A Prison in Paradise

Tsara’ath. Hansen’s disease. Galen’s elephantiasis. The Phoenician disease. These are some of the names used to describe one of mankind’s oldest afflictions:

Leprosy

As long as mankind has recorded its history through documentation and oral stories, leprosy has made its presence known: accounts are found in biblical texts, ancient Indian texts from 3500 – 4000 years ago, and of course in various works of fiction which I’ll be reading and blogging about in the near future.

In this post, we visit Hawai’i, and meet Koolau the Leper, in a short story told by Jack London, author of ‘Call of the Wild’ and ‘White Fang’. Koolau and his followers live on the island of Kauai. Times are hard: they have lived to see their lands taken and used for sugar-cane crops by the Americans, and now, infected with leprosy by the Chinese slaves brought to work on these plantations, Koolau’s community live in fear of being exiled to the leper seclusion zone on the island of Moloka’i.

We plunge into Koolau’s world to hear a rousing speech, as the leper prepares his followers for battle against the threat of quarantined imprisonment.

“Because we are sick they take away our liberty. We have obeyed the law. We have done no wrong..”

The group huddle together, drinking distilled ti-plant to the chords of a ukulele, and lose themselves to the sound and rhythm of dancing. Suddenly, a rocket flares. “It is the soldiers”, says Koolau. “Tomorrow there will be fighting.”

 

Molokai 1922

Kalawao, Moloka’i, ca 1922. Albert Pierce Taylor (1922) Under Hawaiian Skies: A Narrative of the Romance, Adventure and History of the Hawaiian Islands, Board of Education of the Hawaiian Kingdom, p. Page 348  Image in Public Domain, available on WikiCommons at: https://commons.wikimedia.org/wiki/File:Kalawao,_Molokai,_ca._1922.jpg

Jack London’s tale is based on historical events around the Leper War in 1893, occurring after the Republic of Hawai’i decided to isolate all lepers to the island of Moloka’i to try to preserve the Hawaiian economy. This is the story of Koolau the Leper’s last stand, as he fights to maintain the freedom of a community who have lost everything else – their land, livelihoods and health, to colonialism. He is willing to risk everything, killing the sheriff and several policeman who come to arrest him, and proclaiming “I am a free man… I have done no wrong. All I ask is to be left alone. I have lived free, and I shall die free. I will never give myself up.”

The descriptions of the effects of leprosy on Koolau and his community are graphic, suggesting a timeline of several years since the members of this community contracted the infection. “An arm-stump showed where a hand had rotted off”, “a space yawned in face where a nose should have been”, “hideously maimed and distorted”, “great ulcers and livid putrefaction”. London’s description of Koolau himself is vivid: “stumps of hands” and a featureless face “save for gaping orifices and for the lidless eyes that burned under hairless brows”.  Yet, despite these vivid, at times bestial descriptions, London humanises his characters through his depictions of their dancing and emotions.

Koolau the leper.jpg

Koolau the Leper; Kalalau, Kauai. From WikiCommons, image in public domain, originally Hawaii State Archives, Call number PP-19-05-022; author/date not given. Available at: https://commons.wikimedia.org/wiki/File:Koolau_the_Leper;_Kalalau,_Kauai_(PP-19-05-022).jpg

The afflictions that London describes are consistent with those that might be seen with advanced leprosy. This picture of Koolau appears less graphic than the descriptions in this short story, but closer inspection of Koolau’s feet suggest scarring and patchy changes of the skin which may well be due to leprosy.

What is leprosy? The culprit organism is a small bacillus, called mycobacterium leprae. It is still not entirely clear how this gets transmitted between humans; the long-held belief that skin contact is responsible is not certain, and it has been recently suggested that leprosy is possibly transmitted by the respiratory route, that is, by breathing in the organism.

What are the symptoms of leprosy? Well, people with leprosy can exhibit symptoms in two different ways. The first, called ‘tuberculoid leprosy’, causes little patches of skin to become numb, lose pain sensation, and lose any overlying hair. The skin becomes raised with red edges. The second form, ‘lepromatous leprosy’, causes more visual changes, as the skin become thickened and folded where the organism invades. Over time, with severe infection, the infected individual can lose fingers, toes, nose, and other extremities. At one point, Jack London describes the lepers’ faces as ‘leonine’ – this is likely due to the lepromatous form of leprosy whereby the thickened skin creates coarse facial features, rather like a lion’s face.

Leprosy, by its effects on the nerves, makes the infected individual far more at risk of injuries, because they lack the sensation to feel pain or heat. For example, during battle, Koolau becomes aware of a scent of burnt meat – it is his fingers; anaesthetised, they feel no pain and he only notices their injury from the foul smell of his burns, sustained due to the heat of his rifle.

Who gets leprosy in the 21st century? Leprosy certainly remains a current disease, with over 200,000 new cases being reported each year (WHO 2017), especially in the Indian subcontinent, Brazil, SE Asia and across Africa, the Americas. Nowadays, it is not necessarily the terrifying disease it once was: treatment is more effective and leprosy can be cured. Nerve damage may remain permanent, however, and the treatment is a long course, lasting at least 6-12 months using a combination of anti-leprosy drugs to avoid resistance.

IMG-20170702-WA0012[1]

One of many works of literature to tackle the topic of leprosy, ‘Koolau the Leper’ depicts a dark time in Hawai’i’s history, and Jack London’s account appears fairly accurate from both a historical and medical standpoint. I highly recommend this short story, and in fact – lucky you! – it is available to read online at: http://www.online-literature.com/london/72/ Go check it out! For extra information on leprosy, the World Health Organisation is a great source of info, have a look at http://www.who.int/lep/en

Enjoyed this blog? Got a burning question about mycobacterium leprae? Get in touch below and stay tuned for more infectious reads!

 

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