Patient Zero and the Making of the AIDS Epidemic
Page 9
cians from across North America. See also Silversides, AIDS Activist, 16– 17.
What Came Before Zero? 43
For Friedman- Kien, the label of “Typhoid Mary”— the name bestowed
upon an ill- fortuned Irish American cook whose story will be retold later
in this chapter— summed up his view that this individual was spreading
disease to his sexual partners. Laubenstein would echo her professional
partner’s tone when she spoke with a San Francisco journalist in 1986.
In the reporter’s notes for the interview, roughly scribbled as he tried
to keep up with Laubenstein’s words, this man was described as a “vec-
tor of disease.” The importance that he would come to signify to epi-
demiologists was also suggested by Laubenstein’s remark that his “‘lit-
tle bl[ac]k book’ wasn’t little.” When the journalist in question, Randy
Shilts, published And the Band Played On in 1987, he identifi ed “Erik”
as Gaétan Dugas, a French Canadian fl ight attendant whom investiga-
tors at the US Centers for Disease Control (CDC) had previously la-
beled as “Patient 0.”2
A collection of oral history interviews published in 2000 featured
the reminiscences of physicians who had played signifi cant roles in
the American epidemic over the previous twenty years. By this time,
Laubenstein had died, but once again Friedman- Kien gave an interview,
and again he spoke of Dugas, the only patient to be identifi ed by his full
name in that book. Time had not dulled the physician’s recollection,
nor his earlier view that Dugas was sowing disease. Once again, he in-
voked one of the more negative images associated with “Typhoid Mary”:
“While he was in New York, he would go to gay bathhouses and have un-
protected sex with a variety of people despite the fact that we warned
him against it. I once caught him coming out of a gay bathhouse, and I
stopped the car and said, ‘What are you doing there?’ And he said, ‘In
the dark nobody sees my spots.’ He was a real sociopath. At which point
I told a colleague the story. She was enchanted with him, as most peo-
ple were. I stopped seeing him, I was just so angry.”3 This pair of recol-
lections from Friedman- Kien indicate the breadth of feelings aroused by
his interactions with this individual between 1981 and 1982. On the one
2. “Dr. Linda,” interview notes, 1986, p. 2, folder 10, box 34, Shilts Papers. Shilts’s
under lined photocopy of the chapter discussing “Erik” in Fettner and Check’s book can be
found in folder 23, box 34, Shilts Papers.
3. Bayer and Oppenheimer, AIDS Doctors, 61. Leavitt describes a pervasive mid-
twentieth- century characterization of “Typhoid Mary” as “a person to be feared and
shunned, someone who carries contagion inside her body and uses it to harm people
around her.” She also draws an explicit comparison between the experiences of Mallon and
Dugas; Leavitt, Typhoid Mary, 203, 234– 38.
44
chapter 1
hand, he describes his excitement of tracking down an elusive patient
who might offer insight into a mysterious condition. On the other, he re-
ports feeling such anger and disgust with the patient’s behavior that he
ultimately withdrew his services. Friedman- Kien’s telling use of the term
“Typhoid Mary” indicates the way in which historical narratives about
epidemics and the characters featured in them subtly shaped the mind-
sets of those responding to AIDS. It also demonstrates the importance
of being aware of these older histories to comprehend the full communi-
cative force summoned by the story of Gaétan Dugas as “Patient Zero.”
A long history of prejudice, fear, and blame directed toward sus-
pected disease carriers preceded AIDS, and the cultural weight of these
past occasions contributed palpably to responses to this epidemic on its
emergence in the late twentieth century.4 This chapter provides an over-
view of this general history and of the key ideas and precedents that
animated the story of the fl ight attendant and the labels “Patient O,”
“ Patient 0,” and “Patient Zero” as their use spread from the 1980s on-
ward. This longue durée approach treads lightly over several hundred
years of events and ideas in Western Europe and North America from
the late medieval period to the twentieth century.5 Historians tend to be
wary of drawing examples from different periods to illustrate an argu-
ment, since doing so risks severing the incidents from the original in-
terpretive frameworks that imbued them with meaning. However, as the
following pages suggest, other observers have been less concerned about
original context when reappropriating and recirculating older ideas, thus
it seems justifi able to cast a wide net in this instance.
Five themes emerge in this overview which inform the chapters that
4. As Michael Willrich explains in his account of late nineteenth- and early twentieth-
century responses to smallpox in the United States, “The age of AIDS did not invent the
notion of ‘Patient Zero.’” See Willrich, Pox: An American History (New York: Penguin,
2011), 18.
5. This geographic focus is not to suggest that cultural narratives from other parts of
the world did not shape how North Americans made sense of the AIDS epidemic during
this period. Rather, on occasions when history seemed relevant to contemporary observers
and policy makers, they seem generally to have paid more attention to American and Eu-
ropean precedents. See, for example, the testimony and materials submitted for the “Epi-
demics of the Past, Implications for the Future” panel before the Presidential Commission
on the Human Immunodefi ciency Virus Epidemic, April 5, 1988, National Commission on
Acquired Immune Defi ciency Syndrome Records 1983– 1994, MS C 544, History of Med-
icine Division, Archives and Modern Manuscripts Collection, National Library of Medi-
cine, Bethesda, MD (hereafter cited as NCAIDS Records).
What Came Before Zero? 45
follow: plague as divine punishment and the linked rise of scapegoating;
fascination with the origins and spread of disease; recurrent fears about
deliberate disease spreading; dangerous beauty coupled with defi lement
and sexual activity; and the challenges posed by healthy disease carriers.
In some cases, the incidents to follow— such as the stories of well poison-
ing and of “Typhoid Mary” Mallon— were well known to participants re-
sponding to AIDS in the 1980s and 1990s. Others, such as the tale of the
most beautiful fi fteenth- century Italian prostitute said to have generated
the “French Disease,” were less widely circulated and have only more re-
cently been examined by historians. Nonetheless, they are all included to
demonstrate the long history underpinning the impulses to trace conta-
gion, harbor suspicion, and lay blame in times of epidemic. An epigraph
from Randy Shilts’s popular book introduces each theme, demonstrating
how And the Band Played On both was embedded in and contributed to
this intertexual history of epidemics.
Plague as Divine Punishment and the Rise of Scapegoating
> “Maybe Falwell is right,” said Gaetan. “Maybe we are being punished.”6
When Moral Majority leader Jerry Falwell expounded his view in July
1983 that diseases such as AIDS were a “defi nite form of the judgment
of God upon a society,” he was certainly not pronouncing a new view.
Nor was it unprecedented for him to suggest that it was “perverted” ho-
mosexual behavior that had incited this “spanking” from God. Falwell’s
viewpoint, that AIDS was a “gay plague,” echoed the published opin-
ions of Republican speechwriter and senior advisor Patrick Buchanan
and other social conservatives in the spring and summer of 1983. The
explanation was consistent with many centuries of blaming socially dis-
advantaged groups for the appearance of epidemic disease.7 During
these centuries, fi rst in Europe and later in North America, those whose
6. Shilts, Band, 348.
7. Sue Cross, “Jerry Falwell Calls AIDS a ‘Gay Plague,’” Washington Post, July 6, 1983,
B3. A survey undertaken in August 1985 indicated that 11 percent of Americans agreed
with the statement that AIDS was God’s punishment against homosexuals for their way of
life; see Victor Cohn, “Poll Shows Widespread Awareness, Misguided Fears About Dis-
ease,” Washington Post, September 4, 1985, H7; Steven Seidman, “Transfi guring Sexual
Identity: AIDS and the Contemporary Construction of Homosexuality,” Social Text 19– 20
46
chapter 1
religious, social, and sexual behavior did not meet the prescribed stan-
dards of their communities were repeatedly accused of incurring divine
wrath. For many people who made such judgments, notions of contagion
revealed a clear and unbreakable link between an individual’s moral
choices and wider communal responsibility.8
In Western Europe from the eleventh century onward, a trend de-
veloped in which various minority groups— “lepers,” Jews, heretics, and
sodomites— were repeatedly cast as enemies of the state, to the point
that such scapegoating became a permanent cultural fi xture of that part
of the world. Collectively, societies would come to the consensus that a
particular named group was to blame for certain social ills. The mem-
bers of this group were then systematically excluded from society and
faced the loss of their civil rights and, too frequently, the risk of being
put to death.9 These categorized groups might be blamed for specifi c
acts or occurences, or for generic, transferable threats and conspiracies.
Though in some cases a rumor or conspiracy might initially be linked to
a specifi c historical event, these explanations often evolved over time,
serving as adaptable answers for later generations to make sense of new
situations of collective hardship.
In 1321, communities in France and several other Christian countries
blamed and in many cases executed individuals marked by leprosy for an
elaborate plot— involving shadowy foreign powers, secret meetings, and
deadly powders— to poison local water sources.10 A generation later, this
conspiracy was recycled with Jews as the chief villains when Europe was
overcome by the Black Death, reportedly following the arrival in Sicily
of twelve plague- infected Genoese ships from Constantinople in 1347.11
At that time, it was widely understood that there could be a separation
(Autumn 1988): 187– 205. The writing of Buchanan, an established political fi gure and fu-
ture presidential candidate, carried a large infl uence.
8. Margaret Pelling, “The Meaning of Contagion: Reproduction, Medicine and Met-
aphor,” in Contagion: Historical and Cultural Studies, ed. Alison Bashford and Claire
Hooker (London: Routledge, 2001), 17.
9. R. I. Moore, The Formation of a Persecuting Society: Authority and Deviance in
Western Europe, 950 – 1250, 2nd ed. (Oxford: Blackwell, 2007), 93.
10. Carlo L. Ginzburg, Ecstasies: Deciphering the Witches’ Sabbath, trans. Raymond
Rosenthal (New York: Pantheon Books, 1991), 33– 35.
11. Ibid., 63. Historians themselves frequently attempt to trace the source of epidem-
ics in the past. As William Coleman writes, the arrival of a ship is a datable event; see
W. Coleman, Yellow Fever in the North: The Methods of Early Epidemiology (Madison:
University of Wisconsin Press, 1987), 109.
What Came Before Zero? 47
between the underlying cause of plague— for example, the position of the
stars or contaminated air and waters— and the more immediate reason
for its spread, such as interpersonal contact. Given the vigorously anti-
Jewish attitudes of the time and the devastation of the plague, it is, lam-
entably, not diffi cult to imagine how the two theories could have com-
bined into the popular view that the Jews were contaminating well water
with poison to spread the pestilence.12
Such water- based plague anxieties date to ancient times. In his ac-
count of the fi fth century BCE Peloponnesian war, the Greek histo-
rian Thucydides discussed the sudden appearance of a deadly outbreak
during the confl ict’s second year. Though he left speculation about the
plague’s origins and causes to other writers, he recorded a story told by
residents of the Piraeus, the port district on the outskirts of Athens that
was fi rst struck by the pestilence shortly after the Peloponnesians in-
vaded. The residents maintained that their enemies had poisoned the
water reservoirs. For an arid region where drinking water was precious
and often associated with divine benefi cence, the accusation of poison-
ing a communally shared source of life conveys the compounded hor-
ror, fear, and disgust aroused by the double devastation of invasion and
plague. The fact that the disease had not seemed to affect the Pelopon-
nesian peninsula to a degree worth recording would only have added
to their opponents’ presumed culpability.13 Thucydides’s work was not
widely available in Europe when these stories of well poisoning later
recirculated. However, other ancient writers including Seneca, whose
moral essays did infl uence medieval thinkers, particularly from the mid-
thirteenth century onward, also wrote “of springs defi led by poison, of
plague the hand of man has made . . . and secret plots for regal power
and for subversion of the state.”14
During the late medieval and early modern period, differences of
12. Ginzburg, Ecstasies, 64. For more about the classifi cation of causes into primary,
proximate, and predisposing categories, see Pelling, “Meaning of Contagion,” 17– 19; Viv-
ian Nutton, “The Seeds of Disease: An Explanation of Contagion and Infection from the
Greeks to the Renaissance,” Medical History 27, no. 1 (1983): 4– 5; and Epstein, Impure
Science, 53.
13. Robert B. Strassler, ed. The Landmark Thucydides: A Comprehensive Guide to
the Peloponnesian War (New York: Touchstone, 1996), 118– 21; Ellen Churchill Semple,
“Domestic and Municipal Waterworks in Ancient Mediterranean Lands,” Geographic Re-
view 21, no. 3 (1931): 466– 74.
14. Seneca, De Ira [ On Anger] 2.9.3, in Seneca: Moral Essays, vol. 1, trans. John W.
48
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sp; chapter 1
background and class also shaped perceptions, with travelers and the
poor frequently featuring in accounts of plague spreading. In some
northern areas of early modern Italy, for example, these marginalized
groups replaced the Jews or witches who normally featured in such sto-
ries. Wealthier members of society worried that graveyard workers, a
group which tended to draw vagrants and criminals in times of pesti-
lence, might attempt to prolong epidemics. Some feared they had ready
access to deadly matter drawn from bodies and clothing, which they
could surreptitiously scatter throughout unsuspecting neighborhoods.15
Similarly, impoverished linen washers in early sixteenth- century Geneva
were accused of deliberately spreading plague- infected ointment in the
houses they cleaned in order to kill the inhabitants and then steal their
possessions.16 Travelers also implicated local prostitutes in social con-
demnation. Even before brothels became associated in the late fi fteenth
century with the spread of the great pox, or the “French Disease”— a sex-
ually transmitted affl iction now commonly thought to be syphilis— they
faced punitive sanctions in times of plague. It remains unclear whether
these sexual sites drew condemnation more for their indiscriminate wel-
coming of strangers or for encouraging divine displeasure to fall on a so-
ciety that permitted fornication.17
At times, early modern Europeans grouped sodomites with prosti-
tutes as moral offenders to be marked as different and expelled from
the community along with other types of corrupt matter in times of dis-
ease.18 Indeed, historical evidence suggests that in northern Italy both
Basore (London: William Heinemann, 1928), 183– 85; L. D. Reynolds, “The Medieval Tra-
dition of Seneca’s Dialogues,” Classical Quarterly 18, no. 2 (1968): 355– 72.
15. Brian Pullan, “Plague and Perceptions of the Poor in Early Modern Italy,” in Epi-
demics and Ideas: Essays on the Historical Perception of Pestilence, ed. Terrence Ranger
and Paul Slack (Cambridge: Cambridge University Press, 1992), 118.
16. William G. Naphy, “Plague- Spreading and a Magisterially Controlled Fear,” in
Studies in Early Modern European History, ed. William G. Naphy and Penny Roberts
(Manchester, UK: Manchester University Press, 1997), 28– 29. See also Naphy, Plagues,