Mr Chancellor, Mr Vice-Chancellor, Ladies and Gentlemen,
I am fully conscious of the high honour of being asked to address this congregation and to speak on behalf of my fellow honorary graduates. Each of my fellow honorary graduates has made great contributions which have enriched the lives of Hong Kong's five million people. On their behalf, Your Excellency, I wish to thank the University for giving its highest award.
The University of Hong Kong is a unique institution, unique because it was founded on a previous successful institution - the Hong Kong College of Medicine. This College was founded by three graduates of Aberdeen University. The prime mover was Dr (later Sir) Patrick Manson, who became the first Dean. Shortly after his graduation he sailed east and secured the post of medical officer for Formosa in the Chinese Customs Service. However, he has to leave very quickly for he was accused of helping the Chinese Armed Forces to purchase ponies. He moved to Amoy where he continued his research in elephantiasis and discovered the life cycle of the parasite that caused this disease. On his return from leave in Britain, he decided to settle in Hong Kong. His practice became so busy that he had to employ an assistant. It was about this time that he wanted to establish a medical school.
In 1886, he advertised through a friend, Mitchell Bruce, for an assistant with a view to take over his practice, but Dr Bruce was not to divulge the name of the employer.
A young assistant surgeon of Charing Cross Hospital was interested in coming out east to set up a medical practice. Without knowing who his prospective employer was to be, he said to Mitchell Bruce: "If it is Mackie's practice in Alexandria or Manson's practice in Hong Kong, I am going". Thus, James Cantlie, a second Aberdeen graduate came to Hong Kong in 1887. He arrived in the summer of that year to find himself made a secretary to the committee that was to found the College of Medicine for the Chinese. The words "for the Chinese" were subsequently dropped in 1907 for many non-Chinese wished to seek admission to this Medical College. James Cantlie kept himself very busy, treating patients, carrying out research as well as teaching. He had not time to play games, so in order to keep fit he would run alongside his sedan chair at the coolies' jog-trot. He developed an interest in plague and leprosy and established a vaccine institute which was referred jestingly by the European community as "Cantlie's Fad".
A third member of this team of Aberdeen graduates was Dr (later Sir) Ho Kai, who was born in a village near Fatshan. His father was the Reverend Ho Fuk Tong. When Ho Kai was a boy the family moved to Hong Kong. He was sent to study in Britain, had his clinical training in St Thomas' Hospital and graduated MB, CM (Aberdeen).
After graduation he did not return to Hong Kong but went to Lincoln's Inn to read law. On his return to Hong Kong he was called to the Bar. Two years later after their return, his wife, Alice Walkden, died of typhoid fever. He built a hospital to commemorate his wife. It was called the Alice Memorial Hospital which became the teaching hospital of the Hong Kong College of Medicine. This remarkable man, in addition to his medical practice and public services, taught medical jurisprudence.
Among the first batch of medical students to attend classes was Sun Yat Sen, who decided to choose a medical career because "he regarded medical science as the kindly aunt who would bring him on to the high road of politics". Apparently even at this early age, he was already a revolutionary. Upon graduation in 1892 he went to Macau to set up a medical practice. Later he moved to Amoy where, while nominally engaged in medical practice, was a very active organiser of the "Association for the Regeneration of China".
After failing in a petition to the Chinese government, Sun, with a group of conspirators, attempted to capture Canton in 1894. This failed and some of the leaders were captured and executed. Sun himself escaped, first to Macau and then to Hong Kong. Here, he sought the advice of his teacher and friend, James Cantlie. He was advised to leave Hong Kong and was smuggled aboard a steamer sailing for Japan. Finally in October 1896 he arrived in London. By this time James Cantlie had retired from his practice in Hong Kong and was living in London.
It was a Sunday morning, while he was on his way to meet the Cantlies to go to church, that Sun Yat Sen was enticed to enter the Chinese Legation at Portland Place. He was locked up in the attic and plans were afoot to smuggle him out of Britain for execution.
His plight became desperate and after some days he managed to convince the English servant of the Chinese Legation of his predicament. A note was handed to James Cantlie who, together with Patrick Manson, went to see Lord Salisbury who was then the Prime Minister. At first there was disbelief and being a weekend nothing was done. James Cantlie, through the Times, campaigned against the kidnapping act perpetrated by the Chinese in British soil. Ultimately, Sun Yat Sen was released on the advice of the British Consultant to the Chinese Legation, Sir Halliday MacCartney. Subsequently, Sun Yat Sen was successful in his revolution and overthrew the Ching government in 1911. History would have taken a different course, had Sun Yat Sen not chosen to study medicine at the Hong Kong College of Medicine. This College made him a doctor as well as found him saviours, Patrick Manson and James Cantlie, of his life.
Thus the College of Medicine shaped the history of China. Sun Yat Sen was only one example of the epic story. Many graduates of this medical school followed. Some became leaders in medical science and among them may be mentioned, Dr Li Shu Fan. He was also awarded the LLD honoris causa in 1961, and was a principal founder of the Yeung Wo Hospital. He generously donated a large piece of land to his alma mater. Another graduate of the College, C Y Wang, was appointed Professor of Pathology in this University, but unfortunately died in 1931.
1911, the year of Sun Yat Sen's successful revolution, saw the founding of the University of Hong Kong. This was primarily due to the foresight and drive of one man, Sir (later Lord) Lugard. This University incorporated the Medical College which was the central pillar of this seat of higher learning.
Thus we see a successful partnership of two Scottish and once Chinese graduates from Aberdeen University. They had introduced medicine to Hong Kong and indirectly to China and other parts of Asia. However, the cost of running the University depended mainly on private endowment and fees. Before the Second World War, it was not appreciated that higher learning was important in the development of a country. Just before World War II, when the Japanese took over Shanghai, the financial state of the University was desperate, so that more students were admitted than teaching facilities could justify. Fortunately, the Jennings-Logan Report of 1953 brought relief to the University.
Questions might be raised as to the justification of spending large sums of money to upkeep this institution. To answer this, let us look into its achievements.
In the administrative section of government, many of our graduates are holding senior posts in the public services. At least four directors of the Medical and Health services have been our graduates. The public hospitals are staffed almost entirely by doctors educated in the University of Hong Kong. Also, in the private sector, many of these graduates are successful leading citizens. Some of them are renown for their work in the voluntary agencies, and indeed, many of our graduates are members of both the Legislative and Executive Councils. Some have gone abroad and are successful in their respective professions. It is, however, in Medicine that the University of Hong Kong has acquired the highest international reputation. Many of our doctors have gone abroad and at least over 100 doctors are currently practising successfully in the North American Continent. Many are working in academic institutions and several were appointed professors to clinical departments of the top universities in the United States. Thus Hong Kong has had its share of contributing to the welfare of advanced countries.
Seven clinical professors in the University are local graduates. These are appointed not because they are our own graduates but have acquired their positions in international competitions and have been found by independent assessors from the United Kingdom to be superior to their rival applicants from advanced countries.
Locally trained medical teachers of various grades staff the clinical departments and are carrying heavy clinical loads. The general public and sometimes government officials are not aware of the extent of duties the University clinical staff have to perform. One often hears surprised remarks like: "are you also treating patients?" That the University of Hong Kong is no ivory tower is shown by the fact that in 1979 of the 66,569 patients admitted to the Queen Mary Hospital, 49,274 (or 74%) were directly treated by the University staff.
Most of the teaching staff in the clinical departments are locally recruited, but a substantial number of expatriates are also employed. Staff made up entirely of local graduates will give rise to complacency and produce what I call "disuse atrophy of the mind". Expatriate staff, if suitable, should be employed, for they have much to contribute both in ideas and practice.
Both groups should work in perfect harmony, for we are all striving towards the same end, that is, academic excellence. There is no place for racial chauvinism and in this democratic institution voting of a representative should be according to the candidate's ability rather than on racial grounds. Racial harmony can be brought about if everyone makes it his business to be courteous to people of different races. How much better it would sound if one were to say: "The social system of the Hong Kong Chinese needs reform" than to say, "The social system of the Hong Kong Chinese is barbaric". I admit some do believe that racial difference exists even in their anatomical make-up.
For instance, while performing an operation on a black boy in foreign country, I was asked by a European doctor whether I found any anatomical difference (presumably from white and Chinese patients). I was flabbergasted and after a few seconds could only murmur: "Within the four seas all men are brothers". This is not an isolated incidence of bigoted ignorance, for more than thirty years ago, a senior expatriate (not in Hong Kong) remarked that the Asians could never be trained in surgery because of their racial background, for they were incapable of learning. This expatriate returned to his own country, could not find a job and ultimately settled in the village where he was born. Such prejudice is fortunately disappearing but some still lingers on.
Racial ill-feeling like a monster, occasionally rears its ugly head. Let us, therefore, turn our backs on those who preach or practice racial chauvinism.
Qualities of University Staff
In appointing university staff, certain qualities must be looked for:
The candidate should be knowledgeable. Old knowledge can be acquired through apprenticeship and by reading standard books. This will form a foundation on which a university teacher can build his career.
As a member of the staff, he must acquire new knowledge and learn critical thinking. New knowledge can be gained by research which is an essential part of university life. In the Medical Faculty research may take the form of clinical observations. This is essential to good patient care. One often hears of statements like "as a result of too many patients needing attention, little time is left for research". This is not only false but misleading, for it is only while one is actively caring for the sick that problems relating to the illness become apparent. Clinical research and teaching can only be effected when there are patients.
However, it should be realised that clinical research alone without animal experiments is restrictive. It is obvious that human beings cannot and must not be used for experiments. Hence, animal experiments have to be carried out in order to find a cure for human illnesses. There are "pressure groups" in this community who think that animal research is unnecessary. They are the vocal minority. They tend to impose their will on the silent majority. Because of this silence the "pressure groups" concluded that they had the support of five million people. How erroneous they are in this assumption. The silent five million not only fail support them but are often disgruntled and resentful.
Out of ignorance, small "pressure groups" misconstrue that it is the sadistic desire to inflict pain that experiments are carried out. No one will wish to inflict suffering on any creature whether they be animals or human beings. In fact, all animal experiments, before being carried out, are scrutinised by an Ethical Committee. It is only after this Committee is satisfied, that such research is the only acceptable way to solve problems related to human suffering, and is one that is conducted in the best humane way possible, is permission given.
Most advances in medical science stem from doctors who have spent some time working in laboratories. This is best done in their early years of training. One or two years of such laboratory discipline will help the worker not only acquire new knowledge but also to learn critical thinking. Frequently one meets doctors who, having read the latest medical literature, plunge into new form of treatment, often with disastrous results.
No one is born with natural knowledge. It is acquired through industry. While abroad lecturing, one anaesthetist posed a question to me as to the number of hours I took in performing an operation. My answer to him was "as long as the patient needs it". If we study the working patent of successful men like Patrick Manson and James Cantlie, one is amazed at the number of hours they put into their work. In clinical medicine, work cannot be measured in terms of hours. It is unfortunate that some doctors take the forty-four hours a week statement made by the government too literally. They seem to forget that when occasions demand it, one may have to work continuously for seventy-two hours, while on another occasion a thirty-six hours a week will suffice.
It is a strange phenomenon that the physicians work harder in the private sector. At a death enquiry held recently it was reported that a doctor was administering anaesthesia simultaneously to two patients. It was also stated that a patient under general anaesthesia might develop oxygen deficit due to kinking of the tube inserted into the windpipe. If this state of oxygen deprivation should last longer than a few minutes cardiac arrest might lead to either death or worse still, make a complete vegetable out of the patient. This, of course, can be prevented if constant watch is kept on the patient. How can a doctor giving anaesthesia to two patients at the same time monitor the vital signs in both? Further, we read that some doctors thought it justified for an anaesthetist to watch two patients at the same time. It is time the medical profession reforms itself. If they fail to do so, legislation will have to be passed to prevent such evil practice. One wonders what motive lies behind such acts. Is it dedication or financial gain? Perhaps only that practitioner and God could ever supply the answer.
Honesty and Humility
Perhaps in medicine more than other professions that one is subjected to temptation and flattery. At present there is a wide gap in our knowledge of medicine. Yet the words "I do not know" are seldom uttered. For more than twenty years, I have been exhorting my colleagues, at the end of each week, to ponder over all the errors we have committed. It is surprising how often we see the faults in ourselves and if we are honest enough to admit them, we will be able to avoid further pitfalls. Mistakes make over and over again to not constitute experience: correction of errors will lead to professional wisdom.
In reflection of faults one becomes aware of successes too. There is no doubt that the surgeon is often justified in feeling pleased with his achievements. He makes a quick decision and the patient's life is saved. He should, however, not gloat over this success as this will only lead to conceit. This is not easily done as the grateful patient will invariably be over generous in singing his praises. It is all right for the grateful patient even to think that the surgeon could walk on water as long as the latter did not believe it!
Ability to Communicate
Billroth, a great German surgeon of the last century, was asked what should be the language used at a scientific meeting. His remark was that as a patriotic German he would recommend it to be in German, as a diplomat French, but for the sake of the great majority of participants and ease of communication, he would use English.
This is well illustrated during a meeting held in Switzerland. A Spanish speaking delegate although well versed in the English language, decided to present his excellent work in Spanish. When he finished there was absolute silence in the Hall as no one understood his language. His failure to communicate to the audience was complete. He could have achieved the desired effect if he had delivered it in English. It is certainly the language of science and technology.
Recently, a research was conducted by the Educational Group of Hong Kong Chinese University. Their finding was that the students in Hong Kong learn their subjects faster if they were taught in Chinese (Cantonese). This research gained much praise from some quarters, but little thought was given to the interpretation of the facts found in the students' interview. For instance, it never occurred to the researchers that perhaps it was the poor standard of English that made learning difficult when conducted in that language. It was destructive to suggest that English instead of being taught more intensively should be downgraded. The study of English is being actively encouraged even in the People's Republic of China. We, in Hong Kong, should be thankful that there is ample opportunity to learn and practice English. Let us not cast away something that is of genuine benefit.
Communication in English gets worse with each passing year. Many of our graduates aspire to taking up postgraduate studies, usually in the English speaking countries. They should know that it is by constant use that they can be fluent with it. They will be wasting their time going abroad to study if they fail to communicate with their foreign mentors.
Perhaps after rigorous training for some years, professional skill can be acquired. In the case of a surgeon, it is constant hard work in the operating theatre that such skill can be developed. In the 1960s, statements were made that a monkey could be taught to operate. It would have been interesting if those who made these remarks had subjected themselves to be operated on by the monkeys.
Manual dexterity depends on strict discipline and, the manner in which the trainee holds his instrument will determine whether he will be clumsy or skillful.
Medicine is an applied biological science. As such, skill in diagnosis and treatment becomes an art. This is not for sale but used for the benefit of the sick. Compassion for the sick can be cultivated. Often the physician or surgeon is referred to as competent but cold and indifferent. One must learn to have respect for human life and dignity regardless of race, intelligence, social or economic status.
Your Excellency, I have referred to the University staff or having to carry a heavy clinical load. Therefore he has little time for treating rich patients outside the precincts of his hospital. To deprive the rich of medical expertise is wrong but for such experts to hover round the private hospitals, vending their wares also is wrong. It is for us to regulate outside consultative practice to such an extent that abuse of this service is eliminated. Hence, outside consultative practice should be planned on a departmental basis. If the head of a department feels that a particular member of his staff is the correct one to see the patient, then it is his duty to delegate this task. What greater honour can one have than to be a consultant to his own chief?
What is the future of this higher seat of learning? It is my belief, given the same forward looking leadership, the University of Hong Kong will not only continue to thrive but prosper. As long as human beings will continue to inhabit this territory called Hong Kong, there will be the University of Hong Kong.