The Functioning of Leper Colonies (Leprosaria) Explained

In January 1879, under the watchful eyes of armed police to prevent any escape, a group of twelve prisoners were escorted to a Honolulu dock and boarded the SS Mokolii. The vessel departed and by morning reached the Kalaupapa Peninsula, a secluded area on Molokai's northern coast. The group was instructed to row themselves to the barren, rocky shore, where officials awaited to register their names and acquaint them with their permanent new residence, a place they could never depart from [source: NPS].

These individuals, deemed too hazardous to mingle with the general populace, were not criminals but victims of leprosy, or Hansen's disease. This bacterial infection leads to skin lesions, nerve deterioration, and muscle degradation, worsening over time if not treated. Modern medicine has since revealed that leprosy is not highly infectious and is effectively treatable with antibiotics. Historically, however, it was a dreaded and misunderstood disease, notorious for disfiguring appearances and causing the loss or deformation of fingers and toes [source: NIH].

Consequently, numerous individuals with leprosy globally have faced rejection, exclusion, and sometimes compulsory segregation from society. They were relocated to secluded settlements called leper colonies or leprosaria, where they endured their condition away from the fearful eyes of the healthy population.

Although leprosy has not been eradicated entirely, individuals afflicted with the disease are rarely subjected to such cruel treatment nowadays. Nonetheless, leprosaria continue to operate in certain regions of the developing world. What led to the ostracization of those with this disease, and why does it still endure?

Why Was Leprosy So Feared?

The bacterium Mycobacterium leprae, a small rod-shaped organism, is responsible for leprosy. While the exact mode of transmission remains unclear, scientists believe it likely spreads through respiratory droplets expelled when an infected individual exhales or sneezes, or through direct contact with skin lesions [source: NIH].

Symptoms of leprosy can take up to two decades to manifest. Once they do, the disease targets the peripheral nerves, skin, respiratory tract, eyes, and nasal mucous membranes. Affected individuals may experience numbness in their skin and muscle weakness, leading to injuries and eventual loss of function in the hands and feet. In some cases, patients may unknowingly harm themselves due to a lack of sensation, potentially resulting in gangrene and the need for amputation [source: NIH].

Leprosy spreads through prolonged close contact with an infected person, but it is not highly contagious. The bacterium cannot survive long outside a host, and approximately 95% of people are naturally immune to it. Modern medicine offers effective treatment through common antibiotics [source: HRSA].

Historically, leprosy was perceived as a dreadful, disfiguring ailment with no known prevention or cure. Researchers suggest the disease likely originated in Africa and may have reached the Middle East around 3000 B.C.E. [source: Robbins et al.]. The Old Testament's book of Leviticus (chapter 13) describes isolating individuals with suspicious sores and monitoring their progression. If the sores spread, a priest would declare the person unclean and mandate that "his dwelling should be outside the camp" [source: New King James Version].

This practice of isolating leprosy patients persisted for centuries. In medieval Europe, they were compelled to wear distinctive clothing and carry bells to alert others of their presence [source: NIH]. They resided in "leper-houses" or hospitals, such as one established by Queen Matilda in 1118 near London, though they were permitted to enter the city to beg. Some leprosaria were well-maintained, featuring vast farmlands and supported by affluent benefactors [source: Rawcliffe]. However, no cure existed at the time.

How Leper Colonies Began

In 19th-century America, leprosy was so stigmatized that cities like Chicago enacted "ugly laws," such as an 1881 ordinance prohibiting "any person who is diseased, deformed, or unsightly" from appearing in public spaces [source: Amundson and Ruddle-Miyamoto].

At times, harsher measures were taken. While leprosy patients had long been segregated, the late 19th century saw efforts to further isolate them by relocating them to distant areas. This was partly due to European colonial expansion in Asia and Africa, where rulers struggled to manage the high number of indigenous leprosy cases [source: Edmond]. Additionally, medical uncertainty persisted—some believed leprosy was hereditary, while others feared it was highly contagious [source: Edmond and Smith].

In places like Hawaii, then an independent monarchy, officials took drastic action following an 1850s outbreak [source: Associated Press]. The 1865 Act to Prevent the Spread of Leprosy criminalized the disease, condemning patients to lifelong exile [source: Amundson and Ruddle-Miyamoto].

Consequently, authorities established isolated colonies to confine leprosy patients indefinitely. Some were situated in remote inland areas, while others were placed on offshore islands. These leprosaria were found in the Caribbean, the Indian Ocean, South Africa's coast, and the Pacific.

These colonies developed a unique subculture centered around the disease, blending elements of imprisonment and monastic life. We'll explore this further in the next section.

Life in a Leprosarium

In certain nations, leprosaria functioned as heavily guarded prisons—arguably worse, as traditional prisons sometimes permit external contact and offer inmates the possibility of eventual release.

Leprosaria, however, were designed to completely isolate inhabitants from society. This absence of hope often made managing the inmates more challenging, as no other punishment could compare. S.P. Impey, who oversaw the South African colony on Robben Island (later known for housing Nelson Mandela), remarked in the 1890s: "You cannot starve them, and you cannot flog them; all you can do is deprive them of their liberty" [source: Edmond].

The Hawaiian leprosarium on the Kalaupapa Peninsula offered a slightly better environment. Natural barriers—a 2,000-foot (609-meter) cliff and the surrounding ocean—eliminated the need for walls or barbed wire. The fertile land provided abundant food, including sweet potatoes, fruit, and taro [source: NPS]. The Hawaiian government constructed hospitals, homes, and allowed religious leaders to assist the exiled residents [source: NPS].

Among the religious workers was Rev. Joseph De Veuster, a Roman Catholic priest from Belgium, who arrived in the early 1870s to aid the colony's 700 residents. Known as Father Damien, he worked tirelessly to improve their lives, planting trees, establishing schools, forming musical bands and choirs, and persistently advocating for more resources from the Hawaiian government. Due to his lack of attention to hygiene, Father Damien eventually contracted leprosy and passed away in 1889 at the age of 49. Over a century later, he was canonized as a saint by the Roman Catholic Church [source: NPS].

Despite these efforts, life in captivity and isolation was profoundly challenging for leprosy patients, some of whom were taken as young children. "They told me outright that I would die here, that I would never see my family again," recalled one man exiled at age 13. "I heard them say something I will never forget: 'This is your last place'" [source: NPS].

The End of Leprosaria

In the 1920s, the U.S. Public Health Service established a unique colony in Carville, Louisiana. Unlike traditional leprosaria, this facility focused on medical research, working with patients to find a cure. In 1941, scientists discovered Promin, a sulfone drug that offered the first effective treatment, though its painful injections made therapy difficult. By the 1950s, doctors introduced dapsone, an antibiotic that proved more effective, though resistance eventually developed. In the 1970s and 1980s, a combination of antibiotics in a multidrug therapy was developed, reducing treatment time to as little as six months [source: NIH].

As the threat of leprosy diminished, leprosaria began to disappear. Most were shut down by the 1960s. The Hawaiian leprosarium has been transformed into a national historical park, honoring the struggles of those once imprisoned there. Japan, among the last countries to enforce patient quarantine, ceased the practice in 1996 [source: BBC News]. The last remaining European colony, located in Tichilesti, Romania, reportedly houses only a handful of elderly residents [sources: BBC News, Leprosyheritage.com].

However, leprosaria have not entirely vanished. Some still exist in Africa and Asia, often in deplorable conditions. In India, an estimated 1,000 colonies remained in 2011, with around 10,000 people living in Kasturba Gram near New Delhi. Many were exiled by their families, even after being cured. Persistent stigma, fear, and insufficient funding hinder public health initiatives. Fear of exposure discourages many from seeking treatment, contributing to India's 58% share of global new leprosy cases [sources: George, Cookson and Rhodes].

In 2013, the World Health Organization reported 189,018 leprosy patients across approximately 115 countries and territories. India, Brazil, and Indonesia have the highest number of cases. Global and local health authorities continue their efforts to eradicate the disease.