Journal of World History

Global History of Leprosy²

Throughout the history of Hansen’s disease, also known as leprosy, in many (though not all) cultures, the concept of quarantine, segregation, or isolation of those who were suffering from leprosy was a common practice in dealing with what many termed the “dreaded disease” or the “scourge of mankind.”³ Indeed, leprosy is thought to be one of [End Page 611] the world’s oldest diseases, and by the nineteenth century, many of the world’s cultures had experienced the disease at some point in their past. In most of the West, as the disease came to represent more of an artifact in their collective memories than a reality, isolating those with the disease was practiced with varying degrees of strictness.⁴ As the nineteenth century wore on, debates over whether or not the disease was hereditary or contagious largely informed isolation policies (or lack thereof). Prior to the late 1800s, when the prevailing theory was that leprosy was hereditary, large-scale segregation was not thought to be necessary. But as the disease became prevalent throughout the colonized world and contagion theory gained momentum, isolation of the diseased was viewed as the only rational response.⁵

Throughout its history, concepts surrounding leprosy have varied. The earliest evidence of the disease places it in the Indian subcontinent approximately 600 b.c.e., though many expect it was in China and the Nile valley even earlier.⁶ It reached the Mediterranean in 62 b.c.e. with Pompey’s legions and then traveled north as the Roman Empire expanded. Premodern physicians viewed leprosy as a disease of the body, not as the disease of the soul so prominent in literary writings.⁷ But by the 1800s there was an apparent disconnect between what was known in biomedical circles and what was perceived by social commentators concerning leprosy. Biomedical models clashed with missionary and literary models, and the latter two fed the nineteenth-century imagination of Western society. Indeed, armed with misconceptions about “the medieval leper . . . colonial administrators and evangelicals turned to the past for evidence to support their own campaigns for mandatory segregation,” even if that evidence was skewed.⁸ [End Page 612]

Furthermore, in the nineteenth century, prior to the discovery of any antibacterial medications and even prior to wide acceptance and understandings of germ theory, quarantine was the only proven method used by many cultures to control the spread of disease. Separating those with an infectious disease from those who had not yet contracted it was a rational response to any epidemic. However, most infectious diseases resolve themselves (either through the death of those affected or survival of the infection) in days or weeks, or are followed by a declining virulence. Leprosy presented a very different scenario to the modern, colonial world. A disease that was endemic in Scandinavia, northern Africa, India, and China in the mid-1800s was beginning to appear in the colonized world—parts of sub-Saharan Africa, South America, and in the Pacific—and was presenting an “imperial danger” to the Western world. Feeding colonizers’ fears over imperial/tropical diseases and the “diseased indigenous body,” the prevalence of leprosy offered Western colonizers an opportunity to take control of those bodies under the guise of public health policy.

When the leading authorities on the “leprosy question” came together in 1897, quarantine and the Norwegian model of voluntary isolation to prevent the spread of leprosy in affected areas was promoted, but it was the Molokai⁹ model of compulsory isolation—and all of the consequences that entailed—that was predominantly adopted by most nations, especially in their colonial possessions. Molokai served as a model—in its ideology, in its harsh realities, and as a means of controlling colonized bodies. That is, under the rubric of quarantine to prevent the further spread of a disease, in this case leprosy, lay a diverse array of ideological and administrative mechanisms by which an emerging system of knowledge and power extended itself into and over indigenous bodies.¹⁰

Leprosy in Hawai‘i

Leprosy was introduced to the Hawaiian Islands in the early nineteenth century. It was but one of many foreign epidemic diseases brought to the islands through encounters with foreigners. In 1778, Cook’s crew [End Page 613] introduced syphilis, gonorrhea, and tuberculosis. Then there was the ma‘i oku‘u (the squatting sickness, “Asiatic cholera”) of 1804, followed by numerous onslaughts of influenzas, diphtheria, measles, smallpox, whooping cough, and so on.¹¹ For Native Hawaiians, leprosy was in many ways no different than any other infectious disease that had been brought by the foreigners, but foreigners’ reactions to this disease were in many ways different from their reactions to other epidemics.

In the islands, the government of the Kingdom of Hawai‘i under the Mō‘ī (monarch) Lota Kapuāiwa passed the Act to Prevent the Spread of Leprosy in 1865. The new law provided the Board of Health with the authority to find and set apart a tract of land for the use of quarantine of those affected by the disease. The chosen land, the Makanalua peninsula on the northern side of the island of Molokai, soon became the setting for the new leprosy settlement and remained a place of isolation until mandatory isolation was repealed in 1969.¹² The peninsula, commonly known today as Kalaupapa, was often referred to in the nineteenth century as “a land set apart,” the “natural prison,” or “the grave where one is buried alive.”¹³

The first of those afflicted with leprosy were sent to the Makanalua peninsula in January 1866. By 1898, more than five thousand persons with leprosy had been sent to the quarantine settlement, 98 percent of whom were Native Hawaiians.¹⁴ In the first few decades of the new settlement, the “patients” lacked proper supplies of food, water, shelter, medicine, and care. They struggled, but dealt with the challenges as best they could. Family members often accompanied those with the disease to be their mea kōkua (helpers), and many kama‘āina (original residents of the peninsula) remained until the late 1890s.¹⁵ Together, [End Page 614] these three groups created a new community, visitors came and went, and the boundaries of isolation were in practice quite permeable, thus the efficacy of “quarantine” as a tool to control the spread of leprosy is debatable.

In 1873, Father Damien de Veuster arrived at the leprosy settlement, contributed to the care and well-being of the patient-residents, but then contracted the disease himself and died in the settlement in 1889. His life and death in the settlement garnered a great deal of international attention, both in his lifetime and thereafter.¹⁶ But, despite Damien’s fame and Board of Health claims that they were doing all they could to care for those with leprosy, the patient-residents continued to struggle. Indeed, until the discovery of the sulfone drug Promin in 1941, as a successful (though painful) treatment for leprosy, quarantine remained for many as the best means of controlling the spread of the disease. And the settlement on the peninsula of Moloka‘i’s northern shore was held up as a model for many to follow—for a variety of reasons.

International Leprosy Conference

In 1897 the first International Leprosy Congress was held in Berlin. Delegates came from all reaches of the colonized world—where leprosy was of great concern and thought to be an “imperial danger” by some.¹⁷ By this time, the settlement on Molokai had become well known, most notably through the service and death of Father Damien de Veuster. Delegates came from all around the world, including two who were sent from Hawai‘i to the conference, which was also attended by some of the day’s most well-known scientists (bacteriologists/leprologists)— most notably Ehlers, Koch, Virchow, and Hansen.

The purpose of the conference was to establish whether or not the leprosy bacillus was the cause of the disease—if so, how it was transmitted—and what kind of “international parallel action” they could set [End Page 615] up to reduce its spread.¹⁸ Hansen’s presentation was the centerpiece of the conference. Most reports gave particular attention to his argument that isolation was the key to preventing the spread of leprosy and to eventually eliminating it. Hansen also offered Norway’s model as the paradigm for control. In their general conclusions, the International Leprosy Congress acknowledged the scientific contributions of Hansen and Neisser to their current knowledge of the disease and accepted the theory that the disease was contagious, but also asserted that “every leper is a danger to his surroundings, the danger varying with the nature and extent of his relations therewith, and also with the sanitary conditions under which he lives . . . among the lower classes, every leper is especially dangerous.”¹⁹ Further, the congress adopted the resolution “considering the good results which have followed the adoption of legal measures of isolation in Norway,” that

1. 1. In such countries, where leprosy forms foci or has a great extension, we have in isolation the best means of preventing the spread of the disease.

2. 2. The system of obligatory notification, of observation and isolation as carried out in Norway, is recommended to all nations with local self-government and a sufficient number of physicians.

3. 3. It should be left to the legal authorities after consultation with the medical authorities to take such measures as are applicable to the special social conditions of the districts.²⁰

Many scholars have argued that as a result of the 1897 conference, “a policy of strict isolation” for those with leprosy was endorsed for “everywhere in the non-western world.”²¹

In Hawai‘i, as local residents of American descent were lobbying for annexation, leprosy became increasingly identified as a “native disease,” one that was dangerous only to foreigners who adopted indigenous customs or lived too close to Native Hawaiians.²² As was the [End Page 616] case throughout much of the colonized world, colonial settlers viewed leprosy as a highly contagious and fearful tropical disease.²³ In Hawai‘i it was rare for non-Hawaiians to contract the disease (there were fewer than one hundred cases in the nineteenth century), but when this did happen, it was viewed “as an individual disaster, nothing to do with his race as a whole.”²⁴

Though it had long been absent from Europe (and thereby Western culture), leprosy now threatened to find its way back with the spread of Western imperialism. As the scholar Tony Gould has observed, “in these days of wholesale migrations of peoples brought about by colonial activities it would surely not be long before those European countries that thought they had rid themselves of this scourge centuries before had to face up to it again.”²⁵ In the context of leprosy in India, Henry Wright, archdeacon in the Church of England at Grantham, warned that travel back and forth between Britain and the colony would bring leprosy back to the homeland. While he pleaded for “Christian commitment” to the problem, his “imperial danger” thesis not only reflected growing public concern throughout the Western world, but was also found useful by many.²⁶ Westerners wanted to keep leprosy patients “without the camp,”²⁷ whether the “camp” be colonized soil or the homeland, for, as they saw it, if “the contagion was capable of passing between races . . . then perhaps western imperialism was creating an empire of leprosy, in which westerners themselves might be consumed.”²⁸ Indeed, at the 1897 conference, Arning (who had spent a couple of years as a bacteriologist in Hawai‘i) and Hallopeau both presented on the possibilities of leprosy “returning” from the colonies.²⁹ [End Page 617]

Models of Quarantine

At the conference, Hansen presented on the Norway model of isolation; he was, after all, “the architect of the apparently successful mixed ‘obligatory and facultative’ model of segregation,” which he maintained was “superior and responsible for the good results.”³⁰ Hansen declared that, in his view, “the results of isolation rules as practiced in Norway, are the result of isolation . . . Where there are many lepers, isolation at home is insufficient, and institutional care must be given to the isolated.”³¹ He also related how he influenced the Norwegian public’s perception of those with leprosy and attitudes toward compulsory isolation, admitting that those with leprosy do “not want [their] freedom to be restricted” thus he “travel[s] all over the country, where lepers live. . . . I see to it that healthy persons attend our lectures. The healthy persons listen . . . [it] is important that they do not want contact with the lepers. If I achieve that then my goal is reached.”³² Hansen reported that as a result of these public health efforts in Norway, there were more persons with leprosy “living in institutions than outside” and that if similar measures that were working “so well in Norway could be put into universal practice, the disease would be quickly eradicated.”³³

A national leprosy registry was started in Norway in 1856 as part of a control program. Based largely on a hereditary theory of disease causation, the program relied on two main components: one, to ban all marriages among those with leprosy, and two, to establish several institutions throughout the country “where patients would not only receive medical treatment but where they would also be sexually isolated.”³⁴ Though the provision relating to marriage was never implemented, the medical facilities were. Using hospitals in parts of the country where the disease was known to be prevalent, they were able to integrate treatment with the patient registry, thus making it “unnecessary to remove patients to long distances from the districts in which [End Page 618] they lived.”³⁵ In other words, the Norwegian model allowed those with leprosy to maintain connections to their home communities, living in their homes or in hospitals, despite a control program that utilized voluntary isolation. Even with Hansen’s discovery of the bacillus that causes leprosy (Mycobacterium leprae) in 1873, thus supporting contagion theory, “the danger of contagion was assumed to be slight” and “isolation measures in Norway remained relatively mild.”³⁶ As Hansen himself stated in his memoirs, “the Norwegian state had always handled its leprosy victims humanely.”³⁷ Furthermore, even though the law allowed for police enforcement of isolation, “there was throughout the nineteenth century in Norway sufficient public, professional, and parliamentary concern for the civil liberties of lepers to mitigate the imposition of restrictive or punitive measures.”³⁸

When leprosy became a major public health concern in the Hawaiian Islands in the 1860s, Great Britain was prompted to investigate the prevalence of leprosy in all of its colonies; a study of leprosy was also done in Dutch Guiana, and many became concerned that Chinese immigrant workers were responsible for much of the spread of the disease.³⁹ The government of the Kingdom of Hawai‘i believed that quarantine/isolation was the only hope to stop the disease from spreading further. Isolation was enforced by Board of Health officials, the police, and, at times, bounty hunters. Those with, or suspected of having, leprosy were gathered up from their various island districts, brought to a receiving station in Honolulu, and then subsequently sent to the settlement at Kalawao. Throughout the first few decades of the settlement, the community at Kalawao constantly petitioned authorities (in letters sent to the Board of Health and in letters/editorials published in the Hawaiian-language newspapers) for medicine, bandages, a proper food and water supply, physicians, and nurses.⁴⁰ Yet, by the 1890s, “despite the absence of field-based epidemiological surveys and the lack of corroborating evidence, government officials and leprologists nevertheless pointed to Hawaii and the leper colony at Molokai as proof that the disease was reduced with the practice of segregating lepers.”⁴¹ [End Page 619]

At the 1897 Berlin conference, the Norwegian and Hawaiian models of isolation were held up as ideals in leprosy control, implying their overall success. Subsequently, similar forms of quarantine for leprosy, following the Molokai model of isolation, separation, and geographical boundaries, were soon found in many parts of the colonized world, many citing Molokai as their inspiration. Further, “from the 1860s on, application of [a] Christian paradigm formed a basis of policy in Hawai‘i, South Africa, Malaysia and the Philippines. Elsewhere, especially in India, colonial administrators regarded the Hawaiian model as the ideal towards which they might like to aim, . . . In practice however, many of them recognized that local cultural attitudes to the colonial intruders would make it impolitic to intervene in ordinary people’s lives on the scale the Hawaiian model required.”⁴²

Heredity versus Germ Theory

It can be argued that throughout the nineteenth century, the causation of all disease was central to medical inquiry, and the debate over leprosy was significant, for determination of cause would determine “treatment” of the disease, including the support for quarantine. Theories of disease causation varied widely, but the consensus on the need to isolate those with leprosy was gaining momentum by the mid 1800s; this is not surprising as colonizers were coming face-to-face with “the dreaded disease” they thought they had long left behind.

Three schools of thought were competing against each other and challenged notions of contagion: the hereditarian, dietary, and sanitarian theories. The hereditarian theory held that leprosy was inherited, whereas the dietary theory asserted that diet (linked to socioeconomics) was the key to disease prevention. And the sanitarians “viewed leprosy as a nonspecific debility caused by substandard living conditions. . . . [Thus] it is not surprising that British sanitarians put up stiff resistance to the contagion hypothesis, considering that Britain was the mother-country of the nineteenth century public health movement.”⁴³ Interestingly, all schools of thought believed that isolation [End Page 620] in some form was the best way to ‘treat’ leprosy: “Hereditarians . . . hoped that enforcement of sexual segregation in asylums would prevent hereditary transmission of the disease. Contagionists . . . regarded systematic segregation as the only feasible method of eradication of the disease from a country, and proudly pointed at Norway’s record in justification. Sanitarians saw asylums as providing shelter, food, ‘moral and sanitary improvement,’ and therapeutic occupation to demoralized victims of bad living conditions.”⁴⁴

Despite the lack of confirmation over whether the disease was or was not contagious and exactly how it was transmitted, the question remained at the heart of the discussion for segregation (isolation, quarantine, control) of those with leprosy. Indeed, Albert S. Ashmead, MD, in an article he wrote for the New York Times in 1906, conceded that “The popular belief all over the world, so ineradicable, that leprosy is a dangerous disease to have any association with is founded on truth, for none of us know the exact method of transmission.”⁴⁵ While the debates continued, three events helped to reinforce the contagion theory of the spread of leprosy by the end of the nineteenth century, but more importantly, increased the “fear” surrounding the disease.

The first “event” came in 1873 when Hansen identified the bacillus that causes leprosy, Mycobacterium leprae, under the microscope.⁴⁶ As Warwick Anderson explains: “Hansen’s announcement of the discovery of the bacillus of leprosy . . . signaled the entry of leprosy into the emerging etiological mainstream. Its presence in the nasal scrapings of suspects—regardless of clinical signs—came to suggest, to the more scientifically inclined of medical and civic authorities at least, the need to isolate the victim, or carrier, and to engage in relentless efforts to remove the contaminating germ from the population.”⁴⁷ In other words, anyone could be a carrier. By the 1897 conference, few doubted the disease’s contagiousness, and delegates “formally recognized that leprosy was a contagious disease and endorsed not just [Hansen’s] discovery but also the Norwegian model of leprosy control.”⁴⁸

The second event to reinforce the contagion theory and fear of leprosy was the death of Father Damien de Veuster of Belgium, after he [End Page 621] had served at the leprosy settlement on Moloka‘i for thirteen years. Historian Jane Buckingham asserts that Damien’s death:

produced an hysterical response in Britain, triggering public fear that leprosy was an imminent danger to Europeans who had seemed virtually invulnerable. At a time of active imperial expansion and world migration, when leprosy was identified increasingly with non-European races, particularly Chinese and African peoples, Fr Damien’s death made clear the European susceptibility to leprosy. There was fear in Britain not only that leprosy would spread to Europe but also that by living in countries where leprosy existed, Europeans might contract the disease. Never had the vulnerability of the European to infection with leprosy been so publicly displayed.⁴⁹

Previously, the outbreak of leprosy in Hawai‘i had prompted Great Britain, in 1862, to conduct an investigation of leprosy in all of its foreign colonies. The subsequent report found that leprosy was hereditary and concluded that it was minimally contagious, thus “segregation . . . was unnecessary and ineffectual.”⁵⁰ However, the death of Father Damien in Hawai‘i made the disease a more public concern, questioned the conclusions of the earlier report, and resulted in further investigations by the British Leprosy Commission, which “decided that the contagion level of leprosy was high and that isolation should be compulsory.”⁵¹ As Pandya asserts, it had become “painfully clear to imperialists that physically and morally degraded indigenous peoples could endanger Western well-being. The power of the Damien episode in the public sphere lay in its potential for sentimentalisation, the perceived legitimization of the contagionist doctrine, [and] the opportunity to reinforce the West’s sense of moral superiority.”⁵²

The third event that solidified the contagion theory as well as the fears of the imperial world was the First International Leprosy Conference held in Berlin in 1897. Declaring that leprosy was an infectious/contagious disease and that isolation was the best medical practice for stopping its spread, the imperial world now had the backing of science to claim leprosy as a real threat. When the 1897 Berlin congress [End Page 622] took the position that “every leper is a danger to his surroundings” and resolved that isolation was the best means for preventing the spread of the disease, they not only endorsed the contagion theory but effectively declared that the strict quarantine of those with the disease was the key to preventing its spread. What followed was a policy of enforced isolation for those with leprosy everywhere in the non-Western world. Thus, during the next several years, leprosy confinement controls were maintained in the newly U.S.-controlled Hawai‘i as well as introduced in the U.S. possessions Guam and the Philippines, in British-ruled Malaya and Singapore, in German southwestern Africa (now Namibia), and in the settler-dominated Cape Colony (after 1910, incorporated into the Union of South Africa).⁵³

Thus, by the late 1800s, apprehension over the “imperial danger” associated with leprosy was increasing. The Norwegian model of quarantine and voluntary isolation was promoted as the ideal, but it was the Molokai model of compulsory isolation that was utilized, especially in the colonized world. In particular, the “island,” using water as a barrier and Molokai’s implications as a “natural prison” for inspiration, isolated leprosy settlements were established and maintained in the Pacific:

The establishment of each, similar to Anderson’s assessment of the founding of Culion in the Philippines, was that officials set out to “find a distant island on which to establish a leper colony”⁵⁵ and followed the Berlin conference’s advice to pass legislation regulating the confinement of those with leprosy. Furthermore, “the rationale for establishing an isolation center for leprosy patients in the Philippines was the experience in Hawaii of the leper settlement on the island of [End Page 623] Molokai.”⁵⁶ In Fiji, colonial officials chose an island with the notion that “a leprosarium should be out of sight of the public” as it was “the belief of the day . . . that little, if anything, could be done to relieve the disease.”⁵⁷ Of course, lacking a real cure for the bacterial infection, many advocated the physical isolation of patients, but this also meant that “colonial rulers everywhere had to consider the financial implications”⁵⁸—at what cost—to those who suffered from the disease and the authorities who financed their isolation.

Islands of Dis-Ease

But just how successful was Molokai? What was the “reality” of the settlements at Kalawao and Kalaupapa? What were the conditions like for the patients? What were the political, economic, and social realities of this model? And did this form of isolation stop the spread of leprosy in Hawai‘i? While all of these questions may never be fully answered, the realities of the isolation policy and its consequences in Hawai‘i are becoming better understood.

The 1865 Act to Prevent the Spread of Leprosy allowed for the criminalization of the disease. Makanalua peninsula was often referred to as a “natural prison”; suspects were arrested, and by the late 1800s bounty hunters were sent to find those with the disease.

There were constant requests from the patients (to the Board of Health and through the Hawaiian language newspapers) for medicine, bandages, and a better food supply; a proper water supply was a frequent challenge; and there was a constant lack of proper medical care (physicians or nurses). Thus, mea kōkua (helpers) provided most of the care for the “patients” of Kalawao—that is, spouses, children, parents, and so on provided care for their loved ones who had been sent to Kalawao under the isolation policy—or Native Hawaiians were taking care of other Native Hawaiians who had contracted the disease. Not only does this call into question the effectiveness of Hawai‘i’s isolation policy, but it also points to something that made foreigners very uncomfortable, for “central to the thinking of western workers in leprosy . . . was the idea that civilized people everywhere shunned lepers; [End Page 624] any cultural group which didn’t behave in this way was barbarous or at best semi-civilized.”⁵⁹

There was constant resistance to the isolation policy from the very beginning. Examples of resistance include persons avoiding arrest; attempted and successful escapes; various protests, including riots, petitions, and letter writing; and the hiding of loved ones from authorities, which possibly assisted in the spread of the disease. Furthermore, as treatments and a cure were sought, some (patients and mea kōkua) were subjected to medical experiments; Keanu, the convicted murderer who was inoculated with leprosy in lieu of the death penalty, is perhaps the most famous “experiment.”⁶⁰ While patients remained politically active as a community throughout their exile, and there are many examples of political resistance coming from Kalawao and Kalaupapa, including the Hui Aloha ‘Āina and the Kū‘e petitions,⁶¹ it is also clear that during important political events in the kingdom’s history (the 1887 Bayonet Constitution, the 1893 overthrow of the monarchy, the 1898 joint resolution that allowed the United States to take possession of the islands) there was also a parallel and significant spike in the numbers of those arrested and sent to the Molokai settlement.

In the early 1900s, the number of cases of leprosy began to slowly decline, but the permeable nature of Hawai‘i’s isolation policy argues against the success of quarantine and instead postulates that the disease may have naturally transitioned from epidemic to endemic by the turn of the twentieth century. Indeed, “from today’s multidimensional perspective . . . it is highly unlikely that isolation alone eliminated leprosy” from medieval Europe, Hansen’s Norway, or Hawai‘i.⁶² Moreover, as one scholar asserts, “Molokai was less a model colony than a monstrous reflection of the real thing.”⁶³

When the United States took control of the Philippines in 1898, the American military authorities created a board of health, and those in charge of leprosy reviewed recent medical literature, concluding that “only isolation and experimental treatment could accomplish [End Page 625] the eradication of leprosy in the islands.”⁶⁴ It was said that in Manila alone, thousands with the disease “were at large. Some were eking out a miserable existence on isolated sandpits, others begging in the market places, and still others trying to earn a pitiful living . . . The American military authorities took over the Saint Lazarus Hospital and as rapidly as possible gathered up those who had scattered throughout the city and suburbs.”⁶⁵ Victor G. Heiser, who took control of public health in the Philippines in 1905, saw himself as “a secular and uninfected Damien,” and regarded the “scientific treatment of leprosy at Culion as his major legacy to the islands.”⁶⁶ The island was chosen as it presented an ideal site for the colony, “furnished abundant and suitable lands for agriculture and stock raising. Water was available, and the harbor was extensive and safe.”⁶⁷ Much like Molokai, those already living at Culion (a population of about three hundred) were moved to an adjacent island, and Culion, viewed as ideal and fertile, was to be “set apart” for all leprosy patients who were “willing and able to cultivate the soil” while accommodations for men and women in “two widely separated areas” were established.⁶⁸ Culion became a model reformatory, eventually influencing both Molokai and the new U.S. Federal Leprosarium at Carville, Louisiana.⁶⁹

In Fiji, the British moved those with leprosy from the quarantine station on Beqa Island to the newly established state-of-the-art isolation hospital at Makogai (a much more remote island) in November 1911.⁷⁰ The new policy of compulsory segregation brought some of the worst cases to the island at first, with similar difficulties to those who were first sent to Molokai and Culion. Later, isolation was welcomed by some, namely those who had been ostracized within their own cultures throughout the South Pacific for having the disease.

Conclusion

The International Leprosy Congress met again in 1909, in Bergen, Norway. The delegates “confirmed the resolution of the first International Conference at Berlin in 1897, stressing that leprosy was contagious [End Page 626] from person to person, and that every country, no matter what its latitude, was within the range of possible infection and so should take measures to protect itself.”⁷¹ The disease had declined dramatically in Norway, Sweden, Germany, and Iceland through successful isolation policies, thus the 1909 International Leprosy Congress felt it “desirable that other countries with leprosy should isolate patients and forbid them to follow certain occupations which would enhance the danger of contagion.”⁷² But the conference also asserted that the disease was not incurable, that clinical study would one day find a cure, providing some trace of hope.

The 1897 conference had encouraged the acceptance of the Norwegian model of segregation among its delegates. Norway used existing facilities, had several institutions throughout the country, did not remove patients from their home districts, encouraged voluntary isolation (including in patients’ own homes), and demonstrated concerns for civil liberties. But in Hawai‘i, since 1865, the leprosy settlement was established on Molokai’s north shore—on a peninsula surrounded by high sea cliffs and ocean that was referred to by authorities as a “natural prison.” Compulsory banishment to the settlement removed patients from their families, communities, and home islands—rendering them metaphorically and literally “out of sight, out of mind, out of power,” and civil liberties were suppressed.⁷³ The Molokai model, fueled by racism and notions of power and often justified by fear, prevailed throughout the colonized world.

Newly established settlements such as Culion, Makogai, D’Arcy, and Quail Islands continued to separate persons with leprosy from their loved ones and civil society, subjected many of those patients to “intensive surveillance and discipline,” and, following Molokai’s example, “represented the best contemporary model of unproductive isolation.”⁷⁴ Serving well the mechanisms of control, “leprosy impoundment in the approved Hawaiian way could also be seen as one way to authenticate a colonial regime which needed to prove that it was in the mainstream of civilization,”⁷⁵ for as Brother Dutton had proclaimed (albeit in a different context), one’s Molokai could indeed be found anywhere—in the colonized world. [End Page 627]