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Higher Education Modules

Patient Zero and the Early North American HIV/AIDS Epidemic

Class 2: Groups, Individuals, and Behaviors
Introduction

Between the beginning of the 16th and 20th centuries in Western Europe and North America, the explanatory systems for interpreting the appearance and spread of disease changed almost beyond recognition. Yet, the new frameworks often continued to link the appearance of disease to characteristics of the populations in which they appeared. The last third of the 19th century witnessed the rise of bacteriological science, a powerful new explanatory scheme that emphasized the importance of the microscopic germ to disease transmission. Together with this rise, responsibility was increasingly placed on individuals to avoid spreading these dangerous microbes. Public health experts attempted to locate and control germ-carrying individuals and modify their behaviors.

McGough describes how changing attitudes towards female sexuality and the developing notion of diseases as contagious entities contributed to a novel idea in 16th-century Italy—an origin tale which traced the “French Disease” to a single, dangerously beautiful prostitute. McGough situates this tale—which she sees as a direct precursor to Gaétan Dugas’s role as “Patient Zero” of the AIDS epidemic—within a larger framework of social, political, and moral anxieties, emphasizing that origin tales do more than simply trace the emergence of a pathogen. In the same period that this individually-oriented story circulated, McGough demonstrates that the Venetian authorities focussed their preventive response on a specific group—beautiful girls and women whom they viewed as at high risk of committing, or inducing, sinful acts.

Risse adopts an ecological approach in examining three historical epidemics—plague in 16th-century Rome, cholera in mid-19th-century New York, and a 1916 outbreak of polio in the same city. He uses these epidemics to explore the interplay of biological and social factors that facilitate disease outbreaks. Common themes Risse identifies include the differential application of public health measures depending on social status, the disproportionate appearance of disease and blame amongst marginalized social groups, and the tendency for epidemics to reinforce pre-existing social ideas of difference and deviance.

In his chapter, Barnes explores the shifting medical and public health approaches to tuberculosis in 19th and early 20th-century France as the rise of the germ theory of disease divided experts on the relative importance of “seed” (the infectious bacillus) and “soil” (the constitutional and social conditions impacting an individual’s general health and likelihood of falling ill). He highlights the way in which public discussions and fears of contagion were freighted with class-based anxieties, and led to narrowly focused attempts to reduce disease transmission by banning spitting and emphasising each citizen’s individual hygienic responsibilities. Looking at a similar period in American history, Leavitt examines the interconnectedness of science and culture by investigating the life of Mary Mallon, the Irish-American woman who would become immortalized as “Typhoid Mary” and to whom Gaétan Dugas would later be frequently compared. Focusing on Mallon’s experience allows Leavitt to reflect on a classic problem in the history of public health—how to balance the commitment to individual liberty with the population’s expectation of health?—a question with relevance to the late 20th-century challenges of dealing with infections like HIV and tuberculosis.

In the supplemental readings, Lerner investigates the possibility that scientific language can mask a social agenda, by examining the words used to describe patients who do not follow their physicians’ advice. Swenson’s article on the relevance on the history of epidemics in the Western world was a submission viewed by the members of the Presidential Commission on the Human Immunodeficiency Virus Epidemic, who carried out their duties between 1987 to 1988. Swenson himself appeared as a witness before the commission. His appearance and the submitted article suggest a broad social interest during the mid-1980s in the possibility that history—and Western history in particular—could offer lessons to be applied to the challenges posed by HIV/AIDS.

Readings

Barnes, David S. “‘Guerre au bacille!’: Germ Theory and Fear of Contagion in the War on Tuberculosis.” In The Making of a Social Disease: Tuberculosis in Nineteenth-Century France. Berkeley, Los Angeles, and London: University of California Press, 1995, pp. 74-111.

Leavitt, Judith Walzer. “Introduction: ‘A Special Guest of the City of New York,’” and “‘The Rigorous Spirit of Science’: The Triumph of Bacteriology.” In Typhoid Mary: Captive to the Public’s Health. Boston: Beacon Press, 1996, pp. 1-13, 14-38.

McGough, Laura J. “Quarantining Beauty: The French Disease in Early Modern Venice.” In Sins of the Flesh: Responding to Sexual Disease in Early Modern Europe. Edited by Kevin Patrick Siena. Toronto: Centre for Reformation and Renaissance Studies, 2005, pp. 211-37.

Risse, Guenter B. “Epidemics and History: Ecological Perspectives and Social Responses.” In AIDS: The Burdens of History. Edited by Elizabeth Fee and Daniel M. Fox. Berkeley, Los Angeles, and London: University of California Press, 1988, pp. 33-66.

Additional Resources

Lerner, Barron. “From Careless Consumptives to Recalcitrant Patients: The Historical Construction of Noncompliance.” Social Science & Medicine 45, no. 9 (1997): 1423-31. http://europepmc.org/abstract/MED/9351159/reload=0;jsessionid=rdCdYzmrSJ6xmP1RmCOw.22

Swenson, Robert M. “Plagues, History, and AIDS.” The American Scholar 57, no. 2 (Spring 1988): 183-200. JSTOR (41211519).

Discussion Questions
  1. Risse emphasises an “ecological model” for understanding epidemics, one which takes into account the interrelationship of biological and social factors that allow diseases to spread. Using examples from this unit’s readings, how have commercial trade, travel, and social hierarchies affected the spread of disease? What other social and cultural factors have been important?
  2. Using historical examples, describe how groups and individuals have been identified as being responsible for disease outbreaks. Was this blame justified? Why or why not? What other factors may have contributed to this outcome?
  3. To what extent did the mid-19th-century rise of bacteriological science lead to a more individualized focus of blame for the spread of disease? And to what extent did it permit moral views to be disguised in medical language?
  4. In their respective chapters, Leavitt and Barnes describe a narrowing focus of public health work in light of the powerful ascent of bacteriological evidence. What were the advantages and disadvantages of this change?
  5. Citing historical examples, explain why you agree or disagree with the following statements:
    • Public health prevention measures often risk bringing harm to the social groups they address.
    • The public’s right to health must always take precedence over an individual’s right to liberty.
    • Science is free of cultural bias.

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