Sir Patrick Manson--Father of Tropical Medicine

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Chinese Version "John Otte--Missionary Doctor, Architect, Carpenter" "How Ancient China Discovered (and lost!) Surgery"

Gulangyu is known to Western doctors as the “Cradle of Tropical Medicine” because it was here that Sir Patrick Manson (1844–1922), “Father of Tropical Medicine,” made discoveries that helped tackle leprosy, malaria, and other diseases that 150 years ago made Xiamen a “white man’s graveyard.”

Surgeons or Sorcerers?
In his 1873 report of the Amoy Missionary Hospital, Patrick Manson noted that in 1871, it was rumored throughout Amoy that Western doctors gave out magical, poisonous pills that created diseases only they could cure. Pamphlets and posters accused Western doctors of using Chinese’ eyes and hearts for potions, and of drugging and raping Chinese women. When patients died, doctors were accused of murdering them to harvest body parts. When patients survived, doctors were accused of resorting to magic to affect their miraculous cures. In the beginning, theirs was a thankless occupation!

The oldest of nine children, Manson gave up a lucrative career to study medicine. After obtaining his medical degree in 1866 from the university at Aberdeen, he spent 24 years in China, where he tackled not only mosquitoes but also Amoy tigers (he was an avid hunter).

Manson the Tiger Hunter “Life in Amoy in those days in a mixed community of Europeans in China was far from dull. There was a gay social life, and also from time to time sporting events, such as pony races, and shooting expeditions into the surrounding countryside where excellent snipe grounds were provided by the numerous paddyfields.
“Farther field were the wild highlands where every now and again tigers were bagged. Manson was foremost in these adventures and soon gained the reputation of being the best snipe-shot in China.
“But, as he became more familiar with the Chinese and their ways and won their confidence, work began to accumulate.
“Sometimes he was too busy to sleep, as his services were in constant demand.” Sir Philip Manson-Bahr

Locals were slow to trust the sporting Scotsman. For centuries, Chinese had spread tales of foreigners eating Chinese babies and using their eyeballs to line mirrors, and many believed Western doctors’ medicines were poison.

Manson gained their trust by opening his clinic to the street so everyone could see that his surgeon’s scalpel didn’t come in a set, with knife and fork.

Manson was dismayed by Western doctor’s ignorance about the tropical dis-eases he faced. He estimated 1 in 450 people in Xiamen were lepers, but Western medicine had no answers. When he asked the British Museum for information on mosquitoes ; they wrote back six months later to say they had nothing on mosquitoes but were sending a book on cockroaches they hoped would help.

When Manson moved to Hong Kong in 1883 he found that Western doctors could not discern typhoid from malaria, calling it “typho-malaria.” Malaria had wiped out nearly an entire regiment right after Britain occupied Hong Kong in 1841, and for years, 3% of British troops died from the dread disease.

Western medicine was impotent in the face of tropical disease, and Chinese medicine fared no better. In 1877, 2% of Xiamen’s population died of cholera, and to Manson’s frustration, traditional Chinese doctors treated the disease with alum, stimulants, hot poultices, shampooing, and “pinching.” But Manson discovered that, in fact, some Chinese treatments did work.

Chinese cured a woman’s anemia with pills concocted from a black chicken’s dried liver. Western doctors did not learn to treat pernicious anemia with liver until 1926. Perhaps Chinese medicine’s occasional successes helped spur the Scotsman on to the research that gave birth to modern tropical medicine.

Pioneer or Drunken Scotsman? In his quest to conquer China’s diseases, Manson dissected everything from mosquitoes to corpses (in the dead of night, in graveyards, because Chinese frowned on carving up corpses). But it was a lonely life, and in 1877 the discouraged young pioneer wrote to a friend in London,

“I live in an out of the world place, away from libraries, out of the run of what is going on, so I do not know very well the value of my work, or if it has been done before, or better.”

In fact, Manson’s work was so far ahead of his time that other doctors ridi-culed his discoveries. One doctor said Manson’s claims represented “either the work of a genius or, more likely, the emanations of a drunken Scots doctor in far-off China, where, as everyone was aware, they drank too much whisky.”

Manson was first to connect mosquitoes with elephantiasis (1878) and malaria (1894), and he discovered that only female mosquitoes suck blood (males live on fruit juices). Manson also invented new surgical techniques and instruments that even today bear his name (he had one elaborate device made by a local Chinese metal worker). He also helped introduce modern vaccination to China—ironically enough, since Taoists inoculated against smallpox almost 1,000 years ago. Ancient Chinese almost created surgery as well (see end of this chapter).

As news of Manson’s medical prowess spread, patients flooded in. In 1871, Manson’s first year at the Baptist Missionary Hospital, he treated 1,980 patients. His third year he treated 4,476 people. In 1877, he performed 237 elephantiasis surgeries alone. He removed over one ton of tumors from 61 of the cases and lost only two patients. He also got sued.

Suing the Surgeon!
One patient had so much excess tissue that he could not move and he was carted about town in a wheelbarrow. He made a living selling lemonade and peanuts, and created a table by spreading a cloth over his massive deformities. After Manson removed eighty pounds of tumors, allowing him to move freely once again, he promptly sued Manson and sought compensation. He com-plained that without his convenient table of deformed flesh he had lost his livelihood! Sir Philip Manson-Bahr, “Patrick Manson”

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Pioneer Medical Educator Manson, like Otte, knew that the way to combat disease was to multiply the medical warriors through medical education. In 1886, Manson established the Hong Kong College of Medicine, which boasted such alumni as Sun Yat-sen, first president of the Chinese Republic. In September, 1898, he opened the London School of Tropical Medicine, although he was adamantly opposed not only by the government but also, ironically, by the medical establishment (which perhaps still suspected his reams of insights were the work of a drunken Scotsman). After writing his bestselling “Manual of Tropical Diseases”, Manson retired in 1912 to fish in Ireland, but returned to medicine at the beginning of World War I, and in spite of debilitating gout, he pursued medical education until his death in 1922.

How Ancient China Discovered (and lost!) Surgery
(From McGowan, 1913, pp.176-9)

“…There was not a doctor in the Empire who knew anything of anatomy and for any one of them to have performed a serious surgical operation would have meant certain death to the patient. [But]…

“Tradition tells the story of one famous doctor [Huatuo], who lived in the misty past, and whose prescriptions form part of the medical library of every regular practitioner, that is intensely interesting. He seems to stand out more prominently than any of the others who have become conspicuous in the history of medicine, because he evidently had the ambition and perhaps the genius to inaugurate a new system in the treatment of diseases. He evidently felt there were occasions when the knife ought to be used if life were to be saved.

“On one occasion a military officer had been severely wounded in the arm by a poisoned arrow in a great battle in which he had taken part. The doctor, who for long centuries has been a god, and shrines and temples have been erected in which his image sits enshrined, was summoned to his assistance. He saw at a glance that unless heroic measures were at once adopted the man would die of blood-poisoning.

Contrary to the universal practice then in vogue, he cut down to the very bone, extracted the arrow, and scraping away the poison that might have been injected into the flesh, he bound up the gaping wound, using certain soothing salves to assist Nature in her process of healing.

“The result proved a great success, and might have been the means of introducing a new era in the treatment of diseases throughout China.

“Not long after a high mandarin [Caocao], who had heard of the wonderful cure, summoned the same doctor to prescribe for him. He had been greatly troubled with pains in his head, and no medical man that had attended him had been able to give him any relief. His case having been carefully diagnosed, the doctor proceeded to tell him what he thought ought to be done.

“I find,” he said, “that what really is the matter with you is that your brain is affected. There is a growth upon it, which, unless it is removed, will cause your death.
Medicine in this case,” he continued, “will be of no avail. An operation will have to be performed. Your skull must be opened, and the growth that is endangering your life must be removed.

“The thing, I think, can be safely done, and your health will be perfectly restored, and you may continue to live for a good many years.

“If you are pleased to confide in me, I have full confidence in myself that I can do all that is needed to restore you to perfect health.

“Whilst he was talking a cloud had been slowly gathering over the mandarin’s face. His eyes began to flash with excitement and a look of anger to convulse his face. In a voice tremulous with passion, he said: “You propose to split open my skull, do you? It is quite evident to me that your object is to murder me. You wish for my death, but I shall frustrate that purpose of yours by having you executed.” Calling a policeman, he ordered him to drag the man to prison, whilst he gave orders to an official who was standing by that in ten days hence the doctor should be decapitated for the crime of conspiring against his life.

“During the days he was in prison he so won the heart of the jailer by his gentleness and patience that he showed him the utmost devotion and attention. The evening before his execution, he handed over to him some documents that he had been very carefully preserving, and said, ‘I am most grateful to you for the kindness you have shown me during the last few days. You have helped to relieve the misery of my prison. I wish I had something substantial to give you to prove to you my appreciation of the sympathy and tender concern you have manifested towards me.

“’There is one thing, indeed, that I can bestow on you, and that is the manuscripts of all the cases I have attended. These,” he said, handing them to the jailer, “will raise your family to wealth and honor for many generations yet to come. They explain the methods I have employed in the treatment of disease. Never part with them; neither let the secrets they contain be divulged by any of your posterity, and so long as your descendants are faithful to them poverty shall never shadow the homes of your sons and grandsons nor of their children after them.’

“Next day this great medical genius was foully put to death merely to satisfy the caprice of an ignorant official, and the first dawn of surgical enterprise was eclipsed by his death, and many a tedious century would have to drag its weary way along before the vision that had died out in blood would again appear to deliver the suffering men and women of China.”