Abstract
Introduction
Strolling down Brewster Road in the sleepy town of Ipoh, Malaya in the late-1950s, one came across queues of patients waiting to consult Dr Wu, a general practitioner. He was famed for his free consultations for the poor in this tin-mining state of Malaya. However, many do not know of his legacy and contribution to human society in the field of public health and infectious diseases. His generosity, devotion and contribution to medicine and public life has only come to light in recent years through the work of the society under his name.
The early years
Born in Penang, Malaya in 1879, Wu Lien Teh was the fourth child in a family of 11 siblings. At that time of high infant mortality, many of the siblings did not survive. His father was an immigrant from Taishan, China and was a successful goldsmith in Penang. At the age of 17 years, Wu won the prestigious Queen Scholarship after sitting for the papers in Singapore. This took him to Emmanuel College, University of Cambridge to read medicine. He commented: ‘I was thrown into an entirely new world for which I was not quite prepared’. He undertook his clinical years at St Mary’s Hospital, London and was reportedly known to have won virtually all the prizes and scholarships in a class of 135. His early post-graduate outings included stints at the Liverpool School of Tropical Medicine (under Sir Ronald Ross), the Hygiene Institute of Halle (Germany) and the Institute Pasteur (Paris). For his thesis on Malaria and Tetanus, he was awarded an M.D. by Cambridge.
The difficult years
Upon returning to Malaya in 1903, he was unable to get a job as a Medical Officer in the Colonial Medical Service as he was a local. Only British doctors were accepted. Thus, he opted to join the newly formed Institute for Medical Research in Kuala Lumpur to investigate beriberi. His other interests took him to campaign against a social ill predicating family life in Malaya – opium addiction. During that time, there was no financial incentive to abolish opium smoking due to the revenue levied upon opium farms. Wu then founded the Anti-Opium Association in Penang in 1906 and organised a nationwide conference to publicise his antagonism to this ‘widely accepted practice’. Strangely, a turn of events took place in 1907 where he was prosecuted by the authorities for possession of 1 ounce of opium tincture. Allegedly, this was found in a cupboard in a clinic he bought from a British lady doctor. It is unclear whether the case had anything to do with his campaign, but Wu felt deeply humiliated and bitter.
The plague doctor
Shortly afterwards, Wu received an official invitation to serve in China. It was believed that his actions and campaign were noted and acknowledged by the Chinese Government. The offer for the post of Vice-Director of the Imperial Army Medical College, Tientsin, China was accepted. Wu wrote at that time: ‘the inhospitable shores of my birthplace where neither government nor friends seem to need me’.
His first great challenge on mainland China came in 1910, where a mysterious illness afflicted inhabitants of Fuchiaten, in Manchuria. Those affected suffered high fever, haemoptysis and purpura. Death ensued in nearly all cases.
Upon arrival, Wu and his small team were met with apprehension and stubborn traditional beliefs. It was impossible to perform post-mortems as it was considered sacrilege. Fortunately, the death of a Japanese woman allowed him the chance of performing a post-mortem and obtaining microbiological samples. As the disease spread, Wu advocated the stoppage of human movement, the introduction of cremation and the wearing of facemasks. This advice provoked further local antagonism and he was not spared racial prejudice.
Worse was to come. A French specialist Dr Mesny, who had previous experience in Bubonic Plague, was asked to help out as the epidemic worsened. The Frenchman insisted that he would take charge and doubted Wu’s clinical skills. Wu was of the opinion, based on his pathological work, that this was a pneumonic form of plague. He also identified the causative agent. He also discovered that the marmot, a rodent, was the deadly vector of this form of plague. This animal was hunted for their valuable skin – the fur traders who skinned the animals also ate the infected creatures. Wu concluded that the plague could be transmitted by droplet infection, contrary to the Western belief that plague could only be transmitted if bitten by rats or fleas. Mesny doubted most of Wu’s conclusions and refused Wu’s advice on wearing a mask. Six days later, Mesny tragically acquired the plague and died.
Relentlessly, Wu pursued the route for prevention and cremation. Wu started a programme of building isolation hospitals, quarantine stations, contact tracing and home monitoring. In early 1911, Wu discovered over 2000 unburied bodies. It was mid-winter and the ground was frozen. He feared the dead bodies posed a public health risk. Mass cremation was his only solution; however, to the Chinese this was an act of desecration. He had no choice but to send a memorandum to the Chinese Emperor and after three anxious days, an Imperial Edict allowed the process. The first mass cremation in Chinese history took place on 31 January 1911. Even previously dead bodies were dug up and cremated. By 1 March 1911, the last case of pneumonic plague was recorded in that area. The death toll was over 60 000 lives.
Public health in China
The positive China experience was globally recognised, and Wu chaired a major conference in Shenyang, China to calm international concern and to inform physicians on his experience tackling the epidemic. There was also a recognition by Chinese leaders that the country needed a Western-style public health service. Wu was given the responsibility of setting up the North Manchurian Plague Prevention Service. His expertise in the field as a major health figure was used in the further promotion of medical training. He co-founded the National Medical Association of China in 1915 and presided between 1916 and 1920. In 1930, he was appointed as the first director of the National Quarantine Service (NQS). Based in Shanghai, the NQS controlled quarantine procedures in all major ports.
Sensitive to the traditional Chinese medical education in China, he urged the study of medicine should embrace both the traditional healing beliefs and modern medicine in the various medical faculties he founded. He also continued his pursuit against opium smoking. His vociferous efforts resulted in the building of rehabilitation hospitals in Peking and Nanking, and a subsequent ban on opium smoking came into force.
Personal loss
Wu’s career in China was not without human tragedy. His wife, Ruth, travelled with him to China at the outset. They had three sons during his career in China, but sadly two sons and Ruth died during their stay. He later remarried and had another four children.
The later years
In 1937, China became the victim of Japan’s quest for expansion and exploitation. Wu decided to leave Shanghai for Malaya and opened his general practice surgery in Ipoh. He continued practising for over 20 years, led a low-profile lifestyle and engaged quietly in social work. This Nobel Prize for Medicine Nominee returned to his hometown, Penang, to retire in 1960. Barely a week later, he suffered a stroke and died on 20 January 1960. The Times (London) wrote: ‘By his death, the world of medicine has lost a heroic and almost legendary figure and the world at large one of whom it is far more indebted to than it knows’. The British Medical Journal commented: ‘Is it not time Malaysia accord due respect and recognition to this outstanding son of hers?’ as very little is publicised about his exploits in his homeland.