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Furthermore, I think there was confusion in the gay community about the purpose of NIH funds. They needed money for treatment, for patient management, and for support of the health care delivery system for the AIDS patients. They wanted help, whether it was from the NIH or the Public Health Service. They did not care; they needed help. I understand that. I understand their frustration because we only do research, and the CDC says that they only do surveillance. So who was going to help the gay community? They had sick folks out there. I understand that.
I asked Jack Whitescarver early on to take on the responsibility for outreach. NIAID had never had that mandate. The Cancer Institute ([NCI], the Heart Institute [NHLBI] and the Aging Institute [National Institute on Aging] have outreach activities like social research, behavior modification, and demonstration projects. Even without the legislative mandate from Congress, we started with a series of programs all over the country.
We presented to the afflicted communities or to the health care workers all the information we had on AIDS. I went to one meeting in 1982 at UCLA where I spent an extra day going to a gay treatment center that had been organized for STD and behavioral counseling; for all the social problems that these young men and some women had when they left Midwestern homes to come to California. I met with the board of directors. They were a hostile group. It was a hostile meeting. They really were not interested in whether the NIH or the CDC did research. They had a large number of sick people, and they needed help. As they saw it, all we were giving them was a bureaucratic alphabet soup (CDC, FDA, NIAID, NIC, NCI, HICFA, etc.). I understand that frustration.
We (NIAID) held four or five meetings in various cities on health and prevention matters pertaining to AIDS. I think that all the meetings were useful, not only for those patients who had the disease, but also because these meetings got information out early to a large group of people. We had a meeting in downtown Washington, D.C., at the Hilton, in which the ballroom was completely packed. It was so full, we called Dr. Ed [Edward] Brandt, Assistant Secretary, DHHS, and said that he had better come over and talk to these people, which he did. NIAID took the lead in these outreach activities.
Harden: What has happened to those programs, do you know?
Krause: I do not know. Jack Whitescarver was responsible for them, he got a citation for his work, and so you need to talk to him about that. He will have the early history. That is one of the proactive steps we took.
Then I started working very closely with the President of the Society of Physicians for Human Rights, Dr. Neal Schram, an internist from California. I worked very closely with him early on and with his successor. They developed respect for my contributions and asked me to be their banquet speaker at the annual meeting in Chicago in 1984. This is primarily a group of gay and lesbian physicians. I can give you a copy of my talk if you would like to read it. The theme is taken from a letter from Anton Chekov to his brother after he had gone to the penal colony in Sakhalin Island and taken care of the prisoners there. The prisoners were outcasts of Czarist Russia. I took the title of the talk from a remark that he had made. “Does the rough garb of the convict hang in your wardrobe? Let it hang there.” Chekov wrote to his brother Michael, saying that he was satisfied with what he had done and that he could say with peace of mind that the rough garb of the convict now hung in his wardrobe. He had done something for humanity. I was very pleased because when I finished the talk, I got a standing ovation, the only one I have ever received. I had worked very hard on that talk. It meant a great deal to me that NIAID's efforts were recognized in this way. This was in 1984.
Harden: One of the reasons that we are talking about AIDS is because AIDS is not just any disease, but it is a disease that has evoked an enormous public outcry. Dr. Fauci said that he believes it is the first disease virtually to force scientists to publish in the press rather than to publish in scientific journals. This is where I want to get back to your World War II experience. Could you make some comparisons as to how the public health community looked at sexually transmitted diseases then, how it looks at them now, and how the public reacted to the kinds of things that the medical community did to respond? Are there comparisons?
Krause: Yes, there are. There are very interesting comparisons. I was a young nineteen year-old boy at the time of World War II, but news about venereal diseases made quite an impression on me. I did not know anything about venereal disease when I went into the army, but within the first three weeks I had learned a lot, not by personal experience but by what they told us. The Army doctor talked to us about venereal disease: syphilis and gonorrhea. We were shown movies in technicolor of syphilitic chancres on penises and vaginas and a gonorrhea-infected penis with the pus coming out of the urethra. We were shown sociological movies about a soldier picking up a prostitute and not having a condom with him. Three days later he is shown coming away from the urinal with fright on his face because he urinated pus.
The doctor showed us how to put on condoms using a broomstick for a dildo. That got a big laugh. “Here's John, he says, holding up a five-foot broomstick, putting a condom on one end of it. He told how to hold the penis just below the glans and to leave about half an inch of condom at the tip so there is room for the ejaculate. I remember the sergeant telling us later, “You guys remember that I slipped one on too tight once and when I came, my God, I thought it would blow my balls off.”
In wartime, the language was pretty much as you would imagine. I remember when I was taken in, everything was said in the coarsest language you could imagine–at the dinner table: “Pass the fucking butter, pass the fucking soup, pass the fucking milk, what the fuck, what the fuck are you fuckers thinking about, and so forth. You have to realize it is probably part of the process of depersonalizing people, so that they are better prepared for combat. In any event, it happens, it is probably sad. You get all that if you read Norman Mailer's The Naked and the Dead and other modern war literature, you really get absolute coarseness. There is a certain relationship between coarseness and laxity in sexual morals. Language was coarse and very explicit. In many ways Mailer's novels can not compare to All Quiet on the Western Front and The Red Badge of Courage–no overt coarseness in those.
Now let us go to the control side during World War II. We did things then that would be called infringement of human rights today. For example, everybody had a Wassermann test, and you had no choice. That was also true in the civilian community in those days; a premarital Wassermann test was required. Before penicillin, the infected recruit had to be started on long-term syphilis treatment invented by Paul Ehrlich.
We had “short-arm” inspections, which meant inspections of the penis. Often there were spot checks at three o'clock in the morning. The lights would go on in the barracks, and we would hear, “All you fucking bastards get up and put on your shorts and raincoats and nothing else, and go outside, and when the doctor passes in front of you, open the raincoat and show your cocks.” Then you were asked to strip down your penis to see if there was any pus in the urethra. We were a bunch of young guys, so some of them may have just had a wet dream, and on some occasions guys would be hauled out. I must confess, I do not know whether gonorrhea was ever detected in this way. I do remember several guys who had to go over to the dispensary, but it was just semen in the urethra and not gonorrhea pus.
We also had green light stations or “pro” [prophylactic] stations, and there was tremendous propaganda urging us to use the stations. Whether it did any good or not before penicillin, I do not know. The treatment was soap suds and thirty milliliters of argerol solution injected up the urethra. It stung like hell. As a medic, I gave many of them. All this changed with penicillin. "Queen penicillin," it was called.
We had case contact reporting, and I did this for several months in venereal disease control work. I took a two-week course in which I was instructed on how to get a soldier to tell you whom he slept with and from whom he got venereal disease. When we learned the woman's name, we reported it to the U.S. Public Health Service authorities so they could find her and treat her.
It took interviewing skill to get that information. You can say that this was extracting information from the soldier by means that might not be acceptable today. A good interviewer could usually get the name. I remember the first time I interviewed a soldier, I did not get the name of the girl. After an hour-long interview, the sergeant who was in charge of this unit in Fort Riley, Kansas, went in and said, “Well, okay, let's see what I can do.” He went in and five minutes later he came out with the name. I do not know whether he threatened the soldier, but I bet he did.
When a rated soldier no longer had sergeants' stripes and just a silhouette on his sleeve where the stripes had been, you knew he had probably been busted because he got venereal disease. I suspect cooperating with the interviewer was a way of protecting your rank. Sort of a quid pro quo.
You could be broken back down in the ranks and even officers were broken from officer rank to the non-commissioned ranks. It was our responsibility to use a condom, and not to get venereal disease. Period. If you got venereal disease, it was not in the line of duty.
After penicillin, everything was more relaxed. That is the World War II experience. I think in regard to STDs, we did things in the context of the military. Even the civilian population was treated this way. We griped about it, but after all there is nothing fair about war. It is hell.
Harden: Could you draw some comparisons with how the public health community and the public view the same issues with regard to AIDS, like the use of condoms?
Krause: We have been in a very strange situation. It is probably fair to say that if there is any place where the Public Health Service did less than it might have done, it has been in public health education about AIDS, although Dr. Koop did a great deal. The information needed is about the risk of sexual and blood-to-blood transmission. In World War II, the information on the risks and on behavior modification was handled very explicitly. Now with AIDS, matters have been handled very gingerly. The English have done it much better. It is a paradox, because we have gone through a great sexual revolution and there is greater acceptance of sexually related information by the general public, in both the gay and the heterosexual communities. We are living in a period in which the divorce rate is almost fifty percent and in which there is a good deal of sexual activity out of wedlock. Nevertheless, for reasons that are not entirely clear, there has been a restraint on what the Public Health Service can say publicly. Chic [Dr. C. Everett] Koop has gone right ahead, and I admire him for it. He came in as a Surgeon General who was supposed to be an arch conservative, against abortion and, therefore, presumably very safe. Furthermore, though he looked like Moses, he ended up talking about the use of condoms. I do not think the White House knows what to do with him.
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