"AN OPPORTUNITY LOST" An Exhibit on the History of the UNITED STATES PUBLIC HEALTH SERVICE LEPROSY INVESTIGATION STATION MOLOKAI. HAWAII 1909 -1913 U a WEAT1CER BLTtEAU. JUMZ 7 -L*R 2« koun' rilafaU irj. Tciupcr.turr. Mu. 8i. QUA. 70. Waatfcar, Tarubu. ■UOAX.-M Taat C«inf«»li. I JTSc; T* Ton. *W7 SO U Aji.1t.u Botu. la. P«r T»a. Ml.M VOL. XLI.. NO. -U4 HONOLULU, HAWAII TERRITORY, THURSDAY. JUNE 8. igoj. PRICE FIVE CENTS. SURGEON GEN, WYMAN WILL VISIT MOLOKAI Goa With Governor Carter in Local Steamer Tomorrow Ni$ht--To Select Site for Federal Leprosarium. "Writ," Governor Carter i*id oa emerging from the tiwulur rbaaiher after Bvr o'elorb Teater.lar afteraooa, ' 'Rurgeoa General W» man railed oa me today tad if arranged for tb* trip to Molohai. lewviag here Friday n.gbi nod n|>«-nur it and ami the* would be naly loo glad to off. r the Reaainfftoa. but her nlmft ia nut and raaaot be lied ta lime. " Howei-er. the atearaahip eoaapaaiea ba* • offered a eleaaner - either lh« Lihelik* or, if *b* ta sot bera is till, tb* kfavaa Loa-to the Uowrrmct for Hurpoi Ceeeral Wtiuii aad Col. Hep- bora, together with the few Tarritorial reprraentativaa who will go witb tbaaa. "Of eouraa it ia reeogatzod thai thia ia ft Fader*! eipedjtioa, henea vary faw local people will ba ia tba party "Vaa, Preaidaat Plakaaai of tba Board of Healtb will go Ala* Dr. Cooper. I akall go Byaatf. W» akaU ratara Satarday aigbt, probably loar- ia* tba Satttiaaiwat aba at In • 'clack." | Burfaaa-Oeaerai Wjraiaa, bend of tba afanaa Haaaital ftarriea, whiaa aaaa- iftf baa bawa aafarly awaiud by Oar- eraor Carter, atated reaterday that hi" unit tu priaripaltr to arrange, for the aelretinB of the aite for lb« pro [■••ed gntr>rnmeat lahoratorteo. koapi UVr •ng 'II "•l-r -i.'NHl f..r the |<-|.r*m«ritim ■tmrtnrm and ».V>.tn<0 for maiateann<> nf th« eatnl-liahmcnt, the .d.wet nf ail U-ing a - lenliflr 9I.. I* ... I*.. di«*-aiag1"B aeit Taeada> aad in tba meaatiae. haaidaa atakiag tba Morohm trip, will laapert tb* quanntiae atatioa kera. Dr. Cofer. rbief qaarutiaa oaVcr, aad Pi raid—1 Kiakkui arroBipaaied biaj U kia rail oa tba Goreraor yeatarday. ftnrgeon General Wrati aUtaa that a liaiitod aoaabar of pattella will ba traalod at tba 'laproaKjlam wk«a eoaa pi Hal Tkara will b* ao eoaapvlaioa ftbwat it. Ml ao*M paUaata ftra daalratr. •Idow o« lb, UK Jokn H. Pair of BUkop 4 l> • kutk ■Ud Uat nbjht ,< tw,lr* o'cUrL All lur daugbirr, «.r« pnmml at lb, b^d ■d, an Pair had ka»a la poo. >all> Cor l»o r«ara and darlnd In. LAYING OUT THE SITE On March 3,1905, the 58th U.S. Congress passed an "Act to Provide for the Investigation of Leprosy" in Hawaii, charging the United States Public Health and Marine-Hospital Service responsibility for building and adminis- tering a federal leprosarium and appropriating $150,000 for building con- struction and maintenance the first year. Historically, Hawaii had dealt with the dreaded disease of leprosy pri- marily by segregation and banishment of cases to the Island of Molokai as decreed by her 1865 Law of Segregation. Nowfor the first time in history.asa direct result of the 1905 Act, hope burned brightly for the success of a modern facility dedicated exclusively to the prevention, treatment and possi- ble cure of the ancient disease of leprosy. Dr. C. B. Cooper, Hawaii Board of Health President, is credited with piquing the federal government's conscience in 1904 by authoring a 10- page pamphlet entitled "Leprosy in the Hawaiian Islands" and calling it to the attention of the CISPH & MHS. Strongly supported by Surgeon General Wyman of the (JSPH & MHS and at home by Governor Carter and the Hawaii Board of Health, President Theodore Roosevelt, on December 6, 1904, recommended in his annual message to Congress that the Public Health and Marine-Hospital Service should be empowered to establish a hospital and laboratory in Hawaii for the study of leprosy. In exchange for financial and scientific assistance for the project, the Territory of Hawaii agreed to "cede title to one square mile of land, more or less" to the U.S. Government for construction of a Federal Investigation Station on Molokai. This set the stage for an inspection trip in June, 1905, by Surgeon General Wyman himself to personally select the land for the proposed Leprosy Investigation Station. An auspicious entry in the handwritten quarantine station log of "The Honolulu Medical Officer's Journal" stated: This trip is the official beginning of the scientific study of leprosy by the U.S. through Surgeon General Wyman and his corps, the CISPH & MHS. It marks a new era in the medical history of leprosy and will become a part of the important history of the United States. The much heralded visit by a VIP team of Federal and Territorial officials to select an appropriate station location was greeted ashore by the Kalau- papa leprosy settlement brass band on the morning of June 10, 1905. Surgeon General Wyman carefully picked the Kalawao site as being by far the most suitable. It was a foresaken tongue-like tract of land two and three- quarter miles wide at the base of cliffs from 1,800 to 2,000 feet high and jutting out into the ocean for about a mile. Its area of about eight square miles was rimmed by a rocky coastline. The group concluded the day by touring Father Damien's church, St Philomena, the Baldwin Home for leper boys in Kalawao and for girls in Kalaupapa and a hike to the summit of an extinct volcano. As time would prove, the choice was unfortunate—but then a Honolulu location was never even considered. Wireless instructions relative to the Molokai site selection from Passed Assistant Surgeon Cofer to George F. Wright, June 14, 1905, optimistically concluded: The conviction is rifethat only success can attend an under- taking backed by so much professional enthusiasm. Following Surgeon General Wyman's visit, the Governor of Hawaii, by proclamation dated June 28, 1905, duly ceded to the CI.S. Government the land selected as required by terms of the Act. CONSTRUCTION PROGRESS Dr. Walter R. Brinckerhoff, a Harvard University pathologist, was named first director of the U.S. Leprosy Investigation Station to be constructed at Kalawao. He arrived in Honolulu March 1906, to be joined in June by Public Health and Marine-Hospital Service Pharmacist Frank Leighton Gibson and his wife. Gibson was appointed administrative officer in charge of the project building, equipment and finances. Preparation for construction including the drawing of plans, purchasing of materials and contracting of labor finally began in September, 1907, although authorized much earlier by Congress, in March 1905. The Surgeon General in his 1909 Annual Report stated prophetically: ...the difficulties in erecting the buildings were so great as to be almost insurmountable. This was due to the isolated location and the dread of leprosy itself. The Honolulu coordination and on-site construction proceeded under Frank Gibson's dedicated efforts while Dr. Brinckerhoff carried out prelimi- nary experiments in a temporary laboratory in Honolulu. The Station was divided into three compounds: Residence, Executive, and Hospital. The Residence section included individual homes for the staff. The Administrative com- pound had office space and laboratories, storehouses, ice houses, bams and accommodations for the animals to be used in experiments. The Hospital had individual rooms for 40 patients. The very best accounting of the actual difficulties of construction was penned by Mrs. Gibson in her book of remembrances Under the Cliffs of Molokai. She wrote: The grounds had to be cleared by burning rows of houses formerly used by lepers... Every stick of lumber and bit of equipment had to be either floated ashore or loaded into small boats from the deck of the MIKAHALA or IWALANI inter-island steamers. It was some enterprise to buy and check every piece of equipment, from heavy block and tackle to handling the heavy pieces of machinery for the ice machine and electric dynamo down through the lists of linen, dishes, mules, garden seeds and all the delicate lab- oratory equipment. The Station at Kalawao had one of the most complete laboratory outfits in the world. No expense was spared... The next passage clearly shows the prevalent fear of scientists of the day, afraid to associate with the leprous patients they were there to help. Mrs. Gibson continued: Dr. Brinckerhoff had seen to that there would be no double walls in the building, breeding places of germs, mice and rats. He stipulated all single face walls. The entire station was surrounded by a double fence. These two fences were 10 feet apart to ensure protection from any contact whatso- ever, patients or othenvise. It was dogproof and kept bird- proof also, no birds being allowed to even build nests. Dr. Brinckerhoff was even so germ conscious that he wouldn't have any rugs or draperies in his house... The 20foot nun- way in the Hospital compound paralleled the rooms of the patients and, although it was covered by a roof, was open on three sides to the beneficial and antiseptic salt air. For the convenience of the doctors, wash basins were put on the runway... Frustrating and costly building delays occurred frequently. At times, it was observed, the obstacles seemed insurmountable. Two separate impor- tant provisions for an adequate water supply and an adjacent landing facility for the Station were both unforeseen necessities that required special appro- priations from Congress to finish the project. On July 1, 1909, the Station construction work was almost entirely completed with the exception of proper screening of the buildings. The Station opening was postponed yet again because "the proposal received for screening the Station was excessive and had to be rejected ... the necessary wire cloth had to be made and ... the time occupied in its transportation from the Eastern States to Honolulu further delayed the opening of the hospital and laboratory." Finally on December 23, 1909, Dr. Donald H. Currie proudly pro- nounced the Station on Molokai officially open. The Surgeon General con- cluded his 1909 report on a promising note: With a well-equipped station and laboratory, an abundance of clinical material and a well-trained corps of scientific workers, it is reasonable to expect that interesting and useful knowledge bearing on leprosy will be obtained. THE STATION OPENS Just prior to construction completion, Dr. Brinckerhoff's wife died in childbirth causing him to lose all interest in his work and resign his director ship, a broken-hearted man, April 3, 1909. He died in Mew York two vears later. J Dr. Donald H. Currie was appointed successor to Dr. Brinckerhoff on May 31,1909, but continued to work in Honolulu and travelled abroad in the late summer leaving Mr. Gibson in complete charge of the Kalawao Station. The Gibsons moved into their new quarters in July. The government spared little and "the buildings themselves, designed in the prevailing baroque style of the day, were huge, airy, high-ceilinged edifices, encircled by wide veran- dahs held in place by numerous pillars—a mainlander's idea of a southern planter's mansion transported to the sunny, languid tropics." Mrs. Gibson in her remembrances said: Uncle Sam furnished us with the best of everything: fine linen, good furniture, Haviland dishes, silver, electric lights, ice. our own water system and even a Jersey dairy cow and a flock of chickens. The thirty-two Chinese were detailed to help us at first but by and by we did not need so many... Everything had been thought of. The floor of our house was painted black, like a piano top, so to soften the glare of the reflection from the ocean ...We were very comfortable in- deed: the upstairs lanai was furnished with hammocks, chairs and couches: French doors opened from each room into a lanai: electric fans were supplied but seldom used because of the fresh breezes wafting from the ocean ...In- deed, we felt like Adam and Eve in Paradise with all the conveniences of civilization, besides a private post office." One of the biggest thrills associated with the official opening of the Station in 1909 came when the electricity was turned on for the first time anywhere on Molokai. Mrs. Gibson recalled: Many of the populace came to watch. There, before their very eyes, the science of civilized man had demonstrated the actual harnessing and use of the forces of nature... Maybe to a few, this event would also bring enlightenment, bring a ray of hope for their plight, where no hope had been, a ray of hope that there would come a day when science could proudly bring forth its answer to obliterate Hansen s disease." END OF A BRIEF ERA There are many possible reasons that can be suggested to explain why the Laboratory did not survive beyond four years. When the Station officially opened in 1909, only nine lepers volunteered as hospital patients and this small group, a token number of the hundreds possible, never increased in size. Basic cultural misunderstanding, spawning mistrust between the pa- tients and the health professionals, seemed to be the root of the problem. Other compounding issues concerned old resistance to the segregation of lepers on Molokai; bitterness against the U.S. Government for overthrowing the Queen, annexing lands in 1893 and the apparent continued local "an- nexation" of homes and land at Kalawao for federal use; the feeling by some that Station scientists "rounded up patients not for treatment but for use as experimental animals... in spite of the fact only volunteers were accepted'; excessively "germ-conscious" scientists fearful of contracting the disease themselves attempting to treat the afflicted across rigidly imposed physical barriers. Mrs. Gibson explained the fate of the nine patients in this way: Unused as they were to the restrictions of hospital life, they had little liking for it and proved uncooperative. They re- belled against the rigor of treatment and the confinement of living within the grounds after the unlimited freedom of- fered at the settlement... One by one the volunteer patients left, not caring to take the treatments and preferring a freer life in Kalaupapa. When the last one departed, the authori- ties in Washington decided to close the Station ... Dr. George W. McCoy, later to provide leadership for the National Institutes of Health, became the new Director in October 1911 and it was his duty to eventually close the Station. Pharmacist Gibson locked everything up tight and sailed away from Molokai August 7,1913. Occasionally, an expedi tion from Kalihi Hospital would silently return to confiscate needed equip- ment and supplies from the plentiful, locked, musty storerooms of Kalawao. Official disposition of the facility, however, never materialized and it laid fallow and empty until 1929,16 years after it was closed byMr. Gibson and 20 years since it was opened. Then the State gave permission for the buildings to be dismantled. Eventually all of the timbers and other materials so labori- ously brought ashore and assembled followed the nine leprosy patients across the base of the peninsula to Kalau- papa and were transformed into modest homes for mem- bers of the colony. The naked concrete piles upon which the buildings of the Investigation Station once rested alone stand as a memorial to a worthy but unproductive project. It wasn't until 1946 that the Surgeon General Thomas Parron was able to announce a truly new era in the treatment of leprosy resulting from research at the Service's facility at Carville, Louisiana, by Dr. Guy H. Faget: For the first time in the history of leprosy it is nowpossibleto bring hope to its' victims. There is now hope, furthermore. that by diagnosis at an early stage and immediate treatment with the sulfones, it will be possible to arrest the disease within a comparatively short time." SUMMARY In his message to Congress on Novem- ber 4, 1904, President Theodore Roosevelt recommended the construction and opera- tion of a hospital and laboratory in the Hawaiian Islands for the study of leprosy. Congress appropriated the money on March 3, 1905, and on June 9, 1905, the Surgeon General of the United States Public Health and Marine Hospital Service personally laid out the site at the isolated leprosy colony on the Island of Molokai. The Leprosy Investigation Station was opened on December 23, 1909, and closed less than 4 years later on August 7, 1913. For almost 70 years, the reasons for the lack of success of this facility, one of the best equipped and staffed research facilities of its time, have been shrouded in bureaucratic verbiage and the folklore of the Hawaiians. A clear fact is that it took 30 more years for a productive treatment for leprosy to be established at the United States Public Health Service Research Cen- ter in Carville, Louisiana. The exhibit documents the history of the initiation, brief operation and closure of the Station and suggests the lesson of the past that must be remembered for the future if we are to avoid future lost opportunities. CREDITS This exhibit has resulted from research efforts of a great many people from Kalau- papa, the University of Hawaii's School of Public Health, the Bishop Museum of Hon- olulu, Hawaii, the U.S. Public Health Service's Parklawn Library and National Library of Medicine, the U.S. and State of Hawaii Archives, the Hawaii State Health Planning and Development Agency as well as relatives of the original staff at the Leprosy Investiga- tion Station. The principal investigator for this work has been Professor Jerrold M. Michael, Dean of the School of Public Health, University of Hawaii, a retired Assistant Surgeon General of the United States Public Health Service. The exhibit is sponsored by U.S. Senator Spark M. Matsunaga of Hawaii. The photographic material was pre- pared by Mr. Stephen Michael with assistance from Mr. Michael Dennis. The exhibit itself was designed and produced by Mrs. Susan Anderson, Director of the Health Instruc- tional Resources Unit of the Schools of Public Health and Medicine, University of Hawaii.