HEALTH SERVICES 
AND STATISTICS 
TERRITORY OF HAWAII 
Postwar Planning Committees on Health 
Public Health Committee 
Chamber of Commerce of Honolulu 
1948 HEALTH SERVICES AND STATISTICS 
RECOMMENDATIONS OF THE COMMITTEES ON 
NURSING, OCCUPATIONAL THERAPY, 
PHYS10THERAPY AND HEALTH STATISTICS 
POSTWAR PLANNING COMMITTEES ON HEALTH 
Public Health Committee 
Chamber of Commerce of Honolulu 
January 1948 
ft> R POSTCAR PLANNING HEALTH COMMITTEES 
of the 
CHAMBER OF COMMERCE OF HONOLULU 
Steering Committee 
Charles L. Wilbar, Jr., M.D., Chairman 
Nils P. Larsen, M.D, 
R. G. Nebelung, Dr.P.H. 
Vivian Johnson, M.A. 
COMMITTEE ON NURSING 
Mrs, F, Helen Gage, R.N., Chairman 
Mrs. David Y. K. Akana, R.N. 
Mrs. Ethel Brown, R.N* 
Virginia Doyle, R.N* 
Laura Draper, R*N* 
Virginia Jones, R0N, 
Marjorie MacLachlan, R.N. 
Mrs. Basel Mattson, R.N. 
Mrs. Mildred Pinner, R.N. 
COMMITTEE ON OCCUPATIONAL THERAPY 
Mrs, Laura M, Dousett, Chairman 
Lillian Lowrey 
Mrs. Jane E, Olson 
Esther Pyun 
COMMITTEE ON PHYSIOTHERAPY 
Ruth Aust, Chairman 
Thomas Ching 
Mrs, Wilmar Downie, Lt, (ANC) 
Grace Ednie 
Carrol Moyer 
Mrs, Sybil Voorheis 
Bessie Young 
COMMITTEE ON HEALTH STATISTICS 
Samuel D. Allison, M*D. 
Edward Chong 
Eric George 
Andrew W, Lind, Ph.D., Chairman 
A. L, Y. Ward 
Margaret S. Wright 
William Wong 
Public Health Committee Field Staff 
Raymond G. Nebelung, Dr.P.H*, Director 
Maxine C. Beeston, M*P*H* 
Robert C* Sclimitt, M*A, FOREWORD 
This volume is devoted to studies of four very important health 
services} nursing, occupational therapy# physiotherapy, and the keep- 
ing of health statistics. 
In three of these services—nursing, occupational therapy and 
physiotherapy—the central problem is one of obtaining trained person- 
nel. Manpower shortages linger on from wartime dislocations; training 
facilities are frequently lacking in the Territory; and official or 
private agencies are unable to make adequate provision for staffing. 
Even when personnel are adequate, a problem remains. Professional 
workers in allied fields are often hostile to newer developments in 
health and medical services. Lay persons, through ignorance or bias, 
are unwilling to make the optimum use of these services. Sometimes they 
would like to, but are thwarted by economic considerations. Such diffi- 
culties—not uncommon ones in the fields under considoration--are partly 
resolved by an intensive program of health education. 
Health statistics presents other problems. First, existing 
facilities and data must be utilized as fully as possible. Second, 
future surveys and censuses must be much more extensive than they are 
at present. The Bureau of the Census, the Bureau of Labor Statistics 
and a number of other official and private agencies charged with the 
collection and analysis- of data, either on a local or a national scale, 
must be convinced of the necessity of full coverage of Honolulu and the 
Territory, This coverage should take in not only births, deaths and 
incidence of illness, but other information intimately related to 
health—migration, housing, costs of living, income. Since much 
statistical material is collected by states (and territories omitted), 
attainment of this goal must ultimately wait upon statehood for Hawaii. 
The four studies embraced in this volume make specific recommenda- 
tions to remedy some of the defects of current practice. An expanded 
Division of Health Statistics in the Territorial Board of Health is 
suggested, and charged with the responsibility of collecting and 
analyzing a variety of data. A central school of nursing is recommended 
for the University of Hawaii, to give the basic courses now offered by 
the three Honolulu independent schools. Mention is made of the uneven 
distribution about the Territory of certain types of nurses, who are 
frequently clustered on Oahu all out of proportion to that island's 
population. The practice of occupational therapy is not covered by any 
Territorial laws, the enactment of which would seem highly important. 
Educational programs aimed at lay and professional persons are recom- 
mended to increase general understanding of the value of scientific 
phy s i o the r apy. 
The four subjects considered in this volume, either as specialized 
forms of treatment or (in the case of statistics) as powerful, overall 
tools of attack, are unquestionably integral parts of any comprehensive 
community health program. As such, they deserve consideration commen- 
surate with that accorded more dramatic problems, such as tuberculosis, 
mental hygiene, venereal disease or cancer. 
P. J, Pinkerton, M.D., Chairman 
Public Health Committee 
Chamber of Commerce of Honolulu INTRODUCTION 
In this volume is included the reports of the Postwar Planning 
Health Connittoes dealing with Health Statistics, Physiotherapy, 
Occupational Therapy and Nursing. The report on statistics is included 
along with the reports on specific healing arts because of convenience 
in binding those reports together, rather than any fooling that 
statistics is mainly concerned with occupational therapy, physio- 
therapy and nursing activities. 
Accurate statistical analyses of vital records of morbidity and 
of all conditions which affect healthful living are needed to determine 
where emphasis should bo placed in a community’s public health program 
and how successful are various aspects of the program. Priorities for 
use of personnel and money in the field of public health should not be 
determined by guoss or by special interests of public health loaders, 
but only by careful analysis of well compiled data regarding various 
health conditions. Often, what appears to bo a trend in one direction 
or a matter of considerable importance, after subjection to statistical 
analysis is disclosed to mean no trend whatsoever or a trend in the 
opposite direction or a matter of really little importance. Unless we 
have accurate analysis of our public health data we can waste much 
time, energy and funds in channels whore the returns are poor and fail 
to expend those assets in the fields of public health where they are 
most needed. 
The healing arts of physiotherapy, occupational therapy and nurs- 
ing have shewn rapid strides of improvement in recent years and the 
scientific knowledge of those fields should bo made available in our 
Territory to all who need it. High standards for those who work in 
these professions in the Territory are unquestionably desirable. 
Studies made by the leaders of Hawaii in this field, which follow, nay 
well be used as a guide toward obtaining these objectives. 
Charles L. Wilbar, Ur., M.D. 
Chairman, Steering Committee PUBLICATION PROCEDURES AND RESPONSIBILITY FOR REPORTS 
Reports of the postwar planning health committees are prepared 
by the several study groups with the aid of the Public Health Com- 
mittee staff of the Chamber of Commerce, Staff members meet regu- 
larly with the groups during the course of study. 
A tentative final report in outline form is submitted to the 
Steering Committee for review. The study group chairman then meets 
with the Steering Committee which advises, offers suggestions re- 
garding changes, and then refers the project back to the study group 
for further consideration. The final revision is resubmitted to 
the Steering Committee for approval both in outline and narrative 
forms. The purpose of the outline is to enable anyone to appraise 
readily the present status of a particular program and the recom- 
mendations of the study committee without having to peruse the entire 
report. Each finally revised report will include any dissenting 
opinions of the committee members which they may request be pub- 
lished. Reports are issued as the work of the particular committee 
preparing thorn. Individual recommendations may be considered to 
represent the view of the committee as a whole. 
R. G. Nebelung, Dr, P. H, 
Executive Director 
Public Health Committee GEOGRAPHICAL NOTE 
The Territory of Hawaii consists of eight major islands and a 
number of lesser ones. The two largest cities are Honolulu, on Oahu, 
and Hilo, on Hawaii. There are five counties, but Kalawao (consisting 
of Kalaupapa Leper Settlement, on the Island of liolokai) has no local 
government. These geographical unite are listed in the following 
tablei 1/ 
Unit 
[Land Area in 
'Square Miles 
Population 
1940 
1946 
City and County of Honolulu 
4"* ,lf -dwm 1 11 1 m 
603 
258,256 
358,911 
Island of 
Oahu 
589 
257,664 
358,911 
Honolulu dity 
82 
179,326 
267,710 
Rural Oahu 
507 
78,338 
91,201 
Palmyra Island 
N.A. 
32 
N.A. 
Other minor islands 2/ 
N.A. 
560 
N.A. 
Hawaii County 
3/ 
; 4,021 
73,276 
70,871 
Maui County 4/ 
r 
| 1,173 
55,980 
54,610 
Island of 
Maui 
728 
46,919 
44,807 
Island of 
Molokai 4/ 
250 
5,340 
6,173 
Island of 
Lanai 
141 
3,720 
3,630 
Island of 
Kahoolawe 
45 
1 
N.A. 
Kauai County 
623 
35,818 
35,111 
Island of 
Kauai 
551 
35,636 
34,911 
Island of 
Niihau 
i 72 
182 
199 
Total 5/ 
! 
6,420 
423,330 
519,503 
1/ Land area and 1940 population from 1940 13,S, Census, 1946 population 
from Territorial Board of Health estimates for July 1, 1946. The 
1946 estimates are taken from two different published sources and 
in several instances do not add up exactly to the indicated totals. 
2J Not under Territorial jurisdiction, but included for census purposes. 
A number of minor islands in the Hawaiian chain are under Terri- 
torial jurisdiction but are uninhabited. 
ZJ Coextensive with the Island of Hawaii. Hilo city had a 1940 popu- 
lation of 23,353 (27,922 in 1946). 
4/ Including Kalawao County (Kalaupapa Leper Settlement, 14 square 
miles, population of 446 in 1940 and 386 in 1946). 
5f "Other minor islands" included for 1940. 
N.A. Not available. TABLE OF CONTENTS 
NURSING 
Page 
Outline of Suggested Recommendations ....... 1 
Narrative Report 8 
Introductory 8 
The Preparation of Nurses 10 
Course for Practical Nurses. 10 
Undergraduate Study • 11 
Postgraduate Study 13 
Legal Aspects 14 
Fields of Service 15 
Private Duty Nursing 15 
Office 17 
Institutional Nursing 18 
Industrial and Plantation. 19 
Public Health Nursing 20 
. School ...... 21 
OCCUPATIONAL THERAPY 
Outline of Suggested Recommendations 24 
Narrative Report ........ 28 
Introductory 28 
Legal Status 29 
Facilities for Training 30 
Personnel 30 
Occupational Therapy Association of Hawaii. ....... 31 
PHYSIOTHERAPY 
Outline of Suggested Recommendations ..... 34 
Narrative Report ..... 36 
Introductory 36 
Facilities for Training ....... 37 
Personnel , 38 
Problems 39 
HEALTH STATISTICS 
Outline of Suggested Recommendations . . . , , 41 
Narrative Report . ...... 51 
Introduction 51 
Present Facilities. .... 51 
The Funding and Integration of Statistics 52 
Special Problems of Population 53 
APPENDIX 56 
INDEX 
PUBLICATIONS OF THE POSTWAR PUNNING COMMITTEES ON HEALTH Recommendations of 
COMMITTEE ON NURSING 
Mrs, F. Helen Gage, R.H,, Chairman 
Mrs, David Y, K. Akana, R, N. 
Mrs. Ethel Brown, R. H, 
Virginia Doyle, R. N. 
Laura Draper, R. N. 
Virginia Jones, R. N, 
Marjorie MacLachlan, R. N, 
Mrs, Hazel Mattson, R. N. 
Mrs. Mildred Pinner, R. N. Present Situation 
Suggestions and Recommendations for 
(Services and P*esources) 
Immediate Action 
Long-range Objectives or Action 
It is recommended that; 
It is recommended that: 
I. Background of nursing in the 
Territory. 
A, Increase in numbers (1.3 
per 1,000 population in 
1900, 3.3 in 194-0). 
B. Growth of institutions 
since 1859. 
0. Development of training 
facilities since 1916 
D. Professional organizations 
The Nurses1 Association keep 
1. Nurses1 Association 
records of the number of members 
2, Nursing Service Bureau 
3. Territory of Hawaii League 
for Nursing Education 
E. Special Problems 
1. Exceptional growth of 
engaged in each specific activity, 
and maintain a perpetual inven- 
tory, to supplement data of the 
Board for the Licensing of 
Nurses. 
the Territory. 
2. Diverse population. 
3. Socio-economic trends and 
possibilities. 
a. Business cycle and 
its effects. 
b. Prepaid medical care. 
II. Preparation of nurses. 
A. Training course for practical 
nurses. 
j 
OUTLINE OF SUGGESTED RECOMMENDATIONS 
- ..... Goinmittee ■ ■ on.. Nursi ag. . , . c, 
Postwar Planning Committees for Health Present Situation 
(Services and Resources) 
Suggestions an< 
Immediate Action 
1 Recommendations for 
Long-range Objectives or Action 
It is recommended that: 
It is recommended that; 
1. Operation in conjunction 
with Territorial Board for 
Licensing of Nurses 
2, Organization with aid of 
Department of Public In- 
struction and Community 
Nursing Council, 194-7. 
3. Location, Washington 
Intermediate School 
4-. Length of course, 9 months 
a. Theory, 9 weeks 
b. Practice in local 
hospitals, 30 weeks 
5. Entrance prerequisites 
a. Age, 18 years or over 
b. 8th grade or better 
education 
c. Good physical and mental 
health 
6. Staff, 3 
7. Enrollment, 24- (Oct. 194-7) 
B. Professional nurses (R.N.) 
1. Schools 
A central school of nursing 
a. Major schools 
be instituted at the Univer- 
l) The Queen's 
sity of Hawaii. 
2) St. Francis 
3) Kuakini 
b. Affiliated institutions 
Board of Health field practice 
l) University of Hawaii 
facilities be extended to nursing 
2) Kauikeolani Hospital 
schools as they are ready for them 
3) Leahi Hospital 
and facilities become available. 
4.) Board of Health,T.K. 
2. Length of course, 3 years 
3. Entrance prerequisites 
More discriminating pre- 
a. Graduation from accredit- 
requisites be adopted, to assure 
ed high school 
the highest type of student.  
Present Situation 
Suggestions and Recommendations for 
(Services and Resources 
Immediate Action 
Long-range Objectives or Action . 
It is recommended that: 
It is recommended that: 
b. Psychological exami- 
nation 
c. Others 
A. Clinical facilities for 
Needed facilities and affilia- 
training students (See 
tions be instituted where they are 
Appendix Table 12) 
at present lacking (see Appendix 
5. Accrediting (see Appendix 
Table 12) 
Table 12) 
6. Teaching personnel (see 
Appendix Table 12) 
7. Students and graduates, 
relative to mainland 
a* Fewer schools, stur- 
dents and graduates 
• 
relative to population. 
b. Bigger enrollments but 
fewer graduates per 
school. 
B8B SB 
c. Drooping out of more 
students before graduation 
8. Scholarships (see Ap- 
More scholarships be offered. 
pendix Table 12) 
C. Graduate study 
1, University of Hawaii 
a. B.S. in nursing 
b. Certificate in P.H.N, 
2. Leahi Hospital (in 
tuberculosis) 
3. In-service programs 
a. Board of Health,T.H, 
(for P.H.M.) 
b. Various hospitals. Present Situation j 
Suggestions and Recommendations for 
(Services and Resources) 
Immediate Action 
Long-range Objectives or Action 
III, Legal aspects: Text of Statutes 
It is recommended that: 
of the Territory of Hawaii relat- 
1 
ing to registration of nurses and 
1 
regulation of nursing (Act 24.0— 
S.L. 1947) 
A, Definition of the profession of 
nursing 
I 
B, The Board for the Licensing of 
Nurses 
1. Appointment, term, tenure and 
compensation 
2, Powers and duties 
3. Record-keeping function 
Revenue be augmented by in- 
crease in fees and Territorial 
funds so as to employ personnel 
for extensive record keeping, A 
perpetual inventory be main- 
tained of all significant 
information. 
C. Licensing of registered and 
practical nurses 
IV. Fields of service 
A, Private duty 
The Nurses* Association of 
1. Number in Territory, 86 
the Territory and the Terri- 
2. Nurses per 1,000 popula- 
torial League for Nursing Edu- 
tion 
cation make the necessary 
a, u ,S., 0,4- 
studies and assume responsi- 
b. T.H., 0.2 
bility for active leadership in 
attacking the problems confront- 
ing private duty, as well as 
other, nurses: development of 
standards, improvement of pro- 
fessional training and graduate 
study facilities, and improve- 
ment of working conditions, 
wages and hours, in general. 
[ Present Situation 
(Services and Resources) 
Suggestions and Recommendations for 
Immediate Action Long-range Objectives or Action 
3, Conditions of employment 
It is recommended that 
It is recommended that: 
a. Hours 
A program of hourly private 
1) War years, 12 per day I 
duty nursing be considered. 
2) At present, 8 per day | 
Private duty nursing be in- 
eluded in H.M.S.A. hospital 
coverage. 
b. Wages (for 8 hours) 
1) I%0, |8 
Wages and hours of private 
2) 1947, $10 
duty nurses be adjusted to levels 
prevailing in other occupations 
of similar skill levels 
B. Physicians* offices 
Job analysis of office nursing 
1. Number in Territory of 
be instituted by N.A.T.H, and the 
office nurses, 82 
Medical Society. 
2. Percentage of all nurses 
a, U.S. (A.N.A. membership. 
3*6 
b. T.H., 7,8 
C. Institutions 
1, Number of institutional 
nurses in Territory, 443 
2, Nurses per 1,000 population 
a, U.S., 0,8 
b. T.H., 0.9 
3. Distribution by type and 
institution (see Appendix 
Table 11) 
D. Industrial and plantation 
1. Number of industrial nurses 
in Territory, 63 
2. Nursing ratios 
a. Per 1,000 population, 0,1 
(both U.S, and T.H.) Present Situation 
Suggestions and .Recommendations for 
(Services and Resources) 
Immediate Action 
Long-range Objectives or Action 
! 
It is recommended that; 
It is recommended that; 
b. Per 1,000 manufacturingJ 
wage earners 
1) U.S., 0.8 
2) T.H., 3.5 
E. Public Health 
Staff nurses be increased to 
The need for a bedside caro 
1, Number in Territory 
meet ratio of 1:5000, nurses to 
program be studied, and, if need 
(1946-47), 88 
population. 
is indicated, be developed by the 
2, Nurses per 1,000 popula- 
Territorial Board of Health 
tion 
a, U.S,, 0,1 
Financial assistance be con- I 
tinned to promising staff members 
Staff nurse and supervisory per- 
sonnel ratios of 1 nurse to 2500 
b, T,H., 0,2 
3* Kind of service reported 
by Bureau of Public Health 
Nursing 
a. Tuberculosis, 23,3% 
for advanced training on the maini 
land. 
' 
population (assuming a bedside 
care program) and 1 supervisor to 
10 staff nurses and students be 
maintained. 
b. Infant, 21„2% 
Adequate consultant service in 
c. Other, 55.5% 
major fields be maintained. 
4* Sources of salaries 
(June 30, 1946) 
a. Bureau of Public Health 
Nursing, 84 
b. V,D, Bureau, 6 
c, T.B. Bureau, 4 
d. Crippled Childrens 
Bureau, 2 
e. M. & C, H. Bureau, 1 
f. U.S.P.H.S., 1 
5. Facilities 
a. Honolulu, adequate 
b. Elsewhere, generally 
Inadequate buildings outside of 
Offices and conference andi 
inadequate 
Honolulu be replaced or repaired. 
clinic rooms be constructed where 
necessary. Present Situation 
Suggestions and Recommendations for 
(Services and Resources) 
Immediate Action 
Lv*:?.g-range Objectives or Action 
F. School (D.P.I.) 
It is recommended that: 
1* Number in Territory, 16 
a. Oahu, 12 
b. Other islands, U 
Special emphasis be put on main- 
Percentage of all nurses 
taining adequate nursing-to-pupil 
1.5 
ratios in schools outside Oahu. 
Use of Board of Health 
nurses where no full-time 
D.P.I. nurse is utilized. 
, 
1 
i 
i 8 
NURSING 
Introductory 
The history of nursing in the Territory of Hawaii reveals a steady 
growth and expansion. Locally as well as nationally, an ever greater 
number of trained nurses has become available for a given population. 
There has been constant improvement in methods of care, hospitals and 
training facilities. Professional organizations for nurses have emerged. 
These developments have come about in response to definite community 
health needs, but many new problems have joined older ones still un- 
solved, with the result that the nursing profession is called upon today 
to mate even greater adjustments than in the past. 
The ratio of nurses to population has shown considerable improvement 
since 1900. In that year there were about 121,000 nurses in the United 
States, and only 207 in the Territory. The U.S. Census listed these 
nurses under "Domestic and Personal Service." l/ The 1910 Census in- 
cluded a "Trained Nurse" category under "Professional Services" as well 
as one for "Nurses (not trained)" under domestic and personal services. 2 
Each decade witnessed an increase in the number of nurses, both on the 
mainland and in the Islands. 3/ In 1900 there were only 1.3 nurses per 
1,000 population in the Territory; by 1940 there were 3.3. The national 
ratio in the same period increased from 1,6 to 3.4. 4/ Thus Hawaii was 
almost abreast of the mainland. 
Both nationally and locally, the greatest growth relative to popu- 
lation occurred among the trained (as opposed to untrained or practical) 
nurses. In the two decades following World War I, trained nurses in the 
Islands increased from 1.0 per 1,000 persons (in 1920) to 2.6 (in 1940), 
Untrained or practical nurses numbered 0.8 per 1,000 in 1920, 1.0 in 
1930 (their peak), and 0,7 in 1940. A similar trend occurred in United 
States data. 3y 194-0, both the Territory and, the mainland had 0.7 
practical nurses per 1,000 population, and the continental United States 
had a slight edge over Hawaii in the natter of graduate nurses. 
Concomitantly with this improvement in nursing service there 
veloped a great expansion in hospital facilities. The first general 
hospital in the Pacific area was The Queen's, founded in Honolulu in 
y 1900 data are given in greater detail in Appendix Table 1, 
2/ See Appendix Table 2. 
3/ See Appendix Tables 2, 3, 4, and 5. 
4/ See Appendix Table 6. 
5/ Ibid. 9 
1859. 1/ Kuakini .(then called Japanese Hospital) had its beginnings as . 
early as 1899. .?/ In 1927, St. Francis Hospital was opened for patients. 5/ 
Various specialized institutions, such as Leahi (for tuberculosis) and 
Kapiolani (founded in 1890 "to propagate and perpetuate the race"), i/ 
were added to the list of Honolulu medical facilities. A similar growth 
in general and other hospitals occurred in rural Oahu and on the other 
islands. By 1939 there were 68 such institutions in the Territory of 
Hawaii: 57 general hospitals, four tuberculosis sanatoriums, two 
institutions for nervous and mental patients, and five hospitals dedi- 
cated to other purposes. Jy 
Adequate facilities for the training of nurses have been an even 
more recent phenomenon. “The opening of schools of nursing in New 
York, New Haven, and Boston in 18,73 marked the beginning of trained 
nursing in the United States." jy There were 2,155 schools of nursing 
in the United States in 1925, LJ a figure which fell to 1,253 by 1947. S/ 
The first such school in the Islands was established at The Queen*s 
Hospital in 1816, and was followed by schools of nursing at St. Francis 
(1929) and Kuakini (1931). */ 
Professional organizations soon arose to serve the nurses. One 
of the largest national organizations, the American Nurses* Association, 
is locally represented by a member association with a 1946 membership 
of 566, a little more than half the total number of nurses registered 
in the Territory. L2/ This group is in an admirable position to keep 
tab on the distribution of nurses in the Territory, by place and type 
of work. A perpetual inventory devoted to this kind of information 
could well be on© of their functions, to supplement records of the Board 
for the Licensing of Nurses. Another professional organization, the 
Nursing Service Bureau (with a 1947 membership of 119), serves both the 
community and its member private duty nurses by acting as a clearing 
house for jobs, ii/ An important service in still another field of 
nursing is rendered by the recently recognized Territory of Hawaii 
League for Nursing Education. 
y, ’’The Queen’s Hospital: Information for Our Patients and the Public” 
(1945?), p. 4. 
2/ "The Kualdni General Hospital School of Nursing Announcement" (1947), 
p. 4. 
3/ "Biennial Report, 1945-1946, St, Francis Hospital"(l947), p, 1. 
4/ Oahu Health Council Bulletin, September 1947, p, 2. 
5/ See Appendix Table 10* 
6/ Agnes Gelinas, Nursing and Nursing Education (New York, 1946), p. 4, 
7/ Ibid,, p. 9, 
Sj See Appendix Table 13. 
9/ See Appendix Table 12. 
IS/. Facts About Nursing, 1947 (A,N,A,, 1947), p, 11, and Appendix Table 
7 of the present volume. 
See Appendix Table 9, 10 
Problems have kept apace of progress, however. Nursing service 
in the Islands, which apparently had achieved something of an equili- 
brium by 1940, was profoundly disturbed by World War II. In many 
respects it is still seeking an adjustment with postwar conditions of 
population and economy. The Islands have long maintained a more rapid 
rate of growth than the mainland, and this trend seems likely to persist 
for some years after the violent influxes and dislocations of the war 
years. Further confusion is added by the extreme racial and economic 
diversity of the population. Although this growth of the Islands has 
made an expansion of services mandatory, wage and salary adjustments 
to the recent upsurge in costs of living have not been, like those in 
manufacturing and other industries, sufficient to attract the requisite 
number of tyro nurses. Another possibility is that of a downward 
swing of the business cycle—a "depression"—with its inevitable 
corollary of lessened demand for medical treatment, J/ In opposition 
to this influence is the growth in prepaid medical care plans, which 
should create a greater demand for nurses. Thus the future need for 
nurses in Hawaii (as elsewhere) is not at all clear. 
The immediate future is fortunately less beclouded. The present 
study is devoted to an intensive analysis of the current position of 
nursing in the Territory, the better to plan properly for this fore- 
seeable future. 
The Preparation of Nurses 
Nursing education is carried on at three levels in Hawaii. A 
course for practical nurses gives training to persons interested 
primarily in the non-professional types of nursing. Three hospital- 
affiliated schools, all of them located in Honolulu, offer the usual 
three-year graduate nurse program. Postgraduate courses are given 
by the University cf Hawaii and Leahi Hospital. A similar function is 
performed by the in-service training programs of various hospitals and 
Territorial Board of Health, 
Course for Practical Nurses 
A course in Practical Nursing was organized in 1947 with the aid of 
the Department of Public Instruction and the Community Nursing Council. 
Operated in conjunction with the Territorial Board for the Licensing 
of Nurses, it is currently held in Washington Intermediate School, 
1/ This relationship between economic well-being and the demand for 
health services has recently been noted in a local context (Rear 
Admiral Lucius W, Johnson, MC, USN, "Survey of Honolulu Hospitals," 
Hawaii Medical Journal, Noveraber-Deoember 1944), 
2/ For further information, see the Oahu Health Council Bulletin, 
September 1947, p. 4f, and November 1947, p, 4 11 
To be admitted to the course a student must possess certain quali- 
fications. The minimum age permitted is 18, and the applicant must 
have completed the 8th grade successfully. Additional requirements 
include good physical and mental health and a personality and dexterity 
suitable to caring for the sick. Men as well as women are admitted to 
the school. Mature women are encouraged to take advantage of this 
training. 
The length of the course is nine months. "Each class will be given 
nine weeks of theoretical training and then will receive 30 weeks of 
practical training at various Honolulu hospitals, in the field ... and 
at nursery schools. Subjects which the current class is being given 
include simple nursing procedure, home economics, anatomy, personal 
hygiene, ethics and personal relationships, child care and develop- 
ment, community help facilities and a small amount of occupational 
therapy." Jy 
At present the teaching staff consists of three members, teaching 
twenty-four students, jy 
Upon successful completion of this training, a student may apply to 
the Territorial Board for the Licensing of Nurses for a license as a 
practical nurse. The license is granted upon successful passing of an 
examination. W 
Undergraduate Study 
The customary three-year professional program is offered by three 
schools of nursing in the Territory, all of them affiliated with 
Honolulu hospitals: The Queen’s, St, Francis and Kuakini, These 
institutions give credit for work taken at Kauikeolani Children’s 
Hospital, Leahi Ho pital, The Territorial Board of Health and the 
University of Hawaii. It is generally felt that eventually much class- 
room work now given by these schools should be taken over, by a central 
school of nursing located at the University of Hawaii, j\/ For the 
present, however, a strengthening of the individual schools seems to 
be about all that can be expected. 
V Ibid., November 1947, p, 4, 
2/ Ibid. This was the beginning enrollment, October 20, 1947, 
y Ibid., September 1947, p, 4, 
4/ In spite of the fact that the number of schools per 100,000 popula- 
tion in the Territory is far below the corresponding figure for 
continental United States (see Appendix Table 14), The character 
and distribution of the population in the Islands do not require the 
diffusion of educational facilities found on the mainland, such dif- 
fusion often achieved at the sacrifice of variety of courses and 
economy and efficiency of operation. 12 
The three schools generally agree on certain prerequisites to 
admission. / Graduation from an accredited high school is essential* 
preferably in the upper third of the class. The applicant must have 
good mental and physical health, the former to be checked by a psycholo- 
gical or "pre-nursing" test. Where a minimum age is set, it is 18; 
the maximum lies at 30 or beyond. These prerequisites conform to the 
standards of the majority of mainland schools, where 97 percent require 
high school graduation and 46 percent specify scholastic standing in 
the top third of the applicants high school class. Pre-nursing tests 
are mandatory in 79 percent of the mainland schools, and students under 
16 years of age are admitted by 45 percent. 2/ There is considerable 
sentiment, however, that more discriminating admission requirements 
should be adopted, in order to assure the best type of student and a 
high level of professional service in the Islands in the future. 
Clinical facilities available for training students are somewhat 
limited and should be expanded. Only one of the schools has facilities 
or affiliations in all these fields* medicine, surgery, obstetrics, 
contagion, neurology, psychiatry, pediatrics, tuberculosis, public 
health and outpatient (and some of their facilities are capable of 
improvement). Board of Health field practice opportunities should 
eventually be extended to all schools of nursing as they (and the Board) 
become ready for them. Certain gaps should be filled as soon as possi- 
ble. Clinical services currently available in the three Honolulu 
schools or© noted in Appendix Table 12. 
Two of the schools are accredited by the Territorial Board for 
licensing, and the third provisionally accredited. iy 
Full-time teachers number fifteen. Five are employed at The 
Queen1s, seven at St. Francis, and three at Kuakini. Including 
part-time teacher , there are approximately nine students per instruc- 
tor at The Queen’s, fifteen at St. Francis, and eleven at Kuakini. §/ 
St, Francis currently has the largest enrollment, but The Queen’s 
graduated the greatest number of students in 1947, Total enrollment in 
the three schools amounted to 374 students near the end of 1947. 
Thirty-five persons were graduated during the year, jy 
1/ Minimum standards have been advanced by the Board for the Licensing 
of Nurses. 
2/ Facts About Nursing* 1947, p, 21f. 
Zj See Appendix Table 12* 
*/ See Appendix Table 12. 
5/ Calculated from Appendix Table 12. 
s/ See Appendix Table 13, 13 
Comparison with mainland data reveals some disturbing facts. 
Hawaii suffers from shortages of both students and recent graduates 
relative to its population. Local schools have larger enrollments but 
fewer graduates. The ratio of graduates to students each year is very 
low, indicating the dropping out of many persons before the completion 
of the course. The most recent comparable data follow: 1/ 
Ratio 
Year 
Mainland 
Hawaii 
Population per school 
1947 
115,500 
175,000 
Population per student 
1947 
1,350 
1,410 
Population per graduate 
1946 
3,900 
8,700 
Students per school 
1947 
85 
125 
Students per graduate 
1946-47 
3.56 
10.7 
Graduates per school 
1946 
28.5 
20 
Another failing of local schools of nursing is in the matter of 
scholarships. Only nine are offered by the schools at present, 2/ Many 
more should be made available to deserving student nurses. 
The three Honolulu schools have made remarkable progress since 
their inception. Present deficiencies can be largely attributed to 
their newness. Future years should see the satisfactory solution of 
the problems noted above, as well as the resolution of other questions 
not yet recognized. 
Postgraduate Study 
Several opportunities for postgraduate study in nursing exist in 
the Islands. Most importantly, the University of Hawaii offers pro- 
grams leading to the B,S, in Ilursing degree and a certificate in Public 
Health Nursing, Special courses are given by Loahi Hospital. In- 
service training is available for the graduate nurses employed by the 
Territorial Board of Health and some of the hospitals, i 
The University program in Nursing permits a major in ’’either 
Nursing Administration and Education or in Public Health Nursing, and 
requires three years of university work in addition to graduation from 
a school of nursing,” The applicant must also bo registered as a 
nurse in the state or territory in which the undergraduate training 
was secured. This program leads to the Bachelor of Science degree in 
Nursing, 3/ 
l/ From Appendix Table 14, 
2/ See Appendix Table 12. 
3/ "General Catalogue, 1947-1948” (University of Hav/aii Bulletin, 
Vol. XXVI, No, 3, June 1947), p. 47. 14 
Furthermore* ’’with the cooperation of the Territorial Board of 
Health and other community agencies, the University of Hawaii offers a 
one-year program in Public Health Nursing. Classroom work occupies the 
first semester. During the second semester students take part in the 
Public Health Nursing program of cooperating agencies. Students who 
complete the required program with an average gi*ade of £ or higher 
receive a certificate in Public Health Nursing.” }/ 
In addition to its work with the undergraduate schools and Univer- 
sity of Hawaii, the Territorial Board of Health has developed a con- 
structive in-service training program for its own staff. ’’Emphasis 
was placed (during 1946) first on principles of teaching, including 
discussion of patient-nurse and interagency relationships. Later cer- 
tain nursing techniques were reviewed and standardized. A series of 
staff meetings were devoted to various aspects of tuberculosis control. 
After this material had been presented to the Oahu nurses, it was 
taken to the other islands ...” J-y 
The three undergraduate schools do not offer formal postgraduate 
courses, and as a consequence only a limited number of their students 
or staff nurses take advanced training. Logically, of course, such 
training should bo taken at the University, where it is already availa- 
ble, Emphasis should be placed on the availability of postgraduate 
study to graduates of the three Honolulu schools and to staff nurses 
in the various hospitals. 
Legal Aspects 
Once a nurse has graduated, she applies for a license. This fact 
is true of both practical nurses and graduate nurses. She makes her 
application in accord with the provisions of the ’’statutes of the Terri- 
tory of Hawaii relating to registration of nurses and regulation of 
nursing." (Act 240—S.L, 1947.) 
A brief summary of this act may prove of interest. Section 2770 
defines the duties of a registered (professional) nurse and practical 
(non-professional) nurse. A Board for the Licensing of Nurses is 
established and defined in Sections 2771 and 2777 through 2781, Appoint 
raent, term, tenure and composition of the Board are specified. Among 
its powers are the examination and approval of schools of nursing and 
applicants for nursing licenses, and the keeping of a minimum of 
records. The physical, psychological, ethical and educational qualifi- 
cations necessary for a nursing license are stated in Sections 2773 and 
2775. 
1/ Ibid., p. 48 
2/ Annual Report of the Board of Health, Territory of Hawaii, 1946, 
p. 134. 15 
It has been suggested that the revenue of the Board be augmented by 
both an increase in fees and Territorial funds so as to permit the employ- 
ment of adequate personnel to maintain records. There is a paucity of 
reliable, up-to-date statistics regarding nurses, the collection of which 
is within the natural province of the Board for the Licensing of Nurses, 
This information would be supplemented by that recorded by the Nurses* 
Association, 
Fields of Service 
There are eight major kinds of nursing service operating in Hawaii* 
private duty, office, institutional, industrial and plantation, public 
health, school, military and educational. Nursing education has been con- 
sidered in a preceding section. Military nursing is beyond the scope of 
this report. 
Private Duty Ilursing 
Private duty nurses in the Territory of Hawaii are somewhat less 
numerous relative to population than is the case on the mainland. The 86 
private duty nurses registered in the Territory for 1946-1947 comprised 
8,2 percent of all registered nurses in the Islands, compared to a corres- 
ponding mainland figure of 32,4 percent. 2/ Thus, there are 0,2 private 
duty nurses per 1,000 population in Hawaii, just half as many (0.4) as in 
the continental United States. 2/ 
These nurses are mostly clustered on Oahu. Their distribution, by 
islands, is as follows* jy 
Island 
Number of Nurses 
Population per 
Nurse 
Territory of Hawaii 
86 
6,000 
Oahu 
76 
4,700 
Hawaii 
5 
14,000 
Maui 
2 
22,000 
Kauai 
2 
17,000 
Molokai 
1 
6,000 
Others 
0 
It is evident that the outlying islands enjoy far less adequate service 
than Oahu. A more equitable distribution would seem in order. 
y Mainland figure based on A.N.A. membership. See Appendix Table 8» 
i/ See Appendix Table 8, 
y Calculated from Appendix Table 7, 16 
It can hardly be said that there is a shortage of private duty nurses* 
at least in Honolulu, Of the 106 actively employed nurses on the roster 
of the Nursing Service Bureau in September 1946, 29 were employed 15 or 
fewer days. The average number of working days during that month was 19 
days, as compared to 20 in September 1945, j/ The Bureau stated, in 
November 1947, that the supply of private duty nurses was ample for presat 
demands. Jy It would thus appear that either Hawaii’s needs or standards 
are much lower than the mainland with regard to this field of nursing 
service. Admittedly, the two areas are not strictly comparable. 
Most of the Bureau’s placements were for hospital duty--91,5 percent 
in September 1945, and 93,2 percent two years later. Home placements in 
the latter month were only 1,3 percent of the total, iy 
There has been a considerable change in the working conditions of 
private duty nurses since 1940, These changes are reflected in hour, 
wage and salary data. 
The lesser improvement has occurred in incomes. In 1940, when nursing 
service had achieved something of an equilibrium, a private duty nurse 
earned $8 for an eight-hour day. 4/ Assuming five full days of work each 
week and 50 weeks of work a year, this rate resulted in a total yearly 
income of $2,000—although, in all likelihood, most nurses probably earned 
less than this figure. Jy An income of such proportions, low as it was 
for the type of worker required, nevertheless compared favorably with the 
incomes of other professional persons in 1940. jy Nursing salaries were 
1/ Data from Appendix Table 9, A person working daily except Sunday and 
Labor Day would have been employed 25 days in September 1947, Taking 
Saturdays off as well would have reduced the number of working days 
to 21. 
i/ Interview, November 5, 1947. 
See Appendix Table 9, 
y Source, Nursing Service Bureau, November 5, 1947, 
5/ Total incomes were often lower than necessary because of the nurses* 
unwillingness to work on weekends or at night. 
y The following table, adapted from 1940 U.S.Census data (Populations The 
Labor Force, Sample Statistics, Wage or Salary Income in 1939, Table 8a), 
indicates the low status of workers in all professional services! 
All Industries 
Professional 
Total 
Male 
Female 
Total Male Female 
Median 
$800 
$965 
$540 
$910 $1200 $800 
Percent over $2500 
5% 
7% 
1% 
10 0 
A large proportion of these workers were making less than $800 a year- 
50 percent of total U.S, workers, 50 percent of the females employed 
in professional services, and 43 percent of all workers in professional 
services. 17 
forced up by wartime personnel shortages and spiraling living costs, 
and the present rate is $10 per eight hour day. 1/ Thus private duty 
nursing fees have increased about 25 percent during the past seven years, 
compared to a 60 percent rise in the cost of living. 
If the immediate postwar period has not witnessed a significant turn 
for the better in nurses’ salaries, it nevertheless has seen considerable 
improvement in working hours. In September 1945, when the wartime shortage 
of nurses was still in evidence, more than 86 percent of the Nursing Ser- 
vice Bureau placements were for 12 hours, and less than 9 percent for an 
eight hour day. Exactly two years later only 1.7 percent of the place- 
ments specified 12 hours, but 92.5 percent were for 8 hours (see Appendix 
Table 9). 3/ 
The problems confronting private duty nurses (and others as well) 
suggest the advisability of an ever more comprehensive leadership by their 
chief spokesman, the Nurses* Association of the Territory of Hawaii. This 
professional organization could make the necessary basic studies and 
assume the leadership in action in a. program to advance their position# 
They might develop standards, urge better undergraduate and postgraduate 
training facilities, and the adjustment of wages and hours to levels 
prevailing in other occupations requiring similar skills. Programs of 
specialized service and hourly private duty nursing should be sponsored 
by this group. They might also urge the inclusion of private duty nursing 
in H.M.S.A. hospital coverage. 
Office 
Nurses working in physicians' offices and similar places are rela- 
tively numerous in Hawaii. They comprised 7.8 percent of all nurses 
living and registered in the Islands in 1946-1947, compared to a mainland 
ratio (based on A.N-.A# membership) of 3.6 percent, i/ 
There were 82 office nurses in the Territory in 1946-1947, htit 
three of thorn on Oahu, These nurses were distributed among the following 
islands: jy 
1/ Source, Nursing Service Bureau, November 5, 1947. 
National data from U.S, Department of Labor, Bureau of Labor Statistics. 
3/ National data for hours worked during the week of March 24-30, 1940, may- 
be of interest in this connection; 
All industries 
Professional Services 
Male Female 
Male Female 
Working under 35 hours 1\% 17$ 
““13$ 20$““ 
Working over 48 hours 20 14 
24 13 
(From 1940 U.S. Census, Labor Force, U.S. 
Summary, Table 87) 
y See Appendix Table 8, 
5/ Computed from Appendix Table 7. 18 
Island 
Number of Nurses 
Population per Nurse 
Territory of Hawaii 
82 
6,300 
Oahu 
79 
4,500 
Hawaii 
2 
35,400 
Molokai 
1 
6,200 
Others 
0 
A job analysis of office nursing should be initiated by the Terri- 
torial Nurses' Association and the Medical Association. At present there 
is considerable uncertainty regarding the requirements of a good office 
nurse. 
Institutional Nursing 
Nurses employed in institutions are the most numerous group in the 
Territory, and have approximately the same ratio to the population as pre- 
vails on the mainland. Both locally and nationally, about two-fifths of 
total nursing personnel are institutional nurses. They number 0.9 per 
1,000 population in the Islands, as against 0.8 in the continental United 
States, i/ 
As with other fields of service, most of the institutional nurses 
registered and living in the Territory in 1946-1947 we re employed on Oahu. 
Only Niihau and Kahoolawe, with a combined population of less than 200, 
lacked any. These nurses were distributed as follows? 2/ 
Island 
Number of Nurses 
Population per Nurse 
Territory of Hawaii 
443 
1,170 
Oahu 
313 
1,150 
Hawaii 
62 
1,360 
Maui 
38 
1,180 
Kauai 
23 
1,510 
Molokai 
13 
470 
Lanai 
4 
910 
Others 
0 
A complete analysis of nurses employed in Oahu hospitals (other than 
military, mental and leprosy) is contained in Appendix Table 11. This 
table, based on late 1947 data, shows the largest ratio of total nursing 
personnel to beds to exist in Kuakini and St. Francis, while the ratio of 
graduate nurses to beds is highest at Kapiolani, Kauikeolani, and The 
Queen*s, in that order. 
1/ Se@ Appendix Table 8, 
2/ Computed from Appendix Table 7. 19 
It is more difficult to hold than to obtain nurses for Island 
institutions. According to one newspaper article. 
There isn’t the acute shortage of adequate nursing help in 
the territory as is now being experienced on the mainland, but 
Hawaii does have difficulty maintaining permanent workers. ... 
Many of the graduate registered nurses who come here from the 
mainland to work, are merely visiting the islands for a period. 
Most of them do not intend to become residents, .. (the president 
of the Territorial Nurses* Association) said. 
(One hospital’s director of nurses) asserts that the shortage 
here is of nurses qualified with sufficient academic training 
and experience to teach and undertake administrative or other 
highly specialized duties, 
Some institutions experience more difficulty than others. It is well 
known, for example, that a certain unpopularity attaches to work with 
certain types of illness. 
Industrial and Plantation 
The local concept of industrial nursing is somewhat different from 
that held by the mainland. Usually, industrial nursing is confined to 
the factory and its employees. In the Islands there is some feeling that 
plantation nurses serving agricultural workers for the most part should 
be included. Since the inclusion or exclusion of these nurses is seldom 
specifically stated in data from either Hawaii or the mainland, statistics 
would appear rather unreliable for many comparative purposes. 
Even so, industrial nurses are relatively much more common in the 
Islands. Using the 1946-1947 figure supplied by the Board for the 
Licensing of Nurses, 3/ it is seen that six percent of all licensed 
nurses in the Territory are of this category (compared to 3,4 percent 
of the A.N.A, membership). Both nationally and locally, according to 
these data, there was 0.1 industrial nurse per 1,000 population, jy 
An even greater disproportion is indicated by 1947 U.S.P.H.S, figures. 
•i/ Honolulu Star-Bulletin, December 20, 1947. 
Nursing Service Bureau, interview, November 5, 1947, 
y See Appendix Table 7. 
See Appendix Table 8, 20 
which give Hawaii 87 industrial nurses* According to these data, £/ 
there are 0.8 nurses per 1,000 wage earners in manufacturing industries 
on the mainland, compared to a Hawaiian figure of 3,5* Even assuming 
different concepts of such nursing, the difference between the two ratios 
is great enough to be significant. 
The 63 industrial nurses licensed in the Territory in 1946-1947 were 
employed on six islands of the Territory, as follows: 2J 
Island 
Number of Nurses 
Population per Nurse 
Territory of Hawaii 
63 
8,200 
Oahu 
41 
8,800 
Hawaii 
7 
10,100 
Maui 
7 
6,400 
Kauai 
5 
7,000 
Molokai 
1 
6,200 
Lanai 
2 
1,800 
Others 
0 
Public Health Nursing 
There is also a higher ratio of public health nurses in the Terri- 
tory than on the mainland. In 1946-1947 these nurses comprised 8.3 per- 
cent of all nurses in Hawaii, compared to a mainland figure of about 7.7 
percent. 'The local number per 1,000 population was 0.2; nationally it 
was 0.1. i/ The ratio recommended for the Islands is one staff nurse to 
5,000 population (it is now 1:5900). 
Public health nurses were reported on four islands in 1946-1947, as 
follows: 5( 
Island 
Humber of Nurses 
Population per Nurse 
Territory of Hawaii 
88 
5,900 
Oahu 
59 
6,100 
Hawaii 
13 
5,500 
Maui 
7 
6,400 
Kauai 
9 
3,900 
Others &/ 
0 
l/ Quoted by Facts About Nursing, 1947, p. 38, 
2/ And employment data from the Territorial Department of Labor and 
Industrial Relations and U.S. Bureau of Labor Statistics. 
Z/ See Appendix Table 7. 
4/ See Appendix Table 8. 
5/ Calculated from Appendix Table 7. 
s/ The Director of the Bureau of Public Health Nursing asserts that 
there have been public health nurses on both Molokai and Lanai for 
several years. 21 
Care must be taken to maintain a sufficiently large number of both 
staff nurses and supervisory personnel. A ratio of one nurse per 2,500 
population and one supervisor per ten staff nurses (assuming a bedside 
care program) is both feasible and advisable. Financial assistance should 
be continued to promising staff members for advanced training on the 
mainland to help attain this goal. The development of a bedside care 
program would necessitate increased personnel. 
Most of the present staff nurses receive their pay from the Bureau 
of Public Health Nursing of the Territorial Board of Health, This Bureau 
was the source of funds for 34 of the 98 nurses and nurses* aides at work 
during the fiscal year 1946, The Venereal Disease Bureau maintained six# 
the Tuberculosis Bureau four, the Crippled Children*s Bureau two, the 
Maternal and Child Health Bureau one, 2/ and the U.S.P.H.S, one, jy 
The three major types of service rendered are for tuberculosis, 
infant and preschool. Tuberculosis leads, with 23,3 percent of total 
visits. Infant care is second, at 21,2 percent, and preschool third, wiih 
12,5 percent, A study of mainland data reports most visits to be for 
infant care, followed by preschool, school and tuberculosis, in that 
order. 3/ The high position of visits devoted to tuberculosis in the 
Territory is undoubtedly a result of the high incidence of the disease 
in the Islands, 
There is also a decided need for improved facilities. The physical 
plant provided public health nurses in Honolulu is generally adequate, 
but elsewhere it tends to be below minimum standards. These inadequate 
buildings in rural Oahu or the outlying islands should be repaired or 
replaced, and new offices and conference and clinic rooms should be 
constructed where necessary. 
School 
School nursing, as distinguished from public health or other typos, 
provided work for sixteen licensed nurses in Hawaii in 1946-1947. These 
nurses were employed by the Department of Public Instruction. No other 
field of service had such a small personnel (1.5 percent of total 
nurses). 4/ 
l/ An Island public health nurse should be trained in maternal and 
child health. 
Zj Annual Report of the Board of Health, Territory of Hawaii, 1946, p. 134. 
y Ibid., p. 132. Locally, school visits rank eighth. 
See Appendix Tables 7 and 8. 22 
School nurses were found on four islands, as noted in the following 
table: 1/ 
Island 
Number of Nurses 
Population per Nurse 
Territory of Hawaii 
16 
32,000 
Oahu 
12 
30,000 
Hawaii 
2 
35,000 
Maui 
1 
45,000 
Kauai 
1 
35,000 
Others 
0 
• • • • 
Thus, Oahu schools are best served by nurses, and Molokai, Lanai and Niihau 
have no full-time service at all, jy It should be noted, however, that 
public health nurses are furnished schools lacking a full-time D.P.I, 
nurse. Any expansion of school nursing service should take special 
cognizance of the outlying islands. 
See Appendix Table 7, 
y These islands, along with Kahoolawe (1940 population of 1), are the 
least populous of the eight major islands in the Territory. Palmyra, 
of all the minor islands, was the only one with any inhabitants (32) 
in 1940, (See 1940 U.S.Census, Population, 1st Series—Number of 
Inhabitants, Hawaii, p, 2.) Recommendations of 
COMMITTEE ON OCCUPATIONAL THEP^APY 
Mrs# Laura M. Dowsett, Chairman 
Lillian Lowrey 
Mrs. Jane E* Olson 
Esther Pyun Present Situation 
(Services and Resources) 
Suggestions and Re 
Immediate Action 
commendations for 
Long-range Objectives or Action 
I. Legal status 
It is recommended that: 
It is recommended that: 
No territorial act or statute 
Adequate legislation regulat- 
regulating practice of occupa- 
ing the practice of occupational 
tional therapy. 
II. Facilities for training 
A. Mainland training schools 
1. Thirteen fully 
accredited by A.M.A. 
2. Six others which meet 
minimum standards of 
A.M.A. 
B. Hawaii 
1. No specific O.T; train- 
ing program 
therapy be enacted. 
2, Related courses at 
If a medical school is estab- 
University of Hawaii 
lished at the University of Hawaii, 
a school of occupational therapy 
be established in connection with 
it; otherwise, the University of 
Hawaii consider the possibility of 
establishing specific courses in 
occupational therapy as part of 
its present curriculum. 
Committee on Occupational Therapy- 
Postwar Planning Committees for Health 
OUTLINE OF SUGGESTED RECOMMENDATIONS Present Situation 
(Services and Resources) 
Suggestions and Re 
Immediate Action 
commendations for 
Long-ranee Objectives or Action 
III. Personnel in Territory 
(registered with Occupational 
Therany Association of 
Hawaii) 
A. By working status 
1. Active registered, 14. 
2. Inactive registered, 8 
3. Students, 2 
B. By place of work 
1. Oahu, 13 
a. Civilian, 11 
b. Military, 2 
2. Maui, 1 
C. Adequacy (recommended ratio 
is 1 O.T. to 250 patients) 
1. Areas 
a. Oahu, 1:264. 
b. Remainder of Terri- 
tory, 1:1344- 
2. Institutions 
a. Adequate (under 
1:250) 
1) Queen’s, 1:102 
2) St. Francis, 1:115 
3) Leahi, 1:154 
4) Kula San., 1:165 
5) Maluhia, 1:176 
(est.) 
b. Inadequate 
(over 1:250) 
All others 
i 
► Present Situation 
(Services and Resources) 
Suggestions and Recommendations for 
Immediate Action j Long-range Objectives or Action 
IV, Occupational Therapy 
It is recommended that: 
Association of Hawaii 
A. Organized 1938 
1 
B, Affiliation with American 
| 
Occupational Therapy 
Association 
C. Activities 
\ 
1. Office at Queen1s 
1 
Hospital 
2. Placement service 
1 
3. Apprenticeships arranged 
for pre-professional 
students 
4., Scholarship Loan Fund 
a. Annual competition 
1 
for award 
i 
b. Annual calendar sale 
to help finance fund 
| 
c. Awards to date, 6 
i 
V. General problems 
1 
1 
A. Public indifference or 
A well-planned educational pro-f 
ignorance of value of 
gram for both lay and professional 
occupational therapy in 
groups be undertaken by the Occu- 
treatment 
pational Therapy Association of 
B. Insufficient coordina- 
Hawaii in order to interpret the 
tion with other medical 
need and value of occupational 
services 
therapy in the treatment of ill 
' 
and handicapped persons. Present Situation 
(Services and Resources) 
Suggestions and R 
Immediate Action 
ecommendations for 
Lone-ranee Objectives or Action 
C. Too few Island-born occupa- 
tional therapists 
D. Lack of conformity of Civil 
It is recommended that: 
Territorial Civil Service 
It is recommended that: 
The education of Island girls 
as occupational therapists be en- 
couraged by increasing the amount 
Service ratings in the 
ratings be changed from nSPM 
of the Scholarship Loan Fund and 
Territory with mainland 
(semi-professional) to rtPM 
by making it available to more 
standards 
(professional), in conformity 
candidates. 
with mainland standards. 
# 28 
OCCUPATIONAL THERAPY 
Introductory 
The comparatively recent emergence of occupational therapy as a 
valuable adjunct in treatment demands that special attention be focused 
on it* This field has not as yet had sufficient time to expand local 
facilities and personnel to recommended standards. Similarly, many 
lay and professional persons are still unaware of the nature and value 
of occupational therapy. 
Occupational therapy is "'any work or recreational activity, 
mental or physical, definitely prescribed and guided, for the distinct 
purpose of contributing to and hastening recovery from disease and 
injury,1 and it consists of occupations selected and prescribed for 
each individual patient with his or her particular needs in view. ... 
It must be clearly understood that occupational therapy is only a 
part of general therapy. Its aim is tp help in the re-establishment 
of the patient (a) psychologically..., (b) physically (c) socially 
..., and ... (d) economically. 
There are four main types of occupational therapy: diversional 
therapy, functional therapy, industrial therapy, and prevocational 
training in shop experience. 
a. Diversional therapy includes the simple arts and crafts, 
hobbies, and allied "handicraft" activities which serve to divert the 
mind from preoccupation with illness. A wide range of interests may 
be employed, such as, dramatics, music, photography, the graphic arts, 
electricity, woodworking, leather working, radio and motor mechanics, 
and avocational pursuits. 
b. Functional therapy has a prescribed purpose. It is directed 
toward the restoration of function in injured or diseased muscles and 
joints, improving general physical condition, and contributing to the 
return of physical and mental health. 
y Norah H. Haworth and E, Mary Macdonald, Theory of Occupational 
Therapy, 3d edition (Baltimore, 1946), p. 1. According to the 
U.S. War Department Technical Manual TM 8-291, Occupational 
Therapy (Washington, 1944), "occupational therapy is that form 
of treatment characterized by assignment to purposeful physical 
tasks and prescribed by a medical officer. It may be prescribed 
for restoration of function to injured or diseased muscles and 
joints; for controlled activity for nervous or mental disorders; 
for readjustment attending chronic diseases; for reeducation in 
permanent disabilities and for purposeful utilization of leisure 
time." 29 
c. Industrial (work) therapy utilizes the everyday work situa- 
tions. The patient is assigned to perform some useful work with a 
definite goal in mind. For example, the patient with a shoulder in- 
jury who needs to strengthen his muscles may be directed to saw wood 
or paint high surfaces. He performs useful work for the hospital, but 
also aids himself by strengthening his atonic arm and shoulder girdle 
muscles and indirectly by improving his general physical condition. 
d. Prevocational therapy comprises those prescribed exploratory 
shop processes which are planned to develop aptitudes and interests in 
a specific occupation to be used as a guide to vocational training 
... 1/ 
The development of occupational therapy has been quite recent. 
A certain degree of diversional therapy was practiced by the early 
Egyptians, and in classical times the theory was advanced by Seneca 
and Galen. A few European and American hospitals instituted the use 
of a crude form of occupational therapy toward the end of the 18th 
century. It was not until the First World War, however, that modern, 
scientific treatment of the kind we know today had its inception and 
general adoption. The first School of Occupational Therapy was opened 
in Chicago in 1915, Zj The Queen’s Hospital, with the most favorable 
O.T. to patient ratio in the Islands, 3/ did not begin concerted ef- 
fort along these lines until 1929, U 
Legal Status 
Legislation regulating occupational therapy in the Territory is 
badly needed. There is at present no Territorial Act or Statute con- 
trolling its practice locally. Consequently, any person engaging in 
any activity which in any way resembles occupational therapy can be 
employed under the title of O.T. As a protection to both the practice 
and professional interests of occupational therapy, and to superinten- 
dents hiring therapists, to the physicians prescribing it and to the 
patient for whom it is prescribed, a bill should be drawn up empower- 
ing the Board of Health to set up Rules and Regulations governing the 
practice of occupational therapy in the Territory. 
y War Department, op. cit., p. 2. 
2/ Haworth and Macdonald, op. cit., pp. 3-5 
See Appendix Table 15. 
y Eighty-sixth Annual Report of The Queen’s Hospital, pp. 73-74. 30 
Facilities for Training 
Training facilities for occupational therapists are confined to 
the mainland. Even there, fewer than two dozen schools afford train- 
ing in this field up to minimum A.M.A. standards. Locally, related 
courses are available at the University of Hawaii. The student must 
go elsewhere for specific training along professional lines. 
Adequate training may be offered eventually in the Territory. 
If a medical school is established at the University of Hawaii (as 
has been proposed), a school of occupational therapy should be estab- 
lished in connection with it. Otherwise, the University could consider 
the inauguration of specific courses as part of its present curriculum. 
Personnel 
There are twenty-two occupational therapists registered with the 
Occupational Therapy Association of Hawaii. Fourteen are active. In 
addition, there are two students, as yet unregistered. 
Most of the therapists in the Territory are working in non-mili- 
tary institutions on Oahu. Of the 13 working on Oahu, only 2 are in 
military establishments. The remaining registered O.T. works on the 
Island of Maui. The number and distribution of occupational therapists 
in Hawaii is given in considerable detail in Appendix Tables 15 and 16. 
In general, there should be one occupational therapist for each 
250 patients. This standard was proposed by the War Department in 
1944. l/ The American Occupational Therapy Association has not pub- 
lished recommended therapist to patient or bed capacity ratios, and 
individual writers have been similarly reluctant to propose such 
ratios. 2 
According to the proposed standard of the War Department, only 
Oahu, of the Hawaiian Islands, is adequately serviced by occupational 
therapists. A ratio of 1:264, 3/ only slightly inferior to the pro- 
posed standard, prevails on Oahu, A ratio of 1:1344 prevails in the 
remainder of the Territory, These data are given in detail in Appen- 
dix Table 16. 
y Op. cit., p, 3. 
ZJ See, for example, Haworth and Macdonald, op. cit., pp, 99-100j 
Louis J. Haas, Practical Occupational Therapy (Milwaukee, 1944), 
pp. 89-90. 
3/ Total registered O.T.’s to total patients. 31 
Among individual non-military institutions, five establishments 
have a therapist-to-patient ratio better than that suggested by the 
War Department. These five include The Queen’s Hospital, St. Francis 
Hospital, Leahi Hospital, Kula Sanatorium (on Maui), and Maluhia 
Nursing Home, The ratio exceeds 1:250 in all other Island institutions 
Comparison of Island hospitals with actual mainland averages 
reveals little difference. The Hawaiian ratio of one hospital 0,T. to 
472 hospital patients (in 1946) is only slightly inferior to the 1946 
mainland ratio of 1 to 431. Complete data regarding actual ratios on 
the mainland and in the Territory are given in Appendix Table 17. 
Specific recommendations have been made by a group of occupational 
therapists employed in the Islands. Their suggestions would result, 
in many cases, in O.T. to patient ratios less than It250, but have the 
merit of immediate knowledge of local needs. The recommendations were 
based largely on experience with mainland O.T. departments, and in- 
tended to assure maximum operating efficiency. It was felt that the 
suggested standards could best be attained by an intensive educational 
program directed toward lay and professional persons. These specific 
recommendations are given in Appendix Table 18. Island personnel 
numbering 59 persons, 33 of them O.T.’s, 1./ are suggested. 
Occupational Therapy Association of Hawaii 
The local professional organization serving the therapists is 
the Occupational Therapy Association of Hawaii, organized in 1938 and 
affiliated with the American Occupational Therapy Association. Its 
office is at The Queen’s Hospital, A placement service is operated, 
apprenticeships are arranged for pre-professional students, a scholar- 
ship loan fund is administered, and various educational, publicity and 
advisory services are initiated by this local professional organiza- 
tion. 
The placement service is a major activity of this group. Island 
girls should be encouraged to become occupational therapists so that 
departments will be more stable, with less rapid turnover of personnel. 
Therefore, every effort is made to interest students in O.T. and to 
determine which students are good material and are best qualified for 
training. In this interest, students who are interested in going to 
the mainland for such training are encouraged to spend time as volun- 
teers in one of the local departments. 
1/ Compared to 12 O.T.’s in 1947, 32 
A Scholarship Loan Fund has been set up by the Association to 
further the education of Island girls in occupational therapy. The 
money is raised by means of an annual calendar sale. The girls must 
be residents of the Islands and have completed two years of University 
work. This fund could well be increased, and made available to more 
candidates. Six girls have already received this award. 
Occupational therapy is still a comparatively new field and as 
such, the need and value must be interpreted both to lay and profes- 
sional groups. Every occupational therapist is constantly endeavoring 
to educate the lay and professional groups with whom she comes in 
contact. In addition to this, however, the Association as a group 
plans exhibits, conferences with other medical services, and takes 
part in any activity which would serve as an educational one. The 
Association sends delegates to Honolulu medical agencies and councils. 
A campaign is conducted in connection with the calendar sale not only 
to sell calendars for the benefit of the Scholarship Loan Fund, but 
also to educate the public. A Committee on Credentials of the 
Association aids superintendents in employing O.T.’s of the best 
caliber. Cooperation with high school vocational guidance clinics 
promotes familiarity of Island girls with the field. The Association 
sends a delegate to the annual meeting of the American Occupational 
Therapy Association of which the local group is a chapter. Support 
is lent to the movement to change Territorial Civil Service ratings 
from "SP" (semi-professional) to "Fn (professional), in conformity 
with mainland standards. Recommendations of 
COMMITTEE ON PHYSIOTHERAPY 
Ruth Aust, Chairman 
Thomas Ching 
Mrs* Wilraar Downie 
Grace Ednie 
Carrol Moyer 
Mrs. Sybil Voorheis 
Bessie Young Present Situation 
(Services and Resources) 
Suggestions and Recommendations for 
Immediate Action 1 Long-range Objectives or Action 
I. Legal status 
A. Act 87 (R.L.H. 1941) 
B. Rules and Regulations, 
Territorial Board of Health, 
Chapter 14 
It is recommended that; 
It is recommended that: 
II. Facilities for training 
A. Island, none 
No plans be considered for a 
B. Mainland schools for physical 
training program for physiothera- 
therapy technicians (approved 
pists in the Territory until such 
by A.M.A., Sept. 1944) 
time as a medical school may be 
1. Civilian, 23 
2, Army, 4 
established. 
■ 
III. Personnel (civilian) 
A. Number, by place of work 
Outpatient clinics, which 
1. Hospitals, 5 
hitherto have shared hospital 
2. Other private institu- 
physiotherapy facilities with 
The board of trustees and 
tions, 2 
other departments, be given 
others concerned in the operation 
3. Private practice, 2 
their own physiotherapy staffs. 
of the new Convalescent Home 
4- Territorial Board of 
consider the need for an attend- 
Health, 2 
ing physiotherapist and adequate 
5. Inactive, 2 
facilities to provide service 
B. Population per physical 
therapist, 1946 
1. In U.S., 37,000 
2. In T.H., 58,000 
of high standard. 
Cornittee on Physiotherapy 
Postrar Piaimihg,Committees '.for Health 
OUTLINE OF SUGGESTED RECOMffiNDATIOMS Present Situation 
(Services and Resources) 
Suggestions and Re 
Immediate Action 
for 
Long-range Objectives or Action 
C. Hospital patients per hospital 
physical therapist 
1. In U.S., 315 
2. In T.H., 84.9 
It is recommended that? 
It is recommended that: 
D. Lack of physical therapists 
In order to provide more ade- 
All hospitals and institu- 
outside Oahu 
quate physiotherapy services on 
tions consider and study the 
the other islands, hospitals and 
need for at least one physio- 
related institutions be encour-- 
therapist on each of the other 
IV. Problems 
aged to develop and utilize this 
islands in order that needs of 
A. Indifference or ignorance of 
service. 
physicians in utilizing physio- 
persons outside the field 
therapy in the treatment of 
1. Professional persons 
In order to interpret to 
patients may be met. 
2. The Community 
physicians, other professional 
groups and the general public. 
a 11 Physiotherapy Week" be spon- 
sored by specialists in this 
field in cooperation with the 
Oahu Health Council. Special 
efforts be made to impress on 
laymen and professional persons 
the role of physiotherapy in 
treatment services and by physi- 
cians in private practice, and 
the need for trained physical 
therapists. Lay persons be 
warned against quacks and un- 
trained persons. 
B. Inadequacy of services in 
industry. 
Consideration be given to 
the greater promotion and 
utilization of physiotherapy 
in medical insurance and 
industrial health programs. 36 
PHYSIOTHERAPY 
Introductory 
Physiotherapy is in much the same position as occupational 
therapy, with which it is frequently associated. Possessed of a 
similarly long history, it too has seen its greatest development in 
the past few decades. As a result, both fields of treatment have 
occasionally been misunderstood or underestimated by the public and 
by other medical sciences. Neither has yet seen its facilities catch 
up with its new knowledge. They suffer similar problems of personnel 
and training. 
Physical therapy is nthe treatment of disability, injury, and 
disease, by non-medicinal means comprising the use of massage, exer- 
cise, and the physical, chemical and other properties of heat, light, 
water, and electricity (except Roentgen Rays, Radium, and Electro- 
surgery),” 1/ In spite of a somewhat bewildering growth in the 
availability of complex machinery, however, massage and other manual 
therapy remain basic. This fact has been true since Hippocrates stated 
some of the fundamental tenets of physiotherapy, about 4-30 3.C, 2/ 
"Much has been written concerning various forms of physical therapy 
requiring expensive machines and apparatus for its application, and 
many of the profession are apt to overlook the fact that probably the 
most important single measure of physical therapy, and certainly that 
having the widest application lies in the hands of a well trained 
technician, intelligently directed by a physician. Massage, passive 
and active exercise, muscle training exercises and the application of 
heat represent practically the only physical therapy needed in the 
great majority of medical or surgical conditions.” 2/ 
1/ American Physiotherapy Association, Constitution and Bylaws (Chi- 
cago, the Association, July 1942, p. l) (quoted in U.S, Department 
of Labor, Women1s Bureau, Bulletin 203, No. 1, ’’Physical Therapists," 
p. viii). 
2/ Hippocrates, discussing the treatment of a dislocated shoulder, 
noteds ”And it is necessary to rub the shoulder gently and smoothly. 
The physician must be experienced in many things, but assuredly also 
in for things that have the same name have not the same 
effects. For rubbing can bind a joint which is too loose and loosen 
a joint that is too hard. However, a shoulder in the condition 
described should be rubbed with soft hands, and above all things 
gently; but the joint should be moved about, not violently, but so 
far as it can be done without producing pain.” (Quoted in Handbook 
of Physical Therapy. American Medical Association, Chicago, 3d 
edition, 1939, p. 13)* 
Ibid.. p. 13* The last sentence of the original statement is in 
italics. 37 
Scientific physiotherapy, as we know it, is of relatively recent 
origin. Even before Hippocrates, "the ancient Egyptians, Greeks, and 
Romans knew the value of sun, water, exercise and massage. But it was 
not until 1925,‘when physical therapy had demonstrated its worth in 
World Yfar I, that full recognition was given to it as a separate profes- 
sion. Then the American Medical Association formed what is now its 
Council on Physical Medicine, whose activities have grown with World 
War II.n 1/ 
There are several measures of this recent growth in physiotherapy 
The number of full-time and part-time physical therapists in hospitals 
in the United States grew from 2,382 in 1936 to 3,107 in 1941 and 3,937 
in 194,6. 2/ The American Physiotherapy Association, organized in 1921, 
2/ had 1,614 members in 1943, about 2,100 early in 1944, U and more 
than 3,800 by 1946. jJ There was a similar growth in the total number 
of physical therapists. 6/ Approved civilian schools rose from 13 in 
1936 to 23 in 1944* 7/ The number of physical therapists employed in 
the Territory of Hawaii increased 22 percent between January 1946 and 
December 1947. 8/ 
Facilities for Training 
The American Medical Association has established minimum require- 
ments in educational background for physical therapists. Generally 
speaking, these specify approximately a year of study in an approved 
school of physiotherapy. Certain courses must be taken. These approved 
schools, in turn, state as prerequisites for admission either graduation 
from a school of nursing or two years of relevant college work, entail- 
ing the passing of certain subjects. 2/ 
1/ "Physical Therapy,..A Service and a Career" (pamphlet of American 
Physiotherapy Association, New York, 1944*), P* 3. 
2/ "Hospital Service in the United States," Journal of the American 
Medical Association. Vol. 133, No. 15, April 12, 194-7, p. 1077. 
jl/ "The American Physiotherapy Association" (folder of the Association, 
no date). 
u U.S. Department of Labor, op. cit., p. 2. 
i/ See Appendix Table 20. 
6/ "The American Registry of Physical Therapy Technicians estimates 
the pre-war number of physical therapists at 3,100, of whom about 
half i7ere registered. Fewer than fifty of those registered were 
men." (U.S, Department of Labor, op. cit., p. l). 
7/ Ibid.. pp 2 f and 12 f, 
8/ See Appendix Table 19. 
2/ u.s .Department of Labor, op. cit., p. 8. 38 
A number of approved schools of physiotherapy can be found on the 
mainland. Toward the end of the war there were 23 under civilian 
direction and four under the Army. 1/ 
The Islands are less fortunate; adequate facilities for training 
do not exist locally. No training program along these lines seems 
feasible until the establishment of a medical school in the Territory. 
Personnel 
There were thirteen civilian physical therapists living in the 
Territory late in 194-7. Five worked at three hospitals, two with other 
private institutions, two in private practice, and two for the Terri- 
torial Board of Health. Two others were not practicing. In January 
194-6 there were nine civilian physical therapists employed in Hawaii, 
compared to eleven almost two years later. Detailed data are given in 
Appendix Table 19. 
Relative to the United States, the Islands are somewhat short of 
total registered physical therapists. Nationally, there were about 
37,000 people per registered physical therapist in 194-6; locally, the 
number was 58,000. 2/ Since all the Territory's therapists are con- 
centrated on Oahu, the actual ratio is much worse on the other islands 
of the group. Institutions on Kauai, Maui and Hawaii should be en- 
couraged to develop adequate service in this field of treatment. 
Island hospitals are similarly understaffed with regard to physio- 
therapy. Nationally, there are about 315 hospital patients per hospital 
physical therapist, in contrast to a local figure of 8A9. 2/ The a<^e” 
quacy of individual staffs cannot be analyzed; authorities have been 
extremely rel.uctant to postulate a standard patient to therapist ratio 
for Institutions, l/ and no such ratio that is generally acceptable can 
be found in the literature. It seems evident, however, that existing 
general hospital outpatient clinics in Honolulu are in need of their 
own physiotherapy staffs. At the present time they share the hospi- 
tal’s personnel. Adequate staff and facilities for physiotherapy should 
also be provided the projected convalescent home upon its completion. 
1/ Ibid., p. 12 f. 
2/ Host recent comparable data. See Appendix Table 20 
1/ See Appendix Table 21. 
See, for example, the A.M.A. Handbook of Physical Therapy (op. cit.), 
pp. 503 ff., and The 1939 Year Book of Physical Therapy (Richard 
Kovacs, ed.; Year Book Publishers, Chicago, 1939), pp.9 ff* 39 
Problems 
One major problem confronting physical therapists is the indif- 
ference or ignorance of persons outside the field. This could be 
partly overcome by a "Physiotherapy Week" under the sponsorship of 
specialists in the field in cooperation with the Oahu Health Council, 
Special efforts could be made to impress on other professional persons 
and on laymen the importance and nature of physiotherapy. Emphasis 
could be placed on the need for well-trained therapists, and the public 
warned against quacks and inadequately trained workers. 
Another problem is the paucity of physiotherapy in industry. A 
related difficulty is the unwillingness of some medical insurance 
companies to include physiotherapy in their programs. An intensive 
educational effort by the Territorial Chapter of the American Physio- 
therapy Association and other interested groups would help solve these 
problems. Recommendations of 
COMMITTEE ON HEALTH STATISTICS 
Andrew W. Lind, Ph.D., Chairman 
Samuel D. Allison, M. D. 
Edward Chong 
Erio George 
A, L. Y. Ward 
William Wong 
Margaret S. Wright Present Situation 
(Services and Resources) 
Suggestions and , 
Immediate Action 
Recommendations for 
or._4cti.op 
' 
I. Legal Status 
Chap. 60; Sec. 3101-3128 
Obtaining, recording and preser- 
vation of vital statistics in 
the Territory. 
Chap. 61; Sec. 3523; Hawaii 
Housing Authority required to 
file annual report to Governor. 
Chap. 64.; Sec. 3806; Department 
of Institutions required to 
file annual report to Governor, 
covering activities of each di- 
vision thereof. 
Chap. 71; Sec. 4117; Department 
of Labor; Bureau of Research 
and Statistics, responsible for 
investigation and gathering of 
data regarding nages, hours, 
other conditions of labor, and 
employment in the Territory. 
Chap. 84; Sec. 4810; Annual re- 
port to Governor covering con- 
ditions and activities of the 
Department of Social Welfare 
and each division thereof* 
i 
i 
■ 
\ 
j 
i 
1 
1 
Connittee on Health Statistics 
Postwar Planning Committees for Health 
OUTLINE OF SUGGESTED RECOMMENDATIONS Present Situation 
(Services and Resources) 
Suggestions and Rec 
Immediate Action 
emendations for 
Long-range Objectives or Action 
II. Sources of Data 
Agencies and kind of informa- 
tions 
A. Official 
1. Federal 
a. U.S.Department of Con- 
nerce; Bureau of Inter- 
nal Revenue; Income Tax 
b. U.S.Department of Labor 
Wages, cost of living, 
etc. 
c. U.S.Bureau of the Census 
Population, housing, 
1 
incone, etc. 
d. U.S.Public Health Ser- 
vice; Foreign quaran- 
tine, off shipping 
disease incidence, etc. 
e, U.S.Employment Service 
Types of available work; 
available employees. 
f. Federal Security Agency 
Social Security Board 
Socio-economic data. 
t 
g, Amed Services 
2, Territorial 
a. Board of Health 
Vital statistics; mor- 
bidity; preventive 
medical and nursing Present Situation 
(Services and Resources) 
Suggestions and Recommendations for 
Immediate Action ! Long-range Objectives or Action 
services; sanitary con- 
ditions ("prater, sewage. 
food, drug, housing), 
general health indices 
I 
and trends, population. 
b. Department of Public 
Instruction—Health 
status of school-age 
group; vocational re- 
habilitation; etc. 
c. Department of Institu- 
ti ons —Hospitali zati on 
of mental patients; 
crime and rehabilitation 
of juvenile delinquents. 
d. Board of Hospitals and 
Settlements—Leprosy. 
e. Department of Labor 
Industrial accidents; 
workmen's compensation^ 
cost of living; employ- 
ment indices; etc. 
f. Department of Public 
Welfare—Indigent medical, 
dental care and hospitali- 
zation; medically needy; 
general assistance; aid 
to blind; aid to depen- 
dent children; aid to old 
age; child welfare servi- 
ces. Present Situation 
Suggestions and Recommendations 
for 
(Services and Resources) 
Immediate Action 
Lonp’-ranpe 
Objectives or Action 
g- 
Bureau of Sight Con- 
servation—Care, education 
and index of blind in the 
Territory. 
h. 
University of Hawaii 
1) Psychological Clinic 
Tebta and measure- 
ments; psychological 
clinic services; etc, 
2) Agricultural Experi- 
ment Station (HSPA co- 
operating agency) 
Soil, production, agri~• 
cultural data. 
i. 
Department of Agriculture 
and Forestry—Soil, animal 
research, natural resources 
data. 
i- 
Tax Office 
Tax resources, etc. 
3. City and County 
cl • 
Honolulu Police Depart- 
ment 
Crime statistics; traffic 
accidents. 
b. 
Domestic Relations and 
Juvenile Courts 
Social problems data 
: 
c. 
Health Department 
Emergency medical ser- 
vice, etc. Present Situation 
(Services and Resources) 
Suggestions and Recc 
Immediate Action 
)nmendations for 
Long-range Objectives or Action 
B. Voluntary Agencies and Private 
j 
Enterprise 
♦ 
1. American Red Cross 
Home Service Department 
Social welfare data. 
2. Palama Settlement 
Medical and dental care; 
types and frequency of 
diseases; socio-economic 
data on families. 
3. Council of Social Agencies 
Secondary source for 
socio-economic data. 
A. Chamber of Commerce 
Business and financial 
indices; types and kinds 
! 
of commercial enterprises; 
6 uC • 
5• Medical Social Service 
Association 
Socio-economic statistics. 
6. Hospitals 
Illness indices; duration of 
illness and other pertinent 
data regarding hospitalize- 
tion. 
7. Hawaii Sugar Planters 
Association 
Medical, dental, nursing care 
program; industrial accident 
illness; plantation workers 
employment indices. Present Situation 
(Services and Resources) 
Suggestions and Recom 
Immediate Action 
mendations for 
Long-range Objectives or Action 
8. Hawaii Medical Services 
Association 
Medical and hospital pre- 
payment plan statistics. 
9. Insurance Comnanies 
Health and accident insur- 
ance coverage; claims, etc. 
10. Business and industrial 
concerns 
Health and accident preven- 
tion programs; frequency 
rates; etc. 
It is recommended that: 
III. Problems 
An expanded Division of Health 
Statistics be established in the 
A. No one agency, either public 
Board of Health as promotly as 
or private, is responsible 
funds and qualified personnel can 
for the collection of all, or 
be obtained. This agency should 
even a major portion of bio- 
incorporate the facilities for 
metric information which is 
compiling, analyzing and interpret- 
needed by many agencies and 
ing vital statistics already pro- 
institutions for proper 
vided by the Bureau of Vital 
planning of programs in re- 
Statistics; but it should, in 
lation to basic and factual 
addition, set up machinery for 
data« 
performing these sane functions 
with respect to morbidity statis- 
tics and other biometric informa- 
tion necessary in planning for 
better health. This division 
should properly be charged with 
responsibility of securing the 
information needed for accurate Present Situation 
(Services and Resources) 
Suggestions and Recon 
Immediate Action 
imendations for 
Long-range Objectives or Action 
It is recommended that; 
intercensal estimates of popula- 
tion by race, sex, broad age 
groups, and larger geographic 
units within the Territory. The 
Division of Health Statistics 
should endeavor to develop uni- 
form methods of reporting the 
desired statistics—uniform as 
between the agencies of the 
Territory and at the sane tine, 
consistent with nationally 
accepted methods of reporting. 
Since not all the public and 
private agencies concerned with 
the use of vital and morbidity 
statistics, population and other 
biometric data are directly con- 
nected with the Board of Health, 
there might well be established 
B. During the war, the peace- 
an advisory committee represent- 
ing all health agencies in the 
community to assist in integrat- 
ing and coordinating their 
various interests. 
Immediate steps bo taken to 
tine machinery for securing 
secure detailed information 
detailed information regard- 
from the responsible military 
ing movement of civilians in 
agencies as to the movement in 
and out of the Territory mas 
and out of the Territory of 
entirely dislocated. Such 
civilian population during the Present Situation 
(Services and Resources) 
Suggestions and Recommendations 
Immediate Action iLonPi-ranpC- 
for 
Objectives nr Action 
information must now be re- 
constructed from several 
scattered sources. 
1 
war period. It is imoortant that 
this vital information be gar- 
nered before the records are lost. 
These data should be broken down 
by race, citizenship, sex, and 
broad age classes. It may be 
necessary to nrovide special 
funds to the Bureau of Vital 
Statistics in order to fill this 
serious gap in the funded know- 
ledge of Haxmii*s population. 
Within the proposed Division 
of Health Statistics or in the 
present Bureau of Vital Statis- 
tics, Territorial Board of Health, 
facilities be established for 
funding routine information on 
the movements of population in 
and out of the islands. The co- 
operative arrangement which 
existed prior to the war with 
the U.S. Immigration Service 
for making such information 
available should perhaps be ex- 
j panded to include the gross 
figures of inter-island travel. 
Data on intra-territorial move- 
ment should doubtless be 
obtained so as to increase the 
accuracy of intercensal esti- 
mates of population by 
islands. Present Situation 
(Services and Resources) 
Suggestions and Recommendations for 
Immediate Action 1 Long-range Objectives or Action 
It is recommended that: 
C. 
Only a fraction of the sum- 
maries on population and 
occupation prepared in pre- 
vious census reports are yet 
available for the 194.0 census. 
A request immediately be for- 
warded to the Census Bureau, 
Washington, D.C., for the com- 
plete tabulation of the 194-0 
census of population. Even 
though much of the information 
is already out of date, the 
tabulations should be obtained 
both as the best information now 
available and as a basis of com- 
parison with previous and subse- 
quent censuses. 
D. 
Hawaii is not included in all 
population and census reports 
from Washington giving in- 
formation by states and cities. 
Immediate action be undertaken 
through the Hawaiian delegate to 
Congress and the Department of 
the Interior to include Hawaii 
in all census reports from 
Washington giving information by 
states and cities. 
E. 
*« 
-i.' ; 
There has been insufficient 
use of census tracts, both by 
the U.S. Bureau of the Census 
in its collection of data, and 
by local agencies in their 
utilization of census data or 
collecting their own data. 
Local agencies take greater 
cognizance of the information 
available by census tracts, and 
make increased use of these areas 
in collecting and analyzing data 
(e.g., delinquency or disease 
incidence) for which they arc 
responsible. Present Situation 
(Services and Resources) 
Suggestions and Reco 
Immediate Action 
mmendations for 
Longrange Objectives or Action 
It is recommended that: 
Efforts of the Chamber of Com- 
merce special committee on 
census needs and similar grouos 
to assure an adequate Federal 
census in 1950 (especially in 
regard to census tract data) be 
expanded and encouraged. 51 
REPORT ON HEALTH STATISTICS 
Introduction 
The success of any public health program depends on exact knowl- 
edge of a vast multitude of factors affecting the community. Statistics 
pertaining to birth, death, and the incidence of disease are no longer 
sufficient. The importance of economic factors — income, price level, 
stability and type of employment, among others — has been recognized. 
Accurate reporting of housing conditions is considered essential to 
public health planning. Spot maps showing the incidence of sexual de- 
linquency or industrial or home accidents have decided relevance to 
various aspects of a health program. Complete, up-to-date population 
data are especially significant. 
Present Facilities 
The present public facilities for the resources reporting and analy- 
sis of public health statistics are chiefly confined to the Bureau of 
Vital Statistics of the Board of Health, the functions of which are legal- 
ly defined in Sections 3101 to 3128, Chapter 60, Revised Laws of Hawaii, 
194-5• Other departments and bureaus of the government, such as the 
Territorial Departments of Public Instruction, Institutions, Hospitals 
and Settlements, Labor, and Public Welfare, the Police and Health Depart- 
ments of the Counties, and the Territorial courts, all collect and sum- 
marize information which is useful to the student of public health. 
Various agencies of the Federal Government, such as the Bureau of Internal 
Revenue, the Census Bureau, the Employment Service, and the Public Heilth 
Service, also provide statistical data which are available in the analy- 
sis of public liealth trends. It is, however, the Bureau of Vital Sta- 
tistics of the Territorial Board of Health upon which the major respon- 
sibility in this area falls. 
The Bureau of Vital Statistics is called upon to perform a great 
variety of functions, of which the recording of all pertinent information 
regarding births, deaths, and marriages and the preparation of statistical 
summaries and analyses are only a part. It is doubtful whether the pre- 
sent staff of 13 workers in the central office, with its meager compli- 
ment of statistical machines (an 80 column Hollerith sorter, and an 
electrical punching machine) can be expected to accomplish much beyond 
the task of registering the vital statistics of the Territory and pre- 
paring simple statistical tabulations of these records. It seems clear 
to any dispassionate observer that, within the limitations of staff and 
equipment imposed upon it, the Bureau of Vital Statistics has performed 
its duties of registering all births, deaths, and marriages in a very 
satisfactory manner. On the basis of careful investigations by the 
Federal Bureau of the Census of the registration conducted by the Bureau 
of Vital Statistics, the territory of Hawaii has been included in the 
Death Registration Area of the United States since 1917, and in the 52 
Birth Registration Area since 1929. Hawaii1s rating of accuracy in re- 
porting was 97.0 per cent for deaths and 93.0 per cent for births, which 
later increased to 97.7 per cent. The services of the Bureau have been 
less adequate with respect to the analysis of its statistics, but this de- 
ficiency should be partially removed during the next year with the appoint- 
ment of a statistician in charge of public health statistics. 
Several other bureaus of the Board of Health, including those of Com- 
municable Diseases, Venereal Diseases, Tuberculosis, Mental Hygiene, and 
Child Health and Crippled Children, are charged with the responsibility 
of collecting statistics on the incidence of various diseases within their 
respective fields. The adequacy of the reporting of disease depends very 
largely upon the attitudes of the general population and upon the cooper- 
ation of the medical profession; and it must be conceded that an extensive 
educational program will be necessary, perhaps supplemented by legal re- 
enforcement, before Hawaii1 s morbidity statistics can be couiSidered nt all 
adequate. 
A surprisingly complete and satisfactory reporting of the incidence 
of the common diseases on the Hawaiian sugar plantations occurs under the 
auspices and direction of the Hawaiian Sugar Planters1 Association, and 
indicates what might be accomplished on a Territory-wide basis with ade- 
quate facilities and legal enforcement. Most of the other private agencies 
interested in gathering morbidity statistics, such as the hospitals, both 
private, and the larger employers, lack the facilities for integrating and 
correlating their findings. There is, moreover, a great disparity between 
the forms used and the care exercised in the recording of significant data 
by the various agencies. 
The Funding and Integration of Statistics 
The apparent gaps in the present coverage of morbidity statistics and 
the lack of coordination and adequate analysis of the statistics now avail- 
able strongly suggest the need of some integrating agency. The Bureau of 
Vital Statistics, by virtue of its official status and its present staff 
and equipment, seems the logical agency to assume such functions, and it 
is recommended that a Division of Health Statistics be established in the 
Board of Health as promptly as funds and qualified personnel can be ob- 
tained. The agency should incorporate the facilities for compiling, 
analyzing, and interpreting vital statistics already provided by the Bureau 
of Vital Statistics; but it should, in addition, sot up machinery for per- 
forming these same functions with respect to morbidity statistics and other 
biometric information necessary in planning for better health. This di- 
vision should serve as a central clearing house for statistical date gather 
ed by and useful to all agencies in the community, both public and private, 
dealing with problems of health. 
This proposal is consistent with that of the Committee on Public 
Health Administration, which recommends the establishment within the Board 
of Health of a Division of Public Health Statistics. 53 
The use of microfilming equipment for the filing of records and 
for the reproduction of legally acceptable certified copies of records 
is being adopted in some states and might profitably be investigated 
for uses in Hawaii. Especial attention should be directed to the 
analysis and interpretation of the statistics gathered, and this aspect 
of the program should be under the direction of personnel trained not 
only in formal statistical principles, but also with a well-grounded 
understanding of the social forces operating in the Territory. 
Detailed analyses of population and vital statistics so as to permit 
the preparation of life expectancy tables for Hawaii would seem to be 
a major responsibility of this division. 
Since not all the public and private agencies concerned with the 
collection and use of vital and morbidity statistics are directly con- 
nected with the Board of Health, it seems desirable that an advisory 
committee to the Division of Health Statistics be established to assist 
in the integration and coordination of these various interests. All 
the major agencies in the community concerned with public health sta- 
tistics, such as the Hawaii Medical Service Association, the hospitals, 
the life insurance companies operating in Hawaii, the University of 
Hawaii, the larger employers, and the labor unions, should probably 
be represented on such an advisory committee, Many valuable functions 
might be performed by the advisory committee if it is carefully selec- 
ted and its liaison and technical resources are seriously utilized. 
Special Problems of Population 
The maintenance of accurate information on the shifting population 
of the Territory, including its various subdivisions by age, sex, 
ancestral, and geographic groupings, is basic to the solution of almost 
every problem of public health and therefore deserves special atten- 
tion. Certainly, one of the central functions of the Division of Health 
Statistics recommended in this report should be to provide intercensal 
estimates of population with the maximum accuracy which our unique 
island situation makes possible. 
Hawaii, by virtue of its insular character and its moderate size, 
is far better situated than most mainland communities to provide ade- 
quate biometrical information for its public health program. No state 
in the union can obtain the ready check upon the movement of population 
in and out of its borders which the Hawaiian Islands afford. With rela- 
tively little expense and a minimum of legislative support, Hawaii might 
establish a type of continuous population census which would be invalu- 
able for public health analysis and the envy of every mainland health 
administrator. People do not cross Hawaii’s two-thousand mile water 
barrier by foot or in their own automobiles, and it would be relatively 
easy to obtain a perfect and up-to-date record of all population move- 
ment in and out of the various islands of the group. Similarly the in- 
ternal changes in population by age, sex, and ancestry could be easily 
recorded for use by the public health analysis. The centralized system 54 
of political and economic control in Hawaii, in contrast to that of 
most mainland communities, lends itself readily to the easy and inex- 
pensive reporting of population, mortality and morbidity statistics. 
Prior to World War II and since its close, the Bureau of Vital 
Statistics obtained data from the steamship companies and the Federal 
Immigration Service as to the movement of population in and out of the 
Territory so as to provide, together with its own records of births and 
deaths, a highly accurate basis for estimating the total population of 
the Islands. Unfortunately, during the war, the machinery for obtain- 
ing figures of arrivals and departures was completely disrupted, and 
one of the first obligations of the Division of Health Statistics should 
be to reconstruct as accurately as possible the figures of population 
mobility during this period from the various official sources. This task 
should be undertaken so as to test the accuracy of the current estimates 
of population based upon the wartime enumeration and subsequent compu- 
tations of population by the Office of Civilian Defense. 
The effectiveness of our public health program in the treatment and 
prevention of specific diseases, such as tuberculosis, pneumonia, cancer, 
and other diseases which are peculiar to certain ago periods, can only be 
tested by the computation of refined rates based upon accurate population 
figures by specific age groups. In order to make such studies possible 
between census periods (1930, 1940, 1950, etc.), the Division of Public 
Health Statistics should institute as quickly as possible, and certainly 
by 1950, a system of computing interccnsal estimates of population by 
broad age groups and by sex. Figures for intercensal years by racial 
groups have been obtained in the past, and these estimates should like- 
wise be continued. 
The decennial census by the Federal government provides the basic 
information regarding population which all subsequent computations of 
population and of mortality and morbidity rates are necessarily based. 
It becomes highly important to the public health program of the Territory, 
therefore, that the decennial census be conducted with maximum accuracy 
and that the results become available so as to meet the needs of students 
of public health within the Territory. One of the most valuable functions 
which the Advisory Committee could perform to the Division of Health Sta- 
tistics would be as a liaison between the local community and the Federal 
Census Bureau in matters relating to population. For example, a request 
should be forwarded immediately to the Census Bureau for the tabulation of 
a considerable number of items in the 1940 census which have thus far not 
been made available to Hawaii, Even though much of the information is alt 
ready out of date, the tabulations should be obtained both as the best in- 
formation new available and as a basis of comparison with previous and 
subsequent censuses. Similarly strong representations should be made 
through the Hawaiian Delegate to Congress and the Department of Interior 
to guarantee that Hawaii is included in all population and census reports 
from Washington giving information by states and cities. Periodic reports, 
particularly from the Census Bureau, provide valuable information on 
population, vital statistics, housing, manufactures, agriculture, prices. 55 
income, and government finance for the various states and local com- 
munities of continental United States* Although most of the information 
for such reports is sent to Washington by local agencies in Hawaii or 
could easily be provided, the Territory is rarely included in the pub- 
lished reports. Frequently the significance of local experience be- 
comes apparent only through comparison with mainland communities. This 
is particularly true in the field of vital statistics# The Advisory 
Committee of the Division of Health Statistics should play a prominent 
role in the planning for the 1S50 census of population in Hawaii, 1/ 
Special attention should be given to census tract data. Experience 
has proved such statistics to have considerable value in analysis and 
planning, yet little use has been made of tracts, either by the U, S, 
Census or local agencies. In many mainland cities, information regard- 
ing housing, income, disease, accidents, delinquency and educational 
attainment, as well ns population data, are collected by census tracts. 
Some of this work is done as part of the decennial Federal census, but 
a good deal of it is accomplished by the various local official and 
voluntary agencies -- the Police Department, Board of Education, health 
authorities, social agencies, or local university. The resulting fund 
of information has permitted extremely valuable ecological studies in 
a number of fields. An additional breakdown of housing data into block 
statistics was made available by the Bureau of the Census in 1940 for 
cities ever 50,000 population. Steps should be taken to assure the 
maximum use of tracts by the Federal Government in the 1950 U. S, Census 
and by the various local agencies in planning their own surveys. 
y An excellent beginning has been made along this line by a special 
Chamber of Commerce committee on census needs. 56 
APPENDIX 
Contents 
Table 
Page 
1 Persons Gainfully Employed in Medical and Other Health 
Services, United States and Hawaii, 1900 i 
2 Persons Gainfully Employed in Medical and Other Health 
Services, United States, Hawaii and Honolulu, 1910 ii 
3 Persons Gainfully Employed in Medical and Other Health 
Services, United States, Hawaii and Honolulu, 1920 iii 
4 Persons Gainfully Employed in Medical and Other Health 
Services, United States, Hawaii and Honolulu, 1930 iv 
5 Persons Employed in Medical and Other Health Services, 
United States, Hawaii and Honolulu, 1940 v 
6 Employed Nurses per 1,000 Population, United States, Ha 
Hawaii and Honolulu, 1900 to 1940 vi 
7 Number of Hospitals, Physicians, Dentists and Nurses, 
Territory of Hawaii by Islands, 1946 vii 
8 Distribution of Civilian Registered Nurses, by Field 
of Training, United States, Territory of Hawaii, 
and Island of Oahu, 1946-1947 viii 
9 Private Duty Nursing, Hawaii, September 1947 and 
September 1945 ix 
10 Hospitals and Sanatoriums, Territory of Hawaii, 1939 x 
11 Nurses in Hospitals, Oahu, 1947 xi 
12 Schools of Nursing, Territory of Hawaii, 1947 xii 
13 Number of Students and Schools of Nursing, United 
States and Hawaii, 1935-1947 xiii 
14 Student and School of Nursing Ratios, United States 
and Hawaii, 1935-1947 xiv 
15 Registered Occupational Therapists by Place of Work, 
Territory of Hawaii, February 1946 and December 1947 xv 
16 Registered Occupational Therapists in Non-military 
Institutions, Hawaii, by Counties, December 1947 xvi 57 
Table 
Page 
17 Occupational Therapists in Hospitals, United States and 
Ha\vaii, 1946 xvii 
18 Recommended Personnel in Occupational Therapy Depart- 
ments, Territory of Hawaii xviii 
19 Physical Therapists by Place of Employment, Territory 
of Hawaii, January 1946 and December 1947 xix 
20 Approximate Humber of Registered Physical Therapists, 
United States and Territory of Hawaii, 1946 xx 
21 Physical Therapists in Hospitals, United States and 
Territory of Hawaii, 1946-1947 xxi Appendix Table 1, 
PERSONS GAINFULLY EMPLOYED IN MEDICAL AND OTHER HEALTH SERVICES, 
UNITED STATES AND HAWAII, 1900 3 
United States 
y 
Territory of Hawaii Si/ 
Occupation 
Total 
Male 
Female 
Total 
Male 
Female 
Professional service: 
Dentists 
29,665 
28,858 
807 
21 
20 
1 
Physicians and surgeons 
132,002 
124,615 
7,387 
109 
105 
4 
Veterinary surgeons 
N.A. 
N.A, 
N.A. 
6 
6 
0 
Domestic and personal 
service: / 
Nurses iV 
120,956 
12,265 
108,691 
207 
18 
189 
Population 
75 
,994,575 
154,001 
Data not available for the City of Honolulu (population 39,306), 
1900 U.S, Census, Abstract of the 12th Census of the United States, 1900, 
pp, 24-25, 
SJ Report of the Commissioner of Labor on Hawaii, 1901 (data quoted from 
tabulations of the 12th U.S. Census')"! p* 80, These data are given by 
place of birth (native or foreign) in the Report. 
~J United States figure includes raidwives. It will be noted that no U,S, 
Census since 1900 lacks a professional category for nurses, the last 
such omission occurring in the 1900 schedules. 
Thete were 1.6 nurses and midwives per 1,000 population in the United 
States in 1900, and 1.3 nurses per 1,000 population in Hawaii, 
N.A. Not available.  
United 
States 
Territory of Hawaii 
City of Hono! 
.mu y 
Occupation 
Total 
Male 1 Female j 
Total 
Male 
Female 
Total 
Male 
Female 
Professional service: 
Dentists 
Physicians and surgeons 
Trained nurses 2J 
Veterinary surgeons 
39,997 
151,132 
B2j327 
11,652 
1 1 ' 1 
I i 
33,743 1,254 | 
142,117; 9,015 i 
5,819i 76,508 ! 
11,652; 
N.A, 
H.A. 
N.A. SJ 
N.A. 
N.A. 
122 
N.A. 
N.A. 
N.A. 
N.A. 
140 
N.A. 
N.A. 
N.A. 
N.A. 
N.A. 
y 
N.A. 
60 
N.A. 
N.A. 
N.A. 
N.A. 
103 
N.A. 
Semiprofessional pursuits: 
Healers (except nhysicians 
and surgeons) 
6,334 
| 
1 s 
2,162: 4,672 ; 
N.A. 
N.A. 
N.A. 
N.A. 
N.A. 
N.A. 
Domestic and personal services: 
Midwives and nurses 2/ 
(not trained) 
Midwives 
Nurses (not trained) 
[ 
1 
333,043 
6,205 
126,838 
I 
I | 
1 15,926j 117,117 
... j 6,205 
! 15,926 j 110,912 
N.A. 
N.A. 
N.A. 
; 
| 
1 N.A. 
N.A. 
i N.A. 
N.A. 
N.A. 
K .A. 
1 N.A. 
j N.A. 
TT f. 
j I’i * ii * 
N.A. 
N.A. 
N.A. 
N.A. 
N.A. 
N.A. 
Population 
| 
91,972,266 
191,909 
i 
52,183 
§J 1910 U.S. Census, Vol. IV, Population, Occupation Statistics. 
Ibid., pp. 609-611. These data are given by age and by race in the Census volume. 
s/ Nurses per 1,000 population (Hawaii and Honolulu estimated): 
U.S. T.H. Honolulu 
Trained nurses 0,9 0,8 2.1 
Midwives and nurses (not trained) 1.4. N.A. N.A. 
Assuming male to female nurse ratios identical to the national ratios, Hawaii would have a total of 151 trained 
nurses; Honolulu of 111 trained nurses. Because of the relatively large number of male nurses in Hawaii in the 
early decades of the century (see data for 1920), such an assumption probably results in a conservative figure. 
N.A. Not available. 
PERSONS GAINFULLY E?!PL0YED IN MEDICAL AND OTHER HEALTH SERVICES, 
UNITED STATES, HAWAII, AND HONOLULU, 1910 
Appendix Table 2  
United States a/ 
Territbfy of 
Hawaii b/ 
City of Honolulu c/ 
Occupation 
Total 
m 1 
Male "Female 
Total 
Male 
Female 
Total 
Male 
Female 
Professional workers: 
Dentists 
56,152 
54,323 1 1,829 
41 
41 
• • • 
28 
28 
... 
Osteopaths 
5,030 
3,367 1 1,663 
N.A. 
N.A. 
N.A. 
N.A. 
N.A. 
N.A. 
Physicians and surgeons 
144,977i137,753 7,219 
160 
153 
7 
95 
90 
5 
Trained nurses d/ 
149,128 
5,464 i143,664 
13,493 1 
I 
251 
18 
233 
145 
4 
141 
Veterinary surgeons 
13,494 
6 
6 
• • • 
3 
3 
• • • 
Semi-professional workers: 
Healers not elsewhere classified e/ 
14, 774 
6,372! 7,902 
46 
32 
14 
27 
17 
10 
Other workers; 
Physicians* and surgeons* attendants 
7,051 
64l{ 6,410 
1 H.A. 
N.A. 
N.A. 
N.A. 
N.A. 
N.A. 
N.A. 
Dentists* assistants and attendants 
Mxdwives and nurses (not trained) d/ 
6,708 
1,763 4,940 
j N.A. 
N.A. 
N.A. 
N.A. 
N.A. 
156,769 
19,333137,431 
198 
50 
148 
136 
29 
107 
Midwives 
4,773 
J. 4,773 
9 
... 
9 
4 
4 
Nurses (not trained) 
151.996 
19.333132.653 
189 
50 
139 
132 
29 
103 
Population 
105,710,620 
1 
255.9 
! 
12 
53.327 
a/ 1920 U.S, Census, Vol. IV, Population, Occupations, pp, Z.2 ff, 
b/ IMd., p. 1275, 
s/ Ibid,, consists of urban Honolulu 
d/ Nurses per 1,000 population: U,S, T.H. Honolulu 
Trained nurses 1,4. 1,0 1.7 
Midnives and nurses (not trained) 1,5 0.8 1.6 
&/ Excluding osteopaths, physicians and surgeons 
N.A. Not available. 
Appendix Table 3 
PERSONS GAINFULLY EMPLOYED IN MEDICAL AND OTHER HEALTH SERVICES 
UNITED STATES, HAWAII, AND HONOLULU, 1920  
United States a/ 
Territory of 
Hawaii b/ 
City of Honolulu c/ 
Occupation 
Total 
Male 
Female 
Total 
Male 
Female 
Total 
Male 
Female 
Professional Workers: 
Dentists 
71,055 
69,768 
1,237 
132 
129 
3 
85 
82 
3 
Osteopaths 
6,117 
4,554 
1,563 
5 
2 
3 
3 
1 
2 
Physicians and surgeons 
153,803 
146,978 
6,825 
255 
241 
14 
167 
153 
14 
Trained nurses d/ 
294,189 
5,452 
288,737 
707 
10 
697 
493 
5 
488 
Veterinary surgeons 
11,863 
11,852 
11 
12 
12 
• • * 
5 
5 
• • • 
Semi-professional Workers: 
Chiropractors 
11,916 
9,203 
2,713 
10 
8 
2 
8 
6 
2 
Healers not elsewhere classified 
17,640 
7,866 
9,774 
58 
42 
16 
43 
28 
15 
Other Workers: 
Physicians* and surgeons1 attendants 
U,042 
689 
13,353 
20 
5 
15 
14 
4 
10 
Dentists1 assistants and attendants 
13,715 
770 
12,945 
24 
6 
186 
18 
3 
15 
Midmves and nurses (not trained) d/ 
157,009 
13,867 
143,142 
368 
119 
249 
229 
61 
168 
Midwives 
3,566 
• « • 
3,566 
45 
• • • 
45 
26 
26 
Nurses (not trained) 
153,44-3 
13,867 
139,576 
323 
119 
204 
203 
61 
142 
Peculation 
• 
122.775.046 
368,331 
f 
1 
137.582 
Appendix Table U 
PERSONS GAINFULLY EMPLOYED IN MEDICAL AND OTHER HEALTH SERVICES, 
UNITED STATES, HAWAII, AND HONOLULU, 1930 
a/ 19JO U. S, Census, Ab^^gt_pf_tha_ 19LIi„Genrjuo ot' the United States, pp. 317-319. 
b/ 1930 U, S. Census, Putting Territories and possessions, p, B5. 
c/ Ibid« Consists of urban Honolulu, 
d/ Nurses per 1,000 population: U.S. T,H. Honolulu 
Trained nurses 2,4. 1,9 3~6 
Midvdves and nurses (not trained) 1#3 X.O l[? Occupation 
United States 
Territory of Hawaii 
City of Honolulu c/ 
Total 
Male 
Female 
Total 
Male 
Female 
Total 
Male 
Female 
Professional workers: 
Dentists 
70,121 
69,074 
1,047 
211 
204 
7 
140| 
135 
5 
Osteopaths 
6,007 
4,905 
1,102 
8 
2 
6 
a 
2 
6 
Pharmacists 
79,347 
76,131 
3,216 
76 
76 
# • • 
ei 
63 
• • 
Physicians and surgeons 
164,649 
157,041 
7,608 
381 
353 
23 
255 
237 
18 
Trained nurses and student nurses d/ 
355,786 
7,509 
348,277 
1,080 
8 
1072 
736 
4 
732 
Veterinarians 
10,717 
10,638 
79 
20 
18 
2 
13 
11 
2 
Semi-professional workers: 
Chiropractors 
10,629 
8,758 
1,871 
N.A. 
N.A. 
N.A. 
N.A 
« N .A 
* N.A. 
Healers and medical service workers. 
not elsewhere classified 
19,555 
10,045 
9,510 
122 
79 
43 
89 
53 
36 
Optometrists 
10,237 
9,762 
475 
13 
13 
• • • 
9 
9 
... 
Service workers: 
Practical nurses and midwives d/ 
91,107 
3,909 
37,198 
300 
2 
298 
169 
1 
168 
Attendants, hospital and other 
institutions 
24,465 
10,627 
13,838 
539 
321 
218 
208 
162 
46 
Population 
131.669.275 
179.326 
APPENDIX TABLE 5 
PERSONS EMPLOYED a/ IN MEDICAL AND OTHER HEALTH SERVICES, 
UNITED STATES, HAWAII, AND HONOLULU, 1940 h/ 
a/ Except on public emergency work * 
b/ From 194-0 U,S, Census, Population, 2d series. Characteristics of the Population 
c/ Urban Honolulu 
d/ Nurses per 1,000 populations U.S. T.H. Honolulu 
Trained and student nurses 2,7 2.6 4,1 
Practical nurses and midwives 0,7 0,7 0,9 
N,A, Not available. Appendix Table 6 
EMPLOYED NURSES PER 1,000 POPULATION 
UNITED STATES, HAWAII AND HONOLULU, 1900 TO 1940 
Territory 
{ of Hawaii 
City 
of Honolulu 
United States 
Total 
Trained 
Total 
Trained 
Total 
Trained 
Nurses 
Nurses 
Other* 
Nurses 
Nurses 
Other 
Nurses 
Nurses 
Other 
1900 V 
T..i 
N.A. 
N.A. 
N.A, 
N.A. 
N.A. 
1.6 
N.A. 
N.A. 
1910 V 
N.A. 
0.8 
N.A. 
N.A. 
2.1 
N.A. 
2.3 
0.9 
1.4 
1920 S/ 
1.8 
1.0 
0.8 
3.3 
1 7 
1.7 
1.6 
2.9 
1.4 
1.5 
1930 2/ 
2.9 
1.9 
1.0 
5,3 
3.6 
1.7 
3.7 
2.4 
1.3 
1940 e/ 
3.3 
2.6 
0.7 
5.0 
4.! 
0.9 
3.4 
2.7 
0.7 
y Calculated from 1900 U. S. Census (see Appendix Table l). All nurses 
were entered under "Domestic and Personal Service" in this Census. 
y Honolulu and Hawaii estimated from fragmentary 1910 U. S. Census data 
(see Appendix Table 2). United States calculated from 1910 Census. 
"Other" includes both midwives and untrained nurses. 
y Calculated from 1920 U, S. Census (see Appendix Table 3), "Other" 
includes both midwives and untrained nurses. 
y Calculated from 1930 U. S. Census (see Appendix Table 4), "Other" 
includes both midwives and untrained nurses. 
®/ Calculated from 1940 U. S. Census (see Appendix Table 5), "Trained 
nurses" includes student nurses. "Other" includes both midwives and 
practical (not "untrained") nurses. 
N,A, Not available. Appendix Table 7 
NUMBER OF HOSPITALS, PHYSICIANS, DENTISTS AND NURSES, 
TERRITORY OF HAWAII BY ISLANDS, 1946 
" T'T 111 
Item 
— 
Oahu 
Hawaii 
Maui 
Kauai 
Molo- 
kai 
Lanai 
Niihau 
Terr, of 
Hawaii 
Population^ 
358,911 
70,871 
44,807 
34,911 
6,173 
3,630 
199 
519,502 
Hospitals-^/ 
23 
19 
7 
6 
3 
1 
0 
59 
General 
10 
17 
6 
4 
2 
1 
0 
40 
Allied special 
5j 
i 
0 
0 
1 
0 
0 
7 
Other 
Total hospital . 
"normal" bedsiy 
8 
1 
1 
2 
0 
0 
0 
12 
2,692 
836 
580 
283 
131 
26 
0 
4,548 
Physicians, total^/ 
269 
45 
28 
14 
3 
1 
0 
360 
Institutional 
16 
3 
3 
1 
1 
0 
0 
24 
Board of Health 
12 
1 
0 
0 
0 
0 
0 
13 
Plantation 
8 
9 
8 
7 
0 
1 
0 
33 
Group 
46 
0 
0 
0 
0 
0 
0 
46 
Individual 
Dentistsjy 
187 
32 
17 
6 
2 
0 
0 
244 
162 
25 
9 
9 
1 
1 
0 
207 
Registered nurses, 
totally 
787 
110 
74 
56 
19 
8 
0 
1,054 
Institutional 
313 
52 
38 
23 
13 
4 
0 
443 
Private duty 
76 
5 
2 
2 
1 
0 
0 
86 
.Industrial 
41 
7 
7 
5 
1 
2 
0 
63 
Office 
79 
2 
0 
0 
1 
0 
0 
82 
School 
12 
2 
1 
1 
0 
0 
0 
16 
Public health^/ 
59 
13 
7 
9 
0 
0 
0 
88 
Not working 
207 
29 
19 
16 
3 
2 
0 
276 
«/ Data taken from Proposed Tentative Report of Hospital Survey and Planning, 
Territory of Hawaii (Territorial Board of Health, October, 1947), Table 2 
(including changes noted or implied on correction sheet). 
Nursing data as of 1946-1947. There were, in addition to the above, 2 
U.S, navy nurses and 1 U.S. army nurse registered and working in the 
Territory; all 3 of these were located on Oahu. There were 197 nurses 
registered in the Territory but working on the mainland. Data from the 
Territory of Hawaii Board for the Licensing of Nurses and quoted in part 
by the table cited in footnote V. 
2/ Data cited above for Molokai and Lanai are incorrect, according to the 
Director of the Bureau of Public Health Nursing. All nurses except those in government or military service, 
i/ Calculated from Appendix Table 7. 
zJ Calculated from Facts About Nursing. 1947 (Nursing Information Bureau of A.N.A.), p. 11, Excludes 
nurses in government and military service and those listed as "unknown11 (10.5 percent of all members). 
Computed from estimated number of registered professional nurses available in hospitals, public health, 
industrial nursing, private duty nursing, and "other" fields (exclusive of those graduated from nursing 
schools in 194-6 and recently released armed forces nurses). Facts About Nursing, 1946, p, 9. 
e/ Number "available" (see footnote <j/>. 
£/ Includes nursing education. 
Hospitals• 
Less than 0,05. 
%J Probably included in "Other" category. 
1/ Inactive, 
Island of Oahu 
19/6-19Z.7 
Territory of Hawaii ! 
19A6-A7 y 
United States 
Percentage 
Nurses 
Percentage 
Nurses| 
A.N.A. Estimated nurses availa- 
distribution 
per 1,000 
distribution 
_per 
Member- |ble (July 1946) §J 
All | Employed poplila- 
All 
Employed 1,000 
ship iPercentage 
Per 1,000 
nursesi nurses 
tion 
nurses 
nurses 
DOD. 
19A6 SJ <dl stri huti on i population 
- ■ -- 1 
Total nurses 
100.0 i ... 
2.2 
100.0 
• • • 
2.0 
100.0 
100.0 e/ 
1.5 sJ 
Total employed nurses 
73.7 j 100.0 
1.6 
73.8 
100.0 
1.5 
91-8 J 
... 
• • • 
Institutional 
39.8 54.0 
0.9 
42.0 
56,9 
0.9 ! 
42.3 u 
52.4 jg/ 
0.8 g/ 
Private duty 
9.7 | 13.1 
0.2 
i 8.2 
11.1 
0.2 ' 
32. A 
27.1 
0.A 
Industrial 
5.2 | 7.1 
0.1 
6.0 
8.1 
0.1 
3.A 
A.l 
0.1 
Public health 
7.5 1 10.2 
0.2 
8,3 
11.3 
0.2 
7.7 
9.5 
0.1 
School 
1 1.5 I 2.1 
y 
1.5 
2.1 
y 
i/ 
i/ 
1/ 
Office 
1 10.0 j 13.6 
0.2 
7.8 
10.5 
0.2 
3.6 
1/ 
t/ 
Other 
• • • | • • • 
• • • 
| 
... 
• • • 
2.5 
6.9 
0.1 
Not working 
26.3 1 ... 
0.6 
| 26.2 
• • • 
0.5 
8.2 jJ 
• • • 
• • • 
Appendix Table 8 
DISTRIBUTION OF CIVILIAN a/ REGISTERED NURSES, BY FIELD OF NURSING, 
UNITED STATES, TERRITORY OF HAWAII, AND ISLAND OF OAHU, 194-6-1947 IX 
Appendix Table 9 
PRIVATE DUTY NURSING, HAWAII 
SEPTEMBER 1947 AND SEPTEMBER 1945 V 
September 1947 
September 1945 
r 
119 
69 
106 
64 
* 
12,7 
1.8 
13 
5.8 
19 
20 
77 
N.A. 
29 
N.A. 
No. 
* 
No. 
% 
370 
93.2 
159 
91.5 
5 
1.3 
6 
3.4 
10 
2.5 
6 
3.4 
6 
1.5 
2 
1.1 
2 
0.5 
1 
0.6 
3 
0.8 
0 
0 
1 
0.2 
_0. 
0 
397 
100.0 
174 
100.0 
111 
28.0) 
8.sS/ 
110 
27.7) 
15 
146 
36.8) 
32.8°/ 
i 
0.2 
i; 57 
6 
1.5 
93 
53.43/ 
23 
5.8 
9 
5.2 
397 
100.0 
174 
100.0 
31 
91.2 
N.A. 
N.A. 
3 
8.8 
N.A. 
N.A. 
34 
100.0 
N.A. 
N.A. 
29 
100.0 
42 
100,0 
16 
55.2 
22 
52.4 
Employment: 
Membership (Nursing Service Bureau) 
Nurses actively employed 
Average nurses on call daily 
Average calls daily 
Average days employed per nurse 
Nurses employed 15 or more days 
Nurses employed less than 15 days 
Location of placement: 
Hospital 
Home 
Registry relief 
Institutional (permanent) 
Institutional (temporary) 
Physicians* office 
Other calls 
Total calls 
Hours of work: 
7 a.m. - 3 p,m, 
3 p.m. -11 p.m, 
11 p.m. - 7 a.m. 
12 hours (day) 
12 hours (night) 
Other hours 
Total 
Practical nurses: 
Active members 
Inactive nurses 
Total members 
Calls received 
Calls filled 
From statistical reports of the Nursing Service Bureau, Mabel Smyth 
Memorial Building, Honolulu, 
y "Eight'-hour day" 
o/ 7 a#m, - 7 p.ra, 
d/ 7 p.m. - 7 a,m. X 
Appendix Table 10. 
HOSPITALS AND SANATORIUMS, TERRITORY OF HAWAII, 1939 */ 
Type of 
No. of establishments 
hospital or 
sanatorium 
Territory 
of Hawaii 
Oahu 
Remainder of 
Territory 
Beds 
Percentage 
Occupancy 
General 
57 
16 
41 
■ 
3395 
■ 
57*6 V 
Tuberculosis 
4 
1 
3 
1032 
87*3 
Nervous and 
Mental 
2 
2 
0 
1268 
97.3 
Other 
5 
4 
1 
676 
1 
80.7 
— 
Total 
68 
23 
45 
6371 
72.9 y 
®/ From Vital Statistics—Special Reports—Haxvaii: Hospital and Other 
Institutional Facilities and Services, 1939 (U. S. Bureau of the 
Census, 1942). Data only for those institutions reporting, and 
therefore somewhat incomplete. 
i/ Incomplete. City or 
Town •/ 
Hospital y 
Type y 
Beds y 
Nurses 
Ratios 
Total 
Graduate 
Student 
nurses 
Practical 
nurses and 
attendants 
Total 
nursing 
personnel 
per 100 
beds 
Total 
Graduate 
nurses £/ 
per 100 
beds 
Students 
per 
full-time 
instruc- 
tors 
Total 
Admi- 
nistra- 
tive y 
Conors 
Full- 
time 
,1 Duty 
Part- 
time 
Instructors 
(full-time) 
Aiea 
Aiea Community 
General 
o 
5 
5 
i 
4 
0 
0 
0 
0 
12 
12 
Alaa 
D. S. Naval ®/ 
General 
1150 
Eva 
Eva (Eva Plantation Co.) 
General 
42 
6 
6 
i 
5£/ 
0 
0 
0 
0 
14 
14 
... 
Honolulu 
Kalihl •/ 
Leprosy 
44 
Honolulu 
Kapiolanl 
Mat.& Gyn. 
105 
91 
58 
N.A. 
N.A. 
1 
0 
0 
33 
87 
55 
• e • 
Honolulu 
Kaulkeolanl 
Children's 
100 
62 
42 
9 
32 
0 
1 
ii y 
9 
62 
41 
11 
Honolulu 
Kuakini 
General 
120 
143 
47 
9 
32 
2 
4 
77 / 
19 
119 
36 
19 
Honolulu 
Leahl 
T.B. 
480 
94 
38 
16 
20 
0 
2 
12 eJ 
44 
20 
8 
6 
Honolulu 
The Queen's 
General 
384 
326 
159 
29 
124 V 
6 
136 
31 
85 
40 
23 
Honolulu 
St. Francis 
General 
250 1/ 
265 
88 
21 
62 
0 
5 
163 
14 
106 
33 
33 
Honolulu 
Shrlners 
Orthopedic 
28 
16 
8 
2 
6 
0 
0 
0 
8 
57 
29 
• e • 
Honolulu 
Tripler (U.S.Army) y 
General 
621 
Kahuku 
Kahuku 
(Kahuku Plantation Co.) 
General 
30 
13 
6 
1 
5 y 
0 
0 
7 
43 
20 
• • • 
Kaneohe 
Territorial */ 
Mental 
1100 
Pearl 
Mentally 
City 
Walaano Hone y 
Deficient 
713 
Pearl 
Harbor 
U. S. Naval y 
General 
1000 
Waialua 
Waialua 
(Waialua Agricultural Co.) 
General 
38 
12 
4 
1 
3 
0 
0 
0 
8 
32 
11 
... 
Waipahu 
Waipahu (Oahu Sugar Co.) 
General 
50 
8 
6 
1 
5 
0 
0 
0 
2 
16 
12 
• • • 
Waipahu 
The Tanura 
General 
7 
3 
0 
0 
0 
0 
0 
0 
3 
43 
0 
... 
All Oahu Hospital* (19) 
6305 
N.A. 
N.A. 
N.A. 
N.A. 
N.A. 
N.A. 
N.A. 
N.A. 
N.A. 
N.A. 
N.A. 
All Oahu Hospitals Surveyed (13) 
1677 
1044 
467 
N.A. 
N.A. 
N.A. 
18 
376 
178 
62 
28 
21 
All Oahu Civilian General Hospitals (9) 
964 
781 
321 
64 
242 y 
15 
376 
84 
81 
33 
25 
g/ From "Hospital Service In the United States," Journal of the American Medical Association, vol. 113, no. 15, April 12, 1947. List does not in- 
clude five convalescent nursing hones (Bertha Berg, Kanilao, Maluhia, Sophie Mannlon and Ida Silva) and one lying-in hone (Ogawa). The lar- 
gest of these, Ualuhla (176 beds), had 8 graduate nurses (all full-time) and 15 practical nurses at the time of the survey, November 24, 1947. 
Information obtained from interviews with hospital directors and directors of nursing, November 17, 1947. The significance of these figures is 
lessened by the rapid changes characteristic of the nursing situation in the Islands. It is likely that a census of nurses taken on another 
day would reveal a greatly different set of data, with attendant changes in the accompanying ratios. 
gj Including supervisors, assistant supervisors, head nurses and assistant head nurses. 
<j/ Except full-time Instructors. 
Not Included in survey, 
f/ One of them working outside the hospital. 
g/ From other schools of nursing. 
Both full-time and part-time, 
i/ Latest figure (from hospital). 
3/ All civilian hospitals except mental and leprosy. 
N.A. Not available. 
Appendix Table 11. 
NURSES IN HOSPITALS, OAHU, 1947  
The Queen's Hospital 
School of Nursing */ 
St. Francis Hospital 
School of Nursing Jj/ 
Kua3d.nl General Hospital 
School of Nursing ®/ 
Administration 
The Queen's Hospital 
Under third order of the Francis- 
can Sisters of Syracuse, N. Y. 
Kuaklnl General Hospital 
School established 
1916 £/ 
1929 tf 
1931 
Student admission prerequisites 
Graduate of accredited high school; 
age 18-30; good mental and physical 
health; pre-nursing test 
Graduate of accredited high 
school, top 1/3 of class; 
psychological examination 
Graduate of accredited high 
school, top 1/3 of class; 
psychological test; biology, 
chemistry and mathematics; 
age 18-32. 
Length of course 
3 years 
3 years 
3 years 
m w Medicine 
Yes 
Yes 
Yes 
S * c Surgery 
Yes 
Yes 
Yes 
tJ o ® Obstetrics 
Yes 
Yes 
Yes 
5 ® $ Contagion 
Limited 
Affiliation 
No 
05 £ Neurology 
Yes V 
Yes 
No 
g, Psychiatry 
Yes 
Affiliation 
No 
“ « Pediatrics 
Affiliation 
Affiliation 
Affiliation 
c > -h Tuberculosis 
Limited 
Affiliation 
Affiliation 
H £ Public health 
Affiliation 8/ 
No 
Affiliation 
Outpatient 
Yes 
Yes 
No 
Accrediting 
2* »-i _ . . 
•d ' ® Total 
T B L 
T B L; Catholic Hospitals 
Schools of Nursing 
T B L (provisional) 
15 
11 
7 
o ® | Full-time £/ 
5 
7 
3 
• «o Part-time 
10 
4 
4 
Enrollment (November 19A?) 
134 
163 
77 
Graduates (1947) 
21 
5 
9 
Postgraduate courses offered 
0 
0 
0 
Scholarships offered 
61/ 
2 
1 1/ 
a/ Source, Mrs. Mildred McFerren, Director of Nursing, The Queen's Hospital, November 25, 1947 
|»/ Source, Mrs. Mildred M. Pinner, Director of Nursing, St. Francis Hospital School of Nursing, November 26, 1947 
gj Source, Miss Mary A. Hugo, Director of Nursing Service, Kuaklnl General Hospital School of Nursing, December 1, 1947; and "The Kuakini 
General Hospital School of Nursing Announcement" (1947 revision) 
d/ "Bulletin of Information, 1947-1948" (The Queen's School of Nursing) 
e/ "Biennial Report, 1945-1946" (St. Francis Hospital, 1947), page 1 
f/ Neurosurgery 
g/ Observation 
h/ Not entirely consistent with data in Appendix Table 11, collected at a somewhat earlier date 
Four annually for admission to the School of Nursing, one annually to outstanding graduate of the year, one annually for degree in 
nursing education (advance program to be taken at a mainland university) 
i/ For further study, travel expense aid 
TBL Territorial Board for Licensing 
Appendix Table 12 
SCHOOLS OF NURSING, TERRITORY OF HAWAII, 1947 a/ Statistical Abstract of the United States. 1946. p. 8, except as noted. 
t/ Facts"ALouL Nursing. 19a6 (Nursing Information Bureau of the A.N.A.), p. 32, and Facts About Nursing. 1947, 
p. 19. (Based on N.L.N.E, data for state-accredited schools; as of January 1st.) 
Facts About Nursing. 1946. p. 34 and Facts AboutKurslng. 1947. p. 20. (Based on N.L.N.E. data.) 
§J Local fFacts About Nursing. 1943 reports only two accredited schools for 1935, 1939 and 
1943, p. 25.) 
From the various school offices. 
sJ. U.S. Bureau of the Census, Population, Special Reports, Series P-47, No. 3, April 3, 1947. 
&/. Annual Report of the Board of Health. Territory of Hawaii. 1946. p. 35. 
h/. U.S. Bureau of the Census estimate reported by Time, December 8, 1947. 
Territorial Board of Health estimate quoted by Business Service (Chamber of Commerce of Honolulu), 
September 1947. 
1/ As of December 1, 1947. 
N.A. Not available. 
United States 
Territory of Hawaii 
Population 
Enroll- 
Gradu- j 
Population 
Schools y 
Enroll- 
Gradu- 
Year 
(millions) 
Schools y 
ment i/ 
ates y \ 
(thousands) & 
ment 
ates y 
1935 
127.3 
1,472 
67,533 
19,600 
389.6 
3 
N.A. 
20 
1939 
130.9 
1,323 
82,095 
22,^85 
415.7 
3 
N.A. 
18 
1943 
136.5 w 
1,297 
100,4B6 
26,816 | 
N.A. 
3 
N.A. 
44 
194-6 
141.2 y. 
1,271 
128,828 
36,195 
519.5 y. 
3 
N.A. 
60 
1947 
144.7 y 
1,253 
106,900 
N.A. 
525.5 y 
3 
374 y 
35 
Appendix Table 13 
NUMBER OF STUDENTS A!© SCHOOLS OF NURSING, 
UNITED STATES AND HAWAII, 1935-1947 Appendix Table 14, 
STUDENT AND SCHOOL OF NURSING RATIOS 
UNITED STATES AND HAWAII, 1935-1947 JL 
Population per 
Students per 
Graduates 
per 
School 
School 
Student 
Graduate 
School 
Graduate 
Year 
U.S. 
T.H. 
U.S. 
T.H. 
U.S. 
T.H. 
U.S. 
T.H. 
U.S. 
T.H. 
U.S. 
T.H. 
1935 
86,500 
130,000 
1,890 
N.A. 
6,490 
19,500 
46 
N.A. 
3.45 
N.A. 
13.3 
7 
1939 
98,600 
139,000 
1,590 
’ N.A. 
5,820 
23,100 
62 
N.A. 
3.65 
N.A. 
16.9 
6 
1943 
105,000 
N.A. 
1,360 
N.A. 
5,090 
N.A. 
77 
N.A. 
3.75 
N.A. 
20,7 
15 
1946 
111,000 
173,00011,100 
N.A. 
3,900 
8,700 
101 
N.A. 
3.56 
N.A. 
28.5 
20 
1947 
115,500 
— 
175,000 
1.350 
1,410 
. .. 
N.A, 
1 
15,000 
85 
125 
N.A. 
10,7 
N.A. 
12 
Calculated from Appendix Table 13. 
N.A, Not available. XV 
Appendix Table 15. 
REGISTERED OCCUPATIONAL THERAPISTS BY PLACE OF WORK, 
TERRITORY OF HAWAII, FEBRUARY 1946 AND DECEMBER 1947 
r 
December 
2, 1947 
No. O.T.'s 
Working status and 
place of work 
Average 
Census a/ 
. 
No. of 
0. T.'s b/ 
Patients 
per O.T. 
February 6, 
1946 o/ 
Total registered occupa- | 
tional therapists 
• • t 
22 
• • • 
19 
Employed 
• • • 
14 
• • • 
15 
The Queen's Hospital 
307 
3 d/ 
102 
4 
Leahi Hospital 
462 
5 
154 
2 
Territorial Hospital 
(Kaneohe) 
1,100 
£ 
550 
1 
St. Francis Hospital 
115 
115 
1 
Maluhia Nursing Home 
N.A. e/ 
N.A. e^ 
1 
Bureau of Maternal and 
Child Health, Board 
of Health 
. * • 
i 
. 
• • • 
1 
Kula Sanatorium 
(Maui) 
165 
1 
165 
1 
Army 
N.A, 
2 
N.A. 
Tripler Hospital 
383 
1 
383 
N.A. 
Schofield Barracks 
• • • 
1 
• • • 
N.A. 
Navy hospitals 
N.A. 
• • • 
... 
1 
Not working 
i 
8 
... 
4 
"Hospital Service in the United States," Journal of the American 
Medical Association, Vol, 133, No. 15, April 12, 1947, 
V Interview with Miss Esther Pyun, O.T.R., December 2, 1947. 
c/ From outline prepared by Mrs. Laura N. Dowsett, O.T.R. 
d/ Plus one student O.T. 
176 beds, hence no more than 176 patients per O.T 
N.A. Not available. Appendix Table 16. 
REGISTERED OCCUPATIONAL THERAPISTS 
IN 
NON-MILITARY INSTITUTIONS, HAWAII, BY COUNTIES 
DECEMBER 1947 
Area 
1 Registered 
occupational 
therapists ®/ 
! Patients 
[ in institu- 
tions b/ 
Patients per 
occupational 
therapist 
Territory of Hawaii 
12 
I 
4,24-7 2/ 
354 
City and County of Honolulu 
n 
2,003 0/ 
264 
Maui County d/ 
1 
708 
708 
Hawaii County 
0 
452 
• • • 
Kauai County 
* 
0 
. J 
184 
• • • 
«/ Includes only those employed in non-military institutions. From 
Appendix Table 15, 
Summation of average censuses of non-military hospitals, as listed in 
"Hospital Service in the United States," Journal of the American 
Medical Association, Vol, 133, No. 15, April 12, 194*7. 
s/ Excludes Waipahu Hospital (50 beds), for which data were not available 
Includes Kalaupapa Settlement. Appendix Table 17. 
OCCUPATIONAL THERAPISTS IN HOSPITALS, 
UNITED STATES AND HAWAII, £94f> 
Item 
' * • i 
United States 
Hawaii a/ 
Population 
139,893,406 b/ 
519,503 c/ 
Number of hospitals d/ 
6,280 
45 
Average census d/ 
1,239,454 
4,247 
Occupational therapists 
2,873 e/ 
9 f/ 
Population per occupational therapist 
48,692 
56,611 
Hospitals per occupational therapist g// 
2.2 
5.0 
Patients per occupational therapist g/ 
431 
472 
i - - 
a/ Civilian only. 
hy Excludes armed services overseas. From U.S. Bureau of the Census, 
Population, Special Reports, Series P-47, No. 3, April 3, 1947. 
s/ Annual Report of the Board of Health, Territory of Hawaii, 1946> p. 35, 
y Including hospitals without occupational therapists. Data from 
"Hospital Service in the United States," Journal of the American 
Medical Association, Vol. 133, No. 15, April 12, 1947, 
e/ 2,601 full-time, 272 part-time 
fj Ten in 1947 (l per 52,550 population). From Appendix Table 15. 
g/ Calculated from above data. Appendix Table 18, 
RECOMMENDED PERSONNEL IN OCCUPATIONAL THERAPY DEPARTMENTS 
TERRITORY OF HAWAII a/ 
i 
! 
Institution 
Island 
1 
1 Total persons 
Occupati 
Therap: 
.onal 
sts 
i 
CO 
•8 
Volunteers 
1 
Tea- 
chers 
Student nurses 
Recreational therapists 
L- 
Industrial therapists 
General 
Psychiatric 
-p 
£ 
0 i 
nj 
03 
Adult1s 
Children* s 
01 
•Sj 
t\ 
0 
C0| 
1 
o 
w 
For adults 
0 
u 
T3 
iH 
3 
O 
U 
o 
Cm 
1 
r 
T.B. Sanatoria b/ 
... 
12 
a i 
1 
2 
3 
2 
Board of Health c/ 
... 
3 
3<j/| 
1 
Queen*s Hospital 
Oahu 
8 
3 1 
2 1 
1 
i 
1 
St. Francis Hospital 
Oahu 
6 
3 i 
1 
3 
Maluhia Convalescent 
| 
Nursing Home 
Oahu 
5 
2 
3 
Territorial Mental 
1 
1 
i 
Hospital 
Oahu 
9 
6 
3 
Children's Hospital 
! 
1 
and Shriners' 
j 
Hospital 
Oahu 
3 
1 
1 
1 
Waimano Home for the 
Feebleminded 
Oahu 
4. 
1 
1 
2 
Blind Workshop 
Oahu 
4 
1 
1 
2 
Curative Workshop e/ 
Oahu 
5 
\2 
i 
i 
1 
2 
Totals 
• O • 
i 
59 
24 
1 
2 
2 
j— 
2 
1 
2 
14 
2 
i 
3 
2 
1 
2 
2 
Recommended by a group of occupational therapists who have been employed in 
the Islands (see text). 
Jb/ Leahi (Oahu), Kula Sanatorium (Maui), Puumaile (Hawaii) and Mahelona (Kauai), 
c/ Territorial Board of Health, Bureau of Crippled Children. 
i/ One for Oahu, one for Hawaii, and one for Maui and Kauai, 
e/ Proposed (not yet in operation). XIX 
Appendix Table 19. 
PHYSICAL THERAPISTS BY PLACE OF EMPLOYMENT 
TERRITORY OF HAWAII, JANUARY 1946 AND DECEMBER 1947 
1 i 
December 
5, 1947 _____ 
Patients 
January 
{Average 
Number b/ 
per 
U, 1946 
Place of employment 
Census a/ 
Therapist 
(Number) c/ 
Territorial Board of 
I 
Health 
... 
2 
• a • 
1 
Civilian hospitals 
i AAA 
Ai 
99 
3 
The Queen1 s 
307 
2 
15A 
N.A. 
St, Francis 
I 115 
77 
N.A. 
Shriners* 
22 
1 
22 
N.A. 
Other private institu- 
t 
i 
tions 
i 
i * • • 
2 
... 
2 
Medical Group 
! ... 
1 
• • • 
N.A. 
Clinic 
i 
1 
• • • 
N.A. 
Private nractice 
1 
1 
2 
• • t 
3 
Total employed (civilian) 
} 
... 
10£ 
• • • 
9 
Not oracticins 
! 
.1,. ... *. 
2 
• • • 
N.A. 
Total civilian 
. 
i 
j ... 
12i 
.. • 
N.A. 
Army and Navy 
i •...... . 
N.A. 
• • • 
N.A. 
Total civilian and 
! 
1 
military 
,i • • • - 
N.A. 
• • • 
N.A. 
a/ ’’Hospital Service in the United States,” Journal of the American 
Medical Association, Vol. 133, No. 15, April 12, 1947. 
b/ Source, Miis Ruth Aust, December 5, 1947 
sJ Source, outline prepared by Miss Ruth Aust, January 14, 1946. 
N.A. Not available. XX 
Appendix Table 20. 
APPROXIMATE NUMBER OF REGISTERED PHYSICAL THERAPISTS 
UNITED STATES AND TERRITORY OF HAWAII, 1946 
Item 
United 
States 
Territory of 
Hawaii 
Population 
Ul,228,693 a/ 
519,503 b/ 
Physical therapists 
3,BOO c/ 
9 d/ 
Population per physical therapist e/ 
— ii ... wmmmmmmmmlmmm mmmmmmm mm m mmmm ■■ 
37,000 
58,000 
a/ U.S. Bureau of the Census, Special Reports, Series P-47, No. 3, 
April 3, 1947. 
y Annual Report of the Board of Health. Territory of Hawaii. 1946, 
p. 35. 
c/ Estimated from 11 American Physiotherapy Association Directory of 
Members—194611 
d/ Civilian only. From Appendix Table 19. 
e/ Calculated’from above data. Appendix Table 21. 
PHYSICAL THERAPISTS IN HOSPITALS 
UNITED STATES AND TERRITORY OF HAWAII, 1946-1947 
Item 
United 
States 
Territory of 
Hawaii a/ 
Population, 1947 
144,708,000 b/ 
525,477 cJ 
Hospitals d/ 
6,280 
45 
Average census d/ 
1,239,4-54 
4,247 
Physical therapists in hospitals 
Full-time 
Part-time 
3,937 d/ 
3,391 d/ 
546 d/ 
5 e/ 
4 e/ 
1 e/ 
Population per hospital physical 
therapist f/ 
36,800 
105,100 
Hospital patients per physical 
therapist f/ 
315 
849 
Physical therapists per hospital f/ 
0.63 
0.11 
a/ Civilian only. 
b/ U.S. Bureau of the Census estimate reported in Time. December 8, 
1947. 
c/ Territorial Board of Health, Bureau of Vital Statistics estimate. 
d/ "Hospital Service in the United States," Journal of the American 
Medical Association. Vol. 133, No. 15, April 12, 1947. Includes 
hospitals lacking physical therapists. 
e/ December 5, 1947. I'rom Appendix Table 19 
tJ Calculated from above. INDEX 
A 
American Nurses* Association - 
see Nurses* Association 
American Occupational Therapy Association - 
see Occupational Therapy Association 
American Physiotherapy Association 37 
American Red Cross 45 
B 
Bedside care program (proposed) 6 
Biometrics - see Statistics 
Blind Workshop xviii 
Board of Health, T.H, (includ- 2, 3, 6, 7, 10, IX, 20, 
ing various bureaus) 21, 29, 41, 42, 46, 47, 48, 
51, 52, 53, 54, xv, xviii, 
xix 
Board of Hospitals and Settlements, T.H, 43, 51. 
Board for the Licensing of Nurses, T.H. 2, 9, 11, 12, 14, 15, 19 
Bureau of the Census, U. S, 42, 49, 51, 54, 55 
Bureau of Internal Revenue 51 
Bureau of Sight Conservation, T.H, 44 
Bureau of Vital Statistics, T. H. - 
see Board of Health, T. H, 
C 
Census - see Statistics; see Bureau 
of the Census 
Chamber of Commerce of Honolulu 45, 50 
Children*s Hospital 2, 18, xviii 
Chiropractors iv, v 
Civil Service 27, 32 
Clinic xix 
Community Nursing Council 2 
Convalescent Home 34 
Council of Social Agencies - see 
Honolulu Council of Social Agencies 
Court of Domestic Relations 44 
Curative Workshop xviii 
D 
Dentists, number employed i, ii, iii, iv, v, vii 
Department of Agriculture and Forestry, T.H.44 
Department of Commerce, U.S. 42 
Department of Health (C & C) 44, 51 D - continued 
Division of Health Statistics (proposed) - 
see Board of Health, T.H. 
Department of Institutions, T.H. 43, 51 
Department of the Interior, U.S. 49, 54 
Department of Labor, T.H. 41, 43, 51 
Department of Labor, U.S, 42 
Department of Public Instruction, T.H. 2, 21, 22, 41, 42, 51 
Department of Public Welfare, T, H. 43, 51 
Department of Social Welfare, T. H. 41 
E 
Economic aspects of nursing 4, 5, 6, 10, 16, 17 
Education - see Training 
Employment Service, U. S. 42, 51 
F 
Facilities for public health nurses 6 
Federal Security Agency, U. S, 42 
H 
Hawaii Housing Authority 41 
Hawaii Medical Service Association 5, 17, 46, 53 
Hawaii Sugar Planters1 Association 45 
Health statistics - see Statistics 
Historical background 
Nursing 1, 8 
Occupational Therapy 29 
Physiotherapy 36, 37 
Honolulu Council of Social Agencies 45 
Hospitals - see under Institutions 
Hours - see Economic aspects 
I 
Industry- 
Health data 46 
Nurses 5, 19, 20, vii, viii 
Physiotherapists 35, 39 
In-service training - see Training 
Institutions 
Hospitals vii, x, xi See each 
individual hospital 
Nurses in 5, 18, 19, vii, viii, xi 
Occupational therapists in 25, 30, 31, xvi, xvii 
Physiotherapists in 34, 38, xxi 
Insurance companies 46, 53 J 
Juvenile Court 44 
K 
Kapiolani Hospital 9, 18 
Kauikeolani Hospital - see Children's 
Hospital 
Kuakini General Hospital 9, 18 
School of Nursing 2, 9, 11, 12, xi, xii 
Kula Sanatorium 25, 31, xv, xviii 
L 
Labor unions 53 
League for Nursing Education 1, 4, 9 
Leahi Hospital 2, 3, S, 10, 11, 13, 25, 31, 
xv, xviii 
Legal aspects 4, 14, 15, 24, 29, 34, 41, 
See also Licensing 51 
Licensing 
Nurses 4, 11 
Territorial Board - see Board for 
the Licensing ... 
M 
Maluhia 25, 31, xv, xviii 
Medical Group xix 
Medical Social Service Association 45 
Medical Society 5 
Microfilming 53 
Midwives, number employed ii-v 
Military nursing 15 
Morbidity - see Statistics 
Mortality - see Statistics 
N 
Nurses’ Association 1, 4, 5, 9, 19 
Nurses8 number employed i-ix 
See also by specific type of nurse 
Nursing 1-7, 8-22 
See a.1 so by individual phase of nursing 
Nursing Service Bureau 1, 9, 16 
0 
Oahu Health Council 35, 3S 
Occupational therapy 24-27, 28-32, xv-xviii 
See also by individual phase of 
occupational therapy 0 - continued 
Occupational Therapy Association of Hawaii 26, 31, 32 
Office of Civilian Defense 54 
Offices, nurses in - see Physicians* 
offices, nurses in 
Optometrists v 
Osteopaths iii-v 
P 
Palama Settlement 45 
Personnel 
Nursing - see by type 
Occupational therapy 25, 30, 31 
Physiotherapy 34, 35, 38, 39 
Pharmacists v 
Physicians, number employed i-v, vii 
Physicians* offices, nurses in 5, 17, 18, vii, viii 
Physiotherapy 34, 35, 36-39, xix-xxi 
See also by individual phase of physiotherapy 
Plantations 52 
See also Hawaii Sugar Planters* 
Association; see Industry 
Police Department 44, 51 
Population 53-55 
See also Statistics; see Geographical 
Note at beginning of volume 
Practical nurses 1, 2, 4, 10, 11, 14, 
ii-vi, ix, xi 
Private duty nurses 4, 5, 15-17, vii-ix 
Professional organizations - see under 
each organization 
Public health nurses and nursing 3, 6, 13, 14, 20, 21, 22 
vii, viii 
Public Health Service, U.S. - see U.S.P.H.S, 
Q 
Queen*s Hospital 8, 18 
Occupational therapy 25, 26, 31, 32, xv, xviii 
Physical therapists xix 
School of Nursing 2, 9, 11, 12, xi, xii 
R 
Records - see Statistics 
Registration areas 51, 52 
S 
Saint Francis Hospital 9, 18 
Occupational therapy 25, 31, xv, xviii 
Physical therapists xix 
School of Nursing 9, 11, 12, xi, xii S - continued 
Salaries - see Economic aspects 
Schofield Barracks xv 
Scholarships - see Training 
School nurses 7, 21, 22, vii, viii 
Schools of nursing - see Training, Nurses 
Shriners* Hospital xviii, xix 
Statistics 41-50, 51-55 
See also by individual phase or type of statistics 
Student nurses - see Training, Nurses 
Surgeons, number employed i-v, vii 
T 
Tax office 44 
Territorial Hospital xv, xviii 
Tracts (census) - see Statistics 
Training 
Nurses 1-3, 4, 6, S, 10-14, xi-xiv 
Occupational therapy 24, 26, 27, 30, 31, 32 
Physiotherapy 34, 37, 38 
Tripler Hospital xv 
U 
U.S.P.H.S. 42, 51 
University of Hawaii 
Agricultural Experiment Station 44 
Central School of Nursing (proposed) 2, 11 
Credit courses 11, 30 
Graduate study in nursing 3, 10, 12, 13 
Medical school (proposed) 24, 34 
Psychological Clinic 44 
Representation on advisory committee 53 
V 
Veterinarians, number employed i-v 
Vital Statistics - see Statistics 
W 
Wages - see Economic aspects 
Waimano Homo xviii 
Working conditions - see Economic aspects PUBLICATIONS OF THE POSTWAR 
PLANNING COMMITTEES ON HEALTH 
Public Health Committee 
of the 
Chamber of Commerce of Honolulu 
Healthful Housing for the Territory of Hawaii February 1946 
Public Health Administration and Organization 
for the Territorial Board of Health, 
Territory of Hawaii May 1946 
Hawaii’s Sanitation Problems September 1946 
School Health Programs, Territory of Hawaii ......... December 1946 
Communicable Disease Control, Territory of Hawaii..* September 1947 
Planning for Health through Community Health 
Education, Social Hygiene, Mental Hygiene 
and Nutrition December 1947 
Maternal and Child Health January 1948 
Health Services and Statistics January 1948