Arpan K Banerjee reviews Oliver Basciano’s Outcast: A History of Leprosy, Humanity, and the Modern World, exploring the modern history of leprosy through archives, literature, and personal narratives.
Leprosy has affected human society for millennia. Writings in ancient Indian Vedic texts as early as 600 BC described signs of the disease, as did the Indian physician Sushruta in his voluminous writings from the sixth century BC, and the Greek physician Hippocrates in the fifth century BC in the Western world. The disease rapidly acquired a social stigma and became wrongly associated with immorality. Even Manushmriti, from 600 BC, was one of the first Sanskrit texts to be translated into English in the eighteenth century mentioned leprosy. The text forbade people from marrying anyone with the condition and stated that they should not contact those with the disease. People wrongly believed it was highly infectious.
Outcast: A History of Leprosy, Humanity and the Modern World, by Oliver Basciano, a London and São Paolo based journalist, describes the treatment of people with leprosy in different parts of the world throughout modern history, researched from historical archives and by speaking to people living with leprosy. The narrative intersperses information on the pioneering leprologist and personalities involved in the management of these patients. It is a collection of medical historical snippets of infectious diseases, including, of course, leprosy. Referring to historical material and combining the text with stories of current sufferers, the author added a layer of poignancy and compassion to the book. The book movingly portrays stories of current people living with leprosy, and sometimes it seems that, over the centuries, people have made little progress in destigmatising the disease. In his research, the author visits European, South American, African, Japanese, and Siberian hinterland communities, where leprosy colonies were common. The book covers the Molokai community in Hawai’i, Yakutsk in Russia, people with leprosy on Robben Island, South Africa (today better known for its association with Nelson Mandela), and communities in Romania, Brazil, and Mozambique.
The book includes rich references to literature and films in its overview. This includes Graham Greene, who set his 1960 novel A Burnt-Out Case in a leprosy colony in the Congo during the 1950s. Greene himself had visited several leprosy colonies in Africa and dedicated the book to Dr Lechat, a Belgian doctor who oversaw the leprosy colony in Yonda, South Africa. Cinematic references include the 1940 film ‘Spring on Leper’s Island’ by Japanese director Shiro Toyoda based on a book of memoirs by the Japanese doctor Masako Ogawa’s experiences in a Japanese leprosy colony are also a stark reminder of the human and societal aspects of the illness. Masako Ogawa worked at the Nagashima sanatorium before publishing her book of experiences, Spring in a Small Island, in 1938, which was later adapted into a film.
Regional Histories of Leprosy
Geographical locations organise the book, each offering a unique perspective on the history and societal treatment of leprosy. It delves into leprosy in medieval Britain, Hansen’s groundbreaking work on leprosy in Norway, and the inspiring stories of the nineteenth century Belgian priest, Father Damien, who worked in a leprosy camp on Moloka’i, Hawai’i. The book also sheds light on leprosy colonies in Russia, South Africa, Romania, and Mozambique. It critically examines the establishment’s handling of leprosy in Brazil, with a concluding chapter on leprosy in Japan.
Leprosy was once considered a hereditary condition. Gerhard Hansen, a Norwegian physician, discovered Mycobacterium leprae by obtaining tissue samples from leprosy patients and sending them to Albert Neisser, a German physician, who stained the bacterium responsible. Today, leprosy is also known as Hansen’s disease. Presently, at Bergen’s St. Jorgen Hospital, there is a museum dedicated to Hansen and his life and work.
Father Damien, the famous Belgian priest who worked in a leprosy colony in Molokai in the nineteenth century, illustrates that in Hawaiian society there was little stigmatisation of leprosy patients. Stigmatisation usually arose from the visiting colonial authorities, who often imposed their puritanical moral attitudes on the people. The story of people with leprosy in Romania under the communist regime makes chilling reading. Tichilești, in Romania, is Europe’s last leprosy colony, founded in 1875. Its recent stories are inextricably linked to the legacies left by Nazi and communist persecution.
The chapter on Brazil intertwines politics, failed social policy and stigmatisation of people with leprosy in Brazil, as well as reminding us that colonisers introduced leprosy to Brazil at the end of the sixteenth century. Central to this discussion is the tension between enforced segregation and the fundamental human rights of patients to maintain family life and dignity, a debate that has shaped policies for decades.
Similarly, Basciano’s research on leprosy in Japan reminds us how attitudes have changed over the years. In 1998, a group of patients in the Japanese sanatorium initiated legal proceedings against the Japanese government for the curtailment of their human rights over decades. The charges included forced sterilisation along with other forms of inhumane practices meted out to them. This protest would have been unheard of decades or centuries ago.
This book is well written and researched, offering a powerful chronicle of harrowing experiences, isolation and suffering endured by individuals affected with leprosy across centuries and countries. The vivid narratives of people with lived experiences expose the devastating impact of enforced isolation and societal prejudice, reminding readers of humanity’s enduring capacity for cruelty and intolerance.
About the author
Dr Arpan K Banerjee qualified in medicine at St Thomas’s Hospital Medical School. London. He was a consultant radiologist with an interest in infectious diseases in Birmingham 1995-2019. Presently, he is the Chairman of ISHRAD (International Society for the History of Radiology). He has authored numerous papers and books on a range of clinical, radiological, and medical historical topics. His latest book, as a co-editor and contributor, is Pioneers in Radiology Worldwide at the time of Rontgen, published in Paris. He was a Crookshank lecturer and medallist at the Royal College of Radiologists in 2023. Reach out to him at arpankb007@gmail.com.
References
Basciano, Oliver. 2025. Outcast: A History of Leprosy, Humanity, and the Modern World. Faber & Faber.
Wikimedia Foundation. 2025. “Mycobacterium leprae.” Last modified 19 October, 19:28. https://en.wikipedia.org/wiki/Mycobacterium_leprae.
Wikimedia Foundation. 2025. “Gerhard Armauer Hansen.” Last modified 16 November, 13:55. https://en.wikipedia.org/wiki/Gerhard_Armauer_Hansen.
Wikimedia Foundation. 2025. “Father Damien.” Last modified 31 October, 08:01. https://en.wikipedia.org/wiki/Father_Damien
Wikimedia Foundation. 2025. “Tichilești, Tulcea.” Last modified 16 September, 18:06. https://en.wikipedia.org/wiki/Tichile%C8%99ti,_Tulcea.
