In March 1888, Damien received a visit from Dr. Prince A. Morrow, a prominent New York dermatologist and syphilologist best known today as an early proponent of sex education.1 Morrow, then a fellow at the New York Academy of Medicine, had written the month before requesting an account of the progression of Hansen’s disease from Damien’s earliest symptoms through to its (at the time) inevitable conclusion. Damien, who was now so far along in his illness that he could no longer hold a pen, dictated the full account.2
Damien described the beginnings of the illness as an itching on the skin of his face and legs. Then, in the early 1880s, he began to experience a dull, throbbing pain in his left leg that eventually gave away to numbness. In the beginning of 1885, Damien accidentally scalded his foot with boiling water. He felt nothing. One of the earliest signs of Hansen’s disease is loss of sensation in the extremities, and Damien began to suspect the worst. Examination by doctors confirmed his suspicions: he had Hansen’s disease.3
It was a devastating diagnosis. Being diagnosed with Hansen’s disease in Hawaii during the 19th and early 20th centuries was akin to being charged with a crime. Those afflicted with Hansen’s disease were legally required to turn themselves over to state incarceration at the Molokai settlement, leaving behind their families, friends, property, and livelihoods. The government enforced occasional sweeps of the island to ferret out ill people who were unwilling to turn themselves in.4
It is now known that Hansen’s disease is not a particularly contagious bacterial infection. About 95% of the population is naturally immune to Mycobacterium leprae, and most of the remaining 5% experience a relatively mild version of Hansen’s disease called tuberculoid leprosy. A small number of infected individuals, including Damien, are not so lucky. Due to a combination of genetic susceptibility and long-term exposure, possibly exacerbated by poor sanitation, Damien contracted the most serious form of Hansen’s disease: lepromatous. If left untreated, lepromatous Hansen’s disease causes large, insensate skin lesions eventually leading to extreme disfiguration of the extremities and face; nerve damage; breakdown of muscle tissue; and death.5
As if the disease weren’t terrible enough, the isolation of Hansen’s disease patients produced even more anguish. A 1907 government pamphlet on the Molokai settlement remarks, “the separation which the disease causes in families and among friends, is its most distressing feature.”6 By blaming the disease for the “distressing” practice of incarcerating victims of Hansen’s disease, Hawaiian policymakers and medical leaders abdicated responsibility for their actions. It was not the disease that separated sufferers from their healthy families, it was the tight grip of social mores and the law.7
Of course, the law did not affect the Hawaiian population equally. Even at the time of the Molokai settlement’s peak population (just over 1, 200 Hansen’s disease patients), only a tiny percentage was white.8 This disparity was most likely due to lower levels of genetic resistance among indigenous Hawaiians, compounded by poverty, as well as poor access to clean water, sanitation, and professional medical services.9 At the time, however, the high rate of infection among the native Hawaiian population was used to prop up colonialist bias and moral judgment.
Leprosy has had a moral dimension for almost as long as it has existed as a human disease. Like many illnesses, leprosy was often seen as a sign of divine displeasure and sinfulness. Throughout medieval and early modern times, leprosy was connected in particular to sexual deviancy and was even thought to be a venereal disease linked to syphilis.10
While the medical field had largely discarded this theory by the end of the 19th century, the close association between sexual immorality and leprosy was still a widely held belief among the white population of Hawaii. Indigenous Hawaiians, with their freewheeling approach to sex, were clearly at fault for their own sickness. Even Damien drew the connection: “It is an admitted fact,” he wrote, “that the great majority, if not the total number of all pure natives, have the syphilitic blood, very well developed in their system…as we are now, it developed it self [sic] in some instance in the way of what we called leprosy.”11
Damien was a man of his time, as this unflattering quote proves, but he was an extraordinary one. Others bemoaned the sorry state of leprous Hawaiians from a safe distance. Dr. Morrow’s interest in the Molokai settlement, for example, extended only as far as his scientific curiosity.12 But when someone asked Damien if he wanted to be cured of his leprosy, his answer was no: not if the price of the cure was abandoning Molokai and his work among his fellow sufferers.13 It was this very flawed, very human bravery—what some called recklessness—that made Damien a popular saint and martyr long before his canonization.
In previous posts, we have seen Damien through the eyes of his most vocal critics and poetic admirers, religious authorities, and now medical experts. He was a man who attracted the words of others, through his work, his circumstances, and his personality. But of himself, Damien typically had little to say. “As for me,” he wrote to his older brother during his 11th year as pastor of the Molokai settlement, “I am still almost the same, except for my beard which is beginning to turn a little grey.”14
1. For a full discussion of Morrow’s contribution to the early sex education movement in the United States, see Bryan Strong, “Ideas of the Early Sex Education Movement in America, 1890-1920,” History of Education Quarterly, 12 (1972): 129-61.
2.Gavan Daws, Holy Man: Father Damien of Molokai (New York: Harper & Row, 1973), 226-227.
3.Daws, Holy Man, 160-163.
4. Daws, Holy Man, 142-150.
5. Warwick J. Britton, “Leprosy,” Encyclopedia of Life Sciences, online ed. (John Wiley & Sons, Ltd., 2002), 1.
6. Hawaii Board of Health, The Molokai Settlement, Territory of Hawaii: Villages Kalaupapa and Kalawao (Honolulu, issued by the Board of Health of the Territory of Hawaii, 1907), 3. Emphasis added.
7. While segregation of Hansen’s disease patients has long been considered unnecessary and unethical, particularly with the development of effective antibiotic treatment, recent studies suggest that segregation may never have been a successful method for reducing the incidence of Hansen’s disease. New research has shown that the bacteria responsible for Hansen’s disease can survive for long periods of time inside amoebae that are commonly found in standing water and soil. This may explain why leprosy incidence in the Hawaiian Islands only began to decrease in the 1910s, when improvements in quality of life and sanitation began to trickle down to the wider Hawaiian population. See William H. Wheat, Amy L. Casali, Vincent Thomas et al. “Long-term Survival and Virulence of Mycobacterium leprae in Amoebal Cysts,” PL0S Neglected Tropical Diseases, Vol. 8, No. 12 (2014).
8. Daws, Holy Man, 250.
9. In addition, white sufferers of Hansen’s disease had greater mobility and often left the Hawaiian Islands to seek treatment in the U.S. or abroad. One government doctor even proposed setting up an official fund to pay the fares of diseased white men to leave Hawaii. Daws, Holy Man, 148.
10. Saul Nathanial Brody, The Disease of the Soul: Leprosy in Medieval Literature (Ithaca: Cornel University Press, 1974), 41; 60-61. See also Luke Demaitre, Leprosy in Premodern Medicine: A Malady of the Whole Body (Baltimore: Johns Hopkins University Press, 2007), 209.
11. Daws, 148-149.
12. Dr. Morrow ultimately advocated against the U.S. annexation of Hawaii from a sanitation perspective. See Prince A. Morrow, “Leprosy and Hawaiian Annexation,” The North American Review, Vol. 165, No. 49d2 (Nov. 1897).
13. Daws, Holy Man, 216.
14. Daws, Holy Man, 137.