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Ann Thorac Surg 2006;82:1147-1151
© 2006 The Society of Thoracic Surgeons

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Our surgical heritage

Jia-Si Huang: "A Surgeon and Something More"

Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, People's Republic of China

^_* Address correspondence to Dr Wan, Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China (Email: swan{at}cuhk.edu.hk).

	Abstract

Top Abstract Introduction The Man The Leader The Mentor The Spirit of Service... Acknowledgments References

 
In contrast to many industrialized countries, the growth of thoracic surgery in China was much more difficult over the first 5 decades under the ever-changing political and harsh socioeconomic conditions. As a matter of fact, the struggle to establish this specialty in a developing country with more than one fifth of the world population was certainly one of the most crucial challenges in the last century. The unique story of a pioneering Chinese thoracic surgeon—Dr Jia-Si Huang (1906–1984) was a glorious example of heroic leadership and self sacrifice. His fundamental role in developing cardiothoracic surgery in China was clearly reflected not only by some first-in-China operations he personally performed, but also by his continued contributions in educating younger generations of Chinese surgeons.

	Introduction

Top Abstract Introduction The Man The Leader The Mentor The Spirit of Service... Acknowledgments References

 
Two decades ago, if some senior North American thoracic surgeons were asked to name two of their colleagues in China, the answer might simply have been Huang in the South and Wu in the North. Interestingly, doctors Jia-Si Huang (previously spelled Chia-Ssu Huang) and Ying-Kai Wu had many similarities. Both obtained their general surgical training at Peking Union Medical College (PUMC) and were subsequently trained under two American thoracic surgical leaders in the 1940s (ie, Huang trained with John Alexander and Wu with Evarts A. Graham). Both of them returned to China at the end of World War II, and during the next 4 to 5 decades, they both made fundamental contributions to the development of cardiothoracic surgery in their motherland. Eventually both of them played the leading role in Chinese surgical societies and became highly respected figures, representing thoracic surgeons in China. In fact, Huang was the only Chinese surgeon to be elected as one of the 228 founding members of the American Board of Thoracic Surgery, whereas Wu was the only Chinese honorary member of the American Association for Thoracic Surgery to date.

In May 1985, exactly 1 year after the death of Huang, an American thoracic surgical delegation led by Dr Herbert Sloan (who had just retired as the editor of The Annals of Thoracic Surgery) visited Beijing, China. On behalf of the Lyman A. Brewer III International Surgical Society, Dr Sloan presented two oil paintings to the PUMC and the Chinese Academy of Medical Science (ie, the portraits of Drs Huang and Wu) (see Figs 1A, 1B), which symbolized the long-term friendship among colleagues of the two countries.

View larger version (59K): [in this window] [in a new window]   Fig 1. Gift to Peking Union Medical College from the Lyman A. Brewer III International Surgical Society in 1985: portraits in oils of (A) Doctor Jia-Si Huang (1906–1984) and (B) Doctor Ying-Kai Wu (1910–2003). Courtesy of China Union Medical University, Beijing.

	The Man

Top Abstract Introduction The Man The Leader The Mentor The Spirit of Service... Acknowledgments References

 
Jia-Si Huang was born on July 14, 1906 (which was May 23 according to the Chinese lunar calendar) to an intellectual family in Yushan County, Jiangxi province, China. Both his grandfather and his father were officials of the regional Qing government. He was the fourth son among 8 boys of the family (only 5 of them survived beyond childhood). Unfortunately, his father died of a massive hemoptysis at age of 36 when Huang was only 5 years old. Huang's well-educated mother, then 35 years old, raised her 5 sons alone, and she never married again. It is understandable that being the favorite son, Huang was deeply influenced by his mother. When Huang approached 18 years of age, his marriage was even prearranged (which was then a well-accepted tradition in China) by his mother and grandfather. Although reluctant at first, Huang eventually accepted such an arrangement due to his high respect for his mother. His mother died in 1925 when Huang had just entered PUMC for pre-medical study. He never met his bride until the wedding day in April 1926. Interestingly the young couple fell in love with each other soon after the wedding and stayed happily together ever since. In fact, apart from Huang's 4-year stay in the United States, they were never separated for the following 58 years [2].

The decision to pursue medical studies was again not initially made by Huang himself. He showed talent in mathematics and physics early in his primary school days. When he spent his 1-week spring vacation in 1924 with his elder brother in Beijing, Huang was only a first-year high school student. One day when they walked by the beautiful PUMC Chinese palace style campus in downtown Beijing, Huang was casually asked by his brother whether he would like to study there in the future. "Sure," Huang answered without thinking. Six months later his brother applied to PUMC on behalf of Huang. "Your English is good," Huang was strongly encouraged by the brother. "Why not just try, so that 2 years later you could be better prepared for the real examination?" his brother added. Huang did and was accepted by PUMC [2].

(Historical note: PUMC was established by the China Medical Board of the Rockefeller Foundation to become the "Johns Hopkins in China." At the Dedication Ceremony of PUMC on September 19, 1921, John D. Rockefeller, Jr opened his address by reading a cable from his father: "... May all who enter, whether Faculty or Students, be fired with the spirit of service and of sacrifice and may the Institution become an ever-widening influence for the promotion of the physical, mental, and spiritual well-being of the Chinese nation" [3]. As far as thoracic surgery is concerned, PUMC was the cradle for three successful first-in-China landmark operations [4]—lobectomy for bronchiectasis by Dr Da-Tong Wang on September 21, 1937; resection of cancer of the esophagus by Dr Ying-Kai Wu on April 26, 1940; [1] and pneumonectomy for lung cancer by Dr Ji-Zheng Zhang on March 14, 1941).

Huang graduated from PUMC in 1933. After his 2-year basic surgical training at the same institution, he moved to the National Shanghai Medical College and subsequently became a lecturer in surgery in 1939, at the same time when Shanghai was invaded by the Japanese troops. The college and its teaching hospital were relocated in 1940 to Kunming and then to Chongqing, which are two major cities in South China where Huang had a chance to participate in Tsinghua University's selection examination for advanced study in the United States on Boxer Indemnity funds. He successfully passed the examination and became the only candidate selected for medical specialty training on a monthly scholarship of US $100.

On October 23, 1941, Huang arrived at the University of Michigan in Ann Arbor, Michigan, where the first surgical residency program in thoracic surgery in the United States was established by Dr John Alexander [5]. It was natural that under Alexander's guidance, Huang's study interest was focused on the collapse therapy for pulmonary tuberculosis. He was extremely active not only in the operating rooms but also in the laboratory [6]. In 1943 he received his Master of Surgery degree at the University of Michigan and also passed the American Board of Thoracic Surgery examination.

At that juncture, he could have chosen to stay in the United States. The easiest path for him was to join the army. As Huang was already a board-certified thoracic surgeon, the military hospital offered him a job with monthly salary of US $3,000. However he decided to return to China to establish the thoracic surgical specialty there.

His trip was unfortunately delayed by a disease that he was only too familiar (namely, pulmonary tuberculosis) for which he was hospitalized for several weeks. Then Huang got on the first army plane across the Pacific Ocean from New York to Chongqing, China on October 23, 1945. Unluckily again, he lost his luggage while stopping in India; his two suitcases were eventually located 4 months later, and they were empty except for a few papers (ie, the graduate certificate from PUMC, the Masters degree certificate from the University of Michigan, and the American Board of Thoracic Surgery examination certificate). Nevertheless, his hand luggage containing a full set of thoracic surgical instruments was safely brought back home [2].

Between 1945 and 1951, Huang was a professor of surgery at the Shanghai Medical College and the surgeon-in-chief at two hospitals (the China Red Cross Hospital and the Shanghai Zhongshan Hospital). He was elected the second president of the Chinese Surgical Association in 1947.

In the winter of 1950, the Korean War broke out. Huang served at the army hospital and was appointed as the chief of the Shanghai medical team, overlooking more than 300 healthcare workers. During the next 6 months he and his associates performed 942 operations (including 204 major procedures) at the 2nd Military Hospital in Northeast China, with an overall surgical mortality rate of 0.6%. Huang was invited to report his experience at the National Congress in November 1951 in Beijing. He was arranged to sit next to Chairman Ze-Dong Mao during the congressional dinner (Fig 2).

View larger version (106K): [in this window] [in a new window]   Fig 2. Doctor Jia-Si Huang and Chairman Ze-Dong Mao at a National Congress dinner in November 1951, Beijing, China. Courtesy of China Union Medical University, Beijing.

	The Leader

Top Abstract Introduction The Man The Leader The Mentor The Spirit of Service... Acknowledgments References

 
During the next few years, Huang played an important leadership role in developing thoracic surgery in Shanghai. As Vice Dean of the Shanghai Medical College and President of Zhongshan Hospital, he had to deal with heavy administrative duties. However he continued to operate and to train young surgeons. The number of beds in his department increased from less than 30 to 96. In 1956, Huang became the founding president of the Shanghai Chest Hospital, a newly established specialty center for thoracic surgery. He reported their large series of pulmonary resections for tuberculosis, which totaled 1,376 cases [8, 9]. Their experience in surgical treatment for bronchiectasis was also one of the largest in China [10]. In addition, the first Chinese made heart-lung machine was first used at the Shanghai Chest Hospital in July 1958 [11].

During the same period, Huang also dedicated much of his energy to edit the first surgical textbook in the Chinese language, which was distributed for evaluation at medical schools nationwide in 1958. Based on the feedback, it was re-edited and published in May 1960. Subsequently, a much improved 2nd edition of this surgical textbook was published in 1964.

In late 1958, Huang was appointed the President of the Chinese Academy of Medical Science. One of his major tasks now was to build a top-notch medical university similar to that of PUMC. It was a daunting task for Huang and his associates as they had to overcome not only various technical obstacles, but also many political and socioeconomic burdens. Initially called "China Medical University," then it was the only medical school in China providing an 8-year education and training program. This university was officially opened in September 1959, and Huang was assigned to be its first president. He remained in that position for the next 25 years, including the 10-year shutdown period from 1968 to 1978, during the "cultural revolution" disaster. From 1959 through 1968, 506 students studied at this university and many of them eventually became national leaders in their own fields. In the late 1970s, the university was renamed "China Capital Medical University." Medical education, research, and clinical service were redeveloped under the leadership of Huang. Part of the funding to the university was raised by Huang from the China Medical Board of the Rockefeller Foundation and the total amount exceeded $1 million in the early 1980s. He reestablished the regular scientific exchanges and collaborations with the Johns Hopkins University and the National Institutes of Health in the United States. As a result this university (with its current name of "China Union Medical University") has been repeatedly ranked as one of the top two medical schools in China in the past 2 decades.

In 1975, Huang and Dr Jie-Ping Wu (a pioneering urologist in China) and their colleagues started to work on a new edition of the Textbook of Surgery. When this updated two-volume 3rd edition got published in April 1979, it was immediately used by all medical schools across the country.

In 1980, Dr Lyman A. Brewer III (the 54th president of the American Association for Thoracic Surgery) and his wife visited Beijing where they met Huang, Wu, and Zhang (Fig 3). All of them except Wu had previous working experience at the University of Michigan. Brewer was trained under Dr Evarts Graham at Barnes Hospital in St Louis earlier than Wu. After his visit, Brewer generously supported some Chinese thoracic surgeons and their teams for advanced training in the United States. His visit also resulted in a symposium jointly organized in October 1981 by the Chinese Medical Association and the Lyman A. Brewer III International Surgical Society. Focusing on the latest advances in cardiothoracic surgery, this 4-day "East-meets-West" symposium was the first of its type ever held in China. The invited foreign speakers included many world-renowned experts at the time from North America, Europe, South America, and Asia. With more than 150 Chinese surgeons attended the meeting, the impact of this symposium on the future development of cardiothoracic surgery in China was tremendous.

View larger version (119K): [in this window] [in a new window]   Fig 3. Doctors Jia-Si Huang (third from right), Ying-Kai Wu (first from right), Ji-Zheng Zhang (third from left), with Dr Lyman A. Brewer III (fourth from right) and his wife in Beijing in 1981. Courtesy of Professor Le-Tian Xu (second from left).

	The Mentor

Top Abstract Introduction The Man The Leader The Mentor The Spirit of Service... Acknowledgments References

The very first time Shih (then a fourth year medical student) personally benefited from Huang's care was somewhat dramatic. One day he was absent from the morning class and missed Huang's surgical lecture. Knowing the reason for the absence was a sudden onset of abdominal pain, Huang visited his student, Shih, in the afternoon. Acute appendicitis was diagnosed, and Huang performed an appendectomy on Shih. In 1948, Shih contracted pulmonary tuberculosis at the end of his chief residency in surgery. After more than 3 months of medical treatment, Shih underwent a phrenic nerve division operation. Huang was again the surgeon, who was then the Professor of Surgery and Chairman of the Department. Huang also persuaded Shih to stay at Zhongshan Hospital in Shanghai as a faculty staff member. It did not take long to prove this was important to the development of cardiac surgery in China [11].

On May 9, 1979, Huang was invited to deliver a lecture at the American Medical Association's 75th Congress on Medical Education in Washington, DC [12–14]. At that meeting, he received the "World's Outstanding Medical Educator" award along with 9 peers. Several similar talks were given at subsequent international meetings [15–18], which enabled Western colleagues to understand the medical system in China after the "cultural revolution."

On June 22, 1983, Huang underwent surgical repair of his abdominal aortic aneurysm, which was unfortunately complicated by postoperative myocardial infarction. He rested for only 2 months before returning to work. Although officially retired, he was still very active in many academic activities in China. One of his top priorities was the 4th edition of the Textbook of Surgery.

Huang's frequent visit to the western universities in the early 1980s strengthened his belief of the importance of surgical training. Therefore the guideline for the new edition of the textbook changed fundamentally. It was decided that the book should reflect the most updated knowledge and techniques in the field. Accordingly the targeted readers are surgeons rather than medical students. Huang personally rewrote a chapter entitled "Trauma to the Chest." On May 11 and 12, 1984, Huang chaired an editorial meeting for the 4th edition of the Textbook of Surgery. His chapter was used as a sample representing the new format of the book. Two days later, he died from a sudden onset of cardiac arrhythmia while attending an outpatient clinic at PUMC.

The 4th edition of the Textbook of Surgery was published in December 1986. In Huang's honor, the book was named Huang Jia-Si's Textbook of Surgery. Within the next 2 years, it underwent five reprints with over 136,000 copies sold. In mainland China to-date, Huang Jia-Si's Textbook of Surgery is the only medical textbook named after an editor and has been serially published for half a century. Its three-volume sixth edition appeared in 1999 (Fig 4) and the 7th edition is currently in press.

View larger version (121K): [in this window] [in a new window]   Fig 4. Jia-Si Huang's Textbook of Surgery, 6th ed, 1999.

	The Spirit of Service and of Sacrifice

Top Abstract Introduction The Man The Leader The Mentor The Spirit of Service... Acknowledgments References

Huang Jia-Si

May 23, 1906–May 14, 1984

This portrait is presented to the

Peking Union Medical College

To assure that new generations of physicians remain recognized of Huang's leadership in the development of a medical care system for the people of China and his inspiration to worldwide community of medical care providers.

Lyman A. Brewer III, MD

and Richard M. Peters, MD, President

Lyman A. Brewer III International Surgical Society

	Acknowledgments

Top Abstract Introduction The Man The Leader The Mentor The Spirit of Service... Acknowledgments References

 
We wish to thank Professor Mei-Hsin Shih (Shanghai Medical University, Shanghai) for his suggestions and encouragement, and Professor Le-Tian Xu (China Union Medical University, Beijing) for his detailed comment as well as generous support in providing some of the photographs used in this article. We are also grateful to Patricia Watson (Administrative Director of the American Board of Thoracic Surgery) and Robert B. Wallace, MD (Historian of the American Association for Thoracic Surgery), for their help.

	References

Top Abstract Introduction The Man The Leader The Mentor The Spirit of Service... Acknowledgments References

 

1. Wan S, Yim APC. A Chinese thoracic surgeon and his two decisions Ann Thorac Surg 1999;67:1190-1193.[Abstract/Free Full Text]
2. Literature and history research committee of Jiang-Xi province. Selected review on literature and history of Jiang-Xi (Volume 33): Huang Jia-Si, 1st ed. China Literature and History Press: Beijing, 1990 (in Chinese)..
3. Bowers JZ. Western medicine in a Chinese palace. Peking Union Medical College, 1917–1951. Philadelphia: The Josiah Macy Jr Foundation; 1972.
4. Xu LT. The development of cardiothoracic surgery in China 2004Proceedings of 2004 national symposium on advance in thoracic surgery. Urumqi, Xinjiang, Aug 21–24 (in Chinese).
5. Sloan H. Historical perspective of the American Association for Thoracic SurgeryJohn Alexander (1891–1954). J Thorac Cardiovasc Surg 2005;129:435-436.[Free Full Text]
6. Huang CS. Tuberculos tracheobronchitisa pathological study. Am Rev Tubercul 1943;47:500-508.
7. American Board of Thoracic Surgery A 50 year perspective 1998:40-42.
8. Huang CS, Liang QC, Shi MH, Gu KS. Lung resection for 1376 patients with pulmonary tuberculosisShanghai experience. Chin J Surg 1956;4:781-785(in Chinese).
9. Huang CS, Liang QC, Shi MH, Gu KS. Pulmonary resection for tuberculosisanalysis of 1376 cases. Chin Med J 1957;75:171-180.[Medline]
10. Huang CS, Shi MH, Wan TH, Jen CY. Surgical treatment for bronchiectasis Chin Med J 1958;77:587-595.[Medline]
11. Wan S, Yim APC. The evolution of cardiovascular surgery in China Ann Thorac Surg 2003;76:2147-2155.[Abstract/Free Full Text]
12. Huang JS. Medical education in China Invited lecture at American Medical Association's 75th Congress on Medical Education. 1979(May 9, Washington DC)..
13. Huang JS. Medical education in China Am Med News 1979Oct 26.
14. Huang JS. Medicine in the People's Republic of China Maryland State Med J 1979;28:35-39.
15. Huang JS. Medical and health work in new China. 1979Invited lecture at McGill University's 50th anniversary ceremonial meeting, Canada.
16. Huang JS. Medical education in China Invited lecture at "Medical education in Asia: a symposium,". 1981. pp. 79-86June, New York.
17. Huang JS. Medical education in Chinaits historical background, present status, and further development. Invited lecture at Cumberland College of Health Science. 1982Australia.
18. Huang JS. Health service for one billion people including care of the aged. Australia: Hospital Association Magazine; 1983.

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