Erving Goffman, possibly the twentieth century's most influential sociologist, begins his 1963 text Stigma: Notes on the Management of Spoiled Identity by offering a succinct etymology of his title:

The Greeks, who were apparently strong on visual aids, originated the term stigma to refer to bodily signs designed to expose something unusual and bad about the moral status of the signifier. The signs were cut or burnt into the body and advertised that the bearer was a slave, a criminal, or a traitor—a blemished person, ritually polluted, to be avoided, especially in public places. Later, in Christian times, two layers of metaphor were added to the term: the first referred to bodily signs of holy grace that took the form of eruptive blossoms on the skin; the second, a medical allusion to this religious illusion, referred to bodily signs of physical disorder. (1)

Drawing a parallel with the classical sense of the term, Goffman then defines the modern "stigma" as a physical or psychological attribute that marks a discrepancy between an individual's behavior, status, or appearance and the expectations for his or her identity among members of a larger social group (1). In the chapters that follow, Goffman uses personal testimony from various individuals to track the ways in which stigmatized persons manage their public identities through modes familiar to disability scholars, such as concealment and passing. 1 Little remains in Goffman's account of the early Christian sense of the word that he begins by acknowledging, in which stigmata, such as the markings on St. Francis of Assisi's palms, were viewed as signs of divine favor. And so, not surprisingly, references to the Middle Ages surface in the text's testimonials, which link physical disability and sin, presumed to be the dominant view of disability in the medieval period. 2 This tendency to view certain illnesses and disabilities in "medieval" terms is, therefore, also a tendency to see disability as a consequence or indication of personal or moral failings. Despite his promising beginning, in other words, Goffman's evidence is predicated on a view of the Middle Ages that is reductive and has given way to modern prejudices no less primitive than the medievalist perspectives from which they emerge.

In one of a handful of allusions to the Middle Ages in Stigma, Goffman quotes an individual with cerebral palsy, who recalls, "It was after college, business school, and innumerable stretches as a volunteer worker on community projects that I was often bogged down by the medieval prejudices and superstitions of the business world. Looking for a job was like standing before a firing squad. Employers were shocked that I had the gall to apply for a job" (34, emphasis mine). Even in the 1960s, before the Americans with Disabilities Act, the speaker is shocked by "the medieval prejudices" of the business community. The "medieval" ritual of finding a job while disabled is juxtaposed with standing before a firing squad, possibly a more timely image, considering that World War II had ended just a few decades earlier. Nevertheless, the juxtaposition suggests that the speaker's superiors in the business world perceive his disability as a moral offense for which he should be excluded from daily life, or worse. Such an anecdote begins to explain why Goffman appropriates a term so loaded with classical and medieval connotations to describe modern phenomena such as job discrimination in the workplace: it implies that modern attitudes toward disability are so unenlightened as to be "medieval" in the most stereotypical sense. 3

Statements about the "medieval" nature of disability stigma are particularly common in the case of leprosy, or Hansen's disease in modern, clinical terms. (A note on terms: although Hansen's disease is the preferred term among activists and advocates alike, in this essay, I employ the term "leprosy" to connote both the disease's historical stigma and its metaphorical associations, because it is so often used this way in my examples.) Possibly appearing as early as 600 BC, this disease is a chronic condition caused by a bacterial infection that affects the peripheral nerves as well as the skin and other tissues. 4 Because of the disease's long incubation period, the disease's symptoms, which include the appearance of skin lesions, loss of feeling in the limbs, and the distortion of facial features, may take up to a decade to manifest. 5 Since Armauer Hansen did not discover the leprosy bacillus, Mycobacterium leprae, until 1873, it is difficult to say whether all the diagnoses of leprosy documented in the Middle Ages were, in fact, cases of infection with Mycobacterium leprae. Yet regardless of whether or not so-called "convicted lepers" were actually suffering from the disease, there is no doubt that being shown to have leprosy, based primarily on the diagnostic criteria put forth in Guy de Chauliac's 1363 La grande chirurgie, had a stigmatizing effect on the life of the individual (Watts 57). 6 As soon as they were accused of leprosy, these men and women entered into a legally-binding social contract with the healthy members of the community, which required the kinds of interpersonal performances that would later form the basis of Goffman's sociological theory.

For a variety of reasons, the stigma of leprosy in the Middle Ages stuck to the disease for centuries afterward. During the age of imperialism, in particular, Western colonists as well as Christian missionaries were exposed to diseases, including leprosy, that were endemic in countries like India and Korea. 7 Viewing the disease as a threat to the Euro-American population, colonists deemed leprosy a foreign disease as well as a "primeval relic," a product of a culture adjudged to be living in the past (Gould 1). As a result of this view, leprosy, like many other disabilities, became a social construction as much as a medical condition. In the United States, for example, people with leprosy were subject to government-mandated segregation and even, in some cases, loss of civil rights, such as the right to vote. 8 The social construction of leprosy derived primarily from misunderstandings of the disease promoted by medical professionals like the American physician Dr. Isadore Dyer, who advocated for the institutionalization of American leprosy patients in a setting much like the leprosaria of the Middle Ages.

Until the mid-twentieth century, many physicians based their diagnosis and treatment of leprosy on stereotypical and at times inaccurate accounts of the disease in the Middle Ages, a period in which much of the leprous population was consigned to begging in the streets or sent to charitable hospitals, where the treatment of the soul was favored over the treatment of the body. Tony Gould notes, for example, that "medical writers in the nineteenth and early twentieth century can be said to have reconstructed the Middle Ages in such a way as to provide historical justification for their own practice of segregating leprosy sufferers" (5). In almost all cases, physicians judged the condition to be highly contagious and recommended that the leprous population be segregated from the non-leprous population. The lack of effective treatment methods only added to the problem, as up until the 1940s, the only viable treatment for leprosy was an ancient Asian remedy called chaulmoogra oil (Gould 3).

Western imperialists and Christian missionaries also contributed to the social construction of leprosy, as they linked the disease to what they perceived as the natives' promiscuous and primitive behavior, which hearkened back to the Biblical view of leprosy as a disease resulting from sin. Kerri A. Inglis writes of the predominance of this view among colonists in Hawaii, in particular, where a leprosy epidemic in the mid-1800s was attributed to the Native Hawaiians' filth, promiscuity, and diet (41). All these tendencies converged to make leprosy one of the most hated and feared diseases in the nineteenth and twentieth centuries, long after the medieval period from which these views derived. However, I would argue that it was not the disease itself that was hated at feared, but rather the stigma of the disease, which resulted from the accumulation of the negative moral and social meanings that attached to leprosy.

The tendency to justify discrimination against people with leprosy based on fundamentally inaccurate medieval stereotypes is what I want to call "diagnostic medievalism." In order to tease out the implications of this term, I look at two case studies of leprosy and its stigma in the modern era: a twentieth-century hagiography of Father Damien, a priest who contracted leprosy while caring for patients on the Hawaiian island of Molokai, and a historical study of Carville, Louisiana, the site of the continental United States' only leprosarium for many decades. Molokai and Carville were linked in spirit if not in geography; the Louisiana hospital based many of its treatment methods, including mandated segregation, on the earlier example of Molokai, where many Hawaiians were forced to reside after the leprosy epidemic of the mid-nineteenth century.

Carville was distinguished from Molokai in one key way, however: it was intended as a rehabilitative institution exclusively for American citizens, rather than a carceral one for a colonial population. The two accounts I examine here underscore this difference. John Farrow's biography of the Catholic priest Damien presents him as a savior who intervenes to help an otherwise helpless foreign population. Marcia Gaudet's account of Carville, on the other hand, gathers contemporary testimonials from patients in order to highlight the American traditions that were a part of everyday life at the institution. Yet even as they describe different subjects, both texts use forms of description that are especially medievalist in nature—for example, the label of "martyr" that Farrow places on Father Damien or Gaudet's carnivalesque description of the Mardi Gras Masque held annually for Carville patients. In looking at these texts, I argue that such forms of description are ultimately the result of the diagnostic medievalism that attaches itself to leprosy in the nineteenth and twentieth centuries. I want to show that, as a result of this tendency to focus on the moralistic connotations of leprosy and misconstrue the medical causes of the disease, leprosy is and continues to be persistently stigmatized as a medieval disease even in the modern era.

Leprosy in the Middle Ages

Possibly more so than any other disease, leprosy in the Western mindset has been burdened with negative moral connotations since the Middle Ages, such that the figure of the leper has "remained for centuries a symbol of the worst that God could visit on humanity" (Allen 26). The predominant, Judeo-Christian view of the disease has long been that leprosy is a punishment from God for man's sins, an assessment that is paralleled only by the bubonic plague in the fourteenth century. Yet this enduring and intractable perception of leprosy as a sign of sin may, in fact, have resulted from an error in exegesis by the medieval Church Fathers and their heirs. A single passage in Leviticus 13 could be to blame for the confusion. Leviticus tells of a strange skin condition, called tzara'at, which afflicted the Hebrews of the region. 9 If, after being examined by a priest, an individual was determined to have the condition, he or she was forced to withdraw from the surrounding community until the condition abated. As Sheldon Watts explains, St. Jerome, compiler of the Latin Bible in the Middle Ages, translated the Hebrew word tzara'at as the Latin lepra, thus equating the skin condition mentioned in the Bible with a disease that was prevalent in medieval Europe. Later exegetes, following Jerome, would preserve Jerome's translation, thus laying the groundwork for a centuries-long belief "that leprosy was God's punishment for sin and that lepers must be driven out of the camp" (Watts 48).

Leprosy appears in the New Testament as well, but in a slightly different light. Although people diagnosed with leprosy were still seen as carriers of sin and contagion, Christ's charitable treatment of two individuals sharing the same name, Lazarus, added complexity to the revulsion that came to be associated with the disease among the non-leprous population. A man afflicted with sores, named Lazarus the Beggar, is the subject of a parable in Luke 16 illustrating the virtue of poverty and the sin of greed. Medieval exegetes conflated this Lazarus with a second Lazarus, Lazarus of Bethany, who was the brother of Mary Magdalen and her sister Martha and whom Jesus raised from the dead, a miracle recounted in John 11. After this miraculous event, Christ attends a feast at the house of Simon the Leper, and David Marcombe suggests that this sequence of events in the Gospel of John may have been the start of the confusion (3-4). The conflation of these two Biblical stories left open the possibility of lepers' redemption and resurrection, such that many Christians came to see lepers as special recipients of Christ's charity. Even though the stigma of leprosy, based on the Old Testament portrayal of the disease, still held, the New Testament's depiction of people with leprosy led clergy and laypersons alike to see their treatment as opportunities for acts of Christian charity, as evidenced by the building up of leper hospitals—or "Mawdelyns," as they were sometimes called—in the later Middle Ages (Rawcliffe 8). 10

As leprosy grew to near-epidemic proportions, both Biblical portrayals of the disease endured in the minds of medieval people, who imbued the disease with positive and negative moral connotations. As a result, the treatment of leprosy in the West was subject to moral diagnoses rather than medical ones for centuries. Perhaps no medical text had more influence on the procedures for diagnosing leprosy in the Middle Ages than Guy de Chauliac's 1363 La grande chirurgie. 11 In addition to describing the symptoms of the disease in detail, Guy's book recommended that forced isolation be a condition of a positive diagnosis, which, contrary to the modern-day understanding of the term, resembled a legal trial more than a medical procedure, a practice that would continue in the nineteenth century when leprosy reemerged as a threat. As Peter Richards explains, members of the community would put forth accusations of leprosy, and the accused was subsequently examined by a priest for "equivocal" and "unequivocal" signs of the disease (99). In the sixth book of La grande chirurgie, Guy outlines these symptoms and advises that the physician who examines the accused leper diagnose the disease with caution:

Mais en l'examen et iugement des ladres il conuient estre fort aduisé : car c'est tres grande injure de sequestrer les non sequestrables, et de laisser les ladres auec le people. Car le mal est contagieux, et qui infecte.

But in examining and judging lepers one must be strongly advised, for it is a great insult to sequester those who should not be sequestered and to leave lepers among the people, because it is very contagious and because of who it infects. (Nicaise 404, translation mine).

Once a judgment is made, those individuals who were found not to have leprosy would receive a "certificate of freedom from the disease," as per Guy's recommendation, while others would be subject to the demoralizing laws and procedures that had been instituted by the Third Lateran Council in 1179, which issued a decree that effectively criminalized leprosy in major cities and towns (Richards 40). 12

One purportedly medieval practice that endured in the Catholic Church even after the Middle Ages was the leper's mass, in which a priest, having identified a leprous individual, would recite the ten commandments of leprosy (based on the cleansing ritual outlined in Leviticus 17) while the afflicted person was symbolically buried. Peter Allen describes these living funerals in detail, writing:

First, the leper was wrapped in a shroud; then he or she was carried to a church that had been draped in funereal black, where the priest took a final confession and intoned the solemn liturgy of a requiem mass. The service then moved to the churchyard. Standing in an open grave, the leper was directly addressed by the priest—not in Latin, as usual, but in the vernacular, to avoid any possibility of misunderstanding. … Sometimes the priest would scatter a shovelful of earth over the leper's head. (36)

These living funerals concluded with an oral reading of the leper's commandments—ten laws that the diagnosed individual was required to follow until his official death due to natural causes. 13 One of these commandments mandated that the leper carry visible markers of his disease, including a clapper or rattle to warn others of his or her presence, a long pole with which to point out marketplace items, and a red or yellow badge signifying his or her disease (Allen 37). 14 Many—though not all—people diagnosed with leprosy were sent to reside in leper houses, or leprosaria. Gould disputes such accounts of the leper's mass, arguing that this practice "was largely a sixteenth-century concoction and in England, at least, was never performed" (8). But whether or not these living funerals actually took place in the Middle Ages, the leper's mass became inextricable from post-medieval understandings of the Middle Ages and its treatment of leprosy, resulting in the kind of medievalism that would play a role in concretizing the negative stigma that attached to the disease among Westerners, in particular.

Alongside the bubonic plague, leprosy was one of the most prevalent and feared diseases in the Middle Ages until it all but died out in Europe in the sixteenth century. During the imperial age of the nineteenth and twentieth centuries, however, leprosy once again threatened Western populations when colonists were forced to confront the leprosy epidemics of East and South Asian countries, as well as that of Hawaii, which helped to reinvigorate its stigma. 15 According to Michelle T. Moran, "The combination of Christian missionary ventures, scientific medicine, and U.S. imperial activities in the late 1800s helped produce an image of leprosy as a foreign menace that posed a physical danger to Americans" (5). Catholic and Protestant missionaries, in particular, promoted a Biblical understanding of the disease that combined the Old Testament view of leprosy with the New Testament view, presenting native populations as helpless sinners who required the intervention of believers for both conversion and healing.

Not only did this medievalist view add to stigma of the disease, but it also informed its treatment, as the increasingly widespread practice of segregation was largely based on a misinformed understanding of the function and purpose of medieval leprosaria, which were built by medieval clergymen largely for the purpose of "garner[ing] the fruits of both perpetual charity and perpetual prayer" but which had the additional effect of benefiting the health of the leprous population (Richards 11). Gould speculates that medieval people would have been "baffled" by the idea of segregation for the purposes of contagion, although as the writings of Guy de Chauliac suggest, medieval people do seem to have been somewhat fearful of the disease's communicability, even if they were not nearly as focused on its contagion as were nineteenth-century medical professionals (7). Either way, there is little doubt that religious missionaries and Western colonists alike weaponized their misinformed view of the Middle Ages in order to isolate and discriminate against native populations, which they did under the auspices of protecting the Euro-American population from the ravages of a foreign and ancient disease. As the threat grew, the Molokai settlement in Hawaii and leper hospital at Carville came to exemplify these discriminatory tendencies, in which the practices and rituals of the Middle Ages were misconstrued and used to justify segregation at both sites.

Saint Damien the Leper

In 1873, approximately five-hundred years after Guy de Chauliac published his symptomology of leprosy, Hansen discovered the bacterium that causes leprosy, thus setting the stage for decades of scientific research into the disease that would eventually take his name. 16 Hansen's discovery occurred in the context of a distressing outbreak of leprosy in his home country, as well as an increasing concern about the disease among British imperialists. A decade after his discovery, in 1885, an Anglican archdeacon named Henry Wright warned about the "Imperial Danger" of leprosy in India, which he feared would be brought back to England by British colonizers who had contracted the disease from the colonized population (qtd. in Watts 40). Wright, along with the Protestant and Catholic missionaries that had traveled to many of the same countries, encouraged a "Christian" approach to its treatment, though it was only Christian insofar as it relied on an interpretation of Scripture as mandating isolation for people with leprosy, as was mandated for the Hebrews in Leviticus. This antiquated and dehumanizing form of treatment was sanctioned by medical doctors like Dr. George Thin, author of the 1891 book Leprosy, who "believed that medieval regimes had literally followed the Old Testament injunction to capture and confine lepers and that this policy had led to the disappearance of leprosy in Europe by the end of the sixteenth century" (Watts 40). In accordance with this understanding of Scripture, the segregation of leprosy patients became standard practice in the colonies, while Christian missionaries became the patients' primary caretakers.

One of these colonies was the isolated territory of Hawaii, which suffered several devastating epidemics shortly after the arrival of Euro-American colonists and Chinese immigrants in the mid-1800s. 17 The scourge of leprosy, which saw its first diagnosed case in the 1850s, became a particular point of concern among Native Hawaiians and colonists alike, for not only did it afflict Hawaiian royalty, but it also served as proof of the filth and promiscuity of the native population in the minds of the colonists (Inglis 41). In 1865, Hawaii's king, under the influence of Western colonists and the Hawaiian Evangelical Association, signed the Act to Prevent the Spread of Leprosy, which aimed to isolate the leprous population from the non-leprous population. Similar to the medieval form of diagnosis, in which individuals were effectively convicted of leprosy, people suspected of leprosy were arrested and delivered to the Hawaiian Board of Health, where they were inspected for signs of the disease and subsequently isolated if the case required it (Inglis 50). This criminalization of leprosy meant that Hawaiians with the disease were considered "civilly dead," which Kerri Inglis points out "fit well into Christian paradigm which held that 'a person afflicted with leprosy loses all sense of his/her earlier social identity and becomes merely a leper'" (61). As the number of individuals requiring isolation increased, the island of Molokai, which was both self-sufficient and difficult to access, was established as a settlement for the quarantine of Hawaiians with leprosy. Molokai quickly became the most famous settlement for leprosy patients in the world, though not because the administrators' treatment of leprosy was particularly innovative or enlightened, but because one of its voluntary residents became an international celebrity after contracting the disease from the people he had spent years caring for, which made him a martyr among Westerners who continued to view the disease in Biblical and medieval terms.

For several years in the late 1800s, Father Damien de Veuster, a Catholic priest from Belgium, cared for people with leprosy on the island of Molokai until he contracted the disease himself in the 1880s. Following Father Damien's widely-publicized death in 1889, the disease became a cause-célèbre among British and American officials, including Euro-American imperialists who used the case to justify the continued isolation and oppression of native populations. In Britain, the Prince of Wales was named honorary chairman of the newly created National Leprosy Fund; the National Cathedral in Washington, D.C., installed a stained-glass window in Father Damien's honor; and the first World Leprosy Congress was held in Berlin at the end of the nineteenth century (Watts 40). Father Damien's tale held a literary attraction as well; Robert Louis Stevenson wrote an epistolary defense of Damien's actions on Molokai in 1890, and the letter became the basis of several hagiographic biographies of the saint, including Gavin Daws' 1973 Holy Man, as well as John Farrow's 1954 Damien the Leper, which I explore here. While Gould describes John Farrow as one of Damien's "less reliable" biographers, its accuracy is not the point (86). Damien the Leper is, rather, an attempt to mythologize Damien by reconstructing his story in such a way that he becomes a modern-day hero facing down a medieval disease. Farrow's glowing portrayal of Damien as a nineteenth-century saint resembles the hagiographies of the Middle Ages, in that it portrays his virtuous actions among the Hawaiians as miraculous and depicts his death as a form of martyrdom. More significantly, however, Farrow's hagiographic account of the priest's life contributed to the mythology that had been constructed around the disease for centuries, emphasizing leprosy's cultural effects rather than its medical complexities, even as new treatments were being discovered at the time of the book's publication.

In the opening pages of Damien the Leper, John Farrow recounts his encounter with a Native Hawaiian during a trip to the islands for research. He recalls the horror he felt upon discovering that he would be sharing a house with one of the leprosy patients:

I shall never forget that afternoon. I was angry and afraid. I stared at the glittering surfaces of the bed as though I might be able to detect germs. I scratched and scratched again before the agonizing irritations of countless imaginary itchings. I looked at my skin, half expecting to find the fatal white markings, and I scrubbed my body with strong disinfectants until the blood ran. (4)

Farrow's hysterical reaction to discovering he might have to share a bed with an individual diagnosed with leprosy speaks to the fear of physical contagion that, by the twentieth century, had displaced fears of its moral contagion as Westerners' primary misconception of the disease. When Farrow finally meets the man, however, he is drawn in by the story the man tells of Kamiano (the Hawaiian name for Damien), of whom the man speaks with such a degree of reverence that he genuflects upon speaking his name. Already, Farrow's biography has begun to supplant the humanity of the Native Hawaiians with the sanctity of the legendary Belgium priest. This is a recurring theme in Damien the Leper: the so-called "lepers of Molokai" are repeatedly equated with the sick pilgrims of medieval saints' lives, whose cure by the saint's healing touch is less important for the relief it gives the pilgrim than for the miraculous proof it offers the saint. Damien's illness is, for Farrow, a sign of sanctity rather than sin, but it illustrates that a moralizing view of the disease (based on misconstrued Biblical and medieval views) always seems to cling to it, whether that view is positive or negative.

After a brief account of Damien's childhood and schooling, Farrow narrates the priest's fateful voyage to the Hawaiian Islands as part of a mission for the Order of the Sacred Hearts. There, Damien learns about Molokai, a small tract of land bounded by the sea, which was purchased by colonial administrators in the 1860s so that individuals diagnosed with leprosy could be sent there to separate them from the healthy population. The cruel irony of the establishment of this particular leper colony, Farrow notes, is that leprosy, along with several other diseases, were "unknown before the arrival of the white man"—that is, the colonists (49). 18 Even as Farrow expresses sympathy for the natives who were the unwitting victims of the colonists' diseases, he is careful to note the "barbaric customs" maintained by the natives, such as idol worship and cannibalism (46). The medievalism of Farrow's depiction of the natives as primitive and immoral establishes the conditions for Damien's saintly intervention, which includes both his conversion of and his care for the lepers of Molokai. Against the protests of local authorities, Damien goes to live among the inhabitants of the island.

In a letter to his brother that Farrow includes in his biography, Damien describes his decision to live on the island as "a second death," alluding (intentionally or not) to the practice of arresting and isolating Native Hawaiians on Molokai, where they suffered both a lifelong exile and a form of civil death (121). Seeing the disease as a threat to the Hawaiians' bodies and souls, Damien immediately establishes himself as the natives' spiritual savior, encouraging them to shed their barbaric customs by holding weekly mass and performing the sacraments. Since healthy individuals, even medical professionals, are not allowed on Molokai, Damien also serves as Molokai's de facto physician, setting up a hospital, installed with cots, in which Damien not only washes and bandages the patients' sores but also performs crude amputations when necessary. While such interventions differ from the saintly interventions of medieval hagiography, in which a single touch from the saint could cure a pilgrim's disease, Farrow portrays Damien's rudimentary medical acts as nonetheless miraculous, in that Damien, despite having no medical training, was able to help his patients stave off death, at least for a time.

Damien is not, however, able to stave off the disease himself. A few years into his service on Molokai, Damien discovers that he has contracted the disease when he spills boiling water on his foot and feels no sensation, a symptom of the disease he instantly recognizes. He shares the news of his disease with his parishioners during Mass, when, Farrow recounts, "instead of addressing them with the usual My brethren, he had said, slowly and significantly, We lepers…" (160). Farrow's retelling of Damien's contraction of the disease, his slow decline, and his eventual death is a highly contrived—and, indeed, hagiographic—account of Damien's so-called martyrdom on Molokai. Even the account of Damien's announcement to his parishioners that he had contracted the disease is likely exaggerated, even inaccurate. Gould writes that Damien addressed his audience as "we lepers" for years before he contracted the disease; he argues that "it wasn't an affectation, as it might have been from the lips of another; it was a simple statement of identification: Damien embraced leprosy long before leprosy embraced him" (71).

In addition to such factual inaccuracies, many of the tropes of hagiography are on display in the biography's final pages. Thus, for example, when Damien is on his deathbed, his assistant—a newly arrived priest named Joseph Dutton—asks that he be left Damien's mantle so that "like Elias, I may inherit your great heart" (199). Dutton's request makes of the mantle a saint's relic, or an accessory of the saint's that could purportedly heal conditions like blindness, deafness, and broken bones. This comparison is not lost on Damien, who jokingly responds, "What would you do with it? … It is full of leprosy" (199). Even more so than the token of the mantle, the moments following Damien's death mark him as saint-like. When the Sisters of the St. Francis order subsequently examine Damien's corpse, one of them exclaims that "all signs of leprosy had disappeared from the face!" (199). The erasure of scars from the face and the absence of decomposition in the bodies of saints is a hagiographic commonplace; Reginald of Durham's account of the posthumous miracula of Saint Cuthbert, for example, narrates how Cuthbert's corpse, when examined, was found to be whole, pliable, almost uncannily lifelike—with flexible joints and an elasticity of the skin such that it seemed to breathe (Tudor 452). As the Sister's exclamation implies, Damien, like Cuthbert, displays a similarly miraculous postmortem appearance.

Farrow's hagiographic depiction of Damien is likely purposeful, as it aligns with the larger project of myth-making that surrounded Damien for decades after his death, and it is in the service of the myths that have attached to leprosy for centuries. 19 Most disturbingly, it perpetuates the notion that leprosy is one of the most contagious diseases. In fact, Peter Richards notes that "most people have a natural resistance to the disease" (xv). Native Hawaiians were particularly susceptible to leprosy because their years of isolation had not allowed them to build up an immunity to the diseases that the colonists brought to the island (Gould 61). Gavan Daws speculates that in Damien's case, his prolonged exposure to the leprosy bacterium, along with the fact that he inhabited an intimate and unclean environment at Molokai, likely played a role in his contraction of the disease (237). Simply because Damien contracted the disease on Molokai, however, does not mean that contracting the disease is easy or, indeed, common. Moreover, that Farrow chooses to preserve Robert Louis Stevenson's characterization of Damien's death as a "martyrdom," despite the progress made in the treatment of the disease in the intervening decades, implies that the disease was passed on by people who were not only physically ill but morally corrupt (qtd. in Farrow 216).

In many saints' lives, martyrdom occurs when ostensibly immoral pagans persecute and eventually execute a Christian saint. Stevenson and Farrow, in calling Damien a martyr, thus equate the fatal passage of leprosy from the Native Hawaiians to the Christian priest with the pagans' killing of saints in hagiography, suggesting that the Hawaiians share the moral depravity of pagans. Farrow's purposeful mythologizing of the person he calls "Damien the Leper" ultimately illustrates the book's inherent diagnostic medievalism, or knowing use of misconstrued medieval paradigms of leprosy in the face of scientific evidence that would dispute notions of the disease's moral and medical contagion. That this medievalist portrayal of leprosy appears as late as the 1950s reinforces the point that is not the disease, but rather the stigma that is contagious, its cultural and metaphorical meanings sticking to individuals like sores that won't heal.

Carville and the Masque

At the entrance to the National Hansen's Disease Museum in Carville, Louisiana, there is a plaque that commemorates the lives of the patients who were treated at the in-patient hospital that stood at the site from 1894 to 1999. It reads, in part:

Welcome to a community unlike any other in the world, many of whose residents experienced two opposite emotional extremes—one is extraordinary physical suffering, separation of families, endless psychological stress, emotional breakdown, and another is security, healing and comfort—a haven—a place to hide. (Gaudet 189)

For over a century, Carville was the only hospital for people with leprosy in the continental United States. Following the passage of bill calling for the establishment of national leprosarium on the mainland in 1917, people diagnosed with the disease were required to be quarantined at the hospital at Carville until the 1950s, when patients were permitted to receive treatment at outpatient centers (Moran 173). Prior to the opening of the U.S. Public Health Service Hospital in 1921, Carville was the site of the Louisiana Leper Home, a center for the treatment and isolation of leprosy that was managed largely by the Daughters of Charity of St. Vincent de Paul and that was built on the site of the Carville Indian Camp Plantation. Concerned that leprosy would spread from Pacific and Caribbean territories to the mainland, a dermatologist at Tulane Medical School named Dr. Isadore Dyer encouraged the Louisiana state legislature to establish a hospital exclusively for U.S. citizens; patients from U.S. territorial possessions would be barred from admission (Moran 35).

The decision to establish a center for the isolation of leprosy patients, Gaudet speculates, was likely due to the international fame of Father Damien, as well as the local fame of Father Charles Boglioli, an Italian Catholic priest who contracted the disease while serving as chaplain for a New Orleans hospital circa 1866 (11). However, it is also likely that Louisiana leper home was originally intended to serve as a counterexample to the settlement at Molokai, which faced increasing protests from patients, who objected to the isolation and uncleanliness of the site. As Moran explains, "In contrast to the colonialist assumptions that Hawaiians with leprosy were ignorant creatures who failed to appreciate the advantages of Western medicine, mainland medical practitioners depicted Carville's patients as eager recipients of modern science" (129). In essence, Dyer and others promoted Carville as a site for an enlightened, American population who would welcome experimental treatments, as opposed to the primitive and "medieval" population at Molokai. Yet even as medical professionals like Dyer presented Carville as a premier center for medical research, he and others continued to rely on the model of the medieval leprosarium as the primary solution to the disease.

As the establishment of the Louisiana Leper Home, and later, the Carville hospital illustrates, the leper camps of Leviticus had a hold on the collective unconscious of Westerners, even as late as the 1890s. Though fears of the disease were of a different stripe, based on its purported contagion rather than its moral connotations, approaches to its treatment were based on a misinformed understanding of the disease and its treatment in the Middle Ages. At Carville, new patients, like the residents of medieval leprosaria as well as monks and nuns, were required to leave their families and their belongings behind. The leprosarium at Carville, however, added yet another indignity to the process of segregation, recommending that patients adopt a pseudonym for the duration of their stay at the hospital. Gaudet writes, "While being admitted to Carville, patients were encouraged to hide their true identities. Often not even the staff knew their real names" (16-17). 20 In 1921, when the Louisiana Leper Home became the National Leprosarium, a new procedure was instituted that entailed numbering patients for the Federal Register (Gaudet 158). These names and numbers would follow them to the grave, literally: patients who died at Carville were buried in a cemetery on the hospital site and given a grave marker that included their Carville pseudonyms and Federal Register numbers. Like the living funerals that purportedly took place during the Middle Ages, choosing a pseudonym and being assigned a number signified an unofficial death prior to the patient's natural death from the disease. Among the patients of Carville, including Stanley Stein, who published an account of his experiences at the institution in a 1963 memoir, the phrase "going under the pecans" became a euphemism for one's natural death and subsequent burial at the Carville cemetery, where there were several large pecan trees interspersed among the graves (qtd. in Gaudet 157).

In addition to an infirmary and a cemetery, the leprosarium at Carville had a library, a school, a bank, churches, a jail, a bar, and a golf course. Moreover, unlike most other places in the South during the days of Jim Crow, Carville did not segregate its patients by race, though it was by no means race-blind; even though the patient community was ethnically diverse, the minority population was often pushed to the margins when activists like Stanley Stein portrayed the residents of Carville as "average" Americans (read: white Americans) who deserved better treatment from their government (Moran 161). Still, the testimony of several of the patients reveals the close bonds many of the residents felt with each other, especially during Carville's annual Mardi Gras festival. One patient named Louis Bordreaux recalls attending the festival with his wife: "We had beautiful miniature floats, the parade, and of course, a beautiful ball. We elected a king and queen" (Gaudet 122). Costumes were also integral to the festival; in the 1980s, for example, patients dressed up as Dolly Parton, Mike Tyson, and the Surgeon General C. Everett Koop, who had visited Carville in 1988 (Gaudet 130). Mardi Gras offered a welcome opportunity to perform a new identity, while also participating in a ritual that was popular in nearby New Orleans. As Gaudet explains, "To act in a carnivalesque mode is to be allowed the freedom to be 'abnormal' for a while. Paradoxically, to celebrate Mardi Gras, like other masquerade holidays, is normative—it is not only allowable but even expected that one will participate in the seasonal customs, particularly in Louisiana" (119). In essence, Carville's Mardi Gras celebration let the residents of the leprosarium turn the stigma of the disease upside down. Participating in the masquerade gave them the chance to partake in normative rituals, and even in some cases, to pass.

For some of the patients, wearing a mask became a means of physical transformation in addition to a social one, for it was not only an opportunity to pretend to be someone else, but also an occasion to literally cover up scars and disfigurements. While Gaudet reads this in mostly positive terms—as a kind of carnivaleseque performance—passing likely had unintended consequences for the patients who chose to participate. In Claiming Disability, Simi Linton explores the unintended effects of passing, explaining that the while the notion of passing has become familiar to members of both the African American and LGBTQ communities as well as the disability community, it can be to the psychological detriment of individuals who choose to do so. Linton observes, "For a member of any of these groups, passing may be a deliberate effort to avoid discrimination or ostracism, or it may be an almost unconscious, Herculean effort to deny to oneself the reality of one's racial history, sexual feelings, or bodily state" (19). Passing, in other words, may allow one to manage the personal, social, and economic consequences of various forms of social stigma, but it can also result in the denial of one's true identity and, notably, the denial of history. Passing blots out the failures or even the mundane successes of one's life by focusing solely on the "Herculean" achievement of overcoming one's disability by passing as able-bodied. 21 Paradoxically, it can also have the effect of subjecting the individual to longstanding, historical stereotypes and misconceptions about the disease or disability. For patients with leprosy, who had long been subject to medievalist stereotypes, taking part in the medieval masque could be means of reclamation, much like disability activists' reclaiming of the word "cripple," but it could also serve to reproduce the most dehumanizing medieval views of the disease, including the idea that leprosy is a moral disease in addition to a medical condition.

Given the isolation and infamy of the Carville hospital, it was likely impossible for the patients at Carville to ever fully pass, though they were allowed short, periodic trips outside of the institution. A costume may have covered up the physical scars, but the social stigma remained. Even if passing was not the ideal that Gaudet suggests it is, the annual Mardi Gras festival did present an occasion for play—a chance to minimize and mock the ever-enduring stigma of leprosy and to participate in a communal tradition that was popular both within and outside the institution. The Mardi Gras Masque was, as Gaudet writes, "a great equalizer. In medieval carnivals, masked peasants and noblemen mingled together. In Venice, Italy, it is said today that the mask allows one to 'slip on a new skin.' By hiding the face, masks negate the primary means of identification and recognition, but this negation allows the possibility of something new—a transition, a transformation" (141). At least some of the participants claim to have found the Mardi Gras ritual pleasurable, even as it did not fully eliminate the stigma of the disease. This may have been due to the fact that the Carville festival, like the festivals in nearby New Orleans, celebrated medieval identities, such as the fool and the peasant, rather than weaponized them in the promotion of a stigma. The medievalism of the carnival, therefore, was liberating precisely because it allowed patients to turn medievalist stereotypes on their heads and to make so-called "medieval" identities the norm rather than the exception.

Conclusion

According to the World Health Organization, an estimated 212,000 people were affected by leprosy in 2015; the majority of cases were found in India (Singh n.pag.). That same year, the United States reported only 178 new cases; New York City saw just three reported cases, though a specialist in the disease, Dr. Louis Iannuzzi, believes that about half of leprosy cases go unreported (Small n.pag.). Researchers believe that most people have a natural resistance to the leprosy bacterium, and since the 1980s, a highly effective multi-drug therapy has been used to treat the disease. And yet, as exemplified by the cases of Father Damien, whose story of martyrdom rivaled the news of Armauer Hansen's scientific discovery in the 1800s, and that of Carville, which accepted patients diagnosed with the disease until 1999, the stigma of leprosy has proven highly resistant to provable statistics or medical innovations that might otherwise dispel misconceptions about the now-curable disease. Recognizing this unfortunate fact, activists have for decades campaigned to replace the term "leprosy" with the clinical term "Hansen's disease." Patients in both Hawaii and Louisiana pushed public health officials to use the term Hansen's disease, despite its namesake's complicated history with the disease, which included Hansen's experimenting on nonconsenting patients and advocating their quarantine (Kim 168).

Today, the American Leprosy Missions continues the campaign to remove the word "leper" from public discourse by promoting the use of phrases such as "people affected by leprosy," as well as the use of the clinical term, Hansen's disease ("Don't Call Me a Leper" n.pag.). The campaign has been effective in at least two cases, according to the website of American Leprosy Missions, which states:

In 2010, the BBC added an entry to its style guide for journalists and reporters noting: "Avoid using the word 'leper' when describing someone with leprosy. It carries very negative connotations, suggesting an outcast or pariah." That same year, the Human Rights Council of the United Nations General Assembly said that, "States should remove discriminatory language, including the derogatory use of the term 'leper' or its equivalent in any language or dialect, from governmental publications and should revise expeditiously, where possible, existing publications containing such language." ("Don't Call Me a Leper" n.pag.)

Though modest, these successes have begun to recuperate leprosy from a longstanding history of viewing people diagnosed with the disease as deserving of scapegoating and sequestration rather than equal treatment under the law. The "Don't Call Me a Leper" campaign thus allies the efforts of American Leprosy Missions with those of disability rights activists who have called for such "people-first" language since the 1970s (Kafer 111).

The campaign also underscores the role that language plays in the social construction of the disease. Scholars of disability often focus on the institutional and environmental barriers that effectively construct disability, but such an approach overlooks that very crucial role that language has in determining what is or isn't a disabling condition. The case of leprosy makes it patently clear that language and its use in myth-making and everyday speech can have an almost determinative function in the public's understanding of a disease or disability. Whether it is Euro-American imperialists' misconstruing the Biblical view of leprosy to oppress native populations or public health officials' deploying a mythology of the Middle Ages to justify segregation, the term "leprosy" has historically been used to discriminate against people with the disease and, more recently, to oppress other marginalized groups, who do not have the disease but become "lepers" by nature of a perceived threat to hegemonic groups.

Two relatively recent examples show the metaphorical currency that the "medieval" illness of leprosy has had on the collective unconscious of Western society. In the first instance, the term "leprosy" was deployed to oppress a marginalized population during the HIV/AIDs epidemic of the 1980s. At the height of the epidemic, the president of the American Foundation for AIDS Research, Dr. Matilde Krim, referred to children with AIDS as "truly the new lepers" (qtd. in Gaudet 94). Even among scholars, AIDS was described as "the leprosy of our time," the title given to a 1992 book on AIDS in Africa by Willem A. Saayman and J.R. Kriel (qtd. in Orlemanski 144). In many ways, HIV/AIDS did, in fact, become the new leprosy, though not in the strictly metaphorical sense intended by Krim, Saayman, and Kriel. Rather, HIV/AIDS was subject to the same diagnostic medievalism that leprosy was subject to for years, in that it took on loaded moral and social connotations that replicated the medieval notion that diseases like leprosy were a result of sin. Peter Allen observes that in the Middle Ages, leprosy was thought of as a sexually transmitted disease, since some medieval people thought that the disease spread through sexual intercourse. Allen writes that "most of all, leprosy was tied to the sin of lust" (34). Medieval leprosy, thus viewed, set the stage for HIV/AIDs to become the new leprosy, a disease interpreted as God's punishment for sexual relations that Christianity deemed immoral.

By the 1980s, a time when evangelical conservatism was on the rise in the U.S., the AIDS epidemic served as proof of the so-called sin of homosexuality for evangelical television personalities and conservative politicians alike. Allen compares the incendiary remarks of Reverend Jerry Falwell to those of a seventeenth-century writer: "Like Francis Herring, the seventeenth-century English author who described plague as 'the stroke of God's wrath for the sins of mankind,' the Reverend Jerry Falwell felt free to proclaim to a national television audience in 1987 that 'a God who hates sin has stopped [homosexuality] dead in its tracks by saying, 'do it and die'" (121). Similar remarks equating HIV/AIDS with a divine punishment followed, and a 1988 scientific poll showed that nearly sixty percent of respondents felt little to no sympathy for HIV/AIDS patients (Allen 124). 22 Disturbingly, these statements and beliefs had a chilling effect on public policy as well, such that Ronald Reagan did not even publicly address the issue until his second term, during a 1986 address to Congress. The impulse to call AIDS the modern-day leprosy was, therefore, the natural result of repeated moralizing around the disease. As such, AIDS came to be characterized alongside leprosy as a medieval illness, its lay-diagnosis constituting a reenactment of "a drama that had been written centuries before" (Allen xv).

More recently, the ostensible threat of leprosy has been used to justify strict immigration policies that would bar Mexican and Central American immigrants, including asylum-seekers, from entering the United States. In late 2018, when a caravan of Central American migrants was headed to the U.S. via Mexico, some commentators on the Fox News Channel spoke of the threat of diseases, including leprosy, that asylum-seekers would bring with them. Speaking to a Fox News host, a former ICE agent David Ward said, "We have these individuals coming in from all over the world that have some of the most extreme medical care in the world. And they're coming in with diseases such as smallpox and leprosy and TB [tuberculosis] that are going to infect our people in the United States" (Basu and Connor n.pag.). Just as Western imperialists in the nineteenth century used leprosy as a reason for segregating native populations in their home countries, Ward employed the spread of disease to the U.S. as justification for barring the caravan's entrance, even as the threat of the diseases that Ward cited were minimal or, in the case of smallpox, nonexistent. Public health officials declared smallpox eradicated in 1980 after a worldwide vaccination campaign, while tuberculosis is treatable by antibiotics. As for leprosy, Central America has reported only a small number of cases in the years since the World Health Organization declared the disease "eliminated as a public health problem" in 2000 (Basu and Connor n.pag.). That Ward both used the much more loaded term "leprosy" rather than Hansen's disease and lumped leprosy in with diseases that have literally been eradicated suggests a purposeful and malicious intent to deploy the term to oppress a marginalized group. By ignoring the factual reality of the disease in favor of its historical and metaphorical connotations, in other words, Ward deploys a diagnostic medievalism that lets him dubiously argue that migrants threaten not only to spark a public health crisis but also to transport us back to the past, when diseases like leprosy and smallpox were a legitimate threat.

Ultimately, both of these cases illustrate the dangers of leprosy's "medieval" stigma even in the twenty-first century. The stigma of leprosy persists not only because of the term's metaphorical connotations, but also because of the disease's complicated history, in which non-leprous populations who confronted the disease ignored medical knowledge and favored a reconstructed medieval view of the disease, judging it to be highly contagious and a result of sin. As Gould acknowledges, changing the term from "leprosy" to "Hansen's disease" might help, but it will not eliminate the stigma: "A change of name does not necessarily bring about a change in public attitude, and once it becomes known that Hansen's disease is what used to be called leprosy the same old prejudices attach themselves to the new name" (21). Recognizing the medieval origins of this view of leprosy and how it was deployed in later centuries should be the first step to breaking this pernicious link between the disease clinically known as Hansen's disease and its popular connotations as a moral and social contagion. Such an approach would help us shed the diagnostic medievalism that has attached to the disease for centuries.