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THE GARDEN" ISLAND TUESDAY, MAY li. 191S OR CLAIR'S REPORT ON HOSPITAL SITE f Following is the report in full of Dt. A. N. Sir.cl.ir on his in vestigations of sites for the pro posed tuberculosis hospital on Ka- 'uai, giving his reasons for select ing the site near Kspaa: Honolulu, Hawaii, mind it will only be necessary to apply them to the particular sites recommended to me by individual persons on Kauai as well as a few investigated due to-mv own oh servations. Beginning at the nearest point March 8, 1915. to the end of the road on the south- ly hot and uncomfortable site at sidered. and when the lease expires (June, best, the face of the elevation at The lot is almost at sea level and 1916) or when the crop is taken the shore showing the sub-strata there would be considerable cost 0K" a portion of or all the remain to be solid rock with a thin cover- I to put in a sewer system to theder would make a valuable adjunct ing of arid sandv soil, a condition ! Sea that would get enojugh fall tojto the present available land for conducive not only to reflecting j be safe. The water supply to this farm purposes, heat to an uncomfortable degreeot, is limited and well borings on In recommending this site it is Dr. J. S. B. Pratt, President, Board gf Health, Territory of Hawaii. Sir: I have the honor to report here- jerlv side of the island a site was j suggested there, not directly to me but to others by Mr. Cook. This j is on the flat lands on the beach near Kekaha, but as the soil is ex- with on the various sites on Kan- tremelv sandy and for miles there ai, proposed for a" tuberculosis sanatorium and visited by me, at you" direction for the purpose of selecting one most suitable for the needs of such an institution. In considering a site for a tuber culosis sanatorium anywhere the great factors to be considered are 1. Climate, 2, Accessibility, 3, Water Supply, 4, Drainage, for a sewer system particularly, 5, Econ omy of Maintenance. 1. The Climate should be dry, jyet cool, for too great heat is ener- vating to the well, let alone the sick. Elevation is not such a re quisite as was formerly demanded as long as the air is not too loaded with dust. Moist air carries dust titnea fan -l 1 1 tits -I - nir a n sma depressing but the limit of objec ' tionable humidity is a wide one, provided it is dust free and mov ing, 2. Accessibility is required for the easy access of not only patients but of their friends. A sanato rium will not accomplish much if through any factor patients are deterred from taking advantage ot it. The sending of patients to an isolated locality, approaching seg gregation, will meet with general objection on the part of the pa tients, while a difficult location for visits of friends will meet with ob ieciions from both 'patients and friends. 3. Water-supply is important tor ia sanatorium anywhere and particularly on Kauai, as will be noted later. 4. Drainage or facilities for a proper sewer system is important in an institution that expects to house twenty o r thirty people, more particularly if it intends to engage i n dairy and vegetable farming. 5. Economy of maintenance is in terdependent with accessibility not only for transportation of supplies and patients but for supervision: a sanatorium far removed from the control of local physicians will en tail a special medical attendant at a cost of at least twice the salary that such could be obtained if some local physician could supervise the sanatorium in addition to his regular work. These ate general considerations that apply anywhere, but otKKauai there are some local factors that must be considered. The most important local condi . tion to be met is that oL a milk and egg supply, of prime import mice in a tuberculosis sanatorium The facilities on Kauai are such that apart from economical consid erations a sanatorium there will have to support its own diary, pro vide its own eggs as well as grow its own vegetables. It must there fore be situated on good soil and this is the icason referred to above as demanding an adequate water supply. The fact that on Kauai the ma cadam road i s almost entirely "belt-road" makes the choice of a site preferably near this "belt road" for reasons of accessibility already referred to; besides, such a sanatorium should b e placed as centrally as possible so that there will not be too great a distance from the extreme ends of the belt road. The fact that this belt-road does not extend clean around the island but ends at two points about twenty-five miles apart, makes the location about midway from the ends of the road a necessity that would not have to be considered did the road completely encircle the island. is a thick growth of trees on the windward side, the heat lack of water supply caused little in vestigation on mv pajt as Ideal ized such a site was entirely un suitable. At Waimea two sites were sug gested to me by Dr. Lyman and a third by Mr. Faye. Of the two suggested by Dr. Lyman the first consisted of 240 acres almost adjoining Dr. Lyman's j residence. This was thought to be government land of which the ease expired this year. Investigation, however, proved that this land was privately owned (by Mr. Fave and is the great er portion of Waimea Plantation. The acquiring of this land is out of the question. The other site recommended by Dr. Lyman (Pookii) is behind Waimea at an elevation of 1250 feet. It is government land but leased to Mr. Faye (lease expiring in 1921) and an old leasr not con taining the clause allowing it to be taken by the Government for the value of the growing crop. Mr. Faye is willing, however, to set aside a small area for a hospital but it will require the building of a road five miles along at least, (250 feet rise to the mile.) The water supply for this could be obtained from the Kekaha ditch but the site. Mr. Faye pointed out, was directly above the Waimea ditch (for drinking water) into which the land would drain if a hospital were situated there. Investigation showed that in spite of the elevation this site is extremely hot. While the air is certaiulydrv there is no wind, it being in a sheltered part of the island and the ground being very rocky which would also reflect the heat to a very uncomfortable degree. Furthermore, this site would re quire a special medical officer. A telephone line would have to be built for several miles (it cost LeaTii Home $500 a mile to instal a line when it was started.) There would be little or no chance for patients to receive visitors so far from the main road and the road, if built, would probably be too rough to transport patients particularly if suffering from a (hemorrhage) with any degree of speed and safety. The third site pointed out near Waimea was at Halein-jnir. This was still high ..r up in the moun tains. The water supply was'ques tionable and all the objections in regard to inaccessibility o f the Pookii site are so increased as to overcome any desirability trom coolness on account of altitude or other advantage this site may offer. The site at Makaweli recom mended by Dr. West is on a penin sula, slightly above sea level. It is a tract of about forty acres, half of which is at present under culti vation of cane. It is government land and the crop comes off this year. It is fairly accessible from the belt road although I consider it further from the central point of such road (Lihue) than is advis able. The claim is made, however, that as the center of population is at this end of the road, the hospi- but making it very doubtful if anything could be grown on such a soil, particularly grass for stock, or vegetables. The water supply is question able. Dr. West believed it pos sible sufficient drinking and cook ing water could be obtained from the present plantation supplv but all washing of clothes, patients baths, and scrubbing of the hospi tal would have to be done with sea water. As sea water used for this purpose leaves a deposit which is carried by the air and which is ex treniely irritating to the eyes, nose, throat and lungs such a proceedure is not to be recommended. There fore this would entail the pro curing ot a good water supply tor all household purposes, at least, if not sufficient for. a dairy farm could be obtained "and even tinder these conditions the lack of farm produce would greatly militate against economy of mpnagement. Another site mentioned by Dr. West was on the Makaweli side of the Hanapepe Gulch which is government land and at present unoccupied. The road is at present on the other side of this gulch, is well enough known to indicate the in accessibility f such a site from the main road at this point and would require the building of many miles of road to reach it from Makaweli; also water would have to, be piped from a consider able distance. Such water is avail able from the mountain behind but the cost of building a road and a pipe line as well would be in ex cess ot its other advantage I personally was impressed with a large area of unused land or. the Lihue side of Hanapepe Gulch at Kanea. This land, however, be longs to Gay and Robinson (or to Mr. Aubrey Robinson) and upon inquiry was assured that it could not be procured, although it is accessible, in a good climate situa tion, and water could be piped from the source referred to above. I was Instructed to look at avail able lots, if any, back of Kukui- olono hill. Mr. Walter Mchryde informed me all lots in the Kala heo district were taken up by homesteaders except some declivi ties that could not be utilized for building purposes. The ideal situation for a tuber culosis hospital would be on the knoll in Kukuilono Park. While I think no better site for a sana torium is to be found on Kauai than this Park, I will not men tion it as I believe it is not now procurable, besides Mr. McBryde assures me that in winter the kr.oll is wet and cold, miserable and entirely unsuited for a sanatorium site. Consultation with Dr. Water house at Koloa brought out no site ofsufficientmeritto be investigated From my investigations no site was available from Koloa to Kapaa at which place three sites were suggested. One, on the beach, one up in the hills (Lot No. 173) and one near the school on the bluff just before reaching Kealia. As regards the beach site, thi has the advantage of accessibility being on the main road. The site has several disadvantages, how ever. The subsoil trom borings o n nearby lots shows that there is a 1 lyer of solid rock some eight feet neighboring land have yielded aj regard to drainage. Not only is the subsoil excellent for the con struction ot cesspools, etc.. but should any difficulty be encounter ed it would take no considerable expense to instal a pipe-line from the site to the ea, the fall being with the hope that the whole hun- many times more than ample. tal would here be convenient to ! the greatest number ot cases. But even were this factor ad mitted, I would still be unwilling thick tinder a thin top soil mostly sand. This will not only tend to make the site uncomfortably hot but supply of water, slightly brackish.! It i.-t very doubtful when the al ready high salt content of the soil s considered if any farm produce could be grown there. If this site was utilized it would be necessary to obtain land for farming purposes nearby. Such land is available across the road some half a mile from the site and while this is government land, it appeared to me to be too marshy to be of much value for dairv and vegetable farming and the separa tion of the hospital trom its farm would be costly. This site would be suitable if no other site were available but as I btlieve a much more preferable site is almost beside it, having all its advantages of "accessibility besides superior climatic conditions and none of its disadvantages. I do not recommend this site. The site "Lot 173" would be an excellent site as regards farm produce but has fome important disadvantages. There are two roads to this site one on either side of the Kealia bridge arul the better one (on the Kapaa side) is three and and a half miles long. It is a dirt road that Dr. Hoffman has found well nigh impassable in rainy seasons. Beside, to reach the knoll that forms Lot 173 by this road would require some skillfull and expen sive road building to cross a deep Kulch that cuts makai just at the Kapahi camp. In fact, the road on the Kealia side of the bridge would hive to be improved at con siderable, expense to utilize this site. The rainfall on the site is exces sive in 1914 having been at Kapahi Camp 72 inches but this is un usual, Kauai having had unusually heavy rain falls last September. The average rain fall for the last three years was 51 inches. Water could be obtained for this site from the spring at Kapahi, al though 8,000,000 gallons from this spting belongs to the lands below. I was unable to find exactly how much in excess of 8.000,000 gallons this spring supplies. But even though the excess should be con siderable it would be difficult to pipe across the gulch, and the knoll is possibly on a high level than the spring. Drainage would not be difficult and possibly the local physician Dr. Hofmann, might be able to superintend the hospital, but again I believe the remaining site the "school site" to be. so advan tageous I will not discuss the merits of this site further. I call this the "school site" since it is on the sam: plateau as the school at Kapaa. Its situation is on the bend of the road as it curves around from Kapaa towards Kealia This site is well situated foi benefits of climate, situated on the summit of a bluff over a hundred feet high i t receives the trade winds directly from the ocean thereby assuring that there will never be excessively hot weather, and also freedom from dust. In fact, if any objection can be raised to this site it will be on the ac count of the strong winds that may occassionaly blow across it. but this disadvantage can be readily overcomes b y planting a wind break ef iron wood trees and fac ing the open air wards in such a direction that they will be shel tered. The rainfall at Kealia (l! i miles from the site) averages about 30jinches per year dred acres can be obtained as such; Th;s site would be easily acces a tract is needed on Kauai for I "ible for supervision thereby sav- reasons already referred to, mak j ing considerable expense in super vision and administration by the ing this an ideal site for a sanato rium. Buildings for offices and patients can be erected at once on the land near the edge of the bluff and utiliz ing that mauka for a dairy, chickens and vegetables. These being on the leeward side of the buildings will not be objectionable in any way, As the hospital and farm will be small in the begin ning there is ample room for both in the present available land for a year or more and when the lease of the cultivated land expires the farm can be moved farther away to make room for the new build ings of the sanatorium proper. This site i s a very accessible one. It is on the belt road and a road can be built for very little up to the top of the knoll. There is an old grading for portable Hack, probably, on one side of the bluff that only needs leveling to conned the knoll with the road and I have reason to think the county might be persuaded to do this for very little expense, it this site is set aside. This site is somewhat (about 10 miles) to the Kealia side of the center of the belt road which is Lihue, but beyond Kealia the roads are poor compared with the excellent highway from Kekaha to Kaoaa. . To my mind so much greater difficulty will be encount ered in transporting patients over the poorer roads (from Hanalei, etc )than over the fine roads, (from Kekaha, etc.) that so far ns time and ease of transportation is con sidered this site may be said to be equidistant from both ends of the belt road. Moreover, if a site had been se lected nearer the "center of popu lation" the only sites worthy of consideration (those mauka) would consume as much time in reach ing them from Makaweli (say) owing to the time lost traversing the certainly poor road to the hos pital from the main road, as would be consumed in going from Maka weli to Kapaa over a smooth ex cellent roadway the entire dis tance. Again, the situation is readily a cessible to any friends of the patient, being on the main road, so that owing to an excellent "jit ney service" 5 cents a mile friends and even patients can be transported to the hospital at a minimum expense from almost ar.y part of the island, something not possible with a site several miles off the main highway. The telephone line passes the foot of the knoll and no expense would be incurred in obtaining this necessary convenience. Whether electric light could be obtain-d from Kealia could not be ascertained but an acetylene plant can be cheaply installed if electric light is not available. A plantation railway runs from Kea lia landing to the foot of the knoll so that lumber for building or any other freight can be readily trans ported to the ground. The water supply on this site is adequate for all purposes, being two-fold. viz.. a territorial supply and a county supply. The territorial water supply is from the spring alluded to when discussing the site of Lot 173 above. 'This one hundred acres is part of the land entitled to its local physician, being less than two miles from his residence and therefore easily administered by him till such time as the number of in mates warrants the employment of a resident physician. Thus taking ail things into con- Isideration. climate, availability. accessibility, drainage and water supply, favorable soil for farming, economy of uiain'aiuence, this is practically the only site o f nil those looked at that combines these advantages to a high degree. No one of them is possessed at tie cost of some serious objectionable disadvantage from another point of view. In snbmitting this report I desire to express mv thanks to the com mittee on Kauai, appointed t o select a site, for their courtesy to me and for their honest effoits to afford ni e every opportunity to visit the various sites proposed, giving me their time and advice willingly, visiting each site with me and according me the benefit of their knowledge of the locality upon the ground of the site under consideration. A.N. Sinclair. NOTICE Notice is hereby given that no bills will be paid for the entertain ment of the Congressional Party on the Island of Kauai unless the same are approved in writing by H. D. Wishard, Lihue. Wade Warkkn Thayer, Secretary of Hawaii. Honolulu, April 30, 1915. . . lie Co. Ltd. Stocks, Bonds, Real Estate and Insurance NO. 125131 MERCHANT ST. P O. Box No 594 Honolulu j HOTEL WAIMEA I Waimea, Kauai j j I I Breakfast Lunch Dinner Room $ 50 .75 1.00 1.00 . J J DICK OLIVER, Manager Koloa Plantation Store Wholesale and Retail Groceiie Dry Goods of all Descriptions. General Plantation Supplies. rcAiidm'iEDcM ! share of 8,000,0 ri gallons mention-1 I This site consists of about 100 ' ed so that water for farming, etc. J acres of Government land and is! will be ample while the county to recommend this site for several ' militates against drainage. The 11 f 1 111 ' A. T 1!- 1 la reasons. I water win rise in sucu eiriuiugs , unaer lease 10 ivcana plantation, ; nas an excellent supplv trom a: The peninsula is approachedaver! (for cesspool purposes) within a although only about seventy acres'tunnel in the hills which can l: a stretch c.f beach sand and'' 'ect the surface, making is under cultivation. The remain-' obtained for drinking purposes, as while the soil is better in spots the 'cesspools a menace to the health ufi ing thirty ac.es which have no , I was assured by Mr. Wishard of general character of the peninsula ' the site, when the large amount of crop on at present is immediately 1 the Board of Supervisors. ' in With these generalizations in is such tliat it wi;i be an extreme-' water used i.i n Ins pi; a! is ..con- available f o r build ng purposes No t ! h- en be- nut with 1.1MITKI). Dealers in Hay, Grain and Chicken Supplies. Sole Agents for J InterimUonul Stork, Poultry KimvI I and other sMcialtii-. Arabic (or cooling Iron Moofti. lVtHliinm ln- I rtiliutorn ami Brooders. King's Special Chick Food I P. O. Box 452. Honolulu