Taiwan Today

The Navy Medical Research Unit No. 2 is a U. S. agency but most of the doctors and researchers at headquarters in Taipei are Chinese

NAMRU-2 is the most unusual and certainly one of the most important exporting and importing enterprises in the Republic of China. The acronym, which sounds like a cable address, stands for Navy Medical Research Unit No.2. It has been doing business in since May of 1955 and now has branches in many parts of .

Some NAMRU-2 exports cannot be seen without the aid of a microscope and have unfamiliar names. They include acanthocephalans, a spiny headed intestinal parasite, and pentastomids, which are degenerate arthropods which usually live in lung tissue. Bird lice are sent to the in . Roundworms go to in . Lung mites from snakes are supplied to a research institute in .

In the last 10 years NAMRU-2 has come to be recognized as one of the world's major suppliers of specimens of many varieties of animal life. More than 2,500 wild and domestic birds have been cataloged and shipped abroad, as have thousands of fish and reptiles. The largest part of the mammals, birds and reptiles has gone to the Smithsonian Institution in A wide variety of micro-organisms are sent to medical schools and research institutions. The wants tape worms. needs the acanthocephalans. Shipments go to , and other centers of foreign research.

Live animals are supplied to zoos in Europe and the . Some of these can be seen in the Washington Zoo in the capital. The San Diego Zoo is another good customer. Recently a rare marsupial from with many of the charac­teristics of the Australian kangaroo was sent to .

NAMRU-2 also maintains an exchange program. Insects, parasites, snails, crabs, fish and other specimens needed for research reach the laboratories here under this arrangement.

Many specimens are used for research at home. Reptiles are supplied the in . Export of specimens has declined somewhat in the last two years. NAMRU-2 continues to develop its own supply for the extensive research program in and collects new varieties from its stations in other countries.

Of greater importance to mankind, NAMRU-2 exports without charge its contributions to medical science and its knowledge regarding the prevention and cure of a large number of diseases. It imports highly trained research scientists and provides them with what are recognized as the outstanding medical research facilities in .

Work at NAMRU-2 affects the health and welfare of half of the world's land area and more than half of the world's population. has reason for pride in being chosen as the best location for NAMRU-2 operations.

The responsibility for administering this complicated, far-flung enterprise rests in the capable hands of Captain Raymond H. Watten, a tall, well-built Minnesotan, who joined the U.S. Navy immediately after his graduation from Stanford University College of Medicine in during World War II. He has been in since the end of that conflict.

Kindly and soft-spoken, he runs a taut ship with friendly assurance and is respected and liked by his staff. His love of Chinese food shows slightly in an ample waistline. His first love is research and his specialty is tropical diseases; he regrets that administrative responsibilities occupy too many of his working hours. In addition to the routine administration and finance, he must check the scientific reports of his staff and edit them for publication. He would not trade jobs with anyone. His scientific enthusiasm is one contagion which defies all of NAMRU-2's antiseptic safeguards. When Captain R. A. Phillips retired six years ago, Captain Watten was the logical choice to succeed him.

The U.S. Navy's medical research program was born in World War II as the war in the Pacific confronted military forces with a number of strange tropical diseases. The first unit was established at the Rocke­feller Institute in in 1942. When was retaken from the Japanese in 1943, NAMRU-2 moved there for the remainder of the war. The unit was disbanded after 's surrender in 1945.

But the need for scientific knowledge of tropical diseases had not ended. was selected as the best site for re-establishment because of its strategic location in , its stable government and its rapidly developing economy. An agreement was reach­ed with the Republic of China authorizing the U.S. Navy to set up headquarters for a program of research on tropical diseases in the Western Pacific. From its inception, the project had the enthusiastic sup­port of the Chinese government and the endorsement of the medical profession. Buildings and grounds adjoining the were leased to NAMRU-2 for 20 years at a rental of US$1, or five cents a year.

Formerly a nurses' dormitory, the original build­ing was renovated and remodeled to fit the needs of research. Additions have been constructed since and the complex has been air-conditioned. Approximately 90 per cent of the professional, technical and administrative staff is Chinese and working under contract to the .

The transformation of the physical plant required more than two years. Commissioning took place November 6, 1957, with Captain Phillips in command. It had been Captain Phillips who took the US$1 rental from his own pocket to get the project started.

A new wing has doubled the original floor space of 49,000 square feet. Equipment cannot be matched by any similar research center in the Pacific area. For example, when the completed its atomic tests at , the chamber designed to test exposure to radiation was given to NAMRU-2. The walls of the 10 X 10 chamber are made of solid steel six inches thick. To install it was a major engineering feat. The chamber was put in place and a room built around it.

NAMRU-2 uses radioactive isotopes in diagnosis and research. A computer center is provided to record and analyze findings.

One of the NAMRU-2 dividends for Taiwan is a well-stocked medical library and reading room open to all doctors without charge. NAMRU-2 spends more than US$25,000 a year on subscriptions to leading medical journals from all over the world, a valuable contribution to National Taiwan University's Medical School. Medical and research journals on file total 434. The Taipei International Medical Association meets in the conference room on the first Wednesday of each month.

Medical research involves the study of patients as well as laboratory work with microscopes and test tubes. NAMRU-2 has a 20-bed hospital. Patients are those suffering from a disease under study or an ailment which cannot be treated elsewhere. The hospi­tal is unique in several ways. No charge is made for treatment. The nurses not only are highly trained but must be proficient in several languages, including that of the Taiwan aborigines. The hospital quarters serve as a model of cleanliness and efficiency. The Taipei Health Department uses the kitchen as a yardstick in setting standards for restaurants and hotels.

Some patients stay on as employees after their rare diseases have been cured or controlled. One such was admitted four days after the hospital was opened on January 13, 1958. He was suffering from a rare form of Leishmaniasis, an infection caused by a protozoan, and now works as a ward orderly.

The Clinical Investigation Department, which operates the hospital, cooperates with other medical institutions in Taiwan. An iron lung is loaned when needed and the department assists in diagnosing unusual diseases.

The staff consists of 25 military officers, 10 civil service employees who are Americans and 10 others working under contract. Of the 320 technicians, 60 per cent are college graduates. Morale is high because NAMRU-2 offers opportunity for the advancement of all employees.

The administrative chart shows 13 departments, including data processing, graphic arts, clinical investigation, veterinary medicine, microbiology, medical physics, medical ecology, biochemistry and pathology. The physical plant at 7-1 Kung Yuan Street has land area of nearly two acres. There are three permanent buildings and two temporary structures. The United States has invested $930,400 in improvements. To duplicate the physical plant in Taiwan today would cost more than US$3 million. In the United States the cost would be several times that amount.

A major achievement under Captain Watten is the establishment of one of the first full-scale medical research laboratories in a combat zone. This is the NAMRU-2 detachment at DaNang in South Vietnam. Tropical diseases, principally malaria, were taking a heavy toll of American troops in South Vietnam and doctors in the combat zone were not familiar with such cases. The NAMRU-2 detachment was able to diagnose 70 per cent of the cases, compared to only 20 per cent before the laboratory was opened.

NAMRU-2 also sent a surgical research unit headed by Lt. Comdr. Jack L. Ratliff to Vietnam and pro­vided an artificial lung of a new type to treat combat casualties. Called a Sulastic Blood-Membrane-Gas Exchange Unit, the device adds oxygen to the blood of the seriously wounded.

Research in Vietnam has included study of infec­tions in wounds, effects of shock from loss of blood, use of muscle relaxing anesthetics in treatment of wounds and the effects of transfusions with a large volume of stored blood. The unit provides some laboratory functions and has made thousands of diagnostic tests.

NAMRU-2 has conducted 15 major field expedi­tions in Asia beginning in 1958. A project was con­ducted in Dacca in East Pakistan in that year. Another was set up in Bangkok and continued through 1960. Units also have gone to British North Borneo, Philippines, Korea and Indonesia, where a study is under way on filariasis, commonly known as elephantiasis, a chronic disease of the lymph glands. This disease is not common in Taiwan but is widespread in Indonesia. In World War II it was one of the diseases most feared by American GIs, although Captain Watten explains that it was more of a morale problem than a medical hazard. The disease is disfiguring and there is no cure except surgery.

Typical of NAMRU-2's field trips is one recently completed by Dr. John Cross in Borneo. Dr. Cross is a dedicated parasitologist and old China hand. He was serving in the U.S. Navy in Shanghai when he decided to study medicine. After earning degrees at the Universities of Arkansas and Texas, he joined NAMRU-2 in 1966 as a research officer. Like others on the staff, he teaches classes at the Taiwan University Medical School. Last spring he headed a team of five which flew to Indonesia in a Navy plane with their equipment, including a truck, a jeep and an electric generator.

After landing, the team drove more than 100 miles to set up headquarters in a small village in the interior. They examined approximately 2,500 natives, took blood samples and treated ailments. The mos­quitoes which transmit filariasis bite only at night, so blood samples were taken then. To attract people, the team showed movies. Natives preferred old Keystone Kops comedy films to modern films, including those of the American astronauts walking on the moon.

Findings of the expedition are being studied in and may help lead to prevention of the disease. Mild cases have already been arrested after treatment with a newly developed serum.

NAMRU-2 has trained 300 medical research fel­lows from Asian countries and the . Asian countries include the Republic of China, , , , and . More than 200 Chinese medical researchers have gone to the for advanced study after work at NAMRU-2.

Americans who come here to study are in demand not only in the but by many other countries. More than half of them specialize in tropical medicine. One American doctor recently went to the staff of the London School of Tropical Medicine.

From 1957 through 1970, members of the NAMRU-2 staff published 434 papers in medical and research journals. Published abstracts total 297 and staff members have reported on their work at more than 300 local and international medical meetings.

NAMRU-2 is one of four such units operated by the U.S. Navy. Two are in the and the third in . The original intention was to obtain knowledge of diseases afflicting the American military forces in general and the Navy· in particular. This purpose remains but the research has benefited peoples everywhere.

A common misconception is that NAMRU-2 seeks to find new methods of germ warfare. Nothing could be farther from the truth. The unit has never engaged in any study of germ warfare and has no intention of doing so. Its sole purpose is to save lives, not to destroy them.

In the early years, NAMRU-2 concentrated on cholera and trachoma. Cholera is one of the oldest known epidemic killers. Fortunately, the cause and prevention have been generally understood for several years. There was a mild outbreak of cholera in in 1962 but nothing since. Cholera remains a continuing threat in many parts of the world, however, especially in . Polluted water is the chief carrier of the disease. NAMRU-2 has studied the disease and developed better techniques of treatment. New strains of the cholera organism have been discovered.

Cholera deaths can now be prevented unless the patient is already in a state of irreversible shock or suffers from complications such as heart disease or a kidney ailment. Treatment is simple. Victims die because of massive loss of sodium, potassium and water. If proper amounts of these essential elements are given intravenously, the patient recovers.

One of the contributions of NAMRU-2 is a simple test to determine the dosage necessary to restore the proper electrolyte balance. Small bottles are filled with solutions of copper sulphate in varying concentrations. The copper sulphate reacts with drops of blood so that each drop forms a homogenous unit and indicates the degree of dehydration. This test is inexpensive and can be carried out by relatively untrained technicians under adverse conditions.

Researchers at NAMRU-2 point out that there is much to be learned about the microorganisms which cause cholera. They still do not know just how the cholera bacillus kills. One theory is that it breaks down essential functions performed by the cell layer of the intestines. These cells extract sodium from ingested food and pass it into the human system. It is believed the bacillus punches holes in the outer layer of cells, permitting the sodium and potassium to escape. It IS also believed the bacillus introduces toxins which clog the sodium pumps in the cells.

NAMRU-2 has developed a vaccine to prevenl trachoma. Although trachoma is not exclusively au Asian disease of the eye, the highest incidence is found in the Far East and the . More than 300 million Asians are believed to suffer from chronic trachoma. Some medical men rank it next to the common cold as the world's most widespread affliction.

Also in common with the common cold, trachoma presents a difficult research problem. The virus is small and elusive. Credit for isolating the trachoma virus goes to a Chinese scientist, Dr. F. F. Tang, a graduate of the . He found that by exposing infected cultures to a streptomycin solution strong enough to kill contaminating bacteria, the trachoma virus, which is not affected by streptomycin, could be concentrated and pure cultures grown.

The NAMRU-2 trachoma vaccine has been tested in on a large scale. Children inoculated do not get trachoma. Since it is estimated that at least 40 per cent of school children suffer from the disease, the importance of the vaccine is obvious. Further research is needed to reduce the cost and make improvements.

Japanese encephalitis, which is prevalent through­ out the , is now under intensive study. This disease seems to be unconnected with low living standards or poor sanitation. It is transmitted by a mosquito with the impressive name of Culex tritaeniorhyncus, which thrives throughout the .

Culex tritaeniorhyncus cannot be eliminated by the control techniques which have proved so successful in coping with Anopheles minim us, the mosquito which carries malaria. C. tritaeniorhyncus likes to breed in the paddy fields and sluggish drainage ditches of rural areas. As a result, Japanese encephalitis is somewhat rare in cities and dry-farming upland areas.

Microbe hunters found other facts for the dossier of the encephalitis culprit. The disease is not trans­mitted from human to human. Domestic and wild animals therefore must be the intermediate host but they apparently do not contract the disease. Culex tritaeniorhyncus is probably the most common mos­ in summer months when epidemics of the disease occur.

NAMRU-2 discovered another interesting clue. There are outbreaks of Japanese encephalitis in , where the cold of winter kills off the mosquitoes. Researchers reason that the disease must be harbored by animals which hibernate. Bats and snakes are prime suspects.

Two methods of control are under study. One is elimination of the mosquitoes in their breeding areas. Paddy fields may be used as ponds for fast-growing tilapia fish, which thrive on mosquitoes. The other hope is to find a vaccine. The vaccine search has been going on for more than 30 years without success. However, most encephalitis victims who recover are immune. This indicates that antibodies develop rapidly and pro­tect the victim.

The quest at NAMRU-2 goes on unceasingly. Hundreds of thousands of mosquitoes are trapped and tested for infection. The laboratory research is under the direction of Dr. S. H. Hsu, former deputy surgeon general of the Chinese Army. He and his staff have equipment to study insect cells and arthropod-borne viruses. The use of arthropod tissue in laboratory work is comparatively new and the methods are painstakingly difficult. But this research offers hope for new knowledge not only of encephalitis, but of filariasis, dengue, hemorrhagic fevers, Bubonic plague, yellow fever and many other killers.

Asian flu is another quarry of NAMRU-2. This diseases originates in and specifically in Hongkong, whence travelers carry it to all parts of the world. In recent years the has had several epidemics. To complicate the problem, new strains appear and do not yield to the vaccines and treatment developed to combat the original virus. NAMRU-2 researchers suspect the hogs of , which are shipped to Hongkong in large numbers. They may be hosts for the virus which mosquitoes then transmit to humans. Research is continuing.

NAMRU-Z is interested in unusual local ailments. Blackfoot disease is found in an area of only a few hundred square miles on the west coast of . This gangrenous infection begins in the toes or fingers, which turn black and rot off. Loss of hands and feet may follow, although the disease is rarely if ever fatal.

Here NAMRU-2 has provided another example of scientific detective work. The population of the blackfoot area is not much more than 200,000. Most of the people have approximately identical living conditions. Only rarely do two victims appear in the same family. While incidence is higher in one or two villages, there is no real pattern to aid researchers. Age and sex ap­parently are not involved.

There are a few clues. The living standard of the area is one of the lowest in and the average diet is poor in protein and vitamins. However, the standard is not inferior to that in other parts of the world where the disease is unknown. An inhabitant moving to another area does not acquire protection. In some villages the drinking water from deep wells has been found to have a high content of arsenic. Another suspicious circumstance is the heavy dependence on dried sweet potato chips for food. A number of fungi have been found growing on the dried chips.

No cure has been discovered. NAMRU-2 has found that patients treated in its research ward show a satisfactory response to improved diet and techniques for improving peripheral blood circulation. The search goes on for cause and treatment of blackfoot disease.

Many Asian diseases are caused by parasites. Nightsoil used for fertilizer is a common source. The amoeba, for example, is found in the intestinal tract of at least 20 per cent of Asians. Some persons develop a tolerance and others do not.

Some parasitic ailments have the common characteristic of a stage in which the organism finds a host in fresh water snails. One of these diseases is Schistosomiasis, caused by a tiny flatworm which enters the skin while still in the larval stage and thrives in the blood vessels and organs of the abdomen. The disease results in gradual physical deterioration. It may be acquired by eating raw snails, which are considered a delicacy by the aborigines and some others in . Crabs are also a carrier of this and other parasitic diseases.

More than 500 million Asians are affected by parasites of one kind or another. The task of identifying and classifying parasites which cause disease in man is far from complete.

One way to prevent ailments caused by snails would be to control or eliminate them, as is done with mosquitoes. But there are problems. Assuming a poison can be found to kill the snails without also killing fish and animals, the amphibious snail still must be contended with.

Fish are transmitters of parasites. In , especially, raw fish is a delicacy. After three years of research by NAMRU-2 and the Philippine Health De­partment, fish were pinpointed as the source of a mysterious intestinal ailment which has claimed the lives of more than 100 persons in northern since 1967. An intestinal worm was found in three species of fish in the brackish waters of the area and identified as the carrier of Capillaria philippinensis, a parasite responsible for a wasting illness which prevents victims from absorbing nutrients from their food. More than 50,000 fish, reptiles, birds, insects, mammals and crustaceans were studied, not to mention plant life, water and soil samples, in the course of this research.

NAMRU-2 is trying to determine whether a mother's prenatal diet affects the child's growth, mental health and susceptibility to disease. This study began with the work of Dr. Bacon Chow, a professor in the biochemistry department of at . Dr. Chow found that the offspring of undernourished rats were stunted and had impaired neurometer development and poor learning capacity and memory.

Admiral Calvin Galloway, then chief of the Research Division of the Bureau of Medicine, learned of Dr. Chow's work and asked him to consider similar studies in humans. After examining the Navy's research facilities around the world, Dr. Chow selected and NAMRU-2 as the best location.

Initial studies of school children in indi­cated that children from poor families required more food than children from wealthy homes. Dr. R. Q. Blackwell, head of the NAMRU-2 Biochemistry Department, selected Suilin, a small township in central , as the site for the major study. A specially designed metabolic ward was built. It appeared that women of villages around Suilin received adequate calories and vitamins but that their diets were low in protein.

Pregnant women selected for the study were given supplementary diets containing varying amounts of protein under the supervision of nurses. When children reach the age of 15 months, they are brought to the metabolic ward for nitrogen balance studies. One of the problems was that mothers demanded the return of children after only one day in the ward. The women had gone to a temple to ask if their children should remain. They tossed blocks which give "yes" and "no" answers, depending on which way they land, and decided to take the children home. Dr. Chow appealed to the principal of the school district in which the ward is located and the mothers were persuaded to let the children stay.

In behavior measurement laboratory was set up with Dr. Janet Hardy, a pediatrician from , in charge. Her assignment is to determine whether an inadequate maternal diet affects the learning ability of children.

The third phase is a study of the effects of maternal diet on infection. Researchers want to know whether the children of undernourished mothers inherit normal immunoglobulins, and if challenged by a vaccine, whether they can produce antibodies at a normal rate. Two hundred children will be studied over the next three years. Sponsors are the National Science Council of the Republic of China and the United States National Science Foundation.

Scientists of NAMRU-2 are careful to respect religious beliefs and local customs. Each year all staff members join in a solemn ceremony in deference to the teachings of Buddha, who forbade the taking of life. The ceremony is in memory of the departed souls of insects, bacteria, mice, guinea pigs and other creatures used in experimentation.

Captain Watten and NAMRU-2 are concerned with protecting the ecology of . Monkeys, now becoming less plentiful, are no longer killed after ex­periments. Such animals as mice and guinea pigs are bred at NAMRU-2. Insects and parasites are grown in the laboratory.

has many poisonous reptiles and a number of people die from bites every year. NAMRU-2 col­lects and identifies local reptiles and insects and provides serums. Dangerous reptiles include the krait, Russell's viper, the bamboo snake, coral snake, king cobra and boa constrictor. There are poisonous spiders and venomous snails.

NAMRU-2 is seeking an antivenin effective for all snake bites. There are two broad types of venomous snakes. The venom of one group destroys the red blood cells, while that of the other group damages the nervous system. has snakes of both types.

NAMRU-2 has made contributions to veterinary science. In 1969, at the request of the Sino-American Joint Commission on Rural Reconstruction, Lt. John McDonald, a specialist in apiculture, became a Consultant on the diseases of bees. He found that with more rigid controls on insecticides and new types of hives, the production of honey could be doubled. Output now exceeds 400 metric tons annually.

The philosophy of NAMRU-2 was summed up in Captain Watten's personal column in a recent issue of NAMRUGRAM, the unit's monthly publication. He wrote:

"Americans serving their government overseas are expected to reflect a favorable image and to conduct themselves as unofficial ambassadors of the . The military and civilian staffs of NAMRU-2 have always done well in American and Chinese community and civic affairs. From managing Little League teams, teaching English to nurses and medical students, sponsoring and participating in musical and artistic events, the staff of NAMRU-2 has joined with other Americans in to strengthen and maintain a high level of community relations reflecting the best possible image of our democratic institutions.

"The sharing of professional and technical skills and knowledge is another important way the staff of the unit contributes to the medical and scientific community of and many other countries in . The mission of NAMRU-2 specifies that training and research techniques will be provided as required. Since 1958, over 200 technical and profes­sional-level Research Fellows have been trained at NAMRU-2. Next summer (1971) with the assistance of the China Medical Board, NAMRU-2 will expand its fellowship program to include 14 more fellows from . Two each from the , , , , , and will be accepted for 6-12 months training periods.

"To the NAMRU-2 scientist the satisfaction of teaching and helping the highly motivated and intelligent young people of is sufficient reward. The benefits of maintaining good relationships with the free countries of and the impact of modern medical and scientific techniques so greatly needed by many of the countries in this part of the world would be difficult to assess."

As Captain Watten says, the profits of 's most unusual exporter and importer are intangible - the building of better relations and understanding, the conquering of disease and the expansion of knowledge. The dividends from NAMRU-2 are shared by everyone in , as well as by the peoples of all free .