The Colony: The Harrowing True Story of the Exiles of Molokai
http://www.100md.com
《新英格兰医药杂志》
Some years ago, I had the opportunity to visit a leprosy clinic in Boston. It was known as a "Hansen's disease" clinic, a term often preferred by patients. It was held only on Saturday mornings, when the building was otherwise not in use. There was a feeling among all concerned that this arrangement was probably for the best — and perhaps happiest of all were the facility's administrators, who ordinarily were at home on Saturday mornings. Most patients spoke of their disease with shyness and reserve, although many of them had only mild, or tuberculoid, leprosy. One man with lepromatous leprosy and a lack of feeling in his feet hobbled in with a horribly burnt foot. His card-playing comrades had thought it great sport to place a lighted match between his toes and watch his perplexity as he endeavored to figure out what was burning. If such was the life of a leper in one of the most tolerant cities in the country at the end of the 20th century, I wondered how bad the leper's lot had been in ages past.
John Tayman's superb new history of Hawaii's infamous leper colony gives the answer. In the 1850s, leprosy became hyperendemic in the islands, with symptoms developing in as many as 1 in 30 Hawaiians. In response to the crisis, the government banished those with the infection to the Kalaupapa peninsula of Molokai. Robert Louis Stevenson called it "a prison fortified by nature." Jagged lava boulders ringed the shoreline on three sides. Landing a ship was impossible: patients were pitched from rowboats into the surf to fend for themselves. A 2000-ft cliff, impassable by all but the most nimble, shut the site off from the rest of the island. If nature made the peninsula a fortress, men made it into a hell. Patients were promised food, shelter, and medical care; under a succession of supervisors who were corrupt, incompetent, or both, they received starvation rations, were exposed to the elements, and were neglected. The board of overseers expected the Molokai colony to be self-sufficient, but patients with palsied and ulcerated limbs made poor farmers. Every kind of vice flourished, and suicide was common. The few physicians who came there were terrified of the residents or took advantage of them as captive subjects for bizarre and repulsive human experimentation. The terminally ill were literally dumped into a shack to die. That any residents at all survived is a tribute to their stoical cooperation with one another in the face of official indifference.
(Figure)
The Kalaupapa Peninsula, Molokai.
AP Photo/Eric Risberg.
As rumors of the horrors of Molokai leaked out, infected persons who were still at large became fugitives, pursued by bounty hunters into the fastnesses of the islands. Others with noninfectious skin conditions, such as psoriasis, were exiled by error. One unlucky man was misdiagnosed with leprosy after a wild boar bit off his toe.
In later years, conditions on the peninsula slowly improved, especially as the business leaders of the islands began to understand that the relentless bad publicity was detrimental to trade and tourism. Several remarkable people worked tirelessly to benefit the Molokai colony, including saintly, pugnacious Father Damien; Joseph Dutton, a hero of the Civil War and an alcoholic on a quest for redemption; and Mother Marianne, who had to fend off unwanted romantic advances from the prime minister.
Tayman simplifies to some extent the complex public health issues involved in the management of the Molokai colony and gives the impression that the policy pursued there was senseless and arbitrary. However, although the operation of Molokai was cruel and feckless, the theory behind the colony was in accordance with the best medical opinion of the day. For example, William Osler wrote approvingly of the segregation policy as enforced at the leprosarium at Tracadie, NB, Canada. Even some modern medical historians argue that ruthless isolation in leprosaria was the primary factor that brought leprosy under control in Europe, centuries before the development of antibiotics. Furthermore, there is evidence that most cases of leprosy in the Hawaiian epidemic were of the highly contagious lepromatous form (patients shed Mycobacterium leprae from their heavily infiltrated nasal passages).
The Colony begins as a tale of heartbreak, suffering, and terrible loneliness, but it ends as a testimony of triumph and survival, with Tayman writing of the poignant and successful efforts of the survivors of Molokai to overcome prejudice and disability and rejoin society. The book is a painstakingly researched social history, a morality play illuminating the best and worst of human nature, a page-turning narrative, and a deeply sympathetic drama featuring a fascinating cast of characters.
John J. Ross, M.D.
Brigham and Women's Hospital
Boston, MA 02115
jross4@partners.org(By John Tayman. 421 pp., )
John Tayman's superb new history of Hawaii's infamous leper colony gives the answer. In the 1850s, leprosy became hyperendemic in the islands, with symptoms developing in as many as 1 in 30 Hawaiians. In response to the crisis, the government banished those with the infection to the Kalaupapa peninsula of Molokai. Robert Louis Stevenson called it "a prison fortified by nature." Jagged lava boulders ringed the shoreline on three sides. Landing a ship was impossible: patients were pitched from rowboats into the surf to fend for themselves. A 2000-ft cliff, impassable by all but the most nimble, shut the site off from the rest of the island. If nature made the peninsula a fortress, men made it into a hell. Patients were promised food, shelter, and medical care; under a succession of supervisors who were corrupt, incompetent, or both, they received starvation rations, were exposed to the elements, and were neglected. The board of overseers expected the Molokai colony to be self-sufficient, but patients with palsied and ulcerated limbs made poor farmers. Every kind of vice flourished, and suicide was common. The few physicians who came there were terrified of the residents or took advantage of them as captive subjects for bizarre and repulsive human experimentation. The terminally ill were literally dumped into a shack to die. That any residents at all survived is a tribute to their stoical cooperation with one another in the face of official indifference.
(Figure)
The Kalaupapa Peninsula, Molokai.
AP Photo/Eric Risberg.
As rumors of the horrors of Molokai leaked out, infected persons who were still at large became fugitives, pursued by bounty hunters into the fastnesses of the islands. Others with noninfectious skin conditions, such as psoriasis, were exiled by error. One unlucky man was misdiagnosed with leprosy after a wild boar bit off his toe.
In later years, conditions on the peninsula slowly improved, especially as the business leaders of the islands began to understand that the relentless bad publicity was detrimental to trade and tourism. Several remarkable people worked tirelessly to benefit the Molokai colony, including saintly, pugnacious Father Damien; Joseph Dutton, a hero of the Civil War and an alcoholic on a quest for redemption; and Mother Marianne, who had to fend off unwanted romantic advances from the prime minister.
Tayman simplifies to some extent the complex public health issues involved in the management of the Molokai colony and gives the impression that the policy pursued there was senseless and arbitrary. However, although the operation of Molokai was cruel and feckless, the theory behind the colony was in accordance with the best medical opinion of the day. For example, William Osler wrote approvingly of the segregation policy as enforced at the leprosarium at Tracadie, NB, Canada. Even some modern medical historians argue that ruthless isolation in leprosaria was the primary factor that brought leprosy under control in Europe, centuries before the development of antibiotics. Furthermore, there is evidence that most cases of leprosy in the Hawaiian epidemic were of the highly contagious lepromatous form (patients shed Mycobacterium leprae from their heavily infiltrated nasal passages).
The Colony begins as a tale of heartbreak, suffering, and terrible loneliness, but it ends as a testimony of triumph and survival, with Tayman writing of the poignant and successful efforts of the survivors of Molokai to overcome prejudice and disability and rejoin society. The book is a painstakingly researched social history, a morality play illuminating the best and worst of human nature, a page-turning narrative, and a deeply sympathetic drama featuring a fascinating cast of characters.
John J. Ross, M.D.
Brigham and Women's Hospital
Boston, MA 02115
jross4@partners.org(By John Tayman. 421 pp., )