Word for Word/Nameless Dread; 20 Years Ago, the First Clues To the Birth of a Plague - New York Times

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Word for Word/Nameless Dread; 20 Years Ago, the First Clues To the Birth of a Plague
By JACK BEGG Published: June 03, 2001

AIDS. The acronym alone defines a generation. But 20 years ago, the disease was a puzzle. The virus that causes it was already pulsing through many thousands of people's veins, but the symptoms that define it were just beginning to emerge: the lingering malaise, the persistent diarrhea, the bluish-purple spots. Doctors began noticing a similarity of symptoms. A few gay activists sounded an alarm. But knowledge was slow to accumulate. The step-by-step arrival of awareness in the United States becomes clear in the following newspaper reports, bulletins and medical journals, from the first references in May of 1981, through 1982 when the Centers for Disease Control in Atlanta put a name to the disorder. In the words of the time, these excerpts trace the birth of a plague. JACK BEGG The New York Native, then the nation's most influential gay newspaper, carried a report of a strange new ailment on May 18, 1981. Some of its reassurances would prove to be false, but one point was clear: even if the disease first become apparent in gay men, it was not just ''a gay disease.'' Last week there were rumors that an exotic new disease had hit the gay community in New York. . . . The rumors are for the most part unfounded. Each year, approximately 12 to 24 cases of infection with a protozoa-like organism, pneumocystis carinii, are reported in the New York City area. . . . In general, the disease is seen only in severely debilitated patients whose ability to fight infections has been severely compromised. What's unusual about the cases reported this year is that 11 of them were not obviously compromised. . . . Regarding the inference that a slew of recent victims have been gay men. . . . Of the 11 cases . . . only five or six have been gay. Later in May, two Los Angeles doctors submitted a brief account of five of their patients to the C.D.C.'s newsletter, the Morbidity and Mortality Weekly Report. Dated June 4, it was the first clinical description of the disorder. Patient 1: A previously healthy 33-year-old man developed P. carinii pneumonia and oral mucosal candidiasis in March 1981 after a 2-month history of fever associated with elevated liver enzymes, leukopenia [abnormally low white blood counts], and CMV viruria [cytomegalovirus -- a herpes virus -- in the urine] . . . . The patient's condition deteriorated despite courses of treatment with [sulfa drugs], pentamidine and acyclovir. He died May 3. The Los Angeles Times picked up the report on June 5, under the headline ''Outbreaks of Pneumonia Among Gay Males Studied.'' Researchers are investigating mysterious outbreaks of pneumonia that have occurred among male homosexuals in Los Angeles and several other cities. . . . [The C.D.C. report] describes the first five cases, which were all homosexual men in their 20's or 30's, stricken by pneumonia caused by a parasite that usually affects only cancer patients. Another half dozen cases are under investigation in San Francisco, along with an undetermined number in New York, Toronto and Florida. . . . Four weeks later, the C.D.C. ran another bulletin. Doctors from New York and California were seeing another rare disease in gay men. During the past 30 months, Kaposi's sarcoma, an uncommonly reported malignancy in the United States, has been diagnosed in 26 homosexual men. . . . Eight of these patients died -- all within 24 months after KS was diagnosed. Skin or mucous membrane lesions, often dark blue to violaceous plaques or nodules, were present in most of the patients on their initial physician visit. However, these lesions were not always present and often were considered benign by the patient and his physician. Six patients had pneumonia (due to Pneumocystis carinii), and one had necrotizing toxoplasmosis of the central nervous system. One of the patients with pneumonia also experienced severe, recurrent, herpes simplex infection; extensive candidiasis; and cryptococcal meningitis. Since the previous report of 5 cases of Pneumocystis pneumonia in homosexual men from Los Angeles, 10 additional cases . . . have been identified in the state. . . . [This] suggests that the 5 previously reported cases were not an isolated phenomenon. . . . Physicians should be alert. . . . The New York Times received an advance copy of the report and ran its first article on the syndrome on July 3. It mixed together deaths from P. pneumonia and KS and was headlined ''Rare Cancer Seen in 41 Homosexuals.'' Doctors in New York and California have diagnosed among homosexual men 41 cases of a rare and often rapidly fatal form of cancer. Eight of the victims died less than 24 months after the diagnosis was made.

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Word for Word/Nameless Dread; 20 Years Ago, the First Clues To the Birth of a Plague - New York Times

18/03/13 15:15

The cause of the outbreak is unknown, and there is as yet no evidence of contagion. But the doctors who have made the diagnoses . . . are alerting other physicians who treat large numbers of homosexual men to the problem in an effort to help identify more cases and to reduce the delay in offering chemotherapy treatment. A British medical journal, The Lancet, published a report on Kaposi's sarcoma in eight New York City patients on Sept. 19. But because of peer review delays, America's most prestigious scientific journal, The New England Journal of Medicine, did not issue a report on the outbreak until Dec. 10. The authors treated four men, one of whom developed both cancer and pneumonia. The findings were insightful, and despairing. The reason for the appearance of these two unusual illnesses remains unclear. . . . It is likely that sexually active, young homosexual men are frequently reinfected through exposure to semen and urine of sexual partners. Such reinfection -- before recovery from the cellular immune dysfunction induced by previous [viral] infection -- could conceivably lead to overwhelming immunodeficiency or Kaposi's sarcoma. To date there has been no indication of spontaneous recovery of cellular immunocompetence in our surviving patients. All have continued to have a severe wasting syndrome despite intensive supportive measures. . . . The new disease had a nightmarish quality -- fungi grew around victims' fingernails, once handsome faces sagged with lesions. Some thought the symptoms were caused by a bad batch of ''poppers'' -- nitrate inhalants, widely used for a quick high in gay bars and clubs. The writer Larry Kramer issued a warning to the gay community in the Aug. 24 New York Native. If I had written this a month ago, I would have used the figure ''40.'' If I had written this last week, I would have needed ''80.'' Today I must tell you that 120 gay men in the United States -- most of them here in New York -- are suffering from an often lethal form of cancer called Kaposi's sarcoma, or from a virulent form of pneumonia that may be associated with it. More than 30 have died. The men who have been stricken don't appear to have done anything that many New York gay men haven't done at one time or another. We're appalled that this is happening to them and terrified that it could happen to us. It's easy to become frightened that one of the many things we've done or taken over the past years may be all that it takes for a cancer to grow from a tiny something-or-other that got in there who knows when from doing who knows what. . . . This is our disease and we must take care of each other and ourselves. For the remainder of 1981, coverage of the outbreak languished in the mainstream press. Editors were reluctant to write about a virus that could be spread sexually within a community that many readers regarded as offensive. Only when it became clear that nonhomosexuals were among the sick did the major news outlets return to the story. The first Wall Street Journal article on the epidemic appeared on Feb. 25, 1982, under the headline ''New, Often-Fatal Illness in Homosexuals Turns Up in Women, Heterosexual Males.'' A baffling and often deadly new illness, previously thought to be confined to male homosexuals, now has turned up among some women and heterosexual men. . . . Scientists studying the illness say they can't yet predict how much a threat, if any, it poses to the general population. The researchers don't know what causes the disease, how it is transmitted and what makes certain people susceptible to it. For more than a year the epidemic officially remained unnamed. A patient in San Francisco was given a diagnosis of F.U.O.: fever of unknown origin. Some scientists and journalists referred to K.S.O.I. (Kaposi's Sarcoma and Opportunistic Infections) or GRID (Gay-Related Immune Deficiency). A New York Magazine feature story termed it ''The Gay Plague.'' In September 1982, the C.D.C. finally put a name to it: Acquired Immune Deficiency Syndrome.
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