Gong Gong says

This is a posthumous blog of our father's (Lim Kok Ann) life. When our father passed away on 8 March 2003, he left behind an unpublished autobiography. We'd like to celebrate his life by sharing his autobiography through this blog.

"I have dredged these anecdotes from memory just to pass the time; if they amuse my grandchildren their purpose will have been served; if they provide any instruction, it will be a happy coincidence; that they are disjointed is probably to be expected.

Aurora was the name of my grandfather’s house in Kulangsu.   Amoy, where I spent the first five or six years of my life.   I still have vivid memories of events that took place when I was barely three years old.

Lim Kok Ann
October 1996"

Sunday, December 07, 2008

3:14 Flu Fighter.
On the first Monday that I returned to the laboratory I got a call from Dr. Huang who had attended the course we had been giving for Diploma in Public Health students. He asked me if I would like to visit Pulau Bukom with him to see some patients suspected of having got influenza from the Hong Kong outbreak. “What outbreak?” I asked, “Hong Kong?”. It had been in the papers, I was told, but I had not caught up with the news yet. Hale confirmed that an outbreak of influenza had been reported in Hong Kong and very likely the patients in Pulau Bukom, where Shell Oil Company had a large installation and where some port workers lived, had caught influenza from passengers off ships they had visited. It was an opportunity to perform our duties as a WHO Influenza Observer, appointed by WHO in various parts of the world to detect new variants of influenza as early as possible.

I went over to Pulau Bukom with the Public Health doctor and found typical cases of influenza - the patients had fever, running noses, red eyes, some cough,, and were miserable. I took throat swabs and blood specimens and returned to the laboratory. I got some 8-day-old and some 14 day-old chick embryos from Crawford Street where there were a number of hatcheries (who thought I was making some kind of medicine with the un-hatched chicks) and inoculated them with extracts of the throat swabs to which a mixture of penicillin and streptomycin was added. Before the days of these antibiotics, inoculation of bacteria from the throat would assuredly kill the chicks. Then I waited. On the second day - Wednesday - I opened a couple of the 14-day eggs that had been inoculated amniotically, removed the lungs from the baby chick and ground them up to make a suspension. I mixed the clarified suspension with some chick red blood cells and was elated to find that the red blood cells had clumped together as they would be by an influenza virus. I took the precaution of mixing the red blood cells with a suspension made from lungs of un-inoculated chicks to show that the “negative control” lung suspension did not clump chick cells.

Hale was just as excited as I was when I reported my findings. He watched me closely as I prepared my identification tests, using the typing influenza antiserum I had brought back from Melbourne. I mixed the chick embryo extract with the antiserum and added the mixture to chick red blood cells. As controls, I mixed normal serum with the chick embryo extract to the chick red blood cells as well as chick embryo extract alone to the red blood cells. To my consternation, the chick embryo extracts in all cases caused clumping of the red blood cells, whether mixed with influenza antiserum or not. If our assumption was correct that we had isolated an influenza virus, then the HI (anti-clumping) test that we had done should have prevented the chick embryo extract from clumping the red blood cells. That the chick embryo extract had a clumping agent was proven, but I could not prove that it was an influenza virus. Hale said that we had better send the virus isolate, if that was what we had, to the International Influenza Centre for identification, so I prepared sealed glass ampoules of the chick embryo abstract, and sealed ampoules of the patient’s serum taken when the throat specimen was taken and another serum taken three days later. I packed the ampoules in dry ice and sent them off by air-freight to the London International Influenza Centre with instructions for the dry ice to be refilled every 24 hours. Identical packages were sent to the American International Influenza Centre in Washington and other influenza virus laboratories including the Hall Institute in Melbourne. I cabled Dr. Eric French to tell him that I thought I had isolated an influenza virus but I could not type it with the serum he had given me; could he help? It was Friday morning.

The specimens arrived in London on Saturday afternoon and sat in the Airport icebox until the following Monday. French personally went to Melbourne Airport on Friday night to retrieve the specimens that I had sent him and immediately inoculated some chicks amniotically the way that he had taught me. On Sunday morning French went to his laboratory and opened up some inoculated eggs and found that there was, indeed, a red blood cell clumping agent present. He repeated the tests that I had done using the same influenza antisera that he had given me and confirmed my negative results. He then tested the chick embryo extract by another test called the complement-fixation test (CIFT) which proved that our virus isolate belonged to the Influenza A virus group (there were two other Influenza virus groups, B and C Influenza groups that behaved differently by the CFT) but was sufficiently different from other Influenza A viruses as not be neutralized by their antisera in HI tests. his implied also that a person who had experienced the old Influenza A viruses would not be protected against the new variant. French called Sir Mac who came to the laboratory to review his results then called the newspapers. On Monday morning the Singapore Straits Times reported my coup with front page headlines: “Brilliant Singapore scientist discovers new influenza virus”. In following write-ups they called me Flu-fighter. I did not think that they knew my Grand Uncle by marriage, Dr.Wu Lien-Teh, had published his memoirs under the title Plague Fighter.

The aftermath of my discovery of the new Influenza virus, subsequently named Influenza A2virus was something of an anti-climax. The main aim of the world-wide WHO Influenza Observer network was the early detection of new influenza virus variants. The A2 virus was present in Hong Kong at least two weeks before it came to Singapore where the virus was isolated about a week after cases had been recognized. It then took a further week before the virus was identified as a new type. WHO’s interest in new influenza variants was not purely academic; WHO had hoped that early detection and isolation of new influenza variants could lead to better control measures because vaccines could be prepared against the virus and populations elsewhere protected against the new virus before it arrives. This was a vain hope. It took about a month for vaccines to be made against the virus isolates sent to England and to the United States. First the virus had to be adapted for growth in large quantities, then tests for safety and efficacy would have to be made before the vaccine was actually used. By the time the health authorities had a vaccine ready, the new influenza had arrived on their shores and in most cases, second epidemic waves had already begun. Modern transportation enables large numbers of infected people, some not even showing signs of illness to be landed among susceptible populations well within 30 days, the minimum lead time for isolating a new virus and preparing a vaccine from it. Flu-Fighter was an empty label; I fingered the enemy, but nothing I did affected its progress round the world.


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