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Perpetuation of the Hawaiian race was a major concern for our ancestors in the late 1800's and early 1900's. The leaders of the Hawaiian nation at that time were careful to leave behind a legacy of care that would help to do just that, perpetuate the race. In his first speech as king, Kamehameha IV stated the need for a hospital to treat the native population. Due to introduced diseases, the Hawaiian population had plummeted from 350,000 at the time of Captain Cook's arrival, to 70,000, with extinction a very real possibility. King Kalakaua dedicated himself and his queen to the slogan "ho'oulu a ho'oola lahui...to propagate and perpetuate the race". Kamehameha IV and his wife Emma were the first ali'i to establish an institution to assist Hawaiians with one of their major obstacles to perpetuation, their health. The Queen's Hospital as it was called, opened in 1859. Upon her death in 1885, Emma left the bulk of her estate, some 13,000 acres of land on the Big Island and in Waikiki on Oahu, in trust for the hospital that honors her. King Lunalilo founded the Lunalilo Home for the care of poor, destitute and infirm people in 1883, Queen Kapiolani opened The Kapiolani Maternity Home in 1890, Bernice Pauahi Bishop left her substantial estate for the creation and support of the Kamehameha Schools, and Queen Lili'uokalani willed her estate to support the Queen Lili'uokalani Children's Center. Each of the established institution's mission was to grant either health care, education or assistance to all the people of Hawaii, with preference shown to people "with Hawaiian blood in their veins". Each institution has served this mission for over 100 years.

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