Health personnel in Hawaii, 1820-1974. (1975)

One of the most striking aspects of Hawaiian medical history is the high rate of growth in the Islands’ professional health personnel. It was not until 1820, forty-two years after initial contact, that Hawaii had its first Western trained resident physician. Seventy-seven years later, on the eve of annexation, licensed physicians numbered 76. And after another seventy-seven years, in 1974, the total had increased to 1,309. This growth far exceeded the rate of increase in population. The total number of professional and technical health personnel in the Islands has increased even more dramatically. The 1960 U.S. Census reported 4,122 civilians in Hawaii employed as physicians, dentists, optometrists, registered nurses, therapists, health technologists or technicians, or in similar work. By 1970 the total had increased to 5,800. While total population was growing 21.7 percent over this ten-year period, the number of health professionBls increased by 40.7 percent. Statistics on health personnel prior to 1884 are extremely rare and must for the most part be inferred from scattered historical accounts. Dr. Thomas Holman, Hawaii’s earliest resident Western trained physician, arrived with the first band of American missionaries on April 4, 1820, and served in the Islands until October 2, 1821. Until that time, Hawaiians had had to depend on the kahuna lafla’au (traditional native practitioners) and occasional visits by ships’ surgeons. The number of resident physicians apparently increased to two by 1830 and to six by 184O.l By 1853, the year of the smallpox epidemic, perhaps 17 American or European physicians were practicing in the Kingdom.l The first professional dentists soon followed, beginning with Dr. John Mott-Smith in 18512 and Dr. John M. Whitney in 1869.5 The introduction of licensing requirements initially had scant effect on the compilation of medical manpower statistics. Licensing was instituted for foreign physicians in 18595 and for all physicians in 1865,6 but it was not until 1897 that the first published figures on licensed physicians and surgeons-76, including one Chinese and several Japanese-appeared.’ Licensing was required for dentists under legislation enacted in 1892,8 for pharmacists in 1903: and for nurses in 1917.1° Except for one early total on licensed dentists (27 in 1904+), however, statistics on the numbers of licensed health professionals were published infrequently if at all during the early decades of the twentieth century. Census statistics on medical and health personnel were first compiled in 1884. The Hawaiian census of that year reported 29 physicians and surgeons, four dentists, nine nurses, two veterinary surgeons, and 23 druggists at work in the Kingdom. These data were further cross-tabulated by race; the physicians, for example, included no Hawaiians, no Chinese, and 29 “others.“” --Census coverage of health manpower expanded considerably during the twentieth century. The number of professional and technical health occupations for which separate totals were published was four in 1900 and 1910, five in 1920, nine in 1930, eight in 1940, twelve in 1950, and 16 in 1960 and 1970. This increase in statistical detail coincided with a rapid growth in the number of health personnel. Physicians, for example, rose from 109 in 1900 to 341 in 1940 and 961 in 1970; dentists, from 21 to 401 during the seven-decade period; and