The Public Health Service Leprosy Investigation Station on Molokai, Hawaii, 1909-13-an Opportunity Lost JERROLD M. MICHAEL LEPROSY HAS BEEN DESCRIBED in its inhabitants are no longer under various writings since ancient times. 14- quarantine. Nearly 2,000 years ago, Chinese ob- Walter Wyman, who served as servers discussed clinical states that .I Surgeon General of the Public fit the picture of lepromatous lep- Health and Marine-Hospital Serv- rosy so precisely that they could ice from 1891 to 1911, determined scarcely have been describing any to make a concerted and scientific other condition. Other ancient writ- attack on leprosy. He commissioned ings from the Far East would con- three highly competent Public firm the fact that leprosy has al- Health Service medical officers, Dr. ways been endemic to that part of Joseph H. White, Dr. George T. the world. Vaughan, and Dr. Milton J. Questions arise, however, as to Rosenau to make the first nation- the extent of leprosy in the Middle wide study of its prevalence in 1901 East in biblical times. Although it (1). A total of 278 known cases of is entirely possible that sporadically leprosy were tallied. Only 72 of the persons with leprosy migrated there patients were isolated. At that same from Africa, archeological studies time, more than 850 cases existed would suggest that the leprosy of in the Territory of Hawaii. Leviticus encompassed a horde of As evidence of the persistence of rather mundane conditions such as the social stigma that has compli- fungal infections, psoriasis, and Surgeon General Walter Wyman cated control of the disease until acne. today, the medical officers reported During the Middle Ages, Europe origin is uncertain, but it is gen- that there was an inclination on was ravaged by an epidemic of erally believed that the disease be- the part of the patient as well as leprosy that lasted for several cen- gan its spread from infected the patient's family and friends to turies. It ultimately died out except Chinese laborers imported to work conceal the affliction. for small endemic foci in Spain, on the planatations. Because of a The report highlighted a high Portugal, and Greece which persist high degree of susceptibility among incidence of leprosy among immi- to this day. the people of Hawaii, an epidemic grants to Minnesota from Sweden Leprosy was introduced to developed which finally resulted in and Norway. Dr. Gerhard A. Hawaii about 140 years ago. Its a decree by King Kamehameha V Hansen of Norway, who had dis- that called for the isolation of all covered Mycobacterium leprae 25 Professor Michael, a former Assistant victims of the disease. An inaccessi- years previously-giving the old Surgeon General of the Public Health ble peninsula jutting out from the malady the new name of Hansen's Service, is Dean and Professor of Public as Health, University of Hawaii School of north side of the island of Molokai disease-was quoted urging legal Public Health. Tearsheet requests to was selected, and the first patients isolation as the best means of keep- Prof. Jerrold M. Michael, University of were sent there in 1866. A settle- ing the disease from spreading. This Hawaii School of Public Health, 1960 was to have East-West Road, Honolulu, Hawaii ment for leprosy patients still exists comment far-reaching 96822. on the Kalaupapa Peninsula, but effects on the treatment of patients. May-June 1980, Vol. 95, No. 3 203 Dr. Leland Cofer, officer in charge of Pharmacist Frank Gibson (left) and Dr. Walter R. Brinckerhoff, the director, the Honolulu Quarantine Station planning the Leprosy Investigation Station Louisiana for 6 years had main- Hawaii Territorial Board of Health, went to Hawaii in June 1905 to tained a leprosarium in Iberville Dr. Charles Cooper, set out a pro- choose the site. An account of his Parish, at Carville, and had on its posal to assist in handling the care visit there is contained in Dr. statute books a law requiring the of 856 lepers in a population of Cofer's handwritten Quarantine commitment of lepers there. Re- 154,000 in the Hawaiian Islands. Station Log. search at that facility was later to He obtained the support of Gov- The Surgeon General arrived in have dramatic implications for lep- ernor E. Carter and the Congres- Honolulu June 7, 1905, took up rosy treatment. sional Delegate, Hawaiian Prince headquarters at the Alexander At about the same time that he Kuhio Kalanianaole, to request Young Hotel, and called on the commissioned a report on leprosy support for a facility to study the Territorial Governor. Arrangements in the United States, Surgeon Gen- cause and cure of leprosy. were made for the Wilder Com- eral Wyman sent Dr. D. A. Car- President Theodore Roosevelt, in pany's steamer, Likelike, to take his michael to the Hawaiian Islands his Message to Congress on Novem- party to Molokai on June 9, and to make a complete report on lep- ber 4, 1904, recommended that a return to Honolulu on June 11. rosy there. Dr. Carmichael de- hospital and laboratory be con- According to Dr. Cofer's log scribed how this disease, imported structed in the Hawaiian Islands (2): into Hawaii, had spread through for the study of leprosy. Congress This trip is the official beginning of the islands, crippling and killing on March 3, 1905, passed a law the scientific study of leprosy by the the susceptible islanders. He re- appropriating $100,000 for con- United States, through Surgeon Gen- ported on the 1865 law which de- struction of these facilities and eral Wyman and his Corps, the U.S. creed that those with incurable $50,000 for their maintenance dur- Public Health and Marine Hospital cases must be segregated and how ing the first year. Service. It marks a new era in the this was done on a particularly Dr. Cofer followed up on the medical history of leprosy, and will isolated small peninsula of Molokai. congressional action and was soon become a part of the important history of the United States. His successor, Dr. Leland E. Cofer, able to advise the Surgeon General the Honolulu Quarantine Officer, that the Hawaiian Legislature The Surgeon General's party in- described the scenically beautiful agreed to give the Public Health cluded Congressman W. P. Hep- colony that had grown up on a and Marine-Hospital Service 1 burn of Iowa; Dr. Cofer, who had spit of land jutting out into the sea square mile of its leprosy reserva- been instrumental in getting the bill below the high, steep cliffs of tion on Molokai for the construc- for the leprosy investigation station Molokai. tion of the Federal investigation passed; Governor Carter; W. 0. In 1904, the President of the station. Surgeon General Wyman Smith of Honolulu; R. E. Pinkham, 204 Public Health Reports President of the Territorial Board of Health; four surveyors; and a number of military officials. The leprosy patients got out their brass band to greet the Surgeon General at the early hour of 7:30 a.m. Saturday, June 10. Then Dr. Wyman traveled the length and width of the Molokai colony. On its western shore close to the cliffs lay the town of Kalaupapa, with white cottages and churches surrounded by stone or lava fences. The yards were planted with tropical fruits and flowers. On the eastern shore was the village of Kalawao, exposed to the full force of the usually pre- Pr.,{ ^;,w-, -1_* ---_------ vailing trade winds, but with a wild, weird beauty of its own. Surgeon General Walter Wyman with Brother Joseph Dutton, who had cared for the dying Father Damien, at Father Damien's tomb He selected a site at Kalawao, close to the foot of the cliffs. In and the Bishop Home for leper girls teristic of his nature. Next to myself, describing this site in his journal, were visited. he is the most modest man I know Cofer noted that it was "to the Surgeon General Wyman and of-(laughter)-and when he at- me credit east of the Baldwin Home and party all mountain climbed to the tempts to give for carry- ing out this idea, it is simply because the Romanish church but removed summit of the extinct volcano Kauhako, and from this point, the of his kindness. I have known the about 50 feet more or less from whole peninsula was viewed and the doctor a long time. I have been per- these places" (2). relation of the selected site to the mitted to preside over the committee The famed missionary Father surrounding country noted. on interstate and foreign commerce Damien had added a wing to this After a day of much activity and for about 10 years. It is the com- which has the incentive with after he came to Molokai thoughtful work, the party boarded mittee church and re- reference to all matters appertaining 1873. He was buried there in the Likelike at 5:30 p.m. in turned to Honolulu, arriving at to his bureau. I might say here that 1889, having died of leprosy which 10:20 p.m. the General never came to us with he had developed years earlier after any proposition, personal to himself, ministering to the patients in the On June 12, a banquet was held his rank or his pay, all of that he colony. Later his body was re- for the visiting dignitaries. Con- has left to others. The subjects that moved to his native Belgium. (The gressman Hepburn arrived late be- have engaged his attention have been church is still standing today.) cause he and his wife were enjoying for the public weal.