Patient Zero and the Making of the AIDS Epidemic
Page 11
of the Origin of Syphilis in Eighteenth- Century England: Science, Myth, and Prejudice,”
Eighteenth- Century Life 24, no. 1 (2000): 22– 44.
45. D. Goldstein, Once Upon a Virus, 80– 81. A crude remixing of these theories ap-
pears in a short cartoon segment wherein a male fl ight attendant has sex with a chimpan-
zee and potentially infects the latter with a deadly virus; “AIDS Patient Zero,” Seth Mc-
Farlane’s Cavalcade of Cartoon Comedy, directed by Greg Colton (Beverly Hills, CA:
Twentieth Century Fox, 2009), DVD.
What Came Before Zero? 55
the origins of HIV in Africa, it is important to remember that in the
early 1980s, with the bulk of AIDS cases reported in the United States,
the general assumption of non- Americans was that the United States
was the source of the disease.46 In June 1983, for instance, a journal in
France referred to AIDS as “the curse which came from America.” Sim-
ilarly, it was common in the United Kingdom to attribute the arrival of
the disease on gay men who had returned from “sex holidays” in the
States.47 Some Soviet observers, too, proposed the United States as the
source, circulating a false story that the disease was the result of biologi-
cal warfare experiments gone wrong at Fort Detrick, a US Army instal-
lation in Maryland.48 This international response was in marked contrast
to the assumptions of many American researchers who believed that a
previously unnoticed disease in the United States, a country with com-
paratively strong disease surveillance abilities, was likely to have been
introduced from abroad. Some observers, particularly members of other
suspected origin countries, interpreted this view as an act of unjusti-
fi ed racial scapegoating, not to mention an unwillingness on the part of
Americans to deal with what appeared to be domestic problems.
Much like the reaction of African physicians to Western sugges-
tions that they had not recognized a disease in their midst for genera-
tions, Haitians and their supporters would assert that AIDS was in fact
an epidemic brought by Americans to their country.49 They could point
to an American history which combined fears of infectious disease with
a wariness and mistrust of foreigners, particularly immigrants.50 Often
underscored by racist attitudes, popular views of immigrants found ex-
46. See, for example, David M. Morens, Gregory K. Folkers, and Anthony S. Fauci,
“The Challenge of Emerging and Re- Emerging Infectious Diseases,” Nature 430 (July 8,
2004): 242– 49. For a concise review of the literature discussing African origins, see John
Iliffe, The African AIDS Epidemic: A History (Oxford: James Currey, 2006), 58– 64.
47. Altman, AIDS in the Mind of America, 15– 16.
48. Gilman, “AIDS and Syphilis,” 101; Nattrass, AIDS Conspiracy, 27– 28.
49. Treichler, Theory in an Epidemic, 205– 34; Piot, No Time to Lose, 146– 47; Sabatier, Blaming Others, 46– 47, 59– 61.
50. Sander L. Gilman and Dorothy Nelkin, “Placing Blame for Devastating Disease,”
Social Research 55, no. 3 (1988): 361– 78; Alan M. Kraut, Silent Travelers: Germs, Genes,
and The “Immigrant Menace” (New York: Johns Hopkins University Press, 1995); How-
ard Markel and Alexandra Minna Stern, “The Foreignness of Germs: The Persistent As-
sociation of Immigrants and Disease in American Society,” Milbank Quarterly 80, no. 4
(2002): 757– 88; Howard Markel, Quarantine! East European Jewish Immigrants and the
New York City Epidemics of 1892 (London: Johns Hopkins University Press, 1997).
56
chapter 1
pression in medical terms. The existence— or suspicion— of certain com-
municable diseases within an ethnocultural group led at times to the
widespread view that all of the group’s members were likely carriers of
the disease.51 Several authors, most notably Paul Farmer, argued that the
“risk- grouping” of the Haitian immigrant community in 1982 and 1983
with regard to the threat of AIDS infection represented a reworking of
this familiar response to epidemic disease. Such risk groups were soon
used to posit potential origins for AIDS and resulted in what Farmer
memorably labeled a “geography of blame.”52
Beyond the geographic fi nger-
pointing that memorably accompa-
nied the emergence of both the great pox and AIDS, it is worth draw-
ing attention to the ways in which tracing the person- to- person spread of
both diseases within a country, region, or community enabled observers
to construct a web of transmission or, to modify Farmer’s phrase, a ge-
nealogy of blame. The next chapter will show how AIDS investigators,
in their initial attempts to locate cases and establish the transmissibil-
ity of an infectious agent, made use of contact tracing techniques orig-
inally developed to deal with syphilis. This modern public health his-
tory is underpinned by a long- standing popular fascination with tracing
the spread of venereal infections through society. A well- known exam-
ple of this “strange genealogy” can be found in Voltaire’s satire Candide
(1759), published during a century in which venereal disease became
more widely discussed in France.53 When, after some misadventures, the
story’s naive and eponymous hero is reunited with his former tutor Pan-
gloss, he scarcely recognizes him: the man has been reduced to a syphi-
litic wreck, “all covered with sores, his eyes dull as death, [and] the end of
his nose eaten away.” To Candide’s worried question about the cause of
his malady, Pangloss replies that a dalliance with a pretty chambermaid
had produced his “torments of hell.” This maid, he continues, “received
this present from a very learned Franciscan, who had gone back to the
source; for he had got it from an old countess, who had received it from a
cavalry captain, who owed it to a marquise, who had it from a page, who
had received it from a Jesuit, who as a novice had got it in a direct line
51. Kraut, Silent Travelers, 3.
52. Farmer, AIDS and Accusation, 2; Sabatier, Blaming Others, 42– 47.
53. Susan P. Conner, “The Pox in Eighteenth- Century France,” in The Secret Malady:
Venereal Disease in Eighteenth- Century Britain and France, ed. Linda E. Merians (Lex-
ington: University Press of Kentucky, 1996), 15– 33.
What Came Before Zero? 57
from one of the companions of Christopher Columbus. For my part I
shall give it to no one, for I am dying.”54 In this passage, Voltaire demon-
strated his familiarity with authors like Astruc and the most up- to- date
medical explanations for the great pox’s “source.” In addition, his ironic
delineation of the spread of a disease— through opposite- and same- sex
unions, across time and social class— accentuated the sexual and social
taboos that venereal disease could render so painfully visible. By having
Pangloss characterize the disease as a “present” being given, received,
and— in the last sentence— withheld, Voltaire also hinted strongly that in
some cases there was an element of volition involved in its transmission.
In its most extreme form, this view would give expr
ession to fears that
some members of society might maliciously spread their sickness.
Deliberate Disease Spreading
It was around this time that rumors began on Castro Street about a strange guy at the
Eighth and Howard bathhouse, a blond with a French accent. He would have sex with you,
turn up the lights in the cubicle, and point out his Kaposi’s sarcoma lesions. “I’ve got gay
cancer,” he’d say. “I’m going to die and so are you.”55
Accusations of groups and individuals deliberately spreading contagion
have gone hand in hand with epidemics of deadly and painful diseases
like plague and the poxes, great and small. The widespread social dis-
ruptions caused by these outbreaks and a generalized fear of falling ill
gave rise not only to allegations of people behaving carelessly, but also
spreading disease maliciously. These allegations traveled widely in ru-
mors, printed books, and plays, though in many circumstances they ap-
pear to have been culturally expressed fears rather than evidence of ac-
tual misconduct.
From the aforementioned linen washers in Geneva to others in Milan
and England, accusations of individuals spreading plague- causing poi-
sonous ointments have been documented across western Europe from
the fourteenth to the seventeenth centuries. Brutal ends often befell
those accused of such actions, as evidenced by one widely recirculated
54. Voltaire, Candide, Zadig, and Selected Stories, trans. Donald M. Frame (New York:
New American Library, 1963), 21– 23. See also McGough, Gender, Sexuality, and Syphi-
lis, 17.
55. Shilts, Band, 165.
58
chapter 1
tale. Sebastian Münster’s Cosmographia, fi rst published in 1544, was an
astronomical, historical, and geographic account of much of the known
world. In a section that described the Alsatian town of Strasbourg, Mün-
ster recounted the violent punishment that befell the Jews during the
devastation brought by the Black Death. Blamed for contaminating a
water source and bringing plague to the town, hundreds of Jewish res-
idents were burned to death in 1349. Much in demand, Münster’s book
went through more than thirty editions in fi ve languages over the next
eight decades.56 While the story of this massacre remained relatively
constant during this time, the accompanying woodcut illustrations, be-
ginning with a simple depiction of a town well in 1544, underwent sev-
eral metamorphoses, becoming increasingly dramatic and personifi ed
in later editions. By 1550, the German edition’s recounting of the story
featured a woodcut of a hooded individual standing at a well with both
hands gripping the bucket’s rope— an illustration which in many edi-
tions accompanied a description of a remarkable foot- operated well in
the town of Breisach. The 1552 Latin text was complemented by a small
and generic image of an elderly bearded Jewish man wearing robes and a
prayer shawl half- covering his cap. In later German editions— including
the fi nal one published in Basel in 1628, as a massive epidemic of plague
slowly and relentlessly advanced across Europe and eventually ensnared
towns across Switzerland— the printers chose to accompany the anecdote
with a depiction of two men being burned at the stake. In doing so, they
reused woodcuts that had depicted the execution of the Bohemian dissi-
dents Jan Hus and Jerome of Prague in earlier editions (see fi gure 1.1).57
As well as exemplifying the pragmatic, budget- conscious approach to il-
lustration adopted by many early modern printers, these examples of im-
age repurposing demonstrate how different generations found new ways
to interpret the same centuries- old story, making it relevant— perhaps
even sounding a warning— for new audiences.58 This reuse also fore-
shadows how images of Gaétan Dugas as “Patient Zero”— invoked as
56. Matthew McLean, The Cosmographia of Sebastian Münster: Describing the World
in the Reformation (Aldershot, UK: Ashgate, 2007), 1.
57. For more on the 1628– 1629 Swiss plague epidemic, see Edward A. Eckert, “Spa-
tial and Temporal Distribution of Plague in a Region of Switzerland in the Years 1628 and
1629,” Bulletin of the History of Medicine 56, no. 2 (1982): 175– 94.
58. Sachiko Kusukawa, “Illustrating Nature,” in Books and the Sciences in History,
ed. Marina Frasca- Spada and Nicholas Jardine (Cambridge: Cambridge University Press,
2000), 97– 100.
What Came Before Zero? 59
a “plague spreader” for the modern era— would be borrowed, adapted,
and recycled in the late twentieth century.59
In 1898, a librarian at the Surgeon General’s Offi ce in Washing-
ton, DC, wrote a short treatise on an episode from the same early
seventeenth- century plague epidemic. He described a column erected in
1630 to warn of the misdeeds and gruesome executions of two men found
guilty of spreading plague in Milan during the previous year. While un-
der torture, these men had admitted to spreading ointments— allegedly
containing foam from the mouths of dead plague victims— to communi-
cate the disease to unsuspecting passersby. The two, he wrote, had their
fl esh torn with hot pokers, their right hands cut off, their bones broken,
and their bodies extended on a wheel for six hours before being put to
death and burned. The librarian was writing at the height of the bacte-
riological age, a period which generated a newfound confi dence in the
power of science to trace diseases to specifi c causative germs. To him,
the “column of infamy” in Milan served as a testament to the “ignorance
and credulity” of the unfortunate men’s inquisitors and the misplaced
blame of an earlier time of fear and superstition.60
Fears aroused by plague and the newly recognized great pox commin-
gled in the early sixteenth century, with both affl ictions raising concerns
that some of those affl icted had devilish motives. During one of the pe-
riodic outbreaks of plague affecting the German town of Wittenberg
in 1527, the German theologian Martin Luther wrote a much reprinted
open letter discussing whether Christians could, in good conscience, fl ee
the pestilence. In it, he described reports of behavior by some individu-
als that was worse than careless:
When they contract the pestilential disease they keep it secret, go out among
other people, and think that if they can infect and defi le others with the sick-
ness they will themselves get rid of it and become well. With this notion
they frequent streets and houses in the hope of saddling others or their chil-
dren and servants with the pestilence and thus saving themselves. I can well
59. The ethicist Timothy F. Murphy notes the similarity between these historical fi g-
ures and the role played by Dugas in Shilts’s book; see Murphy, Ethics in an Epidemic:
AIDS, Morality, and Culture (Berkeley: University of California Press, 1994), 11.
60. Robert Fletcher, A Tragedy of the Great Plague of Milan in 1630 (Baltimore: Lord
Baltimore Press, 1898), 5, Ebook and Texts Archive, https://
ia800207
.us
.archive
.org/
9/
items/ atragedygreatpl00fl etgoog/ atragedygreatpl00fl etgoog .pdf.
A
B
C
Figure 1.1 Woodcuts ( A– E) accompanying various editions of Sebastian Münster’s Cosmographia, 1544–
1628. Presenting more personalized and violent visual commentar-
ies over time, bookmakers in Basel used and reused different woodcuts to illustrate the
story of Jews being punished for the arrival of plague in Strasbourg in 1349. The fourth
woodcut image ( D)— originally employed in the book’s 1545 edition to depict the burn-
ing of two religious dissidents, Jan Hus and Jerome of Prague— was later reappropri-
ated in 1614, at a time of increasingly brutal punishment for those accused of spreading
D
E
the plague. The same image was later reprinted, with the generic caption “Burning of
the Plague Spreaders,” in Johannes Nohl, The Black Death: A Chronicle of the Plague,
translated by C. H. Clarke (London: George Allen and Unwin, 1926), 179. A, Woodcut,
5.7 × 5.8 cm. Sebastian Münster, Cosmographia, beschreibung aller lender. . . . (Basel:
Henrichum Petri, 1544), cccxvii, http:// gallica .bnf .fr/ ark: / 12148/ btv1b55007851n/ f402, Bi-
bliothèque nationale de France. B, Woodcut, 5.6 × 7.0 cm. Sebastian Münster, Cosmogra-
phei: oder beschreibung aller länder. . . . (Basel, 1550), dlviii, Digital Collections Freiburg, University of Freiburg, http:// dl .ub .uni - freiburg .de/ diglit/ muenster1550/ 0630. C, Woodcut, 3.7 × 4.7 cm. Sebastian Münster, Cosmographiae universalis libri VI in quibus. . . .
(Basel: H. Petrus, 1552), 457, image no. L0077447 (cropped), Wellcome Library, London,
https:// wellcomeimages .org/ indexplus/ image/ L0077447 .html. D, Woodcut, 6.3 × 5.8 cm.
Sebastian Münster, Cosmographey: das ist Beschreibung aller Länder. . . . (Basel: Sebas-
tianum Henricpetri, 1614), 868, Central Library of Geography and Environmental Pro-
tection, Institute of Geography and Spatial Organization, Polish Academy of Sciences,
http:// rcin .org .pl/ publication/ 18809. E, Woodcut, 8.2 × 5.8 cm. Sebastian Münster, Cosmographia, das ist: Beschreibung der gantzen Welt. . . . (Basel: Henricpetrinischen, 1628), 834.
© The British Library Board, General Reference Collection 10003.t.1.