Manson, Patrick

Early years

Memorial plate on the birthplace of Patrick Manson in Oldmedrum

Born in Oldmedrum, a small town near Aberdeen, the second of seven children of the family. His mother, Elizabeth Livingston, was a distant relative of Africa’s distinguished explorer and Christian missionary, David Livingstone . Manson was teased by a “Scandinavian pirate” in childhood due to his Norwegian background. He was also described by the contemporaries of his childhood as a not very smart child, but with great interest in obtaining new knowledge. He grew up in a Presbyterian family, in which he had a good memory, because he could memorize church sermons at the age of 5 years. When he grew up, the surrounding noted his interest in joinery robot, mechanics, cricket hunting with a shotgun. At the age of 15, he began working at the Kuznetsky plant in Aberdeen, but his health disorder prevented him from continuing this activity, because he quickly received a curvature of the spine and paresis of his right hand inherent in this work activity, but much faster than it did in adult workers. .

Medical Education

Therefore, Manson decided to study medicine at the University of Aberdeen . There is an assumption that the choice of medicine was conscious for the fact that earlier he had shot the enraged cat, the cut dissected his insides, and there the boy saw the helminth, which interested him in further studying the parasites. Manson studied hard and graduated from the university, having passed the final exams at the age of 20. He had to wait to get a medical degree, up to the required 21 years by law. At the same time, he visited clinics, hospitals, laboratories, medical museums, and the like while studying the characteristics of their activities. The first scientific work of Manson was the study of changes in the internal carotid artery , which he wrote while he was a physician assistant at the Durham District Hospital for the Mentally Sick (" Durham County Lunatic Asylum "). ^[5] He personally made 17 autopsies of the deceased mentally ill, which gave him the necessary pathological basis for his scientific work. He argued in his dissertation that the severity of brain pathology in these patients correlates with the diameter of their internal carotid artery aneurysm , which is similar to the situation in cirrhosis of the liver when the portal vein expands as a result of portal hypertension. It is for this work that he was awarded the degree of Doctor of Medicine ( MD ) at the University of Aberdeen.

Work on Formosa

In 1866, Manson, inspired by his elder brother, who worked in Shanghai , agreed to take the position of medical officer in the customs service of Formosa . Manson was in voyage for 3 months, rounding Africa through the Cape of Good Hope, passed Madagascar, and finally arrived in Takao on Formosa. Here, his official daily duty was to inspect ships entering the port, treat their crews, collect and save meteorological records. He was also present at the reception of Chinese patients in a local missionary hospital, where he saw a variety of diseases, in particular elephantiasis , leprosy , which gave him a great experience. His only tool for examining patients was a combination of a clinical study, a hand lens and a good record of patient data. He learned how to remove leeches from the nose of patients with a painless way of soaking and relaxing the leech with a hypertonic solution. He successfully treated European patients who developed Tropical Liver Syndrome "after they ate a lot of meat and wine (probably acute fatty hepatosis ) by prescribing hard gymnastic exercises and diets .

Although Manson lived among a small community of 16 Europeans, he eagerly communicated with the locals, learned Chinese and local dialects. There is an assumption that Manson was involved before the struggle between the Japanese and Chinese factions for control of the island. Manson seems to have preferred the Chinese and may have been involved in the purchase of ponies for Chinese troops. In early 1871, he advised the British Consul to go to Xiamen , and he himself moved there with a British mission. Soon his younger brother David came to him and stayed with Patrick for 2 years. Xiamen was a difficult city for Europeans to live in, a place with a hot and humid climate. The city streets were narrow, polluted with sewage and excrement. Pigs and dogs ate them excrement and bred in large numbers. Residents were extremely poor. This city was highly endemic with malaria , typhoid , dengue and leprosy. At that time, 1 out of 450 inhabitants was infected with leprosy. In 1877, an epidemic of cholera took place in Xiamen, with 95% of the population sick, and 2% died. Unfortunately, Patrick's younger brother David also died in Syamen in 1878.

Thanks to a significant number of examined patients, Manson quickly became a good clinician who was able to make a complex diagnosis. In addition, Patrick did many difficult operations for patients with elephantiness, which were so distorted that their relatives threw them. It is believed that only in 1871, Manson cut not less than a ton of tissue from these patients. Thus, he gained authority both in himself and in western medicine in the Eastern environment. However, Manson was surprisingly modest, did not consider himself a successful surgeon , and compared with a skilled teslaire . His modesty was exaggerated, because it was then that he achieved successful results in the surgical treatment of liver abscess common in this region, which often arose in amebiasis . Manson invented several surgical instruments that enabled him to successfully remove pus from such an abscess. He was not only respected for his medical achievements, the locals considered him one of the best tiger hunters.

Taking into account the psychology of Chinese patients, he changed, unlike other European doctors, so his professional actions, street onlookers and relatives of patients could look through the wide glass windows, watch his work. The whole process of the patient's stay under anesthesia, the creation of painless surgical procedure, the removal of tumors and stones, recovery after anesthesia were open to the public. Thus, thanks to observation, humanism, and respectful attitude, Manson deserved the success of the locals and changed their attitude to Western medicine. Realizing that the main thing in improving the medical status of the inhabitants of Xiamen was prevention, he paid much attention to such activities. Manson promoted the vaccination against smallpox , in particular, appointing his Chinese subordinate the chief public vaccinator of the city. Manson taught many local surgeons who started their practice in remote areas of the city, which only increased the quality of medical care. But the local leader of the British Christian community refused to work with parishioners for Manson, so Patrick was forced to treat only patients in the port hospital.

In 1875, Manson returned to London, where he married Isabella Henrietta Turnbull. With her in marriage, he has mav3 sons and a daughter.

During the year of his stay in London, Manson became interested in eye surgery, acquired practical skills, and acquired the appropriate tools. This time, he tried to find information about parasitic diseases, noticed that it was extremely small. He found a message from Timothy Lewis about how he found the nematode "Filaria sanguinis hominis in the blood and urine of an Indian patient who suffered from hiluria . This struck Manson, because in Syamen he often treated sick people who have had hiluria. Manson acquired a folding light microscope , 1876, together with his wife, returned to Xiamen.

Using a microscope, Manson soon discovered that microfilariae were abundant in the blood of patients with elephantiness. He noted the fact that the coated, energetically active microfilariae remained unchanged in the blood of patients at body temperature, but then dropped the shell at room temperature in the tropical region. He traced changes in microfilariae in the digestive tract of females Culex fatigans when they were fed infected human blood. After opening hundreds of such mosquitoes, Manson discovered that microfilariae undergo metamorphosis and migrate from the gastrointestinal tract to the pectoral muscle of mosquitoes. In 1899, Thomas Bancroft showed that these infected mosquitoes can transmit the parasite back to humans through bites. Finally, Manson and others successfully discovered adult Wuchereria bancrofti worms with all stages of microfilar development within the lymphatic circulation, suffering from wuchereriasis and elephantiasis, thus describing the full life cycle of this filariasis , showing how person-to-person transmission of this pathogen occurs through mosquito vectors.

This discovery of the role of mosquitoes as an intermediate host in the life cycle and transmission of transmissible pathogenic microorganisms came only after picky and painstaking research. Manson built a small house, covered with a thin mosquito net. He made microfilaria-infected patients, including his gardener, sleep inside this house. The light burned inside this house, and the doors were open for 30 minutes at night. The next morning, mosquitoes with tummy poured with infected patients' blood found gauze. Mosquitoes were treated with tobacco smoke for immobilization, tagged and transferred into glass vials. Then Manson cut them and examined under a microscope.

Of the 190 Chinese that Manson examined, 15 who had microfilariae in their blood samples had some evidence of elephantiasis or certain signs of illness, most often recurrent fever and edema. After studying 670 people, he found that 1 out of every 10.8 patients in Xiameni was infected, and the rate of infection at a young age is 1 to 17.5, while in older people it is 1 to 3. Manson was a very meticulous scientist, he also discovered the nocturnal frequency of microfilariaemia. By counting the number of microfilariae in the blood of infected patients, Manson found that their number reached a maximum around midnight, which was explained with the human time of going to sleep and the greatest activity of mosquitoes.

His research results were published in the Linnei Zoological Society of London in 1878. After his work was read out at a society meeting, one of those present said that “what they heard is either a work of a genius or, more likely, an emanation of a drunken Scottish doctor in faraway China, where everyone knows that they drink too much a lot of whiskey. But subsequently, Manson’s experiments were replicated, and his mosquito hypothesis was widely accepted.

Manson discovered a parasitic agent (which later became known as the male gametocyte) in the blood of patients with malaria and observed this in many infected for a long time. He reported on this find to Ronald Ross and urged him to take up this important part of the research in India. During the period of mentoring Manson, Ronald Ross wrote 110 letters to him, while Manson responded 85, where he pointed out gaps in knowledge, problems of experimental methodology of scientific analysis, expressed support and encouragement. After Ross completed the description of the life cycle of Plasmodium malaria in a mosquito in 1898, Ross wrote to Manson: “What a wonderful discovery. I dare to praise him because it belongs to you, not to me. ” However, in subsequent years, after Ross received the Nobel Prize in Medicine , he turned everything around and discredited Manson ^[6] .

In 1880, in Xiamen, during a consultation that Manson conducted to a sick person, the latter had a sharp and loud cough at the time of the examination. He coughed up bloody sputum, which he was unable to direct to the spittoon. through what it turned out to be a doctor’s receptionist’s carpet. Manson then took this sputum and subjected to microscopy to find in it large gel-like eggs. When Manson put them in cans filled with water, ciliary creatures formed from them after 2 weeks of being in the water at room temperature in the tropics. Manson later found out that in this way, through a happy accident, he found the helminth eggs “Paragonimus westermanii” (outdated - “Distoma ringeri”), which causes paragonimosis in which the lungs are affected and hemoptysis occurs. He suggested that in order to transmit this helminth in water, there must be an intermediate host in fresh water, most likely a crab-like snail. what you need to complete the life cycle of "Paragonimus westermanii". Manson's hypothesis was finally confirmed in 1916 by Nakagawa. Manson's theory of the presence of intermediate hosts - snails was later successfully applied to the identification of the epidemiological features of transmission of schistosomiasis .

After 5 years in Takao and 11 years in Xiamen, Manson decided to move to Hong Kong . He created a very successful private medical practice that attracted many Europeans and wealthy Chinese patients. In addition, working in a civilian hospital for Europeans, he founded Alice Memorial Hospital with the support of the London Missionary Society. This hospital served Chinese patients and was also a clinic for the Chinese Hong Kong Medical College , which was the forerunner of the University of Hong Kong. He was the founder and dean who, in his inaugural speech on October 1, 1887, emphasized the role of the college in medical education, in the fight against ignorance, superstition and outdated traditions of the Qing feudal dynasty , to popularize Western medical practice. Among the first graduates - the Chinese doctors of this college was the father of the new China, Sun Yat-sen . There is evidence that Manson later hid Sun Yatsen from the persecution of the Chinese police for his revolutionary activities. In 1886, Manson also founded the Medical Society in Hong Kong, in which he focused on addressing gaps in the training of doctors for infectious and parasitic diseases.

Despite the serious employment of the issues of organization of medical care and training, Manson continued his medical practice. In particular, in November 1887, he examined the then Chinese Prime Minister Hung-Chang Lee, whose Chinese doctors suspected cancer of the tongue. Manson at the time had an attack of gout , but this did not prevent him from boarding the ship on which he was prime, and brilliantly conducting a study, as a result of which he established the presence of a hypoglossal abscess , which Manson opened and drained. Hung-Chang Tzu was so amazed by this that he continued to support Manson and became the patron of the Hong Kong Medical College.

In addition, Manson paid much attention to the prevention of infectious diseases in Hong Kong. So he became the initiator of the importation into the region of cows from Scotland and Australia for the provision of milk and dairy products for children, pregnant women and the sick.

Manson returned to London in 1889 and founded a private medical practice with a laboratory. He received membership in the Royal College of Physicians. successfully passed the exam in 1889. He also became the doctor of the Dreadnought Seamen's Hospital, and has been with him for 6 years. He actively promoted the need for special education in the field of tropical medicine. He said: “Education in this field of medicine in Britain is not enough to claim adequacy when used in the tropics. I speak so persistently, based on my own experience, my own mistakes, the mistakes of others, that I have seen. ” This led to strong disputes with his colleagues, and he was forced to leave the Dreadnought. But over time, doctors are more and more convinced of the need for tropical medicine. For this, Manson founded the London School of Tropical Medicine and Hygiene in 1899. At the age of 55, Manson had to spend 3 hours traveling back and forth, 9 miles two to three times a week during his school duties. Like most eminent scientists, he has always been concerned about how to induce constant interest among future generations of doctors, to induce necessary observations in patients and to effectively control infectious diseases.

In 1890, Manson became a member of the Royal College of Medicine ( Royal College of Physicians ). In 1892 he was accepted as a member of the Seamen’s Hospital Society ( Seamen’s Hospital Society ). Then he became a lecturer from tropical medicine in the hospital of St. George. In 1900, he was elected a member of the Royal Society of London and President of the Epidemiological London Society.

In 1903, Patrick Manson was granted the English title of nobility, he was initiated into the Knights Commander (KCMG ) of the Order of St. Michael and St. George , and in 1912 the Knights of the Grand Cross ( English Knight Grand Cross (GCMG ) of this order.

In 1904, he was awarded the Fosergill Gold Medal - the scientific award of the London Medical Society. In 1904, he was awarded an honorary doctorate from Oxford University. In 1907-1909 he was the first president of the Royal Society of Tropical Medicine and Hygiene. In 1912, the Royal Society of London awarded Manson with a scientific award — the Edward Jenner Medal.

Patrick Manson died from the complications of gout, which was ill for a long time, April 9, 1922 in London. He was buried at the Allenweil ​​Cemetery in Aberdeen.

In 1923, the British Royal Society for Tropical Medicine and Hygiene ^[7] introduced an honorary scientific award ( the Manson Medal ) for outstanding research in these areas of medicine, which it named after Patrick Manson. Every year it holds a Christmas lecture in his honor ( English Manson Christmas Lecture ).

Manson made a significant contribution to the study of tropical diseases, including the discovery of helminths - "Filaria demarquaii" (today - "Mansonella ozzardi"), "Filaria diurna" (today - "Loa loa"), "Filaria perstans" (today - " Mansonella perstans ”),“ Bothriocephalus mansoni ”(also“ Spirometra or Diphyllobothrium mansonoides ”),“ Schistosoma mansoni ”, a pathogenic fungus“ Trichophyton concentricum ”, which causes one type of lichen . The identification of these organisms as human pathogens was the basis for understanding the nature and prevention of these invasions.

Manson has received many prestigious awards for his outstanding contributions to medicine. These contributions included not only his studies on filarias, but also the discovery of paragonimiasis, a parasitic worm in dogs, as well as advances in many areas of medicine, including liver abscesses, dermatological diseases, the study of hookworm, Indian visceral leishmaniasis, African trypanosomiasis , schistosomiasis , typhoid fever , diphtheria , smallpox , leprosy , plague , dengue fever , avitaminosis sprue . Manson, in particular, made the first compression of a biopsy specimen taken from a patient with leprosy in order to rid the blood preparation and injections into the center of the material; he received a drop of liquid, which he then painted and examined under a microscope to identify the causative agent of leprosy.

• "Mansonella ozzardi" is a type of helminths, one of the causative agents of serous mononellosis .
• "Mansonella perstans" is a type of helminths, one of the causative agents of serous mansonellosis.
• "Mansonella streptocerca" - a type of worms, the causative agent of hypodermic monsonellosis .
• "Bothriocephalus mansoni" is a type of helminths.
• "Schistosoma mansoni" is a helminth, one of the pathogens of schistosomiasis.
• "Spirometra mansoni" is a type of helminths, the larval stage of which is one of the causative agents of sparganosis .
• “Spirometra mansonoides” is a species of helminths, the larval stage of which causes sparganosis.
• “Sparganum mansoni” is a species of helminths, the larval stage of which causes sparganosis.
• "Mansonia" is a genus of mosquitoes .
• Serous mansonellosis and subcutaneous mansonellosis are helminthiasis from the group of filariidoses .

• On the development of the mosquito, it is considered as a nurse. J Linn Soc (Zool) 1878; 14: 304-311.
• Manson P. Distoma ringeri. Med Times Gaz. 1881; 2: 8-9.
• Manson P. Remarks on the liver for the liver. Br Med J. 1892; 1: 163-167.
• Manson P. Lancet. 1897; 150: 842-845.
• Manson's Tropical Diseases: a Manual of the Diseases of Warm Climates (1898); 7th edition. 1921.
• Manson P. Diseases in tropical climates, p. 928-995. // Hygiene and diseases of warm climates. / Ed .: HA Davidson. - L .: Young J. Pentland, 1893.
• Manson P. Report of a case of schistosomiasis from the West Indies. Br Med J. 1902; 2: 1894-1895.
• Manson P. Lectures on Tropical Diseases, 1905.
• Manson P. Diet in the Diseases of Hot Climates, 1908, with Charles Wilberforce Daniels (1862-1927).

• It is a funeral problem. Emerging Microbes Infect. 2012 Oct; 1 (10): e31. (eng.)
• Venita Jay A PORTRAIT IN HISTORY. Sir Patrick Manson - Father of Tropical Medicine. Archives of Pathology & Laboratory Medicine: November 2000, Vol. 124, No. 11, 1594-1595. (English)

• Encyclopædia Britannica / Sir Patrick Manson. Scottish parasitologist (eng.)