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1964_04_25--72-73-These_Americans_Must_be_Gods

' Producing miracles is expected from this Navy medic THESE AMERICANS MUST BE GODS' By Stanley Kantor,- Tike a biblical plague, cholera had struck 1...a Vietnam, and in the dim wards of a rambling, mildewed Saigon hospital, rows of patients lay stretched out amid a clutter of tubes, jars and buckets. With alarming regularity, pedicabs, taxis or ambulances pulled up to disgorge fresh victims—bodies showing little sign of life other than a look of fear in their sunken eyes. To them, cholera meant certain death, unless a miracle came to pass. A U.S. Navy doctor and his crew brought about that miracle by saving almost every life. One among the survivors, a haggard Vietnamese woman, murmured, "These Americans must be gods." Capt. Robert Allan Phillips, chief of the Navy's Medical Research Unit in the Far East, hardly resembles a deity. He is a laconic, professorial gentleman whose only ordained law is hard work. For more than a decade Phillips and his team—called NAMR U-2 in - official alphabetese— have waged war against an assortment of Oriental diseases which might stagger Doctors Kildare and Casey. They are developing a vaccine to prevent trachoma, an eye infection that cripples at least 400 million people in Asia, Africa, Central and South America and the Caribbean, and they are isolating the mosquitoes that transmit Japanese encephalitis, which inflames the brain. They are working to wipe out schistosomiasis, caused by a parasitic worm that penetrates the skin and damages the intestines. Among their other exotic enemies is paragonimiasis, a debilitating lung ailment spread by parasites lodged in fresh-water crabs, a tasty Chinese delicacy. In pursuit of microbes, Phillips and his men travel constantly from the outer edge of India to the northern tip of Japan. Pressing their hunt, they wade into flooded rice fields to collect water samples, climb hillsides to pluck ticks off a bullock's hide, and even forage in dung heaps for interesting bacterial inhabitants. On a trip to Borneo not long ago, for example, the fauna captured for study ran the scale from fleas to pythons. Indeed, at their headquarters laboratories on Formosa they slice up so many animals that Buddhists congregate outside to pray for the beasts' souls. But the real medical challenge in the Orient is cholera, which kills hundreds of thousands yearly. When an epidemic hit Vietnam recently, Phillips and his unit went into action with the drive of commandos attacking a hostile shore. Alerted one Sunday morning at their Formosa base, the group took less than three hours to load a U.S. Air Force cargo airplane with more than 5,000 pounds of equipment. That same evening they were in Saigon, 1,400 miles away. As in any major conflict, the war against disease involves a good deal of skirmishing against bureaucracy and red tape. The fight against cholera in Vietnam was no exception. Fearful of the economic consequence of any quarantine, the Vietnamese government had been slow to acknowledge the existence of a full-scale epidemic. Moreover, like many recently independent Asian states, it was reluctant to "lose face" by requesting outside assistance. By the time Phillips and his 15-man crew arrived, the epidemic was raging. Helped by the local American AID mission and an Army medical-research unit, Phillips's men quickly set up an establishment of their own. In a suburban hospital they took over three bungalows—one had formerly housed lepers—and transformed them into wards. They turned an oversized broom closet into a laboratory, and at a nearby building they opened a class to instruct Vietnamese medical men in modern techniques. Within a couple of days patients were pouring in—some of them marked by burns and lacerations inflicted as the unsuccessful "treatments" of witch doctors—along with a trickle of curious native doctors, nurses and midwives. "We can't begin to treat a whole population," Phillips says, "but we can show them how to treat themselves." Phillips has perfected a method for treating cholera which is elementary enough for a whole population to learn. Its very simplicity, in fact, so baffled one Vietnamese doctor that he angrily accused the Navy team of using secret wonder drugs. Cholera kills by dehydrating the body, and in acute cases, as many as four gallons of fluid can be lost in 24 hours through diarrhea. Phillips's treatment, a modification of traditional therapy, consists of simply replacing the body fluids as plentifully and as rapidly as possible. A withered patient, his mouth dry and cheeks caved in, is quickly laid out on an army cot and intravenously fed sodium bicarbonate and saline solutions, sometimes at the rate of a quart every 10 minutes. Like a human funnel, he passes the fluid through a hole in the cot, into a bucket. As time goes on, he begins to hold liquids, and gain strength. If circumstances favor, he can recover in as little as three days. "Cholera cures itself, like a common cold," Phillips explains. "The problem is to keep the patient alive by giving him enough fluids fast enough. If he has no other complex diseases, any patient who can get treatment will survive." Not content to gauge a patient's recovery merely by the twinkle of his eye, Phillips employs two widely different techniques to determine when sufficient fluid has gone into a cholera-ridden body. One easy, if rather indelicate, way is to • Natice aide in makeshift Saigon hospital applies the borrowed know-how of healing. measure the patient's bucket to check if he is excreting as much liquid as he is getting. A more sophisticated method is to measure the specific gravity of his blood plasma. This used to require expensive, complex electronic gadgets until, several years ago, Phillips devised a system for weighing blood in a coppersulfate solution, which costs only $1.50 a pound. For this achievement he was made a member of the Order of the British Empire. Though a seemingly mild man, Phillips speaks with unusual frankness on controversial medical matters. He shocks conventional authoritiekfor example, by insisting that the uncomfortable cholera vaccination required by public-health officials nearly everywhere has no proven value against the disease. In fact, Phillips has had only one shot himself in 10 years. That was when friends in Bangkok played a joke on him by telling the airport police that he had forged his vaccination record. Like any other luckless traveler in the Far East, he was ignominiously hauled off and jabbed. Postulate and paradox Phillips has also entered boldly into the competitive arena of medical theory by contending that cholera, while caused by a kind of bacteria, thrives principally among people with nutritional deficiencies. The disease is common mainlyamong rice eaters, whose diets lack protein, and this need, he claims, inhibits the normal flow of vital chemicals between the blood and intestines. Fluids that should pass into the blood accumulate in the intestine, causing diarrhea, the primary symptom of cholera. Precisely why this occurs is a question Phillips cannot yet answer, and one of his major research projects is to find out. The task is difficult. The only animal suitable for experimentation is a 10-dayold rabbit, which is too fragile for conclusive testing. Human beings are, of course, far better guinea pigs, and for Phillips this creates a paradox. He must treat victims as quickly as possible—his team is currently testing an oral medicine that will, if successful, bring patients to recovery in hours instead of days—yet the faster his patients get better the less opportunity he has to study the disease. "It's our duty to make them well," he says wistfully, "but we're cutting down our chance to gain knowledge of a disease we know too little about." Cholera hasn't been a problem in the U.S. for sixty years, and most other Oriental diseases will probably never affect Americans. Then why, it may be asked, should a U.S. Navy unit be expending considerable energies in such out-of-the-way places? Phillips's answer to this is unsentimental. From a strictly military viewpoint, he explains, Asian diseases could someday threaten American


1964_04_25--72-73-These_Americans_Must_be_Gods
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