Recollections of 20 years (1896-1916)

For the Centenary celebrations of the Penang Free School on 21 October 1916, a special edition of the School Magazine was produced. Included within was a very long contribution by Dr Wu Lien Teh where he reflected on the 20 years following his 1896 graduation from his alma mater. The story, tracing his transformation into an internationally recognised public health pioneer, can be broken down into four parts:

• Education & Early Career: After leaving Penang as a Queen's Scholar, he studied medicine at Emmanuel College, Cambridge, and completed clinical training at St Mary's Hospital, London. He pursued advanced research in tropical medicine, bacteriology and hygiene across Liverpool, Cambridge, Halle and the Pasteur Institute in Paris before returning to Penang in 1903.

• Social Activism in Malaya: Following research on beri-beri in Kuala Lumpur and establishing a private practice in Penang, he co-founded the regional anti-opium crusade in 1906, serving as Secretary General of the first Opium Conference in Penang to combat the trade despite pushback from wealthy investors.

• Service in China & Pneumonic Plague: Moving to China in 1908, he served as Vice-Director of the Army Medical College in Tientsin. In December 1910, he was appointed to combat the deadly Manchurian pneumonic plague outbreak. He identified person-to-person respiratory transmission, implemented strict quarantine and face-mask protocols, performed the first post-mortems and ordered the mass cremation of thousands of bodies to successfully eradicate the epidemic by spring 1911.

• International Leadership & Medical Reform: In April 1911, he chaired the International Plague Conference in Mukden and received high honours from the Chinese government. He served as a Chinese delegate to the International Opium Conferences at The Hague (1911 and 1913), helped establish the Manchurian Plague Prevention Service (1912) and the National Medical Association (1915) and spearheaded the construction of Peking's Central Hospital.

A slightly shortened version of Wu Lien-Teh's article subsequently appeared in the Pinang Gazette and Straits Chronicles on 23 December 1916, but here is the story in full, taking up more than five pages in the School Magazine:

Recollections of Twenty Years (1896-1916) 

By WU LIEN TEH (GNOH LEAN TUCK)

I have been asked by the Editor of the Free School Magazine to write an article for publication in the Centenary Number of that Magazine. As the centenary of my old School takes place in October of this year, it will have been exactly twenty years since I left it. A retrospect of this period may therefore be of interest to present and past students.

It was in the month of August, 1896, that I left Penang as a Queen's Scholar to study at Cambridge. Thanks to the advice given by Mr. R. J. Wilkinson, lately Acting Governor of the Straits Settlements, but at that time a Police Court Magistrate, I joined Emmanuel, a College famous for its Puritanism. I had to pass an entrance examination for the College as well as the "Little Go" for the University, as the Oxford and Cambridge Locals had not at that time extended their ramifications to the schools of the Straits. I found no difficulty with Algebra, English History and kindred subjects but knew nothing of theology and was obliged to read through in three weeks "Paley's Evidences of Christianity" required for the examination. I was the second Chinese to have entered his name in the books of the "Varsity," (the first having been Mr. Song Ong Siang, now practising as a lawyer in Singapore) and the first Chinese to have been a medical student of Cambridge. The first few weeks of the First Term were exceedingly lonely, not because my fellow undergrads were unkind, for they were the best fellows in the world but because at seventeen I was thrown into an entirely new world for which I was not quite prepared. My tutor Mr. W. N. Shaw, F.R.S. (now Sir William Shaw, Head of the Meteorological Department, London) and his wife did their best to cheer me up and urged Fellows, Scholars and jovial undergrads to call on me and take me out for long walks. My present love for long walks and things beautiful may be traced to those days, when much against my will I was, so to say, led out to keep myself fit. The strange days of probation rapidly passed away, and by the end of the first Michaelmas Term I was as jolly and fond of ragging as the most mischievous. I can still recall vividly the (forged) invitation to lunch in a third year man's room, my waiting from 12-30 to 2 p.m. without any one appearing, my going away hungry and swearing, and my revenge a few years afterwards at St. Mary's Hospital when I had the pleasure of demonstrating on pathological subjects to the third year man who wrote the unkind invitation and of my taking the M.B. degree a year before he did. The Fresher's period of suffering only came once in his lifetime, and by next year I felt as superior, lofty and old as the towers of King's College Chapel. At college I neither rowed nor ran, but played tennis and once took part in the debating society, but failed to convince the majority of my hearers with my eloquence. As I had to prepare for both my Natural Sciences Tripos (known popularly as Stinks Trip because of the smells from chemical and other sources) and my medical exams, most of my after-noons were occupied in the various laboratories, where I became quite skilful in finding the ovaries of the earthworm, in making serial sections of the chick, and in displaying the cutaneous nerves of the face of the cadaver. Hence my appointment as assistant demonstrator in my third year. I made good friends outside as well as in my own college, and my two sons are named after two Trinity men, one of whom is now F.R.S. and a leading physiologist in England. In my second year I was awarded an Exhibition and in my third a Foundation Scholarship of the College, both of which eased my pocket considerably as it was anything but easy to live on the £200 (value of the Queen's Scholarship) after income tax had been deducted. In fact it was principally through the correspondence which my Tutor, Mr. Shaw had with the Crown Agents that the value of the Straits Scholarships was increased to £250 a year from the year 1899. One of the kindest friends I ever had was Professor Alexander MacAlister, head of the Anatomical Department, whose son-in-law, Sir Donald MacAlister, at that time Tutor of St. John's College, is now President of the General Medical Council. The second and third years of my undergraduate days passed away all too soon, and before I knew about it I had already obtained a First Class in the "Stinks" Tripos and also passed the crucial second M.B. Examination in Anatomy and Physiology. I was pressed by friends to stay a fourth year, take the second part of the Tripos and thus get elected to a College Fellowship, but I was more anxious to finish my medical course at an early date. Hence the September of 1899 saw me in London competing for and winning the University Scholarship at St. Mary's Hospital, which enabled me to complete my three years' hospital training without any cost to myself. A student's life in that vast metropolis with its apparent freedom and irresponsibilities was very different to the routine vivacious life of the old "Varsity," and unless one looked far ahead one was liable to go astray and be absorbed in the whirlpool. Instead of well-regulated college chumming one encountered strange lodging house life associated with uncertain friendship and irregular hours. The majority of my fellow students in London were more economical in their habits and perhaps, more serious in their work than those at Cambridge. Many thought nothing of working from 9 a.m. to 6 p.m. each day, with an eight penny luncheon at Lyons' in between. For the first time I met men who had even less to spend on their education than myself, and this encouraged me to keep within my income. I found the practical and clinical side of the new work more interesting than the lectures, partly because the knowledge imparted in the latter could be acquired from text-books and partly because they were delivered either too early or too late in the day. They must be attended, however for "signing up" as required by the degree-conferring authorities. I enjoyed hospital work exceedingly, because it showed the noblest side of a man's character—courage in suffering, sympathy for others and real charity. The student was taught to be kind and gentle to rich and poor alike, to be observant and accurate in his work, to regard no manual work as mean or dirty and to aim at the highest ideals in the treatment of patients. The senior physicians and surgeons often set a fine example themselves, did their work conscientiously several hours a day without hope of pecuniary reward, and were always ready to accept new ideas from their junior colleagues if that means medical science could be improved. In other words it was being continually kept alive and go-ahead. At the end of 2½ years of hospital work at St. Mary's (i.e. December 1901) I passed my final examination for my medical degree. My old College (Emmanuel), wishing to encourage me in the pursuit of independent investigations, elected me to a Research Studentship of £150 a year. This enabled me to spend the first three months in the Liverpool School of Tropical Medicine where I enjoyed myself examining hundreds of blood films from cases of malaria at all hours of the day and night. Professor (now Sir) Ronald Ross had just made his reputation by proving the method of transmission of malarial fever from the mosquito to man but many obscure points still remained to be cleared up. Liverpool was then just sending expeditions to Africa to inquire into the causes of sleeping sickness, and I had the pleasure of associating with men like Dutton, Bannerman, Todd, Hume and others who afterwards contributed to the advancement of Tropical Medicine. I returned to Cambridge in May to read my Thesis, and obtain the degrees of M.B., B.C., and had the honour of receiving the Kerslake Scholarship in Pathology and Bacteriology and also the Cheadle Gold Medal in Clinical Medicine from St. Mary's. Immediately afterwards I proceeded to join the Hygienic Institute of Halle University in Germany, where amidst my experiments with the tetanus germ I had the opportunity of watching the keenness and unusual pains which the Germans took in the organisation of every activity of human life, from laboratory work and municipal affairs to soldiering and commerce. The Germans were as ambitious, domineering and conceited then as are the Japanese to-day, and only a terrible war with its immeasurable horrors, anxieties and losses, such as we are witnessing to-day, could make them appreciate the doctrine of "Live and let live." Towards the end of 1902 I removed to Paris and worked at the Pasteur Institute under Professor Metchnikoff, that famous Russian savant, who with his active wife lived the simplest of lives in a small suite of rooms and spent all the money they possessed and earned, such as from the Noble Prize of £7000, upon the advancement of medical science. As I learnt organisation in Germany, so I imbibed the doctrines of the simple and modest life in France, where no professor or worker considered himself too great or busy to assist others in the pursuit of truth and knowledge. The average visitor to Paris sees in the Café de Paris, Olympia, Louvre, Rue de la Paix, the shops, theatres, well-dressed women and a thousand other things only the outward manifestations of the glory and genius of France. Had he peeped behind the veil he would have noted that such things were only possible because the masses worked hard from morning till night, and saved a large part of their earnings, while the more brainy ones pondered over problems which eventually resulted in such epoch-making discoveries as the bicycle, automobile, aeroplane, and the treatment of hydrophobia. I entertained for the French nation the deepest feeling of affection because their liberty was real and their friendship sincere.

I returned to England in the spring of 1903, read the thesis and passed the examination for my M.D. degree, two years before I could have it conferred by the Senate. In March I was appointed House Physician to the Brompton Hospital for Consumption and Diseases of the Chest, and here I practised rigorously the excellent habit of sleeping with open windows throughout the year—a habit enjoined upon all patients, including the most serious. Thanks to my six months' stay in that Hospital I gathered considerable experience of chest complaints and routine hospital administration. The call of home was now uppermost in my mind and I left London in September by the Japanese mail steamer "Sado Maru," which arrived a month afterwards at Singapore where I was the guest of Dr. Lim Boon Keng. Here I met the charming Miss Wong, sister of Mrs. Lim, whom I fell in love with at first sight and who was destined to play such an important part in my future career.

The Straits Settlements, which I left seven years ago, appeared indeed strange at first sight. It took me some days before I could understand a word of the Chinese or Malay language. I felt awkward amidst my surroundings, and moved about more like a foreigner than a man returned to the home of his birth. I had, however, made up my mind to devote my best energies to the service of the people, and at once entered into their thoughts and desires. I proceeded by steamer to Penang where I found both my parents in good health, the old children grown up, and new ones added to the large family. Although there was much feasting given by friends to celebrate my home coming, my mind was already turning to Kuala Lumpur, where with a second year's tenure of the Travelling Studentship, I had arranged to continue my investigations in tropical disease at the Research Institute. Here I made a large number of post-mortem examinations on beri-beri cases. I stayed in the capital of the Federated Malay States for a year from 1903-1904, and saw the beginning of systematic rubber cultivation which was so soon to revolutionise the industries of the Malay States. I now settled down to a lucrative practice in Penang, and for three years had the opportunity of treating all classes and conditions of people. My training was, however, not meant for the humdrum existence of a general practitioner, and although my credit in the bank increased my mind was not at all at ease. I longed to be of more use to China and her people, so as to fulfil the wishes of the Right Honourable Sir Cecil Clementi Smith, founder of the Queen's Scholarships, whom I saw twice while in England, and who expressed more than once the opinion that the duty of Straits Scholars was to act as a leaven whereby the benefits of British culture and justice might be conveyed to China for the regeneration of that great people. It was with this end in view that I plunged headlong into the movements for the social welfare of the people, and took a leading part in the anti opium crusade which started in 1906. I knew that in my enthusiasm I would make enemies of my richest patients and friends, who, through no fault of their own, held the majority of shares in the opium monopoly farmed out by the Government. These friends visited me in my home and consulting room to desist me from my propaganda, promising free shares, compensation and what not, but I was obdurate, feeling that my duty lay with the masses of people rather than with my rich friends. I was the Secretary General of the first Opium Conference of the Straits and F.M.S., which was held in Penang and together with Mr. Goh Taik Chee was responsible for much that followed. The next Conference, even more enthusiastic, took place at Ipoh, and the resolutions passed were submitted to the Government and posted all over the world. People, who had up to then remained indifferent or contemptuous, began to look upon the movement seriously, and callous writers and speakers who used to say that opium was bad for Europeans but good for Chinese began to dwindle as their opponents increased in numbers. As a result, the first International Opium Commission was held in 1909 at Shanghai where opium smoking was definitely condemned as a harmful vice. I visited China for the first time in 1907, arriving at Shanghai in June and Tientsin in July — the hottest time of the year. The heat was intense, ranging from 110° to 115° F; the sun's rays seemed to penetrate the retina of the eye, and one felt as if being baked in an oven. The poor ricksha coolies continued to ply their trade as usual, some bareheaded, others with cloths wound round their heads. I found signs of progress everywhere, two medical schools already existed in Tientsin, and thousands of modern schools had been established throughout the province of Chili alone. Viceroy Yuan was then at the zenith of his career and was ably assisted by keen men who had received their training in American Colleges, such as Tang Shao Yi, M. T. Liang, etc. Peking was only four hours by train from Tientsin, and I took the first opportunity to visit the mysterious capital. I found it ill-kept, dirty and dusty, although the thick walls, the imposing Chien Men, the beautiful palaces and temples were undoubtedly monumental works of art to be found nowhere else in the world. I stayed with Captain Tan, whose acquaintance I had made in Newcastle ten years ago when serving under my uncle, Captain Lin Kuo Chang, at that time Superintendent of the construction of the Chinese cruisers. Captain Tan was then in charge of the Nobles School, where the aristocrats of China, mainly Manchus, were being initiated into the modern learning. He pressed me hard to give my services to China and introduced me to the more influential men in Peking. I promised to come next year after my affairs in Penang had been settled. The Army Medical Service attracted me, because I saw therein the potentialities of proper organisation and efficiency. Hence after a few months' stay in Penang, I proceeded to Europe again in the spring of 1908 and took courses in military hygiene in London and Berlin. There I remained six months, and after a few weeks' sojourn in the Straits, I finally left my native home for service under the Chinese Government. There was already political trouble brewing in the capital, for Viceroy Yuan had been removed from his post in Tientsin and had received Irish promotion as a Grand Councillor in the capital. His bitter enemy, General Tieh Liang, the Manchu, had gathered into his hands the model army trained by Viceroy Yuan, and hence I received my commission as Vice-Director of the Army Medical College not from him whom I had come to serve but from his hated rival. A strange irony indeed! The official dispatch reached me on the date of announcement of the combined deaths of the Empress Dowager and Emperor Kwang Hsu. It was not a very auspicious event for the whole country was plunged into deep mourning. During my three years at the Army Medical College, Tientsin, I did my best to infuse, besides knowledge of medicine, duty and discipline among the students, many of whom came from the country villages without any previous scientific training and had very little idea of the requirements of surgical cleanliness or modern sanitation, such as are taught now-a-days in all western colleges. For three years I urged upon the army authorities the absolute need of having an up-to-date hospital, where not only the soldiers could be treated in the most efficient way, but the students could learn accurate clinical methods and thus spread proper scientific medicine. My appeals were not heeded, principally because our old-style officials had not yet realised the immense superiority of western scientific over ancient empiric medicine and were still bent upon conferring equal favours upon Chinese and western medicine, thus incurring double expense without substantial benefit to either. It was during this period of uncertainty (December, 1910) that news reached Peking of the outbreak of plague in North Manchuria. Residents in Peking were getting nervous and more and more deaths were reported daily from Harbin.

On the recommendation of Alfred Sze, Councillor of the Foreign Office (the present Minister to the Court of St. James) I was selected to proceed to Harbin and devise means for stamping out the epidemic without delay. I got myself inoculated with anti-plague vaccine, suffered two days of pain and torture, and arrived in Harbin on December 20th. There I found conditions very unsatisfactory. The local Magistrate was a confirmed opium smoker, prided himself upon being an amateur physician and did not believe in germs or foreign medicines. There were no hospitals, laboratories or disinfection stations, and only a plague house, formerly a bathing establishment, existed into which suspected patients, that is, those who coughed, vomited blood or suffered from headache of any kind were indiscriminately thrown. The taotai (highest official of the district) was anxious to get rid of the pest but did not wish to follow the advice of the medical officers. Add to this the extreme cold, varying from 25° to 33° C., and you have a fair idea of the difficulties which confronted me at the time. However, thanks to the loyal support I received from Peking, and to the increasing number of assistants, including some English missionary doctors, we were able to turn schools, theatres and bath-houses into disinfection stations, and temples and deserted inns into isolation wards and plague hospitals. In the meantime I had had occasion to examine the cases, for up to then I had never seen or heard of an epidemic in which patients died in one to three days after showing signs of the disease, and in which no one recovered. I performed the first two post-mortems in the deserted homes of the dead, cultivated the microbes from the spleen and found them to be the same as ordinary plague bacilli. It was clear that infection took place directly from person to person through the bloody sputum, which the sick brought up in abundant quantities, and the only way to stop the epidemic was to strictly isolate the sick from the healthy, and to cover the mouth and nose of hospital attendants with gauze and cotton wool as a protective measure. Medicines were of no avail for the disease destroyed the lungs too quickly. There was no immediate fear from the dead, for when persons ceased breathing no more bacilli came forth from the lungs. Hence the rat danger so urgent in bubonic plague did not exist. It took nearly a month for the organisation to be perfected and for the officials to come round to my point of view. The plague reached its highest point of virulence in January, when as many as one hundred and eighty persons died in one day out of a population of 18,000. Owing to the frozen state of the ground, and to the difficulty of digging trenches, the number of coffins piled up quickly and by the end of January nearly four thousand were counted on the burial ground. I took the bull by the horns and boldly wired to Peking asking for permission to burn all these coffins. After a delay of two days, the final order was received for the cremation of the dead. On January 31st, two thousand coffins were piled up in columns of 100 each, and in spite of cold, snow and wind burnt splendidly. By the third of February, not one coffin remained on the ground which but a few days ago had witnessed more than half a mile of dead. Our staff now felt less unnerved, worked with greater zeal and hope, and the epidemic was firmly controlled. The last case of plague was reported in the Chinese city on March 1st. It was a triumph of organisation and co-operation. I now turned my attention to other cities, like Shuang Cheng, Changchun, Mukden, etc. where the epidemic had killed thousands of people. They in turn adopted the same methods which we had found so useful in Harbin, and by the end of April the plague had completely stopped throughout North China and Manchuria. That extraordinary epidemic cost China 60,000 lives and over ten million taels. Desiring to make a thorough study of this plague, the Chinese Government convened an International Conference in April, 1911, at which expert scientists of eleven nations sat and devised measures for the prevention of a similar occurrence in future. I had the honour of sitting as President of that Conference. Along with the delegates, I travelled to Peking, and was everywhere received with marked kindness. The most conspicuous was the special audience granted me by the Prince Regent, who thanked me on behalf of the country and humanity and decorated me with the Second Class Double Dragon. It was the first occasion in Chinese history a medical man had been thus honoured.

Preparations for the holding of the International Opium Conference at the Hague having been completed, I was appointed Chinese delegate with Sir Liang Chen Tung and Mr. Tong Kaison to attend that famous gathering. The Revolution broke out at that time (October 1911), but we stuck to our work and sat for nearly one month with the trained diplomatists of Europe, discussing a problem which so vitally affected China. At this Conference I took a considerable share in drafting the scientific part of the proceedings. Eventually the final resolutions were passed, in which all participating nations agreed to mutually help each other in suppressing the opium, morphine and cocaine vices. I felt then that my early pecuniary sacrifices and pioneer work in the Straits had been worth all the labour and worry, for it had at last received international recognition. The first work was for a community; this one concerned a whole nation.

At the conclusion of the Conference I crossed the Channel and visited Cambridge, where I presented some rare specimens of pneumonic plague organs to the pathological museum of my Alma mater, and spent some weeks with Professor Sims Woodhead preparing sections and data for a monograph on the Manchurian epidemic. I returned to Peking via Siberia in 1912 just after Yuan Shi Kai had been formally elected President of the new Republic.

The Manchurian Plague Prevention Service was definitely organised in September of that year, although since the plague Medical Officers had been appointed and isolation stations had been established at the important seaports and railway centres. For four years now this service had carried on its work in Manchuria and exercised its influence wherever possible in bringing knowledge of modern medicine and prevention of disease to the masses. That it has succeeded is beyond question, but China is a huge country and its people are intensely conservative, and unless the government, the educated classes and officials thoroughly awake themselves, progress will be slow.

I was again appointed delegate to the Second Opium Conference held at the Hague in June 1913. This time Mrs. Wu accompanied me and we also visited Berlin, Paris, Cambridge and London. I attended the International Medical Congress in London and read a paper on the origin of the Plague, contending that it was not caused by the Mongolian marmot but by some imported cases of the bubonic pest which through secondary infection had become pulmonary and thus spread as a general epidemic during the winter months.

The International Congress of Medicine was a wonderful affair. Over eight thousand doctors from all parts of the world attended, the most friendly feelings were displayed and none foresaw that within twelve months the present terrible war would begin.

From London I sailed for America, whither I had received telegraphic orders to proceed and attend the Congress of School Hygiene at Buffalo. My first impression of New York was a striking one. There seemed to be eternal bustle and hustle, and no one appeared to have time for even his daily meals. America was certainly progressive and self-conscious, and the wealthy were most liberal with their money, as judged by the humanitarian activities of Carnegie, Rockefeller and others.

My labours at Buffalo having terminated, I visited Chicago and Boston (where John Harvard of Emmanuel founded the first American University), crossed the Rocky Mountains in Canada, stayed a week at that delightful place Laggan, and left Vancouver by the Empress of Asia for Japan. Owing to the extraordinary progress which Japan has made in less than fifty years, I was delighted with the opportunity of seeing the people in their own country. There is no doubt they have an efficient government backed up by a thorough educational system, in which no one (man or woman) is allowed to remain illiterate. Patriotism and self-sacrifice are taught in the home as well as at school, and the best that the west can teach is adapted to the needs of the country. Truly a splendid organisation among a receptive people!

Since 1913, I have been engaged in extending the medical organisation for which I came to China. One of the Chinese assistants, educated in Japan who worked with me in Harbin, is now Chief of the Medical Department at the Board of War, whilst another who was recommended to study in America is now Director of the Army Medical College. More competent colleagues have returned or are returning from Europe and America, and before long we shall be able to accomplish more than has hitherto been possible in the past. The National Medical Association was founded in 1915, and held its first Conference in Shanghai early this year. The Central Hospital of Peking, upon which I had devoted much energy for six years, is now in course of construction, and when completed will serve as an object lesson to officials and others regarding the beneficence and superiority of modern scientific medicine. For this Central Hospital will be equipped with all the latest contrivance for the diagnosis and treatment of disease, so that rich as well as poor may receive the fullest benefit from it.

It is my earnest hope that during the next twenty years I shall be able to witness still greater progress and more happiness in China and the rest of the world.