Colonizing Leprosy: Imperialism and the Politics of Public Health in the United States (review)

Historians typically regard the patients’ rights movement as a product of a host of social and political changes in the 1960s, including the civil rights and other movements centered on individual rights. But the history of U.S. efforts to control leprosy—more formally known as Hansen’s disease—forces us to conclude that patients were, as the historian E. P. Thompson so famously said of workers, “present at their own making” decades before the era in which so much headway was made in democratizing medicine.

Michelle Moran’s analysis of the politics of public health—viewed through the lens of leprosy containment, experimentation, and treatment—is a highly nuanced, gripping account of the interaction between government institutions and patients. This interaction played out in very different ways in the two federal U.S. hospitals devoted to containing and treating leprosy: the National Leprosarium at Carville, Louisiana, and the U.S. Leprosy Investigation Station tied to the leprosy colony on the Hawaiian Island of Kalaupapa.

In Carville, the predominantly white patient population confined with leprosy grounded their resistance to institutionalization by “portray[ing] themselves as ordinary U.S. citizens” and “demand[ing] their civil liberties” (p. 134). In Kalaupapa, in contrast, the largely native Hawaiian population that was segregated “challenged the government’s attempt to label them as inferior or needing Western oversight” through the “creation of a uniquely Hawaiian space that stood in sharp contrast to Euroamerican visions of Kalaupapa as a laboratory for Americanization imposed from above” (p. 170).

The different terms of conflict, thus, drew from and reflected the specific local social contexts in which the two institutions were located. But the broader, bridging story involves the overarching racialized politics of citizenship as it emerged within the era of American imperialism. These interconnected institutional histories, Moran explains, show “not only how public health policy emerged as a tool of empire”—a tool for making American expansion safe by containing both dangerous diseases and peoples—“but also how imperial ideologies became embedded within mainland medical practices” (p. 3). In other words, she makes the case that neither institution can be understood apart from the other or without a deep appreciation of the broader movements of people, goods, or, critically, monetary and ideological influence that accompanied the ways in which America positioned itself in the world.

But what happens when you compare her approach to the interplay between patients and medical authorities within institutions to the negotiations between U.S. and its territories? Both suggest the need to understand power and how power was negotiated. But, in sharp contrast to the dynamism of the patient–institution analysis, a framework of “imperialism” and “colonialism” suggests a kind of one-way assertion of power, an analysis of the ways in which hegemonic nations have dominated, manipulated, and oppressed their satellites. When looked at in this way, the conceptual lens that Moran uses to understand what was more of a transnational phenomenon than simply a U.S. story does not adequately capture the robustness of the story that she so capably tells.

The important thing, then, to underscore about Colonizing Leprosy is to look beyond the subtitle. This is a history that appreciates the complex nature of public health—that is, as an exercise in empire and the social control of deviant populations that was also decidedly an effort to limit the spread and ameliorate the burden of disease. Moran does not view public health as an uncontested and therefore unyielding tool of social control. Rather, she is a kind of pioneer in beginning to map the contours of an exceptionally sophisticated global analysis of public health. It is one that understands the idea of global and local interpenetration—the interaction of distant forces and flows of people, diseases, ideas, and economics with...