Patrick Manson (1844–1922): father of the newly-formed ... Advance/journals... · 3 Patrick...

3Patrick Manson (1844–1922): father of

the newly-formed speciality, fi lariasis research, and founder of the London

School of Tropical Medicine

Patrick Manson (1844–1922) was born at Oldmeldrum, eighteen miles north of Aberdeen. His father was manager of the local branch of the British Linen Bank and Laird of Fingask, while his mother was reported to be a distant relation of David Livingstone (see Chapter 1). Manson was the second son in a family of three boys and four girls. During his childhood he was keen on natural history, and later took to fi shing and shooting. In 1857, when he was thirteen, the fam-ily moved to Aberdeen, where he attended the Gymnasium School and later the West End Academy. At fi fteen years of age he was apprenticed to Blaikie Brothers, ironmasters, based in Aberdeen; however, whilst there he developed what was probably vertebral tuberculosis (Pott’s disease of the spine), which necessitated a prolonged period of rest.

In 1860 Manson entered the University of Aberdeen, qualifying in medi-cine at the age of nineteen; however, he was too young to graduate and in the meantime travelled to London and visited various hospitals, medical schools and museums. Graduating in October 1865, he was appointed medical offi cer to the Durham Lunatic Asylum, where he stayed for a mere seven months. In July 1866 he obtained the MD degree of Aberdeen University, and later that year he applied for and was appointed to a post in the Chinese Maritime Customs.1

51Tropical Medicine: An Illustrated History of The PioneersCopyright © 2007 Elsevier Ltd. All rights of reproduction in any form reserved.

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52 TROPICAL MEDICINE: AN ILLUSTRATED HISTORY OF THE PIONEERS

Chinese Maritime Customs

Manson sailed for Formosa (now Taiwan) and for fi ve years inspected ships call-ing at the port. In addition to treating their crews, he kept careful meteorological records; he also built a private practice consisting of both European and Chinese patients, and attended a native missionary hospital daily. Riding, gardening, bathing and fi shing in the lagoon were leisure activities. Figure 3.1 shows him while in China.

In 1871 Manson moved from Takao to the large port of Amoy on the Chinese mainland, and stayed there for thirteen years (see Figure 3.2). Here, he had medi-cal charge of shipping and a hospital for European seamen; he also served the Baptist Missionary Society’s Hospital (where his research interests were apparently frowned upon), and a Dispensary for Chinese in the native quarter. Manson also car-ried out a great deal of surgery at this time, including many lithotomies. He wrote about some of the local diseases in the Medical Reports of the Imperial Maritime

FIGURE 3.1 Patrick Manson at the age of 31 years (reproduced courtesy of The Wellcome Library, London).


PATRICK MANSON (1844–1922) 53

Customs, and invented an apparatus for draining liver ‘abscesses’.2 He also recorded tropical malabsorption and applied, probably for the fi rst time in English, the Dutch term Sprouw – then in use in Java, Dutch East Indies – to describe this entity.3 However, this was not a milieu in which to embark on research, as there were no libraries or museums, and no scientifi c meetings.

Filariasis research

Manson had seen a good deal of elephantiasis as well as scrotal disease (which he operated upon) at Amoy, caused by both Wucheraria bancrofti and Brugia malayi. While on leave in Britain in 1874–5, he pursued a literature research into this disease; he also met Timothy Lewis (1841–86; see Chapter 1), who had demonstrated ‘embryos’ (microfi lariae) of W. bancrofti in both urine and periph-eral blood, as well as adult nematodes in an elephantoid scrotum. ‘Embryos’ of this organism – Filaria sanguinis hominis – had previously been visualized by the French surgeon, J N Demarquay (1814–75), in hydrocele fl uid in 1863. Simultaneously, Joseph Bancroft (1836–94), working in Brisbane, Australia, had demonstrated both ‘embryos’ and also adults of this helminth, and it was Spencer Cobbold (1828–86), the foremost helminthologist in Britain, who fi rst named the organism Filaria bancrofti.4

FIGURE 3.2 Manson’s house in Amoy (reproduced courtesy of The Wellcome Library, London).



When Manson returned to Amoy (Figure 3.3) in late 1875 or early 1876, he therefore knew a good deal about the cause of elephantiasis. But how did Homo sapiens become infected?5 By late 1877, Manson had examined 670 ‘natives’ and found that, overall, one in every 10.8 was infected with Filaria sanguinis hominis; the number increased from 1 : 17.5 in those aged 10–20 years to 1 : 3 in those more than 70 years old. The ‘embryos’ were sheathed, but when cooled with ice the sheath ruptured and they swam freely; this suggested to Manson that part of the lifecycle took place outside the human body. Knowing that his serv-ant, Hin Lo, had a high concentration of ‘embryos’ in his peripheral blood, he carried out an experiment on 10 August 1877 – a date some designate as the date upon which the formal discipline of tropical medicine ‘took off’, although others trace this to Manson’s letter to T S Cobbold dated 27 November of that year.

This piece of clinical investigation – which modern ethical committees might well frown upon! – went as follows. Mosquitoes (Culex fatigens) were attracted into a mosquito-proof ‘cage’, using a candle, then Hin Lo slept in the closed cage overnight (see Figure 3.4). The following morning the cage was opened and the mosquitoes were collected and dissected by Manson, when they were found to possess a high concentration of ‘embryos’ in their stomachs. The result of this experiment was communicated to Cobbold in London in Manson’s letter dated 27 November. The next step was to demonstrate the development of the ‘embryos’

FIGURE 3.3 Map showing sites of Manson’s work in south-east Asia.

China

HONG KONG

AMOY(XIAMEN)

TAKAOFormosa(Taiwan)

SouthKorea



in the mosquito. The series of events was communicated to the Linnean Society in 1884. Manson also studied the nocturnal periodicity of the ‘embryos’.6

Manson had thus elucidated the man–mosquito component in transmission of a human pathogen for the fi rst time, and this paved the way for mosquito–involvement in malaria (a protozoan disease) and yellow fever (a viral disease). The mosquito–man dimension of the cycle was not, however, elucidated by Manson, but much later by G C Low (see Chapter 8).7

Whilst in Amoy, Manson also carried out research on the life-cycles of several other helminths – including: Distoma ringeri, Paragonimus westermani, Filaria immitis, several other fi lariae, and Bothriocephalus (Diphyllobothrium) mansoni.8

Hong Kong and medical education

Following leave in Aberdeenshire in 1883, Manson and his family (he had mar-ried in December 1875 and by now had a son and daughter) left not for Amoy but for Hong Kong. There he built up a substantial private practice, operated at the Civil and Memorial Hospitals, and became President of the local Medical Society. In addition, he carried out several altruistic roles.

Manson’s major contribution while in Hong Kong was, however, in the fi eld of medical education. He established a school of medicine within the

FIGURE 3.4 Oil-painting depicting Manson’s seminal investigation, i.e. demonstration of the microfi laria of lymphatic fi lariasis from man to mosquito (reproduced courtesy of The Wellcome Library, London).



Alice Memorial Hospital; this formed the focal point of the present Medical School, which was absorbed into the University of Hong Kong in 1911. In late 1886 he became Chairman of the Hospital Committee, and the following year was elected Dean of the proposed College of Medicine for the Chinese.9 In 1886 he had been joined by the surgeon Mr (later Sir) James Cantlie (1851–1926; see Chapter 7), who was later to play an important part in the early years of the London School of Tropical Medicine (see below).

In 1889, having accumulated a good deal of wealth from his private prac-tice, and after 23 years in south-east Asia, Manson decided to retire to Scotland. However, by 1890 the Chinese dollar had depreciated catastrophically and, pri-marily for fi nancial reasons, he moved to and pursued a new career in London.

LONDON LIFE AND FOUNDATION OF THE LONDON SCHOOL OF TROPICAL MEDICINE

Manson was 46 years old when he started a new career, having moved into 21 Queen Anne Street, W1, which was to be his family home for 23 years. He built up a library and small laboratory there, while his income resulted from a private practice which proved slow to take off.10 In 1890 he passed the MRCP examination, and fi ve years later he was elected FRCP. A ‘blue plaque’ has been erected on the front elevation of 50 Welbeck Street, W1 (see Figure 3.5), where Manson lived briefl y following his removal from 21 Queen Anne Street.

FIGURE 3.5 Blue plaque on the front elevation of 50 Welbeck Street, W1, briefl y the London home of Manson following his removal from 21 Queen Anne Street.



The signifi cant breakthrough came in May 1892, when he was appointed Physician to the SHS (see Chapter 20), with fi fteen beds at the newly opened Branch (Albert Dock) Hospital (ADH).11 Whilst in China, and in London for two years, Manson had carefully followed the ‘malaria saga’ which had begun with Alphonse Laveran’s (see Chapter 4) demonstration of Plasmodium spp. in a blood sample in Algeria in 1880. Two years later, in 1894, he was invited to give the Goulstonian Lectures to the Royal College of Physicians; these dwelt on the pos-sible role of the mosquito in conveying the infection to Homo sapiens (in a simi-lar way to his own observation(s) on lymphatic fi liariasis carried out some years before at Amoy) and were published in both the Lancet and the British Medical Journal.12 There is in retrospect no doubt that this induction (hypothesis) subse-quently had a profound infl uence on Ross’s work (see Chapter 5).13 During this time Manson also carried out research on several helminthiases – largely on blood samples and slides sent to him from various tropical locations – and also took a great interest in African trypanosomiasis (see Chapters 8, 9 and 11).14

Manson’s lectures

Arguably, teaching about tropical diseases was equally as important, if not more so, than Manson’s research interest in protozoan and helminthic infections.

On 1 October 1892, Manson, now a Lecturer on Tropical Diseases at St George’s Hospital, delivered an address on the importance of education in tropical medicine. That had been preceded by a series of lectures from May to July of that year, the course being ‘intended for medical men intending to prac-tice in the tropics or in Eastern Asia’. He felt that courses of lectures on tropical diseases (‘the hygiene and diseases of warm climates’) should take place at all UK-based teaching hospitals (which incidentally still doesn’t happen today), and that this should be encouraged by the British Government, who should take cog-nizance of certifi cates issued by the authorities promoting those lectures when selecting medical offi cers for the Colonies.15 In 1898, several years after his lectures (which began in 1892), he published his well-known monograph; the twenty-second edition of this book is currently in preparation.16

It is not known whether the Rt Hon Joseph Chamberlain FRS (1836–1914; see also Chapter 20) was purposely made aware of Manson’s efforts to establish this new discipline, or discovered it by chance. It is, however, known that Chamberlain wrote to the Dean of St George’s (Sir Isambard Owen) with a request that a notice of Manson’s lectures be distributed to Colonial Surgeons who were on leave in Britain. Thus he had the support of a leading politician who felt that Manson’s strategy (i.e. the prevention and cure of tropical disease in the servants of Empire) furthered his concept of ‘constructive imperialism’ – unlike the lukewarm or downright opposition and hostility which he received from many of his colleagues.

The foundation of the London School of Tropical Medicine

In July 1897 Manson was appointed (presumably at Chamberlain’s recommenda-tion) as Medical Offi cer of the Colonial Offi ce following the recent resignation



of the previous incumbent, Sir Charles Cage-Brown. Manson thus had to devote far more time to administration – not since his Hong Kong days had this been his dominant activity – but he still managed to deliver a number of public addresses highlighting the importance of teaching about tropical diseases. The fi rst the Seamen’s Hospital Society (Manson’s principal employer) heard about Manson’s proposed scheme was in May 1897, when he apparently conveyed his thoughts to P J (later Sir James) Michelli (1853–1935), Secretary of the SHS.

FIGURE 3.6 Ordnance Survey map showing the location of the Albert Dock Hospital (ADH) in 1895. The large arrow indicates the site of the ADH, and the smaller arrows the location of the nearest railway stations.



In February 1898, the SHS Committee of Management received the following letter (signed by H Bertram Cox) from the Colonial Offi ce:

Sir, The question of improving the medical service of the British Colonies in West Africa has been receiving Mr Secretary Chamberlain’s serious consideration [the Rt Hon Joseph Chamberlain was the British Secretary of State for the Colonies from 1895 until 1903]. At present the newly appointed medical offi cers receive no special training in the diagnosis and treatment of tropical diseases [my italics] before they proceed to West Africa and, although an attempt is made to give them whenever possible some preliminary instruction at the Headquarters Hospital of the Colony, this course cannot be followed in every case and the arrangement is, on the whole, unsatisfactory.

He continued:

He is advised [presumably by Manson] that the experience and training to be obtained at the Seamen’s Hospital [at the Albert Docks; see Figures 3.6 and 3.7] would be the most suitable in the present instance, and he would be greatly obliged to the Managing Commit-tee if they could give him their valuable assistance in the matter.

The letter suggested further that the Foreign Offi ce should also be involved:

The Secretary of State for Foreign Affairs is being asked whether it is wished that the Pro-tectorates in East and West Africa, at present administered by the Foreign Offi ce, should

FIGURE 3.7 Engraving of the Albert Dock Hospital before the addition of the LSTM (reproduced courtesy of The Wellcome Library, London).



be included in the proposed scheme, but, in any case, it is not probable that more than six offi cers would be under instruction at any one time.

It was envisaged by Manson (with Chamberlain’s support) that, provided the ADH was enlarged, this could form the nidus for a School to house the intended specialty. The facts of the matter were ‘laid before the public’ by (Sir) Henry Burdett, a former Secretary and now a Vice-President, on behalf of the SHS in a letter to the Times in July 1898, the SHS’s Committee having already (in February) approved these plans in principle.17

The proposed London School of Tropical Medicine (LSTM) was spon-sored fi nancially by the Government and the Royal Society, and received strong support from Chamberlain and indeed the Prime Minister of the day – the third Marquis of Salisbury (1830–1903). However, Manson received a great deal of criticism from several colleagues, including John Curnow (1846–1902) and John Anderson (1840–1910), both physicians, and George Robertson Turner (1855–1941), a surgeon, at the Dreadnought Hospital. Their criticism fell under three headings:

1. A belief that other venues, such as the Royal Victoria Hospital at Netley and the Royal Naval Hospital at Haslar, were eminently more suitable for a tropical school

2. That establishment of the LSTM at the ADH would deprive the Dreadnought Hospital of most of its ‘tropical’ cases

3. That the scheme as outlined contained hidden allegations that they were themselves incompetent in their dealing with ‘tropical’ cases.18

In retrospect, these colleagues were correct in believing that there would never be great numbers of ‘tropical’ cases at the ADH; this hospital had in fact been founded in London’s docklands to deal with morbidity (most impor-tantly injuries) suffered by the local personnel employed there.19 However, with Chamberlain’s wholehearted support the venture blossomed, and the LSTM was fi rmly established at the ADH, opening its doors on 2 October 1899.

Later life

Following retirement in July 1912, Manson travelled to Ceylon (now Sri Lanka) and later South Africa and Southern Rhodesia (now Zimbabwe). In 1914 he moved to County Galway, Ireland, where he occupied his leisure hours fi shing and gardening. Figure 3.8 shows him in old age. Manson was a sufferer of severe gout throughout his latter years, and he died on 9 April 1922 after suffering from myocardial ischaemia for about a year. After a memorial service at St Paul’s Cathedral,20 London, he was buried at Allendale Cemetery, Aberdeen.

There are other events which should be incorporated for completion of the father of (modern) tropical medicine’s career. In 1904 he narrowly missed being elected to the Regius Chair of Medicine at Oxford (the successful candidate



was in fact Sir William Osler (1849–1919).21 He was appointed CMG in 1900, KCMG in 1903 and GCMG in 1912. Manson also received honorary degrees from the Universities of Oxford and Cambridge. Figure 3.9 shows a plaque at the Hospital for Tropical Diseases, London, commemorating Manson.

Clearly, Manson’s two major contributions were:

1. Elucidation of the role of the mosquito in transmitting the parasite(s) causing lymphatic fi lariasis (which was followed by similar work on malaria and yellow fever)

2. Foundation of the London School of Tropical Medicine.

FIGURE 3.8 Manson in old age (reproduced courtesy of The Wellcome Library, London).

FIGURE 3.9 Plaque erected at the Hospital for Tropical Diseases, Endsleigh Gardens, commem-orating Manson.



MANSON’S INAUGURAL LECTURE TO THE (ROYAL) SOCIETY OF TROPICAL MEDICINE IN 1907

The rapidity with which understanding of tropical disease advanced in the late nineteenth and early twentieth centuries is well illustrated in Manson’s inaugural lecture to the (Royal) Society of Tropical Medicine and Hygiene in 1907.

Manson, after apologizing for his lack of preparation, assured his audience that he was ‘fast approaching the end of [his] career’; he was in fact already 63 years old. The fi rst object of the newly-formed Society, he claimed, was ‘to bring together the men who are interesting themselves in tropical medicine’. He continued:

Although domiciled in the Metropolis, it is open to any member of the profession [wher-ever he is based], and … to those followers of any science or profession capable of for-warding, directly or indirectly, the interests of tropical medicine.

He emphasized that the Society should be broad-based, and was dependent on, especially, ‘the various branches of natural history’ (see Chapter 2).

Manson also spoke of rapid advances in the discipline which ‘within the last few years … has been as remarkable as it has been great’. In justifying this state-ment, Manson compared the state of tropical medicine in 1907 with that in Davidson’s Hygiene and Diseases of Warm Climates published in 1893. In 1883, due to faulty techniques while in China, he totally failed to fi nd Laveran’s para-site; it was not until 1889, when he was at the Seamen’s Hospital, that he became convinced of the importance of that observation. The section on tropical medi-cine in the recently published edition of Allbutt’s System of Medicine, edited by Humphry Rolleston, was in large part, he continued ‘occupied with the part played by the mosquito in the malarial drama’.

He then referred to other advances – Almroth Wright’s immunization for typhoid, ‘Zammit’s discovery that the “germ” of Malta fever [brucellosis] is eliminated in the milk of apparently healthy goats’, the ‘dependence for prop-agation of [yellow fever] on the offi ces of [the] stegomyia mosquito’, and the rediscovery of ‘the role of the rat in [the] diffusion [of plague]’. Manson spoke of recent advances in the understanding of sleeping sickness (the ‘negro leth-argy’); it was by then known, he claimed, that this trypanosomal disease was ‘to some extent [amenable] to arsenic, mercury and certain dyes’.

He claimed that the ‘tropical fl uxes – diarrhoea and dysenteries – [consti-tuted] the most important [unsolved] department of tropical medicine’, despite the fact ‘that the amoeba is creeping into favour [and the] bacillus dysenteriae [had by then been recognized]’. He stated that sprue ‘remains a mystery’, although undoubtedly ‘a specifi c disease’. There were, he claimed, ‘Still spurs to be won in this fi eld of the tropical fl uxes’, adding that the ‘specifi c relation of the amoeba to a certain type of dysentery and to liver abscess may now be regarded as thor-oughly established’.

Of the helminthic diseases, ‘Looss’s discovery [see Chapter 10] that the larval ankylostome obtains access to the intestinal canal by penetrating the



skin on the surface of the body’, ‘Leiper’s experimental demonstration that the guinea-worm may be acquired through swallowing its Cyclops intermediary’, the discovery of two new parasites (Schistosomum japonicum and Amphistomum watsoni), and the ‘linking up of the larval Filaria diurna with its parental Filaria loa [together with its causative relationship to Calabar swellings]’ came in for special mention.

Kala azar was ‘absolutely unknown’, he continued, when Davidson’s text was written. The modern textbook, Manson claimed, must also ‘have chapters on spirillosis’, because ‘relapsing fever’ covered several infections. Speaking of entomology, in Davidson’s day, he continued, ‘a single culex was all that we had to bother ourselves about; but nowadays we have to know something about some 600 species of mosquitoes’!

Manson concluded by emphasizing how His Majesty King Edward VII’s Government had shown its interest both at home and abroad by assisting with the establishment of new Tropical Schools and laboratories, and by calling an International Conference on sleeping sickness. He also spoke of his personal introduction to tropical medicine, and the fact that in 1907 – unlike the situa-tion 30 years previously, when there was no-one to turn to and only the British Museum library to provide information – there were ‘post-graduate classes of all sorts’, and the (R)STMH should prove a centre (for the fl ying visitor, unlike those studying the discipline at the Schools) for information and should welcome indi-viduals, especially those from abroad. In fact, had the Society existed in 1893, he would doubtless have been shown how to detect Laveran’s parasite (see Chapter 4) at that time. 22

ROSS’S ASSESSMENT OF MANSON

In 1930, eight years after Manson’s death, Ross penned his personal reminis-cences (the book was ‘not meant in any way as an attack on the memory of Manson’) of Manson, largely in order to downplay the latter’s contribution in the genesis of his own discoveries:

We fi nd throughout history that people who at one time were concerned in some important work gradually grow in reputation till they become heroes of romances, and are ultimately credited with many things which they would probably have repudiated had they lived long enough to do so.

Ross wrote (in typical paranoid fashion), in referring to Manson’s induction, which paved the way for his Nobel Prize-winning work, that

his praise was [at the time] exaggerated [because] it is better to err on the side of generosity than the converse; but this was no reason why all my work in India should be attributed to his inspiration.

Ross recalled that he fi rst met the ‘tall handsome man with a benign expres-sion of face’ on 10 April 1894 ‘some years before he was appointed Medical



Adviser to the Colonial Offi ce and fi rst suggested the establishment of [tropical] schools to Mr Joseph Chamberlain’. He described the appointment: it ‘brings only a small salary but a considerable addition to medical practice, and … [it] helped [Manson] to advance his schemes for founding schools of tropical medi-cine [Ross had doubts that this ‘was entirely his own idea’] in British sea-ports’. Their fi rst meeting, he continued, was at the suggestion of Surgeon General Sibthorpe, having ‘toiled at the subject [of demonstrating Laveran’s parasite] for several years’. Manson, who had learned the technique from Dr H G Plimmer, demonstrated the malaria parasite in fresh (unstained) specimens. Manson hypothesized that the mosquito (or some kind of ‘suctorial insect’) might be involved in malaria transmission, as he had demonstrated in lymphatic fi laria-sis. Ross said that he had long abandoned the ‘old theory of malarial miasmas’, but he later implied that Manson, even two years later (British Medical Journal 1896: 778) remained ‘under the infl uence of the miasmatic theory of malaria’, saying that he ‘believed that the mass of malaria existed in the shape of spores fl oating in water and blown about in the air’.

Ross then documented Fedschenko’s work showing that Cyclops was involved in the transmission of F medinensis, as well as details of Manson’s demonstration that T R Lewis’s Filaria sanguinis hominis was transmitted from the blood of man to certain species of mosquito.

He wrote that ‘Manson was always somewhat inclined to over-speculation in scientifi c matters’, and quoted Cobbold (1878) as writing that ‘T L [sic] Bancroft … suggested to him on 20 April 1877 [i.e. fi ve months before Manson’s semi-nal experiment] that the embryos of F bancrofti might be carried by mosquitoes’. Ross also considered Manson ‘scarcely a very expert investigator’.

He was also somewhat dismissive of Manson’s textbook: ‘It is a class of book which I do not favour much’. He was of the opinion that Manson’s elec-tion to the Royal Society resulted from ‘his induction, and [his own] work on malaria’. Ross was also critical of Manson for not following up his fi larial work by attempting to eradicate the infection (as he had attempted to do with malaria in West Africa); Ross claimed that his Indian work was carried out ‘in order to fi nd a method for reducing the incidence of malaria amongst the inhabitants of warm countries’, and not for ‘the sake of parasitology’. 23

NOTES

1 Anonymous. Obituary. Sir Patrick Manson. Br Med J 1922, i: 623–6, 702–3; A Alcock. Patrick Manson, 1844–1922. Trans R Soc Trop Med Hyg 1922, 16: 1–15; H B Guppy. A reminiscence of Sir Patrick Manson at Amoy. Trans R Soc Trop Med Hyg 1925, 18: 385–6; P H Manson-Bahr, A Alcock. The Life and Work of Sir Patrick Manson. London, 1927: Cassell and Co Ltd, p. 273; P H Manson-Bahr. British Masters of Medicine: Patrick Manson (1844–1922). Med Press Circ 1935, 6 February: 120–4. P Manson-Bahr. The Manson saga, 3rd October 1844–9 April 1922. Trans R Soc Trop Med Hyg 1945, 38: 401–17; H H Scott. A History of Tropical Medicine, Vol. II. London, 1939: Edward Arnold, pp. 1068–76; Anonymous. Manson centenary: ‘Father of Tropical



Medicine’. Times, Lond 1944, 15 December; Anonymous. Manson of Tropical Medicine. Lancet 1945, 6 January; Ibid., Indian Med Gazz 1945, August; P Manson-Bahr. History of the School of Tropical Medicine in London (1899–1949). London, 1956: H K Lewis, pp. 113–25; R Ross. Memories of Sir Patrick Manson. London, 1930: R Ross, p. 26; P Manson-Bahr. Patrick Manson: The Father of Tropical Medicine. London, 1962: Thomas Nelson and Sons Ltd, p. 192; G C Cook. Emergence of Dr Patrick Manson on the London medical scene. In: From the Greenwich Hulks to Old St Pancras: a history of tropical disease in London. London, 1992: Athlone Press, pp. 68–79; J W W Stephens, M P Sutphen. Manson, Sir Patrick (1844–1922). In: H C G Matthew, B Harrison (eds), Oxford Dictionary of National Biography, Vol. 36. Oxford, 2004: Oxford University Press, pp. 553–5.

2 P Manson. Remarks on an operation for abscess of the liver. Br Med J 1892, i: 163–7; P Manson. On the operative treatment of hepatitis and hepatic abscess. Med Rep Imperial Maritime Customs China 1883, special series No. 2 (26th issue): 50–63.

3 P Manson. Notes on sprue. Med Rep Imperial Maritime Customs China 1880, special series No. 2 (19th issue): 33–7; G C Cook. Tropical sprue; implications of Manson’s concept. J R Coll Phys Lond 1978, 12: 329–49.

4 T S Cobbold. Discovery of the adult representative of microscopic fi lariae. Lancet 1877, ii: 70–71; T S Cobbold. On Filaria bancrofti. Lancet 1877, ii: 495–6; T S Cobbold. Discovery of the inter-mediary host of Filaria sanguinis hominis (F. bancrofti). Lancet 1898, i: 69.

5 P Manson. Remarks on lymph-scrotum, elephantiasis and chyluria. Med Rep Imperial Maritime Customs China 1875, No. 27 (Part 6): 1–14; P Manson-Bahr. A commentary on the diary kept by Patrick Manson in China and now conserved at Manson House. Trans R Soc Trop Med Hyg 1935, 29: 79–90; P Manson. Further observations on Filaria sanguinis hominis. Med Rep Impe-rial Maritime Customs China 1877, special series No. 2 (14th issue): 1–26; E Chernin. Patrick Manson (1844–1922) and the transmission of fi lariasis. Am J Trop Med Hyg 1977, 26: 1065–70; G C Cook. Discovery and clinical importance of the fi lariases. Infect Dis Clin North Am 2004, 18: 219–30.

6 P Manson. On the development of the Filaria sanguinis hominis, and on the Mosquito considered as a Nurse. J Linn Soc Zoology 1879, 14: 304–11; P Manson. The metamorphosis of Filaria sanguinis hominis in the mosquito. Trans Linn Soc Zoology 1884, 2: 367–88; P Manson. On the periodicity of fi larial migrations to and from the circulation. Med Rep Imperial Maritime Customs China 1881, special series No. 2 (22nd issue): 63–8; P Manson. Notes on fi laria disease. Med Rep Imperial Maritime Customs China 1882, special series No. 2 (23rd issue): 1–16; P Manson. On fi larial periodicity. Br Med J 1899, ii: 644–6; Anonymous. Lymphatic fi lariasis – Tropical Medi-cine’s origin will not go away. Lancet 1987, i: 1409–10.

7 G C Low. A recent observation on fi larial nocturna in Culex: probable mode of infection of man. Br Med J 1900, i: 1456–7; Anonymous. Manson. Times, Lond 1932, 27 July.

8 P Manson. Distoma ringeri and parasitical haemoptysis. Med Rep Imperial Maritime Customs China 1881, special series No. 2 (22nd issue): 55–62.

9 Op cit. See note 1 above.10 G C Cook. Patrick Manson’s London residences. J Med Biog 1997, 5: 186.11 G C Cook, A J Webb. The Albert Dock Hospital, London: the original site (in 1899) of Tropical

Medicine as a new discipline. Acta Trop 2001, 79: 249–55.12 P Manson. On the nature and signifi cance of the crescentic and fl agellated bodies in malarial

blood. Br Med J 1894, ii: 1306–8; P Manson. The Goulstonian Lectures on the life-history of the malaria germ outside the human body. Lancet 1896, i: 695–8, 751–4, 831–3; Ibid, Br Med J 1896, i: 641–6, 712–17, 774–9; E R Lankester. Discoveries in tropical medicine. Nature, Lond 1922, 109: 549, 812–13.

13 R Ross. Malaria and mosquitoes. Nature, Lond 1900, 61: 522–7; R Ross. Memoirs: with a full account of the great malaria problem and its solution. London, 1923: John Murray, p. 547.

14 P Manson, C W Daniels. Remarks on a case of trypanosomiasis. Br Med J 1903, i: 1249–52; M Lyons. Sleeping sickness, colonial medicine and imperialism: some connections in the Belgian



Congo. In: R Macleod, M Lewis (eds), Disease, Medicine, and Empire: Perspectives on Western Medicine and the Experience of European Expansion. London, 1988: Routledge, pp. 242–56.

15 P Manson. The necessity for special education in tropical medicine. Lancet 1897, ii: 842–5; P Manson. The need for special training in tropical disease. J Trop Med 1899, 2: 57–62; Anony-mous. The Lancet 1897, i: 1226.

16 Reviews and notices of books. Lancet 1898, i: 1694–5; Reviews. Br Med J 1898, ii: 157–8.17 Anonymous. Instruction in tropical diseases. Br Med J 1898, ii: 224; A school for tropical dis-

eases. Br Med J 1898, ii: 200–1; Minutes, Seamen’s Hospital Society, Book 13, pp. 97–103(meeting 14 October 1898); Minutes, Seamen’s Hospital Society, Book 13, pp. 142–6 (meeting 10 March 1899); Anonymous. Instruction in tropical diseases. Br Med J 1898, ii: 1565; Anonymous. Tropical diseases. Lancet 1898, ii: 1448; Anonymous. The school of tropical medicine. Br Med J 1898, ii: 1637; Anonymous. The school of tropical medicine. Br Med J 1898, ii: 1832.

18 Op cit. See note 1 above (Cook), pp. 101–46; G C Cook. Doctor Patrick Manson’s leading opposition in the establishment of the London School of Tropical Medicine: Curnow, Anderson, and Turner. J Med Biog 1995, 3: 170–77.

19 G C Cook. ‘Tropical’ cases admitted to the Albert Dock Hospital in the early years of the London School of Tropical Medicine. Trans R Soc Trop Med Hyg 1999, 93: 675–7.

20 The late Sir Patrick Manson: memorial service in St Paul’s. Br Med J 1922, i: 664; Anonymous. Times, Lond 1922, 10 April: 15, 16.

21 H Cushing. The Life of Sir William Osler. Oxford, 1940: Clarendon Press, pp. 642–3.22 P Manson. Inaugural address. Trans R Soc Trop Med Hyg 1907, 1: 1–12. See also M L Lim,

M R Wallace. Infectious diarrhoea in history. Infect Dis Clin North Am 2004, 18: 261–74.23 Op cit. See note 1 above (Ross).


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