When Europeans arrived on the Hawaiian islands in the late 18th century, so did disease - a lot of it. Explorers and settlers introduced pathogens to which Hawaiians had no immunity, including the bacteria that caused leprosy, now referred to as Hansen's disease.
The spread of it significantly impacted the population of Hawaii, wiping out thousands of natives each decade. By the time Hansen's appeared in the middle of the 19th century, King Kamehameha V imposed a law that involved quarantining those affected to the small island of Molokai. The forced relocation was difficult; the conditions on the island, meanwhile, could be atrocious. The Molokai leper colony lasted for more than a century, and even after the quarantine came to an end, individuals with Hansen's continued to live in isolation.
The leper colony on Molokai, HI, represents the most extended medical separation in US history. Today, the remnants of the area are a national park, albeit one that's remote and full of graves, marked and unmarked alike.
Because Hansen's disease is now curable, modern medical professionals no longer refer to people with the condition as lepers. According to Britannica, the term "...no longer has meaning and in fact is considered to be offensive because of the social stigma long associated with the disease."
Based on the "Report on Leprosy" issued by the surgeon general of the United States in 1898, the first reported case of the disease may have occurred in Hawaii as early as the mid-1830s. Surgeon General D.A. Carmichael indicated that Reverend W.P. Alexander, who arrived in Hawaii in 1833, saw a leper shortly after that. Seven years later, residents identified individuals with the disease in Honolulu.
Some of the symptoms associated with leprosy, however, were similar to those of syphilis, making it difficult to ascertain precisely when it arrived and from where.
According to the US surgeon general's report, Dr. Wilhelm Hillebrand claimed the Chinese brought leprosy to Hawaii in 1848. Hawaiian board of health member E.W. Meyer, meanwhile, stated he first heard about a native coming down with it in 1857, but he didn't witness it himself until two or three years later.
In The Colony: The Harrowing True Story of Exiles in Molokai, author John Tayman claims instances of leprosy appeared throughout the first decades of the 19th century. In 1819, French scientists noted seeing individuals showing signs of it and missionaries reported removing the leprous hand of a man in 1829.
Regardless of when it arrived, by 1861, cases of leprosy were so widespread that hospitals were filling up. In addition, the board of health sent out inquiries to the islands about the number of cases, theories on the disease, and encounters with those afflicted.
After Captain James Cook arrived at the Hawaiian Islands in January 1778, he did his best to keep his men away from the natives. William Bayly, an astronomer that accompanied Cook on his third voyage, wrote that Cook prevented his men from getting intimate with the locals "on [account] of a number of our people not being free from the [foul] disease."
A master on the Discovery, Thomas Edgar, commented about the native people:
None of them were permitted to come on board the ships [and] every precaution was taken to prevent the men from medling with them on shore [and] this requir'd the utmost vigilance of the Officers for the women [used] all their arts to entice them into their houses.
In spite of Cook's orders, several men who were aware of the risks "made connections with women." When Cook arrived at Maui in November 1778, he reissued the rules, but descriptions of diseases that afflicted natives shortly after point to the transmission of syphilis.
STIs weren't the only things introduced to native Hawaiians by European explorers and settlers. With no immunity to new infectious diseases - such as measles, chicken pox, polio, and tuberculosis - almost half of the native Hawaiian population perished by 1800, according to some estimates.
During the early 19th century, diseases ravaged Hawaii. In 1848 and 1849, measles, influenza, whooping cough, and dysentery wiped out 10,000 Hawaiians in repeated epidemics that swept through the population. When the first Mormon missionaries arrived in the 1850s, they commented on the number of sick they tended to, noting high cases of scabies and syphilis.
According to records, the first case of smallpox arrived at the port of Honolulu aboard the Charles Mallory in 1853. Before then, smallpox had been kept at bay. But once it struck, it spread quickly.
In June 1853, hundreds of people, including Mormon missionaries, perished. Later estimates indicate between 2,400 and 15,000 Hawaiians fell to the disease as it spread from Honolulu to rural areas in late 1853, lingering until early 1854.
With so much loss of life and disease, King Kamehameha IV addressed government officials, native Hawaiians, Europeans, and Americans alike, calling for "self-preservation." For the remainder of his reign, diseases continued to spread through Hawaii, with leprosy becoming more of a concern. After King Kamehameha V took the throne in 1863, he enacted legislation to remove lepers to a remote part of the island of Molokai.
The "Act to Prevent the Spread of Leprosy" of 1865 allowed the board of health to:
Reserve and set apart any land, or portion of land, now owned by the government, for a site or sites of an establishment or establishments to secure the isolation and seclusion of such leprous persons as in the opinion of the board of health or its agents may, by being at large, cause the spread of leprosy... to cause to be confined in some place or places for that purpose provided, all leprous patients who shall be deemed capable of spreading the disease of leprosy, and it shall be the duty of every police or district justice... to cause to be arrested and delivered to the board of health or its agents, any person alleged to be a leper, within the jurisdiction of such police or district justice.
Not only were lepers subject to detention and exile, the government could also "require from patients such reasonable amount of labor as may be approved of by the attending physicians," and "the property of all persons committed to the care of the board of health, for the reasons above stated, shall be liable for the expenses attending their confinement."
In January 1866, the first lepers arrived at the Kalaupapa colony on Molokai island. During late 1865, the king sent Rudolph Meyer to buy land for the settlement, and when he wrote to the king in December 1865, he indicated the area was "ready for the lepers to come." Doctors in Hawaii had also toured leper colonies in China to prepare for the establishment of the community on Molokai.
Among the first dozen lepers sent to Molokai was J.D. Kahauliko. Kahauliko became a leader among them and, soon after arrival, reported back to the board of health about the status of the group. He indicated they were "getting along in Molokai," but that they needed water.
Another account, by resident Ambrose Hutchison, who arrived in 1879, was much grimmer. According to Hutchinson, they "were left on the rocky shore without food and shelter. No houses were provided for the likes of us outcasts."