When Minnesotans think about leprosy, they may recall Biblical references to the “unclean,” the National Leprosarium in Louisiana, or a Hawaiian leper colony. In our state, however, leprosy was a medical concern during the late 1800s and early 1900s, when many of the affected were Norwegian immigrants.
Since the 1960s, leprosy discovered in its early stages has been successfully treated and cured with a combination of antibiotics. However, leprosy was once and still is a highly feared disease around the world that results in discrimination, maltreatment, and isolation of affected people and their families. Untreated individuals experience disfiguring changes in skin color and texture, swelling under the skin, nerve damage resulting in paralysis of the hands and feet, shortening or loss of fingers and toes, and pain. An 1888 newspaper article described the facial blotches as resembling “the black matter that often accumulates on ears of corn while on the stalk.”
In the 1860s, there were more leprosy cases in Norway, which had three leprosy hospitals, than any other European country. Found primarily on the coast and in peasants more generally, the disease was often attributed to a diet high in fish. In 1873, Gerhard Armauer Hansen, a Norwegian physician, discovered bacteria in the lesions of a leprosy patient and was the first to suggest that bacteria caused leprosy. Others believed that the disease was hereditary since bacteria had not yet been proven by scientists to cause disease. Leprosy is also known as Hansen’s disease and is caused by slow-growing Mycobacterium leprae bacteria.
In 1888, Dr. Hansen arrived in St. Paul to study leprosy because of the high number of Norwegian immigrants in the state. His goal was to prove that leprosy was not hereditary but contagious only through close contact. He stated that if diseased people wanted to live in their own homes, they should have their own eating utensils and clothing, washed separately from others’, and their own beds. He wrote that from 1857 to 1895, there were about 5,053 new cases of leprosy in Norway and about 170 people with the disease immigrated to North America. Since disease symptoms can take up to twenty years to exhibit, he said, only twenty of the 170 were known to be infected prior to immigration. His statements refuted accusations that Norway was sending infected immigrants to the United States to rid Norway of leprosy. Other Norwegian physicians believed that leprosy was hereditary and became symptomatic due to the stresses associated with ocean fishing and farming in the rugged Norwegian landscape.
Also in 1888, Dr. Hansen traveled to Red Wing to spend several weeks with Dr. Christian Grönvold, a member of the State Board of Health and chairman of its leprosy committee. Dr. Grönvold was an immigrant from Norway who lived in Goodhue County, home to a large population of Norwegian immigrants.
Henry Bracken, M.D., served as chief executive officer of the Minnesota State Department of Health and secretary of the State Board of Health. In 1906, a Mr. J. D. wrote to Dr. Bracken that his wife had died of leprosy and that he had fumigated the house with sulfur. He asked for information on what else he should do. Dr. Bracken responded that J. D. should thoroughly clean and scrub the house with formaldehyde and liberally use paint and whitewash throughout. He instructed him to destroy his wife’s clothing and bedding and to contact the health officer in the neighboring town for additional help.
In 1912, a letter appeared in a Minnesota newspaper asking readers to send items such as books and magazines to an eighteen-year-old boy, E. B., who was suffering from leprosy. The writer said E. B. was “deserving of a Carnegie medal” since he had cared for his mother until she died from leprosy in 1905. Now E. B. was isolated in a log cabin and waiting to die himself. County commissioners helped to build the family a new house, and E. B. remained in the old home. Parents in the nearby township refused to allow their children to attend school with the boy’s siblings. (E. B died in 1913.)
Also in 1912, Dr. Bracken resolved a dispute between a creamery and E. B.’s family. The creamery refused to buy the milk from the family since the belief was that the milk could transmit leprosy. Dr. Bracken wrote to the creamery management and said that the people who handled the milk were not in contact with E. B. Leprosy, moreover, was not as contagious as tuberculosis. He said at the time there were seventeen or eighteen cases of leprosy in the state, but there were over 10,000 cases of tuberculosis. Because of his letter, the creamery reversed its decision. In 1921, after E. B.’s sister, who no longer lived with the family, was diagnosed with leprosy, physicians visited the remaining family members and evaluated their conditions. E. B.’s father and other sister and brothers showed no evidence of the disease.
Doctors and officials from other states routinely wrote to Dr. Bracken asking about how the state of Minnesota managed leprosy. He responded that the affected were usually cared for by their families or at county poor farms. They would occupy a room by themselves with their own bedding, towels, and dishes. Soiled bandages were burned and washable bedding and clothing were disinfected. He wrote that there was no quarantine or persecution of the individual and no panic regarding the person.
Dr. Bracken stated that no one with a family member with leprosy should be allowed to enter the country so the disease would die out. He was an advocate for a national home to care for the patients so they could be moved from filthy homes where adequate hygiene was not practiced. He said this action would be more economical, provide more satisfactory care, and segregate but not isolate them. He wrote of a woman from Sweden who wished to die to free her family from the persecution caused by her disease. Her husband, who was a carpenter, could not find work, and her children could not go to school due to public sentiment. Bracken said her family would be free of this stigma if she could be cared for in a leprosarium.
In 1898, Dr. Bracken reported that he knew of fifty-one people affected with leprosy in Minnesota prior to 1890. Of the fifty-one, he said twenty-one were married and had a collective total of seventy-eight children. None of the children or spouses had developed leprosy at the time. As of 1948, there had been ninety-eight leprosy cases reported in the Minnesota population—fifty-three Norwegians, thirteen Swedish, 8 with Swedish or Norwegian parents or grandparents, 8 to 10 that were probably Norwegian, and 14 from other countries.
In the twenty-first century, the Minnesota State Department of Health requires that a newly identified case of Hansen’s disease must be reported to them within one working day of discovery. The disease is uncommon in the twenty-first century, with zero to three cases per year reported. The risk of developing Hansen’s disease in the United States is very low, since 95 percent of the worldwide population has natural immunity. Close and prolonged exposure over several months to an infected individual is required to catch the disease; it is likely spread by droplets released during coughing and sneezing.
Bracken, H.M., M.D. “Are National Leprosaria in the United States Desirable?” Public Health Papers and Reports 26 (1900): 180‒202.
——— . “Leprosy in Minnesota.” Public Health Papers and Reports 24 (1898):186‒191.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2329315/pdf/pubhealthpap00033-0193.pdf
Centers for Disease Control and Prevention (CDC). Hansen’s Disease (Leprosy).
https://www.cdc.gov/leprosy/index.html
Esson, Afton. “Faces of the Past: Dr. Just Christian Gronvold.” Red Wing Republican Eagle, March 22, 2017.
Grönvold, Christian, M.D. “Leprosy in Minnesota.” Infectious Diseases of Men, State Board of Health of Minnesota (August 1, 1892).
Hansen, G. Armauer, M.D. “An Explanation of the Causes Which Have Led to the Decrease of Leprosy in Norway.” St. Paul Medical Journal (April 1899): 243‒247.
https://babel.hathitrust.org/cgi/pt?id=mdp.39015011954842;view=1up;seq=271
Health Resources and Services Administration (HRSA). History of the National Hansen’s Disease (Leprosy) Program.
https://www.hrsa.gov/hansens-disease/history.html
Library of Congress. Immigration Act of 1891.
https://www.loc.gov/law/help/statutes-at-large/51st-congress/session-2/c51s2ch551.pdf
International Leprosy Association. History of Leprosy: Dr. Gerhard Armauer Hansen.
http://leprosyhistory.org/database/person1
“Investigating Leprosy.” St. Paul Daily Globe, July 11, 1888.
https://chroniclingamerica.loc.gov/lccn/sn90059522/1888-07-11/ed-1/seq-1/
“Looking After Lepers—A Prominent Norwegian Physician Now in St. Paul.” St. Paul Daily Globe, February 8, 1888.
https://chroniclingamerica.loc.gov/lccn/sn90059522/1888-07-11/ed-1/seq-1/
McEnroe, Paul. “Leper Mingled with Other State Prisoners.” Star Tribune, June 18, 2012.
http://www.startribune.com/leper-mingled-with-other-state-prisoners/158325835/
127.K.9.7B
Minnesota Department of Health, Reports and Miscellaneous Records, 1872‒2002
Field Investigations by Division of Preventable Diseases, 1921‒1940
Description: Reports of physicians’ home visits, 1921 (#151.XXI).
Minnesota Department of Health. Reporting Leprosy (Hansen’s Disease) (Mycobacterium leprae).
http://www.health.state.mn.us/divs/idepc/dtopics/reportable/leprosy.html
111.D.14.2F (Box 11)
Correspondence, 1898‒1923; Leprosy folder, 1898‒1915
Minnesota Department of Health
State Archives Collection, Minnesota Historical Society, St. Paul
http://www2.mnhs.org/library/findaids/gr01127.xml
Description: Correspondence related to leprosy and its management.
111.D.14.3B (Box 12)
Correspondence, 1898‒1923; Leprosy folder, 1898‒1915
Minnesota Department of Health
State Archives Collection, Minnesota Historical Society, St. Paul
http://www2.mnhs.org/library/findaids/gr01127.xml
Description: Correspondence related to leprosy and its management.
126.B.14.13B
Leprosy file, undated and 1883‒1884 (Charles N. Hewitt files)
Reports and miscellaneous records, 1872‒2002
Minnesota Department of Health
State Archives Collection, Minnesota Historical Society, St. Paul
http://www2.mnhs.org/library/findaids/gr01251.xml
Description: Correspondence with Dr. Grönvold of Norway, Minnesota, on leprosy in Minnesota and the Sandwich Islands (Hawaii).
126.E.3.5
Records of lepers in Minnesota
Reports and miscellaneous records, 1872‒2002
Minnesota Department of Health
State Archives Collection, Minnesota Historical Society, St. Paul
http://www2.mnhs.org/library/findaids/gr01251.xml
Description: Data on people with leprosy, including names, ages, dates of birth, nationalities, residences, children, and dates of immigration to the United States.
“Minnesota News: Leprosy.” Willmar Tribune, March 15, 1899.
https://chroniclingamerica.loc.gov/lccn/sn89081022/1899-03-15/ed-1/seq-3/
“Remember the Poor Boy.” Princeton Union, February 15, 1912.
https://chroniclingamerica.loc.gov/lccn/sn83016758/1912-02-15/ed-1/seq-1/
Qualey, Carlton C. “Pioneer Norwegian Settlement in Minnesota.” Minnesota History 12, no. 3 (September 1931): 247‒280.
http://collections.mnhs.org/MNHistoryMagazine/articles/12/v12i03p247-280.pdf
Schultz, Doug. Minnesota Department of Health, Communications Office. Personal communication with the author, May 30, 2018.
Washburn, Walter L. “Leprosy Among Scandinavian Settlers in the Upper Mississippi Valley, 1864‒1932.” Bulletin of the History of Medicine 24, no. 2 (March‒April, 1950): 123‒148.
World Health Organization (WHO). Leprosy.
http://www.who.int/news-room/fact-sheets/detail/leprosy
In the 1940s, Dapsone is the first antibiotic used to treat leprosy successfully.
Early official records list nine Norwegians immigrants in Minnesota. By 1860, the number increases to 10,811, and by 1875, there are 83,867.
Gerhard Armauer Hansen, a Norwegian physician, discovers bacteria in the lesions of a leprosy patient and suggests that bacteria are the cause of leprosy. Leprosy becomes known as Hansen’s disease.
The St. Paul Daily Globe reports that Dr. Knut Hoegh examines a man from Durand, Wisconsin, who is suspected of having leprosy. The doctor, who is from Minneapolis and a well-known expert on leprosy, declares the illness to be lupus.
The United States Congress passes the Immigration Act of 1891, which excludes persons from entering the country “suffering from a loathsome or a dangerous contagious disease.”
Charles N. Hewitt, M.D., creator of the Minnesota State Board of Health and its first secretary, writes, “in no other state that I know are all known lepers registered and kept under observation, and all suspected cases thoroughly examined.”
A letter to the United States Surgeon General documents attention to hygiene during the transportation of an Italian immigrant from Minneapolis to Diamond Point Quarantine Station, Washington, for treatment of leprosy. He travels with a doctor by train.
The US government establishes the National Leprosarium in Carville, Louisiana. Affected Minnesotans with leprosy are sent there for care.
Dapsone, the first antibiotic used to treat leprosy, is introduced. It is used until the 1960s, when the Mycobacterium leprae bacteria become resistant to it.
Rifampicin and Clofazimine, both antibiotics, are introduced to be used with dapsone in a multi-drug therapy for leprosy.
Leprosy is eliminated as a global world health threat, with a prevalence of less than one case per 10,000 people. In the prior twenty years, 16 million leprosy patients had been treated with the multi-drug therapy.
A multi-institutional study shows that armadillos can be naturally infected with Mycobacterium leprae and thus may serve as a source of infection to humans in the southern United States. The risk is low.
After an inmate reports that he had been treated for leprosy in a refugee camp, medical staff fail to properly evaluate and manage his condition for two months while he is in the St. Cloud and Rush City, Minnesota prisons.
178 new cases of leprosy are reported in the United States. 72 percent (129 total cases) are in Arkansas, California, Florida, Hawaii, Louisiana, New York, and Texas.