The Daniel K. Inouye College of Pharmacy Scripts

“No element out of their past is more firmly rooted than the use of native herbs and allied therapeutic practices.”

“More than a hundred years of contact with European medicine have not made medical converts of the Hawaiian people.”

Handy, Pukui, Livermore Outline of Hawaiian Physical Therapeutics, 1943

Aspects of traditional Hawaiian medical practices have appeared in this journal throughout the decades with the December 1994 issue in this serial, then titled the Hawai‘i Medical Journal dedicated to Hawaiian Medicine and Health.^1–7 Building on these articles, this and the next Scripts column will focus on the historical record of Western pharmaceutical activities in Hawai‘i and Western legislative impact on Hawaiian traditional medicine.

Traditional Medicine

The first written account of traditional healing was presented by David Malo in “The Medical Treatment of the Sick” in Hawaiian Antiquities.⁸ It provides the holistic approach of mind and body: “The medical treatment of the sick was the matter that belonged to the worship of the gods….[the] kahuna lapaau, taking with him an offering for Mai-ola, the god of medicine.”⁹ Domains of traditional healing include lā‘au lapa‘au (healing medicines), kāhea (to call out), lomilomi (softening), ho‘oponopono (to make right), pule (prayer) and oli (chant). The art of compounding remedies was the specialty of kāhuna lapa‘au, a profession based on empirical practice. Lā‘au lapa‘au was just one of the medical specialties, the others being: Hāhā - ability to diagnose, Ha‘ihai‘i iwi - bones and bone setting, Pā‘ao‘oe - infants and young children, Ho‘ohāpai - conception, Ho‘ohānau - give birth, ‘Ō‘ō - to pierce, Po‘i ‘uhane - soul snatching : to restore life. In all of Polynesia, only in Hawai‘i were there such heiau ho‘ola (temple dedicated to healing or giving life) for: (1) training of haumāna (students) with a rigorous 20-year or so curriculum; (2) research, with development of simple surgery, fracture-setting, clyster enema, thermo-helio-therapy, and lā‘au (medicinal plants); (3) special practices, such as cultivation, gathering, and preparation of lā‘au (medicines).¹⁰

Epidemics & the Introduction of Western Medicine

The first Western prescription is dated July 12, 1825 by William Davis, surgeon aboard the frigate HMS Blonde for Kuhina Nui (Prime Minister) Ka‘ahumanu, who is often cited as the favorite wife of Kamehameha I. (The ship was retuning the bodies of King Kamehameha II and Queen Kamāmalu who while visiting England succumbed to the measles in 1824.)¹¹ It is postulated Ka‘ahumanu's acceptance to Western medicine resulted from observing Dr. Davis' aspiration of Kalanimoku's peritoneal cavity of accumulated fluid on May 23, 1825. Dr. Davis' prescription for Ka‘ahumanu was for a liquid preparation of infusion of gentian, fluid extract of eriodictyon, and simple syrup, three teaspoons taken twice a day. Davis also prescribed pills of hydrasis and colocynth and in his accompanying letter expressed a desire for a feather gift.¹²

The native population was severely impacted by the importation of bacterial and viral organisms in the 19th century, beginning with gonorrhea, syphilis, and tuberculosis. Later, pneumonia, influenza, measles, mumps, typhoid, and other infectious diarrheas, smallpox, leprosy, plague, diptheria, and the streptococcus's were introduced to the islands. Ships visiting Hawai‘i sailed from the East Coast ports, and reached the islands by a long voyage around South America. These ships often carried sick and dying passengers or crew who quickly spread disease upon arriving in the islands.

In 1804 an estimated 15,000 lives were claimed (out of a population of 800,000) due to an epidemic of ma‘i ‘ōku‘u, either cholera or typhoid.¹² Also, during the last four months of 1848 and the early part of 1849, an estimated 10,000 lives, more than one-tenth the population died as a result of measles, whooping cough, dysentery, and influenza. The epidemics toll was one of the most devastating in Island history.¹³ Introduced diseases decreased the native population to 135,000 in 1820 and 53,900 by 1876.^14–16

The ali‘i (rulers) took steps to curtail the introduction of these new diseases in 1836 by screening all visiting vessels for smallpox. King Kamehameha III signed a quarantine law in 1839 and established a Board of Health in 1851, preceding any in the United States.¹⁷ In 1859, King Kamehameha IV and Queen Emma raised $13,530 in private funds supplemented by $2,000 by the kingdom's legislature to establish Queen's Hospital now known at the Queen's Medical Center.¹⁸

The Congregationalist missionaries who played pivotal roles in Hawai‘i's economic and social fabric shared a concern for the dramatic decline of the Hawaiian population. In 1838, Dr. Gerritt Judd of the third company of missionaries from the American Board of Commissioners for Foreign Missions published Anatomia, one of the first medical texts written in the Hawaiian language for the students at Lahainaluna Seminary. In 1870, Dr. Judd headed a medical school established by the Department of Education and in 1872 graduated and licensed ten students. Unfortunately, the medical school dissolved shortly after his death in 1873.¹⁹

Introduction of Pharmacies

For about a century following Western contact, pharmacies did not exist separately from medical treatment, as it was a function of the physician. A contributing factor for the lack of drug store ownership is attributed to the lack of trained druggists in early years. International pharmaceutical manufacturers marketing policies influenced in sales Hawai‘i and the development of plantation medicine. Plantations offered universal health care for workers and families and dispensed drugs and medications from their own dispensaries and clinics. The first public pharmacy was established by Dr. Robert W. Wood in 1847 in Honolulu.²⁰ Drs. John Mott-Smith and William Hillebrand (who was named the Queen's Hospital's head physician in 1860) established Family Drug Store in 1853 which was later purchased by Hollister & Co. in 1869. As a member of Kamehameha V's Privy Council, Hillebrand was sent in 1865 by the Bureau of Immigration to China to arrange for laborers from that country to be sent to Hawai‘i to work in the plantations now dominating the economy.

There were few medical personnel among the arriving Asian immigrants. Dr. C.T. Akana arrived from China in 1873 and for 39 years practiced in Honolulu. In later years he specialized in diseases of males and used many herbs imported from China in his treatments. His notices in the Commercial Pacific Advertiser promised “cures where other doctors have failed.” In 1886 three physicians arrived from Japan to administer care to the Japanese immigrants hired to work on the plantations. Plantation doctors requested pharmaceutical components from the drug stores, often in bulk. Dispensing and often, compounding was left to para-professionals as relayed in this account: “Our medical keeping at Kohala was primitive but worked. We would write brief notes on a small sheet which also ordered medications from what we termed the “pharmacy window”—a square hole through a wall into the “drug room,” presided over by a bright young girl whose pharmacy training was from visiting drug salesmen, the Physicians' Desk Reference (it was thinner then), the Merck Manual, and what it said on the bottle.”²¹ The Territorial Association of Plantation Physicians in 1949 reported that most plantation hospitals met national standards and there was a better distribution of doctors and hospitals than any other rural state or territory.

During the 1909 legislative session Senator Charles F. Chillingworth proposed the “Qualifications of applicants, in order to be licensed as a pharmacist under this chapter an applicant shall not be less than 21 years of age and he shall present to the board satisfactory evidence that he is a graduate of a reputable school or college of pharmacy or that he had had four years of experience in pharmacy and shall also pass a satisfactory examination before the board.”²²

While still a territory, administration of laws regulating pharmacy activities was divided between the Department of Health and the Hawai‘i Board of Pharmacy. The Department of Health's Food and Drug Branch enforced the Revised Laws of Hawai‘i 1955 creating the Hawai‘i Board of Pharmacy (Chapter 71). Under the provisions of Chapter 71, the Board determined who would practice pharmacy in Hawai‘i and had wide latitude in defining what constitutes the practice of pharmacy.²³

In the summer of 1960, the Board of Pharmacy formulated for the first time regulations designed to implement the provisions of Chapter 71, Revised Laws of Hawai‘i 1955. Physicians, nurses, hospital administrators, and others who practice the medical arts raised questions. Disagreements existed concerning the dispensing of drugs in small hospitals, filling of oral prescriptions, dispensing of medicines by employees of physicians, and other similar matters. These concerns and related problems in the field of pharmacy prompted Legislative Report No. 4 The role of the State in the regulation of pharmacy. The report concluded with an analysis of pharmacy laws in Hawai‘i and an exploration of alternative approaches to regulation of drugs as a commodity and pharmacy as a profession.²³ The report proposed alternative means of regulating pharmacy activities in the State. At the time of the report there were 230 registered pharmacists in Hawai‘i.

In the next column Western legislative impacts on Native Hawaiian medicinal practice through Hawai‘i's five governments (Kingdom, Provisional, Republic, Territorial, Statehood) will be presented.