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Leprosy is a disease which has long been stigmatized and persons afflicted with it have frequently been segregated from the rest of society. This paper focuses on the evolution of policies concerning the confinement of patients at the national leprosarium operated by the United States Public Health Service (PHS) at Carville, Louisiana. After a brief review of the origins of the Lousiana Leper Home, which eventually became the national leprosarium, the paper traces changing attitudes and policies at Carville from 1921, when the PHS took control of the facility, to the 1950s.

Archival records of physical restraint usage at the St. Louis Insane Asylum (now the St. Louis State Hospital) were examined from January through June 1885. The demographics of restrained patients were determined from archival admission records. In the 6-month (181-day) sample period, 53 patients accounted for the total of 2,537 incidents of night restraint. Sixty percent of the restrained patients were women and 53% were immigrants. By far most (98.5%) of the incidents of restraint were brought on by violent behaviour (fighting, destroying property, injury to self) while most incidents in modern hospitals result from verbal threats or shouting. When these records were combined with day restraint records from the same 6-month period in 1889, an overall incidence rate of 9.7% per month was estimated. This is similar to rates reported from modern psychiatric hospitals. Possible reasons for the discrepancies and similarities in the types of patients restrained and the activities which brought on restraint in the nineteenth and twentieth centuries are discussed.

This paper presents a model designed to contextualize studies of the specialized custodial mental handicap institutions which evolved in Britain and North America during the early decades of this century. The frame of reference adopted is the eugenics movement, and particularly the debate over sterilization vs segregation as the preferred means of controlling the breeding of the 'unfit'. The rise of farm colonies is seen as epitomizing the expression of eugenic ideologies in the social and physical landscapes. The geographical manifestation of eugenically-driven policy is illustrated in a case study of the Langdon colony, an extension of the Royal Western Counties Institution at Starcross near Exeter, as it developed between 1931 and 1938.