Rather than wait several weeks for the results, the new government decided to act on the assumption that their own physicians' diagnosis was correct. Evoking emergency powers, the Board of Health sealed off the affected districts in an effort to contain the outbreak. Business was suspended within the sealed districts; schools were closed; and all public meetings, even church services, were banned. Board members also enlisted other physicians and civilian volunteers to inspect each person in the quarantined districts twice a day. Though the United Chinese Society provided traditional healers from their own community to help perform those inspections, Chinese residents deeply resented the arbitrary invasion of their personal privacy by people they did not know and in many cases with whom they could not even communicate. To make matters worse, any residents who seemed to be coming down with anything were forcibly removed from their homes and taken to a special hospital for observation and treatment by government-appointed physicians, who practiced a form of medicine most Chinese considered alien and dangerous.'
In all of these actions, the American doctors had the complete support of the newly installed annexationist government. Recently inaugurated president Sanford Dole candidly observed in a letter to a friend at the end of July 1895, "cholera has been engrossing our attention for [the] past few weeks. The Board of Health is the government now ... and hundreds of volunteers," he proudly reported, "are carrying out a rigid work of inspecting every house in Honolulu twice a day."7
Inside the quarantined districts, the government also implemented a vigorous cleanup campaign, since the Board's physicians believed that cholera could spread through contaminated food, bad water, and the emanations associated with rotting organic materials. Though most of the deaths were occurring among Hawaiians in the Iwilei district, most of the cleanup efforts took place in the thirty blocks that comprised Chinatown, which everyone agreed had dreadful sanitary conditions and which, according to the medical assumptions of the day, would be an area of potential disaster if cholera should begin to spread.
Working with the Board of Health and with citizen volunteers, the residents of Chinatown had hauled tons of human waste, animal remains, and general garbage out to sea. They scoured privies and applied disinfectants. The Board of Health drafted new requirements for food handling and for the storage of perishable goods in marketplaces. Relief committees provided meals for penniless workers unable to get out to their jobs, and the United Chinese Society issued promissory certificates, redeemable for medicinals at Chinese drugstores and herbal shops, to residents of Chinatown unable to afford suggested remedies.
Eighty-five people died before the cholera outbreak abruptly ended. But the Board's prompt and decisive actions, especially after laboratory results in the United States confirmed the presence of cholera, were hailed around the world as a public health triumph, a bold stroke that probably saved the city from far more devastating losses of life. The sealing-off of Chinatown and the subsequent cleanup campaign in that district seemed particularly successful. Yet various groups within Honolulu itself had come away from the cholera crisis with remarkably different impressions of what had taken place and hence what they should learn from the experience.'
Shortly after it ended, President Dole summarized the 1895 cholera crisis in positive terms: "The experience which the cholera brought was a beneficial one in more ways than one," he concluded. "[I]t brought out conspicuously the fine public spirit that is the chief strength of the Re public; it also swamped in some measure the political divisions of the community, and brought many royalists into relations with the government and its supporters in a way which has done them a great deal of good and which may be said to have given them a new horizon." As he so often did, Dole saw "divine sympathy and powerful aid" at work in the health crisis. Successful suppression of a potential cholera epidemic demonstrated to him that he and his recently inaugurated regime were indeed "working to accomplish God's purpose in this country." As long as they sustained what Dole called "a reasonable degree of correctness in [their] conclusions," the new pro-American rulers of Hawaii self-confidently and self-righteously believed they would continue to enjoy the support of the Lord.'
In sharp contrast to Dole's impression of widespread cooperation and good will, many Chinese in Honolulu had emerged from the cholera episode convinced that white physicians could not be trusted. Though the Board of Health strongly denied any discrimination, several Chinese patients complained repeatedly about the anti-Asian attitude of Western physicians at Honolulu's temporary cholera hospital. Leaders in the Chinese community believed their countrymen's complaints and concluded that they would have to establish their own hospital to insure better care for their community in the future. Chinatown's largest sociopolitical organizations, the United Chinese Society and the China Engine Company, endorsed a formal petition to the legislature requesting a grant of land for that purpose. No doubt influenced by the fact that the hospital committee was headed by Gu Kim Fui, the legislature ceded the petitioners a parcel in the Palama district just west of Chinatown. In addition to serving as president of the United Chinese Society, Gu Kim Fui was one of the most powerful business leaders in Honolulu. Partly as a consequence of being the city's most prominent Chinese Christian, he also had personal ties to many officials in the Dole administration. Both Chinese and whites contributed to the hospital fund, and by March 1897 the new Chinese hospital at Palama, known as Wai Wah Yee Yuen, opened for patients."'
In addition to medical discrimination, the residents of Chinatown also remembered that the policies credited with defeating cholera had left their community financially crippled. A whole season of business had been lost while the district was sealed off from the rest of the city. Overall community income fell drastically when workers could not get out to their jobs. During the cholera crisis, the residents of Chinatown had seen how easily civilian government could be suspended in the face of a medical emergency, how invasive the Board of Health could be when acting unchecked, how quickly people under quarantine could become completely dependent upon the larger community for basic needs, and how shoddily Asians could be treated by white medical volunteers. Consequently, in the opinion of most Chinatown residents and most traditional Chinese healers during the final months of 1899, maintaining extreme discretion with regard to the new disease among them-and even surreptitiously burying the dead-seemed preferable to raising alarms. They did not want a possibly unfounded threat of plague in 1899 to trigger another round of intervention in their lives similar to what they had experienced in 1895•
Also living and practicing inside Chinatown, however, were Chinese physicians who took a strikingly different approach from that of the traditional healers and most of the other residents. At the head of the dissenting faction were Dr. Li Khai Fai and Dr. [Li] Kong Tai Heong, who were married but maintained separate practices. Li Khai Fai had been born into a prominent and scholarly family in a region of south China wracked by political, social, and economic disruption. Most people in the region blamed outside Europeans for their misery, and Li's father had led mobs that stoned European missionaries to death. When Lutherans from Germany subsequently converted the elder Li to Christianity, however, he became a target of the same mobs. At the age of nine, Li Khai Fai had watched in horror as his father, now "a running dog of the white devils," was stoned to death in the street. Li's mother fled with her four children to the relative safety of nearby Hong Kong."
Like her martyred husband, Li's mother believed that Western medicine went hand in hand with Western Christianity as a progressive reform badly needed in China. Consequently, in order to carry forward his legacy, Li's mother enrolled in the Canton Medical School-besides, as she forthrightly acknowledged, she was a widow with four children to feed. Though directed by an American doctor from Ohio, the school had long-standing ties with the Berlin Missionary Society under whose auspices the elder Li had become a Lutheran. As soon as he was old enough, Li Khai Fai followed his mother to the Canton Medical School. He too
was determined to sustain his father's legacy of Western-style reform, but he expanded his vision of progress beyond religion and medicine to embrace Westernstyle political structures as well. At the age of sixteen, he became the radical student leader of a political organization called the Make China Strong Society, which advocated an end to the arbitrary authority of the corrupt and dysfunctional Qing dynasty. Li then left that organization to join a political reform group organized by one of his fellow medical students, Sun Tai Cheong, who had recently returned from Hawaii and who would later be known to the world as Dr. Sun Yat-Sen.'Z
Dr. Kong Tai Heong, left, and Dr. Li Khai Fai. Mamiya Medical Heritage Center. Hawaii Medical Library
While studying at Canton Medical School, the tall and fiery Li met and fell in love with his classmate Kong Tai Heong. Her diminutive size belied the resilience of this forceful and independent-minded young woman, whose route to medical school had been every bit as dramatic as Li's own. Kong had been abandoned as an infant on the doorstep of a Lutheran mission in Hong Kong, with nothing more than her name pinned to the basket in which she was found. Smart and able, she grew up helping the German nuns care for other girls in the orphanage where she lived. The sisters, in turn, arranged for Kong to apply to Canton Medical School, where several of their co-religionists had studied Western medicine. Favorably impressed with this former "basket baby," the faculty admitted her. She immediately excelled and was soon regarded by her professors as the most brilliant medical student in her class.
As students, Li and Kong worked together to master Western medicine with the full commitment of true converts, eagerly embracing the new bacteriological understanding of disease. The most intense period of their training occurred when the plague struck Canton and Hong Kong in 1893 and 1894. Li and Kong often worked around the clock beside their professors, trying to save victims brought into the school's clinic. Despite their best efforts, most of their patients died horrible deaths before their eyes-and their professors assigned them the grim task of disposing of the dead.13
As their graduation approached in June 1896, the two hoped to marry. But their union was initially opposed both by Li's relatives, who did not want his mother's oldest son to marry a woman without a family, and by Kong's professors, who did not want their protegee to run off with a political hothead. The two overcame the objections-Li by arranging to lose the bride his family had selected for him in a card game, and Kong by defying the faculty. But the objections had strengthened the couple's desire to escape to someplace where young professionals could be out from under what they considered the stifling oppression of late-nineteenth-century China, yet still be able to make a difference in the future of Chinese people. They hoped to find such a place in Hawaii, where their friend Sun had gone to school, even though the new government there had recently forbidden incoming Chinese to remain in the islands more than one year.
Li and Kong graduated from Canton Medical School on the morning of June 3, 1896, and were married in a Lutheran chapel that same afternoon. The following day they boarded the Garrick, a steamer carrying Chinese merchandise and Asian foodstuffs to Hawaii. Delayed more than a week by unusually heavy storms at sea, the Garrick arrived exactly one month later. As they entered Honolulu harbor, Li and Kong heard the sound of artillery fire coming from the center of the city, saw palls of smoke drifting toward them, and wondered fearfully what was going on. Downtown beside the Iolani Palace, the pro-American government was firing ceremonial salutes that day, July 4, to recognize the second anniversary of the Republic of Hawaii.
Li worked the rest of the summer as a common laborer, and the two young physicians lived in abject poverty. With the legal status of temporary aliens, Li and Kong could not practice medicine. At one point, these two would-be reshapers of Chinese culture had to pawn their wedding clothes to buy food. Through a mutual acquaintance, Li and Kong met the Reverend Frank Damon, who had served many years as a missionary in Canton. Kong boldly explained both her plight and her hopes to Damon, who arranged a formal audience for Li with President Dole himself. Li so impressed Dole that the president permitted the two young medical graduates to become permanent residents of the new republic and to open practices. By the end of October, they had obtained formal licenses and set up offices in Chinatown, where they began to build practices that served both Chinese and Hawaiian patients.14
Between 1896 and 1899, Li and Kong clashed often with Honolulu's traditional Chinese healers. Li in particular made no effort to hide his contempt for the traditional healers, whom he criticized as the unthinking defenders of a backward way of life. The traditionalists, in turn, portrayed their new rivals as traitorous agents of the hostile white devils, dangerous upstarts bent upon displacing centuries of Chinese medical knowledge. That accusation had some merit because Li, Kong, and a few others like them in the Chinese community had more in common professionally with the American physicians on the Honolulu Board of Health than they did with the city's traditional Chinese healers.
Li Khai Fai, in fact, thought that the Chinese in Hawaii should be trying to cooperate not just medically but in all ways with representatives of the United States. Notwithstanding that nation's record of anti-Asian behavior, he believed, American constitutional principles would ultimately protect the Chinese of Hawaii and put them in a position to help their countrymen back home move away from absolutism and superstition toward democratic liberation and scientific reason. For him, cooperation with the American physicians on the Board of Health would be a step forward rather than a concession to oppressors. And possibly because they had not been in Honolulu during the cholera scare, the two Chinese medical graduates had no preexisting skepticism toward their American medical colleagues."
Consequently, when the mysterious plague-like deaths began occurring in Chinatown during the final months of 1899, Li urged residents to report any suspicious cases to the Board of Health rather than explain them away or hide them from public view. In his opinion, bacteriological investigation was the only way to know for sure whether or not the new disease was plague; and if it was, the community had an obligation to mobilize against it. Li and Kong, after all, had already witnessed what this epidemic could do to a city once it gained a secure foothold. They fervently hoped the Chinese residents of Honolulu would do all they could to prevent the plague from devastating their new home as terribly as it had devastated Canton and Hong Kong during their student days.
A series of events beginning on the night of December ii abruptly ended the internal debates within Chinatown. That evening a manager at the Wing Wo Tai Company, Lau Chung's impressive manufacturing and retail operation in Nuuanu Street, sent one of his employees to find Dr. George Herbert, an English physician who had established a close rapport with the Hawaiians of Maui before coming over to Honolulu as director of the Oahu Insane Asylum. The manager wanted Herbert to examine one of his bookkeepers, twenty-two-year-old You Chong, whose grave symptoms looked to the unhappy merchant suspiciously like the symptoms of the dreaded black death that was rumored to be circulating through the district. Traditional Chinese medications had failed to retard You Chong's decline, and by the time Herbert arrived, the bookkeeper had slipped into a coma. You Chong died at 5:0o A.M. on December 12, 1899. Herbert was convinced, as You's employer had feared, that the patient died of plague."
Before conducting a postmortem, Herbert sent for Dr. Walter Hoffman, a twenty-seven-year-old German physician who had become the city's first official bacteriologist just four months earlier. When word of the autopsy underway at Wing Wo Tai's store spread among Honolulu's physicians, Dr. Duncan Carmichael also joined Herbert and Hoffman. Carmichael represented the United States Marine Hospital Service in Hawaii. If the rumors of plague were true, he would have to report the outbreak to Washington as quickly as possible. Sun Chin, the doctor who had cared for the dead bookkeeper before Herbert's arrival, also witnessed the post mortem, as did Day, who came over to officially represent the Board of Health.
Under the ligh
t of kerosene lanterns, the five doctors opened You's corpse and examined his internal organs. Everything they found was consistent with what they knew about bubonic plague. Hoffman prepared slides from the dead man's lymph glands in order to look for the tell-tale pestis bacteria, but even before he could put them under his microscope, all the physicians present that morning were reasonably certain on the basis of what they observed during the autopsy that You Chong had died of plague.
From Li Khai Fai, the American physicians departing the Wing Wo Tai building learned that another Chinese bookkeeper had died overnight. Employed at the store of Tam Ping Sam Kee just around the corner in Maunakea Street, forty-year-old Yuk Hoy had been under the care of Tong San Kai, another Western-trained Chinese physician, who now joined Hoffman and the other American doctors at a second impromptu autopsy. They quickly saw that Yuk Hoy too had suffered from badly swollen glands and internal hemorrhaging, the classic symptoms of bubonic plague. Hoffman took tissue samples from Yuk Hoy's remains for bacteriological confirmation, but Yuk's case removed any lingering doubts in the minds of the physicians present: the world epidemic had arrived in Honolulu. And the plague was already spreading. By the end of the day, it would strike down two more Chinese workers and a twenty-seven-year-old man from the Gilbert Islands, all of whom lived in the same neighborhood as the dead bookkeepers."
At noon, the Board of Health convened in emergency session to hear testimony from any doctors who had attended recent fatalities, including Li Khai Fai and other Chinese physicians familiar with Western medicine. With the help of his wife and a Chinese-English medical dictionary, Li prepared a formal report on one of the cases the American doctors had not yet seen. Li's report was a classic description of plague: he found the victim with a high fever, "tossing and trembling like the sea in a typhoon, quaking and quivering, bending and unbending in delirium, like the branches of a tree in thunder and lightning gone crazy." Like the hundreds of plague victims Li and Kong had seen in Canton, the dead man had "the same black spots.... the same bleeding through the mouth, the same swellings in the armpits, the groin, ... the same coma at the endand then only death." Wood quizzed Li at length about the Honolulu cases, and all three physicians on the Board pressed him for details about the epidemic he had seen firsthand in China. Most of the other physicians summoned for opinions-both Chinese and white-confirmed Li's opinion that Honolulu had bubonic plague on its hands."
Plague and Fire Page 5