Molokai is one of the least populated of the Hawaiian Islands, but for years it made Hawaii the most notorious place on earth. John Tayman revisits a time when tourism was just a dream

Early one morning in the fall of 1947, a Honolulu physician named Edwin Chung-Hoon began his second exam of the day. His patient was a sweet-natured 12-year-old boy from a working class neighborhood near downtown. Dr. Chung-Hoon had a standard protocol for what he would undertake that morning. During the previous year, physicians in Hawaii had conducted similar examinations 1,038 times. According to a report published three years earlier in the Hawaii Medical Journal, doctors were to be on the alert for a number of presenting symptoms: "blotches" or "lumps" on the patient's face and body, numbness or swelling of the skin, muscle weakness, contracture of the fingers, itching, difficulty in swallowing, and sore eyes and ears. The office visits culminated in a bacteriological exam of a piece of skin cut from an affected area, often an earlobe. Only after investigating the sample microscopically would the physician render his diagnosis. Dr. Chung-Hoon entered the waiting room and told the boy's father the results: His son had leprosy. One week later, the child was exiled.

For 103 years, beginning in 1866, the Hawaiian and then the American governments forcibly removed more than 8,000 people to a remote and inaccessible peninsula on the Hawaiian island of Molokai, sending them to one of the largest leprosy settlements in the world. The governments did so in the earnest belief that leprosy was rampantly contagious, that isolation was the only effective means of controlling the disease, and that every person they banished actually suffered from leprosy and was thus a hopeless case. On all three counts, they were wrong. With the establishment of the colony on Molokai—an island eight miles from Maui that even today remains startlingly wild—officials initiated what would prove to be the longest and deadliest medical segregation in American history, and perhaps the most misguided. In 1865, acting on the counsel of his American and European advisers, Lot Kamehameha, the Hawaiian king, signed into law the Act to Prevent the Spread of Leprosy, which criminalized the disease. The law remained in effect in various forms—through the annexation of Hawaii by America in 1898 and the adoption of Hawaii as the fiftieth U.S. state in 1959—until 1969, when it was repealed. In the law's early days, persons suspected of having the disease were chased down, arrested, subjected to a cursory physical exam, and exiled. Armed guards forced them into the cattle stalls of interisland ships and sailed them 58 nautical miles east of Honolulu to the brutal northern coast of Molokai. There, they were dumped on an inhospitable shelf of land the approximate size and shape of Lower Manhattan, which jutted into the Pacific from the base of the world's highest sea cliffs. It was, Robert Louis Stevenson later wrote, "a prison fortified by nature." Three sides of the peninsula, known as Kalaupapa, were ringed by jagged lava rock, making landings impossible, and the fourth rose as a 2,000-foot wall so sheer that even wild goats tumbled from its face. In the beginning, the government provided virtually no medical care, meager food, and only crude shelter. Soon, thousands had been banished, including dozens of children, luckless foreigners, and even a member of the Hawaiian royal family. Life within this lawless penitentiary quickly came to resemble that aboard a crowded raft in the aftermath of a shipwreck, with epic battles erupting over food, water, blankets, and women. As news of the abject misery spread, others with the disease hid in terror from the government's bounty hunters, or violently resisted. The mortality rate for patients in the first five years of exile was a staggering 46 percent.