Patient Zero and the Making of the AIDS Epidemic
Page 13
80. Ibid., 222.
81. Gilman, “AIDS and Syphilis,” 97.
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subculture as “Gaycult” and pondered its concern with “the question of
beauty”: “One might further acknowledge that there is a certain con-
tinuity between the classical sense of beauty and exercise in Gaycult’s
gymnasium addiction. Whereas in classical terms there was a necessary
relationship between the well- proportioned body and the well- trained
mind and, in turn, the compassionate soul, there appears to be a more
one-
dimensional obsession nowadays.” The writer linked this imbal-
ance, rendered visible by gay men’s attempts to construct well- muscled
bodies, to their fears of demonstrating any feminine attributes.82 Being
more sexually attractive meant one could fi nd partners more easily
when cruising in bars, discotheques, and bathhouses, though this at-
tractiveness also brought risks of its own. One man later recalled New
York City nightlife during the late 1970s, which for some gay men of-
fered the possibility of having sex at the Saint, a popular nightclub. He
noted the precautions taken beforehand: “At these parties there was a
bowl of penicillin outside, right before you left the house, and every-
body would just reach in and take some penicillin and put the penicil-
lin in their mouths as a preventative for the diseases.”83 Early AIDS re-
ports suggested that it was gay men with a very active sexual lifestyle
who were most represented in the ranks of the sick. Among them, the
good- looking men who typifi ed those attending nights at the Saint fea-
tured so prominently that early discussions in Manhattan made refer-
ence to the “Saint’s Disease.”84 Indeed, the author Edmund White sug-
gested that an ulterior motive shaped by physical insecurities might
underlie some of the publicity AIDS drew in late 1982 and early 1983.
“It’s cruel to say,” he told a reporter, “but a lot of the people who are the
loudest on this issue are men in their forties who, perhaps by the harsh
standards set by our community, no longer have the sort of attractive-
ness that’s required in settings where one is likely to have multiple, anon-
ymous encounters.”85 Debates about sexual activity— often provocatively
82. Neil Alan Marks, “New York Gaycult, the Jewish Question . . . and Me,” Christo-
pher Street, November 1981, 20.
83. Zvi Howard Rosenman, interview with author, Los Angeles, July 6, 2007, recording
C1491/01, tape 1, side A, BLSA.
84. Charles Kaiser, The Gay Metropolis (London: Weidenfeld and Nicholson, 1998),
283. Compare this reference with “the saints among us” in Bill Russell’s poem at the be-
ginning of the present book, preceding the table of contents.
85. Quoted in Lindsy Van Gelder, “Death in the Family,” Rolling Stone, February 3,
1983, 18.
What Came Before Zero? 69
labeled promiscuity— consumed gay communities.86 Mainstream amaze-
ment, meanwhile, at the number of partners reported by some early gay
cases with AIDS was not uncommon, as was demonstrated by the re-
actions of those present at the NCAB meeting discussed in this book’s
introduction.87
The “Healthy Carrier”
Gaetan, the Quebeçois [ sic] version of Typhoid Mary88
Direct comparisons between “Typhoid Mary” Mallon and Gaétan Dugas
— from Alvin Friedman- Kien’s recollection that begins this chapter to
the widely circulated line from Shilts’s book that opens this section—
have been frequent. Mallon was an Irish- born woman who arrived in the
United States in 1883, early in a period of mass immigration between
1880 and 1924 that attracted more than twenty- three million people.89
She settled in New York City and, seeking domestic employment as did
many other Irish American single women of the period, found work as
a cook for a series of wealthy families.90 In the summers, she traveled
with her employers to their summer estates on the Jersey shore or on
86. Brier, Infectious Ideas, 11– 44.
87. Douglas Elliott, the only openly gay counsel in regular attendance at the Commis-
sion of Inquiry on the Blood System in Canada, and whose work there is discussed in de-
tail in chapter 5 of this book, later remembered similar astonishment at one stage of the
in quiry’s hearings. When one expert giving testimony explained that some of the persons
diagnosed with AIDS in 1982 and 1983 had reported more than one thousand lifetime sex-
ual partners, Elliott recalled that “there was this audible gasp in the room . . . and then,
not the witness, but everyone else in the room, including Justice [Horace] Krever, they all
looked over at me [ laughing].” Elliott, C1491/39, tape 2 side B, August 27, 2008; emphasis on recording. A review of the inquiry’s verbatim transcripts suggests that Elliott was
thinking of Dr. Brian Willoughby’s testimony at the regional hearings held in Vancouver
on April 8, 1994; Verbatim Transcripts of Commission of Inquiry on the Blood System
in Canada, 247 vols. (Gloucester, ON: International Rose Reporting, 1997), 30:5897– 98,
CD- ROM.
88. Shilts, Band, 158.
89. Kraut, Silent Travelers, 52. During that period, there was also a corresponding rise
in nativist prejudice from an anti- immigrant movement that, Kraut demonstrates, em-
ployed biomedical arguments to gain acceptance for its views.
90. Leavitt, Typhoid Mary, 164.
70
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Long Island.91 To her knowledge, as she protested repeatedly in her later
years, she had never been sick with typhoid fever.92
By the time that Mallon’s story fi rst captured the public’s attention in
1907 through articles published in New York newspapers, the concept of
healthy human beings who were able to pass on infectious “germs” with-
out themselves being sick was not widely held. For a period of almost
thirty years, bacteriologists in North America and Europe had drawn on
the scientifi c work of Louis Pasteur and Robert Koch, championing the
primacy of microorganisms in the etiology of disease and arguing that
specifi c germs were at the root of specifi c diseases. The adoption of a
bacteriological theory of disease causation was gradual and was resisted
by many observers who contended that its reductionistic focus on the
transmission of microbes from person to person ignored the apparent
success of sanitationists in reducing mortality from epidemic diseases,
particularly cholera and typhoid, with improvements in water delivery
and urban cleanliness.93 With regard to tuberculosis, the new theory di-
vided experts on the relative importance of “seed”(the infectious germ)
and “soil” (the constitutional and social conditions affecting an individ-
ual’s general health and his or her likelihood of falling ill).94 One partic-
ular failing of the “germ theory,” as seen by one of its ardent later sup-
porters, was its inability to account for epidemic outbreaks that did not
appear to stem from a sick individual.95
With the cultivation of diphtheria bacilli from the throat of a healthy
&n
bsp; patient in 1884, the German bacteriologist Friedrich Loeffl er theorized
the existence of a “healthy carrier” state.96 Koch confi rmed this possibil-
ity with comparable fi ndings for cholera in 1893; studies of typhoid in-
fection over the next thirteen years, particularly in Germany, confi rmed
91. Ibid., xvii.
92. Ibid., 185– 89, 194.
93. Margaret Pelling, Cholera, Fever and English Medicine, 1825– 1865 (Oxford: Ox-
ford University Press, 1978); Charles E. Rosenberg, The Cholera Years: the United States
in 1832, 1849, and 1866, with a New Afterword (London: University of Chicago Press, 1987).
94. David S. Barnes, The Making of a Social Disease: Tuberculosis in Nineteenth-
Century France (Berkeley: University of California Press, 1995), 74– 111.
95. Charles- Edward Amory Winslow, The Conquest of Epidemic Disease: A Chapter
in the History of Ideas (1943; repr., London: University of Wisconsin Press, 1980), vii.
96. Ibid., 339.
What Came Before Zero? 71
that this disease could also have its human carriers.97 Contemporary
medical publications in England and the United States indicate a famil-
iarity on the part of doctors in both countries with such studies. Doctors
and medical offi cers of health of the time referred liberally to disease
carriers on both sides of the Atlantic to develop their ideas on disease
etiology.98 The case of Mallon, described by George Soper in 1907, drew
wide comment.
In the fi rst published account of the case, Soper, a sanitary engineer,
articulated a narrative structured similarly to Friedman- Kien’s recollec-
tion at the opening of this chapter— in the format of a detective story.99
Soper had been hired by a wealthy Long Islander to investigate an out-
break of typhoid that had taken place in his holiday home during the
summer of 1906. Using a standardized sequence of inquiries that built
on fi eldwork techniques dating from before the bacteriological period
and relying considerably on recently developed laboratory tests, Soper
was able to eliminate common environmental sources of typhoid infec-
tion such as contaminated well water and soft clams.100 Learning that
the household had switched cooks just before the outbreak of typhoid,
Soper fi rst attempted to contact Mallon, the replacement cook in ques-
tion. With no luck, he did some research into her work history, using
information provided by her employment agency. Ultimately he was
97. Ibid. See also William H. Park, “Typhoid Bacilli Carriers,” Journal of the Ameri-
can Medical Association 51, no. 12 (1908): 981– 82.
98. See, for example, Park, “Typhoid Bacilli Carriers,” 981– 82; D. S. Davies and
I. Walker Hall, “A Discussion on the Etiology and Epidemiology of Typhoid (Enteric) Fe-
ver: Typhoid Carriers, with an Account of Two Institution Outbreaks Traced to the Same
‘Carrier,’” Proceedings of the Royal Society of Medicine 1 (1907– 8): 191.
99. George A. Soper, “The Work of a Chronic Typhoid Germ Distributor,” Journal
of the American Medical Association 48 (1907): 2019– 22. Several commentators have re-
marked on the detective- like narrative style of medical investigations: see Leavitt, Typhoid
Mary, 16; Wald, Contagious, 23– 25; and chapter 2 of this book for further discussion.
Soper himself refers to the discovery that the household in question had changed cooks
shortly before the outbreak of typhoid as a “clue” (“Typhoid Germ Distributor,” 2021).
100. For the prebacteriological origins of epidemiologic investigations, and particularly
his discussion of the importance attributed to the fi rst case, or cases, in an attempt to dis-
cover, in the words of hygienist Edmund A. Parkes, “the infl uence of essential anteced-
ents,” see W. Coleman, Yellow Fever in the North, 183. See also William Coleman, “Epide-
miological Method in the 1860s: Yellow Fever at Saint- Nazaire,” Bulletin of the History of
Medicine 58, no. 2 (1984): 145– 63.
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chapter 1
able to posit Mallon as the cause of seven separate typhoid outbreaks
occurring in the families for which she had worked, despite her appear-
ing, as Soper put it, to be “in perfect health.”101 Deciding that Mallon
was a “chronic typhoid germ distributor,” Soper shared his information
with the medical offi cer of the New York City Department of Health.102
Mallon was forcibly removed and detained on North Brother Island in
the East River, where she remained for three years before being released
in 1911 on the condition that she not work as a cook. She achieved no-
toriety in the media in 1915 when she was discovered cooking again un-
der an assumed name at a maternity hospital. A typhoid outbreak that
occurred after she started work there resulted in illness in twenty- fi ve
people and death for two others. Subsequently, Mallon was apprehended
and spent her remaining twenty- three years living in isolation on North
Brother Island.103 The stories that were told about her experience over
the following decades varied. In some, she was the hapless victim of an
overaggressive public health department. Others overlooked her limited
fi nancial means and viewed her as a careless transmitter. More forceful
versions of the story declared that she had willfully infected and killed
the unlucky consumers of the food she prepared.104
Mallon’s case was brought up in similar debates about the role of
healthy carriers in England, particularly when the fi rst recorded exam-
ple of a carrier- induced typhoid outbreak in that country drew, in the
words of medical journal the Lancet, “the deepest interest in Parlia-
mentary circles.”105 In the Brentry Home for Inebriates, near Bristol, a
“continuing outbreak of enteric fever,” occurring between September
1906 and November 1907, led to twenty- eight cases of typhoid and two
deaths.106 Dr. D. S. Davies, the medical offi cer of health for Bristol, who
was described as “fresh from a perusal of German literature relative to
‘carrier’ cases,” was able to trace the Brentry cases to a healthy carrier
cook, whom he subsequently determined to be the outbreak’s solitary
101. Leavitt, Typhoid Mary, 16; Soper, “Typhoid Germ Distributor,” 2022.
102. Soper, “Typhoid Germ Distributor,” 2022.
103. Leavitt, Typhoid Mary, xviii.
104. Ibid., 202– 30.
105. “An Outbreak of Enteric Fever and Human ‘Carriers,’” Lancet 171, no. 4409
(1908): 685.
106. “Dissemination of Enteric Fever Due to a ‘Typhoid Carrier,’” Lancet 171, no. 4404
(1908): 246.
What Came Before Zero? 73
cause.107 At a meeting of the Epidemiological Section of the Royal Soci-
ety of Medicine, Dr. Davies and Dr. I. Walker Hall, a pathologist, pre-
sented their fi ndings to colleagues108 and surprised them with the an-
nouncement that the female inmate at the Brentry home in question had
also been linked to an earlier outbreak of typhoid at a girls’ home near
Bristol in 1904, where she had also worked as a cook.109
While Davies and Hall’s report presented compelling evidence for
the case of an infective chronic
carrier of typhoid, it is also worth noting
the element of threat, pollution, and social irresponsibility suggested by
their use of language throughout. Chronic carriers are noted to be “ob-
viously the most dangerous class” of contagious individual; “when these
chronic carriers are engaged in the preparation of food, or in dairy work,
they are apt to give rise to intermittent local outbreaks of typhoid fever,
probably by contamination of the food with the hand after daefecation
or micturition.”110 Mrs. H., the cook in question, had been “entrusted”
with dairy work and to prepare milk for children to drink.111 There was
little doubt, according to Davies and Hall, that such an offensive and
“‘gross’” transfer of infection, “through carelessness and neglect to wash
the hands after attending to the calls of Nature,” amounted to an abuse
of such trust. They associated cooks with waitresses and schoolboys as a
group whose dirty fi ngernails were teeming with microorganisms, sug-
gesting “uncomfortable thoughts anent ‘our daily bread’”—
a potent
phrase which succinctly linked class anxieties, germ phobia through
meal preparation, and Christian prayer.112 Davies and Hall closed their
paper by looking dually to bacteriology and the law for answers, wonder-
ing whether there was a solution to be found in “bacterial methods” or
whether a carrier “capable of distributing disease and death” could be
placed under any statutory restrictions.113
107. “The ‘Bacillus Carriers’ of Enteric Fever,” Lancet 171, no. 4410 (1908): 733; “Out-
break of Enteric Fever,” 685.
108. Ibid., 733.
109. Davies and Hall, “On Typhoid Fever,” 187.
110. Ibid., 177.
111. Ibid., 180.
112. Ibid., 187.
113. Ibid., 189. Such fears would be captured in discussions about AIDS “carriers” a
century later. For a critical overview of the manner in which “the need to fi nd the vector
of infection demonstrates our human obsession with origins and causation,” see the en-
tire special issue of Sexuality Research and Social Policy entitled “Reckless Vectors,” 2,
74
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The pair’s carrier hypothesis was not met with universal support.
In his own paper at the same session and in the ensuing discussion,