How Leper Colonies (Leprosaria) Work

Leprosy is caused by a tiny rod-shaped microbe called Mycobacterium leprae. Scientists aren't exactly sure how it is transmitted, but they think it probably spreads when an infected person breathes out or sneezes and releases moist droplets carrying the microbe, or else when a cut in his or her skin is touched by someone [source: NIH].

It may take as long as 20 years for symptoms to appear. But once they do, leprosy attacks the peripheral nerves, skin, upper respiratory tract, eyes and mucus membranes of the nose. A person with leprosy may lose sensation in his or her skin, and experience muscle weakness. Those problems, in turn, can cause the patient to suffer traumatic injuries and eventually lose the use of the hands and feet. Sometimes a patient injures himself and doesn't even know it, as he has no feeling in his hand or foot. As a result, gangrene might set in and amputation of the limb might follow [source: NIH].

Leprosy is spread by prolonged close contact with an infected person, but it isn't that contagious. The bacterium can't live outside a host body for very long. And even if a person is exposed to it, chances are that he or she won't become infected, since about 95 percent of humans are naturally immune to it. And today, it can be successfully treated with common antibiotic drugs [source: HRSA].

But throughout most of history, people only saw a horrible, disfiguring disease that no one knew how to prevent or remedy. Scientists believe that the disease originated in Africa, and may have spread to the Middle East about 3000 B.C.E. [source: Robbins et al.]. It's mentioned in the Old Testament book of Leviticus (chapter 13), which instructs the Hebrews to isolate anyone with a suspicious sore and watch to see whether it spread. If so, a priest would pronounce the person unclean and order that "his dwelling should be outside the camp" [source: New King James Version].

That pattern of shunning leprosy patients continued for many centuries. In medieval Europe, they were forced to wear special clothes and to ring bells to warn others when they passed by [source: NIH]. They had to live in "leper-houses" or hospitals such as one on the outskirts of London that was founded by Queen Matilda in 1118, though they were still allowed to enter the city to beg for alms. Some of these leprosaria were quite well run, with acres of farmland and generous endowments by wealthy landowners [source: Rawcliffe]. But of course, there was no cure.

In 19th-century America, leprosy remained such a taboo that many cities passed "ugly laws" such as Chicago's 1881 ordinance, which ordered "any person who is diseased, deformed, so as to be an unsightly or disgusting object" to stay out of the streets and public places [source: Amundson and Ruddle-Miyamoto].

But sometimes, an even more cruel solution was imposed. Though leprosy patients had been forced to live apart from uninfected people for centuries, during the late 19th century, there was a movement to isolate them even more, by exiling them to remote locales. One reason for this was that as European countries began to seize more territory in Asia and Africa to establish colonies, the new rulers decided that there were too many native people with leprosy to manage [source: Edmond]. In addition, doctors were still confused about the cause of leprosy -- some thought it was hereditary, while others believed it was highly contagious [source: Edmond and Smith].

In other places such as Hawaii, which was still an independent monarchy, government officials simply decided that they didn't want to take any chances after an 1850s epidemic [source: Associated Press]. In 1865, Hawaii enacted the Act to Prevent the Spread of Leprosy, which made patients criminals and sentenced them to permanent exile [source: Amundson and Ruddle-Miyamoto].

As a result, officials began to set up separate colonies, to which leprosy patients could be removed and detained for the rest of their lives. Some were set up inland, in sparsely inhabited areas away from cities, while others were located on offshore islands. There were island leprosaria in the Caribbean, in the Indian Ocean, along the coast of South Africa and in the Pacific.

Those colonies became home to a strange disease-centric subculture that was varying parts prison and monastery. We'll talk about that in the next section.

In some countries, leprosaria were essentially fortified prisons -- but worse, because in the latter, inmates sometimes are allowed contact with people from the outside world, and even for those with long sentences, there was always the hope that they'd someday be released.

Leprosaria, in contrast, aimed to sever any connection with the outside world. That lack of hope could make the inmates more difficult to deal with, because after that, any other punishment paled in comparison. S.P. Impey, superintendent of the South African colony on Robben Island (later famous as Nelson Mandela's prison) noted 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 in Hawaii, in contrast, was a little more pleasant. It didn't need any walls or barbed wire. It was cut off from the rest of the island of Molakai by a sheer cliff about 2,000 feet (609 meters) high, and otherwise was surrounded by the ocean. In addition, the land around the colony was fertile and provided an ample supply of nourishing food -- sweet potatoes, fruit and a local vegetable called taro [source: NPS]. The Hawaiian government built a hospital and houses for the exiles to live in, and allowed clergy from various denominations to go to the colony to help them [source: NPS].

One of those religious workers was a Belgian-born Roman Catholic priest, Rev. Joseph De Veuster, who arrived in the early 1870s to assist the colony's 700 inhabitants. Father Damien, as he became known, did his best to make life there more bearable. He planted trees, organized schools, musical bands and choirs, and continually badgered the Hawaiian government for more resources for the exiles. Because he wasn't particularly careful about hygiene, Father Damien eventually became a leprosy patient himself and died in 1889 at age 49. One hundred and twenty years later, he was canonized as a saint by the Roman Catholic Church [source: NPS].

But even with those efforts, living in captivity and isolation was incredibly hard for people with leprosy -- some of whom had been snatched up by officials as young children. "They told me right out that I would die here, that I would never see my family again," recalled one man, who was exiled at age 13. "I heard them say this thing that I will never forget. They said, 'This is your last place'" [source: NPS].

Starting in the 1920s, the U.S. Public Health Service established a colony of a different sort at Carville, Louisiana. Instead of merely housing patients in isolation, medical researchers worked with them in an effort to find a way to treat the disease. In 1941, scientists discovered a sulfone drug called Promin that provided the first-ever cure for leprosy, but it required painful injections that made treatment an ordeal. In the 1950s, doctors found an antibiotic, dapsone, which worked better, though the bacterium eventually developed a resistance to it. Finally, in the 1970s and 1980s, they began combining the antibiotic with other drugs in a chemical cocktail, and developed a regimen that could cure leprosy in as little as six months [source: NIH].

As leprosy's threat began to subside, colonies themselves started to vanish. Most closed in the 1960s. The Hawaiian leprosarium is now a national historical park that commemorates the ordeal of the people who once were confined there. Japan, one of the last nations to quarantine leprosy patients, finally ended the practice in 1996 [source: BBC News]. Perhaps the last remaining colony in Europe is in Tichilesti, Romania, where reportedly only a few elderly patients remain [sources: BBC News, Leprosyheritage.com].

But leprosaria have not completely disappeared. There are still some in Africa and Asia, often in poor conditions. In India, it was estimated in 2011 that there were 1,000 of them. About 10,000 people live in a colony in Kasturba Gram, near New Delhi. Most were banished there by family members, even after they were cured. Lack of funding, stubborn fears and the stigma of the disease hinder public health efforts. Because victims often are reluctant to seek treatment for fear of being found out, India accounts for 58 percent of the world's new leprosy cases [sources: George, Cookson and Rhodes].

In 2013, the World Health Organization reported that there were still 189,018 leprosy patients in about 115 different countries and territories. The three countries with the most patients are India, Brazil and Indonesia. International and local officials continue their efforts to wipe out the disease.