Zachary Gussow - Leprosy, Racism, And Public Health

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LEPROSY, RACISM, AND PUBLIC HEALTH

LEPROSY, RACISM, AND PUBLIC HEALTH

Social Policy in Chronic Disease Control

Zachary Gussow

First published 1989 by Westview Press, Inc.

Published 2021 by Routledge
605 Third Avenue, New York, NY 10017
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN

Routledge is an imprint of the Taylor & Francis Group, an informa business

Copyright 1989 by Taylor & Francis

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.

Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe.

Library of Congress Cataloging-in-Publication Data
Gussow, Zachary, 1923
Leprosy, racism, and public health: social policy in chronic
disease control / Zachary Gussow.
p. cm.
Includes index.
ISBN 0-8133-0674-4
1. LeprosySocial aspectsUnited StatesHistory. 2. Leprosy
Government policyUnited StatesHistory. 3. RacismUnited
StatesHistory. I. Title.
[DNLM: 1. Leprosyhistory. 2. Leprosyprevention & control.
3. Prejudice. 4. Public Healthhistory. 5. Public Policy. WC
335 G982L]
RA644.L3G878 1989
362.1'96998'0097dc19
DNLM/DLC
for Library of Congress 88-5567
CIP

ISBN13: 978-0-3670-0292-3 (hbk)

ISBN13: 978-0-3671-5279-6 (pbk)

DOI: 10.4324/9780429032783

IN MEMORIAM

CHARLES WATKINS, M.D.
Chairman, Department of Psychiatry, Louisiana State University Medical Center, and Assistant to the Chancellor, 1957-1974

Contents

1. 1. 1 Symbol and Disease
2. PART 2 THE WESTERN WORLD IN TRANSITION: THE NINETEENTH CENTURY
   1. 2 The Port City of New Orleans: A Necropolis
   2. 3 Endemicity in the United States: Leprosy in Louisiana
   3. 4 Norway: The Enlightened Kingdom
   4. 5 Hawaii: An Imperialist Solution
3. PART 3 THE PERIOD OF ALARM: TURN OF THE CENTURY
   1. 6 Changing American Images of the Chinese
   2. 7 Beginnings of a U.S. National Leprosarium
4. PART 4 THE LEPROSARIUM: THE TWENTIETH CENTURY
   1. 8 The Carville Leprosarium: The Asylum Years, 1894 to Post-World War II
   2. 9 The National Hansen's Disease Center: New Managers and Old Habits
5. PART 5 CONCLUSION
   1. 10 The Secularization of Leprosy

1. 1. 1 Symbol and Disease
2. PART 2 THE WESTERN WORLD IN TRANSITION: THE NINETEENTH CENTURY
   1. 2 The Port City of New Orleans: A Necropolis
   2. 3 Endemicity in the United States: Leprosy in Louisiana
   3. 4 Norway: The Enlightened Kingdom
   4. 5 Hawaii: An Imperialist Solution
3. PART 3 THE PERIOD OF ALARM: TURN OF THE CENTURY
   1. 6 Changing American Images of the Chinese
   2. 7 Beginnings of a U.S. National Leprosarium
4. PART 4 THE LEPROSARIUM: THE TWENTIETH CENTURY
   1. 8 The Carville Leprosarium: The Asylum Years, 1894 to Post-World War II
   2. 9 The National Hansen's Disease Center: New Managers and Old Habits
5. PART 5 CONCLUSION
   1. 10 The Secularization of Leprosy

1. xiv

Guide

Tables and Figures

Tables

2.1 Cost of acclimation: Showing the life cost of acclimation; or liabilities to yellow fever from nativity, as exhibited by the epidemic of 1853, in New Orleans

3.1 A list of cases recorded in such annual reports of the Charity Hospital, New Orleans, as have been preserved

5.1 The nationalities of the population at all the census dates from 1866 onward

Figures

4.1 Course of leprosy in Norway from 1856 to 1927

4.2 Number of new cases in five-year periods from 1857 to 1925

5.1 Leprosy in Hawaii: Cases segregated by years, 1866-1905

6.1 Number of references to leprosy in index to the London Times, 1870-1930

Preface

I had given no thought whatsoever to leprosy prior to my moving to New Orleans in 1961. Leprosy was not a disease that affected those I knew or with whom I had grown up. My people developed cancer and had strokes and heart attacks; earlier they would have contracted an acute infectious disease. At the time I journeyed south, mental illness attracted research attention, and when I joined the faculty in the Department of Psychiatry, Louisiana State University School of Medicine, I fully expected to be preoccupied with diseases of the mind. Instead, to phrase it in medieval terms, I became involved with a "disease of the soul."

The ideas presented in this book and, above all, its perspective that the modern Western stigmatization of leprosy is of recent origin and not, as is generally believed, the result of tradition that dates from ancient biblical times, emerged out of ongoing fieldwork conducted at the United States Public Health Service Hospital, Carville, Louisianathe only leprosarium in the continental United States.

Fieldwork at Carville, along with side excursions among outpatients attending clinics in New Orleans and San Francisco, continued throughout most of the 1960s. In 1973, my work was extended to East Africa, particularly Tanzania; it also included brief surveys in Kenya and Ethiopia.

An invitation extended to me by Dr. Oliver W. Hasselblad, then president of the American Leprosy Missions, to present a paper at the Ninth International Leprosy Congress, London, 1968, had provided me an opportunity to review the current thinking about leprosy stigma. A new approach, based on mid-nineteenth- and early twentieth-century Western social history, was presented. A paper based on it was subsequently published in 1970 in the Bulletin of the History of Medicine and later, in 1971, in more analytic form, in the American Anthropologist.

Ideas I first outlined in 1968, to which I later added my observations of leprosy control programs in hyperendemic Third World nations, provide the central historical assumptions and background on which the present work builds. The work encompassed in this book thus spans a period of more than two decades of investigation, thought, and writing.

Generally, social scientists seek out institutions for study. Less well appreciated are those situations wherein administrators seek to have their own institutions examined by social scientists. Late in the 1950s, Carville was experiencing profound changes in leprosy policy, and the new administration strongly felt the need for studies of hospital sociology. Discussions about research were initiated by Dr. Edgar B. Johnwick, medical officer in charge, early in 1957 with members of the Department of Psychiatry, Louisiana State University School of Medicine. Dr. George Devereux, a psychoanalytically trained anthropologist and visiting consultant to the department, later joined the discussion. Three years later, Dr. Devereux, with whom I had earlier worked, called to ask if I would consider a position "in the South." Leprosy was never mentioned, nor was it mentioned when I was interviewed for the job in New Orleans.

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