San Francisco, the AIDS capital of the nation, is presumably a city that should be open to a variety of views on how to combat the virus. As the experience of Dr. Lorraine Day of San Francisco General Hospital suggests, the greater the concentration of homosexuals and AIDS carriers in an area, the narrower the limits of the debate.

Until February 1 of this year, Dr. Day was the chief of orthopedic surgery at San Francisco General. She describes orthopedics, or skeletal surgery, as a kind of carpentry of the body. She sometimes uses high-speed drills and saws to rebuild patients who have been mangled in accidents or blasted by gunfire. Orthopedists frequently nick themselves with their tools or are struck with bone splinters while doing a job that is literally drenched with blood. “I work up to my armpits in blood,” says Dr. Day; “I’ve been doing it for 15 years.”

In the early 80’s, when it was learned that AIDS is transmitted by blood. Dr. Day started asking the specialists in infectious diseases what chance there was of getting the virus from a cut or from a bloody bone splinter. She was assured that there was no chance at all. But on October 7, 1987—a date she will never forget—she learned that a nurse at the hospital had gotten AIDS by accidentally sticking herself with a contaminated needle. “My whole life passed before me,” says Dr. Day, who is angry about the false assurances she was given. “Either those people should have known and didn’t, or they knew and didn’t tell us,” she says.

Dr. Day began to study the AIDS literature herself, in an attempt to find out just how dangerous her work was. She learned, for example, that the HIV virus can stay alive in saliva at room temperature for seven days, and that it can survive freezing. AIDS has reportedly been contracted from transplants of frozen bone marrow. “This is not a fragile virus,” she says.

She started asking her patients to take voluntary blood tests so that she would know what risk she ran during surgery, and she started wearing protective clothing. There has long been a head-to-toe suit that doctors wear when they put artificial parts, like new hip joints, into a patient’s body. Bacteria, even in tiny quantities, cling to the parts and can cause infection, so doctors must isolate themselves completely from the patient. Even their breath is filtered to protect the patient. Dr. Day started wearing one of these suits during surgery. She also had the manufacturer install another filter to clean the air coming into the suit, since power tools can throw up a fine spray of blood.

Dr. Day also became curious to know how many HIV-positive patients came through her department, and started asking patients to take a blood test even if they could be treated without surgery. She learned that 10 to 30 percent of her patients were HIV-positive or in high-risk groups, and that during one aberrant month, the number was 90 percent. Her testing program made her famous. A homosexual patient, whose ankle fracture did not require surgery, refused to take the test and reported to the newspapers that he had been turned down for surgery because he would not take an AIDS test.

Newspapers and television stations marveled at the doctor who wore a “space suit” during surgery, and homosexual groups charged her with anti-AIDS hysteria. When she began to speak her mind about AIDS, things got worse. “The disease has been handled politically rather than medically,” she says. “If it had been handled like any other communicable disease, it would be under control by now.” She has campaigned for routine testing, contact tracing, and mandatory reporting as is done with carriers of venereal disease.

Precisely because she favors measures that would reduce the chances that susceptible people will catch the disease, Dr. Day has been accused of hating these people. Dr. Laurens White, past president of the California Medical Association, has been quoted as calling her a “right-wing fanatic,” who thinks that homosexuals and drug users are the “scum of the earth.”

Michael Shriver of ACT-UP/San Francisco (AIDS Coalition to Unleash Power) says she is “a sick, sick, sick, sick person.” Since Dr. Day has been asked to lecture about AIDS, Mr. Shriver accuses her of “turning fear of AIDS into a money-making venture.” He calls contact tracing “a totally discredited concept,” and points to the risk of employer or insurance carrier discrimination against people known to have AIDS. An AIDS carrier himself, he refuses to acknowledge that the risk uninfected people run of getting a fatal disease should be weighed in the balance against the risk of discrimination against a carrier.

Dr. Day is no longer doing surgery at San Francisco General. She finally decided that day-in-day-out contact with infected blood was a risk she had run for long enough. She has voluntarily moved her practice to the University of California at San Francisco, where there are far fewer AIDS patients. “I had operated on as many or more AIDS patients than anyone else in the country, and I figured I had been on the front lines long enough,” she says; “I have an obligation to stay alive and raise my family. It’s time for somebody else to take over.”