1. Introduction

This is a study of the treatment of the people who were exiled as criminals to an peninsula on the island of Moloka'i for the crime of leprosy during the second half of the nineteenth century. The peninsula was then named Makanalua, but has been renamed Kalaupapa, after the community that became the center of life for the exiles and their companions. The study is motivated by two factors. One is a desire on the part of the authors to explore the complex intersection of race, disease, and impairment. The other is the authors' discovery that they were sitting on top of an archive of information relating to the episode, one of the truly dramatic examples of persecution based on such an intersection: the 1865 Act to Prevent the Spread of Leprosy of the nation of Hawaii. This Act made criminals of people who had leprosy (Hansen's Disease), and sentenced them to permanent exile, isolated from their homes, families, and community.

The racial nature of this episode derives from the complex politics of Hawaii during this period. It was a constitutional monarchy, ruled by a succession of hereditary monarchs of Polynesian ancestry. In 1893 a group of Europeans and Americans (and Hawaiian-born offspring of American missionaries) arranged a rebellion, with the illegal assistance (by U.S. law) of Marines from a United States warship in the Honolulu harbor. The monarch was overthrown and a provisional government formed. Hawaii was annexed by the United States in 1898, an arrangement that greatly benefited the business interests of the Western 'revolutionaries' as well as the expansionist interests of the United States.

The 1893 'revolution' was the culmination of a gradual growth of Western influence over the government of the monarchy. In 1865 the Board of Health was already dominated by Westerners; medicine was a Western invention. But nearly everyone convicted (diagnosed) of the crime of leprosy was a native Hawaiian — 97% of the exiles during the first 20 years (Woods 1887, 7). This disparity — set in the context of nineteenth-century Western concepts of the nature of 'race'1 — provides the racial vector of the episode.

The racial implementation of the Hawaii leprosy law has been examined by many recent scholars, most of them from a strongly anti-racist perspective (with which we of course agree). We will briefly review that research. However, we will show that the episode has a third vector, the stigma of impairment. The concept of stigma is central to Disability Studies. It designates the social discredit experienced by people who fail to conform to social expectations. The central stigma in our study attaches to leprosy itself, which can produce physical impairments such as paralysis and the loss of sight or vision, but also (and perhaps more importantly) cosmetic impairments which are customarily described as "loathsome." The strength of this stigma is almost unique in the history of Western medicine. Stigmas do not attach directly to physical symptoms, but to the symptoms in their context. Sores on the skin may bear stigmas of their own, but when caused by leprosy bear a much greater stigma. Unlike (say) cold sores, or blisters from a weekend hiking trip, they are loathsome signs of physical and moral filth. Quite in keeping with the high degree of stigmatization of leprosy, the expression 'leper' has become a sort of emblem of any highly stigmatized person. The epithet is every bit as degrading to its targets as the most vicious of racial slurs. Millions of people still live with the disease and its consequences, and they are seriously harmed by the continued use of the slur. We will use the expression only in direct quotations. We strongly condemn the academic argument that the term 'leper' is useful in conveying social context. This is no more true for this physical slur than it is for racial slurs. No modern author would use racial slurs to refer to African Americans in the 1880s merely because European Americans used the slurs at that time. Nevertheless, the great majority of recent anti-racist commentators on the Moloka'i phenomenon continue to use the term 'leper' to refer to people who had, and have, the disease. This is an oppressive practice that must stop.2

Historical research involves surprising complications. It would be easier if modern concepts matched the concepts of the period being studied. This is not true, as one recent study reveals. Douglas Baynton has shown that concepts of race and sex that were prevalent in the early 20th century presupposed that the stigmatized groups (women, ethnic or "racial" minorities) were literally disabled, in the sense that they were functionally impaired when compared to white men (Baynton 2001). The concept of race was conflated with certain kinds of disability; the concept of non-white race as distinct from disability did not exist for most nineteenth century thinkers.

A second conceptual conflation involves the modern distinction between biological and cultural traits. We see these as nature versus nurture; nature is carried by biological heredity, while nurture is acquired from one's cultural environment. It is surprising to learn that this very distinction was an achievement of 20th century anti-racist activism. During the period of our study, most experts believed that cultural traits were just as heritable, and just as racially fixed, as skin color and hair texture. "The men of each race possess an indestructible stock of ideas, traditions, sentiments, modes of thought, an unconscious inheritance from their ancestors, upon which argument has no effect" (Stocking 1994, 5, quoted from an 1895 talk by the prominent psychologist G. Stanley Hall).

Lamarckian views of heredity were prevalent at the time. According to such theories, social customs quickly become hereditary, and therefore racial (Stocking 1994; Barkan 1992). So both impairment and culture were conceptually tangled with the concept of race during the nineteenth and early twentieth centuries. We will examine the nature of these intersections.

2. Leprosy

Leprosy (Hansen's disease) is uniquely stigmatized. It is not the disease called Tzaraath in Leviticus, but it has been identified as such at least since the Middle Ages. The traditional European attitude towards people who were believed to have the disease was similar to those commanded in Leviticus. Shun them and separate them from the community; regard them as unclean and "loathsome" both physically and spiritually. In Europe in the Middle Ages people diagnosed with leprosy were pronounced "civilly dead," and were not allowed to own property or to bequeath it. Thousands of leprosaria were built across the continent. These institutions segregated the population of people who had (or were suspected or accused of having) the condition. When a culture was discovered in which leprosy is known but not stigmatized, this rare fact is remarked upon by anthropologists (Shiloh 1965; Gussow and Tracy 1970; Bloombaum and Gugelyk 1979; Shankar 2007).

During the period we are studying, sensationalistic descriptions of the symptoms of leprosy appeared regularly in popular and academic journals. The most dramatic were cosmetic effects — a "leonine" (lion-like) appearance of the face because of the loosening of skin and softening of the nose cartilage, sores and scales on the skin, and the degeneration of the extremities due to neurological loss. Gradual sensory loss often occurs from infection of the nerves, which can also lead to the loss of muscular control over the extremities. Insensitivity can lead to infection of unnoticed injuries; loss of the blink reflex in the eyes can lead to blindness. Hearing loss and a hoarse voice are frequent. The shortening of fingers and toes led to the myth that they had "dropped off" — an error that is repeated by many physicians. The most serious effects, prior to antibiotics, were secondary to unnoticed injuries which become infected. Insensitivity in one's foot led to persistant small injuries, which led to gangrene, which led to amputation. However, patients who received conscientious care could live long lives with leprosy. But who will conscientiously care for an outcast? Speaking about leprosy in Africa in populations that apparently did not have access to antibiotics, Ailon Shiloh states that leprosy "may cripple, but it is seldom fatal" (Shiloh 1965, 141). This was certainly not so at the exile settlement on Moloka'i. By our calculations, the mortality rate was between 11% and 23% per year, averaging 15% between 1865 and 1897 (based on data from the Hawaii Board of Health as reported in Inglis 2004, 233). Of course leprosy was only a contributing factor in these deaths. The wretched living condition was more to blame than the bacillus.

Antibiotic treatments for the condition began in the 1930s. With modern treatment there is no reason to quarantine leprosy patients. Treatment blocks transmission of the infection. Susan Sontag discussed the situations in which a disease tended to become highly stigmatized: when it was intractable (no known cure) and capricious (no known cause, Sontag 1989). Leprosy fit this pattern well during the nineteenth century, and it was treated as if it did for many years thereafter. Today's knowledge of the causes of leprosy is, strictly speaking, irrelevant to our story. However, the reader may as well know that even though the pathogen has been identified (Mycobacterium leprae) we still do not know how the infection is passed. The bacterium has never been cultured in vitro. It is customarily said that about 95% of the world's population is genetically immune to leprosy. Even in susceptible individuals the incubation period is highly variable, up to thirty years. So it is understandable that opinions about causation were divided in the nineteenth century. Leprosy was thought to be contagious, or perhaps hereditary, or perhaps caused by lack of sanitation, or perhaps by dietary deficiencies (Pandya 1998). Advocates of each theory could cite facts in their favor, but none (not even the discovery of the bacillus in 1873) was conclusive. Whatever one's theory regarding causation, blame could easily be placed on the individual who had the disease. That's how stigma works. Patients were said to have engaged in immoral behavior, or their parents did, or they had unclean personal habits, or ate bad food (typically raw fish).

Sontag and others (such as Watts 1997) have shown how theories of disease causation not only tended to blame the patient for having the disease, but also blended together the physical and the moral reasons for blame. Immoral (i.e. sexual) behavior is tantamount to physically unclean behavior (e.g. living in slovenly circumstances). Even the strictly medical literature of the period shows that moral and physical "uncleanliness" were strongly associated when the topic was leprosy. A person with the disease was "unclean" in every possible sense. When a person was examined for leprosy by a physician, the possible outcomes were "a leper," "a suspect" (when the diagnosis was uncertain) or "clean." Note the categorical contrast between "a leper" and "clean." This indicates the extreme bigotry embedded in that concept (and the social irresponsibility of authors who continue to use the slur on the excuse that it conveys "social context").

From a purely (modern) medical point of view, symptoms of untreated leprosy will fit into one of two categories, although a number of patients are "mixed" in that they exhibit both sets of symptoms. The neurological (sometimes anaesthetic) form affects the nerves. It results in loss of sensation in patches of the skin, and the deformation and shortening of the extremities. It is almost completely non-contagious, and is experienced by people who have partial but not complete immunity to the infection. Nevertheless, people who had this form of the disease were treated just as badly as those that had more infectious forms. The more infectious form of the disease is called lepromatous or tubercular, producing lesions on the skin and the leonine facial appearance. This is the form taken in people who have a lower degree of immunity. It is contagious, but very weakly.

3. 'Ohana, 'aina, and kokua

The native Hawaiian response to the disease of leprosy and the exile law can only be understood in the context of traditional Hawaiian culture. According to Hawaiian mythology, the people are directly linked by their ancestry to the land and to the gods. The first human was born of gods, the sky father and earth mother. The taro plant, the staple crop of Hawaiians, represented a stillborn elder brother who continues to nourish the people. This mythology expresses relationships among land and family that were, and are, very real among cultural Hawaiians. "The fundamental unit in the social organization ... was the dispersed community of 'ohana, or relatives by blood, marriage and adoption ... tied by ancestry, birth and sentiment to a particular locality which was termed the 'aina" (Handy and Pukui 1972, 2). Individuals depended on their 'ohana for all kinds of support, for food when food was scarce, for protection in times of danger, for care when one was ill. No matter the circumstances, when a person was in need their 'ohana would kokua, or help out, pulling together to provide for those who could not provide for themselves.

A person who is separated from his or her ohana must face challenges on their own, with no expectation of support. Such a person was cut off from the rest of Creation, with no link to the land, no link to the gods. Traditional Hawaiians conceived of their own personal identity as situated within their genealogy (their history), their 'ohana (their extended family), and its 'aina (its local geographical home). Without one's 'ohana and 'aina, one was without one's self. It's easy to imagine how horrible the sentence of exile for the crime of leprosy must have been to Hawaiians. One fact mitigated those horrors. It was that a kokua (a helper) would often accompany the exiled individual. The kokua was a member of the person's 'ohana, often a husband or wife. Survival would have been all but impossible during the early years of the Moloka'i settlement were it not for the kokuas.

4. Reactions to leprosy in Hawaii

Leprosy was first diagnosed in Hawaii in 1848. It was not, by far, the first disease introduced by European visitors. Several earlier epidemics had swept through the community. Smallpox, measles, syphilis, influenza, and a disease thought to be cholera each had devastating effects prior to the discovery of leprosy. When Captain Cook made the first European contact with the islands he estimated the population at 400,000, although later estimates go to 800,000 or more (Stannard 1989). The official census figures for native Hawaiians show the demographic tragedy that followed. In 1832 the native population was about 130,000. In 1850 it was about 84,000. In 1900 there were about 28,000 native Hawaiians and 8,000 part-Hawaiians. It is still not fully known what caused the tragic drop in population, but the effects of Western diseases on people who had no hereditary immunity was one important cause (as it was in many other colonized populations).

The native Hawaiian attitude towards leprosy differed from the Western reaction in two ways. One was the perceptual response. Hawaiians lacked the visceral reaction of Western people to the symptoms of leprosy, the reaction which led to the descriptions of the symptoms as loathsome, repulsive, indescribably horrible, and so on. A typical Western description was Clifford's: "The tubercular variety of leprosy is even more dreadful, and I must be excused from describing its later developments. Suffice it to say that the body is ..." (Clifford 1889, 145). Even after excusing himself from describing the horrors of tubercular leprosy, Clifford nevertheless spends about a page breathlessly detailing them. Such lurid descriptions of the "leprous" body were inserted in virtually all discussions of the disease. Hawaiians had no such perceptual response. To the surprise of Westerner observers, Hawaiians did not regard the symptoms of the disease as disgusting. Hawaiian non-disgust with the symptoms of leprosy was as surprising to Westerners as any other difference between the groups.

The second difference between the Hawaiian and Western response to leprosy was the social response. Westerners shunned and segregated those with leprosy. Hawaiians did not. Healthy members of an 'ohana would care for sick members, just as they always had. They had no reluctance to touch or to share food with people with the disease. This response fits nicely with the 'ohana tradition, and a modern observer would infer that it stemmed from that cultural tradition. But this is not how Westerners of the 19th century interpreted Hawaiian acceptance of people with leprosy. They believed that Hawaiians had different innate responses to perceptual stimuli (such as disease symptoms) from Westerners' innate responses. It would be an error to assume that Western disgust was caused by rational fears of contagion. They certainly did not consider it in this way. They considered it to be biologically innate; a "wholesome horror" in Woods's view (Woods 1887, 8). Moreover, the stigmatization of leprosy occurred in an atmosphere of medical ignorance and controversy about the cause of the disease. A contagion theorist, a heredity theorist, a nutrition theorist, or a sanitation theorist could each find ways justify segregation, and each did (Pandya 1998; Sato and Frantz 2005).3 Hawaiians did not.

Immediately after the passage of the 1865 Act, land was purchased on the Kalaupapa Peninsula on Moloka'i, an area that was accessible only by sea or by hazardous pathways down steep cliffs — a natural prison. Exiles were shipped there and dropped off with a few provisions. From 1865 to 1873 there was no medical service for those exiles, even though they had been exiled on medical grounds. From 1873 until the 1880s some slight medical service was provided by a new exile who had been employed as a physician's assistant in Honolulu. The policy of forced exile to a geographically isolated "colony" was not an expression of the traditional Western prejudice against leprosy. It was an innovation. "This practice in Hawaii of segregating lepers initated the modern use of isolated ... colonies, and by the end of the century Molokai became the Western model for controlling the disease worldwide" (Gussow 1989, 85). People had been shunned and ostracized in medieval Europe, but they were not torn from their families and transported to remote prison islands. Moloka'i was the first. The policy would have been brutal, no matter who it was inflicted upon. In a cruel irony, it was inflicted upon people whose core values were 'aina and 'ohana; one's birthplace and one's family. Inglis's writings emphasize the contrast between the exile law and the culture of native Hawaiians. "Significantly Hawaiians did not name the disease for what it did to their bodies but for what it did to their 'ohana': they called it mai ho'oka'awale, meaning the separating sickness" (Inglis 2004, 410, see also Gugelyk & Bloombaum 1996).

5. The stigma of non-disgust

According to Erving Goffman, a stigma is commonly associated with a stigma theory (Goffman 1963). The stigma theory is a conceptual apparatus that helps to justify and rationalize the stigma, and make it appear that its customary social manifestations (such as segregation) are objectively legitimate aspects of the natural world. From the perspective of philosophy of science, stigma theories are irrefutable in the sense explained by Karl Popper (Popper 1950). Any observed fact that might count as evidence against the theory is reinterpreted in such a way that it counts as an additional confirmation of the theory. For example, one might think that the Hawaiian attitude towards leprosy might be used as evidence that the symptoms of leprosy are not objectively loathsome after all — that loathsomeness is merely a social prejudice of Westerners. But no Westerner took this stance. Instead, the Hawaiian attitude was itself targeted as a second stigma. Hawaiian non-disgust with the symptoms of leprosy was judged to be an additional sign of (racial) degeneracy, not a sign of cultural compassion and charity. It was one of the racial traits which (together with other stigmatized traits such as indolence) was responsible for Hawaiians' high rate of leprosy.

This non-disgust was widely reported in the Western press:

The Hawaiians are the most amiable, good natured, social people on earth. Life without society to them is unbearable, and a crumb of bread or a dish of poi is not palatable unless they can share it with a friend. They are always visiting from island to island and congregating together, never excluding any on account of disease, however contagious or loathsome. They surround smallpox sufferers and kiss, embrace and sleep with lepers without any suspicion of results. (Hagan 1886, 88)

Many similar accounts of Hawaiian non-disgust were published (Bliss 1873, 92; Gibson 1873; Bishop 1888, 10; Woods 1887, 3; Musick 1898, 93; Anonymous 1894; Anonymous 1897-1998; Mouritz 1916, 10). Some claimed that Hawaiians were the only race on earth that did not have an instinctive disgust towards the symptoms of leprosy, that lacked the "wholesome horror" of leprosy.

The twin stigmas of leprosy itself and Hawaiian non-disgust towards leprosy are spectacularly displayed in a short story by Jack London. In "Ko'olau the Leper," London gives a fictionalized version of the violent resistance of a Hawaiian man who was diagnosed with leprosy but refused to comply with a (Western) sheriff's order that he be separated from his family and exiled to Moloka'i (London 1909). The story is doubly exploitative. First, the descriptions of the symptoms are lurid beyond any plea of artistic license. Second, the thrill of the story is magnified by the description of an orgy among those with the disease, with voyeuristic descriptions of the couplings of the loathsome body parts. In this way, London multiplies the 'loathsome' stigma by the non-disgust stigma. Not only are their bodies loathsome, but they are eager to have sex with others just like themselves! What could be worse (or more titillating)?

London's double stigmatization of Ko'olau was unusual in its sensationalism, but not in its multiplication of stigma. The fact that Hawaiians did not find leprosy loathsome was seen as an indication of their less-than-civilized status. A Westerner's gut reaction of disgust towards leprosy was innate and involuntary; the same was true of a Hawaiian's non-disgust. This belief is consistent with the racism of the period; cultural and biological traits were considered to be inherited in the same way.

The stigma of non-disgust was not a mere matter of reputation; it affected the medical treatment not only of leprosy patients but also the kokua who cared for them. Dr. A. A. Mouritz was physician to the settlement on Moloka'i from 1884 to 1887. He carried out medical experimentation on healthy kokuas — inoculating them with leprosy in an attempt to determine the causation of the disease. Despite his claim that the kokuas actually wanted to be infected (in order to get free rations), the evidence shows that he deceived them about the nature of his treatments. We will report in detail on this episode elsewhere, but we want to make one point about it here. Mouritz justified his actions by the non-disgust stigma; Hawaiians just don't mind if they get leprosy (Mouritz 1916, 59).

6. Race

Sheldon Watts's important book Epidemic and History: Disease, Power, and Imperialism traces the history of Western medicine as it was applied in the non-European world being colonized. The new field called tropical medicine ostensibly dealt with the diseases of natives of the colonized territories. But its real purpose was "to enable the white races to live in, or at the very least to exploit, all areas of the globe" (Watts 1997, xiii, see also ; Shankar 2007; Gussow 1989; Worboys 2001). The dominance of Westerners over the rest of the world was rationalized by a version of evolutionary theory according to which white Europeans were the higher and more 'evolved' race (Gould 1981; Drescher 1992). Westerners would inevitably (and justly?) dominate, because they would out-compete the non-white world. These views seemed to fit nicely with the demographic collapse of many populations after contact with Europeans; civilization simply did not suit them. The notion that indigenous groups should govern themselves was met with arguments that a) they were incompetent to do so, b) they didn't want to, and c) they would be better off if Westerners governed them:

The natives [of Hawaii] have proved themselves to be incapable of governing and unfitted for the condition of civilization, as is shown by their rapid decline in numbers and their inability to adapt themselves to changed conditions, and the importance of their supposed opinions on annexation has been greatly exaggerated. ... It is natural that the white man should become the governing power." (Shaw 1898, 332)

Several other epidemics had decimated Hawaii's native population. But Westerners reacted to leprosy differently than they did to other diseases. As Herman sees it, "treatment of leprosy served as a focal lens for policies and statements aimed at marginalizing Hawaiians physically, discursively, and politically" (Herman 2001, 320). The racial nature of the Hawaiian leprosy policy is most evident when it is compared to the policy of Norway during the same period. Norwegians with leprosy were not arrested, detained, or exiled. They were treated in local and regional hospitals, never far from family members. When quarantine was felt to be needed, it was provided without criminalization or imprisonment. According to Gussow, "...the approaches that evolved in Norway and Hawaii emerged as the two most important and also the most thoroughly contrasting models developed by Western nations [sic] in managing the disease" (Gussow 1989, 73-85). (Hawaii was a Polynesian monarchy, not a Western nation, until 1893 (Osorio 2002). However, the Board of Health was under Western control, so Gussow's mistake is understandable.)

What explains the dramatic contrast between Norway and Hawaii in the treatment of leprosy? The relationship between the policy makers and the patients. Norwegians with leprosy shared ethnicity with Norwegian policymakers. Not so in Hawaii. Westerners instigated the law and enforced it: native Hawaiian police officers would not send people to Moloka'i, so Western officers had to be called in to do the job. But native Hawaiians made up the population against whom it was enforced. It was frequently reported that wealthy Westerners could avoid exile by treatment from private physicians, or by simply leaving the islands (Tayman 2006, 119; Anonymous 1897-1998, 561). Hawaiians had no such choice. Even members of the royal family were subject to exile. The same disparity on a worldwide level explains the fact that the "Hawaiian model" of leprosy control was chosen over the "Norwegian model" at the first International Leprosy Congress in Berlin in 1897. Policymakers were Western colonial authorities, and the people with leprosy were primarily native citizens of colonized nations in Asia and Africa (Gussow 1989; Watts 1997).

So the intersection of race and disease is crucial to understanding the Moloka'i exile phenomenon and its expansion across the colonized world. Nevertheless, race and disease do not explain everything about the phenomenon. In particular, they do not explain why it is leprosy rather than one of the many other epidemics introduced by Western colonization that produced the extremes of prison islands. The answer is the special stigma that attaches to leprosy, a kind of stigma that is best understood from a Disability Studies perspective. The stigma associated with leprosy intersects with disease and the racial dynamics of colonialism to produce a unique violation of human rights. To the special stigma of leprosy we now turn.

8. Repulsion as a social cause

The stigmatized traits of the body — the loosened skin, softened nose bridge, blistered and misshapen hands and feet — explain why it was leprosy rather than tuberculosis, smallpox, syphilis, measles, or influenza that was chosen to be criminalized in Hawaii. The functional impairments that leprosy caused — the loss of vision and hearing, and functional impairments of the extremities — were well known, and surely contributed to the public fear. But the public discourse of the period indicates that the functional impairments were secondary to sheer "loathsomeness" as triggers of disgust. In today's world (roughly the post-World War II world) it is hard to comprehend the 19th and early 20th century attitudes towards aesthetic judgments of human ugliness or "loathsomeness." Social Darwinism combined with eugenics to give a certain privilege to the judgments of ugliness that one human group passed on another, especially when a member of a "higher" group judged a "lower." These judgments were regarded as legitimate and objectively valid. The ugliness that eugenic authors attributed to "lower" races reflected their status in the racial hierarchy. Photographs illustrating supposedly degenerate families, such as the notorious Kallikak family reported by the eugenicist H. H. Goddard, were retouched to give the individuals a darker, and therefore more sinister appearance. The racial implications of this association were obvious (Gould 1981, 171). Movies produced by the German SS in association with the Aktion T-4 euthanasia project (designed to kill "incurably" disabled people) paraded the most unusual-looking residents of German care homes before the audience in a context that clearly implied that people who look like this would be better off dead (Lifton 1986, 48; Gallagher 1990, 60). Similar entertainments appeared in America. The movie "The Black Stork" advocated the killing of disabled infants, displaying the ugliness of the victims and clearly associating disability with race (Pernick 1997; Pernick 2000).

During the 1930s the famous ethologist Konrad Lorenz adjusted his theories of innate releaser mechanisms to serve Nazi party goals in precisely this way. He argued that the supposedly-innate feelings of disgust that one race had for another were valuable in the natural world, keeping racial standards high and avoiding the "degeneration" that would follow from race mixing (Burkhardt 2005,). The possibility that these feelings of disgust were not biologically innate, but mere social indoctrination, was dismissed by Lorenz and the Nazi eugenicists, just as the idea that the symptoms of leprosy were only culturally 'loathsome' was dismissed by the Westerners who built the exile program in Hawaii.

It took years of struggle by the followers of Franz Boas and other cultural anthropologists before there was significant academic acceptance that such things as standards of beauty were culturally relative (Barkan 1992; Stocking 1994; Spiro 2002). The broader acceptance of cultural variation as morally legitimate required much more than academic argumentation — it required the recognition, after WWII, of the horrors that eugenics actually entailed. Prior to this recognition, those who were in power freely used beauty and ugliness as indications of high and low value as human beings.

When people of today look back at the facts surrounding the Moloka'i settlement, they usually think in terms of contagion and quarantine. But as we have seen, no one quite knew what caused leprosy in the mid-19th century. A minority of knowledgeable commentators have always recognized that ugliness itself, not contagion, was the cause of the social discredit of leprosy, and therefore of segregation and abuse. Watts cites the Alexandrian physician, Aretaeus of Cappadocia, writing in the first century CE,who did not attribute diseases to moral failures or punishments of the gods:

"However, he did point out that because of the physical disfigurement it caused, true leprosy frightened many people: 'for this reason there are those who would abandon their most cherished relatives in the desert and the mountains ... even if one's own son, father, or brother.'" (Watts 1997 46)

The discovery of Mycobacterium leprae proved at least some degree of contagion to leprosy, but those who were familiar with the disease knew that its contagiousness was very low. Did this lead to demands for throwing open the gates of the prisons? No. Even those who knew how very limited the threat of contagion from leprosy was nevertheless approved of the segregation of people who had the disease solely on the grounds of their ugliness!

"Apart from its limitedly contagious properties, the disfiguring repulsiveness of leprosy alone demands its segregation; its specific contagion, compared to that of Tuberbulosis [sic] is less than one-tenth of one per cent." (Mouritz 1916, p. 11)

"Consumption and cancer are contagious to perhaps a greater degree than leprosy, but their ravages do not disgust the mind through the eye as leprosy does. For this reason these classes of patients are not segregated, ... But leprosy is a repulsive disease, and isolation is suggested as a precautionary measure." (Anonymous 1894)

"In fact, in 1925, Rogers and Muir [influential British leprologists] claimed that contagion was never the reason for the age-old practice of isolating lepers; rather, that the 'terrible deformities of the face and extremities brought about by' leprosy exaggerated public opinion about how contagious the disease really was: 'the disease is probably but little, if at all, more infective than tuberculosis, though the serious facial disfigurement in the nodular form, and the crippling loss of fingers and toes in the litt-infective nerve variety, ultimately make the sufferers so repulsive, that in all historical ages, and in many parts of the world, compulsion has been used to destroy or isolate them ...'" (Gussow 1989, 218-219; citing Rogers and Muir 1925, 56, 101)

Notice that Mouritz and the NewYork Times editorial staff defend the segregation policy based on ugliness alone. The Times editorial staff does so with a lofty expression of bigotry, saying that leprosy "disgust[s] the mind through the eye." Rogers and Muir do not go quite this far, but they do claim that always and everywhere the ugliness has caused people to "destroy or isolate" others who have leprosy. These comments were written during the period when many American cities instituted what are now called the "ugly laws." One such law established in Chicago in 1881 stated that

"Any person who is diseased, maimed, mutilated, or in any way deformed, so as to be an unsightly or disgusting object, or an improper person to be allowed in or on the streets, highways, thoroughfares, or public places in this city, shall not therein or thereon expose himself to public view." (Burgdorf and Burgdorf 1974, 863)

The law was intended to control the practice of begging, which traditionally is associated with the supplicant exposing the physical evidence of his or her stigma (Staples 2003; Schweik forthcoming). When physical ugliness intersects with race and colonial interests, as it did in Hawaii in the second half of the 19th century, institutions like the Moloka'i settlement can result.

Legislatively speaking, the final chapter in the story of the Moloka'i settlement is the Hawaii legislature's retraction of the 1865 Law to Prevent the Spread of Leprosy. This happened not at the turn of the century, by which time it was known that contagion from leprosy was very low and certain identifiable cases were not at all contagious. Nor did it happen in the 1930s when sulfa drugs could make every patient non-contagious. It was 1969 before free-living people with leprosy in the state of Hawaii were not criminals, and could go about their business without fear of arrest and exile to the settlement on Moloka'i.

The outbreak of Leprosy affected native Hawaiians, both physiologically and socially, more than any other group in Hawaii. As Bayton has shown, disability was intrinsic to the Western concept of non-white race. This was no less true in Hawaii. This very fact shows that the well-studied intersection of race and disease will not adequately account for the health dynamics of colonized people. The intersection of race and disease does not result in exile laws, as was seen in many early epidemics in Hawaii. The exile laws resulted from the three-way intersection of race and disease with the special stigma of leprosy, its loathsomeness. The fact that Hawaiian eyes did not perceive that loathsomeness was taken as additional evidence of Hawaiians' lack of civilization, one more excuse for the Western suppression of Hawaiian self-determination. It was this collision — this convergence of concepts and circumstance in Hawaii which produced Kalaupapa.