C is iana Bas os • Ins i u o de Ciências Sociais, Uni e sidade de Lisboa, Po ugal, co espon
dence: Ins i u o de Ciências Sociais, Uni e sidade de Lisboa, Po ugal, A . Anibal Be encou 9,
1600-189, Lisboa, PRT. c is iana.bas [email protected]
Ci e his a icle: C is iana Bas os, 'The Ne e -Ending Poxes o Syphilis, AIDS, and Measles',
Cen au us, 64.1 (2022),155–170
<h ps://dx.doi.o g/10.1484/J.CNT.5.129634>
DOI: 10.1484/J.CNT.5.129634
This is an open access a icle made a ailable unde a CC by 4.0 In e na ional License.
© 2021, The Au ho (s). Published by B epols Publishe s.
CRiSTiANA bASToS
The Ne e -Ending Poxes o Syphilis, AIDS, and
Measles
▼ Spo ligh A icle in How Epidemics End, ed. by E ica
Cha e s
▼ AbS Ac In his a icle, I add ess some in ec ious diseases
ha ne e eally “ended,” e en hough hei mo bidi y, hei social
impac , and hei public isibili y ha e aded away: AIDS, syphilis,
and measles. I will use da a om di e en p ojec s I ha e
conduc ed on each o hose epidemics: HIV/AIDS a he doc o al
aining le el in he 1990s, wi h a geog aphical ocus on B azil and
he Uni ed S a es; syphilis in he con ex o a 2010 p ojec on he
social his o y o heal h in Lisbon in he la e 19 h and ea ly 20 h
cen u ies; and measles as pa o my cu en p ojec on labo
mig a ion in he 19 h cen u y, wi h a ocus on epidemic ou b eaks
in mig an ships om Madei a o Hawaii.
▼ Keywo dS Epidemics and Endemics, Skin Exp essi eness,
Vic im-Blaming, Sani a y Su eillance, Lock Hospi als, Vaccines
▼ iSSUe Volume 64 (2022), issue 1
Do Epidemics End?
The his o y o human heal h shows ha ou bu s s o disease e en ually come o an
end. Ye he why, he how, and e en he when o ha ending a e no always clea o
undispu ed. We end o know mo e abou he ci cums ances o a plague's beginning
han abou he causes o i s waning. Tha con as eme ges bo h in his o ical accoun s
and in li e a y depic ions o epidemics, wi h no able examples including Daniel
De oe's Jou nal o he Plague Yea ,se in London in 1665; Albe Camus's La Pes e,se
in 1940s F ench colonial Alge ia; Ke in Chong's The Plague, eplica ing Camus's
s o yline in con empo a y Vancou e ; and José Sa amago's Blindness, se in a ic ional
156 CRISTIANA BASTOS
place and ime.1 Thei plo s gene ally begin wi h a p imal sign o chain o e en s lead‐
ing o a d ama ic pe iod in which a ansmissible disease causes andom de as a ion,
dea h, ha oc, losses, qua an ines, cu ews, poli ical choices, s ess, despai , ea , io‐
lence, and ex eme collec i e su e ing; and hen one day he e a e ewe occu ences,
and hen ewe , un il, like he aind ops a he end o a s o m, hey become unno iced,
i ele an , and a e gone o good. In ic ion as in eal li e, in he his o y o epidemics
as in poe y, he end does no come wi h a bang, bu wi h a whimpe .2 Li es once
suspended esume he no malcy o hei p e-epidemic days; cu ews, qua an ines,
s a es o excep ion, sani a y ba ie s, ba ack wa ds, and hospi als a e all disman led
and gone. Rememb ance o he u moil goes unde g ound, ending ha epic cycle in
amnesia.3
Bu why, how, and when does he end a i e? As Cha e s and Hei man no e,
some es ablished accoun s o no o ious epidemics associa e hei ending wi h a
s aigh o wa d change in one ac o , such as he a ia ion in he dominan oden
species in he case o he plague, o he eplacemen o a pump handle in he case o
chole a, o he use o an adequa e accine h ough a well-implemen ed p og am in
he case o smallpox.4 Howe e , he au ho s u he no e, unde nea h hose simpli ied
accoun s he e is complexi y, uzziness, and mul i ac o ial p ocesses ha a e subjec
o shi ing in e p e a ions and equi e u he analysis.
Epidemics may also no eally end, bu become endemic among a popula ion, a
egula in hei biological landscape ha no longe appea s in d ama ic wa es bu
keeps eappea ing he e and he e in isola ed clus e s. The comple e e asu e o a
disease om he ace o he ea h is a a e e en . So a , among ubiqui ous human
diseases, smallpox alone has been success ully e adica ed, and only a e a massi e,
coo dina ed global p og am o accina ion ha b idged poli ical i al ies and eached
he mos emo e places on ea h in he 1970s.5 Ku u, which a ec ed a mo e es ic ed
numbe o people in New Guinea, was also ex inguished due o a numbe o com‐
bined e o s on he on s o medical and an h opological esea ch, in e en ions, and
a change in habi s.6 Polio, again highly ubiqui ous, is nea e adica ion as we w i e in
2021. Measles, which o decades was absen om he immedia e ho izon o public
heal h, makes occasional eappea ances o en linked o non-compliance wi h exis ing,
eliable accina ion—in o he wo ds, h ough he c acks o a alse sense o an ending.
As o mala ia, ube culosis, HIV/AIDS, and a numbe o o he in ec ious diseases,
he goal o e adica ion s ill seems a away.
COVID-19, o SARS-CoV-2, is he cu en pandemic challenge. In spi e o
p edic ions o u u e epidemics, wa nings, p ojec ions, and wha we should ha e
lea ned om he pas , he new plague s ill ook mos people by su p ise. Na ional
go e nmen s, local au ho i ies, g oups, and indi iduals di e ged in hei pe cep ions
1Camus (1947); Chong (2018); De oe (1722); Sa amago (1995).
2Ellio (1925/1927); Rosenbe g (1989, p.8).
3C osby (2003); Rosenbe g (1989).
4Cha e s & Hei man (2021).
5 Bha acha ya (2006); Ga e (1994).
6Lindenbaum (2015).
THE NEVER-ENDING POXES 157
o he new epidemic. Rumo s and denialism appea ed, as on o he occasions, bu
now sp ead widely and wildly ia social media and wi h he suppo o denialis
go e nmen s and eligious leade s. The Wo ld Heal h O ganiza ion's leade ship was
c i icized as being slow o ac . S ill, in spi e o some laws, he e was emendous
ac i i y in biomedical esea ch and public heal h p omo ion ha esul ed in he
as de elopmen o e icien accines and hei manu ac u e and use in massi e
campaigns. The e we e also issues o accine na ionalism and discussions on pa en s,
s ocks, p o i s, p o isions, and cos s. Unsu p isingly, he e was a s eam o new
a ian s o he i us, challenging he con idence abou eaching an end in a sho ime.
The complex in e play o all hese ac o s has enhanced unce ain ies abou he
u u e. Will he new disease be ex inguished by accina ion, like smallpox? O by a
change in habi s, like ku u? Will we each an “asymp o ic” nea -end, as happened wi h
lep osy? Will COVID become pa o he human heal h landscape, coming back e e y
now and hen, like chole a, Ebola, dengue, abies, and o he s? O will i s ay nea by,
like in luenza, ube culosis, o mala ia? O is i one among a se ies o coming plagues,
i s impac la ge han Zika, Chikungunya, SARS, and o he ecen ones, bu no he
las in ha se ies?7
The momen is igh o discuss, deba e, and e isi some o he epidemics o he
pas as a way o engaging wi h he p esen and he u u e. Wi h he collec i e anxie y
gene a ed by COVID and he ela ed explosion o public in e es in any hing abou
epidemics, om ilm and no els o expe deba es on epidemic his o y, public heal h,
zoonoses, ecosys ems, and so o h, wha was once a semi-obscu e ield o schola ship
has become highly in demand inside and ou o academia.
My con ibu ion o he deba e on “how epidemics end” consis s in e isi ing
some epidemics ha we e once de as a ing and ea ed, and ha did no eally “end,”
bu pa ially aded away om public pe cep ion: AIDS, syphilis, and measles. I will
add ess AIDS in New Yo k Ci y and Rio de Janei o in he 1980s–1990s; syphilis in
he la e 1800s and ea ly 1900s in he ci y o Lisbon, in ne wo k wi h medical pa ne s
in F ance and Ge many; and measles on boa d mig an ships a eling om Madei a
o Hawaii in he 1880s.This sequence pa ly elici s my own ajec o y in add essing
epidemics, whe he p esen o pas , wi h an e hnog aphic–an h opological pe spec‐
i e ha emphasizes no only social con ex bu also social s uc u es o inequali y,
mul iple agencies, subjec i e expe iences, and con adic o y meanings in ol ed.
Al hough no all hose ailmen s a e known as “poxes” (as in smallpox and pa ly
in syphilis), hey all ha e a s ong componen o skin exp essi eness: Kaposi sa coma
o AIDS, pockma ks and skin blo ches o syphilis, and eddish ash o measles.
Skin exp essi eness p oduces isual signs ha se e as indexes o illness. Once hose
symp oms disappea , he public pe cep ion o he disease's p e alence may con ibu e
o shaping a pe cep ion ha he “plague” has ended be o e i eally has.
7 Ga e (1994); Kelly, Keck, & Lyn e is (2020); Lindenbaum (2015); Wa s (1997).
158 CRISTIANA BASTOS
AIDS
I came in o academic adul hood du ing he peak o AIDS in one o i s epicen e s,
New Yo k Ci y, in he la e 1980s and ea ly 1990s.8 The ace o AIDS was no longe
he a e emacia ed young gay man wi h he lesions associa ed wi h Kaposi sa coma,
he one pa hology ha , oge he wi h pneumonia by pneumocys is ca inii, led some
doc o s o iden i y he new synd ome in he ea ly 1980s. AIDS in he ci y was
e e ywhe e and had many aces; i was like a o ex de ou ing young li es, commu‐
ni ies, and ene gies—bu i was also a dynamo o inno a i e esponses in ol ing
ca e, p e en ion, demands o ac ion, and mo e esea ch. The in ensi y o he new
epidemic and i s impac on he li e o he ci y hooked in mos o us who had plans o
esea ch in he social and biomedical disciplines. I became he subjec o my doc o al
disse a ion and he basis o u he wo k.9
AIDS was excep ional, unexpec ed, and no el on se e al on s: o i s peculia
epidemiological dis ibu ion, which s a ed by disp opo ionally a ec ing young and
o he wise heal hy gay men, plus use s o injec ing d ugs and blood ecipien s; o
i s unusual clinical pa e n, which saw uncommon diseases come oge he in a al
syne gies, om Kaposi sa coma o pneumonia, he pes, c yp ospo idium, CMV, EBV,
and so o h; and o he pe plexi y i caused abou why people we e dying o
“me e” in ec ions in ha ime and place. Emphasis should be gi en o “ ime” and
“place”— he place being an a luen cosmopolis, and he ime being he a e ma h
o he supposedly de ini i e ic o y o e in ec ious diseases achie ed in he p e ious
decade. As opposed o ch onic and degene a i e diseases, which p e ailed in de el‐
oped and iche coun ies, in ec ious diseases had become pe cei ed as a ma e o
unde de elopmen , symbolically dis an , bo h in space and ime, om New Yo k—a
ci y obli ious o i s epidemic pas o chole a, yphoid, in luenza, polio, ube culosis,
and o he s.10
Adding complexi y o he si ua ion and ueling ange among he a lic ed was
he delayed go e nmen al esponse o AIDS, which was pa ly ela ed o a p e alen
homophobia ha disquali ied he epidemic as a public heal h issue and amed i
h ough he a chaic lenses o collec i e punishmen o sin ul exis ences o miasma ic
con agion in ma ginal ghe oes—adding he insul o blaming he ic ims o he
ongoing collec i e inju y. Ac i is s and communi ies ook i in o hei own hands o
c ea e social esponses in he a eas o ca e and p e en ion and lobbying o clinical
esponses. The powe ul slogan “Wha do we wan ? The cu e o AIDS!” was chan ed a
demons a ions and public e en s, as i calling o an end o a collec i e a lic ion ha
seemed o ha e no end in sigh .11
8As a doc o al s uden o an h opology a he Ci y Uni e si y o New Yo k G adua e Cen e . I am pa icula ly
indeb ed o he inspi ing and li ely cou ses o medical an h opologis s Shi ley Lindenbaum, Lei h Mullings, and
Ida Susse , and medical his o ian Da id Rosne .
9Bas os (1999).
10 Among o he s, Aimone (2010); Rosenbe g (1987).
11 GMHC (2020); Hubba d & Schulman (2012); Schulman (2021).
THE NEVER-ENDING POXES 159
To add u he complexi y o he analysis, i should be no ed ha while o some
New Yo ke s AIDS was a comple e excep ion in hei li e expec a ions, o many o he
New Yo ke s AIDS was one mo e among he mul iple dange s o which hey we e
pe manen ly exposed. The ci y known o i s cosmopoli an glamou and gay eedom
was also a uni e se o augmen ed ulne abili ies due o social inequali ies, subs ance
addic ion, exclusion om sa e y ne s, and li es li ed on he s ee s and in p eca ious
shel e s. The neolibe al push o he 1980s had de unded and some imes disman led
he social p og ams ha mi iga ed he heal h ulne abili ies o hose in mo e disen‐
anchised si ua ions. Homelessness in New Yo k had expanded d ama ically.12
Resea ch on he social dimensions o AIDS ga e mo e isibili y o he emendous
heal h inequali ies and ulne abili ies h oughou he ci y. Fo a ew yea s, he AIDS
epidemic uni ied he u ban social ex emes—in New Yo k, in o he ci ies, and in he
wide wo ld. AIDS was soon o be decla ed a pandemic, ha is, a global epidemic.
AIDS was globally sha ed ye expe ienced in con as ing ways depending on place,
gende , class, and o he social a iables.13
Wi h an in e es in he con as ing expe iences o a sha ed pandemic, I ocused
on si ua ions in which in ec ious disease was no pe cei ed as an unexpec ed ou bu s
om he pas , o om nowhe e, bu as some hing ha had been he e all along o
he popula ion, he heal h se ices, and esea che s in biomedicine, epidemiology and
socie y. Tha in e es led me o B azil, a coun y in which opical medicine was in‐
sc ibed in he na a i e o na ion-building, as opposed o being associa ed wi h o me
colonial powe s, as in many A ican and Asian coun ies. In B azil, opical medicine
emained an impo an sec o o esea ch and public heal h, accoun ing o epidemic
and endemic in ec ions; i ga e bi h o he medical special y Doenças In ecciosas e
Pa asi á ias (In ec ious and Pa asi ic Diseases), o DIP. DIP physicians we e ained
o iden i y he pa hogens and ea he obscu e endemic diseases ha some imes
appea ed in epidemic ou bu s s like leishmania, lep ospi osis, ypanosomiasis, Cha‐
gas, yphus, yellow e e , dengue, chole a, and so o h. Thei clinical in e en ions
used o be o he all-o -no hing kind: he pa ien s—mos o en om disen anchised
backg ounds and u al a eas—would ei he die wi hou much in e ac ion wi h he
doc o s, o ully eco e and walk ou o good. When AIDS in B azil was eloca ed
om he ca e o de ma ology (which includes sexually ansmi ed diseases) o ha
o DIP, he local in ec ious disease physicians aced a new challenge, di e en om
hei ou ines wi h se e ely ill pa ien s whose subjec i i ies we e empo a ily d owned
in hei e e ish, quasi-le hal condi ions, mos o en caused by he obscu e bugs o
unde de elopmen and po e y. AIDS was he opposi e: highly isible in he media,
ma ked by a mo bid glamou o i s associa ion wi h “ i s wo ld” u ban cen e s and
celeb i ies, a ac ing special esou ces, so a incu able, and p one o he exp ession
o pa ien s' subjec i i ies in bo h clinical and poli ical se ings.14
12 Susse & Gonzalez (1992).
13 Bas os (1999); Susse (2009).
14 Bas os (1999).

160 CRISTIANA BASTOS
Heal h ca e p o essionals ea ing AIDS, people wi h AIDS, hei amilies and
communi ies all had o lea n wi h one ano he how o na iga e he unmapped
e i o ies o he new epidemic, no knowing whe he he e would be an end o i ,
wha he nex day would b ing, i any e icien ea men would come, and, i so, i i
would be a o dable o e e yone in need. This mode o wo king oge he , iden i ied
by i s pa icipan s as an “AIDS cul u e,” le a ma k in B azilian heal h ca e and public
awa eness. Tha ma k would ansla e in o inno a i e policies ha e en ually had
an impac way beyond B azil. B azilian esea che s may no ha e achie ed a cu e
o AIDS o a global change in he pe cep ion o in ec ious disease based on hei
eal-li e expe ience, bu hey b ough oge he , in ways ha had global impac , he
cen ali y o in ec ious diseases (in esea ch and heal h ca e) and he impo ance
o collabo a i e wo k by all pa ies in ol ed, om HIV-posi i e people and AIDS
ad oca es o heal h ca e p o essionals, scien is s, and policy-make s.15
When an e icien combina ion o an i- e o i al ea men s (hence o h ARTs)
was announced a he In e na ional Con e ence on AIDS held in Vancou e in 1996,
hose who could a o d o pay o ea men celeb a ed en husias ically. Wha had
been a kille in ec ious disease could now be u ned in o a ch onic condi ion. Those
who could no a o d o pay o he p edic ably expensi e ARTs and had been li ing
wi h he diseases o unde de elopmen all along exp essed some cau ion: would
ARTs simply ein o ce he wo ldwide sani a y di ide ha se he ch onic ailmen s
pa e n o he iche agains he in ec ious landscape o he poo e ?
A his junc u e, wha had e ol ed in B azil as an “AIDS cul u e”—in which heal h
ca e wo ke s, people wi h AIDS, ac i is s, and decision-make s con e ged o igh he
epidemic—made a di e ence a a local and global le el, a ec ing many li es, e en
i only o a pe iod. AIDS ad oca es in São Paulo and Rio success ully a gued (and
won in a s ing o cou cases, i s o he adi ional AZT, hen o he new p o ease
inhibi o s) ha unde he cons i u ional p inciples o g an ing he igh o li e o i s
ci izens, he B azilian go e nmen should pay o ARTs o people wi h AIDS.16 This
ac ion opened a new pa h ha in he end led o he lowe ing o he cos o ARTs,
and hei subsequen wide a ailabili y, by b inging down he cos s associa ed wi h
pa en s and oyal ies h ough hei manu ac u e as gene ics. The dynamics expanded
h oughou he wo ld, along wi h new o ms o using AIDS assis ance unds om
de eloped coun ies o pay o ARTs in poo e coun ies. Fo example, dedica ed
p og ams o heal h p omo ion we e unded by la ge cha i ies, and a Uni ed Na ions
in e agency s uc u e, UNAIDS, was c ea ed o add ess AIDS.17
The de elopmen o e icien ARTs in he second hal o he 1990s and he
ea men 's wo ldwide di usion in he ea ly 2000s u ned wha had been a le hal
pa hology in o a ea able condi ion. Bu did ha b ing he epidemic o an end,
o simply change i s global dis ibu ion and, as a consequence, i s global isibili y?
15 Bas os (1999; 2008); Biehl (2004); Pa ke (2011); Te o & Ga cia (2008).
16 Sche e , Salaza , & G ue (2005).
17 Bas os (2008); Be kman, Ga cia, Muñoz-Laboy, Pai a, & Pa ke (2005); Follé (2010); Gal ão (2005); Gal ão,
Bas os, & Nunn (2012); Nunn, Fonseca, & G uskin (2009); Schech e & Cha les (2008).
THE NEVER-ENDING POXES 161
The uni ying pandemic ha exis ed in he 1990s, mobilizing No h and Sou h in he
pu sui o a cu e o all, ceased o exis unde ha o ma ; and while he e ec s o he
global e o agains AIDS helped in e oding he adi ional gap in access o heal h
ca e, he di ide emained. HIV con inued sp eading h oughou he wo ld; AIDS
babies g ew in o adul s who would no know li e wi hou he i us; and, p edic ably,
s uc u al asymme ies condi ioned access o ea men , including in B azil, whe e
in he mean ime he poli ics o dis ibu ion also changed. The end o AIDS emains
elusi e and a wo k in p og ess condi ioned by poli ical decisions and mul iple o he
ac o s.18
Syphilis
In he 2000s my esea ch in e es s shi ed o his o ical epidemics and o he ma e s.
I e en ually s udied syphilis in he ea ly 20 h cen u y—an in ec ion so embedded in
socie ies a ound he wo ld ha i be e i s he ca ego y o endemic. I conduc ed
e hnog aphic-inspi ed esea ch on he eco ds o a syphilis clinic in an annex o
he skin and ene eal diseases hospi al o Des e o in Lisbon. My esea ch was
complemen ed wi h he s udy o he pe sonal dia ies o he clinic's chie physician
om 1897 o 1933, Thomaz de Mello B eyne , and wi h he use o a a ie y o o he
sou ces, including a collec ion o wax moulages ep esen ing syphilis symp oms.19
By he ea ly 20 h cen u y, syphilis was a highly p e alen in ec ion a ound he
wo ld, ha ing epo edly been b ough —a leas he sexually ansmi ed, le hal, and
dis igu ing a ian ha s a ed de as a ing Eu ope in he 16 h cen u y— om he
Ame icas o Eu ope by ea ly ans-A lan ic a ele s. In wha has been e e ed as he
“Columbian Exchange,” syphilis was he coun e pa o smallpox, measles, in luenza,
and o he le hal in ec ions aken om Eu ope o he Ame icas.20 Syphilis—o lues,
o Gallic illness, o he “pox”— ound a s eady home in Eu ope and sp ead ac oss
he wo ld h ough ma i ime and land a el, ade, conques , wa , colonial se lemen ,
and so o h.21 I a ec ed men and women, ich and poo , da k and ligh , old and
young, and e en newbo ns, whose congeni al syphilis ( ansmi ed du ing p egnancy
o bi h) was o a long ime pe cei ed as an he edi a ian a e and a sign o he
degene a ion o some g oups.22
Fo cen u ies, he e we e no e icien ea men s o syphilis; pallia i es included
me cu y, guaiacum, wa e he apies, and a numbe o local emedies ha a ied om
place o place. The use o make-up o disguise syphili ic acial ma ks and wigs o co e
alopecia became ashionable and we e o en used by men and women o he uppe
s a a, ega dless o whe he hey we e sick o no .
18 Agos ini, Rocha, Melo, & Maksud (2019); Cue o & Lopes (2021); Kenwo hy, Thomann, & Pa ke (2018).
19 Bas os (2011; 2017).
20 C osby (1972).
21 Among o he s, B own (2006); Le ine (2003); Wa s (1997).
22 B own (2006); Ke ze (2008).
162 CRISTIANA BASTOS
P os i u ion and p os i u es we e mos o en blamed o he ansmission o
syphilis, along wi h a wide ange o ene eal diseases ha ell in he same ca ego y.
Some go e nmen s banned p os i u ion al oge he . O he s chose o egula e he
sexual ade, keeping i as a legal ac i i y whose p ac i ione s could be moni o ed
and egula ly checked by he sani a y police. In he places ha adop ed such egimes,
he impac o su eillance a ied acco ding o class and loca ion; while high-class
b o hel wo ke s could a o d in-house inspec ions and ea men , he mo e ulne able
and lowe inges we e moni o ed a he police headqua e s and, i caugh wi h symp‐
oms, locked in p ison hospi als. In la e-19 h-cen u y Lisbon, ha mean Des e o's
lock in i ma ies o S . Ma y Magdalene and S . Aegyp iaca. In he wo ds o one o
i s doc o s, Des e o was mo e p ison han hospi al, a s igma ized human dumps e
o people wi h skin-exp essi e, epulsi e ailmen s and o p os i u es caugh wi h
ene eal symp oms by he sani a y police.23
The appoin men o uncon en ional physician D B eyne o Des e o in 1897
b ough a ew imp o emen s. Dona ions om D B eyne 's well- o-do connec ions
(including he uling mona ch) helped mi iga e he gene al sho age o means in
he d ead ul in i ma ies and ob ain some basic equipmen . The ou pa ien clinic was
also poo ly equipped and he e a e many no es om B eyne complaining o he
sho age o medicines. S ill, he managed o p o ide he s anda d ea men s used in
be e -endowed places: me cu y-based injec ions, pills, onics, oils, and oin men s.24
E en hough D B eyne had ouble making an academic ca ee a home in
Lisbon—acco ding o himsel , due o his oyalis sympa hies in a medical milieu ha
was mos ly p o- epublic—he was ully inse ed in o a as in e na ional ne wo k.
He had done pos g adua e wo k in Pa is and e u ned he e e e y now and hen,
pa icipa ed in in e na ional mee ings, and was keenly awa e o new he apeu ic
de elopmen s. I is hus no su p ise ha he was an ea ly en husias o wha appea ed
o be a p omising cu e o syphilis—Sal a san—and began using i in 1910.
Sal a san, o 606, had been de eloped in Ge many by Ge man Nobel Lau e‐
a e Paul Eh lich and Japanese mic obiologis Saachi o Ha a.25 P e ious wo k on
an i- ypanosomiasis (sleeping sickness) ea men s, ele an o opical–colonial
medicine, had led o he de elopmen o he success ul a senical compound A oxyl
in Ge many. Sal a san was also an a senical, and—unlike A oxyl, which was used
mos ly in colonial A ica—was immedia ely in demand in Eu ope, being i s used
on pa ien s in 1909.26 In 1910, i was al eady in Lisbon, ia T opical Medicine head
Ay es Kopke, who sen i o Des e o, whe e an assis an physician adminis e ed i o
23 Bas os (2011; 2017).
24 Molés ias Si ilí icas e Vené eas, Regis os de Consul a (1897–1909), Colecção de De ma ologia do Hospi al do
Des e o, Cen o Hospi ala de Lisboa Cen al, Hospi al dos Capuchos, Lisboa, Po ugal; see also Thomaz de
Mello B eyne , Diá ios (1894–1933), p i a e collec ion deposi ed a he A qui o Nacional da To e do Tombo,
Lisbon, Po ugal, consul ed wi h he kind consen o his descendan s.
25 Eh lich ecei ed a Nobel P ize in 1908 o his wo k on dyes and mic oscopic isualiza ion. Ha a was nomina ed
h ee imes o a Nobel P ize, bu ne e awa ded one. Al hough amous in Japan, Ha a's ole in Ge man
biomedicine is o en o e looked: Ve non (2019).
26 Williams (2009).
THE NEVER-ENDING POXES 163
a emale inpa ien . I was he mon h o Augus and B eyne was on summe e ea ,
bu on his e u n he immedia ely p aised he ea men and adop ed i bo h in he
hospi al and in his p i a e p ac ice. His no es show a since e en husiasm o he new
possibili ies o Sal a san.27
Th oughou Eu ope, Sal a san was applauded and adop ed. I was seen as a
“magic bulle ,” a possible edemp ion om syphilis, and he ool ha would end a
cen u ies-old scou ge. Howe e , i was soon disco e ed ha Sal a san had ha m ul
side e ec s. En husiasm abou i cooled. Wi hin a ew yea s, Eh lich had de eloped
a mo e pe ec compound, Neo Sal a san (914). S ill, i was no he inal wo d on
syphilis e icien ea men s. Bismu h was also adop ed as a he apy, bu wi h limi ed
esul s. I was only when penicillin became widely a ailable ha he end o syphilis
came in o sigh .28
Adop ed wi h cau ion—since Sal a san had p o en o be occasionally le hal—
penicillin slowly en e ed he ea men epe o y and eally did p o e o be a magic
bulle . The d ug c ea ed a symbolic end o syphilis, i s symp oms mo ing ou o
public sigh . Wi h he a i al o an e icien he apy, he e was a change in he ense
balance be ween hose who wan ed o ou law p os i u ion and hose who suppo ed
i s legal s a us as a means o con olling he sp ead o syphilis. The a gumen los
s eng h wi h penicillin in he pic u e, and p os i u ion was inally ou lawed in Po u‐
gal in 1963.29
Did syphilis end, a leas in his place? No en i ely. We can hink o i as ha ing
an asymp o ic quasi-end—a ading away om public conce n, a disman ling o he
syphilis appa a us and ela ed public policies. While he pa hogen emains ou he e,
in endemic o ms o epidemic e-eme gences, he complex o syphilis as i exis ed, a
leas in Lisbon, in ol ing d ead, disguise, and su eillance h ough he combina ion o
sani a y police, legal p os i u ion, and lock hospi als, had an end, albei one wi h no
clea da e o epo , slowly and some ime pas he mid-20 h cen u y—p ecisely 1963
o Po ugal. The in ec ion, howe e , emains in he backg ound, e up ing e e y now
and hen, in his place and o he s.
Measles
In he con ex o my cu en esea ch on plan a ion labo and acializa ions, I came
ac oss a se ies o h ee de as a ing epidemics o measles on boa d he s eame s
Hankow, Ci y o Pa is, and Bo deaux anspo ing Po uguese A lan ic islande s o
he suga -cane plan a ions in Hawaii in he 1880s. The Hawaii Boa d o Immig a ion
and he Plan e s Associa ion had begun a policy o di e si ying hei wo k o ce,
which a he ime consis ed mos ly o Chinese, Hawaiian, and la e Japanese labo e s.
Madei an and Azo ean amilies we e con ac ed o wo k on he suga ields o Hawaii
27 Bas os (2011).
28 B and (1985); Williams (2009).
29 Sa ai a (2014).