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.