THE WHITE DEATH Julian Cribb (Sydney: Angus & Robertson, 1996) 1. Portrait of a Catastrophe 1 2. The Cruel Sculptor 17 3. Out of Africa 33 4. Speculations 47 5. Mission of Mercy 63 6. War on a Killer 85 7. Inklings 100 8. The Smoking Gun 115 9. In the Open 132 10. Wall of Silence 152 11. Pandora's Box 170 12. The White Death 187 Glossary 212 This online version of The White Death differs from 1996 print edition in several respects, including pagination, minor textual details, new material in chapter 12 and omission of the prologue, photographs, appendices and index. The appendices are available online at http://www.uow.edu.au/arts/sts/bmartin/dissent/documents/AIDS/ Curtis92ul.html and http://www.uow.edu.au/arts/sts/bmartin/dissent/documents/AIDS/ Hamilton94/AIDSvsLawsuit.html — 1 — Portrait of a Catastrophe David Carr suffocated to death in Manchester Royal Infirmary, UK, on 31 August 1959. His end was the outcome of an horrific lung infection caused by two rare organisms, Cytomegalovirus and Pneumocystis carinii along with a host of other bizarre symptoms. The doctors who attended him were baffled, regarding the character of his disease as almost freakish. Carr was just twenty-five years old at the time he died. He had grown up amid the working class surrounds of Reddish, a suburb of Manchester, in the industrial English Midlands. A popular figure, like other boys of his background he had been a keen footballer, playing for the local club, Central Rovers. After leaving school, he went to work as an apprentice linotype operator for the Manchester Evening Chronicle but was called up to do his two years national service in the armed services. On 7 November 1955 he had reported for duty with the Royal Navy as a rating, and after a tour in shore service at various British naval bases, was ordered on a voyage to Gibraltar aboard HMS Whitby. While there, it was believed, he obtained a leave pass and went on a brief excursion by ferry across the straits to Tangier in Morocco, North Africa, notorious at the time as a flagrant centre of the sex trade, and consequently a cherished resort for sailors of all nationalities. It was in Tangier, doctors later came to suspect, that Carr acquired the seeds of his doom. On his return to Britain, he received his discharge from the Navy on 6 November 1957, returned to his home in Manchester and became engaged to be married shortly thereafter.1 But all was not well with David Carr. Since the last months of his service with the Royal Navy his gums had been giving him trouble, and, within a year, some large, brownish spots appeared on his back and shoulders, for which he was given X-ray treatment. In spite of this, his health continued to deteriorate. His symptoms became ghastly: by December 1958 he was breathless, wasted, tired and feverish. He was afflicted by a heavy cough which produced purulent sputum flecked with blood. He suffered from haemorrhoids, and in February a painful fissure opened up around his anus, extending for ten centimetres. A small pimple in one nostril rapidly grew into a second ulcer. On admission to the Royal Infirmary he was found to be severely emaciated and febrile. Doctors noticed his immune white cell count was abnormally low, 1 yet his lymph glands seemed fine and his heart and lungs were otherwise normal. But the scaly brown lesions had spread across his back and shoulders. After admission to hospital, and even under treatment, the ulcer which had begun in his nostril grew into his upper lip and mouth, dribbling a constant stream of pus down his throat which caused the surface of the tongue to slough. The anal fissure spread remorselessly until it ulcerated a large area of both buttocks. His body was colonised by organisms: cytomegalovirus, golden staph and the parasite pneumocystis honeycombed his lungs. His fingers became clubbed and small abscesses dotted his skin. Severe pneumonia set in. In spite of massive doses of antibiotics, it eventually claimed his life. The doctors at the Royal Infirmary, pathologist George Williams, registrar Trevor Stretton and senior registrar John Leonard, did not know what to make of this bizarre array of symptoms. At first they were inclined to suspect tuberculosis, but tests rapidly eliminated that possibility, along with several other less common conditions. They then opted for an extremely rare disease, Wegeners granulomatosis, which was their prevailing opinion at the time Carr died. Finally, after extensive post-mortem examination, they concluded the culprit was cytomegalic inclusion disease (CID), a rare viral condition in which infected cells form into giant units. Strangely, though, CID is a disease of infants and scarcely ever kills an adult. Although Carr's death certificate attributed his demise to Wegeners granulomatosis, the post-mortem found that he had suffocated from a massive lung infection. The case was sufficiently unusual for Williams and his Royal Infirmary colleagues to record in detail for The Lancet. Their report appeared in October 1960.2 Specimens were taken from Carr's corpse and preserved. His other remains were cremated and the ashes scattered at Manchester Crematorium, whose Book of Remembrance sombrely records "cherished memories of the happiness he gave". At the time of Carr's death, of course, nobody had ever heard of a disease called AIDS. Nobody even dreamed that such a disease could exist. Its discovery lay more than two decades in the future. * * * In 1979, twenty years after David Carr's demise, a sharp- eyed Los Angeles doctor named Joel Weisman began to observe in certain of his patients a cluster of puzzling symptoms which included fever, loss of weight, diarrhoea, fungal infections and 2 swollen lymph glands. The other common thread was that patients were all young, male and homosexual. It was the heyday of gay liberation, an era when male and female homosexuals across the western world finally began to scent victory in their long struggle against stigma and prejudice. California, as in so many social trends, was the bow-wave of an attitudinal revolution that was starting to ripple around the globe. Many gays were celebrating their new-found freedom of sexual and individual expression by aggressive promiscuity, a symbolic defiance of the puritanical principles by which society seemed bound: "An unplanned outcome of the gay liberation movement of the 1970s was a vast business of gay bath houses and sex clubs. These establishments capitalised on the prevailing ethos, in which pressing beyond the limits of conventional sexual behaviour was a political act, proof positive of ones freedom from repressive social norms. At the same time this institutionalization or commercialization of sex led to a tremendous increase in sexually transmitted diseases.... 3 The symptoms in Dr Weisman's patients multiplied. Sometimes they appeared to get better, at other times worse. The best guess seemed to be cytomegalic disease -- the same one that David Carr's doctors had suspected as the primary cause of his demise -- coupled with some other infectious agent such as the Epstein-Barr virus (EBV). The problem was complicated by persistent fungal infections and diarrhoea. One patient, in particular, went into a decline, suffering rapid weight loss and heavy lung infection. Early in 1981 he was admitted to the California University Hospital where Dr Michael Gottlieb recollected a similar case he had treated in late 1980. Both patients had severely impaired immune systems, both suffered the same lung infection, both were male, both were gay. The puzzle was why two mild and relatively common viruses should have such a severe effect on this small group of patients. Checking the state medical records, the doctors located a third case, and then another. By May 1981 five cases had come to light and the first patient had died two months earlier of severe pneumonia.4 What particularly seized the attention of medical workers was the catastrophic nature of the complex of otherwise relatively harmless infections, and the terrible suffering they inflicted. "In June of 1981," recalled Dr Samuel Broder, "we saw a young gay man with the most devastating immune deficiency we had ever seen. We said: We don't know what this is, but we hope we don't ever see another case like it again. But it was already far too late for 3 that." 5 By that same month the suspicions of researchers at the United States Centers for Disease Control (CDC) in Atlanta, America's disease watchdog, had been alerted by the growing trickle of reports of unusual infections and rare cancers which had begun appearing in New York, Los Angeles and San Francisco over the previous two years. All the cases reported to that point were young, male and homosexual, and all were afflicted by the same agent, pneumocystis. The CDC scented a possible epidemic and decided that sufficient grounds already existed to issue a national alert. This duly appeared in the CDC weekly bulletin on 5 June 1981. "The appearance of pneumocystis in these five, previously healthy individuals without a clinically apparent underlying immunodeficiency is unusual," they commented cautiously, and went on to note "an association between some aspects of homosexual lifestyle or disease acquired through sexual contacts and Pneumocystis pneumonia in this population ... All the above observations suggest the possibility of a cellular-immune dysfunction related to a common exposure that predisposes individuals to opportunistic infections such as pneumocystis and candidiasis." This was the first hint that a new, completely unknown, killer was on the loose. It was, as medical historian Dr Mirko Grmek later dubbed it, the birth certificate of AIDS.6 According to United States records, the first patient to die had been diagnosed in 1978 as suffering from Hodgkin's disease - his symptoms were swollen lymph glands, weight loss and fever, but the post-mortem examination revealed no trace of this complaint.