Issue 12.4: August/September 2009

The Queen's Gift

story by Catharine Lo

It was after dinner on an autumn night in 1849 when Abner Kealoha showed up at the Rooke House in Honolulu. His son had a high fever, and Abner had come to seek help from Dr. Rooke, who was known to receive patients who couldn’t afford to pay. The doctor had already gone to bed, but his 14-year-old daughter Emma, who had made a careful study of her father’s practice, offered her assistance. Abner agreed, and Emma prepared a mix of curative powders. The child’s fever broke—and for the first time Emma experienced the profound gratification that comes with helping the sick.

In the 1840s in Hawai‘i, most of those sick were Native Hawaiians who had no immunity to newly introduced foreign diseases. During a mid-19th-century visit to the Islands, American William Bliss observed, “The dismal coughs which I hear on every side lead me to conclude that the whole nation is affected with consumption.” His words were no exaggeration. When Captain Cook arrived in 1778, the Hawaiian population was estimated to be anywhere from 350,000 to one million. By 1848 it numbered just 90,000; and in that year epidemics of dysentery, measles, whooping cough and influenza broke out. According to one source, of the 1,500 children born that year, not one lived past age 2. By the end of 1849, the epidemics had killed another 10,000 people, and in 1853 an epidemic of smallpox killed 6,000 more. The dead numbered so many that, under threat of fine or imprisonment, able-bodied men were recruited to help bury them. Day and night, residents of Honolulu heard the creaking of the wagons that collected the corpses.

Young Emma witnessed suffering all around her. In her own life, death had already taken her schoolmate, her grand-mother and her uncle. The urgency her father had impressed on her was, she knew, glaringly real: Something had to be done before the entire Hawaiian race was lost.



When she turned 19, Emma found herself in a unique position to respond to the need. She accepted a marriage proposal from Alexander Liholiho ‘Iolani, the newly ascended King Kamehameha IV—a proposal that would make her Hawai‘i’s queen. Alex and Emma were friends from childhood who had both attended the Chiefs’ Children’s School, where young ali‘i were taught. Emma’s own royal blood came from her maternal grandmother, Kuamo‘o Ka‘oana‘eha, Kamehameha I’s niece. Her maternal grandfather was John Young, Kamehameha I’s intimate advisor.

On May 18, 1856, Emma, escorted by her hanai (adoptive) father, Dr. Rooke, walked down the aisle at Kawaiaha‘o Church wearing an elaborately embroidered white silk dress. The 22-year-old king stood at the altar in a blue Windsor coat, beaming behind his trimmed beard. Surrounded by a crowd of 3,500, Alexander and Emma took their vows. Theirs was a bond decreed by pedigree, bound by love and united in purpose.

The principal mission of the young monarchs was to “stay the wasting hand that is destroying our people,” Liholiho told the Legislature. For the next few years, he and Emma focused their attention on establishing a hospital to treat Hawaiians. To secure the funding, the royal couple set out on foot and solicited donations door to door. They asked those who were unable to pledge cash to contribute fishnets, necklaces and spears that could be sold.

“I wonder how many know how hard King Kamehameha IV, and his Good Queen Emma, worked,” wrote then Honolulu resident Mary Montano. “I remember full well the day she came to our home. She had written a list of articles for each to give, and gave us full instructions on how to make them. … Many families were surprised when Her Majesty, not finding anyone at the front door, would wander around the back way.”

Including the $500 they each personally committed, Alex and Emma raised an astonishing $13,530 for the hospital. The Legislature assigned an additional $6,000, and a corporation to manage the hospital was officially established. Immediately, a board of trustees was assembled and the charter and bylaws written. On May 24, 1859, almost exactly three years after the couple’s wedding, the institution was named Queen’s Hospital in recognition of Emma’s devotion to the cause. Hawaiians called it Hale Ma‘i o ka Wahine Ali‘i, “Sick House of the Lady Queen.”

As the search for a location began, a temporary dispensary with eighteen beds opened in August 1859 on King Street. The next task was encouraging the populace to use it. Western diseases had been a disaster for the Hawaiians, and they were understandably wary of putting their faith in—and handing their bodies over to—Western medicine. There was also the fact that, as one Hawaiian newspaper observed, Hawaiians had a fundamentally different way of thinking about health: They saw illness as a function of imbalance in a person’s mana, and they were “taught how to take care of the spirit.” By the time Cook arrived, the Hawaiians had developed a sophisticated system of medicine replete with la‘au lapa‘au (healing with plants) and bodywork such as lomilomi. But the diseases that came from beyond Island shores were too foreign and too vicious to be contained by native healing.

Emma’s father, Dr. Rooke, was British, and her mother, Grace, was Hawaiian—and so she understood both worlds. To allay the concerns of her people, the queen formed a hui of women who visited native households and distributed information about new diseases, ways to avoid them and the benefits of the hospital.

In December 1860, five months after the cornerstone was laid, the doors of the newly constructed Queen’s Hospital opened. The hospital sat at the foot of Punchbowl on a 9-acre property known as Manamana, or “branching out.” It had been purchased from Chief Kapa‘akea for $2,000; it was, notably, the birthplace of his children, future monarchs David Kalakaua and Lili‘uokalani.

The two-storey coral building, designed by architect Theodore Heuck (who later designed the Royal Mausoleum and ‘Iolani Barracks), cost $14,729. It housed a reception area, a physician’s room, a dispensary, storerooms, a dining room and three ventilated wards with 124 beds. Honolulu had few large buildings in 1860—even ‘Iolani Palace had not been built yet—and Queen’s became one of the city’s most prominent landmarks, along with Kawaiaha‘o Church, Washington Place and the old royal palace. Dr. William Hillebrand was hired to be Queen’s first—and only—physician, and he cared for all who came for treatment. Hillebrand was also an exceptional botanist, and he planted a stunning collection of trees from around the world on the hospital grounds, including a baobab tree from Africa that is today the largest baobab in the United States.

In addition to Hillebrand, a purveyor was hired to serve as a medical jack-of-all-trades: superintendent, druggist, head nurse, bookkeeper, anesthetist and surgical assistant. The first trained nurses did not arrive until 1892, but there were kokua, or watchers—usually family members of the sick—who stayed overnight and assisted with cooking, cleaning and laundry. I.P. Rodrigues was a tailor who worked in the hospital from 1879 to 1882. “Some of my work was to get the patients drunk,” he recalled, “so they would not feel the pain so much, as we lacked anesthetics in those days.”

Queen’s was designed to treat all in need, regardless of their ability to pay. As the hospital’s trustees emphasized, medical care was to be made available to “all indigent, sick and disabled Hawaiian subjects, native and naturalized.” The hospital was kept afloat by money that came from the kingdom, private donors and those patients who did pay. The going rates at the hospital? A major operation was $25, a minor operation $10, and a patient could have a private room for $2.50 a day.

In its first twenty-two months of operation, Queen’s Hospital treated 3,055 patients, for everything from whooping cough to cancer. A total of 2,966 patients were cured; only forty-nine died. In addition, 8,774 free prescriptions were dispensed. These were significant numbers given that the entire population of Honolulu at the time was about 14,000. The queen and her hui had done an excellent job of assuaging native apprehension about the hospital. In 1861 the local newspaper The Polynesian declared, “Now the applicants throng to be received, and they gladly come from the remotest corners of the Kingdom to partake of the healing influences of this institution: and the consequence is public confidence and renewed hope in the preservation of their race. The Hospital has now proved itself capable of standing between the living and the dead, and of rolling the tide of extinction backward, 
a pride and a glory to its originators, a blessing to humanity.”

Though Emma’s humanitarian efforts relieved the suffering of thousands, she herself soon experienced tremendous grief. Three years after Queen’s Hospital opened, her son, Albert, died of brain fever at age 4. Then, fifteen months later, her beloved husband died of chronic asthma. Emma was inconsolable. For almost two weeks she did not leave the Royal Mausoleum, sleeping in the vault next to her husband and son each night.

Her deliverance came from continuing the work that she and Alexander had begun on key institutions in Honolulu, including St. Andrew’s Cathedral, the first Episcopal church in Hawai‘i; St. Andrew’s Priory, Hawai‘i’s first all-girls school; and ‘Iolani School, the prestigious institution named for the king. Emma’s instinct to nurture stayed constant all her life; when she died of a stroke at the age of 49, she had more than 100 goddaughters.


This year marks the 150th anniversary of Queen’s Hospital, now the Queen’s Medical Center and Hawai‘i’s largest hospital with 528 beds, 3,000 employees and 1,200 physicians on staff. A century ago, in 1909, twenty-four years after Emma’s death, the hospital was privatized, and today it caters largely to patients based on their ability to pay. In today’s world of insurance companies and HMOs, health care has changed dramatically. So, too, has Hawai‘i’s political landscape. But none of that change makes the sentiments that drove Emma any less real or any less noble. As her husband so eloquently put it when he laid the cornerstone of the hospital in 1860, “There is something wholesome in being called from time to time to acknowledge however strong our own health may be, and however prosperous our fortunes, that, after all, the destitute and sick are our brothers and sisters.” HH