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Presidential address
(The previous number of these Transactions, Vol. 47, No. 5, was published on 25th September, 1953.)
OPENING MEETING OF THE FORTY-SEVENTH SESSION of the ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE
held at
Manson House, 26, Portland Place, London, W.1 on
Thursday,
15th
October,
1953,
at
7.30
p.m.
PRESIDENTIAL ADDRESS
RETROSPECT BY
F. NORMAN WHITE, e.I.E., M.D., D.P.H. It is inevitable that a presidential address delivered by one as old as I should be chiefly concerned with events of a bygone age and be to a regrettable extent autobiographical. From the somewhat copious records of a not uneventful life I have selected certain episodes, not for their intrinsic importance--some, indeed, are almost trivial~but because they either retain an interest or significance in the light of present-day conditions or else concern individuals who have made important contributions to tropical medicine in the years gone by. It is just fifty years since I first arrived in India, when tropical medicine first became an absorbing interest to me. I shall have very little to say tonight about my short seventeen years' service in the I.M.S., full of interest though they were. I should like, however, to refer to the closing chapter of my Indian career. During the latter half of the first World War I was entrusted with the work of the Sanitary Commissioner of the Government of India. They were years of great stress and anxiety. The, at best, meagre health and medical services had been depleted by the war effort and were only just sufficient for routine work, if all went well. Things went persistently badly. In the autumn of 1917 malaria was epidemic in parts of Northern India: the plague epidemic of 1917-18 was the most severe that India had suffered for eleven years: failure of the monsoon in 1918 resulted in food scarcity and high prices: there was considerable anxiety regarding the importation of various infections, and fresh strains of infection, with troops returning from overseas: and then came influenza. The epidemic wave of influenza in the autumn of 1918 in the central, northern and western parts of India and in territories across India's north-west frontier was a catastrophe almost without parallel in the history of epidemics. Within the space of two months it caused the
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deaths of some six million people in India alone, more than half the total n u m b e r of deaths that had been attributed to plague during the previous twenty years. T h e so-called Spanish influenza had been unduly prevalent in Europe during the spring and early summer of 1918, spreading along lines of communication from western Europe to most parts of the world. It had caused much sickness but little mortality. T h e pandemic appeared to have died down, when suddenly it flared up again with terrible intensity and almost simultaneously in all parts of the world, except Australasia, but nowhere with the severity that it did in India and adjacent territory. Everywhere adolescents, young adults and people in the prime of life suffered most: the very young and the old displayed a surprising immunity. No one who took an active part in our impotent efforts td control the disease in the worst affected parts of India is likely to have forgotten his experiences. T h e first reports of alarming mortality were from Bombay whither I hurried. M y brief visit there was long enough to ascertain the nature of the disease and to satisfy myself that it was not yellow fever. T h e possibility of the introduction of yellow fever into India was, for a time, something of a nightmare to some of us. I was very soon recalled to Delhi where conditions were almost as bad as in Bombay, and in Delhi I stayed for the remainder of those tragic weeks. All doctors who escaped infection worked day and night. In a report that I wrote for the Government of India on the conclusion of the epidemic I quoted from a report sent me from the Punjab; it ran as follows : " The hospitals were choked so that it was impossible to remove the dead quickly enough to make room for the dying; the streets and lanes of the cities were littered with dead and dying people; the postal and telegraph services were completely disorganized; the train service continued, but at all the principal stations dead and dying people were being removed from the trains; the burning ghats and burial grounds were literally swamped with corpses, while an even greater number awaited removal; the depleted medical service, itself sorely stricken by the epidemic, was incapable of dealing with more than a minute fraction of the sickness requiring attention; nearly every household was lamenting a death, and everywhere terror and confusion reigned." T h a t gruesome description in no way exaggerates conditions during a few terrible weeks as some of us saw them. Rural areas suffered even more than towns. Some villages in the Central Provinces were literally de-populated. By the end of November mortality rates had returned to normal almost e v e r y w h e r e - - a n d the long war was over. One reason which prompted this reference to that terrible epidemic is that it was the indirect cause of my leaving India. Influenza had spared neither Europe nor America and the Allied countries convened a medical conference in Paris in March 1919, to take stock of the situation and to frame measures, if possible, to prevent the recurrence of a like catastrophe. I was delegated at very short notice to represent the G o v e r n m e n t of India at that Conference. I was accompanied by Colonel Greig, I.M.S., who had done considerable work on the bacteriology of the Indian outbreak. In Paris, after nine years unbroken absence from Europe, I made m y first contact with many distinguished European medical colleagues whom I was later to know so well. One of the members of the British delegation at that conference later became a President of our Society, Rear-Admiral Sir Percy Bassett-Smith. I saw much of him during that ten-day stay in Paris: he was a delightful companion. F r o m Paris I came back to England on leave, resigned m y Commission in the I.M.S., and on the 1st January, 1920, became a medical officer in the Ministry of Health. M y stay in the Ministry was destined to be very short. At that time the League of Nations was just coming into being. T h e Secretary General of the League, Sir Eric D r u m m o n d, and the nucleus of an international Secretariat had temporary office accommodation in Curzon Street, London. T h e r e had been no General
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Assembly of the League but the Council had held its first meeting towards the close of 1919. At its second meeting in February, 1920, the Council decided to convene an International Conference of Health Experts to frame a constitution for a Health Organization which would enable member states of the League to honour their obligation under Article 23 of the Covenant of the League to " take steps in matters of international concern for the prevention and control of disease." That International Conference of Health Experts met in London in April, 1920. Before dealing with its main agenda the Conference was asked to consider and advise on a very urgent health problem. Uncontrolled epidemics of typhus and relapsing fever were spreading from Russia into the eastern districts of Poland and of adjacent countries bordering on Russia, and constituted a very grave threat to war-devastated Europe. A delegation from Poland, which included Chodzko and Rajchman, brought alarming news as to the gravity of the situation. An ambitious programme of control measures was elaborated by the Conference: amongst other things it advocated the establishment of a long line of cleansing stations and hospitals at strategic points close to the Russian frontier and the appointment of an ad hoc international Epidemic Commission to co-ordinate a combined effort and to work with the Health Administrations of Eastern Europe. The approximate cost of the scheme as then planned exceeded three million pounds. Sir George Buchanan was the chief British delegate at the Expert Conference: he asked me to help him and I was called on to do considerable work for the Typhus Conference with the result that at its close I was invited to take medical charge of the international Epidemic Commission that it was proposed to set up. I was seconded from the Ministry of Health to the League of Nations for a period of three months in the first instance. I stayed with the League for fifteen years. In the following month--May, 1920--1 went with the report of the London Conference to Rome where the Council of the League held its third meeting. The Council was a peripatetic institution before the League established its permanent headquarters in Geneva. The Council in Rome approved the recommendations of the London Conference but reduced the sum to be spent to two million pounds, which sum, they thought, might be contributed by member states. I was instructed to go at once to Poland to study the situation anew and to frame detailed proposals for the expenditure of that sum to the best advantage. Thus the Epidemic Commission of the League of Nations came into being. It was an event of some significance. It was the first occasion on which States undertook to accept financial responsibility for epidemic control measures in times of peace, in countries other than their own.' Time does not permit of any detailed description of the interesting developments that followed. At first financial contributions from States came in very slowly. The delay thus enforced in starting serious work, vexatious enough at the time, turned out for the best. Fighting flared up again between Soviet and Polish forces. The Red Army made a deep incursion into Poland almost to the gates of Warsaw whence they were driven back, incidently leaving much typhus and some cholera in their train. Had our programme been put in hand as promptly as I had desired the most important of our installations would have been overrun. Meanwhile the summer drew to a close. The first General Assembly of the League of Nations was due to take place at the beginning of December, 1920, in Geneva, whither the Secretariat had moved to permanent headquarters. It was decided to send a Commission
PI~SIDENTIAL
ADDRESS
of three to report on conditions in Poland, as they were at the close of Russo-Polish hostilities, direct to the Assembly. This task was entrusted to Madsen, the Director of the State Serum Institute of Copenhagen, Pottevin, the Deputy Director of the Office International d'Hygi~ne Publique of Paris and myself. At the end of October we leftfor Poland. W e visited several areas in the Frontier provinces. One day I particularly remember. In the Lida area, east of Grodno, which the Russians had evacuated but a few weeks before and where no Polish civil administration had yet been set up, we visited numerous villages selected more or less at random from a map. W e found some villages partially or wholly destroyed. Typhus fever was found in every inhabited village visited: in some villages in every house. Cases of both cholera and relapsing fever were seen that day. Conditions were indescribably bad. Never before nor since have I seen a greater degree of louse infestation. (There was no D D T in those days and typhus fever was a most disagreeable disease to fight). Conditions elsewhere along the frontier were but little better. Trains packed with refugees were arriving, each with its quota of typhus patients and the dead bodies of typhus victims. It was a somewhat lurid report that we presented to the First General Assembly of the League of Nations in Geneva in December. It was not difficult to make out a convincing case for international action. The Assembly confirmed the earlier decisions of the Council regarding the establishment of the Epidemic Commission. National contributions began to come in and we started serious work. My head office remained in London and we opened an office in Warsaw. My most active colleague was L. Rajchman, then Director of the Warsaw Bacteriological Institute which he had founded. A year or so later he became the first Director of the Health Section of the League of Nations Secretariat and it was to his enthusiasm, drive and initiative that the remarkable achievements of the League's Health Organization in its early years were mainly due. Colonel Gautier of the French Army Medical Service and a representative of the League of Red Cross Societies were the two other Commissioners in Warsaw at that time. The resolution of the Assembly of the League of Nations which had authorized a start of the campaign, within the limits of the funds that had been promised, instructed the Epidemic Commission to solicit the close co-operation of the Office International d'Hygi~ne Publique, the Comit6 International de la Croix-Rouge and the League of Red Cross Societies. To facilitate this co-operation an Advisory Committee was set up on which each of these bodies was represented. Professor Madsen represented the Office International d'Hygi~ne Publique; Dr. Ferri~re and M. Frick the Comit~ International de la Croix-Rouge; Professor Winslow the League of Red Cross Societies, of which he was at that time the Medical Director: the League Secretariat was represented by Dame Rachel Crowdy, the Director of the Social Section. This Advisory Committee met only once, in Poland in April, 1921. It approved the work being done and the administrative arrangements that had been made by the Epidemic Commission. The League of Red Cross Societies gave very material assistance throughout the campaign. From th e beginning the Epidemic Commission's work had been hampered by lack of reliable information regarding the health conditions prevailing inside Soviet Russia at that time. The medical profession in the west had had no contact with their Russian colleagues for four years. The iron curtain was almost as impenetrable then as it is now. In January, 1921, I tried to establish contact. Through the good offices of Frick of the Comit6 International de la Croix-Rouge I was invited to accompany a German delegation from Berlin to Riga where it was to meet a similar Russian delegation to arrange for the repatriation of
F. NORMAN W H I T E
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prisoners of war. Some important health problems were involved and I hoped that I should be able to make contact with some important Russian health officials. Professor R. Otto, Director of the Robert Koch Institute, was the chief medical adviser of the German delegation. His name was well known to students of tropical medicine in those days. This was my first meeting with him: our association was most friendly and, to me, both profitable and full of interest. The political atmosphere of Riga in those days was not a little tense. Russian and Polish delegations were there negotiating a peace treaty. My stay in Riga was eventful, very interesting and revealing in many ways, but my visit failed in its main objective. I returned with but little more reliable information regarding health conditions inside Russia than I had when I went. In September, 1921, we tried again with better results. In the meantime news of the appalling famine conditions prevailing inside Russia had reached the outside world. Nansen had set up his famine relief organization under the auspices of the League of Nations. It was due to Nansen's intervention that permission was given for Rajchman and me to visit Moscow. I find it impossible to refer even thus casually to Nansen without paying a tribute to the memory of that truly great man. All who were privileged to know him, even slightly, will feel as I do that life would have been poorer without that experience. Nansen was a name to conjure with in Russia in those sombre days. Rajchman and I arrived in Moscow, by train from Riga, on the 24th September, 1921, and stayed a week, a week so full of unusual experiences that in retrospect it seems much longer. " Red Moscow, the Heart of the World Revolution," as I saw it self-described in English on the shuttered window of a delapidated shop in an important thoroughfare, was a very sad city in those days. We were quartered in a rat and bug infested room in what was still euphemistically called the Savoy Hotel. We might have been more comfortably housed in one or other of the foreign mission buildings, which had recently been opened, but we were most anxious to avoid giving any impression that our visit to Moscow had any other motive than matters of public health. The time was not very opportune for the visit of a Pole and an Englishman. Polish-Russian relations were still somewhat strained, and Lord Curzon, our Foreign Minister, had just sent another note to the Soviet Government that was almost tantamount to an ultimatum. You must remember that in 1921 the Russian revolutionary government was but four years old; Lenin was still supreme and Trotsky was in command of the armed forces; the interesting attempt to abolish money had been tried and failed but money was still a commodity of doubtful value (I changed money at the rate of 300,000 roubles to the pound: the rate subsequently fell much lower than that): private trading which had been prohibited was legal once more, but there was little to buy in the shops: epidemics of typhus and relapsing fevers and cholera had ravaged most parts of the vast country and were still widespread: and then came famine. Conditions were catastrophic. Litvinoff, the deputy foreign minister, received us courteously. When he was convinced that our interests were strictly confined to matters of public health and that we were sincerely anxious to do what we could to assist his country in her efforts to control epidemic disease, we had few further troubles. We went everywhere unmolested. We had several interviews with Siemaszko, the People's Commissar for Public Health; he and several members of his staff eventually became co-operative. We were shown all we asked to see in the way of hospitals, research institutes, laboratories and other health institutions. I regret time does not allow of a description of some of these. There was a good deal to admire, most
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of all, I think, the devotion of some doctors and nurses who were doing selfless work in conditions which appeared to me to be deplorably hard. We were most anxious to make contact with Tarassevitch but he was not in Moscow. The older members of my audience may remember the great reputation Tarassevitch had as a bacteriologist and research worker before the first World War; he was the acknowledged leader of medical research in Russia. He had collaborated with Metchnikoff, the celebrated disciple of Pasteur. We learnt that he had been a member of a Committee of all parties that had been formed to take charge of all famine relief work. The members of that Committee had been arrested soon after its formation. Tarassevitch was released almost at once. We eventually learnt of his whereabouts from a relative of his who offered to act as our guide. In a car lent to us by the Polish Legation we motored to a small village some 55 verst north of Moscow where Tarassevitch was having a holiday in a small cottage. He was a very delightful man of little more than fifty years of age, but he looked older. He spoke French with great ease and fluency. Having recovered from the surprise of the unheralded arrival of such unexpected foreign visitors, he enjoyed the opportunity of learning something at first hand of events and medical affairs in the outside world from which he had been so completely cut off. We talked for about five hours and were treated most hospitably. We persuaded him to drive back with us to Moscow. We foregathered again that evening in his Moscow fiat where he had asked several of his friends and colleagues to meet us. Talk went on to the small hours of the morning. I learnt more of events in Russia than I ever expected to be able to do in so short a visit. I have spoken thus much of Tarassevitch because to me he was and is the prototype of those of our Russian colleagues who in spite of every discouragement and incredible hardship stuck to their posts and did everything possible to relieve the sufferings of their people during those years of dire misfortune. I met several such men. Of their political or ideological affiliations I knew little or nothing but they excited my deep admiration. The Moscow I have described was Moscow at its worst. At a second visit which I paid that city in 1924, when I addressed a large pan-Russian Medical Congress on " International Co-operation in Public Health," I found conditions vastly improved. When Rajchman and I left Moscow Tarassevitch promised to write an account of the epidemics that had devasted Russia during the years of isolation from the west. Arrangements were also made to attach a member of the Epidemic Commission to Nansen's Famine Relief Office in Moscow, to keep us in touch with Russian health authorities. Dr. Farrar, who had just retired from the Ministry of Health, was selected for the post. That appointment was made against my better judgement. Farrar was about 60 years of age and typhus fever as then occurring in Eastern Europe had a very high case mortality rate among doctors of that age. But an opportunity of philanthropic work of that kind was so attractive to Farrar that I yielded to his entreaties. There was never any doubt about his technical competence or general suitability for the work. I took him to Geneva to introduce him to Nansen with whom he travelled to Moscow. Farrar died of typhus fever in Moscow, Christmas, 1921, little more than a month after his arrival. I salute the memory of a very lovable colleague. In a report on " Epidemics in Russia since 1914 " which Tarassevitch, faithful to his promise, sent us in 1922, reference is made to the high mortality rates that had prevailed among Russian doctors. The chief causes of death in the medical profession had been tuberculosis, suicide, and typhus fever, in that order. This part of his report closes with two paragraphs that I shall quote in full : " The number of the victims and of the lives sacrificed bears clear and eloquent witness to the
F. NORMAN W H I T E
44-7
fact that Russian doctors have remained faithful to their traditions, that they have served and continue to serve their country, humanity and science to the utmost of their capacity, and that each of these martyrs to duty has carved the epitaph ' Feci quodpotui.' "Fresh victims must be added to this sad list: I need only mention Dr. Farrar (of the Nansen Organization) and Dr. Giirtner (of the German Red Cross). We, who are always on the brink of death and disaster, are accustomed to bear such blows in silence. But we cannot keep silent when noble and generous men, who leave their country, their homes, their families, their accustomed occupations to come to our assistance, join our ranks and are struck down in our midst. We tender our profoundest sympathy, gratitude and respect to their colleagues and to their families. These martyrs have not fallen in vain; they give us new strength and courage; they bear the torch which is to lighten our darkness and they implant in us the faith that one day unity and peaceful work will reign throughout the world and throughout our country." T h a t pathetic tribute reveals much of the character of Tarassevitch. It was full of encouragement to me then and it has not lost its significance for me today, though more than thirty years have passed since it was written and men of the calibre of the writer are few and far between. During the twelve years that followed the period of which I have spoken I was privileged to work intimately with medical m e n and research workers of very many nationalities and in many countries. It was always possible to obtain whole-hearted friendly collaboration in any work designed to promote the welfare of humanity, or to enlarge our knowledge of the causation, prevention or cure of disease. T h e contribution to world peace and international understanding which such co-operative work can make is not negligible. T h a t is one reason why the work of the World Health Organization, "which has carried on and greatly extended work begun by the League of Nation's Health Organization, merits every support. T i m e does not allow me to complete the story of the Epidemic Commission. We received but a quarter of the sums we had originally hoped for but we were able to give very material assistance to the Health Administrations of Eastern Europe, chiefly Poland, in coping with a difficult and dangerous epidemic situation. In January, 1922, the head office of the Epidemic Commission was moved from L o n d o n to Geneva and our activities were incorporated in the newly created Health Organization of the League. I was still styled Chief Epidemic Commissioner but I acted, in addition, as Rajchman's deputy. T h e only other episodes in my career to which I shall refer tonight are all concerned with a mission to the Far East which I undertook in 1922-23. T h e Japanese m e m b e r of the Health Committee, on behalf of his Government, had proposed the despatch of a Mission to the Far East to study the incidence of diseases of international importance in the countries of the Far East; the part played by shipping in the spread of infection; the measures taken to prevent such spread in the ports of departure and arrival, and to make suggestions for the improvement and standardization of port health procedure. T h e proposal was approved. It was originally intended that the Mission Should consist of three delegates of different nationalities but eventually I sailed alone. In the part of the investigation that concerned Hongkong, Shanghai and part of Japan and the Philippines I had H. F. Smith of the United States Public Health Services as an " unofficial " colleague. As a prelude to the work of the Mission I attended, as a delegate of the League of Nations, the first Far Eastern Conference of the League of Red Cross Societies that was held in Bangkok in November, 1922. H e r e my preoccupations were largely concerned with problems of opium growing, drug addiction and the like. T h e relative peace and prosperity of the Far East after nearly three years' contact with war shattered Europe were more than welcome. M y mission was the first League of Nations mission to visit the Far East, a fact that very m u c h facilitated the inquiry. In 1922 enthusiasm for the League was in the ascendant.
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Many of us believed that a trail was being blazed that would lead to lasting peace. There was an enthusiasm and a spirit of dedication among League pioneers, both in the Secretariat and outside, that are wonderful to recall. My association with them is a memory that I treasure perhaps more than any other. There was some evidence of this enthusiasm in several parts of the Far East. The League of Nations Union in Japan, for example, was an active and very influential body. Thus it was that the amount of co-operation, hospitality and kindness accorded me throughout my long tour was so vastly in excess of my deserts or my expectations. The tour lasted nine months during which all important ports were visited. I kept a very detailed private diary of my doings and impressions during those strenuous months. Today that diary makes strange reading. I found much more to praise than to deprecate but, alas, many of the conditions I described, I might almost say the countries I described, exist no longer. This is noteworthy in chapters dealing with China, Japan, Formosa, Korea, Manchuria, the Dutch East Indies and, to some extent, French Indochina. Many activities of much fair promise seem to have come to naught. Japan in 1923 had a liberal administration. There I received cordial co-operation, •ungrudging help and much hospitality from officials and innumerable health workers. I made contact with several research workers of international reputation, including Kitasato. Baron Kitasato had become a senator and was too deeply immersed in politics to do any active research but he continued to take a very lively interest in the important work that was being done in the Kitasato Institute: he was looked upon as the father of Japanese medical research. I received much hospitality, kindness and help from him and his associates. Kitasato was one of the original Honorary Fellows of our Society. With Miyajima I paid short visits to Formosa and Korea, in both of which colonies I was favourably impressed by the medical and health activities of the administration. Korea was of special interest to me thirty years ago because it had never suffered from plague though it had had constant maritime communication with plague infected ports since the beginning of the century. Moreover only the Yalu River separates it from Manchuria where epidemics of pneumonic plague of great severity had occurred. To my delight I found Professor Shiga in charge of the medical and health administration of Korea. I had first met Shiga at an international medical congress in Bombay in 1908: the fifteen years that had elapsed had aged him but little. Shiga was the last surviving original Honorary Fellow of our Society. My few days with him in Seoul are a very happy memory. I wish I had time to tell you something of Korea as it was thirteen years ago. No place that I have ever seen seemed less likely to become the cockpit of rival ideologies. Its people seemed care-free and the reverse of belligerent. Seoul was an attractive town. There was a good deal of interest in hospitals and laboratories in both Seoul and Pusan. Shiga very kindly offered to accompany me on my journey through Manchuria. Our party on that memorable journey included Shiga, Miyajima, Tsurumi (Chief of the Sanitary Department of the South Manchurian Railway) and Wu Lien Teh whose work on plague is familiar to all of you. He had come from China to Seoul to meet me. It was interest in problems of pneumonic plague that prompted the extension of my journey so far north: there had been quite a severe epidemic in 1920-21. We went as far north as Harbin where the Trans-Siberian, Manchurian and Vladivostock Railways meet. Wu Lien Teh was then Chief of the Manchurian Plague Prevention Service which had its headquarters laboratory, hospital and quarantine station in Harbin: some interesting research work was being done. Manchuria was then a Chinese Province under the somewhat despotic rule of the notor-
F. NORM£N W H I T E
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ious Chang Tao Lin. The Kwangtung Leased Territory (some 1,300 square miles in extent) with its capital Port Arthur had passed into Japanese hands at the end of the Russo-Japanese war in 1905. At the same time the South Manchurian Railway from Dairen to Changchun, with its branch lines, was annexed by Japan: this included leased enclaves at all the important railway centres. From Changchun the Chinese Eastern Railway ran north to Harbin: the medical personnel of this section of the line at the time of my visit was Russian. The Japanese Medical and Sanitary Services of the South Manchurian Railway were doing very good work; their hospitals and medical schools at Mukden and Dairen were contributing much to the welfare of Manchuria. I parted with my Japanese friends in the port of Yingkou (Newchwang) with great regret; I had abundant excuse for being very Japanophile thirty years ago. With Wu Lien Teh I travelled to Peking and opened another chapter of my Odyssey. My journey through French Indo-China started in Haiphong. In Hanoi the Governor General was good enough to interest himself personally in the arrangements for my tour. Dr. Asselin, the Deputy Director General of the Civil Medical and Sanitary Services was deputed to accompany me and no more competent or delightful guide could have been found. We travelled by motor car on almost perfect roads through Tongkong, Annam, Cochin China and Cambodia, a distance of some 3,000 kilometres, stopping to inspect hospitals and other institutions of health interest in the towns through which we passed, and collect documentation that had been prepared for me. There were few finer motor drives anywhere in the world than that along the coastal road of Annam thirty years ago. In Nhatrang, a small port at the southern end of that coast, there is a Pasteur Institute, devoted at that time to veterinary research and the production of veterinary vaccines and sera. Its director was Yersin, the discoverer of the plague bacillus. He was about sixty years of age but was still an active and enthusiastic research worker. He had many interests but plague was no longer one of them though, incidentally, Nhatrang had long been a minor but interesting focus of endemic rat-plague. For him, I think, plague had begun to lose its interest as soon as he had isolated its bacillus. Chief among his preoccupations at the time of my visit were cattle plague, astronomy, and some experimental work concerned with quinine and rubber cultivation. He loved the Orient and rarely visited France: a year or two later he did return; we dined together in Paris. H i s stay in his mother country was of the shortest: before we could meet again he was on board an eastward-bound steamer; the call of the east was too strong. He died in 1943 at the age of eighty. The Pasteur Institute of Saigon, the chief research institute of Indo-China, was doing admirable work under the direction of Noel Bernard, an original investigator whom I hold in the highest regard. He was of the greatest help to me as was l'Herminier, the volatile Director of Health of Cochin China. An interesting focus of endemic plague in Pnom Penh prompted the extension of my tour into Cambodia. I have left no time to pay my tribute to the work that was being done in the Dutch East Indies thirty years ago. I made a most interesting tour through Java. All workers in tropical medicine know how much we owe to medical research work carried out in the Dutch East Indies during the first four decades of this century. I went to Java with great expectations, none of which was disappointed. My Far East tour provided a~n admirable opportunity for a comparative study of colonial public health administrations, British, French, Dutch, Japanese, and of the United States as exemplified in the Philippines. There were interesting differences--differences of priorities
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and emphasis rather than of fundamentals. Every administration studied had something worthy of emulation. In these strange days much writing and much oratory is devoted to the denigration of colonization. Colonization and colonies have become words of almost sinister import. Some quite clever people have taken part in this campaign of vituperation but many more much less well informed. For those who have devoted their working lives to the health problems of peoples in tropical countries such outbursts must often appear fantastic or singularly ill informed. When I hear or read such utterances my mind turns to the countless members of our profession of many nationalities who have done so much for the welfare of colonial peoples, to the research institutes and workers in tropical lands whose discoveries have led to the control or elimination of many diseases that formerly extorted so heavy a toll in suffering and premature death, and to the many who have sacrificed their lives in these high endeavours. Some of them are famous but the memory of many lives only in the hearts of the people among whom they lived and worked. The record is a proud one. Great Britain's pride in her colonial possessions at the dawn of this century was not altogether unjustified: there is very much on the credit side of the account. Fellows of our Society need no reminding of all this but it is well that we should sometimes pay a tribute to the memory of our colleagues who have fallen by the way. The very voluminous report that was the outcome of my Far East tour contained recommendations regarding the establishment of an Epidemiological Intelligence Bureau in Singapore which would be responsible for the collection and regular and rapid dissemination of up-to-date information regarding health conditions in ports throughout the Far East--in code to health administrations and in clear by wireless transmission for the information of ships at sea. Throughout my tour I was impressed by the fact that much more information of epidemiological interest and importance was available locally than could be gleaned from health reports etc. Sometimes such information only became significant by the light of knowledge of the behaviour of the disease in question elsewhere. I hoped that the Singapore Bureau, when it materialized, might act as a clearing station for information of this kind and might also be able to co-ordinate inquiries in the different countries into epidemiological problems of interest to the area as a whole. The proposal for the creation of the Singapore Bureau was approved by the Health Committee and the Council of the League of Nations and thanks to a generous grant from the International Health Division of the Rockefeller Foundation the Bureau was installed and began work in February, 1925. Prior to its opening details concerning its function and methods of work were agreed upon at a Conference at Singapore which was attended by delegates from the Health Administrations of all countries of the Far East. I was privileged to preside over that harmonious and fruitful Conference. The Bureau fully justified itself and did much to facilitate and render more effective port health procedure. In spite of the vicissitudes to which it has been subjected it still carries on, To its first director, my friend the late Gilbert Brooke, the then distinguished port health officer of Singapore, belongs much of the credit for the success and smooth working of the Bureau in its early years. Now that my story approaches its end I am oppressed with a fear that the stories I have conjured up from bygone days can have had but scant interest for the present generation. Delving into the past has enabled me to introduce to you some well known, some little known, colleagues who meant so much to me. Most have joined the great majority but they have been living companions to me during the preparation of this talk. There are many others in many countries, to whom I am equally indebted; they are not forgotten.
OPENING MEETING OF THE FORTY-SEVENTH SESSION of the ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE
held at
Manson House, 26, Portland Place, London, W.1 on
Thursday,
15th
October,
1953,
at
7.30
p.m.
PRESIDENTIAL ADDRESS
RETROSPECT BY
F. NORMAN WHITE, e.I.E., M.D., D.P.H. It is inevitable that a presidential address delivered by one as old as I should be chiefly concerned with events of a bygone age and be to a regrettable extent autobiographical. From the somewhat copious records of a not uneventful life I have selected certain episodes, not for their intrinsic importance--some, indeed, are almost trivial~but because they either retain an interest or significance in the light of present-day conditions or else concern individuals who have made important contributions to tropical medicine in the years gone by. It is just fifty years since I first arrived in India, when tropical medicine first became an absorbing interest to me. I shall have very little to say tonight about my short seventeen years' service in the I.M.S., full of interest though they were. I should like, however, to refer to the closing chapter of my Indian career. During the latter half of the first World War I was entrusted with the work of the Sanitary Commissioner of the Government of India. They were years of great stress and anxiety. The, at best, meagre health and medical services had been depleted by the war effort and were only just sufficient for routine work, if all went well. Things went persistently badly. In the autumn of 1917 malaria was epidemic in parts of Northern India: the plague epidemic of 1917-18 was the most severe that India had suffered for eleven years: failure of the monsoon in 1918 resulted in food scarcity and high prices: there was considerable anxiety regarding the importation of various infections, and fresh strains of infection, with troops returning from overseas: and then came influenza. The epidemic wave of influenza in the autumn of 1918 in the central, northern and western parts of India and in territories across India's north-west frontier was a catastrophe almost without parallel in the history of epidemics. Within the space of two months it caused the
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deaths of some six million people in India alone, more than half the total n u m b e r of deaths that had been attributed to plague during the previous twenty years. T h e so-called Spanish influenza had been unduly prevalent in Europe during the spring and early summer of 1918, spreading along lines of communication from western Europe to most parts of the world. It had caused much sickness but little mortality. T h e pandemic appeared to have died down, when suddenly it flared up again with terrible intensity and almost simultaneously in all parts of the world, except Australasia, but nowhere with the severity that it did in India and adjacent territory. Everywhere adolescents, young adults and people in the prime of life suffered most: the very young and the old displayed a surprising immunity. No one who took an active part in our impotent efforts td control the disease in the worst affected parts of India is likely to have forgotten his experiences. T h e first reports of alarming mortality were from Bombay whither I hurried. M y brief visit there was long enough to ascertain the nature of the disease and to satisfy myself that it was not yellow fever. T h e possibility of the introduction of yellow fever into India was, for a time, something of a nightmare to some of us. I was very soon recalled to Delhi where conditions were almost as bad as in Bombay, and in Delhi I stayed for the remainder of those tragic weeks. All doctors who escaped infection worked day and night. In a report that I wrote for the Government of India on the conclusion of the epidemic I quoted from a report sent me from the Punjab; it ran as follows : " The hospitals were choked so that it was impossible to remove the dead quickly enough to make room for the dying; the streets and lanes of the cities were littered with dead and dying people; the postal and telegraph services were completely disorganized; the train service continued, but at all the principal stations dead and dying people were being removed from the trains; the burning ghats and burial grounds were literally swamped with corpses, while an even greater number awaited removal; the depleted medical service, itself sorely stricken by the epidemic, was incapable of dealing with more than a minute fraction of the sickness requiring attention; nearly every household was lamenting a death, and everywhere terror and confusion reigned." T h a t gruesome description in no way exaggerates conditions during a few terrible weeks as some of us saw them. Rural areas suffered even more than towns. Some villages in the Central Provinces were literally de-populated. By the end of November mortality rates had returned to normal almost e v e r y w h e r e - - a n d the long war was over. One reason which prompted this reference to that terrible epidemic is that it was the indirect cause of my leaving India. Influenza had spared neither Europe nor America and the Allied countries convened a medical conference in Paris in March 1919, to take stock of the situation and to frame measures, if possible, to prevent the recurrence of a like catastrophe. I was delegated at very short notice to represent the G o v e r n m e n t of India at that Conference. I was accompanied by Colonel Greig, I.M.S., who had done considerable work on the bacteriology of the Indian outbreak. In Paris, after nine years unbroken absence from Europe, I made m y first contact with many distinguished European medical colleagues whom I was later to know so well. One of the members of the British delegation at that conference later became a President of our Society, Rear-Admiral Sir Percy Bassett-Smith. I saw much of him during that ten-day stay in Paris: he was a delightful companion. F r o m Paris I came back to England on leave, resigned m y Commission in the I.M.S., and on the 1st January, 1920, became a medical officer in the Ministry of Health. M y stay in the Ministry was destined to be very short. At that time the League of Nations was just coming into being. T h e Secretary General of the League, Sir Eric D r u m m o n d, and the nucleus of an international Secretariat had temporary office accommodation in Curzon Street, London. T h e r e had been no General
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Assembly of the League but the Council had held its first meeting towards the close of 1919. At its second meeting in February, 1920, the Council decided to convene an International Conference of Health Experts to frame a constitution for a Health Organization which would enable member states of the League to honour their obligation under Article 23 of the Covenant of the League to " take steps in matters of international concern for the prevention and control of disease." That International Conference of Health Experts met in London in April, 1920. Before dealing with its main agenda the Conference was asked to consider and advise on a very urgent health problem. Uncontrolled epidemics of typhus and relapsing fever were spreading from Russia into the eastern districts of Poland and of adjacent countries bordering on Russia, and constituted a very grave threat to war-devastated Europe. A delegation from Poland, which included Chodzko and Rajchman, brought alarming news as to the gravity of the situation. An ambitious programme of control measures was elaborated by the Conference: amongst other things it advocated the establishment of a long line of cleansing stations and hospitals at strategic points close to the Russian frontier and the appointment of an ad hoc international Epidemic Commission to co-ordinate a combined effort and to work with the Health Administrations of Eastern Europe. The approximate cost of the scheme as then planned exceeded three million pounds. Sir George Buchanan was the chief British delegate at the Expert Conference: he asked me to help him and I was called on to do considerable work for the Typhus Conference with the result that at its close I was invited to take medical charge of the international Epidemic Commission that it was proposed to set up. I was seconded from the Ministry of Health to the League of Nations for a period of three months in the first instance. I stayed with the League for fifteen years. In the following month--May, 1920--1 went with the report of the London Conference to Rome where the Council of the League held its third meeting. The Council was a peripatetic institution before the League established its permanent headquarters in Geneva. The Council in Rome approved the recommendations of the London Conference but reduced the sum to be spent to two million pounds, which sum, they thought, might be contributed by member states. I was instructed to go at once to Poland to study the situation anew and to frame detailed proposals for the expenditure of that sum to the best advantage. Thus the Epidemic Commission of the League of Nations came into being. It was an event of some significance. It was the first occasion on which States undertook to accept financial responsibility for epidemic control measures in times of peace, in countries other than their own.' Time does not permit of any detailed description of the interesting developments that followed. At first financial contributions from States came in very slowly. The delay thus enforced in starting serious work, vexatious enough at the time, turned out for the best. Fighting flared up again between Soviet and Polish forces. The Red Army made a deep incursion into Poland almost to the gates of Warsaw whence they were driven back, incidently leaving much typhus and some cholera in their train. Had our programme been put in hand as promptly as I had desired the most important of our installations would have been overrun. Meanwhile the summer drew to a close. The first General Assembly of the League of Nations was due to take place at the beginning of December, 1920, in Geneva, whither the Secretariat had moved to permanent headquarters. It was decided to send a Commission
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of three to report on conditions in Poland, as they were at the close of Russo-Polish hostilities, direct to the Assembly. This task was entrusted to Madsen, the Director of the State Serum Institute of Copenhagen, Pottevin, the Deputy Director of the Office International d'Hygi~ne Publique of Paris and myself. At the end of October we leftfor Poland. W e visited several areas in the Frontier provinces. One day I particularly remember. In the Lida area, east of Grodno, which the Russians had evacuated but a few weeks before and where no Polish civil administration had yet been set up, we visited numerous villages selected more or less at random from a map. W e found some villages partially or wholly destroyed. Typhus fever was found in every inhabited village visited: in some villages in every house. Cases of both cholera and relapsing fever were seen that day. Conditions were indescribably bad. Never before nor since have I seen a greater degree of louse infestation. (There was no D D T in those days and typhus fever was a most disagreeable disease to fight). Conditions elsewhere along the frontier were but little better. Trains packed with refugees were arriving, each with its quota of typhus patients and the dead bodies of typhus victims. It was a somewhat lurid report that we presented to the First General Assembly of the League of Nations in Geneva in December. It was not difficult to make out a convincing case for international action. The Assembly confirmed the earlier decisions of the Council regarding the establishment of the Epidemic Commission. National contributions began to come in and we started serious work. My head office remained in London and we opened an office in Warsaw. My most active colleague was L. Rajchman, then Director of the Warsaw Bacteriological Institute which he had founded. A year or so later he became the first Director of the Health Section of the League of Nations Secretariat and it was to his enthusiasm, drive and initiative that the remarkable achievements of the League's Health Organization in its early years were mainly due. Colonel Gautier of the French Army Medical Service and a representative of the League of Red Cross Societies were the two other Commissioners in Warsaw at that time. The resolution of the Assembly of the League of Nations which had authorized a start of the campaign, within the limits of the funds that had been promised, instructed the Epidemic Commission to solicit the close co-operation of the Office International d'Hygi~ne Publique, the Comit6 International de la Croix-Rouge and the League of Red Cross Societies. To facilitate this co-operation an Advisory Committee was set up on which each of these bodies was represented. Professor Madsen represented the Office International d'Hygi~ne Publique; Dr. Ferri~re and M. Frick the Comit~ International de la Croix-Rouge; Professor Winslow the League of Red Cross Societies, of which he was at that time the Medical Director: the League Secretariat was represented by Dame Rachel Crowdy, the Director of the Social Section. This Advisory Committee met only once, in Poland in April, 1921. It approved the work being done and the administrative arrangements that had been made by the Epidemic Commission. The League of Red Cross Societies gave very material assistance throughout the campaign. From th e beginning the Epidemic Commission's work had been hampered by lack of reliable information regarding the health conditions prevailing inside Soviet Russia at that time. The medical profession in the west had had no contact with their Russian colleagues for four years. The iron curtain was almost as impenetrable then as it is now. In January, 1921, I tried to establish contact. Through the good offices of Frick of the Comit6 International de la Croix-Rouge I was invited to accompany a German delegation from Berlin to Riga where it was to meet a similar Russian delegation to arrange for the repatriation of
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prisoners of war. Some important health problems were involved and I hoped that I should be able to make contact with some important Russian health officials. Professor R. Otto, Director of the Robert Koch Institute, was the chief medical adviser of the German delegation. His name was well known to students of tropical medicine in those days. This was my first meeting with him: our association was most friendly and, to me, both profitable and full of interest. The political atmosphere of Riga in those days was not a little tense. Russian and Polish delegations were there negotiating a peace treaty. My stay in Riga was eventful, very interesting and revealing in many ways, but my visit failed in its main objective. I returned with but little more reliable information regarding health conditions inside Russia than I had when I went. In September, 1921, we tried again with better results. In the meantime news of the appalling famine conditions prevailing inside Russia had reached the outside world. Nansen had set up his famine relief organization under the auspices of the League of Nations. It was due to Nansen's intervention that permission was given for Rajchman and me to visit Moscow. I find it impossible to refer even thus casually to Nansen without paying a tribute to the memory of that truly great man. All who were privileged to know him, even slightly, will feel as I do that life would have been poorer without that experience. Nansen was a name to conjure with in Russia in those sombre days. Rajchman and I arrived in Moscow, by train from Riga, on the 24th September, 1921, and stayed a week, a week so full of unusual experiences that in retrospect it seems much longer. " Red Moscow, the Heart of the World Revolution," as I saw it self-described in English on the shuttered window of a delapidated shop in an important thoroughfare, was a very sad city in those days. We were quartered in a rat and bug infested room in what was still euphemistically called the Savoy Hotel. We might have been more comfortably housed in one or other of the foreign mission buildings, which had recently been opened, but we were most anxious to avoid giving any impression that our visit to Moscow had any other motive than matters of public health. The time was not very opportune for the visit of a Pole and an Englishman. Polish-Russian relations were still somewhat strained, and Lord Curzon, our Foreign Minister, had just sent another note to the Soviet Government that was almost tantamount to an ultimatum. You must remember that in 1921 the Russian revolutionary government was but four years old; Lenin was still supreme and Trotsky was in command of the armed forces; the interesting attempt to abolish money had been tried and failed but money was still a commodity of doubtful value (I changed money at the rate of 300,000 roubles to the pound: the rate subsequently fell much lower than that): private trading which had been prohibited was legal once more, but there was little to buy in the shops: epidemics of typhus and relapsing fevers and cholera had ravaged most parts of the vast country and were still widespread: and then came famine. Conditions were catastrophic. Litvinoff, the deputy foreign minister, received us courteously. When he was convinced that our interests were strictly confined to matters of public health and that we were sincerely anxious to do what we could to assist his country in her efforts to control epidemic disease, we had few further troubles. We went everywhere unmolested. We had several interviews with Siemaszko, the People's Commissar for Public Health; he and several members of his staff eventually became co-operative. We were shown all we asked to see in the way of hospitals, research institutes, laboratories and other health institutions. I regret time does not allow of a description of some of these. There was a good deal to admire, most
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of all, I think, the devotion of some doctors and nurses who were doing selfless work in conditions which appeared to me to be deplorably hard. We were most anxious to make contact with Tarassevitch but he was not in Moscow. The older members of my audience may remember the great reputation Tarassevitch had as a bacteriologist and research worker before the first World War; he was the acknowledged leader of medical research in Russia. He had collaborated with Metchnikoff, the celebrated disciple of Pasteur. We learnt that he had been a member of a Committee of all parties that had been formed to take charge of all famine relief work. The members of that Committee had been arrested soon after its formation. Tarassevitch was released almost at once. We eventually learnt of his whereabouts from a relative of his who offered to act as our guide. In a car lent to us by the Polish Legation we motored to a small village some 55 verst north of Moscow where Tarassevitch was having a holiday in a small cottage. He was a very delightful man of little more than fifty years of age, but he looked older. He spoke French with great ease and fluency. Having recovered from the surprise of the unheralded arrival of such unexpected foreign visitors, he enjoyed the opportunity of learning something at first hand of events and medical affairs in the outside world from which he had been so completely cut off. We talked for about five hours and were treated most hospitably. We persuaded him to drive back with us to Moscow. We foregathered again that evening in his Moscow fiat where he had asked several of his friends and colleagues to meet us. Talk went on to the small hours of the morning. I learnt more of events in Russia than I ever expected to be able to do in so short a visit. I have spoken thus much of Tarassevitch because to me he was and is the prototype of those of our Russian colleagues who in spite of every discouragement and incredible hardship stuck to their posts and did everything possible to relieve the sufferings of their people during those years of dire misfortune. I met several such men. Of their political or ideological affiliations I knew little or nothing but they excited my deep admiration. The Moscow I have described was Moscow at its worst. At a second visit which I paid that city in 1924, when I addressed a large pan-Russian Medical Congress on " International Co-operation in Public Health," I found conditions vastly improved. When Rajchman and I left Moscow Tarassevitch promised to write an account of the epidemics that had devasted Russia during the years of isolation from the west. Arrangements were also made to attach a member of the Epidemic Commission to Nansen's Famine Relief Office in Moscow, to keep us in touch with Russian health authorities. Dr. Farrar, who had just retired from the Ministry of Health, was selected for the post. That appointment was made against my better judgement. Farrar was about 60 years of age and typhus fever as then occurring in Eastern Europe had a very high case mortality rate among doctors of that age. But an opportunity of philanthropic work of that kind was so attractive to Farrar that I yielded to his entreaties. There was never any doubt about his technical competence or general suitability for the work. I took him to Geneva to introduce him to Nansen with whom he travelled to Moscow. Farrar died of typhus fever in Moscow, Christmas, 1921, little more than a month after his arrival. I salute the memory of a very lovable colleague. In a report on " Epidemics in Russia since 1914 " which Tarassevitch, faithful to his promise, sent us in 1922, reference is made to the high mortality rates that had prevailed among Russian doctors. The chief causes of death in the medical profession had been tuberculosis, suicide, and typhus fever, in that order. This part of his report closes with two paragraphs that I shall quote in full : " The number of the victims and of the lives sacrificed bears clear and eloquent witness to the
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fact that Russian doctors have remained faithful to their traditions, that they have served and continue to serve their country, humanity and science to the utmost of their capacity, and that each of these martyrs to duty has carved the epitaph ' Feci quodpotui.' "Fresh victims must be added to this sad list: I need only mention Dr. Farrar (of the Nansen Organization) and Dr. Giirtner (of the German Red Cross). We, who are always on the brink of death and disaster, are accustomed to bear such blows in silence. But we cannot keep silent when noble and generous men, who leave their country, their homes, their families, their accustomed occupations to come to our assistance, join our ranks and are struck down in our midst. We tender our profoundest sympathy, gratitude and respect to their colleagues and to their families. These martyrs have not fallen in vain; they give us new strength and courage; they bear the torch which is to lighten our darkness and they implant in us the faith that one day unity and peaceful work will reign throughout the world and throughout our country." T h a t pathetic tribute reveals much of the character of Tarassevitch. It was full of encouragement to me then and it has not lost its significance for me today, though more than thirty years have passed since it was written and men of the calibre of the writer are few and far between. During the twelve years that followed the period of which I have spoken I was privileged to work intimately with medical m e n and research workers of very many nationalities and in many countries. It was always possible to obtain whole-hearted friendly collaboration in any work designed to promote the welfare of humanity, or to enlarge our knowledge of the causation, prevention or cure of disease. T h e contribution to world peace and international understanding which such co-operative work can make is not negligible. T h a t is one reason why the work of the World Health Organization, "which has carried on and greatly extended work begun by the League of Nation's Health Organization, merits every support. T i m e does not allow me to complete the story of the Epidemic Commission. We received but a quarter of the sums we had originally hoped for but we were able to give very material assistance to the Health Administrations of Eastern Europe, chiefly Poland, in coping with a difficult and dangerous epidemic situation. In January, 1922, the head office of the Epidemic Commission was moved from L o n d o n to Geneva and our activities were incorporated in the newly created Health Organization of the League. I was still styled Chief Epidemic Commissioner but I acted, in addition, as Rajchman's deputy. T h e only other episodes in my career to which I shall refer tonight are all concerned with a mission to the Far East which I undertook in 1922-23. T h e Japanese m e m b e r of the Health Committee, on behalf of his Government, had proposed the despatch of a Mission to the Far East to study the incidence of diseases of international importance in the countries of the Far East; the part played by shipping in the spread of infection; the measures taken to prevent such spread in the ports of departure and arrival, and to make suggestions for the improvement and standardization of port health procedure. T h e proposal was approved. It was originally intended that the Mission Should consist of three delegates of different nationalities but eventually I sailed alone. In the part of the investigation that concerned Hongkong, Shanghai and part of Japan and the Philippines I had H. F. Smith of the United States Public Health Services as an " unofficial " colleague. As a prelude to the work of the Mission I attended, as a delegate of the League of Nations, the first Far Eastern Conference of the League of Red Cross Societies that was held in Bangkok in November, 1922. H e r e my preoccupations were largely concerned with problems of opium growing, drug addiction and the like. T h e relative peace and prosperity of the Far East after nearly three years' contact with war shattered Europe were more than welcome. M y mission was the first League of Nations mission to visit the Far East, a fact that very m u c h facilitated the inquiry. In 1922 enthusiasm for the League was in the ascendant.
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Many of us believed that a trail was being blazed that would lead to lasting peace. There was an enthusiasm and a spirit of dedication among League pioneers, both in the Secretariat and outside, that are wonderful to recall. My association with them is a memory that I treasure perhaps more than any other. There was some evidence of this enthusiasm in several parts of the Far East. The League of Nations Union in Japan, for example, was an active and very influential body. Thus it was that the amount of co-operation, hospitality and kindness accorded me throughout my long tour was so vastly in excess of my deserts or my expectations. The tour lasted nine months during which all important ports were visited. I kept a very detailed private diary of my doings and impressions during those strenuous months. Today that diary makes strange reading. I found much more to praise than to deprecate but, alas, many of the conditions I described, I might almost say the countries I described, exist no longer. This is noteworthy in chapters dealing with China, Japan, Formosa, Korea, Manchuria, the Dutch East Indies and, to some extent, French Indochina. Many activities of much fair promise seem to have come to naught. Japan in 1923 had a liberal administration. There I received cordial co-operation, •ungrudging help and much hospitality from officials and innumerable health workers. I made contact with several research workers of international reputation, including Kitasato. Baron Kitasato had become a senator and was too deeply immersed in politics to do any active research but he continued to take a very lively interest in the important work that was being done in the Kitasato Institute: he was looked upon as the father of Japanese medical research. I received much hospitality, kindness and help from him and his associates. Kitasato was one of the original Honorary Fellows of our Society. With Miyajima I paid short visits to Formosa and Korea, in both of which colonies I was favourably impressed by the medical and health activities of the administration. Korea was of special interest to me thirty years ago because it had never suffered from plague though it had had constant maritime communication with plague infected ports since the beginning of the century. Moreover only the Yalu River separates it from Manchuria where epidemics of pneumonic plague of great severity had occurred. To my delight I found Professor Shiga in charge of the medical and health administration of Korea. I had first met Shiga at an international medical congress in Bombay in 1908: the fifteen years that had elapsed had aged him but little. Shiga was the last surviving original Honorary Fellow of our Society. My few days with him in Seoul are a very happy memory. I wish I had time to tell you something of Korea as it was thirteen years ago. No place that I have ever seen seemed less likely to become the cockpit of rival ideologies. Its people seemed care-free and the reverse of belligerent. Seoul was an attractive town. There was a good deal of interest in hospitals and laboratories in both Seoul and Pusan. Shiga very kindly offered to accompany me on my journey through Manchuria. Our party on that memorable journey included Shiga, Miyajima, Tsurumi (Chief of the Sanitary Department of the South Manchurian Railway) and Wu Lien Teh whose work on plague is familiar to all of you. He had come from China to Seoul to meet me. It was interest in problems of pneumonic plague that prompted the extension of my journey so far north: there had been quite a severe epidemic in 1920-21. We went as far north as Harbin where the Trans-Siberian, Manchurian and Vladivostock Railways meet. Wu Lien Teh was then Chief of the Manchurian Plague Prevention Service which had its headquarters laboratory, hospital and quarantine station in Harbin: some interesting research work was being done. Manchuria was then a Chinese Province under the somewhat despotic rule of the notor-
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ious Chang Tao Lin. The Kwangtung Leased Territory (some 1,300 square miles in extent) with its capital Port Arthur had passed into Japanese hands at the end of the Russo-Japanese war in 1905. At the same time the South Manchurian Railway from Dairen to Changchun, with its branch lines, was annexed by Japan: this included leased enclaves at all the important railway centres. From Changchun the Chinese Eastern Railway ran north to Harbin: the medical personnel of this section of the line at the time of my visit was Russian. The Japanese Medical and Sanitary Services of the South Manchurian Railway were doing very good work; their hospitals and medical schools at Mukden and Dairen were contributing much to the welfare of Manchuria. I parted with my Japanese friends in the port of Yingkou (Newchwang) with great regret; I had abundant excuse for being very Japanophile thirty years ago. With Wu Lien Teh I travelled to Peking and opened another chapter of my Odyssey. My journey through French Indo-China started in Haiphong. In Hanoi the Governor General was good enough to interest himself personally in the arrangements for my tour. Dr. Asselin, the Deputy Director General of the Civil Medical and Sanitary Services was deputed to accompany me and no more competent or delightful guide could have been found. We travelled by motor car on almost perfect roads through Tongkong, Annam, Cochin China and Cambodia, a distance of some 3,000 kilometres, stopping to inspect hospitals and other institutions of health interest in the towns through which we passed, and collect documentation that had been prepared for me. There were few finer motor drives anywhere in the world than that along the coastal road of Annam thirty years ago. In Nhatrang, a small port at the southern end of that coast, there is a Pasteur Institute, devoted at that time to veterinary research and the production of veterinary vaccines and sera. Its director was Yersin, the discoverer of the plague bacillus. He was about sixty years of age but was still an active and enthusiastic research worker. He had many interests but plague was no longer one of them though, incidentally, Nhatrang had long been a minor but interesting focus of endemic rat-plague. For him, I think, plague had begun to lose its interest as soon as he had isolated its bacillus. Chief among his preoccupations at the time of my visit were cattle plague, astronomy, and some experimental work concerned with quinine and rubber cultivation. He loved the Orient and rarely visited France: a year or two later he did return; we dined together in Paris. H i s stay in his mother country was of the shortest: before we could meet again he was on board an eastward-bound steamer; the call of the east was too strong. He died in 1943 at the age of eighty. The Pasteur Institute of Saigon, the chief research institute of Indo-China, was doing admirable work under the direction of Noel Bernard, an original investigator whom I hold in the highest regard. He was of the greatest help to me as was l'Herminier, the volatile Director of Health of Cochin China. An interesting focus of endemic plague in Pnom Penh prompted the extension of my tour into Cambodia. I have left no time to pay my tribute to the work that was being done in the Dutch East Indies thirty years ago. I made a most interesting tour through Java. All workers in tropical medicine know how much we owe to medical research work carried out in the Dutch East Indies during the first four decades of this century. I went to Java with great expectations, none of which was disappointed. My Far East tour provided a~n admirable opportunity for a comparative study of colonial public health administrations, British, French, Dutch, Japanese, and of the United States as exemplified in the Philippines. There were interesting differences--differences of priorities
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and emphasis rather than of fundamentals. Every administration studied had something worthy of emulation. In these strange days much writing and much oratory is devoted to the denigration of colonization. Colonization and colonies have become words of almost sinister import. Some quite clever people have taken part in this campaign of vituperation but many more much less well informed. For those who have devoted their working lives to the health problems of peoples in tropical countries such outbursts must often appear fantastic or singularly ill informed. When I hear or read such utterances my mind turns to the countless members of our profession of many nationalities who have done so much for the welfare of colonial peoples, to the research institutes and workers in tropical lands whose discoveries have led to the control or elimination of many diseases that formerly extorted so heavy a toll in suffering and premature death, and to the many who have sacrificed their lives in these high endeavours. Some of them are famous but the memory of many lives only in the hearts of the people among whom they lived and worked. The record is a proud one. Great Britain's pride in her colonial possessions at the dawn of this century was not altogether unjustified: there is very much on the credit side of the account. Fellows of our Society need no reminding of all this but it is well that we should sometimes pay a tribute to the memory of our colleagues who have fallen by the way. The very voluminous report that was the outcome of my Far East tour contained recommendations regarding the establishment of an Epidemiological Intelligence Bureau in Singapore which would be responsible for the collection and regular and rapid dissemination of up-to-date information regarding health conditions in ports throughout the Far East--in code to health administrations and in clear by wireless transmission for the information of ships at sea. Throughout my tour I was impressed by the fact that much more information of epidemiological interest and importance was available locally than could be gleaned from health reports etc. Sometimes such information only became significant by the light of knowledge of the behaviour of the disease in question elsewhere. I hoped that the Singapore Bureau, when it materialized, might act as a clearing station for information of this kind and might also be able to co-ordinate inquiries in the different countries into epidemiological problems of interest to the area as a whole. The proposal for the creation of the Singapore Bureau was approved by the Health Committee and the Council of the League of Nations and thanks to a generous grant from the International Health Division of the Rockefeller Foundation the Bureau was installed and began work in February, 1925. Prior to its opening details concerning its function and methods of work were agreed upon at a Conference at Singapore which was attended by delegates from the Health Administrations of all countries of the Far East. I was privileged to preside over that harmonious and fruitful Conference. The Bureau fully justified itself and did much to facilitate and render more effective port health procedure. In spite of the vicissitudes to which it has been subjected it still carries on, To its first director, my friend the late Gilbert Brooke, the then distinguished port health officer of Singapore, belongs much of the credit for the success and smooth working of the Bureau in its early years. Now that my story approaches its end I am oppressed with a fear that the stories I have conjured up from bygone days can have had but scant interest for the present generation. Delving into the past has enabled me to introduce to you some well known, some little known, colleagues who meant so much to me. Most have joined the great majority but they have been living companions to me during the preparation of this talk. There are many others in many countries, to whom I am equally indebted; they are not forgotten.