never a
heavy or crude oil, as it finds its way into the pipes and sewers
and is most dangerous in forming a stoppage.
Grease traps are a necessary adjunct to any properly designed
sewer to prevent grease entering the sewers.
Rudoplh Hering, the expert employed to design the sewer system, stated that "the only proper method and least expensive one
for the disposing of the sewage of Honolulu is by a discharge into
the ocean at such a point, and under such conditions that a thorough dilution may be obtained." He said: "All of the sewage
should be screened before it is discharged so there will be no
floating matter left to drift about on the surface of the ocean. Any
floating matter carried in the sewage should be retained by
double screens before it reaches the pumps, and may be removed
as it becomes necessary. Any fine, solid particles passing the
screens will be further commuted in passing through the pumps
and will be discharged at the outfall in a condition to prevent their
rising to the surface through 100 feet of water.  The bottom
of the ocean at the proposed point of discharge slopes downward
to a great depth.  There is no question but that all the sewage
so discharged will disappear."
Now, handling so large a quantity, we ignore the advice given
and the screens are not in use. The reason given is that there was
too much screening to handle. We recommend that screening be
continued unless the outfall is repaired so as to discharge into
100 feet of water; in which event, unless serious nuisances occur
it would seem that the system would be practical and efficient.
CHAPTER 9.-DRAINAGE (MAP).
SECTION I.-EARLY EFFORTS.
In the Session laws of 1876 there is an Act permitting those
who desire to drain wet lands and find it necessary to cross other
land, to do so by petition to any Circuit Court Judge, praying for
right-of-way. The delays and technicalities of the law were evidently cumbersome even at that time, for in 1882, Agent J. H.




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97
Brown stated "that the Board of Health should have the power
to cut drains across property to drain off pols of stagnant water,
whicl can be gotten rid of in no other way." Next in 1888, Dr.
Emerson, President of the Board of THealth, said  "There are
places with stagnant water within the town limoits which shoul be
filled. Most of thetI belong to people too poor to fill them and
the lots are not worth the outlay, blt some action slhotll be taken
to stop these nuisances.t
WATEBR rCLOSET BTiEr   Two TmARO PATCiHES
In 1890 reports show that a large coral stone drain was built
by H. F. Ilebbard, Road Supervisor, carrying the surfae water
ditches vere built aroiun l the entire base of Punuuchbowl to M14akiki
gulch drilaining the tolp and interior of Pmmuuchbowl, and twio new
drlainage iditches were openeld on the plains froni Kinug Street to
makai.
That due conidieration to the large rainfall in brief periods was
not given is billstrated by the annonnceient of W. E, Rowell that
"both Punehiowl an  Makiki ditches roke and overfloved tdint
ing 1890 and again in 18"
Cll c~.:  G 0:tlf~irbs>;  Ji 119.~r: -gl;ll~?  ~~;(~~""~::0      ~ 'i-,-;:81-rc-t.Bi~r-;~~~s~l~~~Ir ~~t"   g~  ~ "~~d  It,joS~ _~~ttr~3~c-v d rZ '~ Liji '1~~ll I020le 01f~ 0,J:)fl3c~@  C '.   0




98


In 1896, C. B. Reynolds reported to W. O. Smith, President of
the Board of Health, "that, due to cholera, much has been done to
improve conditions, the straightening of Nuuanu Stream, the reclamation of swamps at Leleo and the removal of wash-houses."
This year an Act was passed to provide for improvement of land
in Honolulu deleterious to public health, and for the creation and
foreclosure of liens to secure the payment of the expense incurred.
This gave a long and technical method by which the health authorities in their discretion could begin proceedings by notice to
the Minister of the Interior, "who is to serve the owner of the
property with notice and grant time in which to make improvements." There is right to appeal to a board of three citizens, who
as experts pass on the action of the health authorities.  All liens
are good for only three years;
In 1897 the report of Rudolph Hering, civil engineer, on plans
for a sewer system for the first time forcibly brought to public attention the necessity of drains for surface and storm water; not
only because of the unsanitary conditions they created, but also
because of the damage to streets. Hering, in his report, states
"that from four valleys the surface water naturally flows to the
sea. In each the quantity will be too great to allow it to flow on
the streets, therefore provision should be made for underground
channels." He then recommended four additional drains in town
to provide for the surface water, "these should be built to the sea,
with walled sides and paved bottoms."  He thought the less
densely populated portions of the city could be left without objection for some time. He stated "that the velocity desirable in
drains, when run half full, is at four feet per second, so as to be
self-cleansing. Drains should be circular in shape with smooth
interiors and regular curved sides." This resulted in more culverts of a permanent nature.
In 1901, Marston Campbell, Road Supervisor for Honolulu,
called attention to the neglect of storm water drainage. "There
being but few small drains and catchment-basins where there is
a congestion of water. In no case are these adequate. In stormy
weather the streets are impassable. The growth of the city lessens
the absorbent area and turning additional roof water into the
streets increases the difficulty." He, however, told of the con



99


struction of Kukui storm drain and of similar work progressing
in Fort Street and one in Alakea Street.
In 1902, C. B. Dwight, Road Supervisor, showed that culverts,
drains and catch-basins had become recognized necessities, and
about this time was the first mention of the home manufacture
of cement drains.
In 1904, the Makiki ditch walls were built in concrete, and the
report of 1905 showed construction of storm sewers down Victoria Street from Kinau to Spencer, making a total of 19,804
lineal feet of storm drains in operation. In July the counties took
over the street work, although the Territory completed from the
loan fund the Liliha Street drain in 1906.
In 1911 the Unsanitary Land Act of 1896 was considerably
amended. It was made to apply to the whole Territory. The time
allowed in which to begin improvements was reduced to twenty
days and in many ways it was patched up and improved. It still
provides for a board of three citizens to pass on and determine if
the land is really deleterious to public health, making them experts
superior to the health authorities. The law is long and technical
and it remains to be tested in the Courts, and to be tried by able
lawyers.
SECTION II.-RAINFALL.
To illustrate the excessive rainfall in short intervals and the
necessity for large surface drains, we cannot do better than republish the following letter:
Government Survey,
Honolulu, T. H.,
June 24, 1897.
Mr. F. S. Dodge,
Hawaiian Government Survey,
Dear Sir:-From the official records of the Weather Bureau, I cull
the following examples of flooding rains in Honolulu:
In February, 1893, there fell on the 2d, 2.30 inches; on the 3d, 5.16
inches (within about eleven hours); on the 5th, 1.35 inches; on the
6th, 1.90 inches; in nine consecutive days ending February 10th, nearly
14 inches.
In November, 1893, there fell on the 19th and 20th, 5.66 inches of
rain, falling in two principal showers, at the rate of nearly an inch
an hour.
On the evening of May 3d, 1892, there was a thunder shower with
a rainfall of 4.35 inches, nearly all of it in less than two hours' time.
Water in the principal streets of Honolulu was 6 inches deep where
there was not a heavy grade. This is the heaviest rain I myself have
seen in Honolulu in recent years.




100


I remember one, many years ago when no records were kept, in
which there must have been a rainfall of more than 10 inches, much of
it at the rate of 1 to 2 inches an hour.
On May 10, 1885, there was a rainfall record 'of 10 inches of rain;
time occupied in falling not stated. In the heavy rain of December 30
and 31, 1896, the total rainfall in 24 hours was between 6 and 7 inches,
of which 3.50 inches fell in nine consecutive hours, and after an interval
of ten or twelve hours there was a downpour of about 1.25 inches in
less than 40 minutes.
In the heavy rains it may be stated that a rainfall for several
consecutive hours of half an inch an hour is common; 1 inch per hour
is less frequent, but may be expected, perhaps, once a year. Rains at
the rate of 2 inches per hour are not exceptional, but occur as often
as once in ten years, perhaps, generally lasting, however, less than an
hour, but frequently preceded and followed by rain at a more ordinary
rate.
Yours very truly,
(Signed)   A. B. LYONS.
Since 1897 the records show the greatest recorded rainfall in
any one day in Honolulu to have been on March 16, 1908, when
5.04 inches were measured by the Hawaiian Section of the Federal
Weather Bureau under Wm. B. Stockman.
Taking the maximum daily rainfall each year from 1877 to
1884, the average is nearly 4 inches.
SECTION III.-NATURAL.
The District of Honolulu is located on the southern end of the
Island of Oahu, occupying the entire space between the main ridge
of mountains and the sea, beginning with the ridge between
Moanalua and Kalihi Valleys and ending in the southerly direction at the boundary of Maunalua not far from where the main
ridge ends at the sea.
It contains some 44,000 acres out of 384,000, or a little over
one-eighth of the Island.
The northeast boundary is the summit of the main range varying in altitude up to 3,000 feet, cut with many ravines and valleys,
five of which have running streams of water. Within the area
are two hills (extinct craters) one at the sea's edge projecting the
coast line into the sea and rising 760 feet, the well-known point
of Diamond Head. The other, Punchbowl, of about 500 feet elevation, is at the base of the foothills, a little to the left of the center of the whole area.
The five main valleys with running streams are: Kalihi, Nuuanu, Pauoa, Manoa and Palolo.




101


Kalihi is not yet sufficiently populated to consider surface
drainage except along the main thoroughfare of King Street.
Between Kalihi and Nuuanu towards the sea is a wide area of
flats, which are drained by the Kapalama Stream rising in an enclosed spring at the upper end of the Rice Mill Road.
Nuuanu Stream has two branches which join above Schooi
Street and below Kuakini, the north branch rising just above the
Country Club, and the east or main branch starting at the big
new storage reservoir above Luakaha. The Pauoa Stream flows
into Nuuanu Stream below Kukui, thus the Nuuanu outlet drains
the areas of Pauoa and Nuuanu Valleys, and the westerly slopes
of Punchbowl. It takes but little of the central portion of the city
because of the rise or old reef near Kukui Street. Roughly speaking, it drains the town area, below the valleys, bounded by Liliha
Street on one side and on the other by Emma, Vineyard, Fort and
Beretania Streets.
Manoa Stream, after draining its valley, crosses Waialae Road
and spreads out in the flat beyond the old Moiliili church, where
it supplies part of the water for the rice and taro fields below.
Palolo, after draining its valley, turns abruptly towards the city
and crosses the Waialae Road in the same flat near the Manoa
Stream, mingling its water in the vast flat enclosed by the slope of
Diamond Head, the slopes of Punchbowl, the foothills of Makiki,
Manoa and Palolo, the higher portions of which have been built
upon and form some of our choicest residence districts of the city,
the lower portion of which are still swamps and compose Kewalo,
Kalia and Waikiki districts.
The swamps back of Waikiki are drained by five openings to
the sea, two at the entrance to Kapiolani Park, one at the Moana
Hotel, and two at old Waikiki. The one at the Japanese Club is
connected with that of the Piiniao Stream in Kalia.
There are accordingly eight natural drains into the sea-the
five at Waikiki, Nuuanu into the harbor, Kapalama and Kalihi
Streams.
SECTION IV.-ARTIFICIAL.
The necessity of protecting city streets from the storm water
that flowed off the slopes of Punchbowl, caused the first extensive
attempt to direct or control the waste storm water.




102


From Prospect Street westerly a ditch, enclosing nearly half tle
hill, carries the water to Pauoa Stream. The top and easterly
slopes of Punchbowl, naturally drained by gulches towards the
sea and across the plains, are now artificially drained, their water
being diverted across into Makiki gulch, and crossing Wilder
Avenue, Beretania and King Streets, flow along Kalakaua a short
distance, emptying into the swamps at Pawaa, Waikiki. Formerly
this Makiki water crossed the Waikiki Road and ran more directly to the sea; since this addition there has not been any attempt made to free the Waikiki swamps of this water or that of
Palolo and Manoa.  Heretofore the swamp has been used for
rice culture and the area of wet land increased whenever possible.
Waikiki residences have built up a high barrier between the
swamp ponds and the sea, and some of the old outlets have been
closed up. The grades of Kalakaua Avenue and the old Waikiki
Road have been raised and additional culverts put in across it, as
the backing up of the storm water indicated the necessity of so
doing.
Sheridan and Ward Avenues both have open, walled ditches
that drain a large area of the old plains.
Upper Liliha Street has two ditches to carry off the water that
drains towards the street from each side; they join at above Vineyard, cross a block and Kukui Street, then flow through the center of the next block, crossing Beretania Street into the middle of
the triangular block above the depot, and stand there overflowing
into a closed drain along King Street into Nuuanu Stream.
Lower Liliha Street has been considerably raised and the side
away from town has a drain that catches the overflow from the
taro patches at Parker Lane, near Vineyard Street, takes also the
water from Kanoa Road, crosses King Street just beyond Liliha,
empties into the ponds ard swamps below, and fines an outlet
along the railroad track into the sea beyond Iwilei.
With these main ditches there are a large number of street culverts and drains caring for the water that congests, during the
rains, throughout the city, and discharging it into the natural
streams and dry gulches or into the sea or harbor.




103


SECTION V.-SWAMPS.
In the District of Honolulu the low lands along the sea from
one end to the other, a distance of six miles, are mostly composed
of alluvial deposits from water erosion gradually having filled in
the area enclosed by the reef, thus making along the waterfront
a series of swamps extending inland, wherever the surface is sufficiently low in level.
Thus we have Kalihi swamps, salt flats and shallows, with a
considerable area under water at high tide. Then come the Kapalama swamps from Kalihi to Iwilei, the latter being a remnant of
an old reef, punctured by Nuuanu Stream, but continuing through
the town across to Kukui and Fort Streets. The easterly side of
the harbor was once a swamp called Waikahalulu flats, which
were filled in the early 80's from Queen Street down, composing
what was called for so long the esplanade and now forms our
main steamer and naval docks.
Kakaako has gradually been filled and drained, but much still
is below the level. Kewalo, where it emerges into Kakaako, presents a swamp district of grave importance, for being nearest the
city it has been built upon and occupied by the working people.
The ponds just below King Street beyond Alapai have been infected with cholera.
Beyond Kewalo lower Kalia forms a large swamp of waste
area, while Waikiki swamp spreads for miles below Kalakaua
Avenue and above, off to the flats where Palolo and Manoa
Streams unite.
To all these natural swamps have been added areas where wet
agriculture has been practiced, until today it is difficult to define
the area which forms the natural swamps, nor can the source of
the water in the swamps be definitely determined without proper
surveys and measurements. Certain springs are known, but by
far the greater volume of water comes from the valleys and artesian wells.
The total area of wet land, excluding the valleys, is one-third
the area below the foot-hills.




104


SECTION VI.-NEED OF PLANS.
A glance at the map and a study of our present surface drainage
shows how little attention has been paid to the proper disposal of
storm water, and where any improvements have been made they
were prompted by the immediate need and executed without due
regard to the immense rainfall or any comprehensive plan, owing
to lack of sufficient money. A method that is always certain to
cost a far greater sum than is necessary, requiring changes and
enlargements that could be avoided and saved, if money were
available for plans and studies, and each portion was built as a
part of a definite plan.
The carrying of surface water off Punchbowl by intercepting
ditches along the foot-hills into Makiki gulch takes an immense
quantity unnecessarily and unwisely into Waikiki swamp above
Kalakaua Avenue. This should be diverted directly into the sea.
The closing of the old outlets into the sea at Waikiki and the partial filling back the storm water up and force it to find new
channels at the point of discharge.
On our map the City and County Engineer, G. H. Gere, has
made some valuable suggestions of drains that should be built at
once, in order to prevent the necessity of filling of low lands and
in order to dispose of storm water after any filling is done.
SECTION VII.-WET LANDS.
Heretofore wet agriculture has extended in every direction, reclaiming wet swamp areas and absorbing flats which could be
irrigated by gravity or from artesian wells, wherever a profitable
crop of rice, taro, or lotus could be grown. The area occupied
has only been reduced as parts of it became more valuable for
other purposes.
The cause of change in economic value is sometimes due to the
fall in value of crops, increased cost of labor, or the enhanced
value of surrounding lands for dwelling or other purposes.
The increasing knowledge of the immense loss due to mosquitoes is now putting wet agriculture to a still more severe test, and
we are beginning to inquire if against the value of crops should
not be set the loss due to mosquitoes, and the easy spread of contagion.




105


Another serious defect in our method of wet agriculture within
the city limits, is that we permit dwellings to be used, which are
surrounded with standing surface water, without provision for
proper sewage disposal, thus enhancing the danger of water infection, and the possibilities of typhoid and cholera.
We believe the wet land problem presents a serious and difficult question, the economic aspect of which cannot be ignored.
We are unanimous in the opinion that wet agriculture in the city
limits should be stopped. One plan is to select an area surrounding the center of the city in which the raising of crops on wet
land or in water shall be prohibited, and gradually extending this
limit. Within the area put many stricter regulations in force,
making it more metropolitan in character, and giving free garbage service, and increasing the value of the land for dwelling
purposes by cutting new streets, providing better access, better
fire protection, water, and sewer service.
Another plan is to permit the owner or taxpayer to elect how
he wishes to use or classify his land for the ensuing year in his
returns to the tax office. Then prevent the occupation of houses
or groups of dwellings that are immediately surrounded by wet
agriculture, so that no dwelling can be occupied that is within a
given distance of wet agriculture, and that all dwellings must be
located on land above a certain level, fronting on some street or
alley owned and cared for by the municipality, and thus reduce
the danger from infection by surface water.
If a citizen dries up his wet land and makes it available for city
use and concludes to wait for a tenant or a purchaser, should he,
in all fairness, be kept in competition with the owner who still
continues to secure a small return from wet agriculture?
One thing is certain, that we can best abolish wet agriculture
in the city limits by making the land so used too valuable for such
purposes. Money expended along such lines will often be of
double value, as it will accomplish this object and furnish needed
improvements. The land suitable for other purposes will be withdrawn from wet agriculture and the area gradually reduced.
Meanwhile certain swamps and low lands must be filled in order
to protect our public health. Thus there will be a supply in excess
of demand of land for dwellings, and the prohibition of dwellings
on certain unsuitable low lands will not therefore work a hardship.




CHiAPTER 10.-GARBAGE.
SECrTION I.-OUR PAST.
A study of the Board of Health reports show that the credit for
tle first attempt to   remove re e and waste belongs to J. MottSmith, father of the present Secretary of the Territory.
WAq'FP ILOOT IN V           iGETABLE G AbITT& RA"-Y POgR M~ARKT
SKING IN DITCH-jWATE6. PASI11G CLOSE   T
In the Bord of Hjlth          e oft of 1878, Pr i nt Mott-Smith
stated "that a.system of street cleaning has een nder way since
July Ist, at a cost of $8625 for one wagio    iuring the six
nionths."
In 1880, S. G. Wiler. President of the Board stated "that
street cniig in   oi       bean Jly 1 1878. It at frt c   red
only the street area, am1 now inclides the refuse from residences."
He reported a cost of $2,261.9 for two years
In 184 President W. MG. M isn e       fr  tt leaning
inclding garbage, for two years at a cost of $6,861
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107


In 1886 he deemed it advisable and transferred the control to
the Department of the Interior of which he became the head.
In 1888, Dr. J. M. Kimlball, President, stated that "the pay sysm is unsatisfactory, as many householders prefer the risk rather
than to pay the fifty cents per month charge, with the result that
the community suffers and filth accumulates in out of the way
corners only to be found when intolerable. ' He thought garbage
collection should be under the Board of Health; that its removal
was absolutely essential to preserve public health, and that the
expense should be borne by all in proportion to their ability to pay
-xes. Dr. Kimball was the first man to suggest a furnace for
the disposal of combustible waste.
The Interior Department reports make no mention of the garbage collection, but in 1880 they show that two four-wheeled
wagons were in operation for removing street sweepings, indicating that the city was not kept free from waste except the streets
only.
In 1892, President David Dayton of the Board of Health, stated
"that the free collection of garbage (city waste) under the IBoard
of Health began January 1, 1891; during the fifteen months to
April 1, 1892, 3,877 loads or 9,620 cu. yds. were removed."
In 1894, W. O. Smith, President of the Board, received a report from Agent Reynolds, stating, "that the free garbage and
excavator work is excellent, that previous to 1892 garbage was,remated at the works of A. F. Cooke, that since then it has been
dumped in Kalia," and he recommended that it be covered with
earth. Street cleaning for this period is not mentioned by the
Minister of the Interior.
In 1896, Agent C. B. Reynolds reported to the President of the
Board, that the cleaning of streets had been sadly neglected
although some sweeping had been done. No records are given
of the amount of waste handled, but the report states that "the
cost of the garbage and excavator service from April 1, 1894, to
December 31, 1895, twenty-one months, is $9,440.78."
In 1898, W. 0. Smith, still President of the Board of Health,
reported that the work of removing waste was progressing at a
cost for two years of $15,025.28.
In 1900, Dr. C. B. Wood, as President of the Board, first sug.




108


gested that a garbage incinerator was necessary and that the
dumping of garbage in Kewalo was vicious. Marston Campbell,
the Road Supervisor under J. A. McCandless, Superintendent of
Public Works, reported 18,504 cu. yds. of debris removed from
the street area during the year of 1900 at a cost of $8,000, this
in addition to the garbage and excavator service.
In 1901, Dr. J. H. Raymond, President of the Board of Health,
showed that 1,139 loads of garbage were removed and burned
during November and December of 1900, and yet that the free
service was unable to keep up to the demand. He placed the cost
of garbage and excavator work during 1900 at $33,302.70 and
recommended that the work be let out by contract. During this
year the Council of State made an appropriation of $20,000 for
a garbage crematory. Superintendent of Public Works, J. A.
McCandless, contracted for a Thackery Incinerator erected for
$19,595, but the proposed site being objected to, the contract was
cancelled, and $16,844.59 was paid for material, leaving a balance
of $3,155.40 which was used for the increased cost of a foundation on the finally selected site below the sewer pumps. In July,
1901, the garbage and excavator service was again transferred
from the Health to the Public Works Department.
In 1902, Sam Johnson reported to J. H. Boyd, Superintendent
of Public Works, that the garbage and excavator service heretofore covered the area within School to Emma, and Alapai to River
Street, and that neither the ashes nor the manure was removed,
that he had added five double wagons, divided the town into districts, made certain men responsible for each portion, extended
the area so as to include from Punahou Street to the Pacific Fertilizer Works and as far mauka as Judd Street, removing all
refuse offered; that on October 1, 1901, a schedule of charges was
established, and the system changed from a free back to the payment plan. Johnson reported 9,210 loads, or 23,025 cu. yds. of
garbage collected; 2,352 cesspools cleaned, and 7,183,764 gallons
of sewage removed during the year ending June 30, 1902, at a
gross expenditure of $43,563.41, which, less the sum of $13,373.90
collected as fees, made the net cost of $30,189.51.
In 1903, Johnson reported the extension of the area served west




109
of Punahou Street and that 11,400 loads or 23,500 cu. yds. of garbage had been collected.
In 1904, provision was made for daily visits within the area
bounded by the Pacific Fertilizer Works, the McCully Tract, Judd
Street and the waterfront. The charges of October 1, 1901, were
readjusted, and 12,358 loads, or 30,895 cu. yds. of refuse were
collected. Johnson's report shows that burning on the dumps on
the Beach Road and in Iwilei had been carried on; that the excavators discharged at the Sewer Pumping Station, and that there
was no towing of scows to sea, the market waste being burned in
a temporary furnace.
On March 1, 1905, the garbage incinerator was completed at a
total cost of $26,564.88 and put into operation. Johnson reported
for the year ending June 30, 1905, 13,371 loads or 33,427 cu. yds.
of waste removed, and that four months' operation of the Thackery Incinerator cost $1,605.66.
SECTION II.-COST OF MANAGEMENT.
On July 1, 1905, the County took charge. Since then there are
no reports on the amount of work or waste collected, but the cost
is given by Auditor Bicknell, as follows:
1905-Expenses (6 months).............. $11,040.34
Received.........................  4,701.96
Net  Cost...................... $  6,338.39
1906 —Expenses........................ $23,569.98
Received.........................  8,874.70
Net  Cost...................... $14,695.28
1907-Expenses........................ $18,708,42
Received.........................  10,294.20
Net  Cost......................  $  7,414.22
1908-Expenses........................ $16,489.92
Received.........................  11,636.05


$ 5,8-53.87


Net Cost......................




110


1909-Expenses........................ $16,081.70
Received.........................  13,254.75
Net  Cost...................... $  2,826.75
1910-Expenses........................ $15,642.60
Received........................  13,558.35
Net  Cost...................... $  2,084.25
SECTION III.-PRESENT SYSTEM.
The area now served by the garbage system by districts and
amount of service is as follows:
No. 1. From the fertilizer works on King Street, up Liliha to
Wyllie Street, including Iwilei and all the section below School
Street up to River Street, service twice a week with one double
wagon.
No. 2. From Wyllie on Nuuanu to Beretania, from the stream
to Punchbowl, including Pauoa Road and down Alakea, along
King, and up Punchbowl, service twice a week with two double
wagons.
No. 3. From Prospect Street down Hackfield, out Lunalilo,
including all the area above on both sides of Wilder Avenue beyond Punahou to Metcalf as far down as King, and up Punahou
Street, with three double wagons, giving all portions service twice
a week and some portions three times.
No. 4. Along Kinau, Beretania, Young and King Streets, from
Punahou Street to Kewalo and Kakaako, service twice a week
with four double wagons.
No. 5. The central portions of the city comprising the waterfront, River, Beretania and Alakea Streets, daily service with five
double wagons.
No. 6. Upper Manoa and the slopes of Punchbowl along Luso
Street, service three times a week with six single drays.
Making a total area of approximately 3,000 acres.
The service aims to remove as regularly as possible with the
limited equipment all refuse set out for collection by regular subscribers. The charges range from 35c to $7 per month.
The equipment consists of thirteen mules and one horse, seven




4'


111
wagons, one buggy, four excavator carts and five pumps, harness,
etc., valued at about $3,065.
SECTION IV.-COLLECTION.
Mr. Charles Egerton, President of the Sanitary Product Company, which purchases the refuse of some of our largest cities,
says that "the disposal of waste and refuse of a city of only 50,000
people is difficult, because experience shows that it is only with
cities of over twice that number that the value of the material approaches the cost of disposal, not to mention its collection." He
claims the material must be divided into three parts; 1st, food
waste; 2d, combustible waste; 3d, non-combustible waste.
Our record in handling the waste of Honolulu shows that we
began in 1878 with a free service, and at the end of nine years
changed to a pay service. Seven years thereafter the conditions
had become intolerable and we returned to a free service under
the Board of Health.
Within the next ten years the service became too extravagant,
and it was passed over to the Public Works Department, under
which in 1901 it became a pay service which has lasted to date.
During the periods of pay service there has been much complaint. The experience of other cities shows conclusively that a
pay service is never effective, for many individuals prefer the risk
and danger of infection, rather than pay the charges, no matter
how small or reasonable. The waste material is then hidden or
deposited in the nearest vacant space. It accumulates until it
can no longer be concealed, or, if food waste, it decomposes and
becomes a public nuisance. Finally the Board of Health or some
civic organization undertakes a special campaign to remedy the
disgraceful condition, and thus certain citizens succeed in having their waste disposed of without cost to themselves. The burden is therefore not as evenly or equitably distributed under a
pay system as if the whole cost were a public charge-where each
pays in proportion to his ability.
The work of the Central Improvement Committee on "clean-up
day" illustrates the inevitable results of a pay system. We quote
from the report: "Almost every district leader has taken occasion to recommend in his report a free garbage collection service




112


as the only remedy to the disgraceful and disgusting conditions
found on June 24th last."
A free system is the only way to keep the city clean, to reduce
the danger of infection, to keep down the number of rat harbors,
and to remove the old cans, bottles, and containers likely to hold
water and then breed mosquitoes. To quote again from the report on "clean-up day": "From our experience there seems to
be a real desire and willingness on the part of the majority, regardless of race or condition, to live decently and it is the duty
of the community to remove, in just so far as possible, all excuse
for not so living."
We are unable to compare the cost per unit with the past or
with that of other cities, as there are no published statements giving the volume collected. A letter from the County Supervisor in
charge of service shows that 4,065 cu. yds. were collected in November under the stimulus of the mosquito campaign, but an
average for a year is needed on which to base any judgment.
Elsewhere garbage is usually measured by weight rather than
by cubic yards, for a wagon load of two yards may mean much
or little. In 1901 the army authorities removed 6,852 tons of
house refuse alone in Havana, street sweepings being kept apart.
The general average of waste material for all American cities
is stated to be about half a pound per citizen per (ay when the
collection is constant and effective.
SECTION V.-DIISPOSAL.
The disposal of waste in Honolulu has usually been simply to
dump it on the nearest, most convenient low ground, and there
let it decay and rot, only occasionally attempting to burn it.
The dump heap has always been the best rat-harbor, the rat
catchers taking as many as thirty in a single night.
During four months of 1905 the garbage incinerator was operated, but it was closed down as soon as the municipality took
charge because of the expense. Now, however, it has again been
put into operation, and we hope its use will be continued until
sufficient time has elapsed to give it a fair test. Incineration is the
best and cheapest method of disposing of garbage, although selfdumping scows are used in some seaports.




113
O)in November 29, 1911, at the request of tlhis C6tomsission for
his opinion of the best method of disposalof the city's waste, Dr.
Rupert Blue said:   "Your Commission should recommend the
Meldrum l)estructor System to be used in conu.ection with the
munlicipal free collection of all refuse. All garbage must be
separated-the combustible from the non-comlbustible and all contaimers used for swill or food refuse should be sold by the municipality at cost in order to have theill water, rat and fly proof."
SINmK  RAIN FR)M Rm 0M i F  IN i AoVFE m ENECENT  ISCiHARES INT}
IT   EAM m JDEg PLATIFORM  X X 
Block just maaka of 0.. & LJ dept
This statemnemt led to an i  nivestigatio i of the Melflruil Destructor ad we fotmimd that disagreemenlt between aulthirities creates
some doubt respecting the value of the various typtes of furiaces.
The followinige are the most geleeral inll lse
CREMAT)RY-lIs a futrnace for buritimig garbage amil refuse,
mixed, buit withlout ashes or noncomlbustiblle wiaste
INCINERATOR -Is a furnace ofly for refuse and waste that
is combistible.




114


DESTRU CTOR-Is a furnace that destroys all classes of
waste together or in unsorted condition.
The use of destructors is not common in the United States.
They are designed to maintain a uniform high temperature, and
a utilization of the waste gases for some other practical purpose.
They are of two types, cell destructors or separate burning chambers, and the continuous grate furnaces with burning-chamber
common to all the grates. The Meldrum is an example of this
latter class. In this furnace there is one long chamber common
to all the grates, but divided so that each grate has its own ashpit
and forced air supply, thus each grate and pit may be operated as
a single unit.  The charging is done periodically, so that when
green material is put on one grate the others supply the necessary
heat at once to immediately destroy the gases and smoke thrown
off by this fresh charge. There are other peculiarities about the
Meldrum that make it more useful-such as the use of a steam
jet and exhaust heat for the boiler.
We append a table showing the number of each of the seven
prominent kinds of destructors in use and the application of the
heat to various purposes.
Some of the recent and more notable American installations of
the Meldrum Destructors are as follows:
1906 Westmount, near Montreal, P. Q., successful and satisfactory.
1907 Seattle, Washington, satisfactory, net cost 28c per ton.
1908 Schenectady, N. Y., satisfactory.
SECTION VI. —STREET SWE'EIPIN(G.
The destruction of the city's own waste from its streets is as
important as that of the disposal of individual waste or refuse, and
carries with it the responsibility which a municipality should evidence as an example to its citizens.
As H-onolulu's population increases the necessity for better
street cleaning and sweeping will become more important, and the
proper disposal of such waste a more serious question.
These problems are of grave importance for the dust of our
streets causes diseases, among which are colds, pneumonia and




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115


tuberculosis. The habit of spitting furnishes the street dust with
dried particles from the discharges of the mouth, nose and throat
of infected individuals. The discharges from the animals used or
moving along our streets are also ground into the dust that we
take into our systems. The safest and best plan is to burn all
street sweepings in a destructor.
The cost of street sprinkling and sweeping may be less with
paved roads, but a tropical city above all others needs to have its
streets constantly washed and the dirt swept up as fast as it collects.
Money spent economically for clean streets brings bountiful returns in health among those for whom the municipality is created.
CHAPTER 11.-REGULATION OF FOODS.
SECTION I.-EARLY REFERENCE.
The public protection of food and milk through regulation and
inspection is one of the most modern functions adopted by our
local authorities. The earliest efforts toward the regulation of food
supply was in 1868, when the establishment of slaughter houses
was prohibited, except after the approval of the Board of Health.
No further public attention was given to this important matter
until 1882, when the Legislature first attempted to regulate the
sale of milk. The law passed, however, did not reach those who
kept cows for private use and sold only surplus milk, nor was it
properly enforced.
This was followed in 1888 by an attempt to control the manufacture of poi, the principal food of the natives. This statute provided for the erection of a central poi factory in which all the manufacture of poi within certain city limits was to be confined. This
law was to become effective as soon as the building was completed. As there never was any building erected, the effort was
without result.
The next public suggestion in the Government reports for further control of foods is that of C. B. Wilson, clerk of the market,




116


who in 1890 recommended the inspection of all foods sold in the
markets as well as inspection of animals to be slaughtered.
In 1892 the Government veterinarian investigated the effect of
liver fluke in beef cattle, and reported it harmless except, of
course, as to the infected livers found in the markets, which were
destroyed.
The Legislature of 1909 provided by resolution for a Milk
Commission. The Governor appointed James A. Rath, W. D.
Baldwin, M. D., and F. G. Krauss as members of this commission which made a thorough inspection and splendid report in
1910. They found the sanitary conditions of our dairies most
unsatisfactory. Their report deserves greater consideration than
it has received.
In 1910, the Health Report announced the death of R. A. Duncan, Food Commissioner, in June, and that no successor as yet
had been appointed, and that the municipality had taken over the
fish, meat and cattle inspection and that dairies were being inspected in cooperation with the Federal and Territorial Food
Commissioner.
Fish inspection began in 1894, according to President W. 0.
Smith (see page 10, Report of 1896), and was most vigorously enforced (luring the cholera epidemic of 1895.
In 1906 the general license law was extended so as to cover the
sale of milk, providing a fine for the sale of skimmed or adulterated milk and giving power to inspect as well as to confiscate
when adulterated milk was found.
In January, 1886, the regular inspection of beef was begun, and
at the end of 1897 appeared the report of W. T. Monsarrat and J.
R. Shaw, veterinary surgeons, on tuberculosis in beef cattle. The
first regular report on meat inspection is in the Health Report of
1898.
On May 16, 1898, under the Republic of Hawaii, the first Pure
Food Act was approved by S. B. Dole, and E. C. Shorey became
Food Commissioner, continuing until June 30, 1904.
In 1903 the Pure Food Act was amended so as to prohibit the
use of preservatives and so as to adopt a general standard of milk.
In 1904, L. E. Pinkham recommended new laws giving greater
power over the environment of milk and poi. R. A. Duncan, Food




117


Commissioner, from July 1, 1904, reported milk and certain foods
examined as well as on water analyses, it being evident that meat
and fish inspection had been more thorough.
In 1907, the Food Commissioner pointed out the necessity of
power to control the sanitary conditions (environments) of
dairies.  During the year ending June 30, 1908, 43 dairies supplied the city with milk.
SECTION II.-INSPECTION OF BEEF, FISH, MILK.
The inspection of beef and fish since 1909 has been under the
municipality and as yet no printed report of the work has been
made.
In addition to the beef and food inspectors in the city proper,
there is also one for the country districts of the Island of Oahu.
The city maintains two fish inspectors as well as a milk inspector
who assists the Federal and Territorial Food Commissioner.
The Federal Bureau of Chemistry under the Department of
Agriculture and the Territory combine on the appointment of a
Food Commissioner who looks after the chemistry of foods and
drugs, both of home manufacture and those imported. The only
standards which the Territorial laws now specify are those of
poi, milk and dairy products, ice cream, etc.
The report of the Food Commissioner for 1911 shows a total of
369 stores that handle foodstuffs, 51 poi shops, 13 bakeries, 4 soy
factories, 3 macaroni factories, and 1 meso factory.
SECTION III. —SOURCES AND CONTROL OF MILK.
The supply of milk being so important a factor with reference
to infant mortality and there being 245 deaths in Honolulu last
year of children under one year of age (about 22 per cent of all
deaths), the Commission has made a special study of the subject
and for its information secured during October a new inspection of all dairies.
This inspection showed 50 different sources of milk-that is,
places where more than one cow was kept and milk occasionally
sold. (For list see appendix.) The number of cows milked was
915 and from them approximately 5,476 quarts of milk sold daily,
an average of not quite six quarts to the cow.
At present the control of the milk supply is under both the




118


Territory and County. The Territory's Pure Food Act of 1898
prohibits and defines adulteration of milk. The amendment of
1903 prescribes a standard of 2'2 per cent butter fat and 11'2
per cent solids; violations are made misdemeanors, punishable by a fine of from    $10 to $100.    County  Ordinance Number 17, approved March 21, 1910, requires a permit
(no fee), defines impure and adulterated milk, and adopts a
standard of 3 per cent butter fat and 8'2 per cent solids, excluding milk fat, with other conditions; violations being misdemeanors and conviction resulting in fines of not less than $10 or over
$100, or imprisonment of not to exceed three months, or both
fine and imprisonment.
From the special milk inspection made it was found that 41
dairies used city water, 3 had private artesian wells, and 4 were
using surface water.
One located in Manoa used a mud-hole, unprotected from surrounding surface drainage, as the source of water for washing
utensils. Three located on King Street, not far from the old baseball grounds, used wells about seven feet deep unprotected from
surface drainage, and within a short distance (50 ft.) from their
pig-pens.
It ought not to be necessary to continually inspect the source of
milk. Public expense is sufficiently taxed, if the milk itself is inspected and tested. The condition of dairies, the environment of
the milk, should be prescribed by law, and heavy penalties provided for violations, as there is no neglect more reprehensible
than that of allowing the innocent and helpless to be fed with
polluted milk.
As milk is often the means of transmitting typhoid and other
disease, no one who is ill should be allowed to come in contact
with the milk or its containers. No person should do the milking,
handle the milk or containers, who is sick or whose hands are
wounded so that the skin is broken, nor should containers of
milk be taken from a place infected with disease to any other
place.
Another serious defect in the protection of the milk supply is
the careless indifference to the use of milk from cows infected
with tuberculosis. We should in justice to those who have dis



119


posed of their infected cattle, without compensation, require a
heavy penalty from those who do not do likewise.
The divided responsibility between the Territory and Municipality is a serious defect. The duplicity of standards illustrates
the evil of double control, and those who suffer or complain are
referred from one to the other authority.
SECTION IV.-PROTECTION.
The endeavor to prevent the public from being served with
adulterated. foods, poi of poor quality at high cost, milk that kills
instead of nourishes, meat that is flyblown, and fish that is decomposed, is not supported as it should be.
This is well illustrated by the attempt to fly-screen the market
and the utter indifference of many customers. Some seem  to
prefer meat that is exposed to dirt and dust as well as flies rather
than change to a dealer who attempts to provide decent protection.
Again, some customers demand the privilege of poking or
feeling raw meat and fish with their fingers and are perfectly
willing to accept both treated in the same way by others, forgetting that certain hands may not be clean, that some may be
diseased, thus perhaps unwittingly and innocently setting an example which spreads the contagion of various diseases, of which
unknown to themselves they may already be victims.
E. B. Blanchard, the Food Commissioner, in his last report
points out that the handling of raw fish is even more careless
than that of meat. Much of our fish now comes from a distance
on ice, so it is often, on arrival, several days old when exposed
to our normal but high temperature. At the market iced fish is
put on warm tables and exposed in the warm air sometimes all
day. Thus it is often decomposed before it is eaten.
The remedy lies with the customers. In time they will learn
to give their trade to the dealer who screens and refrigerates his
beef, or to the fish dealer who keeps his fish on cool tables under
glass at a low temperature and who allows none to touch or
handle his wares. The dealer will eventually learn that clean,
honest wares and high reputation are of more value to him than
the immediate sale of a permanent or doubtful supply. At pres



120


ent the customer is indifferent and the dealer lacks integrity,
while the authorities do not sufficiently control the situation.
SECTION V.-VEGETABLES.
If those in Hlonolulu who delight in fresh vegetables and strawberries the year round, were only to visit the gardens where they
are raised, inspect the water where they are washed, and examine
the system by which they are fertilized, there would be no difficulty in forming a "Consumers' Pure Vegetable League," under
which some method of guaranteeing the purity of the vegetables
could be devised, and by which the patient Oriental truck gardener, who has succeeded where others have failed, would greatly
increase his sales.
On May 27, 1911, this Commission visited the district into
which Parker Lane leads from Liliha Street, and there saw a
truck garden, where the stream which furnished the water in
which the vegetables were washed, first ran within two feet of
a privy vault in which a liquid mass of human feces and maggots
floated at the level of the stream. The reader can draw his own
conclusions as to just what would happen when the level of the
stream  receded.
It is dangerous to eat raw vegetables in Honolulu under present conditions due to the custom of storing up human excreta
for use, either as fertilizer or in solution for irrigation.
In the City of Hong Kong the necessity for vegetables cultivated in a sanitary manner has brought about a special garden
with special service direct to private houses.
Health officials cannot stop the Oriental customs without the
universal cooperation of the housewives.
Because vegetables are supposed to come from the head of
some valley, does not necessarily assure them as being free from
infection.  Because, from investigation and questions, you have
been once convinced that your vegetables are pure, does not
always protect you.
You would not feed poison to your children or any one of
your household. You would not leave it unmarked about the
house, yet some of the most deadly germs may be in your icechest even now as you are reading this.




121
Dr. Crrie's report o c the conditions he fIound in uipper Manoa
during the cholera epidemic in e:ebruary, 1911, is indeed a severe
indictlenlt on the sanitary contditionsi tolerated. Add to tlose
conditionis the fac thtat it is often to these very gardens up in the
valleys that carriers, fresh fromi infected ports, go to visit friends
and the danger of sudden intfection can he better realized.
CHAPTER      12. -LVING    CONI)ITINS.
SECTION I.-ITHE iPAST
1iving conditions did not become  an imnportant questionL  t the
people of ITonohl6Il unittil thle lenlsity of populahtion  ecales great
BvYS PAyINsG IN THE STREsAM PASSINo BY isONOJsLti A.TsLBeTIC PARK
iwithin    i cerarti  otionls of it. The copper late engraving of
on11oulshs nadhe in 1839 at Lahainahsia shw  scattered houses
snod sin evidece of                                ofnLgestissal.  Ianv Enlsetb's series i  i pictures
froun the fathlOniCh h tch his h834, gshsvws that the tewni thien ccil*t    ' e "Friendist," rivlter 184 Pg4 72. j




122


tered about the lower end of Nuuanu Street.  No houses are
shown beyond River Street nor is the Waikiki side of Fort Street
built up. Numerous and extensive gardens appear to be quite
a feature of the town, especially between Beretania and the waterfront.
The constant and material growth of Honolulu began as a
result of the Reciprocity Treaty with the United States. The
census of 1878 gives the population as 14,114. Captain Brown,
health officer, then reported that of the deaths which occurred in
Honolulu 60 per cent were without medical attention of any kind
during their sickness.
The period of 1880-1881 was noticeable because of the spread
of measles and typhoid fever and the passage of an Act, providing sanitary conditions of dwellings, which first regulated air
space. This Legislature also passed the first Act to regulate and
control laundries and wash-houses, as well as poisons, and poisonous drugs. Captain Brown in 1880 stated that "the cleaning of
streets since 1878 has been of great benefit."
In 1882, he first called attention to the necessity of cutting new
streets to relieve the congestion and permit the admission of the
excavator service begun June 1, 1881, as well as to give fire protection.
In 1882, the first fire limits were established in which some
attention to construction of buildings was attempted. These limits began at the waterfront 80 ft, east of Nuuanu Valley Road;:
thence to King Street; thence along King Street 80 ft. beyond
Fort Street; thence to the sea.
In 1884 eight new wash-houses were added to the sixteen on
Nuuanu Stream.
The congestion of the Orientals and poorer people gradually
overcrowded the area formerly called Chinatown between Nuuanu and River Streets. By 1885 the city had nearly 21,000 people
and the death rate averaged 40 per 1,000 for the previous ten
years.
In 1886 came the big fire of April 18, that swept clean this
overcrowded portion of the city. This was Honolulu's first great
opportunity to rebuild slowly, carefully and thoroughly, but the
policy of the "present best" at future cost prevailed.  Cheap,




123


wooden buildings outside the fire limits again crowded and
cramped each other. Additions and lean-tos were made until the
original buildings could no longer be recognized.
In 1886, W. M. Gibson first publicly stated the necessity for
controlling poi shops by centralizing them and the desire for more
stringent regulation of wash-houses. He pointed out that the
great fire should be a "blessing," but the Legislature changed the
fire limits only by adding the area from King Street up Smith
Street to Hotel; along Hotel to Alakea Street; thence to the sea,
including very little of the Oriental quarter which then extended
to the stream.
Captain Brown reported consumption increasing; that one in
every eight deaths was due to this cause.
C. B. Reynolds suggested the control and size of cesspools and
the abolition of wooden sidewalks.
This period shows the first attempt at school inspection.
The Board of Health Report for 1888 by Dr. Emerson showed
that the health authorities were without power to take advantage
of the great fire. So simple a precaution as keeping open cesspools out from under houses was ignored. Public opinion, custom and law then permitted immense vaults to be built sometimes
as large as 18 ft. in diameter and 25 ft. deep in which was deposited all food waste and human refuse; when decomposition took
place mosquitoes bred and all kinds of vermin collected.
All efforts resulted only in an Act passed to control the erection, repairs and moving of buildings within certain wide limits,
requiring a permit from the Minister of the Interior.
It is noticeable, however, that the average death rate for the
ten years following the great fire fell from 40 to 25.38 per 1,000.
In 1890, Dr. Kimball. President of the Board of Health, reported the first use of regular sanitary inspection. He stated that
"eternal vigilance is the price of a clean, healthy town as well as
of liberty." He showed that in 1884 the Legislature decreed free
medical attendance and medicines to all with native blood and
that this law was abolished in 1888. He urged better conditions
for the manufacture of poi.
In 1892, David Dayton reported the necessity of removing
wash-houses from Nuuanu Stream. Agent C. B. Reynolds said




124


that "the new law of 1890 for licensing restaurants and lodging
houses had greatly benefited sanitary conditions."
In 1894, the first fish inspection began, previously no protection
to the public was thought necessary.
In 1895, came the first cholera, resulting in the first real cleansing of the city under voluntary citizen direction. This resulted in
the removal of the old, dilapidated fish market, which stood on
the harbor front near the end of River Street.
In December, 1899, the first case of Asiatic plague occurred,
and in January, 1900, the second big fire.  Again the "present
need" largely prevailed, for although building restrictions were
required for the burned district, yet many cheap tenements were
erected across Nuuanu Stream beyond River Street, where they
still remain a disgrace to our city.  Again the death rate fell
after the fire.
Not only did the great epidemic and conflagration reduce our
death rate and hasten the installation of sewers, but with the latter came the improvement in plumbing, which began under the
Board of Health Regulation of January 26, 1900, and the first
inspection was approved November 7, of the same year.  The
task was tremendous, for previously plumbing was simply to
provide connection with the cesspools and the danger due to defects was limited to small areas. Little attention was paid to the
advance in methods or quality of material used, and the general
conditions were indeed bad.
Since 1900 the improvement in living conditions has been constant, the public generally accepting the change.  Plumbing is
now a matter of inspection and control. Duck ponds, as well as
pigstyes, are now considered nuisances.
In 1902, the slaughter-houses were removed from Iwilei to
Kalihi, and Dr. Sloggett wanted a mosquito campaign started.
In 1904, care of the indigent sick as well as the dead became
recognized as a public charge, and the first citizens' mosquito
campaign was reported.




125


SECTION II.-POPULATION.
Population Table.
Year.               All Islands.          Honolulu.
1853                  73,138               11,455
1860                  69,800               14,370
1866                  62,959               13,521
1872                  56,897               14,852
1884                  80,578               20,487
1890                  89,990               22,907
1896                 109,020               29,920
1900                 154,001               39,306
1910                 191,909               52,183
It is impossible from the census of 1910 to give the exact proportion of the various races composing the population of Honolulu as distinct from the whole Territory. The nearest estimate,
which, of course, is not correct, is to assume that the people of
Honolulu are divided as regards race in the same proportion as
that of the Territory, which gives the following:
Hawaiians and Part-Hawaiians................10,482
Anglo-Saxon, Teutonic, etc................... 4,043
Latins, Portuguese, Spanish and Porto Ricans.. 7,935
Orientals................................28,790
Blacks  and  others...........................  933
Total....................................52,183
SECTION III.-THINGS TO BE SEEN.
Honolulu first impresses the average traveler as beautiful,
sometimes by comparison as clean, but his second impression, if
he observes at all, must modify his first. If beauty is perfection
made useful-Honolulu is far from beautiful.
Let the visitor move off the main streets into the alleys; let
him climb through any block or square; he will come away with
a composite picture of cheap, temporary structures, wooden sidewalks, piles of driftwood and brush for fuel located in corners
and under houses, garbage and refuse everywhere, rickety leantos, dark and dirty kitchens smoky with grime and soot, damp and




126
rotten wooden paths or walks to enable one to keep out of the
surface drainage during rain and out of the slime at other times.
He will find places with most inviting entrances and fronts, where
the conditions in the rear, usually unseen, are disgraceful if not
dangerous; yards graded and filled but the space under the house
left low to catch and hold water; leaking taps, broken plumbing
and disgusting toilets, tottering outside staircases, broken verandas, defective gutters, rusted-out leaders, everywhere splendid
protection for rats with ample food for them, and magnificent
breeding places for mosquitoes. Let him lift any board that has
been on the ground for some time and observe the cockroaches
that are certain to be found.
Let him watch the people passing about bare-footed, notice the
bits of food waste scattered about by children, cats, dogs and
chickens, then left to decompose in courts or in areas where the
surface is nothing but foul, damp earth.
Now, let the stranger move out of the crowded portions and
observe the wet agriculture permitted close to the city's center.
Taro, growing alongside of otherwise charming cottage residences, saturating the adjoining ground. One property owner indifferent, another careful and painstaking.
Let him note cottages with the space under them rarely left
open, but boarded up, battened, or latticed, as if the owner intended to provide protection for the rat against his natural enemies, for into the lattice, between the battens, and under the
boards neither cat nor dog can follow.
This will explain some of the difficulties encountered during the
struggle for a clean, healthy city.
There are those who believe the past improvements in our sanitary condition have been adequate. There are others who think
we have a healthful climate and that is quite enough, while another
class are of the opinion that we are already far in advance of
other communities similarly located and so should be contented
and indifferent.
SECTION IV.-SANITARY SURVEY.
Honolulu is a city of magnificent distances, large impenetrable
blocks and great contrasts. It lies along six miles of waterfront,
scatters over flats and stretches up the slopes to the foothills into




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five valleys, that cut the main ridge of mountains, and it spreads
over into the ridges between them.
The District of Honolulu is some 44,000 acres, not more than
one-tenth of which can be said to be inhabited. About one-third
of the whole is swamps or under wet agriculture (36 per cent).
There are 130 miles of streets, roads and lanes covering 855 acres.
We have marked on the maps 18,381 buildings, and omitted
from lack of time Nuuanu Valley above Judd Street, and all of
Kapalama beyond the Rice Mill Road, and above Liliha Street
from School to Judd Street.. In this Survey 12,800 acres were
examined. We found more than 2,600 connections with sewers,
2,263 cesspools, 2,403 privy vaults and 37 dry closets..
In the disposal of refuse, yard and house, 38 householders
claimed to bury it, 4,914 to burn it, and 1,713 patronized the garbage service. As to food waste, swill, 68 householders burned,
2,221 feed it on the place, and 4,060 reported that swill men took
it away. We found 3,272 householders kept chickens and 197 of
them kept them under their houses. Of all the buildings only
3,273 offered free access for the enemies of rats, while only 303
were of cement or bricked in, so that 15,410 remaining buildings
offered ideal protection for rats.
We accounted for the sleeping accommodation of 49,145 people,
including 15,375 children, located in 7,941 dwellings, 12 boarding
houses, 34 hotels, 193 lodging houses, and 470 tenements; using
266 garages, 897 stables, and 1,374 stores.
Everywhere we found sidewalks just built as if to harbor rats.
The boards are often a danger to pedestrians.  Between the
cracks lies evidence of one reason why they are maintained-the
space below furnishes a place for hiding tin cans and waste of all
kinds.
There is no more marked evidence of indifference to sanitary
conditions than the wooden sidewalks which border our streets.
They are relics of the past which appeal neither to the useful, the
esthetic nor the artistic, nor can economy be claimed for them.
At best they are temporary make-shifts and they must be banished.
The most crowded section under existing conditions is the 782
acres that lies between Beretania, Fort, Vineyard and Liliha
Streets. On this low lying land live 5,667 people, over one-tenth




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of the city's population. This gives a density of 72 to the acre.
Our survey shows tenement conditions existing in 124 of the 862
buildings, 124 owners or tenants keep chickens and 32 maintain
them under their houses.
It is surprising to find in our balmy climate that so many people
are afraid of fresh air. An inspection shows windows nailed up,
covered with cloth or paper with the cracks stuffed up as if in
arctic weather; people living in dark, close rooms, by preference,
due, of course, to bad habit or custom.
The worst existing conditions are in Kakaako beyond Punchbowl and below Queen Street, where, with a density of only 54
people to the acre, we find the ratio square feet of openings per
1,000 cu. ft. of air space down to six, and this is the only portion
of the city where it falls below eight-the standard.
A death rate of over 20 per 1,000 in a city like Honolulu indicates that it is far from being abreast of the times in sanitary conditions.
That our constant, even temperature and moisture is against
us cannot be admitted as insurmountable, when we see that in
the canal zone the engineers have reduced the death rate to under
10 (excluding new arrivals) and that there the heat and moisture
are far greater than here in Honolulu.
SECTION V.-TENEMENTS.
As already shown, in 1880 an Act was passed by the Legislature providing for the sanitary control of dwelling houses. This
was evidently in order to prevent the over-crowding in tenements.
Among other regulations it provided that such buildings must
have water-tight roofs. Previous to 1880 there had been some
control over hotels and victualing houses, even as far back as
1846, when the Act to organize the executive departments was
adopted. Prior to that on May 11, 1842, a license was required
for public houses, but the control, in none of these years, was for
sanitary purposes.
Not until 1890 was there any other attempt to legally control
our tenements. The Legislature of that year established a license
for lodging and tenement houses, hotels, boarding houses and restaurants, the fee for which was nominal, but no license could be




129
granted except on a certificate from the Board of Health to the
effect that the sanitary condition of locations and buildings was
satisfactory and suitable. Among the seven conditions of the
license was one as follows: "Building and premises shall be kept
in good sanitary condition in accordance with the law and orders
of the agent of the Board of Health." Penalty was provided for
those who failed to secure licenses, or who, holding one, violated
the requirements and conditions.
In 1899 the conditions were amended by prohibiting any tenements or lodging houses to be established or maintained in any
locality which the Executive Council thought unsuitable or objectionable-a wise provision which disappeared with the Executive
Council.
In 1908, September 28, the County of Oahu ordained that no
tenement could be built within 50 feet of any public school and
provided a penalty of $200 with new offense for every day of its
continuance. This was re-adopted by the municipality on January
25, 1909.
In 1909 (Act No. 151, Page 208), the Legislature turned over
all licenses of this nature to the municipality or counties.
We advisedly say the Board of Health's share for the difficulties
with tenements is under so many sources of control that the divided responsibility causes little to be accomplished and accounts for
the present intolerable conditions, not only because the environment of these poor people is unhealthy, but because the social
and moral environment is seriously affecting public welfare.
The last Grand Jury severely commented upon our tenements
as a source of crime, and recommended that the building regulations of tenements be so revised that the common decencies of
life might be observed by the tenants.
Our survey of sanitary conditions shows 470 buildings in
Honolulu in which tenement conditions exist, 124 in the area
bounded by Fort, Vineyard, Liliha and Beretania Streets. This
area contains approximately 51 acres with a density of population of 110 to the acre.
The responsibility for our tenement condition is so divided that
it is lost.
Back stairs that are too rickety for fire escapes need to be
prohibited in the building ordinances as much as anything that




130
is made unlawful in the fire laws. The results of defective plumbing are as much due to the sanitary inspectors as the plumbing
inspector, and who is to blame?
Those who live in tenements are entitled to better protection.
They are now under the sheriff, the fire marshal, the building inspector, the plumbing inspectors, and the Board of Health inspectors. Surely they do not need more protection.
Other cities suffering under the same divided responsibility
have established Tenement House Boards or Commissions of a
permanent nature and centered all authority in them; notably
New York, where the commission can not only order any tenement vacated, but has the authority to order one removed so
there will be no longer temptation for further use.
Our worst living conditions are not in the dwellings owned outright by the poor, but are found in buildings which are held as
an investment or rented for revenue. The owner of no other
class of property is allowed to offer it for use or sale when in
such a dilapidated state that its condition makes it a menace to
public health.
SECTION VI.-LARGE BLOCKS.
The most striking feature of our city is that of the large areas
without proper openings or streets.
Turn to any map and observe the more than 20 acres bounded
by Nuuanu, Kuakini, Liliha and School Streets, cut by a stream
but by no open thoroughfares for access in case of fire, for water
or for sewer service.
On this and the adjoining block towards the sea 1,920 people
live. The large rectangle below Vineyard from Liliha over to
Fort Street is the most densely populated area we have, there
being 5,667 people living within four streets.
Examine any portion of the city, and you will find large areas
inaccessible and around which transportation is forced. When
these blocks have few people on them and are of little value there
is no great need of thoroughfares, but there are so many blocks
that should be cut up it is impossible to enumerate them all. Two
years ago a plan for opening certain blocks was presented to the




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Chamber of Commerce by Dr. J. S. B. Pratt. His map is still in
existence and is excellent as far as it goes.
The unwieldy size of so many blocks is a serious defect in the
growth of our city and the economy of life in it. This condition
exists in almost every portion of our city. It is due to slow
growth and habit. Through these causes. citizens become indifferent until the density of population or sanitary necessity forces
action, and this, of course, is always a great expense to the public
treasury.
One cause is the complicated legal machinery to be operated
when attempting to open a new street, the long delays it provides
and permits and the prominence it gives to damages while betterments are all but ignored, as well as the fact that proceedings
may be stopped at any time at the discretion of an official.
Many of our people have come to think it right that the whole
Territory should provide Honolulu with funds to pay all damages
and one-half of the betterments on property to be taken for highways in the municipality.
Progressive citizens in active cities elsewhere recognize that
betterments in time always more than offset damages, and the
remnants often become of more value than surrounding property
and set the standard for its value. They recognize that the city
cannot grow and develop reasonable progress without assuming
some limited risks.
SECTION VII.-NEW STREETS.
We believe that the people of the City and County of Honolulu
should demand that the old-fashioned, antiquated customs be shed
in order that the future of the city may not be hampered in its
growth, and in order that the inhabitants may fully develop their
opportunities.
It is time to give up the guardianship of the Territory, pay our
own bills for the original capital outlay needed for new street improvements, to lay therein water and sewer mains, and to build
thereon sidewalks, curbs, gutters, and to pave or macadamize the
same. The need of this is great, and the situation must be faced.
There is not revenue enough for such purposes and we have not
the right to ask the whole Territory to pay for such improve



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ments, nor can we continually delay for the necessarily slow
movements of territorial legislation.
We have abundant local capital, and, if the cost of needed improvements can be put in legal shape, it will supply a demand for
an investment that will keep this capital at home where the interest payments will be disbursed as incentives of economy and
thrift to many small investors.
The burden of our street improvements can be lightened by distributing it over a number of years, letting the unearned increment
in a measure offset the cost. The gain in sanitary conditions will
be more than sufficient to pay the interest, and there is a saving
to be made in laying out and putting through needed streets before the increased population enhances the value of real estate.
If the right of eminent domain can be used by a majority of
those owning the property through which a proposed street is
desired, then the more intelligent property owners can secure immediate improvements and when they have demonstrated that
their foresight has increased the value of the land others will
follow, and Honolulu can then become through its own efforts a
city worthy of her natural surroundings.
SECTION VIII.-MOUTH HYGIENE.
Among living conditions there is no topic more neglected in
discussion or ignored in public activities than that of mouth
hygiene. Our dentists are supersensitive and fear to be accused
of crying their wares. We do nothing collectively to save the
waste from neglected mouths and teeth.
The Chicago Board of Health feels justified in announcing
from their research work that the seat of infection of pneumonia
is in the media around the teeth and in their cavities, and that it
passes in some way as yet unknown to others; but they feel certain that the care of the teeth will reduce, if not control, the mortality from pneumonia. Pneumonia in Honolulu is near the top
of the death list.
Many cities now provide free clinics for schools, at which the
child is examined, not alone for defective teeth, but for his throat,
ears, eyes and nose. There are many among us who do not realize the importance of mouth hygiene. These very individuals




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would refuse to sleep in a room or in a house permeated with the
odor of decaying flesh, yet they remain indifferent to the condition of their mouths and become accustomed to their own offensive odor, and expect their system to absorb all the poison of their
own decomposition.
Many carry the tell-tale scars, showing how unnecessarily they
have suffered. The ignorant expect both children and adults to
pass successfully through ordeals of such nature. They do not
seek relief until after months of pain, then failing to get well,
their vitality exhausted, possibly having contracted some other
disease because of their condition, they conclude to pay for a
doctor but rarely a dentist. Much of health depends on the teeth.
Prevention costs so little. The loss of sick days is often far greater than the cost of care.
HEALTHGRAMS.
"Typhoid to prevent costs a few cents, to cure costs many dollars."
"All is not pure that sparkles. Sparkling water may be loaded with
typhoid germs."
"Dope for cold is meat for doctors."
"Vaccinate and save your face.
Smallpox is a disgrace."
"Don't serve your friends food or drink, unless you know it is safe
from flies and filth."
"The danger line from the water-closet to the china-closet should be
restricted by washstand and towels for use."
"Make your neighbor's yard jealous of your back yard."
"Alcohol has hammered hob-nails into many a man's liver."
"In the consideration of health, an ounce of intelligence is worth a
ton of ignorance."
"A diversified industry that is certain of profit-raising strong,
healthy human beings and keeping them alive."
"Do unto others as you have others do unto you"; meaning "don't
carry disease germs about and cause sickness, perhaps death, am'ong your
friends. "
"As long as the thickly populated portions of the city are kept in
good sanitary condition, and the water supply remains uncontaminated,
the conditions of health will continue favorable." —David Dayton.
" Dust is dangerous."
"The greatest wealth is health."
"The sanitary condition of a community is a matter that each individual should take interest in."
"Build your reputation for civic pride in your back yard."
"Because your neighbor throws garbage into the street, or alley, is
no reason why you should follow his example, but it is a reason why
you should set him a good example."
"Colds are catching. "
"Eat less that you may eat more tomorrow."




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"Health is not put up in bottles, neither can it be bought at the
corner drug store. "
"Fruit a la filth-the kind you buy from stands exposed to dust
and flies."
"Where the sun does not go, the doctor does."-Italian Proverb.
"Keep your hands clean. Soap is a good friend, dirt an enemy."
PART III.-RECOMMENDATIONS.
CHAPTER 13.-GENERAL BETTERMENTS.
SECTION I.-WET AGRICULTURE.
We recommend to the full consideration of the public the plan
of control of wet agriculture within the city limits.
We urge that the interests of health and comfort require that
every person who wishes to flood any land within the proper limits of the city for the purpose of raising a crop of any kind that
must stand in water during a part of its growth, shall be required
to pay a reasonable fee and to secure a license, the conditions of
which shall be:
1. A description of the land, giving the area in square feet.
2. That the boundaries shall be at least 50 ft. from any building.
3. That during the term of the license no building shall exist
on the property described.
4. That the land shall not be used for human habitation or
any other purpose than wet agriculture without first securing a cancellation of the license, and without first abandoning the wet agriculture proposed.
5. Any violation shall, upon conviction, be heavily penalized.
This plan would at least clearly define the area of land used in
wet agriculture and which is peculiarly subject to contamination
and which offers especial opportunities for mosquito breeding,
and therefore requiring careful watching and inspection in order
to protect the public health.




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SECTION II.-RECLAIMING SWAMPS.
It is obvious that all swamps and low lands which may become
swamps should be filled or otherwise reclaimed, in order that
their ever-present menace to health shall be entirely and finally
removed.
A careful study of the question shows many difficulties, not the
least of which is the great cost involved. It has been impracticable for this Commission to prepare detailed plans for this reclamation work. The survey made for this Commission shows
the wet areas and contains much other information. We therefore recommend that the best method to pursue is, first to secure
an expert engineer-one experienced in swamp reclamationand secondly to provide sufficient funds to enable him to make a
detailed survey of, and report concerning all the wet lands within
the city limits.
This survey and report should cover the cause of the swamps;
the various sources and volume of water in them; the various
methods of obliterating them together with the cost and advantages of each and cost of material available for filling purposes.
After this data is obtained and reported, the engineer should
then prepare complete and comprehensive plans for entire districts. These plans should include storm drains sufficient to provide for the great rainfall on all the tributary area. Preliminary
drains can be cut to conform with the final location of the storm
ditches. These would immediately lower the level of the standing
water and reduce the swamp areas to a minimum, so that they
can better be cared for until funds are available to obliterate them.
Thus gradually and finally these sources of danger, which constantly menace our health and seriously affect our good name, will
be destroyed.
We urge this course for the following reasons:
1. In order that each piece of work as undertaken may be
final, complete and in conformity with all other parts or
portions of the work, that must eventually be done in order
to be rid of the swamps.
2. In order that, with complete information concerning all the
swamp lands in the city, the immediate need may not unwittingly result in a sacrifice of one portion for another, by, 




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taking from it the material best located and most economical for its use.
3. In order that economy may be obtained in filling as large
tracts as may be conveniently handled in one operation and
in order to study carefully the best sources of material
needed.
4. Because Congress is more likely to listen to an appeal for
assistance, if we are thoroughly informed and there are
definite grounds on which to ask aid, seaports being a
source of national wealth and their health affecting the
nation's commerce.
SECTION III.-OPENING STREETS.
We recommend legislation to provide means by which new
highways may be opened more easily and freely than at present.
We urge the passage of a law under which the initiative shall
come from a citizen who owns property, a portion of which is to
be taken for the proposed highway, and a law in order to be effective requires the consent of the owners of more than half the
area of the property to be affected.
This area should be determined by some official, to whom the
application of the citizen with his rough description and map is
to be referred, this official should then submit the same to the tax
assessor, who should be required to furnish a more detailed and
accurate map of the area to be affected, showing, as near as may
be, each separate piece of property affected, with the name and
address of the last known owner, the number of square feet in
each, and the assessed value of each together with the value of
the improvements stated separately.
This information, secured without cost, should in a given time
be returned to the applicant in order that he may, if so advised,
proceed to request the consent in writing of sufficient owners to
satisfy the requirements of the law. Upon presentation of such
consent, it should be the duty of a proper official to appoint appraisers to determine the value per square foot of each piece of
property, and the value separately of the improvements.
Immediately after the appraisal, by exercise of the right of
eminent domain, the property necessary for the project should be




137


condemned. In this process the betterments should first be determined, and thereafter damages, if any, fixed.
The responsibility for each step in the process should be clearly
defined and a reasonable time allowed for the execution of each
step, together with a penalty for failures.
It should become the duty of the proper person to certify to the
official in charge of finance the amount of money needed to pay
for all the property condemned, the cost of condemnation and the
cost of appraisal.
It should be made the duty of the official in charge of road
construction to have prepared and furnished in a stated time to
the financial official estimates of the time required and the cost
of construction of the improvements asked for in the application,
and these improvements obviously should include all original
capital outlay needed for the completion of the highway in a manner suitable to the nature of the surroundings, either by paving,
macadamizing, or surfacing with coral or dirt, with water and
sewer mains, sidewalks, curbs, culverts, storm drains, and all sinilar improvements requested in the application included.
To the cost thus stated should be added the interest to be paid
out during a period of ten years, together with the cost of providing for and securing all the funds necessary for the projectsuch as printing, advertising and whatever else may be reasonable
to aid the sale of bonds or other securities of like nature, issued
by the city and backed by a lien on the property benefited by the
improvement.
After the sale of these securities, the funds should be divided
and placed in separate accounts, one, a special fund to meet the
interest, and another for the "project." From the latter by proper
means the payments should be made, first for the property condemned, with provision for a deposit in the Circuit Court or elsewhere in case of a delay in any settlement beyond a specified time;
secondly for the construction of the improvements as needed.
The law should require the Territory or municipality to complete the project within the time and at a cost not exceeding that
specified in the estimate by its official.
The securities or evidences of debt, whether local improvement
bonds, script, or whatever form that may be thought best, should




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be issued in denominations discretionary with the financial official,
one-tenth part of the whole redeemable each year, guaranteed by
the municipality and secured by a prior lien on each piece of
property in the area affected after deducting that needed for the
highway. Each lien should be for an amount which bears to the
whole sum of the securities sold the same ratio that the appraised
value of each piece of property bears to the sum of the appraised
value of the property in the area affected; so that, if any owner
places a high valuation upon his property as compared with those
around him, then he will be subjected to a proportionally larger
lien.
The law should make these bonds or securities payable onetenth each year, and enforcible precisely as are taxes, subject to
the same penalties and provisions in order to secure their collection.
Such a law should provide machinery, that, once started, could
not be stopped at the whim of an official. It should permit those
who desire improvements and are willing to pay the cost to obtain
them, thus preventing the blocking or delaying of progress, and
should, of course, reasonably safeguard the rights of all.
SECTION IV.-WATER CONTROL.
To reduce the expense of supplying good water and to check
the present extravagant waste, we recommend that all connections-other than for purely domestic purposes-be metered.
That is, we believe the water used for all irrigation, for lawns,
yards, gardens and vegetables, or any other mode of irrigation,
for developing power, or for any manufacturing purpose, should
be charged for in proportion to the quantity of water delivered.
At the same time all should be given a generous supply of water
for personal needs, for bathing, washing, laundries, cleaning verandas, lanais, stables, poi shops, alleys, areas, courts, etc.
If a person is afflutnt enough to own his own garden or a
swimming tank, or wants to run water into his rice or taro patch,
he should pay for whatever amount he uses on a low and liberal
basis.
This would reduce the cost of our water supply by preventing




139
waste, and reduce the expense of our sewer system, now overtaxed, resulting in a double economy.
SECTION V. —MILK CONTROL.
We recommend:
First-That the use of other than city water be prohibited in
or about places which are the source of milk supply, except upon
special permit of the Board of Health issued after satisfactory
proof is submitted of the purity and good environment of any
other proposed supply, a reasonable penalty for violation being
provided by law.
Second-That all those in charge of dairies-the source of milk
supply-as well as the owners of any cows whose milk is being
consumed, and the owners of any land where cows are kept, be
required to immediately report to the Board of Health any sickness among those who are likely to come in contact with the milk
or its containers, and that any failure so to do be heavily penalized.
Third-That a heavy fine be imposed upon any person convicted of selling milk from cows infected with tuberculosis.
Finally, especial attention is called to the recommendations
of the Milk Commission of 1910-that the control of milk be
taken from the municipality and given to the Territorial Board
of Agriculture in order to secure protection for the whole Territory, to remove the possibility of political favor and to insure an
effective enforcement of regulations governing milk and its
source of supply.
SECTION VI.-REFUSE DISPOSAL.
We recommend a free service for the collection and disposal
of all waste and refuse within limits to be established by the municipality, covering the area where the congestion is greatest. Beyond those limits the municipality might remove all waste for pay.
No "pay system" over the whole city will be effective without
power to penalize those who fail to provide for the disposal of
their waste.
We endorse so much of Dr. Blue's statement and recommend:
1. That there be "officially stamped containers" used for food
waste (swill) which must be water, rat and fly proof.




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2. That to keep or discharge food waste (within the limits of
the garbage and excavator service) in other than official
containers be made a misdemeanor and punishable by fine.
We believe that the man who deposits and leaves waste to
decay should be taught that the responsibility rests on him. It is
a matter of indifference whether the act be committed by the fouryear-old son of an Oriental swill collector who keeps pigs, or the
American foreman of a pineapple factory whose owner rides in
a motor car.
SECTION VII.-TENEMENT HOUSE COMMISSION.
We recommend the creation of a special Tenement House Commission to study and report on tenement conditions.
For the purpose of this Commission the term "Tenement
House" should be defined as meaning a multiple dwelling arranged for occupation by more than two families, each of which
can live independently and do its cooking separately.
The subjects for study and report should be:
1. Protection against fire, and means of escape in case of fire.
2. Construction, material to be used, light and ventilation.
3. Sanitary protection, including:
a. Water supply.
b. Water-closet accommodation.
c. Laundry, bathing and kitchen accommodations.
d. Surface drainage under and above the premises, on or
in adjoining alleys, courts or areas.
e. Garbage disposal.
f. Rat-harbors.
g. Mosquito breeding places.
h. Over-crowding.
i. Sewage disposal.
4. Method of enforcing health regulations.
5. Extent of power to be granted in the control of tenements.
SECTION VIII.-PUBLICITY.
We recommend that the Board of Health be authorized and
required to publish a monthly bulletin for free distribution among
the medical practitioners and school teachers throughout the Ter



141


ritory, as well as among such officials of the Territory or Counties as may annually file requests for copies, and among such others as the Board may deem best.
For this purpose the Legislature should provide a specific appropriation to include the salary of a person to be placed in charge
of such publicity work, say 5 per cent of the amount usually appropriated for health purposes.
HEALTHGRAMS.
"A common poison-a baby's bottle with a long rubber tube."
"Dirty milk kills babies-look for the dirt in the bottom  of the
bottle. "
"No spit, no consumption."
"Kill the flies or they will kill you."
"It is not a waste of time to contend with self-satisfied ignorance,
or short-sighted selfishness which opposes every effort for prevention and
restriction of disease."-W. M. Gibson.
"Educate the mother and save the child."
"Much the hardest, most discouraging, and oftentimes the best work
on the part of the employees of the Board of Health not only fails to
reflect credit and appreciation where it is due; but on the other hand
tends to great misunderstanding and harsh criticism on the part of the
general public. I have never been associated with a more painstaking,
hard-working, conscientious organization than the Board of Health of
Hawaii."-L. E. Cofer.
"The five 'Fs'-filth, fingers, flies, food, fever."
"Closed windows are open friends to consumption."
"Let the first lesson be how to keep well."
"The fact is that all natives of this group are ignorant of the laws
of health and hygiene."-Dr. George L. Fitch, 1882, Page 54.
"In saving the child you save the state."
"If you allow flies to flock into your place, your trade will fly from
you.  (A hint to restaurant-keepers, grocers and market men.)
"Chew your food-your stomach has no teeth."
"It is a careless community that neglects the health problems of its
educational system. "
"Not every fly carries disease germs, but you can't tell which does,.
so take no chances."
"Cleanliness is next to godliness," but it takes many godly people a
long time to 'get next.' "
"'Swat the fly.'"
"If there is a contagious disease at home, don't visit other homes.'
"Encourage homesteaders by enforcing clean, healthy dwellings."
"Sometimes what you keep from the doctor you will give to the
undertaker. "
"Build out the rat-it is the simplest way to get rid of him."'-Dr.
Rupert Blue.
"Health is the supreme law."-Roman Adage.




142


PART IV.-RESULTS.
CHAPTER 14.-SAVING IN WASTE.
SECTION I.-LIFE AND ITS VALUE.
It has been shown that a large part of deaths are preventable,
and that there has been in Honolulu alone during the year ending
June 30, 1911, 1,251 deaths. If the knowledge now possessed
can be spread among all of the 52,183 people living in Honolulu,
a saving of a large number of deaths can be effected in a single
year.
The necessities of agricultural industries and the desire for a
greater population prompts, at large expense to the taxpayer, the
importation of immigrants and has secured legislation which permits of a large sacrifice in the real value of our Government lands
when placed in the hands of homesteaders.
If better sanitation was taught to everyone, and 500 lives were
saved each year, the expense of immigration could be reduced
and the annual increase of population would supply the real
homesteaders-a natural demand for land not now  cultivated.
This should appeal to the reasonable man and secure a grant of
more power to the Board of Health, if conditions are to be what
they should be, and if intelligent advantage is to be taken of existing opportunities.
The value of life varies with age. It has been repeatedly estimated in capitalizing labor. In England carefully made figures
have shown that human labor capitalized was worth five times all
other forms of capital. Professor Fisher assumes for the United
States $700 as the average earning capacity of workers with 25
per cent idle, so that $525 is the average earnings for all.
With this basis and the census as to age, he finds the average
value of life to be $2,900. The same theory applied at death gives
the average value of each life at death to be $1,700.
For Hawaii we believe the average earning cannot be much
lower, and on the other hand we have not so many idle; but to
be safe we will assume a difference of 20 per cent less; then our
vital assets-the capitalized value of the lives of 52,183 people in




143


Honolulu-are $131,064,560. Therefore, when providing for the
sanitation of Honolulu alone, we are considering the protection of
that which is almost as valuable as the taxable wealth in the whole
Territory.
SECTION II.-VALUE OF PREVENTABLE LOSS.
The cost of unnecessary death and sickness offers the most
tangible measure of the worth of sanitation and hygiene. Experts
show that it is conservative to assume that life can be prolonged
15 years, that mortality can be reduced 40 per cent and morbidity
reduced 30 per cent, therefore let us apply these results of careful
study to our local conditions.  Such reasoning may not be above
criticism, but it will at least draw attention to our subject and
enable the mind to better grasp or measure its importance.
Last year there were 1,251 deaths in Honolulu; of these say 25
per cent were not workers; this leaves 878 deaths of workers.
In the United States the average annual earnings for all workers,
from the highly-paid managers of corporations and the big professional men down to the workmen in the sweat shops, is said
to be about $700 per individual. Let us, to be safely conservative,
assume for Hawaii one-half of that amount, or $350, then those
who died last year could have earned $307,300. Now, by effort
prevent 40 per cent of our deaths and the annual saving, based
upon last year's record, is $122,920.
If for every death there were two people seriously ill all the
time and the average earning capacity is but $350 per annum, then
we suffer a loss from this cause each year of $875,700. But all
do not work, therefore deducting 25 per cent for the idle there is
left a loss of $656,775. Now, prevent only 30 per cent of serious
illness, and there is an annual possible saving of $187,032.50.
If every person loses three days each year from mirnor ailments
and 25 per cent are idle, then there is a loss of 117,414 working
days, which at $1 per day gives us an annual loss of $117,414.
By preventing 30 per cent of this loss there is an annual possible
saving of $35,224.20.




144


Result.
Saving from preventable deaths.......... $122,920.00
Saving from serious illness..............  187,032.50
Saving from preventable minor ailments...  35,224.20
Total annual saving.................. $345,176.70
This would pay 5 per cent interest on an investment of $6,903,534 expended in sanitary improvements.
These estimates do not take into account the time that life may
be prolonged, which means that the average age at death can be
postponed and the average length of life increased with its increased earning power. Nor do they take into consideration the
possibilities of future medical discoveries, which are certain to
increase the ratio of preventability; nor the saving in cost of
medical attendance, medicines and nursing, or the saving in
fatigue, or the accumulated effect of resisting power due to better
health.
England reckons that the lives saved through the lowered death
rate from what it was between 1866 and 1875 to what it became
in the period from 1880 to 1889 amounted to 858,804 lives.
These lives represent, on the English basis of the per capita
valuation of life, a social capital saved of $650,000,000, and that
without taking any notice of the saving due to sickness.
In ten years England has more than regained the sum spent in
fifteen years for sanitary improvements, although the average annual expenditure was $40,000,000.
CHAPTER 15.-POSSIBILITIES.
SECTION I.-ECONOMIC VALUE.
Of what value is it to make laws; to have courts, and to provide
police and fire protection; to have schools; to build roads and
bridges and wharves; to make other public improvements; to conserve our soil and water, to protect the forests, fish and birds, if
we are without health to enjoy this wonderful inheritance; or, if
those who live after us are to be without health to enjoy the bless



145


ings that are passed on to them? If we are to be weak and sick,
suffering from many diseases, and die in proportionately large
numbers, all of these things will count for little.
Health, by which is meant the possession of a strong, well body,
free from pain, should bring with it great power to work, to think,
and to benefit the world. It should also bring great happiness
and enjoyment to those who possess it.
The person who can get up in the morning and look forward
to a day's work or a day's enjoyment, is the one on whom the
world's real work depends. We seldom find a strong, vigorous
mind in a weak body. The invalid is usually the idle member of
the family or community. He can, as a rule, do nothing to help
others, and thus there is a community loss in the labor of the sick
and of those who care for him.
It is, therefore, not surprising that the world is awakening to
the fact that there is a great waste of time, money, work and
happiness, and the fact that if this waste can be stopped or
checked, it is well worth all the time, study and the cost required
to bring it about.
Physicians are now aiming not only to cure but to prevent
disease, and they are discarding drugs in as many cases as
possible.
Health means more ability to work, the accomplishment of
greater things, more capacity to learn, more pleasure in everyday life, and so it is as important to preserve health as it is to
prevent death.
SECTION II. —SELFISH GAINS.
It has been shown that environment may be controlled and
thereby death postponed, disease prevented, more pleasure and
enjoyment of life gained, work rendered a delight instead of a
burden, and ability and capacity increased.
These are the direct and selfish results of enlightened sanitation
and hygiene.
The isolation of Honolulu makes the task here easier and this
should be an encouragement. The health of Honolulu can be
bettered with greater ease than that of many cities. A death rate
of 10 in every 1,000 is admitted to be well within the range of
possibilities-this is less than one-half the present rate.  The




146
climate is ideal, in it youth blossoms and old age remains full of
vigor. The task should be taken up in earnest and every energy
devoted to these ends.
SECTION III.-INFLUENCE.
We can by the application of the knowledge we now possess
favorably influence by example the whole region of the basin of
the Pacific.
Our surroundings can be so improved by intelligent effort for
better sanitary conditions that we can attract, long before we
reach ideal conditions, many who will see that we are determined
to build here a city of wonderful health as well as beauty, and
seeing this they will be more likely to decide that it is among just
such people and in just such a city that they wish to live.
Thus others will join those who are struggling with tireless
energy to overcome the habits, customs, and ignorance that binds
us to an environment, which impairs our health and limits our
energy, mars our happiness and causes unnecessary loss and
waste.
Gradually, perhaps, almost imperceptibly, we will surely cause
these detrimental conditions to disappear, until for health, comfort, and the joy of living, Honolulu will be the Mecca of a large
part of the world.
HEALTHGRAMS.
"The first aid to the dyspeptic-a good laugh."
"The more you expand your chest the less you will contract colds."
"An anemic child is the ghost of civilization."
"Hygiene aims to make growth more perfect, life more vigorous,
decay less rapid, death mrore retnote."'
"High living develops low vitality."
"It costs no more to raise a man capable of living 80 years than it
does to grow one who has not the capacity of living to be 40 years old."
"In view of the results, it cannot be deemed too great a sacrifice to
invest nearly one-tenth of the revenue of the kingdom for the promotion
of health.-W. M. Gibson.




147


ACT 28.
AN ACT
To Authorize the Appointment of the Sanitary Commission of
Honolulu and to Appropriate Money for the Expenses of Such
Commission.
WHEREAS, owing to local conditions and its commercially central position in the Pacific, the City of Honolulu and through it
the Territory of Hawaii are in grave and increasing danger of
the introduction and spread of contagious and infectious diseases
from the Orient and Mexico and Central American ports; and,
WHEREAS, owing to the large military and naval plans of the
United States for said city and its surroundings and the position
of Hawaii as a health outpost as well as a military and naval outpost for the protection of the mainland of the United States, it
is of the greatest importance to the people of the Pacific Coast and
the entire nation, as well as to the people of Hawaii, that timely
and suitable action be taken to render said City proof against
such diseases; and,
WHEREAS, owing to the possible extent and character of the
work required for this purpose, plans based on a thorough investigation on the ground should first be formulated by experts; therefore,
Be it Enacted by the Legislature of the Territory of Hawaii:
SECTION I. That a Commission of five persons to be designated as the Sanitary Commission of Honolulu be and is hereby constituted to investigate the sanitary conditions of Honolulu with
reference to present and future dangers and requirements and to
report the result of such investigation with its recommendations
of what work should be done and the necessary plans and specifications for doing it.
SECTION II. One member of the Commission shall be a civil
engineer, one a physician and one an attorney-at-law. The members shall be appointed and commissioned by the Governor by and
with the advice and consent of the Senate. The report of the




148


Commission shall be made to the Governor on or before December
31, 1911.
SECTION III. The sum of Five Hundred Dollars ($500) or as
much thereof as shall be necessary, is hereby appropriated from
the Treasury of the Territory for the expense of the Commission,
for transportation, clerical assistance, printing and such other
expenses as the members thereof shall determine to be necessary.
The members of the Commission shall serve without pay.
SECTION IV. This Act shall take effect from and after the date
of its approval.
Approved this 20th day of March, A. D., 1911.
WALTER F. FREAR,
Governor of the Territory of Hawaii.




i49


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LIST OF DAIRIES IN HONOLULU OCTOBER, 1911.
nes.              Location.            No. Cows.      Qts. Milk.
'ond...........W aikiki.............  70             500
y..........    Kalihi Road...........   4               20
Lki............  anoa  Valley..........   8               40
edell..........Gulick  Avenue.........  5               29
ilbey...........Waialae Road.........      8               55
endonca........ Markham   Lane........      4               20
res..,........ Tunawai Lane.........                      15..............Nuuanu Valley.......        4               15
a..............Kalihi...............    14               60
nto..........   Kalihi-Kai...........  3              12
rond...........Fort  Street...........  8               50
>erg............Waialae............    150            1050
n............. Moanalua...........  106             565
rade.....M.... Manoa Valley.........  89         500
ellina..........Nuuanu Valley.......    72             510...............Puhale..............    40              150
ea............. Kalihi-Uka..........    5              30
vison..........Manoa Valley.........      9              36
veia............Kapahulu Road.......      16             104............... Kalihi  Road..........   7               45
ooper.......... Manoa Valley.........     12              60
hool.......... Kalihi...............     18             110
iga........... Nuuanu Valley........      7               30
to.............Pauoa  Valley.........    5               30............... Sea View.............     8               45
Irm.......................... 26           200
wa............. 6..                                       40
iros............ '                        3              15
n...........   Nuuanu Valley........      3               10
amura..........School Street.........    4              30
es.............Middle  Street.........   4               6
immins........College Street......        4               30
Vhitney........ Punahou Street.......     5               20
oung........... Kalihi-Kai.......    24             180
M. White.......Makiki Street.........     8               62
Richard....... Puunui.............        2                8
e.............Sea View............. - 8                 45
a............. Makai Baseball Gr.....                     40
nura................28
[iles........... K al i  oa........... 13              36
E. Wall....... Keaumoku Street......       5               18
castre..........Beretania Street.......    3               10
os.............Waikiki............        6              30
>rown......... Kaimuki.............       6              34
u Dairy.......Kapahulu Road....          22             100...............Leahi Street..........' 30          175
of Hawaii......Manoa Valley.........       9             100
ita............Ka-Moiliili...........     6              46
Valpo.......    Laimi, Nuuanu Valley.       4               16
ace............Kaimuki.............   4              16
890             5376
families about....................    25              100
Total.......................   915  Total... 5476


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