[Image of catalog record for this film title.] [Health, Education, and Welfare, Public Health Service, National Institutes of Health, National Library of Medicine] [A National Medical Audiovisual Center Production] [in cooperation with The AmericanSociety of Tropical Medicine and Hygiene] [Workers in Tropical Medicine] [Martin D. Young, Sc.D. Research Professor of Parasitology, College of Veterinary Medicine and College of Medicine, University of Florida] [Interviewed by: William E. Collins, Ph.D., Bureau of Tropical Diseases C.D.C., September 1979] [Introduction by: William Trager, Ph.D. President, ASTMH] Dr. Trager: As president of the American Society of Tropical Medicine and Hygiene, it is my special privilege to introduce the series Workers in Tropical Medicine. This series, initiated in 1979, represents a collaboration between the society and the National Library of Medicine. It features interviews with scientists and physicians who have distinguished themselves in the field of tropical medicine. Now, relatively few Americans have had personal experience with the so-called tropical diseases. And yet, with increasing international travel, more and more Americans are coming to know at first hand some of these diseases, and their effects. In the less developed countries of the world, several hundreds of millions of people are affected by malaria, schistosomiasis, and sleeping sickness, to name but a few. Malaria, once a dreaded disease in the United States, is still one of the most widespread diseases in the world. Each year, in Africa alone, malaria kills nearly a million children. These diseases are complex and elusive. They form an unwelcome part of the social fabric of the communities in which they exist. Fortunately, the World Health Organization, with the collaboration of private and government agencies, agencies such as the United States Agency for International Development, has initiated a special program to promote research and training in tropical disease. And we can take courage from the recent worldwide eradication of smallpox. As you view these oral histories of Americans who have dedicated their lives to the understanding and the control of tropical diseases, I trust you will come to appreciate the challenge, the costs, and the expertise required to prevent and hopefully to eliminate these diseases. Dr. Collins: I think, Martin, at the beginning it would be good to briefly review your career. You were born in Georgia, Martin Dunaway Young was born in Georgia. He spent his early childhood in Grantville, Georgia, and graduated from high school in Palmetto, Florida. Upon graduation you entered Emory University and there completed your Bachelor of Science degree in 1931, and your Master of Science degree in 1932. After two years as a professor of biology at Augusta Junior College in Augusta, Georgia, you entered your graduate school work at Johns Hopkins University. There you completed your studies for the Doctor of Science degree, and in 1934, entered the U. S. Public Health Service. Your first assignment, Martin's first assignment, was at the South Carolina State Hospital, the U. S. Public Health Service Laboratory in Columbia, South Carolina, where you spent 24 years of your career in studies of malaria at the South Carolina State Hospital. You then transferred to the National Institutes of Health in Bethesda, Maryland, where you became Chief of the Laboratory of Parasite Chemotherapy, Assistant Chief, sorry, and then later, Associate Director for Extramural Research at the National Institute of Allergy and Infectious Diseases. Upon your retirement, after 27 years of duty in the Public Health Service, you then assumed the role as Director of Gorgas Memorial Laboratory in the Republic of Panama. After serving as director for 10 years, Martin then retired again, and assumed his present position as Research Professor in Parasitology at the School of Veterinary Medicine and the School of Medicine at the University of Florida in Gainesville, Florida. I think to start off, Martin, it would be nice to review some of the activities, and some of the people who influenced your work in your college and graduate training. Dr. Young: Well, when I went to Emory, I didn't know really what I was going to do. But this was resolved in the sophomore year, when I took a course in biology under Dr. Wilford B. Baker. After that I majored in biology, and after getting a bachelor's degree, went for a master's degree under Dr. Robert C. Rhodes [?], a very inspiring teacher. Then after two years teaching at the Junior College of Augusta, I went up to work with Dr. Justin Andrews and Dr. [Robert W.] Hegner at the School of Hygiene and Public Health at Johns Hopkins, where I got a doctor's degree. I was very lucky to work with these two people because Justin was a meticulous, careful scientific worker, and you learned a lot by observation. And Dr. Hegner was also a very good worker and had an unusual facility for writing. About the end of the last year at Hopkins, Dr. Louis L. Williams, Jr., a Public Health Service officer, had come over to give some lectures on malaria. And he found out that I was graduating, and at that time he had a position open at a mental hospital in South Carolina, to work with experimental malaria. As a result of this meeting, I went down to South Carolina. [Photo of South Carolina State Hospital, Columbia, S. C.] Dr. Young: And joined the laboratory. Dr. Bruce [Mann?] was in charge, and shortly after I got there, the only technician left, which left me with 40-50 patients a day to do blood smears on, do the [blood] counts on, inoculate, treat, and whatnot. Dr. Collins: Why were malaria studies being located or conducted in the mental hospital at that time? Dr. Young: Well, Dr. Williams saw an opportunity to learn more about the biology of malaria, because malaria was being used, which began in the middle '20s, for the treatment of the syphilitic insane. In those days, one of the major causes of admissions to mental hospitals was due to syphilitic insanity. The syphilis would invade the central nervous system and people would become very erratic. And it had been found previously by Wagner von Jauregg in Austria that malaria would cure most of the patients who were ill from syphilis, after it had attacked the nervous system. So using malaria to treat a disease gave us an opportunity of learning more about the malaria disease itself. It's one of the few instances where you use one disease to treat another disease. Dr. Collins: Certainly your 24 year stay in Columbia was a remarkable period of assignment for someone in the Public Health Service. It is a long time, and of course, during that period you had the opportunity to develop many projects, do many studies. Can you review some of the more important studies that you think resulted from your work there in Columbia? Dr. Young: Well, of course, we found out a lot of things about malaria induced in patients. We would give the malaria by inoculating infected blood, or we'd give the malaria by letting mosquitoes that had malaria bite the patients. And because we were able to follow the malaria in patients, for a long time, longer than you would in the field or in other conditions, we found out things about malaria that would be very difficult to find out any other way. Such as the number of paroxysms, the number of fevers, that the people would have in an untreated case. And how long the malaria would last in the body. We found that certain types of malaria would last in the body four or five years. And we found out things about how many mosquitoes it would take to transmit malaria. And of course, the development of new drugs was part of the program. The laboratory was designated as the Public Health [Service] center for distributing malaria. And we sent known,tested strains of malaria all around the country, to psychiatrists and to mental hospitals to treat their cases. At one time I estimated that probably 15 to 20 thousand cases of neurosyphilis in the United States had been treated with the malaria that we sent out for this purpose. Dr. Collins: Four years after your assignment to Columbia, of course, war broke out. How did the war effort and your studies at South Carolina coincide? I knew you had many wartime responsibilities and that -- were you able to maintain your work at Columbia and also your other activities during the wartime period? Dr. Young: Yes, it became evident to everybody that much of the war would be fought in tropical countries, and that malaria would be a problem, as it turned out to be. So the Army wanted to know what effect malaria being brought back in by soldiers would have on the malaria situation in the United States. And they encouraged me to set up a program. And the first thing I did, the best thing I did was to get Dr. Robert Burgess in to help grow mosquitoes. A lot of people think it's sorta queer that you have to grow mosquitoes, but they are rather delicate animals and they take a lot of care. Dr. Burgess made a great contribution by finding out how to get mosquitoes to feed on command, finding out how to keep them until the malaria developed in the mosquito, and then how to feed the mosquitoes on people. And because of this program, we were able to base two other large programs. One was the studies on imported malarias which involved eventually about a thousand troops that came back with malaria. And I was authorized to set up laboratories. I set up a laboratory in San Francisco in the Presidio in the Army hospital there. One in Longview, Texas, one in [?] North Carolina. These are particular places where a lot of malaria patients came back. And during the three and a half year period of this study, we looked at something like a thousand soldiers. And we took this malaria and inoculated it into about another thousand soldiers and volunteers, and we found out a lot of things. We found out that, as a rule, the tropical malarias are more severe than those in the temperate zones. Also we found out that these malarias would infect our mosquitoes very well indeed. And that there was a chance that we would have epidemics resulting from these foreign malarias. This was serious because there was no cross-immunity between the foreign malarias and the domestic malarias. And in fact there have been a few, ten or 12 little mini-outbreaks due to the introduction of foreign malarias. Also we found that the mosquito Anopheles freeborni that grows on the west coast of the United States is the best experimental vector of malaria in the country. The second one is the one we've known about for a long time, Anopheles quadrimaculatus, which is in the southeast. Dr. Collins: Did you restrict your studies to one species of Plasmodium or did you... Dr. Young: No, we looked at every species that the people brought back. And we looked at malarias from the Mediterranean area, from Africa, but most of our malarias came from the South Pacific. And that's where the malaria was causing more casualties than enemy action, so we had a lot of malaria to look at. Dr. Collins: Due to your activities, one particular strain, I know, came out which turned out to be the standard for studies for the next decade. Could you tell us something about that particular strain of malaria? Dr. Young: Well, a fellow named Chesson had come back in, we believe, directly from New Guinea. And he relapsed at the Texas hospital, and we, the boy was treated, and we found out that this malaria relapsed in a short time, in contrast to the domestic malarias, and it relapsed frequently. Well, the drug testing programs were getting underway at Stateville, Illinois and Atlanta federal prisons. And they wanted a severe type of malaria to test new candidate compounds against. So we named this the Chesson strain and began to furnish it to various laboratories as being a good type of malaria to test new drugs against. It was a severe test. Dr. Collins: I know many new drugs were studied and some of these activities, and I think some of the early efforts you had also showed the first evidence of resistance. Can you tell us something about the studies you made to find out that some of the drugs lost their ability to control malaria? Dr. Young: We noticed in treating some of the induced infections that they responded rapidly but they relapsed. At that time we were using a new drug called pyrimethamine, which had been labeled a wonder drug. But then after these cases relapsed, when we would challenge the infection again with the same amount of drug, it had practically no effect on the parasite. After several tests, we realized that the parasite, various kinds of parasites, various species, could quickly become resistant to pyrimethamine, and pyrimethamine lost its very pronounced and helpful characteristic of sterilizing gametocytes, once it became resistant. And this resistance was passed through mosquitoes, so once you got it established, there was no way to stop it from being transmitted, and you had to use some other sort of drug. Well, this laid the groundwork for some future work, investigations, because we realized that these parasites could respond very quickly, and as far as we were concerned, adversely, to some of these compounds that we thought were so good, and seemed to be the hope to get rid of malaria. Dr. Collins: Shortly thereafter, I think, you were involved in some of the first documentation of resistance to 4-aminoquinolines. Could you give us some background on that? Dr. Young: Well, a friend of mine, Dr. Donald Moore [?] in Dallas, Texas called me and said that a couple explorers down in the Magdalena Valley in Colombia had come back to Texas and they had malaria, and the local physician had treated them, but they weren't responding. And he asked me if we would study the malaria in Columbia [South Carolina] under controlled conditions. [Photo of Martin Young at desk, looking at a chart] Well, I was like everybody else; I was skeptical because these people had received chloroquine which was widely known to be an excellent drug; most scientists didn't believe that resistance would ever occur. And I expect I was among those. So I put this malaria into some mental patients, and then after people had some fevers, five or six fevers, I treated it. And much to my surprise, the parasites didn't respond as they should. They continued to exist, and increased doses of this drug would not kill the infection. And we found that this resistance indeed had occurred, this resistance was passed through mosquitoes and when new patients were bitten, the parasites were still resistant to chloroquine. Not only to chloroquine but to the other sister drugs, the other sister compounds, members of the 4-aminoquinoline group. And up until then, this group of drugs was by far the best drugs we had for the treatment of malaria. Later on, some years later, we found the various areas of resistance occurring, some on the west coast of Colombia, and then about 1963, one of the first documented cases from Asia came back. He was a Navy man and put in the Navy hospital in Bethesda. I was called in on that one. And this was our first knowledge of drug resistance, chloroquine resistance, in Asia. We thought it was the first, but we found out later that a very good Bangkok scientist had also found this, and published in a journal that we didn't get, the Southeastern Journal of Tropical Medicine. [both chuckle] Dr. Collins: Certainly your studies in Columbia spanned such a long period that I know at the time people around the world referred to the Columbia laboratory as probably one of the major centers of malaria research in the world. In 19--what is it, I believe, in '61, you were finally relieved to--I don't know if you were relieved to leave Columbia or not after all that time [both chuckle], but you then were transferred to Bethesda [Maryland]. And you had two assignments there in a relatively short period. One as Assistant Chief in the Laboratory of Parasite Chemotherapy, and then as Associate Director for Extramural Research at NIAID. Can you tell us something about your experiences and assignments, and that sort of thing in Bethesda? Dr. Young: Well, I went up in 1961, I want to say somewhat reluctantly--I'd become pretty attuned to working in the mental hospital, and I liked Columbia. I went up as Assistant Chief to work with Bob Coatney, run his program, which had gotten to be pretty big. I worked with him for about 15 months, and the job as Associate Director became open, and Justin Andrews asked me if I'd come over and take that job, [Photo of Martin Young standing next to shelved books] And I did, and I worked for Justin for two years, for me a very fine experience. Although this program had to do with multimillion dollars worth of grants, my job in that particular position was policymaking, and helping to run the council of the National Institute of Allergy and Infectious Diseases. Dr. Collins: After 27 years in the Corps, then you decided to retire. This certainly must have had some mixed feelings from having been in the Public Health Service so long, but as I understand it, you [?] started a whole new career then, as director of Gorgas [Memorial Laboratory]. What was your feeling and decisions and that about retiring and then taking on this new assignment? Dr. Young: I'd wanted to get back to the laboratory, and I'd decided that if an opportunity to get closer to the laboratory became available that I'd take it. And this opportunity did occur in Panama; the director there wanted to step down, so [Photo of the Gorgas Memorial Laboratory, Republic of Panama] Dr. Louis Williams heard that I might retire, and he recommended that I be appointed director, and after some negotiations, I was appointed director of the Gorgas Memorial Laboratory. Dr. Collins: Can you give us some idea of the functions and duties at Gorgas? What were the goals and that sort of thing as far as your career was concerned, in being assigned to Gorgas? Dr. Young: Well, Gorgas is a very interesting laboratory, and I think, a very valuable asset in the study of tropical diseases. It was founded in 1929, and there's a continuous history of investigations in imported tropical diseases. Malaria was one of the first things they began to look into at Gorgas, and of course, having worked in malaria a long time, I was interested in keeping it up. And I went down to, in addition to administration, to try to do some malaria work. At that time, we were having difficulties with drug resistance with the troops in Vietnam, and there was a big push on to find new antimalarial drugs. And the people at Army R and D asked me if I'd be interested in doing some experimental work, which of course, I was, and I proposed what I thought at the time sort of a wild idea that I'd like to see if I could grow human malaria in monkeys. [Photo of Dr. Young holding a small monkey] This had been tried before in various parts of the world, but I knew it hadn't been tried in all the monkeys in that area. [Photo of laboratory monkey] So they funded some of this research and we began to go out and find malaria where we could in people--and there was a lot of it in Panama--get monkeys where we could; there were seven different kinds. And by trial and error, inoculate infected blood into monkeys. And then, some six or eight months after we started, one day it grew out in a monkey. The monkey had malaria, and this was the Aotus monkey, which is a small, big-eyed, beautiful monkey, the only nocturnal monkey in the world. It lives in tree holes in the daytime and comes out at night. Following that, we found that once we'd grown the malaria in this beautiful monkey, we could transfer this malaria to other monkeys; so I think by this time, one or more forms of human malaria has been grown in each of the seven species of monkeys that occur in Panama. Dr. Collins: Your initial studies were with, I think, your first report was with Plasmodium vivax, but then you were able to extend it to [Plasmodium] falciparum also. So you had the two major human malarias now in the laboratory, ready to work on in primates you had available in Panama. Certainly a remarkable change from what we had before, where no experimental animal was available for human malaria. Do you have any comment on what the future might be in monkey work, and that sort of thing, in human malaria? Dr. Young: Yes, I think that it's very evident that we're going to need more animal models like this, probably monkeys. The resource of prisoner volunteers for this type of experimental study is dwindling, and has practically disappeared. So we need a model in which to grow malaria so we can do all the studies necessary for various developments. I think it's been evident now for some time, that we were going to have to grow monkeys, set up our own colonies. It took a long time to get this started, but our supply of monkeys coming in from the jungles is dwindling, and although jungle monkeys have proved to be very useful, the truth of the business is that they are not an ideal laboratory animal, because you don't know what they've had. You don't know what spectrum of insults from various disease antigens, viruses, worms, and whatnot. And we need to develop clean monkeys for the laboratory, just like we've developed clean rats and mice to work on, so we can not have these unknown factors entering into the experimental protocol, and affecting us in ways that we can't determine. Dr. Collins: Also at Gorgas you did a lot of studies on chloroquine- resistant malaria. I understand you alluded earlier to the documentation of chloroquine resistance on the Pacific coast. Could you tell us something about the presence of resistant malaria in the country, in the area where you were working at that time. Dr. Young: Well, this came about by chance. The U.S. government had decided to look at two possible canal routes to see if they could dig new canals at sea level with nuclear energy, [?]. And they wanted to assess the impact of these on the environment and also on the impact of the environment on the people who might be working and living along these canals. One route was through eastern Panama, the second route was through northern Colombia. And our laboratory had the job of doing the biomedical examinations, looking at the diseases that the people had, the vectors that were there, like the phlebotomous sandflies and the mosquitoes and whatnot. At the Colombia proposed site, in a little town called Carichi, we found that a high percentage of the people in this little town had had malaria. And also that a high percentage of these people in this town had malaria that was resistant to chloroquine. This was the first time that malaria had been found on the west coast of Colombia. By this time, we knew that resistant malaria was occurring in Venezuela, Brazil, and several other places in northern South America, but it hadn't been found on the coast until... Dr. Collins: In this case we're always referring to P. falciparum malaria as far as the resistance. Dr. Young: P. falciparum malaria is the only one so far that had been proven resistant to this particular drug. Then later on we found that this resistant malaria had come into Panama, and gotten as far as the Panama Canal. And so far as I know, chloroquine-resistant malaria is not in Central America, although people had thought it would be--do you know of any cases? Dr. Collins: No, but they're looking! [both chuckle] Dr. Young: Yeah, I know, they've been looking for a long time. Dr. Collins: I think that the studies in Panama are more or less the first warning of the introduction of the malaria. If it breaks through Panama and moves on up into Central America, it'll be found in Panama first and moving up, and so... Dr. Young: Well, I think it's got a counterpart in the yellow fever story. Yellow fever apparently enters Panama about once every seven, eight years, and this seems to be tied in to several epidemiological situations. Apparently yellow fever moves around in the Great Amazonian Basin periodically. And as it goes along, it kills out most of the howler monkeys, and it immunizes those, the other types that it doesn't kill. Apparently it takes about six, eight years to make this circle, and find a new monkey host. And as the circle swings up to the point where Panama joins Colombia, the virus goes up into Panama. This yellow fever, it's called jungle yellow fever. And the cycle of yellow fever goes on high above the ground, in the canopy of the jungle. The mosquitoes that transmit it breed up there, the monkeys stay up there, and the virus is of course circulating between the mosquitoes and the monkeys. And it gradually moves north, at the rate of some ten miles a month. And there have been several times when it's moved north, and one time it jumped the Panama Canal, about 1948, and went as far as Mexico. I was there in 19-, my last year there, it again came into Panama, and it got almost to the Canal Zone. And we were concerned that it might jump the Canal Zone, but it didn't. I think dry weather set in, and when dry weather comes, it stops moving, because the mosquitoes are not there to transmit it. Dr. Collins: After ten years at Gorgas, you then moved on again to another career, another environment, at the University of Florida in Gainesville. Could you tell us something about your present research activities and that? Dr. Young: Well, I thought that my years in the mental hospital and working in prisons, and then in jungles, probably was a good background to do some work in the university. [both laugh] So I went up to the University of Florida and they gave me a research position there. And shortly after I got there, I ran into a young scientist, Dr. Forrester [?] who'd just found malaria in turkeys, in wild turkeys. This was the first time that this malaria--that wild turkeys had been found with malaria. So he was excited about working out the life cycle, and invited me to join him. And we set about on a joint project, again involving an entomologist named Dr. [?]. It was not known how this malaria was transmitted between the turkeys down in the swamps of Florida. But the entomologist had colonies of mosquitoes, and we tried some ten or eleven different species of mosquitoes and found in pretty short order that one was a very good vector, and since then we've found three different species of mosquitoes that can be experimentally infected with this turkey malaria. And it's now proven that one of these, Culex nigripalpus, is the natural transmitter of malaria in these swamps. Dr. Collins: In contrast to the studies you did with monkeys, you now have an animal, that when you're through with, you can do something with -- I presume you can roast your results when you're finished? [both laugh] Dr. Young: Yes, and it tastes very good. I've often thought that malaria improves the taste of some of these birds. [both laugh] Dr. Collins: You've received a great number of awards and honors, the Darling Medal from WHO for your research on malaria, 1963, the Amador Guererro Award from the Republic of Panama, the Certificate of Merit from the Gorgas Memorial Institute, and the La Prince Medal of the American Society of Tropical Medicine and Hygiene. One of the early awards which you received which I think had a great influence on your development in your career was the Rockefeller Public Service Award, which you obtained in 1963. Can you tell us something about the award, and how you used it in developing your career? Dr. Young: I think that was 1953... Dr. Collins: '53, sorry! Dr. Young: This was the first year that these awards were given. Mr. Rockefeller, John D. the third, thought that workers in the federal services weren't getting the recognition that they deserved. He recognized that there were very many hardworking, sincere, outstanding people in the public service, and he proposed to the government that an incentive award be set up to recognize people sort of in mid-career, to encourage them to stay in government service. And the first year they gave, they selected ten candidates, ten people to give the awards to, of which I was one. You had to send in a proposal, and my proposal was to take a nine-months trip, and visit the major tropical disease research laboratories around the world. Well this came about, and it certainly was one of the outstanding events of my life, because I was able to see how people worked, see the diseases in the laboratory, see the diseases in the field, and I came back with a much broader vision of how to do tropical disease research. And I still enjoy the memories and friendships of people I met in those days. And we had at the Columbia laboratory as you may remember, we had a lot of visitors also from these foreign countries, so that there was sometimes already ready-made acquaintance-ships which proved to be very helpful. Dr. Collins: Of course as a result of the development of your career, you had many opportunities and assignments to visit other areas, ones where you were a consultant, or ones where you were attending meetings, did you have some in your mind that serve as highlights, certain countries or areas that were important to you in your career? Dr. Young: Well, certainly my first foreign assignment was a highlight to me, for me. I went to Liberia; the Public Health Service had run a station there for some time, helped build a hospital, but they didn't know much about any one disease in Liberia. And they asked me if I wanted to go. Dr. [?] , my superior officer, called me in and told me they were looking for somebody, and he says, "I'm telling you this, but I don't think you want to go." And I said, "Oh yes, I want to go." And he says, "Well, you better go and talk to your wife about it. I don't think you want to go!" I came back the next day and told him I wanted to go. And I think that he sort of viewed me with suspicion for some time after that, for wanting to go to Liberia. But I went over and did a malaria survey. It took five months, and I went to many parts of the country, walking, renting planes, any way I could go, to get around to these various places, and I learned a lot about home-grown malaria in Africa, and about the customs of the people. It was an exceedingly interesting and valuable experience. Dr. Collins: You also went, I understand, to Romania, to India, and Jamaica, among other places, in your various assignments. Dr. Young: Yes, the ICA [International Cooperation Administration]] which was the forerunner of USAID, wanted a team to go to India to assess the malaria control program, because there was talk of converting from a control program into an eradication program. So three of us went in 1957 and spent five months there. At that time, India had the greatest malaria problem in the world. They were having between 50 and 100 million cases a year. And something like a million people were dying of malaria. The control program had been in effect, and was reducing the incidence of malaria in India, and after looking after the facilities and the staff, and the way they were handling the work, we decided, we recommended rather, that with some changes in the operation and greater support, that we thought they were ready to move into an eradication program. And they did, they got additional funds from the U. S. and from WHO, and moved into the program in a very effective way. And some eight or ten years later, the malaria cases in India were down to some 40 thousand, from being up in the millions. Since then, adverse factors have set in, the mosquitoes have become resistant, and I think the administration has gotten less efficient. And now malaria is resurgent in India, and is back up in the millions of cases, I think something like 40 million cases a year now, when they were almost free of malaria. Dr. Collins: Since you've had this long career, great experience in malaria, things like this that have happened, such as in India, what do you, shall we say, not necessarily predict, what are your insights, let's say, on what should be done in tropical diseases, particularly malaria, and what probably is going to be done? Dr. Young: Well, I guess the first thing you realize is tropical diseases are tremendous health problems, and any one of the major diseases is going to be very difficult to eradicate. It seems to me that we've got to continue to develop new ways of combatting disease, as well as better administration to handle the ways that we know have been effective in the past. We continue to look for new drugs against malaria and against filariasis, and schistosomiasis, and the other severe diseases. There's some evidence that there are new approaches being made that might show some promise. In addition to the use of insecticides against malaria vectors and the use of drugs against the malaria parasite, one of the new approaches now is to try to combat the mosquito vector with an organism that is pathogenic to the vector, a biological agent. And there are several of these that show some promise. One is a fungus and there are several protozoa, and some bacteria. And the idea there is to grow these organisms in culture, and then seed the places where the mosquitoes grow and see if these pathogens will either kill the mosquito or will prevent it from transmitting malaria. There are certain other areas in which I think we're going to need some changes, in social customs, which probably will be very difficult in many cases to bring about. For example, there's a parasitic infection in Africa and India called guinea worm, and this worm has a life cycle where as the young stages when they leave the human body go into the water, and they're taken up by small microscopic animals, and then when people drink this water, they go into the gut and go back in the human. This infection could be, I believe, wiped out in one generation simply by preventing people from walking into the reservoirs where the water is. If they don't walk into the reservoirs, the worms can't get in the water. The custom now in India is to walk down with a bucket and get the water, and when they walk down there the worms escape from their legs and go into the water. So I think that rope and buckets to haul the water up out of the reservoir, the well, could eliminate this disease. Most diseases, though, I don't think would be this simple to eliminate. Dr. Collins: Much of your work has been in the chemotherapy of malaria, on the application of drugs and looking at their mode of action and that. What do you think the future is for drugs in malaria control? Will it be reduced or assume a bigger role, do you think? Dr. Young: That's hard to predict. The, I think, as far as I can predict, we'll always need drugs. As long as you have clinical malaria, you're going to need drugs. We have quite a few drugs now that can be used; not all in the same situation, but we might have to alternate between drugs. I suspect that we're going to have to continue to seek drugs, although so far some quarter of a million compounds have been examined by various agencies for their antimalarial action. And we might find better drugs and compounds that don't even exist now that would be manufactured by the chemists and the drug companies. So it seems to me we've got to continue to look for drugs, but we've got to continue to try other approaches, too. Dr. Collins: Americans have always played a major role in malaria research and malaria activity throughout the world. What do you think will be the future for recruiting Americans into this field, and for support, American support, for a disease which in general is considered of minor importance in the continental United States, at least? Dr. Young: Well, because a disease is of minor importance doesn't mean that we shouldn't work on it, because on working on this disease we find many things that are useful in other areas. An example of the additional benefits that one finds when one is working on one disease is the story of chloroquine. Chloroquine was developed for the treatment of malaria. But after it was found to be good against malaria, it was also found to be good against certain other diseases, like lupus. So if chloroquine was never used again for the treatment of malaria, it still might be used against other diseases. So there's always a fallout of benefits in addition to the main objective you have in mind when you start working on some of these drugs, some of these approaches. Dr. Collins: You had experience with the grants program at the National Institutes of Health, governmental activities in your work in South Carolina, working for a private agency in Panama with the Gorgas; how about funding, future funding? Do you think that it has a future from governmental support or military support -- what sort of support or programs would best support malaria research in the country? Dr. Young: If you're asking, and I think you are, what I believe to be one of the major needs in support of malaria research, I would say consistent budgetary support, rather than the off-again on-again type of support we've had now for a number of decades. When an emergency occurs, all at once a lot of people have to be gotten into the field to do malaria research, and some of them are not well-trained and it takes a lot of time to train them; then the emergency passes--this could be a war--the funding goes down, and the next, the research is at a very low level. I believe the greatest benefit would be a consistent support of a good basic program and research. Not only for malaria, but for other tropical diseases. Now you brought up the question of malaria being of such minor importance; this hasn't always been the case. It wasn't very many years ago that we were having 500,000 cases of malaria a year in the United States. Our potential for malaria is still here. There are probably as many malaria mosquitoes available now as there's ever been. But we know malaria can come back into this country because it has. Almost every year we have reports of malaria being in people in this country. It's spread by certain people returning from the tropics, and mosquitoes bite them, and then they spread the disease to somebody else. I think the prospects for malaria causing a big epidemic in the United States is very low, because we have a good intelligence service run by the CDC, that keeps up with the malaria, and I think if there should be a local threat, it could be quickly wiped out. We know much more about it. This, I think, is true of some other tropical diseases, too, that are not even here now, but they might be here. Yellow fever could come back into this country very easily. We've got yellow fever vectors scattered all around the coast of the south. We recently had an invasion of a new disease for this country, Venezuelan equine encephalitis, which invaded Texas from Mexico and caused a lot of trouble; and all at once they had a great crash program on to protect horses in Texas. And this parasite also grows in people, it can cause a lot of trouble in people. So we need to know about diseases all around the world. And this is not even bringing into focus the fact that we have people stationed all around the world. We have armies, we have all sorts of travelers that go to these places, so we do have a worldwide interest in tropical diseases. And every major country realizes that they've got to have an interest in tropical diseases. We just simply can't isolate ourselves from them. Dr. Collins: Throughout this discussion on your career development, that sort of thing, if I can digress a bit, there were a number of people that were mentioned in passing which had an important role in developing the career of you as a malariologist/parasitologist. And I think that it would be appropriate at this time to discuss a few individuals and their influence on the development of your career. Several that I have here listed I think you have mentioned before, is Dr. Wilford [?] Baker and Dr. Rhodes at Emory. Could you elaborate on how they influenced you to go into malariology? Dr. Young: Well, when I took Dr. Baker's course, he was such a dynamic teacher that I immediately became interested in biology. And incidentally I saw this happen to quite a few of my fellow classmates. One of them was Dr. John Edgar McCrone [?] who's now the epidemiologist for the state of Georgia. And Dr. Robert Burrows who I think was a Greek scholar or something like that, and he got interested in biology, and of course has written a book on the diagnosis of parasites. So that because of the dynamic presentation of these courses, we got interested and went on, most of us for graduate degrees. Dr. Rhodes was an inspiring man. He's a tremendous personality, and in those days he had the unusual outlook of being not only a minister, but teaching evolution at a college where religion was, ranked in high order at Emory. Then at Johns Hopkins, as I said, I ran into Justin Andrews, from whom I learned a lot, and [Robert W.] Hegner. But probably the man who had the most influence after my graduate work was Dr. Louis L. Williams. He was the one who recruited me to work in Columbia, South Carolina. He's been, was a lifelong friend, and he was the one who was influential when I retired from the Public Health Service, in having me appointed as director of the Gorgas Memorial Laboratory. So there are four or five people who have been very influential. I was very lucky to meet them. Dr. Collins: Two others that you have mentioned to me earlier were Dr. Rolla Dyer and Dr. James Shannon at the National Institutes of Health. Can you comment on how they interplayed with your career and that sort of thing? Dr. Young: Well, Dr. Dyer influenced everybody in the National Institutes of Health. He saw that the OSRD program, the program for developing antimalarial drugs during World War II, was a very successful venture. And he recognized that biomedical research was going to grow in this country, and he further thought that if there was going to be a lot of support for biomedical research, it should be governed, it should be under the influence of some institution that had a great deal of experience. And at that time, the NIH was the institution that was most experienced in this country. So he got the research grant program as part of the National Institutes of Health, and of course now we know that for many years it's been a major part of the funding, and has had a tremendous influence on biomedical research, not only in this country, but worldwide, Europe and other places. Dr. Shannon I first became acquainted with one Saturday afternoon during World War II when I got a phone call at home. And he was working, he was also working looking at drugs. At that time he was in New York, and he asked me if I could furnish him some malaria to put in his patients. Later on he became the director of the National Institutes of Health, and of course, was a major influence on all of us who had the opportunity of working with him. And of course, the man who's been a co-worker and a tremendous influence for me is Dr. Robert Coatney. We started working together at Columbia, but it didn't take him but two or three years to get out of the mental hospital, and he came up to Bethesda, where he spent the rest of his time, when he wasn't some other place--foreign countries, prisons, whatnot. And Bob, as I know you'll hear later, will, had the idea of using prisoner volunteers for the final testing of compounds that looked like they were good candidates as antimalarial drugs. And this program has been a tremendous program and has done a great deal of good in finding and defining the activity and the toxicity of drugs. And he asked me to work with him, furnishing mosquitoes, so at Columbia laboratory, we had a pretty big malaria mosquito factory. We'd grow a million mosquitoes a year and infect 50,000--100,000 mosquitoes a year, and furnish these to Bob and his work in Atlanta prison, and also at Seagoville, Illinois [note: Seagoville federal prison is in Texas, not Illinois] with Dr. [?] who had also a big drug program up there. So I got to know a lot of outstanding scientists and some famous crooks, and a lot of colorful people in this work. Dr. Collins: Well, as we conclude this interview, I'm sure you want to make one final comment at least about the person who stayed with you all the time, Jodell [sp?] your fine, lovely wife. Dr. Young: Well, yes, she's been of course a tremendous help, and very patient, and for this I'm very happy, very thankful. Dr. Collins: Thank you so much, Martin. [Martin D. Young, Sc.D. Research Professor of Parasitology, College of Veterinary Medicine and College of Medicine, University of Florida] [Interviewed by: William E. Collins, Ph.D., Bureau of Tropical Diseases C.D.C.] [A National Medical Audiovisual Center Production] [in cooperation with The American Society of Tropical Medicine and Hygiene] [Workers in Tropical Medicine]